Country overview: Luxembourg
- Situation summary
- Data sheet
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 | Luxembourg | EU (27 countries) | Source | ||
|---|---|---|---|---|---|
| Population | 2008 | 483 799 | 497 455 033 | Eurostat | |
| Population by age classes | 15–24 | 2008 | 11.8 % | 12.6 % 1 | Eurostat |
| 25–49 | 38.7 % | 36.3 % 1 | |||
| 50–64 | 17.3 % | 18.4 % 1 | |||
| GDP per capita in PPS (Purchasing Power Standards) 2 | 2007 | 266.5 | 100 | Eurostat | |
| Total expenditure on social protection (% of GDP) 3 | 2006 | 20.4 % | 26.9 % p | Eurostat | |
| Unemployment rate 4 | 2008 | 4.4 % | 7 % | Eurostat | |
| Unemployment rate of population agends under 25 years | 2008 | 16.3 % | 15.5 % | Eurostat | |
| Prison population rate (per 100 000 of national population) 5 | 2006 | 163.6 | Council of Europe, SPACE 2006.1 | ||
| At risk of poverty rate 6 | 2006 | 14 % | 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
To date, no representative large-scale general population survey on the use of psychoactive substances has been conducted in the Grand Duchy of Luxembourg.
Comparable data from national school surveys (HBSC, 2000) conducted in Luxembourg between 1992 and 2000 show increasing lifetime prevalence in young people aged 16–20 for all common illegal substances. In particular, lifetime prevalence of cannabis increased from 9.3 % in 1983 to 38.9 % in 1999 among 16–20-year olds. Lifetime prevalence rates for ecstasy increased from 1.2 % in 1992 to 5.2 % in 1999 in the same age group. Increases in lifetime prevalence rates for other drugs (opiates, cocaine) were less pronounced or even showed a decline (amphetamines). Results of the HBSC 2002 survey indicated a lifetime prevalence of cannabis use of 28 % and 4 % for inhalants/volatile substances among students.
The ESPAD study has not been conducted in Luxembourg.
Prevention
The national drugs action plan 2005–09 addresses primary prevention as a main intervention area in Luxembourg. Two important actors in the field of primary drug prevention are The National Prevention Centre on Drug Addiction (CePT) and the Division of Preventive Medicine of the Directorate of Health.
The main objectives and features of universal prevention policy are based on information provision and a holistic perspective, which is not substance-specific, targeted at school settings. Even though the implementation of curricular school-based prevention programmes are not mandatory in the curriculum, drug prevention in school settings is seen as a priority and a two-year training module for teachers was offered. Trained psychologists are supposed to detect, at the very early stage, problems or behaviours in relation to substance abuse. The project ‘OUT-TIME’ links drug prevention to adventure pedagogical instruments and focuses on pupils in 5th and 6th classes of primary schools. Target groups are educational staff, pupils and parents. The methodology of the project is based on the hypothesis that youngsters, who are physically in a good shape, are mentally challenged and who can rely on stable orientation marks such as empathic parents show a lower probability to use (abuse) drugs. The annual ‘adventure weeks’ aim to provide the opportunity to youngsters to experience group dynamics, conflict management, limit and risk assessment as well as the feeling of solidarity within a group of socially and culturally different people. The programme further aims at the reduction of risk factors and the enhancement of protection factors, by focusing on youngsters and their environment, rather than on drugs and addiction. Selective prevention focuses on avoiding social exclusion and on crisis interventions in schools. Besides CHOICE, an early intervention programme for juvenile first-time offenders, a major target is polydrug use and the increasing use of alcoholic-mix drinks. Furthermore, special attention is given to youngsters and to the local Portuguese community. In the framework of the EU PIC-Equal programme, a project on ethno-specific prevention measures is about to be set up that focuses on linguistic and sociocultural specificities of ethnic minorities and, in particular, Portuguese natives. Selective prevention in recreational settings are anti-drug discos, art performances, theatre, media materials, seminars, travelling exhibitions and travel experiences.
Problem drug use
In 1999 and 2000, a series of national estimates of the number of problematic drug users were carried out applying a variety of methods (the capture–recapture method and multiplier methods), and using data from a variety of sources. Problem drug use was defined approximately according to the EMCDDA definition. In 2000, the average estimate was 9.9 problem drug users per 1 000 inhabitants aged 15–64. This estimate is outdated, however, based on the information from a series of indicators, the country does not expect a significant change since 2000.
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
In 1995, the national focal point implemented a multi-sector national drug monitoring system based on both private and public network partners. This network system was named Réseau Luxembourgeois d’Information sur les Stupéfiants (RELIS). The data on treatment demand for 2007 was reported from seven treatment centres, with a total of 376 treatment clients and 34 new treatment clients.
