Report from the Commission to the European Parliament and the Council on the implementation of the Council Recommendation of 18 June 2003 on the prevention and reduction of health-related harm associated with drug dependence
Date: 2007-04-18
Institutions: European Commission
Subjects: disease prevention, drug addiction, health policy, public health

COMMISSION OF THE EUROPEAN COMMUNITIES 

Brussels, 18.4.2007 
COM(2007) 199 final 

REPORT FROM THE COMMISSION TO THE EUROPEAN PARLIAMENT AND 
THE COUNCIL 

On the implementation of the Council Recommendation of 18 June 2003 on the 
prevention and reduction of health-related harm associated with drug dependence 

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TABLE OF CONTENTS 

1. 

2. 

3. 

4. 

5. 

BACKGROUND.......................................................................................................... 3 

METHODOLOGY – DATA COLLECTION ............................................................. 3 

MAIN OUTCOMES RELATED TO THE IMPLEMENTATION OF THE 
COUNCIL RECOMMENDATION............................................................................. 4 

CONCLUSIONS.......................................................................................................... 8 

FOLLOW-UP OF THE 2003 COUNCIL RECOMMENDATION........................... 10 

TECHNICAL ANNEXES........................................................................................................ 12 

5.1. 

5.2. 

ANNEX I – Abbreviations and technical terms used ................................................ 12 

ANNEX II – Figures .................................................................................................. 13 

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1. 

BACKGROUND 

On 18 June 2003, the Council adopted a Recommendation on “the prevention and reduction 
of health-related harm associated with drug dependence”1. The aim of the Recommendation is 
to  reduce  the  number  of  drug-related  deaths  (DRDs)  and  drug-related  health  damage  by 
encouraging  Member  States  to  set  up  and  develop  responses  and  strategies  to  prevent  and 
reduce  drug-related  harm.  This  sense  of  urgency  was  reiterated  in  the  EU  Drugs  Strategy 
2005-2012 and the EU Drugs Action Plan 2005-2008. 

The Recommendation includes three main points for Member States' action: 

(1) 

(2) 

(3) 

to set as a public health objective the prevention of drug dependence and the reduction 
of related risks and to develop and implement comprehensive strategies accordingly; 

to  reduce  substantially  the  incidence  of  drug-related  health  damage  (such  as  HIV, 
hepatitis B and C, and tuberculosis) and the number of DRDs, through 13 sub-points 
relating  to  harm  reduction  services  and  facilities  (e.g.  distribution  of  injection 
materials, vaccination, treatment, information and training); 

to develop appropriate evaluation to increase the effectiveness and efficiency of drug 
prevention  and  to  reduce  drug-related  health  risks,  through  9  sub-points  covering 
quality assurance, monitoring and evaluation of programmes.  

The Recommendation foresees that the Member States report back on the implementation of 
the above points within two years after its adoption and invites the Commission to prepare a 
report.  

The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) publishes yearly 
a report on the state of the  drugs problem in EU including information on DRDs  and drug-
related infectious diseases such as HIV/AIDS and hepatitis. See figure 1. 

2. 

METHODOLOGY – DATA COLLECTION 

This Report is based on two main sources. 
First, in 2005, the Commission asked the 25 Member States to report on the state of affairs 
regarding the implementation of the Council Recommendation.  

Moreover,  the  above  information  was  subsequently  processed  by  the  Trimbos  Institute,  an 
independent  research  centre  in  the  field  of  mental  health  and  addiction,  which  had  been 
commissioned to write a background document in preparation of this Report. The background 
document  includes  detailed  information  on  existing  policies  and  practices  across  Member 
States  for  the  prevention  and  reduction  of  health-related  harm  associated  with  drug 
dependence,  together  with  a  review  of  the  current  situation  regarding  the  effectiveness  of 
harm reduction interventions2. 

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OJ L165, 03/07/2003, p. 0031 – 0033 
See Annex 2 

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3. 

