Nations

European Union

1. "Several reports indicate that individual drug use or possession of illegal drugs for personal consumption are not amongst the top priorities of European law-enforcement authorities: more serious crimes and drug trafficking are the main objects of judicial practice against drug-related offenders. The new measures towards the decriminalisation or non-prosecution of drug-use offences implemented in some Member States seem to confirm this tendency." (p. 25) ^f

2. "In summary, in Spain, Italy, Portugal, and Luxembourg, there has been decriminalisation by law, meaning that the law does not foresee possession for personal consumption of some or of any drugs as criminal offences. The same framework will probably be applied in the near future in Belgium, after the announced law is issued." (p. 4) ^ff

3. "In Italy and Spain, possession is an offence but sanctioned administratively (no criminal proceedings involved); in Luxembourg, criminal prosecutions are only applied in specific situations (in front of minors, at school, in the workplace); in Portugal the criminal sanction has been substituted by the social and, when needed, therapeutic measures imposed by special Commissions; while in Belgium the prohibition of possessing cannabis privately for personal consumption could be removed in future, and no sanctions would be foreseen for 'non-problematic' possession for personal use. In Ireland, possession of cannabis leads to a fine at first offence, an increased fine at second offence, and possible imprisonment only at the third or subsequent offence, and in Austria the sanction is suspended for a probationary period." (p. 5) ^ff

4. "Cannabis remains the most commonly used drug in the EU, with many countries reporting lifetime prevalence rates in excess of 20 % of the general population. A conservative estimate would suggest that at least one in every five adults in the EU has tried the drug."

Source: European Monitoring Centre for Drugs and Drug Addiction, "Annual Report 2003: The State of the Drugs Problem in the European Union and Norway" (Lisboa, Portugal: EMCDDA, 2003, p. 9.

5. "Cannabis lifetime experience and recent use are higher in the United States than in any EU country. Cocaine lifetime experience is also higher in the United States than in any EU country, and recent use is higher than in most countries, except Spain (2.6 %) and the United Kingdom (2.0 %). Ecstasy use is higher than in all EU countries except Spain, Ireland, the Netherlands and the United Kingdom."

Source: European Monitoring Centre for Drugs and Drug Addiction, "Annual Report 2003: The State of the Drugs Problem in the European Union and Norway" (Lisboa, Portugal: EMCDDA, 2003, pp. 16-17.

6. "In all EU countries, cannabis is the illegal substance most commonly used, both in terms of lifetime experience (any use during a person's lifetime) and in recent use. Use of other illegal substances is less common. Cannabis lifetime experience in the adult population (15 to 64 years according to the EMCDDA standard, although with some national differences) ranges from about 10% in Finland to about 20 to 25% in Denmark, France, Ireland, the Netherlands, Spain and the United Kingdom. Other substances have been experienced by far fewer persons. Experience with amphetamines is reported by 1 to 4% of adults, but by up to 10% in the United Kingdom. Ecstasy has been tried by 0.5 to 4% of European adults and cocaine by 0.5 to 3%. Heroin experience is reported generally by less than 1% of adults, which contrasts with its high presence in drug-problem indicators." (p. 7) ^f

7. "Indicators suggest that cannabis use has been increasing across the EU, although this increase appears to have stabilised in some countries, albeit at what can generally be considered to be historically high levels. Some evidence of a convergence in patterns of use is also found, although rates still vary considerably, with France, Spain and the United Kingdom, in particular, reporting relatively high levels of use, and Finland, Sweden and Portugal reporting comparatively low figures. In all countries, estimates of the prevalence of recent use (last-year prevalence) among the adult population remain below 10 %. When young adults are considered, rates of use rise considerably. In all countries, recent use (last-year) prevalence peaks in the 15- to 25-year age group, with France, Germany, Ireland, Spain and the United Kingdom all reporting that over 20 % of this age group have used cannabis in the last 12 months. Lifetime use estimates are higher, with most countries reporting lifetime prevalence estimates of between 20 % and 35 % among young people. The number of people using cannabis on a regular basis is small in overall population terms (generally less than 1 %), although higher rates of regular use may be found among young people, and in particular among young men."

Source: European Monitoring Centre for Drugs and Drug Addiction, "Annual Report 2003: The State of the Drugs Problem in the European Union and Norway" (Lisboa, Portugal: EMCDDA, 2003, p. 9.

"After cannabis, the most commonly used drug in EU countries is usually either ecstasy or amphetamine, with rates of lifetime experience among the adult population generally ranging between 0.5 % and 5 %. In the past, prevalence of amphetamine use was generally higher than prevalence of ecstasy use, but this difference is now less apparent. Among school populations, lifetime experience of inhalants is second only to that of cannabis and in general is considerably higher than experience of either ecstasy or amphetamines." Source: European Monitoring Centre for Drugs and Drug Addiction, "Annual Report 2003: The State of the Drugs Problem in the European Union and Norway" (Lisboa, Portugal: EMCDDA, 2003, p. 9.

8. "Differences in the prevalence of drug use are influenced by a variety of factors in each country. As countries with more liberal drug policies (such as the Netherlands) and those with a more restricted approach (such as Sweden) have not very different prevalence rates, the impact of national drug policies (more liberal versus more restrictive approaches) on the prevalence of drug use and especially problem drug use remains unclear. However, comprehensive national drug policies are of high importance in reducing adverse consequences of problem drug use such as HIV infections, hepatitis B and C and overdose deaths." (p. 12) ^f

9. Regarding problem drug use, the European Monitoring Centre for Drugs and Drug Addiction reported in 2003 that "National estimates of problem drug use vary between two and 10 cases per 1 000 of the adult population (that is between 0.2 % and 1 %). No common trend in the number of problematic drug users in the EU can be observed, although studies suggest that in at least half of EU countries some increase has occurred since the mid-1990s. Probably around half of 'problem drug users' in the EU are drug injectors, i.e. around 500,000-750,000 of the EU's estimated 1-1.5 million problem drug users. The proportion of injectors varies considerably between countries and has changed over time, with levels of injection falling in almost all countries during the 1990s, although there is some evidence of more recent increases. National estimates of injecting drug use vary between two and five cases per 1 000 of the adult population (or 0.2-0.5 %)."

Source: European Monitoring Centre for Drugs and Drug Addiction, "Annual Report 2003: The State of the Drugs Problem in the European Union and Norway" (Lisboa, Portugal: EMCDDA, 2003, p. 10.

10. "A recent study on the prosecution of drug-related offences, commissioned by the EMCDDA in 2000, also found that the judicial process involving possession/use of small amounts of drugs in private is usually dropped before court stage. Public possession/use, sale by drug users and acquisitive crimes linked to drug addiction, however, often result in stronger measures by prosecutors and courts." (p. 25) ^f

11. "In most of the EU, the introduction of harm-reduction measures - such as increased access to sterile needles and syringes, greater availability of condoms, and HIV counselling and testing - has helped to control HIV transmission among injectors. Substitution treatment, which can greatly reduce the frequency of injecting, is also available in all Member States, mostly in the form of oral methadone, but in most countries large improvement is still possible in terms of coverage." (p. 41) ^f

12. "The persistence of hepatitis C infection among young injectors requires innovative approaches to harm reduction. The introduction of medically supervised injecting rooms and controlled heroin distribution are two such approaches being considered by some EU countries." (p. 41) ^f

13. "Each year, 7,000-9,000 acute drug-related deaths are reported in the EU. The overall EU trend has continued to increase in recent years, although less dramatically than was the case in the 1980s and early 1990s, and with a more complex and divergent picture appearing at the national level. Most of the victims are young people in their 20s or 30s, representing a considerable cost to society and loss of life.
"In most cases (typically over 80 %), opioids are present in the toxicological analyses, often in combination with other substances (such as alcohol, benzodiazepines or cocaine). Cocaine or ecstasy alone is found in a smaller number of cases. Some of the factors that appear to be associated with increased risk of opioid-related deaths are drug injecting, polydrug use and, in particular, the concurrent use of alcohol or depressants, loss of tolerance and not being in contact with treatment services. It is known that proper and timely interventions can help to prevent many fatal overdoses, supporting the need for interventions in this area that encourage those witnessing a drug-related overdose to take appropriate action."

Source: European Monitoring Centre for Drugs and Drug Addiction, "Annual Report 2003: The State of the Drugs Problem in the European Union and Norway" (Lisboa, Portugal: EMCDDA, 2003, p. 11.

14. In the European Union, "Healthcare, educational and social policies are becoming more important in reducing drug-related problems in the widest sense, and it is increasingly recognised that the criminal justice system alone is not always capable of handling the problem of drug use. The link between social exclusion policy and drug issues is stronger in some countries, such as Ireland and the United Kingdom, than in others. Several countries in the EU have introduced legislative changes to facilitate the treatment and rehabilitation of addicts and other legal changes have opened up possibilities for early interventions among young experimental drug users. Denmark, Germany, the United Kingdom and Norway have increased healthcare investment in an attempt to reduce the number of drugrelated deaths. In line with the EU action plan’s commitment to provide a variety of wide and easily accessible treatment options, some countries, for example Finland and Greece, have changed their financing schemes as well as regulations regarding substitution treatment."

Source: European Monitoring Centre for Drugs and Drug Addiction, "Annual Report 2003: The State of the Drugs Problem in the European Union and Norway" (Lisboa, Portugal: EMCDDA, 2003, p. 12.

15. In the European Union, "Syringe exchange is now an established method to prevent the spread of infectious disease through injecting drug use, although the availability and coverage of such programmes is variable and accessing sterile equipment can still be a problem. Only in Spain are syringeexchange services being implemented systematically in prisons. Specific measures to prevent hepatitis C transmission as well as hepatitis B vaccination are increasingly considered as important complements to HIV prevention. First aid training and risk education have become more prominent as particular interventions to prevent fatal overdoses. Another important development is that medical care is increasingly becoming available at low-threshold level, integrated in local drug services."

Source: European Monitoring Centre for Drugs and Drug Addiction, "Annual Report 2003: The State of the Drugs Problem in the European Union and Norway" (Lisboa, Portugal: EMCDDA, 2003, p. 12.

16. "The majority of reported drug offences are related to drug use or possession for use (54) - ranging from 39 % of all drug law offences in Portugal (55) to 89 % in Austria. In Spain, Italy and the Netherlands, where drug use is not a criminal offence, all drug offences relate to dealing or trafficking. Finally, Luxembourg and Norway (56) report a majority of offences for both drug use/dealing and drug trafficking. In 2001, cannabis remained the drug most often involved in drug law offences - accounting for 34 % of drug-related reports in Portugal and Sweden and as many as 86 % in France. In Luxembourg, heroin is the most commonly involved drug, while in the Netherlands most drug offences are related to ‘hard drugs’ (drugs other than cannabis and its derivatives)."

Source: European Monitoring Centre for Drugs and Drug Addiction, "Annual Report 2003: The State of the Drugs Problem in the European Union and Norway" (Lisboa, Portugal: EMCDDA, 2003, p. 33.

