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Summaries — Perspectives on Drugs (PODs) 2013
<This is an internal document designed to help you prepare for interviews and presentations>
The PODs — part of the European Drug Report package — are online interactive analyses
providing deeper insights into a selection of important issues.
1. Mass media campaigns for the prevention of drug use in young people
The use of mass media campaigns in drug prevention is both relatively common and not
without controversy. Both policymakers and practitioners have hotly debated the effectiveness
of such campaigns in reducing drug use, or the intention to use, drugs among young people.
This POD aims to contribute to the debate via a review of available evidence on this topic.
Presenting the results of a meta-analysis of evaluation studies, largely from the US, the
analysis shows that the media campaigns examined had no effect in reducing drug use and a
weak effect on intention to use illicit substances. The review concludes that, in the absence of
strong evidence, media campaigns for preventing illicit drug use among young people should
not be provided outside rigorously designed and evaluated programmes. It also states that, in
Europe to date, there has been no systematic evaluation of whether mass media campaigns
are leading to changes in drug use attitudes and behaviours.
2. Hepatitis C treatment for injecting drug users
Transmitted through the sharing of needles, syringes and other injecting equipment, hepatitis
C is the most common infectious disease among injecting drug users (IDUs) in Europe today,
with national samples of IDUs showing between 18% and 80% infected with the virus (HCV).
Often known as the ‘hidden epidemic’, hepatitis C infection can go for long periods
undiagnosed, with many of those infected showing either mild or no symptoms for 20 years or
more. Unlike hepatitis B, hepatitis C has no vaccine, yet the disease is preventable. This POD
explores some of the positive advances in treating the disease today, including a new
generation of medicines which act in a shorter period of time and carry reduced side-effects
(e.g. direct-acting antivirals; interferon-free treatment). But, it says: ‘In spite of the burden of
disease and recent improved treatment outcomes for hepatitis C patients, available data show
treatment uptake to be very low among IDUs’.
3. Preventing overdose deaths in Europe
It is estimated that over 70 000 lives have been lost to drug overdose in Europe in the first
decade of the 21st Century. Overall, around 6 500 overdose deaths, mainly related to opioids,
were reported in Europe in 2011. While this is down on the 7 700 cases reported in 2009,
reducing drug-related deaths remains a major challenge for public health policy in Europe,
with rising death tolls reported in some countries. This POD looks at the variety of factors that
increase the risk of fatal and non-fatal overdoses, be they related to patterns of use or setting
(e.g. disruption of treatment, release from prison). It also describes how these deaths may be
prevented via interventions aiming, on the one hand, to reduce the occurrence of overdose
events (e.g. via awareness raising, risk assessment) and, on the other, to prevent fatal
outcomes of overdoses (e.g. improved bystander response). The latter features training peers
and families of drug users to recognise and respond to overdoses, including the
administration of an antidote (naloxone) to reverse the effects of opioids.
4. Emergency health consequences of cocaine use in Europe
Several thousands of cocaine-related emergencies are reported each year in Europe, and
hundreds of cocaine-related deaths, mainly in the small number of western European
countries with high prevalence of use. The types of cocaine-related problems reported are
both acute and chronic, including cardiovascular and neurological complications, dependence
and psychiatric problems. Illicit use of cocaine currently places a considerable burden on
emergency services in Europe. Since the end of the 1990s, there has been a three-fold
increase in some European countries in the number of these emergencies registered.
Fatalities relating to cocaine use (at least 500 cases reported per year, mainly in Spain and
the UK) are likely to represent only the tip of the iceberg, with many deaths going unreported.
This POD explores the potential of using hospital emergency data for monitoring acute
problems associated with cocaine. It also underlines the need to explore the potential benefits
of monitoring trends in acute toxicity related to other drugs (e.g. amphetamines, prescription
opioids, new psychoactive substances) in order to improve insight into problems and health
consequences across a broad spectrum of substances.
See Perspectives on drugs (PODs) at www.emcdda.europa.eu/edr2013
5. Trends in heroin use in Europe: what does treatment demand data tell us?
Use of opioids, mainly heroin, still accounts for the largest share of drug treatment demand
and drug-related morbidity and mortality in Europe. Understanding heroin use trends is
therefore a priority due to the public health impact of this drug. Multiple indicators suggest that
Europe is currently witnessing a decline in heroin use, although countries show varying
patterns and trends. In this POD, treatment demand data were explored to assess changes
over time in the number of people who entered treatment for the first time in their life with
heroin as their main problem drug. The analysis confirms a decrease of first-time treatment
demand for heroin use in Europe over the last decade, the decline occurring earlier in western
European countries than in eastern European countries. This time difference between the two
regions is supported by other analyses which highlight differing time trends in heroin
epidemics in these regions. The most recent data, however, seem to suggest a tendency
towards convergence of heroin use patterns across Europe as a whole. The decline in heroin
use has important public health implications and can contribute to reductions in a range of
serious health problems, including infections related to injection and overdose deaths.
6. Characteristics of frequent and high-risk cannabis users
Cannabis is Europe’s most commonly used illicit drug, with approximately 20 million adults
(15–64 years) having used the drug in the last year; 3 million on a daily, or almost daily, basis.
Cannabis is the second most frequently reported drug, after heroin, among all clients entering
specialised drug treatment in Europe. And among those clients entering treatment for the first
time in 2011, it was the drug most frequently reported. This POD explores the characteristics
of frequent and high-risk cannabis users and reflects on how examination of this group can
help design appropriate and tailored interventions for those cannabis users most at risk of
experiencing problems. Young males are overrepresented among frequent and high-risk
cannabis users and interventions should be primarily tailored to them. However, older users
and females might have different characteristics and needs which should also be addressed.
