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Doc. 9303
21 December 2001
Social consequences of and responses to drug misuse in member states
Report
Social, Health and Family Affairs Committee
Rapporteur: Mr Paul Flynn, United Kingdom, Socialist Group
Summary
This is a time of major reform in drug policies in member states. In 2001 Belgium, Portugal and the United Kingdom announced important changes. The Netherlands and Switzerland have long established pragmatic policies. There is an urgent universally acknowledged need to reduce the level of harm caused by drugs, both licit and illicit. However, it is less clear how this end is to be achieved. Forty years ago there was an international consensus view that strictly enforced drugs laws could eliminate all illegal drug use. Few countries now believe that. Harm reduction policies are now widely preferred. This report attempts to compare the various approaches adopted in member states. Some traditional views concerning the effectiveness of attempting to control the level of drug use via legal sanctions are challenged. It is concluded, however, that, given the current paucity of data, it is extremely difficult to establish objectively the effectiveness of the various approaches to reducing drug harm.
I. Draft recommendation
1. The Assembly notes with concern that, with little reliable comparable data on drug harm, it is nearly impossible objectively to assess the success (or failure) of various drug policies with a high degree of certainty. Until this problem is addressed, drug policy will continue to be made with defective knowledge.
2. Existing data imply that the prevalence of drug use in a particular state does not appear to vary in relation to the severity of the legal sanctions attached to drug possession and use in that state. To express this conclusion slightly differently, there appears to be no evidence that measures designed to deter drug use have any effect whatsoever on the prevalence of drug use.
3. Therefore, the Assembly recommends that the Committee of Ministers encourage member states to review their national drugs policies, in cooperation with the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and the Pompidou Group, with the aim of implementing drug policies which aspire to achievable goals, that is to say, the minimisation of drug harm.
4. The Assembly commends the governments of the Netherlands and Switzerland for the emphasis placed on harm reduction in their respective drugs policies.
5. The Assembly notes that in their respective drugs policies, the governments of the United Kingdom and Sweden continue to place great emphasis on attempting to deter drug use by means of severe legal penalties, despite evidence that this approach lacks utility.
6. The Assembly particularly commends the government of Switzerland for its success in stabilising and then reducing the number of drug-related deaths since 1994.
7. The Assembly considers it vital to develop information for young people on the medical and social risks of the various forms of drug misuse, particularly the risks to brain physiology of such designer drugs as ecstasy.
8. The Assembly considers it necessary to continue the control and repression of drug use in sports circles.
9. Whatever the drugs policy implemented by individual states, the profits made by drug dealers must always be considered as proceeds of unlawful activities. The drug liberalisation policies pursued in some states must not nullify efforts to suppress the laundering of the proceeds of crime.
10. The Assembly recognises and supports the efforts undertaken by the Pompidou Group since its creation in 1971 and its integration into the Council of Europe in 1980.
11. Therefore, the Assembly recommends that the Committee of Ministers instruct its appropriate committees and invite the Pompidou Group to do all they can to:
i. establish or improve common indicators for all Council of Europe states whereby the use of drugs and the health and social consequences of drug use throughout Europe can be measured and compared;
ii. assist the collection of data relating to these indicators and to the relationship between deprivation and drug harm. Standardisation of research methods as well as of data recording methods is required;
iii. help establish the nature of the relationship between deprivation and drug harm in member states;
iv. ensure that the lessons of the successful Swiss example are identified and learned;
v. encourage the exchange and implementation of evidence-based prevention schemes, treatment methods and rehabilitation programmes;
vi. develop youth information on the health and social risks of all forms of drug misuse, particularly designer drugs;
vii. continue controlling and repressing the use of drugs by sports enthusiasts;
viii. prosecute and suppress all methods of laundering the proceeds of drug dealing.
12. Given the likelihood of a causal link between deprivation and drug harm, the Assembly recommends that the Committee of Ministers encourage member states to adopt drug policies that reflect awareness of this link.
13. The Assembly recommends that the Committee of Ministers invite the member states, in their drug policies:
i. to consider that drug misuse embraces a wide variety of forms of addiction and that its treatment necessitates a differentiated approach;
ii. to develop and concentrate effective prevention campaigns on children and teenagers, so that they do not have recourse to drugs;
iii. to adopt concerted European repressive policies against drug dealers and stiffen the penalties incurred;
iv. to confiscate the proceeds from drug dealing and channel them into measures for preventing drug misuse and the treatment and rehabilitation of drug addicts;
v. to develop research into the nature and effects of designer drugs.
14. The Assembly invites the Committee of Ministers to instruct the Partial Agreement of the Pompidou Group:
i. to concentrate on support activities for east European and central Asian countries in their efforts to combat drug trafficking and the production of illegal drugs;
ii. and to co-operate with the European Union in activating an early warning system for new drugs as soon as they appear on the market.
II. Explanatory memorandum by Mr. Paul Flynn.
Introduction
1. Whilst there are profound differences of opinion over the best way of approaching modern recreational drug use and the problem of drug misuse, there is at least consensus on the following issue: There in an urgent need to reduce the amount of harm caused by drugs.
2. This consensus breaks down, however, when we begin to consider how reduction in the amount of harm caused by drugs (hereafter, drug harm) is to be achieved. A variety of approaches (hereafter, drug policies) have been adopted in member states and the aim of this report is to draw some conclusions about which drug policies have been most successful in reducing drug harm.
3. Measuring the comparative success of drug policies is, of course, problematic. There are no universally accepted criteria for success, for example, by which competing drug policies can be assessed. The method adopted in this report will be to: (a) identify the drug policies1 adopted in selected member states; (b) identify a number of different indicators of the level of drug harm in those states (both in terms of the current level and the trend in the level or drug harm over time): and (c) hypothesise a connection between policies and levels of harm.
4. In a report of this nature, it is impractical to attempt to consider the experiences of all member states. Instead, four states have been chosen: the United Kingdom: the Netherlands: Sweden: and Switzerland. These states have been chosen for a number of reasons. Most importantly, these states can be seen to represent two different types of approach to drug use and misuse: on the one hand, a continued emphasis on prohibition of certain drugs in the United Kingdom and Sweden: on the other, a greater emphasis on harm reduction and on differentiating between hard drugs (substances seen as potentially extremely harmful) and soft drugs (substances seen as less harmful) in the Netherlands and Switzerland.
5. The indicators chosen to try and show the level of drug harm pertaining in these states are based on those used by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)2, but are somewhat wider-ranging. They can be split into two groups. In the first group are indicators relating to the level of drug use: (a) proportion of people who have used various substances at any time in their lives; (b) proportion of people who have used various substances in the last 12 months; (c) prevalence of problem drug use3. It is worth noting, however, that there are no rigorously defined and generally accepted criteria for measuring drug-related harm4. Those employed in this report must therefore, be treated with a degree of caution.
6. In the second group are indicators relating to the level of drug harm5: (a) number of drug-related deaths; (b) prevalence of drug-related diseases; (c) level and cost of drug-related crime (other than actual drug offences); (d) numbers imprisoned for drug offences; (e) estimate of the overall financial cost to the state (i.e. health costs, law enforcement costs etc) of drug use.
7. The hypothesis that there is a connection between the drug policies adopted in a particular state and the level of drug harm suffered by that state is, of course, an uncertain one. There are, for example, many factors other than the drug policies currently in place, particularly socio-cultural factors, which can be seen to affect levels of drug harm and, particularly, levels of drug use in particular states6. Further, it is very difficult to isolate individual policies from the overall package of policies in place at a particular time. Nevertheless, although the connection hypothesised is uncertain, it seems relatively uncontroversial to suggest that there is some connection between drug policies and drug harm and that this connection can best be explored by means of comparing the levels of drug harm pertaining in states with different drug policies.
8. In accordance with the method adopted in this report, conclusions about the effectiveness of various drug policies (or packages of policies) will be based on the levels of drug harm connected with the policies adopted in the United Kingdom, the Netherlands, Sweden and Switzerland respectively.
Legislation and Policy
9. In this Section, the various drug policies adopted in the United Kingdom, the Netherlands, Sweden and Switzerland will be introduced. The main points considered will be:
(a) The legal penalties imposed for (i) using/possessing for use, (ii) trafficking (i.e. importing or exporting) and (iii.) selling the most common illicit drugs of abuse, i.e. cannabis, ecstasy, heroin, cocaine, amphetamines and LSD;
(b) What harm reduction measures, including treatment for problem drug users and drug education, are adopted;
(c) What the distinguishing features of the drug policy adopted in the four states are;
(d) What measures are taken to address the use of licit drugs, i.e. alcohol, tobacco, painkillers and licit psychoactive substances (i.e. hypnotic/sedatives, antidepressants, opioid/opiate analgesics, anti-psychotics, anti-epileptics, etc);
(e) Other measures adopted to prevent the use of these drugs.
