Country overview: Denmark
- Situation summary
- Drug use among the general population and young people
- High-risk drug use
- Treatment demand
- Drug-related infectious diseases
- Drug-induced death and mortality among drug users
- Treatment responses
- Harm reduction responses
- Drug markets and drug-law offences
- National drug laws
- National drug strategy
- Coordination mechanism in the field of drugs
- Public expenditure
- Drug-related research
|Year||EU (28 countries)||Source|
|Population||2013||5 602 628 ||505 665 739||Eurostat|
|Population by age classes||15–24||2013||12.8 %||11.5 % ||Eurostat|
|25–49||32.8 %||35.0 % |
|50–64||19.1 %||19.7 % |
|GDP per capita in PPS (Purchasing Power Standards) 1||2012||126||100||Eurostat|
|Total expenditure on social protection (% of GDP) 2||2011||34.2 %||29.0 % p||Eurostat|
|Unemployment rate 3||2013||7.0 %||10.8 %||Eurostat|
|Unemployment rate of population aged under 25 years||2013||13.0 %||23.4 %||Eurostat|
|Prison population rate (per 100 000 of national population) 4||2012||68.6||:||Council of Europe, SPACE I-2012|
|At risk of poverty rate 5||2012||13.1 %||17.0 % e||SILC |
p Eurostat provisional value.
1 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.
2 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.
3 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.
4 Situation of penal institutions on 1 September, 2012.
5 Share of persons aged 0+ with an equivalent disposable income below the at-risk-of-poverty threshold, which is set at 60 % of the national median equivalised disposable income (after social transfers).
The latest survey among the general population (16 years and over, using a multi-method) was carried out in 2013. The sample size consisted of 10 740 people aged 16–64. Previous surveys were conducted in 1990, 2000, 2005, 2008 and 2010.
In the 2013 survey the lifetime prevalence of cannabis use was 35.6 %, followed by amphetamines at 6.6 % and cocaine at 5.2 %. Last year prevalence of cannabis use was 6.9 %, and last month prevalence was 2.7 %. One in two young adults aged 16–34 had ever tried cannabis (lifetime prevalence of 45.9 %), while one in ten had ever tried amphetamines or cocaine. About 17.6 % of young adults reported using cannabis in the last year and 6.4 % reported using it in the last month. These data, when compared to previous studies, indicate a slight upward trend in cannabis use among young adults since 2010. The survey also indicates a decreasing trend in amphetamines and ecstasy use among young people aged 16–24 since 2000, while cocaine use remained reasonably stable during that period among this age group.
The survey also examined the prevalence of ketamine and GHB use, and found that less than 1 % of 16- to 24-year-olds reported recent use of these new substances.
The European School Survey Project on Alcohol and Other Drugs (ESPAD) study has been conducted regularly in Denmark since 1995 among students aged 15–16. Trends show that lifetime prevalence of illicit drugs increased between 1995 and 1999, stabilised between 1999 and 2003, and in 2007 showed a slight yet significant increase. However, the most recent study from 2011 indicates a significant reduction in lifetime prevalence rates for the most common illicit drugs among 15- to 16-year-olds. The lifetime prevalence of cannabis use in 2011 was 18 % (23 % in 2003; 25 % in 2007), amphetamines were 2 % (4 % in 2003; 5 % in 2007), cocaine was 2 % (2 % in 2003; 3 % in 2007) and ecstasy was 1 % (2 % in 2003; 5 % in 2007). Inhalants were the second most reported substance used at 4 %, and a decline in lifetime prevalence rates was also noted in 2011 (8 % in 2003; 6 % in 2007). In general, more males than females had tried cannabis and amphetamines, while as many males as females reported ever having tried cocaine and heroin; however, ecstasy and hallucinogens had been tried by more females than males.
In 2010 a nightlife survey was carried out by the Centre for Alcohol and Drug Research of Aarhus University, which indicated that more than half of nightclub visitors had ever used cannabis, while about 40 % had used an illicit substance other than cannabis. Polydrug use is common in these settings, when a mix of illicit and licit substances is used.
In Denmark, drug prevention is situated within wider comprehensive measures, implemented by various actors, that aim to enhance mental health and overall well-being through minimising inequalities among different social groups.
The main responsibility for prevention lies with the municipalities, with the assistance and support of the Danish Health and Medicines Authority. Municipalities plan universal and selective prevention in schools, the community and local recreational centres. The Danish Health and Medicines Authority provides support by producing information material and developing prevention projects, as well as monitoring and providing overall guidance. In 2012–13 it issued prevention packages for municipalities on alcohol and drug use among young people, on mental health and on tobacco.