MAIN  OUTCOMES  RELATED  TO  THE  IMPLEMENTATION  OF  THE 
COUNCIL RECOMMENDATION 

3.1. 

Recommendation point 1 - Harm reduction as a public health objective 

In all Member States, the prevention and reduction of drug-related harm is a defined public 
health  objective  at  national  level.  In  this process,  the  Recommendation  played  an  important 
role in particular in most of the countries joining the EU in 2004.  

Member  States  have  also  included  a  reference  to  the  Council  Recommendation  in  the  EU 
Drugs Strategy 2005-2012. 

3.2. 

Recommendation  point  2  –  Harm  reduction  services  and  facilities  in  the 
Member States 

All  Member  States  have  established  harm  reduction  services  and  facilities,  some  to  a  lesser 
extent. 

The data assembled for the background document provide a good overview of the availability 
of services and facilities in the Member States. 

See Figure 2, Annex II. 

•  Harm reduction facilities and services in the Member States 

All Member States have implemented the policy of providing information and counselling to 
drug  users.  Further  measures  of  information,  education  and  communication  (IEC)  are 
telephone  help  lines  and  a  broad  range  of  educational  leaflets,  which  are  available  to  drug 
users in all countries. Twenty-two countries use websites and some even have internet-based 
counselling tools. Training courses that address prevention of risks and harm are provided in 
21 countries. In Malta, for example, such training is available for drug users on an individual 
basis for those who attend an outpatient unit.  

The communities and families of drug users are widely involved in harm reduction activities 
in the Member States and specific information packages are available for them in the majority 
of  countries.  In  the  United  Kingdom,  for  example,  families  are  involved  in  overdose 
prevention training to reduce DRDs.  

Outreach work is a common response strategy to prevent infectious diseases. Either street-
based  or  in  recreational  settings  such  as  dance  parties/raves,  it  is  well  implemented  across 
Member States though with geographical variations within countries. For example, outreach 
projects  and  low-threshold  services  exist  throughout  Italy  and  the  variety  of  facilities  has 
expanded over time. Moreover, mobile methadone treatment has recently been introduced in 
some areas of the country.  

Peers  and  volunteers  are  systematically  involved  in  outreach  work  in  the  majority  of 
Member  States  (19).  Information  on  the  training  of  peers  and  volunteers  is  available,  even 
though information on their concrete involvement in outreach work is limited. In Belgium, for 
example,  (former)  drug  users  are  trained  to  disseminate  HIV  prevention  and  overdose 
prevention messages. 

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Networking and cooperation between outreach work agencies exists in the vast majority of 
Member States (20), even though the number of agencies is quite small in some of them. It is 
very encouraging that Lithuania and Latvia will soon implement this policy.  

Provision  for  drug  treatment  exists  in  all  Member  States  and  they  implement  opioid 
substitution  treatment  (Cyprus  is  preparing  such  treatment  programmes).  There  are 
maintenance  and  detoxification  regimes  to  stabilise  and  reduce/terminate  drug  use, 
respectively. Opioid substitution treatment is a common response strategy to reduce DRDs, 
and substitution treatment with methadone and/or buprenorphine, supported by psychosocial 
care, is available in almost all countries (24). Sweden, for instance, was the first country to 
provide  methadone  maintenance 
treatment,  and  a  strict  high-threshold  methadone 
maintenance programme is currently running.  
Several  studies  show  a  relationship  between  maintenance  treatment  of  opiate  users  and  a 
reduction  of  drug-related  deaths.  Effectiveness  may  increase  with  higher  doses  and  when 
psychosocial intervention supplements treatment programmes.  

Regarding  the  prevention  of  the  diversion  of  substitution  substances,  almost  all  Member 
States  (22)  reported  that  measures  such  as  strict  registration,  supervised  consumption,  urine 
testing, and daily pick-up of doses are in place to prevent leakage to the black market. Estonia 
and Slovenia, for example, specifically reported that the implementation of policy to prevent 
diversion is the result of the Recommendation. 