The International Context
10. The "drugs problem" is, of course, an international problem, particularly trafficking in illicit drugs. There are three UN Conventions on international cooperation relating to illicit drugs: the 1961 Single Convention on Narcotic Drugs7 (with a protocol added in 1972); the 1971 Convention on Psychotropic Substances; and the 1988 UN Convention Against Illegal Traffic in Narcotic Drugs and Psychotropic Substances (also known as the Vienna Convention)8. All three Conventions have been ratified by a large number of states. The United Kingdom, the Netherlands and Sweden have ratified all three Conventions. Switzerland has not ratified the 1988 Convention, although many of its basic elements have been implemented in Swiss law.
11. The 1961 and 1971 Conventions aim to limit the use of 'narcotic' and 'psychotropic'9 drugs to medical and or scientific purposes. These Conventions require parties to create 'punishable offences' to control the use of certain drugs, placing controls on manufacture, production, cultivation, importation, purchase or possession. The 1988 Convention supplements and strengthens the earlier Conventions. In particular, the 1988 Convention requires parties to establish breaches of its terms as criminal offences under their domestic law.
12. The 1988 Convention concentrates largely on trafficking offences which are seen as particularly grave and must be liable to sanctions which take account of this gravity. It specifies that sanctions should include imprisonment or other forms of deprivation of liberty, pecuniary sanction and confiscation. The 1988 Convention also requires that each party establishes the possession, purchase and cultivation of illicit drugs for personal consumption as criminal offences, closing an apparent loophole in this area in the earlier Conventions.
13. However, the UN Conventions leave precise implementation on most matters to individual states. It is worth noting that the requirements of the Conventions are more specific with regard to offences relating to trafficking than to offences relating to personal consumption. All three UN Conventions have 'saving clauses' to the effect that offences relating to personal consumption are "subject to [a state's] constitutional principles and the basic concepts of its legal system". In contrast, with respect to trafficking offences, the requirement to establish criminal offences is absolute. The effect is to allow parties more flexibility with regard to personal consumption offences than for trafficking offences. According to a recent survey comparing the drug laws in various European states10, the UN Conventions in the drugs field allow states significant room for manoeuvre in matters such as the drafting of offences, the classification of drugs, maximum penalties and actual sentences. The UK law could be radically changed without breaking international drug treaty agreements, according to a study "European Drug Laws: the room for Manoeuvre" published by the charity DrugScope in August 2001, in which Dr Nicholas Dorn states "For many years a major impediment to drug reform has been the belief that UN Conventions restrict any change." The report indicates that current law could be changed to introduce civil penalties such as fines for drug possession.
14. In addition to the UN Conventions, both the Maastricht Treaty of the European Union (EU) and the Schengen Agreement between some members of the EU contain provisions on this subject. These provisions generally relate to combating the trafficking of illicit drugs between parties. The Schengen Agreement is particularly interesting in that its parties agree to respect the differences between their respective national drug policies.
The United Kingdom
15. United Kingdom drug policy is based on the view that criminal sanctions are effective in deterring drug abuse and is primarily concerned with enforcement of the prohibition of certain substances. Since the 1971 Misuse of Drugs Act (hereafter MDA), use of drugs other than opium is not an offence. However, possession and acquisition of certain drugs is an offence and these drugs are divided into three categories for the purpose of law enforcement. Drugs seen as most dangerous are placed in Class A and drugs seen as less dangerous are placed in Class B and C11.
Penalty for Possession |
Penalty for Trafficking |
Penalty for Supply | |
Class A |
7 years |
Life |
Life |
Class B |
5 years |
14 years |
14 years |
Class C |
2 years |
5 years |
5 years |
16. In the United Kingdom, cannabis (herbal and resin) and amphetamines are Class B drugs. Ecstasy (and related compounds), heroin, cocaine (including crack) and LSD are Class A12. The maximum sentences for all drug offences are amongst the severest in Europe.
17. However, not all drug offenders are given the maximum penalty available under the law. In general, offenders convicted of the most serious offences, i.e. supply, face the severest penalties. According to Home Office figures, for example, of those found guilty of supply in 1999, 53% were imprisoned (up from 38% in 1990) for an average period of 2.5 years13.
18. In 1997, 50% of drug offenders were cautioned (up from 13% in 1985), 22% were fined (down from 48% in 1985) and only 9% imprisoned (down from 17% in 1985). 89% of all drug offenders were dealt with for possession offences. 63% of those dealt with for cannabis possession in 1997 were cautioned. The parallel figure for cocaine is 22% (up from 8% in 1990), for heroin 17% (up from 7% in 1990) and for amphetamines 25% (up from 10% in 1990). Although there has been a reduction in the number of cautions since 1997 this has not been as a result of fewer offenders. However, a significant number of offenders are still dealt with a caution.
19. There has been, however, an equally clear trend towards increasing numbers of offenders until 1998, but in 1999 there was a drop. The overall number of drug offenders dealt with in the United Kingdom in 1999 was 119,725 (up from 26,958 in 1985). 81,380 (74%) of these were dealt with for possession of cannabis.
20. Whilst United Kingdom drug policy is largely focused on enforcement, there is a growing emphasis on treatment for problem drug users, particularly those involved with the criminal justice system. The United Kingdom Government's new 10-Year strategy, for example, places great importance on expanding treatment capacity, particularly given the widely recognised shortage of drug services14. Treatment available includes needle exchanges, substitution treatment (i.e. methadone for heroin addicts) and, at low levels, heroin prescription.
21. In general, drugs policy in the United Kingdom remains premised upon the traditional distinction between licit and illicit (i.e. those controlled by the MDA) drugs15. In theory, the distinction is based on the relative dangers and harmfulness associated with particular drugs, Although alcohol and tobacco are not amongst the drugs controlled by the MDA, their potential harmfulness is recognised by restrictions on their sale, education programmes to publicise the health risks and by the availability of treatment services for problem users.
22. The Drugs Tsar acts as a Governmental expert adviser on action against drugs and is charged with implementing and coordinating the 10-year strategy. Under the strategy, drug action teams (DATs) operate as strategic planners at local level and work on a local basis to ensure that the strategic plan is implemented coherently country-wide16. The post of Drugs Tsar has recently been greatly reduced to a part-time basis. This move is seen as a loss of conviction in the efficacy of the 10-year strategy with which he is associated.
The Netherlands
23. Dutch drug policy since the 1976 Opium Act distinguishes between hard drugs (drugs that involve unacceptable harm, both to users and society) and soft drugs (drugs that are less harmful to users and society). The penalties for possession are not maxima. The penalties for trafficking and supply of these substances are maximum. Since January 1, 2001 new public prosecutors' guidelines have been enforced. The asked punishment by the prosecutors in courts for criminal acts on drugs depend on the specific circumstances of the case, like for instance recidivism, the amount of violence, personality of the offender etc.
Penalty for Possession |
Penalty for Trafficking |
Penalty for Supply | |
Hard Drugs |
1 year |
12 years |
8 years |
Soft Drugs |
3 months |
4 years |
2 years |
24. Heroin, cocaine, LSD, amphetamines and ecstasy are seen as hard drugs. Cannabis and its derivatives are seen as soft drugs.
25. The possession of up to 5 grams17 of soft drugs is seen as a summary offence liable to a custodial sentence not exceeding one month, whereas possession of all hard drugs is indictable. However, possession of small quantities of soft drugs has been, in effect, decriminalised as Dutch police do not enforce the law against those possessing small quantities.
26. The well publicised guidelines issued by the Public Prosecutions Department (PPD) give highest priority to combating trafficking and lowest to cases of possession. In practice, this means that, although the police do confiscate any drugs found in someone's possession, the PPD would refrain from prosecuting - on the grounds of public interest - in cases that involve small quantities (up to 0.5 grams of hard drugs or 5 grams of soft drugs) unless the offender is also suspected of dealing or another drug-related crime18.
27. Following the 1976 Opium Act, a managed retail market of petty dealers in and consumers of soft drugs was allowed to develop. 'Coffee shops', where soft drugs may be sold under certain conditions19, were permitted. However, wholesale dealers and traffickers in both soft and hard drugs continue to be prosecuted, as do those caught in possession of quantities of soft and hard drugs. Recently the Dutch Government voted to decriminalize the back door supply.
28. In this way, Dutch drug policy attempts to separate the market for cannabis from that for hard drugs and to avoid criminalisation of soft drug users.
