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 | 2010 | 5 534 738 | 501 105 661 p | Eurostat | |
| Population by age classes | 15–24 | 2010 | 12.2 % | 12.1 % p | Eurostat |
| 25–49 | 33.7 % | 35.8 % p | |||
| 50–64 | 19.6 % | 19.1 % p | |||
| GDP per capita in PPS (Purchasing Power Standards) 1 | 2009 | 121 | 100 | Eurostat | |
| Total expenditure on social protection (% of GDP) 2 | 2008 | 29.7 % | 26.4 % p | Eurostat | |
| Unemployment rate 3 | 2010 | 7.4 % | 9.6 % | Eurostat | |
| Unemployment rate of population aged under 25 years | 2010 | 13.8 % | 20.9 % | Eurostat | |
| Prison population rate (per 100 000 of national population) 4 | 2009 | 67.5 | Council of Europe, SPACE I-2009 | ||
| At risk of poverty rate 5 | 2009 | 13.1 % | 16.3 % | 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, 2009.
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).
Drug use among the general population and young people
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 surveyed16–34–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. 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
A special characteristic of the prevention culture in Denmark within the European context is its decentralised delivery of prevention and focus on community involvement.
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 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 to 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. Following the evaluation, these projects are now sustained by 27 municipalities. The City of Copenhagen had established a prevention and early detection centre — ‘U-Turn’ — offering services to drug users under the age of 25.
Problem drug use
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 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.
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 2009, the treatment demand data were reported from 165 out of 180 treatment units. Approximately 5 296 clients entered into treatment, out of which 1 827 were first-time treatment clients.
In 2009 for the first time, cannabis was the most frequently reported primary drug among all clients in treatment, at 45.2 %, followed by 35.5 % for opioids. The significance of cannabis as the primary drug is even higher for first-time treatment clients. About 65.1 % of the first- time clients reported cannabis as the primary used drug, followed by 12.2 % for amphetamines and 11.8 % for opioids.
In 2009, 36 % of all clients entering treatment were aged more than 35 years. A different age distribution was reported among new treatment clients, with 49 % being under the age of 25 years. In 2008, 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 76 % for male and 24 % 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 2009, 6 % 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.
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 2008, there were a total of 208 drug-related deaths. The existing data indicates a declining tendency of drug-related death in the country since 2006. In 2008, 80.8 % of death cases were linked to opiates but 13.9 % were due to drug of mixed or unknown origin. As regards gender distribution, 75.4 % were male, whereas 25.5 % were female.
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. 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. 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 (2009), there were a total of 7 750 clients on substitution treatment, 6 072 of whom were on methadone and 1 202 on buprenorphine. In 2009, the estimated number of clients receiving buprenorphine has increased when compared to 950 in 2008. 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 30 drug users were on heroin treatment by July 2010.
Harm reduction responses
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.
Using social reserve funds for 2006, the Government and the parties behind the reserve fund decided to launch activities against hepatitis C 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 against hepatitis A and B and treatment referral). The results will be evaluated on an annual basis.
Drug markets and drug-related offences
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 17 403 drug offence reports was registered in 2009, which is less than in the previous four years (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 2009, the quantity of herbal cannabis seized increased to 366 kg compared to 171 kg seized in 2008. Despite a decline in the number of cocaine and ecstasy seizures, the quantities of both seized drugs have increased in 2009 (cocaine — from 56 kg in 2008 to 72 kg in 2009; and ecstasy — 17 631 tablets in 2008 to 53 929 tablets in 2009). While in 2009, the quantity of heroin and amphetamines seized continued to decline when compared to previous years.
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, 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 2010, a number of synthetic cannabinoids, fluoramphetamine and Tapentadol INN 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.
National drug strategy
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.
Coordination mechanism in the field of drugs
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.
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, 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 2010 Danish National report mainly focused on aspects related to responses and interventions, but topics in drug use prevalence and supply and markets were also approached.
