Country overview: Italy
- 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 | Italy | EU (27 countries) | Source | ||
|---|---|---|---|---|---|
| Population | 2008 | 59 619 290 | 497 455 033 | Eurostat | |
| Population by age classes | 15–24 | 2008 | 10.2 % | 12.6 % 1 | Eurostat |
| 25–49 | 37.1 % | 36.3 % 1 | |||
| 50–64 | 18.6 % | 18.4 % 1 | |||
| GDP per capita in PPS (Purchasing Power Standards) 2 | 2007 | 105.5 | 100 | Eurostat | |
| Total expenditure on social protection (% of GDP) 3 | 2006 | 26.6 % p | 26.9 % p | Eurostat | |
| Unemployment rate 4 | 2008 | 6.1 % 1 | 7 % | Eurostat | |
| Unemployment rate of population agends under 25 years | 2008 | 20.3 % 1 | 15.5 % | Eurostat | |
| Prison population rate (per 100 000 of national population) 5 | 2006 | 65.2 | Council of Europe, SPACE 2006.1 | ||
| At risk of poverty rate 6 | 2006 | 20 % | 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
In 2007, a new general population survey on drug use was carried out in Italy. The survey was based on a postal questionnaire sent to a stratified random sample of the resident population aged 15–64. Illegal drug use included cannabis, heroin, cocaine amphetamines, ecstasy. About 31.2 % of the sample aged 15–64 reported using cannabis at least once in their lives, in 2005 it was reported to be 29.3 %. Lifetime prevalence rates of cocaine and ecstasy were 6.8 % and 2.9 % respectively. Lifetime prevalence rate of amphetamine use was 3.1 %. Last year prevalence of cannabis was 14.6 % and last month prevalence 7.2 %. Last year prevalence of cocaine was 2.2 % and last month prevalence 0.8 %, regarding the other substances, prevalences were lower, at 1 %. The overall trend indicates an increase in the use of cannabis since 2001 for lifetime and last year prevalence of cannabis and cocaine use. As regards the group of younger adults (15–34 years), the lifetime prevalence of cannabis and cocaine were respectively 36.1 % and 7.5 %. Last year prevalence of cannabis was reported by 20.9 % of the sample and 3.1 % cocaine. Finally, last month prevalence of cannabis was declared by 10.4 % and 1.2 % for cocaine.
Data based on the ESPAD surveys, regularly conducted since 1995, among 15–16-year old students revealed that the lifetime prevalence rate of cannabis varied from 25 % in 1999 to 27 % in 2003 and to 23 % in 2007. In 2007, results showed that inhalants lifetime prevalence was reported by 5 % of the students which is equal proportion for cocaine use. Lifetime prevalence of ecstasy was reported by 3 % of the sample, 3 % also for the lifetime prevalence of heroin, amphetamines use was reported by 4 % as well 4 % reported LSD use. Results indicated 19 % for the last year prevalence of cannabis use (22 % in 2003, 20 % in 1999), 13 % for the last month prevalence of cannabis (15 % in 2003, 14 % in 1999). In addition, the reported lifetime prevalence of cannabis use among males was 26 % and 21 % among females.
Prevention
The coverage of school-based prevention seems to be high and well monitored: 82 % of schools have reported prevention projects for the 2007–08 school year. Most of them focus on personal skills. Interventions in professional institutes are more drug specific than those in high schools.
Involvement of the family is considered central to all prevention efforts in Italy. Universal prevention specifically targeted at families is largely distinguished by three types of initiatives: mutual assistance between families, meetings with families and training for families. For the implementation of the Strengthening Families Programme (SFP), a originally selective prevention approach, several centres throughout Italy have been created, where family, school and the local area act together, both in reducing risk factors in children (bullying, dependency, unrest) and in improving the family situation and parents’ educational skills.
Universal prevention activities targeted at the community focus on recreational and cultural activities, counselling and clubs for young people, together with prevention projects delivered via the media.
Selective prevention is carried out mostly by schools in projects which concern young people in the community or in foster care (80 %), students who abandon their schooling early or who are socially marginalised (40 %) and underage offenders (around 43 %); while street operators are the most used to approach the homeless (75 %), immigrants and those belonging to ethnic groups (54 %). Local bodies are the most frequent channel for underage offenders or youngsters in trouble with the law (60 %) and gym goers as potential abusers of steroids and other drugs to improve their performance (50 %).
Mass media campaigns continue to be an essential part of the prevention strategy.
Problem drug use
Various estimates of the number of problem drug users have been conducted in Italy since 1996 applying different methodologies (multivariate method, multiplier method, capture–recapture method and back calculation method). The latest estimates (2007) based on the multivariate indicator method suggest that there has been an increase in the number of problem drug users in Italy compared to 2001. In 2007, on average around 337 178 people (315 788–352 457) were estimated to be eligible for treatment with a prevalence of 8.6 per 1 000 (8.1–9.0) inhabitants aged 15 to 64. Italy was able to provide separate estimates by drug. There were estimated to be 218 500 problem opioid users (5.6 per 1 000 aged 15–64) and 167 456 problem cocaine users (4.3 per 1 000 aged 15–64) in 2007.
