For the purposes of IDPC’s regional work, the Western European Region is composed of the following countries: Austria, Belgium, Denmark, Iceland, Ireland, Italy, Finland, France, Germany, Luxembourg, Norway, Portugal, Spain, Sweden, Switzerland, The Netherlands, and the United Kingdom.
Illicit opiate and cocaine crops are not grown on any significant scale in Western Europe. Cannabis, by contrast, is now widely grown in the region, with a large expansion in the drug's illicit cultivation over recent decades. This is part of a trend whereby drugs are increasingly produced in close proximity to their intended consumer markets, in order to avoid the risk associated with transit across national and regional borders. The scale of illicit cannabis cultivation varies within the region, but precise data do not exist; however, it is reported that cannabis is mostly produced in indoor settings (EMCDDA Annual Report, 2012: The State of the Drugs Problem in Europe).
Europe continues to be the leading global centre for ecstasy and amphetamine manufacture even though (as in the case of cannabis) production trends show a move toward the geographical sites of their eventual consumption. The leading Western European countries for ecstasy and amphetamine production are the Netherlands and Belgium. Relatively little methamphetamine is produced in the region, although minor manufacturing facilities have been reported in Austria and Germany (World Drug Report, 2012).
The flow of heroin from Afghanistan into Western Europe follows the Balkan route through South-Eastern Europe; the central hub of this route is in Turkey where a sophisticated organised crime network handles onward distribution. It is a well-established and highly organised smuggling route; although heroin is trafficked by sea and air, most enters the region via land (World Drug Report. 2012).
Cocaine originates from the Andean highlands of South America, and reaches Western Europe by sea, sometimes routed via the Caribbean. Trafficking routes pass mainly through Argentina, Brazil, Ecuador, Mexico and Venezuela. The countries of the Iberian peninsula and the Netherlands constitute the major points of entry for cocaine into Western Europe, and to a lesser extent, Belgium. In recent years a transhipment and storage area in West Africa has been developed by traffickers and, more recently still, routes have been opened up through South Africa (EMCDDA Annual Report, 2012).
Amphetamine Type Stimulant (ATS) are the most trafficked drugs from Western Europe to other parts of continent and to markets around the world. However, despite signs of an expansion of the methamphetamine market in Europe, the number of illicit methamphetamine laboratories seized in the region has declined since 2008.
Cannabis remains the most widely consumed drug in Western Europe and the region is the world’s biggest market for cannabis resin (hashish). However, over the past 20 years, cannabis resin has been overtaken by the herbal form of the drug. Herbal cannabis consumed in Europe is mostly imported from Africa (especially South Africa), and less often from the Americas (especially the Caribbean islands). However, consumption has stabilised in recent years (EMCDDA Annual Report, 2012).
Opiate consumption has reached a plateau following several years of increase. Those countries in the region reporting higher levels of heroin use included Ireland, Luxembourg, Italy and Malta, while the lower end of the scale is formed by Czech Republic, Germany, Spain, among others. Heroin is the main opiate consumed in the region, and represents the major part of what is captured in these figures. However, levels of prevalence in Western Europe are notably lower than in East and South East Europe.
Western Europe remains the largest cocaine consumer market after North America. The region’s cocaine market has expanded in the last decade and cocaine is the second most popular controlled drug after cannabis, with an annual prevalence of cocaine use among the general population of about 1.3% (World Drug Report. 2012).
While overall trends in ecstasy use have remained stable, recent reports indicate increasing purity in the ecstasy available in the region and a possible resurgence in its use. Amphetamine use remained at a significant level. There have been recent reports of methamphetamine being increasingly available in Finland, Norway and Sweden (World Drug Report. 2012).
Finally, there has been an upsurge in the use of new psychoactive substances (NPS) – also called ‘legal highs’ – in the region. In September 2013, the European Commission reported that “more than 2 million people in Europe… are taking pills or powders that are sold to them as ‘legal’… Every week, one new substance is detected somewhere in the EU. And the problem has worsened sharply in recent years”.
In terms of modes of transmission, the UN Reference Group on Injecting Drug Use estimated that the number of people who inject drugs in the region is between 816,000 and 1,299,000. Italy reportedly has the highest number of people who inject drugs in the region with over 326,000 users, followed by the UK and France, each with over 120,000 users (read more).
Regional Drug Policies
The European Union Drugs Strategy
The foundation of the European approach to drug policy is crystallised in the EU Drugs Strategy 2013 – 2020 which seeks to ‘ensure a high level of human health protection, social stability and security, through a coherent, effective and efficient implementation of measures, interventions and approaches in drug demand and drug supply reduction at national, EU and international level, and by minimising potential unintended negative consequences associated with the implementation of these actions’. Although the strategy contains some weaknesses in certain domains, it clearly promotes a balanced policy between demand and supply, based on evidence, human rights, civil society involvement and harm reduction.
