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 78 million Europeans, that is over one in five of all 15- to 64-year-olds (see Table 4: Prevalence of cannabis use in the general population for a summary of the data). Considerable differences exist between countries, with national prevalence figures varying from 1.5 % to 32.5 %. For most of the countries, the prevalence estimates are in the range of 10-30 % of all adults.
An estimated 22.5 million Europeans have used cannabis in the last year, or on average 6.7 % 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 million Europeans used the drug in the last month, on average about 3.6 % of all 15- to 64-year-olds.
Time frame of use
European estimates are computed from national prevalence estimates weighted by the population of the relevant age group in each country. To obtain estimates of the overall number of users in Europe, the EU average is applied for countries lacking prevalence data (representing not more than 3 % of the target population). Populations used as basis: 15–64, 336 million; 15–34, 132 million; 15–24, 63 million. As European estimates are based on surveys conducted between 2001 and 2009/10 (mainly 2004–08), they do not refer to a single year. The data summarised here are available under General population surveys in the 2011 statistical bulletin.
|15–64 years||Estimated number of users in Europe||78 million||22.5 million||12 million|
|European average||23.2 %||6.7 %||3.6 %|
|Range||1.5–32.5 %||0.4–14.3 %||0.1–7.6 %|
|Lowest-prevalence countries||Romania (1.5 %)
Malta (3.5 %)
Bulgaria (7.3 %)
Hungary (8.5 %)
|Romania (0.4 %)
Malta (0.8 %)
Greece (1.7 %)
Hungary (2.3 %)
|Romania (0.1 %)
Malta (0.5 %)
Greece, Poland (0.9 %)
Sweden (1.0 %)
|Highest-prevalence countries||Denmark (32.5 %)
Spain (32.1 %)
Italy (32.0 %)
France, United Kingdom (30.6 %)
|Italy (14.3 %)
Czech Republic (11.1 %)
Spain (10.6 %)
France (8.6 %)
Spain (7.6 %)
|15–34 years||Estimated number of users in Europe||42 million||16 million||9 million|
|European average||32.0 %||12.1 %||6.6 %|
|Range||2.9–45.5 %||0.9–21.6 %||0.3–14.1 %|
|Lowest-prevalence countries||Romania (2.9 %)
Malta (4.8 %)
Greece (10.8 %)
Bulgaria (14.3 %)
|Romania (0.9 %)
Malta (1.9 %)
Greece (3.2 %)
Poland (5.3 %)
|Romania (0.3 %)
Greece (1.5 %)
Poland (1.9 %)
Sweden, Norway (2.1 %)
|Highest-prevalence countries||Czech Republic (45.5 %)
Denmark (44.5 %)
France (43.6 %)
Spain (42.4 %)
|Czech Republic (21.6 %)
Italy (20.3 %)
Spain (19.4 %)
France (16.7 %)
Spain (14.1 %)
|15–24 years||Estimated number of users in Europe||19 million||9.5 million||5 million|
|European average||30.0 %||15.2 %||8.0 %|
|Range||3.7–53.8 %||1.5–29.5 %||0.5–17.2 %|
|Lowest-prevalence countries||Romania (3.7 %)
Malta (4.9 %)
Greece (9.0 %)
Cyprus (14.4 %)
|Romania (1.5 %)
Greece (3.6 %)
Portugal (6.6 %)
Slovenia, Sweden (7.3 %)
|Romania (0.5 %)
Greece (1.2 %)
Sweden (2.2 %)
Norway (2.3 %)
|Highest-prevalence countries||Czech Republic (53.8 %)
France (42.0 %)
Spain (39.1 %)
Denmark (38.0 %)
|Czech Republic (29.5 %)
Spain (23.9 %)
Italy (22.3 %)
France (21.7 %)
|Spain (17.2 %)
France (12.7 %)
Czech Republic (11.6 %)
Italy (11.0 %)
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 Cyprus and Portugal (1).
