• 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

Drug use among the general population and young people

The last available data regarding drug use among the general population in Greece are from the household survey conducted by the University Mental Health Research Institute (UMHRI) in 2004. Overall, lifetime prevalence of illicit drug use showed a significant increase between 1984 and 2004, peaking in 1998 and followed by a downward trend between 1998 and 2004. The most recent survey (2004) shows that 8.6 % of the Greek population aged 12–64 reported lifetime use of illicit drugs, mainly cannabis.

In 2006, a study was conducted in Athens, Thessaloniki and Heraklion among the population aged 15–64. Results showed that 19.4 % of respondents had tried any illicit drug at least once, and that lifetime prevalence was higher among males (24.8 %) than among females (14 %). Lifetime prevalence of cannabis was reported by 19.3 % of respondents. Respondents in Athens reported higher drug use than in the two other cities.

As regards the student population, the latest ESPAD study was conducted in 2007, and involved a nationwide sample of high school students aged 15–16 years. In 2007, similarly to 2003, 6 % had ever tried marijuana or hashish (9 % in 1999). In 2007, inhalants lifetime prevalence was reported by 9 % of the students (15 % in 2003 and 14 % in 1999). Lifetime prevalence of amphetamines was reported by 3 % of the sample, 2 % reported ecstasy use, 2 % reported LSD use as well. Results indicated 5 % for the last year prevalence of cannabis use (similar to the finding of ESPAD 2003), 3 % for the last month prevalence of cannabis (2 % in 2003).

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Prevention

Drug prevention in Greece is mostly implemented by the nationwide network of 71 Prevention Centres established by ΟΚΑΝΑ, local authorities, by the Ministry of Education, as well as by other governmental and non-governmental drug-specialised or health services, etc. which, among other tasks, are active in the field of prevention.

Major emphasis is placed on prevention interventions in the school setting. Prevention in primary and secondary education encompasses programme-based interventions in the context of the health promotion programmes of the Ministry of Education, and interventions designed and delivered by Prevention Centres, as well as by other agencies. Prevention interventions in primary education are implemented during the so-called ‘flexible zone’ of the school timetable or become part of the optional afternoon programme in ‘all-day’ schools, while in secondary education interventions are implemented outside school hours. The development of personal and social skills plays an important role in these activities, both in primary and secondary education. Knowledge about drugs and changing attitudes towards drugs are also important components of programmes implemented in secondary education. Furthermore, Prevention Centres, as well as other agencies, provide training seminars and supervision sessions to help teachers implement health promotion programmes. However, 0.9 % to 2 % of students in primary and secondary education respectively participated in school-based prevention activities in 2008–09. The participation rate in school-based prevention activities seem to be on decline if compared to data from 2005–06, which is attributed to non-existence of EU funded Health education programmes for the respective years.

Families are also one of the core target groups: family prevention includes information events and training programmes (parents’ groups). In addition, Prevention Centres, as well as other agencies, appear to be responding to the challenge of organising prevention interventions outside the school setting for pre-adolescents and adolescents. These interventions include experiential groups and creative activities such as; drama groups, music groups and painting groups. In the view of providing information and raising public awareness about drugs and drug dependence, drug-specialised agencies utilise the Internet, mobile units, while prevention professionals target other members of the local community such as volunteers, the army, public security forces, health professionals and youth mediators.

Although drug prevention in Greece focuses more on universal interventions, it is clear that efforts are being made to develop and implement selective and indicated interventions reaching groups and individuals at risk. Icarus Prevention Unit (KETHEA) designs and implements selective and indicated prevention interventions; targeting young offenders, immigrants, re-migrants, refugees, disabled children, children from dysfunctional environments, at-risk families and children living in care institutions. The indicative prevention activities primarily include individual or group counseling and referrals to other specialised services. In addition, three telephone helplines are operated by the drug prevention services to provide information, brief counselling, crisis management and referrals.

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Problem drug use

An estimation based on the capture–recapture method was conducted for the first time in 2001. Since 2002, it has included three data sources. A problem drug user in Greece is defined as someone who will at some point seek treatment for heroin use.

