Round table: Substance use disorders (SUD)
Authors:   Organised by: EUPHA (PMH) Chair persons: Jutta Lindert – EUPHA (PMH), Martin McKee - UK
Published: November 2019

Substance use disorders are among the priority conditions identified by the World Health Organization mental health gap action program. The health community has taken a range of (non-exclusive) positions on how to respond to them. These include a spectrum from prohibition, through regulation, to harm reduction and another from individually targeted measures to collective policies. Which measures are adopted depend on many factors outside the health system, including beliefs about the relationship between the individual and the state, the power of producer interests (tobacco/ alcohol industries), and the predominant public narrative. In contrast, a public health approach would focus on the risks of harm, to the individual and society, its distribution within the population, and the potential for unintended consequences. In this workshop, we will explore policy responses to four harmful substances, in four different European countries. These are electronic cigarettes (Martin McKee), cannabis (Jean-Pierre Couteron) illegal drugs (Henrique Barros) and alcohol (Jutta Lindert).

First, the case of electronic cigarettes have divided the health community. While some groups, mainly in England, have embraced them, others have expressed concerns, with US authorities describing their increasing use by adolescents as a public health emergency. We will ask why these different views exist, exploring the use of different paradigms, the prioritization of different population groups and conditions, and the role of cognitive biases. This presentation will highlight some of the wider divisions in approaches to substance use disorders. Second, the use of cannabis in France will be presented. France ranks fourth in the European Union in terms of monthly consumption of cannabis and second only to Denmark in terms of persons who have ever used cannabis. As of November 2018 the penalty for possession of cannabis in France was reduced to a €200 fine. This presentation will discuss the rationale for and expectations of this policy. Third, we will focus on Portugal which, in 2001, became the first country to decriminalise the possession and consumption of all illicit substances. Rather than being arrested, those caught with a personal supply are given a small fine or told to appear before a local commission. Finally, the challenges for Public health of harmful alcohol use will be presented. The harmful use of alcohol creates a serious health burden in refugees. Germany has among the highest alcohol consumptions in Europe, after Luxembourg, is the European country with the lowest percentage of people who abstain from drinking. Alcohol is widely accepted. This creates challenges for refugees coming from countries with much more restrictive approaches to alcohol. This presentation will explore the challenges that arise when a population coming from a regulated environment move to one that is highly liberalised, including a discussion of the challenges in developing culturally appropriate public health responses.

Key messages

Substance use is a major public health challenges. Legal and policy responses differ widely in the European Union - evidence based policies are highly beeded.