Population survey data suggest that, on average, 32.0 % of young European adults (15-34 years) have ever used cannabis, while 12.1 % have used the drug in the last year and 6.6 % 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 (15.2 %) or last month (8.0 %). 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 20 times those of the lowest-prevalence countries.
Cannabis use is generally higher among males, with for example, the ratio of males to females among young adults reporting use of cannabis in the last year ranging from just over six to one in Portugal to just under unity in Norway (2).
Figures from Australia, Canada and the United States on lifetime and last year use of cannabis among young adults are all above the European averages, which are 32.0 % and 12.1 % respectively. For instance, in Canada (2009) lifetime prevalence of cannabis use among young adults was 48.4 % and last year prevalence 21.6 %. In the United States, SAMHSA (2010) estimated a lifetime prevalence of cannabis use of 51.6 % (16-34 years, recalculated by the EMCDDA) and a last year prevalence of 24.1 %, while in Australia (2007) the figures are 46.7 % and 16.2 % for the 14- to 39-year-olds. Among 15- to 16-year-old school students, a small number of European countries (Czech Republic, Spain, France, Slovakia) report levels of lifetime prevalence of cannabis use that are comparable to those reported in Australia and the United States.
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 2009-10, national school surveys were carried out by Italy, Slovakia, Sweden and the United Kingdom.
The data from the 2007 ESPAD and 2009-10 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, Spain, France, the Netherlands, Slovakia and the United Kingdom (England) report prevalence levels ranging from 26 % to 33 %. 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 two to one or higher in Cyprus, Greece, Poland and Romania (3).
Trends in cannabis use
During the late 1990s and early 2000s, many European countries reported increases in cannabis use, both in general population surveys and in school surveys. Since then, the European picture has become more complex. Many countries report that cannabis use is stabilising or even decreasing, while a small number of countries (Bulgaria, Estonia, Finland, Sweden) may be witnessing an increase. While almost all European countries have carried out general population surveys in recent years, only sixteen countries have provided sufficient data to analyse trends in cannabis use over a longer period of time.
Trends in these sixteen countries can be grouped according to prevalence levels (Figure 5). First, a group of six countries (Bulgaria, Greece, Hungary, Finland, Sweden, Norway), located mainly in north and southeast Europe, have always reported low last year prevalence of cannabis use among 15- to 34-year-olds, at levels not exceeding 10 %. Secondly, a group of five countries (Denmark, Germany, Estonia, Netherlands, Slovakia), located in different parts of Europe, report higher prevalence levels, but not exceeding 15 % in their latest survey. All of the countries in this group, except the Netherlands, reported notable increases of cannabis use in the 1990s and early 2000s. With the exception of Estonia, this group of countries reported an increasingly stable trend in the following decade. Finally, there is a group of five countries that have all, at some point in the past 10 years, reached the highest levels of cannabis use in Europe, with last year use among young adults in the region of 20 % and higher. These are countries in the south and west of Europe (France, Spain, Italy, United Kingdom) and the Czech Republic. In this group, trends may be diverging. While the United Kingdom and, to a lesser extent, France have reported decreases in their most recent surveys, Spain has reported a relatively stable situation since 2003. All three had reported increases in cannabis use during the 1990s. Italy and the Czech Republic have both reported increases followed by decreases in recent years. Differences in survey methods and response rates, however, do not yet allow confirmation of the most recent trends in these two countries.
It is worth noting the particular case of the United Kingdom, where surveys are conducted annually. After a history of the highest levels of cannabis use in Europe at the beginning of the 2000s, in 2010, last year prevalence of cannabis use fell below the EU average for the first time since EU monitoring began.
The recorded stabilisation or decrease in cannabis use refers to last year use, which includes recreational patterns of use. However, it is not clear whether intensive and long-term use have also stabilised.
Similar patterns were 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, reported overall stable and low lifetime prevalence of cannabis use during the whole period. Most western European countries, as well as Slovenia and Croatia (11 countries), which had high or strongly increasing lifetime cannabis use prevalence until 2003, saw a decrease or stabilisation in 2007. In most of central and eastern Europe, the increasing trend observed between 1995 and 2003 appears to have levelled out. In this region, six countries reported a stable situation and two an increase between 2003 and 2007.
