Opinion on the communication from the Commission - Community action in the field of drug dependence - Proposal for a European Parliament and Council Decision adopting a programme of Community action on the prevention of drug dependence within the framework for action in the field of public health (1995-2000)

(95/C 110/04)

On 20 September 1994 the Council decided to consult the Economic and Social Committee, under Article 129 of the Treaty establishing the European Economic Community, on the abovementioned communication.

The Section for Protection of the Environment, Public Health and Consumer Affairs, which was responsible for preparing the Committee's work on the subject, adopted its Opinion on 31 January 1995. The Rapporteur was Mrs Guillaume.

At its 323rd Plenary Session (meeting of 22 February 1995), the Economic and Social Committee adopted, by a majority vote, with seven abstentions, the following Opinion.

1. Introduction

The Committee welcomes the Commission proposal for a Community strategy for action in the field of drug dependency: an increasing and complex phenomenon with huge social and economic costs to society. Competency for this lies within Article 129 of the Treaty. There is need for coordinating action and rationalization of existing instruments.

2. General comments

2.1. Drug dependence within the framework of public health must be seen in tandem with the EU Action Plan to combat drugs. Recognition is also given to the links with major social problems: exclusion, unemployment, crime and that drug dependency knows no frontiers.

2.2. Under Article 129 of the Maastricht Treaty, the Community addresses the promotion of health and prevention of disease. Drug addiction is the specific threat mentioned and identified as a priority - a matter of common concern to be addressed in the context of cooperation in the fields of Justice and Home Affairs. This priority also reflects the changing perceptions of how to fight against drugs both at national and global level.

2.3. Since drug addiction was first discussed in 1985, the problem has been regularly aired, analysis made from Member States' experiences in conjunction with the specialist institutions of the UN and the WHO. With the opening-up of East-Central Europe, the international aspect of the drug scourge becomes even more pertinent.

2.4. Despite the lack of reliable, and sometimes contradictory information, data does appear to show serious increases in the following areas:

- in drug-related mortality (from Schengen country figures);

- in number of first-time use of drugs;

- in the % of drug addicts among prisoners;

- in the increase of AIDS cases;

- in the concern of citizens and their families about the risks of HIV.

Despite various statistics pointing to an escalation of drug misuse and greater public concern, the increasing numbers requesting treatment may indicate that more drug users are wanting to overcome their drug dependence.

2.5. According to one recent European survey (), results showed that while there is general approval for the establishment of special centres of care, the reaction to the use of substitute drugs was muted and the free distribution of syringes was approved of for instance by the young and also by inhabitants of big cities. Surveys or polls are of dubious worth, but nevertheless reflect the attitudes of society towards drugs, which now appear to be both changing and more sensitive.

2.6. This has led to the Commission being requested to support Member States and define basic activities including exchanges of information, pilot projects and the establishment of a Community network of NGOs, aiming to maximize cost effectiveness and impact. This reflects the changed attitude of Europeans towards this problem in the emergence of prevention as a top priority. Article 129 gives the Commission authority for research into causation, which is also emphasized by the important role attached to the European Monitoring Centre on Drugs in providing data and information hitherto not available.

2.7. As drug dependency is a complex phenomenon, the Committee accepts that its prevention needs effort on local, national and global level involving multi-disciplinary and multi-dimensional responses:

i)

activities to target high-risk groups and critical age groups;

ii)

education and training for all involved;

iii)

the setting-up of an advisory body on drug dependency with representation from each Member State with national committees as the central point of reference for all the many agencies involved, including non-governmental organizations.

2.8. There is a perception of success in today's society which is promulgated by the media and is based on status, career progression and material possessions. This may cause individuals to feel a sense of failure and despair if they do not achieve in these areas. Such despair may cause some to seek solace in drug use and may inhibit the rehabilitation and reintegration into society of reformed drug users.

2.9. The Committee recommends that the broader approach is taken to encourage the promotion of healthier life styles rather than the narrow, negative approach epitomized by the 'say no to drugs' campaign in the USA. While positive role models e.g. sportsmen and women, are useful for the former approach, they are only effective in primary prevention. Many who begin using hard drugs are for the most part rebellious and anti-hero and do so as an expression of their anti-establishment lifestyles.

2.10. The Committee is broadly in favour of the Commission's recommendation in all three areas of activity:

1) improving public awareness in particular by means of coordinated transnational activities;

2) maximizing on the opportunities in other Community policies, programmes and instruments to prevent and combat drug dependency;

3) initiatives and actions relating to young people of school-going age in relevant environments and promote best practices in this regard.

