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Drug situation

Treatment demand indicator

The treatment demand indicator (TDI) measures the yearly uptake of treatment facilities by the overall numbers entering treatment for drug use, and by the numbers amongst these of people entering for the first time (treatment incidence). Information on the number of people seeking treatment for a drug problem provides insight into general trends in problem drug use and also offers a perspective on the organisation and uptake of treatment facilities. Treatment demand data come principally from outpatient clinics' treatment records.

Overview

Tables present information on the number of people seeking treatment for drug use. This data provide insight into general trends in drug use and also offer a perspective on the organisation and uptake of treatment. Treatment demand data come from each country with varying degrees of national coverage, principally from outpatient and inpatient clinics treatment records (Table TDI-1, Table TDI-2).

In 2006, 19 European countries reported data on 4208 (1) outpatient units and 304742 clients; 17 EU countries and Turkey reported data on 7471 inpatient units covering 32434 clients; 12 countries reported data on 6961 other types of treatment units (low threshold agencies, treatment units in prison, general practitioners) and 23420 clients. According to the available data on the number of treatment units existing by country, those units cover around 78.4% of existing outpatient, 59.5% of inpatient and 74.2% of other type of units(2). For other types of facility there is limited information from the countries on their reporting coverage. It is important to take into consideration that the coverage ratio only refers to countries where data are available both on the number of existing treatment units in the country and on the number of treatment units included in the data collection (14 countries for outpatient and 14 for inpatient and 10 for other units, see Table TDI-7).

Tables TDI-1 to TDI-8 are based on data from all types of treatment centres concerning new clients and all clients; they present the current situation for 2006 data and the trend for the last 10 years (1996 to 2006) where data are available (Sources: the EMCDDA standard tables ST.03 and ST.04).

Tables TDI-9 to TDI-24 report data on clients’ characteristics and patterns of drug use from outpatient and inpatient treatment centres. In particular, they report data on age and gender, primary drug for seeking treatment, age at first use of primary drug, frequency of use of primary drug, educational level, labour and living conditions. Some tables only refer to outpatient treatment clients (Tables TDI-9 on age and gender distribution, TDI-17 on route of administration and TDI-23 on polydrug use).

Tables TDI-25 to TDI-33 describe the age distribution, mean age and the age at first use of the primary drug among male and female clients.

Tables TDI-34 and TDI-35 describe drug clients treated in prison units for 4 countries providing data in those treatment settings.

Tables TDI-36 to TDI-38 describe drug clients entering treatment for primary use of amphetamines or ecstasy.

Tables TDI-39 and TDI-40 provide the first results of a pilot project on treatment prevalence, which include people in continuous treatment in nine countries.

Tables TDI-102 to TDI-115 are large tables reporting detailed data by country and by primary drug. In particular:

  • Tables TDI-102 to TDI-109 and Tables TDI-111, TDI-112 present a breakdown by country of the summary Tables TDI-10, TDI-11, TDI-18 on age distribution, age at first use and frequency of use by the primary drug of clients entering treatment;
  • Tables TDI-113 to TDI-115 focus on drug sub-type for opioids (heroin, methadone, other opiates) and cocaine (cocaine HCl and crack).

Figures TDI-1 to TDI-7 are graphics on trends and characteristics of drug treatment clients in Europe.

Summary points

Treatment in profile

Cooperating agencies in 23 countries submitted data for 2006, reporting overall 354377 requests for treatment during the year, excluding clients in treatment continuing from previous years. Out of them, there were 141437 new demands for drug treatment, which represents more than one third of the total number of clients (Table TDI-2 part (i), part (ii)).

Demands were made by 47 new clients in every 100000 inhabitants aged 15–64 in the European Union Member States and Turkey. Marked differences are found between countries in the incidence of drug clients: from 3 to 148 per 100000 inhabitants. Differences in the incidence are related to countries’ variation in data coverage as well as treatment availability and extent of problematic drug use (Table TDI-6).

Out of the reported data(3), 87% of treatment demands are reported from outpatient treatment, 9.3% from inpatient treatment and the remaining 3.7% from other types of treatment units (low threshold agencies, treatment units in prison, general practitioners and other types of treatment services). It has to be noted that while 19 countries are reporting data from outpatient units, 17 countries are reporting data from inpatient units and 12 countries are reporting data from other types of units. Therefore, this reflects both a better level of data coverage in outpatient centres and the organisation of the treatment system in most European countries (Table TDI-7).

