2006 NATIONAL REPORT (2005 data) to the EMCDDA by the Reitox National Focal Point. Denmark

Transcription

1 2006 NATIONAL REPORT (2005 data) to the EMCDDA by the Reitox National Focal Point Denmark New Development, Trends and In-Depth Information on Selected Issues

2 Preface This year s report on the drug situation in Denmark has been prepared by the National Board of Health, the Danish Focal Point. The report was written in the autumn of 2006 to be submitted to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). The report is available in a Danish as well as an English version in accordance with EMCDDA guidelines. The report provides an overview of the drug situation in Denmark. It is based on the most recent statistic and epidemiological data as well as current information on focus areas, projects, activities and strategies within drug prevention, harm reduction and treatment of drug users. In addition, the report provides an outline of applicable Danish law and politics within the drugs area. Ms Kari Grasaasen, sociologist, has had the coordinating responsibility for the report and prepared the chapters on epidemiology as well as the theme chapter on cocaine. Mr Bent Ulrikkeholm, consultant, has prepared the chapter on prevention and Ms Helle Petersen, staff specialist, and Mr Christian Hvidt, senior hospital physician, have jointly prepared the chapter on the health-related interventions in relation to drug use. Ms Inger Marie Bernhoft, senior scientist, has prepared the theme chapter on Medicine and illicit drugs trafficking and Professor Svend Sabroe has written the theme chapter on Drug Use among the under 15s. The remaining chapters of the report include written contributions from the National Board of Health s statistics office, the Danish Ministry of Justice, the Ministry of Social Affairs, the Ministry of the Interior and Health, the counties and other cooperative partners. The Danish member of EMCDDA s Scientific Committee, Ms Anne Marie Sindballe, expert consultant, and a reading panel appointed by the National Board of Health have provided their comments and constructive criticism. Set up and proofreading has been made by Ms Birgitte Neumann, the National Board of Health, and the English translation of the report has been made by Ms Anita Pontoppidan, LinguaMedica Medical Translation Agency. November 2006 Else Smith Head of Centre

3 Table of Contents Table of Contents 5 Summary 8 1 Background to Denmark's drug strategy Overview/summary New legal framework, including new drugs under control Institutional framework, strategies and policies Budget and public expenditure Social and cultural context 14 2 Drug use in the population Overview/summary Drug use in the population Drug use in the school and youth population 19 3 Prevention Overview / summary Universal prevention - school Prevention in the community 23 4 Problem drug use Overview/summary Estimated number of drug users in Denmark Profile of clients in treatment Methadone treatment and prescription 33 5 Drug-related treatment Overview/summary Treatment system Support and contact person scheme Fund for improving social measures for treating drug users Inpatient treatment Women receiving drug treatment Developing quality assurance for treatment 39 5

4 6 Health correlates and consequences Overview/summary Drug-related deaths and mortality rate among drug users Poisoning from illicit drugs Drug-related infectious diseases Co-morbidity and drug users in psychiatric treatment 49 7 Responses to Health Correlates and Consequences Overview / summary Prevention of drug-related deaths Prevention of infectious diseases among drug users Measures related to psychiatric co-morbidity Measures related to other health issues 55 8 Social correlates and consequences Overview/summary Social exclusion and problems Drug-related crime 60 9 Responses to social correlates and consequences Overview / summary Homelessness and accommodation services Education programmes Employment programmes and benefits Counselling programmes Prevention of drug-related crime Drug market Overview / summary Drug accessibility and demand Drug seizures Drugs and related problems among under 15s Introduction Alcohol and drug abuse among children under Children at risk and drug-using parents Policy and legislation relating to young people involved with drug abuse79 6

5 11.5 Prevention and treatment of young people with drug abuse problems Cocaine Introduction Experimental use of cocaine Problems and harmful effects resulting from the use of cocaine Treatment and prevention of cocaine use Effect of medicines and illicit drugs when driving Introduction Scope of the problem when driving Scope of the problem in traffic accidents Risk of accident Road Traffic Act and police checks Prevention Conclusion 92 Annex 93 List of references 93 Websites 97 Supplementary tables 98 List of tables 103 List of figures 104 Studies used 106 7

