DRUG WAR FACTS Compiled and updated by Douglas A. McVay for Common Sense for Drug Policy, http://www.csdp.org/ Updated: December 2007 --------------------------------------------------------------------- International Facts and Trends Index of Nations: European Union Candidate New-Member Countries to the EU (Central and Eastern Europe) Australia Belgium Canada Denmark France Germany Greece Netherlands Portugal Russian Federation Spain Sweden Switzerland United Kingdom United States (Where possible, national sections are subdivided as follows: A. Overview; B. Prevalence Estimates; C. Problem Substance Use and Substance-Related Harm; D. Harm Reduction Efforts; E. Treatment; F. Substance Use and the Justice System.) European Union A. Overview 1. "The EU drug strategy 2005–12, adopted by the European Council in December 2004, takes into account the results of the final evaluation of progress made during the previous period (2000–04). It aims to add value to the national strategies while respecting the principles of subsidiarity and proportionality set out in the treaties. It sets out two general goals for the EU with regard to drugs: "-to achieve a high level of health protection, well-being and social cohesion by complementing the Member States' action in preventing and reducing drug use and dependence and drug-related harm to health and the fabric of society; "-to ensure a high level of security for the general public by taking action against drug production and supply and cross-border trafficking, and intensifying preventive action against drug-related crime through effective cooperation between Member States." Source: "Annual Report 2005: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2005), p. 18. 2. "Important policy differences between European Member States still exist, often reflecting differences in the national drug situations and in the configuration of responses. Nonetheless, the new drug strategy suggests that the European policy debate on drugs is increasingly characterised by agreement on a common framework for activities. For example, virtually all demand reduction strategies include prevention, treatment and harm reduction elements, although the emphasis on each varies between Member States." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 11. 3. "A continuing trend, again evident in the new information reported this year, is for changes to national drug laws to emphasise more strongly a distinction between offences of drug possession for personal use and those involving trafficking and supply. Generally, there is a shift towards increased penalties for the latter and a reduced emphasis on custodial sentences for the former. This development is in line with a greater emphasis overall across Europe on widening the opportunities for drug treatment and on giving more attention to interventions that divert those with drug problems away from the criminal justice system towards treatment and rehabilitation options." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 11. 4. "For those countries that have made a legal distinction with respect to the possession of drugs for use rather than supply, the question arises whether there is an explicit need to legislate on what quantities of drugs constitute a threshold for personal use. Here no consensus currently prevails and different approaches have been adopted across Europe, ranging from the issuing of general operational guidelines through to specification of legal limits." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 11. 5. "Although expenditure is frequently measured over differing time periods, and there is no common definition of drugrelated public expenditure, available estimates suggest that drug spending has increased in several countries, including the Czech Republic, Denmark, Luxembourg, Austria and Poland. "Countries reporting drug expenditure for the year 2004 included the Czech Republic (EUR 11.0 million), Spain (EUR 302 to 325 million), Cyprus (EUR 2.8 million), Poland (EUR 51 million) and Norway (EUR 46 million). Two countries reported more recent budgeted expenditure for tackling drugs: Luxembourg (EUR 6 million in 2005) and the United Kingdom (EUR 2 billion in 2004/05). "In Slovakia, it is estimated that total public expenditure in the field of drugs in 2004 was EUR 14.5 million, of which law enforcement accounted for approximately EUR 8.4 million and social and healthcare for EUR 6.1 million. "In Sweden, it is estimated that drug policy expenditure during 2002 was around EUR 0.9 billion (lower estimate EUR 0.5 billion, higher estimate EUR 1.2 billion). Comparing the 2002 estimates with figures for 1991 shows that public expenditure on drug policy has increased substantially. "In Ireland, the mid-term review of the national drug strategy, published in June 2005, recognises that 'a measure of the expenditure is vital to gauge the cost effectiveness of the different elements of the strategy', and work will commence shortly to estimate police expenditure. In Portugal, the Institute for Drug and Drug Addiction (IDT) is funding research to develop and test a model to estimate the costs of drug abuse, and in Belgium a follow-up to a 2004 study on public expenditure was instituted at the end of 2005. Although sparse, these interesting data show that research on drug expenditure constitutes an increasingly important part of the policy agenda of some Member States." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), pp. 18-19. 6. "Differences in the prevalence of drug use are influenced by a variety of factors in each country. As countries with more liberal drug policies (such as the Netherlands) and those with a more restricted approach (such as Sweden) have not very different prevalence rates, the impact of national drug policies (more liberal versus more restrictive approaches) on the prevalence of drug use and especially problem drug use remains unclear. However, comprehensive national drug policies are of high importance in reducing adverse consequences of problem drug use such as HIV infections, hepatitis B and C and overdose deaths." Source: European Monitoring Center for Drugs and Drug Addiction, "2001 Annual Report on the State of the Drugs Problem in the European Union" (Brussells, Belgium: Office for Official Publications of the European Communities, 2001), p. 12. 7. "In Europe, the scope of drug policies is beginning to stretch beyond illicit drugs and to encompass other addictive substances or even types of behaviour. This is found in the drug policies of some Member States and in EU drug strategies. Increasingly, research is addressing the issue of addiction or addictive behaviours irrespective of the substances concerned." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 25. 8. "It can thus be concluded that consumption trends move in different directions in the European countries in question (Norway and the 15 countries which until recently made up the EU), the result being in fact a convergence of consumption patterns: 'wine countries' reduce their wine consumption and see beer and spirits account for ever-larger shares of total alcohol consumption, while trends are the direct opposite in typical 'spirits countries'. This convergence across countries of consumption levels also brings about a convergence of alcohol-related mortality. This is true in particular of liver-cirrhosis mortality, which has been falling in the 'wine countries' of the EU and rising in the 'beer countries' while Norway, Finland and Sweden, taken together, manifest a fairly stable level." Source: Centralförbundet för alkohol- och narkotikaupplysning, "Drogutvecklingen i Sverige 2006" (Stockholm, Sweden: CAN, 2006), Report No. 98, p. 34. 9. "When it comes to alcohol policy, it seems that the 15 'old' EU member states have converged to some extent. While alcohol policy has grown weaker in Finland and Sweden, several other countries -- including Southern European ones -- have reinforced their policies, for instance by lowering legal blood-alcohol levels for drivers and introducing stricter age limits for purchasing alcohol in both shops and restaurants." Source: Centralförbundet för alkohol- och narkotikaupplysning, "Drogutvecklingen i Sverige 2006" (Stockholm, Sweden: CAN, 2006), Report No. 98, p. 34. B. Prevalence Estimates 1. "Cannabis is the illegal substance most frequently used in Europe. Its use increased in almost all EU countries during the 1990s, in particular among young people, including school students. "It is estimated that about 65 million European adults, that is about 20% of those aged 15–64, have tried the substance at least once, although it should be remembered that most of these will not be using the substance at the present time. National figures vary widely, ranging from 2% to 31%, with the lowest figures in Malta, Bulgaria and Romania, and the highest in Denmark (31%), Spain (29%), France (26%) and the United Kingdom (30%). Of the 25 countries for which information is available, 13 presented lifetime prevalence rates in the range 10–20%." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 38. 2. "Use of illegal drugs, including cannabis, is concentrated mainly among young people. In 2004, between 3% and 44% of Europeans aged 15–34 reported having tried cannabis, 3–20% had used it in the last year, and 1.5–13% had used it in the last month, with the highest figures again coming from the Czech Republic, Spain and the United Kingdom. The European averages for this age group are 32% for lifetime use, 14% for last year use (compared with 2% for 35- to 64-year-olds) and over 7% for last month use (compared with 1% for 35- to 64-year-olds). "Cannabis use is even higher among 15- to 24-year-olds, with lifetime prevalence ranging between 3% and 44% (most countries report figures in the range 20–40%), last year use ranging from 4% to 28% (in most countries 10–25%) (Figure 2) and last month use ranging from 1% to 15% (in most countries 5–12%), with higher rates among males than females. In the new Member States levels of cannabis use among young adults aged 15–24 are typically in the same range as those in the EU-15 Member States, but among older age groups rates of use drop substantially." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 39. 3. "By contrast, in the 2004 US national survey on drug use and health (60), 40.2% of adults (defined as aged 12 years and older) reported lifetime use [of cannabis], compared with the EU average of about 20%. This is higher even than in those European countries with the highest lifetime rates (Denmark 31.3% and the United Kingdom 29.7%) although differences in last year use estimates are less marked: this figure is 10.6% in the United States compared with a European average of 7%, and several European countries reported figures similar to those found in the United States." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 39-40. 4. "Although the predominant European trend since the mid-1990s has been upward, some countries exhibit a more stable pattern. For example, although rates of cannabis use in the United Kingdom since the 1990s have been particularly high, they have remained stable over this period. In addition, there has been little change in the levels of cannabis use in several low-prevalence countries, including Finland and Sweden in the north of Europe and Greece and Malta in the south. Most of the increases in cannabis use recorded in ESPAD since 1999 have occurred in the new EU Member States. Analysis of school data and general population survey evidence suggests that, on most measures, the Czech Republic, Spain and France have now joined the United Kingdom to form a group of high-prevalence countries." Source: "Annual Report 2005: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2005), p. 11. 5. "In many European countries the second most commonly used illegal substance is some form of synthetically produced drug. The use of these substances among the general population is typically low, but prevalence rates among younger age groups are significantly higher, and in some social settings or cultural groups the use of these drugs may be particularly high. Globally, amphetamines (amphetamine and methamphetamine) and ecstasy are among the most prevalent synthetic drugs." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 47. 6. "Globally, Europe remains the main centre of ecstasy production, although its relative importance appears to be declining as ecstasy manufacture has spread in recent years to other parts of the world, notably to North America (United States, Canada) and East and South-East Asia (China, Indonesia, Hong Kong) (CND, 2006; UNODC, 2006). Although the Netherlands remained in 2004 the main source of ecstasy for Europe and the world as a whole, ecstasy laboratories were also uncovered in Belgium, Estonia, Spain and Norway (Reitox national reports, 2005; UNODC, 2006). The ecstasy seized in the EU is reported to originate from the Netherlands and Belgium, and to a lesser extent Poland and the United Kingdom (Reitox national reports, 2005)." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 48. 7. "Traditionally, population surveys have shown that, next to cannabis, amphetamines and ecstasy are the illegal substances most commonly used, albeit the overall prevalence of their use is lower than that of cannabis. Use of ecstasy became popular during the 1990s, whereas amphetamines have been used for much longer." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 50. 8. "Among EU Member States, use of amphetamines and ecstasy appears to be relatively high in only a few countries, namely the Czech Republic, Estonia and the United Kingdom. Recent surveys among the adult population (15–64 years) report that lifetime prevalence of amphetamine use in Europe ranges from 0.1% to 5.9%, except in the United Kingdom (England and Wales), where it reaches 11.2%. On average about 3.1% of all European adults have used amphetamines at least once. After the United Kingdom, the countries with the next highest figures are Denmark (5.9%), Norway (3.6%) and Germany (3.4%). Last year use is much lower: 0.6% on average (range 0–1.4%). Based on general population surveys, it has been estimated that almost 10 million Europeans have tried this substance, and more than 2 million will have used amphetamine in the previous 12 months." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), pp. 50-51. 9. "Among young adults (15–34 years) experience of amphetamine use is reported by 0.1–9.6%, with the United Kingdom (England and Wales) reporting a lifetime prevalence rate of 16.5% (which may reflect a historical phenomenon, see below). Half of the countries providing data have prevalence rates below 4%, with the highest rates after the United Kingdom reported by Denmark (9.6%), Norway (5.9%) and Germany (5.4%). An average of 4.8 % of young Europeans have tried amphetamine. Denmark (3.1%) and Estonia (2.9%) report the highest last year prevalence rates. It is estimated that, on average, 1.4% of young Europeans have used amphetamine in the last year (see also Figure 4)." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 51. 10. "Ecstasy has been tried by 0.2–7.1 % of all adults [in EU member nations] (average 2.6%). Half of the countries report prevalence rates of 1.8% or lower, with highest prevalence rates being reported by the Czech Republic (7.1%) and the United Kingdom (6.7%). The prevalence of last year use of ecstasy ranges from 0.2% to 3.5%, but half of the countries report prevalence rates of 0.5% or below. It has been estimated that almost 8.5 million Europeans have tried ecstasy, and almost 3 million have used it in the last year." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 51. 11. "Among young adults across the European countries, the prevalence of lifetime use of ecstasy is 5.2%, ranging from 0.5% to 14.6%, although rates of less than 3.6% are reported by half of the countries. The Czech Republic (14.6%), the United Kingdom (12.7%) and Spain (8.3%) report the highest prevalence rates." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 51. 12. "For comparison, in the 2004 US national survey on drug use and health, 4.6% of adults (defined as 12 years and older) reported lifetime experience with ecstasy and 0.8% reported last year use (the corresponding figures for the EU are 2.6% and 0.9%). Among young adults aged 16–34 years, lifetime experience was 11.3%, and last year use 2.2% (5.2% and 1.9% respectively in Europe)." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 51. 13. "Lifetime experience of the use of LSD among adults ranges from 0.2% to 5.9%, with two thirds of countries reporting prevalence rates between 0.4% and 1.7%. Among young adults (15–34 years), lifetime prevalence of LSD use ranges from 0.3% to 9%, and among the 15–24 years age group it does not exceed 4.5%. The prevalence of last year use of this drug in the 15–24 years age group is over 1% only in the Czech Republic, Estonia, Latvia, Hungary, Poland and Bulgaria." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 51. 14. "Based on recent national population surveys, it is estimated that about 10 million Europeans have tried cocaine at least once (lifetime prevalence), representing over 3% of all adults. National figures on reported use range between 0.5% and 6%, with Italy (4.6%), Spain (5.9%) and the United Kingdom (6.1%) at the upper end of this range. It is estimated that about 3.5 million adults have used cocaine in the last year, representing 1% of all adults. National figures in most countries range between 0.3% and 1%, although prevalence levels are higher in Spain (2.7%) and the United Kingdom (2%)." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 59. 15. "As with other illegal drugs, cocaine use is concentrated among young adults. Lifetime experience is highest among young adults aged 15–34 years, although last year use is slightly higher among 15- to 24-year-olds. Cocaine seems to be predominantly a drug used by those in their 20s, but, compared with cannabis use, cocaine use is less concentrated among younger people. Lifetime experience among 15- to 34-year-olds ranges from 1% to 10%, with the highest levels again found in Spain (8.9%) and the United Kingdom (10.5%). Last year use ranges between 0.2% and 4.8%, with the figures for Denmark, Ireland, Italy and the Netherlands being around 2%, and for Spain and the United Kingdom over 4% (Figure 6). Data from school surveys show very low lifetime prevalence for the use of cocaine, ranging from 0% in Cyprus, Finland and Sweden to 6% in Spain, with even lower lifetime prevalence rates for use of crack cocaine, ranging from 0% to 3% (Hibell et al., 2004)." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 59. 16. "A rough estimate of current cocaine use in Europe would be about 1.5 million adults aged 15–64 years (80% in the age range 15–34 years). This can be considered as a minimum estimate, given probable under-reporting." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 61. 17. "For comparison, according to the 2004 United States national survey on drug use and health, 14.2% of adults (defined as 12 years or older) reported lifetime experience with cocaine, which contrasts with a European average of 3%. Last year use was 2.4%, compared with a European average of 1%, although in some EU countries, e.g. Spain (2.7%) and the United Kingdom (2%), reported figures are in the same range as in the United States. The comparatively higher lifetime figures in the United States may be in part related to earlier spread of cocaine use in that country." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 61. 18. "The levels and patterns of illicit drug use in the selected English-speaking countries vary considerably (Table 4.3). Marijuana/cannabis use in the last 12 months was most prevalent in Canada (17%), and least prevalent in the Republic of Ireland and Northern Ireland (5%). Ecstasy and amphetamine use was most prevalent in Australia (4%). Cocaine use was most common in the USA (3%)." Source: Australian Institute of Health and Welfare, "Statistics on drug use in Australia 2006" (Canberra, Australia: Australian Institute of Health and Welfare, April 2007), Drug Statistics Series No. 18., Cat. no. PHE 80, p. 25. 19. "Among young adults (aged 16–34), US figures [for cocaine use] were 14.6% (lifetime), 5.1% (last year) and 1.7% (last month), whereas the EU average figures for 15- to 34-year-olds were, respectively, about 5% (lifetime), 2% (last year) and 1% (last month)." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 61. 20. "Recent cocaine use (last year) increased markedly in the second half of the 1990s among young adults in the United Kingdom, until 2000, and in Spain, until 2001, with an apparent stabilisation in recent years. In Germany, a moderate increase was observed over the 1990s, but the figures have remained stable in recent years, at levels clearly lower than in Spain and the United Kingdom. "Moderate increases in last year use have been observed in Denmark (up to 2000), Italy, Hungary, the Netherlands (up to 2001) and Norway. This trend needs to be interpreted carefully as it is based on only two surveys in each country." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 61. 21. "In Europe, two forms of imported heroin are found: the commonly available brown heroin (its chemical base form) and the less common and usually more expensive white heroin (a salt form), which typically originates from South-East Asia. In addition, some opioid drugs are produced within the EU, but manufacture is mainly confined to small-scale production of home-made poppy products (e.g. poppy straw, poppy concentrate from crushed poppy stalks or heads) in a number of eastern EU countries, for example Lithuania, where the market for poppy stalks and concentrate seems to have stabilised, and Poland, where production of 'Polish heroin' might be decreasing (CND, 2006)." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 66. 22. "Heroin consumed in Europe is predominantly manufactured in Afghanistan, which remains the world leader in illicit opium supply and in 2005 accounted for 89% of global illicit opium production, followed by Myanmar (7%)." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 66. 23. "Worldwide, tobacco consumption seems to have been in decline since around 1996. Per capita demand for cigarettes in the industrialised countries started to decline in the early 1980s, and while per capita demand has not declined overall in countries outside the OECD, demand growth has slowed down since about 1995, and no longer compensates for declining demand in the industrialised countries (van Liemt 2002). World unmanufactured tobacco supply was projected to decline nearly 14% in 2002 in an effort to bring supplies more in line with consumption (USDA 2002)." Source: Australian Institute of Health and Welfare, "Statistics on drug use in Australia 2006" (Canberra, Australia: Australian Institute of Health and Welfare, April 2007), Drug Statistics Series No. 18., Cat. no. PHE 80, p. 11. C. Problem Substance Use and Substance-Related Harm 1. "Estimates of the prevalence of problem opioid use at national level over the period 2000–04 range between one and eight cases per 1,000 population aged 15–64 (based on midpoints of estimates). Estimated prevalence rates of problem opioid use differ greatly between countries, although when different methods have been used within one country the results are largely consistent. Higher estimates of problem opioid use are reported by Ireland, Italy, Luxembourg, Malta and Austria (5–8 cases per 1,000 inhabitants aged 15–64 years), and lower rates are reported by the Czech Republic, Germany, Greece, Cyprus, Latvia and the Netherlands (fewer than four cases per 1,000 inhabitants aged 15–64 years) (Figure 8). Some of the lowest well-documented estimates now available are from the new countries of the EU, but in Malta a higher prevalence has been reported (5.4–6.2 cases per 1,000 aged 15–64). One can derive from the limited data a general EU prevalence of problem opioid use of between two and eight cases per 1 000 of the population aged 15–64. However, these estimates are still far from robust and will need to be refined as more data become available." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), pp. 68-69. 2. "Reports from some countries, supported by other indicator data, suggest that problem opioid use continued to increase during the latter half of the 1990s (Figure 9) but appears to have stabilised or declined somewhat in more recent years. Repeated estimates on problem opioid use for the period between 2000 and 2004 are available from seven countries (the Czech Republic, Germany, Greece, Spain, Ireland, Italy, Austria): four countries (the Czech Republic, Germany, Greece, Spain) have recorded a decrease in problem opioid use, while one reported an increase (Austria -- although this is difficult to interpret as the data collection system changed during this period). Evidence from people entering treatment for the first time suggests that the incidence of problem opioid use may in general be slowly declining; therefore in the near future a decline in prevalence is to be expected." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 69. 3. "Getting homeless problem drug users into stable accommodation is the first step towards stabilisation and rehabilitation. Based on the estimated numbers of problem drug users and the proportion of homeless people among clients in treatment, there are approximately 75,600 to 123,300 homeless problem drug users in Europe. As facilities are currently available in most countries, and as some countries continue to implement new structures, the effect of these measures will depend on ensuring that homeless problem drug users can access these services." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), pp. 34-35. 4. "In the Baltic states, the available seroprevalence data indicate that transmission among IDUs may still not be under control (Figure 10). In Estonia, a recent study suggests that prevalence in IDUs is increasing in one region (Tallinn: from 41% of a sample of 964 in 2001 to 54% of 350 in 2005) and exceptionally high in another (Kohtla-Järve: 90 % out of 100). In Latvia, two time series of seroprevalence data among IDUs show a continued increase until 2002/03 while a third series suggests a decrease since the peak in 2001. In Lithuania, data for 2003 suggest an increase in HIV among tested IDUs in drug treatment, needle exchanges schemes and hospitals, from between 1.0% and 1.7% during 1997–2002 to 2.4% (27/1,112) in 2003." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), pp. 75-76. 5. "In the countries that have historically had high rates of HIV infection among IDUs (Spain, France, Italy, Poland and Portugal) there are new signs of continuing transmission at national level or in specific regions or among specific subgroups of IDUs. In these countries, it is important to note that the high background prevalence, resulting from the large-scale epidemics that occurred in the 1980s and 1990s, increases the likelihood that high-risk behaviour will lead to infection." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 76. 6. "HIV prevalence among tested IDUs continues to vary widely between countries in the EU (Figure 10). In a number of countries HIV prevalence among IDUs has recently increased or has been high for many years. In contrast, in several countries, HIV prevalence among IDUs remained very low during 2003–04: HIV prevalence was less than or around 1% in the Czech Republic, Greece, Hungary, Malta, Slovenia (based on national samples), and in Slovakia, Bulgaria, Romania, Turkey and Norway (based on subnational samples). In some of these countries (e.g. Hungary), both HIV prevalence and hepatitis C virus (HCV) prevalence are among the lowest in Europe, suggesting low levels of injecting (see 'Hepatitis B and C'), although in some countries (e.g. Romania) there is evidence that the prevalence of hepatitis C is increasing." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 77. 7. "The prevalence of antibodies against hepatitis C virus (HCV) among IDUs is, in general, extremely high, although there is wide variation both within and between countries. Prevalence rates of over 60% among various IDU samples tested in 2003–04 are reported from Belgium, Denmark, Germany, Greece, Spain, Ireland, Italy, Poland, Portugal, the United Kingdom, Romania and Norway, while prevalence rates less than 40% have been found in samples from Belgium, the Czech Republic, Greece, Cyprus, Hungary, Malta, Austria, Slovenia, Finland and the United Kingdom." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 77. 8. "HCV antibody prevalence data among young IDUs (aged under 25) are available from 14 countries, although in some cases sample sizes are small. There is wide variation in results, with countries reporting both high and low figures from different samples. The highest prevalence rates among young IDUs in 2003–04 (over 40%) were found in samples from Belgium, Greece, Austria, Poland, Portugal, Slovakia and the United Kingdom, and the lowest prevalence (under 20%) in samples from Belgium, Greece, Cyprus, Hungary, Malta, Austria, Slovenia, Finland, the United Kingdom and Turkey. Considering only studies of young IDUs with national coverage, the highest prevalence rates (over 60%) are found in Portugal and the lowest (under 40%) in Cyprus, Hungary, Malta, Austria and Slovenia. Although the sampling procedures used may result in bias towards a more chronic group, the high prevalence of HCV antibodies found in a national sample in Portugal (67% among 108 IDUs under 25 years) is still worrying and may be indicative of continuing high-risk behaviour among young IDUs." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), pp. 77-78. D. Harm Reduction Efforts 1. "Harm reduction strategies form an important part of the European response to drug use today, and improving access to services for the prevention and reduction of health-related harm is a main priority of the EU drug strategy 2005–12. The common strategic platform on the reduction of health related harm that the EU drug strategy provides is mirrored in many national policies across the EU and has supported a mainstreaming of evidence-based responses in this area." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 33. 2. "Experiences in some Member States suggest that drug prevention interventions at the individual level may be more effective if also supported by regulatory policies on legal drugs that can limit the access of young people to these substances and reduce their social acceptability. As a result, environmental prevention strategies that address the normative and cultural framework of substance use are gaining ground in parts of Europe, supported by the first steps taken at EU level: the tobacco advertisement directive and the WHO framework convention on tobacco control." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 27. 3. "While health promotion — as a framework condition for prevention — strives to encourage people to adopt healthy lifestyles and to create healthy living conditions for all, the new term 'public health prevention' is increasingly mentioned by some Member States (Italy, Netherlands, Slovakia) and Norway. Public health prevention entails a range of prevention measures aimed at improving the health of vulnerable sections of society, among which drug prevention is one element. These measures are particularly suited to the needs of young people, whose problem behaviours, including drug use, are strongly conditioned by vulnerability (social and personal) and by living conditions." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 27. 4. "The reduction of drug-related deaths was defined for the first time as a European drug policy objective six years ago, and it is an objective of the current EU action plan. The number of countries which include a direct reference to the target of reducing drug-related deaths in their national policies has continued to increase in recent years, with eight countries adopting such strategies during 2004 and 2005 (bringing the total number to 15). Besides national policies, complementary approaches at city level are common: several capital cities (including Athens, Berlin, Brussels, Lisbon and Tallinn) but also wider semi-urban regions (e.g. the eastern region of Ireland, around Dublin) have their own strategies for reducing drug-related deaths. In the Czech Republic, Italy, the Netherlands and the United Kingdom, local or regional policies are reported to exist, and in Bulgaria strategies have been drawn up at local level in nine cities." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 31. 5. "In many EU countries, strategies aimed at reducing infectious disease are clearly geared towards HIV/AIDS, particularly Estonia, Spain, Cyprus, Latvia and Lithuania. However, in 10 countries (37%), infectious disease strategies explicitly mention the prevention of hepatitis C infection among drug users. Ireland launched a consultation process in 2004, preparing such a strategy, and in Germany recommendations on prevention and treatment were issued. Professional and public discussion in Austria was boosted by an international conference on the topic held in Vienna in 2005." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), pp. 32-33. 6. "Although most European countries now distribute sterile injecting equipment, the nature and range of provision vary between countries. The most common model is to provide the service in a fixed location, usually a specialised drugs service, but often this type of provision is complemented by mobile services that attempt to reach out to drug users in community settings. Syringe exchange or vending machines complement the available NSP services in eight countries, although provision appears to be restricted to a handful of sites, with only Germany and France reporting substantial activities (around 200 and 250 machines respectively). Spain is the only EU country where needle and syringe exchange is regularly available in a prison setting, with provision available in 27 prisons in 2003. The only other EU country reporting activity in this area is Germany, where provision is limited to one prison." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 79. 7. "Pharmacy-based exchange schemes also help to extend the geographical coverage of the provision and, in addition, the sale of clean syringes in pharmacies may increase their availability. The sale of syringes without prescription is permitted in all EU countries except Sweden, although some pharmacists are unwilling to do so and some will even actively discourage drug users from patronising their premises." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 79. 8. "Formally organised pharmacy syringe exchange or distribution networks exist in nine European countries (Belgium, Denmark, Germany, Spain, France, the Netherlands, Portugal, Slovenia and the United Kingdom), although participation in the schemes varies considerably, from nearly half of pharmacies (45%) in Portugal to less than 1% in Belgium. In Northern Ireland, needle and syringe exchange is currently organised exclusively through pharmacies." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 79. 9. "The purchase of syringes through pharmacies may be a major source of contact with the health service for some injectors, and the potential to exploit this contact point as a conduit to other services clearly exists. Work to motivate and support pharmacists to develop the services they offer to drug users could form an important part of extending the role of pharmacies, but to date only France, Portugal and the United Kingdom appear to be making significant investments in this direction." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 79. 10. "As a result of the serious health and social problems associated with crack cocaine use, there is more experience of developing services for this group, although activities are limited to those relatively few cities in Europe that have experienced a significant crack cocaine problem. In a number of cities crack cocaine users have been targeted by outreach schemes that attempt to engage with what is often viewed as a difficult group to work with. Although overall the evidence base remains relatively weak, some studies have suggested that benefits can accrue. For example, one study of an innovative outreach treatment programme in Rotterdam (Henskens, 2004, cited in the Dutch national report) identified factors that were observed to be important for treating this group of clients, who are often difficult to engage in conventional drug services." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 64. 11. "A more controversial approach has been adopted in some cities in Europe, where the concept of safe consumption rooms, usually targeting drug injection, has been extended to drug inhalation. Rooms for supervised inhalation have been opened in several Dutch, German and Swiss cities (EMCDDA, 2004c). Although the supervision of consumption hygiene is a main objective of such services, there is some evidence that they could also act as a conduit to other care options; for example, monitoring of one service in Frankfurt, Germany, reported that, during a six-month evaluation period in 2004, more than 1 400 consumptions were supervised, while 332 contact talks, 40 counselling sessions and 99 referrals to other drugs services were documented." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 64. 12. "Despite the overall expansion of treatment options, engaging with some groups of drug users, particularly those with long-term and chronic problems, remains a challenge for drug services. Outreach and low-threshold interventions are common approaches to attempting to make contact and engage with these hard-to-reach populations. A more controversial approach is the development in some countries of supervised drug consumption rooms mostly targeting drug injectors but now sometimes also extending provision to crack cocaine or heroin smoking (see EMCDDA, 2004c). Another controversial area of service development and experimentation is the use of heroin by a few countries as an agent for drug substitution treatment. Although, overall, activities in this area remain very limited compared with other treatment options, some studies have suggested that heroin prescribing may have potential benefits for clients where methadone maintenance treatment has failed. For example, a recent German randomised controlled trial of heroin-assisted treatment (Naber and Haasen, 2006) reported positive outcomes in terms of both health and reductions in use of illicit drugs. Nonetheless, no clear consensus currently exists across Europe on the cost and benefits of this approach and it remains an area where there is considerable political and scientific debate." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), pp. 33-34. 13. "In the EU Member States, problem drug users can access social measures through facilities either exclusively dedicated to drug users or targeting socially deprived groups. Among these measures, housing is one of the key pillars. The service most commonly offered to homeless problem drug users is access to 'generic housing services' (in 21 countries), while 18 countries offer housing facilities solely for problem drug users and 13 countries combine the two systems. However, there are doubts about the effective access of homeless problem drug users to these facilities. Low availability, local resistance to providing drug users with new facilities, restricted criteria for access and difficulties for homeless problem drug users in sticking to the rules are among the problems reported." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 34. E. Treatment 1. "Substitution therapy for opioid dependence (mainly treatment with methadone or buprenorphine) is in place in all EU Member States as well as Bulgaria, Romania and Norway, and there is now a substantial European consensus that it is a beneficial approach to the treatment of problem opioid users, although in some countries it remains a sensitive topic (see Chapter 2). The role of substitution treatment is becoming less controversial internationally; the UN system came to a joint position on substitution maintenance therapy in 2004 (WHO/UNODC/UNAIDS, 2004), and in June 2006 WHO included both methadone and buprenorphine in its model list of essential medicines." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 72. 2. "While methadone continues to be the most commonly prescribed substitution treatment in Europe, treatment options are still expanding, and buprenorphine is now available in 19 EU countries, Bulgaria and Norway, although it is not clear whether it is officially approved for maintenance treatment in all countries where it is reported to be used. Considering that high-dosage buprenorphine treatment was introduced in Europe only 10 years ago, the drug's popularity as a therapeutic option has developed remarkably quickly (see Figure 1)." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 72. 3. "Some countries (Germany, Spain, the Netherlands and the United Kingdom) also have heroin prescription programmes, although the number of patients receiving this kind of treatment is very small compared with other forms of drug substitution (probably constituting less than 1% of the total). This form of treatment remains controversial and is generally provided on a scientific trial basis for long-term users in whom other therapeutic options have failed." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 72. 4. "It is estimated that in the EU more than half a million opioid users received substitution treatment in 2003, which represents one third of the currently estimated 1.5 million problem opioid users (EMCDDA, 2005a). The new Member States and candidate countries account for only a small fraction of the clients in substitution treatment in the European region, which can partly be explained by lower levels of opioid use in these countries. Although the overall provision of substitution treatment remains low in these countries, there are some indications of increases in Estonia, Lithuania and Bulgaria." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 30. 5. "Over the last decade, but even more so in the last five years, many European countries have 'opened the doors' to treatment by expanding their provision of substitution treatment and reducing access limitations. Never before have such large numbers of drug users been reached by the system of care. Many but not all require assistance beyond the treatment of their dependency, and many seem to need low-threshold care as well as substantial support for their reintegration." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 31. 6. "A survey conducted among national focal points (NFPs) in 2005 assessed the general characteristics of treatment provision in Europe. National experts were asked whether the majority of opioid users were treated in drug-free or medically assisted programmes or whether both modalities were equally prevalent. "The results show a ratio largely in favour of medically assisted treatment, with the main substance used being methadone (except in the Czech Republic and France; for more details see Chapter 6). The results further show that drug-related treatment in most countries is predominantly provided in outpatient settings — only Latvia and Turkey provide most treatment in inpatient settings. Traditional psychotherapeutic treatment modalities (psychodynamic, cognitive-behavioural, systemic/family therapy or Gestalt therapy) are the most frequently used modalities in outpatient treatment in Ireland, Latvia, the United Kingdom, Bulgaria and Turkey. Nine countries report the provision of predominantly 'supportive' methods (which can include counselling, socio-educative and environmental therapy, motivational interviewing or relaxation techniques and acupuncture), and 10 countries combine the different methods in their outpatient work." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 31. 