New school survey data from the latest HBSC (Health behaviour in school-aged children) surveys also point to an overall stable or decreasing trend in drug use among students (15-16 years) in most countries during the 2006-2010 period. Mirroring the trend among adults, in England, lifetime cannabis use among school students has almost halved from 40 % in 2002 to 22 % in 2010. In Germany, lifetime cannabis use among school students has also halved, from 24 % in 2002 to 11 % in 2010. However, increases have been recorded since 2006 in the Czech Republic, Greece, Latvia, Lithuania, Romania and Slovenia.
Long-term trend data from school surveys in Australia and the United States also indicate a decreasing trend in cannabis use up to 2009 (4). However, the most recent US school survey, carried out in 2010, indicates a possible resurgence in cannabis use; with school students reporting increased last year cannabis use and lower levels of disapproval of the drug (Johnston et al., 2010). In the 2010 survey, American school students aged 15- to 16-years-old reported levels of use of cannabis higher than those of cigarette smoking, on some measures: 16.7 % had used cannabis in the past month, while only 13.6 % had smoked cigarettes (Johnston et al., 2010).
The picture is different among school students in Europe, where levels of last month cigarette smoking remain considerably higher than those for cannabis use. Between 2003 and 2007, ESPAD school surveys in 23 EU countries reported an overall reduction in last month cigarette smoking (from 33 % to 28 %) and a reduction, or at least a stabilisation, in cannabis use (from 9 % to 7 %) (Figure 6). In Europe, where cannabis and tobacco are commonly mixed together for smoking, decreases in tobacco smoking may exert some influence on cannabis trends.
Patterns of cannabis use
Available data point to a variety of patterns of cannabis use, ranging from experimental use to dependent use. Many individuals tend to discontinue their cannabis use after one or two experiments; others use it occasionally or during a limited period of time. Of those aged 15-64 who have ever used cannabis, 70 % have not done so during the last year (5). Among those who have used the drug in the last year, on average, nearly half have done so in the last month, possibly indicating more regular use. These proportions, however, vary considerably across countries and between genders.
Cannabis use is particularly high among certain groups of young people, for instance, those frequently attending nightclubs, pubs and music events. Targeted surveys recently conducted in nightlife or dance-music settings in Belgium, the Czech Republic, the Netherlands, Lithuania and the United Kingdom reported prevalence levels that are much higher than the European average among young adults. Cannabis use is also often associated with heavy alcohol use: among young adults (aged 15 to 34), frequent or heavy alcohol users were, in general, between two and six times more likely to report the use of cannabis compared to the general population.
The types of cannabis product and the ways they are used can have different associated risks. Patterns of cannabis use that result in high doses being consumed may put the user at greater risk of developing dependence or other problems (Chabrol et al., 2003; Swift et al., 1998). Examples of these practices include using cannabis with very high THC content or in large amounts, and inhaling from a water pipe.
General population surveys seldom distinguish between use of different types of cannabis. However, in 2009 new questions were introduced in a UK general population survey to identify the prevalence of the use of herbal cannabis, including 'skunk' (the street name given to a generally high potency form of the drug). The 2009/2010 British Crime Survey estimates that around 12.3 % of adults have ever taken what they believed to be 'skunk'. While similar proportions of cannabis users report lifetime use of herbal cannabis (50 %) and cannabis resin (49 %), those using the drug in the last year are more likely to have used herbal cannabis (71 %) than resin (38 %) (Hoare and Moon, 2010). While these estimates cannot be generalised to other populations in Europe, the findings illustrate some changes in cannabis consumption over time.
