Demand for treatment for drug use

Overview

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

About half the countries provide information on the extent to which their reports cover out-patient treatment facilities - over the last two or three years this is approximately 75 % of all units (disregarding their size). For other types of facility, there is very limited information from the countries on their reporting coverage. All data presented refer to this reporting base.

Tables TDI-1 to TDI-7 are based on data from all types of treatment centres concerning new clients and all clients; they present the current situation for 2004 data and the trend for the last 10 years (1994 to 2004) where data are available. (Sources: the EMCDDA standard tables ST.03 and ST.04).

In 2004 20 countries submitted data by treatment centre type, covering about 90% of the total reported treatment demands and of new clients’ (those requesting treatment for the first time in their lives) treatment demands. Table TDI-8 reports data for 6 types of centre (outpatient centres, inpatient centres, low threshold agencies, treatment units in prison, general practitioners providing treatment for drug addiction, other types of centre).

Tables TDI-9 to TDI-27 report on the detailed data available only for outpatient treatment centres (sources: EMCDDA detailed TDI standard reporting schedules)

Tables TDI-28 to TDI 42 report data with a breakdown by gender. Males to females ratios are reported for socio-demographic characteristics for outpatient treatment clients. Tables 40 and 41 concern all types of treatment centres; Table 31 reports a comparison between treatment data and drug related deaths data.

Summary points

Treatment in profile

Cooperating agencies in 21 countries submitted data for 2004, reporting overall around 380,000 requests for treatment during the year, excluding clients in treatment continuing from previous years (Table TDI-2).

Treatment demands are made principally in outpatient treatment centres. This reflects both the organisation of treatment services within a country and the lower coverage of some centre types (Table TDI-8).

Males drug users predominate among all clients, and among new treatment clients and as out-patients in all European countries but with male to female ratios varying greatly between 9 to 1 and 1.6 to 1. The mean age of new clients is generally 2 to 3 years less than the overall average (Table TDI-5 part (i). for out-patient clients see Table TDI-9, Table TDI-19 part (ii)).

The treatment requests from 19 countries for which data for the year 2004 were available comprised 62% for opioid treatment requests. Cocaine treatment comprised 8% of all demands, and cannabis about 15%. These proportions differ widely between countries (Table TDI-5 part (ii), Figure TDI-2 part(ii)).

Treatment demands from people never previously treated ('new clients'), make up less than one third of this total. Demands were made by 44.8 new clients in every 100.000 inhabitants aged 15-64 in the European member states, Bulgaria, Romania and Turkey. Marked differences are found between countries in the incidence of new clients: from 1.3 to 89.0 per 100.000 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-7).

Trends in reported treatment demands

From 1996 to 2003 there was a increase in the number of reporting agencies and a slight decrease in 2004. In all the countries, except 3 (Czech Republic, Hungary, Luxembourg) there was an increase in the number of the reporting centres. Table TDI-2 part (iii), although In some countries data on number of units covered are not available. In Germany there were 227 more reporting centres.

Total reported treatment demands remain almost stable (+2%) compared with the preceding year for member states reporting both figures (notably this excludes France and Spain). This trend is not uniform: 7 member states report declines and 11 an increase. Most of them report small relative changes, although the 1% decrease in Italian treatment demands represents 1,286 cases; 5 member states report relative increases greater than 10%, outstandingly Germany (+16% or 6,000 more requests) (Table TDI-2 part (ii)).

In 2004 requests from clients new to treatment represent a general increase of around 5% over the preceding year amongst the countries reporting both years. Changes in new treatment demands are similar to changes in overall demands (Table TDI-2 part (i)). Adequate data over a 6 year trend are reported across 17 EU countries, Bulgaria and Romania - see Figure TDI-1 part (i) and Figure TDI-1 part (ii) for details – and it is possible here to detect a total fall of about 15% in absolute numbers of new heroin treatment demands; this strongly contrasts with those for cocaine over the same period (risen about 28%) and more so cannabis demands (risen about 44%. See also Table TDI-3 part (i), Table TDI-3 part (ii), Table TDI-3 part (iii), and Table TDI-3 part (iv).

New treatment demands are still principally for opioids treatment, even though overall composition of the new-to-treatment population has changed strongly towards cannabis. The relative importance of opioids amongst new treatment demands has decreased in most of the countries. By contrast the relative position of cocaine dropped in only 4. A similar variety of changes occurred with other stimulants and with cannabis.

