Prevalence and patterns of use
Cannabis use among the general population
It is conservatively estimated that cannabis has been used at least once (lifetime prevalence) by about 75.5 million Europeans, that is over one in five of all 15- to 64-year-olds (see 'Table 3: Prevalence of cannabis use in the general population — summary of the data' for a summary of the data). Considerable differences exist between countries, with national prevalence figures varying from 1.5 % to 38.6 %. For most of the countries, the prevalence estimates are in the range 10–30 %.
An estimated 23 million Europeans have used cannabis in the last year, or on average 6.8 % of all 15- to 64-year-olds. Estimates of last month prevalence will include those using the drug more regularly, though not necessarily in a daily or intensive way. It is estimated that about 12.5 million Europeans used the drug in the last month, on average about 3.7 % of all 15- to 64-year-olds.
Cannabis use among young adults
Cannabis use is largely concentrated among young people (15–34 years), with the highest prevalence of last year use generally being reported among 15- to 24-year-olds. This is the case in all the reporting countries, with the exception of Portugal (1).
Population survey data suggest that, on average, 31.6 % of young European adults (15–34 years) have ever used cannabis, while 12.6 % have used the drug in the last year and 6.9 % have used it in the last month. Still higher proportions of Europeans in the 15–24 age group are estimated to have used cannabis in the last year (16 %) or last month (8.4 %). National prevalence estimates of cannabis use vary widely between countries in all measures of prevalence. For example, estimates of last year prevalence of use among young adults in countries at the upper end of the scale are more than 30 times those of the lowest-prevalence countries.
Cannabis use is generally higher among males than among females, for example, the ratio of males to females among young adults reporting use of cannabis in the last year ranges from 6.4:1 in Portugal to 1.4:1 in Bulgaria (2).
Time frame of use
European prevalence estimates are based on weighted averages from the most recent national surveys conducted from 2001 to 2008/09 (mainly 2004–08), and therefore cannot be attached to a single year. The average prevalence for Europe was computed by a weighted average according to the population of the relevant age group in each country. In countries for which no information was available, the average EU prevalence was imputed. Populations used as basis: 15–64 (334 million), 15–34 (133 million) and 15–24 (63 million). The data summarised here are available under General population surveys in the 2010 statistical bulletin.
|15–64 years||Estimated number of users in Europe||75.5 million||23 million||12.5 million|
|European average||22.5 %||6.8 %||3.7 %|
|Range||1.5–38.6 %||0.4–15.2 %||0.1–8.5 %|
|Lowest-prevalence countries||Romania (1.5 %) |
Malta (3.5 %)
Cyprus (6.6 %)
Bulgaria (7.3 %)
|Romania (0.4 %) |
Malta (0.8 %)
Greece (1.7 %)
Sweden (1.9 %)
|Romania (0.1 %) |
Malta, Sweden (0.5 %)
Greece, Poland (0.9 %)
Lithuania, Hungary (1.2 %)
|Highest-prevalence countries||Denmark (38.6 %) |
Czech Republic (34.2 %)
Italy (32.0 %)
United Kingdom (31.1 %)
|Czech Republic (15.2 %) |
Italy (14.3 %)
Spain (10.1 %)
France (8.6 %)
Czech Republic (8.5 %)
|15–34 years||Estimated number of users in Europe||42 million||17 million||9.5 million|
|European average||31.6 %||12.6 %||6.9 %|
|Range||2.9–53.3 %||0.9–28.2 %||0.3–16.7 %|
|Lowest-prevalence countries||Romania (2.9 %) |
Malta (4.8 %)
Cyprus (9.9 %)
Greece (10.8 %)
|Romania (0.9 %) |
Malta (1.9 %)
Greece (3.2 %)
Cyprus (3.4 %)
|Romania (0.3 %) |
Sweden (1.0 %)
Greece (1.5 %)
Poland (1.9 %)
|Highest-prevalence countries||Czech Republic (53.3 %) |
Denmark (48.0 %)
France (43.6 %)
United Kingdom (40.5 %)
|Czech Republic (28.2 %) |
Italy (20.3 %)
Spain (18.8 %)
France (16.7 %)
Czech Republic (16.7 %)
|15–24 years||Estimated number of users in Europe||19.5 million||10 million||5.5 million|
|European average||30.9 %||16.0 %||8.4 %|
|Range||3.7–58.6 %||1.5–37.3 %||0.5–22.4 %|
|Lowest-prevalence countries||Romania (3.7 %) |
Malta (4.9 %)
Cyprus (6.9 %)
Greece (9.0 %)
|Romania (1.5 %) |
Greece, Cyprus (3.6 %)
Sweden (4.9 %)
Portugal (6.6 %)
|Romania (0.5 %) |
Greece, Sweden (1.2 %)
Cyprus (2.0 %)
Poland (2.5 %)
|Highest-prevalence countries||Czech Republic (58.6 %) |
France (42.0 %)
Denmark (41.1 %)
Germany (39.0 %)
|Czech Republic (37.3 %) |
Spain (24.1 %)
Italy (22.3 %)
France (21.7 %)
|Czech Republic (22.4 %) |
Spain (16.9 %)
France (12.7 %)
Italy (11.0 %)
Cannabis use is particularly high among certain groups of young people, for instance, those frequently attending nightclubs, pubs and music events (Hoare, 2009). Targeted surveys recently conducted in electronic dance music settings in the Czech Republic, Austria and the United Kingdom reported that over 80 % of respondents have ever used cannabis, a rate that is much higher than the European average among young adults (Measham and Moore, 2009).
