Interventions

School-based prevention remains at the core of activities directed towards all young people, usually from the pre-teens upwards. Although a broad evidence-base exists identifying effective approaches, such as interactive teaching with a focus on personal and social life skills, only a few countries, such as Spain, Greece and Ireland, systematically implement such programmes in the school curriculum. Of the other countries, Sweden and France concede that school drug prevention practice is not state of the art but often rather eclectic, non professionalised action.

However, a growing concern that the most vulnerable young people will not be reached in schools has triggered the development of specific preventions aimed at groups experimenting with drugs in recreational settings, such as discos, clubs and music events. Peer and on-the-spot counselling seem to be the most promising approaches. Prevention initiatives and early interventions directed at socially excluded youths and young offenders similarly seem to be most effective when implemented using a personalised methodology. Good results have been reported from projects in Germany, Austria, Portugal and the United Kingdom. Although vulnerable families, possibly with drug-using parents, are considered to be at high risk, supportive services for such families are rare.

Syringe exchange is now an established method to prevent the spread of infectious disease through injecting drug use, although the availability and coverage of such programmes is variable and accessing sterile equipment can still be a problem. Only in Spain are syringe exchange services being implemented systematically in prisons. Specific measures to prevent hepatitis C transmission as well as hepatitis B vaccination are increasingly considered as important complements to HIV prevention. First aid training and risk education have become more prominent as particular interventions to prevent fatal overdoses. Another important development is that medical care is increasingly becoming available at low-threshold level, integrated in local drug services.

Drug-related treatment still very much equals treatment for opiate use, or polydrug use including opiates, with the exception of Sweden and Finland, where injecting amphetamine use is still important. More recent developments in problem drug use, partly away from opiates and injecting drug use, have triggered the emergence of new kinds of early interventions, as described above, rather than reform of existing drug treatment structures. Substitution treatment is prominent and has further expanded and diversified in recent years. Over the EU as a whole, the expansion in the last 5 years is estimated to be 34 %, the largest increases being reported from countries with a low initial provision, such as Greece, Ireland, Portugal, Finland and Norway. Care for long-term, ageing, deprived drug users, often with psychiatric comorbidity, is a serious challenge to drug policy, which has not found adequate solutions. The EMCDDA will look into this issue further in the coming year.

Innovations in penal policy have introduced alternatives to prison, diverting drug users to quasi-compulsory treatment or community service on the assumption that their needs are better met by such interventions. Alternatives to prison specifically prevent young drug users coming into contact with the criminal subculture in prisons. The need for alternatives to prison has also arisen from acute overcrowding in prisons. Drug use and drug users in prisons are an increasingly important problem, calling for flexible responses. Health and welfare authorities are increasingly involved and taking responsibilities for service provision for drug users in prisons, although there is still room for improved cooperation. Often, treatment that is standard in the community is not available or accessible in prison. In most countries harm reduction measures in prisons are relatively limited.