In recent years there has been an increased focus on alcohol and universal prevention interventions in educational institutions, and ways of working with young people outside the educational system are being tested and developed. Nevertheless, manualised prevention programmes are rarely implemented.
There are also no fixed national guidelines on the form, content and scope of interventions for school-based prevention; however, municipalities usually recommend several interventions for implementation. These subjects are very often taught in grades 6 to 9, with the individual teacher organising the lesson. Municipality alcohol and drug counsellors support this work, to a certain extent. The publication ‘Drugs out of town’ provides further guidance to schools on how to formulate alcohol and drug preventive policies in schools, enhance cross-sectoral cooperation between schools, administration and the police and deliver evidence-based interventions. The Health and Medicines Authority supplies teachers and schools with further information materials to be used in educational processes, as well as in work with parents. Selective prevention is mostly targeted at recreational settings, with close cooperation between the main players involved in this area (municipalities, police and restaurant owners). The municipalities’ licensing boards are increasingly using plans for restaurants as a means of prevention in a nightlife context and are working closely with restaurant owners’ associations. Numerous municipalities offer courses on prevention to restaurant owners. In 2009–11 the Responsible Alcohol Serving project ran in 20 municipalities. Although it focused on alcohol, the evidence from similar projects elsewhere indicated that the activities also contributed to a reduction in the prevalence of drugs in nightlife settings. An evaluation showed a high level of interest from all actors in cooperating and contributing to a safer nightlife environment. A number of campaigns and information events have been organised at music festivals, including at Denmark’s largest, the Roskilde Festival.
In order to reach those who experiment with drugs, and those who are hard to reach, several web-based services are available in Denmark. www.netstof.dk is an internet based portal for young people seeking information and advice on alcohol, cannabis and other drugs. SMASH, a short message service (SMS)-based prevention initiative, has been developed as an anonymous support and counselling project for young cannabis users, to provide harm reduction, information and support in relation to stopping cannabis smoking. Following evaluation, the project is now running in 27 municipalities.
In the area of indicated prevention, Copenhagen established a prevention and early detection centre, U-Turn, which offers services to drug (mainly cannabis) users under the age of 25. The U-Turn model has been extended to six other municipalities and targets young people in vocational education settings who have drug use problems that do not require treatment interventions.
View ‘Prevention profile’ for additional information.
Up to 2012 the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) defined problem drug use as injecting drug use (IDU) or long duration/regular drug use of opiates, cocaine and/or amphetamines. Ecstasy and cannabis were not included in this category. However, in 2012 a new definition of ‘high-risk drug use’ was adopted. The new definition includes ‘problem drug use’, but is broader (mainly in its inclusion of high-risk use of more substances). Details are available here.
The latest estimate of the number of problem drug users in Denmark was carried out in 2009, applying the capture–recapture method and including two data sources, the National Registry of Patients and the National Register of Drug Users Undergoing Treatment. Problem drug users were defined as those reporting persistent use of illicit drugs, including cannabis, which leads to physical, psychological and social consequences. The total number of problem drug users was estimated at 33 074 (range: 31 151–34 997), which corresponds to a rate of 9.12 per 1 000 population aged 15–64 (range: 8.59–9.65). Compared to the estimates from 2001, 2003 and 2005, the number of problem drug users appears to be increasing.
Based on the general population survey, it is estimated that about 0.4 % of the Danish population aged 15–64 used cannabis daily or almost daily in 2013. The latest capture–recapture estimate suggested that there were about 10 900 problem cannabis users in 2009.
The number of people who injected drugs in 2006 was estimated to be about 13 000 (range: 10 066 to 16 821).
Up to 2011 data on treatment demand was collected by the National Board on Health, and after 2011 by the National Board of Social Services (NBSS). The NBSS collects data on treatment, managing the register of drug users in treatment, which is a joint reporting portal for all relevant authorities collecting treatment data. This move to a merged register has required technical changes that caused delay in data collection. For that reason the last available data from Denmark are from 2011.
In 2011 treatment demand data were reported from 130 of 145 treatment units. Approximately 5 686 clients entered treatment, of which 1 847 were new clients entering treatment for the first time.
