2005 Annual report on the state of the drugs problem in Europe Name, place, date and time

Latest on the drug problem across Europe Overview of the European drug phenomenon in 29 countries Data and analyses: across Europe and by country Latest trends and responses Selected issues: drug-related public nuisance alternatives to prison buprenorphine

A multilingual, state-of-the art package 2005 Annual report: In print and online in 22 languages Additional online material in English: Selected issues Statistical bulletin Reitox national reports

Headlines 2005 Part I

Headlines 2005 Cocaine becoming stimulant drug of choice for many young Europeans in parts of Europe Upward trend in use of amphetamines + ecstasy Cannabis still Europes most popular drug – more even picture as national differences narrow Up to 2m problem drug users in the EU Polydrug use, central to EU drug phenomenon

Headlines 2005 (continued) Heterosexual transmission overtakes injecting drug use as route of new AIDS cases Overall low HIV prevalence among IDUs Hepatitis B and C still major causes of disease among IDUs Overdose, main cause of death among opiate users, but numbers of young fatalities falling

Cocaine – stimulant drug of choice for many young Europeans in parts of Europe Cocaine: now major element in EU drug picture Indicators of trafficking and consumption point to a rise in importation and use of the drug Still large differences between countries Between , amount of cocaine seized in the EU nearly doubled (47 tonnes to over 90)

Around 9 million Europeans have tried cocaine in their lifetime (3% of all adults) Between 3 and 3.5 million are likely to have tried the drug in the last year (1% of all adults) Around 1.5 million are classified as current users (last month) (0.5% of all adults) Between 1% and 11.6% of young adults have tried cocaine. Use mainly among young, urban males Cocaine facts and figures

Cocaine facts and figures (continued) Highest levels of recent use among young adults are in Spain + the UK (over 4%, similar to US) Around 10% of requests for treatment for drug problems in the EU are linked to cocaine use Determining role in around 10% of drug deaths; but deaths by cocaine use alone are rare New concern: links to cardiovascular problems Crack cocaine limited to a few big cities (NL, UK)

Recent (last year) use of cocaine among young adults (15–34 years)

Other stimulants – main trends Upward trend in amphetamine and ecstasy use in most EU countries (young adults) Highest rates of recent amphetamine use (young adults) in Denmark, Estonia and UK (+/-3%). UK only EU country with significant fall in recent use Highest rates of recent ecstasy use (young adults) in Estonia, Spain, Czech Republic and UK. Stabilisation in Germany, Greece and UK

Other stimulants (continued) Europe still major centre for ecstasy production but manufacture spreads to other parts of world Global amphetamine production and seizures still concentrated in Europe Growing problems with methamphetamine use in Africa, Asia, Australia, New Zealand and US. No significant use in EU, except Czech Rep + SK Experimentation with magic mushrooms, now relatively common phenomenon (15–16 years)

Trends in recent (last year) amphetamine + ecstasy use in young adults (15–34 years)

Cannabis still EUs most popular drug Over 62 million Europeans have tried cannabis (or over 20% of all adults) Around 20 million have used it in the last year (over 6% of all adults) Around 9.5 million are current users (almost 4% of all adults) Roughly 3 million young adults, mostly males, are estimated to be daily or almost daily, users

Cannabis – national differences narrow ESPAD data from surveys of drug use in European schoolchildren (15–16 years) 1995 (lifetime prevalence of cannabis use): dramatic differences between countries (41% UK, 37% Ireland, but most countries rates below 10%) 2003: nine EU Member States reported estimates of lifetime use in excess of 20% ESPAD and other survey data show some signs of convergence. Rises most pronounced in new Central and Eastern EU Member States

Trends in recent use (last year) of cannabis among young adults (aged 15–34)

Up to 2m problem drug users in the EU Between 1.2 and 2.1 million problem drug users and between 850,000 and 1.3 million injectors Prevalence estimates since mid to late 90s show some rise in number of problem drug users in Denmark, Austria, Finland, Sweden and Norway Stabilisation or decline in the Czech Republic, Germany, Greece and Ireland Elsewhere, no clear conclusions on trends

Problem drug use (continued) Numbers of new heroin users may have fallen across Europe (peak in most countries early 90s) Rates of injecting among heroin users in treatment have declined in several countries In Denmark, Greece, Spain, France, Italy and the UK, less than 50% of new opiate users entering drug treatment say they inject

Polydrug use Now central feature of EU drug phenomenon Substance-specific analysis no longer realistic Analysis of public health impact of drug use today must take into account the complex picture of the inter-related consumption of psychoactive substances, including alcohol and tobacco