In 2007, among all clients entering treatment, opioids were the main substance used at 76.9 %, followed by 11.8 % for cocaine and 5.6 % for cannabis. 33 % of all clients entering treatment were aged more than 35 years. As far as gender distribution is concerned, 73 % of all clients were male, whereas 27 % were female.
Drug-related infectious diseases
Data on HIV prevalence rates among drug users are available through the multi-sector national network (RELIS) and are based on voluntary self-reports. In 2007, the prevalence rate of HIV infections based on self-reports was 3.5 % (2.76 % in 2006) among current injecting drug users (IDUs) (= injecting drug use in the last 12 months) in contact with drug treatment centres, low-threshold services, hospitals, drug units at prisons and the drug unit of the judicial police.
A recent study on ‘Prevalence of hepatitis B and C and HIV infections among problem drug users in Luxembourg’ (Origer, A., Removille, N. (2006)) assessed for the first time nationally the serology-based prevalence rate of 71.4 % for HCV, 21.6 % for HBV and 2.9 % for HIV.
Drug-related deaths
In Luxembourg, the Special Registry for drug-related deaths is located in the drug unit of the Judicial Police (SPJ) which maintains a register of all direct overdose cases due to illegal drug use documented by forensic evidence. The General Mortality Registry is located in the Statistical Department of the Directorate of Health, which indexes all deaths according to ICD-10 that have occurred on the national territory, by means of death certificates provided by GPs.
The number of fatal overdoses registered by the special registry showed an increasing trend from 1997 (nine cases) to 2000 (26 cases), decreasing anew to an almost historical low level of eight cases in 2005. A new upward trend was observed from 2006 onwards with 19 confirmed cases and 27 confirmed cases for 2007. Forensic data from 2007 suggested that opiates were involved in 100 % of all the cases. Acute ecstasy-related deaths have not been reported in Luxembourg. As regards the distribution by age and sex, the majority of cases were male (74.1 %) and the mean age was 32.4 years.
Treatment responses
All drug treatment infrastructures in Luxembourg, general hospitals excluded, rely on governmental support and control. Most specialised agencies have signed a convention with the Ministry of Health, which guarantees their annual funding. NGOs involved in drug treatment fall under the obligations of the so-called ‘ASFT’ law (8/09/98) and the subsequent Grand-ducal Decree of 10 December 1998, both regulating the relation (duties and rights) between the State on one side, and NGOs or organisations providing psycho-medico-social and therapeutic care on the other. The overall management of the agencies is ensured by a ‘coordination platform’ that includes three members of the concerned institution, and at least one representative from the competent ministry. All major decisions must be approved by the coordination platform. All institutions work in close collaboration and could be viewed as an interdependent therapeutic chain, even though there are no formal agreements between them. With the exception of detoxification departments, all treatment units or agencies accept any drug-using patient, irrespective of the type of substance(s) that are involved.
Detoxification treatment is provided by five different hospitals via their respective psychiatric units. There are a total of six outpatient treatment centres and one residential therapeutic community. The programme within the residential therapeutic community is divided into three progressive phases, and the duration varies from three months up to a year. A new specialised residential centre for young problem drug users opened in 2007 in the north of the country.
Substitution treatment is mainly delivered through office-based medical doctors. In addition, there is a structured substitution treatment programme of the ‘Jugend an- Drogenhëllef’ Foundation which mainly provides liquid oral methadone. Until the beginning of 2001, there was no legal framework regulating drug substitution treatment. In 2002, the Grand-ducal Decree on substitution programmes of 30 January 2002 was approved, which regulates drug substitution in general by means of substitution treatment licences granted to specialised medical doctors and specialised agencies. The new legal framework lists medicines for substitution, including methadone, buprenorphine and morphine-based medications, as well as substitution treatment modalities. In 2007, the total number of clients in substitution treatment was 1 092, with 95 % of the clients receiving methadone maintenance treatment and the rest, high-dosage buprenorphine treatment.
Harm reduction responses
Since 2001, when the basic drug law of 1973 was amended, a legal framework for a series of harm reduction and maintenance measures, such as substitution treatment and needle exchange, has been established. Nevertheless, harm reduction interventions were initiated and developed prior to the new legal framework. The law amendment in 2001 allowed for the maintenance and further development of existing interventions, as well as the implementation of new services such as drug consumption rooms and medically-assisted heroin distribution, which is currently under discussion. In July 2005, the first injection room at national level has become operational and has been integrated in the low-threshold emergency centre for drug users. By July 2008, 586 injectors had signed the mandatory user contract. In the first seven months of 2008, a total of 14 500 injections were supervised at the facility by trained staff, representing a significant increase from previous years.