6 Summary The current drug situation in Denmark The National Board of Health has made an estimate on the number of drug users in Denmark, which shows that in 2005 there was an estimated 27,000 drug users, of which 7000 alone were cannabis users. The estimated number of drug user in Denmark has thus been stable since The estimate does not include experimental drug use, but includes the number of individuals with a more constant use of drugs leading to physical, mental and/or social injuries. Actual drug addicts are thus included in the estimate, including the stabilised drug addicts (e.g. individuals in methadone treatment). At the same time, more recent national studies agree that the experimental use of cannabis as well as other illicit drugs has reached a high, however stable level. This current stabilisation follows in the wake of dramatic increases in the use of illicit drugs in the years up to Cannabis continues to be the single most widespread illicit drug, followed by amphetamine, cocaine and ecstasy in the sequence mentioned. The experimental use of illicit drug continues to be a phenomenon primarily occurring during the years of adolescence. Use primarily takes place within the group of year-olds and peaks among the year-olds. Very few young people embark on drug use after the age of 20 years. Although the national studies document overall stability, there is a trend towards minor discrepancies within the choice of drugs. Studies carried out in schools (ESPAD), among the young people (MULD) and among the young adolescent (SUSY) shows small, however significant increases in the use of cocaine. Cocaine thus appears to be the only drug on the increase, but to this end it should also be mentioned, that the young people s use of other drugs, such as amphetamine and ecstasy have decreased similarly. The small increase in experimental use of cocaine is observed concurrently with the increasing supply on the market measured by police confiscations. There still appears to be increases in the number of injurious effects from drug use, although a halt has been observed in increases, especially in the number of individuals seeking treatment for their drug use. A total of 13,316 persons were admitted to treatment for drug use in 2005, which was 1.2% more than in Previously, increases in the number of persons admitted to drug treatment have been somewhat higher, i.e. 13.9% from 2002 to 2003 and 7% from 2003 to The proportion of drug users admitted to treatment for the first time in 2005 accounted for 30% of all admitted to treatment in 2005 (1578 out of a total of 5228 persons). Especially the young population make up the new group of individuals admitted to drug treatment, and typically their problems relate to cannabis and/or central stimulants. In 2005, almost half (49%) of the young people between the age of 18 and 24 years in drug treatment had cannabis as their main drug in terms of use, whereas 11%, 7% and 2% of the young people are being treated for amphetamine, cocaine and ecstasy, respectively, as their main drug. In addition to the increasing use of illicit drugs up through the 1990s, the assumption is that the increased treatment capacity, treatment guarantee and better and more targeted treatment programmes contribute to the documented increase in injuries resulting from drug use, which is apparent from treatment statistics. 8

7 Also the data on individuals admitted to psychiatric wards suggest a constant flow of new admissions of individuals with drug-related problems, especially in relation to cannabis. Almost half (908 out of a total of 2102) of the psychiatric admissions with a drug-related secondary diagnosis involve cannabis, and from 1996 to 2005 the number of such admissions doubled. The central stimulants, including cocaine, are an increasing element contributing to the psychiatric admissions, although the number of these admissions is much lower than the cannabis-related ones. Statistics on visits to emergency departments due to poisoning from illicit drugs shows a trend of an increasing number of poisonings from illicit drugs and particularly central stimulants. The young people typically present with poisonings caused by cannabis and central stimulants, whereas opioids and polydrug use typically are drugs causing poisoning among the older age groups. These figures are, however, minimum figures due to diverse registration practice and imprecise diagnostics. The number of registered drug-related deaths in 2005 is similar to those of 2004 accounting for 275 in both years. This figure is somewhat higher than in the years , with approximately 250 deaths on an annual basis. During the past 10 years, the number of drug-related deaths, however, has fluctuated between 239 (1999) at the one end of the score and 275 (1997, 2004 and 2005) at the other. The vast majority of drug-related deaths are caused by poisoning from one or several drugs, with the majority of poisonings being caused by opioids. New developments within prevention, treatment and harm reducing initiatives During recent years, the number of preventive initiatives and harm reducing interventions in Denmark has increased on a local, regional and governmental level. The aim of these initiatives is to curb the development of experimental drug use as well as limit the damage caused by using illicit drugs. Regional and local drug prevention initiatives are increasingly carried out in cross-sectoral settings, and new and additional network projects are spread among professionals in order for preventive action to be more targeted, especially within commercial party settings and youth educations. On a national level, an initiative has been launched to import, develop and test the US training material Life Skills Training in the folkeskoler (primary and secondary schools) in Denmark. The aim of this training programme is to boost the young people s self-esteem, competencies and positive health conduct in relation to tobacco, alcohol and drugs. The basic educational principle laid down in the training material involves high pupil activity with pupil discussions, exercises and homework. During the autumn of 2006, the National Board of Health has also published material Om hash og unge [Facts about cannabis and young people] to all schools in Denmark. The material will be used at parent meetings and aims at giving the parent group an opportunity to discuss cannabis and, where possible, identify common norms. In connection with the Government s 2003 Action Plan, the model municipality project Narkoen ud af byen [Drugs out of town] was launched and is expected to be finalised in The overall goal of the model municipality project is to reduce drug prevalence through local and coordinated interventions, and more specifically the project aims at reducing availability and prevalence of drugs among young people as well as reduce the number of acute injuries. The 14 municipalities taking part in the project focus on activities in primary school, youth education programmes, in party settings, counselling, outreach activities, special residential areas, fitness centres 9

