Country overview: Norway
- Situation summary
- Data sheet
- Barometer
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 | Norway | EU (27 countries) | Source | ||
|---|---|---|---|---|---|
| Population | 2008 | 4 737 171 | 497 455 033 | Eurostat | |
| Population by age classes | 15–24 | 2008 | 12.7 % | 12.6 % 1 | Eurostat |
| 25–49 | 34.9 % | 36.3 % 1 | |||
| 50–64 | 18.6 % | 18.4 % 1 | |||
| GDP per capita in PPS (Purchasing Power Standards) 2 | 2007 | 178.6 | 100 | Eurostat | |
| Total expenditure on social protection (% of GDP) 3 | 2006 | 22.6 % | 26.9 % p | Eurostat | |
| Unemployment rate 4 | 2008 | 2.6 % | 7 % | Eurostat | |
| Unemployment rate of population agends under 25 years | 2008 | 7.3 % | 15.5 % | Eurostat | |
| Prison population rate (per 100 000 of national population) 5 | 2006 | 67.8 | Council of Europe, SPACE 2006.1 | ||
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.
Drug use among the general population and young people
The most recent national survey on the use of alcohol and other substances in the general population aged 15 or older was conducted in 2004. The survey is repeated every five years. In 2004, 17 % of respondents aged 15–64 reported the use of any illegal substance at least once in their lives (lifetime prevalence rate). Lifetime prevalence rates among the same age group were 16.2 % for cannabis, 3.6 % for amphetamines, 2.7 % for cocaine, 0.7 % for heroin and 1.8 % for ecstasy. Among younger age groups, lifetime prevalence rates reached 26.8 % for any illegal drug (aged 15–34). The questions used in 2004 were compatible with the EMCDDA standard on general population surveys, and the next survey is planned for 2009.
The European School Survey Project on Alcohol and other Drugs (ESPAD) was regularly repeated in Norway since 1995 among students aged 15–16. A comparison of the data shows that while there was an increase from 1995 to 1999 in lifetime experience of illegal drugs, the latest data indicate a decrease. Lifetime prevalence rates of any illegal drug use other than cannabis, inhalants included, was 3 % in 1995, 6 % in 1999 and 3 % in 2003. The proportion stating that they had ever used cannabis (6 % in 1995, 12 % in 1999) decreased to 9 % in 2003. In 2007, 6 % had ever tried marijuana or hashish (9 % in 2003 and 12 % in 1999). In addition, the reported lifetime prevalence of cannabis use among males was 7 % and 5 % among females. In 2007, inhalants lifetime prevalence was reported by 7 % of the students, as regards other substances, lifetime prevalence were reported to be 1 %. Results also indicated 4 % for the last year prevalence of cannabis use (in 2003, it was 6 %) and 2 % for the last month prevalence of cannabis (3 % in 2003).
Prevention
The Directorate for Health is responsible for the coordination of the national prevention strategy. In 2006, the Directorate, in order to meet the need for a national strategy for early intervention in the drugs and alcohol field, drew up a proposal for a national strategy. Delivery of universal drug prevention programmes mainly falls under the responsibility of regional competence centres, together with local municipalities and NGOs working in the drug field. The implementation of curricular school-based prevention programmes is the overriding feature of these programmes. There is increasingly strong monitoring of programme content and coverage, and the components of many of the programmes in place are in line with international recommendations. Norway has increased research about, and evaluations of, school-based prevention programmes.
Selective prevention is mostly targeted at youths outside school through outreach work, and such initiatives benefit from considerable political and practical visibility. Recently, research and interventions have concentrated on the needs of immigrants with greater focus on violence-related problems and problem behaviour that can conceal problem drug and alcohol use. Selective prevention in recreational settings is carried out by municipalities, by many bottom-up associations with a focus on health promotion, through peer approaches and the provision of alternative leisure activities. Several new indicated prevention programmes for disruptive children and their families and for children from families with addiction problems have been implemented and evaluated.
Special characteristics of the prevention culture in Norway within the European context are: a strong promotion of quality-based approaches and evaluation; and the implementation of small-scale programme-based interventions through the local municipalities assisted by specialised competence centres and NGOs.
