Country overview: Belgium
- Situation summary
- Data sheet
- Barometer
Contents
- Drug use among the general population and young people
- Prevention
- Problem drug use
- Treatment demand
- Drug-related infectious diseases
- Drug-related deaths
- Treatment responses
- Harm reduction responses
- Drug markets and drug-related offences
- National drug laws
- National drug strategy
- Coordination mechanism in the field of drugs
- Drug-related research
| Year | Belgium | EU (27 countries) | Source | ||
|---|---|---|---|---|---|
| Population | 2008 | 10 666 866 | 497 455 033 | Eurostat | |
| Population by age classes | 15–24 | 2008 | 12.1 % | 12.6 % 1 | Eurostat |
| 25–49 | 35.1 % | 36.3 % 1 | |||
| 50–64 | 18.8 % | 18.4 % 1 | |||
| GDP per capita in PPS (Purchasing Power Standards) 2 | 2007 | 118.2 | 100 | Eurostat | |
| Total expenditure on social protection (% of GDP) 3 | 2006 | 30.1 % | 26.9 % p | Eurostat | |
| Unemployment rate 4 | 2008 | 7.1 % | 7 % | Eurostat | |
| Unemployment rate of population agends under 25 years | 2008 | 18.2 % | 15.5 % | Eurostat | |
| Prison population rate (per 100 000 of national population) 5 | 2006 | 95.6 | Council of Europe, SPACE 2006.1 | ||
| At risk of poverty rate 6 | 2006 | 15 % | 16 % 7 | SILC, 2007 |
|
p Eurostat provisional value.
1 2007 figures.
2 Gross domestic product (GDP) is a measure of economic activity. It is defined as the value of all goods and services produced less the value of any goods or services used in their creation. The volume index of GDP per capita in Purchasing Power Standards (PPS) is expressed in relation to the European Union (EU-27) average set to equal 100. If the index of a country is higher than 100, this country's level of GDP per head is higher than the EU average and vice versa.
3 Expenditure on social protection contains: benefits, which consist of transfers, in cash or in kind to households and individuals to relieve them of the burden of a defined set of risks or needs.
4 Unemployment rates represent unemployed persons as a percentage of the labour force. Unemployed persons comprise persons aged 15 to 74 who were: (a) without work during the reference week; (b) currently available for work; (c) actively seeking work.
5 Situation of penal institutions on 1 September, 2006.
6 Share of persons aged 0+ with an equivalent disposable income below the at-risk-of-poverty threshold in the current year and in at least two of the preceding three years.
7 EU-25 countries.
Drug use among the general population and young people
In 2004, the ‘National health interview survey’, carried out among the general population aged 15 years and older, included questions on cannabis use. Lifetime prevalence of cannabis was reported by 13 % of respondents aged 15–64, compared with 10.8 % reported in 2001. Overall, last year prevalence of cannabis use was reported by 5 % of respondents, with last year prevalence reported at 12 % for those aged 15–24 years and 11 % for those aged 25–34 years.
The Health Behaviour in School-aged Children (HBSC) study was carried out in the Flemish community and in the French community in 2005–06, among a representative sample of students aged 12–18. In both communities, cannabis was the drug most frequently reported by students aged 15 and 18: 24.6 % (15–16 years) and 43.5 % (17–18 years) in the Flemish community, and 29.6 % (15–16 years) and 47.0 % (17–18 years) in the French community had used cannabis at least once in their lives. In 2005, compared to 2002, lifetime use of cannabis increased slightly in the age group 17–18, in both communities, but not in the age group 15–16.
In 2007, the ESPAD survey was repeated among students aged 15–16 in the Flemish community. Lifetime prevalence of cannabis use was 24 %, being higher among boys (28 %) than girls (19 %). Regarding other drugs, lifetime prevalence was 8 % for inhalants, 5 % for ecstasy, 4 % for cocaine and 5 % for amphetamines. Last year prevalence of cannabis was 19 % and last month was 12 %.
Prevention
Strategies for drug prevention in Belgium differ significantly across the three language communities and differences even exist at the level of planning. Major investments to develop drug policies at schools have been encouraged in the French community, whereas such policies have already been implemented in the Flemish community. A common main objective adopted is to better involve all actors: parents, students, teachers and directors in prevention matters resulting into a comprehensive, integrated approach.
The differences between the communities are particularly accentuated for universal school-based prevention programmes. The French community follows a model in which specialised associations or internal services provide training in schools or counselling. In the Flemish community, programme-based interventions have been adopted and a similar situation is reported in the German community. Furthermore, in the German community, priority is given to prevention projects on alcohol use and recently, attention is also being given to the prevention of tobacco use.