Analyses estimated that there were 3.2 problem drug users per 1 000 inhabitants between the ages of 15–64 years in 2009 (in total, 24 097 with 95 % CI between 21 362 and 27 272 users). The majority of these lived in Attica region. The estimated numbers have been stable since 2002 taking into account their confidence intervals. In 2009, the estimated number of injecting drug users was 10 658 (between 8 999 and 12 713).

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.

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Treatment demand

Treatment demand data in Greece are collected through a well-established network of treatment providers, excluding private practitioners and private hospitals. In 2009, 67 treatment centres submitted treatment demand data out of the 83 treatment centres comprising of outpatient centres, inpatient centres and low threshold agencies.

In 2009, a total of 5 501 individuals entered treatment out of which 2 603 were first time treatment clients. In 2009, the primary substance of abuse among all clients entering treatment were opioids, at 84.0 %, followed by cannabis at 9.6 % and cocaine at 4.5 %. Furthermore, among those entering treatment for the first time, the primary substance of abuse was opioids at 79.3 %, the second most frequent substance was cannabis at 14.7 %, followed by cocaine at 4.5 %.

In 2009, 20 % of all clients entering treatment were aged less than 25 years. A higher percentage in age distribution was reported among new treatment clients, with 26 % being under the age of 25 years. In 2009, the male-to-female ratio for all clients entering treatment was 85.5 % for male and 14.5 % for female. The same distribution was also reported among new treatment clients with 86 % for male and 14 % for female.

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Drug-related infectious diseases

Since 2001, a national drug related infectious diseases network (DRID network) has operated in Greece in order to collect data on infectious diseases among intravenous drug users. This network includes 45 reference points —such as treatment centres, low threshold services and public health laboratories/reference centres — which provide individual or aggregated data annually to the Greek focal point about the results of drug users tested for HBV, HCV and HIV.

The most recent available information on prevalence of the hepatitis C virus (HCV) and hepatitis B virus (HBV) among injecting drug users (IDUs) has been derived from those agencies which provided testing data on HBV and HCV for the years 2001 to 2009. In 2009, the data indicate that infection rates among IDU (ever-in-lifetime IDUs) have ranged between 2.3 % and 3.0 % for the HBV and between 43.5 % and 64.4 % for HCV. The data also show that there is a great variation in the prevalence of HCV infections among different regions in Greece, which may be partly attributed to the distribution of substitution and drug-free centres within and among the regions.

Surveillance data on the prevalence and incidence of HIV/AIDS among IDUs in Greece are derived from the Hellenic Centre for Infectious Diseases Control (HCIDC-KEEL) of the Ministry of Health and Welfare. The ratio of IDUs to the total number of HIV-positive cases registered in Greece up to end of October 2009 was reported at 3.4 % (329 cases out of 9 798). However, it should be noted that for 24.0 % of the cases, the mode of transmission was not specified. Among 462 new HIV cases (including AIDS cases) from the beginning of 2009 (until the end of October 2009), 2.2 % were intravenous drug users (vis-à-vis 1.5 % in 2008). HIV prevalence among injecting drugs users available through DRID network indicates that in 2009, HIV prevalence rates remained low and ranged 0.4 % and 1.5 % among the tested IDUs.

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Drug-related deaths

The Greek focal point collects data on drug-related deaths from the Public Security Directorate of the Hellenic police. These data are based on the results of forensic tests and toxicological laboratories, and the Forensic Services of the Ministry of Justice. Data on drug-related deaths are only available for deaths caused by an acute intoxication of drugs. This classification corresponds with the EMCDDA standard definition for special registries. In 2009, provisional data indicated that 59 drug-related deaths are recorded in Greece (110 in 2008, 205 in 2007, 253 in 2006 and 325 in 2005), of which all were confirmed with the appropriate toxicological analyses indication opiate as a main cause of DRD (94.9 %).

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Treatment responses

The Organisation Against Drugs (OKANA) performs the legal function of national coordinator on drug demand reduction which reports to the Ministry of Health and Social Solidarity. Furthermore, OKANA is one of the biggest public providers of treatment and reintegration programmes in Greece. It is also the only organisation which has legal permission to establish, operate and monitor substitution treatment programmes.

