Opinion of the European Economic and Social Committee on the "Proposal for a Council Recommendation on the prevention and reduction of risks associated with drug dependence" (COM(2002) 201 final — 2002/0098 (CNS))
Date: 2002-10-24
Institutions: European Economic and Social Committee
Subjects: cooperation policy, drug addiction, exchange of information, health policy, health risk, public awareness campaign, public health, toxicology

14.3.2003

EN

Official Journal of the European Union

C 61/189

Opinion of the European Economic and Social Committee on the ‘Proposal for a Council
Recommendation on the prevention and reduction of risks associated with drug dependence’

(COM(2002) 201 final — 2002/0098 (CNS))

(2003/C 61/31)

On 10 June 2002 the Council decided to consult the European Economic and Social Committee, under
Article 262 of the Treaty establishing the European Community on the above-mentioned proposal.

The Section for Employment, Social Affairs and Citizenship was responsible for preparing the Committee’s
work on the subject and appointed Ms Le Nouail-Marlière as rapporteur-general.

At its 394th Plenary Session (meeting of 24 October 2002) the Committee appointed Ms Le Nouail-
Marlière as general rapporteur and adopted the following opinion by 93 votes to one, with three
abstentions.

1. Summary of the draft recommendation of the Council

proposed by the Commission

— to reduce substantially over five years the incidence of
drug-related health damage (HIV, hepatitis B and C,
tuberculosis, etc.) and the number of drug-related deaths;

The EU Member States have adopted common
1.1.
measures for combating drug addiction since the mid 1980’s.
In 1990 the Rome European Council adopted the first
European Plan to Combat Drugs. It was then revised and
updated by the Edinburgh European Council in 1992. The
1995-1999 EU Action Plan stressed the need for a multidisci-
plinary and integrated response, centred on demand reduction,
supply reduction,
trafficking and
illicit
international co-operation and co-ordination.

the fight against

1.2.
The Amsterdam Treaty singles out drugs as a major
scourge and danger to public health; drugs clearly remain a
priority subject for Community Action in the field of Public
Health. The third paragraph of Article 152(1), states that ‘The
Community shall complement the Member States’ actions in
reducing drugs-related health damage, including information
and prevention.’ The reduction of drug-related health damage
appears here as a new objective of the co-operation between
Member States, alongside the traditional co-operation in the
prevention field.

The EU Drugs Strategy (2000-2004) (1), endorsed by
in December 1999, has three main

1.3.
the European Council
public health targets:

— to reduce significantly over five years the prevalence of
illicit drug use, as well as new recruitment to it, particu-
larly among young people under 18 years of age;

— to increase substantially the number of successfully

treated addicts.

1.4.
The main goal of the proposed Council recommen-
is to facilitate the
dation, based on Treaty Article 152,
achievement of the second public health target by the Member
States.

The proposal

1.5.
includes measures aiming to further
integration between health and social care, while improving
methods of training health care professionals in such matters
and the prevention of drug-related infections.

1.6.
The Member States are recommended to make drugs
prevention and the prevention of drug-related health risks a
public health goal, to introduce comprehensive prevention
and treatment policies and to increase the effectiveness and
efficiency of their efforts in drug prevention by establishing an
appropriate means of assessment, including use of scientific
evidence and more appropriate data collection.

Special emphasis is placed on the appropriate exchange
1.7.
of information within the European Union, which must be
stepped up.

2. General observations

( 1) EESC opinion on a European action plan to combat drugs (2000-

2004) — OJ C 51, 23.2.2000.

2.1. Why is this a recommendation and not a more binding
legal instrument?

C 61/190

EN

Official Journal of the European Union

14.3.2003

The rule of subsidiarity does not allow stronger legal actions
in the field of public health. Article 152 of the Treaty reads:
‘The council, acting by a qualified majority on a proposal from
the Commission, may also adopt recommendations for the
purposes set out in this article’. This is the only recommen-
dation in the field of public health, but there are recommen-
dations that are more connected to law enforcement etc. (i.e.
the supply side).

