ITALY New Development, Trends and in-depth information on selected issues

Transcription

1 Focal Point Logo 2006 NATIONAL REPORT (2005 data) TO THE EMCDDA by the Reitox National Focal Point ITALY New Development, Trends and in-depth information on selected issues REITOX

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7 Region or ))* ))* autonomous province E5::++: E:0*5)) E:+*+)*)))F E)556)))F Piedmont / E5*+:+:: % 1 )),))1 / E6)))))))F4))* E5))))))))) %,,))* Valle d'aosta E*))))) E6)66 E56))) Lombardy Trento autonomous province Bolzano autonomous province Veneto E))))/)): ))* 1 8 G E/F1 / ))* 1 E+:)))))) 7 ' E5))))))/6@% $1 C ' E:05)))))/$ 1 ' E5)))))3 E E)):+) " C! 6+,0 E+0:+))) 8 E5)) 8 E*+*+5*:))) /)):))* ))61 E)*56+*)) / %8@@ / 81 E*6)0):0 /@% 1 D- E:5))))) ))* E) E*)))))) E:00):) / 1 E6))0)) E+))5*)) / 8@@ 8@@ E)0+:6) / ( ( 1 E+)))))))) %)

8 Region or autonomous province Friuli Venezia- Giulia Liguria Emilia ))* E) / H A % ))* / 1 E6)))) / 3 1 E6))))))) /*)I A ))* E)+)56 /)))))1 %4 8 2" % /8@C1 E*)))))) /)):1 89@C 1 E) E:))))) % E) E+)))))) % / )):1' E)*)505+ %2

9 Region or autonomous province Tuscany Marche Umbria ))* E*):)6)* ))* E0)))+))/ $ 1 ;!5,))) /4!@1% $ 1 % ))*))0 *I 9@C % ))* 4!@% $ E0*)))) E6))))))))/4@&1J E))))50)) E*)0+)))))) E))))))) E6))*0*)) Lazio E56)6+ E:)*6) Abruzzo E))) E5**00)) E)66)) 3 )): E:)*)) & )): E: ))*'@ E:0550K$ ( E55*)5 E5++++ E+56))))K Molise E:6*+:K / 1 E Campania E*))))))) E5:0+ E0*656))))) E05)))))) %/

10 Region or autonomous ))* E % 6 ))* ))* $/1 4!4@ ( )))) %4 8 E0))))) E:60*))))) 8 )): ))*))0 $ Apulia $ %$ /*)I *)I 3 1 % )) Basilicata E:*:5: E E:6*0*:+ E)6:)5*:,,, Calabria Sicily,, 2 2 Sardinia ))*@ % K E6):650)) E)0*0))) E+*0)) / E:)))))))) 3 / 2!8 %3

11 )$"$$( ) '$"! 8 * *:/@82 ))1 ($A 0$0! ))* 6+I )) 0I (/.1,0-$00!'$5$! %++++/6 8 75% 7 65% 6 55% year of ))@82L ))* 8. ( /05I1 D +5*I +*:I (,-$000!'$ CANNABIS COCAINE HEROIN ))* prevalence prevalence 1 7 3H A %4

12 ; :* *:.% ( :**: 06I 6I*:60I* :,0 )- ' '1!" "! $7" $!! '$ prevalence age ))* 8 $ /1 /*:*:1 ))* )) ( /* 1 / *1 7"!0! 8 )),02-7!"!$5$!%++++/6 8 75% 7 65% 6 55% year of ))@82L ))* prevalence M F %

13 ))* 6*I )) ( /+0I1,0/-7"!0!'$ CANNABIS COCAINE substance ))* C /6+I1+I,0 3- ' '1!" "! "7! '$ $ prevalence prevalence age ))* &3 3 *:*:: /0I 65I1. 6 ( /:**:1 06I 6:I* : % ( M F %*

14 % ( &@82L * + " &@82L ))) &@82L ))* ( (,04-$00!'$5$! )))&@82L ))* ; ))) +)I ( ))* 0+I 8 (/56I1,0- $ 00! " 7! '$ prevalence prevalence CANNABIS COCAINE year of study HEROIN ))* HALLUCINOGENS 87&%8!&@ STIMULANTS )+

15 D ( /6)I1 /0:I1 /65I1 /0I :I**I+ 7"!0$0"10 ))* ))) 3 6) 6*I 3 ( C( 8 5I 6I,0*- 7 "!!! " 7! '$ prevalence CANNABIS COCAINE HEROIN substance HALLUCINOGENS 87&%8!&@ ))* %$ /6)I I**:I+ 8 ( ))) ))* ( 6) 6*I " :)I ( )

16 ., 7. D ( &@82L /*+1 / ( 4 3 K * :)I $*+ % :$ (D * : * 3 3 &3 *** 5 ( )%8" % 3 8 $))))/ 1 )): :) ))0 )): $ ( )): ( :5* *0 0 /.)1! (/ 9 2 % & 1 9 &!! )%

17 ,0+-""$""!""$'11! %++)"% M hours and 32minuts 8ho urs and 31minuts 3 hours and 40 minuts 48hours and 25minuts 15 hours and 27 minuts % 2003 ( 2004 % total dedicated time in netw ork's programs % total dedicated time in new s programs total dedicated time in new s 7 hours and 31 3$. )): /: ))1 / 1% $ % )) )): $ % )) )) )): / 1 $ / 1,0-9"':$0!0; %++) "% smoking life storys drug's market legislation alcohol information7 recovery doping2 therapeutic ))

18 C( (/ 1 ) ))% 5 7 *I )): )) /.1,0 %- 9 " ':$! %++) smoking life storys drug's market legislation alcohol 7 2 information recovery doping therapeutic use )): /. 1 $ / 1 $ &,0 )- 9 " ':$ ' %++) " % smoking life storys 7 drug's market legislation alcohol 2 information recovery )2

19 4 )): / )) )):1 ( )) )):. /3 1 )): $/.:1,02-9"':$$! %++)"% * half and 1 hour * half and 1 hour 3 half * and 1 hour 2 8)* 1 around half hour 0 around half hour around 2 hours 8)* around half hour half and 1 hour * smoking life storys 7 drug's market legislation 2 alcohol information 8 )): 7 )/

20 % <,< 9< ))* " " :7 *7 69 %%!0$0"10. ))* " " :7 *7 69 %)8 %2!!$$! : / 0* 2!)+,+)1 :2 )3

21 %!0 %!0! % * 6: )) /@82L 1 % ( % / $1 / 1%$ & & B C %, $0$$ 0$! 0 = %++/"1 %@82L ))* $ ( % A '%-'0!>? $"!0 $$!'$!""1 "788"%&@%"@ 2@%D9%B!B4&@B!@&@ 22C& CB;'50I 7.7'0I 8 ) 9, ( 1 /,, 1O!B'05:I!B'5+I!B'+:*I N&@'6I N&@')5I N&@'**I (O!B'5)*I 0I /(1 6I )5I +I ( " ))* 3 5)))$ *6: )4

22 %%'< % /+I1 ) /6I1 I $,-'5$ %0 )+"1" "1$6 :)I *I )I *I )I *I )I *I )I " " " ) ))* * : /I1 ; 5I 8 ' 5I ):I,%-'5$06"''1("!! 25% cannabis use prevalence 2 15% 1 5% M F age ))* " )) HA 6I+I )

23 ,)- ' 5$ 0 % 06 $!%++ 0 %++/ 14% cannabis use prevalence 12% 1 8% 6% 4% ))@82L ))* % )) * : 50I K ))* 5I,2-'($06!/%2 1" $!%++"%++/ cannabis use prevalence 2 15% 1 5% year of study year of ))@82L ))* %)$ 66I ( % I )5I)I )*

24 ,/-$5$ %0 )+"1" "1$6 cocaine use prevalence 8% 7% 6% 5% 4% 3% 2% 1% ))* % * :*:/ :0I:I +I0I1,3-$5$06"''1("!! 6% Consumption in life Consumption in the last 12 months Consumption in the last 30 days Daily consumption cocaine use prevalence 5% 4% 3% 2% 1% M F age group ))* " )) HA I I 2+

25 ,4-$5$06 $!%++0 %++/ 3, cocaine use prevalence 2,5% 2, 1,5% 1, 0,5% $ 6I:I /.51,-$5$06!!"%/ )2 $!%++++/ cocaine use prevalence 0, 4,5% 4, 3,5% 3, 2,5% 2, 1,5% 1, 0,5% 0, year of study year of ))@82L ))* %29 % I % )I)6I ))5I 2

26 ,*-95$ %0 )+"1" "1$6 5I 6I :I I )I )5I )6I ):I )I ))I " " " ) ))* % )6I ):I *:% 3 3/):I)I1 *::/)+I))I 1 :**:/)5I)0I1!$ **6:,+-95$06"''1("!! heroin use prevalence 0,8% 0,7% 0,6% 0,5% 0,4% 0,3% 0,2% 0,1% 0, age ))* )) ; )) )*I ))* )I/1 M F 2%

27 ,- 9 5$ 0 % 06 $!%++ 0 %++/ 0,6% heroin use prevalence 0,5% 0,4% 0,3% 0,2% 0,1% 0, year of ))@82L ))* % *: )+I)I,%-95$06!!"%/ )2 $!%++++/ 1, 0,9% 0,8% 0,7% 0,6% 0,5% 0,4% 0,3% 0,2% 0,1% 0, year of ))@82L ))* %/9$!< I 9 )6I )I B))I heroin use prevalence 2)

28 ,)-9$!5$ %0 )+ "1""1$6 hallucinogen use prevalence 4, 3,5% 3, 2,5% 2, 1,5% 1, 0,5% 0, Consumption in life Consumption in the last 12 months Consumption in the last 30 days Daily consumption ))* " /*: 1 /+I1K 3 /I1,2-9$!5$06"''1( "!! hallucinogen use prevalence 2,2% 2, 1,8% 1,6% 1,4% 1,2% 1, 0,8% 0,6% 0,4% 0,2% 0, age ))* ))))* )I )6I M F 22

29 ,/- 9$! 5$ 0 % 06 $!%++ ++/ hallucinogen use prevalence 0,8% 0,7% 0,6% 0,5% 0,4% 0,3% 0,2% 0,1% 0, year of ))@82L ))* % / )0I +I1,3-9$!5$06!!" /%2 $!%++++/ 2,5% hallucinogen use prevalence 2, 1,5% 1, 0,5% 0, year of ))@82L ))* %3<0"77 % 6I)6I )*I ))*I 2/