The Committee recommends that extra funding should be given to those border towns where the prevalence of drug addiction is particularly high.

3. Specific comments

3.1.

Classification and terminology

3.1.1. 'Drug misuse' is defined as the non-medical use of drugs that are only intended for use in medical treatment, and the use of drugs that have no accepted medical purpose.

3.1.2. Drug misuse may be experimental, recreational or dependent. Experimental drug misuse, however, refers to the first tentative use of drugs to discover their effects. Recreational drug misuse is the continuation of drug misuse beyond experimentation but not amounting to dependent misuse. Recreational misuse may vary from very occasional to very frequent use. Dependent drug misuse (drug dependence) is characterised by a compulsion to take a drug on a continuous or periodic basis in order to experience its psychic effects or to relieve discomfort caused by its absence.

3.1.3. Because of the more restricted definition of drug dependence and the fact that most drug misuse is recreational and non-dependent it is recommended that the term 'drug misuse' be adopted.

3.1.4. Drugs most commonly misused include:

- opiates such as heroin;

- stimulants such as cocaine, amphetamine and Ecstasy;

- tranquillisers;

- hallucinogens such as LSD;

- cannabinoids such as cannabis;

- steroids and stimulants to enhance performance in sport.

3.1.5. In some countries drugs are described as 'hard' drugs, e.g. heroin, and 'soft' drugs, e.g. cannabis, in order to reflect how dangerous a drug is (in the US 'hard' drugs are referred to as 'narcotics' but this is especially confusing as in medical and pharmacological terminology a narcotic is a drug which induces narcosis, i.e. sleep). The dangers of drug misuse are not restricted to the drug itself but are, amongst other factors, influenced by the type of drug misuse (experimental, recreational or dependent) and the manner in which the drug is used (e.g. smoked, snorted, by mouth, or injected). Amphetamines may be viewed as a soft drug if taken orally, occasionally, and in small doses but as a hard drug if injected on a regular or dependent basis. Because of these difficulties in classification it is recommended that the term 'drug misuse' should cover the misuse of any or all drugs and that, when necessary, specific and clearly understandable terminology is employed, e.g. injecting drug misusers.

3.2. Difficulties may arise where Member States differ on whether care, counselling, treatment or rehabilitation of drug misusers fall within the scope of Article 129. The Committee stresses the importance of exchange of information between Member States in view of reducing differences of approach. Greater exchange of information in these areas may ensure added value at Community level.

3.3.

Tests on body tissues

3.3.1. Some (especially in the United States) have advocated the random testing of body tissues to detect drug misuse/dependence. It has been argued that such testing will deter individuals from using drugs and will identify those who have used drugs, thereby enabling them to receive appropriate advice or treatment. With the exception of those individuals whose drug use might significantly jeopardise the safety of others (e.g. bus drivers; air traffic controllers), or in the case of competitors in sporting events, the Committee does not favour random testing. For this reason, the Committee questions the necessity of the Communication mentioned in point 56 on the reliability of tests currently undertaken.

3.3.2. The reasons are the following:

- possible benefits of testing are outweighed by infringement of civil liberties;

- practical difficulties in obtaining samples of blood, urine or hair;

- hair testing may reveal drug use months or years earlier;

- accurate results from testing necessitate the use of expensive procedures;

- variations in the metabolism of different drugs mean that heroin and cocaine are only detectable a day or two after the drug has been taken, whereas cannabis may remain detectable for weeks or months;

- testing may reveal the presence of drugs taken for medical treatment including methadone;

- the drug most commonly detected is likely to be cannabis, a drug which generally causes less problems and is unlikely to require treatment.

3.4. The Committee recommends that:

1) High priority must be given to enhance public awareness, in a positive and responsible manner. The media must be encouraged to emphasize responsibility and partnership between parents, families, teachers, police and the health and help agencies involved.

2) All awareness programmes need to be properly evaluated, but in the case of Drug Prevention Weeks, maximizing on media focus and highlighting for example school programmes have seemed very effective indeed.

3) Telephone lines are invaluable and used by families and friends for often practical and simple advice. It is well proven that ignorance of how to get help is far higher than ignorance of how to get drugs.

3.5. The Committee feels that emphasis should be given to schools in at-risk areas. Vocational guidance should include education for teachers and youth leaders and any professionals likely to be in contact with drug users - i.e. prison officers.