7. "Concerning inpatient care, the 12-step Minnesota model is frequently used in residential care in Ireland, Lithuania, Hungary and Turkey, while six countries predominantly apply psychotherapeutic treatment modalities, five countries 'supportive' methods and 10 countries a combination of such approaches." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 31. 8. "Treatment units or programmes that exclusively service one specified target group are a common phenomenon across the EU. Children and young people under the age of 18 are treated in specialised agencies in 23 countries; the treatment of drug users with psychiatric co-morbidity takes place in specialised agencies in 18 countries; and women-specific services are reported to exist in all countries except Cyprus, Latvia, Lithuania, Bulgaria and Turkey. Services designed to meet the needs of immigrant drug users or of groups with specific language requirements or religious or cultural backgrounds are less common but have been reported from Belgium, Germany, Greece, Spain, Lithuania, the Netherlands, Finland, Sweden and the United Kingdom." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 33. 9. "The development of 'safer' substitution products (i.e. substances less likely to be diverted into the black market) makes it likely that drug dependency treatment will move even further towards the GP's surgery. This is also a process of normalisation, which allows drug dependency to be treated like a chronic disease such as diabetes." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 34. 10. "Some countries report that the large groups of heroin users in substitution treatment create a corresponding demand for social reintegration support, especially for paid work. Under the current economic circumstances, many countries may find it difficult to meet the vocational reintegration needs of older heroin users, even if they are stabilised in drug maintenance treatment. This situation is aggravated by the high levels of morbidity among this group." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 34. F. Substance Use and the Justice System 1. "Over the five-year period 1999–2004, the number of 'reports' of drug law offences increased overall in most EU countries (in fact in all reporting countries except Italy and Portugal, with particularly marked increases — twofold or more — in Estonia, Lithuania, Hungary and Poland). In 2004, this increasing trend was confirmed in most reporting countries, although a few countries reported a fall over the previous year — the Czech Republic, Greece, Latvia, Luxembourg, Portugal, Slovenia (since 2001), Slovakia, Finland and Bulgaria." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), pp. 23-24. 2. "In most EU Member States the majority of reported drug law offences are related to drug use or possession for use, ranging in 2004 from 61% of all drug law offences in Poland to 90% in Austria. In the Czech Republic, Luxembourg, the Netherlands and Turkey, most reported drug law offences relate to dealing or trafficking, with the proportion varying from 48% of all drug offences in Luxembourg to 93% in the Czech Republic." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 24. 3. "Over the same five-year period [1999-2004], the number of offences for use/possession for use increased overall in all reporting countries, except Italy, Portugal, Slovenia, Bulgaria and Turkey, which reported a declining trend. The share of all drug law offences accounted for by these offences also increased in most reporting countries over the period, although the rate of increase was generally low, except in Cyprus, Poland and Finland, where more marked upward trends were reported. However, in Luxembourg, Portugal, Bulgaria and Turkey, the proportion of drug offences related to use/possession for use fell overall." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 24. 4. "In most of the Member States, cannabis is the illicit drug most often involved in reported drug law offences. In the countries where this is the case, cannabis-related offences in 2004 accounted for 34–87% of all drug law offences. In the Czech Republic and Lithuania, amphetamines-related offences predominated, accounting, respectively, for 50% and 31% of all drug law offences; while in Luxembourg cocaine is the most reported substance (in 43% of drug law offences)." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 24. 5. "In 1999–2004, the number of 'reports' of drug law offences involving cannabis increased overall in the majority of reporting countries, while decreases were evident in Italy and Slovenia. Over the same period, the proportion of drug offences involving cannabis increased in Germany, Spain, France, Lithuania, Luxembourg, Portugal, the United Kingdom and Bulgaria, while it remained stable overall in Ireland and the Netherlands, and decreased in Belgium, Italy, Austria, Slovenia and Sweden. Although in all reporting countries (except in the Czech Republic and Bulgaria and for a few years in Belgium) cannabis is more predominant in offences for use/possession than in other drug law offences, the proportion of use-related offences involving cannabis has decreased since 1999 in several countries -- namely Italy, Cyprus (2002–04), Austria, Slovenia and Turkey (2002–04) -- and has fallen over the last year (2003–04) in most reporting countries, possibly indicating a reduced targeting of cannabis users by law enforcement agencies in these countries." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 24. 6. "Over the same five-year period, the number of 'reports' and/or the proportion of drug law offences involving heroin decreased in the majority of reporting countries, except Belgium, Austria, Slovenia and Sweden, which reported upward trends in the number of 'reports' involving heroin and/or the proportion of drug offences that involved heroin. "The opposite trend can be observed for cocaine-related offences: in terms of both number of 'reports' and the proportion of all drug offences, cocaine-related offences have increased since 1999 in most reporting countries. Bulgaria is the only country to report a downward trend in cocaine offences (both numbers and proportions of drug offences)." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 24. 7. "In 2004, an estimated 60,000 seizures of 74 tonnes of cocaine were made in the EU. Most seizures of cocaine are reported in western European countries, especially Spain, which accounts for about half the seizures and amounts recovered in the EU in the last five years. Over the period 1999–2004, the number of cocaine seizures increased overall at EU level, while quantities seized fluctuated within an upward trend. However, based on reporting countries, quantities appear to have declined in 2004 -- perhaps in comparison with the exceptional amount recovered in Spain the year before." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 58. 8. "In 2004, the average retail price of cocaine varied widely across the EU, from EUR 41 per gram in Belgium to over EUR 100 per gram in Cyprus, Romania and Norway. The average prices of cocaine, corrected for inflation, showed an overall downward trend over the period 1999–2004 in all reporting countries except Luxembourg, where it declined until 2002 and then increased, and Norway, where prices rose sharply in 2001 and then stabilised." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), pp. 58-59. 9. "Compared with heroin, the average purity of cocaine at user level [in the EU] is high, varying in 2004 from 24% in Denmark to 80% in Poland, with most countries reporting purities of 40–65%. Data available for 1999–2004 indicate an overall decrease in the average purity of cocaine in most reporting countries, although it increased in Estonia (since 2003), France and Lithuania, and remained stable in Luxembourg and Austria." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 59. 10. "In 2004, the average retail price of brown heroin varied widely across Europe, from EUR 12 per gram in Turkey to EUR 141 per gram in Sweden, while that of white heroin varied between EUR 31 per gram in Belgium and EUR 202 per gram in Sweden, and the price of heroin of type undistinguished ranged from EUR 35 per gram in Slovenia to EUR 82 per gram in the United Kingdom. Data available for 1999–2004 show a decrease in the average price of heroin, corrected for inflation, in most reporting countries." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 67. 11. "The average purity of brown heroin at user level varied in 2004 from 10% in Bulgaria to 48% in Turkey, while that of white heroin varied between 20% in Germany and 63% in Denmark, and that of heroin of type undistinguished ranged from 16% in Hungary to 42–50% in the Netherlands. The average purity of heroin products has been fluctuating in most reporting countries since 1999, making it difficult to identify any overall trend." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 67. 12. "Data on drug use among the prison population in the last five years (1999–2004) were provided by most European countries (1). They show that, compared with the general population, drug users are overrepresented in prison. The proportion of detainees who report ever having used an illicit drug varies among prisons and detention centres, but average rates range from one third or less in Hungary and Bulgaria to two thirds or more in the Netherlands, the United Kingdom and Norway, with most countries reporting lifetime prevalence rates of around 50% (Belgium, Greece, Latvia, Portugal, Finland). Cannabis remains the most frequently used illicit drug, with lifetime prevalence rates among prisoners ranging between 4% and 86%, compared with lifetime prevalence rates of 3–57% for cocaine, 2–59% for amphetamines and 4–60% for heroin." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 69. 13. "Although the majority of drug users reduce or stop their drug use after incarceration, some detainees continue and others start using drugs (and/or injecting drugs) while in prison. According to available studies, 8–51% of inmates have used drugs within prison, 10–42% report regular drug use and 1–15% have injected drugs while in prison. This raises issues around the potential spread of infectious diseases, in particular in relation to access to sterile injection equipment and sharing practices among the prison population." Source: "Annual Report 2006: The State of the Drugs Problem in Europe," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2006), p. 69. 14. On average per year from 1999 to 2001, the homicide rate in the European Union was 1.59 homicides per 100,000 population. Source: Barclay, Gordon & Cynthia Tavares, "International Comparisons of Criminal Justice Statistics 2001," Home Office Bulletin 12/03 (London, England, UK: Home Office Research, Development, and Statistics Directorate, October 24, 2003), p. 10, Table 1.1. Candidate and New-Member Countries to the European Union (Central and Eastern Europe) 1. Regarding drug use in candidate eastern European countries, the European Monitoring Centre for Drugs and Drug Addiction reported in 2003 that "Current trends are hard to assess, as very recent data are lacking in most countries. There are tentative indications from some studies that in some countries the increase in drug use may have started to stabilise in the early 2000s, especially in major cities, where prevalence levels are usually several times higher than in rural areas (e.g. in Warsaw as well as in cities in Hungary and the Czech Republic). In other countries, data are rare or only limited qualitative or impressionistic information suggesting continuing increases is available. In all countries, the pattern of use is dominated by experimental or occasional use, mainly of cannabis. At the same time, these studies suggest an increased intensity of use by those (the minority) who continue to use. In other reports, diffusion of drug use from cities to smaller towns and rural communities is described. The 2003 ESPAD study should help cast light on trends among 16-year-old schoolchildren, although the results will not be available until 2004 and, as noted above, will not reflect trends in older groups of young people, up to the age of 25 or so, in whom drug use prevalence is likely to be higher." Source: European Monitoring Centre for Drugs and Drug Addiction, "Annual Report 2003: The State of the Drugs Problem in the Acceding and Candidate Countries to the European Union" (Lisboa, Portugal: EMCDDA, 2003), pp. 18-19. 2. "From available data, and subject to the reservations expressed above, it appears that the level of problem drug use in the CEECs [Central and Eastern European Countries] is approaching, and in some cases has surpassed, levels reported for EU Member States. The 2002 report on the drug situation in the candidate CEECs (EMCDDA, 2002a) estimated the proportion of problem drug users among the population aged 15 to 64 to be over 1 % in Estonia and Latvia, around 0.5 % (the EU average) in Bulgaria, the Czech Republic and Slovenia, and around 0.25 % in Poland (lower than the EU average but based on older data). Rapid increases in new cases of heroin smoking reflected in treatment data over recent years suggest that the estimate for Poland would now be higher, while a new estimate for Slovenia implies a rate of problem drug use of over 1 %. No estimates are available for Hungary, Lithuania, Romania or Slovakia." Source: European Monitoring Centre for Drugs and Drug Addiction, "Annual Report 2003: The State of the Drugs Problem in the Acceding and Candidate Countries to the European Union" (Lisboa, Portugal: EMCDDA, 2003), p. 22. 3. Regarding drug use in candidate eastern European countries, the European Monitoring Centre for Drugs and Drug Addiction reported in 2003 that "Substitution treatment, in particular with methadone, has been slow to develop. The first (experimental) methadone programme started in Slovenia in 1990, to be followed by others in the Czech Republic (1992) and Poland (1993). In other countries, the first methadone programmes date from 1995 or later, although by 2001 all countries had introduced at least one. However, except in Slovenia, the number of programmes is limited and coverage remains very low indeed. In Slovenia, a nationwide network provides methadone treatment to perhaps 20% of the estimated total heroin-dependent population. In all other countries, coverage is less than 5%, and in many countries under 1 to 2%. This contrasts with an average coverage of well over 30% in the EU Member States (Figure 2). Other pharmacological treatments are available to a limited extent in some countries, including naltrexone and buprenorphine, but systematic information is not available." Source: European Monitoring Centre for Drugs and Drug Addiction, "Annual Report 2003: The State of the Drugs Problem in the Acceding and Candidate Countries to the European Union" (Lisboa, Portugal: EMCDDA, 2003), p. 24. 