30 ,4-0"775$ %0 )+"1""1$6 stimulant use prevalence 4, 3,5% 3, 2,5% 2, 8 2 1,5% 1, 0,5% 0, Consumption in life Consumption in the last 12 months Consumption in the last 30 days Daily ))* % /0I)+I13 *:)+I)I /)I )I *::)I 3 :**:1,- 0"77 5$ 0 % 06 "''1("!! 2, 1,8% 1,6% 1,4% 1,2% 8 1, 2 0,8% 0,6% 0,4% 0,2% 0, age ))* stimulant use prevalence M F % )) /)I1))*/)6I1 23

31 ,*- 0"77 5$ 0 % 06 $!%++++/ stimulant use prevalence 1, 0,8% 0,6% 8 0,4% 2 0,2% 0, year of ))@82L ))*., $ &9 / *I 1 % )) ))* " 6I+I4 K II % )) )*I ))* )I %%!0$0"10 ( &@82L! " /"!1 +++ % & " /&"2281 $ % &@82L ))* :)))) *+ % /*) 1 ( % %%, $0$$ 0 "$! 0 = %++/"1 24

32 ))* $ % A '%%-$!"'$"!$0$$ "B!@2&&248"%B@ &"&!%8.&2@%D9%B!B4&@B!2&!%@ '5:I '+6I '6I '65:I O!':0I "'+*I!'66I N&@'5:I,, 3,,,!$%'+:I!$%'+*I!$%'+6+I!$%'+0:I "'6I N&@':0I "'I "'6I (O!'00I "'0I!'650I "'I -!'+60I "'I -!'+56I N&@':I,!'5)5I "'+I (!')+I "'0+I '0I '+0I / 1!!':65I &'("'+I )*+("':I!$%'06I 8&CN'+6I,!'5I!$%'566I ))* 8 B K3 65I +I K*I 0I 8 /+:I1 /+*I1 /+0I1 +0I3 C K 0I ( I / (1 ) I :I 8+I, 0I :I 2

33 ) :I 6+I 6*I 406I +6I( 5I %%%'< " ' /I1 $ :I *I ) < I 3 0*))) *+ ))*,%+-'5$ %0 )+"1 ))* $ 0I I,%-'5$06"''1("!! cannabis use prevalence cannabis use prevalence 4 35% 3 25% 2 15% 1 5% 5 45% 4 35% 3 25% 2 15% 1 5% Consumption in life Consumption in the last 12 months Consumption in the last 30 days age group Daily consumption MALES FEMALES 2*

34 ))* % $ * 6 3 0! /:)I1 /5*I1 : " &@82L ))) ))) 6I 5I ))* 5/ 5I1,%%- ' ($ 0 % 06! 1 " )))&@82L ))* %%)$ % / (1 *I *I ) 0I )*I,%)-$5$ %0 )+"1" "1$6 cannabis use prevalence cocaine use prevalence 5 45% 4 35% 3 25% 2 15% 1 5% 8% 7% 6% 5% 4% 3% 2% 1% Consumption in life Consumption in the last 12 months year of study Consumption in the last 30 days Daily Consumption /+

35 ))* 8.: ::I 6I,%2-$5$06"''1("!! ))* B 3 /*61 /0+1 3! 5*I$ :0I&@82L ))) K3 +/I )))1,%/- $ 5$ 0 % 06! * 1 " $!%+++++/ cocaine use prevalence cocaine use prevalence 1 9% 8% 7% 6% 5% 4% 3% 2% 1% 14% 12% 1 8% 6% 4% 2% age group year of study MALES )))&@82L ))* /

36 %%29 % *I 6I )5I 2 )*I,%3-95$ %0 )+"1" ))* 3,%4-95$06"''1("!! heroin use prevalence heroin use prevalence 3, 2,5% 2, 1,5% 1, 0,5% 0, 3, 2,5% 2, 1,5% 1, 0,5% 0, Consumption in life Consumption in the last 12 months Consumption in the last 30 days age group Daily consumption MALES ))*. 0 3 I * 6 /I1" ))) /%

37 ,%- 9 5$ 0 % 06 $!%+++ 0 )))&@82L ))* ))) 3 I 8 *,%*- 9 5$ 0 % 06! / 1 " $!%+++++/ heroin use prevalence heroin use prevalence 4, 3,5% 3, 2,5% 2, 1,5% 1, 0,5% 0, 4,5% 4, 3,5% 3, 2,5% 2, 1,5% 1, 0,5% 0, year of study year of )))&@82L ))* :I % I )5:I )I /)

38 ,)+-9$!5$ %0 )+ "1""1$6 ))* " 5I*I,)-9$!5$06"''1( "!! hallucinogen use prevalence hallucinogen use prevalence 5% 4% 3% 2% 1% 5% 4% 3% 2% 1% Consumption in life Consumption in the last 12 months Consumption in the last 30 days age group Daily consumption MALES FEMALES ))*. 4 I*:*I+ K )5I I " ))) +I 3 + /2

39 ,)%-9$!5$06!*1" $!%++++/ 7% 6% 5% 4% 3% 2% 1% year of study ))* %%3<0"77 % I 0I I )0I,))-0"775$ %0 )+"1""1$6 hallucinogen use prevalence stimulant use prevalence 4, 3,5% 3, 2,5% 8 2 2, 1,5% 1, 0,5% 0, Consumption in life Consumption in the last 12 months Consumption in the last 30 days Daily ))* % 3 I I //

40 ,)2-0"77 5$ 0 % 06 ))* 8 ( 5+ :I*I % ))) 6I.*,)/- 0"77 5$ 0 % 06 $!%++++/ stimulant use prevalence 8 2,5% 2 stimulant use prevalence 4,5% 4, 3,5% 3, 2, 1,5% 1, 0,5% 0, 4, 3,5% 3, 2,5% 1, 0,5% 0, , 2 1,5% age group year of study MALES )))&@82L ))* ; + 6I ))):I ))* /3

41 ,)3-0"775$06! *1" $!%++++/ stimulant use prevalence 7% 6% 5% 8 4% 2 3% 2% 1% year of )))&@82L ))*., " K 3 D /*I1 /:I1 /I1 /I1*I ) I 2 ):I )*I /4

42 %)8 2 % A $ 0I +)I (*I I I ; 5*I 0:I ))* 0I $ % )) *I% 3 / 1 8 5I /( 1 /I1. 0 5:I $ I / +0I 1*I,0 %)4- $! "'! " $! '$0 Three or more substances 5% Tw o substances 11% Subjects using one or more substance in the past 12 ))* 5I $ ))*/% 1 '%)-$!"'$ One substance 84% % 5I :I )):I % )6I )*+I ))I % 0+I 0I ))* /

43 % 85I/1 % 3 :I ( ) :I( /:I )I 1,)-$!"' "!! "!'$0 Students using one or more substance in the past 12 Three or months more substances 9% Tw o substances ))* 8 ( I +I +5I '%2-$!"'"$ One substance 78% % 0*I 0I ))I % 65I 66I ))I % *:I *5I ))*., 4 0I $ 4 5I 8 5I /I1:I ( ) :I ( 5I /* 6: 1 /*

44 %2!!$$! %2 $!"! 5 4/ " %"$)+*@*+6 ))*"B *):+ / 0* 2! )+,+)1 :00+$ B 3 5)I ))*/ $1 )I )))))* / $1 8 $ 0I ))* 0)I 7 $ 8.+ +I )))))*,)*-':$""4/"%)+*@*+ %+++A%++/ Source: Based on data from Central Office for documentation and statistics (D.C.D.S.) 8 $ ))* 0+I / $1I 0I I )))))* / 3 )I ))) 0I ))*1 /0I )))I ))*1 3+

45 ,2+-' '1'$ ':$""4/"% 14% 12% 1 8% 6% 4% 2% Heroin Cocaine )+*@*+ /2"2@1 % ))))): % 8 *:))* 55I / $ 1 5I 3 I I % I % *: 0I /6I1 /+I1 /I1 /I18 $ $ /.:1,2-' '1'$"! ':$""4/" %)+*@*+ %+++A%++/ 9% 8% 7% 6% 5% 4% 3% 2% 1% Heroin /2"2@1 %3 * $ ))* /I1 % *0I 18% 16% 14% 12% 1 8% 6% 4% 2% Heroin Cocaine 3

46 I +I I ':$""!!! ; $ )))))* 50)* / 5I I 8 $ $.:,2%- $!"''1!" '! "" MORE B&%78!B!&%&8%&!% THAN A TREATMENT 9% 8% 7% 6% 5% 4% 3% 2% 1% /2"2@1 M 8 < ))6 3 +*I $ 9 /P 1 % 3 / (1. : $,2)-'"':$+++A%++/" """$$ 6 % subjects in treatment , time /2"2@1 3%

47 ., % :00+ $ ))* 0* 2!)+,+)B0+I I 0I I D)))))* $ 4 $ 34 $ %2%!$01 8 2):I ))* / ( 1 0:I $ " 05I I/.::1B *)I ( 4 60I (I(,22B!$015%++/6 12% 7% 3% 78% Cannabinoids Cocaine Opiates Other 2 ( +I 6I ( *)I /.:*1 3)

48 ,2/A"$"01!"!5%++/6 education level previous employment 3% 16% 8% 39% 46% 5 36% primary school secondary school high school student labourer employed unemployed Source: Based on data from Ministry of Defence., ):I $ " 05II 8 *)I (4 60I I / (1 32

49 ) ; )<77 3 & ( 3/

50 33

51 )7 $ ( ' ' 3 - K ( % ( ))* &B )<77 )7$0 ))* & 9 /91 (, $ ( ( 8 $ % ' % K > '7? ))))) 6:)0 $ 60 K % $ 9A ' %& $K %4 $K %% $ %4N$ > 7 O?. 4 4 *)) / *))) 1 B0$. % 3 ( % ' >,-? B % 3 ))) %$ ' ( 34

52 - ( - 3 %BC8-90D! % ' 7 7 & 9 K % 3 3 ( 8 ( :6 06))) ( 8 $ K ' $ 3K K (( D!$ B6:)0$ '7 *I /60$1! ( 3 7 $ $ $ $ 4 60 $ B /%B1 D +I $ A% B +5I 5:0I "% '7$ 3