3.6. The Committee should endorse the need for:

- staff-student exchanges;

- establishment of pilot schemes between local authorities;

- establishment of multi-disciplinary drug-prevention networks;

- support systems to aid risk reductions.

3.7.

Drug substitution, early detection, syringe exchanges

3.7.1. The advent of HIV brought about a practical response by most EU countries in schemes to distribute clean injecting equipment to injecting drug misusers and an expansion in the prescribing of the heroin substitute methadone to those dependent on opiates. There is good evidence that needle exchange schemes have led to drug misusers presenting themselves to services earlier, have limited the spread of HIV infection and have encouraged many to embark upon treatment programmes. Methadone maintenance treatment is now available in all EU countries except Greece and Greece is about to begin. Methadone treatment varies enormously throughout the EU both in the extent to which it is available and the nature of the way treatment is delivered. In the UK and Denmark methadone is usually dispensed from community pharmacists for addicts to take home but all other EU countries favour the consumption of methadone on-site at specialist clinics. Whilst there is good international evidence that methadone maintenance treatment improves physical and psychological health and reduces mortality rates, criminality and HIV transmission, there is a pressing need for research into what types of methadone treatment programmes are most effective. The varied approach to methadone maintenance amongst Member States offers the opportunity for cross-national research into service effectiveness. Although methadone is the most widely accepted treatment for opiate dependence, the results of currently ongoing research involving other opiates such as buprenorphine (and heroine) should be monitored.

3.7.2. The widespread availability of drugs in most prisons, the high prevalence of injecting drug misusers amongst the prison population and the present reluctance of authorities to provide clean injecting equipment or methadone treatment for prisoners combine to provide an ideal environment for the spread of HIV infection. Some innovative schemes have attempted to address this problem. Drug misuse in prisons is an area which requires urgent action and would benefit from cooperation and collaboration between Member States.

3.8.

Environment

3.8.1. There is no doubt about the importance of environmental factors in influencing drug misuse at various levels. Environmental factors may affect the vulnerability of an individual to first using drugs, to progressing from initial drug use to the use of more dangerous drugs, from first experimental use to more regular recreational use and then to dependent use. Environmental factors are also important in determining whether an individual continues to use drugs or stops, and whether cessation of drug use is temporary or permanent.

3.8.2. The current epidemic of drug misuse which started in the 1980s and has continuously worsened is markedly dissimilar to the earlier and smaller escalation of drug misuse which occurred in the 1960s. Whilst the latter largely affected the middle classes and often was the result of a search for 'personal growth' or 'inner meaning', the more recent epidemic predominantly (but not exclusively) affects socially deprived urban areas with high unemployment. When there is little prospect of a job and a salary to spend on recreational activities a life of drug dependence has an appeal to many. Addicts lead a busy life raising money - usually illicitly - to pay for their drugs and visiting their dealer each day. Many cite 'boredom' as a reason for a relapse into drug dependence once they have become drug-free. For others the prospect of vast financial rewards and little opportunity for legitimate employment make drug dealing an attractive career option.

3.9.

Women and ethnic minorities

3.9.1. While there is no apparent discrepancy in treatment, there is evidence that access to advice and treatment for drug dependence is less readily available to women and to members of ethnic minorities. Women drug misusers are subject to greater stigmatisation than men and may fear intrusion by social services if they are pregnant or have children. Both those with the responsibilities of child-care and those for example employed as 'prostitutes' may find accessing services especially difficult. Those from ethnic minorities need access to information and treatment that takes into account their language and culture.

4. Conclusions

The magnitude of the drug problem is immense. The consequences of drug dependence have enormous financial, health and social costs. Each Member State is already committing resources to address the problem, but robust evidence of effective action is scarce.

The Committee endorses the Commission's initiative in this area recognizing the urgent need to support:

1) the evaluation of current research and practices;

2) the promotion and evaluation of innovative programmes, particularly in education;

3) the exchange of information and experience.

The Committee acknowledges that money alone will not cure the drug problem: it believes that greater resources should be targeted towards information exchange through networking at all levels. It urges that maximum and imaginative use be made of modern technology. Since the solutions are neither easy nor short-term, the Committee urges that adequate resources are committed on a long-term basis.

Done at Brussels, 22 February 1995.

The President

of the Economic and Social Committee

Carlos FERRER

() Source: Eurobarometer 37 - Drugs Prevention Week.