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Please note that the information on this page is based on the EMCDDA Annual report 2010: the state of the drugs problem in Europe. Most statistical data relate to the year 2008 (or the last year available).

 
 

Annual report 2010: the state of the drugs problem in Europe
Cannabis

Published: 10 November 2010

Treatment

Treatment demand

Cannabis was the primary drug in about 21 % of all treatment entries (about 85 000 clients) reported by 27 countries in 2008, making it the second most reported drug after heroin. Primary cannabis users account for less than 5 % of treatment entrants in Bulgaria, Estonia, Lithuania, Luxembourg and Slovenia, and more than 30 % in Denmark, Germany, France, Hungary and the Netherlands, with most cannabis clients entering treatment in outpatient settings (1).

These differences may be explained by the prevalence of use of cannabis and other drugs, drug treatment needs, treatment provision and organisation or referrals practices. In one of the two countries with the largest proportions of cannabis clients, counselling centres target young drug users (France), while in the other (Hungary), cannabis offenders are offered drug treatment as an alternative to punishment. The criminal justice system plays a substantial role in treatment referral in both of these countries but, overall, Member States report that most cannabis users entering treatment in Europe do it on their own initiative. Some users might also enter drug treatment because they have other underlying conditions, such as mental health problems, and cannot find appropriate treatment elsewhere (Zachrisson at al., 2006).

Many cannabis clients report the use of alcohol or other drugs. Based on a data collection in 14 countries, 65 % of them take another drug, mostly alcohol or cocaine, and some report the use of both alcohol and cocaine (EMCDDA, 2009b). Cannabis is reported as a secondary drug by 24 % of all outpatient drug clients (2).

Trends in new demands for drug treatment

In the 18 countries for which data are available, the number of primary cannabis users among those entering treatment for the first time in their life increased from about 23 000 to 35 000 between 2003 and 2007, before slightly decreasing to about 33 000 in 2008. Starting in 2005 and 2006, 13 countries have reported decreases in new cannabis clients (3). This might reflect recent declining trends in cannabis use, but could also be linked with service capacity saturation or use of other services (e.g. primary and mental healthcare).

Client profiles

Clients entering outpatient treatment for primary cannabis use in Europe are mainly young males, with a male to female ratio of 5:1 and a mean age of 25 years. Among drug users entering outpatient treatment for the first time, primary cannabis use is reported by 69 % of those aged 15–19 years and by 83 % of those younger than 15 years (4).

Overall, 22 % of primary cannabis users entering outpatient treatment are occasional users (or have not used it the month before entering treatment), probably often referred by the criminal justice system; 11 % use cannabis weekly or less often; about 17 % use it 2–6 times a week; and 50 % are daily users, the most problematic group. Considerable differences are observed between countries. In Hungary, Romania and Croatia more than half of cannabis clients are occasional users, while in Belgium, Bulgaria, Denmark, Ireland, Spain, France, Malta and the Netherlands more than 50 % are daily users (5).

Treatment provision

Cannabis treatment in Europe covers a wide range of measures, including internet-based treatment, counselling, structured psychosocial interventions and treatment in residential settings. There is also a frequent overlap in this field between selective prevention, harm reduction and treatment interventions (see 'Responding to drug problems — an overview').

In France, the network of youth counselling centres, also known as cannabis clinics, provide users with services varying in duration and approach depending on the severity of drug use. In a study carried out in 226 of the 274 counselling centres in 2007, 47 % of outpatients were diagnosed as occasional users showing no symptoms of dependence or abuse, and about 30 % of these received no further counselling (Obradovic, 2009). In contrast, among the 53 % diagnosed with dependence or abuse at admission, nearly 80 % were offered further counselling, and most others were referred to treatment centres. Half of the clients attending a second counselling session reported a reduction in their cannabis use. This was more often the case among self-referred users and those referred by health professionals, while those referred by the criminal justice system were more likely to drop out after a few sessions.

As an alternative to criminal prosecution, the criminal justice system in Hungary refers eligible drug offenders to a ‘preventive counselling service’, and the more severe cases to specialist treatment facilities. Users referred by the criminal justice system, about 85 % of all cannabis clients, must take part in drug treatment or psychosocial counselling at least once a fortnight for six months, to obtain a discharge certificate. Otherwise, they may face criminal prosecution.

