EMCDDA logo Annual report on the state of the drugs problem in the European Union 2001

Home of the Annual Report
Introduction to the annual report
Chapter 1: Drug demand and drug supply
Drug use
Health consequences
Law-enforcement indicators
Drug-market indicators
Chapter 2: Responses to drug use
Chapter 3: Selected issues
Chapter 4: The drugs problem in central and eastern European countries
Figures and tables
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Health consequences of drug use

Health consequences: Demand for treatment | Drug-related infectious diseases | Drug-related deaths and mortality of drug users

Demand for treatment

Characteristics of clients entering treatment (such as social characteristics) and consumption behaviours (such as the proportion of injectors or opiate users) are potential indicators of wider trends in problem drug use. However, biases may arise owing to different methods of collecting the information and differences in the offer of treatment services between countries.

Figure 6, All clients admitted for treatment for heroin, cannabis, amphetamines, cocaine and other substances in some Member States

Despite differences in treatment policies and recording practices, it is possible to identify both common and particular trends across Europe.

In most countries, opiates are the main drug for new clients entering treatment (especially heroin). The variation between countries is quite high — from 22.4 % in Finland to 84.2 % in Greece, but the most frequent percentages are between 50 and 70 %. Apart from heroin, other main substances for which treatment is sought are cannabis (over 15 % in Belgium, Denmark, Finland and Ireland) and cocaine (especially the Netherlands at 15.4 % and Spain at 17 %). Ecstasy is the main drug only in a low number of cases, the highest value being 8.9 % in Ireland. Strong differences exist concerning amphetamines, the highest percentages being reported from Finland (39 %), Sweden (17 %) and Belgium (15 %).

Figure 7



(1) Some countries were not included because of the lack of comparable data in the presented years.
(2) Data are related to all opiates.

Reitox national reports 2000.

Common trends are identified in the number of new clients seeking treatment - new clients demanding treatment for heroin are decreasing while they are increasing for cannabis and especially cocaine use. The highest increase in cannabis clients regards Germany (from 16.7 % in 1996 to 40 % in 1999 although it is important to note that this data only refers to outpatient units) and Ireland (from 20.7 % in 1996 to 29.4 % in 1999) and Denmark (from 25 % in 1996 to 31 % in 1999), whilst the biggest rise in cocaine users is reported by Spain (from 21.6 % in 1998 to 30.9 % in 1999) and the Netherlands (from 14.7 % in 1994 to 23.2 % in 1999).

These trends are confirmed by data of all clients admitted to treatment over the years, where the increase in cocaine users is clear, as well as in the comparison between new and all clients admitted to treatment in some Member States. Furthermore, an increase in cocaine use as secondary drug is shown in clients using opiates as a main substance.

Figure 7 OL Trends for all clients admitted to treatment for heroin, cannabis and cocaine

Figure 8 OL All and new clients admitted to treatment for cannabis and cocaine use in some Member States, 1999 data

In general, clients demanding treatment use more than one drug and differences are identified in single user groups.

An increase in the demand for substitution treatment is reported in many countries, especially by pregnant women; it is probably due to these services being more widely available.

Injecting drug use and other routes of administration

The proportion of injectors among clients in treatment for heroin varies markedly, from 12.5 % of injectors in the Netherlands to 72.7 % in Greece. A general decrease in injecting heroin is quite common in most countries, even if variable (Ireland reports a contrary increasing trend in injecting drugs). A comparison between all and new clients demanding treatment for heroin seems to confirm the decrease in injecting heroin (an average of about 10 % fewer inject heroin).

Figure 9 OL Proportion of injectors among all and new clients admitted to treatment for heroin use in some Member States, 1999 data

Many factors could influence the ways of administration and these are still not really clear or demonstrated by scientific studies, but could include market factors, cultural traditions and interventions.

At market level three main factors could influence the route of administration: the relative availability of smokeable heroin (base form) or injecting (hydrochloride) heroin, heroin price (a higher price leads to more injecting), heroin purity (lower purity is related to a higher level of injecting use).

From a cultural point of view, there are some traditions especially linked to ethnic minorities; within the Suriname's subgroup, aversion to injecting seems to have influenced the route of administration (sniffing or smoking) used by heroin consumers. The same influence was not found in other subgroups such as North African consumers in France or Antilleans, who also traditionally smoke or sniff heroin.

Various evaluation studies also highlight the relation between prevention activities (facilities, information on the risks of injecting) and changes in attitudes from injecting to sniffing or smoking as an influencing factor.

Social characteristics
Clients entering treatment tend to be males in their 20s or 30s. The mean age is 29 years for all clients and 27 for new clients. The women are usually younger than men, demanding treatment almost a year before men. The oldest clients are in Sweden and the Netherlands, whilst the youngest are in Ireland and Finland, although in the case of Ireland this also reflects the demographic situation in the country. The gender distribution varies with a similarity among southern countries, where men are the largest majority (86/14 in Italy, 85/15 in Spain, 84/16 in Portugal, 84/16 in Greece) and among northern countries with a higher presence of women in treatment (70/30 in Ireland, 72/28 in Sweden).

The social conditions of clients demanding treatment seem to be worsening, in terms of level of education and employment. The majority of clients are concentrated in urban areas, but this could also be due to a different level of services provision in rural areas.

Health consequences: Demand for treatment | Drug-related infectious diseases | Drug-related deaths and mortality of drug users

Drug use | Health consequences | Law-enforcement indicators | Drug-market indicators
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