4. Regarding drug use in candidate eastern European countries, the European Monitoring Centre for Drugs and Drug Addiction reported in 2003 that "While needle and syringe exchange programmes (SEPs) have been implemented in all countries, only the Czech Republic reaches a substantial proportion (estimated at over 50%) of drug injectors through a national network of SEPs and low-threshold projects, although in some countries, such as Slovenia, a reasonable level of coverage is achieved in some cities." Source: European Monitoring Centre for Drugs and Drug Addiction, "Annual Report 2003: The State of the Drugs Problem in the Acceding and Candidate Countries to the European Union" (Lisboa, Portugal: EMCDDA, 2003), p. 28. 5. Regarding drug use in candidate eastern European countries, the European Monitoring Centre for Drugs and Drug Addiction reported in 2003 that "However, most 16-year-olds in the CEECs have never used illicit drugs and, among those who have, the vast majority have used only cannabis. On average, lifetime prevalence of illicit drug use by 16-year-olds in the CEECs is 19%, ranging from 12% in Romania to 35% in the Czech Republic. On average, the lifetime prevalence of cannabis use by 16-year-olds in the CEECs is 16%, ranging from 1% of the surveyed population in Romania (although 8% have tried smoking heroin at least once) to 34% in the Czech Republic. In contrast, in almost all of the CEECs, more than 90% of 16-year-olds have tried alcohol at least once, and nearly two thirds admit to having been drunk at least once in their life." Source: European Monitoring Centre for Drugs and Drug Addiction, "Annual Report 2003: The State of the Drugs Problem in the Acceding and Candidate Countries to the European Union" (Lisboa, Portugal: EMCDDA, 2003), p. 35. 6. "Relatively high national rates of HIV prevalence among different subgroups of IDUs tested during 2001 were reported from Estonia (13%) and Latvia (12%). However, in the capital of Estonia, Tallin, the local HIV prevalence rate in 2001 reached the alarmingly high value of 41%. In Latvia and Poland, HIV prevalence among IDUs rose above 5% in 1998 and has remained above 5% since. In Lithuania, HIV prevalence increased to more than 1% in 1997 but remained consistently below 5% until 2001. In contrast, between 1996 and 2001, HIV prevalence among IDUs remained consistently below 1% in Bulgaria, the Czech Republic, Hungary, Slovakia and Slovenia (European Centre for the Epidemiological Monitoring of AIDS, 2002). In these countries, HIV prevalence rates among IDUs are lower than those in any EU Member State, where levels of infection in different subgroups of IDUs vary from about 1% in the UK (surveys and unlinked anonymous screening) to 34% in Spain (routine diagnostic tests in drug treatment) (EMCDDA, 2002c)." Source: European Monitoring Centre for Drugs and Drug Addiction, "Annual Report 2003: The State of the Drugs Problem in the Acceding and Candidate Countries to the European Union" (Lisboa, Portugal: EMCDDA, 2003), p. 48. 7. "In all CEECs for which information is available, sterile injection equipment can be purchased from pharmacies without a prescription. In 2001, in most CEECs the price of syringes in pharmacies was EUR 0.1. The exceptions were Estonia, where the price was lower (EUR 0.06), and Slovenia and Romania, where it was higher (EUR 0.14 and up to EUR 0.2 respectively). Only in Slovenia and Latvia can syringes also be exchanged or distributed through pharmacies. Not a single CEEC reported the existence of a national programme to support the sale of syringes to IDUs in pharmacies, although Estonia and Latvia reported sporadic efforts to provide at least some training for pharmacists with the aim of raising awareness of the need to prevent drug-related infectious diseases among IDUs. With the exception of Lithuania, no CEEC reported the distribution of prevention information targeted specifically at IDUs through pharmacies. Information on the numbers of syringes sold to IDUs through pharmacies would be very valuable in assessing the overall access of IDUs. The Czech Republic reported that in 2001 approximately one million syringes were sold to IDUs through pharmacies (97.8 syringes per 1,000 total population). National estimates of the proportion of IDUs who purchase sterile injecting equipment through pharmacies are generally not available, except in Hungary, where the figure in 2001 was approximately 30–40%." Source: European Monitoring Centre for Drugs and Drug Addiction, "Annual Report 2003: The State of the Drugs Problem in the Acceding and Candidate Countries to the European Union" (Lisboa, Portugal: EMCDDA, 2003), pp. 52-53. 8. "All CEECs have in place some community-based or outreach harm reduction programmes that provide access to sterile injecting equipment and information on safer drug use and often also promote safer sex, including the distribution of condoms." Source: European Monitoring Centre for Drugs and Drug Addiction, "Annual Report 2003: The State of the Drugs Problem in the Acceding and Candidate Countries to the European Union" (Lisboa, Portugal: EMCDDA, 2003), p. 53. 9. "Substitution treatment is available to IDUs in all CEECs; however, availability varies considerably. In 2001 in Slovenia, 679 IDUs per million total population were on methadone maintenance, but the corresponding rate in Estonia was only 3.6. Total estimated numbers of IDUs receiving methadone substitution treatment per million population in 2001 or the most recent year for which an estimate is available are shown in Figure 15. With the possible exception of Slovenia, access to methadone substitution is clearly insufficient. The next highest rates were in Slovakia and the Czech Republic, but here the numbers of drug users receiving methadone were approximately 10–20 times lower. Like coverage of SEPs, more meaningful rates would take account of the estimated numbers of IDUs." Source: European Monitoring Centre for Drugs and Drug Addiction, "Annual Report 2003: The State of the Drugs Problem in the Acceding and Candidate Countries to the European Union" (Lisboa, Portugal: EMCDDA, 2003), p. 54. 10. "It is interesting to note that a number of acceding and candidate countries have moved towards criminalising possession for personal use, or use itself, over the past 12 years, while the most recent drug law modifications within the European Union countries have addressed the same question in a different way (ELDD, 2002)." Source: European Monitoring Centre for Drugs and Drug Addiction, "Annual Report 2003: The State of the Drugs Problem in the Acceding and Candidate Countries to the European Union" (Lisboa, Portugal: EMCDDA, 2003), p. 60. Australia A. Overview 1. "The National Drug Strategy 2004–2009 (NDS) provides a framework for a coordinated and integrated approach to drug issues in the Australian community. The MCDS has responsibility for the implementation of the NDS. The NDS is complemented, supported and integrated with a range of national, State and Territory government and non-government strategies, plans and initiatives. "The mission of the NDS is 'to improve health, social and economic outcomes by preventing the uptake of harmful drug use and reducing the harmful effects of licit and illicit drugs in Australian society'. "The challenge for all levels of government, the community and non-government organisations (NGOs) is to work together on these objectives to improve health, social and economic outcomes by preventing the uptake of harmful drug use and reducing the harmful effects of licit and illicit drugs in Australian society." Source: Intergovernmental Committee on Drugs, "National Drug Strategy 2004-2009: Annual Report July 2004-June 2005 to the Ministerial Council on Drug Strategy" (Canberra, Australia: Drug Strategy Branch, Australian Government Dept. of Health and Ageing, Dec. 2006), p. 5. 2. "The principle of harm minimisation has formed the basis of successive phases of Australia's National Drug Strategy since its inception in 1985. "Harm minimisation does not condone drug use, rather it refers to policies and programs aimed at reducing drug-related harm. It aims to improve health, social and economic outcomes for both the community and the individual, and encompasses a wide range of approaches, including abstinence-oriented strategies. Source: Ministerial Council on Drug Strategy, "The National Drug Strategy: Australia's Integrated Framework 2004-2009" (Canberra, Australia: Drug Strategy Branch, Dept. of Health and Ageing, May 2004), p. 2. 3. "Australia’s harm-minimisation strategy focuses on both licit and illicit drugs and includes preventing anticipated harm and reducing actual harm. Harm minimisation is consistent with a comprehensive approach to drug-related harm, involving a balance between demand reduction, supply reduction and harm reduction strategies. It encompasses: "supply reduction strategies to disrupt the production and supply of illicit drugs, and the control and regulation of licit substances; "demand reduction strategies to prevent the uptake of harmful drug use, including abstinence orientated strategies and treatment to reduce drug use; and "harm reduction strategies to reduce drug-related harm to individuals and communities." Source: Ministerial Council on Drug Strategy, "The National Drug Strategy: Australia's Integrated Framework 2004-2009" (Canberra, Australia: Drug Strategy Branch, Dept. of Health and Ageing, May 2004), p. 2. 4. "The success of Australia's drug policy is based on four features: "the principle of harm minimisation, which recognises the need to use a wide range of approaches in dealing with drug related harm, including supply-reduction, demand-reduction (including abstinence oriented interventions) and harm-reduction strategies; "the comprehensiveness of the approach, encompassing the harmful use of licit drugs (tobacco, alcohol and pharmaceutical drugs), illicit drugs and other substances (inhalants, kava); "the promotion of partnerships between health, law enforcement and education agencies, affected communities, business and industry in tackling drug-related harm; "a balanced approach — across all levels of government — between supply-reduction, demand-reduction and harm-reduction strategies, between preventing use and harms, and facilitating access to treatment." Source: Ministerial Council on Drug Strategy, "The National Drug Strategy: Australia's Integrated Framework 2004-2009" (Canberra, Australia: Drug Strategy Branch, Dept. of Health and Ageing, May 2004), p. 11. 5. "According to the Australian Institute of Health and Welfare (AIHW) Australia's Health 2004 report, in 2000–01 expenditure on public health activities relating to the prevention of hazardous and harmful drug use in Australia was approximately $146.2 million." Source: Intergovernmental Committee on Drugs, "National Drug Strategy 2004-2009: Annual Report July 2004-June 2005 to the Ministerial Council on Drug Strategy" (Canberra, Australia: Drug Strategy Branch, Australian Government Dept. of Health and Ageing, Dec. 2006), p. 7. B. Prevalence Estimates 1. "Based on responses to the 2004 NDSHS [National Drug Strategy Household Survey], 38% of Australians aged 14 years and over had used any illicit drug at least once in their lifetime, and 15% had used any illicit drug at least once in the last 12 months." Source: Australian Institute of Health and Welfare, "Statistics on drug use in Australia 2006" (Canberra, Australia: Australian Institute of Health and Welfare, April 2007), Drug Statistics Series No. 18., Cat. no. PHE 80, p. xi. 2. "The six most common illicit drugs used in the previous 12 months were marijuana/cannabis (11%), ecstasy, meth/amphetamine, and pain-killers/analgesics for non-medical purposes (all 3%), tranquillisers/sleeping pills and cocaine (1%)." Source: Australian Institute of Health and Welfare, "Statistics on drug use in Australia 2006" (Canberra, Australia: Australian Institute of Health and Welfare, April 2007), Drug Statistics Series No. 18., Cat. no. PHE 80, p. 21. 3. "Marijuana/cannabis was the most common illicit drug used, with one in three persons (34%) having used it at least once in their lifetime and 11% of the population having used it in the previous 12 months." Source: Australian Institute of Health and Welfare, "Statistics on drug use in Australia 2006" (Canberra, Australia: Australian Institute of Health and Welfare, April 2007), Drug Statistics Series No. 18., Cat. no. PHE 80, p. xi. 4. "Methamphetamine use was relatively uncommon in Australia in 2004: around 3% aged 14 years and over had used it in the last 12 months and 9% in their lifetime. Powder was the most common form of methamphetamine used (74%). The majority of users reported taking the drug in their own home or at a friend’s house (66%)." Source: Australian Institute of Health and Welfare, "Statistics on drug use in Australia 2006" (Canberra, Australia: Australian Institute of Health and Welfare, April 2007), Drug Statistics Series No. 18., Cat. no. PHE 80, p. xi. 5. "The proportion of the population who had used any illicit drug in the last 12 months fluctuated between 1991 and 2004, reaching the same level in 2004 as the prevalence in 1991 (15%). While the proportion of people who had recently used marijuana/cannabis in 2004 (11%) was the lowest over this 13-year period, the proportion using ecstasy (3%) was the highest for that substance in the same period." Source: Australian Institute of Health and Welfare, "Statistics on drug use in Australia 2006" (Canberra, Australia: Australian Institute of Health and Welfare, April 2007), Drug Statistics Series No. 18., Cat. no. PHE 80, p. xi. 6. "The average age of first use of illicit drugs ranged from 18.6 years for inhalants, to 25.2 years for tranquillisers/sleeping pills and steroids for non-medical purposes. The average age of initiation was 18.7 years for marijuana/cannabis, 20.8 years for meth/amphetamine and 22.8 years for ecstasy." Source: Australian Institute of Health and Welfare, "Statistics on drug use in Australia 2006" (Canberra, Australia: Australian Institute of Health and Welfare, April 2007), Drug Statistics Series No. 18., Cat. no. PHE 80, p. 21. 7. "The overall prevalence of tobacco smoking in Australia is in decline, a trend which contributes to Australia being considered an international leader in tobacco control. Australians have decreased their daily tobacco use to 17.4 per cent in 2004 compared to 19.5 per cent in 2001 (NDSHS, AIHW 2004). This is among the lowest of any country in the world. "Even though these results are positive, tobacco remains the single largest preventable cause of disease and premature death in Australia and kills over 19,000 Australians each year. It is estimated to cost the Australian community approximately $21 billion in social costs per year." Source: Intergovernmental Committee on Drugs, "National Drug Strategy 2004-2009: Annual Report July 2004-June 2005 to the Ministerial Council on Drug Strategy" (Canberra, Australia: Drug Strategy Branch, Australian Government Dept. of Health and Ageing, Dec. 2006), p. 7. 