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 policies[1] 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 use[3]. It is worth noting,
however, that there are no rigorously defined and generally accepted criteria
for measuring drug-related harm[4]. 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 harm[5]: (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 states[6]. 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
Drugs[7] (with
a protocol added in 1972);the1971 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 states[10], 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 C[11].
|
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 andresin) and
amphetamines are Class B drugs. Ecstasy (and related compounds), heroin,
cocaine (including crack) and LSD are ClassA[12]. 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 years[13].
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 from17% 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 services[14].
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) drugs[15]. 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-wide[16]. 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 grams[17] 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 crime[18].
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 conditions[19], 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 Drugs[20]". 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 use[21], 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 drugs[22] 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 crime[24].
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 recorded[26]. 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 consumers[28].
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 methods[29]; differences in
age ranges chosen[30]; social and cultural
factors which influence willingness to honestly report drug use; the relative
proportion of a state's population which lives in urban areas[31].
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 report[32], 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 use[33]. 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 Kingdom[34] 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 years[37]. 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 Netherlands[38]
|
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.
Sweden[39]
|
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 drawn[41].
|
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 available[42]. 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 25occasions 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 cannabis[45]. 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
Swedenor the Netherlands;
(e) The United Kingdomhas
higher prevalence of cannabis usethan 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 compared[46]. However, by lookingat
the figures one can get a good idea of whether drug-related deaths are rising
or falling.
Number of Drug Related Deaths[47]
|
Year |
UK[48] |
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 2000per 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 AIDS[50]. 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 ofAIDS involving IDUs[52].
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 ofAIDS 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 research[54] into establishing the
proportion of those arrested by police who test positive for certain drugs
began[55]. 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 methadone[56]. 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 £12, 674 a year, as against £3,065
for those testing negative for all drugs. Those testing positive for cocaine
had an average illegal income of £11,225 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
participants[57]. 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 sound[59]. 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 users[60].
Numbers imprisoned for drug
offences
United Kingdom
87.
According to Home Office figures, around 13.12% of the 64,602[61] 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 2000were 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 42per100,000. 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 100,000.1,790people 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 states[63] and even between
different areas of the same city.
101.
Socio-economic deprivation[64] 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 harm[65].
102.
Research into opiate use in the Wirral area of Liverpool amongst the 16-24 age
group conducted between 1984 and 1985[66], 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
Lewisham[67],
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 groups[68]. 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
unemployment[69]. 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 Survey[70] identified similar
general trends. For example, respondents from households earning less than
£5,000 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 April1991and 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 30[72].
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 available[73], 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 areas[74].
107.
These data, of course, do not necessarily indicate a causal relationship
between deprivation and drug harm in the UK during the 1990s[75], let alone more
generally[76]. 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 offered[77].
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:
MrsRagnarsdóttir (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.Seebelow 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 thefact 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 Drugs onderzoek (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 http://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.