17. In the European Union, "Syringe-exchange programmes are available in all countries, but coverage is very limited in Sweden and Greece. A proposal to continue the two existing programmes and to expand needle-exchange programmes nationwide has recently been made in Sweden. In many other countries, accessibility of sterile injecting equipment has further improved, and better coverage of rural areas has been achieved through installation of vending machines and involvement of pharmacists."

Source: European Monitoring Centre for Drugs and Drug Addiction, "Annual Report 2003: The State of the Drugs Problem in the European Union and Norway" (Lisboa, Portugal: EMCDDA, 2003, p. 48.

18. "Distribution of an opiate antagonist, naloxone, is one measure taken in some countries with the aim of reducing heroin overdoses (Sporer, 2003). In Italy, a significant number of Unità de Strada (street drugs services) provide drug users with naloxone, which can be administered as an interim emergency measure while awaiting medical help. A pilot study in Berlin of combined first aid training and naloxone distribution found increased competence to react adequately in drug emergencies and medically justified use of the antagonist in the large majority of cases (93 %) (Dettmer, 2002). The same study also pointed to the relevance of naloxone for emergencies occurring in domestic settings."

Source: European Monitoring Centre for Drugs and Drug Addiction, "Annual Report 2003: The State of the Drugs Problem in the European Union and Norway" (Lisboa, Portugal: EMCDDA, 2003, p. 49.

19. "In some German and Spanish cities, supervised consumption facilities have been introduced, targeting the often marginalised populations of open drug scenes. Supervised consumption rooms are also to be found in the Netherlands. Among other services, they provide immediate emergency care in cases of overdose. A study of consumption rooms in Germany (Poschadel et al., 2003) found that they contributed significantly to a reduction in drug-related deaths at city level and improved access to further health and treatment services for problem drug users who are not reached by other services."

Source: European Monitoring Centre for Drugs and Drug Addiction, "Annual Report 2003: The State of the Drugs Problem in the European Union and Norway" (Lisboa, Portugal: EMCDDA, 2003, p. 49.

20. In the European Union, "Methadone is by far the most used substitution substance. Buprenorphine, the most used substitution substance in France for years, is also prescribed by private doctors in Portugal and Luxembourg. Sweden is preparing restrictions on the prescription of buprenorphine, and in Finland illicit misuse of buprenorphine has caused demand for treatment, with a few deaths reported related to misuse of buprenorphine and depressants. Currently, buprenorphine is used to a much lesser extent than methadone in Belgium, Denmark, Germany, Greece, Spain, Austria and the United Kingdom."

Source: European Monitoring Centre for Drugs and Drug Addiction, "Annual Report 2003: The State of the Drugs Problem in the European Union and Norway" (Lisboa, Portugal: EMCDDA, 2003, p. 49.

21. "The Netherlands has already conducted a trial with medical co-prescription of heroin and presented its findings in February 2002 (http://www.ccbh.nl; Central Committee on the Treatment of Heroin Addicts, 2002). Clients admitted to the trial received both methadone and heroin. The evaluation showed that the clients in the experimental group experienced considerable health benefits compared with the control group, which received methadone treatment only.
"Between March 2002 and February 2003, the German cities of Bonn, Cologne, Frankfurt, Hamburg, Hannover, Karlsruhe and Munich launched a heroin-assisted treatment programme in the framework of a scientific randomised controlled trial. A total of 1 120 clients were admitted to the heroin trial, which will be closely monitored and evaluated by the Centre for Interdisciplinary Addiction Research, Hamburg (Zentrum für Interdisziplinäre Suchtforschung), for two study periods each of 12 months (http://www.heroinstudie.de/).
"In Spain, the autonomous regions of Cataluña and Andalucia are preparing trials of co-prescription of heroin. In Barcelona (Cataluña), the total cohort of the study will be 180 male clients aged 18-45. The heroin prescribed will be for oral administration.
"In Luxembourg, a decree of 30 January 2002 allows for a trial of heroin prescription to be conducted in the framework of a pilot project managed by the Directorate of Health.
"In the United Kingdom, heroin is prescribed through general practitioners to an estimated 500 clients."

Source: European Monitoring Centre for Drugs and Drug Addiction, "Annual Report 2003: The State of the Drugs Problem in the European Union and Norway" (Lisboa, Portugal: EMCDDA, 2003, p. 50.

Acceding and Candidate Countries to the European Union (Central and Eastern Europe):

1. Regarding drug use in candidate eastern European countries, the European Monitoring Centre for Drugs and Drug Addiction reported in 2003 that "Current trends are hard to assess, as very recent data are lacking in most countries. There are tentative indications from some studies that in some countries the increase in drug use may have started to stabilise in the early 2000s, especially in major cities, where prevalence levels are usually several times higher than in rural areas (e.g. in Warsaw as well as in cities in Hungary and the Czech Republic). In other countries, data are rare or only limited qualitative or impressionistic information suggesting continuing increases is available. In all countries, the pattern of use is dominated by experimental or occasional use, mainly of cannabis. At the same time, these studies suggest an increased intensity of use by those (the minority) who continue to use. In other reports, diffusion of drug use from cities to smaller towns and rural communities is described. The 2003 ESPAD study should help cast light on trends among 16-year-old schoolchildren, although the results will not be available until 2004 and, as noted above, will not reflect trends in older groups of young people, up to the age of 25 or so, in whom drug use prevalence is likely to be higher."

Source: European Monitoring Centre for Drugs and Drug Addiction, "Annual Report 2003: The State of the Drugs Problem in the Acceding and Candidate Countries to the European Union" (Lisboa, Portugal: EMCDDA, 2003), pp. 18-19.

2. "From available data, and subject to the reservations expressed above, it appears that the level of problem drug use in the CEECs is approaching, and in some cases has surpassed, levels reported for EU Member States. The 2002 report on the drug situation in the candidate CEECs (EMCDDA, 2002a) estimated the proportion of problem drug users among the population aged 15 to 64 to be over 1 % in Estonia and Latvia, around 0.5 % (the EU average) in Bulgaria, the Czech Republic and Slovenia, and around 0.25 % in Poland (lower than the EU average but based on older data). Rapid increases in new cases of heroin smoking reflected in treatment data over recent years suggest that the estimate for Poland would now be higher, while a new estimate for Slovenia implies a rate of problem drug use of over 1 %. No estimates are available for Hungary, Lithuania, Romania or Slovakia."

3. Regarding drug use in candidate eastern European countries, the European Monitoring Centre for Drugs and Drug Addiction reported in 2003 that "Substitution treatment, in particular with methadone, has been slow to develop. The first (experimental) methadone programme started in Slovenia in 1990, to be followed by others in the Czech Republic (1992) and Poland (1993). In other countries, the first methadone programmes date from 1995 or later, although by 2001 all countries had introduced at least one. However, except in Slovenia, the number of programmes is limited and coverage remains very low indeed. In Slovenia, a nationwide network provides methadone treatment to perhaps 20 % of the estimated total heroin-dependent population. In all other countries, coverage is less than 5 %, and in many countries under 1 to 2 %. This contrasts with an average coverage of well over 30 % in the EU Member States (Figure 2). Other pharmacological treatments are available to a limited extent in some countries, including naltrexone and buprenorphine, but systematic information is not available."

4. Regarding drug use in candidate eastern European countries, the European Monitoring Centre for Drugs and Drug Addiction reported in 2003 that "While needle and syringe exchange programmes (SEPs) have been implemented in all countries, only the Czech Republic reaches a substantial proportion (estimated at over 50 %) of drug injectors through a national network of SEPs and low-threshold projects, although in some countries, such as Slovenia, a reasonable level of coverage is achieved in some cities."

5. Regarding drug use in candidate eastern European countries, the European Monitoring Centre for Drugs and Drug Addiction reported in 2003 that "However, most 16-year-olds in the CEECs have never used illicit drugs and, among those who have, the vast majority have used only cannabis. On average, lifetime prevalence of illicit drug use by 16-year-olds in the CEECs is 19 %, ranging from 12 % in Romania to 35 % in the Czech Republic. On average, the lifetime prevalence of cannabis use by 16-year-olds in the CEECs is 16 %, ranging from 1 % of the surveyed population in Romania (although 8 % have tried smoking heroin at least once) to 34 % in the Czech Republic. In contrast, in almost all of the CEECs, more than 90 % of 16-year-olds have tried alcohol at least once, and nearly two thirds admit to having been drunk at least once in their life."

6. "Relatively high national rates of HIV prevalence among different subgroups of IDUs tested during 2001 were reported from Estonia (13 %) and Latvia (12 %). However, in the capital of Estonia, Tallin, the local HIV prevalence rate in 2001 reached the alarmingly high value of 41 %. In Latvia and Poland, HIV prevalence among IDUs rose above 5 % in 1998 and has remained above 5 % since. In Lithuania, HIV prevalence increased to more than 1 % in 1997 but remained consistently below 5 % until 2001. In contrast, between 1996 and 2001, HIV prevalence among IDUs remained consistently below 1 % in Bulgaria, the Czech Republic, Hungary, Slovakia and Slovenia (European Centre for the Epidemiological Monitoring of AIDS, 2002). In these countries, HIV prevalence rates among IDUs are lower than those in any EU Member State, where levels of infection in different subgroups of IDUs vary from about 1 % in the UK (surveys and unlinked anonymous screening) to 34 % in Spain (routine diagnostic tests in drug treatment) (EMCDDA, 2002c)."

7. "In all CEECs for which information is available, sterile injection equipment can be purchased from pharmacies without a prescription. In 2001, in most CEECs the price of syringes in pharmacies was EUR 0.1. The exceptions were Estonia, where the price was lower (EUR 0.06), and Slovenia and Romania, where it was higher (EUR 0.14 and up to EUR 0.2 respectively). Only in Slovenia and Latvia can syringes also be exchanged or distributed through pharmacies. Not a single CEEC reported the existence of a national programme to support the sale of syringes to IDUs in pharmacies, although Estonia and Latvia reported sporadic efforts to provide at least some training for pharmacists with the aim of raising awareness of the need to prevent drug-related infectious diseases among IDUs. With the exception of Lithuania, no CEEC reported the distribution of prevention information targeted specifically at IDUs through pharmacies. Information on the numbers of syringes sold to IDUs through pharmacies would be very valuable in assessing the overall access of IDUs. The Czech Republic reported that in 2001 approximately one million syringes were sold to IDUs through pharmacies (97.8 syringes per 1 000 total population). National estimates of the proportion of IDUs who purchase sterile injecting equipment through pharmacies are generally not available, except in Hungary, where the figure in 2001 was approximately 30-40 %."

8. "All CEECs have in place some community-based or outreach harm reduction programmes that provide access to sterile injecting equipment and information on safer drug use and often also promote safer sex, including the distribution of condoms."

