Country overview: Italy
- 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||Italy||EU (27 countries)||Source|
|Population||2012||60 820 696 p ||503 663 601 b p||Eurostat|
|Population by age classes||15–24||2012||10.0 %||11.7 % b p||Eurostat|
|25–49||36.0 %||35.4 % b p|
|50–64||19.4 %||19.5 % b p|
|GDP per capita in PPS (Purchasing Power Standards) 1||2011||100||100||Eurostat|
|Total expenditure on social protection (% of GDP) 2||2010||29.89 % p||29.4 % p||Eurostat|
|Unemployment rate 3||2012||10.7 %||10.5 %||Eurostat|
|Unemployment rate of population aged under 25 years||2012||35.3 %||22.8 %||Eurostat|
|Prison population rate (per 100 000 of national population) 4||2011||110.7||:||Council of Europe, SPACE I-2011|
|At risk of poverty rate 5||2011||19.6 %||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).
A general population survey on drug use was carried out in Italy in 2012. The survey was based on a postal questionnaire sent to a stratified random sample of more than 60 000 residents aged 18–64 (response rate: 33.4 %). Illicit drug use was classed as use of cannabis, heroin, cocaine, amphetamines and ecstasy. About 21.7 % of the respondents reported having used cannabis at least once in their lives. The lifetime prevalence rate of cocaine was 4.2 %, while for both amphetamines and ecstasy it was 1.8 %. Last year prevalence of cannabis use was 3.5 % and last month prevalence was 1.5 %. Last year prevalence of cocaine use was 0.6 % and last month prevalence was 0.2 %. The survey display a wide variation in results compared to previous surveys (2001, 2003, 2005 and 2008), which may reflect methodological differences, and, given a lack of comparability between the surveys, the results should be treated with caution.
The European School Survey Project on Alcohol and Other Drugs (ESPAD) studies among students aged 15–16 have been conducted regularly since 1995. The latest study was in 2011, and it indicates an overall decrease in the use of all illicit drugs over time. The lifetime prevalence rate of cannabis dropped from 27 % in 2003 to 21 % in 2011. In 2011 lifetime prevalence of inhalants was 3 %, which is equal to the figures for hallucinogens and cocaine. Lifetime prevalence of amphetamines, ecstasy and heroin was reported by 2 % of the sample. Last year prevalence of cannabis use was 18 % while last month prevalence was 12 %.
Another survey among school students aged 15–19 was conducted in 2012. This study indicated that 13 % of 15- to 16-year-olds had ever used cannabis, while the prevalence rates for other illicit substances were much lower. The lifetime prevalence of cannabis use among 17- to 18-year-olds in the same study was 27 %, while 16 % of 17- to 18-year-olds reported using cannabis in past 30 days.
The Health Behaviour in School-aged Children study was conducted in Italy in 2002 and 2009.
In 2010–11 a total of 17 Italian cities (eight in 2010–11, and nine in 2011 only) participated in projects that attempted to assess drug use levels in the population, applying innovative methodology. Analyses of wastewater samples were performed to determine the extent of drug use for drugs such as cannabis, cocaine, heroin and amphetamine type stimulants. Air sampling was used to establish the contamination levels of cocaine and cannabis. Cannabis was the main drug detected in the wastewater samples in both study periods, followed by cocaine. Heroin and synthetic stimulants were detected in much smaller quantities.
Planning and implementation of prevention activities in Italy is mainly the responsibility of the regional and autonomous provinces; however, the Department for Anti-Drug Policies at the Presidency of the Council of Ministers provides part of its annual budget to support universal and selective prevention activities.
Universal prevention activities in schools are mainly limited to information provision and awareness raising through lectures and discussions, while more interactive methods such as role-playing or peer-to-peer activities remain limited.
Family involvement is considered central to all prevention efforts in Italy and almost all regions have universal prevention projects targeting families, guardians, teachers and peers, and individual work with parents. 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. Several centres have been created throughout Italy to implement the Strengthening Families Programme (SFP), a selective prevention approach where family, school and the local community work together both to reduce risk factors in children (bullying, dependency, unrest) and to improve the family situation and parents’ educational skills.