Cannabis use among school students
The ESPAD survey, carried out every four years, provides comparable data on alcohol and drug use among 15- to 16-year-old school students in Europe (Hibell et al., 2009). In 2007, the survey was conducted in 25 EU Member States as well as Norway and Croatia. In addition, in 2008, national school surveys were carried out by Spain, Italy, Sweden and the United Kingdom; and Belgium (Flemish Community) conducted a regional school survey.
The data from the 2007 ESPAD and 2008 national school surveys reveal that the highest lifetime prevalence of cannabis use among 15- to 16-year-old school students is in the Czech Republic (45 %), while Estonia, France, the Netherlands, Slovakia and the United Kingdom report prevalence levels ranging from 26 % to 32 %. Lifetime prevalence levels of cannabis use of between 13 % and 25 % are reported by 15 countries. The lowest levels (less than 10 %) are reported in Greece, Cyprus, Romania, Finland, Sweden and Norway. The gender gap in cannabis use is less marked among school students than among young adults. Male to female ratios for cannabis use among school students range from close to unity in Spain and the United Kingdom to 2:1 or higher in Cyprus, Greece, Poland and Romania (3).
European figures can be compared with those from other parts of the world. For instance, in Canada (2008) lifetime prevalence of cannabis use among young adults is 53.8 % and last year prevalence 24.1 %. In the United States, SAMHSA (2008) estimated a lifetime prevalence of cannabis use of 49 % (16–34 years, recalculated by the EMCDDA) and a last year prevalence of 21.5 %, while in Australia (2007) the figures are 47 % and 16 % for the 14- to 39-year-olds. All these figures are above the European averages, which are respectively 31.6 % and 12.6 %.
Among school students, the Czech Republic, Spain, France and Slovakia report levels of lifetime prevalence of cannabis use that are comparable to those reported in the United States and Australia (4).
Trends in cannabis use
During the period 1998 to 2008, for the 15 countries that are able to provide sufficient data, three major trends can be observed in cannabis use among adults ('Figure 4: Trends in last year prevalence of cannabis use among young adults (aged 15–34)'). Five countries (Bulgaria, Greece, Hungary, Finland, Sweden) have reported low (under 9 %) and relatively stable prevalence levels for last year cannabis use among young adults. Six countries (Denmark, Germany, Spain, France, Netherlands, United Kingdom) reported higher prevalence levels, but at stable or decreasing levels in recent years. Four other countries (Czech Republic, Estonia, Italy, Slovakia) also reported higher levels of cannabis use among young adults, but with increasing trends in recent years.
When looking at more recent trends in cannabis use among young adults, of the 12 countries with repeated surveys during the period 2003–08, the majority report a stable situation (Denmark, Germany, Spain, Hungary, Sweden, Finland, United Kingdom). Five countries report increased cannabis use over this period; of at least two percentage points in Bulgaria, Estonia and Slovakia, and about eight percentage points in the Czech Republic and Italy.
Similar patterns are found across Europe in the time trends in cannabis use among school students between 1995 and 2007 (EMCDDA, 2009). Seven countries, located mainly in northern or southern Europe (Greece, Cyprus, Malta, Romania, Finland, Sweden, Norway), report overall stable and low lifetime prevalence of cannabis use during the whole period. Most west European countries, as well as Croatia and Slovenia, which had high or strongly increasing lifetime cannabis use prevalence up until 2003, have seen a decrease or stabilisation in 2007. Among these 11 countries, nine report a decrease and two a stable situation. The picture is different in most of central and eastern Europe, where the increasing trend observed between 1995 and 2003 appears to be levelling out. In this region, six countries report a stable situation and two report an increase between 2003 and 2007.
Three countries that conducted school surveys in 2008 (Belgium-Flemish Community, Sweden and the United Kingdom) report stable or lower lifetime prevalence of cannabis use than reported in 2007, while Spain reports a decrease of more than three percentage points. School survey data from the United States and Australia also indicate a decreasing trend, which was first observed in Australia in 1999 (5).
Patterns of cannabis use
Available data point to a variety of patterns of cannabis use, ranging from experimental use to dependent use. Many individuals use the substance only once or twice, others use it occasionally or during a limited period of time. Of those aged 15–64 who have ever used cannabis, 30 % have done so during the last year (6). Among those who have used the drug in the last year, on average, half have done so in the last month.