53 ')-''107:$$""0$0! 56!! +:I +I 5:0I +5*I+6I +I $ %B %$ '7 +5I +)5I 5*I +5I+::I 9 $ 2 2 8% 2 $ 6++6*66:+ K 3 7 /5I1 /**I1 /6I1 7 /%1 ')%-$:$ 2 $ 6++ 6*6 6:+ 5I **I 6I 9 E 0$'" % $ % % /60I1 / 2)+,+)1 ')) $'!0:$ 28 $ 8 I 8 I B 8 I % 8 I 5 60I * 56I 0) :I )0 ))) %$ '7 *5 60*I 5) 0I 0 *:I :65 9 3*

54 $$$ $ A *+I /+6 60 $1 /:601 /%:1 ')2-.$$"":$ $ ' I 8 I *+I : $ %$ ' 06* *55I 6)* *I 9 ( % 3/ C78 1 7$% 3 3 6*6+I 3+3$ ')/-:$""(77"'1$0! 8 8!3 I 8 3 $ 60 6* 6+ + $ %$ '7 6:)0 5: 9 )A":$ & /"1 ( %& ( $ ))* & 2 +,+++ 8 $ % ' $ $ ( 4+

55 4 $ %0+ % 3 3 & " /&"2281 $ 2A :$56 %%8&!%$ C)+,+) )) 3 % %8&!%' ( K K K K ( 3 4 % 2 $.' 2 /" $1 2 /.% $1 2 :*/B;$12 2 0/= P $1% ' /1 % %$! % %8&!% $ B!%B!. "&!%& (3 / $1 % A " /8@"1 /A.1F:$ % 4CN NB9@&C4, D B 4CN NB9@&C4 $ - / 1 ( 3 4 N ( ( /> (?1 7177$0 8 *)) 4

56 % ' - %$ 0I $ K :I $ $ :)*I * $+I */4 1.!)-':$"'171"$0 % of schools in sample No project number of +*:I$ A% /%B1 7 +*:I $ %B 00I $ A ( 4 $ )) $ $ $ % K )*I $ /4 1 4%

57 .!)%-8$!"'17:$$0 road accidents alcoholism illicit substance abuse licit substance abuse harm reduction eating disorders early school leavers social marginalization mental health, depression, suicide AIDS and sexually transmitted diseases contraception and sexual education immigration and social integration other 5% 1 15% 2 25% 3 35% %$ $ ' 1 / )0I 0I 82@ 3 +I 3 6I1 1 / )*I I *5I )I1 1 / *I - 0:I ++I1 3$ /65I1 % $ $8 4, ( /6)+I1 /+5I1 4)

58 .!))-!!7:$ $ $ $ $ % $ 4 :.!)2- "!7$0 1 % of schools in sample Local Health Units/ Drug services Local authorities Law enforcement authorities Private and social agencies LEGEND: 1= raise information on social/health risks; 2= raise info lev el on help/counselling serv ices; 3= create a protectiv e school env ironment; 4= improv e self esteem and self perception; 5= strengthen personal and social skills; 6= reduce social ex clusion; 7= reinforce school role and educational %55I$ C 7 8 /@%1!3 /*I1 /6I1 /0*I1; $ 3/06I1 $ % $ 4 * Other 42

59 .!)/-"!7$ percentage of programmes Teachers Social Assistants Peer group Tecnicians Psychologists Educators Law enforcement authorities Ex-Problem drug users % $/*I1 ( $/)I1 /+I1/+I1% /I1 /+*I1 & I $ % - (/4 61 ' ( 3 /::+I1 3 /:*I1 /:)*I1@ $ )) Nurses Clergy Other 4/

60 .!)3-$0"7$7 Methods used in school prevention Percentage ofprogrammes Frontal lessons Seminars / meetings Interactive courses Team w ork & $ % ::I $ 6I +I K +I $ *I $/4 01.!)4-17:$7 Process and outcome evalutation 43% Programme previously evaluated 5% Only process evaluation 13% No evaluation scheduled 22% Only outcome evaluation %( ( 3 $43 C78 ( /56I1 $ 43

61 % K % $ $! A B *I $ $ /0+I1 8 ( 7 ( B 06I :0I *I.!)-8! 0 $77" Regularly 13% Seldom 47% Very common 5% Do not answ er 2% Never )%<770.1 G G I 5I +I /

62 .!)*-.?$1!77!"&1!1 ))70$$1 % $%/)I1, ( K 6)I % ( ( % ( /4 )1.!)+-!$$'"$"@!!!" "7!$$ Family to family peer approaches Not mentioned 13% Mentioned 6 Family or parents meetings or evenings Not knorw n 7% Priority 2 Trainings for % ( N"/"8.1 $ 9%"8. K K K ( K K ( 4

63 ( K K 3 K K "8. / (1 >? ( - ( )G$ ) G"8. ( %"8. 'D" " "-4 % = % "8. )%$7"!"7 )%$7"!"$0A77 8 $ $ ( % /4 1 $ ' -.!)-'"0A$07:$ Immigrants Problem/at risk families Ethnic groups Early school leavers Pupils w ith accademic problems social behaviour Youth in disadvantaged neighbourhods Depression Sensation seekers Attention deficit disorder Family conflict and neglect Oppositional defiant disorder Youth in care institutions (not in prison) Other social problematic behavoiur Other 2% 4% 6% 8% 1 12% 14% 4*

64 $ 4 /)I1 /5I1 /5I1 % " " /""1 2 +,),++) )+ & 3 8 % )%%7!'$$$( 8 & ' % 3( *)I3 I /4 1.!)%-!$$'"70$ 0!"@$7 Not know n 17% Not explicitly mentioned Priority in w ritten drug policies 3% Mentioned in w ritten drug policies 5 ( ' ( / 1 K ( / (1K ( 7= 3 K K K +

65 >? / - 1 /@% 1K., ; +I $ *)I % %B' +*:I $ %B % $ ' 6)I $ ( )I $ $ ( B $ ( / 1 7 ( 5)I - (

66 2 &8<,< 27$"$"$ 2% 2)8$0$$"A$ %

67 27$"$"$ 3 ( C B : : ',, % ( K : )06 ))* C &B '2-8$"%++/5'7"776 F 8 " "0!0 87 "$ ; 0 500G ))* ):): :*) " 4))*&B K( ' 4 : +*6:+ ): / )+061 6):6:0: /:6)514 ))* $*)I / 1K )I : D &B C >,,? )

68 '2%-''1'$! $"%++/ F!0$ "$ 87 "$!0$ "$ 87 "$ ))* +*6:+ ): 6):6 " % * 6: ))* 0: 5 ))) " / 1 / 1 *) *0 * 0 ))) % )) ))*/:1 % ))) * 6:.!2-"0"7$ +++"!"/32 57!7" * : ) * 34 /2 )/ )) )) )) )): " $"$ 0 0 " $$ 0 5':$6 % ( ( % / * /+)I1( + 8 ( 6*)I ( +)I 2

69 & B C D( " 4))* +66 " ( /* 6: 1 06))))* 6: ))* 8 ))* +0: : )))) *6: '2)-0'0"0"$$ 1%++/5'70"776 '$ $"$00&$A $0" ;70 9 %* 33) %* +3B)+ )+ $ * 42 /2B* " >? +0* ))*.!2%- $"$ " 4 : +0) ++) 3 ))) ++0 / /

70 .!2)- $"$$$ " 8 +5) % ( ++) ))) ))* +0:., % ))* + ) ))) *6: ( 2 ))* % ))) *))) )) )))) ))* /J )I 1 % **)) ))+))) ))*/J6:I 1 2% % /@L1% 7 $ ( % $ 7 **0 :I ))*

71 B 7 ))* * 5)02 /4 ::1! (.! 22 A ' 0 ' "! 7$ '7"71+0"0'%++A%++/ Clients in treatment in Public outpatient treatment centres (Ser.T.) ,49 4,63 4, ,42 4, clients in treatment client per inhabitants! " 7 *6: )):* )))) :6 ))* /4 ::192 /6+5I1 )I %&8%&!%1 % /4@% %&8%&!%1/5I 1 /&=B9@%&8%&!%1/5:I1% ))* ( 50I 8 %2 % 2 ))* % 9 ))* /4@%%&8%&!%1 ) /&=B9@%&8%&!%1 /*1% $ N of clients per inhabitants *8<))6 A+)I B % )): +:5I 4

72 /:*1 ):*+.! 2/ B $!"'! %++/'1 1 ("!! Males Females 3 25% 2 15% 1 5% Q* * + ) : * + ) : * :+ Age groups :) :: :* :+ *) *: ** *+ 6) 6: RS6* first treatment! " 7 ))*/*6I1 ( / 1K IK /*I1 8 ( /5)I1 0I/4 :61.!23B$!"'"71 10"%++/ '11''$ ,5% 6 46,4% 4 26,5% 24,1% 12,1% 2 7, 3,1% 1,4% opiates cocaine cannabis 4 :0 ))* 2 8 % ' / % 2 15% 1 5% previous treatment first treatment Q* * + ) : * + ) : * :+ previous treatment Age groups :) :: :* :+ *) *: ** *+ 6) 6: RS6*

73 : % /6 5 1.! 24 A ' 0 7! 7 0! 01 '$ 0!"0$!! %++/!7$ '11'$ opiates cocaine cannabis other age at first use age at first treatment actual ))* ( $ / 1 6I % $ 6I 6I ( 8( ( '*I 6I /4 :51.! 2 A $!"' $%++/ $$0'0!01'$ ,2 63, ,9 30, ,1 opiates 6,3 cocaine injecting sniffing ( ( / *, 186*I( : :6I $ /4 :+1 % 3 $ /6I1 (/I1 /)I1 *

74 .! 2* A $!"' $%++/ $$0'0!01'$"0!! 100,0 80,0 60,0 65,7 64,5 40,0 45,9 % :I 5I / ::1 % ( /*I1 /+I1 % /0I ))*1 /+I1 3/5I1 /I1 /I1 ( 0I ))*K :)I / 1 *5I ' 22 B $!"'! 7$'1 ' '$"1'$%++/ 20,0 0,0 2,2 3,7 4,7 23,9 26,2 < >45 injecting sniffing smoking/inhaling I B 9 /012 '01& &&13 &314 : : : '13 +&1' '/14 '+15 % &5515 / / :) / 1 /:6I1 /:I1K '0)I 0*I 9 /*:I1 /:0I13 /:I1 /5I1 /6I1 10,5 6,8 4,7 *+