Selective prevention is mainly targeted at recreational settings and families-at-risk. In recreational settings, selective prevention is mostly limited to the dissemination of information through information stands, peer prevention and through websites targeted at party-goers or through mobile teams whose aim is to intervene in places (generally, in large festive events) where there is important (synthetic) drug use. The ‘Quality nights’ charter in Brussels and Partywise in the Flemish community are health promotion labels (like ‘Safe clubbing’ guidelines) in recreational settings. They aim to improve health and safety of participants to festivals, parties, etc. by involving the events organisers and the operators in order to give them a sense of responsibility about health topics.
Differences between the three communities also exist in selective prevention programmes targeted at families-at-risk. The Flemish community developed a number of prevention programmes, such as ‘Broeders Alexianen’ in Tienen, a programme that helps children of alcoholics to understand and deal with the addiction of the parent, and the programme ‘Bubbels & Babbels’, a prevention project focusing on the problems of children of ex-drug-dependent parents.
The French community treatment services provide assistance to drug-addicted mothers by improving the mother–child relationship as well as the children’s living conditions. In the French community, in a particular neighbourhood, special means are granted as a ‘priority action zone’ (socially/economically deprived). A ‘Parent’s house’ was created, aiming to support parenthood, and a project of ‘homework school’, a place where children can be accompanied after school in their homework, before joining their home. This support goes beyond homework help, and also targets problems such as the respect of limits, or risky behaviours that children might experiment. It is difficult to report on indicated drug prevention as no strategies or services specifically exist in this area. Special characteristics of the prevention culture in Belgium within the European context are: heterogeneous objectives and strategies across the federal entities; a common focus on strengthening the network of fieldworkers available for young people; innovative programmes addressing, for example, children; and strong efforts in environmental strategies in recreational settings.
Problem drug use
The national definition of problem drug use has been discussed in Belgium without coming to a consensus. Data sources (mainly treatment data) have been improved as a basis for PDU estimation. Estimations of the prevalence of problematic drug use and descriptions of the characteristics of problematic users have been provided by local studies.
The EMCDDA defines problem drug use as intravenous drug use (IDU) or long duration/regular drug use of opiates, cocaine and/or amphetamines. Ecstasy and cannabis are not included in this category.
Treatment demand
In Belgium, treatment demand data is registered by more than 10 different registration systems, and due to differences in registration systems, inferences about the pooled data should be made cautiously. However, in recent years, a Belgian version of the European treatment demand indicators protocol has been developed. In December 2005, a protocol agreement regarding treatment demand indicators was signed by the members of the Inter-Ministerial Commission of Health. In 2008, the first treatment demand data were reported.
The treatment demand data for Belgium for 2005 was based on 33 outpatient centres out of the 39 centres, 19 inpatient centres out of the 21 centres. In 2005, a total of 4 966 persons demanding treatment were registered with the system.
In 2005, 44 % of all clients entering treatment were aged less than 25 years. As regards to gender distribution among all clients entering treatment, 81 % were males and 19 % females. Treatment demands were mainly related to opiates, cannabis was the second most important substance.
Drug-related infectious diseases
In Belgium, diagnosed HIV-positive persons and AIDS cases are registered at the Scientific Institute of Public Health in Brussels. From the beginning of the epidemic until December 2007, 20 004 HIV-infected patients have been registered. The proportion of IDUs among HIV cases decreased from around 10 % in 1986 to approximately 1 % in 2007.
Data on HIV, HBV and HCV infections rates among users who have injected at least once are available in Belgium from three different sources. For the French community, the data on HIV are based on self-reported data, and are collected through treatment monitoring centres. Data based on biological tests for a selected sample of IDUs who were in contact with a medical doctor are made available through ‘De Sleutel’, a Flemish institution composed of several ambulatory and residential treatment centres. Another data source is the outpatient clinic ‘Free Clinic’ located in Antwerp, whose data are based on voluntary blood screening offered to patients on a regular basis.
In terms of prevalence rates and trends, a declining trend has been observed in the French part of the country since 1994, and in the data from the Flemish institution (De Sleutel) since 1998 with regard to HIV infection rates. The percentage of self-reported HIV infection among IDUs asking for treatment in the French community was 4.2 % in 2007 and in the Walloon Region, the self-reported rate was 5.2 % in 2007. Biological tests carried out through the Flemish institution in 2007 revealed an HIV infection rate of 3.7 %. Among IDUs who agreed to a test at the Free Clinic in Antwerp, 6.0 % were infected with HIV in 2007 (compared to 7.1 % in 2005 and to 5.7 % in 2006).