Data from a sample of 13 European countries, accounting for 77 % of the adult population of the European Union and Norway, show that of the estimated 12.5 million Europeans who used cannabis in the past month, about 40 % may have consumed the drug on 1–3 days during that month; about one-third on 4–19 days and one quarter on 20 days or more. From these data it can be estimated that over 1 % of European adults, about 4 million, are using cannabis daily or almost daily. Most of these cannabis users, about 3 million, are aged between 15 and 34 years, representing approximately 2–2.5 % of Europeans in this age group (7). Daily or almost daily cannabis use may be about four times more prevalent in males than in females.
Ten European countries reporting data to the ESPAD study among 15- to 16-year-old school students report relatively high proportions (5–12 %) of male students having used cannabis on 40 or more occasions. This proportion was at least double that found among the female students. Most of these countries also reported that between 5 % and 9 % of the respondents had initiated cannabis use at age 13 or younger. This group is of concern, as early onset of use has been associated with the development in later life of intensive and problematic forms of drug consumption.
Dependence is increasingly recognised as a possible consequence of regular cannabis use, even among younger users (8). However, the severity and consequences of cannabis dependence may appear less serious than those commonly associated with some other psychoactive substances (e.g. heroin or cocaine). The development of cannabis dependence might also be more gradual than that found with some other drugs (Wagner and Anthony, 2002). It has been reported that half of dependent cannabis users who stopped using the drug were able to do so without treatment (Cunningham, 2000). Nonetheless, some cannabis users — particularly heavy users — can experience problems without necessarily fulfilling the clinical criteria for dependence (9).
Cannabis use has been correlated with membership of a vulnerable or socially disadvantage group, such as with early school leavers, ‘truants’, children in care institutions, young offenders and young people living in economically deprived neighbourhoods (EMCDDA, 2008). It can also be associated with the use of other substances. For example, young adults (aged 15 to 34) who reported frequent or heavy alcohol use in the past year were between two and six times more likely to report the use of cannabis compared to the general population. And, although most cannabis users do not use other illicit drugs, they are more likely to do so than the general population. Adolescent cannabis users also report two to three times higher prevalence of tobacco smoking compared to the general 15- to 16-year-old school population.
Some cannabis users engage in more risky patterns of use, such as using cannabis with very high THC content or in large amounts, and inhaling from a water pipe (‘bong’) instead of a ‘joint’. These users generally report more health problems, including dependence (Chabrol et al., 2003; Swift et al., 1998).
(1) See Figure GPS-1 in the 2010 statistical bulletin.
(4) See Figure EYE-1 (part xii) in the 2010 statistical bulletin.
(5) See Figure EYE-1 (part xii) in the 2010 statistical bulletin.
(6) See Table GPS-2 in the 2010 statistical bulletin.
(7) The European averages are an estimation based on a weighted average (for the population) for countries with information, and imputed for countries without information. The figures obtained are 1.2% for all adults (15–64 years) and 2.3% for young adults (15–34 years). See Table GPS-10 in the 2010 statistical bulletin.
(8) See the box ‘Risk factors for cannabis initiation and dependence’.
(9) See the box ‘Adverse health effects of cannabis use’.
Chabrol, H., Roura, C. and Armitage, J. (2003), ‘Bongs, a method of using cannabis linked to dependence’, Canadian Journal of Psychiatry 48, p. 709.
Cunningham, J.A. (2000), ‘Remissions from drug dependence: is treatment a prerequisite?’, Drug and Alcohol Dependence 59, pp. 211–13.
EMCDDA (2008), Drugs and vulnerable groups of young people, EMCDDA Selected issue, Publications Office of the European Union, Luxembourg.
EMCDDA (2009), Annual report 2009, the state of the drugs problem in Europe, Publications Office of the European Union, Luxembourg.
Hibell, B., Guttormsson, U., Ahlström, S., Balakireva, O., Bjarnason, T. et al. (2009), The ESPAD report 2007: alcohol and other drug use among students in 35 European countries, Swedish Council for Information on Alcohol and Other Drugs (CAN), Stockholm.
Hoare, J. (2009), ‘Drug misuse declared: findings from the 2008/09 British Crime Survey’, Home Office Statistical Bulletin 12/09.
Measham, F. and Moore, K. (2009), ‘Repertoires of distinction: exploring patterns of weekend polydrug use within local leisure scenes across the English night time economy’, Criminology and Criminal Justice 9, pp. 437–64.
SAMHSA (2008), National survey on drug use and health, Substance Abuse and Mental Health Services Administration, Rockville MD.
Swift, W., Hall, W., Didcott, P. and Reilly, D. (1998), ‘Patterns and correlates of cannabis dependence among long-term users in an Australian rural area’, Addiction 93, pp. 1149–60.
Wagner, F.A. and Anthony, J.C. (2002), ‘From first drug use to drug dependence; developmental periods of risk for dependence upon marijuana, cocaine, and alcohol’, Neuropsychopharmacology 26, pp. 479–88.