Incidence estimation studies indicated that after a decline since around 1990, the yearly number of new problem heroin users was again growing from the mid-1990 ties.
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
The treatment demand data in Italy for 2007 was based on reports from 516 outpatient treatment centres, out of the 543 outpatient treatment centres across Italy.
During 2007, a total of 51 609 outpatient clients entered treatment, out of which 35 586 were first time treatment clients. Data indicate that 62.4 % of all clients entering treatment reported opioids as the primary drug, followed by 23.3 % for cocaine and 12.8 % for cannabis. A similar distribution was identified among new treatment clients: 56.8 % reported that opioids were the primary drug, followed by 25.9 % for cocaine and 15.6 % for cannabis.
In 2007, 40 % of all clients entering treatment were aged more than 35 years. A similar distribution in age was reported among new treatment clients with 33 % over the age of 35 years. As far as gender distribution is concerned, 86 % of all clients entering treatment were male whereas a smaller proportion of 14 % were female. The same pattern in gender distribution was reported among new treatment clients with 86 % for male and 15 % for female.
Drug-related infectious diseases
In Italy, persons attending drug treatment at a public drug treatment service and drug-using prisoners are offered a voluntary test for drug-related infectious diseases. The data are collected annually by the Ministry of Health. No distinction is made between injecting drug users and non-injectors, although special attention is paid to those with high-risk behaviour.
Overall, there has been a continued reduction of the proportion of all clients testing HIV positive for Italy as a whole. In 2007, 11.9 % of the clients tested were HIV positive. (12.1 % in 2006 and 13.8 % in 2005). The highest HIV prevalence rates are found in the northern regions of Italy. The HCV prevalence rate was 60.2 % in 2007, 61.9 % in 2006 and 61.4 % in 2005. Trends are difficult to interpret due to changes in the number of people tested, which varies considerably by region and by year.
Drug-related deaths
National data on direct drug-related deaths in Italy are collected by the special registry maintained by the Central Drugs Directorate (DCSA) of the Ministry of Interior. The total number of direct drug-related deaths recorded in the special registry in 2007 was 589, and remained invariant in comparison with the previous two years (517 in 2006 and 603 in 2005). Trends in drug-related deaths in the last 10 years show a maximum peak in 1996 followed by a progressive decrease in deaths until 2003, with a brief inversion of the trend between 2005 and 2007, and a reduction of about 20 % in 2006, when compared to 2005.
The General Mortality Registry maintained by the National Institute of Statistics (ISTAT) collects data on direct drug-related deaths coded using ICD-9. The data from the General Mortality Register is currently only available until 2002, but it also suggests a downward trend during the 1990s. A new arrangement for the flow of information on deaths is planned at the institutional level, bringing together the data from the Institutes for Legal Medicine and an integration of the data from the special register (DCSA) and the General Mortality Register (ISTAT).
Treatment responses
In Italy, the coordination of drug-related treatment is carried out at regional level, and heads of the local drug departments or drug services coordinate drug-related treatment. The Regional Government establishes the treatment delivery services, manages accreditation of private community treatment centres and records the number of treatment centres. Both the public and private sectors provide treatment, and both are funded through the Regional Health Fund. Funds are allocated on a yearly basis to the regions by the Government.
The Italian drug treatment system includes two complementary sub-systems: SerTs and therapeutic communities. SerTs are public drug treatment units which mainly carry out outpatient treatment, and are part of the national health system. Within the SerT, integrated treatment is usually provided, with the client receiving both medically-assisted and psychosocial treatment, and with just under half of all clients receiving drug-free treatment alone. Even if drug-free treatment is also available in the SerTs, they remain the main provider of substitution treatment. Moreover, SerTs may also carry out reintegration programmes. The majority of therapeutic communities are private and non-profit organisations. They carry out in-patient treatment, but also semi-residential and outpatient treatment. Referral to therapeutic communities is made by the SerTs, which in most cases authorise the local NHS unit to pay the fees for the treatment. The largest number of services is located in the northern regions of Italy, which have the largest number of problem drug users and highest urban densities. Interventions carried out in both the public and the private services include psychosocial support, psychotherapy and social service interventions, and also detoxification in residential settings and vocational training in semi-residential settings. Detoxification is also carried out in general hospitals. However, the number of problem drug users in hospital settings is believed to be low. The Presidential Decree 309/90, Article 43 stipulates that substitution treatment can be initiated by general practitioners, specialised medical practitioners and treatment centres. However, the provision of opioid substitution treatment outside specialised treatment centres is rare.
The most widely-used substitution substance in Italy is methadone (introduced in 1975), although the use of buprenorphine has been increasing since its introduction in 1999. In 2007, the total number of clients in substitution treatment was 112 896 of whom 95 453 were on methadone and 17 443 on buprenorphine.
