The Annual Report 2012 from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) will be published today. The Health Research Board (HRB) provides the Irish figures for the EMCDDA report. This media briefing compares the situation in Ireland with that in Europe.
According to the EMCDDA report, we may be entering a new era in which heroin will no longer play such a central role in Europe?s drugs problems. The number of new heroin users is declining in several countries while access to substitution treatment for opioid (mostly heroin) users has risen. There is a wide range of new psychoactive substances available and the drugs market is changing rapidly. The stimulant market is particularly complex. Cocaine, amphetamines and ecstasy are still the most important stimulants but a number of new synthetic drugs, such as cathinones, are becoming more significant.
According EMCDDA Director Wolfgang Gotz; ‘It is critical that we better understand the health and social impact of these emerging trends and develop measures to reduce demand. To do this, better forensic and toxicological analysis is essential, as is the need to proactively engage with those most at risk’.
The situation with respect to Europe and Ireland is presented below under a series of headings.
- Cannabis is still Europe’s most commonly consumed illicit drug. One in five adults aged 15-64 years have tried cannabis at some point in their lives. Most countries report that cannabis use is stabilising or decreasing. Of the countries which have recorded the highest level of last year prevalence among young people (15-34 years) over the past decade, only Italy recorded an increase.
- Around 1% of adults, three-quarters of whom are aged 15-34 years use cannabis daily or almost daily. There is increasing awareness that dependency is a possible consequence of cannabis use and the number of individuals seeking help due to their cannabis use is growing in some European countries.
- Cannabis resin seizures declined in 2010 after a steady increase in the previous decade. The amount of cannabis seized continued to decline and the 560 tonnes recorded in 2010 was a new low.
- Europe is now a significant producer of cannabis. The overall trend is toward ‘import substitution’, that is imported cannabis products being replaced by herbal cannabis grown inside Europe’s borders.
- Ireland is placed in the mid-range among European countries for cannabis use. The NACD 2010/11 general population survey reported that 6% of the general population (15-64 years) used cannabis in the year prior to the survey, similar to the rate reported in 2006/7. Recent (taken within the last year) cannabis use was highest among young adults (15-34 years) at 10.3% and men at 9.1%.
- The fifth European School Survey Project on Alcohol and Other Drugs (ESPAD) was conducted in 36 European countries during 2010/11 and collected information on alcohol, tobacco and illicit drug use among 15?16-year-old students. Fourteen per cent of respondents in Ireland had used cannabis in the year prior to the survey compared to the European average of 12%.
- The number of cannabis seizures increased in 2011 (3,137) when compared to 2010 (2,268). But the general trend has been downwards since 2008 when 5,652 seizures were made. While seizures of cannabis resin decreased between 2009 and 2011, the number of herbal cannabis seizures almost doubled from 981 to 1,833 during the same period, reflecting a change in the nature of cannabis production and use.
Opiates (mainly heroin)
- More than 200,000 (48%) clients who entered drug treatment in 2010 reported opioids, mainly heroin, as their primary problem drug.
- Analysis of data in 24 countries on opioid users entering treatment for the first time in their lives showed a decrease from 61,000 in 2007 to 46,000 in 2010. The average time lag between first opioid use and first treatment entry is about nine years, so recent decreases in the number of heroin users entering treatment for the first time should at least partly reflect a reduction in heroin incidence that occurred some time ago.
- After a period of stable or increasing trends in opiate-induced deaths up to 2008, most EU countries reported stable numbers in 2009 with provisional data for 2010 pointing to a decrease in such deaths in Europe.
- Around 36% of those entering treatment for opioid use in 2010 reported injecting. There are big variations between countries, from 7% in the Netherlands to 94% in Latvia. While data from most countries show a steady decrease from 2000, in eastern European countries injection is still the main route of administration.
- While the rate of HIV transmission among drug users continues to decrease, Greece and Romania have reported outbreaks of HIV infection with a local epidemic among injectors in Athens.
- The EMCDDA estimates that about 1,830 people died of HIV/AIDS attributable to drug use in the European Union in 2009, with almost 90% of these deaths occurring in Spain, France, Italy and Portugal.
- During 2011, an estimated 696,000 opioid users were in receipt of substitution treatment, the most common type of treatment for opioid dependence in Europe. Medium term trends show a continuous increase in substitution treatment since 2003. About half of all problem opioid users in the Europe have access to substitution treatment, but some countries have considerably lower coverage levels, Greece (28%), Lithuania (17%), Slovakia (12%), Poland (8%) and Latvia (2%).
- Latest figures for seizures and drug-law offences point to an overall decrease in heroin supply. Around 55,000 seizures resulted in the interception of 19 tonnes of heroin in 2010, compared with 56,000 seizures and 24 tonnes in 2009.
- In Ireland, 4,930 (58%) of those who entered treatment in 2010 reported opioids, mainly heroin, as their primary problem drug.
- Around 2% of those entering treatment for drug problems in 2010 reported opiates other than heroin as their primary drug.