29. Premised on the view that criminal law only plays a minor role in preventing drug use, the primary focus of Dutch drugs policy is seen to be harm reduction, particularly with regard to those unwilling or unable to give up drug use. Assistance is given to drug addicts in various ways, including: the provision of methadone (according to recent data from the Dutch Ministry of Health, 12,500 of the 28,000 opiate addicts in the Netherlands are on methadone); provision of sterile needles, provision of food, medical care and accommodation; provision of assistance in managing finances and finding jobs. The Netherlands is currently experimenting with prescribing heroin for addicts and the provision of gebruiksruimten (using spaces) for addicts.
30. It is worth noting that the Dutch law on drugs is seen to be in line with the UN Conventions of 1961, 1971 and 1988, as well as the Maastricht Treaty and the Schengen Agreement.
31. In the Netherlands, alcohol and tobacco are regarded as stimulants rather than drugs and although restrictions are placed on their sale, it is left up to the individual to avoid addiction, However, schools devote considerable attention to the risks involved in smoking and excessive consumption of alcohol. Alcoholism is generally treated in the same way as drug addiction.
Sweden
32. "The Swedish Drug policy is based on the idea that drugs are, and shall remain a marginal phenomenon in Swedish society…The overall objective is a society without Drugs20". The stated goal of Swedish drug policy is to create a "drug-free" society, i.e. a society free from all non-medical use of narcotic drugs. Under Swedish law, generally seen as the most severe in Europe, all drug use21, possession, acquisition and trafficking are punishable crimes. Setting up a contact between a supplier and a consumer is also punishable by law. The penalty for drug offences depends on the seriousness of the crime and the law establishes three degrees of seriousness: minor, simple and aggravated.
33. Those convicted of "minor" offences may be ordered to pay a fine or imprisoned for up to 6 months. For those convicted of 'simple' offences, the sentence is always imprisonment, with a maximum sentence of 3 years. 'Aggravated' offences are punishable by sentences of no less than 2 years, with a maximum sentence of 10 years.
34. Possession of small quantities of the most common illicit drugs22 of abuse is generally seen as 'minor' and tends to be punished by fines. Fines are much greater for ecstasy, LSD, heroin and cocaine possession than for cannabis and amphetamine possession. In some cases, particularly those involving cannabis, fines can be 'exchanged' for counselling. Possession of larger quantities often results in imprisonment for up to 1 year.
35. Supply and trafficking offences are generally seen as 'simple' or 'aggravated'. Sentences for these offences also vary depending on quantity seized and type of drug involved.23 It should be noted, however, that supply and trafficking offences are always punished with imprisonment.
36. In 2000, a total of approximately 9200 persons were imprisoned in Sweden. On a yearly basis, the average number of prisoners was about 3700. 32% of the total number of persons was sentenced to imprisonment for drug-related crime24.
37. According to the Swedish Drugs Commission, "Sweden's restrictive policy on drugs must be sustained and reinforced"25. The Drugs Commission "puts forward proposals aimed at creating coherence and balance and at strengthening, renewing and developing restrictive policies on narcotic drugs". As a result, a very different approach to treatment for problem drug users is taken in Sweden than is generally seen in other European states. Nearly all services are drug-free. There is a small methadone prescription programme in Sweden's four main cities, but there are only 800 places available. Needle exchanges exist in the very south of the country (in Malmö and Lund) but not in other areas. The Drugs Commission also acknowledges that "much of the preventative work that is being done today is characterized by temporary measures and projects", "supportive environments for young persons have deteriorated" and there are "grave deficiencies in the design of drug abuser care, added to which, the volume of such care is not commensurate with actual needs".
38. Preventing the misuse of legal drugs is seen as of equal importance. Measures undertaken are predominantly public health promotion-based, aimed at improving knowledge of adverse consequences of abuse, raising awareness and counselling for those with special needs. Sweden deserves commendation for its remarkable success in reducing nicotine related deaths by a harm reduction measure. The use of "snus" or oral snuff avoids the carcinogen effects of smoking and ingesting tar. This has resulted in Europe's greatest reduction in nicotine cancers. Professor Martin Jarvis, of the UK's Imperial Cancer Research Fund, has called for wider use of smoking replacement techniques. He said "Cigarettes kill half of all regular users. Snus has some health problems but it does not produce the deadly tar that kill smokers."
Switzerland
39. The 1951 Federal Law on Narcotics is the main legal basis for combating illicit drug use in Switzerland. The law regulates medical use of narcotics and prohibits the production, trafficking, possession and consumption of opium, heroin, hallucinogens and cannabis. In accordance with Swiss federalism, implementation of this law is primarily the responsibility of the 26 cantons.
40. In 1999, 44,336 violations of the Law on Narcotics were recorded26. Over 80% of these were for possession or consumption. However, only a small proportion of those charged with drug offences are imprisoned and this proportion has fallen sharply over the last 10 years (from 6.8%. in 1990 to 3.4% in 1996).
41. Switzerland has been re-assessing its drug policy in recent years. Beginning in 1991, Swiss policy has been moving away from emphasis on criminal sanctions and towards a strategy focused on harm reduction. The move away from emphasis on criminal sanctions has been most pronounced with regard to cannabis. In August 1999, the Swiss Federal Department of Health issued a report arguing that cannabis does relatively little damage to health and its consumption cannot be avoided through prohibition. In 2001 plans to legalise the consumption of cannabis have been unveiled.27
42. At present, drug use, possession and acquisition remains prohibited under Swiss law. However, enforcement of the law varies greatly between the different cantons which have different degrees of tolerance towards drug use. Most cantons have effectively decriminalised cannabis consumers28.
43. Although around half of the Swiss drugs budget is spent on law enforcement, there is a growing emphasis on treatment and harm prevention. Those who are drug dependent are encouraged to enter therapy and about 100 in-patient institutions currently provide this facility for 1,750 people. Switzerland has about 16,000 addicts on methadone treatment and the Federal Government also supports needle exchange programmes, injection rooms and housing and employment programmes for addicts.
44. Switzerland has also pioneered the prescription of heroin to severely addicted users in specialist treatment centres. There are currently 20 treatment centres, offering 1,194 places. In 2000 only 1,038 were occupied.
45. Misuse of alcohol, tobacco and other legal drugs is tackled with a primary focus on prevention through health promotion and education, with therapy and harm reduction measures available for those with particular problems. In common with other European countries, there are restrictions on the sale of alcohol and tobacco.
Prevalence of Drug Use
46. Unfortunately, there is no standardised means of measuring the prevalence of drug use. However, many states in Europe do now conduct surveys on drug use. Comparisons of survey results can help to identify and understand drug-use patterns and differences in prevalence of use between states clearly do exist. However, direct comparisons should be made with caution. Differences may result from: differences in data-collection methods29; differences in age ranges chosen30; social and cultural factors which influence willingness to honestly report drug use; the relative proportion of a state's population which lives in urban areas31.
47. In addition, consistent information on trends is still extremely limited, as few European states have conducted a series of surveys using the same methods. Nevertheless, some tentative trends can be identified by comparing recent results with older surveys.
48. To put the prevalence of drug use in the United Kingdom, the Netherlands. Sweden and Switzerland in perspective, it is useful to have some idea of the averaged levels of use across Europe. According to the most recent European Monitoring Centre for Drugs and Drug Addiction report32, lifetime experience of cannabis (by far the most prevalent illicit drug in most of Europe) in the general adult population ranges from 10 - 30%. The next most prevalent illicit drugs are amphetamines, with about 1 - 4% of the general population, cocaine with 1 - 3% and ecstasy with 0.5 - 3%. Recent use of cannabis (i.e. during the last 12 months) in the general adult population ranges from 1 to 9%. Recent use of substances other than cannabis is generally very low, rarely exceeding 1% among the adult population and generally below 2% among young adults.
49. It is widely accepted that lifetime use is a very bad indicator of the prevalence of drug use and that even recent use (i.e. last 12 months) is quite unreliable. Far more indicative are figures for last month use and 'continuation rates', i.e. the proportion of lifetime users who also report last month use33. Unfortunately, whilst for some states there are considerable data which include these indicators are available, there are very few available for others. As a result, these less reliable indicators will be employed with the caveat that the picture of drug use prevalence they provide may be rather crude.
50. However, more detailed figures are available on the prevalence of drug use in the United Kingdom34 and the Netherlands.35 Therefore, a more detailed comparison will be made between the data for these states.
51. To put the following data into some sort of perspective, according to WHO figures, in most European states, between 50 and 80% of 15 year-olds have tried smoking tobacco and around 20% are daily smokers. WHO figures also suggest that between 30% and 50% of Europe's 15 year-olds report having been drunk at least twice. Figures for the general population will, of course, be significantly higher.