9. "Substitution treatment is available to IDUs in all CEECs; however, availability varies considerably. In 2001 in Slovenia, 679 IDUs per million total population were on methadone maintenance, but the corresponding rate in Estonia was only 3.6. Total estimated numbers of IDUs receiving methadone substitution treatment per million population in 2001 or the most recent year for which an estimate is available are shown in Figure 15. With the possible exception of Slovenia, access to methadone substitution is clearly insufficient. The next highest rates were in Slovakia and the Czech Republic, but here the numbers of drug users receiving methadone were approximately 10-20 times lower. Like coverage of SEPs, more meaningful rates would take account of the estimated numbers of IDUs."

10. "It is interesting to note that a number of acceding and candidate countries have moved towards criminalising possession for personal use, or use itself, over the past 12 years, while the most recent drug law modifications within the European Union countries have addressed the same question in a different way (ELDD, 2002)."

Australia

1. "The principle of harm minimisation has formed the basis of Australia's Drug Strategy since 1985. Essentially, harm minimisation refers to policies and programs designed to reduce drug-related harm, and aims to improve health, social and economic outcomes for both the community and the individual through a wide range of integrated approaches including supply-reduction, demand-reduction and harm-reduction strategies." (p. 1) ^a

2. The Australian Institute of Health and Welfare reports that "In 1998, around one in five Australians (22%) aged 14 years and over were current regular smokers, while around 40% were ex-smokers." The AIHW notes that: "Tobacco smoking was responsible for the majority of drug-related deaths in 1998. Approximately 18,800 deaths and 136,700 hospital episodes were attributable to tobacco smoking. "During the 1998-99 financial year, the Commonwealth Government acquired in excess of $8 billion in revenue from the importation and sale of tobacco products in Australia." (p. 2) ^a

3. "In 1998, Australia ranked 20th in the world in terms of per capita consumption of pure alcohol, with approximately 7.6 litres consumed per person." (p. 2) ^a

4. The Australian Institute of Health and Welfare reports that "In 1998 slightly over 1,000 deaths were associated with illicit drug use. Of the total number of hospital episodes related to drug use, around 7% were attributable to the use of illicit substances." (p. 3) ^a

5. "Approximately 23% of Australians reported using any illicit drug in the 12 months preceding the survey in 1998. Marijuana was the most common illicit drug used, with around two-fifths (39%) of those aged 14 years and over having used the drug at some time in their lives. Of those who have ever used marijuana, almost half had used in the past 12 months. Amphetamines had been recently used by around 4% of those aged 14 years and over, while 2% had used ecstasy/designer drugs, and around 1% had used heroin, cocaine, or injected an illegal drug, during the previous 12 months." (p. 3) ^a

6. Regarding polydrug use, the Australian Institute of Health and Welfare reported that "According to the 1998 NDSHS, around one in three recent drinkers reported recent tobacco use, while one in five reported recent marijuana use. Of those who had smoked tobacco recently, 90% had also consumed alcohol, while around two-fifths had recently used marijuana. The proportions of recent users of pain-killers/analgesics for non-medical purposes who reported recent use of alcohol, tobacco or marijuana were 87%, 39% and 41% respectively, while 96% of recent marijuana users reported recent alcohol use and 57% had used tobacco." (p. 3) ^a

7. Regarding Australia's high rates of reported drug use, the UN Drug Control Programme notes that "High levels of ATS (Amphetamine-Type Stimulants) abuse in the Oceania region are mainly found in Australia, which reported a prevalence rate for amphetamines of 3.6% in 1998. Such high figures do point to high levels of consumption; but they may also have to do with the specific social and legal context in which studies take place. This results in the case of Australia (and some other countries with a long tradition of social research) in more readiness to admit to drug use, and thus far less under-reporting than in countries where drug users fear that such information could be used against them." (p. 74) ^u

8. "An extensive network of needle and syringe programs (NSPs) has been established in Australia; in the financial year 1994-95, around 700 NSPs distributed six million syringes nationally and an additional four million were distributed through pharmacies. Early and vigorous implementation of harm reduction measures, such as methadone maintenance, peer-based education and NSPs, has successfully maintained low seroprevalence of HIV infection among people who inject drugs in Australia." ^w

9. "Nuns who run one of Australia's best known hospitals are to operate the country's first legal and medically supervised heroin injecting room after a radical overhaul of the drug laws in New South Wales. The 18 month trial will be administered by the Sisters of Charity, who also run Sydney's inner city St Vincent's Hospital. An estimated 50 000 visits a year by drug users are expected at the centre, which will be staffed by a medical supervisor, a registered nurse, and security staff. The controversial plan will include the provision of clean needles and syringes; users must supply their own drugs." ^x

Belgium

1. "In January 2001, the Government of Belgium released a Political Note in which it expressed the intention to modify the main drug law in order to make non-problematic use of cannabis non-punishable. The Note stated the intention that 'The criminal judge will no longer interfere in the lives of people who use cannabis on a personal basis and who do not create harm or do not show dependence.' a royal decree will be issued instructing prosecutors not to pursue people for possession of cannabis. The production, supply, sale and ownership of larger quantities will remain actively prosecuted, as will the use of cannabis which leads to 'unsociable behaviour'. Use and possession will still be prosecuted in cases involving minors, public nuisance, use in school premises, or in any place where the public order will be threatened." (pp. 3-4) ^ff

2. "The Belgian legislation does not distinguish the applied penalties neither according to the types of drugs ('hard' or so-called 'soft' drugs), nor to the quantities of the seized drugs. Only the concepts of possession, group use and trafficking are considered and are applied by the judicial authorities according to criteria applicable in each individual case." (p. 15) ^s

3. "In 1998, according to the decision of the Federal Parliament, a directive/circular modified the action of judicial authorities: a distinction was established between the possession of cannabis and other illegal drugs with non acceptable risk for health, and the access to needle exchange was made possible (the drug law itself - even regarding cannabis - was not changed)." (p. 15) ^s

4. On February 24, 2000, members of the Belgian Parliament made a proposal "modifying the law on drug of 24/02/1921 in order to partially decriminalize the possession of cannabis and its derivatives. The authors proposed that the positive right should be clarified. The prohibition policy against cannabis should be given up because a.o. its ineffectiveness. Nevertheless, the prosecutions against dealers should be continued and the drug use prevention efforts emphasized." (p. 26) ^s

5. "The Belgian Government intends to issue a decree in order to consider not punishable the 'non-problematic' use of cannabis. (p. 25) ^f

Canada

1. "In 1992 the government approved Canada's Drug Strategy, a co-ordinated effort to reduce the harm caused by alcohol and other drugs. The strategy calls for a balanced approach to reducing both the demand for drugs and their supply through such activities as control and enforcement, prevention, treatment and rehabilitation, and harm reduction." (p. 1) ^v

2. "In 1999 about 50,000 people were charged with offences under the Controlled Drugs and Substances Act in cases where the most serious offence was drug-related.... In that same year, we estimated that Canadian criminal courts heard 34,000 drug cases that involved more than 400,000 court appearances. About 19 percent of offenders in the federal correctional system are serving sentences for serious drug offences. "For the roughly 50,000 persons charged, 90 percent of the charges related to cannabis and cocaine. Cannabis accounted for over two thirds of the charges, and about half of all charges were for possession." (p. 4) ^v

3. "An estimated 125,000 people in Canada inject drugs. Injection drug use is a major risk factor in the spread of HIV/AIDS and hepatitis. In 1999 it resulted in an estimated 34 percent of all new HIV infections." (p. 4) ^v

4. The Auditor General of Canada notes that Correctional Service Canada (CSC), which is responsible for offenders serving criminal sentences of over two years, provides substance abuse and harm reduction services to inmates: "Substance abuse is one of seven criminogenic factors contributing to criminal behaviour. Nearly two thirds of offenders entering the federal corrections system have drug abuse problems. An estimated 53 percent of offenders participate in substance abuse programs while serving their sentences. "In addition to substance abuse programs, CSC has provided methadone treatment to some opiate-addicted injection drug users. Injection drug users pose a serious problem for institutions as they can contribute to the spread of HIV/AIDS and hepatitis. As a harm reduction measure, CSC also makes bleach available in prisons to sterilize needles shared by inmates." (p. 13) ^v

5. The Canadian government in 2001 established regulations to expand the use of marijuana as a medicine. According to an editorial in the Canadian Medical Association Journal in May 2001, "The new regulations promise more transparency in the review of applications to grow or possess medicinal marijuana, a broader definition of medical necessity, and greater latitude for physicians in determining the needs of individual patients.... Health Canada's decision to legitimize the medicinal use of marijuana is a step in the right direction. But a bolder stride is needed. The possession of small quantities for personal use should be decriminalized." ⁿ

Denmark:

1. The Danish government says of its drug policy, "Danish drug policy is based on persistent and targeted prevention intervention, multi-pronged optional co-ordinated treatment and effective control. Drug prevention policy rests on the principle of prohibition of drugs, a high level of information as well as action to impact on social conditions. In this connection, it is especially a deprived childhood, too little contact with adults and marginalisation in relation to education and training which results in a small group of young people becoming vulnerable to the experimental use of drugs, which subsequently, in many cases, leads to actual addiction." (p. 9) ^y

2. "Where possession of drugs is meant for own consumption, such an offence is punishable by a fine provided that it is not repeated. For first offences, possession of very small quantities for own use normally results in the police issuing a warning to the person in question." (pp. 15-16) ^y

3. "In Denmark possession of narcotics is a criminal offence. However a guideline of 1971, on legal process in drugs cases, stipulates that it was not the intention of the drug law to criminalize the use of drugs and corresponding possession of drugs for own consumption." (p. 6) ^ff

4. The Danish government estimates that in 2000, approximately 3% of the population of Denmark aged 16-44 had tried cannabis in the previous month, while a total of 4% had tried cannabis within the previous year. This compares with estimates from 1994 of 2% having used in the previous month, and 5% in the previous year. The Danish National Board of Health reported in 2000 that "It is primarily the young segment of the population (16-24 years of age) who have smoked cannabis within the last year, both in 1994 and 2000. More men than women report in 1994 and in 2000 that they have experimented with cannabis within the last month and last year. The difference in consumption between the two genders is, however, least pronounced among the young segments of the population - among the 16-24-year-olds." (p. 20) ^y

5. "While the use of cannabis has stabilised from 1994 to 2000, the use of 'hard' illegal drugs has increased significantly from 194 and up until today. Less than 1% of the 16-44 year-old reported in 194 that they had used hard drugs such as amphetamine, cocaine, heroin and hallucinogens within the last year, whereas even fewer had tried the hard drugs within the last month. As it appears from table 2.1.22, 2% of the 16-44-year-olds report in 2000 having experimented with one or several of the hard drugs within the last year, including 1% within the last month. The share of this group who report having tried hard drugs within the last month has thus increased approximately 5 times from 1994 to 2000, and the share of this group who report having tried hard drugs within the last year has gone up by more than 4 times as much during the same period." (pp. 15-16) ^y