75 /*I1" 6*I :I 0I +I /I1 ; 6:I :0I 6I I.! 2+ B $!"'! %++/! 7$"7""'11 '$ 0' 0 ' '$" only one substance 46% only one substance 43% Opiates users Cannabis users three or more subst. 11% three or more subst. 17% two subst. 43% two subst. 4 only one substance 31% only one substance 25% three or more subst. 2 three or more subst. 38% Cocaine users Other substances users two subst. 49% two subst. < ))* I 6I % ' /*0I1 /:*I1 /*I1 /*I1 /4 :1 *

76 .!2B$!"'$%++/$$"!0 "!0?'11'$! opiates cocaine cannabis other self-referred health and social sources court / probation / : K * 5I 5I*I B ( 8 6I :I *I 8 ( 6I $ I K 0I - -.!2%B$!"'$%++/!7$ $0'"$75!0A0"!6"15A 0"!6 $$"!0'$"! opiates cocaine cannabis other 0 opiates cocaine cannabis other low middle high employed unemployed non 3 ' $I 8 0)I *%

77 ' 5)I 3 )I 3 B /)I1.!2)B$!"'$%++/! 7$0'07!500"065!0A0"!6 $$"!0'$"!05A0"! opiates cocaine cannabis other 0 opiates cocaine cannabis other alone with parents with others stable accommodation unstable accommodation in 9 0I ))*8 +IK 8 /6I1 & /I1 8 /5I1 )I ( ( :+I *I., ))* 2 % )/)) 51% : % / 0)I1% D*)I 0)I *)

78 5+ ))* /))) )):1'+I +I: % % $ *I 5I /0*I1 : /0I1 I5I% /::1.!22-'"0$0'0' $"0'$ % 71% % 12% 18% 1 2 or 3 more than 4 Heroin Cocaine Cannabinoids 2 /2"2@1 % / 1 : / 6I *I :1" $ /I 0I1 /+I *)I1 /I:I1/:*1 *2

79 .!2/-'"0$0'0' $"0'$ 6)I *)I :)I )I )I )I )I 7 " " : 2 /2"2@1 % */

80 / <,A8 /7$ /%!A /)8"$1" *3

81 *4

82 /!A" /07$ ))* A 7 ** K 2))* % 6 ( C78' 6)I3 K C /0)I1 /0*I1D /00I1& /05I1 =" /5I1C /50I1/%*1 '/-$A0'$"$7!8$0) %++/ Regions and Auton. Provinces Socialrehab facilities present Ministry of Justice Region Agreements Province Municipality LHU Agency Piemonte Valle d'aosta Lombardia Trento Aut. Prov Bolzano Aut. Prov Veneto Friuli Venezia- Giulia Liguria Emilia Romagna Tuscany Marches Umbria Lazio Abruzzo Molise Campania Puglia Basilicata Calabria Sicily Sardinia G2"2@ 8 3 6(% Other 6 4 >@ ))*? G2 2"2@ *

83 8 0 ) ( = A8 % 8 & 9 D 3 ) ( C C-8--/%*1 '/%-<"1"$A0'$"%++/ Regions and Auton. Provinces Users in socialrehab facilities Staff in social-rehab facilities n. of users per staff in nonprofit sector Ser. T. Users Ser. T. staff n. of users per Ser. T. staff Piemonte , Valle d'aosta Lombardia , Trento Aut. Prov Bolzano Aut. Prov Veneto , Friuli Venezia-Giulia 247 3, Liguria , Emilia Romagna , Tuscany 982 1, , Marches , Umbria 337 3, Lazio , Abruzzo , Molise Campania , Puglia , Basilicata , Calabria , Sicily , Sardinia , !8 T! 8 2 2U 8 FF K )) 6:( 8-- )): % /% *1 :)I / 66I C-1 (/ 0I *I1 % 3 ( / *I :I3 1 0 % +)I@% **

84 '/)-$!"'1"++/ Regions and Auton. Provinces Physicians Nurses / health workers PsychologistsEducators Social workers Administrative Others Piemonte Valle d'aosta Lombardia Trento Aut. Prov Bolzano Aut. Prov Veneto Friuli Venezia-Giulia Liguria Emilia Romagna Tuscany Marches Umbria Lazio Abruzzo Molise Campania Puglia Basilicata Calabria Sicily Sardinia /%*:1% - '/2-!H! ""$ 7$ 0! "! Regions and Auton. Provinces % - Piemonte Valle d'aosta Lombardia Trento Aut. Prov % C78! % 1 ++

85 Regions and Auton. Provinces Bolzano Aut. Prov. Veneto Friuli Venezia-Giulia Liguria Emilia Romagna Tuscany Marches Umbria Lazio Abruzzo Molise Campania % - 8 % 8 D 0 )6++ D 8 2K =A 8 2 % 2 /@% @ 8 ):B)++0>. ++5? : * 8 ) ++: 8 78 % 8 2 )* + )) 2 /@%1 % " & C 8 2! 8 2 / ))* ( 2 % :)@% C % " 8 C798 % 8 2 >8-2 / 0:0,):1))* 0,)* 82K4. 5)))6 +2 /89@C %"@% "@%A = = % C

86 Regions and Auton. Provinces % % Puglia - C79 Basilicata %@% K " 8 Calabria 2 %28 2 Sicily % A C ' 2 % Sardinia !8 T! 8 2 2U 8 /%C!A.D 8 ( ' &"228 ( $, % 7 ))* 3, />?1 :6**: /6I *1% ( )) )) I / 3, 1 )I $, />71 +%

87 .!/-$!"'17""0 %++A%++/ 10 75% 32,0 19,8 23,4 36,3 35,8 5 25% 68,0 80,2 76,6 63,7 64, pharmacological /@L 1 $ ( $ D ( $ /50I1 /6I * 1 " ( /:I1 /:I14 /+I1 /*I1 /4 *1,0 /%- $! "' "7" "!! 1 1$0A$ 1''$%++/ o ther 3% cannabis 25% o piates 43% co caine $ % " >? / 1 +)

88 /$ 1/%**1 ' // B 8 $ 5"" 6 ' 1$0A $@0'7 " $ $A"!0$ $0$$! ++/ 1 1$0A$ 0'7 ""5 */I **351442&1&26 +3/*51/4'510+/8 %/45144'&1/4' +4*5133&5143/8 +*+*516&/&15& &1'05 +)251663&1'50 %514/3&1+&2 42&1552&1+0'8 +44)513&25140'8 4//&1++4' %/%51'&451'4&8 4%+&123''15'28 +*%/5133/&1' &551/'48 +/)45120/ F $ %, /*6I1 ( $ / I1 3 /I1%,0/)- $!"' 1 1$0A$ "@ 0' , , ,1 0 Councelling Psycho therapy Social service +2

89 ( :5I K )) )) :I/4 *:1,0/2-$!"'11$0A$"@0'7 7""++A%++/ ,2 48,5 47,8 46 % ,9 43, /)8"$1" ))* / 5:1 % )):)) )) /4 *1 /"!3 3 D 1 " /@L 1!" ))*( )) /4 **1.!//-$!"'17""0 %++)A%++/ ,7% 40,2% 29, ,6% 18,8% 30,8% 2 39,8% 41, 40,1% only pharmacological integrated (pharmacological with psychosocial terapy) $!"))* +/

90 8 / 1 6*I )) *+5I )): 0I ))* $ ; / 1 %$ 5*I * ( / *I 1 B 6)I ' 0I K /*I1 /4 *61,0/3- $!"' "7" "!!!""!A'" 1''$%++/ cannabis 2% o ther 1% cocaine 5% o piates $ " /@L 1 $ ( ( / 1 / 1 / 1/%*61 +3

91 '/3 A 8 $ 5"" 6'!""!A'" " $ $A"!0$ $0$$! 0 %++/!""!A'" ""5 */I **451605&1&2+ 4*&15+0&1+258 ))4&15+5& )51626&1'54 +**351645&1&&/ %++*&105+'1+348 /3&1//4'1'&&8 %4&1&5+&1/5'8 %%3&1524&12+28 % &1/&6 )3&15&'& /01203& /&1&36'13'/8 4) & +/)) F $ 0"!" ( I /4 *01,0/4-$!"'!"7""0 %++A%++/ 3, 2,5% 2, 1,5% 1, 0,5% 0, / 1 ))* /)) )):1 5I +4

92 / 1 )) ( /4 *51,0/- $!"' 1 0" 7"" 0 %++A%++/ 10 75% 64,7 64,6 64,5 66,7 66,4 5 25% 22,3 22,6 22,8 21,4 20,3 13,0 12,8 12,8 12,0 13, short term medium @L $' - 6*I / 3 1 I D K -, /*0I1 /I1/:I1K - D ' * /*:I :I1K ( 5I / D 1 / D 1 % :( (/4 *+1 +

93 ,0/*-$!"'"7""!!0!" $!1''$%++/ cannabis 1,8% ot her 0,5% cocaine 1,9% opiates 95,8% $ % D 6I )): I )))) % D " D :I )))I ))*/4 *)1.!/+-$!"'"7""0&00 >!">%++A%++/ ,6 15,1 15,0 15,3 14,6 10,4 10,0 8,8 5,3 3, % clients in buprenorphine treatment on reporting centres clients % clients in buprenorphine treatment on total centres 8 D 3 /:I ))6:I ))* D " D I I ))* /4 *1 +*

94 ,0/- $!"' 1 &0 7"" ++A%++/ 10 75% 41,8 53,3 55,3 64,1 63,7 5 38,7 25% 29,7 29,1 21,6 23,2 19,5 17,0 15,6 14,3 13, short term medium term 0! ))* )) )):!3 *1,0/%-$!"'(7""0 %++A%++/ 5% 4% 4,5 4,6 3% 2,8 2,5 2% 1,7 1% $ $ /+*I1 / 1 /6I1 <!""!A'" $ ' 3 +I$, :)I )I ( /1 /4 *1 +