The United Kingdom 36
Cannabis |
Cocaine |
Amphetamines |
Ecstasy |
Solvents | |
Lifetime Use (aged 16-59) |
25% |
3%, |
10% |
4% |
n/a |
Recent Use (aged 16-59) |
9% |
1% |
1% |
1% |
n/a |
Lifetime Use (aged 16-29) |
42% |
6% |
20% |
10% |
n/a |
Recent Use (aged 16-29) |
23% |
3% |
8% |
4% |
n/a |
Lifetime Use (aged 15-16) |
37.5% |
7.3% |
7.3% |
3% |
4% |
52. The estimated prevalence of problem drug use amongst the general population (aged 15 - 54) in the United Kingdom is 6.6/ 1000.
53. The trend in drug use in the United Kingdom, both lifetime and recent, is that use rose steadily between the late 1960s and the mid-1990s, but appears to have levelled off in recent years37. The most rapid rises in use were between 1980 and 1985, and between 1990 and 1995 when there was extremely rapid growth in the use of amphetamines and ecstasy.
The Netherlands38
Cannabis |
Cocaine |
Amphetamines |
Ecstasy |
Solvents | |
Lifetime Use (aged l6-59) |
18.1% |
2.4% |
2.1% |
2.1% |
N/a |
Recent Use (aged 16-59) |
5.2% |
0.7% |
0.4% |
0.8% |
N/a |
Lifetime Use (aged 16-29) |
27% |
3.7% |
3% |
4.4% |
N/a |
Recent Use (aged 16-29) |
9.8% |
1.4% |
0.8% |
1.8% |
N/a |
Lifetime Use (aged 15-16) |
20% |
0.8% |
1.6% |
1.7% |
0.5% |
54. The estimated prevalence of problem drug use amongst the general population (aged 15 - 54) in the Netherlands is 3/ 1000.
55. Soft drug use in the Netherlands is said to have stabilised in the first few years after the Opium Act was amended in 1976. Use appears to have risen steadily between 1984 and 1997. As regards use of hard drugs, the number of problem users appears relatively stable, although lifetime use of drugs like cocaine and ecstasy has risen steadily during the 1990s.
Sweden39
Cannabis |
Cocaine |
Amphetamines |
Ecstasy |
Solvents | |
Lifetime Use (aged 16-59) |
13% |
1% |
2%. |
N/a |
N/a |
Recent Use (aged 16-59) |
1% |
N/a |
N/a |
N/a |
N/a |
Lifetime Use (aged 16-29) |
16% |
1% |
3% |
1% |
N/a |
Recent Use (aged 16-29) |
2% |
N/a |
N/a |
N/a |
N/a |
Lifetime Use (aged 15-16) |
7% |
1.1% |
1.1% |
1% |
8% |
56. The estimated prevalence of problem drug use amongst the general population (aged 15 -54) in Sweden is 2.7/ 1000.
57. In Sweden, occasional drug use appears to have fallen between the beginning of the 1970s and 1991. Since 1991, occasional drug use in Sweden has roughly doubled. Severe drug use increased slightly between 1979 and 1992, but appears to have increased more rapidly since then.40
Switzerland
58. Unfortunately, directly comparable data are not available for Switzerland. However, data are available from research carried out by the Swiss Institute for the Prevention of Alcohol and Drug Problems which enable rough comparisons to be drawn41.
Cannabis |
Cocaine |
Amphetamines |
Ecstasy | |
Lifetime Use (aged 15-39) |
26.7% |
4.2% |
1.6% |
2.8% |
Lifetime Use (aged 14-16) |
18.6% |
1% |
N/a |
1.4% |
59. The estimated prevalence of problem drug use amongst the general population (aged 15 - 54) in Switzerland is 7.4/ 1000.
60. The trend in use of cannabis showed a doubling in lifetime use between 1986 and 1994 and a continuing rise until 1997, the last year for which figures are available. During the same period, use of cocaine and amphetamines has also increased, albeit far more slowly. Since 1992, indicators point to a stabilisation in the number of heroin users.
The United Kingdom and the Netherlands
61. As suggested above, more data concerning the prevalence of drug use in the United Kingdom and the Netherlands are available42. In particular, there are much better data concerning last month use and continuation rates.
62. Given the very different approaches adopted to cannabis use in the United Kingdom and the Netherlands, of particular interest is the comparison between the prevalence of cannabis use in the two states.
Lifetime use of Selected Illicit Substances (persons aged 16 – 59)
Cannabis |
Cocaine |
Amphetamines |
Ecstasy |
Heroin | |
UK |
25% |
3% |
10% |
4% |
1% |
Netherlands |
20.3% |
2.8% |
2.4% |
2.5% |
< 0.5% |
Last Year Use of Selected Illicit Substances (persons aged 16- 59)
Cannabis |
Cocaine |
Amphetamines |
Ecstasy |
Heroin | |
UK |
9% |
1% |
1% |
1% |
< 0.5% |
Netherlands |
5.7% |
0.8% |
0.8% |
0.9% |
< 0.5% |
Last Month Use of Selected Illicit Substances (persons aged 16-59)
Cannabis |
Cocaine |
Amphetamines |
Ecstasy |
Heroin | |
UK |
5% |
< 0.5% |
1% |
< 0 5% |
< 0.5% |
Netherlands |
3.2% |
< 0.5% |
< 0.5% |
< 0.5% |
< 0.5% |
Last Month Continuation in Use of selected Illicit Substances (persons aged 16-59)43
Cannabis |
Cocaine |
Amphetamines |
Ecstasy |
Heroin | |
UK |
20% |
N/a |
10% |
n/a |
N/a |
Netherlands |
15.8% |
N/a |
8.3% |
n/a |
N/a |
Lifetime Use of Selected Illicit Substances (persons aged 16-24)
Cannabis |
Cocaine |
Amphetamines |
Ecstasy |
Heroin | |
UK |
44% |
7% |
21% |
11% |
1% |
Netherlands |
29.8% |
3.1% |
3.9% |
5.5% |
< 0.5% |
Last Month Use of Selected Illicit Substances (persons aged 16- 24)
Cannabis |
Cocaine |
Amphetamines |
Ecstasy |
Heroin | |
UK |
17% |
1% |
5% |
2% |
< 0.5% |
Netherlands |
7.7% |
0.5% |
0.5% |
1% |
< 0.5% |
Last Month Continuation in Use of Selected Illicit Substances (persons aged 16 – 24)
Cannabis |
Cocaine |
Amphetamines |
Ecstasy |
Heroin | |
UK |
39% |
14% |
24% |
18% |
N/a |
Netherlands |
26% |
16% |
13% |
18% |
N/a |
63. As these data show, there appears to be much greater prevalence of use of all the selected illicit substances in the United Kingdom than in the Netherlands.44
64. Continuation rates in the two states are generally quite similar. However, amongst those aged 16-24 there are much higher continuation rates for cannabis and amphetamine users in the United Kingdom than in the Netherlands. This implies that cannabis and amphetamine use in this age group in the Netherlands can be seen to be not only less prevalent than in the United Kingdom but also more temporary and infrequent amongst those who actually do use cannabis and/or amphetamines.
65. The drug policies adopted in most states appear to be premised on the assumption that heavier legal penalties for drug use limits use. However, it is clear from the above data that there is far less use of cannabis in the Netherlands, where there are no legal penalties for possession and transportation of 'user amounts', than in the United Kingdom, where legal penalties are relatively heavy.
66. It is also worth noting that in the Netherlands, only a third of those who have ever tried cannabis have used it on more than 25 occasions during their lifetimes (a total of 6.8% of persons aged 16 - 59). In addition, of those who report having used cannabis last month, only 26% report using it 'intensively', defined as 20 days use or more per month. In other words, in the Netherlands, only 0.8% of those aged 16-59 are intensive users of cannabis45. It can thus be concluded that the vast majority of cannabis use in the Netherlands is occasional and/or experimental.
Conclusions
67. Keeping in mind the warnings about the crudeness of the data and the dangers of comparisons mentioned above, some tentative conclusions can be drawn:
(a) Sweden appears to have the lowest prevalence of drug use among the states considered;
(b) The United Kingdom appears to have the highest prevalence of drug use, followed by Switzerland and the Netherlands;
(c) The United Kingdom also has a particularly high prevalence of drug use amongst young people;
(d) The United Kingdom and Switzerland appear to have much higher rates of problem drug use than either Sweden or the Netherlands;
(e) The United Kingdom has higher prevalence of cannabis use than the Netherlands;
(f) Intensive cannabis use is extremely rare in the Netherlands.
Levels of Drug-Related Harm
Drug Related Deaths
68. Due to differences in recording methods employed, death rates in different states cannot be directly compared46. However, by looking at the figures one can get a good idea of whether drug-related deaths are rising or falling.