In May 2006, a new national HIV/AIDS action plan covering the period 2006 to 2010 was launched by the Ministry of Health. The action plan is based on eight pillars including prevention of infectious diseases and harm reduction in drug-using populations.
The national needle exchange programme in Luxembourg is decentralised and consists of drug counselling centres, drop-in centres for sex workers and populations-at-risk, low threshold services and five automatic dispensers situated in the most affected towns throughout the country. Syringes are provided by specialised agencies, vending machines and pharmacies. NSPs are also being implemented in prisons. A downward trend regarding the sale of syringes by pharmacies has been observed since 1997, and drug agencies have gained importance with regard to the distribution of syringes. Another step has also been the Grand-ducal Decree of December 2003, which regulates the national syringe distribution programme by defining facilities and the professionals authorised to provide syringes to drug users.
The number of sterile syringes distributed in the framework of the national needle exchange programme has been constantly rising from its first implementation in 1993 (76 000) to 2005 (435 000 syringes) but has strongly decreased thereafter, reaching a total of 287 347 syringes in 2007. Syringe return rates are high (93 % in 2006) and have witnessed a steady upward trend from previous years.
Drug markets and drug-related offences
Data on seizures and drug-related offences are reported by the Specialised Drug Department of the Judicial Police in Luxembourg. In 2007, 282 drug-related offences were registered, with 33.7 % for heroin-related offences followed by 33 % for cannabis-related offences and 30.1 % for cocaine-related offences.
In 2007, the quantities of seized cannabis decrease considerably when compared to 2006. In 2006, 5 kg of cannabis resin were seized whereas in 2007, 0.5 kg of cannabis resin was seized In 2007, a decrease was also reported in the quantity of cocaine seizures when compared to 2006. In 2007, 3 kg of cocaine were seized, whereas in 2006, 4 kg of cocaine were seized. The quantity of heroin seizures remained the same in 2006 and 2007 with a total seized quantity of 9 kg.
Ecstasy-type substances were first seized in 1994, and in terms of number of seizures in 2007, the number of seizures decreased by half when compared to 2004 and 2005. In 2007 there were a total of seven ecstasy seizures whereas in 2004 and 2005 there were 14 ecstasy seizures. In 2007, the quantity of seized ecstasy also decreased when compared to 2006, with a total of 145 seized ecstasy tablets in 2007 to a total of 555 seized ecstasy tablets in 2006.
National drug laws
In 2001, the national drug law was amended to make the use of cannabis an illegal activity that will result in a fine; there is no prison sentence if there are no aggravating circumstances (e.g. use in schools). Users of other illicit substances risk between eight days and six months of imprisonment and/or a fine. Prosecution may be halted or penalties reduced in cases where a drug user has taken all the steps to seek immediate, specialised help.
The law does not foresee a difference between small-scale and large-scale drug deals or distribution. The respective sentences currently range from one to five years’ imprisonment and/or a fine, while imprisonment of 5–10 years is foreseen if the distributed drug has caused severe damage to health (e.g. incurable diseases). If the drugs had fatal consequences for the user, the punishment may increase to 15–20 years.
National drug strategy
Luxembourg’s ‘National strategy and action plan on drugs and drug addiction 2005–09’ is comprehensive, and its goal is to ensure a high level of health protection, public security and social cohesion. It focuses on illicit drugs, covers two pillars — supply and demand reduction — and four transversal axes: risk, nuisance and damage reduction; research and information; international relations; and horizontal coordination mechanisms. It includes 43 separate actions divided into seven fields: primary prevention; treatment and care; socio-professional reintegration; reduction of risks and damage; research/evaluation and information; supply reduction; and coordination and international relations.
Coordination mechanism in the field of drugs
Coordination among the competent ministries takes place via the Inter-ministerial Commission on Drugs (ICD), chaired, since 2006, by the national drug coordinator. It is composed of senior delegates from the main governmental departments, the Ministry of Health and invited experts and constitutes the top decision level with respect to coordination and orientation of drug actions. Both the ICD and the Ministry of Health are responsible for the implementation of national drugs strategies and action plans, supervise field activities and are responsible for guaranteeing an effective consultation process with other involved ministries (e.g. justice, foreign affairs).
Drug-related research
The current national drug action plan explicitly refers to research as an integrated part of the transversal axes of demand and supply reduction. Research domains include a wide variety of areas and the national focal point is the national reference centre for drug-related research. It also manages most of the available funds in this area, together with the National Research Fund and the National Fund against Drug Trafficking. Other relevant research actors include the National Prevention Centre for Drug Addiction, university departments and external experts. The national focal point also disseminates research information through its website and presents new research studies to the national press. Research findings also play an important role in training programmes for professionals in this area. Recent drug-related studies mentioned in the 2008 Luxembourgish National report mainly focused on aspects related to consequences of drug use.