95 ,0/)-$!"'"0'"1 "01''$%++/ ,7% 14, 10,6% 5,4% 6, 17,1% 15,2% ,9% 74,3% 87,7% 67,1% 2 23,8% o piates cocaine cannabis other only pharmacological integrated (pharmacological with psychosocial terapy) $ % $ ; /0I1/4 *:1,0/2-$!"'"7""!!"!A1 1''$%++/ cannabis 2% o ther 1% cocaine 7% o piates $ ( 8 ( $, ( / 1 B ' 3 ( /%*01

96 '/4A8$5""6'"!A1" $$A"!0$$0$$!0!A1 ""5 6*/I &6&95+& 3*&9+/'& )/59/2'5944/8 +//596/5& /&95&' 2%&9&+&&903+8 )/%&9534&90&58 +)596/&&9'3/ +)5945+&9+20 /4/&9&//'9&248 + /)* / )%+59&0259/'28 /%596//295&' %)59460&9'00 + %3*59''&59+'08 F $ 7A$ 8 "B 2))*500 / 1 % 0 /0) ): 5 16*I )I *I % $ /4 **1 2 3 ' 3 3 )) *' K ))*:' 7 %

97 .!//-$!"'7A$ '11$1 $') %++A%++/ ,7 67,7 68, , ,4 21,4 19,4 10,9 10,9 11, ,5 25, residential services half-residential services outpatient G2"2@., ))* A 7 ** K )I @%A )(3 )(%,, % 3, /6I1 4 * / 1 /+I1 /*I1%, / $ 1 )) )):K $ *( " / I 1 5:I D %!3 I% 4 3 ( )

98 PART 6 99J< 6.1 Drug related deaths 6.2 Drug related infectious diseases 6.3 Psychiatric co-morbidity 2

99 6. Health correlates and questions. 6.1 Drug related deaths. Deaths associated with drug abuse constitute one of the five key indicators, identified by the European Monitoring Centre for Drugs and Drug Addictions (EMCDDA) in Lisbon, for formulating and evaluating policies on drug addiction. This phenomenon reveals itself in Italy in various ways depending on the source. ISTAT measures drug related deaths through the General Mortality Register, which is currently updated as far as 2002 regarding deaths directly attributed to substance abuse (according to the IDC9 classification). The institutes of legal medicine carry out toxicological investigations in order to find the cause of death whether directly or indirectly due to drug abuse (these inquests are conducted only at the explicit request of magistrates, who can entrust the task to various branches of the institutes of legal medicine, particularly since not all institutes are attached to Italian universities). Lastly, the DCSA (Central Anti-drug Services Department) holds drug related death records through the Special Register of Deaths at the Interior Ministry. This third register is evidence-based and refers to cases of deaths which are directly attributable to drugs (where there is clear proof of an overdose) where the police have been involved, as opposed to cases where death was caused indirectly as a result of drugs (such as road accidents due to the driver being under the influence of drugs or fatalities associated with pathological complications due to substance abuse). As such these records at present constitute the principal and most up-todate source of data. Analysis of the information provided by the DCSA reveals that in 2005 there were 603 cases of death by acute intoxication from drugs, a figure in line with the previous year (600 cases). Most significantly, it can be seen that in this last two year period there has been a noticeable increase in such deaths, giving rise to an upturn in the progressively decreasing trend shown in the period 1996 to 2003 (see Graph 6.1). Graph 6.1: Distribution by gender of drug related deaths, F M Source: Based on data from Interior Ministry (DCSA) data. Males consistently represent at least 9 of the total deaths occurring in each year, except for 2003, in which, notwithstanding the fact that that year recorded the lowest number of deaths of the decade, around 12% were women (amounting to 63 out of a total of 517 for that year). From 1996 to 2005 there were no records in the DCSA register of overdose related deaths in youths under 15, whereas 15 to 19 year olds represented two to 3% of the total. Deaths from overdoses among 20 to 35 year olds, which in 1996 amounted to 75% of the total, reduced over time and in 2005 constituted 45%. At the same time the number of fatal overdoses in the over 35 group increased, rising from around 22% to 53% of the total (see Graph 6.2). /

100 Graph 6.2: Percentage distribution of drug related deaths, according to age group, > Source: Based on data from Interior Ministry (DCSA) data. It is therefore evident that, over time, the average age of death has increased, rising substantially from 30 in 1996 to 35 in 2005 (see Graph 6.3). Significantly, separating the results by age illustrates that women have a lower average age of death than men in all but the first and last years of the period, in which the average ages for men and women coincided. Graph 6.3: Distribution by gender of average age of death, average age ALL average age M average age F Source: Based on data from Interior Ministry (DCSA) data. The cause of death in 254 cases was attributed to heroin (of which more than half occurred at home and around 17% in the street), in 43 cases cocaine (of which 42% at home, around 19% in the street and 14% in hospital), in 4 cases methadone and in 1 case amphetamines; in half the cases (301) the substance was not recorded. There were 30 foreign nationals (three of which were of unknown origin) among the deceased in 2005, equating to 5% of deaths per annum. This was lower than the previous year when the figure was 7% (41 foreign nationals, 11 of unknown origin). Map 6.1: Regional distribution of overdose related deaths, 2005 rates x 10,000 3

101 Source: Based on data from Interior Ministry (DCSA) data. " 3 % 8 ". The official statistics which refer exclusively to sudden death directly associated with drug abuse do not take into account either those situations in which drugs have indirectly led to death, such as accidents or pathological causes, or those cases where the police were not involved in the investigation. The cause of death was established through toxicological investigations or post mortems only in some cases if requested by the magistrate. There is therefore inevitably an underestimation of this phenomenon. Analysis of the information provided by the DCSA reveals that in 2005 there were 603 cases of death by acute intoxication from drugs, a figure in line with the previous year (600 cases). Most significantly, it can be seen that in this last two year period there has been a noticeable increase in such deaths, giving rise to an upturn in the progressively decreasing trend shown in the period 1996 to The cause of death in 254 cases was attributed to heroin (of which more than half occurred at home and around 17% in the street), in 43 cases cocaine (of which 42% at home, around 19% in the street and 14% in hospital), in 4 cases methadone and in 1 case amphetamines; in half the cases (301) the substance was not recorded. 5% of the deceased were foreign nationals. Umbria and Lazio were the regions with the highest rates of fatal overdose. 4

102 6.2 Drug related infectious diseases The prevalence of infectious diseases among drug addicts has also been identified by the European Monitoring Centre for Drugs and Drug Addictions (EMCDDA) in Lisbon as one of the key indicators for monitoring illegal substance usage. The data used for the Italian study was supplied by the Health information System (SIS) of the Ministry of Health and is based on patients using drug addiction treatment services (Drug Addiction Reporting Activities, files ANN.04, ANN.05, ANN.06). HIV/AIDS In the course of 2005, 496 testing centres out of 550 (9 of the total in Italy) submitted data in time for the current report, yielding a sample size of 65,848 tests. It should be borne in mind that the number of subjects tested for the HIV virus among Ser.T users is also relevant for monitoring the development of HIV support services in general at both a local and national level. Around 43% of Ser.T users (a population which includes both new patients and those already undergoing treatment in previous years) were tested for the HIV virus and 13.8% of those tested positive. Graph 6.4 highlights the fact that the number of tests carried out involved a higher percentage of existing patients (46.1%) compared with new users (34.2%) and that more female subjects than males underwent the test (respectively 47.2% and 42.9%).,032-' '1!""1 $!0"9 ;!'!" 6)I *)I :)I )I )I )I )I! 8C& &3! 7 &3 The percentage of subjects testing positive appears to be high for those already in treatment compared with new users, both in the case of men (15% versus 3%) and women (23% versus 4%). Comparing genders, subjects testing positive were higher among women than men, both for new users (4% of females versus 3% of males) and moreover for existing patients (23% versus 15%).,03/-' '1!""1 00"79 ; $!0" *I )I *I )I *I )I! &3! &3 8C& 4&8C&

103 @'D 7 The proportions of testing positive for HIV (subjects testing positive as a percentage of the number of tests carried out within services) is of great interest at both a local and national level.,033-'$!0!9 ;7!'! " %++A%++/ ,8 14,8 14,2 13,9 13,8 % % $ /. 601 % *I:I ))))* / K 82@ 5)0 ))6 ))*1 5 ))$ *I*0I,034-'$!0!9 ;7! '!" %++A%++/ 10 8 % 6 4 5,1 5,7 4,7 4,2 3, Report on AIDS cases notified in Italy ISS - (December 2005) *

104 Analysis of new cases in relation to gender (see Graph 6.8) reveals that in 2005, among the 1,720 female addicts tested, the percentage testing positive was slightly higher than the percentage of the 9,842 men tested (3.7% of women versus 3.3% of men), with a female to male ratio of 1.12:1. However, as Graph 6.8 indicates, the trend over 2001 to 2005 was for the male and female positive testing results to draw closer together.,03-''1!"$!0!9 ;7! '!" %++A%++/ ,2 8,3 7,0 % 6 4 4,7 5,2 5,0 4,4 4,2 3,7 3,3 M F I $ ))*%,03*-'$!0!9 ;7!(! '!" %++A%++/ 20 16,9 16,5 16,1 15,9 16,1 15 % Among existing users a difference can be seen between the sexes. In 2005 the percentage of female addicts testing positive was significantly higher than the results for the men, with a female to male ratio of 1.6:1. %+

105 ,03+-''1!"$!0!9 ;7! (!'!" %++A%++/ ,4 25,2 23,9 24,2 23,1 % ,5 15,1 14,8 14,6 14,9 M F %$ 7=:) = $ ( /5+I1K I $ *I 7= :I /, $ 1 0I / $ 1 %

106 ,0 3- $!"' '11 '$ ' 9 ;7 ':$!"(!%++/ % 9 0 % 8 0 % 7 0 % 6 0 % 5 0 % 4 0 % 3 0 % 2 0 % 1 0 % 0 % o p io id s c o c a in e c a n n a b in o id s o th e r opiate new clients existing 7 7= % 8 % $ 7= Viral Hepatitis B Monitoring of the number of hepatitis B tests carried out on subjects in the care of substance abuse services provides a useful indicator of how the disease is being combated, with various remedies for primary prevention and also with the commercial availability of the vaccine 9. In the course of 2005, in all centres across Italy, 61,396 hepatitis B tests were carried out, constituting some 37.8% of the total number of patients at Ser.T. Of these, 41.7% tested positive. Graph 6.12 indicates that there was more intensive testing among existing patients compared with new patients (43% versus 3), but there were no substantial differences between the sexes (approximately 4 of both males and females were tested).,03%-' '1!""1 $!0"0 &!'!" 5 45% 4 35% % The 2 cost of this vaccine is 19 per dose, three being required for a course of treatment (Source: International Vaccine Service, Rome) 15% 1 5% New clients Existing clients New clients Existing clients MALE FEMALE %%