Number of Drug Related Deaths47
Year |
UK48 |
Netherlands |
Sweden |
Switzerland |
1986 |
1362 |
42 |
138 |
136 |
1987 |
1332 |
20 |
141 |
195 |
1988 |
1348 |
33 |
125 |
205 |
1989 |
1321 |
30 |
113 |
248 |
1990 |
1339 |
43 |
143 |
280 |
1991 |
1411 |
49 |
147 |
405 |
1992 |
1533 |
43 |
175 |
419 |
1993 |
1615 |
38 |
181 |
353 |
1994 |
1796 |
50 |
205 |
399 |
1995 |
1956 |
33 |
194 |
361 |
1996 |
2150 |
63 |
250 |
241 |
1997 |
2144 |
70 |
265 |
209 |
1998 |
2922 |
61 |
263 |
181 |
1999 |
2943 |
N/a |
275 |
196 |
Number of Drug-related Deaths / Million
Year |
UK |
Netherlands |
Sweden |
Switzerland |
1986 |
25.8 |
2.6 |
15.7 |
19.4 |
1987 |
25.3 |
1.3 |
16.0 |
27.8 |
1988 |
25.6 |
2.1 |
14.2 |
29.2 |
1989 |
25.1 |
1.9 |
12.8 |
35.4 |
1990 |
25.4 |
2.7 |
16.3 |
40.0 |
1991 |
26.8 |
3.1 |
16.7 |
57.8 |
1992 |
29.1 |
2.7 |
19.9 |
59.8 |
1993 |
30.6 |
2.4 |
20.6 |
50.4 |
1994 |
34.1 |
3.1 |
23.3 |
57.0 |
1995 |
37.1 |
2.1 |
22.0 |
51.6 |
1996 |
40.8 |
4.0 |
28.4 |
34.4 |
1997 |
40.7 |
4.4 |
29.2 |
29.8 |
1998 |
49.8 |
3.8 |
29.4 |
25.8 |
1999 |
49.9 |
N/a |
30.5 |
28.0 |
Drug-related Deaths Index (Base Year 1986)
Year |
UK |
Netherlands |
Sweden |
Switzerland |
1986 |
100 |
100 |
100 |
100 |
1987 |
98 |
48 |
102 |
143 |
1988 |
99 |
79 |
91 |
151 |
1989 |
97 |
71 |
82 |
182 |
1990 |
98 |
102 |
104 |
206 |
1991 |
104 |
117 |
107 |
298 |
1992 |
113 |
102 |
128 |
308 |
1993 |
119 |
91 |
131 |
260 |
1994 |
132 |
119 |
148 |
293 |
1995 |
144 |
79 |
141 |
265 |
1996 |
158 |
150 |
182 |
177 |
1997 |
157 |
167 |
192 |
154 |
1998 |
215 |
145 |
191 |
133 |
1999 |
216 |
N/a |
199 |
144 |
69. The UK has experienced a steady rise in drug-related deaths since 1990. Drug-related death rates in the Netherlands appear to have remained relatively stable.49 The number of drug related deaths in Sweden has risen throughout the 1990s, with a particularly sharp rise in the most recent year for which figures are available. Switzerland saw a remarkable rise in the number of drug related deaths between 1986 and 1992. However, since 1992 the number of drug related deaths has levelled off and has even begun to fall. This success in substantially reducing the number of drug deaths recorded is unique amongst the states considered here. The Swiss government attributes this success to the greater emphasis placed on harm reduction in their drug policy after 1991.
70. It is worth noting that the number of deaths each year attributable to illicit drugs is minuscule compared to the numbers associated with alcohol (i.e. around 2000 per year in the Netherlands and 900 per year in Sweden) and tobacco (i.e. around 20,000 per year in the Netherlands). In addition, a number of other licit substances also kill significant numbers each year (e.g. widely available painkillers such as paracetamol, aspirin and Ibuprofen are estimated to kill over 2,000 people per year in the United Kingdom).
71. Is also clear that the public perception of the dangers of various substances has little relation to the actual dangers associated with those substances. Ecstasy, for example, is widely held to be an extremely dangerous drug whilst the antidepressant Dothiepin is virtually unknown. According to data supplied by the Office for National Statistics, in the five years between 1993 and 1997, ecstasy was mentioned on 83 death certificates in the United Kingdom. Dothiepin was mentioned on 1100 death certificates, 235 in 1997 alone.
72. Another important measure of drug-related harm is the prevalence of certain drug-related diseases. Unfortunately, there are very few directly comparable data available.
73. The best data available are those relating to AIDS50. In the United Kingdom, 6% of all recorded cases of AIDS have involved intravenous drug users (IDUs). The equivalent figure for the Netherlands is 11%, for Sweden 12% and for Switzerland, 29% (down from 40% in 1997)51.
74. These figures suggest that Switzerland has a continuing problem with AIDS amongst IDUs. However there has been a dramatic reduction in the number of recorded cases of AIDS involving IDUs52.
AIDS cases in injecting drug users by country and year of diagnosis (1996-2000).53
1996 |
1997 |
1998 |
1999 |
Jan-June 2000 |
Cumulative Reported Total | |
Netherlands |
48 |
42 |
26 |
19 |
3 |
568 |
UK |
115 |
76 |
44 |
24 |
17 |
1071 |
75. It is, however, unclear what proportion of AIDS cases involving IDUs are actually related to injecting drug use. Therefore, a more reliable measure are the data on the incidence of AIDS cases related to injecting drug use collected by the European Centre for the Epidemiological Monitoring of AIDS. According to these data, between 1985 and 1998, 10.9% of AIDS cases in the Netherlands were recorded as relating to injecting drug use. The equivalent proportion for Sweden is 11.5% and for the UK, 6.5%. Unfortunately, these data do not include Switzerland.
76. Given that intravenous drug use is practised by only a tiny proportion of the population of each of the four states, it is clear that there is a much higher prevalence of AIDS amongst IDUs than amongst non-IDUs.
Level and cost of drug-related crime (other than actual drug offences)
77. It is commonplace to hear assertions about the level of crime that is drug-related, particularly estimates of the amount of property crime which is drug-related.
78. However, again, very few directly comparable data on the level and cost of drug-related crime (other than actual drug offences) are available. Some country specific data are, however, available. These data at least allow some general points to be made.
79. In 1995 the Netherlands Justice Department estimated that a third of all property crime in the major cities, and up to 50% of burglaries, was attributable to drug addicts. Unfortunately the methodology used to generate these estimates is unclear.
80. In 1996, United Kingdom Government-sponsored research54 into establishing the proportion of those arrested by police who test positive for certain drugs began55. It found that 61% of arrestees tested positive for illicit drugs: 46% for cannabis; 18% for opiates; 12% for benzodiazapines; 11% for amphetamines, 10% for cocaine and 8% for methadone56. 11% of arrestees said that they were currently dependent on heroin, 2% on cocaine and 3% on crack.
81. As regards specific offences, almost half of arrestees suspected of shoplifting tested positive for opiates and about a third tested positive for cocaine. Up to a quarter of suspected car thieves tested positive for opiates.
82. According to the same research, 46% of arrestees who reported using drugs during the last 12 months believed that their drug use and crime were connected, the most commonly cited connections being the need for money to buy drugs and the fact that drug use has an effect on judgement. Arrestees who said that their drug use and crime were connected also reported illegal incomes which were two or three times higher than those who said their drug use and crime were not connected.
83. The research concluded that the best predictors of volume of illegal activity were reported use of heroin and crack. Those testing positive for opiates, for example, had an average illegal income of Ł12, 674 a year, as against Ł3,065 for those testing negative for all drugs. Those testing positive for cocaine had an average illegal income of Ł11,225 a year. Those testing positive for opiates and cocaine were also seen to commit a far greater volume of offences than those testing positive for other drugs or those testing negative.
84. These findings do not of course tell us the extent to which drug use, particularly problem drug use, causes crime. However, they do go some way towards indicating a correlation between drug use and crime, particularly between use of heroin and cocaine and crime.
85. A key objective of the Swiss experiment with prescribing heroin to addicts, which began in 1994 was to reduce the amount of illegal activity amongst participants57. Participants had to have been heroin dependent for at least two years. According to Swiss Federal Office of Public Health figures, 44% of those entering the programme reported that they were unemployed and 70% reported that they supported themselves via "illegal activities" (i.e. property crime, prostitution, drug dealing, etc). After 18 months, unemployment had fallen to 20% and the proportion reporting that they supported themselves via "illegal activities" had fallen to 10%58.
86. There is considerable controversy over whether or not the Swiss trials are scientifically sound59. In particular, it is widely argued that the outcomes attributed to the trials may have had more to do with heavy investment in social services for the participants (five times as much per participant was spent on social services in this trial than in standard methadone treatment) than with the prescription of heroin. Nevertheless, these trials do go some way towards indicating the type of approach, which may contribute to reducing the level of drug-related crime amongst drug users60.
