• 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

In 2008, a 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 32 % 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 7.0 % and 3.0 % respectively. Lifetime prevalence rate of amphetamine use was 3.2 %. Last year prevalence of cannabis was 14.3 % and last month prevalence 6.9 %. Last year prevalence of cocaine was 2.1 % and last month prevalence 0.7 %, 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 37.5 % and 7.6 %. Last year prevalence of cannabis was reported by 20.3 % of the sample and 2.9 % cocaine. Finally, last month prevalence of cannabis was declared by 9.9 % and 1.1 % for cocaine.

In 2010, a new general population survey was conducted. The final results of the study will be available in 2011.

The ESPAD surveys are regularly conducted since 1995. In 2010, Italian Student Population Survey was conducted using self-reported anonymous on-line questionnaire corresponding to the ESPAD protocol. Data among 15–16-year old students revealed that the lifetime prevalence rate of cannabis varied from 25 % in 1999 to 27 % in 2003 (both data from the corresponding ESPAD studies) and to 12 % in 2010. In 2010, results showed that inhalants lifetime prevalence was reported by 1 % of the students which is equal proportion for heroin, ecstasy, LSD and amphetamine use. Lifetime prevalence of cocaine was reported by 2 % of the sample. These results show a steady overall decrease in use of all illicit drugs among 15–16 years old over time. The lifetime use of cannabis among 17–18 year olds was 27 %, followed by cocaine (4 %) and inhalants and volatile substances at 3 %. The 2010 data suggest also strong trend towards polydrug use in the last 12 months, with alcohol, tobacco being the most common concomitant substances. Concomitant use of cannabis is prevalent among cocaine and heroin users, but cocaine is also used by more than 80 % of heroin users.

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Prevention

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 young people through peer groups in out of school settings, counselling and clubs for young people, prevention at recreational and cultural activities, together with local prevention projects delivered via the media and the Internet.

Selective prevention activities are mainly aimed at immigrants, socially and academically marginalised young people, and families with problem drug use and/or with mental health problems.

Mass media campaigns continue to be an essential part of the prevention strategy.

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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 (2009) 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 2009, on average around 393 490 people (382 500–404 500) were estimated to be eligible for treatment with a prevalence of 10.0 per 1 000 (9.7–10.2) inhabitants aged 15 to 64. Italy was able to provide separate estimates by drug. There were estimated to be 216 000 problem opioid users (5.5 per 1 000 aged 15–64) and 178 000 problem cocaine users (4.5 per 1 000 aged 15–64) in 2009. The prevalence estimates indicate an increasing trend in the total number of problem drug users over recent years, and in particular, in the number of problem cocaine users.

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.

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Treatment demand

The treatment demand data in Italy for 2009 was based on reports from a sample of 131 addiction treatment units, out of the 525 treatment centres which reported the data. In total there are 533 treatment centres across Italy.

During 2009, a total of 54 141 clients entered treatment, out of which 33 983 were first time treatment clients. Data indicate that 55.4 % of all clients entering treatment reported opioids as the primary drug, followed by 27.6 % for cocaine and 14.3 % for cannabis. A similar distribution was identified among new treatment clients: 43.7 % reported that opioids were the primary drug, followed by 32.7 % for cocaine and 19.7 % for cannabis.

In 2009, 47 % of all clients entering treatment were aged more than 35 years. A similar distribution in age was reported among new treatment clients with 38 % over the age of 35 years. As far as gender distribution is concerned, 85 % of all clients and the same proportion of new clients entering treatment were male whereas a smaller proportion of 15 % were female.

In 2010, the National Information System on Addiction (SIND) was introduced and allows collection and analysis of individualised treatment demand data on subjects undergoing treatment in local treatment services and also in penitentiaries. This is regarded as a significant step forward to enhance data collection and reporting on treatment demand in Italy.

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Drug-related infectious diseases

In Italy, persons attending drug treatment at a public drug treatment service 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 2009, 11.5 % of the clients tested were HIV positive. (11.7 % in 2008, 11.9 % in 2007 and 12.0 % in 2006). The HCV prevalence rate was 58.5 % in 2009, 59.2 % in 2008, 60.2 % in 2007 and 62.0 % in 2006. Trends are difficult to interpret due to changes in the number of people tested, which varies considerably by region and by year. In 2009, slightly more than one third of clients test positive for hepatitis B virus, although number of tested individuals was small. The highest prevalence rates of all three infections (HIV, HBV and HCV) are found in Emilia Romagna, Liguria and Sardinia.