- The number of deaths where heroin was implicated in the cause of death (alone or with another drug or substance) decreased sharply from 115 in 2009 to 70 in 2010. This is the first time since 2005 there has been a decrease in the number of deaths due to heroin poisoning.
- Over one third of heroin users who entered treatment in Ireland in 2010 reported injecting drug use. The proportion of injector cases has been decreasing steadily since 2005.
- In Ireland there were 16 newly diagnosed HIV cases among injecting drug users in 2011, down from 22 in 2010. These are considered to be very low numbers.
- In Ireland 55% of problem opiate users were in substitution treatment in 2007. The number of people in opiate treatment in Ireland is higher than the European average indicating that provision of treatment is good.
- In Ireland there has been a continued decline in the number of heroin seizures, from 1,455 in 2009, to 1150 in 2010 and to 752 in 2011.
Stimulants and new psychoactive substances
- Cocaine remains the second most commonly used illicit drug in Europe, although high levels of cocaine use are observed only in a small number of mostly western European countries.
- With the exception of Ireland, where the situation has stabilised, the countries most affected by cocaine use among young adults (15-34 years) reported a decline in last year use of this drug by this age group in the most recent survey in each European country.
- Around 15% of drugs users entering treatment report cocaine as their main problem drug.
- The number of cocaine seizures fell slightly from 100,000 in 2008, to around 88,000 in 2010.
- In 2010, at least 640 deaths related to cocaine were reported in 16 countries.
- Some countries reported that the number of cocaine-related hospital emergencies was three times higher in recent years than it had been at the end of the 1990s.
- The 2010/11 general population survey reported 1.5% of adults and 2.8% of young adults (15-34 years) used cocaine in the year prior to the survey, compared to 1.7% and 3.1% respectively in 2006/7.
- The 2010/11 ESPAD survey reported that 3% of Irish 15-16-year-old students had used cocaine at some point in their life, just above the European average of 2%.
- In Ireland in 2009, 11% of those who entered treatment reported cocaine as their primary drug and this fell to 9% in 2010.
- The number of cocaine seizures increased from 566 in 2003, to 1,749 in 2007 and decreased considerably in 2008 (1,010) and again in 2010 (588).
- In Ireland the number of cocaine deaths increased from 10 in 2003, to 66 in 2007 then decreased to 52 in 2009.
Other stimulants and new psychoactive substances
The European Early Warning System (EWS) identified 24 new psychoactive substances in 2009, a further 41 in 2010 and an additional 49 in 2011. The EWS has already identified more than 50 new substances in 2012 which will represent the largest number ever reported in a single year. The two largest drug groups monitored by the EWS are synthetic cannabinoids (e.g. found in ‘Spice’) and synthetic cathinones (e.g. mephedrone, MDPV) which mimic the effects of other stimulants (including cocaine). It is not straightforward to make direct comparisons with Ireland under this heading because, for example, the banning of headshops in Ireland means that these drugs are no longer legally available, and also many of the drugs identified through the EWS have not yet appeared in Ireland.
- While overall last year use of amphetamines among young adults (15?34 years) is stable or declining, crystal meth use appears to be increasing. Germany, Estonia, Latvia and Austria are among the countries that have seen significant increases in seizures of the drug between 2009 and 2010.
- Deaths linked to the use of the stimulant drug 4-methylamphetamine (4-MA), which is not currently a controlled drug, along with reports of drug seizures in 14 European countries, have promoted a risk-assessment exercise by experts from a number of European agencies. 4-MA belongs to the group of synthetic phenethylamine drugs and is sold on the illicit market, usually mixed with amphetamine.
- Use of ecstasy (MDMA) is concentrated among young adults (15-34 years). Out of total of two million adults who reported using the drug in the past year, 1.5 million, were in the 15-34 age group. The proportion of MDMA in drugs sold as ecstasy had been declining in recent years due to measures to prevent diversion of precursor chemicals, but MDMA has reappeared, and is increasing, due to the identification of a new precursor.
- The most recent snapshot study identified 693 online shops purportedly selling psychoactive products, with three natural products – kratom, salvia and hallucinogenic mushrooms – the most frequently sold ‘legal highs’. There were 170 of these shops in January 2010. The snapshot identified a marked rise in the availability of synthetic cathinones, suggesting that online operators are seeking a replacement for mephedrone, now banned in the EU.
- Ireland has had notable success in limiting the sale of new psychoactive substances through legislation in 2010 and 2011. This was achieved through the combined efforts of a number of government departments and statutory agencies.
- The 2010/11 general population survey reported 3.5% of adults and 6.7% of young adults (15-34 years) used new psychoactive substances, such as herbal smoking mixtures, party pills or herbal highs, or powders such as cathinones during the year prior to the survey. Data on new psychoactive substances has been scarce in Europe but the EMCDDA have identified Ireland, Spain and the UK as countries which have carried out representative surveys and will therefore be in a position to present trend information in this area in the future.
