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