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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 2009 was 484, and is somewhat smaller in comparison with the previous four years (502 in 2008, 589 in 2007, 517 in 2006 and 652 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. Slightly more than half DRD cases were recorded toxicology testing results, indicating opiates as the most prevalent substance causing death. 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).

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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 provided and reintegration programmes are also implemented. 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 2009, the total number of clients in substitution treatment was 107 892 (with a service coverage of 85 %) of whom 89 968 were on methadone and 16 708 on buprenorphine.

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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. Harm reduction interventions are delivered through fixed sites, mobile units, outreach programmes and needle and syringe dispensing machines. In 2008, a survey conducted among the 240 low-threshold services, showed that 157 services aimed to reduce harm and risks related to drug use, while remaining services provided other related services. An in-depth analysis of 55 harm reduction services showed that 41 services provide clean needles and syringes and other materials, 45 condoms, but 22 distributed naloxone. Almost all surveyed services provide counselling (54) and referral services (49) to their clients.

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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 2009 was largely supplied by cocaine produced in Colombia, heroin from Afghanistan, marijuana and synthetic drugs from the Netherlands.

In 2009 there were 23 187 anti-drug operations conducted by the police, that led them to 19 686 seizures of illegal drugs, a continuous growth since 2004. Police operations in 2009 enabled to seize the largest quantity of herbal cannabis (7 483 kg in 2009, 2 400 kg in 2008), mainly in Lombardy (18.1 % of total volume) and Campania (17.6 %). More than 7 000 police operations resulted in seizure of 19 474 kg of cannabis resin, which is less than in 2008, but it remains the main drug seized in the country. The quantities of cocaine and heroin seized by the police were less than in 2008 (respectively 4 070 kg and 11 149 kg). In 14 amphetamine seizures, 4 kg of the substance was seized, which is the largest amount of seized amphetamines in the past decade.

In 2009, a total of 59 918 drug-related offences were reported. Out of which were related to cannabis with 61.3 % of all drug-related offences, followed by 20.9 % for cocaine- related offences and 12.8 % of heroin-related offences.

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National drug laws

In Italy, the offence of possession for personal use is punishable by administrative sanctions (such as suspension of driving licence) which may have a duration of up to one year, increased from four months since February 2006. A distinction between illicit drugs is no longer made, only a distinction between illicit drugs (Table I) and medicinal drugs (Table II). Now, 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 six to 20 years’ imprisonment, though this can be reduced by 33–50 % if the substances are medicinal from Table IIA. When the quality or quantity of the substance is considered not so serious, the penalty may be one to six years imprisonment.

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National drug strategy

During the course of 2009, there were a series of meetings held by Central Administrations, the Regions and Autonomous Provinces and private non-profit organisations to begin the drafting of the new action plan. The National Conference on Anti-drug Policies held at Trieste and the principles set forth in the European Action Plan for 2009–12 were the basis for the design of the new National Action Plan against drugs.

The New National Action Plan on Drugs has the main objective of redefine national general operational strategies, moulding them into a realistic and viable Action Plan 2009–12 through the concerted effort of three parties:

• central administrations
• regions and autonomous provinces
• non-governmental organisations operating in the field.

The New National Action Plan on Drugs 2010–13 has been formally approved by the Council of Ministers on 29 October 2010.

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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 Anti-drug 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.

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Drug-related research

Research activities have primarily focused on the creation of a National Network for Addiction Research (NNRD) with the main objective to encourage and set up applied research projects in specialised areas focusing on and based on neuroscience. The network’s 15 collaborating centres implement research projects funded by 4 % of the invested budget in this area and provide practitioners in drug-related fields with up-to-date knowledge in their fields. Ongoing projects range from cerebral mapping of the craving and resisting areas using transcranial magnetic stimulation and neurotraining to the study of cerebral alterations, alterations in the immune system, emotional alterations and genetic damage resulting from the use of, in particular, cannabis and cocaine, to the study of addiction progression, of risk conditions and of the advent of psychiatric conditions as a result of drug use.

Recent drug-related studies mentioned in the 2010 Italian National report mainly focused on aspects related to the prevalence of drug use and responses to the drugs situation.

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