2007 Annual report on the state of the drugs problem in Europe

1. 2007 Annual report on the state of the drugs problem in Europe NB embargo 22 November 10:00 CET (Brussels time)

2. Latest on the drugs 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: • Drugs and driving • Drug use among the under 15s • Cocaine and crack cocaine use: a growing public health issue

3. A multilingual information package 2007 Annual report: In print and online in 23 languages • http://www.emcdda.europa.eu/events/2007/annualreport.cfm • Additional online material in English: • Selected issues • Statistical bulletin • Country data profiles • Reitox national reports

4. Part I: Annual report –2007 overview • After over a decade of rising drug use, Europe may now be entering a more stable phase • Heroin use and drug injecting generally less popular • Cannabis use stabilising, signs of popularity waning among the young in some countries • Cocaine use rising again and record amount of cocaine seized • HIV: overall positive assessment, but around 3 500 new infections among IDUs in 2005 • High levels of drug-related deaths

5. Cannabis use stabilising • Some 70 million adults in the EU (15–64 years) have ever tried cannabis. Some 23 million have used it in the last year • After escalating cannabis use in the 1990s, data suggest that use is stabilising overall and falling in some countries • Among high-ranking countries, rates have stabilised or are beginning to fall in Spain and have dropped by some 3–4 percentage points in the Czech Republic, France and the UK • Data from mid-ranking countries show a stabilisation in Denmark and the Netherlands

6. Figure GPS-4: Trends in last-year prevalence of cannabis among young adults (aged 15–34), measured by national surveys

7. Signs of popularity waning among the young • Among the UK’s younger cannabis users (16–24 years), last-year use fell from 28.2% in 1998 to 21.4% in 2006 • Spanish School Survey (14–18 years): last-year use fell from 36.6% in 2004 to 29.8% in 2006 • Cannabis use still rising among young adults (15–34 years) in Hungary, Slovakia and Norway, but most rises are small • The exception is Italy. Rates of last-year cannabis use in young adults rose from 12.8% in 2003 to 16.5% in 2005.

8. Figure GPS-10: Last-year prevalence of cannabis use by age group in the UK, measured by national population surveys

9. Attention turns to intensive cannabis use • Only a relatively small proportion of cannabis users report using the drug on a regular or intensive basis • But still ‘a significant number of individuals’, says report • 18% of the 70 million adults who have ever tried cannabis, reported having used it in the last month, over 13 million • Around 1% of European adults (around 3 million people) may be using the drug on a daily, or almost daily, basis

10. Treatment demands for cannabis problems • Between 1999 and 2005, numbers of Europeans demanding treatment for cannabis problems approximately trebled • And new demands for treatment for cannabis problems rose from 15 439 to 43 677 clients • In 2005, 29% of all new demands were cannabis-related • Innovative interventions are now developing in Europe to meet the different needs of occasional, regular and intensive users

11. Figure TDI-1, part ii: Trend in estimated number of new clients entering treatment by primary drug used (1999–2005). Trend in numbers of clients by primary drug.

12. Chapter 3, Figure 4: Trends in pattern of use of treatment services (1999–2005). Principal drug for which clients ask treatment as % of all requests.

13. Cocaine use rising again • 2007 report: some 4.5 million Europeans (all adults aged 15–64 years) are likely to have used cocaine in the last year • 2006 report: estimate of 3.5 million adults • Second most commonly used illicit drug after cannabis • Ahead of ecstasy and amphetamines

14. Cocaine figures • Some 12 million Europeans (4% of adults) have ever tried it • Some 2 million have taken it in the last month, more than double the estimate for ecstasy • Among young adults (15–34 years), increases in last-year cocaine use were registered in most reporting countries • Some 7.5 million young adults have ever tried cocaine, 3.5 million in the last year, 1.5 million in the last month • In highest prevalence countries (Spain, UK) recent increases were small, suggesting that prevalence may be levelling off. Clear rises were reported by Denmark and Italy.