Out-patient treatment patterns

Among the countries that are able to supply the data, the main referral source reported for new outpatients is self-referral, then the criminal justice system and the general practitioners; the other sources of referrals have much less impact (Table TDI-16).

In out-patient socio-demographic data marked differences are found between countries, depending on the main drug distribution, the organisation of treatment facilities and the socio-demographic situation. Overall, summarising ,

• 13% of all outpatient clients live in social institutions or in an unstable accommodation (Table TDI-15)

• Around 13% of all outpatient clients are living with children, either alone or with a partner (Table TDI-14)

• The proportion of new outpatient clients without a regular employment is high, especially when compared with the general population (36.2% among new drug clients and 9% in the general population) (Table TDI-13, Table TDI-20)

• Data on primary level of education cover only about 10% of the clients and are correspondingly unreliable as a pan-European picture. (Table TDI-12).

Treatment for opioids

The males to females ration among opioids users is 3.5 to 1. marked variation are reported between countries in gender ratios which drip to near equality and extend to 4 or more in some populations (Table TDI-21 part (i) and Table TDI-21 part (ii)).

Amongst new outpatient treatment demands for opioid use:-

• Overall about 61% of clients report using the drug on a daily basis (Table TDI-18 part(i))

• 55% report injection as their route of opioid administration and 32% smoke it (Table TDI-17 part(i))

• Many of these clients use opioids with another drug or in combination or in sequence; for 28% of them cannabis is the secondary drug and for 10% it is alcohol (Table TDI-24 - part (i)). Among new outpatients, 9.4% of clients report opioids as secondary drug of use Table TDI-23.

Treatment for cocaine

Cocaine related treatment demands are higher among new clients than all clients (Table TDI-3 part (ii), Table TDI-4 part (ii), Table TDI-5 part (ii)).

Amongst new outpatient treatment demands for cocaine use:-

• the gender ratio is 5.8 males for each female amongst new outpatient treatment demands for cocaine use (Table TDI-21)

• around half of the clients sniff cocaine and another 43% smoke or inhale it (Table TDI-17 part (ii))

• cocaine is often used in combination with another drug: for 32% of clients with cannabis, for 17% with alcohol and for 29% with opioids (Table TDI-24 part (i), Table TDI-24 part (iii)). Cocaine is reported as secondary drug by 12% of clients (Table TDI-23).

Treatment for amphetamines and ecstasy

Stimulants other than cocaine, specifically amphetamines and ecstasy, are infrequently reported as primary reason for attending drug treatment. Some countries are exceptions to this and report them as accounting for between a quarter and more than half of all primary treatment demands (Table TDI-3 part (iv), Table TDI-4 part (ii), Table TDI-5 part (ii)).

Among new outpatient clients for stimulants other than cocaine:

• 70% report using amphetamines, 26% ecstasy and the remainder stimulants other than cocaine, amphetamines or ecstasy (Table TDI-22)

Treatment for cannabis

Overall, cannabis is the second most reported primary drug among treatment demands. There are marked differences between countries in the proportion of new clients demanding treatment for cannabis as primary drug (Table TDI-3 part (iii), Table TDI-4 part (ii), Table TDI-5 part (ii)).

In the detailed reports received from outpatient clinics, cannabis is often reported as primary drug without reporting the use of other drugs; when reported with other substances, it is usually combined with alcohol or stimulants, including cocaine Table TDI-24 part (i); Table TDI-24 part (iv). Overall 24.6% of new clients report the use of cannabis as secondary drug (Table TDI-23).

Among new outpatient clients for cannabis:

• in the month prior to entering treatment 34% of new clients report using cannabis only occasionally or not at all and 34% report using it on a daily basis Table TDI-18 part (ii). The fact that a group of clients enters treatment without an intensive use of cannabis may be related to several factors: they might be referred by the police to treatment, by schools, family or social networks, without having a recognised cannabis abuse (see AR 2004 chapter on cannabis).

• males to females ratio for new client treatment demands for cannabis use is the highest among all drug types (6 to 1) (Table TDI-21)

• almost all new cannabis clients started to use the drug the first time when they were younger than 20, with 37% starting before the age of 15 (Table-11 part (i); Table-11 part (ix)).