Cannabis was the most frequently reported primary drug among all treatment clients in 2011, at 63 %, followed by opioids at 18 % and amphetamines at 10 %. Cannabis was the most frequently reported primary drug by a larger proportion of new treatment clients, at about 73 %, followed by amphetamines at 10 % and opioids at 7 %. Overall injection rates among treatment clients are low; however, among those with primary opioids use about one-third reported injecting the substance, while less than a quarter of new opioid-related treatment clients reported injecting behaviour.
In 2011 some 37 % of all treatment clients were under the age of 25, while new treatment clients tended to be younger, with 54 % under 25. In 2011 the male to female ratio for all clients entering treatment and new clients entering treatment was similar, at approximately three to one.
Human immunodeficiency virus (HIV) infections are registered by the State Serum Institute, based on anonymous reporting and voluntary testing. In 2012 eleven newly diagnosed HIV positive cases and four new acquired immune deficiency syndrome (AIDS) cases in people who inject drugs (PWID) were reported.
Six of 19 cases of acute hepatitis B virus (HBV) infection with a known transmission route were attributed to injecting drug use in 2012, and 174 of 215 chronic cases of hepatitis C virus (HCV) infection with a known transmission route were attributed to injecting drug use.
A special study from 2004–08 indicated that the HIV prevalence level among PWID was 2.1 %. In the same study, around 37.1 % of a sample of PWID tested positive for aHBc (anti-Hepatitis B core antigen), and the prevalence of HCV among PWID was around 52.5 %. However, these results should be interpreted with caution as the users tested were not representative of PWID in Denmark.
Drug-induced deaths are registered in the register of the National Police and the Cause of Deaths register of the State Serum Institute. Data extraction and reporting from the Cause of Deaths register is in line with the EMCDDA definitions and recommendations. The National Police register collates all death cases reported to police for the purpose of post-mortem examination. In a Danish context (not for international comparisons), it constitutes an important source of information for the analysis of developments overt time.
According to the Cause of Deaths register, in 2011 there were 190 drug-induced deaths in Denmark, the lowest recorded number since 1995. With regard to gender, males prevail (143 deaths). The mean age of victims was 44.4 years. Toxicological results were known for 183 deaths, and the majority of them (136 cases) were linked to opiates.
Based on these data, the drug-induced mortality rate among adults (aged 15–64) was 46.3 deaths per million in 2011, more than double the European average of 17.1 deaths per million in 2012.
The data from the Police Register suggests that a total of 210 deaths were caused by drugs in 2012. This is a decrease compared to 2011, when 285 deaths were registered. In 2012 a total of 166 of the 210 deaths were caused by drug poisoning, of which 142 were related to opiates. The presence of methadone was reported in most of these cases, and in almost all cases more than one psychoactive substance was involved. There was a decline in the number of deaths where heroin/morphine is reported and an increase in the proportion of deaths were methadone is assumed to be the most significant cause of death.
The main goals of Danish drug treatment policy are to achieve a reduction in drug use or to achieve full abstinence through enhanced use of psychosocial interventions, systematic follow-up of treatment, and to tackle problems other than those of drug use.
Following local government reform in 2007 municipalities became responsible for organising both the social and medical treatment of drug users. While the 98 municipalities are responsible for drug treatment, the five regions are responsible for psychiatric, primary and public health care. The Social Services Administration is responsible for referring a person for medical and social treatment for drug use, and the preparation of his/her treatment plan is a mandatory action according to the Social Service Act. Access to drug treatment is guaranteed within 14 days of the first contact or request from drug users over the age of 18, and in some cases under 18. People who are entitled to treatment may choose between public and private treatment programmes within a framework of a prescribed treatment plan.
Clients are usually treated as outpatients, and this may be supplemented by day or inpatient treatment if a change in environment and/or a more structured intervention is needed. The most prevalent approaches to treatment in Denmark are cognitive, socio-educational and solution focused. Treatment for opioid users is predominantly medically assisted and is accompanied by psychosocial counselling. In recent years new initiatives such as a cannabis and cocaine project in Copenhagen city have been developed to tackle a specific demand for the treatment of cannabis and cocaine users, and several initiatives to address socially marginalised drug users, drug users with concurrent mental disorders, and underage youth are also supported.