In 2009, the total number of officially-recognised drug treatment programmes in Greece was 77, run under the auspices of governmental and non-governmental organisations. The aforementioned programmes are divided into the following categories: 11 drug free inpatient programmes, 31 drug-free outpatient programmes and 22 substitution treatment units, out of which seven are methadone substitution units and 15 are buprenorphine substitution units. Furthermore, around 28 counseling centers operate in the country and is usually an access point for drug treatment for increased proportion of drug users. In addition, two specialised detoxification structures are in operation, IANOS, within the Rehabilitation Department for Dependent Individuals with scheduled programme duration of 21 days, and ATRAPOS unit for adolescents with scheduled programme duration of 120 days. A number of specific treatment interventions exist for adolescent drug users, which are targeted towards adolescent cannabis users, and there are also three specialised units for female problem drug users. Government funds are the sole source of funding for the majority of programmes, except one programme which is funded by local authorities. The main theoretical models applied in drug treatment programmes are therapeutic communities, systemic approaches and psychodynamic theory.

Substitution treatment has seen a systematic expansion and decentralisation since late 2002. Pharmaceutical substances used in substitution treatment are methadone which was introduced in 1993 and buprenorphine which was introduced in 2002. According to the Greek Ministerial Decree 19546/2003, substitution treatment can only be provided by officially recognised treatment centres.

According to the latest available estimates (2009), a total of 2 544 patients were on methadone and 2 222 on buprenorphine out of a reported total of 5 360 patients in opioid substitution treatment.

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Harm reduction responses

Addressing the health problems of dependent drug users has always been a concern for dependence treatment programmes in Greece. Low-threshold services in Greece implement a very broad range of interventions in the area of harm reduction and prevention and care for infectious diseases, including overdose prevention. Their number, however, continues to be limited: such services operate only in Attica and Thessaloniki, and there is no coverage for the rest of Greece. Approximately 69 000 syringes were distributed through the four existing needle and syringe exchange/distribution points at fixed and mobile outlets in 2009. Low-threshold services also provide printed material and training to drug users in safe use and first aid.

A significant number of interventions are implemented by street work programmes, designed to prevent the spread of infectious disease and to reduce drug-related harm in high risk user populations. It should be noted that the Thessaloniki street work program was discontinued in 2009 due to lack of funds. In 2009 a partnership between the ΟΚΑΝΑ street work service and the Athena–Hygeia prevention centres street work programme of the city of Athens continued. The key objective of this partnership is for interventions to be extended in order to reach new groups of users (e.g. young cannabis users) and to identify new drug scenes. The main joint actions include: (i) distribution of printed information material about the services available to drug users, about prevention of the spread of infectious diseases and about safer use practices and (ii) needle and condom distribution. Free vaccination against hepatitis A and hepatitis B viruses is provided by one low threshold facility in Athens.

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Drug markets and drug-related offences

In terms of drug trafficking, heroin originating from south-west Asia is smuggled into Greece through the ‘Balkan route’. Figures for 2008 suggest that 41.5 % of the seized heroin comes from Turkey, 10.2 % from Albania, 1.8 % from Bulgaria, 0.1 % from Lebanon, and the remaining 46.4 % comes from other countries or is of unknown origin. Raw cannabis is imported mainly from Albania (69.3 %) and for 66.4 % of seized processed cannabis country of origin was unknown. Cocaine is shipped in from South America, smuggled into Greece transported by air (31.5 %),land (9.6 %), and sea (1.8 %). directly (18 % from Costa Rica) or through transit countries, such as Bulgaria (0.9 %), Albania (8.7 %), Liberia and Ivory Coast (both 5.3 %). In 2008, 18.4 % of the seized quantities of psychotropic substances came from Bulgaria, 5.7 % from the UK, and the overwhelming majority (75.9 %) was of unknown origin.

