Developments in Drug Policy and Responses 1 1.1 Political Framework in the Drug Field
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German Reference Centre for the European Monitoring Centre for Drugs and Drug Addiction Roland Simon, IFT Institute for Therapy Research Hedwig Spegel, IFT Institute for Therapy Research Rolf Hüllinghorst, German Council on Addiction Problems (DHS) Guido Nöcker, Federal Centre for Health Education (BZgA) Marion David-Spickermann, Federal Centre for Health Education (BZgA) Report to the EMCDDA by the Reitox National Focal Point Germany: Drug Situation 2001 prepared on behalf of the European Monitoring Centre for Drugs and Drug Addiction EMCDDA and the German Ministry for Healthand Social Security (BMGS) Version: 18.12.2002 IFT Institute for Therapy Research (Epidemiology and Co-ordination) Roland Simon (Dipl. Psych., Director of the DBDD) Hedwig Spegel (Dipl. Soz., MPH) Parzivalstr. 25 D - 80804 Munich Tel.: +49 (0) 89 - 36080440/42 Fax: +49 (0) 89 - 36080449 Email: [email protected] / [email protected] Federal Centre for Health Education (BZgA) (Prevention) Dr. phil. Guido Nöcker (Social scientist) Marion David-Spickermann Ostmerheimer Str. 220 D - 51109 Köln Tel.: +49 (0) 221-8992247/90 Fax: +49 (0) 221-8992300 Email: [email protected] / [email protected] German Council on Addiction Problems (DHS) (Treatment) Rolf Hüllinghorst Westring 2 D - 59065 Hamm Tel.: +49 (0) 238-901510 Fax: +49 (0) 2381-901530 Email: [email protected] Contents Contents ................................................................................................................................I List of Tables ..........................................................................................................................VI List of Figures ........................................................................................................................VII Abbreviations ........................................................................................................................VIII Introduction .............................................................................................................................XI Summary.............................................................................................................................. XIII Part I: NATIONAL STRATEGIES: INSTITUTIONAL AND LEGAL FRAMEWORK 1 DEVELOPMENTS IN DRUG POLICY AND RESPONSES 1 1.1 POLITICAL FRAMEWORK IN THE DRUG FIELD...................................................................... 1 1.1.1 OBJECTIVES AND PRIORITIES OF THE NATIONAL DRUG POLICY ......................................... 1 1.1.2 BASIC ELEMENTS OF DRUG POLICY AT NATIONAL, REGIONAL AND LOCAL LEVEL ................. 2 1.1.3 NATIONAL STRATEGIES AND FEDERAL STRUCTURES ........................................................ 3 1.1.4 REALIZATION OF NATIONAL TARGETS AND STRATEGIES.................................................... 3 1.2 LEGAL FRAMEWORK ........................................................................................................ 5 1.3 LAWS IMPLEMENTATION................................................................................................... 8 1.4 DEVELOPMENTS IN PUBLIC ATTITUDES AND DEBATES ........................................................ 8 1.5 BUDGET AND FUNDING ARRANGEMENTS ......................................................................... 13 Part II: EPIDEMIOLOGICAL SITUATION 2 PREVALENCE, PATTERNS AND DEVELOPMENTS IN DRUG USE 17 2.1 MAIN DEVELOPMENTS AND EMERGING TRENDS ............................................................... 17 2.1.1 OVERVIEW OF MOST IMPORTANT CHARACTERISTICS AND DEVELOPMENTS OF DRUG SITUATION....................................................................................................... 17 2.1.2 EMERGING TRENDS AND CHANGING PATTERNS OF USE AND DRUG USERS....................... 18 2.2 DRUG USE IN THE POPULATION ...................................................................................... 20 2.2.1 CANNABIS .................................................................................................................. 24 2.2.2 AMPHETAMINES .......................................................................................................... 26 2.2.3 ECSTASY ................................................................................................................... 27 2.2.4 COCAINE.................................................................................................................... 29 2.2.5 LSD........................................................................................................................... 33 2.2.6 HEROIN AND OTHER OPIATES (E.G. CODEINE, OPIUM, MORPHINE) .................................. 34 2.2.7 MUSHROOMS CONTAINING PSYLOCIBINES..................................................................... 