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-law 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||2012||5 580 516 ||503 663 601 b p||Eurostat|
|Population by age classes||15–24||2012||12.7 %||11.7 % b p||Eurostat|
|25–49||33.1 %||35.4 % b p|
|50–64||19.2 %||19.5 % b p|
|GDP per capita in PPS (Purchasing Power Standards) 1||2011||125||100||Eurostat|
|Total expenditure on social protection (% of GDP) 2||2010||33.3 %||29.4 % p||Eurostat|
|Unemployment rate 3||2012||7.5 %||10.5 %||Eurostat|
|Unemployment rate of population aged under 25 years||2012||14.1 %||22.8 %||Eurostat|
|Prison population rate (per 100 000 of national population) 4||2011||71.0||:||Council of Europe, SPACE I-2011|
|At risk of poverty rate 5||2011||13.0 %||16.9 % e||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, 2011.
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, by interviews) was carried out in 2010. The lifetime prevalence of cannabis use among 11 611 adults aged 16–64 was 32.5 %, with amphetamines at 6.2 % and cocaine at 4.4 %. Last year prevalence of cannabis use was 5.4 %, with cocaine at 0.9 % and amphetamines at 0.7 %. Cannabis was also the most frequently used drug in the last month, reported by 2.3 % of the sample, followed by amphetamines at 0.3 % and cocaine at 0.2 %. Among those aged 16–34 (3 381 individuals), lifetime prevalence of cannabis use was 44.5 %, with amphetamines at 10.3 % and cocaine at 8.9 %. In 2010 there was a decline in the use of cocaine and other stimulants such as amphetamines and ecstasy, especially among those under the age of 25, when compared with figures for 2008.
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-years-olds. In 2011 the lifetime prevalence of cannabis was 18 % (23 % in 2003; 25 % in 2007), with amphetamines at 2 % (4 % in 2003; 5 % in 2007), cocaine at 2 % (2 % in 2003; 3 % in 2007) and ecstasy at 1 % (2 % in 2003; 5 % in 2007). Inhalants are the second most reported substance of abuse at 4 %, and a decline in their lifetime prevalence rates was also 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; however, ecstasy and hallucinogens have been tried by more females than males.
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 it issued a prevention package for municipalities on alcohol and drug use among young people.
In recent years there has been an increased focus on alcohol and universal prevention programmes in educational institutions, and ways of working with young people outside the educational system are being tested and developed.
There are no fixed guidelines on the form, content and scope of interventions for school-based prevention. This subject is very often taught in grades 6 to 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, 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 focuses on alcohol, the evidence from similar projects elsewhere indicates 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.
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.
The most recent 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 drug users was estimated at 33 074, of which 11 000 were estimated to be cannabis users. Compared to the estimates from 2001, 2003 and 2005, the number appears to be increasing. This is due to an increase in the number 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 EADHEP project, which began estimating the number of injecting drug users (IDUs). The number of IDUs in 2006 was estimated to be about 13 000 (95 % CI: 10 066–16 821).
Up to 2012 the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) defined problem drug use as injecting drug use or long duration/regular drug use of opiates, cocaine and/or amphetamines. Ecstasy and cannabis were not included in this category. Details are available here.
Up to 2011 data on treatment demand was collected by the National Board on Health, and after 2011 by the Registry of the National Board of Social Services, 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 2011 treatment demand data were reported from 130 of 145 treatment units. Approximately 5 686 clients entered treatment, of which 1 847 were new treatment clients.
Cannabis was the most frequently reported primary drug among all treatment clients in 2011, at 63.4 %, followed by opioids at 17.5 % and amphetamines at 9.5 %. Cannabis was the most frequently reported primary drug by a larger proportion of new treatment clients at about 72.6 %, followed by amphetamines at 10.3 % and opioids at 7.1 %.
In 2011 some 37 % of all treatment clients were under the age of 25. New treatment clients tend 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.
HIV infections are registered by the State Serum Institute, based on anonymous reporting and voluntary testing. In 2011 some 4 % of newly diagnosed HIV positive cases for which the source of infection was known were injecting drug users. This figure has remained at between 4 % and 11 % for the past 10 years.