— the methods of prevention of drug dependence;

— improving information, education and training in the
field, especially for young people and among vulnerable
groups.

The Committee notes that other

2.2.
currently being prepared:

instruments are

— Proposal for a Council framework Decision laying down
minimum provisions on the constituent elements of
criminal acts and penalties in the field of drug trafficking.

— Initiative by the Kingdom of Spain for the conclusion of
a Convention on the suppression by customs adminis-
trations of illicit drug trafficking on the high seas.

— Draft Council Resolution on treatment of criminal drug

abusers as part of service of sentence.

— Draft Council Resolution on generic classification of new

synthetic drugs.

— Draft Council Recommendation drawing

up an
implementing protocol on taking samples of seized drugs.

3.3.
The programme also strived to enhance co-operation
with other countries and international organisations active in
the field of drug prevention. The actions have been implement-
ed in close co-operation with Member States.

3.4.
In order to ensure cost-effectiveness and added value
of the Community’s involvement, priority has been given to
projects carried out on a large scale, projects that are relevant
from the methodological point of view,
innovative where
applicable and likely to have a real impact on achieving the
aims of the programme. They shall bring together public
sector and non-governmental organisations offering sufficient
proof of competence in the field and likely to encourage
multidisciplinary co-operation.

3.5. Most of the projects funded are in the field of public
health intervention rather than pure science, but with emphasis
on evaluation. The number of funded projects during the
whole period is approximately 180 and the total amount
granted is EUR 38 million. The candidate countries have
participated in some of these projects.

3.
This recommendation seeks to implement preventive
programmes based on the tested evidence of projects already
tried out in some Member States, and to extend the scope of
possible schemes by involving the parties concerned in such
prevention.

At the end of this year the Action Programme —
3.6.
together with the other 8 specific or vertical public health
programmes — is coming to an end and will be replaced by
one New Public Health Programme 2003-2008. The total
budget for this period is EUR 312 million. The fragmented
the old programme will be replaced by a
approach of
horizontal integrated programme consisting of 3 strands:

3.1.
The aims of the drug programme are to encourage co-
operation between Member States, provide support for their
action and to promote co-ordination of their policies with a
view to preventing addiction to illegal drugs. The programme
was initially for the period 1996 — 2000, but it was later
extended to the end of the year 2002.

1.

improving health information;

2.

rapid response mechanism;

3.

tackling health determinants through prevention and
health promotion.

3.2.

The activities have focused on:

— improving knowledge of drug dependence and its conse-

quences;

3.7.
The drug problems will be an integrated part of the
third strand. Nothing indicates that this important field will
lose emphasis it enjoys presently, especially as it is stipulated
‘the Community shall
in article 152 of
complement the Member States’ action in reducing drugs-
related health damage, including information and prevention’.

the Treaty that

14.3.2003

EN

Official Journal of the European Union

C 61/191

4. Drug policy in the Member States

member states, but to a different degree. It is to be noted that
only some of these methods are included in the present
recommendation.

4.1.
Drug policies vary in different Member Sates of the EU.
On one end of the spectrum is the most repressive strategy.
The overriding aim in some Member States is ‘drug free
society’. Drug misuse is regarded as unacceptable and should
never become an integral part of society. The problem of drug
misusers is treated more as a matter for the criminal justice
system than a matter of the social services. Risk reduction
methods are used and accepted to some extent, but are
strictly controlled. Methadone maintenance, in one example,
is controlled under rules defined by the national Board of
Health and Welfare and the number of patients may not
exceed a certain number.

A. Methods included in the recommendation.

Methadone maintenance.

Vaccinations.

Information.

Clean needles and syringes.

Outreach, low threshold services.

