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
Chapter 2: Responses to drug use
Political and strategic responses
Specific responses
Chapter 3: Selected issues
Chapter 4: The drugs problem in central and eastern European countries
Figures and tables
 
Download complete report in 12 languages  in Adobe PDF  format
News Releases and press information
 
 

Search Site Map Contact

CHAPTER 2

Specific responses

Demand reduction

A range of interventions with different objectives and operating in different settings are covered in this section. An overview of the various settings and approaches in demand reduction are provided in Figure 21.

 
Figure 21 Classification of concepts in demand reduction

Prevention measures
Prevention in schools
Drug prevention in schools remains a priority in all Member States. Many teaching guidelines exist on prevention and it may be necessary to carry out a market overview in order to select the most appropriate material (as has been done in Germany). In most curricula, drug prevention is included in a context of general health promotion. Peer-to-peer approaches (that is students educating one another) are considered advantageous, although they are difficult to establish and sustain. Parents involvement is considered crucial.

 
Mobilising pupils in prevention activities

At the request of the Ministry of Education in France, an evaluation was carried out of the schools that took part in a pilot programme 'Les eleves acteurs de prevention'. The pupils received guidance in organising campaigns and transmitting knowledge on the issues concerned to their fellow students. Their involvement in managing the programme earned them the recognition of their peers. The experiment proved a success for half of the schools involved but even where it was not, it attracted a great deal of interest from pupils in all schools. Its impact on the atmosphere and quality of life in schools was very positive, both in terms of the pupils' perception and the schools' external reputation.


Increasingly, the police take an interest in primary drug prevention in schools (in Belgium, France, the Netherlands, Austria and Sweden) although there has been some debate as to whether they are equipped with the necessary educational skills for this type of work.

Students do take drugs (see Chapter 1, Drug use in the school population) and are in the risk zone. This was formerly largely denied since schools feared damage to their image. Increasingly - in Spain, France, Luxembourg, the Netherlands, Austria and the United Kingdom - strategies are set up to develop school policies on the prevention of risk behaviour, early intervention and the facilitation of referral to addiction care. Of particular concern are young people who drop out of school or who are expelled. Spain reports standardised interventions for this group and in the United Kingdom 95 % of secondary schools have policies covering drug-related incidents.

Prevention in local settings and communities
Prevention activities in local communities have expanded in the past years and take varying shapes and forms. All Member States report different types of parents' training in the community. For example, in Spain, 25 000 families participated in escuelas de padres in 1999, and, in France, there are 75 special counselling centres for young people to provide help for emotional, family or social problems. In the Nordic countries, groups of parents walk the streets of their community in order to provide support to young people on weekend nights. In Denmark, 1 300 parents are involved in this activity.

Sports and athletic associations are given a more prominent role in drug prevention than reported in previous years in many countries including Belgium, Germany, Greece, Spain, France, Italy and the United Kingdom. In Germany, cooperation between sports clubs and drug prevention has existed since 1994 and, in 2000, another 2 500 youth sports leaders were trained. A conference on addiction prevention in sports clubs focusing on the quality of drug prevention in sports clubs and on drug use and sports clubsÕ rituals and culture was organised in Potsdam, Germany, in March 2000.

Coordination between actors is crucial for success. In Denmark, Greece, Finland, France, Ireland, Italy, Portugal, Sweden and the United Kingdom agreements within local or regional authorities on drug prevention strategies are in place or under development countrywide.

Treatment
Drug-free treatment
Currently little is known about the availability of drug-free treatment across the EU. However, drug-free treatment seems to be dominating the treatment offered in Finland, Greece, Norway and Sweden. The tendency in those countries is to have shorter treatment periods of three to six months instead of one to two years, although in Greece the mean duration of treatment is 12 months. A recent meta-analysis carried out in Germany and covering several European countries concludes that there is a positive relationship between the length of treatment and treatment success. However, evaluation of different treatment options is still to be improved.

Case management (low-threshold, intensive, personalised assistance) is increasingly set up to guide a drug user through the treatment networks, for example in Belgium, Germany and the Netherlands. The results of five Dutch studies on dual diagnosis (the coincidence of drug and psychiatric problems) show that case management has slightly positive effects on patients' satisfaction, drug use, psychiatric symptoms, social skills and utilisation of care services.

