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Please note that the information on this page is based on the EMCDDA Annual report 2011: the state of the drugs problem in Europe. Most statistical data relate to the year 2009 (or the last year available).


Annual report 2011: the state of the drugs problem in Europe
Drug-related infectious diseases and drug-related deaths

Published: 15 November 2011

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 aim to prevent and control the spread of infectious diseases among drug users by a combination of approaches, including surveillance, vaccination and treatment of infections; drug treatment, particularly opioid substitution treatment, and the provision of sterile injection equipment; in addition, community-based activities provide information, education and behavioural interventions, often implemented through outreach or low-threshold agencies. 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).


The effectiveness of opioid substitution treatment in reducing HIV transmission and self-reported injecting risk behaviour has been confirmed in several studies and reviews. There is growing evidence that the combination of opioid substitution treatment and needle and syringe programmes is more effective in reducing HIV or HCV incidence and injecting risk behaviour than either approach alone (ECDC and EMCDDA, 2011).

Building on improvements in the treatment of hepatitis C, many countries are increasing their efforts to prevent, detect and treat hepatitis among drug users. The European Union is supporting several initiatives to improve hepatitis C prevention among drug users. These initiatives include: mapping national standards and guidelines for HCV prevention in the EU (Zurhold, 2011); compilation of examples of awareness-raising, prevention, treatment and care interventions (Correlation Project and EHRN, 2010); development of training materials for policymakers, medical professionals and local service providers (e.g. Hunt and Morris, 2011).

Provision of free, clean syringes organised through specialised facilities or pharmacies exists in all countries except Turkey, but despite considerable expansion in the past two decades, information on geographical coverage shows imbalances, with several countries in central and eastern Europe and Sweden reporting lack of availability in some areas (see Figure 18).

Recent data on syringe provision through specialised needle and syringe programmes are available for all but three countries and are incomplete in another two (1). They show that nearly 50 million syringes per year are distributed through these programmes. This is equivalent to an average of 94 syringes per estimated injecting drug user in the countries providing syringe data.

For 13 countries, the average number of syringes distributed in a year per injecting drug user can be estimated (2). In seven of these countries, the average number of syringes given out by specialised programmes is equivalent to less than 100 per injector, four countries give out between 100 and 200 syringes, and Luxembourg and Norway report the distribution of more than 200 syringes per injector (3). 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).

Over the last four reporting years (2005-2009) the total number of syringes given out by syringe programmes has increased 32 %. A sub-regional analysis of syringe provision trends shows a flattening of the increase among the pre-2004 EU Member States and a rise in the newer Member States.


(1) See Table HSR-5 the 2011 statistical bulletin. For 2007-09, data on the number of syringes were not available for Denmark, Germany and Italy. Data on the Netherlands cover only Amsterdam and Rotterdam and data on the United Kingdom do not include England.

(2) See Figure HSR-3 in the 2011 statistical bulletin.

(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

Correlation Project and Eurasian Harm Reduction Network (2010), Hepatitis C transmission and injecting drug use: harm reduction responses, Eurasian Harm Reduction Network, Vilnius.

ECDC and EMCDDA (2011), Joint ECDC-EMCDDA guidance on infection prevention and control among injecting drug users, European Centre for Disease Prevention and Control, Stockholm.

Hunt, N. and Morris, D. (2011), Hepatitis C treatment and care for IDUs, Training module, Eurasian Harm Reduction Network, Vilnius.

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.

Zurhold, H. (2011), European standards and guidelines for HCV prevention. Report on WP 2 of the DPIP-funded project 'Identification and optimisation of evidence-based HVC prevention in Europe for young drug users at risk', ZIS, Hamburg.

About the EMCDDA

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: Friday, 28 October 2011