Data from a sample of 14 European countries accounting for 65 % of the adult population of the European Union and Norway show that almost half of those who used cannabis in the last month had consumed the drug on 1-3 days during that month; about one-third on 4-19 days and one fifth on 20 days or more. In most of these 14 countries, females are more likely to use cannabis on an occasional basis, while the majority of daily or almost daily cannabis users are male (Figure 7). Based on these figures, male users in many countries appear to be at particular risk of becoming frequent users, and this should be considered when developing prevention activities.
New data on drug use among adolescents show that daily cannabis use is also a growing problem in the United States. Prevalence of daily use of cannabis increased significantly, to 6 % among 17- to 18-year-old high school students in 2010 (Johnston et al., 2010).
Dependence is increasingly recognised as a possible consequence of regular cannabis use, even among younger users, and the number of individuals seeking help due to their cannabis use is growing in some European countries (see below). It has, however, been reported that half of dependent cannabis users who stopped using the drug were able to do so without treatment (Cunningham, 2000). Some cannabis users - particularly, heavy users - can experience problems without necessarily fulfilling the clinical criteria for dependence.
In 2009, cannabis was the primary drug of about 98 000 reported treatment entrants in 26 countries (23 % of the total), making it the second most reported drug after heroin. Cannabis was also the most reported secondary drug, mentioned by around 93 000 clients (28 %). Primary cannabis users account for more than 30 % of treatment entrants in Belgium, Denmark, Germany, France, Hungary, the Netherlands and Poland, but less than 10 % in Bulgaria, Estonia, Greece, Lithuania, Malta, Romania and Slovenia (6).
Differences in the prevalence of cannabis use and its related problems are not the only factors explaining the differences in treatment levels between countries. Other factors, such as referral practices and the level and type of treatment provision are also important. Examples of this are evident in France and Hungary, two countries that report a high proportion of cannabis users entering treatment. France has a system of counselling centres, which target young clients (7). In Hungary, cannabis offenders are offered drug treatment as an alternative to punishment, which can swell the numbers.
In terms of trends over the last ten years, among the 21 countries for which data are available, all countries, except Bulgaria, report an increase in the proportion of clients entering treatment for the first time in their life because of cannabis use. For the period 2004-09, in the 18 countries for which data are available, the number of primary cannabis users among those reported entering treatment for the first time in their life increased by about 40 % from 27 000 to 38 000 (8). The most recent figures (2008-09) show a continuing upward trend in the majority of reporting countries.
Profile of treatment clients
Cannabis clients mainly enter treatment in outpatient settings and are reported to be one of the youngest client groups entering treatment, with a mean age of 25 years. Young people citing cannabis as their primary drug represent 74 % of reported treatment entrants aged 15-19 years and 86 % of those younger than 15 years. The male to female ratio is the highest among drug clients (about five males to every female). Overall, 49 % of primary cannabis clients are daily users, about 18 % use it 2-6 times a week, 12 % use cannabis weekly or less often, and 22 % are occasional users, some of whom have used it in the month before entering treatment. These proportions differ between countries (9).
(1) See Figure GPS-1 in the 2011 statistical bulletin.
(4) See Figure EYE-1 (part vi) in the 2011 statistical bulletin.
(5) See Figure GPS-2 in the 2011 statistical bulletin.
(7) In addition, many opioid users in France are treated by general practitioners and are not reported to the treatment demand indicator, thereby inflating the proportions of users of other drugs.
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. 211-3.
EMCDDA (2009), Annual report 2009: the state of the drug 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. and Moon, D. (eds) (2010), ‘Drug misuse declared: findings from the 2009/10 British Crime Survey’, Home Office Statistical Bulletin 13/10.
Johnston, L.D., O'Malley, P.M., Bachman, J.G. and Schulenberg, J.E. (2010), Marijuana use is rising; ecstasy use is beginning to rise; and alcohol use is declining among U.S. teens, University of Michigan News Service, Ann Arbor, MI.
SAMHSA (2010), Results from the 2009 National Survey on Drug Use and Health: Volume I. Summary of National Findings, Substance Abuse and Mental Health Services Administration, Rockville, MD (available online).
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. 1 149-60.