• 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
• Public expenditure
• 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 and 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 of amphetamine use was 3.2 %. Last-year prevalence of cannabis was 14.3 % and last-month prevalence was 6.9 %. Last-year prevalence of cocaine was 2.1 % and last-month prevalence was 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. With regards to 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.

A new general population survey was conducted at the beginning of 2012. The final results of the study will be available in September 2012.

The ESPAD surveys among 15–16-year-old students are regularly conducted since 1995. The last study was conducted in 2011 and indicates an overall decrease in use of all illicit drugs among 15–16-year olds over time. The lifetime prevalence rate of cannabis dropped from 27 % in 2003 to 21 % in 2011. In 2011, inhalants lifetime prevalence was reported by 3 % of the students, which is proportionately equal for hallucinogens and cocaine use. Lifetime prevalence of amphetamines, ecstasy and heroin was reported by 2 % of the sample. In 2011, the last year prevalence was reported by 18 % of respondents, while 12 % have used cannabis in the past 30 days.

The Health Behaviour in School-aged Children study was conducted in Italy in 2002 and 2009, while the data on the National Student Population Survey among 15–19-year olds is reported in 2010 and 2011. The latest national survey reports the lifetime use of cannabis among 17–18 year olds at 26 %, followed by cocaine and hallucinogens at 3 %, and inhalants and volatile substances at 2 %.

In 2010, eight Italian cities participated in projects which 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, e.g. cannabis, cocaine, heroin and amphetamine type stimulants; while air sampling was used to find the contamination levels with cocaine and cannabis. 

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Prevention

Planning and implementation of prevention activities in Italy is mainly responsibility of Regional and Autonomous Provinces; however, the Department for Anti-Drug Policies at the Presidency of the Council of Ministers provides about half of its annual budget to support universal and selective prevention activities. 

Involvement of the family is considered central to all prevention efforts in Italy and more than half of the regions already have universal prevention projects targeting family, guardians, teachers and peers, and individuals working 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. For the implementation of the Strengthening Families Programme (SFP), an 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 in schools are mainly limited to information provision and awareness raising through lectures and discussions, while more interactive methods such as role plays or peer-to-peer activities remain limited.

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 socially and academically marginalised young people, and families with problem drug use and/or with mental health problems. In 2010, ‘young party goers’ emerged as a new target audience for selective prevention activities.

Mass media campaigns continue to be an essential part of the prevention strategy and mainly focus on general information and awareness raising regarding both legal and illegal drugs.

View ‘Prevention profile’ for additional information.

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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, based on treatment multiplier. There were estimated to be 218 423 problem opioid users (5.5 per 1 000 aged 15–64) in 2010. The prevalence estimates indicate an increasing trend in the total number of problem drug users over recent years.

Incidence estimation studies indicate that after a raise since around the 1990s, the yearly number of new problem heroin users was steadily falling to approximately 15 000 during the last two years.

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 2010 was based on reports from a sample of 189 addiction treatment units. In total, there are 533 service units across Italy.

During 2010, a total of 56 146 clients entered treatment, out of which 35 597 were first-time treatment clients. Data indicate that 48.5 % of all clients entering treatment reported opioids as the primary drug, followed by 28.7 % for cocaine and 20.1% for cannabis. A similar distribution was identified among new treatment clients: 39.5 % reported that opioids were the primary drug, followed by 32.5 % for cocaine and 24.7 % for cannabis. However, for around one third of the registered clients, the information on primary drug was not known or was missing.

In 2010, 44 % of all clients entering treatment were aged more than 35 years. A similar distribution in age was reported among new treatment clients with 39 % over the age of 35 years. As far as gender distribution is concerned, 84.8 % of all clients and a similar proportion of new clients entering treatment were male.

