Country overview: Denmark
- Drug use among the general population and young people
- 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
- Public expenditure
- Drug-related research
|Year||EU (27 countries)||Source|
|Population||2011||5 560 628
||502 476 606 p||Eurostat|
|Population by age classes||15–24||2011||12.5||:||Eurostat|
|GDP per capita in PPS (Purchasing Power Standards) 1||2010||127||100||Eurostat|
|Total expenditure on social protection (% of GDP) 2||2009||33.4||29.5 % p||Eurostat|
|Unemployment rate 3||2011||7.6||9.7 %||Eurostat|
|Unemployment rate of population aged under 25 years||2011||14.2||21.4 %||Eurostat|
|Prison population rate (per 100 000 of national population) 4||2010||71.3||:||Council of Europe, SPACE I-2010|
|At risk of poverty rate 5||2010||13.3||16.4 %||SILC
p Eurostat provisional value.
b Break in series.
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, 2010.
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 last survey among the general population (+16 years old, survey done by interviews) was carried out in 2010. The lifetime prevalence of cannabis among 11 611 surveyed adults in the age group 16–64 years was reported by 32.5 %, followed by amphetamines — 6.2 % and cocaine — 4.4 %. Last-year prevalence of cannabis was reported by 5.4 %, followed by cocaine — 0.9 % and amphetamines — 0.7 %. Cannabis was also the recently most frequently used drug — last-month prevalence was reported by 2.3 %, followed by amphetamines (0.3 %) and cocaine (0.2 %). Among 3 381 of the surveyed 16–34-year olds, 44.5 % reported having tried cannabis at least once, 10.3 % reported amphetamines use and 8.9 % cocaine use at least once in their life. In 2010, a decline is observed, when compared with the 2008 study, in the use of cocaine and other stimulants, such as amphetamines and ecstasy, especially among those aged below 25 years.
With regard to drug use among young people, the ESPAD study has been regularly conducted in Denmark since 1995 among students aged 15–16. Trends show that lifetime prevalence of illicit drugs increased between 1995 and 1999. This stabilised between 1999 and 2003, yet in 2007 showed a slight, yet nonetheless significant increase. However, the most recent study in 2011 indicates a significant decline in lifetime prevalence rates for the most common illicit drugs among 15–16 years olds. In 2011, reported lifetime prevalence of cannabis was 18 % (23 % in 2003 and 25 % in 2007), amphetamines at 2 % (4 % in 2003 and 5 % in 2007) as well as cocaine at 2 % (2 % in 2003 and 3 % in 2007) and ecstasy at 1 % (2 % in 2003 and 5 % in 2007). Inhalants are the second most reported substance of abuse at 4 % and as for illicit substances, a decline in the lifetime prevalence rates is noted in 2010 (8 % in 2003 and 6 % in 2007). In general, more males than females have tried cannabis and amphetamines, while as many males as females reported ever having tried cocaine and heroin, but ecstasy and hallucinogens have been tried by more females than males.
The main responsibility for prevention is under the municipalities, with the assistance and support of the National Board of Health. Municipalities plan universal as well as selective prevention in schools, community and local recreational centres. The National Board of Health provides support by producing informative material and developing prevention projects, as well as monitoring and providing overall guidance.
In recent years, there has been an increased focus on alcohol and universal prevention programmes in educational institutions, and ways in which to work with young people outside the educational system are being tested and developed.
For school-based prevention, there are no fixed guidelines on the form, content and scope of interventions. This subject is very often taught in grades 6–9, with the individual teacher organising the lesson. 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.
Selective prevention is mostly targeted at recreational settings in close cooperation between the main players involved in this area (municipalities, police and restaurant owners). The municipalities’ licensing boards are using, to a greater extent, plans for restaurants as a means of prevention in a nightlife environment and are working closely with restaurant owners’ organisations. In numerous municipalities, courses are offered to restaurant owners. In 2009, a project ‘Responsible alcohol serving’ was launched in nine municipalities. Although it focuses on alcohol, the evidence from similar projects elsewhere indicates that the activities contributed also to reduced prevalence in drugs in the nightlife settings. A number of campaigns and information events are organised during music festivals, for example, the largest one is in Roskilde.
SMASH, an SMS-based prevention initiative, has been developed as an anonymous support and counselling project for young cannabis users with the purpose of providing harm reduction, information and support in relation to stopping cannabis smoking. Following the evaluation, these projects are now sustained by 27 municipalities.
In the area of indicated prevention, the City of Copenhagen had established a prevention and early detection centre — ‘U-Turn’ — offering services to drug users (mainly cannabis) under the age of 25.
View ‘Prevention profile’ for additional information.