Universal prevention activities targeted at the community focus on young people using peer groups in out-of-school settings, counselling and clubs for young people, recreational and cultural activities and local prevention projects delivered via the media and the Internet.
Selective prevention activities are mainly aimed at socially and academically marginalised young people, school drop-outs 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, and mainly focus on general information and awareness raising about both licit and illicit drugs.
View ‘Prevention profile’ for additional information.
Various estimates of the number of problem drug users have been conducted in Italy since 1996, applying different methodologies (multivariate indicator, multiplier, capture–recapture and back calculation). 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 since 2001. In 2009 there were an estimated 393 490 problem drug users (range from 382 500 to 404 500), with a prevalence of 10.0 per 1 000 inhabitants aged 15–64 (range: 9.7–10.2). Italy was able to provide separate estimates by drug, based on the treatment multiplier. The estimates suggest that there were 193 000 problem opioid users (4.8 per 1 000 inhabitants aged 15–64) in 2011.
Up to 2012 the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) defined problem drug use as injecting drug use (IDU) 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.
Treatment demand data for 2011 was based on reports from a sample of 91 addiction treatment units, coming from the new National Information System on Addiction. There are 563 service units across Italy.A total of 57 577 clients entered treatment in 2011, of which 33 679 were new treatment clients. Data indicated that 55.3 % of all clients entering treatment for whom the primary drug was known reported opioids as the primary drug, followed by 24.3 % for cocaine and 18.8 % for cannabis. A similar distribution was identified among new treatment clients: 42.4 % reported that opioids were the primary drug, followed by 30.3 % for cocaine and 25.2 % for cannabis. However, for around one-third of the registered clients, information on the primary drug was not known or was missing.
In 2011 some 42 % of all treatment clients were over the age of 35, and 21 % were under the age of 25. New treatment clients tended to be slightly younger, with 36 % over 35 and 29 % under 25. With regard to gender distribution, 87.1 % of all treatment clients and a similar proportion of new treatment clients were male.
In 2010 the National Information System on Addiction (SIND) was introduced. This allows individualised treatment demand data on subjects undergoing treatment in local treatment services and in prisons to be collected and analysed. This is regarded as a significant step forward to enhance data collection and reporting on treatment demand in Italy.
In Italy, people attending drug treatment at a public drug treatment service or general hospital are offered a voluntary test for drug-related infectious diseases. The Ministry of Health collects the data annually. No distinction is made between injecting drug users and non-injectors, although special attention is paid to those reporting a high-risk behaviour.
Overall, there has been a continued reduction in the proportion of all clients testing HIV positive for Italy as a whole. In 2010 some 11.5 % of the clients tested were HIV positive (11.5 % in 2009; 11.7 % in 2008; 11.9 % in 2007; 12.0 % in 2006). The hepatitis C virus prevalence rate was 60.5 % in 2010 (58.5 % in 2009; 59.2 % in 2008; 60.2 % in 2007; 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 2011 slightly more than a third of clients tested positive for the hepatitis B virus, although the number of individuals tested was small. There are significant variations in the prevalence of drug-related infectious diseases between regions, which is discussed in detail in the 2012 National report.
In 2011 some 18 out of 22 regions reported 161 new HIV infections among injecting drug users.
National data on direct drug-related deaths in Italy are collected by the Special Registry maintained by the Central Directorate for Antidrug Services (DCSA) of the Ministry of Interior. Trends in drug-related deaths show a maximum peak in 1996 followed by a progressive decrease and stabilisation during 2002–07, with a continuous decline in the following years. The total number of direct drug-related deaths recorded in the special registry in 2011 was 362, and this continues a declining trend observed since 2008 (374 in 2010; 484 in 2009; 517 in 2008; 606 in 2007). With regard to gender and age, 86.7 % of death cases were male, and the mean age at the time of death was 36.9 years. Slightly more than half of the drug-related deaths had toxicology testing results available, which indicate 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.