Heterosexual transmission overtakes injecting drug use as route of new AIDS cases Most new AIDS cases in EU to 2001 attributed to IDU; heterosexual transmission now overtaking Why? Better access for HIV-positive IDUs to highly active antiretroviral therapy (HAART). Over 75% of those needing HAART now have access to it in most of Western Europe Better access for IDUs to treatment/harm- reduction services; some decline in injecting

AIDS cases by transmission group and year of diagnosis (1987–2003) adjusted for reporting delays, EU

Overall, low HIV prevalence among IDUs Prevalence of HIV infection among IDUs – low in most EU Member States and candidate countries Infection rates around, or below, 1% of IDUs in the Czech Republic, Greece, Hungary, Slovenia, Slovakia, Finland, the UK, Bulgaria and Romania Higher rates (+/- 10%) in Estonia, Spain, France, Italy, Latvia, Netherlands, Poland and Portugal Hepatitis B and C, still major causes of disease among IDUs in Europe

Overdose main cause of death among opiate users, but numbers of young fatalities falling Lower proportion of overdose deaths under the age of 25 than a decade ago in most EU-15, suggesting fall in new young addicts and number of young injectors Different picture in new EU Member States and candidates, where deaths under 25 increased from mid-1990s–2002 Total number of reported drug-related deaths from the EU- 15 countries and Norway fell from in 2001 to cases in 2002, representing a 15% decrease Across the EU, drug-related deaths remain at historically high levels, but there are signs that these may have peaked

Long-term trend in acute drug-related deaths in the EU, 1985–2003

Headlines 2005 Part II

Headlines 2005 Over half a million Europeans now receive substitution treatment. Use of buprenorphine now more common Treatment for other drug problems more limited Concern over impact of drug use on communities Rise in drug law offences in most of EU Countries opt for treatment over prison

Over half a million Europeans now receive substitution treatment Major increase in services for opiate dependence (seven-fold over last decade) +/- 530,000 clients receive substitution treatment across 28 countries (EU-25, NO, BG, RO) Availability still differs markedly across Europe, particularly between the EU-15 and the new and prospective Member States 10 new MS, BG + RO account for only just over 1% of substitution treatment clients in Europe

Buprenorphine, an increasingly common therapeutic choice Around 80% of those in substitution therapy receive a methadone prescription Greater range of therapeutic options now available. Almost 20% of clients in substitution treatment now receive buprenorphine By late 2004, all former EU-15 countries reported some/limited use of buprenorphine treatment Among the 10 new EU Member States, it is only common in the Czech Republic

Treatment for drug problems still limited Despite expansion in substitution treatment for opiate dependence, treatment for other types of drug use remains limited Overall treatment options for those with cocaine problems are poorly developed Few countries offer services tailored to problem cannabis users, despite rising treatment demand More investment needed to ensure that treatment options are available to all those who need them, no matter where they live or what drug they use

Impact of drug use on our communities New tendency for drug control policies to focus on targeting drug-related behaviours which have a negative impact on the community as a whole Public nuisance, new umbrella concept covering anti-social behaviours, disturbances and activities (e.g. public drug taking; street dealing) Reducing drug-related public nuisance, now a key goal of national drug policy in five countries. Others address the acts covered by the term under broader title of security or public order Other responses: laws against drug-specific public nuisance; local policing, etc.

Rise in drug law offences in most of EU Violations of drug law (drug law offences) – upward trend in 20 countries (1998–2003) Drug use or possession (personal use) account for largest proportion of drug law offences Proportion of drug law offences involving cocaine generally increased (98–2003). Cannabis still drug most often cited in drug law offences in most EU Heroin-related offences fell in all reporting countries (1998–2003), except Austria and the UK

Countries opt for treatment over prison For many problem drug users, prison can be a particularly detrimental environment Broad political consensus to divert drug using offenders from imprisonment to treatment Prisons are overcrowded – treatment option can be a more cost-efficient way of sentencing The new EU drugs action plan 2005–2008 asks Member States to make effective use of, and develop further alternatives to, prison for drug abusers who commit drug-related offences

Policy-makers support data collection EMCDDA working for over a decade with Member States to develop comprehensive picture of the European drug phenomenon Quantity and quality of data in 2005 Annual report reflect commitment of policy-makers across EU to invest in, and support, data-collection process Strong consensus on need to base actions on a sound understanding of the drug situation and to share experience on what works to respond to it These aspirations are found in the new EU strategy and action plan on drugs