Expenditure in drug-demand reduction

In the process of calculating ‘a list’ of all direct public expenditure in drug-demand reduction in the EU Member States, and on the basis of the data received from national focal points, a comparison of similar expenditure has been attempted.

Although all possible statistical precautions have been taken, it is not possible to avoid the problem that the reported figures may sometimes correspond to different categories in different countries and the fact that in some countries figures are just not available. Indeed, for Belgium, Denmark, Italy and especially Germany and Sweden, some relevant information on demand-reduction expenditure is missing and, thus, the total figure is certainly grossly underestimated. In the case of other countries (Greece, Spain, France, Luxembourg, Austria and Portugal) data can be considered to be more comprehensive despite some residual uncertainty regarding the categories of spending included. In the Netherlands and Norway, in particular, the reported estimates concern both illicit drugs and alcohol, making the final figures for those two countries, in comparison with others, rather high. Finally, most data refer to 1999 as baseline figures for the EU action plan evaluation process, but there are some exceptions. For Ireland, the figures reported are planned State expenditure in the area of demand reduction for the year 2000, for France the data date back to 1995 and for United Kingdom the data refer to the financial year 2000–01. The reading of the amounts shown in Table 6 must therefore take into account the above-mentioned constraints.

Table 6: Breakdown of direct public expenditure figures in millions of euros as reported in the Reitox national reports 2002

Country

€ million

Categories of expenditures in 1999

Belgium

139

Treatment (100); rehabilitation (22.5); methadone (8.9); communities and regions: prevention, care, training, coordination (8.3) (not included: €7 million allocated to the prevention of criminality by the Ministry of Internal Affairs)

Denmark

67

Expenditures on ‘drug addiction’ by counties and municipalities DKK 495.5 (66.5); prevention at central level DKK 6.2 (0.8), in counties and municipalities not known

Germany

343.2

Emergency accommodation (3.0); psychosocial accompanying (13.3); 951 outpatient counselling facilities (57.9); inpatient rehabilitation (25 % of 434 million euros (99.7)); integration in work (4.3); cared housing (8.0); treatment in addiction departments in hospitals (97.0); substitution treatment (not known but estimated minimum of 30.0), Lander budget ‘addiction’ 23.9% (drugs share) of €127 million (30.0) (not included: prosecution and enforcement expenditure)

Greece

16.2

39 prevention centres (OKANA), salaries and staff (KETHEA), housing and operational costs (2.4); treatment: drug-free, substitution and low threshold (11.9); social rehabilitation (0.3); research (0.3) OKANA, data not included; education (0.8), some central administration costs (0.5)

Spain

181.5

Central level: Ministries of Interior (GDNPD), Defence (prevention), Health and Consumption, Education and Culture; Foreign Affairs, Work and Social Matters (19.8); fund of confiscated goods allocated to demand reduction 66 % (2.8); Autonomous Communities (158.7, of which 22.3 from the GDNPD)

France (1995)

205.8

Subutex (91.4); Social Health and Urban Affairs (101.9); Education (Research) (6.6); Youth and Sport (1.3); Work, Employment and Training (0.12); MILDT (66 % of 6.9 million euros (4.5) (not included: international cooperation and subsidies to international organisations)

Ireland (2000) Estimated State exp.

57.1

Department of Health and Children (treatment, prevention, research) (32.0); Department of Enterprise, Trade and Employment (reintegration) (6.0); Department of Education and Science (prevention) (7.5); Department of Tourism, Sport and Recreation (prevention, research, evaluation, coordination) (11.6)

Italy

278.5

Outpatient treatment (99.1); residential and semi-residential treatment (88.8); National Drug Fund projects promoted at the local/Regional level (67.6); National Drug Fund projects sponsored by Ministries (23.0). No data were available from eight regions and only partial data were available from most other regions

Luxembourg

13.7

Ministry of Health (5.7); Family, Social Solidarity and Youth (2.3); Education Professional Training and Sport (0.5); other ministries (0.3); Social security reimbursement (4.9)

Netherlands

287.9

General Act on Special Disease Management (to regional care offices and addiction clinics) (76.0); Ministry of Health, Welfare and Sport (outpatient addiction care) (74.2); funds for homeless addicted, neglected drug addiction (about two-thirds of 150 million euros (112.5)); drug-related nuisance (24.1); drug prevention activities (1.1) (most of the figures concern both drugs and alcohol)

Austria

52.3

Federal, provincial and municipal sources including health insurance funds, public employment services and the Healthy Austria Fund: primary prevention (2.4); outreach work and harm reduction (3.3); counselling, care and treatment (40.7); reintegration (4.2); quality assurance (0.6); other expenditures/not assignable (0.8).

Portugal

71.7

Presidency of the Council of Ministers (16.2); Ministries of Health (41.6); of Education (3.1); of Employment and Social Affairs (9.5); of Defence 1.2

Sweden

62.5

Very rough estimate on costs for demand reduction expenditures on alcohol and drugs (Tullverket, 2000). Municipalities 300 SEK (€30), Counties 250 SEK (€25) and State 50 SEK (€5). Non-governmental organisations, foundations and companies 25 SEK (€2.5).