Numbers imprisoned for drug offences
United Kingdom
87. According to Home Office figures, around 13.12% of the 64,60261 people imprisoned in England and Wales in January 2000 were imprisoned for drug offences. In other words, 9,610 people are currently imprisoned for drug offences in England and Wales. Assuming that a similar proportion of those imprisoned in Scotland and Northern Ireland are imprisoned for drug offences, a total of around 10,650 people are currently in prison for drug offences in the United Kingdom as a whole.
88. In January 2000, the imprisonment rate in England and Wales stood at 113 (125 in 1997) per 100,000 of the national population. Between 1993 and 1998 there was a steady increase in the prison population of England and Wales. In 1993 the prison population stood at 44,600, an imprisonment rate of 85 per 100,000. By 1998, it had risen to peak at 66,500, an imprisonment rate of 125 per 100,000. By 2000 the prison population had fallen slightly to 65,390. Although the rise has levelled off somewhat, the prison population of England and Wales was projected to rise to 65,900 by September 2001, 67,300 June 2002, 68,900 June 2003, 70,500 in 2004 and 72,000 in 2005.
89. The proportion of the prison population imprisoned for drug offences appears to have risen slowly during the 1990s. In 1996, for example, less than 11% of the 55,300 people imprisoned in England and Wales were imprisoned for drug offences. As stated above, this proportion had risen to just over 13% by January 2000. The actual number of people imprisoned for drug offences in England and Wales rose from around 6,900 in 1996 to 9,610 in January 2000.62
The Netherlands
90. According to figures supplied by the Dutch Ministry of Justice, around 17% of people imprisoned in the Netherlands in 2000 were imprisoned for drug offences. In other words, there are around 1999 people imprisoned for drug offences in the Netherlands.
91. The Netherlands has an imprisonment rate of 87 per 100,000 of the national population. There was a rapid increase in the imprisonment rate in the Netherlands between 1990 and 1996. In 1990, 6,892 people were in prison, the imprisonment rate standing at 42 per 100,000. 1,310 people were in prison for drug offences in 1990 (19% of the prison population). By 1996, 11,931 were in prison, an imprisonment rate of 74 per 100,000. 1,790 people were in prison for drug offences (15% of the prison population). The rise in the overall rate of imprisonment seems to have levelled out since 1996, but there has been a steady rise in the numbers of people in prison for drug offences during the 1990s.
92. According to 1995 Department of Justice figures, the Netherlands spends around NLG 650 million per year policing, prosecuting and imprisoning drug offenders.
Sweden
93. According to official figures, in 1994, 18% of the inmates of Swedish prisons had been convicted of drug offences. By 1998, this figure had risen to 30%. In 2000, a total of 9200 were imprisoned in Sweden. On a year basis, the average number of prisoners was about 3700, 32% of the total number of prisoners being sentenced to imprisonment for drug-related crimes.
94. Sweden has an imprisonment rate of 64 per 100,000 of the national population.
Switzerland
95. According to the Swiss Federal Statistics Office, in 1998, 31.5% of the 4,346 inmates of Swiss prisons were convicted of drug offences. In other words there were 1,367 people in prison for drug offences in 1998.
96. Since 1993, there has been a sharp fall in the number of people in prison for drug offences. In 1994 for example, the peak year, there were 1,738 people in prison for drug offences (40% of the total prison population). By 1998, there were fewer people in prison for drug offences than in 1990. This fall in the number in prison for drug offences can be seen as a result of the change in drug policy in Switzerland after 1991.
97. Taking only those actually sentenced, Switzerland has an imprisonment rate of 79 per 100,000 of the national population. Including those in prison on remand, Switzerland's imprisonment rate is around 92 per 100,000, a 20% increase since 1990. Switzerland has a large percentage of foreigners in prison.
Overall financial cost to the state of drugs
98. Unfortunately, there are no reliable data available on this issue. Estimates are often made, but there is no means of establishing the scope of these estimates.
Conclusion
99. Given the lack of any consensus over what constitutes drug harm and the limited data available, it is impossible to come to any firm general conclusions about the levels of drug harm pertaining in the four states considered here.
Deprivation and drug harm
100. It is widely accepted that drug harm is unevenly distributed within, as well as between, states. Large differences can, for example, be seen in the levels of drug harm pertaining in different regions of states63 and even between different areas of the same city.
101. Socio-economic deprivation64 is often identified as a key correlate of the uneven distribution of drug harm, with more deprived areas and groups tending to have higher prevalence of drug harm. Whilst it is important to note that the relationship between socio-economic factors and drug harm is complex - not all socially deprived areas and groups have high levels of drug harm, and high levels of drug harm can be observed in some wealthy areas and groups - there is some evidence from the UK to suggest a correlation between deprivation and drug harm65.
102. Research into opiate use in the Wirral area of Liverpool amongst the 16-24 age group conducted between 1984 and 198566, found that the overall prevalence rate of 18.2 per 1,000 masked enormous variation between different parts of the Wirral. Prevalence rates ranged from zero to a high of 162 per 1,000. This geographical variation in prevalence was found to strongly correlate with indicators of the deprivation level within each area, particularly high levels of unemployment, council tenancies and single parent families.
103. A 1993 study, covering Bradford, Nottingham, Glasgow and the London borough of Lewisham67, found that, whilst there appeared to be no apparent correlation between socio-economic deprivation and drug use per se (in fact, these data show that drug usage appears to be most prevalent amongst the least deprived), the general trends observed were for very frequent and injecting usage to be more prominent amongst the most deprived socio-economic groups68. This study also concluded that frequent drug usage tended to be more prevalent in areas of cities with higher proportions of deprived groups and higher levels of unemployment69. At a hearing in Dublin, members of the Dail Eireann and Senate expressed strong views that drugs misuse disproportionately affected socially deprived communities. The Rapporteur is grateful for the evidence of 6 Irish experts who had carefully examined the draft report. Two were enthusiastically supportive of the draft conclusions, one hostile and three neutral. The discussion was very informative.
104. Analysis of the results from the 1998 British Crime Survey70 identified similar general trends. For example, respondents from households earning less than Ł5,000 per annum were found to be twice as likely to have taken one or more of the most addictive illicit drugs heroin, methadone, cocaine and crack) during the last year than those from high income households. Further, unemployed respondents were found to be seven times more likely to have taken one or more of the most addictive illicit drugs during the last year than those in employment.
105. Evidence to suggest a correlation between deprivation and drug harm can also be gleaned from analysing data on admissions to hospital for drug-related emergencies. There were 3,715 admissions to hospital for drug-related emergencies in Glasgow between 1 April 1991 and 31 March 1995. The place of residence of each patient admitted for a drug-related emergency during this period was classified according to the Carstairs Deprivation Index (CDI)71. It was found that the admission rate from the most deprived areas of Glasgow exceeded that of the least deprived by a factor of 3072.
106. Further evidence emerges from analysis of drug related deaths. For the purpose of this report, the UK Office for National Statistics has classified each drug-related death in the UK between 1993 and 1997 according to the CDI. According to the most recent data available73, 27% of the UK population live in areas with the lowest CDI scores, i.e. the most deprived areas. However, between 1993 and 1997, 44.2% of those whose deaths were drug-related resided in the most deprived areas. 14.5% of the UK population lives in areas with the highest CDI scores, i.e. the least deprived areas. However, between 1993 and 1997 only 7.1% of those whose deaths were drug-related resided in the least deprived areas. Although these figures should be treated with some caution, they suggest that the drug-related death rate amongst those residing in the most deprived areas of the UK is three times the rate amongst those residing in the least deprived areas74.
107. These data, of course, do not necessarily indicate a causal relationship between deprivation and drug harm in the UK during the 1990s75, let alone more generally76. Nevertheless, they appear sufficient to enable us to conclude that deprivation correlates with drug harm strongly enough to indicate the likelihood of a causal link.
108. Scientists are generally more willing to accept correlation as evidence of causation where reasonable causative mechanisms are offered. Whilst this report is not the place to offer and assess possible candidates for identification as causative mechanisms, it should be noted that many possible candidates have been offered77.
109. If there is a causal link between deprivation and drug harm, this clearly has important implications for drug policy. The alleviation of the worst forms of socio-economic deprivation would become an important element of drug policy. Further, there would be strong reasons for targeting treatment services and other drug-related resources at the most deprived areas.
Conclusions
110. In the absence of reliable comparable data on drug harm, it is nearly impossible to objectively assess the success (or failure) of various drug policies with a high degree of certainty. As a result, drug policy is being made with inadequate information and will continue to be until reliable comparable data are available.
111. Therefore, as an essential first step towards more rational, effective drug policies in Europe, we need to develop indicators whereby drug harm throughout Europe can be measured and compared.
112. We also need to enhance the collection of data relating to these. Standardisation of research methods as well as of data recording methods is required.