6. "In 1995, more than 17% of the 15-16 year-olds report ever having tried cannabis. There was a significant increase in 1999 where the share that state having ever tried cannabis is over 24%. 8% had used it within the last month; in 1995 this was 6%. There are great differences in experimental use between boys and girls in 1999 when 30% of boys and 19% of girls state having ever used cannabis. Twice as many boys as girls had used cannabis during the last month." (pp. 24-25) ^y

7. "Syringes and needles distributed free of charge are still much in demand. Thus, since 1986 the city of Copenhagen has made syringes and needles available free of charge through pharmacists, dispensing machines, hostels and other outlets. In 1999, a total of 613,932 sets were distributed, which is a small decline compared to 1998. Furthermore, an increasing number of separate needles were dispensed. (pp. 30-31) ^y

8. "In 1995, the proportion of first-time HIV-positive where the source of infection has been reported as being intravenous-injecting drug addiction is 11% (34 persons). The percentage dropped to 6% (13 persons) in 1998 and had again gone up to 9% (24 persons) in 1999. Based on the data provided by the HIV reporting system, 'Statens Sterum Institut' has estimated that the spread of the infection among drug addicts has dropped since the mid-80s. It is assumed that less than 4% of the drug addicts are HIV-infected. This estimate is based on the analysis, under which there are 11,000 injecting drug users in Denmark." (p. 41) ^y

France:

1. According to "France Drug Situation 2000," a report prepared for the European Union's European Monitoring Centre on Drugs and Drug Addiction, "The Law of 1970 makes public or private use punishable by one year in prison and/or a fine, even if there has not been a perceptible negative impact upon those in the user's entourage. Another of the law's articles is out of the realm of practicality even if it attests to the ambiguous legal status of users (both delinquent and ill). Users may avoid proceedings by spontaneously seeking treatment. The provisions for anonymity guarantee that the Law will not ask for any explanations after treatment. It is also possible to escape proceedings if the prosecutor decides to close the matter or rules for a court-ordered treatment programme." (p. 9) ^z

2. "In France prohibition and punishment of simple drug use has provoked a strong debate for decades. In June 1999 a Directive of the Ministry of Justice asked prosecutors to prioritise treatment approaches for petty offenders both related to drug use or to other small crimes. Particularly where problematic drug users are concerned, the recommendation of the Directive is to apply therapeutic alternatives to prisons to the largest extent possible, while 'the imprisonment of drug users, not having committed other related offences, must be the last resort.' (citing the French Minister of Justice NOR JUS A 9900148C, June 17, 1999) (p. 6) ^ff

3. According to "France Drug Situation 2000," a report prepared for the European Union's European Monitoring Centre on Drugs and Drug Addiction, "In polls before 1999, the majority view which appeared to be defined is that prosecutions and legal penalties should be imposed on consumers of heroin and of cocaine (85% in favour), of cannabis (70%) or of alcohol (approx. 50%). However, polling of such opinions is very sensitive to the way in which questions are put: three quarters of interviewees in this way, were not in favour of the idea that drug addicts should be punished. Likewise, if the person and his individual freedom are emphasised rather than the legal aspects of the question of utilisation, then one third of interviewees, as in 1999, will be induced to express their consent for the proposal according to which the prohibition of smoking cannabis is an infringement of the right for free utilisation of one's own body." (p. 18) ^z

4. According to "France Drug Situation 2000," a report prepared for the European Union's European Monitoring Centre on Drugs and Drug Addiction, "Alcohol and tobacco consumption levels are by far those which cause the most serious extent of damage, either on the health or social level, or with regard to potential dependency." (p. 29) ^z

5. According to "France Drug Situation 2000," a report prepared for the European Union's European Monitoring Centre on Drugs and Drug Addiction, "In 1999, 21.1% of individuals from 12 to 75 years old stated that they had already consumed an illegal substance in their lifetime and 7.6% over the last 12 months." (p. 31) ^z

6. According to "France Drug Situation 2000," a report prepared for the European Union's European Monitoring Centre on Drugs and Drug Addiction, "According to Adult 'heath barometer' surveys, cannabis consumption significantly increased between 1992 and 1999. Surveys conducted amongst young people, particularly in a school environment, confirmed this development, which is also reflected in the 1998 young people's 'health barometer' (refer the section on young people's consumption). All of these surveys tend to confirm the comments made on site: the usage of cannabis is becoming more commonplace." (p. 33) ^z

7. According to "France Drug Situation 2000," a report prepared for the European Union's European Monitoring Centre on Drugs and Drug Addiction, "The determinable turnover for illicit drugs (cannabis and heroin) using the assumptions retained could reach nearly 9 billion francs. By modifying certain parameters in the plausible margins, one may likely obtain variations in expenditures that could double. The assumptions made here and the reasoning used lead us to consider that the turnover for cannabis and heroin should not be over 20 billion francs or go under 4 billion francs." (p. 72) ^z

8. According to "France Drug Situation 2000," a report prepared for the European Union's European Monitoring Centre on Drugs and Drug Addiction, "A limited number of alternative forms of low-threshold care are available to drug users in France. These include a syringe exchange programme, boutiques, sleep-ins and mobile facilities such as methadone buses, introduced in Paris in 1998 and more recently in Marseilles." (p. 98) ^z

9. According to "France Drug Situation 2000," a report prepared for the European Union's European Monitoring Centre on Drugs and Drug Addiction, "Sales of syringes to drug users by pharmacies were estimated at 13.8 million in 1997.... Syringes are also distributed free under syringe exchange schemes. Some of these are agreed and financed by the directorate-general of health, and others are paid for in various ways. A survey of syringe exchange schemes estimated that they distributed 1.5 million in 1996; we do not have any figures for 1997, but they are probably fairly similar. The schemes accounted for only about 10% to 11% of total syringes distributed to drug users during the year." (p. 99) ^z

10. According to "France Drug Situation 2000," a report prepared for the European Union's European Monitoring Centre on Drugs and Drug Addiction, "The number of new drug-related AIDS cases fell sharply in 1996 and 1997. However, the same was true of all cases irrespective of the cause of infection, and the trend is linked to the effectiveness of tritherapy treatments introduced in 1996. When it comes to assessing the impact of syringe accessibility, it is more relevant to observe trends in the rates of HIV positivity among intravenous drug users. This is not monitored statistically in France, unlike new cases of AIDS. However, a number of surveys have shown a decline in seroconversion and the prevalence of HIV in those who inject drugs." (p. 100) ^z

Germany:

1. According to "Germany Drug Situation 2000," a report prepared for the European Union's European Monitoring Centre on Drugs and Drug Addiction, "In March 2000 the Drug Commissioner of the Federal Government Mrs. Nickels presented her report on drugs and addiction. There prevention is stressed as the main focus of the national drug policy: Preventive interventions should focus on the use of illegal psychotropic substances but increasingly the abuse of alcohol and tobacco also. 'Health promotion' and 'the strengthening of life skills' are concepts placed in the foreground. A further aim of the Federal Government is to support addiction treatment which is oriented to efficiency and quality. In accordance with their psychological, physical and social condition addicts are to be offered individualised help which is easy to access by a differentiated drugs system. Therefore help should range from low threshold services reaching from harm minimisation and survival to offers that help drug addicts to get abstinent of drugs." (p. 2) ^aa

2. "In Germany the Consitutional Court decided in 1994 that prosecution for possession of very small quantities of cannabis might be waived as a rule in cases of occasional personal consumption, small quantities and where there is no danger to others. The federal Länder must provide uniform application of this provision." (p. 6) ^ff

3. According to "Germany Drug Situation 2000," a report prepared for the European Union's European Monitoring Centre on Drugs and Drug Addiction, "At the end of February 2000 German Federal Parliament and Federal Chamber of German Laender agreed upon a law, which is expected to create a safe legal position for drug consumption rooms. §10a of the third amendment of the Narcotic Law (BtMG) contains a catalogue of minimum requirements for rooms, as well as for medical and social care. the first aim is to reduce the risks of drug intake through appropriate framework conditions and legalise staff activities. It has also been clarified that staff is forbidden to actively support drug consumption. When opening drug consumption rooms abstinence-oriented counseling and treatment have to be offered to opiate addicts and arranged if wanted. Each Land government is free to allow drug consumption rooms and to create corresponding rules. It is up to the Land government to pass a decree and fulfill by that requirements for a permission of drug consumption rooms. The mentioned legal procedures have to be installed in the Federal Laender within two years after coming into force of the new decree. This has taken place in Hamburg (April 2000) and in North Rhine-Westphalia (September 2000)." (p. 4-5) ^aa

4. According to "Germany Drug Situation 2000," a report prepared for the European Union's European Monitoring Centre on Drugs and Drug Addiction, "In April 2000 the Hamburg Land parliament was the first Federal land to pass the legal basis for drug consumption rooms according to the requirements of the Third Amendment of the Narcotic Law.... In the eight Hamburg drug consumption rooms opiate addicts ought to be motivated to treatment or to substitution aiming at quitting drug use." (p. 9) ^aa

5. According to "Germany Drug Situation 2000," a report prepared for the European Union's European Monitoring Centre on Drugs and Drug Addiction, "Based on results and experiences from the study in Switzerland and now also from the Netherlands a clinical multi-centre study on ambulatory heroin supported treatment of heroin addicts will be designed in Germany. The study will include the clinical trial of heroin based prescriptions." (p. 5) ^aa

6. According to "Germany Drug Situation 2000," a report prepared for the European Union's European Monitoring Centre on Drugs and Drug Addiction, "The German government also has intensified the discussion on the legal position of non-medical use (possession and purchase) of cannabis products. The Federal Constitutional Court has requested the Laender already in 1994 to use uniform conditions and limits for the prosecution of an offence when cannabis for personal use is not prosecuted. The 'small amounts' and further legal requirements to stop prosecution are still defined differently in the regulations of the Land justice administrations. For cannabis it varies between 5 and 30 gram, for heroin between 0.5 and 6g. In the practice of courts and public prosecutors nation-wide more than 90% of all criminal procedures with a maximum of 10g cannabis are suspended however." (p. 8) ^aa

7. According to "Germany Drug Situation 2000," a report prepared for the European Union's European Monitoring Centre on Drugs and Drug Addiction, "While penalties for drug trafficking increased during the last years, other legal regulations comprise to depenalise drug users partially. Courts or prosecuting attorneys' offices should refrain from prosecution and judges should refrain from penalties, in case only minor guilt would be judged for the offender, only 'insignificant quantities' of drugs for personal use are involved, there is no public interest in prosecution and especially others are not endangered of have been harmed." (p. 12) ^aa

8. According to "Germany Drug Situation 2000," a report prepared for the European Union's European Monitoring Centre on Drugs and Drug Addiction, "Almost 2 million German citizens (4.5% in the West and 2.3% in the East) aged between 18 and 59 have used cannabis in the past 12 months. In Eastern Germany there is an increasing use of cannabis compared to the representative surveys in 1995. Recent use (last 12 months) is 2 times as frequent among men than among women and is much more widespread in younger age groups (18-39 years) 7.8% in the West and 4.5% in the East) than among elder people. The figures from the new Laender prove that cannabis use has already spread considerably there." (pp. 23-24) ^aa

