The Annual report 2011 from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) will be published today. The Health Research Board (HRB) provides the Irish figures for the EMCDDA report. This media briefing compares the situation in Ireland with that in Europe.

The report shows drug use to be relatively stable in Europe, with some positive signs that cocaine use may have peaked and that cannabis use continues to decline among young people in many countries. The National Advisory Committee on Drugs (NACD) will publish their third survey of drug use among the Irish population (aged 15–64 years) next Tuesday, 22 November. The number of new cases entering treatment for problem cocaine use has declined over the past two years, indicating a possible decrease in cocaine use in Ireland. The 2007 Health Behaviour in School-aged Children (HBSC) survey shows a small increase in lifetime cannabis use among schoolchildren over three time points, indicating that cannabis use continues to increase among young people in Ireland.

Signs of stability in relation to some of the more established drugs are offset by new threats across Europe. Over the last nine years, and more intensively over the last three to four years, selling new psychoactive substances in head shops and online has emerged as a new phenomenon across Europe, including Ireland.

The situation with respect to Europe and Ireland is presented below under a series of headings.

Opiates (mainly heroin)
European situation
• All countries across Europe provide both drug-free and substitution treatment. About half of Europe’s problem opiate users have access to opiate substitution treatment, mainly methadone.
• Around 5% of those entering treatment for drug problems now report opiates other than heroin as their primary drug; this proportion is much higher in Northern Europe. For instance, in Estonia three quarters of those entering treatment now report fentanyl, a synthetic opiate, as their main problem drug.
• Among opiate users entering treatment, rates of injecting vary considerably between countries, ranging from under 10% in the Netherlands to over 90% in Latvia and Lithuania. However, a five-year analysis of trends among heroin users entering treatment shows that the proportion of those reporting injecting (40% in 2009) is falling in most European countries.
• Latest European data show that the average rate of newly reported HIV cases continues to fall, though epidemics have been reported in Greece and Romania.
• The EMCDDA estimates that between 10,000 and 20,000 opiate users die each year from overdose, disease, suicide and trauma. The review estimates that the mortality rate among regular opiate users is 10 to 20 times higher than that among their non-opiate-using peers.
• The availability of heroin was reported to have dropped in a number of European countries at the end of 2010 and in early 2011, with the drought being particularly evident in the UK and Ireland. The EMCDDA has proposed a number of possible explanations for this shortage.1

Irish comparison
• 55% of problem opiate users were in opiate treatment in 2007, the latest year for which we have an estimate.
• Around 2% of those entering treatment for drug problems reported opiates other than heroin as their primary drug.
• 36% of heroin users entering treatment reported injecting drug use. The proportion of injector cases has decreased since 2005.
• The number of newly diagnosed HIV cases among injecting drug users in 2010 was 22; this is considered very low.
• Opiates continued to be associated with the majority of fatal overdoses. In 2009, 180 poisoning deaths were associated with opiates, alone or with another drug.
• A total of 1,345 non-poisoning deaths were recorded among drug users between 1998 and 2007; 60% were due to trauma (mainly hangings and road traffic collisions) and 40% were due to medical causes (mainly cardiac events and respiratory infections). The proportion attributable to opiate use has not been calculated.
• The number of heroin seizures continued to decline, falling from 1,455 in 2009 to 1,150 in 2010. An unpublished independent study by the Drug Treatment Centre Board reported a reduction in the presence of heroin metabolites in the urines of problem opiate users in the period December 2010 to February 2011. Drug users reported a shortage of heroin during this period.

Cocaine
European situation
• Of the five high prevalence countries, four – Denmark, Spain, Italy and the UK – reported a decline in last-year cocaine use among young adults.
• Around 17% of drugs users entering treatment reported cocaine as their main problem drug.
• There are approximately one thousand cocaine-related deaths in Europe each year.
• The number of cocaine seizures continued to rise in 2009, though volume and purity have fallen in recent years.

Irish comparison
• Ireland is ranked fifth for cocaine use in the EU. The 2006/7 NACD general population survey reported that 1.7% of adults had used cocaine in the year prior to the survey and that the percentage was higher among young adults (3.1%) and among men (2.3%).
• In 2009, 11% of those who entered treatment reported cocaine as their primary drug; this proportion fell to 9% in 2010.
• The number of cocaine deaths increased from 10 in 2003 to 66 in 2007 and decreased to 58 in 2008.
• The number of cocaine seizures increased from 566 in 2003 to 1,749 in 2007, and decreased considerably in 2008 (1,010) and 2010 (588).