113. It is also vital that the nature of the relationship between deprivation and drug harm in member states is more clearly established. To this end, we need to increase the amount and quality of comparable data regarding this relationship.
114. Available data imply that the prevalence of drug use in a particular state does not appear to depend on the severity of laws pertaining in that state. To express this conclusion slightly differently, there is no evidence that we have seen that measures designed to deter drug use have any effect on drug use whatsoever. It could, therefore, be argued that states should focus on implementing drug policies which aspire to achievable goals, i.e. the minimisation of drug harm, rather than unachievable ones, i.e. control of the level of drug use.
115. Of the states considered in this report, the governments of the Netherlands and Switzerland place greatest emphasis on harm reduction in their respective drugs policies, whereas the governments of the United Kingdom and Sweden continue to place greatest emphasis on attempting to deter drug use by means of severe legal penalties. The United Kingdom has announced proposed changes in its laws that will change the possession of cannabis to a non-arrestable offence. Portugal and Belgium have also announced radical changes.
116. The government of Switzerland has been notably successful in stabilising and then reducing the number of drug-related deaths since 1994. It is important that the lessons of this success are identified and learned by all member states. More generally, we need more exchange of evidence-based prevention schemes, treatment methods and rehabilitation programmes between member states.
117. Finally, given the likelihood of a causal link between deprivation and drug harm, it is vital that states demonstrate an awareness of this link by making the reduction of deprivation an integral part of drug policy.
Reporting committee: Social, Health and Family Affairs Committee
Reference to committee: Doc. 8989 and Reference No. 2627 of 28 June 2001
Draft recommendation unanimously adopted by the committee on 14 December 2001
Members of the committee: Mrs Ragnarsdóttir (Chairman), Mr Hegyi, Mrs Gatterer, Mr Christodoulides (Vice-Chairs), Mrs Albrink, MM. Alís Font, Arnau, Mrs Belohorská, Mrs Biga-Friganovic, MM. Berzinš, Bilovol, Mrs Björnemalm, Mrs Bolognesi, MM. Brînzan (alternate: Tudose), Brunhart, Cerrahoğlu, Cesário, Cox, Dees, Dhaille, Dzasokhov, Evin, Flynn, Mrs Gamzatova, MM. Gibula, Glesener, Goldberg, Gönül, Gregory (alternate: Kiely), Gusenbauer, Gustafsson, Haack, Hancock, Herrera, Mr Hörster, Mrs Jäger, Mrs Jirousová (alternate: Palečková), Baroness Knight (alternate: Mr Vis), Mrs Lakhova, Mr Liiv, Mrs Lotz, Mrs Luhtanen, Mr Manukyan, Mrs Markovska, MM. Marmazov, Marty (alternate: Schmied), Mattei, Mrs Milotinova, MM. Mladenov, Monfils (alternate: Timmermans), Olekas, Ouzký, Padilla, Pavlidis, Podobnik, Popa, Poroshenko, Poty, Provera, Rigoni, Rizzi (alternate: Tirelli), Seyidov, Mrs Shahtakhtinskaya, Mrs Smerecynska, MM. Smirlis, Surján, Telek, Mrs Tevdoradze, Mrs Troncho, MM. Tudor, Vella, Mrs Vermot-Mangold, MM. Vos, Wójcik, Mrs Zafferani, Mr Zidu
NB: The names of those members present at the meeting are printed in italics.
Secretaries to the committee: Mr Newman, Ms Meunier and Ms Karanjac
1 An aspect of drug policy not considered in this report is prevention, i.e. measures which aim specifically to persuade and/or encourage individuals not to use drugs or to stop addiction and other forms of problem use developing among those already taking drugs. Prevention will not be considered here as there is, as yet, no evidence available concerning the impact of programmes aimed specifically at preventing drug use and abuse. Anecdotal evidence concerning the impact of much longer running smoking prevention programmes (which are, of course, analogous to some extent) suggest that these programmes have tended to coincide with increases in smoking amongst those in target groups. Nevertheless, the committee decided to add their view in recommendation 13ii.
2 Demand for treatment by drug users; drug-related deaths: the incidence of drug related infectious diseases; prevalence of drug use; and prevalence of problem drug use.
3 Problem Drug use covers addiction to opiates or stimulants, intravenous drug use and drug use associated with criminal behaviour.
4 This is clearly a matter for concern. One finding of this report might be that progress needs to be made in producing criteria whereby the absolute level of drug harm can be assessed and compared between different states and different periods in the same state. The EMCDDA aims at, as two of its core tasks, the implementation of five harmonised key indicators of drug harm and of the systematic and scientific evaluation of drug policies. However, these aims are not yet achieved and the Council of Europe should be doing all it can to assist the EMCDDA to do so.
5 Note that, in common with most scientists working in this field, the author of this report does not assume that all drug use can be classed as drug harm. What is assumed, however, is that low levels and low frequency of drug use is preferable to higher levels and greater frequency.
6 The primary determinant of prevalence of use appears to be fashions in international youth culture and other autonomous developments including levels of long-term unemployment.
7 This convention consolidated and replaced earlier UN treaties and conventions in this area.
8 It is worth noting that some elements of this Convention were implemented under the auspices of the Council of Europe.
9 The terms ‘narcotic’ and ‘psychotropic’ are not defined on the Conventions, but specific substances are listed in the respective Schedules.
10 Room for Manoeuvre, DugScope, March 2000.
11 Note that the following are maximum penalties and are not always, or even often, enforced. See below for a discussion of sentencing policy in the United Kingdom.
12 Class A includes cannabinol and derivatives, dipiphanone, magic mushrooms, methadone, morphine, opium and Class B drugs prepared for injection. Class B includes barbiturates, codeine, dihydrocodeine and methyl amphetamine. Class C includes anabolic steroids, bezodiazapines, buprenorphine and mazindol.
13 However up to half of the 11, 381 imprisoned for drug offences in the United Kingdom in 1999 (up from 3, 388 in 1989) were imprisoned for possession and 90% of those arrested for drug offences were arrested for possession. It is also worth noting that, despite the fact that the maximum sentences available for possession are from 2 to 7 years, the current average sentences for possession is around 3 months.
14 Research by Drug Action Teams for The Home Office in 1999 found waiting time for initial assessment for alcohol and drug treatment was 14 weeks, well above The Government’s target of 4 weeks. Further, average waiting time between initial assessment and admission was 17.5 days.
15 However, treatment services generally make little distinction between licit and illicit drugs and offer treatment to people with ‘substance dependency’ rather than ‘drug dependency’ problems.
16 The 10-year strategy appears to be confined only to those drugs of abuse controlled by the MDA.
17 The cut-off used to be 30 grams but was reduced to 5 grams in 1996 to correspond more closely with the amount generally seen as the required amount for personal use.
18 In 1998, 100% of the 7, 700 arrests for drug offences in the Netherlands (up from 5, 400 in 1986) were related trafficking or supply.
19 Coffee shop owners do not tend to be prosecuted, provided they ensure that: (a) no more than 5 grams are sold to any customer at one time; (b) no hard drugs are sold; (c) neither the drugs on sale nor the coffee shop are advertised; (d) no nuisance is caused; and (e) no drugs are sold to persons under 18. Coffee shops are allowed to stock up to 500 grams of cannabis products. A licensing system has been established to regulate the number and location of coffee shops. No one with a police record can be issued with a license and holders must adhere to the five rules stated above.
20 Opening speech by Minister for Justice, Mr Thomas Bodstrom, Hassela Nordic Network conference on drug Related Issues, Visby, May 2001.
21 In contrast to other European countries, being under the influence of particular drugs is seen as a criminal offence and leaves one open to possible arrest and compulsory drug testing. The maximum penalty for drug use is 6 months imprisonment.
22 "The cut off points are: less than 60 grams of cannabis; 1 tablet of LSD or ecstasy; 0.05 grams of heroin; 0.2 grams of cocaine; and 0.2 grams of amphetamines.
23 For example, the penalty for selling 2 grams of cannabis is normally 1 month in prison. For 8 kg of cannabis, it is 4 years imprisonment. Over 10 kg, the penalty varies from 5 to 10 years. The penalty for selling heroin varies from 2 months for less than 0.05 grams to 10 years for anything over 901 grams.
24 Ministry of Health and Social Affairs 16th October 2001.
25 The Swedish Commission on Narcotics Drugs (1998:04)
26 This represents a five-fold increase since the 1980s.
27 These plans will only apply to the consumption, not production or supply of cannabis.
28 A measure of the reduced emphasis on cannabis in Swiss law enforcement can be seen in the reduced proportion of the charges filed under the Law on Narcotics involving cannabis. in 1980, 70% of charges filed concerned cannabis, and only 30% heroin and cocaine. In 1990, the equivalent figures were 53% for cannabis and 47% for heroin and cocaine and in 1997, 49% for cannabis and 52% heroin and cocaine.