8 and children living in drug use families. In order to support the municipal preventive activities in an optimum manner, the National Board of Health prepared a guideline referred to as Vejledning til modelkommunerne i Narkoen ud af byen [Guidelines for model municipalities participating in Drugs out of Town]. The guidelines apply key principles in the work involving drug prevention and are based on methods that work as well as describes in which settings prevention should be initiated. From 2005, the National Board of Health has supported the establishment of a national information campaign, Festival Denmark against drugs, launched at music festivals in collaboration with the festival organising team. This collaboration involves a total of 14 festivals that are members of the trade organisation Festivaldanmark, with young people as the audience. The initiative is an extended version of the initiatives carried out since 2003 at the largest festival in Denmark, the Roskilde Festival. The idea is to communicate a clear attitude towards drugs on the part of the festival organisers and evaluations indicate that the campaign has seriously gained ground and is well received by the audience. As mentioned earlier, there are still new drug users seeking treament for their problem. As a follow-up on the introduction of the social treatment guarantee for drug users from 2003, the Danish parliament adopted an act effective 1 October 2005 on a treatment guarantee to young people under the age of 18 in special cases. The law provides that the municipalities must speed up and act quickly and effectively in order for young people to be treated socially for their abuse. A special reserve has been set aside for 2006 and 2007 for the development of targeted services for young cannabis users. New drugs and new legislation The National Board of Health is still active in intensive monitoring of illicit drugs. The purpose is to consider whether control measures and bans can be implemented when new drugs appear on the market. Following expert recommendations from the National Board of Health, the drugs BZP, 2C-T-4, mcpp, MeOPP and TFMPP were banned effective 3 December 2005 and must subsequently only be used for medical or scientific purposes. A number of new laws have been adopted and implemented in 2005/2006. In connection with the regional reform, a number of health laws of significance to the drugs area will take effect from 1 January In addition, the ministerial order on free hepatitis vaccine to specially deprived groups per 1 August 2006 has been extended. Theme chapters The theme chapter on Drug use among the under 15s describes the prevalence, problems and focus areas in relation to the very young people with experimental drug use. The theme chapter on Cocaine places a particular focus on prevalence and injurious effects only in relation to cocaine. Finally, the theme chapter Medicines and illicit drugs in traffic deals among other things with accidents and risks of using drugs in traffic. 10

9 1 Background to Denmark's drug strategy 1.1 Overview/summary The national drug strategy in Denmark is based on a ban against any non-medical or non-scientific use of drugs combined with persistent and targeted efforts, multipronged and coordinated treatment programmes, as well as efficient control. In its action plan The Fight against Drugs, the Government has drawn up the basic conditions governing its response to drug abuse. Drug abuse is a complex problem. Intervention must therefore be carried out on a broad front across professional and agency boundaries. This is a task to be tackled in collaboration with local, regional and central authorities within the health, social, legal and customs sectors. The Ministry of the Interior and Health is responsible for coordinating the government's response centrally. The ministry is also responsible for controlling the legal use of drugs. It oversees as well the government's tasks associated with treatment within the healthcare sector and preventive intervention, including matters pertaining to medical treatment The Ministry of Social Affairs is responsible for the government's social treatment programmes. The Ministry of Justice has the main responsibility for supervision and policing, including measures for drug users in prison. The Ministry of Tax Affairs is responsible for custom controls and inspecting precursors. At regional and local level, the counties and municipalities are responsible for their specific treatment and prevention programmes. The counties and municipalities are assisted by the central authorities in such matters as monitoring, overall guidelines, documentation, passing on knowledge, etc. 1.2 New legal framework, including new drugs under control In 2006, the following laws and administrative regulations have been passed concerning the use of drugs: The necessary laws for implementing the regional reform on 1 January 2007 (see also Section 1.3) have been passed. The following laws are relevant to the use of drugs and all come into effect concurrently with the regional reform: Act no. 573 of 24 June 2005 on social services. The provisions of this act include regulations on social treatment for drug abuse. Act no. 546 of 24 June 2005, the National Health Act. The provisions of this act include regulations on the medical treatment of drug abuse. Act no. 545 of 24 June 2005 on the amendment of various laws within the health and certain other sectors. The law provides for amendments, including the Medical Profession s Act concerning the right of doctors to prescribe narcotic drugs as part of their treatment for individuals involved in drug abuse. An amendment is being made, with effect from 1 October 2006, to Section 80 of the Social Services Act, pursuant to Consolidated Act no. 699 of 7 June 2006, whereby the scheme for providing support and contact persons for those suffering from mental illness is being extended to also include those 11