Harm reduction and drug dependence treatment
HIV prevalence among people who inject drugs is below 10% throughout most of Western Europe, with the exception of Italy (11.5%), Portugal (4.9% to 17.2%) and Spain (32.3%) (Global State of Harm Reduction, 2012). The prevalence of hepatitis C (HCV) amongst people who inject drugs is very high across Europe. Rates of infection vary widely both between and within countries; with prevalence levels reaching up to 61.2% in the UK and 78.3% in Switzerland (read more).
All Western European countries possess well-defined drug strategies. These vary between a small minority of countries aiming to establish a ‘drug-free society’ such as Sweden and some other Nordic countries, and others like the Netherlands, Switzerland, Spain, Portugal, etc. that address drug use through a pragmatic public health and social inclusion approach. In 1994, Switzerland adopted its ‘Four pillars’ drug policy (prevention, treatment, harm reduction and law enforcement), effectively integrating the drug strategy within public security, health and social cohesion objectives. Results have been positive, with a recorded reduction in overdose deaths and HIV levels among people who inject drugs.
Most Western European countries have developed and scaled up harm reduction services. Harm reduction is also explicitly mentioned in the EU Drugs Strategy for 2013-2020. Needle and syringe programmes (NSPs) are established in most countries in the region. The Netherlands has the most NSP sites, followed by Spain and the UK. In 2010, Iceland was the only country not to have NSPs although injecting had been reported in the country. NSPs are delivered through a variety of models; some are located within basic drug services, others in pharmacies and vending machines. Similarly, opioid substitution treatment (OST) programmes are widely available in the region (Global State of Harm Reduction, 2012).
Criminal justice, decriminalisation and depenalisation
Countries in Western Europe have been at the forefront of promoting a health-based approach to drug use and therefore reducing, or sometimes removing altogether, criminal sanctions against people who use drugs. This has been the case in Switzerland, the Netherlands, the UK, Spain and Portugal, among other countries.
Since the 1970s, the Netherlands has adopted a de facto decriminalisation model to cannabis. Whilst possession and use remains illegal, the Dutch Ministry of Justice issued guidelines to the police urging them not to enforce the law. As such, the possession of less than 5 grams is no longer targeted by law enforcement officials. In the 1980s, the concept of licenced ‘coffee shops’ was also introduced, giving the option to buy and sell small quantities of cannabis – this was in an effort to separate the market between ‘soft drugs’ and ‘hard drugs’. In 2012, the Dutch government tried to set up a new system to restrict access to the coffee shops to adults residing in the Netherlands. The objective was to prevent foreign drug tourists from travelling to the Netherlands. However, the government finally decided not to introduce this new ‘pass system’, stipulating instead that visitors should present their identity card at the coffee shops to confirm their residence in the Netherlands. The implementation of this rule is left at the discretion of municipalities, some of which have decided to continue to allow non-Dutch residents to purchase cannabis (Read more).
In Denmark, the Ministry of Justice recently rejected Copenhagen City Council’s request to experiment with legalising cannabis in the city, a plan which would have been similar to the Dutch cannabis shops system. Despite this set-back, the Copenhagen example shows a clear move towards alternative policies with regard to people who use drugs.
Portugal is also regarded as a pioneer in drug policy reform. For over 12 years, Portugal has developed a solid decriminalisation model in which personal drug use remains illegal but is dealt with administratively rather than criminally. When arrested in possession of up to 10 doses of drugs, the individual is no longer sent to the criminal justice system, but to a ‘dissuasion committee’ composed of health and social professionals who can impose a fine, propose treatment and other health and social services, according to the needs of the person. Coupled with strengthened public health facilities and support services, evidence suggests the policy has been a success, with a decrease in prison overcrowding, reductions in drug-related health harms and deaths, a decrease in drug-related crime and improved law-enforcement outcomes (IDPC Drug Policy Guide. 2012).
Other countries have preferred to depenalise drug possession for personal use. In the UK for example, a discretionary ‘cannabis warning scheme’ was introduced in 2004, within which first-time cases of drug possession for personal use are issued with a police warning, which does not result in either arrest or criminal record and is dealt with on the street. Evidence suggests that since the introduction of this scheme, cannabis use has not increased (IDPC Drug Policy Guide. 2012).
With regards to production and trafficking, many European countries have also worked hard to ensure proportionality in their drug laws. In the UK, for instance, the Sentencing Council reviewed its guidelines on drug offences in 2012 to provide a more consistent, transparent and proportionate approach to sentencing practices for drug offences in the UK. For example, the reviewed guidelines include a series of mitigating factors in order to address the serious negative consequences linked to lengthy prison sentences for vulnerable women caught in the drugs trade (read more).
For more information regarding drug policy in Western Europe, please click here.
For a full list of IDPC members in Western Europe, please click here:
- New recreational drugs and the primary care approach to patients who use them
- Opioid maintenance in European Prisions: Is the treatment gap closing?
- Polish addiction ombudsman: Avoiding punishment is not enough
- Tackling the problem of hepatitis C, substance misuse and health inequalities: a consensus for London
- Policy recommendations for vulnerable populations