Male drug users predominate among all clients, but with male to female ratios varying greatly between countries. Gender ratio among clients in 2006 varies approximately from 2 males for every female in Czech Republic, Hungary and Finland and to 7 males for every female in Cyprus and Italy. There appears also to be a wide variation in primary drug of use by gender: among drug clients entering outpatient treatment for primary cannabis use there are 5 men clients for every woman, while among clients entering treatment for hypnotics and sedatives there is only 1 man for every woman. However, figures for hypnotics and sedatives are quite low (TDI-5 part (i), TDI-21).

Most clients are aged 20 to 30, with a mean age varying between 22 in Latvia and 34.6 in The Netherlands. (Tables TDI-4 part (i), TDI-5 part (i)).

In 2006, the treatment requests from 23 countries comprised 47% for heroin treatment requests, 16% for cocaine and 21% for cannabis. These proportions differ widely between countries. Among new demands for drug treatment in 23 countries, 34% were due to heroin, 28% to cannabis, 24% to cocaine and 6% to stimulants other than cocaine (Figure TDI-2).

Trends in reported treatment demands

The number of reporting agencies increased from 2176 in 1996 to 5651 in 2006, with a slight decrease in 2004 and 2005 (Table TDI-2 part (iii)).

Total reported treatment demands increased by around 9% compared with the preceding year for member states reporting both figures; notably this excludes Spain and Poland. This trend is not uniform across countries (Table TDI-2 part (ii)).

In 2006 requests from clients new to treatment represent a general increase of around 10% over the preceding year amongst the countries reporting both years. Changes in new treatment demands are similar to changes in overall demands, but variations are reported between countries (Table TDI-2 part (i), part (ii)).

Looking at trend of new clients according to the main drug of use, as reason for entering treatment, (only for the clients for which the primary drug is known), data over the period 2002 to 2006 are analysed across 19 EU countries (Figure TDI-1) and it is possible here to detect a total fall of about 25% in absolute numbers of new heroin treatment demands; this strongly contrasts with those for cocaine over the same period and for cannabis demands Treatment demands for those two substance are doubled or almost doubled (Table TDI-3 part (i), part (ii), part (iii)).

New treatment demands are still principally for heroin treatment, even though the relative importance of heroin amongst new treatment demands has decreased in most of the countries. By contrast the relative position of cocaine and cannabis has increased in several countries. Between 2005 and 2006 the relative decrease of heroin treatment demand seems to be stabilising.

Socio-demographic profile of drug treatment clients from outpatient and inpatient treatment centres

Differences in socio-demographic characteristics of drug treatment patients are found according to individual reporting country and main drug of consumption. Variations may be due to differences in the organisation of treatment facilities, in the profile of problematic drug users and in other elements to be clarified. Overall, the following characteristics of drug clients in outpatient and inpatient treatment centres can be summarised:

  • most of the drug clients live in a stable accommodation, and a smaller group (correspondingly 9% and 12% of all outpatient and inpatient clients) live in an unstable accommodation, mainly homeless; 8% (outpatient) and 10% (inpatient) of all clients live in social institutions (Table TDI-15 part (ii), part (iv));
  • 35% of outpatient and 42% of inpatient drug clients were living with their parents before entering treatment; around 15% of all outpatient clients and 8% of all inpatient clients are living with children, either alone or with a partner (Table TDI-14 part (ii), part (iv));
  • 2% of all outpatient and 5% of all inpatient clients have never been to school or have never finished a primary level of education and 8% of outpatient and 6% of inpatient clients have reached a higher level of education (Table TDI-12 part (ii), part (iv));
  • the proportion of drug clients without a regular employment is high, especially when compared with the general population. Unemployment rates are 49% among all outpatient clients and 75% among all inpatient clients against around 5% in the general population (Table TDI-20 part (ii), part (iv); Table TDI-13 part (ii), part (iv)).