9. According to "Germany Drug Situation 2000," a report prepared for the European Union's European Monitoring Centre on Drugs and Drug Addiction, "The use of drugs other than cannabis has become much more significant in comparison to previous years. This most probably is linked to an increasingly spread of ecstasy use. In spite of this, reported experiences with drugs mostly still related to cannabis use. Only around one third of all persons with drug experience, 6.8% of younger adults (18-39 years) in the West and 2.5% in the East report, having ever used a drug other than cannabis. Lifetime experiences with other illegal drugs can be found mostly between 1.3% (East) and 4.5% (West) (in case of heroin less than 1%) of the population. In the West amphetamines, ecstasy, LSD and cocaine are more frequently consumed, in the East ecstasy and amphetamines." (p. 24) ^aa

10. According to "Germany Drug Situation 2000," a report prepared for the European Union's European Monitoring Centre on Drugs and Drug Addiction, "With regard to experience with drugs (lifetime) among adults aged between 18 and 59, the latest representative surveys (Kraus & Bauernfeind 1998) reveal that in the old Laender 14.2% of the subjects have used illegal drugs during their lifetime. Taken as a proportion of the population as a whole, this corresponds to around 5.7 million adults with experience of drugs. Within this group there are plainly more men with experience of drugs (17.1%) than women (11.3%). In the group of younger adults aged between 18 and 39, the proportion of people with experience of drugs is as high as 21.5%. In the new Laender the prevalence rates are considerably lower. The figure for adults between 18 and 59 with experience of drugs is 4.8%, representing 400,000 people (240,000 men, 161,000 women). In this group the frequency of experience with drugs among men is almost 50% higher as among women. As in the old Laender, higher prevalence rates are found in the group of younger adults aged from 18 to 39. The corresponding proportion in the new Laender is 8.9%, more than half of the level in the old Laender." (p. 26) ^aa

11. According to "Germany Drug Situation 2000," a report prepared for the European Union's European Monitoring Centre on Drugs and Drug Addiction, "On the basis of the report from the AIDS centre of the Robert Koch Institute (http://hiv.rki.de) the proportion of drug addicts amongst new notified AIDS cases in 1999 was about 12% in Germany. In Hamburg and Baden-Wurttemberg its percentage of 34.6% and 26% was nationally at its highest (Table 12). Referred to a cumulative total number of 18,524 AIDS cases in the register the percentage is 14.9%. It has been possible to slow down substantially the spread of the HI-virus among drug users in the last years. Prevention measures, campaigns to discourage needle-sharing and innovations such as substitution and syringe-exchange programmes have clearly had an effect here." (p. 60) ^aa

12. According to "Germany Drug Situation 2000," a report prepared for the European Union's European Monitoring Centre on Drugs and Drug Addiction, "Sterile syringes can be bought cheaply in pharmacies. If drug users don't have money, the pharmacy is obliged to deliver cost free sterile syringes to them. They can also be handed out or exchanged at syringe machines or at syringe exchange services of the AIDS and drug help services. In some German cities general mobile needle exchange services for intravenous drug users are existing, in Hamburg for example there is a DROB-INN bus nearby the railway station. Also for the prevention of hepatitis in Germany measures to prevent infections are offered to drug addicts and persons at risk." (p. 105) ^aa

13. According to "Germany Drug Situation 2000," a report prepared for the European Union's European Monitoring Centre on Drugs and Drug Addiction, "Given the fact that about 80% of drugs addicts are unemployed, about 50% don't have any professional training, about 60 to 70% have no sufficient school education and about 20% do not have stable housing there are diverse areas of responsibilities. It has to be taken into consideration that the development of drug addiction was often accompanied by school or job failure, therefore qualification in this specific area is absolutely necessary in treatment of drug addiction. Facing about 60,000 treated drug addicts per year at least 30,000 offers in the field of re-integration should be available. In fact existing services in the field of occupation/ qualification can reach about 1,500 persons, in the field of education about 300 persons, in the field of housing about 2,000 persons and in the field of culture (theatre, music, arts etc.) about 200 persons at best." (p. 110) ^aa

Greece:

1. "In Greece, data from indirect indicators (treatment, deaths, low-threshold services) suggest that problem drug use is increasing." (p. 13) ^f

2. "Drug-free treatment seems to be dominating the treatment offered in Finland, Greece, Norway and Sweden. The tendency in those countries is to have shorter treatment periods of three to six months instead of one to two years, although in Greece the mean duration of treatment is 12 months." (p. 27) ^f

3. "Injecting drug use has decreased strongly during the 1990s in most, but not all, countries. As a consequence, rates of injecting drug use (measured among opiate users entering treatment) differ strongly, from a low of about 10% in the Netherlands to a high of about 70% in Greece." (p. 40) ^f

Netherlands:

1. Drug policy in the Netherlands is based on minimizing risk and reducing harm. That is why the use of cannabis (marijuana and hashish) is tolerated, as is the private personal cultivation of cannabis, and the sale of cannabis through coffee shops. ^b

2. Cannabis is not legal in the Netherlands per se. ^{b, e}

3. Hard drugs are not tolerated at all in The Netherlands, and trafficking of any kind can carry a stiff prison sentence. ^{b, e}

4. "In the Netherlands, cannabis use is not legalised, only tolerated by the authorities. According to the Opium Act, possession of marijuana for personal use is a crime. However, the law distinguishes between drugs, to ensure a separation of markets; substances are classified as 'hemp' (cannabis products) and 'drugs of unacceptable risk' (other drugs). Toleration of hemp has led to a number of 'coffee shops' coming into existence over the years. Under guidelines issued by the Public Prosecution Service in 1996, these will not be prosecuted for selling cannabis under certain conditions (no minors, no more than 5g, no nuisance, no advertising, no hard drugs). However, under Dutch law possession of drugs remains prohibited and punishable, particularly when above the tolerated quantities. The maximum sentence for the possession or sale of no more than 30 grams of hemp is 1 month in prison (and/or a fine), but a prison sentence of 4 years (and/or a fine) applies to imports and exports or professional cultivation. the maximum sentence for hard drugs is 1 year in prison (and/or a fine) for the possession of 'user quantities,' while it is 12 years in prison (and/or a fine) for imports or exports. These maximum sentences can be raised by one third if the offence has been committed more than once." (pp. 5-6) ^ff

5. "Drug policy in the Netherlands has four major objectives: (1) prevention of drug use and treatment and rehabilitation of addicts; (2) reduction of harm to drug users; (3) diminishing public nuisance caused by drug users (i.e. disturbance of public order and safety in the neighbourhood); and combating the production and trafficking of drugs."

Source: Trimbos Institute, "Report to the EMCDDA by the Reitox National Focal Point, The Netherlands Drug Situation 2002" (Lisboa, Portugal: European Monitoring Centre for Drugs and Drug Addiction, Nov. 2002), p. 7.

6. "Dutch drug policy gives priority to a public health approach. In some cases, this resulted in a certain degree of tolerance and non-prosecution, instead of strict law enforcement. We give some examples:
"• The Drugs Information and Monitoring System (DIMS): this service co-ordinates pill testing at special test locations (not at parties) to determine health risks, to get insight in available new drugs and in trends in substance use (see also 10). Participants of DIMS will not be prosecuted (Staatscourant 2000, nr.250).
"• Safe Injection Rooms/User Rooms: in some municipalities hard drug users can use drugs in protected rooms, specially created for them by the local authority (see also 10). Drug dealing in or around user rooms is forbidden (Staatscourant 2000, nr.250).
"• Coffee-shop policy: Coffee shops are alcohol free outlets resembling bars, pubs or cafés, where adults - eighteen years or older - may individually purchase cannabis up to five grams (Staatscourant 2000, nr.250). Yet, suppressing large-scale commercial production of cannabis is a high law enforcement priority."

7. "The number of opiate addicts in the Netherlands - between 26,000 and 30,000 - is stable, and low compared to other EU countries (2.6 per 1,000 inhabitants in the Netherlands; 4.3 per 1,000 inhabitants in France; and 6.7 per 1,000 inhabitants in the United Kingdom)."

8. Regarding drug use among young people aged 12-18, in 2002 the Trimbos Institute reported that "The use of illegal drugs is still low among this age group. Cannabis scores highest, but the use of hard drugs and synthetic drugs is almost non-existent in this age group and deaths and overdoses are rare. Cannabis use increased steeply from 1988 to 1996, but lifetime and last month prevalence stabilised afterwards (until 1999) at 19% and 15%. Boys are more frequent users than girls. The first experimental drugs for young people are predominantly tobacco and alcohol. This pattern remained stable over the last five years or even tended to decrease. Young alcohol users also use cannabis and tobacco more frequently."

9. Regarding drug use among people aged 12 and over in the Netherlands, the Trimbos Institute reported, "Prevalence rates for cannabis use were roughly twice as high among men than women (in 2001: LTP 21.3% vs. 12.8%; LMP 4.3% vs. 1.8%). This also applied to the percentage of users who ever tried hard drugs1 (LTP: 6.2% vs. 3.7%). However, there was no gender difference for the percentage of current users of hard drugs (LMP: 0.8%). Increases in use between 1997 and 2001 were evident both among men and women. Yet, the change in last month prevalence of ecstasy use was largely due to women (0.1% in 1997 and 0.5% in 2001)." (Note: LTP = Life Time Prevalence; LMP = Last Month Prevalence)

10. "Injecting behaviour among drug users in the Netherlands has decreased in the past decades.
"• From 1986 to 1998 the prevalence of injecting among drug users recruited in the Amsterdam cohort on HIV and AIDS declined from 66% to 36% (Van Ameijden & Coutinho, in press). This is largely due to increased injection cessation rates and reduced relapse into injection.
"• According to a recent cross-sectional study among young problem drug users in Amsterdam (mean age 25 years), 39% had ever injected drugs and 22% was a current injector (Welp et al., 2002). Compared to a sample of young drug users from the Amsterdam cohort study recruited between 1985 and 1989, a history of injecting had declined from 83% (1985-1989) to 56% (1998).
"• According to LADIS (2000) 13% of the opiate users in treatment was an injector."

11. The ratio of drug-related deaths in The Netherlands is the lowest in Europe. ^{h, q}

12. Violent crime rates in The Netherlands are much lower than in the US,q as is the rate of transmission of HIV/AIDS through injection drug use. ^q

13. The level of official corruption in The Netherlands, as reported by the watchdog group Transparency International and noted by the Dutch Ministry of Justice, is remarkably low, rating a better score in the Corruption Perception Index than the UK, Germany, and Austria, all of whom were rated as less corrupt than the US. ^{p, q}

14. "The government increasingly seeks the international debate. In December 2001, an international conference on municipal cannabis policies was organised by the Dutch Minister of Justice. This Cities Conference in Utrecht was attended by 120 participants from 50 European cities from 20 countries. It was concluded that in many of these cities a de facto policy of decriminalisation of the possession of small amounts of cannabis has taken place. Thus, the gap between official policy and practice is widening (Ministerie van Volksgezondheid, Welzijn en Sport, 2002a, p.17-18)."