In Italy, the coordination of drug-related treatment is carried out at regional level by heads of the local drug departments or drug services. The regional government establishes the treatment delivery services, manages accreditation of private community treatment centres and records the number of treatment centres. To ensure quality of treatment, the regions are given responsibility for adoption of treatment guidelines; however, in a significant portion of the regions such tools have not yet been adopted. Both the public and private sectors provide treatment, and both are funded through the Regional Health Fund. Funds are allocated to the regions by the government on a yearly basis.
The Italian drug treatment system includes two complementary sub-systems: public drug addiction service units (SerTs), and therapeutic communities. SerTs 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 inpatient 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 treatment. Most services are located in the northern regions of Italy, which have the highest number of problem drug users and greatest 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. Treatment programmes usually do not distinguish between different types of substances used by their clients. Programmes focusing on cocaine users, children and adolescents who use psychoactive substances are in place in most of Italy, while programmes for ethnic minorities are available in less than a fifth of all regions.
The Presidential Decree 309/90, Article 43 stipulates that substitution treatment can be initiated by general practitioners, specialised medical practitioners and treatment centres, and should be implemented in combination with psychosocial and/or rehabilitative measures. 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 2011 there were 109 987 clients in substitution treatment, of whom 93 119 were on methadone and 16 868 on buprenorphine. In 2010–12 the Department of Anti-Drug Policy carried out a pilot project to evaluate the outcome of opioid substitution treatment. The results of the evaluation are yet to be presented to the parliament and will be included in the next National report.
View ‘Treatment profile’ for additional information.
The national policy on drugs in Italy focuses more on prevention and reduction of chronic drug misuse, rather than harm reduction. However, the National Action Plan on Drugs 2010–13 identifies the prevention and reduction of infectious disease transmission among drug users as one of its goals. In this context, actions were taken to enhance screening on infectious diseases among injecting drug users and also to integrate informational and educational activities in treatment settings.
Some 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 include needle and exchange programmes and information dissemination.
Programmes targeted at harm reduction are more extensive in the northern and central Italian regions, and tend to be focused on the larger cities. Harm reduction interventions are delivered through fixed sites, mobile units, outreach programmes and needle and syringe dispensing machines.
The Italian drug market is largely supplied by cocaine produced in Colombia, heroin from Afghanistan, and marijuana and synthetic drugs from the Netherlands. The market is dominated by large organised crime structures with well-established international links and operating bases in principal drug production and trafficking regions, such as South America, South East Asia and Northern Europe. A large proportion of illicit drugs passes through Italy en route to other European Union countries. With regard to production, cannabis cultivation is reported predominately in southern Italy, and a number of laboratories for manufacturing and processing of other illicit substances, mainly cocaine, are seized across the country each year.
In 2011 the police conducted 23 103 anti-drug operations that led to 19 469 seizures of illegal drugs. Police operations in 2011 led to the seizure of 10 908 kg of herbal cannabis, the largest amount since 2003. The increase in the quantities seized was greatest in the Lazio, Apulia and Lombardy regions. The amount of cannabis resin seized has been quite stable since 2009, with about 20 tonnes of the substance seized annually. A growing trend continued in the number of seizures involving cannabis plants, and a record number of more than 1 million plants were seized in 2011, with Sicily accounting for more than 90 % of seizures. In 2011 a record amount of 6 342 kg of cocaine was seized, which is almost twice as much as in 2009. Although the quantity of heroin seized by the police continued to decline in 2010–11, the amounts remained quite high (at 811 kg in 2011). In total, 19 kg of amphetamine and 1 000 tablets were recovered from 124 seizures, which indicates an increase since 2008, when 1 kg of the substance was seized.
In 2011 a total of 67 442 people were reported as being involved in drug-law offences. More than half were related to cannabis, followed by cocaine-related offences and heroin-related offences.
In Italy, the Consolidated Law, adopted by the Presidential Decree No. 309 on 9 October 1990 and subsequently amended, provides the legal framework for licit trade, treatment and prevention, prohibition and punishment of illicit activities in the field of drugs and psychoactive substances. Since February 2006 the offence of possession for personal use is punishable by administrative sanctions (such as suspension of the driving licence), which may be up to one year, increased from four months. A distinction is made between illicit drugs (Table I) and medicinal drugs (Table II). 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 not usually applied, and instead the offender receives a warning from the Prefect and a formal request to refrain from use. The offender may also voluntarily request treatment or rehabilitation, and proceedings will then be suspended whilst the user is referred for 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 from Table IIA (medicinal). When the quality or quantity of the substance is considered not as serious, the penalty may be one to six years’ imprisonment.