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 2010, 11.1 % of the clients tested were HIV positive (11.5 % in 2009, 11.7 % in 2008, 11.9 % in 2007 and 12.0 % in 2006). The HCV prevalence rate was 61.0 % in 2010, 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 2010, slightly more than one third of clients tested positive for the hepatitis B virus, although the 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. Trends in drug-related deaths show a maximum peak in 1996 followed by a progressive decrease and stabilisation during 2002–07.  The total number of direct drug-related deaths recorded in the special registry in 2010 was 374, and continues a declining trend observed in the previous four years (484 in 2009, 517  in 2008,  606 in 2007 and  551 in 2006). With regards to gender and age, 88.8 % of death cases were male, and the mean age at the time of death was 36 years. Slightly more than half of the DRD cases 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 Registry (DCSA) and the General Mortality Registry (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 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. 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, 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 2010, the total number of clients in substitution treatment was 103 584 of whom 85 047 were on methadone and 17 005 on buprenorphine. In 2010–11, the Department of Anti-Drug policy launched a pilot project to evaluate an outcome of opioid substitution treatment and its results to be presented to the Parliament.

View ‘Treatment profile’ for additional information.

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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

The Italian drug market is largely supplied by cocaine produced in Colombia, heroin from Afghanistan, marijuana and synthetic drugs from the Netherlands. As far as production is concerned, 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 2010, there were  22 064 anti-drug operations conducted by the police, that led them to 18 759 seizures of illegal drugs, and, unlike the trend reported in previous years, indicate a drop in the number of seizures. Police operations in 2010 enabled to seize 5 337 kg of herbal cannabis (8 098 kg in 2009, 2 400 kg in 2008), mainly in Liguria (30.4 % of the total volume) and Lombardy (14.7 % of the total volume).  Almost 6 000 police operations resulted in seizure of 20 141 kg of cannabis resin, which is comparable with seized amounts in 2008.  A growing trend continued in the number of seizures involving cannabis plants, however, the amounts seized were significantly below the record amounts registered in 2007 (71 988 plants in 2010 and 1 529 779 plants in 2007). The quantities of cocaine and heroin seized by the police were less than in 2009 (3 836 kg in 2010 and 4 073 kg in 2009 for cocaine; 944 kg in 2010 and 1 155  kg in 2010 for heroin). In 39 amphetamine seizures, 7 kg of the substance was seized, which indicates an increase, following a drop to 1 kg reported in 2008.

In 2010, a total of 72 072 persons were reported for being involved in drug-related offences. Out of which, more than half were related to cannabis , followed by those charged for cocaine-related offences and heroin-related offences.

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National drug laws

In Italy, the Consolidated Law, adopted by the Presidential decree No 309 on 9 October 1990 and further 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 have a duration of up to one year, increased from four months. The 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 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.

New psychoactive substances are also regulated through amendments to the above-mentioned Consolidated Law.

View ‘Legal profile’ for additional information.

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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. 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) a series of initiatives are envisaged. 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:

1. 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;
2. Technical and scientific guidelines are designed to provide methodological support in implementing the drugs strategy;
3. 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.

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Coordination mechanism in the field of drugs

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 tasked with 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 SerT (public services) and NGOs’ activities. Prevention and reintegration activities are assigned to provinces and municipalities.

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Public expenditure

In Italy drug action plans do not have associated budgets and there is no review of executed expenditure. Estimates of drug-related expenditure are also very limited. One recent study (¹), which aimed to estimate the social costs of drug use, included an estimate of public expenditure (²), but the methodology used was not detailed.

In 2009, the total drug-related public expenditure (¹) was estimated at representing approximately 0.25 % of GDP, with 53.4 % for law enforcement and 46.6 % for social and health care.

The available data do not allow reporting on trends in drug-related expenditure. A new estimate for drug-related public expenditure is foreseen for 2012.

(¹) See the National report of Italy (2011).

(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.

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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 2011 Italian National report mainly focused on aspects related to the prevalence of drug use and responses to the drugs situation and consequences of drug use.

View ‘Drug-related research’ for additional information.

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