37 2.2.8 ADDITIONAL STUDIES ON THE LEVEL OF SOME FEDERAL LAENDER ................................. 38 I 2.3 RISKY DRUG USE ..........................................................................................................39 2.3.1 NATIONAL AND LOCAL PREVALENCE ESTIMATES OF DRUG USE .......................................40 2.3.2 PROBLEMATIC DRUG USE AT LOCAL LEVEL....................................................................41 2.3.3 RISK BEHAVIOUR OF DRUG USERS................................................................................42 3 HEALTH CONSEQUENCES 44 3.1 DRUG TREATMENT DEMAND...........................................................................................44 3.1.1 CHARACTERISTICS OF DRUG USERS .............................................................................44 3.1.2 DIAGNOSTIC DATA IN THE OUT-PATIENT TREATMENT SECTOR.........................................45 3.1.3 DIAGNOSTIC DATA FROM INPATIENT TREATMENT ...........................................................46 3.2 DRUG-RELATED MORTALITY...........................................................................................47 3.3 DRUG-RELATED INFECTIOUS DISEASES...........................................................................51 3.3.1 HIV UND AIDS ...........................................................................................................52 3.3.2 HEPATITIS B AND C.....................................................................................................54 3.4 OTHER DRUG-RELATED MORBIDITY ................................................................................56 4 SOCIAL AND LEGAL CORRELATES AND CONSEQUENCES 57 4.1 SOCIAL PROBLEMS........................................................................................................57 4.2 PROBLEMS RELATED TO POLICE AND JUSTICE .................................................................59 4.3 SOCIAL AND ECONOMIC COSTS OF DRUG CONSUMPTION..................................................63 5 DRUG MARKETS 64 5.1 AVAILABILITY OF DRUGS ................................................................................................64 5.2 SEIZURES.....................................................................................................................64 5.3 PRICE AND PURITY ........................................................................................................67 5.3.1 CANNABIS ..................................................................................................................68 5.3.2 AMPHETAMINES ..........................................................................................................69 5.3.3 AMPHETAMINE DERIVATES...........................................................................................69 5.3.4 COCAINE ....................................................................................................................69 5.3.5 HEROIN......................................................................................................................71 6 TRENDS PER DRUG 72 6.1 CANNABIS ....................................................................................................................72 6.2 SYNTHETIC DRUGS (AMPHETAMINES, ECSTASY, LSD, OTHER/NEW DRUGS) ......................72 6.3 HEROIN/OPIATES ..........................................................................................................73 6.4 COCAINE/CRACK ..........................................................................................................74 6.5 MULTIPLE USE (INCLUDING ALCOHOL, PHARMACEUTICS, SUBSTANCE SNIFFING)................74 7 DISCUSSION 77 7.1 CONSISTENCY BETWEEN INDICATORS.............................................................................77 7.2 IMPLICATIONS FOR POLICY AND INTERVENTIONS..............................................................77 7.3 METHODOLOGICAL LIMITATIONS AND DATA QUALITY ........................................................77 II Part III: DEMAND REDUCTION INTERVENTIONS 8 STRATEGIES IN DEMAND REDUCTION AT NATIONAL LEVEL 78 8.1 MAJOR STRATEGIES AND ACTIVITIES .............................................................................. 78 8.2 APPROACHES AND NEW DEVELOPMENTS ........................................................................ 80 8.2.1 APPROACHES AND NEW DEVELOPMENTS AT FEDERAL LEVEL.......................................... 81 8.2.2 APPROACHES AND RECENT DEVELOPMENTS AT LAENDER LEVEL.................................... 84 9 PREVENTION 87 9.1 SCHOOL PROGRAMMES ................................................................................................. 88 9.1.1 TRAINING OF LIFE COMPETENCE .................................................................................. 88 9.1.2 MEASURES FOR ADOLESCENTS