Germany, the Netherlands and the United Kingdom offer Internet-based cannabis treatment in order to facilitate treatment access to users who are reluctant to seek help within the specialist drug treatment system. Online treatment interventions include either a self-help programme without contact to counsellors, or a structured programme with scheduled contacts (see EMCDDA, 2009a). A quality label and guidelines in this field are now being developed in the Netherlands.

The Netherlands also reports the evaluation of a novel family motivational intervention for cannabis users with recent onset of schizophrenia. This intervention aims at reducing cannabis use, increasing medication compliance and improving parent–child relations among this group. Preliminary results, after three months, show a significant reduction in cannabis use compared to usual psychoeducation, while the other outcome variables did not differ.

Recent studies on treatment of cannabis users

Relatively few studies have assessed the effectiveness of targeted interventions for cannabis users (Levin and Kleber, 2008), despite the increase in the number of treatment demands. Research has been conducted into both pharmacotherapeutic and psychosocial interventions, but the results are not conclusive.

A recently published randomised controlled trial assessed the effectiveness of motivational interviewing compared to drug information and counselling, and found no significant differences in cannabis use (McCambridge et al., 2008). It also found that practitioner effects might influence cannabis cessation rates, thereby limiting the transferability of the interventions. European studies in this area are assessing the effectiveness of multidimensional family therapy (INCANT), motivational enhancement, cognitive-behavioural therapy and psychosocial problem solving (CANDIS) and Internet-based treatment.

Two studies have recently been published on the pharmacotherapy of cannabis dependence; neither of which reported significant results. In the Netherlands, a randomised controlled trial compared the effects of a serotonin uptake inhibitor (olanzapine) and a dopamine antagonist (risperidone) on patients with psychotic comorbidity (van Nimwegen et al., 2008). In the United States, a preliminary study compared the effects of an antidepressant (nefazodone), a dopamine uptake inhibitor (sustained release bupropion) and a placebo on use and withdrawal symptoms among cannabis users (Carpenter et al., 2009).

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Footnotes

(1) See Figure TDI-2 (part ii) and Tables TDI-5 (part ii) and TDI-24 in the 2010 statistical bulletin.

(2) See Table TDI-22 (part i) in the 2010 statistical bulletin.

(3) See Figure TDI-1 and Table TDI-3 (part iv) in the 2010 statistical bulletin.

(4) See Tables TDI-10 (part iii) and (part iv) and TDI-21 (part ii) in the 2010 statistical bulletin.

(5) See Tables TDI-18 (part ii) and TDI-111 (part viii) in the 2010 statistical bulletin.

Bibliographic references

Carpenter, K.M., McDowell, D., Brooks, D.J., Cheng, W.Y. and Levin, F.R. (2009), ‘A preliminary trial: double-blind comparison of nefazodone, bupropion-SR, and placebo in the treatment of cannabis dependence’, American Journal of Addiction 18, pp. 53–64.

EMCDDA (2009a), Internet-based drug treatment interventions: best practice and applications in EU Member States, EMCDDA Insights, Publications Office of the European Union, Luxembourg.

EMCDDA (2009b), Polydrug use: patterns and responses, EMCDDA Selected issue, Publications Office of the European Union, Luxembourg.

Levin, F.R. and Kleber, H.D. (2008), ‘Use of dronabinol for cannabis dependence: two case reports and review’, American Journal of Addiction 17, pp. 161–64.

McCambridge, J., Slym, R.L. and Strang, J. (2008), ‘Randomized controlled trial of motivational interviewing compared with drug information and advice for early intervention among young cannabis users’, Addiction 103, pp. 1819–20.

Obradovic, I. (2009), Évaluation du dispositif des « consultations jeunes consommateurs » (2004–2007) - Publics, filières de recrutement, modalités de prise en charge, OFDT, Saint-Denis.

Van Nimwegen, L.J., de Haan, L., van Beveren, N.J., van der Helm, M., van den Brink, W. and Linszen, D. (2008), ‘Effect of olanzapine and risperidone on subjective well-being and craving for cannabis in patients with schizophrenia or related disorders: a double-blind randomized controlled trial’, Canadian Journal of Psychiatry 53, pp. 400–5.

Zachrisson, H.D., Rödje, K. and Mykletun, A. (2006), Utilization of health services in relation to mental health problems in adolescents: a population based survey’, BMC Public Health 6:34 (available online).

 

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The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is the reference point on drugs and drug addiction information in Europe. Inaugurated in Lisbon in 1995, it is one of the EU's decentralised agencies. Read more >>

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Page last updated: Tuesday, 26 October 2010