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The latest annual report from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA, http://www.emcdda.eu.int) describes a wide range of areas where intensive forms of drug use may be having a significant impact on society, and among the main findings are:
AIDS cases related to drug injecting overtaken by heterosexually transmitted casesUntil 2001, the majority of new AIDS cases in the EU could be attributed to drug injecting, but heterosexual contacts have now overtaken injecting drug use as the most common cause of new AIDS cases [2]. An important factor for the reduction in AIDS is likely to be the improved access for HIV-positive injecting drug users (IDUs) to highly active antiretroviral therapy (HAART). Over 75% of those needing HAART now have access to it in most of western Europe, although availability in the Baltic states remains poor (3). Improved access for IDUs to treatment and harm reduction services, and a decline in drug injecting in some countries, are also now having an impact on rates of drug-related HIV transmission in Europe, and are likely to contribute to a decline in drug-related AIDS incidence. AIDS cases in the European Union by transmission group and year of diagnosis (1987 to 2003*) adjusted for reporting delays
End of 2004 data from EuroHIV was not available as the EMCDDA report went to press, but these are available at http://www.eurohiv.org. Low HIV prevalence among IDUs, but hepatitis B and C infections still highHIV infection rates remain low in most countries: between 0%-1% of tested IDUs in the Czech Republic, Greece, Hungary, Slovenia, Slovakia, Finland, the United Kingdom (UK), Bulgaria and Romania; and under 5% in Germany, Lithuania and Luxembourg (2001–2004). Higher estimates (>=10%) are reported from Estonia, Spain, France, Italy, Latvia, Netherlands, Poland and Portugal. However, rates of newly diagnosed HIV infection among IDUs in Estonia and Latvia have now fallen dramatically, suggesting that the recent epidemic in these two countries may have peaked already. Hepatitis B and C, however, are still major causes of disease among IDUs in Europe. Studies in several countries – Belgium, Estonia, Greece, Italy, Poland, Portugal and Norway – continue to find HCV antibody prevalence of over 60% among IDUs (2002–2004). Twenty four EU member states (except Cyprus), as well as Norway, Bulgaria and Romania, now provide sterile injecting equipment via needle and syringe programmes for IDUs. Although the extent of provision varies, coverage is substantial in many countries. Up to 2 million problem drug users in the EU, data on injecting still scarceThe EMCDDA’s operational definition of problem drug use is ‘injecting drug use or long duration/regular use of opiates, cocaine and/or amphetamines’. The EMCDDA estimates that there are between 1.2 and 2.1 million problem drug users in the enlarged EU today, of whom between 850 000 and 1.3 million are likely to be IDUs. Prevalence estimates since the mid to late 1990s show some rise in the number of problem drug users in Denmark, Austria, Finland, Sweden and Norway, and a stabilisation or decline in the Czech Republic, Germany, Greece and Ireland. Elsewhere, no clear conclusions on trends in problem drug use can be drawn from the data available. In general, few well-documented national level estimates of IDU prevalence are currently available. Rates of injecting among heroin users in treatment have also declined in several EU countries – Denmark, Greece, Spain, France, Italy and the UK – with under 50% of new opiate users entering specialist drug treatment services reporting to be injectors. Rates are low in Spain, the Netherlands and Portugal, at under 30%. Some notable exceptions are Finland and several of the new EU member states, where most heroin users inject the drug. There are strong indications that drug problems in Europe have diversified in recent years, with those entering treatment now more likely to report problems involving cocaine (including crack) and cannabis or the use of more than one drug (polydrug use). Overdose still the main cause of death among opiate users, but numbers of young fatalities now fallingOverdose is still the main cause of death among opiate users in the EU, and one of the leading causes of death among young people in Europe. However, in most of the 15 countries that made up the EU (EU-15) before May 2004, with the exceptions of Finland, Sweden and the non-EU country Norway, there is now a lower proportion of overdose deaths in people under the age of 25 than a decade ago, suggesting a fall in the recruitment of young addicts and the number of young injectors. The picture is different in the new EU member states and candidate countries reporting data, where deaths under the age of 25 increased substantially from the mid-1990s to 2002. Across the EU, drug-related deaths remain at their highest ever levels, but there are signs that these may have already peaked. Following a 40% increase between 1990 and 2000 (EU-15), many countries now report a decline to figures similar to those found in the early 1990s. Cocaine becoming stimulant drug of choice for many young EuropeansIndicators of cocaine trafficking and consumption now clearly point to a rise in importation and use of the drug and there is growing evidence of cocaine-related health problems. Latest figures show that the amount of cocaine seized in the EU nearly doubled between 2002 and 2003, from 47 tonnes to over 90 tonnes, suggesting that Europe is now a major market for the drug. Since the late 1990s, evidence of a rise in recent cocaine use among young adults (15–34 years) has been reported from surveys in Denmark, Italy, Hungary, the Netherlands and Austria. In Spain and the UK the most substantial rises occurred prior to 2001, but more recent data suggest that this upward trend may now be levelling off. The use of crack cocaine in Europe – a form of cocaine particularly associated with public health and social problems – is only reported in a few major cities. Based on surveys in the general population, the EMCDDA estimates that between 3 and 3.5 million adults in Europe (1% of all adults) are likely to have tried cocaine in the last year, while around 1.5 million (0.5% of all adults) have used it in the last month. Around 10% of requests for treatment for drug problems in Europe are now linked to cocaine use, although considerable variations are recorded between countries. Cocaine use is frequent among opiate users and is commonly detected with opiates in cases of drug overdose. It is estimated that cocaine plays a ‘determining role’ in around 10% of all drug-related deaths (ranging from 1% to 15% depending on the country). This could mean that there are several hundred cocaine-related deaths per year at EU level. Over half a million Europeans now receive substitution treatment: major increase in services for opiate dependence, but availability still unevenThe total estimated number of clients in substitution treatment in Europe has now passed the 500 000 mark. Following a sevenfold increase over the last decade, at least 530 000 clients now receive substitution treatment across 28 countries, through specialist treatment centres or general practitioners. It is estimated that somewhere between a quarter and a half of those with opiate problems in Europe may now be receiving treatment of this kind. The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA, http://www.emcdda.eu.int) has based its 2005 annual report on data referring to 2003 or the most recent year available. It collects data from all 25 European Union (EU) member states, as well as Norway and three EU candidate countries (Bulgaria, Romania and Turkey). References:
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