10 involved in drug and alcohol abuse, as well as people with particular social problems, who do not have or cannot live in their own home. Ministerial order no. 746 of 29 June 2006 on providing free hepatitis vaccinations to specially vulnerable groups replaced as of 1 August 2006 ministerial order no. 160 of 7 March 2005 on providing free hepatitis vaccinations to injecting drug users and their relatives. In addition to the group of people previously included (injecting drug users, their partners and any permanent sexual partners), people who live with or are a permanent sexual partner or anyone with chronic hepatitis B, people infected with hepatitis C, children in day-care centres where there is a pre-school age child attending, known to be infected with chronic hepatitis B, and children under the age of 15 who frequent residential areas where there are known cases of hepatitis B infection, will now also be offered free vaccination against hepatitis B. This initiative is included in the 2006 budget for tackling drug abuse, see Section 1.3 for more information. The Ministry of Justice issued on 7 March 2006, in accordance with Section 10 (subsection 2) of Consolidated Act no. 786 of 9 August 2005 on the restaurant and hotel business, a circular to the police and prosecution service, in which attention was drawn to the fact that the local chief constable or the representative on the licensing board should be aware of opportunities, when granting licences for the sale of alcohol, to impose conditions in relevant cases, whereby signs are clearly displayed in the relevant place indicating that drugs will not be tolerated and that anyone found in possession of drugs will be reported to the police. Relevant cases are intended to mean those particular cases where police have noticed at a particular public house or discotheque dealing in and use of narcotic drugs. In 2006 the following narcotic drugs are subject to control: Ministerial order no of 24 November 2005 modifying the ministerial order on narcotic drugs has stipulated that the substances BZP (A 2)(1- benzylpiperazine), 2C-T-4 (2,5-dimethoxy-4-isopropylthiophenethylamine), mcpp (1-(3-chlorphenyl)piperazine), MeOPP (1-(4-methoxyphenyl)piperazine) and TFMPP (1-(3-triflourmethylphenyl)piperazine) must only be used for medical and scientific purposes from 3 December Institutional framework, strategies and policies In 2004, a political agreement was signed which meant that a reform of Denmark's regions would be implemented by 1 January 2007, which would basically change the conditions for administering local and regional activities. The laws (mentioned in Section 1.2) required to implement the regional reform have been passed by the Danish parliament (the Folketing). The consequences of regional reform for the national drug strategy are that the responsibility for prevention as well as for social and medical treatment of drug users will be transferred to the regions. A political agreement was signed in October 2005 aimed at implementing the 2006 budget for tackling drug abuse (see also Section 1.4). This agreement, which must be seen as a follow-up to the 2004 budget agreement, has resulted in a series of initiatives, which are maintaining and expanding existing activities for tackling drug abuse. Efforts are being stepped up across a broad front, with the ambitious 12

11 objective of restricting, to an even greater extent, drug abuse and the serious harm which drug abuse inflicts on the drug users themselves, as well as on their families and the surrounding community. The 2006 agreement includes the following initiatives: Treatment for drug users in prisons will be increased so that the general treatment guarantee for drug users will also include inmates in prison and probation service institutions. The introduction of guaranteed social treatment for young people under 18 affected by serious drug abuse problems will ensure that young people suffering such major drug dependency problems that the general provision for young people cannot be applied will receive treatment. Larger regions in the relevant situation can apply for resources from a fund to cover half of the costs involved in launching a healthcare programme targeted at the most severely addicted drug users. Methadone injections are being introduced as a treatment option for people hugely involved in intravenous drug use, showing current or impending signs of damage to their health, in spite of adequate normal treatment, where the methadone is taken orally. Efforts aimed at treating, in particular, drug users infected with hepatitis C have been stepped up across the whole country. The group of people being offered free vaccination against hepatitis B is being expanded so that people who live with someone with chronic hepatitis B, people infected with hepatitis C and children under the age of 15 who frequent residential areas where there are many injecting drug users will now also be included in this programme. To support opportunities to help in the fight against drug-related problems in the immediate vicinity of Copenhagen's Vesterbro district, a fund has been set up which associations and other organisations can apply for resources to cover the cost of developing and implementing locally based initiatives, aimed at, in the broad sense, of improving conditions for drug users and solving the problems which a drug environment inflicts on this district. As described in the 2004 National Report, the Copenhagen Metropolitan Police Force carried out the largest raid yet against cannabis dealing at Christiania on 16 March 2004 as a response to the overt cannabis dealing that had been going on for a large number of years on the premises. On 10 July 2006 the Copenhagen Metropolitan Police reported that following the intervention at Christiania on 16 March 2004, 58 people were convicted of possession of cannabis with intent to sell or contribute to selling it. These 58 also included people who had taken part in the organised monitoring team intended to protect the extensive cannabis dealing activity that had been professionally set up at Christiania. The 58 persons were convicted for possession of a total quantity of approximately 550 kg of cannabis, with prison sentences ranging from four months up to two years and six months, with the majority of those convicted receiving prison terms of between one year and six months and two years and six months. 1.4 Budget and public expenditure The information about the multi-annual budget funds and pooled reserves appear in the 2005 National Report. Details of new government grants are as follows: 13

