Strasbourg, 26 April 2004

P-PG/ND (2004) 4

Changing consumption patterns and care of users

SUMMARY OF TECHNICAL REPORTS

(P-PG/ND (2004) 2 and P-PG/ND (2004) 3)

(Document prepared by the Secretariat)

The problems associated with new and changing drug consumption patterns, including the effects and impact of occasional and frequent consumption, must be addressed with a view to proposing measures to minimise the negative consequences for the individual and for public health and improving the quality and efficacy of care.

In this context, the PG experts define "new drugs" as currently changing and emerging drugs and / or patterns of consumption, including poly-drug use; “new drug” users are people who use these products on an occasional or regular basis; finally, “care” is the response of the social and health systems to the needs and requests for treatment, information, secondary prevention and other risk reduction measures.

Two surveys were launched in an attempt to determine the scale of the problem in Europe. The findings are presented in two documents:

i.          Synoptic report of the replies to the questionnaire on current policies and practices for responding to new and emerging drugs and to new patterns of consumption;

ii.         Synoptic report of the replies to the questionnaire on the national data about ecstasy, cocaine and amphetamines.

This document proposes a summary of the most pertinent findings of the above-mentioned questionnaire surveys.

All countries report an increase in the number of patients receiving treatment for drug abuse. Traditional drugs like alcohol, heroin and other opiates, LSD and so-called "natural" drugs (like hallucinogenic mushrooms, cacti, datura, qat and salvia) continue to occupy an important place in the new consumption patterns. In many countries heroin is followed by cannabis in terms of the number of users admitted for treatment.

Cannabis remains the most frequently used drug. Consumption is on the increase in several countries and is particularly high among young adults, especially males. Cannabis is often consumed in association with other substances (poly-drug use).

The consumption of synthetic substances (ecstasy, amphetamines) and cocaine seems to concern festive users first and foremost and, to a lesser extent, drug addicts or regular users, so these substances are more often consumed at festive gatherings than in private homes, where they are used by addicts.

Ecstasy is taken orally by festive users and addicts alike, whereas amphetamines are taken orally or sniffed by festive users and injected by addicts, and cocaine is sniffed by festive users and smoked or injected by addicts.

The new drugs that raise the greatest problems of consumption are ketamine, GHB, synthetic drugs like benzylpiperazine, 2-CB or PCP, as well as solvents and gases (nitrous oxide, butane).

There is also the problem of pharmaceutical substances such as buprenorphine, methadone and codeine, regular medicines which are sold illegally for non-medicinal use, a phenomenon which is not new in itself.

All these substances can have serious physiological effects and the psychological and social consequences of their consumption are described in the literature. There are no particular differences from one country to another.

In general the countries identify the same substances and consumption patterns, but seldom provide figures indicating the magnitude of the problem. From the few figures that were provided it would appear that the problems caused by these new substances are increasing and likely to become more visible in the longer term.

In most countries all these products are accessible, ie available and affordable, which explains why the problem of poly-drug use combining new and traditional drugs is on the rise. The most frequent combinations are cannabis with alcohol, and cocaine with alcohol, cannabis or heroin.

Trends and changes in the drug market are monitored by government departments (police, customs, health). Countries have set up early warning systems where close co-operation between the different departments concerned provides timely information.

Most countries carry out scientific and social research into illegal drugs. The research may be epidemiological, pharmacological, clinical (especially in neurology) or therapeutic (particularly in association with substitution treatment).

Given the random nature of current evaluation methods and the quality of the data available, it is not always possible to interpret trends with a great deal of accuracy. Furthermore, as there is no broad assessment method that can be applied to every country in the same way, meaningful comparisons are difficult to make.

Most countries report that they are actively engaged in dispensing care to users of emerging drugs (information, prevention, risk reduction, treatment centres). The consumption of these drugs is discussed openly in the media (press and television) by politicians and professionals who work with drug abusers.

A large number of countries suggest out-patient treatment for users of emerging drugs, combined with psychotherapy. This often needs to be coupled with pharmacotherapy. Psychosocial assistance is also proposed so that users have access to the most appropriate treatment all round.

A certain consensus emerged to the effect that most cases do not really require the introduction of a new treatment system but merely the further development of the various existing approaches.