Country overview: Denmark
- 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 | Denmark | EU (27 countries) | Source | ||
|---|---|---|---|---|---|
| Population | 2008 | 5 475 791 | 497 455 033 | Eurostat | |
| Population by age classes | 15–24 | 2008 | 11.7 % | 12.6 % 1 | Eurostat |
| 25–49 | 34.4 % | 36.3 % 1 | |||
| 50–64 | 19.9 % | 18.4 % 1 | |||
| GDP per capita in PPS (Purchasing Power Standards) 2 | 2007 | 120.1 | 100 | Eurostat | |
| Total expenditure on social protection (% of GDP) 3 | 2006 | 29.1 % | 26.9 % p | Eurostat | |
| Unemployment rate 4 | 2008 | 3.5 % | 7 % | Eurostat | |
| Unemployment rate of population agends under 25 years | 2008 | 8.5 % | 15.5 % | Eurostat | |
| Prison population rate (per 100 000 of national population) 5 | 2006 | 69.2 | Council of Europe, SPACE 2006.1 | ||
| At risk of poverty rate 6 | 2006 | 12 % | 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
The last survey among the general population (+16 years old, survey done by mail/web-based) carried out in 2008, indicates that lifetime prevalence of cannabis was reported by 38.6 % of the sample, last year prevalence by 5.5 % while last month prevalence by 2.2 %. In 2000, lifetime prevalence of cannabis was 31.3 % and last month prevalence of cannabis was reported by 2.8 % of the sample. Among 16–34–year olds, 48 % reported having tried cannabis at least once, 10.5 % reported amphetamines use and 9.5 % cocaine use at least once in their life. Last year prevalence of cannabis was reported by 5.5 % of aged 16–64, 1.4 % reported cocaine and 1.2 % amphetamines.
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. Compared to 2003, in 2007 lifetime prevalence of cannabis increased from 23 % to 25 %, ecstasy from 2 % to 5 %, amphetamines from 4 % to 5 % and cocaine from 2 % to 3 %. In general, more males than females have tried most substances, with the exception of ecstasy, which has been tried by almost as many females as males.
Prevention
The main responsibility for prevention is under the municipalities, together with the assistance and support of the National Board of Health. Municipalities plan universal as well as selective prevention in schools and local recreational centres. The National Board of Health provides support by producing informative material and developing prevention projects such as the current project ‘Drugs out of town’.
In recent years, there has been an increased focus on alcohol and drug 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 the teaching about drugs. 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. One more standardised life skills programme has been implemented and evaluated with promising results.
Selective prevention is mostly targeted in the context of 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 for restaurant owners. 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.
A special characteristic of the prevention culture in Denmark within the European context is its decentralised delivery of prevention and focus on community involvement.
Problem drug use
The most recent estimation of the number of problem drug users was carried out in 2005, 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 27 000, of which 7 300 are estimated to be cannabis users. Compared to the estimate of 2001, the number of problem drug users is considered to be stable, yet there appears to be an increase in cannabis and stimulant users seeking treatment and a decrease in opioid/heroin users seeking treatment.
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
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 2007, 4 661 clients entered into treatment, out of which 1 515 were first-time treatment clients.
Opioids are still the most frequently-used drugs among all clients entering treatment, at 44.5 % in 2007, followed by 33.2 % for cannabis. However, cannabis is the primary drug most reported by first-time treatment clients, at 51.6 % in 2007, followed by 13.5 % for amphetamines and 17.2 % for opioids. Among opioid users entering treatment, a relevant proportion were misusing methadone.
In 2007, 37 % of all clients entering treatment were aged more than 35 years. A different age distribution was reported among new treatment clients, with 48 % being under the age of 25 years. In 2007, the male-to-female ratio for all clients entering treatment was 78 % for male and 22 % for female. A similar distribution was also reported among new treatment clients, with 78 % for male and 22 % for female.
Drug-related infectious diseases
HIV infections throughout Denmark are registered by the Staten Serum Institute based on anonymous reporting and voluntary testing. In 2007, 8 % of newly-diagnosed HIV positive persons, for which the source of infection was known, were intravenous drug users (compared to 4 % in 2004). This percentage has remained more or less the same between 5 % and 11 % over the past 10 years.
During 1999 and 2006, the proportion of acute cases of hepatitis where the infected person has been an intravenous drug user, has been reported at approximately 1 % for hepatitis A, varying between 6 % and 37.1 % for hepatitis B and from 29 % to 60.7 % for hepatitis C. These results must, however, be interpreted with caution as the users tested were not representative of injecting drug users in Denmark.
As a whole, despite minor fluctuations, there seems to have been a decline in the number of registered acute hepatitis cases in the Danish population over recent years.
Drug-related deaths
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 2006, there were a total of 227 drug-related deaths. As regards gender distribution, 73.6 % (167) were male whereas 26.4 % (60) were female. From 2000 to 2005, the number of drug-related deaths has decreased substantially from a total of 240 drug-related deaths in 2000, as compared to a total of 207 drug-related deaths in 2005. Nonetheless, for the year 2006, a slight increase (9.7 %) can be observed.