15. Chapter 5, Figure 7: Trends in last-year prevalence of cocaine use in young adults (15–34)

16. Impact of cocaine on public health • One indication of how cocaine is impacting on public health is the rise in demand for treatment for cocaine problems • In 2005, close to a quarter (22%) of all new demands for treatment in Europe were cocaine-related: a total of 33 027 clients, compared with 12 633 in 1999 • Most treatment demands occur in a small number of countries: Spain and the Netherlands are responsible for the majority of reports of cocaine treatment in Europe • Treatment services are faced with offering care to a broad spectrum of clients (see Selected issues, Part II below)

17. Record amount of cocaine seized • Numbers of cocaine seizures and quantities intercepted increased in Europe between 2000 and 2005 • 70 000 cocaine seizures amounting to a record 107 tonnes in 2005 (up over 45% on quantities seized in 2004) • Around half the total number of seizures and the greatest volume seized were in Spain (48.4 tonnes in 2005; 33.1 in 2004) • Portugal was the country with the second largest quantities intercepted (18.1 tonnes in 2005; 7.4 tonnes in 2004)

18. Transit routes • Iberian Peninsula, main point of entry of cocaine into Europe • Most cocaine seized in Europe enters the continent from South America or via Central America and the Caribbean • West African countries increasingly used as transit routes • EU responds to changes in trafficking routes via enhanced coordination and cooperation between Member States • Maritime Analysis and Operations Centre – Narcotics (MAOC-N) established in September 2007

19. HIV: overall positive assessment • Rate of HIV transmission among injecting drug users (IDUs) was low in most EU countries in 2005 • With the expansion of services, the HIV epidemics seen earlier in Europe seem largely to have been avoided • Baltic States, also relative decrease in new infections • But some 3 500 new infections among IDUs in the EU in 2005 • Among EU MS reporting data, Portugal has highest HIV transmission rate in IDUs (+/- 850 new infections in 2005) • Up to 200 000 IDUs live with HIV, up to 1 million live with HCV

20. High levels of drug-related deaths • Overdose, a major cause of preventable death among young Europeans • Deaths historically high: 7 000–8 000 overdose deaths per year and no downward trend detectable in most recent data • Recent rises in deaths recorded in several countries, and clear rises of over 30% in: Greece (2003–2005), Austria (2002–2005), Portugal (2003–2005) and Finland (2002–2004) • Europe lacks comprehensive approach to overdose prevention • …and risks failing to meet targets to reduce drug-related deaths

21. Drug-related deaths (continued) • Risk factors possibly contributing to the problem: more polydrug use by opioid users and rises in heroin availability • The sustainability of the generally stable heroin situation in Europe is called into question by rising Afghan opium production • 6 610 tonnes of opium produced in 2006 — 92% in Afghanistan • Estimates of global heroin production increase again: 606 tonnes in 2006, up from 472 tonnes in 2005 (UNODC, 2007)

22. Chapter 8, Figure 13: Overall trend in acute drug-related deaths, 1996–2005 for all Member States with available data

23. Part II: Selected issues –2007 overview Three in-depth reviews published alongside the 2007 Annual report • Drugs and driving • Drug use and related problems among very young people (under 15s) • Cocaine and crack cocaine use: a growing public health issue

24. Drugs and driving (1) • After alcohol, cannabis and benzodiazepines are the psycho-active substances most prevalent among Europe’s drivers • A consistent finding regardless of study type (e.g. roadside tests at random/on suspicion, in hospitals, post-mortem) • Studies are equally divided as to which of the two substances is more prevalent • Exceptions: in Finland, Sweden, Latvia and Norway, amphetamines are more frequently found in drivers than cannabis and benzodiazepines. In Slovenia, opioids are found more often than benzodiazepines.

25. Drugs and driving (2) • Performance tests show that use of cannabis and benzodiazepines results in impaired driving ability, varying according to dose, tolerance and delay after intake • Risk assessment studies show that combining these drugs with alcohol significantly increases the risk of being involved in, or responsible for, a traffic accident • Cannabis-using drivers tend to be young males while benzodiazepine-using drivers middle-aged and often female • Alcohol: still no 1 substance endangering lives on our roads