Opioid substitution treatment (OST) is provided free of charge, primarily at specialised outpatient treatment units operated by the municipalities. Methadone, which has been available in Denmark since 1970, is the predominant substance; buprenorphine is offered alongside methadone and the National Board of Health’s guidance (currently the Danish Health and Medicines Authority) issued in 2008 recommends it as the first-line medication for opioid-dependent drug users that have not previously been treated. Figures from 2011, the latest available estimates, show that 7 600 clients were on OST, of whom 6 200 were on methadone and 1 400 on buprenorphine. As part of the treatment provided to the most seriously affected heroin abusers, in January 2010 the government initiated a scheme of treatment using medically prescribed heroin, and 198 drug users were in heroin treatment by April 2013. In spring 2013 the treatment scheme was evaluated, and it was suggested that a treatment option with tableted heroin should also be offered.
View ‘Treatment profile’ for additional information.
In addition to treatment services, projects have been implemented to reduce or minimise drug-related harm among high-risk drug users. Such projects include, for example, outreach street work, drop-in centres, needle and syringe programmes and social support at home. Needle and syringe programmes have been established in Denmark since 1986. The number of syringes given out by these programmes is not being monitored, but a 2009 evaluation confirmed that drug users had high levels of access to clean injecting equipment across municipalities. The services are administered either through free dispensing of syringes and syringe sales at pharmacies, through treatment institutions, in drop-in centres or through syringe dispensing machines at public sites. Some municipalities also dispense needles and syringes at shelters and hostels. The provision of sterile water and other the injecting equipment is common. Since 2013 a naloxone take-home programme to prevent opioid-induced deaths has been implemented in four municipalities. Four supervised drug consumption facilities (two in Copenhagen and one in Odense and in Aarhus) operate on the basis of legal provisions made in 2012.
In 2007 the National Board of Health adopted a special action plan for the prevention of HCV. As a result, by 2009 most municipalities had launched a number of specific actions, such as counselling, screening, and vaccination against hepatitis A virus and HBV. Recently, programmes facilitating marginalised drug users’ access to general health services have also been implemented. Active referral of newly detected HIV, HBV and HCV cases for further examination, counselling and treatment is also encouraged.
Morocco continues to be the primary producing country of the cannabis that reaches the Danish market, with Spain, Portugal and the Netherlands being the main transit countries. The vast majority of heroin is reported as originating in Afghanistan and Pakistan. Amphetamines and ecstasy seized in Denmark are produced in the Netherlands and Belgium and, to a minor extent, in Poland and the Baltic States. Cocaine seized in Denmark is produced in South America and distributed via the Netherlands and Spain. However, the importance of trafficking routes via the West African and Baltic regions has increased in recent years.
A total of 21 498 drug offence reports were registered in 2012, the highest annual number ever reported.
The National Commissioner of Police Statistics indicates that the number of seizures and the quantity seized fluctuate, and are affected by bulk seizures and police activity. In 2012 the total number of drug seizures, except heroin and cannabis plants, increased when compared to 2011 figures. The amounts of seized cannabis resin, cocaine and methamphetamine declined when compared to 2011 data, while for heroin and cannabis plants the seized amounts stayed at the level of 2011. In 2012 a record amount of 302 kg of amphetamine (255 kg in 2011; 194 kg in 2010) and 72 654 ecstasy tablets were seized (the highest amount of ecstasy seized since 2001, when 150 080 tablets were seized). The amount of herbal cannabis seized was also higher in 2012 than in 2011 (223 kg in 2012; 168 kg in 2011; 375 kg in 2010). The amount of seized cocaine remained fairly stable in 2010–11 (43 kg and 42 kg respectively).
According to the Consolidated Euphoriant Substances Act of 2008, import, export, sale, purchase, delivery, receipt, production, processing and possession of drugs are defined as criminal offences. The penalty under this Act is a fine or imprisonment for a maximum of two years. Illegal possession for own use usually involves a fine, which varies depending on the type and quantity of drugs involved. In some cases the possession of dangerous drugs for the purpose of own use may also result in short-term imprisonment. The Act had already been amended in 1996 to increase the penalty for professional drug dealers, who had previously avoided serious sanctions by only carrying very small quantities of drugs at a time. From 2004 the distribution of drugs in restaurants, discotheques or similar places frequented by children or young people has been deemed to be a significantly aggravating circumstance that should always be punished with a prison sentence.
More serious offences are punished under Section 191 of the Criminal Code. The precondition for resorting to this instead of the Euphoriant Substances Act is that the criminal offence involves the transfer of, or the intention to transfer, at least 25 g of heroin or cocaine, 50 g of amphetamine or 10 kg of cannabis. Since 2004 the penalty under Section 191 of the Criminal Code has been imprisonment for 10–16 years, with up to 25 years in particularly serious cases.