8. "In 2004, around 84% of the population aged 14 years and over had consumed at least one full serve of alcohol in the last 12 months. People were most likely to drink either weekly (41%) or less than weekly (34%); 9% of Australians consumed alcohol on a daily basis. People aged 60 years and over recorded the highest prevalence of daily drinking (17%). "The pattern of alcohol consumption by the Australian population has remained relatively unchanged over the period 1991 to 2004." Source: Australian Institute of Health and Welfare, "Statistics on drug use in Australia 2006" (Canberra, Australia: Australian Institute of Health and Welfare, April 2007), Drug Statistics Series No. 18., Cat. no. PHE 80, p. x. C. Problem Substance Use and Substance-Related Harm 1. "In 2003, it was estimated that 8% of the burden of disease in Australia was attributable to tobacco use and 2% to illicit drug use. Three per cent of the total burden of disease was attributable to alcohol consumption. However, alcohol was also estimated to prevent 1% of the burden of disease in 2003." Source: Australian Institute of Health and Welfare, "Statistics on drug use in Australia 2006" (Canberra, Australia: Australian Institute of Health and Welfare, April 2007), Drug Statistics Series No. 18., Cat. no. PHE 80, p. xi. 2. "Begg et al. (forthcoming) estimate that illicit drug use was responsible for 2% of the total burden of disease in Australia in 2003. There were 1,705 deaths and almost 51,500 DALYs [disability-adjusted life years] attributable to illicit drug use." Source: Australian Institute of Health and Welfare, "Statistics on drug use in Australia 2006" (Canberra, Australia: Australian Institute of Health and Welfare, April 2007), Drug Statistics Series No. 18., Cat. no. PHE 80, p. 36. 3. "According to the annual Needle and Syringe Program (NSP) Survey, hepatitis C prevalence among people attending needle and syringe programs remained high over the period 1997 to 2005, at around 60%." Source: Australian Institute of Health and Welfare, "Statistics on drug use in Australia 2006" (Canberra, Australia: Australian Institute of Health and Welfare, April 2007), Drug Statistics Series No. 18., Cat. no. PHE 80, p. xi. 4. "Hepatitis C was the major condition for deaths attributable to illicit drug use in 2003 (759 deaths), followed by hepatitis B (329 deaths). Hepatitis C was also responsible for a significant proportion of DALYs attributable to illicit drugs (11,709 DALYs), while the main contributor was heroin/polydrug use (16,758 DALYs)." Source: Australian Institute of Health and Welfare, "Statistics on drug use in Australia 2006" (Canberra, Australia: Australian Institute of Health and Welfare, April 2007), Drug Statistics Series No. 18., Cat. no. PHE 80, p. xi. 5. "The number of new AIDS diagnoses in Australia among people who had a history of injecting drug use (including male homosexual contact and injecting drug use) varied over time from 31 diagnoses in 1997 down to 17 in 2001 and up to 29 diagnoses in 2004 (Table 6.7). In 2005 there was an increase of AIDS diagnoses among injecting drug users to 41." Source: Australian Institute of Health and Welfare, "Statistics on drug use in Australia 2006" (Canberra, Australia: Australian Institute of Health and Welfare, April 2007), Drug Statistics Series No. 18., Cat. no. PHE 80, p. 41. 6. "Between 1997 and 2004, the proportion of people who contracted AIDS and were injecting drug users remained relatively stable, ranging between 8% and 13% of new AIDS diagnoses. In 2005, there was an increase of new AIDS diagnoses among injecting drug users (16%), with 8% among injecting drug users with no male homosexual contact." Source: Australian Institute of Health and Welfare, "Statistics on drug use in Australia 2006" (Canberra, Australia: Australian Institute of Health and Welfare, April 2007), Drug Statistics Series No. 18., Cat. no. PHE 80, p. 41. 7. "The number of deaths from AIDS among injecting drug users decreased from 29 in 1997 to 17 in 2005 (Table 6.8). However, the proportion of AIDS deaths among people who had a history of injecting drug use increased by seven percentage points, from around 12% in 1997 to 19% in 2005." Source: Australian Institute of Health and Welfare, "Statistics on drug use in Australia 2006" (Canberra, Australia: Australian Institute of Health and Welfare, April 2007), Drug Statistics Series No. 18., Cat. no. PHE 80, p. 41. 8. "In 2005, 46% of injecting drug users surveyed for the IDRS had overdosed on heroin at some time in their lifetime (Table 6.11), and 9% of injecting drug users reported non-fatal heroin overdose on at least one occasion in the last 12 months. Nearly half (48%) of the injecting drug users responding to the survey reported that they were currently receiving treatment. Around 24% injected in a public space on the last occasion, ranging from 8% in the Northern Territory to 42% in Victoria." Source: Australian Institute of Health and Welfare, "Statistics on drug use in Australia 2006" (Canberra, Australia: Australian Institute of Health and Welfare, April 2007), Drug Statistics Series No. 18., Cat. no. PHE 80, p. 41. 9. "The death rate from accidental opioid overdose among people aged 15–54 years increased from 36.6 deaths per million persons in 1988 to peak at 101.9 deaths per million persons in 1999, before declining sharply to 34.6 deaths per million persons in 2001 (Figure 6.2). In the following 4 years, the death rate from accidental opioid overdose has declined slightly to 31.3 in 2004. "There were 357 accidental deaths due to opioid use among persons aged 15–54 years in Australia in both 2003 and 2004 (Table 6.12). The majority of accidental deaths due to opioid use in 2004 occurred in New South Wales (144 deaths) and Victoria (126 deaths)." Source: Australian Institute of Health and Welfare, "Statistics on drug use in Australia 2006" (Canberra, Australia: Australian Institute of Health and Welfare, April 2007), Drug Statistics Series No. 18., Cat. no. PHE 80, pp. 45-46. 10. "Around one in five Australians (35%) aged 14 years and over consumed alcohol at risky or high-risk levels for short-term risk on at least one occasion in the last 12 months. One in ten Australians consumed alcohol at levels that are considered risky or high risk for alcohol-related harm in the long term." Source: Australian Institute of Health and Welfare, "Statistics on drug use in Australia 2006" (Canberra, Australia: Australian Institute of Health and Welfare, April 2007), Drug Statistics Series No. 18., Cat. no. PHE 80, p. x. 11. "According to A Guide to Australian Alcohol Data 2004, alcohol is second only to tobacco as a preventable cause of death and hospitalisation in Australia. Alcohol is a significant contributor to public disorder and violence and crime. People seek treatment for alcohol abuse more frequently than for any other licit or illicit drug. "Reducing the level of alcohol abuse is a shared responsibility between the Australian and state and territory governments. The majority of Australians drink at low risk levels for most of the time (as defined by the Australian Alcohol Guidelines). However, risky or high risk drinking levels for both the short and long term is estimated to cause about 3,000 deaths per annum and is responsible for almost 5 per cent (gross harm) of the total disease burden in Australia. Alcohol abuse generates $7.6 billion in social cost to the community per annum." Source: Intergovernmental Committee on Drugs, "National Drug Strategy 2004-2009: Annual Report July 2004-June 2005 to the Ministerial Council on Drug Strategy" (Canberra, Australia: Drug Strategy Branch, Australian Government Dept. of Health and Ageing, Dec. 2006), p. 8. D. Harm Reduction Efforts 1. "A comprehensive harm-minimisation approach must take into account three interacting components: the individuals and the communities involved; their social, cultural, physical, legal and economic environment; and the drug itself. Harm minimisation approaches will vary according to the nature of the problem, the population group, the time and the locality. For example, strategies that aim to reduce harm for under-age drinkers will differ from strategies that target older smokers. Similarly, different strategies may be appropriate to accommodate the needs of injecting drug users living in rural Queensland and those living in metropolitan Sydney." Source: Ministerial Council on Drug Strategy, "The National Drug Strategy: Australia's Integrated Framework 2004-2009" (Canberra, Australia: Drug Strategy Branch, Dept. of Health and Ageing, May 2004), p. 11. 2. "The first National HIV/AIDS Strategy was launched in 1989. According to Professor Richard Feachem, from the World Bank, who oversaw the evaluation of the second National HIV/AIDS Strategy: "'The first National HIV/AIDS Strategy released by the Commonwealth Government in 1989 provided a framework for an integrated response to the HIV epidemic and a plan for action across a range of policy and program activities. Needle and Syringe Programs were a key component on the education and prevention strategy.' "Professor Feacham concluded: 'Needle and Syringe Exchange Programs must be a foundation of Australia's prevention efforts in a third Strategy and beyond'. The third National HIV/AIDS Strategy (Partnerships in Practice: National HIV/AIDS Strategy 1996-97 to 1998-99) continued to support Needle and Syringe Programs as an important part of its prevention program for people who inject drugs. "The fourth National HIV/AIDS Strategy and the first National Hepatitis C Strategy, continue to support Needle and Syringe Programs as effective harm reduction interventions." Source: Health Outcomes International, the National Centre for HIV Epidemiology and Clinical Research, and the Centre of Health Economics-York University, "Return on investment in needle and syringe programs in Australia" (Canberra, Australia: Australian Government Department of Health and Ageing, October 2002), p. 9. 3. "Between 1991 and 2000, an estimated $141 million ($150 million in 2000 prices) was expended on NSPs across Australia, comprised of $122 million (87%) by government, and $19 million (13%) in consumer expenditure." Source: Health Outcomes International, the National Centre for HIV Epidemiology and Clinical Research, and the Centre of Health Economics-York University, "Return on investment in needle and syringe programs in Australia" (Canberra, Australia: Australian Government Department of Health and Ageing, October 2002), p. 2. 4. "The first Australian Needle and Syringe Program began in Sydney in 1986 as a trial project. The testing of syringes returned to this Darlinghurst Program detected an increase in HIV prevalence, suggesting that HIV was spreading among clients. In the following year Needle and Syringe Programs became NSW Government policy. Other States and Territories followed soon after. "There are a number of different models of Needle and Syringe Programs operating in Australia that vary between different jurisdictions and sometimes by locality. Depending on the jurisdiction, the proportions of these that are government run and non-government run also vary. Furthermore, of the NSPs operating in the non-government sector, a number of these are 'peer-based' NSPs. Peer-based NSPs can be distinguished by the employment of past or current drug users in the development and provision of NSP services to networks of injecting drug users." Source: Health Outcomes International, the National Centre for HIV Epidemiology and Clinical Research, and the Centre of Health Economics-York University, "Return on investment in needle and syringe programs in Australia" (Canberra, Australia: Australian Government Department of Health and Ageing, October 2002), p. 9. 5. "Needle and Syringe Programs tend to be located in relatively public places because they need to be accessible. Various government-sponsored pharmacy schemes operate throughout Australia. Generally the schemes provide 1ml syringes, which can either be purchased, or, in NSW, exchanged free on return of a pack with used syringes. In addition to those participating in the government-sponsored schemes, other pharmacies sell needles and syringes and other equipment used for injecting on a commercial basis." Source: Health Outcomes International, the National Centre for HIV Epidemiology and Clinical Research, and the Centre of Health Economics-York University, "Return on investment in needle and syringe programs in Australia" (Canberra, Australia: Australian Government Department of Health and Ageing, October 2002), p. 10. 6. "Australia's NSPs were estimated to have cost Commonwealth and State governments $122 million by 2000, but the return on this investment was the prevention of an estimated 25 000 HIV and 21 000 HCV infections. By 2010, our NSPs will have prevented an estimated 4500 deaths from AIDS and 90 deaths from HCV. The savings to governments for HIV and HCV were estimated to be at least $2.4 billion (allowing for conventional government 5% annual discounting of future costs) or as much as $7.7 billion (without discounting). By any reckoning, this represents an enormous saving in both lives and dollars. In light of these outcomes, opposition to NSPs amounts to public health vandalism and financial recklessness with taxpayers' dollars." Source: Law, Matthew G. and Robert G. Batey, "Injecting Drug Use in Australia: Needle/Syringe Programs Prove Their Worth, but Hepatitis C Still on the Increase," Medical Journal of Australia, 2003; 178 (5):197-198, from the web at http://www.mja.com.au/public/issues/178_05_030303/law10754_fm.html, last accessed June 14, 2007. 7. "An extensive network of needle and syringe programs (NSPs) has been established in Australia; in the financial year 1994-95, around 700 NSPs distributed six million syringes nationally and an additional four million were distributed through pharmacies. Early and vigorous implementation of harm reduction measures, such as methadone maintenance, peer-based education and NSPs, has successfully maintained low seroprevalence of HIV infection among people who inject drugs in Australia." Source: MacDonald, Margaret A., et al., "Hepatitis C Virus Antibody Prevalence Among Injecting Drug Users At Selected Needle and Syringe Programs In Australia, 1995-1997," Medical Journal of Australia, 2000;172:57-61, from the web athttp://www.mja.com.au/public/issues/172_02_170100/macdonald/macdonald.htmllast accessed June 14, 2007. 