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statistics >>> emcdda report >>> trends in drug use and its consequences

Trends in drug use and its

consequences

Cannabis

Cannabis remains the most widely available and

commonly used drug across the EU, with substantial

increases in use over the 1990s. Continuing rises in

countries with previously lower levels and some stabilisa-tion

in higher-prevalence countries confirm the tendency

towards convergence noted last year.

• At least 45 million Europeans (18 % of those aged 15 to

64) have tried cannabis at least once. Around 15 million

(about 6 % of those aged 15 to 64) have used cannabis in

the past 12 months.

• Use is higher among younger age groups. About 25 %

of those aged 15 to 16 and 40 % of those aged 18 have

tried cannabis. In some countries, use has doubled since

1990, in others the rise is less marked and in a few it has

stabilised.

• ‘Curiosity’ is a primary motive for trying cannabis, and

use is more experimental or intermittent than persistent.

• The increase in numbers attending treatment centres for

cannabis use noted last year is confirmed, especially

among younger clients. Additional drugs are also often

involved.

• Cannabis remains the primary drug in drug offences,

mostly for use or possession rather than trafficking.

Numbers of seizures have increased sharply since 1997.

Amphetamines and ecstasy

Amphetamines and ecstasy are the second most

commonly used drugs in Europe. Following increases in

the 1990s, ecstasy use appears to be stabilising or even

falling, while amphetamine use is stable or rising.

• Between 1 and 5 % of those aged 16 to 34 have taken

amphetamines and/or ecstasy. Rates are higher in

narrower age groups, but rarely exceed 10 %.

• The proportion of clients seeking treatment for amphet-amine

or other stimulant use is low, but increasing in

some countries.

• Drug use continues to shift away from large dance

events to more geographically diffuse club, bar and

private settings.

• A wider range of drugs and patterns of use are

observed, linked to different social groups and lifestyles.

• Both the numbers and quantities of amphetamine

seizures stabilised in 1998. Ecstasy seizures have been

stable since 1997, although the quantities involved

fluctuate.

Cocaine

While cocaine is less commonly used than amphet-amines

or ecstasy, its use is rising — particularly among

socially active groups — and spreading to a broader

population.

• Between 1 and 6 % of those aged 16 to 34 and 1 to 2 %

of schoolchildren have tried cocaine at least once,

although some surveys show levels of up to 4 % among

15 to 16-year-olds.

• Higher levels of use are found among socially outgoing,

employed young adults in urban centres.

• Cocaine tends to be used experimentally or intermit-tently

and is usually sniffed in powder form.

• Many clients treated for heroin use also use cocaine

either intravenously or smoked as ‘crack’.

• Severe problems associated with smoking ‘crack’ have

been identified, particularly among female sex workers.

• The proportion of clients seeking treatment for cocaine

use is increasing in many countries. How far this is linked

to heroin use or has developed from heavy recreational

use of other drugs is unclear.

• In 1998, numbers of cocaine seizures continued to

increase, while the quantities involved fluctuated.

Heroin

Heroin dependence remains broadly stable. Known users

are a largely ageing population with serious health, social

and psychiatric problems, although indications of heroin

use amongst some younger groups are noted.

• Heroin experience overall remains low (1 to 2 % in

young adults) and school surveys show pupils are highly

cautious about using heroin.

• Some countries report anecdotal evidence of increased

heroin smoking among young people, and some school

surveys reveal greater experimentation.

• Heroin use is reported amongst young, heavy, ‘recre-ational’

users of amphetamines, ecstasy and other drugs.

Other high-risk groups include marginalised minorities,

homeless young people, institutionalised youth and

young offenders, prisoners (women in particular) and sex

workers.

• New clients entering treatment for heroin use are less

likely to inject and more likely to smoke the drug than

clients returning to treatment.

• Numbers of heroin seizures and the quantities involved

are stable across the EU, although variations exist

between countries.

Multiple drug use

Patterns of weekend and ‘recreational’ drug use increas-ingly

involve combinations of illicit and licit drugs,

including alcohol and tranquillisers.

• ‘Nightlife’ studies reveal heavy multiple drug use by a

minority of young people.

• Use of synthetic drugs such as ketamine and gamma-hydroxybutyrate

(GHB) is reported, but is much less

common than use of amphetamines or ecstasy.

• More significant is the increase in cocaine use, often in

conjunction with heavy alcohol consumption.

• Abuse of volatile substances (lighter fuel, aerosols, glue)

is often more common amongst schoolchildren than

amphetamines and ecstasy, and is increasing in some

countries.

Problem drug use and demand for treatment

Patterns of problem drug use — often characterised as

‘addiction’, especially to heroin — are changing across

the EU. In addition to heroin dependence, problem use of

cocaine (often with alcohol), multiple use of drugs such

as amphetamines, ecstasy and medicines, and heavy

cannabis use are emerging.

• The EU has an estimated 1.5 million problem drug —

mainly heroin — users (between two and seven per 1 000

inhabitants aged 15 to 64). An estimated 1 million are

likely to meet clinical criteria for dependence.

• The proportion of clients entering treatment for heroin

use is generally declining, while new admissions for

cocaine or cannabis use show some increases —

especially among young clients.

Drug-related deaths

The number of acute drug-related deaths (overdoses or

poisonings) has stabilised across the EU following marked

increases in the second half of the 1980s and early 1990s.