The HBV infection rate (HbsAg) among IDUs was 54.0 % in 2007, compared with 55.0 % in 2006 (Free Clinic). In 2007, HCV infection rates among IDUs range from 51.7 % (Walloon Region) to 34.0 % (data from De Sleutel) and 80 % among IDUs at the outpatient clinic in Antwerp.
Drug-related deaths
In Belgium, drug-related deaths are recorded by the general mortality register located at the National Institute of Statistics. The national focal point extracts data on drug-related deaths, based on the EMCDDA’s drug-related deaths standard, a standard protocol for extracting these data from registers in the Member States of the European Union (which includes acute deaths directly related to drug consumption or overdoses). The latest available data at the national level are from 1997, and it appears that the number of drug-related deaths rose gradually between 1987 and 1997. However, trends must be interpreted with caution, due to possible changes in reporting over the years. The vast majority of drug-related cases involved opiates (99 % in 1997). In 2007, no eligible registers are available to estimate drug-related deaths at national level. Data on drug-related deaths in the Flemish community and Brussels are available until 2004.
Treatment responses
The national drug strategy document, the ‘Federal drug policy note of 2001’, specifies that the treatment offer should be based on a multidisciplinary approach adapted to the complex bio-psychosocial problem of addiction. In Belgium, different levels of decision-making provide funding for treatment, including the regional and federal governments. For example, at the federal level, the Federal Public Service for Public Health, Food Chain Safety and Environment provides the financing for a number of therapeutic communities, crisis centres and day centres which were set up in the 1970s and have expanded their capacities in recent years. Meanwhile, mental health centres, for example, are financed by the Walloon Region or by the Flemish community.
Different services for treatment and/or healthcare for drug users are available in a large part of the country, except in the German community where specialised treatment centres for drug users are not implemented. Overall, treatment offerings encompass specialised inpatient treatment centres, outpatient centres, low threshold services, units in psychiatric hospitals or psychiatric units in general hospitals, general welfare centres in general health services and specialised self-help groups. Eight social reception centres are located in the major cities and provide a low threshold access to treatment, counselling and outreach. Most after-care and re-integration programmes are delivered in outpatient and inpatient structures. For example, there are halfway houses in therapeutic communities, day treatment in drug centres and also employment rehabilitation programmes.
Although methadone substitution treatment was introduced in 1994 and buprenorphine in 2003, only in 2004 was a Royal Decree on substitution treatment adopted, which mentions methadone and buprenorphine as substitution substances. However, texts defining the working implementation of the Decree are still being awaited. In the Flemish Region, most methadone maintenance programmes are provided by low threshold drug services. However, in smaller towns and rural areas, methadone may also be prescribed by GPs under the supervision of drug services In the French community, a broad range of agencies such as low-threshold facilities, GPs, outpatients specialised units and mental health facilities offer access both to methadone and buprenorphine, but GPs still play the most important role. According to the latest available estimates (2007), a total of 16 275 clients were on substitution treatment, 15 383 of which were on methadone. In 2007, a pilot heroin-assisted treatment project was conceived in Liege with 200 problem heroin users, which aims to effectively start delivering treatment in 2009.
Harm reduction responses
In 1995, the Belgian federal government formulated an action plan for illegal drugs, based on a health perspective and on the harm reduction philosophy. In 1998, a law was adopted allowing for needle exchange programmes. Today, such programmes (stationary, mobile or in pharmacies) are available across the country except in the German community. In general, harm reduction projects are set up by NGOs and some are managed by cities, and funded by the Federal Public Service Home Affairs.
In the French community, needles exchange programmes have existed since 1994. In 2000, the Flemish community made the necessary legislative adaptations and in 2001, needle exchange programmes were also officially implemented. Similar programmes to those in the French community have been implemented (one in each province). However, since the programmes only started in 2001, they are still expanding in terms of sites to cover all geographical areas. In 2007, around 599 000 and 371 000 syringes were distributed through needle exchange programmes in the Flemish and French community respectively, with an exchange rate above 90 % in both communities. In Belgium, access to safe injection equipment in prisons is not available. Also, in recent years, special emphasis has been given to counselling and testing for hepatitis C.