12 In 2006 around DKK 3.8 million in government funds are expected to be spent on preventing drug abuse. A total of DKK million have been earmarked for the period for implementing the initiatives in the agreement on the 2006 budget for tackling drug abuse. The funds are assigned to the following separate initiatives: Guaranteed treatment in prisons... DKK million Guaranteed treatment for young people... DKK 32.0 million Targeted healthcare programme... DKK 28.0 million Methadone injections... DKK 20.0 million Intervention against hepatitis C... DKK 36.0 million Free vaccination against hepatitis B... DKK 14.0 million Vesterbro fund... DKK 16.0 million Municipalities, counties, voluntary social organisations and associations, as well as private operators have been allocated for the period DKK 70 million from the fund for improving social measures for treating drug users. It has not been possible to specify a separate amount for control strategies used in tackling drug abuse. As regards expenditure on a local and regional basis, the local and regional accounts and budgets show a steep increase since 1995 in the funds allocated for social treatment of drug abuse. The 2006 budget makes provisions for DKK million. The equivalent figure for 1995 was DKK million. The local and regional expenses incurred in relation to the prevention and medical treatment of drug abuse cannot be retrieved from the local and regional accounts and budgets. 1.5 Social and cultural context In the parliamentary year, members of the Opposition tabled a motion for the introduction of drug injection rooms. This bill was rejected by a parliamentary majority at the 2nd reading. The government refuses to introduce drug injection rooms as being too radical and in contravention of international drug conventions and its core drug policy. In the parliamentary year, members of the Opposition tabled a motion for a bill to add foul-smelling substances to lighter fuel. The bill was rejected by a majority during its first reading in parliament. The government does not believe that there is any technical or health reason for adding a foul-smelling substance to lighter fuel. 14

13 2 Drug use in the population 2.1 Overview/summary The phenomenon of trying drugs is typically one associated with young people, and most of them stop at some point. The majority of those who try drugs do so on an experimental basis for a short period during their younger years. Surveys among the whole population indicate that the experimental use of drugs is highest in the age group and that very few try drugs for the first time after the age of 20. In age groups over 40, only a small percentage have used any type of drugs within the last year (SUSY 2000 and ). There is a general trend that the same young adults are those who expose themselves to different types of risk behaviour. Surveys indicate that it is often the same young adults who consume large amounts of alcohol and smoke tobacco and cannabis every day. Also, there is a significant co-variation between having taken cannabis and having taken one or more other illicit drugs. For instance, among year-olds, 58% of boys who have been smoking cannabis within the past month have tried one or more other drugs, whereas only 3% who have not smoked cannabis within the past month have tried several other drugs. As far as girls are concerned, 42% of those who have been smoking cannabis within the past month have also tried one or more other drugs, whereas only 2% of those who have not smoked cannabis within the past month have tried one or more other drugs (MULD ). A new population survey into the experimental use of illicit drugs (SUSY 2005) was carried out in This survey is a follow-up to the surveys carried out in 1994 and 2000, which makes it possible to compare results from the three survey years (SUSY 1994, 2000 and 2005). The total sample in 2005 included almost 22,000 Danes aged 16 and over. The surveys are nationally representative and have been carried out based on completing a self-assessment questionnaire. The results indicate overall that there has not been any increase in the prevalence of illicit drugs among the adult population between 2000 and now. This stagnation comes after a sharp rise in prevalence between 1994 and In % of the population aged between 16 and 44 had tried cannabis at some point, with 8% having taken cannabis within the previous year. By comparison, around 13.5% of the same age group had tried illicit drugs other than cannabis and slightly under 3% within the past year. Amphetamine is the most prevalent illicit drug after cannabis among young people, as well as among the population in general. Cocaine then features as the third most prevalent drug. All the more recent national surveys concur that the experimental use of cannabis and other illicit drugs in Denmark is currently at a high, but stable level. 2.2 Drug use in the population The description of the use of illicit drugs among the adult population is based on the last three national SUSY surveys into self-reported use from 1994, 2000 and SUSY stands for Sundheds- og Sygelighedsundersøgelse (Health and sickness survey). 2 MULD stands for Monitorering af Unges Livsstil og Dagligdag (Monitoring young people's lifestyle and daily life). 15

14 (SUSY 1994, SUSY 2000 and SUSY 2005). All surveys have been carried out by the existing National Institute of Public Health. The analyses included concerning the prevalence of drugs are based on the age group. The prevalence among people over the age of 44 is very limited, which is why the over 44 age group is not included in the analyses below. Prevalence of cannabis The results from the population surveys among year-olds carried out in 1994, 2000 and 2005 indicate rises in the experimental use of cannabis up until After this, the figure levels off, with even a slight drop. If we look at current use (cannabis used within the last year), 8% of year-olds in 2005 said that they had taken cannabis within the previous year. These figures were 7% and 10% in 1994 and 2000 respectively. Table Percentage of women and men in the various age groups who have tried cannabis within the last year in 1994, 2000 and N= n= n=4484 Denmark s population in the age groups in year-olds Men Women year-olds Men Women year-olds Men Women year-olds Men Women year-olds Men Women year-olds Men Women All year-olds Men Women Source: SUSY 1994, SUSY 2000, SUSY All As can be seen from Table 2.2.1, the current use of cannabis is most widespread among the younger age groups and then declines with increasing age. In the case of men, the largest prevalence in 2005 was in the age group, while among women the largest prevalence was among year-olds. 16

