• 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

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 2009. The survey is repeated every five years. In 2009, lifetime prevalence rates among 1 624 respondents aged 15–64 were 14.6 % for cannabis, 3.8 % for amphetamines, 2.5 % for cocaine, 1.0 % for ecstasy and 0.9 % for LSD. Among younger age groups (aged 15–34), lifetime prevalence rates for cannabis use reached 21.9 %, amphetamines 6.0 %, cocaine 4.2 %, ecstasy 2.1 % and LSD 1.5 %. Around 3.8 % of all adults reported use of cannabis within the past year (4.6 % in 2004), while the last 12-month prevalence of cannabis use among 15–34 year olds was 7.0 % (9.6 % in 2004). Recent cannabis use (within the last 30 days) was reported by 1.6 % of all adults aged 15–64 (2.2 % in 2004) and 2.1 % of 15–34 year olds (4.5 % in 2004). The results indicate that there is relatively strong decline since 2004 in the proportions of those who report using cannabis in past 12 months and past 30 days, especially among those aged 15–34.

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 was 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).

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Prevention

The Directorate of 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, integration of prevention activities into child welfare services and promoting access to healthcare services. In 2009, a training package for the child welfare services staff on how to implement early interventions was published. Outreach services are funded through the municipal grant programmes. Lately, the researches and interventions have concentrated on the needs of immigrants, children with behavioural problems and young cannabis smokers. 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.

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Problem drug use

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 injecting drug users in Norway increased until 2001, after which it declined until 2003 and then flattened out to a level of 8 810 to 12 480 injecting drug users in 2008. The most recent available estimates suggested that there were approximately 6 600 to 12 300 problem heroin drug users, including both injection and smoking in 2008, corresponding to a rate of 2.1 to 3.9 per 1 000 inhabitants aged 15–64 with a central estimate of 3 per 1 000).

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

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.

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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 2009, 282 new cases of HIV infection were reported, of which 11 cases 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 approximately 10–15 cases of HIV infection a year. Since 1984, approximately 13 % of the total number of registered HIV positive persons have injecting drug use as a risk factor. Despite the relatively stable incidence of HIV among IDUs, the data show that there is an increase in the number of hepatitis A and B infections, and the high incidence of hepatitis C indicates that there is still extensive needle sharing.

In 2009, 23 hepatitis B cases (acute cases only) among IDUs out of a total of 52 cases with known transmission route were reported (44 %). All IDUs attending free needle distribution centres in Oslo are also offered HBV testing. In 2009, the results showed that 36.9 % were infected with HBV (179 persons tested). The HCV notification system was launched in 2008 and contains data on all laboratory-confirmed hepatitis C cases regardless of whether the case is acute or chronic. In 2009, 2 323 HCV cases were reported, but only for 1 192 cases information on risk factors was provided. Among those cases where the transmission route was known, 1 018 (85.4 %) were infected through needle sharing.

In 2009, results of testing of injecting drug users in contact with health services indicate HIV prevalence at 2.4 % (4 559 tested clients) and hepatitis C virus prevalence at 72.9 % (4 151 tested clients).

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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 (Kripos). 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 Kripos 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 (Kripos: 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 Kripos are in line with the EMCDDA standard definition of special registries, which includes death due to poisoning by accident, suicide, homicide or undetermined intent. Data from Statistics Norway is also in line with the EMCDDA standard definition Selection B.

In 2008, SSB recorded 263 deaths in comparison to 275 deaths reported for 2007, 251 deaths reported for 2006 and 234 deaths reported for 2005. Both the SSB figures and 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. Toxicological analysis confirms that 95 % of DRD in 2008 involved opiates.

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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. In Norway, all treatment options are directed to problem users of alcohol, medicines and drugs. 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.