Treatment responses
Since 1996, the counties in Denmark have held responsibility for the treatment and recovery of drug addicts. However, following the local government reform of 2007, the responsibility for the social as well as the medical treatment of drug users has been transferred from the counties to the 98 municipalities. While the 98 municipalities are responsible for drug treatment, the five regions are responsible for psychiatric care, primary and public healthcare.
On 1 January 2003, a new provision came into effect, whereby Section 85 of the Danish Social Services Act was amended, obliging the county to initiate social treatment of drug use within 14 days after the drug user has made a request to be admitted into treatment. Furthermore, the Danish Social Services Act of May 2005, also guarantees drug treatment within 14 days for drug users under the age of 18 years. In relation to the quality of drug treatment, guidelines on the quality standards for social treatment of drug addiction were issued in 2008.
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. Care and community-orientated intervention, which is targeted at those with the most serious drug dependence problems takes place in particular at drop-in centres. The majority of inpatient treatment units are privately-owned institutions or owned by a charitable fund. Some inpatient treatment institutions provide methadone stabilisation aimed at clients in methadone treatment, with the purpose of reducing secondary drug use to a minimum and establishing social and employment activities. Within inpatient settings, many are oriented towards socio-educational approaches and follow the Minnesota model.
Substitution treatment takes place primarily at specialised outpatient treatment units operated by the municipalities. Methadone, which has been available since 1970, is the predominant substance Buprenorphine is currently offered along methadone maintenance treatment, but on a smaller scale. According to the latest available estimates (2004), there were a total of 6 300 clients on substitution treatment, 5 700 of whom were on methadone and 600 on buprenorphine. As part of the treatment provided to the most seriously affected heroin abusers, the Danish Government has decided to launch a scheme of treatment with medically prescribed heroin. The National Board of Health is now preparing a plan for the practical completion of the scheme and a realistic date for initiation.
According to the legal framework of June 2007, office-based medical doctors are allowed to carry out substitution treatment under certain conditions, one of these conditions is that only doctors in the municipality and in the criminal system are allowed to carry out long-term substitution treatment.
Harm reduction responses
Harm reduction activities are part of the Social Welfare Act. 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. In most cases, pharmacies administer the scheme 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. the latest estimates (2005) indicates that about 910 000 syringes were distributed through needle exchange programmes.
Using social reserve funds for 2006, the Government and the parties behind the reserve fund decided to launch activities against hepatitis C should on a national scale. As a result, the National Board of Health prepared an action plan in 2007, in which it is recommended to the municipalities to take a number of specific actions with regard to coordination and interventions (e.g. information, screening, vaccination and treatment referral). The results will be evaluated on an annual basis.
Drug markets and drug-related offences
In the ‘Report on organised crime in Denmark, 2002’, the National Commissioner of Police points out that Morocco continues to be the primary producing country of cannabis which reaches the Danish market. 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 assumed to be primarily produced in the Netherlands and Belgium. Cocaine seized in Denmark is produced mainly in South America and distributed via the Netherlands and Spain.
The Police Drug Statistics indicate that the number of seizures of most drugs have increased in recent years. However, this does not apply for 2006 and 2007, where a decrease in the number of drug seizures was reported for most of the different illegal drugs. In spite of a decrease in the number of seized drugs during 2006 and 2007, police statistics show that the quantity of seizures for ecstasy, cocaine and heroin increased such that the quantity of seized cocaine increased from 76 kg in 2006 to 88 kg in 2007. The quantity of seized heroin increased from 29 kg in 2006 to 48 kg in 2007. Whereas the quantity of seized ecstasy tablets increased by threefold from 2006 to 2007 with a total of 67 680 seized ecstasy tablets in 2007 as compared to a total of 22 712 of seized ecstasy tablets in 2006.
National drug laws
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 importation, exportation, 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.
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 heroine 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 grave drug cases.
A new law to allow medical prescription of heroin to addicts became effective on 1 July 2008.
National drug strategy
Denmark’s second action plan, ‘The fight against drugs’, was published in October 2003 and is part of a global social reform programme called ‘Our common responsibility’, to help the most vulnerable in Danish society. The action plan is comprehensive in scope, comprises 36 initiatives and focuses mainly on illicit drugs. It sets targets and puts in place resources to achieve concrete results in the areas of prevention, social work, medical treatment, law enforcement and treatment of criminal drug abusers, and also includes international cooperation.
Coordination mechanism in the field of drugs
There is no specific formal central coordination body or national coordinator in the field of drugs in Denmark. Coordination is based on frequent informal contact between relevant administrations. Generally, coordination of drug-related activities is shared between the Ministry of the Interior and Health, the Ministry of Justice and the Ministry of Social Affairs. The Ministry of the Interior and Health has the main responsibility for the coordination in the field of drugs at central level. At the regional level there is a tendency to divide tasks, including drug-related issues between the 14 counties and the 275 municipalities. The municipalities have been responsible for treatment and prevention since January 2007.
Drug-related research
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, journals, websites, conferences and thematic days. Recent drug-related studies mentioned in the 2008 Danish National report mainly focused on aspects related to responses and interventions.