Recent figures in terms of seizures in Greece are reported by the Central Anti-drug Coordinating Unit. In 2009, there was an increase in the quantity of heroin, cocaine, herbal cannabis, and amphetamine and ecstasy seizures when compared to 2008. In 2009, 595 kg of heroin (448 kg in 2008), 626 kg of cocaine (67 kg in 2008), 7 320 kg of herbal cannabis (4 601 kg in 2008), 0.2 kg of amphetamine (0.1 kg in 2008), 46 115 tablets of ecstasy (8 620 in 2008) were seized. The quantities of seized heroin in 2008–09 indicate the upward pattern and are the second and the third highest amount seized in Greece since 1985. An almost ten-fold increase in the quantity of seized cocaine in 2009 when compared to 2008 is attributed to the large number of seizures made the Special Controls Services.

Data on drug-law offences are collected by the Hellenic Police and other Prosecution Authorities. In 2009, a total 16 469 persons were reported with drug-related offences, what confirms an increasing trend observed over the past five years. Most offences were related to cannabis, followed by heroin and cocaine law offences.

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National drug laws

The Greek drug law of 1987 and its amendments were codified in 2006. Under this law, drug offenders in Greece are assessed as either dependent or non-dependent. The law distinguishes between drug possession or acquisition for personal use or commercial use, and the punishment varies accordingly. In 2003, a new law stipulated that individuals obtaining or otherwise processing drugs for personal use only, in quantities to satisfy their own needs only, or using drugs or cultivating cannabis plants in numbers and areas justified for personal use only, are sentenced to no more than one year in prison. In accordance with this law, the offence is not recorded on the offender’s criminal records on condition that they do not commit a relevant offence for a five-year period. Offenders may be admitted to a special treatment unit or a special prison department operating under the auspices of lawfully-recognised agencies upon the order of the investigating judge. Traffickers may be sentenced to between five and 20 years' imprisonment, with a life sentence possible. In 2009, the Greek drug law was further amended reinstating that the drug offender charged with drug dealing has to serve a minimum three-fifths of the sentence to be considered for conditional release, which facilitates his/her transition to off-prison treatment and reintegration structures.

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National drug strategy

Greece’s National Strategy on Drugs 2006–12 was adopted in 2006 and it was later complemented with a new National Action Plan on Drugs 2008–12. The Greek drug strategy is comprehensive and balanced, focusing on illicit drugs and alcohol and covering the same pillars as the EU drug strategy: coordination, demand reduction, supply reduction, international cooperation, training, research and evaluation. The Action Plan has five axes (Prevention; Treatment; Social reintegration; Research, training, monitoring and documentation; Cross-sectional cooperation and social participation) and has as its goals: ensuring the right to treatment and the gradual elimination of waiting lists; facilitating access to prevention and information services; securing additional funds for prevention policy; reducing the demand for drugs; countering social stigma and mobilising civil society; developing cooperation with employers with a view to the social reintegration of drug users; and transforming Greece into a regional centre of dependence-related innovation and knowledge.

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Coordination mechanism in the field of drugs

The coordination, monitoring and evaluation of the overall policy implementation in demand reduction were assigned by the national action plan to the Greek Organisation Against Drugs (OKANA). In 2010, the Interministerial Committee for the Coordination of the Fight against Substance Dependence (DESKE) was established and is composed by representatives from the Ministries of Health, Education, Justice, Citizen Protection, National Defense, Labor, Home Affairs, Finance, Culture and Foreign Affairs. The main mission of the Committee is to draw up a mid-term two-year (2011–12) Action Plan on Drugs under coordination by OKANA, and also assist OKANA in monitoring the implementation of the national action plan.  

The Central Anti-drug Coordination Unit — National Intelligence Unit (SODN-EMP) is in charge of the coordination of information provided by all prosecution authorities.

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Drug-related research

The national drug strategy foresees a scientific approach to the drugs problem through monitoring, evaluation and research. Several governmental sources provide funding mainly to university departments, including the national focal point, and a major treatment centre which is also active in the research field. The majority of the research conducted is epidemiological, but clinical research on treatment, amongst other types of research, is also carried out. Each year, the national focal point collects information on this topic through a structured questionnaire and makes it available through a dedicated website. Research findings are also available through scientific journals, websites and national drug conferences. Recent drug-related studies mentioned in the 2010 Greek National report mainly focused on aspects related to drug use prevalence, but also include a study on the socio-economic evaluation of substitution treatment.

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