15 Table Percentage of year-olds who have taken cannabis during the last month, last year and at some point in 1994, 2000 and 2005 Cannabis taken Last month Last year (last month included) At some point (last year included) Source: Unpublished figures from SUSY 1994, SUSY 2000 and SUSY The results indicate that the current use of cannabis has levelled off, with even a slight drop between 2000 and Although there is a rise from in the percentage who have tried cannabis at some point, the results can be regarded as indicating that fewer take cannabis now compared with in 2000 because "current use" is assessed as being the most reliable measurement of prevalence 3. Prevalence of other illicit drugs In the case of the other illicit drugs taken all together, a similar trend is observed, with an increase in experimental use among year-olds from 1994 to 2000, replaced by a small, yet significant drop from 2000 to Less than 3% of year-olds said in 2005 that they were currently using illicit drugs other than cannabis (used within the last year). Table Percentage of year-olds who have taken last month, last year and at some point one or more illicit drugs other than cannabis in 1994, 2000 and 2005 Used one or more illicit drugs other than cannabis 1994 (n=2.521) 2000 (n=6.878) 2005 (n=4440) Last month Last year (last month included) At some point Source: Unpublished figures from SUSY 1994, SUSY 2000 and SUSY Prevalence of illicit drugs among young adults The table below focuses on the prevalence of various illicit drugs among "young adults" in the age group in This is typically the age group which starts off using illicit drugs and where the prevalence of illicit drugs is largest. 3 The category "used at some point" is a more inaccurate measurement than "used last year" as the longer the period being asked about, the greater the likelihood that the respondent either has forgotten or has tried to suppress the relevant event. 17

16 Table Percentage of year-olds who have tried one or more different illicit drugs in 2005 within the last month, last year and at some point Last month Last year (last month included) At some point Cannabis Amphetamine Cocaine Psilocybin mushrooms Ecstasy LSD Heroin Other drugs* "Illicit drugs other than cannabis" total Source: Unpublished figures from SUSY *The category Other drugs covers GHB, various medicines, etc. 44% of young people under the age of 24 have tried cannabis at some time, with 21% currently taking it, in other words, they said that they had used cannabis within the last year. The prevalence of cannabis among young people in 2005 is at the same level as in In the case of other illicit drugs such as amphetamine, cocaine and ecstasy, which are the most prevalent drugs after cannabis, there has been no increase in the use of these either since It may seem, however, as if there is a trend towards a "shift" in the type of drugs chosen during this period, when fewer were choosing drugs like amphetamine and ecstasy and more were choosing cocaine. This trend is highlighted in Table (the trend among year-olds for all illicit drugs from 2000 to 2005 is shown in the Annex). Table Percentage of men and women in the age group currently using cocaine, amphetamine and ecstasy in 2000 and 2005 SUSY 2000 SUSY years men women Total men women Total Amphetamine tried in the last year Cocaine tried in the last year Ecstasy tried in the last year Source: SUSY 2005, unpublished figures from the National Institute of Public Health. As the table above shows, 5.6% of year-olds in 2000 said that they had used amphetamine within the last year, while this was the case for 4.1% in In the case of ecstasy, 2.2% of year-olds in 2000 said that they had used ecstasy within the last year, while this percentage had dropped in 2005 to 1.5%. Given that this was accompanied by a rise in the proportion of people who said that they had 18

17 used cocaine between 2000 and 2005, there may be a trend towards a shift in the drugs being chosen by this age group. Significantly more young men than women are currently using amphetamine, cocaine and ecstasy. In fact, the current use of ecstasy in particular was very limited among young women in The conclusion which can be drawn then is that there was no increase in prevalence among year-olds during this year, either for the use of cannabis or other illicit drugs. On the other hand, trends were observed towards a slight shift in the drugs these young people were choosing, with the use of cocaine on the way up, while the use of amphetamine and ecstasy was falling. Frequency of use of illicit drugs In the SUSY survey in 2005, those who were currently using cannabis or other illicit drugs within the previous month were asked how many times they had taken drugs. There was a total of 9% of year-olds who had used cannabis and/or other illicit drugs during the previous month. Just under 70% of these used the drug 1-3 times. The remainder took drugs more frequently (18% used drugs 4-9 times and 12% more than 10 times during the previous month). When it comes to indications of how frequently drugs are taken, the figures are very small, which is why there is a great deal of uncertainty about these results. Most of those who used drugs during the previous month only took cannabis. An analysis was carried out to see if there is a difference in frequency for those only using cannabis and those using other illicit drugs, but no difference was indicated between these two groups. It must be emphasised however that the group who used illicit drugs other than cannabis during the previous month was very small. Regional differences in the use of illicit drugs. Regional comparisons were made during the SUSY surveys in terms of the prevalence of illicit drugs. The results clearly highlighted that the prevalence of illicit drugs is by far the biggest in the Copenhagen region and less prevalent in other regions. In the Copenhagen region, the number of year-olds who have tried both cannabis and the other illicit drugs is up to double the number, compared with young people in other regions. The same trend towards regional differences is also shown in the age group, even though this difference is not at all as striking among young people under the age of Drug use in the school and youth population As shown above, the younger age groups are those which account for the most prevalent use of cannabis and other drugs. The use among young people aged between 16 and 20 is described in this section using the "MULD surveys" carried out in 2000, 2001, 2002, 2003 and The use among year-olds is described in the present report this year in Chapter 11, which is devoted to the whole topic of drug use among young people, mainly based on the international ESPAD school surveys. All surveys carried out among young people show that the experimental use of drugs levels off in later years, but at a relatively high level. Table provides the results from all five MULD surveys. 19