107 @'D 7 Of the subjects tested, 23% were positive for hepatitis B out of new users, both for men and women, whereas among existing users 46% tested positive, again with negligible difference between the sexes.,03)-' '1!""1 00"70 &$!0" 5 45% 4 35% 3 25% 2 15% 1 5% New clients Existing clients New clients Existing clients MALE FEMALE Source: Based on data from the Ministry of Health From the data available, it appears there were similar percentages of subjects vaccinated for hepatitis B among men and women (around 7% versus 9%) in the new user group, while many more men than women were vaccinated in the existing user group (approximately 24% versus 12%). Graph 6.14 Distribution of subjects vaccinated against hepatitis B, as a percentage of all subjects 25% 2 15% 1 5% New clients Existing clients New clients Existing clients MALE 7 The Ministry of Health definition of vaccinated is that a patient has followed a course of treatment and has undergone a subsequent check-up that confirms that he/she has responded to the vaccine. It is considered that the vaccine is neither effective nor useful in subjects who have active hepatitis B or who have had the condition in the past. Even taking this definition into %)

108 account, it is worth noting the particularly low percentage of females vaccinated compared with males in the existing users group (see Graph 6.14). This gives a clear indication on where the focus of future testing and prevention measures should be concentrated. Considering the trend over the period 2001 to 2005, the percentage of subjects tasting positive appears to be dropping in 2005 although the levels themselves are considerably high (see Graph 6.15).,03/-'00"70&$! 0" %++A%++/ ,5 43,4 43,2 43,7 41,8 30 % ))* *I / *I,0 33- $!"' '11 '$ ' 0& 7':$!"(!%++/ opiate opioids cocaine cannabinoids other new clients existing Viral Hepatitis C In the course of 2005 in the Italian Ser.T, 75,213 hepatitis C tests were carried out (this corresponds to 46% of the total patients at Ser.T, both new entrants and existing patients from previous years). Of the subjects tested, 61.4% tested positive. Graph 6.17 shows that most of the testing occurred among existing patients and that slightly more females than males underwent tests.,034-' '1!""1 $!0"0!'!" %2

109 New clients Existing clients New clients Existing clients FEMALE Observation of the percentage distribution of patients testing positive reveals little disparity between male and females. Again the high levels of those testing positive in the existing user group should be noted (67% for men and 7 for women).,03-' '1!""1 00"70 $!0" New clients Existing clients New clients Existing clients FEMALE Analysis of the trend over time shows that there has been a slight reduction in those testing positive for hepatitis C. The reduction from 2001 to 2005 is around 5%, a tangible result which testifies to the efforts being made in specialised services in terms of primary prevention. The absence of an effective vaccine however means that expecting a further decline is probably unrealistic. There remains though the requirement for multiple and structured techniques for prevention, not least because of the social costs of the disease.,03*-'00"70$! 0" %++A%++/ ,3 64,9 64,9 63,5 61,4 % %/

110 Again for patients who tested positive for hepatitis C, the data for 2005 (see Graph 6.20) shows that opiate abuse is associated with almost all cases (89% for new patients, 97% for existing patients). It can also be seen that cocaine users constitute 1 of new patients testing positive for this disease. Graph 6.20: Percentage distribution, by primary substance of abuse, of opioids cocaine cannabinoids other hepatitis C positive subjects among new and existing users at Ser.T in 7 FINDINGS In 2005, a number of patients accessing national services for drug addiction were tested for HIV, hepatitis B or hepatitis C. Of these, 13.8% were HIV positive, 41.7% tested positive for hepatitis B and 61.4% tested positive for hepatitis C. Relative to 2001, the percentages of those testing positive for the three diseases (14.8% for HIV, 43.5% for hepatitis B and 66.3% for hepatitis C in 2001) have reduced slightly. HIV positive addicts have an average age of 40. Almost all existing HIV positive patients at Ser.T (89%) were opiate users. Among new patients however, only around 5 of subjects were opiate users, whereas 4 declared cocaine as the primary substance. Cocaine users for all tree diseases either opiate new clients existing clients take the drug intravenously or additionally inject opiates. For patients testing positive to hepatitis B, there was a strong concentration, among both new and existing users, of opiate abuse which exceeded 85% in both categories. Cocaine use affected 15% of new patients. A similar picture emerges for hepatitis C patients where very high numbers (89% for new patients and 97% for existing patients) were opiate users and 1 of new subjects used cocaine. The cost of diagnostic and therapeutic treatment 10 for the diseases under consideration, in addition to the social costs due to many patients affected by chronic hepatitis B and C developing into cirrhosis 11, serves to underline the necessity for both constant monitoring of the conditions and a major 10 DRG 205M7: Liver conditions excluding neoplasia, malignancy, cirrhosis and alcoholic hepatitis. Ordinary admission: 2,340; first day of hospitalisation or attendance at day hospital 265; each successive day 177. (Health Ministry Official Bulletin No. 11, 20 April 2006) 11 DRG-202M7: Cirrhosis and alcoholic hepatitis Ordinary admission: 4,817; first day of hospitalisation or attendance at day hospital 275; each successive day 209. (Health Ministry Official Bulletin No. 11, 20 April 2006) %3

111 commitment to this cause on the part of health professionals. Personnel involved in this field need training in order to implement the required measures for prevention and reduction of damage, to help prevent the spread of infection and to improve the quality of life of sick patients Infections in prisons From the standard tables issued in 2005, it can be seen that 89,887 individuals entered prison, of which 25,541 were evaluated as addicts. This year the Department of Penitentiary Administration has provided, in addition to the standard data, information for each subject from a non-random sample on the status of his or her addiction. The sample consists of 8,180 prisoners entering the system during 2005 (the sample encompasses 32% of the total population of prisoners with known addictions). Of these prisoners, 4,878 (6) were affected by infectious diseases. 4% of the sample group were women and 31% were foreign nationals. 17% of the subjects were considered to have a history of opiate abuse, 21% cocaine, and less than 1% benzodiazepine or alcohol, while 61% were listed as being multiple users (in 65% of cases with heroin and cocaine). 41% of males with infectious conditions were aged between 25 and 34 years old, while 3 were 35 to 44. The age distribution among women prisoners was 33% between 25 and 34 and 31% aged 35 to 44. The youngest age group included similar percentages for both males and females (18% and 19% respectively). In the older age groups there was a higher percentage of women: the 45 to 54 band included 13% women as against 9% men and the over 55s consisted of 5% females versus 2% males.,03%-$!"''1!!"!"':$$"'1 $" 45% 4 35% 3 25% 2 15% 1 5% >54 Male Female Source: Based on data from the Justice Ministry, Department of Penitentiary Administration For both the Italian and the foreign addicts in the sample group entering prison in 2005, the age group with the highest number of subjects suffering from infectious diseases was 25 to 34, with 44% of foreign nationals and 39% of Italians. It was also evident that a high percentage of non- Italians were in the youngest band, aged between 15 and 24 (27% of the sample group versus 14% for Italians). The older age groups contained higher percentages of Italians. %4

112 ,03%%-$!"''1!! "!':$ $"'1$" 5 45% 4 35% 3 25% 2 15% 1 5% >54 Italian Foreig Foreigner Source: Based on data from the Justice Ministry, Department of Penitentiary Administration Of the subjects studied, 42% were tested for HIV, 28% for hepatitis B and 33% for hepatitis C. By comparison 69% were tested for tuberculosis. Among those tested for HIV, 12% tested positive; 38% tested positive for hepatitis B and 44% for hepatitis C. 2% of those tested were found to have tuberculosis. Graph 6.23: Distribution of subjects testing positive for infectious diseases as 50 % 45 % 40 % 35 % 30 % 25 % 20 % 15 % 10 % 5 % 0 % H IV H B V H C V T B C a percentage of those tested. Source: Based on data from the Justice Ministry, Department of Penitentiary Administration The age group in which subjects were the most affected by HIV, hepatitis B and hepatitis C was the 35 to 44 band. 0.5% tested positive for dormant tuberculosis while 1.2% had contracted the active condition. Previous cases of tuberculosis were present in the age groups between 25 and 54 while, for active TB, the main ages affected were 15 to 44. %

113 Graph 6.24: Distribution by age group of subjects testing positive for 7% 6% 5% 4% 3% 2% 1% >54 HIV HBV HCV Previous TBC TBC in acute phase infectious diseases as a percentage of those tested. Source: Based on data from the Justice Ministry, Department of Penitentiary Administration As can be seen from Graph 6.25, all the tested diseases were particularly relevant to the foreign nationals in the group, with the exception of hepatitis C. Of the 195 non-italians testing positive for the various diseases, 17% presented active tuberculosis, compared with 2% of Italians in the group (1,327 subjects). HIV positive foreigners represented 18% of their group, while Italians 15%. For hepatitis B the results were 41% and 32% respectively. Hepatitis C however followed the opposite trend with 51% of Italians testing positive as against 23% of foreigners. Graph 6.25: Distribution by nationality (Italian and non-italian) of subjects HIV+ HBV+ HCV+ TBC Italian Foreigner Foreig testing positive for infectious diseases as a percentage of those tested. Source: Based on data from the Justice Ministry, Department of Penitentiary Administration., ))* $ **: 28 $ / 1 % 55)$/I 1:505/6)I1 :I I 0I$ I I- - 6I /6*I 1 %*