Problem drug use
Estimates can be given for intravenous drug use only. However, several existing data sources suggest that problem drug use is mostly constituted by injecting drug use in Norway. Norwegian IDU estimates were updated recently, but the overall trend remains unchanged. The number of intravenous drug users in Norway increased until 2001, after which it declined until 2003 and then flattened out. The most recent available data suggested that there were approximately 8 500 to 12 500 injecting drug users in Norway in 2006 (8 524–11 933 according to mortality multiplier method, corresponding to a rate of 2.8 to 3.9 per 1 000 inhabitants aged 15–64 with a central estimate of 3.3 per 1 000). The municipal survey method produces estimates which are higher, but the researchers believe that these figures are too high.
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
A registration system for treatment of clients with drug and alcohol problems has been established in Norway, and is based on a client registration form. Due to official regulations protecting personal information, each facility or institution only submits aggregated data to the national registration system. As a result, it is not possible to distinguish clients whose problems are primarily alcohol-related or drug-related. In addition, double counting of clients, that is those who were registered at several treatment facilities during the same time period, cannot be ruled out. In 2009, the inclusion of all admission in the interdisciplinary specialist health service in the Norwegian Patient Register started. It is expected that individual-based data can be reported from 2010.
Drug-related infectious diseases
In Norway, HIV infections are reported to the Norwegian Notification System for Infectious Diseases (MSIS), a national reporting system. The number of HIV cases among IDUs remains relatively low. In 2007, 248 new cases of HIV infection were reported of which 13 cases (5.2 %) were IDUs. The incidence of HIV among injecting drug users in the group has remained at a stable low level over the last decade with about 10–15 cases of HIV infection a year. Despite the relatively stable incidence of HIV among IDUs, the data show that there is an increased number of hepatitis A and B infections, and the high incidence of hepatitis C, show there is still extensive needle sharing.
In 2007, 60 hepatitis B cases (acute cases only) among IDUs out of a total of 118 cases were reported (50.8 %). In Oslo, small-scale annual prevalence studies have been conducted in recent years among current injecting drug users (those who have injected during the last 12 months). All IDUs attending free needle distribution centres in Oslo are also offered testing. In 2007, the results showed that 69 % were infected with HBV (222 persons tested). HBC is not monitored in Norway to the same extent as hepatitis A an B, and the number of new cases of drug users being infected with hepatitis C virus is therefore not known.
Drug-related deaths
Data on drug-related deaths are collected by two bodies: Statistics Norway (SSB), based on the General Mortality Register; and the special registry of the National Criminal Investigation Service (NCIS). The SSB data are based on medical examiners’ reports, autopsy reports and doctors’ declarations of deaths. The SSB data are coded according to ICD-10 and concern deaths directly caused by drugs. The data from the NCIS include cases of acute poisoning (overdoses) as well as deaths that are clearly related to drug abuse and are based on reports received from police districts around the country.
While both databases showed an upward trend in the second half of the 1990s the number of cases declined markedly from 2001 onwards (NCIS: 338 cases; SSB: 405 cases). Both databases are not compatible and the Ministry of Health and Care Services has requested the establishment of a uniform registration to better monitor developments in drug fatalities. The data from the NCIS are in line with the EMCDDA standard definition of special registries, which includes death due to poisoning by accident, suicide, homicide or undetermined intent.
In 2006, SSB recorded 251 deaths in comparison to 303 deaths reported for 2004. Both the SSB figures and the Kripos figures appear to indicate that, after the reduction following the peak years of 2000 and 2001, a certain stabilisation of the number of mortalities has occurred.
Treatment responses
Since the new reform in drugs policy from January 2004 onwards, the Norwegian state, represented by the regional health authorities, has been responsible for the treatment of problem drug and alcohol users. The aims of the reform are to provide better and more comprehensive treatment and to improve access to health services. Treatment is mainly financed by public funds. In addition, the Ministry of Labour and Social Inclusion, the Ministry of Health and the Care Services have extraordinary funds at their disposal for the development of special high priority efforts in the areas of epidemiology, research, prevention and treatment.