 
Evaluating types of treatment

In Norway, a project is evaluating types of treatment for drug users to find out if some treatments obtain better results than others and to find out which clients benefit from which type of treatment. As drug users often use several different treatments, the point of departure is that each treatment builds on the achievements of any previous treatment - the hypothesis being that resources invested are not lost.


The Netherlands provides a somewhat negative picture of a difficult target group who fail to change their drug using behaviour even after several attempts. The purpose of inpatient motivation centres is to offer the opportunity to drug users to recuperate, to help them develop their social skills and to structure daily life in order to increase their motivation to enter into regular care. However, the drop-out rate at these centres is 60 % and it is concluded that drug users who are not motivated cannot be helped successfully.

Substitution treatment
Substitution treatment has been expanding moderately in the EU over the last years. Greece, Finland, Norway and Sweden have recently facilitated access to substitution treatment, mainly methadone. Buprenorphine, which is the main substitution substance in France, has been introduced in Belgium, Denmark, Finland (for detoxification), Germany, Italy, Luxembourg, Norway, Portugal, Austria and the United Kingdom, whereas LAAM is prescribed in Denmark, Spain, and Portugal. Studies are in progress in the Netherlands concerning rapid detoxification with naltrexone as a medical treatment, and this may be considered as an alternative to other treatments. Naltrexone has been used in Portugal for the last 10 years.

Heroin continues to be prescribed on a selective basis in the United Kingdom. Experimental heroin prescription for treatment of refractory chronic drug users is available in the Netherlands within the context of scientific experiment and a heroin prescription trial will be initiated in Germany in 2001. Luxembourg is also considering a heroin trial in 2002. Experts agree that heroin prescription should only be considered when all other treatment options available are exhausted. Heroin prescription puts a heavy burden on clients and the need to present themselves at the treatment centre two or three times a day is disruptive to them. However, there is evidence of its effectiveness for very deprived drug users in terms of crime reduction, health improvement and social integration.

Table 1 - Substitution treatment among problem drug users

Harm-reduction measures
Outreach work
Mapping outreach work (that is contacting drug users in their own setting) in the EU is not an easy endeavour since many activities are carried out locally by non-governmental organisations and by structures that tend to be quite complex.

The origins of outreach work lie in traditional youth work (with the aim of guiding drug users into treatment) and in public health concerns (especially the prevention of infectious diseases). Outreach work may include social work among addicts, needle exchange, low-threshold services and/or special services for ethnic minorities, prostitutes and other hard-to-reach groups and is available to problem drug users who are not in regular treatment services in all Member States. Peer support among drug users has been organised in Denmark, France, the Netherlands, Austria, and the United Kingdom in order to respond to the needs of drug users.

 
Outreach project for homeless women

In Sweden, the Stockholm Social Services started an outreach project in 2000 targeting homeless women, many of whom have little or no contact with social services. One of the aims is to motivate the women to increase their contacts by providing them initially with simple medical help. The project is exemplary in that it is a joint venture between the social services, voluntary organisations and the medical treatment sector.


Outreach work is expanding in most Member States. However, in Sweden, outreach work was more common some 10 to 15 years ago and a new study reports that, owing to a reduction in resources, many drug users are not approached by any such services. New developments include outreach work for North-African drug users in the Netherlands, and the introduction of special services for women drug users in Denmark, Norway, Austria and Sweden.

One specific outreach activity, which has been adopted in France, the Netherlands, Austria and Spain is on-site pill testing at dance events. Pill testing attracts visitors because the content of pills is always of major concern to them. Most projects also offer information talks, harm reduction messages and crisis intervention. A recent EMCDDA study ('An inventory of on-site pill testing interventions in the EU' (42KB) EMCDDA 2001) suggests that pill testing can efficiently warn against the unexpected and dangerous effects of dance drugs.

Low-threshold services
Low-threshold services are expanding in most Member States. Users« rooms — that is rooms where injecting drug users can use drugs under hygienic and safe conditions - were legalised in Germany in February 2000, and one users' room was introduced as a pilot project in Madrid, Spain in 2000. In the Netherlands, they have existed for several years where they also serve heroin smokers and cocaine and crack users. Similar initiatives are being discussed in Austria, Luxembourg and Portugal. In relation to a discussion in Denmark concerning the introduction of injection rooms in association with existing low-threshold services, the Danish Ministry of Health has chosen to shelve this initiative as a result of international conventions dealing with this matter.

