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 | 2010 | 502 066 | 501 105 661 p | Eurostat | |
| Population by age classes | 15–24 | 2010 | 11.9 % | 12.1 % p | Eurostat |
| 25–49 | 38.6 % | 35.8 % p | |||
| 50–64 | 17.8 % | 19.1 % p | |||
| GDP per capita in PPS (Purchasing Power Standards) 1 | 2009 | 271 | 100 | Eurostat | |
| Total expenditure on social protection (% of GDP) 2 | 2008 | 20.1 % | 26.4 % p | Eurostat | |
| Unemployment rate 3 | 2010 | 4.5 % | 9.6 % | Eurostat | |
| Unemployment rate of population aged under 25 years | 2010 | 16.1 % | 20.9 % | Eurostat | |
| Prison population rate (per 100 000 of national population) 4 | 2009 | 137.6 | Council of Europe, SPACE I-2009 | ||
| At risk of poverty rate 5 | 2009 | 14.9 % | 16.3 % | SILC | |
p Eurostat provisional value.
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, 2009.
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).
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 recently 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 2005–06 survey indicated a lifetime prevalence of cannabis use of 25 % for 15-year old boys and 21 % for 15-year old girls, while the proportion of boys and of girls reporting recent use of cannabis significantly differed and was 13 % and 6 % respectively.
The ESPAD study has not been conducted in Luxembourg.
Prevention
The National Drugs Action Plan 2010–14 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. Drug prevention in school settings is seen as a priority and specific training for teachers is offered, and drug-related information and prevention modules are mandatory in school curricula. Trained psychologists may 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 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. The most recent developments include launch of CePT Toolbox to assist implementation of school-based prevention activities and publication of recommendations for educational professionals on how to address cannabis in the school environment.
Selective prevention focuses on avoiding social exclusion and on crisis interventions in schools. Besides CHOICE, an early intervention programme for juvenile first-time offenders, the selective prevention projects target polydrug use and the increasing use of alcoholic-mix drinks, as well as at-risk families. Selective prevention in recreational settings are anti-drug discos, art performances, adventure days, theatre, media materials, seminars, travelling exhibitions and travel experiences.
Problem drug use
In 1999, 2000 and 2007, a series of national estimates of the number of problematic drug users were carried out applying a variety of methods (the capture–recapture method, truncated Poisson and multiplier methods), and using data from a variety of sources. Problem drug use was defined approximately according to the EMCDDA definition. In 2007, the average estimate was 7.7 problem drug users per 1 000 inhabitants aged 15–64 (in total between 2 089 -3 199 problem drug users), representing a decrease compared to previous estimates. Results of a new serial PDU prevalence study on 2010 data will become available in 2011.
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 2009 was reported from 14 out of a total of 15 treatment centres, with a total of 350 treatment clients.
In 2009, among all clients entering treatment, opioids were the main substance used at 79.1 %, followed by 10.6 % for cannabis and 9.1 % for cocaine. 31 % of all clients entering treatment were aged more than 35 years, but 20 % were younger than 25 years. As far as gender distribution is concerned, 79 % of all clients were male, whereas 21 % were female.
Drug-related infectious diseases
Data on drug-related infectious diseases are collected at the national level through the National Retrovirology Laboratory of the CRP-Sante. Between 1984 and 2009, a total number of 946 persons with HIV has been registered, 117 of them were injecting drugs users (12.4 % of total), and this is the third most prevalent route of HIV transmission following homo/bisexual and heterosexual transmission.
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 2008, the prevalence rate of HIV infections based on self-reports was 1.8 % ( 3.5 % in 2007) 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 2005 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. In 2009, 14 confirmed cases are reported, which indicates an overall decline since early 2000. With regards to the distribution by age and sex, the majority of cases were male (71.4 %) and the mean age was 30.3 years. The toxicological examination confirmed presence of opiates (heroin and methadone) in more than three quarters of the DRD cases.
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, and a number of collaboration agreements between agencies were signed in 2008 and 2009 to ensure thorough care and rational use of available resources. 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 five specialised outpatient treatment centres, one residential therapeutic community and one specialised psycho-medical inpatient transition unit. 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 non-specialised residential centre admitting young problem drug users opened in 2007 in the north of the country. A dedicated psycho-social and medical care programme is operational in the national prison (CPL).
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, morphine-based medications, and heroin within the framework of a pilot project, as well as substitution treatment modalities. In 2009, the total number of clients in substitution treatment was 1 212, 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. 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 December 2009, 788 injectors had signed the mandatory user contract. More than 96 000injections were supervised at the facility by trained staff between June 2005 and December 2009. According to the national drug action plan 2005–09, a feasibility assessment of heroin assisted treatment (HAT) was conducted and it is expected that HAT will be introduced as a complementary treatment option in 2013.