The most recent estimation of the number of problem drug users was carried out in 2009, applying the capture–recapture method and including two data sources (the National Registry of Patients and National Register of Drug Users Undergoing Treatment). Problem drug users were defined as drug users reporting persistent use of illegal drugs, including cannabis, which leads to physical, psychological and social consequences. The total number of drug users was estimated to be 33 074, of which 11 000 are estimated to be cannabis users. Compared to the estimates from 2001, 2003 and 2005, the number of estimated problem drug users appears to be increasing, due to raising numbers of cannabis and stimulant users seeking treatment, however, the actual number of opioid/heroin users seeking treatment is decreasing.
During the period 2004–08, the National Board of Health supported the ‘DEADHEP’ project, which started to estimate the number of intravenous drug users. The number of intravenous drug users in 2006 at present is estimated to be about 13 000 (95 % confidence interval of 10 066–16 821).
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.
Data concerning treatment demand in Denmark is collected by the Registry of the National Board on Health, which was established in 1996. The Registry includes data on individuals referred to treatment for their drug use, categorised by the national and local centres covering outpatient and inpatient treatment. In 2010, the treatment demand data were reported from 135 out of 150 treatment units. Approximately 5 337 clients entered into treatment, out of which 1 882 were first-time treatment clients.
In 2010, cannabis was the most frequently reported primary drug among all clients in treatment, at 49.1 %, followed by 32.2 % for opioids and 8.2 % for amphetamines. The significance of cannabis as the primary drug is even higher for first-time treatment clients. About 67 % of the first-time clients reported cannabis as the primary used drug, followed by 11.5 % for amphetamines and 10.8 % for opioids.
In 2010, 34 % of all clients entering treatment were aged more than 35 years. A different age distribution was reported among new treatment clients, with 51 % being under the age of 25 years. In 2010, the male-to-female ratio for all clients entering treatment and the new clients entering treatment was similar, with 77.4 % for male and 22.6 % for female.
HIV infections throughout Denmark are registered by the Staten Serum Institute based on anonymous reporting and voluntary testing. In 2010, 5 % of newly-diagnosed HIV positive persons, for which the source of infection was known, were intravenous drug users. This percentage has remained more or less the same between 4 % and 11 % over the past 10 years.
A special study from 2004–08 indicates the HIV prevalence level among injecting drug users at 2.1 %. In the same study, around 37.1 % of sampled injecting drug users tested positive for aHBc (anti-Hepatitis B core antigen), and the prevalence of HCV among injecting drug users was around 52.5 %. These results must, however, be interpreted with caution as the users tested were not representative of injecting drug users in Denmark.
In 2009, 12 out of 89 acute hepatitis B cases with known transmission route were attributed to intravenous drug users. In terms of hepatitis C, 173 out of 203 chronic cases with known transmission route were attributed to intravenous drug use in 2009.
In Denmark, drug-related deaths are registered in the National Board of Health’s Cause of Deaths register. The register applies the European definition of drug-related deaths. The register contains deaths caused by injurious use of drugs, addiction and drug psychoses, as well as deaths caused by poisoning, namely intentional and unintentional poisoning.
According to the National Board of Health’s Cause of Deaths register in 2009, there were a total of 222 drug-related deaths, which is a slight increase when compared to 2008 (208 death cases). In 2009, the toxicological analyses confirmed presence of opiates in 93.6 % of death cases. As regards gender distribution, 72.5 % were male, and the mean age at the time of death was 44 years.
Following the local government reform of 2007, municipalities bear responsibility for organisation of the social as well as the medical treatment of drug users. While the 98 municipalities are responsible for drug treatment, the five regions are responsible for psychiatric care, primary and public healthcare. The Social Services Administration is responsible for referral of a person to the medical and social treatment of drug abuse and preparation of his/her treatment plan is a mandatory action according to the Social Service Act. There are guarantees of access to drug treatment within 14 days after the first contact or request for drug users above, in some cases also under the age of 18 years.
Treatment in Denmark is usually provided as outpatient treatment, which may be supplemented by inpatient treatment if there is a need for a change of environment and/or a more structured intervention. Treatment is predominantly medically-assisted and is accompanied by psychosocial counselling. In recent years, new initiatives such as the cannabis and cocaine project in Copenhagen city have been developed to tackle specifically demand for treatment of cannabis and cocaine users.
Substitution treatment takes place primarily at specialised outpatient treatment units operated by the municipalities and it is free of charge. Methadone, which has been available since 1970, is the predominant substance; buprenorphine is offered alongside methadone maintenance treatment and the National Board of Health’s guidance issued in 2008 recommends it as the first-line medication for opioid-dependent drug users which had not previously been treated. According to the latest available estimates (2010), there were a total of 7 515 clients on substitution treatment, 6 089 of whom were on methadone and 1 281 on buprenorphine. As part of the treatment provided to the most seriously affected heroin abusers, in January 2010, the Danish Government initiated scheme of treatment with medically prescribed heroin, and about 130 drug users were on heroin treatment by June 2011.
View ‘Treatment profile’ for additional information.