Treatment for opioids

Opioid use is still the main reason for entering treatment in Europe counting for 47% of all treatment demands reported in 2006 and for 34% of new demands (Figure TDI-2); although the strong differences reported between countries, the percentage of all clients treated for opioids use range between 40-98 % (Table TDI-5 part(ii). In most countries the proportion of opioid users is lower among new treatment demands (Table TDI-4 part(ii). In some countries opioids other than heroin are reported as primary reason for entering treatment: Finland and France reported 40% and 7.5%,for buprenorphine use, respectively; Sweden and Latvia reported between 5% and 8% of clients entering treatment for use of opioids other than heroin, buprenorphine and methadone (mainly painkillers) (Table TDI-113)

Data from outpatient and inpatient treatment centres reported show the following profile of opioid clients on gender, age distribution and patterns of drug use:

  • the males to females ratio among opioid users is 3-4 males to 1 female client for outpatient and inpatient clients. Marked variations are reported between countries in gender ratios which drip to near equality and extend to 5 or more in some populations (Table TDI-21 part(ii), part(iv));
  • the mean age of opioid clients is 32 years in outpatient centres and 30 in inpatient centres; among new demands for opioid treatment the mean age is approximately one year lower (Table TDI-10 part(i), part(iii), part(v), part(vii);
  • 3 out of 4 clients start using opioids before the age of 25,.The most prevalent age group was represented by clients ranging from 15 to 19 years old. (Table TDI-11 part(i); part(iii), part(v), part(vii));
  • 61% of outpatient and 59% of inpatient clients reported using opioids as a primary drug on a daily basis; among new clients the proportion of daily users is even higher (68% among outpatient clients and 75% among inpatient clients) (Table TDI-18);
  • in outpatient centres 43% of all clients and 40% of new clients consuming opioids as the primary drug reported injection as their main route of drug administration; and correspondingly 34% and 40% of them smoked it (Table TDI-17 part(i), part(v));
  • outpatient clients using opioids as primary drug use other drugs -in combination or in sequence; 25.1% of them use cocaine as secondary drug, 23.1% another opioids 17.9% cannabis, 8.5% alcohol, and 0.8% other substances not specified (Table 23 part(i), part(ii));
  • opioids is also used as secondary drug by 13% of outpatient clients and 11% of inpatient clients with a non-opioid primary drug (Table TDI-22).

Treatment for cocaine

In 2006, cocaine is the primary drug for 16 % of all treatment demands and 24 % of new treatment demands (Figure TDI-2); marked country variations are reported; since several years Spain and The Netherlands have the highest proportion of cocaine users in drug treatment (correspondingly, 46.9 % and 34.7 % of all clients. Also, Italy reported a high proportion of all clients entering treatment for primary cocaine use (24.8 %). In most countries, the percentage of cocaine clients is higher among the new demand for drug treatments (Table TDI-3 part (ii), Table TDI-4 part (ii), Table TDI-5 part (ii)).

Data from outpatient and inpatient treatment centres show the following profile of cocaine clients on gender, age distribution and patterns of drug use:

  • the gender ratio among cocaine clients is 5.3 males for every female cocaine client in outpatient centres and 4.4 in inpatient centres; among new clients the gender ratio is higher in outpatient centres than in inpatient centres (5.6 and 5 respectively) (Table TDI-21 part (i), part (ii), part (iv));
  • the mean age of all cocaine clients is 31 years; new clients are around 1 year younger on average in both outpatient and inpatient settings (Table TDI-10 part (i), part (iii), part (v), part (vii));
  • most cocaine clients start their drug use before the age of 25 (Table TDI-11 part (i); part (iii), part (v), part (vii));
  • outpatient cocaine clients can be divided into two groups, according to their frequency of cocaine use in the month before entering treatment: cocaine clients using it occasionally or have not used it at all (41.1 % of new and 47.6 % of all clients) and clients using cocaine daily or several times a week (58.9 % of new and 52.4 % of all clients) (Table TDI-18);
  • more than half of cocaine outpatient clients (55.2 %) sniff the drug and another 32 % smoke or inhale it; 9 % of cocaine clients inject the drug (6 % if they are new to treatment (Table TDI-17 part (ii), part (vi));
  • cocaine is often used in combination with another substance: 26.5 % of outpatient clients use cocaine with alcohol, 24.5 % with cannabis, 9.9 % with opioids and 0.9 % with other substances not specified (Table TDI-23 part (i)). Cocaine is also reported as a secondary drug by 18 % of outpatient clients and by 10 % of inpatient clients (Table TDI-22).

Treatment for amphetamines and ecstasy

Stimulants other than cocaine are infrequently reported as primary reason for attending drug treatment (5.5 % among all clients and 6 % among new clients). Among clients entering treatment for stimulants other than cocaine, 80 % report using amphetamines, 16 % ecstasy and 4 %, the remainder stimulants other than cocaine, amphetamines or ecstasy (Table TDI-8 part (i)). Marked differences are reported between countries: some Member States (Czech Republic, Sweden, Finland, Slovakia and Latvia) report amphetamines and methamphetamines as accounting for between 20 % and 60 % of all primary treatment demands. Only a few countries report some clients in treatment for primary ecstasy use (Table TDI-4 part (ii), Table TDI-5 part (ii)).