Early health responses to new synthetic drugs
These measures aim to avert potential health problems relating to the consumption of substances, unidentifiable to the users, who themselves are not seeking contact with treatment and counselling services i.e. unknown substances consumed by unknown users. These responses are implemented either through structural measures such as the organisation of safe raves (staff training, provision of water and chill-out facilities) or information measures on party drugs through media campaigns, interactive web sites and CD-ROMS, or by specifically providing information on the results of on-site or off-site pill testing through the Internet or special journals. Thus, these interventions are sometimes linked to outreach work measures such as on-site pill testing.

In Denmark, Spain, Ireland, Italy and the Netherlands local authorities approach young people's leisure venues (such as clubs, bars and discos) to provide the staff with training and support to enable them to respond more effectively to drug-related situations.

 
Training for nightclub staff

In Ireland, training and support is given to nightclub staff in order to enable them to respond more effectively to drug-related situations in nightclubs. The first two phases of the project involve the organisation of training programmes for club owners/managers and door supervisors. They focus on increasing their knowledge about drugs, exploring their attitudes towards drugs and examining legal, health and safety issues. The third phase is designed to disseminate accurate information on drugs to young club goers through distributing a credit card-sized booklet known as the vital information pack (VIP) in a number of venues including third level colleges and clubs. In phase four, a one-day conference will be organised to gain support from the music/dance industry for the development of acceptable policies in dance venues. The final phase involves standardising training for door supervisors and providing these elements in a modular form.


The concept of 'real time' monitoring of youth scenes is reported by Luxembourg. Following an initial evaluation phase, the game kit 'Ecstasia' has been applied to different youth settings and integrated in appropriate school courses. It boosts discussion, sharing experiences and finding alternatives to drug use, especially as regards synthetic drugs. The group dynamics stimulated by the game enable issues to be addressed to which young people should be sensitised. The evaluation suggests increasing the creative and action-oriented elements of the game.

The Internet provides an enormous variety of drug information reflecting all positions on drug policy, although quality control of such information is not possible. Most national prevention organisations as well as NGOs have or plan their own homepage, mainly with information but also with interactive features, for example the Italian Io non calo la mia vita (http://www.iononcalo.it), the Swedish Drugsmart (http://www.drugsmart.com) and the drug search facility (http://www.drugscope.org) provided by DrugScope in the United Kingdom. An innovative initiative is reported from Finland where an anonymous consultancy and self-assessment test is available on the Internet (http://www.a-klinikka.fi/plimenu1.htm). The EMCDDA database, EDDRA, gives references to over 250 evaluated projects in the field of demand reduction and is continuously growing.

 
Drug treatment and testing order schemes in the United Kingdom

The UK Government has introduced drug treatment and testing order (DTTO) schemes whereby courts can make an order requiring offenders to undergo treatment either as an alternative to prison or as a sentence in its own right. The roll out of DTTO is estimated to result in some 3 425 orders being made by 2001. This is to be compared to some 120 000 persons convicted of drug offences in 1999. Drug prevention advisory services, in conjunction with probation services, will provide on-the-ground support for the national roll out of DTTO, disseminating practice findings from the pilot programmes and assisting local drug action teams in developing appropriate commissioning arrangements.


Reduction of drug-related crime
Prevention of drug-related crime
All Member States have programmes for diversion to treatment under specific conditions, for example the gravity of the offence or the age of the offender. This is considered to decrease the rate of subsequent crime, although evaluation information is rarely available.

Drug users continue to pose a major problem in the criminal justice system with up to 50 % of prisoners with drug-related problems. Given the high turnover rate in prisons, it is estimated that 180 000 to 600 000 drug users pass through the system annually in the EU. The prevalence of drug use varies depending on the type of prison. It is more significant in large and in short-stay prisons, more prevalent in women's than in men's prisons.

Table 2 provides a rough overview of assistance to drug users in prisons in the EU — the EMCDDA report 'Assistance to drug users in prisons' (169KB) provides full details.

Table 2 - Assistance to drug users in prison in the EU

Social rehabilitation and reintegration
Education, training, housing and employment are key areas in the rehabilitation of drug users after treatment, after imprisonment or in long-term substitution maintenance programmes. However, it appears that this area of assistance is still rather undeveloped even though professionals often emphasise that aftercare and reintegration is a very important aspect of drug treatment and that improvements in this field would be needed.