15. "The Dutch parliament yesterday voted to decriminalize the wholesale trade in cannabis ..." ^d

16. According to a report in the British Medical Journal in September of 2000, "Cannabis use among Dutch schoolchildren aged 10-18 years has fallen for the first time in 16 years, a national survey of risk behaviour among 10,000 young people has shown." r The story notes that according to Trimbos, the Netherlands Institute for Mental Health and Addiction ( www.trimbos.nl ), "about one in five young people had used cannabis at some point in their lives but less than a tenth had used it in the previous four weeks ("current users")." ^r

17. According to "Netherlands Drug Situation 2000," a report prepared for the European Monitoring Centre on Drugs and Drug Addiction, "Cannabis is by far the most popular illicit drug in the Netherlands. The total number of cannabis users in the Netherlands is estimated at some 320,000. The estimated number of cannabis dependent persons may vary between 30,000 and 80,000. Until 1996 cannabis use showed a steep increase among pupils. However, between 1996 and 1999 prevalence rates stabilised. Prevalence rates of hard drugs, such as cocaine, amphetamines, ecstasy and opiates are much lower. Use of these drugs also stabilised among pupils. Changes in policies, availability, attitude or lifestyle have been put forward to explain these trends but the precise factors remain to be determined. Drug use is higher certain subpopulations [sic], including visitors to house-parties, discotheques and cafes (particularly ecstasy), young people with multiple psychosocial problems and (juvenile) delinquents in judicial institutions. There are indications that cocaine sniffing is increasing among 'outgoing' youth in Amsterdam. The number of opiate addicts is estimated at between 25,000 and 29,000. Most of these users also consume other substances. Cocaine is becoming the main drug in smal networks of (young) marginalised drug users." (p. 6) ^bb

18. According to "Netherlands Drug Situation 2000," a report prepared for the European Monitoring Centre on Drugs and Drug Addiction, "In all major Dutch cities syringe exchange services are available anonymously." (p. 8) ^bb

Portugal

1. The European Monitoring Centre on Drugs and Drug Addiction noted in its 2001 Annual Report on the State of the Drugs Problem in the EU that "In Portugal no penal sanctions will be applied to repress the private use of illicit substances after 1 July 2001 (law 30/2000 adopted in November 2000). The drug-use offender will instead be oriented to treatment or counseling by specific commissions." (p. 25) ^f

2. "In Portugal the law no. 30/2000, of 29 November 2000, introduced the decriminalisation of possession and use of all drugs, effective from 1 July 2001. The previous system considered use and possession as a criminal offence, sanctioned by penal measures. Now, if an individual is caught in possession of a modest quantity of drugs (below ten daily doses), and police have no further suspicions or evidence that more serious offences such as sale or traffic are involved, the drug will be seized and the case transmitted to a local Commission composed of 3 members (a lawyer, and two from a range of doctors, social assistants, and psychologists), supported by a technical team. The Commission meets the person in order to evaluate his/her situation and with the aim of eventually diverting the person from prosecution or sending them to treatment; sanctioning with fines, even if possible, is not the main objective in this phase. The procedures will be suspended following the first appearance in front of the Commission, provided the use is occasional or regular, but not habitual (addicted)." (p. 3) ^ff

3. According to "Portugal Drug Situation 2000," a report prepared for the European Union's European Monitoring Centre on Drugs and Drug Addiction, "From the issues concerning the legal framework, the decriminalisation of drug use stands out as the core axis of the new strategy, expressed in line with the rationality defined by the Legislator. However, this decriminalisation cannot be considered in an atomic way but rather inserted in a more wider context which aims at health promotion, risk reduction and rehabilitation of drug abusers. It seeks to avoid the stigmatisation of drug users, which will always result from the contact between them and the criminal justice system. This is not a decriminalisation by omission but rather a constructive decriminalisation project from which a new policy dynamics based on drug use will emerge. The National Strategy points the way to maintaining the disapproval of drug use, as the offence leaves the criminal sphere to enter the administrative one. In practical terms, possessing or using drugs will not lead the individuals to the criminal territories, as the social criticism will be circumscribed to the imposition of administrative sanctions." (pp. 67-68) ⁱ

4. According to "Portugal Drug Situation 2000," a report prepared for the European Union's European Monitoring Centre on Drugs and Drug Addiction, "Between 1992 and 1998, lifetime use prevalence of tobacco, beer and wine - the most widely used substances - decreased. In the secondary level less than 8% of students experienced tobacco and beer, and less than 5% experienced wine, and in the final basic level, this decrease was even higher reaching 11% for tobacco, 13.5% for beer and 7% for wine. However, in the secondary level, the higher use prevalence refers to spirits/distilled drinks: 785 of the students had already used them and 74% had used beer. Thus, in 1998, around 3/4 of the secondary classes' students had already used drinks with a very high alcohol level (gin, vodka, whisky, etc.). In the final basic level those values indicate that 44% of the students had already tried beer and 40% had already used distilled drinks (therefore, a little less than half the students." (p. 17) ⁱ

5. According to "Portugal Drug Situation 2000," a report prepared for the European Union's European Monitoring Centre on Drugs and Drug Addiction, "In secondary school, tranquillisers and cannabis have similar lifetime use prevalence (around 15% and 19%, respectively) with no (significant statistic) variation between 1992 and 1998. Concerning stimulant use prevalence, they also remained constant at 6% during the same period. In the final basic level, tranquillisers presented the higher lifetime use percentages (around 10%), whereas the percentage of students who had already used cannabis or stimulants was close to 4%. In the night classes, in 1998, the higher use prevalence went to tranquillisers (26%) followed by cannabis (20%) and stimulants (8%).... Concerning recent use, it is possible to verify that the respective use prevalence show rather lower values and that they remained stable between 1992 and 1998. Thus, in the last 30 days before the survey - Chart 2.1 - in secondary school, 6% were cannabis users, 5% were tranquillisers users and 1% were stimulant users. In the final basic level 2% were cannabis and tranquillisers users and 1% were stimulants users. In night classes, in 1998, those values were of 7% and 1%, respectively." (p. 17) ⁱ

6. According to "Portugal Drug Situation 2000," a report prepared for the European Union's European Monitoring Centre on Drugs and Drug Addiction, "The National Commission for the Fight Against AIDS (Comissao Nacional de Luta Contra a SIDA), in cooperation with the National Association of Pharmacies (Associacao Nacional de Farmacias), implements the national syringe exchange programme 'Say no to a second hand syringe' which was set up in October 1993 to prevent HIV spread amongst IV drug users. It currently involves approximately 2,175 pharmacies nation-wide and 3 mobile centres: 1 at Casal Ventoso, 1 in Curraleira (another problematic neighbourhood in Lisbon) and 1 in the Algarve.... The programme is also being enlarged through protocols with several organisations which will also ensure clinical care and support, HIV and other infectious diseases detection, meals, psycho-social support, legal support and referral to other health care services. Those new partners include drop in centres for prostitutes and for the homeless and other low threshold programmes." (p. 52) ⁱ

Spain

1. "It is not a crime in Spain to possess drugs for personal use but is a serious administrative offence. It is unlikely to be punished unless committed in public." ^h

2. In Spain since 1992, "possession for personal use of all drugs has not been subject to criminal prosecution. Nevertheless, when a person is caught in possession of a modest quantity of drugs and police have no further suspicions or evidence that more serious offences are involved, such as sale or traffic, the drug will be seized. The case will then be transmitted to the administrative authorities, so the person will receive a notification to attend a meeting with them. If found guilty of possession of drugs for person use, they will be charged with a fine ... especially if presenting signs of addiction, the person is invited to follow counseling or treatment." (p. 3) ^ff

3. According to "Spain Drug Situation 2000," a report prepared for the European Union's European Monitoring Centre on Drugs and Drug Addiction, "Cannabis is the most frequently used illegal drug in Spain. According to the Door-to-door Survey on Drug Abuse in 1999, 19.5% of the Spanish population aged between 15-64 had tried cannabis at some time in their lives (21.7% in 1997), 6.8% in the last year (7.5% in 1997) and 4.2% in the last month (4% in 1997). These figures give the impression that the number of sporadic users of this drug had fallen slightly, but not the number of frequent consumers (monthly or daily)." (p. 40) ^g

4. According to "Spain Drug Situation 2000," a report prepared for the European Union's European Monitoring Centre on Drugs and Drug Addiction, "Annual use prevalence of ecstasy among the Spanish population aged between 15-64 decreased from 1.3% in 1995 to 0.9% in 1997 and 0.8% in 1999, and that of amphetamines or speed dropped from 1.1% in 1995 to 0.9% in 1997 and 0.7% in 1999, LSD other hallucinogens falling from 0.9% in 1997 to 0.6% in 1999." (p. 41) ^g

5. According to "Spain Drug Situation 2000," a report prepared for the European Union's European Monitoring Centre on Drugs and Drug Addiction, "Data regarding use of heroin or opiates in Spain, provided by the National Door-to-door Survey on Drug Abuse, situate their prevalence levels in 1999, at 0.6% and 0.1% respectively, for the indicators 'at some time during their lives' and 'last month' among those members of the Spanish population who are aged over 15." (p. 18) ^g

6. According to "Spain Drug Situation 2000," a report prepared for the European Union's European Monitoring Centre on Drugs and Drug Addiction, "In 1999, 3.1% of those members of the Spanish population aged between 15 and 64 had tried cocaine at some time during their lives and 1.5% in the last year (DGPNSD 2000a). Consumption levels are appreciably higher among younger people, the 15 to 29 age interval having prevalence levels of 4.5% and 2.8% respectively for the same periods of time. The early ages at which cocaine use begins is confirmed by the fact that in 1998, 4.8% of Spanish students aged between 14-18 had consumed it at some time during their lives and 4.1% in the last year (DGPNSD 2000d)." (DGPNSD 2000a: Delegacion del Gobierno para el Plan Nacional Sobre Drogas, Encuesta Domiciliaria Sobre Use do Drogas 1999, Ministerio del Interior. 2000d: DGPNSD, Encuesta Sobre Drogas a Poblacion Escolar, Minsterio del Interior.) (pp. 18-19) ^g

7. According to "Spain Drug Situation 2000," a report prepared for the European Union's European Monitoring Centre on Drugs and Drug Addiction, "There is still a high proportion (prevalence) of intravenous drug users infected by the AIDS virus (HIV). According to the Survey on Heroin Users in Treatment, in 1996, of those heroin users admitted for treatment 77.4% had taken the VIH antibody detection test, and of these 22.7% were found to be seropositive, regardless of the pathways used to administrate the drugs. The prevalence of seropositivity to HIV was the highest (32%) among those heroin addicts who had injected drugs at some time during their lives." (p. 26) ^g

8. According to "Spain Drug Situation 2000," a report prepared for the European Union's European Monitoring Centre on Drugs and Drug Addiction, "Syringe exchange programmes and sanitary kits have also increased and covered a greater number of users. A total of 408 programmes have been operating in 1999, where 12 social emergency centres, 23 mobile units, 385 chemist's shops, and 92 other centres have participated. The total number of syringes and/or sanitary kits delivered is approximately 3,783,361." (p. 55) ^g

Sweden:

1. "Sweden has a restrictive policy on drugs (Proposition 2001/02:91. Nationell narkotikahandlingsplan); This was established already in 1968 when a drug policy bill was agreed upon in the Parliament, a year before a national Committee on the Treatment on Drug Abusers was ready to present its final report and recommendations on co-ordinating measures (SOU1969:52). A year before, 1967, an incident in a project with free prescriptions to drug abusers in Stockholm led to an intense debate in media and the closure of the project. This project was started in 1965. That was also the starting point for a project in the Central House of Detention in Stockholm, where Professor Nils Bejerot, by noting and counting fresh needle marks among new detainees wanted to demonstrate that the free prescription project would cause an increased prevalence of drug abuse in society. His views were much debated. Together with apprehensions of an escalating drug problem and in accordance with a restrictive alcohol policy the course was set."