On the other end of the spectrum, the central goal is
4.2.
to reduce the risks experienced by drug misusers, those in their
immediate environment and society in general. Some Member
States make a clear distinction between ‘soft drugs’, such as
cannabis and ‘hard drugs’ such as opiates and amphetamine.
Great effort is made to hinder misusers from ending up in an
illegal environment where outreach work can be difficult.

5. Risk reduction /harm reduction

B. Risk reduction methods not included in the recommendation

Medical prescription of heroin.

Injection rooms.

On-the- spot-testing.

Open drug scenes.

6. The need for evaluation

5.1.
Risk reduction is a general concept covering the
reduction of any type of harm caused by the behaviour of
individuals or by social and/or medical interventions. In the
drug field it is particularly used to signify the reduction of risks
for infections and other types of morbidity in drug users who
continue to use drugs.

5.2.
There have been arguments over the morality of harm
reduction. Some people say that it condones or promotes drug
use but people who support it say it is realistic and helps keep
drug users safe and alive and respects choice and individual
freedom. The thrust of policies is moving in the direction of
pragmatism, emphasising evaluation. The state of research
does not justify extreme positions.

5.3.
In using the concept risk reduction instead of harm
reduction the recommendation is more neutral and risk
reduction is in fact almost universally accepted.

5.4. Methodology. There exists a variety of risk reduction
methods. Many of the risk reduction methods mentioned in
the present directive are already being used in many or all

Evaluation involves clarifying and defining concepts and
methods and assessing the impact of
interventions. The
European Commission has been promoting evaluation in the
drug field as a co-organiser of two European conferences on
the subject. The Community Action Programme for the
Prevention of Drug Dependence identifies data, research
and evaluation as primary areas for action. The European
Monitoring Centre for Drugs and Drug Addiction (EMCDDA)
plays a crucial role in this connection. Its main task is to
provide objective, reliable and comparable information at
European level concerning drugs and drug addiction and their
consequences.

7. Conclusions

7.1.
The EESC notes that this recommendation focuses on
the aim of reducing drugs-related health damage, in accordance
with Treaty Article 152, and in particular encompasses
information and risk prevention, as well as specific responses
to the need to reduce the demand for drugs; it does not tackle
the reduction of supply. The EESC regrets, however, that the
aims specified in the recommendation lack an interface
dimension which would encourage the pooling of efforts in
different fields: health, police, education, social services and
employment.

C 61/192

EN

Official Journal of the European Union

14.3.2003

The EESC is pleased to see, in connection with the
7.2.
reduction and prevention of drug-related risks,
the
implementation of specific programmes to prevent AIDS and
other infectious diseases is advocated and stepped up.

that

7.3.
The Committee agrees, as already touched on in its
opinion (1), on the need to include measures focusing on this
area of public health at specific levels (schools, health care
networks, firms) so as to monitor target groups as closely as
possible, both on a local geographical basis and in terms of
social patterns. Risk factors are changing all the time and
protective measures must keep pace.

7.4.
Prevention and forms of action to curb drug depen-
dence can be incorporated into occupational health and safety
programmes. The workplace may not necessarily be the source

( 1) EESC opinion on a European action plan to combat drugs (2000-

2004) — OJ C 51, 23.2.2000.

of drug dependence but it can be an environment where such
situations become entrenched. The social partners should be
mobilized, along with the traditional players in the health and
social sectors, in framing combined prevention/reintegration
programmes
to assist drug-dependent workers where
necessary.

The recommendation could therefore provide under
7.5.
points 2 or 3, in connection with the horizontal occupational
health programmes, for preventive programmes (information,
awareness-raising, direction towards care services, action to
facilitate access to treatment) which prioritise high risk sectors
and involve the social partners.

7.6.
The Committee supports the recommendation in the
belief that prevention and reduction of the risks associated
with drug dependence must be integrated into the Community
framework, which provides for exchange of best practices and
the protection of persons affected by a centuries-old social
scourge which strikes blindly, in constantly shifting shapes
and forms.

Brussels, 24 October 2002.

The President

of the European Economic and Social Committee

Roger BRIESCH