Higher socio-economic status tends to protect from frequent cannabis use, however, findings
among current frequent users regarding employment and educational status vary between
countries and studies. Studies comparing frequent users, with and without dependence, are
scarce, but suggest, among others, that dependent users exhibit more mental health
problems, more problems related to their cannabis use and are more often polydrug users.
7. The new EU drugs strategy (2013–20)
A new EU drugs strategy (2013–20) was endorsed by the Justice and Home Affairs Council of
the European Union on 7 December 2012. Building on the results of the previous strategy,
this agreement presents the drug policy position and aspirations for all EU Member States,
identifying common objectives to reduce drug demand, dependence and supply. Two
consecutive four-year action plans will translate the strategic priorities into specific actions
with a timetable, responsible parties, indicators and assessment tools. This POD looks at
some of the features of the new strategy and how it aims to: address the significant changes
currently taking place in the EU drugs market; further develop health and social responses;
and promote an empirical and evidence-based approach to drugs policy. The POD also
presents the drug strategies of other world regions.
8. Controlling new psychoactive substances
Recent years have witnessed a proliferation of new psychoactive substances becoming
available in Europe, some of which find their way onto the market, packaged and promoted as
‘natural’ or ‘legal’ products and sold in specialised physical or online shops. The diversity of
the new substances reported, and the speed with which they appear, represents a major
policy challenge, with the burden falling on national legal systems ill-designed to face such a
phenomenon. At national level, the new drugs phenomenon has provoked a range of
innovative legal responses geared towards controlling the open sale of these substances.
This POD looks at three types of legal response to this phenomenon, including: controls using
consumer safety or medicines legislation; extending and adapting existing laws and
processes; and devising new legislation to tackle new substances. Although there is no
agreement across Europe as a whole on any one particular way to respond to the new drugs
threat, two longer term trends are nevertheless identifiable. Firstly, there appears to be a
general move towards the use of the threat of prison to deter suppliers; and secondly, it
seems that countries are choosing not to use criminal sanctions for those possessing a new
substance for personal use.
See Perspectives on drugs (PODs) at www.emcdda.europa.eu/edr2013
9. Models for the legal supply of cannabis: recent developments
Three United Nations Conventions provide the international legal framework on drug control,
and these instruct countries to limit drug supply and use to medical and scientific purposes.
Nevertheless, increasingly there are debates about decriminalisation, or even legalisation, of
drugs, and cannabis in particular. Such proposals raise concerns about increases in use and
harms, and questions about the ways in which the distribution of cannabis for non-medical
purposes might be carefully regulated to mitigate these. This POD explores different models
of cannabis supply that are currently debated in Europe and in the Americas. In the EU, a
system of limited distribution has evolved in the Netherlands since the 1970s, with further
developments over the last year. At the end of 2012, detailed proposals for cannabis
regulation were put forward in two US states and Uruguay. If implemented, these will
contribute three additional models that may be closely observed in the future to understand
the advantages and disadvantages of a particular regulated system. Besides these systems,
the model of the ‘Cannabis social club’ has been increasingly mentioned in drug policy
debates. Advocates of these clubs argue that policies of non-prosecution of individuals in
some countries can be equally applied to registered groups of individuals effectively to permit
a closed production and distribution system. At present, the model is rejected by national
authorities in Europe.
10. Synthetic cannabinoids in Europe
Synthetic cannabinoids are the largest group of compounds monitored at European level by
the EU Early warning system (EWS) on new psychoactive substances. These chemicals
mimic the effects of THC, the active ingredient found in cannabis. Although synthetic
cannabinoids were probably available on the market as herbal blends from 2006 or before, it
was only in 2008 that forensic investigators detected the substance JWH-018 in ‘Spice’
products. Since 2008, synthetic cannabinoids have continued to be reported via the EWS at a
rapid rate: 9 in 2009, 11 in 2010, 23 in 2011 and 30 in 2012. Relatively little is known about
the pharmacology and toxicology of synthetic cannabinoids, but there have been reports in
Europe of non-fatal intoxications and a small number of fatal cases associated with the use of
products containing them. The number of substances, their chemical diversity and the rate of
their emergence makes this group of compounds particularly challenging in terms of detection
and monitoring. This POD provides an update on the current knowledge on these substances
and their effects, as well as trends in production, availability and use.
11. Synthetic drug production in Europe
Synthetic drugs have been produced illicitly in Europe for more than 40 years and, by global
standards, Europe remains a significant producer today. Although most of the synthetic drugs
produced in Europe are sold on domestic markets, non-negligible quantities are exported
abroad. The three synthetic drugs most produced in Europe are amphetamine (sulphate salt),
the ‘ecstasy’-type drugs (especially MDMA) and methamphetamine (hydrochloride salt). This
POD looks at the four regions of Europe where most illicit synthetic drugs production takes
place, the precursors and pre-precursors needed to make synthetic drugs, and current trends
in production in Europe (e.g. increased methamphetamine production; higher capacity of
amphetamine production facilities; resurgence of ecstasy). The POD states that the most
serious challenge now facing law enforcement in manufacturing countries is the chemical
alpha-phenylacetoacetonitrile (APAAN), a precursor of BMK (the precursor of both
amphetamine and methamphetamine). APAAN is placed on the European Commission’s
voluntary monitoring list, but the chemical is not placed under international control. Legitimate
uses for it in Europe are extremely limited and it is therefore probable that the main use for
APAAN in Europe is the illicit manufacture of BMK.
12. New drugs and the Internet
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See Perspectives on drugs (PODs) at www.emcdda.europa.eu/edr2013