29 Some academics, for example, are highly critical of the sampling methods used by many organisations which monitor the prevalence of drug use.
30 Throughout Europe, for example, illicit drug use appears to be much higher in the 16 - 29 age range than in other ranges.
31 Illicit drug use appears to be concentrated in urban areas.
32 Extended Annual Report on the State of the Drugs Problem in the European Union. EMCDDA, 1999. Note that this survey does not include Switzerland.
33 On this point, see, for example, M D Abraham, Drug Use and Lifestyle; Behind the Superficiality of Drug Use Prevalence Rates, 1998. Available at 'www.frw.uva.nl/cedro/library/palrna.html'.
34 See, for example, M Ramsey and S Partridge, Drug Misuse Declared in 1998: Results from the British Crime Survey, Home Office Research Study 197.
35 See, for example, M Abraham, P Cohen, R-J van Til and M de Winter, Licit and illicit Drug Use in the Netherlands 1997, Centrum voor Drugsonderzoek (CEDRO), University of Amsterdam, 1999. CEDRO has specially computed data from its 1997 survey for this report so that they are perfectly comparable with the British Crime Survey data.
36 Based on 1997 and 1998 figures, collated in the 2000 EMCDDA report.
37 See, for example, British Crime Surveys for 1994-1998.
38 Based on 1996 and 1997 - 98 figures, collated in 2000 EMCDDA report and Abraham et al, op cit
39 Based on 1998 figures, collated in 2000 EMCDDA report.
40 For information on Swedish drug trends, see the Swedish Council for Information on Alcohol and Other Drugs Drug Trends Report, 1999 at www.can.se.
41 The data for 15-39 year-olds are from 1997. The data for 14-16 year-olds are from 1994.
42 The data for the UK are taken from M. Ramsey and S. Partridge, Drug Misuse Declared in 1998, op. cit. The data for the Netherlands are from M Abraham et al, Licit and Illicit Drug Use in the Netherlands 1997, op cit. The authors of this report have kindly recomputed their data so as to make them directly comparable with the UK data (i.e. covering the same age cohort).
43 Last month use of most of the selected substances is too small for reliable continuation rates to be given.
44 At least some of the difference may, of course, be as a result of different sampling methods used.
45 Unfortunately, comparable data are not available for the UK.
46 In the UK, for example, any death reported to be 'due to drug dependence... non-dependent abuse [or]...accidental, suicidal or undetermined poisonings' is classified as drug-related. However, in the Netherlands since 1996, only deaths reported to be due to 'mental and behavioural disorders due to drug use...accidental poisoning by narcotics, … psychodysleptics [and ]... psychostimulants' are classified as drug-related.
47 Based on EMCDDA report and figures provided by the Swiss Federal Office of Public Health.
48 Figures for England and Wales only.
49 The sharp jump between 1995 and 1996 can be attributed to a widening of the definition of drug related death.
50 See the UNAIDS/WHO Epidemiological Fact Sheets for the United Kingdom, the Netherlands, Sweden and Switzerland. Figures are up to 1999.
51 The prevalence of AIDS cases involving IDUs might go some way towards explaining the much higher incidence of the disease in Switzerland in comparison to the other states considered in this report.
52 This has been, at least partially, due to an increase in the number of syringes distributed to drug users and the availability of condoms from syringe distribution centres. These measures have particularly targeted drug-addicted prostitutes who are seen as a key group in the containment of the disease.
53 WHO European Region Data reported by 30 June 2000. HIV/AIDS Surveillance in Europe Mid-Year Report 2000.
54 T Bennett, Drugs and Crime; The Results of Research on Drug Testing and interviewing Arrestees, Home Office Research and Statistics Directorate, 1998.
55 Cannabis, opiates (including heroin), methadone, cocaine, amphetamines (including ecstasy), benzodiazapines, LSD and alcohol.
56 Note that the much higher proportion of those testing positive for cannabis as opposed to those testing positive for opiates may be as a result of the fact that cannabinoids metabolites remain in urine in detectable quantities for up to a month after consumption whilst opiates remain in detectable quantities for no more than a couple of days.
57 Social Characteristics of Participants in Swiss Multicenter Trails at Time of Entry, A Dobler-Mikova, A Uchtenhagen, F Gutzwiller and R Blatzer, Zurich, 1994.
58 In general, criminal activity by drug users appears to be reduced significantly by participation in treatment programmes.
59 See, for example, S L Satel and E Aeschbach, The Swiss Heroin Trials: Scientifically Sound?, Journal of Substance Abuse Treatment, vol 17 (4).
60 Note that only 5% of participants in the Swiss trial had moved into abstinence treatment after 18 months.
61 This total and all of the following figures include prisoners held on remand as well as sentenced prisoners.
62 In 1992, Scotland's prison population stood at 5, 257, an imprisonment rate of 102 per 100, 000. By 1997, it had risen to 6, 084, an imprisonment rate of 119 per 100, 000. Thus, whilst there has been a rise in the Scottish prison population, this has been slower and from a higher base than in England and Wales. Figures for 1998 (6,018, 118 per 100,000) and 1999 (5,900, 115 per 100,000) suggest that, as in England, the rise in the prison population has levelled off.
63 According to figures collated by the EMCDDA in its 1999 report, for example, the rate of problem drug use in The Hague is around twice as prevalent (12.6 -13.3 per 1,000 population aged 15-54) as in Utrecht (6.3 per 1,000).
64 Standard constituents of socio-economic deprivation are poverty, inadequate housing, unemployment and lack of educational opportunity.
65 There is also a considerable body of US research suggesting a relationship between deprivation and drug harm. See, for example: J C Ball & C B Chambers eds, The Epidemiology of Opiate Misuse in the United States, Springfield, Ill: Charles C Thomas, 1970; P Bourgois, 'Crack in Spanish Harlem', Anthropology Today, vol 5 (1989), pp 6-11: and P M Marzuk, K Tardirf, AC Leon et al, 'Poverty and Fatal Accidental Drug Overdose of Cocaine and Opiates in New York City', American Journal of Drug and Alcohol Abuse, vol 23 (1997), pp 221 - 228. At the time of writing, however, the author has been unable to find any research in this area relating to the Netherlands, Sweden or Switzerland.
66 H Parker, R Newcombe & K Bakx, The New Heroin Users: Prevalence and Characteristics in Wirral, Merseyside, British Journal of Addiction, vol 82 (1987), pp 147 -157
67 M Leitner, J Shapland & P Wiles, Drug Usage and Drugs Prevention, London: Health Education Authority, 1993.
68 See ibid, pp 26 - 28. It should be noted, however, that the number of 'problematic users' in the sample used by Leitner et al is not sufficient to enable firm conclusions about the relationship between problem drug use and socio-economic deprivation to be drawn. Because problematic drug use is so rare amongst the general population - fewer than 4 people per 1,000 can be identified as problem drug users according to EMCDDA figures for the EU - the difficulty of small sample sizes of problematic users is endemic to general population surveys.
69 Ibid, pp 54 - 57.
70 M Ramsey & S Partridge, Drug Misuse Declared in 1998, op cit, Chapter 5, pp 47 - 53
71 See V Carstairs & R Morns, Deprivation and Health in Scotland, Aberdeen: Aberdeen University Press, 1991. This index assigns each postal area a deprivation score based on the level of overcrowding, level of male unemployment, proportion of persons in households the head of which is of low social class and the proportion of persons with no car.
72 See Drug Misuse and the Environment, Advisory Council on the Misuse of Drugs, 1998, pp108-109.
73 Data from the 1991 census.
74 The proportions of people residing in the least and most deprived areas are calculated using 1991 figures, whilst the data for drug-related deaths cover 1993 -1997. There is likely to have been some variation in the proportions of people residing in the least and most deprived areas between 1991 and 1997. However, this variation is not likely to be large enough to make a significant difference to the relative likelihood of drug-related death posited here.
75 It might be suggested, for example, that drug use causes deprivation. Unemployment may be higher amongst problem drug users because problem drug users have difficulty meeting the full demands of full-time employment as a result of their drug use: they may have become unemployed as a result of their drug use rather than beginning using drugs because they were unemployed. Problem drug users may tend to reside in the most deprived areas because residing in such areas is cheaper and their intensive drug use means that they are unable to afford to live in less deprived areas. The data from Glasgow on the place of residence of those admitted to hospital for drug-related emergencies concerned their current place of residence as opposed to where they lived before they began using drugs.
76 Even if there was sufficient evidence of a correlation between deprivation and drug harm in the UK during the 1990s to indicate a causal link, this would not be sufficient to conclude that there is a general causal link between deprivation and drug harm. The situation in other states and in other periods may be radically different.
77 See, for example, Drug Misuse and the Environment, op. cit. p 112.