The majority of treatment services accessible for problem drug users, whether outpatient or inpatient, is 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 administered 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. In 2010, new National guidelines for opioid substitution treatment of opioid dependency came into force. These guidelines aim to increase nationwide access to OST as part of comprehensive treatment and the rehabilitation process.

At the end of 2008, a total of 5 383 clients were in opioid substitution treatment, 2 998 of whom were on methadone, but 2 385 received a buprenorphine/naloxone combination.

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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 2009, there were approximately 30 fixed needle and syringe exchange sites, some also including mobile units.

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. According to a 2009 survey, an estimated 3.1 million syringes were distributed to injecting drug users in 14 of the municipalities that responded to the survey. 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 December 2009, 1 664 persons had been registered as users and 49 272 visits had 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.

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Drug markets and drug-related offences

According to the Norwegian Customs, most of the amphetamine and methamphetamine in Norway comes from illegal laboratories in the Netherlands, Poland and Lithuania. This last country has taken over the role of main supplier of synthetic drugs such as amphetamine and methamphetamine. The main routes from Lithuania and Poland go by ferry via Sweden or through Germany and Denmark. 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 Afghanistan via Turkey and along the so-called Balkan route to Western Europe. It then goes to the Netherlands and Germany. Furthermore, cocaine enters from South America through African countries or directly through ports and airports in Europe.

Data on drug seizures is provided by the Norwegian National Bureau of Crime Investigation. Cannabis is the most frequently seized drug in Norway. In 2009, 9 883 cannabis resin, 1 648 herbal cannabis and 205 cannabis plants seizures were reported. Cannabis is followed by amphetamines and methamphetamines. Data available show that the number of methamphetamine seizures increase about ten-fold in the last nine years from a total of 392 methamphetamine seizures in 2001 to a total of 3 720 methamphetamine seizures in 2009. The number of heroin seizures decreased substantially (42 %) in the last two years, from a total of 1 987 heroin seizures in 2006 to a total of 1 145 heroin seizures in 2008, but in 2009, the number of heroin seizures raised to 1 430 again. With regards to the quantities of seized drugs, a substantial increase was reported in the amount of ecstasy seized between 2006 to 2007 with 28 636 tablets in 2006 to a total of 78 725 seized ecstasy tablets in 2007, however, the quantity decreased to 61 % in 2008 (30 678 tablets) and continues a declining trend also in 2009 (22 449 tablets). A substantial increase in the quantity of amphetamine and methamphetamine seized was reported over the last seven years. In 2001, a total of 93 kg of amphetamine was seized whereas in 2007 a total of 392 kg of amphetamine was seized, although in 2008–09 quantities of seized amphetamines reduced to 260 kg and 197 kg respectively. With regards to methamphetamine in 2001, a total of 16 kg of methamphetamine was seized, when compared to 234 kg seized in 2009. The quantities of seized heroin rose significantly up to 130 kg seized in 2009, and it is the largest annual quantity of heroin ever seized.

A total of 39 280 drug-related offences were reported in 2009, which is a slight increase from 2008 when 37 488 drug related offences were registered. The proportions of use-related and supply-related offences were almost equal, 48.7 % and 47.4 % respectively.

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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 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.

In 2010, a list of narcotic substances was amended by adding 11 new drugs, which means that import, export or production of these drugs are controlled under the Regulations related to narcotics.

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National drug strategy

The former Norwegian Government’s ‘Action plan to combat alcohol and drug-related problems 2003–05’, was replaced by a new ‘Action plan for the drugs and alcohol field’ which was launched in October 2007 and initially was intended to run until 2010; however, it was proposed that the period of the plan is to be extended until the end of 2012. This plan 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.

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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 of 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.

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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 of Health and the municipalities. Research is mainly conducted by the Norwegian Institute for Alcohol and Drug Research (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 privately 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. Recent drug-related studies mentioned in the 2010 Norwegian National report mainly focused on aspects related to consequences of drug use but also included studies on the prevalence of drug use and on responses to the drug situation.

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