In addition to treatment services, projects have been implemented with the aim to reduce or minimise drug-related harm for chronic drug users. Such projects include, for example, outreach street plan work, drop-in centres, syringe exchange programmes and social support at home. Syringe exchange schemes have been established in Denmark since 1986. The amount of syringe exchange programmes are not monitored in Denmark, but the 2009 evaluation confirmed high access of drug users to clean injecting equipment across municipalities. The services are administered either through dispensing and sales at pharmacies or through dispensing machines with clean needles in public sites. Some municipalities also dispense needles and syringes through shelters and boarding houses. Some municipalities also offer sterile water together with the injecting equipment. In 2010, a pilot project with distribution of Naloxone is launched in one of the municipalities in order to assess its relevance for nationwide scale-up.
In 2007, a special action plan for the prevention of hepatitis C was prepared by the National Board of Health. As a result, a large part of the municipalities have launched a number of specific actions, such as counselling, screening, vaccination against hepatitis A and B and treatment referral by 2009.
Morocco continues to be the primary producing country of cannabis which reaches the Danish market, with Spain, Portugal and the Netherlands as main transit countries. The vast majority of heroin is reported as originating in south-west Asia and reaches the national market via the traditional routes, through Iran and Turkey. 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 West African and Baltic regions had increased during the past years as well.
The total number of 17 825 drug offence reports was registered in 2010, which is slightly more than in 2009 (17 403 offences) but still below the figures registered in 2005–08 (19 526 in 2005, 19 900 in 2006, 18 506 in 2007, 18 692 in 2008).
The National Commissioner of the Police Statistics indicate that the number of seizures and amounts seized of most drugs decline in recent years, after the increase observed in the beginning of the 21st century. However, annual statistical data fluctuates and reflects mostly the result of bulk seizures and police activity. In 2010, a number of all drug seizures increased when compared to 2009 figures; however the amounts seized increased only for cannabis resin, herbal cannabis and heroin. While the seized amounts of cocaine, amphetamines and ecstasy were below those reported 2009. In 2010, 2 318 kg of cannabis resin, 375 kg of herbal cannabis and 39 kg of heroin were seized.
Law enforcement in relation to drugs is based on either Section 191 of the Criminal Code or on the Consolidated Euphoriant Substances Act of 2008, depending on the type and quantity of drugs involved. According to the Euphoriant Substances Act, import, export, sale, purchase, delivery, receipt, production, processing and possession of drugs, are defined as criminal offences. The penalty under the Euphoriant Substances Act is a fine or imprisonment for a maximum of two years. Illegal possession for own use usually involves a fine, which increases, depending on the type and quantity of drugs involved. In some cases, 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 in order to increase the penalty for professional drug pushers who, until then, had avoided serious sanctions by 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 was deemed to be a significantly aggravating circumstance, and should always be punished with a prison sentence. In 2011, mescaline cactus, methyl amphetamine and 22 synthetic cannabinoids were subjected to control measures and restricted use for medical and scientific purposes only.
The precondition for resorting to Section 191 of the Criminal Code instead of the Euphoriant Substances Act is that the criminal offence involves the transfer, 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 is imprisonment for between 10 and 16 years, with up to 25 years in particularly serious drug cases.
A new law to allow medical prescription of heroin to addicts became effective on 1 July 2008.
View ‘Legal profile’ for additional information.
In October 2010, a new action plan — ‘The fight against drugs II’ was launched to follow the previous plan published in October 2003. Just as the previous action plan, the new plan is comprehensive in scope and comprises 19 specific initiatives within the four pillars of Danish drug policy: prevention, treatment, harm reduction and law enforcement. The main goals of the Danish drug policy are to reduce the demand for and the supply of drugs.
View ‘National drug strategies’ for additional information.
There is no specific drug coordination body in Denmark. The Ministry of Health and Prevention has among its other tasks the responsibility for the coordination in the field of drugs at central level. Coordination is based on frequent informal contact between relevant administrations. Mainly, coordination of drug-related activities involves the Ministry of Health and Prevention, the Ministry of Justice and the Ministry of Social Affairs.
In Denmark, multiannual 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 between 2004 and 2007. In 2006 this budget was reinforced and a new budget of EUR 33.6 million was defined for the period 2006–09. This agreement was strengthened in 2008 and 2009, with an additional EUR 16.4 million. Additional increases were registered in the following years 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.
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 main concerns in this area and surveys are thus often initiated, and partially funded, by the national focal point at the National Board of Health. Dissemination of results is ensured through a wide variety of channels including reports, websites, conferences and thematic days. The National Board of Health has also formulated a number of research-based principles on which schools should base their drug preventive interventions. Recent drug-related studies mentioned in the 2011 Danish National report mainly focused on aspects related to drug use prevalence but topics in responses and interventions, and supply and markets were also approached.
View ‘Drug-related research’ for additional information.