The national HIV/AIDS action plan covering the period 2006 to 2010 launched by the Ministry of Health among other issues includes prevention of infectious diseases and harm reduction in drug-using populations. The new 2011–15 national HIV/AIDS action plan has been elaborated taking into consideration the recommendations of the external evaluation of the previous one.
The national needle exchange programme in Luxembourg is decentralised and consists of four fixed sites: drug counselling centres, drop-in centres for sex workers and populations-at-risk, low threshold services and four vending machines situated in the most affected towns throughout the country. One NSP is implemented in prison (CPL). Approximately one third of RELIS indexed injecting drug users procure clean syringes mainly from the pharmacies, and this proportion is estimated to be stable in the past years.
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 down to 260 000 syringes distributed in 2008, although in 2009, the total number of distributed syringes at fixed sites, through vending machines and in a prison programme increased up to 303 000.
Drug markets and drug-related offences
Data on seizures and drug-related offences are reported to the Réseau Luxembourgeois d'Information sur les Stupéfiants et les toxicomanies (RELIS) by the Specialised Drug Department of the Judicial Police Service (SPJ). Before 2007, a complete upgrade of the National Monitoring System regarding drug law offences was carried out. Inconsistencies with data provided before 2007 may be possible. The number of police records for presumed offences against the modified 1973 drug law show a stable trend between 1996 and 1998, an important increase between 1998 and 2003 (825 to 1 660) and stabilised since 2006 (1 200 in 2006, 1 372 in 2007, 1 219 records in 2008 and 1 305 records in 2009).
The number of drug law offenders (‘prévenus’) has declined from 1 368 in 1996 to 1 170 in 1998 followed by an increase in following years (peaked in 2003 with 2 271 offenders reported). From 2003 onwards, trends show a significant decline, however in 2009 an increase is observed again and in total 1 963 drug law offenders were reported. The majority of drug law offences relate to cannabis, followed by heroin and cocaine.
The number of seizures, for some drugs, has grown since the 1990s. Since the beginning of the century, the number of cannabis seizures has clearly increased but the number of heroin and cocaine seizures has tended to stabilise. Markedly, the number of cannabis seizures increased between 1994 and 2009 (167 to 772 seizures, respectively). However, quantities of seized herbal cannabis and cannabis resin are on the decline. This indicates that a majority of the cannabis seizures result in small quantities of a seized substance. Crack (cocaine-base) seizures have not been reported to date by national authorities. However, it appeared on the national market according to field agencies. The first national seizures of ecstasy-type substances (MDMA, MDA, etc.) were recorded in 1994. The availability of ecstasy appeared to soar between 1994 and 1996. However, in 2009 a record number of 9 478 ecstasy tablets were seized. Amphetamines are other substances seized in high amounts in 2009 (27 kg).
Variations have been observed as to the quantity of illicit substances seized, since the beginning of the 1990s. Data indicates a general decreasing tendency of the amounts of heroin, cocaine and cannabis seized until 2002. However, since 2002, data shows an increase in the quantity of drug seizures mainly concerning heroin and herbal cannabis. Quantity of cocaine seized is highly variable since the beginning of the 1990s. Compared to 2008 data, the quantities of drug seized of most substances listed soared in 2009, except for amphetamine, ecstasy and cannabis plants.
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 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.
Synthetic agonists of cannabinoids receptors (eg. CP-47,497) and mephedrone were put under national control in the Grand Duchy of Luxembourg in 2009 and 2010 respectively.
National drug strategy
Luxembourg’s ‘National strategy and action plan on drugs and drug addiction 2010–14’ is comprehensive, and its goal is to ensure a high level of health protection, public security and social cohesion. It focuses on illicit and non-illicit drugs, although it refers to separate thematic action plans (alcohol, tobacco, psychotropic medicaments, other addictions, etc.). The illicit drugs action plans covers two pillars — supply and demand reduction — and four transversal axes: risk, nuisance and harm reduction; information and evaluation; international cooperation and research; and horizontal coordination mechanisms. It includes 60 separate actions divided into seven fields: primary prevention; treatment and care; socio-professional reintegration; reduction of risks and damages; research/evaluation and information; supply reduction; and coordination and international relations. The new strategy builds upon the outcome of the external evaluation of the previous action plan. It is results-oriented and places a special focus on primary prevention, social reintegration, diversification and access to treatment, and quality management.
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, supervising 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 2010 Luxembourgish National report mainly focused on aspects related to monitoring problem drug use, responses to the drug situation and to prevalence, incidence and patterns of drug use.