No alternatives to punishment are specified for drug-related offences. However, probationary measures can be applied at the sentencing stage, if the court finds punishment unnecessary (this may be applied in cases of any crime) and the law mentions an obligation to undergo treatment as one of these measures.
A new law to allow the medical prescription of heroin to addicts became effective on 1 July 2008, while in 2012 a law allowing the Minister of Health to grant permission for drug consumption rooms to be opened and operated came into effect.
On 1 July 2012 group bans on psychoactive substances came into force following the amendment of the Euphoriant Substances Act, so that Denmark will apply a ‘generic classification’ to control certain new psychoactive substances entering the country.
View the European Legal Database on Drugs (ELDD) for additional information.
The Danish Government launched its current drugs strategy document, the Fight Against Drugs II, in October 2010. It replaced an earlier strategy from October 2003. The 2010 startegy is primarily concerned with illicit drugs and adopts a comprehensive approach to the problem. It is built around four pillars addressing prevention, treatment, harm reduction and law enforcement. A total of 19 specific initiatives are defined under the different pillars. The strategy’s main goals are to reduce both the demand for drugs and their supply.
View ‘National drug strategies’ for additional information.
Denmark has no specific drug coordination body. However, the Ministry of Health has responsibility for coordination in the drugs field at a central level. In Denmark coordination is based on frequent informal contact between relevant ministries. Among its drug-related tasks, the Ministry of Health is responsible for legislation related to psychoactive substances, controlling the legal use of dugs for medical and scientific purposes and overseeing government action in the field of prevention. The Ministry of Health, together with the Danish Health and Medicines Authority, is also responsible for the medical treatment of drug users. The Health and Medicines Authority issues authorisations to companies seeking to transport psychoactive substances for medical purposes and works with the International Narcotics Control Board in this respect. It also develops professional guidelines, monitors drug use through surveys of the population and the drug markets, and acts as the EMCDDA’s national focal point in the Reitox network. The Ministry of Social Affairs and Integration is responsible for providing support to drug users seeking assistance with housing, education and employment. Precursor control issues are the responsibility of the Ministry of Tax, while the Ministry of Foreign Affairs is tasked with international drug policy issues.
At a local level, municipalities are responsible for prevention, treatment and social reintegration measures for drug users. Municipalities work closely with the Ministry of Health in monitoring drug use and developing appropriate responses.
In Denmark, multi-annual drug budgets are attached to the national action plan and have been implemented, since 2004, under the format of the Social Reserve Grants Agreement. Available data on drug-related public expenditures are multi-annual and include only labelled expenditures (1).
The Social Reserve Grants Agreement had a planned budget of EUR 19.5 million for drug-related initiatives for 2004–07. In 2006 this budget was reinforced and a new budget of EUR 33.6 million was defined for 2006–09. This agreement was strengthened in 2008 and 2009 with an additional EUR 16.4 million. In 2011 another EUR 9.6 million was set aside. In 2012 EUR 3.2 million was budgeted for 2012–15. In 2013 the social treatment of drug abuse was prioritised, and a budget of EUR 13.8 million was assigned for 2013–18. Additional increases in expenditure for drug treatment were registered, for instance at local government level or in prisons, but the total budget is difficult to estimate.
The available information does not allow reporting on the drug-related annual public expenditures effectively spent and their evolution over time.
(1) Some of the funds allocated by governments for expenditure on tasks related to drugs are identified as such in the budget (‘labelled’). Often, however, the bulk of drug-related expenditure is not identified (‘unlabelled’) and must be estimated by modelling approaches. The total budget is the sum of labelled and unlabelled drug-related expenditure.
View ‘Public expenditure profile’ for additional information.
Drug-related research in Denmark is mainly funded by governmental grants and can be characterised as applied research, often based on the evaluation of public services. It is mainly commissioned by ministries and undertaken by academic centres and government institutes. Healthcare planning and priority setting are also primary concerns in this area and surveys are thus often initiated, and partially funded, by the national focal point at the Danish Health and Medicines Authority. Dissemination of results is ensured through a wide variety of channels, including reports, websites, conferences and thematic days. The Danish Health and Medicines Authority has also formulated a number of research-based principles on which schools should base their drug prevention interventions. Recent drug-related studies mentioned in the 2013 Danish National report mainly focused on aspects related to responses to the drug situation but topics including the consequences of drug use, supply and markets, and prevalence, incidence and patterns of use were also reported.
View ‘Drug-related research’ for additional information.