'Back to the future' in Finland

In Finland, the programme 'Back to the future' (funded by the Integra programme of the EU) has been involved in projects with young drug addicts. The project results reinforce the notion that people facing unemployment and income problems after recovering from drug abuse problems are in an extremely difficult situation. The problems they encounter include inadequate housing, reduced working capacity, lack of vocational training and problems associated with work and maintaining a drug-free lifestyle. Education was available to the project participants but they found it hard to approach educational systems and work options and it was not easy for them to find employers willing to enter into apprenticeship contracts. Although the State automatically guarantees the study loan, the banks refused to provide personal loans because almost 90 % of the clients were not credit worthy. The project found that the actions available to social and health services are inadequate to resolve multiple welfare problems. Active measures are required of the rehabilitation system which involve an individual and tailor-made approach transcending administrative boundaries and adequate financing.


Evaluation
Evaluation is the key to ensuring the quality of drug-related responses, as is adequate planning, infrastructure, professionalism, supervision, training, research and networking. Quality assurance procedures are increasingly being introduced in the demand reduction area in the EU. Quality assurance initiatives concerning prevention are reported from Germany, Greece, Finland, France, Italy, the Netherlands and Austria, and quality assurance of care from Germany, Greece, Luxembourg, the Netherlands, Norway, Austria, Portugal and the United Kingdom.

Training is established for general practitioners and other health care professionals in Belgium, Germany, Finland, Ireland, Italy, Austria and the United Kingdom, whereas other countries - Greece, France, Italy, Luxembourg, the Netherlands and Sweden - state that even if some training is available for prevention, health and criminal justice professionals, there is still a need for courses of high quality.

 
Quality assurance in demand reduction

In Austria, quality assurance procedures are becoming increasingly important in the field of drug demand reduction. Guidelines for quality work and minimum standards for all fields of addiction activities as well as for the case management of substitution clients have been drawn up. Minimum standards, as quality prerequisites for drug and alcohol counselling, have been defined and will be implemented in a stage-by-stage plan. In Vienna, special competence centres were established, which are responsible for networking and ensuring the transfer of information to fields of activity that do not explicitly deal with drug issues (such as youth work and health care).


Supply reduction

The following information has been extracted from Europol reports.

New techniques of prompt intervention and disruption at various levels of a criminal investigation avoid long, drawn out and resource-intensive inquiries. New EU judicial and law-enforcement cooperation structures should be fully exploited by Member States, so as to increase the sharing of information, both within Member States and at international level.

The level of organised crime in the EU is increasing. Production and trafficking of drugs appear to remain the prime activities of criminal networks. The continuing diversification and evolution of drug routes challenge law-enforcement efforts. Criminals continue to examine the successes and failures in the trafficking of their illegal commodities and change their operations accordingly, by altering routes, devising new methods of concealment or recruiting new couriers.

According to Europol (EU situation report on drug production and drug trafficking 1999/2000) an encouraging project against the diversion of chemical precursors was 'Operation purple', aimed at preventing the diversion of potassium permanganate - a chemical used in the production of cocaine - and bringing together 23 nations, including seven Member States, that produce, import, export, or transit the chemical, as well as the International Narcotics Control Board, ICPO/Interpol and the World Customs Organisation. The project aims at preventing chemical diversion, taking into account that the availability of precursors plays a key role in the production of drugs. Since the start of its operation, 248 shipments of the chemical have been tracked, involving 7 778 tonnes. As a direct result, 32 shipments of potassium permanganate have been stopped or seized, totalling almost 2 226 tonnes. This is supposed to represent 29 % of all shipments monitored. A similar operation will be conducted on acetic anhydride, a chemical used in the processing of heroin.

Further to the political developments aimed at increasing judicial and law-enforcement cooperation, Europol's competence will be broadened to money laundering in general, regardless of the type of offence from which the laundered proceeds originate.

Currently, Europol and experts from Member States and the EMCDDA are developing a harmonised database on drug seizures, with common definitions and parameters, to be introduced in all Member States. This should lead to a standardised collection of data EU-wide, which will allow for a better comparison and analysis of the drug situation in the various Member States.


Political and strategic responses | Specific responses

© EMCDDA 2001 | home | webmaster | disclaimer