8. "The Sydney Medically Supervised Injecting Centre (MSIC) aims to reduce harm associated with illicit drug use by supervising injecting episodes that might otherwise occur in less safe circumstances such as public places or alone. Specifically, it is anticipated that supervising such injecting episodes will reduce the risk of morbidity and mortality associated with drug overdoses and transmission of blood-borne infections, while providing ready access to safe needle syringe disposal. It is also hoped that by extending the circumstances in which health professionals have contact with injecting drug users (IDUs) more, particularly those most 'at risk', will be engaged with the health and social welfare system sooner than otherwise. "The Sydney MSIC is at 66 Darlinghurst Road Kings Cross, in the centre of the Kings Cross business district. Access is from Darlinghurst Road. "No drugs are sold or kept on the premises. Registered clients receive clean needles and equipment, and advice about their health. "The MSIC conducts tours of the premises for members of the public on a regular basis." Source: Website of the Sydney (Australia) Medically Supervised Injecting Centre at http://www.sydneymsic.com/index.htm, last accessed June 14, 2007. 9. "Based on the results presented in Chapter 2, it appears that there were no significant barriers to access and considerable demand for MSIC services, with the registration of almost 4,000 injecting drug users across 18-months and over 55,000 supervised injections. The MSIC engaged its target client group, individuals who inject on a regular basis with histories of public injecting and drug overdose. MSIC provided over 13,000 occasions of other onsite clinical service delivery such as vein care and injecting advice and counseling, and nearly 1,400 referrals for drug treatment, health care and social welfare assistance. During the trial period, MSIC staff effectively managed 409 drug overdoses without any fatalities." Source: MISC Evaluation Committee, "Final Report on the Evaluation of the Sydney Medically Supervised Injecting Centre" (Sydney, Australia: MISC Evaluation Committee, 2003), p. 202. E. Treatment 1. "In the 2004–05 Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS-NMDS) collection, alcohol was the most common principal drug of concern in treatment episodes (37%), followed by marijuana/cannabis (23%), heroin (17%) and meth/amphetamine (11%). The proportion of treatment episodes where alcohol was the principal drug of concern increased with age, while the proportion of episodes where marijuana/cannabis was the principal drug of concern decreased with age." Source: Australian Institute of Health and Welfare, "Statistics on drug use in Australia 2006" (Canberra, Australia: Australian Institute of Health and Welfare, April 2007), Drug Statistics Series No. 18., Cat. no. PHE 80, p. xiii. 2. "Almost 39,000 clients were receiving pharmacotherapy treatment at 30 June 2005, with the majority of these treatments received from a private prescriber (70%). Excluding clients where the type of drug used could not be identified, there were 25,369 (72%) methadone maintenance therapy clients and 9,947 (28%) buprenorphine maintenance therapy clients." Source: Australian Institute of Health and Welfare, "Statistics on drug use in Australia 2006" (Canberra, Australia: Australian Institute of Health and Welfare, April 2007), Drug Statistics Series No. 18., Cat. no. PHE 80, p. xiii. F. Substance Use and the Justice System 1. "Marijuana/cannabis is the most common illicit drug for which people are arrested in Australia, accounting for almost three-quarters (71%) of arrests relating to illicit drugs in 2004–05 (Table 9.1). The proportion of arrests for amphetamine-type stimulants increased from 5% to 11% over the period of 1996–97 to 2000–01 and further increased to 13% in 2004–05. In absolute terms, the number of consumer and provider arrests for amphetaminetype stimulants increased from 3,907 in 1996–97 to 8,846 in 2000–01, increasing further to 10,068 in 2004–05." Source: Australian Institute of Health and Welfare, "Statistics on drug use in Australia 2006" (Canberra, Australia: Australian Institute of Health and Welfare, April 2007), Drug Statistics Series No. 18., Cat. no. PHE 80, p. 71. 2. "The overall number of consumer and provider arrests for illicit drugs fell from 85,046 in 1996–97 to 77,333 in 2004–05. Marijuana/cannabis arrests fell from 69,136 in 1996–97 to 54,936 in 2004–05." Source: Australian Institute of Health and Welfare, "Statistics on drug use in Australia 2006" (Canberra, Australia: Australian Institute of Health and Welfare, April 2007), Drug Statistics Series No. 18., Cat. no. PHE 80, p. 71. 3. "The majority of illicit drug arrests are related to the consumption rather than the provision or sale of substances (Table 9.1). For example, in 2004–05, over three-quarters of arrests for marijuana/cannabis (84%) and steroids (83%) were related to the consumption of those substances." Source: Australian Institute of Health and Welfare, "Statistics on drug use in Australia 2006" (Canberra, Australia: Australian Institute of Health and Welfare, April 2007), Drug Statistics Series No. 18., Cat. no. PHE 80, p. 71. 4. "Overall, total consumption-related illicit drug arrests in Australia declined from 73,800 in 1996–97 to 62,209 in 2004–05. Arrests relating to provision of illicit substances also decreased from 1996–97 to 2002–03, from 24,994 to 14,613 (ACC 2006)." Source: Australian Institute of Health and Welfare, "Statistics on drug use in Australia 2006" (Canberra, Australia: Australian Institute of Health and Welfare, April 2007), Drug Statistics Series No. 18., Cat. no. PHE 80, p. 71. 5. "Of the 2,021 persons in prison for drug-related offences at 30 June 2005, 1,607 (80%) were imprisoned for dealing/trafficking drugs, 257 (13%) for manufacturing/growing drugs and 157 (8%) for possessing/using drugs. "The proportion of people imprisoned with a drug-related most serious offence ranged between 9% and 11% over the period 1995 to 2005. In 2005, one in ten sentenced prisoners was imprisoned for drug-related offences." Source: Australian Institute of Health and Welfare, "Statistics on drug use in Australia 2006" (Canberra, Australia: Australian Institute of Health and Welfare, April 2007), Drug Statistics Series No. 18., Cat. no. PHE 80, p. 73. 6. "Almost 60% of prisoners reported a history of injecting drug use in 2004 (Table 7.9). The risk of carrying a bloodborne disease was greatly increased for those prisoners who injected drugs. Hepatitis C antibody was found in 35% of the prison population surveyed and in 56% of prisoners who injected drugs. This compares with an estimated prevalence of 1.3% in the general population (NCHECR 2005). One in five prisoners tested positive to the hepatitis B core antibody as did over one in four (27%) prisoners who reported injecting drugs. Less than 1% of prisoners tested positively to the HIV antibody; however, this was still higher than prevalence in the general population (0.07%) (NCHECR 2005)." Source: Australian Institute of Health and Welfare, "Statistics on drug use in Australia 2006" (Canberra, Australia: Australian Institute of Health and Welfare, April 2007), Drug Statistics Series No. 18., Cat. no. PHE 80, p. 60. 7. Australia's incarceration rate is 126 inmates per 100,000 of national population, with a total prison population of 25,353 out of an estimated national population of 20.2 million. Source: Walmsley, Roy, "World Prison Population List (Seventh Edition)" (London, England: International Centre for Prison Studies, 2007), p. 6, Table 5, citing the Australian Bureau of Statistics. 8. Australia's homicide rate is 1.87 per 100,000 national population (average per year 1999 to 2001). Source: Barclay, Gordon & Cynthia Tavares, "International Comparisons of Criminal Justice Statistics 2001," Home Office Bulletin 12/03 (London, England, UK: Home Office Research, Development, and Statistics Directorate, October 24, 2003), p. 10, Table 1.1. Belgium: 1. "In January 2001, the Government of Belgium released a Political Note in which it expressed the intention to modify the main drug law in order to make non-problematic use of cannabis non-punishable. The Note stated the intention that 'The criminal judge will no longer interfere in the lives of people who use cannabis on a personal basis and who do not create harm or do not show dependence.' a royal decree will be issued instructing prosecutors not to pursue people for possession of cannabis. The production, supply, sale and ownership of larger quantities will remain actively prosecuted, as will the use of cannabis which leads to 'unsociable behaviour'. Use and possession will still be prosecuted in cases involving minors, public nuisance, use in school premises, or in any place where the public order will be threatened." Source: "Decriminalisation in Europe? Recent Developments in Legal Approaches to Drug use" (Lisbon, Portugal: European Monitoring Centre on Drugs and Drug Addiction, November 2001), pp. 3-4, available on the web at http://wldd.emcdda.org/databases/eldd_comparative_analyses.cfm 2. According to the Belgian National Report on Drugs 2003, prepared for the European Union's drug monitoring agency: "Changes to the Narcotic Drug Act (24 February 1921) "The major existing change in the legal framework, and probably the one most spoken of by politicians, media and others, are the modifications to the Narcotic Drug Act. These changes have been mentioned in two laws (of 4 April and 3 May 2003) and one royal decree (16 May 2003). An overview of the most important topics: "Incorporation of a Council Regulation (n° 3677/90), regulating substances that can be used to produce illicit substances (so-called 'precursors') into police authorities; "Drug use in group is not seen as punishable in se any more; instead, this will be changed to drug use in the presence of minors; "Cannabis gets a separate statute (defined as another “category”): the possession of an amount of cannabis, meant for personal use, by an adult (i.e. 18 years or older), without the presence of nuisance or problematic use will only lead to a registration by the police. In the case of nuisance, however, a punishment can be imposed of minimum three months up to one year of prison sentence and / or a fine of 1.000 to 100.000 euro (to be multiplied by 5, the revaluation factor). "Commerce, production, export and importation of substances regulated by the Narcotic Drug Act remain forbidden, and maintain their original punishments." Source: Report to the European Monitoring Center on Drugs and Drug Addiction by the Reitox National Focal Point of Belgium, Scientific Institute of Public Health, Unit of Epidemiology, "Belgium Drug Situation 2003" (Brussels, Belgium: Scientific Institute of Public Health and EMCDDA, 2004), p. 6. 3. "In 1998, according to the decision of the Federal Parliament, a directive/circular modified the action of judicial authorities: a distinction was established between the possession of cannabis and other illegal drugs with non acceptable risk for health, and the access to needle exchange was made possible (the drug law itself - even regarding cannabis - was not changed)." Source: Report to the European Monitoring Center on Drugs and Drug Addiction by the Reitox National Focal Point of Belgium, Scientific Institute of Public Health, Unit of Epidemiology, "Belgium Drug Situation 2000" (Brussels, Belgium: Scientific Institute of Public Health and EMCDDA, 2000), p. 15. 4. On February 24, 2000, members of the Belgian Parliament made a proposal "modifying the law on drug of 24/02/1921 in order to partially decriminalize the possession of cannabis and its derivatives. The authors proposed that the positive right should be clarified. The prohibition policy against cannabis should be given up because a.o. its ineffectiveness. Nevertheless, the prosecutions against dealers should be continued and the drug use prevention efforts emphasized." Source: Report to the European Monitoring Center on Drugs and Drug Addiction by the Reitox National Focal Point of Belgium, Scientific Institute of Public Health, Unit of Epidemiology, "Belgium Drug Situation 2000" (Brussels, Belgium: Scientific Institute of Public Health and EMCDDA, 2000), p. 26. 5. "A directive has been written by the Minister of Justice (16 May 2003) urging the Public Prosecutor to use a limit of 3 grams for cannabis possession or in case of plant a limit of 1 plant (or seed). In this case, on condition that there are no aggravating circumstances (like use in the presence of minors, public nuisance or problematic drug use), the police will only need to make a simple, anonymous registration of the facts." Source: Report to the European Monitoring Center on Drugs and Drug Addiction by the Reitox National Focal Point of Belgium, Scientific Institute of Public Health, Unit of Epidemiology, "Belgium Drug Situation 2003" (Brussels, Belgium: Scientific Institute of Public Health and EMCDDA, 2004), p. 7. 6. "The lifetime experiences of cannabis and XTC/amphetamines were reported by respectively 10.8% and 2.3 % of population aged between 15 to 64 years old. The last month prevalence of cannabis use was reported by 2.8% of this population and the last month prevalence of XTC was lower than 1%. "Both prevalences of cannabis use are proportionally higher among men (respectively 13.3% and 4.1%) than women (respectively 8.3% and 1.6%). These gender differences appear also in the lifetime prevalence of ecstasy and/or amphetamines use (3.1% among men and 1.6% among women). "The lifetime prevalence and the last month prevalence of cannabis use as well as XTC/amphetamines decreases appreciably with the age. The critical groups relate to the age groups between 15-24 and 25-34 years. "The lifetime prevalence of cannabis use is more important among people with a high education diploma. The last month prevalence of cannabis and the lifetime prevalence of ecstasy and/or amphetamines uses are not influenced by the educational level." Source: Report to the European Monitoring Center on Drugs and Drug Addiction by the Reitox National Focal Point of Belgium, Scientific Institute of Public Health, Unit of Epidemiology, "Belgium Drug Situation 2003" (Brussels, Belgium: Scientific Institute of Public Health and EMCDDA, 2004), pp. 14-5. Canada A. Overview 1. "The introduction of a new National Anti-Drug Strategy is an important commitment of Canada’s New Government that is being supported in Budget 2007. This new strategy covers three priority areas, with common objectives, to combat illicit drug production, prevent illicit drug use and treat illicit drug dependency. This new approach will result in a more focused program for dealing with illicit drug use. "The investment of $63.8 million over two years will build on existing programs and initiatives ($385 million per year) that are being refocused to create a new National Anti-Drug Strategy. This new strategy places particular emphasis on additional actions to combat the illicit production and distribution of drugs, to address gaps in preventing illicit drug use, to create awareness of illicit drugs and their negative effects, particularly among youth, and to treat and rehabilitate those with drug dependencies." Source: Canadian Dept. of Finance, The Budget Plan 2007, Tabled in the House of Commons by the Honourable James M. Flaherty, PC, MP, Minister of Finance, March 19, 2007, p. 257. 