Trends vary, however, among countries.

• Stable or decreasing rates may be linked to stable or

decreasing prevalence of heroin, safer usage or increased

access to treatment, especially substitution programmes.

• Countries with previously low numbers of acute deaths

directly linked to drug administration (‘overdoses’) report

substantial rises in recent years. This may reflect

increased prevalence of problem drug use, but also

improved recording practices.

• Other countries continue to report less sharp, but

steady increases in acute deaths.

• Numbers of drug-related deaths are significantly higher

among men than women, reflecting the higher preva-lence

of problem drug use in males.

• Most acute deaths involve opiates, often in combina-tion

with alcohol or tranquillisers. Some countries report

significant numbers of deaths from volatile substances

among adolescents. Deaths from cocaine, amphetamines

or ecstasy are uncommon.

• Overall annual mortality among problem drug users

has fallen in some countries, following rises over several years. This reflects a drop in overdose and AIDS deaths

and indicates that some deaths are preventable.

Drug-related infectious diseases

Overall trends in HIV and hepatitis B and C prevalence

among injecting drug users appear relatively stable,

although some local increases in HIV infection are

reported.

• Incidence of new AIDS cases varies greatly between

countries, but generally continues to fall, probably

because of new treatments that delay onset.

• Prevalence of hepatitis C infection among drug inject-ors

is high — between 50 and 90 % — even in countries

with low rates of HIV infection.

• Trends concerning hepatitis B are difficult to identify

because the presence of antibodies may indicate vaccin-ation

rather than infection.

• Risk behaviours that may transmit infection are of

concern. High-risk groups include: young injectors not

exposed to earlier education campaigns; women, who

tend to share injecting equipment more than men; heroin

injectors who also use cocaine; and imprisoned drug

users.

Other morbidity

Possible long-term neural damage linked to heavy use of

ecstasy is a growing concern.

• Increasing numbers of studies with both animals and

humans suggest that chronic exposure to ecstasy causes

functional and morphological changes in the parts of the

brain that regulate physiological and psychological

functions such as sleep, appetite, mood, aggression and

cognition.

• Some studies report mild cognitive impairment in

heavy ecstasy users, but the scientific literature is incon-sistent

regarding other functions. Other unresolved issues

include the ‘dangerous’ dose range, frequency of use and

whether deficits are reversible.

• Use of GHB — which in small doses diminishes tension

but in marginally larger doses can cause potentially fatal

intoxications, particularly when taken with alcohol and

other sedatives — is also causing concern.

Trends in responses to drug use

Policy and strategy developments

New drug strategies have been adopted by Spain, France,

Portugal and the UK as well as by the European Union

itself.

• National drug policies are becoming more balanced in

approach, with greater emphasis placed on demand

reduction relative to supply reduction.

• The drug problem is increasingly viewed in a broader

social context and common aims include drug

prevention, reduction of drug-related harm and crime

deterrence.

• Accurate scientific evidence, clear objectives, measura-ble

performance targets and evaluation are key to these

strategies.

• Depenalisation of drug use offences is becoming more

common. The consensus is emerging that drug users

should not be imprisoned because of their addiction, and

alternatives provided in law are increasingly imple-mented.

Prevention

Drug prevention in schools, recreational settings and

among high-risk groups is a priority in all EU Member

States.

• School drug-prevention programmes combine informa-tion

for pupils with training in life skills such as self-assertiveness.

Peer-group approaches actively involve

young people in implementing prevention activities in

their schools.

• Specific training and guidelines for teachers, as well as

initiatives targeting parents, are increasingly being

developed.

• Use of the Internet as an educational tool for pupils,

teachers and parents alike is growing.

• Drug-prevention training for youth workers, night-club

and bar staff is being introduced in some countries.

• Prevention of synthetic drug use is becoming more

professional, combining information, outreach work,

counselling and sometimes pill testing.

• Local cross-sector youth policies are being developed

to meet the needs of high-risk groups.

• Evaluation methodology to assess outreach work with

high-risk groups is urgently needed and the EMCDDA is

developing guidelines to bridge this gap.

Reducing the harmful consequences

of drug use

Reducing the harmful consequences of drug use is key to

the drug strategies of many Member States.

• Syringe-exchange programmes are expanding across

the EU and activities are intensifying to counter falling

awareness of the risks of injecting.

• Outreach work and low-threshold services are growing

as a complement to conventional drug-treatment centres.

• ‘Users’ rooms’, where drugs can be consumed under

hygienic and supervised conditions, remain controversial

and a study funded by the European Commission is

evaluating their effectiveness.

Treatment

To cope with the growing numbers and divergent needs

of those seeking treatment for drug use, diversified

patterns of care are being developed throughout the EU.

• Cooperation has increased between youth and social

services and conventional drug services, which alone are

often inadequate to treat new drug-use patterns and new

target groups.

• Specialised services for women exist across the EU,

many specifically targeting pregnant women and mothers

with children, as well as female sex workers.

• Public-health and psychiatric services are increasingly

involved in the treatment of multiple-drug use.

• Substitution treatment is expanding — including in

prisons — both in terms of the numbers of clients and the

substances used.

• Awareness of the need for adequate after-care for drug

users leaving treatment or prison — or for those in long-term

substitution treatment — has risen considerably.

• A large proportion of the prison population are drug

users and treatment is increasingly provided to avoid

relapse into illegal drug use and crime.