Drug-free treatment aimed at achieving a future drug-free life is the main approach adopted by the majority of Norwegian treatment programmes. The majority of treatment services accessible for problem drug users, whether outpatient or inpatient, are aimed at dealing with addiction in general and not specifically for users of illicit drugs. A wide range of different treatment and care programmes exist in Norway, these can be classified into four levels namely; outpatient functions and assessment units, detoxification, inpatient treatment of less than six months and inpatient treatment of more than six months.
In Norway, substitution treatment using methadone has been available nationwide since 1998, and since 2001 also buprenorphine. Substitution treatment is carried out under the auspices of, or by, regional centres. However, responsibility for application and follow-up lies with the municipal health and social services. Regulation 24 of April 1998, No 455 Article 2-1 (3)d stipulates that both methadone and buprenorphine substitution treatment can be initiated and administrated by treatment centres. Specialised GPs play an important role in the provision of opioid substitution treatment but can only operate within strict shared care arrangements with specialised drug treatment centres.
At the end of 2007, a total of 5 058 clients were in opioid substitution treatment, 61 % of whom were on methadone.
Harm reduction responses
Interventions in the area of harm reduction in Norway broadly include needle distribution programmes, low-threshold health measures and outreach work.
In Norway, the municipalities have chosen to organise their low-threshold services on the basis of local needs and challenges. Some of them have developed the services in cooperation with voluntary organisations, while others are based in the health and social services. In 2007, an estimated 3.3 million syringes were distributed to injecting drug users in 11 of the 23 municipalities for which such services were available. Several municipalities have established a field nursing service involving considerable outreach activity. The services offered are health checks, nursing of sores, vaccinations, distribution of user equipment, nutritional and hygiene guidance, prevention of overdoses, advice and guidance, follow-up and referral to other parts of the health service etc.
In major cities and some municipalities, distribution/exchange programmes exist, often using a combination of self-service dispensers, outreach services and low-threshold points of contact. Schemes may also involve cooperation with the health services. In addition, almost all pharmacies in Norway sell needles and syringes to injecting drug users.
Furthermore, a drug injecting room in the centre of Oslo, established under a temporary act as a trial in 2004 and operational from February 2005, has been made permanent in 2009. Only hardcore heroin injectors above the age of 18 are eligible to use the facility. Until February 2007, 409 persons had been registered as users and 17 226 supervised consumptions been registered. The outcome of the trial showed that the facility provided improved options for contact with a ‘hard to reach’ target group. Safer use education and individual advice by trained staff are likely to have made a limited contribution to preventing infections. The room’s capacity of 24 supervised injections per day limited the measurement of its outcomes with regard to contributing to the prevention of drug-related deaths in the city.
Drug markets and drug-related offences
According to the Norwegian Customs, most of the amphetamine and methamphetamine in Norway comes from illegal laboratories in Russia, Poland and Lithuania. Lithuania has taken over the role of main supplier of synthetic drugs such as amphetamine, methamphetamine and rohypnol to Norway. Poland and the Netherlands are still important source countries, but the majority of those arrested are Lithuanians. Until last year, the main routes from Lithuania and Poland were through Germany and Denmark to the Øresund Bridge and on through Sweden to Norway. In 2007, there was a shift towards the Baltic car ferries. Cannabis mostly comes to Norway from Morocco via two main routes, namely Spain and Italy up to the Netherlands, and Germany and on to Denmark and Norway. Heroin comes from Pakistan and Afghanistan via two northerly routes via Bulgaria and Romania, Ukraine and Russia, and then to Poland and Lithuania. Two southerly routes go through Greece and the Balkans to the Netherlands and Germany. Furthermore, cocaine enters from South America to Spain and from there to the Netherlands and Germany before continuing up through Denmark to Norway.