2. "Needle exchange and methadone programs are widely endorsed by United Nations agencies and supported by enormous bodies of published research as key HIV prevention measures. Numerous countries have operated supervised injection sites with great success for many years, and Canada’s only such site, in Vancouver’s Downtown Eastside, has been subject to rigorous evaluation that has produced a considerable body of peer-reviewed research showing its multiple benefits for both those who use the facility and the surrounding community. "Yet the federal budget fails to mention harm reduction or to allocate any funds for harm reduction measures, representing a serious setback for HIV and hepatitis C programs in Canada. It is inevitable that cutting harm reduction out of the federal drug strategy undermines provincial and municipal efforts to sustain these essential and cost-effective programs. In the past, the federal government has supplemented provincial allocations for needle exchange programs and promoted awareness of and research on these programs. The allocations in Budget 2007 repudiate long experience and vast scientific evidence; the price will be paid for in increased risk of HIV and hepatitis transmission. "In fact, what is contemplated appears to be a U.S.-style "war on drugs" - an approach that has been proven time and again to be counter-productive and a tragic waste of public funds, diverting resources from services that are desperately needed to address what is, at root, a health problem. "While abandoning proven harm reduction measures, Budget 2007 includes significant resources for law enforcement initiatives dedicated to "combating illicit drug production and distribution." Previous analyses, including the 2001 report by the Auditor-General of Canada, have found that law enforcement has, for many years, represented by far the greatest portion of federal spending on drugs. Hundreds of millions of Canadians’ tax dollars have been spent on law enforcement efforts to stem the supply of illicit drugs, with virtually no progress to show for this huge expenditure. In fact, as concluded in a recent study by the British Columbia Centre for Excellence in HIV/AIDS, many law enforcement measures that are heavily financed in Canada actually contribute to drug-related harms. To add to the waste, at least one third of the new funds allocated in the 2007 budget will go toward law enforcement." Source: Csete, Joanne, Executive Director, Canadian HIV/AIDS Legal Network, Letter to Members of Parliament and the Senate, March 30, 2007, from the web at http://www.aidslaw.ca/publications/interfaces/downloadFile.php?ref=1037, last accessed June 27, 2007. 3. "Although Canada's Drug Strategy was renewed in 2003 following criticisms regarding spending, activities, leadership and a lack of appropriate monitoring and evaluation, many of the problems of the past remain. Currently, through Canada's Drug Strategy, the federal government continues to invest heavily in policies and practices that have repeatedly been shown in the scientific literature to be ineffective or harmful. Specifically, while the stated goal of the Canada's Drug Strategy is to reduce harm, evidence obtained through this analysis indicates that the overwhelming emphasis continues to be on conventional enforcement-based approaches which are costly and often exacerbate, rather than reduce, drug-related harms. Further, Canada's Drug Strategy has not seized the opportunity to promote a national standard of care that reduces the most deadly harms associated with illicit drug use." Source: DeBeck, Kora, Evan Wood, Julio Montaner and Thomas Kerr, "Canada's 2003 Renewed Drug Strategy -- An Evidence-Based Review," HIV/AIDS Policy & Law Review (Toronto, Ontario, Canada: Canadian HIV/AIDS Legal Network, Dec. 2006), p. 10. B. Prevalence Estimates 1. "Overall, 44.5% of Canadians report using cannabis at least once in their lifetime, and 14.1% report use during the 12 months before the survey. Males are more likely than females to have used cannabis in their lifetime (50.1% vs 39.2%) and during the past year (18.2% vs. 10.2%). Younger people are more likely to have ever used cannabis in their lifetime, with almost 70% of those between 18 and 24 having used it at least once. Younger people are also more likely to be past-year users. Almost 30% of 15-17 year olds and just over 47% of 18 and 19 year olds have used cannabis in the past year. Beyond age 45, less than 10% of the population has used cannabis in the past year." Source: "Canadian Addiction Survey, A National Survey of Canadians Use of Alcohol and Other Drugs -- Prevalence of Use and Related Harms: Highlights" (Canadian Centre on Substance Abuse, Nov. 2004), p. 6. 2. "Lifetime cannabis use increases with education, rising from 34.9% among those without high school completion to a peak of 52.4% among those with some postsecondary education and 44.2% among those with a university degree. "Lifetime experiences with cannabis use increases with income adequacy (income relative to the number of people in a household), from 42.9% of those with a low income adequacy to 44.6% of those with a moderate income and 54.8% of those with a high income adequacy. The association between income adequacy and pastyear use is not significant." Source: "Canadian Addiction Survey, A National Survey of Canadians Use of Alcohol and Other Drugs -- Prevalence of Use and Related Harms: Highlights" (Canadian Centre on Substance Abuse, Nov. 2004), p. 6. 3. "The use of illicit drugs is generally limited to cannabis only. About 28.7% of Canadians (63.4% of lifetime users) report using only cannabis during their lifetime, and 11.5% (79.1% of past-year users) used only cannabis during the past year. "Excluding cannabis, the illicit drug most commonly used during one’s lifetime is reported to be hallucinogens, used by 11.4% of respondents, followed closely by cocaine (10.6%), speed (6.4%) and ecstasy (4.1%). The lifetime use of drugs such as inhalants, heroin, steroids and drugs taken intravenously is about 1% or less of the population. The percentage reporting the use of any five drugs other than cannabis (cocaine or crack; hallucinogens, PCP or LSD; speed or amphetamines; heroin; ecstasy [MDMA]), is 16.5%, and the percentage reporting the use of any of the eight drugs, including cannabis, is 45.2%." Source: "Canadian Addiction Survey, A National Survey of Canadians Use of Alcohol and Other Drugs -- Prevalence of Use and Related Harms: Highlights" (Canadian Centre on Substance Abuse, Nov. 2004), p. 7. 4. "Although about one in six Canadians has used an illicit drug other than cannabis in their lifetime, few have used these drugs during the past year. Rates of drug use in the past 12 months are generally 1% or less, with the exception of cocaine use (1.9%). About 3% of Canadians (4.3% of males and 1.8% of females) report using at least one of the five drugs other than cannabis, and 14.5% (18.7% of males and 10.6% of females) report using any of the eight drugs, including steroids and inhalants." Source: "Canadian Addiction Survey, A National Survey of Canadians Use of Alcohol and Other Drugs -- Prevalence of Use and Related Harms: Highlights" (Canadian Centre on Substance Abuse, Nov. 2004), p. 7. 5. "Self-reported rates of illicit drug use are increasing in Canada. The proportion of Canadians reporting any illicit drug use in their lifetime rose from 28.5% in 1994 to 45.0% in 2004, and in the past 12 months from 7.6% to 14.4%." Source: "Canadian Addiction Survey, A National Survey of Canadians Use of Alcohol and Other Drugs -- Prevalence of Use and Related Harms: Highlights" (Canadian Centre on Substance Abuse, Nov. 2004), p. 11. 6. "The past-year use of cannabis rose from 6.5% in 1989 to 7.4% in 1994, and to 14.1% in 2004. For cocaine and crack, rates declined from 1.4% in 1989 to 0.7% in 1994, and rose again to 1.9% in 2004. While past-year rates for the combined category of LSD/speed/heroin rose slightly from 0.4% in 1989, to 1.1% in 1994, and to 1.3% in 2004, these findings are not statistically significant." Source: "Canadian Addiction Survey, A National Survey of Canadians Use of Alcohol and Other Drugs -- Prevalence of Use and Related Harms: Highlights" (Canadian Centre on Substance Abuse, Nov. 2004), p. 11. 7. "Most Canadians drink in moderation. In the 12 months before the survey, 79.3% of Canadians aged 15 or older report consuming alcohol, 14% are former drinkers and 7% lifetime abstainers. Of the past-year drinkers, 44% report drinking weekly. The rate of past-year drinking is significantly higher among males than females (82.0% vs. 76.8%, respectively). Past-year drinking rates peak among youth 18 to 24 years of age, with about 90% of people in that age range consuming alcohol during the course of the year." Source: "Canadian Addiction Survey, A National Survey of Canadians Use of Alcohol and Other Drugs -- Prevalence of Use and Related Harms: Highlights" (Canadian Centre on Substance Abuse, Nov. 2004), p. 4. 8. "According to this examination, the overall percentage of drinkers in Canada declined from 77.7% in 1989 to 72.3% in 1994 and has now risen again to 79.3% in 2004. Variations in drinking patterns across studies are consistent with the corresponding variations in rates of alcohol use. Furthermore, changes in rates of self-reported alcohol use are consistent with alcohol sales data." Source: "Canadian Addiction Survey, A National Survey of Canadians Use of Alcohol and Other Drugs -- Prevalence of Use and Related Harms: Highlights" (Canadian Centre on Substance Abuse, Nov. 2004), p. 10. C. Problem Substance Use and Substance-Related Harm 1. "The most commonly reported drug-related harm involves physical health, reported by 30.3% of lifetime and 23.9% of past-year users of drugs other than cannabis, and 15.1% of lifetime and 10.1% of past-year users of any drug. Following physical health, a cluster of harms, represented somewhat equally, includes harms to one’s friendship and social life (22.3% and 16.4% of users excluding cannabis, 10.7% and 6% of any drug users), home and marriage (18.9% and 14.1% excluding cannabis, 8.7% and 5.1% of any drug users), work (18.9% and 14.2% excluding cannabis, 9.2% and 5.1% of any drug users), and financial (19.6% and 18.9% excluding cannabis, 8.4% and 6.5% of any drug users). Source: "Canadian Addiction Survey, A National Survey of Canadians Use of Alcohol and Other Drugs -- Prevalence of Use and Related Harms: Highlights" (Canadian Centre on Substance Abuse, Nov. 2004), p. 7. 2. "The data indicate that the number of Canadians who report having used an injectable drug at some point in their life increased from 1.7 million in 1994 to a little over 4.1 million in 2004. Of those, 7.7% (132,000) reported having used a drug by injection in 1994 compared with 6.5% (269,000) in 2004." Source: "Canadian Addiction Survey, A National Survey of Canadians Use of Alcohol and Other Drugs -- Prevalence of Use and Related Harms: Highlights" (Canadian Centre on Substance Abuse, Nov. 2004), p. 11. 3. "In Canada, as of 2004, 269 000 people reported using needles to inject drugs. In the first six months of 2005, over 20 percent of all newly recorded HIV infections in Canada were associated with injection drug use; among newly infected women, injection drug use accounted for 38 percent of recorded infections." Source: DeBeck, Kora, Evan Wood, Julio Montaner and Thomas Kerr, "Canada's 2003 Renewed Drug Strategy -- An Evidence-Based Review," HIV/AIDS Policy & Law Review (Toronto, Ontario, Canada: Canadian HIV/AIDS Legal Network, Dec. 2006), pp. 1, 5. 4. "In 2004, the medical costs of HIV infection among injection drug users in the city of Vancouver was estimated to be in excess of $215 million. Nationally, direct health care costs attributable to illicit drug use were estimated to be over $1.13 billion for 2002. In that same year, illicit drug use is believed to have contributed to over 215,000 sick days resulting in income loss of over $21 million." Source: DeBeck, Kora, Evan Wood, Julio Montaner and Thomas Kerr, "Canada's 2003 Renewed Drug Strategy -- An Evidence-Based Review," HIV/AIDS Policy & Law Review (Toronto, Ontario, Canada: Canadian HIV/AIDS Legal Network, Dec. 2006), p. 5. D. Harm Reduction Efforts 1. "Vancouver Coastal Health (VCH) in partnership with the PHS Community Services Society opened North America’s first legal supervised injection site (Insite) scientific research pilot project in September 2003. "Since opening its doors, Insite has been a safe, health-focused place where people can go to inject drugs and connect with health care professionals and addiction services. It is an integral part of Vancouver Coastal Health’s continuum of care for people with addiction, mental illness and HIV/AIDS in the Vancouver community." Source: Vancouver Coastal Health Authority, "Insite - Supervised Injection Site - Health Services," from the web at http://www.vch.ca/sis/, last accessed June 27, 2007. 2. "On Friday, September 1, 2006, Federal Health Minister Tony Clement announced that the government had "deferred the decision" on Vancouver Coastal Health's application to extend the operating exemption for the SIS until December 31, 2007. "The Minister said that during that time, additional studies will be conducted into how supervised injection sites affect crime, prevention and treatment. "The SIS, Insite, will be allowed to continue operations during this review. "During the period until December 31, 2007, Health Canada will not entertain any applications for the establishment of additional injection sites in other parts of Canada until the NDS is in place, and the Vancouver review is completed." Source: Vancouver Coastal Health Authority, "Insite - Supervised Injection Site - Health Services," from the web at http://www.vch.ca/sis/, last accessed June 27, 2007. 3. "About the study: The North American Opiate Medication Initiative is a clinical trial that will test whether heroin-assisted thera