18 Table Percentage of year-olds who have tried illicit drugs, MULD 2000 MULD 2001 MULD 2002 MULD 2003 MULD 2004 (n=2046) (n=2090) (n=2041) (n=1768) (n=1772) Cannabis tried at some point Cannabis taken last month Amphetamine tried at some point Ecstasy tried at some point Psilocybin mushrooms tried at some point Cocaine tried at some point LSD tried at some point Heroin tried at some point Tried to smoke heroin at some point Other drugs Source: MULD 2000, MULD 2001, MULD 2002 and unpublished figures from MULD 2003 and MULD 2004 respectively. *The category Other drugs covers GHB, various medicines, etc. In this series of surveys there are no significant differences between the figures for drug use in 2000, 2001, 2002, 2003 and The only exception is cannabis, where the surveys indicate a slight, but significant rise in the use of cannabis at some point over the first years surveyed, compared with a small, but significant drop in the use of cannabis during the previous month from 2003 to The MULD surveys provide the same picture with regard to the prevalence of the different drugs described for the slightly older age groups in Section 1.2. More than one third of young people in the age group report having tried smoking cannabis at some point. Amphetamine is the second most frequently used drug after cannabis. Depending on the study year, 6-9% of the young people have tried amphetamine at some point. 3-4% have tried ecstasy at some point, and the use of ecstasy is therefore about half as prevalent as amphetamine and more or less at the same level as the use of psilocybin mushrooms and cocaine. Among year-olds there are also clear gender differences in the use of drugs, with a larger percentage of boys having tried drugs than girls. The 2005 annual report contains a special chapter on this topic, with analyses of gender differences in drug use and of the harm caused by illicit drugs. Starting age The latest SUSY analyses on the experimental use of illicit drugs confirm earlier survey results showing that almost everyone who experiments with illicit drugs starts using them before the age of 20 (SUSY 2005). 20

19 3 Prevention 3.1 Overview / summary The main aim of drug prevention is to limit the number of new drug users. Prevention is therefore one of a total of four intervention areas in the drugs policy: prevention, treatment, harm reduction and supply control. The following main principles have been set out in the government's action plan against drug abuse "Fight against Drugs" 2003 (Ministry of the Interior and Health 2003): It must be broad-based, which means include several intervention areas; it must be comprehensive, which means include both alcohol and illicit drugs, and it must be targeted at standards and behaviour. There are currently three levels of responsibility for prevention: government, regional and local. As of 1 January 2007, the local authorities will be responsible, but the government/national Board of Health will continue to have a consultative role. In the meantime, the main responsibility lies with the local and regional authorities (only with the local authorities after 1 January 2007). At a local level, it is possible to set up both universal and selective prevention in schools and local leisure facilities in cooperation with clubs, as well as restaurants, bars, discos and in certain residential areas. At local level, drug prevention is often based on cross-agency cooperation among schools, social services and the police, known as SSP cooperation. There are major variations from one local authority to the next, but part of SSP's work involves picking up signals, tackling social problems affecting children and young people. It also proposes and implements activities that will help to prevent drug abuse and crime. Regional authorities have been involved in recent years, to some extent, in setting up local networks in local areas to ensure coordination and cooperation between local and regional authorities. The National Board of Health's job as part of the prevention effort is to support local prevention work by producing informative material and through projects for developing methods (the current project is "Drugs out of town"), as well as by providing advice to other authorities. 3.2 Universal prevention - school Primary school is the key intervention area for universal prevention as it provides the opportunity to make contact with more or less every child and young person and their parents. There is a general obligation in primary schools to promote prevention and health education as part of the compulsory subject on health, sexuality and family life. Teaching about alcohol and drugs may be included in this lesson, but it is up to the individual school and class teacher to assess whether and how the subject of drugs should be dealt with in the lesson or at parents meetings. This means that there are no fixed guidelines on the form, content and scope of the teaching about drugs. This subject is very often taught in grades 6-9, with the individual teacher organising the lesson. Alcohol and drug counsellors support this work, to a certain extent, and the SSP organisation has drawn up, in an ever-increasing number of municipalities, a local teaching programme for alcohol and drug abuse prevention. 21