114 0I * :I B$ :I7=5I DI "6+I 8 7= I 5I D ::I "BI )*I $ I **: %D *:: 8 ))* 3 " )+

115 6.3 Psychiatric co-morbidity Co-morbidity within drug addiction services among mentally disturbed patients and patients disturbed by substance abuse Planning of treatment programmes for subjects who present disturbed behaviour from psychotropic substance use/abuse must take into account the requirement to evaluate the concomitant presence of other psychiatric conditions, since these may influence the process and outcome of such treatment. The fact that it is impossible among subjects with psychiatric co-morbidity to separate the psycho-pathological disturbance from that associated with the dependence, requires a different type of organisation and further specialisation among professionals in specialist services. As regards public services in Italy, these new requirements manifest themselves in the following organisational changes: - The presence of a psychiatrist at the centre - Collaboration with the Mental Health Department - Treatment programmes and rehabilitation courses specifically adapted for patients with this type of double diagnosis The therapy community is also interested in these changes as shown by the existence of a specialist service for users with psychiatric disturbances. From the SIMI Italia study carried out this year on a sample representing national specialised services, it emerges that 62.1% of Ser.Ts have one psychiatrist, either within the organisation or contracted in with an office at the centre. Allowing for the fact that one psychiatrist can work for more than one Ser.T, the percentage of centres which have at least one psychiatrist available for patients with psychiatric problems rises to 69% (see Graph 6.26). Graph 6.26: Clinical psychiatrists in drug addiction services Psychiatrist in SerT's staff Psychiatrist within Ser.T staff SerT w ith a consulting Psychiatrist in the Department's Ser.T with consulting staff psychiatrist on department In the case of the therapy community, the data collected in the SIMI Italia project shows that 16.7% of therapists have a specialist service for users who are psychiatrically disturbed, 22.2% have recourse to an external specialist and 61.1% do not provide this service as standard but may be able to seek occasional external help (see Graph 6.27). )

116 Graph 6.27: Psychiatric treatment available in the therapy community external consultant 22,2% Not planned 61,1% internal psychiatrist 16,7% The presence of a psychiatrist at a centre is far from the only requirement for supporting patients with associated psychiatric problems. For this reason synergies and collaboration with the infrastructure and staff of the Mental Health Department are considered to be of paramount importance. In the sample study on national specialist services, drug addiction centres were surveyed on the extent to which they have a structured collaboration with mental health services. As shown in Graph 6.28, 48.3% of the sample confirmed that they enjoy structured cooperation with the mental health department, whilst in 27.6% of Ser.Ts there is some working together albeit on a less formalised basis. Only a quarter of the sample (24.1%) either stated that there was no collaboration or did not respond to the question. Graph 6.28: Collaboration between Ser.T and the Mental Health Department Does not Does not exists 15,5% Did Do not answ er not 8,6% Not structured 27,6% Structured Therefore, if it is considered that there are Ser.Ts in which there is an in-house psychiatrist, in addition to those which have an active collaboration with the Department of Mental Health, the percentage of centres which are able to offer psychiatric support to patients with a double diagnosis rises to 82.7% of the sample. In this group of Ser.Ts, therapy and rehabilitation programmes specifically aimed at subjects with a double diagnosis are offered by 95.2% of centres (see Graph 6.29). )%

117 Graph 6.29: Rehabilitation programmes offered to patients with double diagnosis Ser.T. con Ser.T programmi s with specific specifici programmes 96% Ser.T. Ser.T s without SENZA specific programmi programmes specifici The specifics of the treatment which double-diagnosis patients undergo can be seen by studying the frequency of psychiatric sessions which supplement the activities of the multidisciplinary team. Graph 6.30 indicates how often a double-diagnosis patient encounters a physiatrist for an interview or for psychotherapy. In particular it can be seen that in 62.5% of cases a patient sees a psychiatrist for an interview more than twice a month and in 5 of the surveyed centres the patient visits a specialist for psychotherapy two or more times per month. Graph 6.30: Frequency with which a double-diagnosis patient meets a psychiatrist for an interview or psychotherapy 6 % of the sample of SerT Interview s Psychotherapy Less than once a month once a month 2-4 times a month more than 4 times a month Do not answ er Did From the information gathered at an analytical level within the 2005 SIMIItalia project, it is possible to specifically examine the therapeutic treatment in relation to the psychiatric diagnosis and the type of treatment carried out. In a sample consisting of 2,065 subjects, 3 received a positive psychiatric diagnosis. Graph 6.31 describes the distribution of diagnoses by substance within the sample group. ))

118 Graph 6.31: Relationship between diagnoses and primary substance of abuse positive psychiatric diagnosis negative psychiatric diagnosis 4 2 opiate Oppiates Cocaine Cannabis Other illicit 4$, 4 $ % $ : 3 % $ % 6 H A Table 6.1: Measure of the odds-ratio relationship between psychiatric comorbidity and various socio-demographic characteristics among users at Ser.Ts. odds ratio (95% Conf Presence of psychiatric co-morbidity Interv) ( )* ) :Q) 1.368( ) * ::Q) 1.372( ) R::Q) 3.012( )* Education level, low vs. high 1.006( ) Education level, medium vs. high 0.834( ) Employed vs. economically inactive 0.286( )* Unemployed vs. economically inactive 0.781( ) Live with parents vs. alone 0.929( ) Live with others vs. alone 0.648( )* Opiates vs. cannabis 1.121( ) Cocaine vs. cannabis 0.533( )* Other substances vs. cannabis 3.944( )* Consumption of two substances vs. one 1.525( )* )2

119 Consumption of 3 or more substances 0.630( )* vs. one * statistically significant values ( 4 % & $., The percentage of Ser.Ts which have a least one psychiatrist in their own department for patients with psychiatric problems is 69%. For therapists, 4 of the community either provide or have access to psychiatric services. From the information gathered at an analytical level within the SIMIItalia study in 2005, it is possible to specifically examine the therapeutic treatment in relation to the psychiatric diagnosis and the type of treatment carried out. In the sample, consisting of 2,065 subjects, 3 received a positive psychiatric diagnosis. 4$, 4 $ 4 $ Co-morbidity within the Mental Health Department among mentally disturbed patients and patients disturbed by substance abuse The preliminary results of a multi-centre investigation 12, which carried out an epidemiological survey of double-diagnosis patients in the care of mental health departments (DSMs), have shown that there is evidence of psychiatric co-morbidity in over 1% of cases 13 (see Table 6.2) 12 Multi-centre study PADDI (Psychiatric and Addictive Dual Disorders in Italy), carried out by the Università degli Studi in Milan, the Department of Mental Health Sciences, Royal Free and University College Medical School London, UK, the Università degli Studi in Pavia, and the Università degli Studi "G. d'annunzio" in Chieti. Financed by the National Department for Anti-Drugs Policies, Prime Minister s Office. 13 Of the 216 DSMs in Italy, 78 participated in the survey. The preliminary data refers to 22 DSMs with a patient list numbering 64,367. )/

120 Table 6.2: Prevalence of double-diagnosis patients Area No. DSMs Prevalence (x % Conf Interv patients) North Central South Total Source: PADDI Multi-centre Study Among these cases, the most frequent diagnosis was personality disorder, followed by schizophrenic and delusional disorders (see Graph 6.32). % ,6 Schizophrenic and delusional disorders 17,3 Mood disorders Graph 6.32: Distribution of double-diagnosis patients by psychiatric disorder Source: PADDI Multi-centre Study Analysis of the profiles of drug use among patients with various psychiatric conditions (see Graph 6.33) reveals that substance abuse is particularly prevalent in cases of personality disorder and schizophrenic/delusional disorder, while the drug dependence rate is highest among subjects affected by other forms of non-organic psychosis. Multiple use of substances, while present in all the diagnostic categories, was particularly varied among patients with personality disorders. 5,2 Other non organic psychosis 9,6 Neurotic disorders 37,4 Personality disorders )3

121 Graph 6.33: Distribution of double-diagnosis patients, by condition and % ,4 Schizophrenic and delusional disorders 73,2 49,4 49,3 40,4 Mood disorders 63,6 52,2 50,6 41,9 38,2 31,8 Other non organic psychosis Use Abuse Dependence Neurotic disorders 50,6 89,5 52,5 Personality disorders profile of use (use/abuse/dependence) Source: PADDI Multi-centre Study * The sum of the profile of use percentages for each psychiatric condition may exceed 10 in cases where the subject abuses more than one substance or is dependent on other substances (multiple use). Irrespective of the type of condition, alcohol is the most frequent substance of abuse or dependence (see Graph 6.34). Graph 6.34: Distribution of double-diagnosis patients by substance (abuse or Personality disorders Neurotic disorders Other non organica psychosis Mood disorders Schizophrenic and delusional disorders Alcohol Opioids Cannabinoids Cocaine and stimulants Hallucinogens Barbiturates dependence) and diagnosis Source: PADDI Multi-centre Study )4

122 ., The prevalence of double-diagnosis patients under the care of Italian mental health departments amounts to 1.31% with considerable geographical variation throughout the country. The prima facie evidence supports the hypothesis that the socio-cultural context, in addition to factors intrinsic to the conditions, influence the rates of co-morbidity between psychiatric disorders and substance use. Alcohol is the most widespread substance of abuse or dependence, a statistic which is in line with European and international trends. )

123 4,, 8 J<.99 47"!A""0 4%7""!A"$" )*

124 2+

125 47"!A""0 % %( ( % ' - " ( K - 2 K - 2 K - 93K % ( ( '( ( /6**I1 :I /4 01.! 4-.?$1 7 0 "$! 7$50"$!6 8 % of the SerTs of the sample les s than onc e a month onc e a month 2-4 times a month more than 4 times a % C)+,+) ' ( 3 /01 2

126 .! 4%-.?$1 7 0 "$ 0$ 5 % of TC of the sample less than once a month once a month 2-4 times a month more than 4 times a month +:I :0I 5I 8 2 ( D *6+I2 /01 $ /6I1.! 4)- 8 "'! 0 $ 0 "!!7$ 8 % of the SerT of the Sample Material available Material distributed in proactive w 8 ( & " /&"2281 ( %&"228 4 ( 2%

127 ( B I $ &"228 8 /*+I1 ( 6I /4 0:1.!42-!0 No info / do not respond 25,9% Evaluated 12,1% Not evaluated 62,1% D ( ( ( 2 /, % ( /50+I1 *6+I /4 0*1.! 4/- 07!$ ""!A" "0 10 % of the SerT of the sample Mat. available for the clients Mat. distributed in proactive w ay 2)

128 @' ( *+I /061.!43-0"'07!$""!A""0 No info / Do not respond 15,5% Evaluated 25,9% Not Evaluated 3 /!1 2 3 % *: " &2 4%7""!A"$" 8 2 ( ( % ' 3 ( ( % % ' -,