Source: Swedish National Institute of Public Health & Swedish Council for Information on Alcohol and Other Drugs, "National Report: Sweden 2002" (Lisboa, Portugal: European Monitoring Centre for Drugs and Drug Addiction, 2003), p. 9.

2. "Between 1917 and 1955 Sweden had an alcohol rationing system, and even today embraces a comparatively restrictive alcohol policy. This tradition makes a restrictive drug policy a logical option." ^b

3. According to the Sweden's 2002 national drug report to the European Monitoring Centre for Drugs and Drug Addiction, "During the 1990s there has been reduced funding in this field [drugs] and at the same time there has been an increase in the availability of drugs with a corresponding increase in lifetime prevalence of drug use among young people. However, the annual school survey in grade 9 made during the spring showed a decrease in use of alcohol, drugs and tobacco. This decrease was the first in more than a decade. "There are indications that the number of problematic abusers has increased in this period and also that the social services are less informed about their whereabouts and conditions than they used to be. There are also fewer specialised agencies involved."

4. Swedish authorities report that drug use in Sweden is on the rise. The Swedish Council for Information on Alcohol and Other Drugs (CAN) reported in 2001 that among 15-16 year olds for all illicit drugs, "In 2000 10% of the boys, and 8% of the girls reported lifetime prevalence." Additionally, "In 1999 3% of the 9th year school students and military conscripts had used an illicit drug within the last 30 days. Some 5% of persons aged 16-24 have reported drug use during the last 12 months in telephone interviews." (p. 44) ^o

5. According to the Sweden's 2002 national drug report to the European Monitoring Centre for Drugs and Drug Addiction, "Indicators such as seizures (amounts as well as number of seizures), prices on the street and anecdotal data from users unanimous tell the same story: supply is more generous and prices lower than ever. The variety of drugs has also expanded during the 90s and now follows what happens in the rest of the EU."

6. According to the Sweden's 2002 national drug report to the European Monitoring Centre for Drugs and Drug Addiction, "With start in the early 1990s, an increase in lifetime prevalence of drugs has been observed among youths. In grade 9 (15-16 year) this has meant a gradual change from 4 % among boys and 3 % among girls to 10 and 9 % in 2001. This upward trend still holds true for the 18 year old male military conscripts. Recent data (2000) from the repeated study among 16-24 years old also indicate an ongoing increase at the national level.
"However, the school survey in grade 9 in 2002 points in a new direction. For the first time since 1990 the figures are mowing down. In 2002 8 % of the boys and 8 % of the girls stated that they had tried a drug. The number of smokers has also gone down since last year; for boys from 30 to 25 %, and for girls from 36 to 34 %. This is preliminary data from the 2002 school survey (CAN 2002a), which is made with the same methodology as the ESPAD survey."

7. According to the Sweden's 2002 national drug report to the European Monitoring Centre for Drugs and Drug Addiction, "About 12 % of the general population aged 15-64 reports lifetime prevalence for drugs. Lifetime prevalence is slightly higher in the age group 15-34 compared to the total. This is an indication that people nowadays 40 to 50 years old tried drugs during their adolescence at a time when drugs, mostly cannabis, were spread in wider circles. Broken down to 25-34 and 35-44 years we find those with the greatest lifetime prevalence, namely 17 %. Persons over 55 very seldom have tried drugs. The proportion of drug experienced in the 15-24 and the 45-54 year group were 11 %.
"Telephone interviews are made among young persons aged 16-24. In the years 1996, 1998 and 2000 it was relieved that 9, 11 and 13 % had used drugs. The methodology used differs from that used in the previous surveys, so direct comparisons cannot be done.
"Less than 1 % of all respondents 15-64 have used drugs during the latest twelve months. In surveys in 1998 and 2000 respondents also were asked if they had used drugs the latest 30 days. Practically none had done that."

8. According to the Sweden's 2002 national drug report to the European Monitoring Centre for Drugs and Drug Addiction, "Reported lifetime experience [of an illicit drug] was highest in the early 1970s, about 15 %. It thereafter dropped to about 8 % and in the late 1980s it reached its lowest level at 4 %. From that level it has again raised and was 9 % (10 % for boys and 8 % for girls) in 2001 (Andersson 2000). In 2002 figures went down for the first time in a decade (CAN 2002a). This year 8 % have tried drugs (same proportion for boys and girls). Figures for alcohol and tobacco also went down. Analysis of the measurement is ongoing and an explanation of this eventual break in the trend must wait.
"Cannabis is the most commonly used drug, and in about 2/3 of the cases the only drug used. About 1 % has experience of amphetamine, ecstasy and LSD.
"Last month prevalence was reported by about 3 % during the 1970s. After that it has been lower, in 1994 1 %. From that point it has increased to 3 % among boys and 2 % among girls the last two years. The survey in 2002 is not fully analyzed and published."

9. According to the Sweden's 2002 national drug report to the European Monitoring Centre for Drugs and Drug Addiction, "The number of persons suspected of offences against the Narcotic Drugs Act and the Goods Smuggling Act (only drugs included) has continuously been increasing since the middle of the 1980s. A total of 6 567 suspected persons were reported during 1985 and in 2000 the corresponding figure was 12 545 persons."

10. "Throughout the 1990s the seizures of several drugs have increased. Particularly seizures of amphetamines and heroin have gone up significantly during the period, in numbers but also in kilos. Increase in seizures holds true also for LSD, ecstasy and cocaine, but at much lower and more fluctuating levels.
"Heroin and amphetamine prices have decreased significantly during the decade. Ecstasy and LSD prices fluctuate and the price intervals reported are considerable, probably due to limited availability. Cocaine and cannabis prices remain relatively unchanged and also the cannabis seizures have more or less hovered during the 1990s, both in numbers and size (apart from the very high figures of 1999).
"To sum up: availability of particularly heroin and amphetamines seem to have increased during the 1990s and there are no signs of this these trends to taper off."

11. "A quite obvious trend observed in regular national surveys during the 1990s is the increase in lifetime prevalence of drugs among Swedish teenagers. Among students in grade 9 (15-16 yearolds) the lifetime prevalence of drugs increased from 3 % in 1989 to 8 % in 1999, 9 % in 2000 and 2001 (boys 10 % and girls 9 %). During the last three years the lifetime figure has been pretty stable, though. The increase among girls seems to have halted since 1996 while boys still show a small increase. The school survey in 2002 might point in another direction, as only 8 % (both boys and girls) had used drugs. This drop is accompanied with corresponding drops in use of alcohol and tobacco too.
"The upward trend continues among older teenagers however. In the early 1990s, 6 % of the 18-year old male military conscripts had tried drugs at any occasion and the corresponding figure for 1999 and later was 17 %. Similar increases among older teenagers have also been noted in studies done by various polling institutes as well as in repeated local studies. Also recent use (last year, last 30 days prevalence) have increased among teenagers during the 1990s, even though the figures have not yet reached the levels of the first half of the 1970s."

12. "The Swedish unemployment rates were rather low during the 1970s and the 1980s. During the first half of the 1990s unemployment rates reached relatively high levels, especially among youths (16- 24 years). In the late half of the 1990s the figures have decreased, but the unemployment rates 1998 was still four-folded compared to 1989. One possible reason for increases in drug use among younger people, apart from an increased supply, is problems connected to social exclusion and high levels of youth unemployment. Negative future prospects, at least for certain groups of youths, might be a reason for not giving up experimentation with drugs, which in turn might lead to long lasting severe drug use.
"During the 1990s there has been financial cut downs within the general welfare systems as well as in special forms of treatment (walk in clinics, therapeutic communities, etc). This might have had impact both on recruitment of new drug users who fall through the welfare net but also on the possibilities to offer drug users appropriate treatment. Statements from social workers, policemen, hospital staff and others sometimes indicates that the group of severe drug users are worse off nowadays, regarding economic and health aspects."

13. According to the Sweden's 2002 national drug report to the European Monitoring Centre for Drugs and Drug Addiction, "Harm reduction in its usual definition is not in practice. In conflict with the restrictive policy two needle exchange programmes exist. They are situated in Scania (Lund since 1986 and Malmö since 1987) on clinics for infectious diseases as a reaction on an expected HIV-epidemic at that time. The National Drug Coordinator will present a recommendation on the programmes future in February 2003. One alternative is to close them down."

