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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
Drug-related infectious diseases and drug-related deaths

Published: 10 November 2010

Preventing and responding to infectious diseases

The prevention of infectious diseases among drug users is an important public health goal of the European Union and a component of most Member States’ drug policies. Countries respond to the spread of infectious diseases among drug users by a combination of approaches, including: drug treatment, particularly opioid substitution treatment; the provision of sterile injection equipment and other paraphernalia; and community-based activities that provide information, education, testing and behavioural interventions, often implemented through outreach or low-threshold agencies (1). These measures, together with antiretroviral therapy and tuberculosis diagnosis and treatment, have been promoted by UN agencies as the core interventions for HIV prevention, treatment and care for injecting drug users (WHO, UNODC and UNAIDS, 2009).

In Europe, the availability of drug treatment and harm-reduction measures has increased considerably since the mid-1990s. Both opioid substitution treatment and needle and syringe programmes now exist in all countries except Turkey. While the provision of these interventions remains limited in several countries, it is estimated that one in two problem opioid users in Europe could be receiving opioid substitution treatment (see 'Opioid use and drug injection'). A recent review (Kimber et al., 2010) concludes that there is now sufficient evidence that this type of treatment reduces HIV transmission and self-reported injecting risk behaviour; but evidence of a reduction in hepatitis C transmission is more limited. A cohort study in Amsterdam found, however, that ‘full participation’ in both needle and syringe programmes and opioid substitution treatment was associated with a much lower incidence of both HIV and HCV among injecting drug users (Van den Berg et al., 2007), while a recent cohort study in the United Kingdom linked opioid substitution treatment with statistically significant reductions in HCV incidence (Craine et al., 2009).


The most frequently reported priority is access to sterile injecting equipment. Data on syringe provision through specialised needle and syringe programmes in 2007–08 are available for all but four countries (1). They show that about 40 million syringes per year are distributed through these programmes. This is equivalent to an average of 80 syringes per estimated injecting drug user in the countries providing syringe data.

The average number of syringes distributed in a year per injecting drug user can be calculated for 13 European countries ('Figure 14: Syringes distributed through specialised programmes, per estimated injecting drug user'). In seven of these countries, the average number of syringes given out by specialised programmes is equivalent to less than 100 per injector, five countries give out between 140 and 175 syringes, and Norway reports the distribution of more than 320 syringes per injector (1). For the prevention of HIV, UN agencies judge the annual distribution of 100 syringes per injecting drug user as low, and 200 syringes per injector as high (WHO, UNODC and UNAIDS, 2009).

A recent study on the cost-effectiveness of needle and syringe programmes in Australia, where 30 million syringes are distributed each year, estimates that they have prevented more than 32 000 cases of HIV infection and almost 100 000 cases of hepatitis C, since their introduction in 2000 (National Centre in HIV Epidemiology and Clinical Research, 2009).

New data for 2008 from 14 countries show increases in syringe provision to drug users in Belgium (Flemish Community), the Czech Republic, Estonia, Hungary, the United Kingdom (Northern Ireland) and Croatia, thereby confirming earlier trends. Increases were also reported in Portugal and Lithuania, where numbers had previously declined. A decrease compared to 2007 was reported in Greece, Romania and Slovakia, as well as in Luxembourg and Poland, where the downward trend was already observed the year before. The programme in Cyprus was not used by drug users.

Needle and syringe programmes in Europe increasingly provide a range of other injecting-related items (e.g. mixing containers) to prevent them being shared. They also provide equipment that can be used for non-injecting forms of drug use, for example pipes or aluminium foil, in order to encourage users to discontinue injecting. Another example of this is reported by the Czech Republic, where low-threshold agencies started to provide methamphetamine injectors with hard gelatine capsules that can be filled with the drug and swallowed.

Recent developments in the diagnosis, prevention and treatment of chronic hepatitis have been reported by European countries. These include the adoption of specific programmes or action plans (e.g. Denmark, France, United Kingdom – England, Scotland and Northern Ireland). Existing interventions include specific information materials; safer-injection training targeting new and young injectors, implemented by outreach teams (e.g. Romania) or through peer education (e.g. in prisons in Spain and Luxembourg); and easily accessible and free counselling and testing. The United Kingdom also reports the use of contingency management to encourage testing. Other reported measures aim at keeping injection levels low through retention in drug treatment; at the integration of viral hepatitis services into settings that serve drug users; and at revising HCV treatment guidance to improve access to such treatment (e.g. Czech Republic). Several countries have also launched initiatives aimed at increasing knowledge and awareness about chronic viral hepatitis among health care and social service providers (Austria) and among the public (e.g. Germany, Ireland, Netherlands).


(1) For further information about national priorities and provision levels, see Table HSR-6 in the 2010 statistical bulletin.

(2) See Table HSR-6 in the 2009 statistical bulletin and Table HSR-5 in the 2010 statistical bulletin. For 2007/8, data on the number of syringes were not available for Denmark, Germany, Italy and the United Kingdom.

(3) These figures do not include pharmacy sales, which may represent an important source of sterile syringes for drug users in several countries.

Bibliographic references

WHO, UNODC and UNAIDS (2009), Technical guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users, World Health Organization, Geneva.

Kimber, J., Palmateer, N., Hutchinson, S. et al. (2010), ‘Harm reduction among injecting drug users: evidence of effectiveness’, in Harm reduction: evidence, impacts and challenges, EMCDDA Monograph, Rhodes, T. and Hedrich, D. (editors), Publications Office of the European Union, Luxembourg, pp. 115–63.

Van den Berg, C., Smit, C., Van Brussel, G., Coutinho, R.A. and Prins, M. (2007), ‘Full participation in harm reduction programmes is associated with decreased risk for human immunodeficiency virus and hepatitis C virus: evidence from the Amsterdam cohort studies among drug users’, Addiction 102, pp. 1454–62.

Craine, N., Hickman, M., Parry, J.V. et al. (2009), ‘Incidence of hepatitis C in drug injectors: the role of homelessness, opiate substitution treatment, equipment sharing, and community size’, Epidemiology and Infection 137, pp. 1255–65.

National Centre in HIV Epidemiology and Clinical Research (2009), Return on investment 2: Evaluating the cost-effectiveness of needle and syringe programs in Australia, Sydney (available online).

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Page last updated: Tuesday, 26 October 2010