Data on drug seizures is provided by the Norwegian National Bureau of Crime Investigation. It is interesting to note that the number of methamphetamine seizures tripled in the last six years from a total of 392 methamphetamine seizures in 2001 to a total of 1 284 methamphetamine seizures in 2007. On the other hand, the number of heroin seizures decreased substantially in the last six years. From a total of 2 501 heroin seizures in 2001 to a total of 1 204 heroin seizures in 2007. With regards to the quantities of seized drugs, a substantial increase was reported in the amount of seized ecstasy between 2006 to 2007 with 28 636 tablets in 2006 to a total of 78 725 seized ecstasy tablets in 2007. A substantial increase in the quantity of seized amphetamine and methamphetamine was reported over the last six years. In 2001, a total of 93 kg of amphetamine was seized whereas in 2007 a total of 392 kg of amphetamine was seized. With regards to methamphetamine in 2001, a total of 16 kg of methamphetamine was seized, as compared to 167 kg, seized in 2007.
National drug laws
In Norway, there are no separate laws relating only to illicit drugs. The use and possession of minor quantities of drugs fall under the provision of the Act on Medicinal Products. Penalties comprise fines or imprisonment for up to six months. The manufacture, acquisition, import, export, storage and trafficking of narcotic drugs are prohibited by the Penal Code §162, and here the penalty for drug offences is fines and/or imprisonment of up to two years. An offence may also be aggravated, following a special evaluation which will consider what type of substance is involved, its quantity and the nature of the offence. Aggravated drug felonies are punished by up to 10 years’ imprisonment. If a ‘considerable quantity’ is involved the term of imprisonment may be 3–15 years, and ‘very aggravating circumstances’ may give rise to up to 21 years' imprisonment. Nevertheless, in Norway, the Act on sentence execution § 12 allows for voluntary treatment as an alternative to a prison sentence. This decision is made by the governor of the Prison Service Institutions, while the overriding responsibility lies with the Correctional Services (of the Ministry of Justice and the Police). A trial scheme for a drug treatment programme under court control started in 2005. This trial scheme is under evaluation before eventually becoming permanent. A temporary Act relating to injection rooms, which may be established by individual municipalities, has been made permanent in 2009.
National drug strategy
The former Norwegian Government’s ‘Action plan to combat alcohol and drug-related problems 2003–05’, was recently replaced by a new ‘Action plan for the drugs and alcohol field’ which was launched in October 2007. This plan runs until 2010, is comprehensive and covers both alcohol and illicit drugs. The main aim is to raise professional standards through research and strengthening competence and quality, while the overriding goals are: (1) A clear public health perspective; (2) better quality and increased competence; (3) more accessible services and increased social inclusion; (4) binding cooperation; and (5) increased user influence and greater attention to the interests of children and family members. The plan assigns chief responsibility for each measure to a specific body, which will be responsible for instigating the measure and involving other parties.
Coordination mechanism in the field of drugs
The Ministry of Health and Care Services is responsible for the overall coordination of the alcohol and drug policy, while each ministry is responsible for its respective areas. The Department of Public Health, Section for Alcohol and Drug Policy, is responsible for the overall day-to-day coordination of the alcohol and drug policy.
The Directorate for Health is the Government’s primary advisor in health and social affairs matters. The Directorate is responsible for coordinating the national prevention efforts. Its most important responsibility is to ensure that adopted health and social affairs policies are implemented in accordance with the Ministry’s guidelines.
The municipalities are responsible for drug prevention and care services for drug addicts. Five regional health authorities are responsible for providing the necessary specialist health services to the population in their respective regions.
Drug-related research
Norway’s drug-related research covers drugs, alcohol and tobacco, and to a certain extent, also gambling. Research into drugs and alcohol is one of the priorities of the government’s investment in research and falls within the objectives of improving quality and developing skills in the drugs and alcohol field. The main funding sources are, therefore, governmental departments, partly through the Research Council of Norway, and partly through the Directorate for Health and the municipalities. Research is mainly conducted by SIRUS, the Norwegian Centre for Addiction Research — SERAF and The Institute of Public Health (biomedicine). To some extent such research is also carried out at some university departments, and private funded research institutes. Several websites, including the SIRUS (national focal point) website, disseminate research findings along with scientific and non-scientific national and international journals.