- Ecstasy use by young adults (15-34 years) in Ireland was below the European average in 2010/11. The general population survey reported that 0.9% of 15-34 year-olds used the drug in 2010/11, a decline from 2.4% in the 2006/7 survey. However, reports through the early warning system indicated that there were a small number of adverse events in late 2011 and early 2012.
- Two per cent of 15-16-year-old students who participated in the 2010/11 ESPAD survey had used ecstasy at some point in their life. The proportion was the same in the year prior to the survey, indicating recent introduction to the use of this drug.
- There have been three seizures of small quantities of 4-MA in Ireland, but no reports of adverse events or fatalities to date. In Ireland 4-MA is controlled under the Misuse of Drugs Act.
Responding to drug use in European prisons
It is estimated that around 635,000 people are held in penal institutions in the EU compared with around 582,000 in 2001. A new EMCDDA report published today alongside the annual report examines the provision of drug-related services in European prisons including counselling, treatment of dependence and the prevention of infectious diseases. Lifetime prevalence levels for heroin use among prisoners in 13 of the 17 countries surveyed were between 15% and 30% – the rate is less than 1% for the general population. Some prisoners initiate drug use or begin to engage in more harmful practices (e.g. sharing injecting equipment) while in prison. Overcrowding, poor hygiene and a lack of healthcare provision affects many prisons, and contribute to the overall poor health status found in inmates.
The report notes that many countries have scaled up the provision of interventions within prisons, particularly substitution treatment for those who are opioid dependent. However prisons rarely offer a standard of care equivalent and comparable to that provided to the wider community. According to the report, penitentiary healthcare has in the past decade increasingly been recognised as part of public health care. There is a need to improve continuity of care for prisoners on their release when the risk of overdose death is extremely high due to reduced tolerance. The report highlights the need for pre-release counselling and overdose prevention training.
There are 14 institutions in the Irish prison system comprising 11 traditional ‘closed’ institutions, two open centres, and one ‘semi-open’ facility (the Training Unit). During 2010, there were a total of 17,179 committals to prison in Ireland for all offences, representing an 11.4% increase on the figure for 2009.
In 2009 voluntary drug tests were carried out to monitor drug use and responses to treatment in prison. Excluding methadone, between one-tenth and two-fifths of those screened tested positive for at least one drug.Drug treatment services are available in all but two institutions. In the event of a prisoner in one of these institutions requiring drug treatment services, they can be transferred to an alternative prison where such services are available. There were 539 people attending methadone treatment in prison in Ireland in July 2011. An addiction counselling service, contracted to an NGO, provides 1500 prisoner contacts per month for addiction counselling. The Irish Prison Service works to ensure continuity of Methadone Maintenance Treatment between prisons and the community.
The risk of overdose is high for recently released prisoners due to reduced tolerance and in recent years a number of deaths have occurred shortly after release. While much has been done to provide better health services there is a need for education and awareness among prisoners about the risk of overdose in the days and weeks following release.
The use of legal substances that mimic the effects of illegal drugs appears to be on the rise in Australia, yet little is known about their long-term impact on users.
Deakin University health researchers, in collaboration with colleagues at the University of Tasmania and the National Drug and Alcohol Research Centre at the University of New South Wales, are running a study to better understand Australian’s experiences of using these substances, referred to as emerging psychoactive substances.
“There has been a lot of research conducted in Europe and the United Kingdom looking at why people take these substances and the harm they report experiencing as a result. However, there is relatively little information from the Australian perspective,” said Deakin public health expert Matthew Dunn.
“In Australia we do not have a good understanding of who is using these substances, and we have no knowledge as to why they are using them. Are they people who are already using illegal drugs, such as ecstasy and cocaine? Are they people who have never used an illegal drug in their life? These are important questions when considering how we respond to these emerging substances, as well as how we design and disseminate education and harm reduction messages to those who may use these substances.”
The researchers are calling on people to share their experiences, good and bad, of using legal and illegal drugs through an online, anonymous and confidential questionnaire.
There is a wide range of substances on the market that mimic the effects of cannabis, stimulants like methamphetamine or cocaine, ecstasy and psychedelics like LSD. Some of these are sold online as legal alternatives to illegal drugs, yet many are in fact illegal in Australia, Dr Dunn explained.
“With the UK experiencing a rise in harm attributed to emerging psychoactive substances and research indicating that efforts to make them illegal is not seriously dissuading use, we need to take a thorough look at the situation here to be sure our response to these substances is appropriate in the Australian context,” he said.
“There is a gap in our knowledge of who is using these substances and why, and what impact this is having on their wellbeing. The results of our study will go some way to filling these gaps.”
People interested in taking part in the study can fill in the online questionnaire at https://healthsurveys.deakin.edu.au/opinio/s?s=264
Dr Matthew Dunn is available for interview.
Media contact: Mandi O’Garretty, Deakin Media Relations, (03) 5227 2776, 0418 361 890
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