A special study from 2004–08 indicated that the HIV prevalence level among injecting drug users was 2.1 %. In the same study, around 37.1 % of a sample of injecting drug users tested positive for aHBc (anti-Hepatitis B core antigen), and the prevalence of hepatitis C virus (HCV) among injecting drug users was around 52.5 %. However, these results should be interpreted with caution as the users tested were not representative of injecting drug users in Denmark.
One in 13 cases of acute hepatitis B virus (HBV) with a known transmission route were attributed to injecting drug users in 2011, and 172 of 198 chronic cases of HCV with a known transmission route were attributed to injecting drug use.
Up to 2011 drug-related deaths were registered in the National Board of Health’s Cause of Deaths register, and subsequently by the State Serum Institute. The register applies the European definition of drug-related deaths. It includes deaths caused by injurious use of drugs, addiction and drug psychoses, as well as deaths caused by poisoning, namely intentional and unintentional poisoning. In addition, the Danish national focal point includes data from the National Commissioner of Police register, which collates all death cases reported to police for the purpose of post-mortem examination, in its National report.
According to the Cause of Deaths register, in 2010 there were 204 drug-related deaths in Denmark, the lowest recorded number since 1995. With regard to gender and age distribution, 77.5 % were male, and the mean age at the time of death was 44.7 years.
Following local government reform in 2007, municipalities became responsible for organising both the social and 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 health care. The Social Services Administration is responsible for referring a person for medical and social treatment of drug abuse, and the 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 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.
Substitution treatment 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 substitution treatment, 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.
View ‘Treatment profile’ for additional information.
In addition to treatment services, projects have been implemented to reduce or minimise drug-related harm for chronic drug users. Such projects include, for example, outreach street work, drop-in centres, syringe exchange programmes and social support at home. Syringe exchange programmes have been established in Denmark since 1986. The number of syringe exchange programmes is not 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 dispensing and sales at pharmacies or through dispensing machines with clean needles at public sites. Some municipalities also dispense needles and syringes through shelters and hostels. Some also offer sterile water with the injecting equipment. In 2010–11 a pilot project distributing naloxone was implemented in one municipality, to assess its relevance for nationwide scale-up. Since 2012 legal provisions have been made to enable drug consumption rooms to be opened and operated.
In 2007 the National Board of Health prepared 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, vaccination against hepatitis A virus and HBV and treatment referral. Recently, programmes facilitating marginalised drug users’ access to general health services have also been implemented.
Morocco continues to be the primary producing country of the cannabis that reaches the Danish market, with Spain, Portugal and the Netherlands 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 21 211 drug offence reports were registered in 2011, the highest annual number ever reported.
The National Commissioner of the Police Statistics indicates that the number of seizures and the quantity seized have declined for most drugs in recent years, after an increase at the start of the twenty-first century. However, annual statistical data fluctuate, and are affected by bulk seizures and police activity. In 2011 the total number of drug seizures, except heroin, increased when compared to 2010 figures, while levels remained the same as 2010 for amphetamine, methamphetamine and ecstasy; however, the amounts of seized amphetamine and methamphetamine increased when compared to 2010 (255 kg of amphetamine and 9 kg of methamphetamine). In 2011 some 43 kg of cocaine and 37 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 this 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 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 was deemed to be a significantly aggravating circumstance, which 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 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 between 10 and 16 years, with up to 25 years in particularly serious cases.
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 ‘generic classification’ to control new psychoactive substances entering the country.
View ‘Legal profile’ for additional information.
In October 2010 a new action plan, The Fight Against Drugs II, was launched to follow the plan published in October 2003. The 2010 plan is comprehensive in scope and comprises 19 specific initiatives within the four pillars of drug policy: prevention, treatment, harm reduction and law enforcement. The main goals are to reduce the demand for and supply of drugs.
View ‘National drug strategies’ for additional information.
There is 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 the period 2004–07. 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. In 2011 another EUR 9.6 million was set aside, and in 2012 EUR 3.2 million were budgeted for the years 2012–15. Additional increases were registered, for instance at local government level, but the total budget is difficult to estimate.
The available information does not allow the drug-related annual public expenditures effectively spent and their evolution over time to be reported.
(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 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 prevention interventions. Recent drug-related studies mentioned in the 2012 Danish National report mainly focused on aspects related to drug use prevalence but topics including responses and interventions, consequences of drug use and supply and markets were also reported.
View ‘Drug-related research’ for additional information.