129 4, :*I I /4 001.!44-'1!"@ 5 % of the SerT of the sample Syringe or other sterilized material available f or the clients Syringe or other sterilized material delivered in proactive w ayavailable f or the ( *I 2 I.!4-'$"A"$! 6 % of the SerT of the sample 4 2 Prophylactics available f or Sert's clients Prophylactics delivered to Sert's clients in proactive w 7= "D 4 5+0I 2 6)I@ 2/

130 .!4*- "!A"$ 10 % of the SerT of the sample Inf o Materail available f or Sert's clients Info Material delivered to Sert's clients in proactive w % 2 $ /:I1 $ /4 0)1.!4+-0"!A"$ No inf o / Do not respond 15,5% Evaluated 22,4% Not Evaluated %( ( % ' ( ( ( 3 % 23

131 ( ( % % ', 4 2 ( 24

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133 2*

134 $"?$ % ( /32)+,+)1 " $ 2 " 8 /2"@81 ' 8 2/281K< '2 < 8 /< B 1; ( / 8 2 < 1 / < B 2 < 8 < 1 2 $ $ < < 2 $ 4 $ $ $ $! "$ " $!! "! "$054)"426 0! ))* :+ 5I))/51B)I 0: 2 /0* ( 1,0-' "!$0!"%++A%++/ Foreigners Italians D V2"@8/<1 % 0: 6I ))+I ))* 0/51,-$! "!$0!"%++A%++/- 6A0"!0$0!"42K /+

135 '6!0A0"!0$0!"4) 12% 1 8% 6% 4% 2% Italians Foreigners D V2"@8/<1 ; 0: %!"! A ))K " 8 0:. / 51 96% 94% 92% 9 88% 86% Italians Foreigners /

136 8-,!0$"'$0!"42%++/ D V2"@8/<))61 $ /+)I +I 1 /+* ) 1 0:/ :: 1 % 0/%51 '-'""%++/'"( 1 "1 $ All art.73 art.74 Art.74 % art.74 >13,7% (2) 7,7% a 13,7% (6) 5,5% a 7,6% (12) All Italians Foreigners F M F M F M Arrested 0,73 0,78 0,70 0,75 0,82 0,87 Freed 0,27 0,22 0,30 0,25 0,18 0,13 Charged Arrested 0,72 0,78 0,70 0,74 0,81 0,87 Freed 0,28 0,22 0,30 0,26 0,19 0,13 Charged Arrested 0,78 0,83 0,76 0,83 0,83 0,81 Freed 0,22 0,17 0,24 0,17 0,17 0,19 Charged D V2"@8/<))61 /%

137 8 )): /5I1 :I 5I /. 51,0 )- $! $0!" '"7"" ' , 2, 17,6% 8 43,3% 6 Students Employed 4 80,4% Unemployed 2 48,7% Italians Foreigners D V2"@8/<))61 "$7$ )) )): /. 5:1 / +I $ /:*I1,0 2- ' $H "!! 1 %++%++/ < V 8 2 *I 2 C )): ))* 6I +I /. 5*1 Italians Foreigners /)

138 ,0 /- 1 " $7$" $ "0"$)+*@*+%++A%++/ All entries Entries for D.P.R. 309/ D< V 8 2 % /.561 6I )):I / *I1,0 3- $!"' "!!1 0$7$")+*@*+%++A%++/ 45% 4 35% % 32% 3 25% 32% Foreigners 26% 27% 26% 26% 25% 2 Italians 15% 1 5% D< V 8 $ ))* -/ 8 2*000 2)+,+)6I +IK 55)* < B 65I +I1 $ ( /+I1 $ 0: 0I 2 $ 0: 0 /5I6)I 1 /2

139 % 5I 0 I 8 $ 0: / * 1K /) 1! 6I $ ))* /. 501 *I /0I 20I 1 I (,0 4- $!"' $$! $7$" "4)"42%++/ % 24% 64% art.73 17% 31% 52% art.74 D< V 8 2 **I $ 06I 2 < B : 55)*$ 6I ))*)I )): /I 0I 1$ 0/I:I0:1 Others D.P.R. 309/90 None 14 2 < B //

140 ,0 - $!"''1 1 "'1 $7$! %++/ 3 25% 2 23% 17% 21% 15% 14% 1 5% Italians Foreigners art. 73 art. 74 D 2 < 8 V < B /< 1 8 ( / /) 1/ 1 %$"'1"!""$ 8 55) * / **: 1 *+ / 6I 1 $ /+6I +:I < B 1 % - +I (6+I 2 $ $ 8 +I 0I )I " $ I ( /5I1 /.5+1 / 2 )+,+) *:I I K *I I K $ I I :I :)I 1 15 % 55) **: /3

141 ,0 *- $!"' 7 $"'1"!A""$" "! 0""07!7$%++/ % 1 11% 4 17% 2 Italians Alternative measures 31% 33% 11% 1 15% 11% 24% 32% Foreigners 14% 14% Italians Prisoners D 2 < 8 < B /< ; $ $/*0I1 6I/*I 1 8 $ )I :I I 0I *+I 6I /.5)1 54% 8% 9% 15% Drugs Against the State, other social institutions, public safety and order Against person Against property Other Foreigners /4

142 ,0+-$!"'"!A""$"$$"!'$ '"%++/ % 17% 22% Poliab users D< V2 8 $$A$!:7 8 < < 2 6 ))* $ ( II6I )I $ 2 $ $ 4 2 )+,+) / ( 1 $ /.51 $ /6I 0)I 1 59% 3% 3% 17% 36% Other Opioids Cocaine Poliabusers Opioids and other Cocaine and other Other Opioids and cocaine 16 >! 9; @ 2A@B 3 ))* /

143 ,0 - $!"' $ $"'1"! ""$ $$A $!':$!0!007:7:$7$%++/ 10 2% 5% 5% 6% % 6 25% 45% % 35% 7 48% C.P.A. I.P.M. U.S.S.M C.T. Ministeriali Production, traffick and selling Against poperty Against person D< V< < 2 % ( $ $ /.51 $ 0I 6)I 0I0I,0 %- $!"' $ $"'1"! ""$ $$A $!':$5'0 "!6!0!007:7 :$7$%++/ % 36% 62% 6% 61% 32% 5% 23% 72% 7% 56% 37% C.P.A. I.P.M. U.S.S.M C.T. Min. C.P.A. I.P.M. U.S.S.M C.T. Min. Italians D< V< < 2 " ( $ $ K AI +I )):I *:I ))* ))0 > $? 0 $ $ K+I 1% 38% 6 4% 57% 39% Foreigners 4% 36% 6 Production, traffick and selling Against poperty Against person 5% 24% 71% 17 % >$?' $ < < /*

144 5I:0 +6I / )) ))*1/+0I1 - &9 /6I1,0)B$!"'"!A""$"$$A$!:7!0!007:7:$1 '1'$'"%++/ 7% 7% 12% 74% cannabinoids cocaine/crack opiates other substances D< V< < 2 " 0:I$ /.51 / I1 / 0I1 /.5:1 >?/R)):+1 >?/R)):1,0 2- $!"' 0 " $'" $%++A %++/ (% ) Cocaine Opioids D< V< < 2 9 *I 7 :I ( I +I (% ) $ 8 $$ 5 )): 5I ( K $ $ 3+

145 / 6I66I 1K $ /6*I>? )):1 /**I >? )):1 " / 6I1., " *6 *000 % ( I *I / )): 6I 185I +I 0I 5 " +: 2)+,+)5I ( I2 ( /I 0I 6I 1 < $ + 8 $ I0I 18 19! $ 3

146 * 9 J< *$! *%7"!A"$ 3%

147 *$$"$?$ *$! % "! " % 3-3 ( $ 3 $( 3 $ % 3 $ 8 A 3%! ' % 3 - % /31 >? >? :I 6I $>? - /.+1 3)

148 ,0* 7'1! 50! "$ 16 5(6 '$ D"! % /31 >? >? *5I >? 5I /.+1",0*% $$'1! 0! "$ 16 5(6 '$ Low 61% Low 38% No info 5% No info 4% Very good 5% Very good 13% Reason able 29% Reason able 45% D"! $ 3 >? ' /31 ( K / 1 32

149 4 ( ( /31 -$ $ *I /31 3 *5I )I /.+1,0*)!07$$7" % of districts Services exclusively for PDUs In setting with others No info D"! 9! % /31 % ' K K K - $.+: ' 3 /31 % ( /31%3 % /0I1 /31/+I1 8! I *5I 7 II 3/

150 I*)I,0*2$!"$00!! D"! "$ 8 % $A 3 /31 /:I1 *)I $ ' *I 0I /31 ( 3 /31 /. +*1,0*/$!"'"$0"$7 6 4 % of Districts % of Districts 2 2 housing services/ intervention temporary accomodations, shelters,... exclusively for PDU's basic education exclusively for PDU's assisted housing facilites in setting with other groups secondary education in setting w ith other groups long term housing, subisidies, D"! 1"! ( ( ' $ 33

151 % $ $ $., ( $A ( $A ( ( $ 8 ' $ ( / ( 66I6+I $,0*3$!"'"$01"7$! % of districts exclusively for PDU's in setting with other groups D"! 8 /31 ( $ $ ( 5I /31 0$! D / 1 ( - ; $ /31 $ /31 34

152 . +0 6*I :*I /I14 )I /31,0*4$!"'"$ % of districts 2 debt counselling counselling on social and family relations legal counselling leisure time activities D"! ))* 5I $ /6I / /3)I I@%1 *6I :I ( I I 0I /

153 ,0*- $!"''1 1!1!" 01! 11"++/ ,4% 17,4% ,7% Other 6 55,5% Mainteinance 5 27,9% Medium term 4 Short term , 31, 1 11,2% Outpatient treatment centres Treatment units in prison D7 % 3 $A / 1 & 3 /.++1,0**-$!"'1!1$"'101 1%++/ Integrated 36,4% Psychosocial 63,6% D7 $ /.+)1 / 6:I1 / I1 /I1 3*

154 ,0 *+- $! "' 1$0$ " 0'7 1!1%++/ ,9% D7 3,5% 63,6% Counselling Psychotherapy Social Service 4+

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