14. Swedish drug use data reports define severe drug abuse as "all intravenous drug abuse, regardless of substance, and all daily or near-daily drug abuse, regardless of how the substance is taken." (p. 43) According to CAN's 2001 report on drug abuse, in 1998 "the number of abusers was estimated at 26,000 (with the interval between 24,500-28,500)." (p. 45) It is further estimated by CAN that in 1998: 47% of the 'severe drug abusers' had used heroin in the last year, and only 28% of the 'abusers' had opiates as their primary drug. 73% of the 'severe drug abusers had used amphetamine in the last year, and 32% had amphetamine as their dominant drug 54% of the 'severe drug abusers' had used cannabis in the last year, but only 8% had cannabis as their dominant drug. 89% of the 'severe drug abusers' had injected drugs within the last year. (p. 46) ^o

15. "Since drug use is prohibited with a maximum of six months imprisonment, the police are allowed to conduct drug tests (blood or urine) if there is reasonable cause to believe that a person is under the influence of drugs, however not on persons younger than 15 years old. The conservatives have however suggested a change in the legislation so that also these persons could be tested." (p. 13) ^t

Switzerland

1. Switzerland takes a four-fold approach to drug policy, including law enforcement, prevention, addiction therapy, and harm reduction. (pp. 5-7) ^cc

2. The Swiss government sponsors a program of limited heroin assisted treatment for heroin users. According to the Swiss Federal Office of Public Health, "It has emerged that heroin-assisted treatment is a suitable option only for a small proportion (currently 4%) of the 30,000 severely dependent injecting drug users. Heroin-assisted treatment is not a replacement for other substitution or abstinence-based therapies, but an important addition for those drug users that have so far fallen through the therapeutic net. This is confirmed by the relatively modest increase in patient numbers since the bar on the legally permitted maximum number was lifted." (p. 2) ^dd

3. "The federal government also provides recommendations from experts concerning oral methadone treatment and supports the evaluation of this type of treatment. About 15,000 drug-addicts follow a methadone maintenance program, about half of them at private doctors, the rest in specialized clinics." (p. 7) ^cc

4. "For the last 15 years, the federal government has therefore been supporting a variety of measures (e.g. needle-exchange programs, injection rooms, housing and employment programs) in order to improve the health and the lifestyle of drug addicts and to prevent the spread of HIV and other infectious diseases. Compared with the late 1980s, the incidence of new HIV infections among drug addicts has decreased significantly." (p. 7) ^cc

5. Switzerland is preparing to legalize marijuana and hashish. ^m

6. The Manchester Guardian reported in October 2000, "Switzerland is preparing to introduce legislation that effectively would allow the consumption of cannabis, adding to the country's pioneering but controversial record on drugs policy. The Swiss government said it would draw up legislation next year after consultation among local authorities and community associations revealed that there was widespread support for decriminalising cannabis. "'Two-thirds of the organisations consulted said they were in favour of this move,' the interior minister, Ruth Dreifuss said yesterday.
"But the same groups opposed any such move on hard drugs, and officials ruled out softer laws on possessing or using such substances.
"Switzerland has the most liberal approach in Europe towards the treatment of heroin addicts. Since 1998 it has been providing clean needles and allowing the distribution of heroin to addicts under strict medical supervision." ^c

United Kingdom

1. "The UK drug strategy sets out four key aims. These are: To help young people resist drug misuse in order to achieve their full potential in society. To protect our communities from drug-related anti-social and criminal behaviour. To enable people with drugs problems to overcome them and live healthy and crime free lives. To stifle the availability of illegal drugs on our streets." (p. 6) ^ee

2. "Since 1998 the government has provided additional funding to increase the number of drug using offenders engaged with treatment services. This included the introduction of Drug Treatment and Testing Order pilot schemes. Under this order courts may, with the offender's consent, make an order requiring the offender to undergo treatment either as part of another community order or as a sentence in its own right. It is envisaged that such schemes will be available in all courts in England and Wales by 2001. Police forces in England and Wales are also operating Arrest Referral Schemes whereby problem drug users are identified and encouraged to take up appropriate treatment. These schemes are also currently being expanded, with the target of 100% coverage of all police stations by 2002." (p. 8) ^ee

3. "Throughout 1998 and 1999 an inquiry into the Misuse of Drugs Act 1971 was carried out under the auspices of the independent research charity, the Police Foundation (Police Foundation 2000). The Inquiry team, chaired by Viscountess Runciman, considered changes which have taken place in UK society since the introduction of the Act in 1971 and assessed whether the law as it currently stands needs to be revised in order to make it both more effective and more responsive to those changes.... The Police Foundation report recommends that certain changes be made to the classification of drugs, for example whilst heroin and cocaine would remain in Class A (the most dangerous category) ecstasy and LSD would transfer to class B and cannabis would become a class C drug. The report does not call for any drug currently covered by the Act to be legalized. The report also suggests that changes be introduced to the penalties for possession of drugs, that laws against dealers and traffickers be strengthened, and that a significant shift in resources towards treatment services be made." (p. 8) ^ee

4. The United Kingdom officially downgraded the classification of cannabis from Class B to Class C effective Jan. 29, 2004. The London Guardian reported that "Under the switch, cannabis will be ranked alongside bodybuilding steroids and some anti-depressants. Possession of cannabis will no longer be an arrestable offence in most cases, although police will retain the power to arrest users in certain aggravated situations - such as when the drug is smoked outside schools. The home secretary, David Blunkett, has said the change in the law is necessary to enable police to spend more time tackling class A drugs such as heroin and crack cocaine which cause the most harm and trigger far more crime."

Source: Tempest, Matthew, "MPs Vote To Downgrade Cannabis," The Guardian (London, England), Oct. 29, 2003.

5. "Data from the 2001/2002 sweep of the British Crime Survey (Aust et al, 2002) shows 'ever use' for adults aged 16-59 is unchanged from the previous year. In the 2001/2002 and 2000 survey 34% of 16-59 year olds had ever used an illicit drug compared to 32% in 1998, 29% in 1996 and 28% in 1994 (Aust et al, 2002).
"12% of adults aged 16-59 had used drugs in the last 12 months in 2001/2002 compared to 11% in 2000 and 1998, and 10% in 1996 and 1994. Reported illicit drug use in the last month for 16-59 year olds in 2001/2002 increased to 8%, compared to 6% in all the previous sweeps of the survey (1994-2000). Most of this reported drug use is accounted for by cannabis (Aust et al, 2002)."

Source: DrugScope, "Report to the EMCDDA by the Reitox National Focal Point: United Kingdom Drug Situation 2002" (Lisboa, Portugal: European Monitoring Centre for Drugs and Drug Addiction, 2003), p. 22.

6. According to the 2002 report on the drug situation in the United Kingdom prepared for the European Monitoring Centre for Drugs and Drug Addiction, "49% of 16-24 year olds in 2001/2002 reporting ever using an illicit drug compared to 52% in 1998. For 16-24 year olds drug use in the last 12 months has decreased from 30% in 1998 to 29% in 2001/2002. For the same age group drug use in the last month has remained stable at 19% in 1998 and 19% in 2001 (Aust et al, 2002)."

7. "Preliminary results from the 2001 'drug use, smoking and drinking among young people in England' by the National Centre for Social Research and the National Foundation for Educational Research, show that 12% of pupils aged 12-15 had used drugs in the last month and 20% had used drugs in the last year. Between 1998 and 2000, last month drug use among young people aged 11-15 increased from 7% to 9% and last year use increased from 11% to 14%. A revised method of measuring prevalence was used in 2001 and thus the data between 2001 and previous years are not strictly comparable. It is likely though that drug use has remained stable or slightly increased from 2000 (NCSR & NFER, 2002).
"As in previous years, cannabis was the most likely drug to have been used with 13% of pupils aged 11-15 having used it in the last year. Use of cannabis in the last year among boys was slightly higher (at 14%) than girls (12%). Cannabis use increased sharply with age with 1% of 11 year olds having used the drug in the last year compared to 31% of 15 year olds. Again, this is similar to results from 2000 (NCSR & NFER, 2002)."

8. "The most recent estimate of problem drug use in the UK relates to 1996. Current studies will provide new estimates in 2003 as well as figures for smaller (Drug Action Team) areas. Recent work has been undertaken to provide more accurate figures for 1996 (Frischer et al., 2001). This work looked at estimates using three different types of methodology. The findings estimate that in England, Scotland and Wales:
"- 143,000 people are at risk of mortality due to drug overdose;
"- 161,000 to 169,000 people have ever injected drugs;
"- 202,000 are opiate users;
"- and 266,000 are problem drug users."

9. "Estimates of problem drug use suggest that prevalence of problem drug use is between 3 to 4% for the London districts of Lambeth, Southwark and Lewisham, Camden and Islington, and Newham. Further there may be as many as 266,000 problem drug users in Great Britain as a whole." (p. 10) ^ee

10. "Two in five injectors in England and Wales are infected with hepatitis C antibody. In Scotland and England and Wales, there is a clear relationship between prevalence of infection and duration of injecting career, indicating that harm reduction initiatives may be having an impact on hepatitis C transmission. A total of 56% of all known cases of hepatitis C in Scotland (10,161) were known to have ever injected drugs (Codere and Shaw 2000)." (p. 10) ^ee

11. "The number of drug offenders increased by 13% to 127,900 in 1998. 90% were possession cases, mainly of cannabis. There was an increase of 32% in the number of cocaine offenders (excluding crack ones) to 4,400, of 30% in the number of heroin offenders to 11,400, and of 13% in cannabis offenders to 97,200." (p. 10) ^ee

12. "In 1998 there was a modest fall in the proportion of offenders cautioned to 47%, 23% were fined and 8% sentenced to immediate custody. The number of persons given immediate custodial sentences rose by 4% compared to a 19% increase between 1996 and 1997." (p. 10) ^ee

13. "Relatively high proportions of prisoners reported using heroin during their current stay in prison -- 10-20% of prisoners in England and Wales, and 31% in Scotland." (p. 10) ^ee

14. "A recent survey of syringe exchange provision in the UK suggested that in 1997 an estimated 2,320,000 syringes were distributed by approximately 2,300 outlets in England, Scotland and Wales (J. Parsons, personal communication). No syringe exchanges in Northern Ireland were identified. Syringe exchanges distributed large numbers of syringes and are probably in contact with more injecting drug users than any other intervention." (p. 45) ^ee

15. According to Viscountess Runciman, chair of a panel of the British Police Foundation which looked into the drug laws, the UK "has a far more severe regime of control over possession offences than most other European countries". ^h

16. "A marijuana-based medication for people suffering from multiple sclerosis and severe pain is expected to be approved for sale in Britain early this year, British officials say. The drug, Sativex, developed by GW Pharmaceuticals, a British company, is a liquid extract from marijuana grown by the company under license from the government. Developed to be sprayed under the tongue, it would be the first drug in recent decades to include all the components of the cannabis plant, advocates of medical marijuana say."

Source: Tuller, David, "Britain Poised To Approve Medicine Derived From Marijuana, New York Times (New York, NY), Jan. 27, 2004.

United States

1. "The National Drug Control Strategy proposes a ten-year conceptual framework to reduce illegal drug use and availability 50 percent by the year 2007." ^l

2. "In the United States, whose legislation serves as a model for international drug control agreements and which claims the leadership of the global antidrug fight, the war 'on drugs' is one of the main reasons for a rapid and dramatic increase of the prison population that started in the mid-1980s." ^k

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^ee Report to the European Monitoring Center on Drugs and Drug Addiction by the Reitox National Focal Point of the United Kingdom, DrugScope, "United Kingdom Drug Situation 2000" (London, England: DrugScope and EMCDDA, 2000).
^ff "Decriminalisation in Europe? Recent Developments in Legal Approaches to Drug use" (Lisbon, Portugal: European Monitoring Centre on Drugs and Drug Addiction, November 2001), available on the web at http://eldd.emcdda.org/databases/eldd_comparative_analyses.cfm

For additional information on European drug policies, check out the European Monitoring Centre on Drugs and Drug Addiction at http://www.emcdda.org.