Finally, an early warning system (EWS) was developed and aimed at exchanging information on new and/or dangerous drugs and their related risks. The EWS network includes among others: the national focal point, sub-focal points, forensic laboratories, police, judicial authorities, emergency wards and helplines.
Drug markets and drug-related offences
Illicit drugs seized in Belgium are often destined for other European countries, in particular the UK, the Netherlands and France. The majority of seizures in Belgium involve cannabis. Although cultivation of cannabis is increasing, nationally large-scale importation of Moroccan hashish still dominates. The data from the Federal Police show that cannabis is the most commonly-involved drug of all drug-related offences.
In 2007, an increase in the number of drug-related seizures for most of the drugs, namely cannabis, heroin, cocaine, amphetamines and ecstasy was reported when compared to 2006. Furthermore, in 2007 the quantity of seized heroin increased substantially, with a total of 270 kg in 2005, 176 kg in 2006 and a total of 548 kg in 2007. For amphetamines, a similar trend can be observed, with a total of 175 kg seized in 2005, 119 kg in 2006, and a total of 484 kg in 2007.
The port of Antwerp is the third largest container port in the world, and is pivotal in international drug trafficking. Synthetic drugs are illegally produced in Belgium, in particular ecstasy, with export countries including the US, Canada, the UK and, recently, Australia. Before 2000, illegal laboratories producing synthetic drugs were mainly concentrated in the eastern part of the country, but it seems that they are now more geographically distributed. There has been an increase in the circulation of synthetic drugs within Belgium, as well as their export from Belgium to other European countries. The quantity of seized ecstasy tablets has been increasing since 1990 with a total of 541 245 seized ecstasy tablets in 2007.
National drug laws
In Belgium, a change in the law and a new prosecution directive were enacted in the first half of 2003. Cannabis was differentiated from other illicit substances, and the two concepts of problem drug use and public nuisance were introduced. The new status of cannabis allowed the public prosecutor not to prosecute if there was no evidence of problematic drug use or of public nuisance. After the Constitutional Court found that these concepts were insufficiently defined, a new directive issued in February 2005 called for full prosecution only in cases involving disturbance of public order or other aggravating circumstances. This includes possession of cannabis in or near places where schoolchildren might gather and also ‘blatant’ possession in a public place or building.
For drugs other than cannabis, Belgian law punishes possession, production, import, export, or sale by imprisonment for between three months and five years and/or a fine. There is no separate offence of ‘trafficking’, but the term of imprisonment may be increased to 15 or even 20 years in the event of specific aggravating circumstances.
National drug strategy
The Belgian federal ‘Drug policy note’ was adopted in 2001, and is not time-restricted. It is the first ever national drug strategy and covers both illicit and licit drugs (i.e. alcohol, tobacco and some medicines). The strategy’s main goal is to prevent and limit risks for drug users, their environment and for society as a whole. The Drug policy note takes a comprehensive approach and is based on three pillars: (1) prevention of drug consumption, (2) harm reduction, assistance and re-integration and (3) enforcement. It also envisages a system of coordination units on drugs at federal level represented by communities, regions and the federal state.
Coordination mechanism in the field of drugs
In Belgium, three levels of coordination units are under development: (i) a general drug policy unit (or general coordination unit), headed by a drug coordinator, to be placed under one of the federal ministries. This unit should include actors from the different sectors/ministries (health, security, international affairs, other), regions and communities. Its task will be to develop and follow up the national drug policy (for the federal government); (ii) sub-coordination units in the health, control and international affairs sectors. Each of these units would include representatives from the relevant ministries at the federal, regional and community level. Their task is to develop and follow-up the national drug policy in their field (for the relevant inter-ministerial committees on health, security, etc.); and (iii) a national (federal and communities) inter-ministerial conference on drugs to monitor the evolution of the drug problem and the responses developed to reduce it.
In 2006, a single ‘Drugs health policy unit’ was implemented to oversee that the other bodies, in particular the general drug policy unit and its drug coordinator, and the inter-ministerial conference, are implemented in the very near future.
Drug-related research
The federal drug strategy provides a budget for scientific research in the drug field which is managed by the Federal Science Policy Office through a research programme to support the federal policy. Most studies funded through this programme are executed by networks of researchers, and the emphasis is mainly placed on drug treatment and on drug-related crime and nuisance. The national focal point collects information on ongoing and concluded studies through its network of partners, and disseminates information on drug-related research findings to different audiences through different channels. Recent studies mentioned in the 2008 Belgium National report mainly focused on aspects related to prevalence of drug use in different settings.