New psychoactive substances are also regulated through amendments to the Consolidated Law.
View ‘Legal profile’ for additional information.
National drug strategy
The Italian National Action Plan on Drugs 2010–13 was adopted by the Council of Ministers on 29 October 2010. Taking a comprehensive approach, 89 objectives are set out in the Action Plan in two pillars, demand and supply reduction, across five cross-cutting areas of intervention. Demand reduction activities include prevention, treatment, rehabilitation and reintegration, while supply reduction covers evaluation and monitoring, legislation, combating drugs and youth justice. Primarily focused on illicit drug use, the Action Plan also covers licit drug use and addictive behaviours as elements, predominantly in the context of prevention. A series of initiatives are envisaged within each of the five cross-cutting intervention areas (prevention; treatment and diagnosis; rehabilitation and reintegration; evaluation and monitoring; legislation, combating drugs and youth justice). These cover the themes of coordination, cooperation, raising public awareness, assessing results and costs, scientific research and data collection, and training and organisation.
The main Action Plan is accompanied by three other elements designed to support overall strategy implementation:
- Individual regional plans can be drawn up by the Regions and Autonomous Provinces, following the approach of the National Action Plan on Drugs, as well as their own planning priorities.
- Technical and scientific guidelines are designed to provide methodological support in implementing the drugs strategy.
- The Projects Plan sets out the different national projects being carried out under the five cross-cutting areas of intervention in the National Action Plan on Drugs. It is renewed and implemented on the basis of annually defined financial resources. The second Projects Plan, for 2011–12, covers 10 areas: overall prevention; prevention of drug-related diseases; treatment and support via Public Drug Treatment Units (SerTs) and therapeutic communities; reintegration; epidemiology and assessment; warning system and technological innovations; planning and organisation; research; training; and international activities.
View ‘National drug strategies’ for additional information.
The National Anti-drug Coordination Committee is responsible for the coordination of Italian policy at the inter-ministerial level. Chaired by the appointed minister of the Presidency of the Council of Ministers, it is comprised of all the relevant ministers.
Established in 2008, the Department for Anti-drug Policies is responsible for the day-to-day operational coordination of Italian drug policy. While originally a Department of the Presidency of the Council of Ministers, it was later placed under the competency of the Minister for International Cooperation and Integration. Its responsibilities include ensuring coordination among the different ministries, as well as functioning as a link between central, regional and local authorities through the mechanism of the State–Regions Committee and the State–Regions–Municipalities Unified Committee. The Department’s work also includes policy activities at the European and international levels, alongside reviewing scientific knowledge on different aspects of drug addiction. The head of the Department is the national drug coordinator, who also chairs its advisory body, the Scientific Committee.
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 the activities of SerTs (public services) and non-governmental organisations. Prevention and reintegration activities are assigned to provinces and municipalities.
In Italy drug action plans do not have associated budgets and estimates of drug-related expenditures are also limited. One recent study (1) estimated the social costs of drug use, and included an estimate of public expenditures (2) with a well-defined method. The same method was used to estimate total drug-related public expenditure in 2009 and 2010.
In 2010 total drug-related public expenditure was estimated to be approximately 0.25 % of gross domestic product, with 55.9 % for law enforcement and 44.1 % for social and health care.
The available data do not allow trends in drug-related expenditures to be reported.
(1)See Italy’s 2012 National report.
(2) 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 expenditures.
View ‘Public expenditure profile’ for additional information.
Research activities have primarily focused on the creation of a National Network for Addiction Research (NNRD), with the primary objective of encouraging and setting 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 include: cerebral mapping of the craving and resisting areas of the brain using transcranial magnetic stimulation and neurotraining; 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; and 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 2012 Italian National report mainly focused on aspects related to the prevalence of drug use, responses to the drugs situation and consequences of drug use.
View ‘Drug-related research’ for additional information.