Data from outpatient and inpatient treatment centres show the following profile of clients using stimulants other than cocaine on gender, age distribution and patterns of drug use:

  • the males to females ratio among users of stimulants other than cocaine is the lowest compared to other drug users, after the clients reporting use of hypnotics and sedatives as a primary drug (but figures are very low in that case); there are 2 males for every female in drug treatment for stimulants use, but countries variations should be considered (Table TDI-21);
  • the mean age of amphetamines and ecstasy clients is 27 years among outpatient clients and 29 among inpatient clients; clients entering treatment for the first time in their life are usually younger (Table TDI-10 part (i), part (iii), part (v), part (vii));
  • the mean age at onset of drug use for most clients entering treatment for the use of stimulants other than cocaine is lower than 25, with most of them starting their drug use before the age of 20 (Table TDI-11 part (i); part (iii), part (v), part (vii));
  • around half of outpatient clients in treatment for stimulants other than cocaine use them only occasionally or have not used them in the month prior to treatment; around one third use them daily or several times a week. Among inpatient clients, the proportion of regular users (daily or several times a week) is higher (63 % among new patients and 40 % among all patients), but figures reported are quite low and caution should be paid in interpreting the data (Table TDI-18);
  • half of outpatient clients in treatment for use of stimulants other than cocaine take them orally; drug injection is used by 16 % of drug clients (12 % among new clients); marked variations are reported between countries, namely in Czech Republic, where most drug clients are in treatment for methamphetamine use and 80 % inject it (Table TDI-17 part (iii), part (vii); Table TDI-4 part (ii));
  • many outpatient clients use stimulants — amphetamines and ecstasy — with another drug, mainly other stimulants (37.3 %) or cannabis (35.8 %), alcohol (19.2 %) and 7.6 % other not specified drugs. (Table 23 part (i));
  • stimulants other than cocaine are used as a secondary drug by 7 % of outpatient clients and by 9 % of inpatient clients (those with other primary drugs) (Table TDI-22).

Treatment for cannabis

Overall, cannabis is the second most reported primary drug among treatment demands and counts for 21 % of all treatment demands and 28 % of new demands (Figure TDI-2). There are marked differences between countries in the proportion of clients demanding treatment for cannabis as a primary drug (Table TDI-4 part (ii), Table TDI-5 part (ii)). According to available data, most cannabis clients enter treatment in outpatient centres and only a few countries report a non trivial proportion of cannabis clients in inpatient treatment (Table TDI-24).

Data from outpatient treatment centres on gender, age distribution and patterns of drug use show the following profile of cannabis clients:

  • together with gender ratio among primary cocaine users, the males to females ratio for clients in treatment for cannabis is the highest among all drug types (5 males to 1 female) (Table 21 part (i), part (ii));
  • cannabis users have a mean age of around 24 years, being the youngest clients in drug treatment after clients in treatment for use of volatile/inhalant substances (but figures in that last case are very low) (Table TDI-10 part (i), part (iii)). Among the younger clients, 80 % of under 15 and 67 % of 15–19 year olds are in treatment for primary cannabis use (Table TDI-10 part (ii));
  • virtually all cannabis clients start their drug use before the age of 20 (Table TDI-11 (part (i)), part (iii));
  • in the month before entering treatment, 55 % of all clients report using cannabis only occasionally or not at all, 34 % have used it once or more times a week and only around 11 % report using it on a daily basis. Among new clients, the proportion of those using the substance daily (42 %) or several times a week (21.4 %) is higher than among all clients (Table TDI-18 part (ii)). Marked differences are reported between countries, with countries reporting around half of clients with occasional or no use in the 30 days prior to treatment and countries with 50 % or more daily cannabis users (Table TDI-111 part (iv));
  • cannabis is sometimes reported as a primary drug used in combination (or sequence) with another substance; when cannabis use is reported with another substance, it is usually combined with alcohol (21 %), stimulants other than cocaine (12 %) or cocaine (10 %) (Table TDI-23 part (i)). Overall, 21 % of all clients reported the use of cannabis as secondary drug (Table TDI-22 part (i)).


(1) Denmark: number of outpatient treatment centres were not reported.

(2) See results of the project on coverage

(3) Data available for Malta and The Netherlands are not included, due to the fact that these two members are not reporting the number of clients broken down by type of treatment unit.