Finland

76.2

Healthcare (inpatient) (15.1); healthcare (outpatient) (7.9); drug-related pensions (4.3); drug-related sickness benefits (0.5); compensation (insurance companies) (0.9); substance abuse services (in/outpatient) (26.5); living allowances (4.8); child welfare (10.9); research and prevention (5.2)

UK 2000–01

466.3

Estimation for the financial year 2000–2001 (12 months to 31 March 2001). ‘Drug Treatment’ £234 million (€367.4); ‘Protecting young people’ (Prevention), £63 million (€98.9)

Norway

224.9

Estimation of costs at central, county and municipal level for drugs and alcohol-related services prevention, treatment and healthcare (in-/outpatient, drug free, substitution), social services for drug addicts outreach work, harm/risk reduction, rehabilitation and reintegration

Sources: Reitox national reports 2002.

The total amounts spent by EU countries in the field of drug-demand reduction in 1999 basically seem to reflect the size and wealth of each country (Kopp and Fenoglio, 2003). Unsurprisingly, the largest and richest countries (Germany, France, Italy and the United Kingdom) appear to allocate, in absolute terms, more financial resources than the small countries, although spending is also relatively high in the Netherlands and Norway (possibly because alcohol addiction interventions are included in the figures).

Research shows (Godfrey et al., 2002; Origer, 2002; Kopp and Fenoglio, 2003) that estimates of this kind could be a valuable source of information at national level. Comparisons over time within a country can reveal an increase or decrease in drugs-related budgets. Comparison across sectors (demand, supply, international cooperation, etc.) might reveal, in addition to formal strategies, the concrete financial effort expended in tackling the drugs phenomenon.

At EU level ‘cross-country’ comparisons (the most complex) can determine common patterns, or differences, in the amounts allocated to drug policy and allow expenditure to be compared against a European average or across world regions.

In addition, the use of macroeconomic indicators (such as gross domestic product (GDP), total population, total government expenditure or number of problem drug users) at national and European level can help to measure the extent of the expenditure and to give a more informative interpretation of data that, taken alone, would be of little value.

Indeed, the comparison of expenditure on drug-demand reduction and, for example, the GDP of each country could reveal how much of its wealth a country is likely to spend to prevent drug use and combat the consequences of drugs. According to the data collected in this research, it appears that in 1999 Norway allocated approximately 0.1 % of its economic wealth (GDP), followed by the Netherlands (0.078 %) (although both countries included in their estimation drugs and alcohol). Portugal (0.074 %), Finland (0.073 %) and Ireland (0.070 %) spent the greatest proportion of GDP on drug demand-reduction activities; in comparison, the largest and apparently richest countries seem to lag behind. However, the known incompleteness of the data for the latter may bias the comparison.

The interpretation of this information is not straightforward, and not only because of the lack of data. The proportion of wealth that is dedicated to drug addiction control in the EU Member States can be interpreted as reflecting the extent of the drug problem or the size of the response to it (or both), or the level of the social and health interventions in the population. Exploring such questions can contribute to a better understanding of the phenomenon and deeper comprehension in the field of cost estimates.

Another way of analysing public expenditure is to look at it in the context of the area it is intended to deal with, in this case problem drug users (112). Using as an indicator the estimated number of problem drug users, expenditure per individual most in need of assistance can be calculated. Unfortunately, this calculation is beset by two problems: first, the figures do not necessarily relate directly to problem drug users – drug addicts – as prevention, education and coordination can also be targeted at individuals who are not classified as problem drug users; and, second, calculation of the number of problem drug users is, for obvious reasons, rather uncertain.

Again, according to our data, the value of services consumed by each drug addict in need is considerably higher in some countries (Finland, Luxembourg, Austria) than in others (Greece, Portugal, France, United Kingdom). This could be interpreted as the result of a stronger commitment to drug services in the former group; however, it is more likely that the figures depend on the quality and type of intervention. Indeed, differences in the levels of expenditure do not automatically translate into the level of commitment, but rather represent a different level of reaction, which is determined by the specificity of the situation.

Together with the expenditure per problem drug user, it is useful to calculate the burden of drug demand-reduction policy on society as a whole. Considering the expenditure on drug-demand reduction in the 16 countries studied (15 Member States and Norway), and from the limited data available (Table 6), the total (minimum) amount spent in the EU in 1999 on prevention of drug use and the care of drug addicts amounted to around EUR 2.3 billion. This means that each EU citizen contributed between EUR 5 and 10. Of course, it is likely that this amount may be considerably higher.

Finally, as emphasised by several participants in the research, a common methodology would be crucial to cross-country research, assuming that this type of information, and its subsequent analysis, turns out to be relevant for decision-making.


(112) Injecting drug use or long duration/regular use of opiates, cocaine and/or amphetamines. To calculate expenditure per problem drug user, the estimates of numbers of problem drug users as reported by the national focal points using average rates were used. For more information see Statistical Table 4: Estimated number of problem drug users in EU Member States, 1995–2001.