26. Drugs and driving (3) • Many countries have tightened laws, increased penalties or altered national strategies to address the problem • Countries’ legal responses to drug driving vary greatly, from ‘zero tolerance’ laws (sanctioning detection of the substance per se) to impairment laws (sanctioning if the person is deemed unfit to drive) • ‘Zero tolerance’ laws for illicit drugs (e.g. cannabis) have been introduced in Belgium, Portugal and Sweden (1999) and France and Finland (2003) • Several countries have passed laws to allow or define roadside drug testing (e.g. by saliva, sweat testing), but some draft laws await reliable test kits before enactment

27. Drugs and driving (4) • Most EU MS carry out mass media campaigns on health risks of substance use and driving, but these focus mainly on alcohol • Only around one-fifth of EU countries target cannabis and benzodiazepines specifically • Drug-specific prevention programmes are now a prominent feature in driving schools • ‘One-size-fits-all’ campaigns may be unsuitable (cannabis and benzodiazepine users have quite different profiles) • Many unaware of possible effects of medication on driving ability (5 countries use pictograms on medicinal packaging)

28. Drug use among the under-15s (1) • Illicit drug use in very young people is rare and regular use rarer • Largely found among specific groups of the population where drug use occurs alongside other psychological/social disorders • Cannabis is the illicit substance most commonly used, followed by inhalants (e.g. glue, aerosols) • Of 15–16 year-old school students reporting to have used cannabis, first use by age 13 is uncommon (typically 1%–4%) • School surveys showed that daily tobacco smoking by age 13 varied in EU countries (7%–18%). Between 5% and 36% of school students reported having ever been drunk by that age

29. Drug use among the under-15s (2) • Few under-15s enter drug treatment (less than 1% of all clients) • Referred by family, social services or by criminal justice system • The large majority do so for primary cannabis use, and to a lesser extent for use of inhalants • Under-15s whose family members use psychoactive substances are known to be at higher risk of early drug use (at least 28,000 clients in drug treatment live with their children) • In 2005, 18 drug-related deaths among the under-15s were reported in Europe (0.2% of the total number of such deaths) 

30. Drug use among the under-15s (3) • Responses targeted at very young drug users range from universal prevention approaches (e.g. schools, communities) to early interventions (e.g. counselling) when use is suspected • Mid-way between these are prevention responses tailored to high-risk groups (e.g. families at risk) • In most EU countries, measures to prevent the early use of licit substances are viewed as prevention against use of illicit ones later • Promoting the use of illicit drugs among young people incurs stiff penalties in several countries • Sale of illicit drugs near schools or locations attended by young people is also severely penalised

31. Cocaine and crack cocaine use (1) Considerable concern in recent years regarding: • rises in cocaine use in recreational settings and among young people in general in some countries • concurrent use of cocaine and heroin becoming more common among problem opioid users • problem use of crack cocaine. This remains rare but causes concern in some marginalised groups in some areas

32. Cocaine and crack cocaine use (2) • Adverse health effects of cocaine use include: cardiovascular, cerebrovascular and neurological disorders • Risk of cocaine toxicity may be influenced by concomitant use of other substances (e.g. alcohol, heroin) • Some 400 deaths recorded as cocaine-related in 2005 – deaths from purely pharmacological overdose are relatively infrequent • Possible under reporting of cocaine-related deaths

33. Cocaine and crack cocaine use (3) • Flexible treatment services are required that can attract and respond to the specific needs of very different cocaine users • No effective medication exists at present to help cocaine users maintain abstinence or reduce use • Cocaine users in treatment are generally prescribed medications, such as anti-depressants or benzodiazepines, to provide symptomatic relief (anxiety, depression) • New developments: experimental therapeutic drugs to reduce withdrawal symptoms/cravings have shown potential in clinical trials. Immunotherapy for cocaine dependence through a cocaine vaccine (TA-CD) is under investigation.

34. Time to acknowledge progress • Now faced with a more complex and heterogeneous drug situation in Europe than a decade ago • Important to show where intelligent investments are paying dividends • Drug use has stabilised in many important areas, albeit at historically high levels – some cases merit cautious optimism • Dramatic increase in countries’ investment in prevention, treatment and harm-reduction activities and better cooperation in supply reduction • Assessing progress is crucial right now as we enter a period of reflection on recent achievements. In 2008, the EMCDDA will contribute to the evaluation of the EU drugs action plan and UNGASS review process.