Cannabis
European situation
• Cannabis is still Europe’s most commonly consumed illicit drug. One in five adults aged 15-64 years have tried cannabis at some point in their lives. The latest European data confirm the general stabilisation or downward trend in cannabis use among young adults (15–34 years). Surveys of school children mirror this decline.
• The number of cannabis resin seizures increased steadily between 2004 and 2009, while the total amount (volume) seized declined.
Irish comparison
• Ireland is placed in the mid-range for cannabis use. The 2006/7 NACD general population survey reported that 6.3% of the general population had used cannabis in the year prior to the survey. Recent cannabis users were mainly young (aged 15–34) (10.4%) and male (8.5%).
• The number of cannabis users attending treatment increased from 991 in 2003 to 1,893 in 2010, which respresents 25% of clients in treatment in 2010.
• The number of cannabis seizures more than halved in 2009 (2,314) when compared to 2008 (5,662) and remained stable in 2010 at 2,268.

New psychoactive substances
European situation
• The European Early Warning System identified 24 new psychoactive substances in 2009, 41 in 2010 and 34 so far in 2011.
• The most recent EMCDDA snapshot survey of online retailers selling new psychoactive substances identified over 600 online shops, almost twice as many as a year ago. The survey also revealed a variety of new products, an increase in warnings, restrictions and disclaimers. It also revealed an increasing ability to mask the identities of both sellers and buyers.
• There is a growing interplay between the availability of new psychoactive substances online and illicit drug markets. The substances most commonly found in both markets are cathinones (for example mephadrone), piperazines (for example BZP) and phenylethylamines.
• The rapid spread of these new drugs has encouraged some member states, such as Ireland and Poland, to adopt imaginative responses.

Irish comparison
• Ireland has had notable success in limiting the sale of new psychoactive substances. This was achieved through the combined efforts of a number of government departments and statutory agencies.
• Gardaí identified 113 head shops in the country at the time of their peak in early 2010, with at least one in every county. On 11 May 2010 the Department of Health banned specific synthetic cannabinoids, benzylpiperazine (BZP) and piperazine derivatives and specific cathinones. On 11 May there were 102 shops open, 11 having closed for a variety of reasons. On 12 May, gardaí visited all 102 head shops and warehouses and seized all banned products. By 13 May there were 34 head shops selling psychoactive substances.
• On 16 August 2010, the Department of Justice and Law Reform introduced The Criminal Justice (Psychoactive Substances) Act 2010. This legislation was enacted to introduce more general control by way of criminal justice legislation to deal with head shop products as they emerged. The Act also gives appropriate powers to the gardaí and to the courts to intervene quickly, by way of prohibition notices and prohibition orders, to prevent the sale of psychoactive substances.
• Following the introduction of the new Act, gardaí visited the remaining 19 head shops in early September 2010 and none were selling psychoactive substances. On 4 October 2010, the number of head shops open had decreased to ten.
• Further legislation was introduced on 3 November 2011 to ban 60 additional new psychoactive substances, including the following: additional cathinone substances; naphthylpyrovalerone and related substances (e.g. the legal high product Pure NRG); further synthetic cannabis-type substances (often sold as SPICE smoking mixtures); dimethocaine and desethyl dimethocaine (contained in the legal high products Amplified and MindMelt); desoxypipradol (found in the legal high product WHACK); aminotetralins and aminoindans (e.g. the legal high product Pink Champagne); fluorotropacocaine (also found in the legal high product WHACK); bromodragonFLY; salvinorin A found in the plant Salvia divinorum; and, mitragynine and 7-hydroxymitragynine found in the plant known as Kratom.


Gidelines for the treatment of drug dependence
European situation
• Almost all European countries now have drug treatment guidelines. A review of guidelines published today identified more than 140 guidelines from across Europe.

Irish comparison
• Ireland has a methadone treatment protocol, adopted in 1998, which covers statutory and regulatory issues around methadone prescribing and dispensing.

1 Among the possible explanations for the apparent heroin shortage in Europe are: the diversion of the drug to markets in Asia, a fall in opium production in Afghanistan in 2009, and an opium poppy blight affecting the major poppy growing provinces in 2010.