20 In its guidelines for model municipalities in the "Drugs out of town" campaign, the National Board of Health has drawn up a series of research-based principles, which should be used as the basis for organising the school's drug prevention activities. Some of the recommendations made include schools drawing up a general policy on alcohol and drug abuse, establishing cooperation with the parents in order to delay when children start drinking alcohol and to prevent them from experimenting with drugs, as well as schools teaching about the subject according to evidence-based principles. Teaching material "Tackling - self-esteem, health and social life" In cooperation with the publisher Alinea, the National Board of Health has been instrumental in importing, developing and testing a Danish version of the American research-based teaching material "Life Skills Training", called "Tackling" in Danish. The Danish version of the material has been adapted to Danish conditions, and evaluation will show if this type of material has a measurable effect in Denmark. The National Board of Health is cooperating with the National Institute of Public Health on a research-related evaluation of the material s use in Danish schools. In addition, prevention counsellors from 6 counties will be participating in a project monitoring group. Around 150 schools are taking part in the project, with half of them being intervention schools and the other half control schools. The purpose of the teaching material is to boost young people's self-esteem, their social skills and develop a positive healthy attitude with regard to tobacco, alcohol and drugs. The aim is to raise the starting age and prevent drug and alcohol abuse. The material's basic principle is to have a high level of pupil involvement, which is one of the key requirements for it to have any impact. The material may be used in 7th grade (approximately 25 hours), 8th grade (approximately 20 hours) and 9th grade (approximately 10 hours). The teaching is carried out by the teacher without any external experts or guest teachers. Teachers therefore attend an introduction course and then a follow-up course a year later. Tackling 1 appeared in 2005, Tackling 2 comes out in September 2006 and testing of Tackling 3 has actually started in September Another follow-up survey is being carried out at the moment for research purposes. The results from this research project are expected to be available by the end of Youth education institutions There has been an increasing focus on alcohol and drug prevention in youth education institutions in recent years, both at a government and regional level. Work is being done, in particular, on implementing alcohol and drug abuse policies and advice for young people at secondary schools, business schools, technical colleges and production colleges. Activities are based in particular on the experiences from the methodology-development project which the National Board of Health, Aarhus and North Jutland counties ran between 2000 and 2003 ("Development project on ecstasy prevention"), as well as on the survey by the Danish Institute for Upper Secondary Education: "Party culture and drugs in upper secondary schools", The main intervention principles are described in the National Board of Health's guidelines for model municipalities in the "Drugs out of town" campaign from

21 3.3 Prevention in the community Regional and local intervention Part of the work carried out by regional alcohol and drug counsellors in recent years has involved getting professional networks, which can improve the intervention at local level, up and running. The counsellors teach, to a certain extent, in grades 6-10 in school, and teachers with this skill are often included in a key staff team, which means that their teaching can be updated. Several counties have also set up key staff teams with a network function in youth education institutions, where alcohol and drug abuse policies are implemented as part of prevention work. The Centre for Abuse and Prevention in Randers municipality has completed a qualitative interview survey in 2006 among young people in the area at risk of being marginalised. The survey will provide the municipality with a better basis for targeting its prevention activities at these young people. The survey can be downloaded from A number of counties and municipalities are implementing special measures aimed at young people - and the adults around them - who are major users of cannabis and other drugs. For example, Viborg county has set up a special counselling team, which serves the young people, their parents and professionals who are in contact with these young people. Aarhus municipality is working specifically on educating parents, to supplement the work they are doing with young users. Parents groups are being set up where parents can provide support for each other. This support for young people's networks is having a positive effect on the whole intervention effort. Frederiksberg municipality is developing teaching material in 2006 based on the film entitled "Nordkraft", which will initiate a debate about the use of drugs and other addictive substances in youth education institutions. South Jutland county has run courses for class teachers as part of the "Drugs out of town" campaign (see more about this below). Information sessions have also been held for young people and parents in many municipalities in the county after five young people from the county died from being poisoned by illicit drugs in "Drugs out of town" anti-drug campaign The three-year development project "Drugs out of town" is the largest prevention initiative in the government's 2003 action plan "Fight against Drugs". Since autumn 2004, 14 model municipalities have been targeting their efforts at establishing locally based and coordinated activities aimed at: Reducing the availability of drugs Reducing the number of young people using drugs, as well as the harmful effects associated with drug use, such as poisoning, drug-induced psychoses and violence. Guaranteeing cross-agency coordination within environments promoting prevention. In the social grants budget for 2003 and the Budget for 2004, an amount of DKK 20.8 million was allocated, DKK 15 million of which were set aside for 14 model municipalities, with DKK 1 million being transferred to a development fund for the model municipalities. The project will end on 30 April