Problem drug use

Problem drug use is defined as ‘injecting drug use or long duration/regular use of opiates, cocaine and/or amphetamines’ (8).

Figure 4

Estimates of problem drug use in different EU Member States (most recent one-year prevalence per 1 000 inhabitants aged 15–64)

Figure 4

NB:

Figures show the combined country range of different estimates. They may be based on different methods and data sources and should be interpreted with caution (see online statistical tables for specific estimates and full details). The dot shows the midpoint of the range, while the line represents the uncertainty range or 95 % confidence interval. The longer this line, the wider the range of the prevalence estimates is (not available for Spain or Ireland). All estimates are compatible with the EMCDDA definition of problem drug use. The Swedish estimate has been adjusted to fit this definition.

Sources: national focal points through EMCDDA project: ‘National prevalence estimates of problem drug use in the European Union, 1995–2000’, CT.00.RTX.23, Lisbon, EMCDDA, 2003. Coordinated by the Institut für Therapieforschung, Munich.

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Given the dependability of current estimation methods, data quality and data availability, it is not always possible to interpret trends reliably. In addition, there is no estimation method that can be used in all countries in a comparable way, therefore between-country comparisons should be carried out with caution.

Several countries report changes in estimates, suggesting increases in problem use since the mid-1990s. Out of 16 countries, eight report higher estimates of problem drug use (Germany, Spain, Italy, Luxembourg, Finland, Sweden) or injecting drug use (Belgium and Norway) during the 1990s, although the increase reported in Sweden at national level does not seem to be confirmed in two local studies) (9).

The prevalence estimates of problem drug use are all between two and 10 cases per 1 000 of the population aged 15–64 (using the midpoints of the estimates). The highest rates are reported in Italy, Luxembourg, Portugal and the United Kingdom (6–10 per 1 000 inhabitants aged 15–64). Rates are lowest in Germany, the Netherlands and Austria, each with about three problem drug users per 1 000 inhabitants aged 15–64. Data for Belgium and Norway are not available (Figure 4).

In Finland and Sweden, the majority of problem drug users are primary amphetamine users (an estimated 70–80 % in Finland in 1999). This is in contrast to the situation in other countries, where problem drug users are mostly primary opiate users (and often polydrug users). In Spain, cocaine has become an important factor in recorded drug problems (treatment and emergency data), and this is confirmed by recent prevalence estimates. Some countries (Germany, the Netherlands) report a high prevalence of crack cocaine use among problem drug users, although mainly in large cities and principally among primary opiate users.



Figure 6

Trends in injecting drug use in EU Member States, 1990–2001 (percentage of current injectors among heroin users in treatment)

item Denmark | item Greece | item Spain | item France (2) | item Ireland | item Italy (1) | item Luxembourg | item Netherlands | item Portugal | item Finland | item Sweden | item UK

NB:

(1) Italy: data from standard table 04 (2002).

(2) Data are not available for France 1998; figure is based on interpolation.

Data represent several thousands of cases per country per year and in most countries include almost all treated cases at national level.

Sources: national focal points through EMCDDA project: ‘Treatment demand indicator’.

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Separate estimates are given for injecting drug use, a subcategory of all problem drug use. These estimates are based on multiplier methods using mortality data and rates of human immunodeficiency (HIV) or hepatic C virus (HCV) infection. As it is difficult to distinguish rates of current injection (probably best represented by mortality-based estimates) and lifetime injection (from the HIV/HCV estimates), the estimates are difficult to compare. Estimates of injecting drug use are in general between two and five cases per 1 000 of the population aged 15–64 (data are not available for five Member States). The estimate for Luxembourg is higher, at almost 6 per 1 000. Estimates of injecting drug use indicate the population at risk for serious health consequences or drug-related death (Figure 5).

Analysis of the proportions of injectors among heroin users in treatment suggests marked differences in prevalence of injecting drug use between countries and varying trends over time (Figure 6). In some countries, injecting drug use appears to be low (Portugal, the Netherlands), whereas in other countries levels of injection among heroin users in treatment are high (Greece, Luxembourg). In almost all countries, injecting drug use among treated heroin users seems to have fallen during the 1990s, although data for some countries suggest increases since 1996 and more recently (Ireland, Finland), which, if confirmed, are worrying and should be acted upon. In the United Kingdom, the proportion of injectors fell until 1996, but it increased the next year and since then has remained stable.

The same data on the percentage of current injecting among opiate users in treatment, weighted by the estimated absolute numbers of problem drug users (see Statistical Table 4), suggest that roughly 60 % of problem drug users in the EU are injectors, but with large variation between countries (not shown). If the rate of problem drug use in the EU as a whole is between 4 and 6 cases per 1 000 population aged 15–64, this translates into between 1 and 1.5 million problem drug users, of whom 600 000–900 000 are injectors.


(8) For more detail see Box 2 OL: Definition of and methods used to estimate problem drug use.

(9) See Box 3 OL: Trends and patterns of problem drug use by country.