Harm reduction responses
The national policy on drugs in Italy focuses more on prevention and reduction of chronic drug misuse, rather than harm reduction. Despite these priorities at the national level, outreach programmes exist at the local level operated by both public and private social and health organisations, together with specific projects funded through the National Drugs Fund. Both the outreach programmes and projects financed through the national fund may include needle and exchange programmes and information dissemination.
As with treatment services, programmes targeted at harm reduction are more extensive in the northern and central Italian regions, and are more focused on the larger cities. Distribution and/or exchange of syringes and needles are available through mobile units, outreach programmes and dispensing machines. Other components of harm reduction are usually integrated within the overall drug treatment system at the local level. In 2006, a survey conducted among the departments for drug addiction and local health authorities, showed that distribution of syringes was an active initiative for 30 % of the departments, which made available syringes upon request from clients, while 36 % offered proactive distribution. Distribution of condoms is more likely to occur in a proactive way (40 %). Distribution of information materials is the most widespread activity reported (86 % and 75 %) and has been evaluated in 24 % of territories. 44 % of departments/services distribute syringes and/or sterilised material, 28 % use both methods and 16 % use just one method (8 % proactively and 8 % with materials available for clients). Of the departments which distribute syringes, 67 % also distribute condoms.
The Services for Drug Addiction carry out vaccinations for hepatitis B and other procedures to minimise the spread of infectious diseases. Recent drug-related studies mentioned in the 2008 Polish National report mainly focused on aspects related to prevalence of drug use.
Drug markets and drug-related offences
As highlighted in the Annual report of the Central Drug Unit of the Ministry of the Interior, the Italian drug market in 2006 was largely supplied by cocaine produced in Colombia, heroin from Afghanistan, hashish produced in Morocco, marijuana from Albania and synthetic drugs from Holland.
In 2007 a total of 68 370 drug related offences were reported. Out of which were related to cannabis with 56.6 % of all drug-related offences, followed by 25.5 % for cocaine- related offences and 13.6 % of heroin-related offences.
Based on the figures recorded by the Central Drug Unit for the final sale of illegal psychoactive drugs, in 2007 the average price for black heroin was EUR 50.9/gram in 2007 and white heroin EUR 72.9/gram, The average price per gram for cannabis remained stable from 2001 to 2006. The average price for ecstasy was EUR 18.8 per tablet and EUR 29.2 per unit of LSD.
National drug laws
Possession of all drugs is prohibited in Italy and punishable by administrative sanctions in the case of personal use. Controlled substances are classified into two categories, and depending on the category the administrative sanctions (such as suspension of driving licence) may have a duration of one to four months. Since February 2006, no distinction is made between illicit drugs, and a maximum quantity determines the threshold between personal possession and trafficking. If a person is found in possession of illegal drugs for the first time, administrative sanctions are usually not applied, but the offender receives a warning from the Prefect and a formal request to refrain from use. The offender may also voluntarily request a treatment or rehabilitation service, and proceedings will then be suspended whilst the user is referred to treatment. Failure to attend or complete a treatment programme may result in the application of the above sanctions. The penalty for production, sale, transport, distribution or acquisition is one to six years’ or six to 20 years’ imprisonment depending on classification of the drug(s) involved. When the quality or quantity of the substance is considered not so serious, the penalty may be six months to six years imprisonment depending on the classification of the drug(s) involved.
National drug strategy
In January 2008, Italy adopted a new action plan on drugs for the year 2008, which should be followed by a subsequent four-year plan (2009–12) to be synchronised with the new EU action plan. The 2008 plan was prepared by the Italian Ministry of social solidarity with the aim of covering all the main priorities and fields. It includes five main areas: coordination, demand reduction, supply reduction, international cooperation, and information/training/research and evaluation, along with 66 different actions to be implemented during 2008, including one dedicated to the monitoring and evaluation of the whole plan.
Coordination mechanism in the field of drugs
At the political level the national coordination in the drug field is assigned to the National Committee of Anti-drug Policy which is composed of all the relevant Ministers and chaired by the appointed Under Secretary of the Presidency of the Council of Ministers.
The Department for Antidrug Policies has been set up in support of the National Committee and within the competence of the appointed Under Secretary. The Department is the coordinating body among Ministries and, through the State–Regions Committee and the State–Regions–Municipalities unified Committee, is the institutional interface with the regional and local Authorities. Moreover, the Department holds responsibilities for international and European activities.
Coordination at the regional level is undertaken through the regional office for drugs and drug addiction within either the Health or Social Policy Department. The Health Local Units (ASL) are responsible for SerT (Public services) and NGOs activities. Prevention and reintegration activities are assigned to Provinces and Municipalities.
Drug-related research
The Department for Antidrug Policies has been set up by law on 20 June 2008 as the Italian Coordination Structure in the field of drugs and drug addiction. During its first phase of activity a big effort has been devoted to organising the internal offices and staff in order to implement the institutional relationship with national and international organisations involved in the field.
Within the Department, the Technical and Scientific Area has been created and new surveys and drug related researches are now under construction.