The  testing/screening  of  infectious  diseases  is  available  nationwide  to  drug  users  in  19 
Member States and in certain geographical areas in three countries. Prevention and education 
measures as well as specific treatment programmes for the prevention of infectious diseases 
targeted at drug users are available nationwide in 15 countries and for specific geographical 
areas in five countries. Vaccination campaigns for hepatitis B focusing specifically on drug 
users are available nationwide in 15 countries and for specific areas in five further countries. 
In Luxembourg for example, an action and research programme was initiated in 2005 by the 
National  Focal  Points  (NFPs)3  to  provide  for  on-site  testing  (hep.  A,  B,  C,  and  HIV)  and 
vaccination  (hep.  A,  B)  by  specialised  national  non-governmental  organisations  (NGOs). 
Vaccination programmes exist throughout the EU, but do not always specifically target drug 
users. 

Needle and syringe exchange programmes are available to drug users in 24 Member States, 
in 15 of which nationwide. Condom distribution is available from drug services throughout 
the EU with a few exceptions (2). Needle and syringe exchange programmes, combined with 
information or education strategies, which target drug users in their daily environment have 
been  shown  to  be  both  effective  and  cost-effective  in  reducing  risk  behaviours  among 
injecting drug users and are therefore likely to prevent the transmission of infectious diseases. 

All countries have a policy ensuring that emergency services are trained and equipped to deal 
with  overdoses  and  in  most  them  (20),  ambulances  routinely  carry  the  opiate  antagonist 
naloxone.  However,  the  medical  staff  working  in  emergency  services  does  receive  specific 
training in dealing with drug overdoses in 10 countries only. 

The  last  sub-point  under  this  point  of  the  Recommendation  calls  for  support  for  training 
activities  leading  to  a  recognised  qualification  for  professionals  responsible  for  the 
prevention  and  reduction  of  health-related  risks  associated  with  drug  dependence.  Such  a 
policy  exists  in  almost  all  Member  States  (22).  Training  for  outreach  workers  and 

3 

http://www.emcdda.europa.eu/?nnodeid=403 

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professionals  in  maintenance  treatment  is  available  respectively  in  21  and  20  countries. 
Training for professionals in low-threshold services is provided in 19 countries. 

•  Harm reduction services in prisons 

The EMCDDA reports that the lifetime prevalence of injecting drug use among prisoners in 
Europe is between 7% and 38%. A policy to provide drug users in prisons with services that 
are similar to those available to drug users outside prisons exists in 20 Member States and is 
about to be introduced in four countries. 

The background document reports that needle and syringe exchange programmes in prison are 
probably effective in reducing needle sharing among injecting drug users and the transmission 
of drug-related infectious diseases. They may also reduce abscesses.  

The distribution of drug paraphernalia4 is not a common practice in the prisons (11 countries 
only). Three countries provide needle and syringe exchange in prisons. In Spain, for example, 
a needle and syringe exchange programme is available in 38 prisons.  

Substitution and detoxification treatments are available in prisons in, respectively, 17 and 19 
countries although the coverage varies greatly. Condom distribution is available in prisons in 
16 countries. 

See Figure 3, Annex II.  

•  Integration of harm reduction with social and mental health care 

The Member States indicate that harm reduction is considered at policy level to be an integral 
part  of  (mental)  health  and  social  care,  but  according  to  the  background  document  this 
integration has not always been put into practice: “Member States continue to struggle with 
drug users who have both a dependency problem and a mental health problem (co-morbidity 
or double diagnosis) and the reintegration of former drug users to a regular working life and 
housing is often still problematic”.  

Twenty-three  countries  have  a  policy  to  promote  appropriate  integration  between  health 
services (including mental health services) and social care, on the one hand, and specialised 
approaches to risk reduction on the other. It is reported as implemented practice in four-fifths 
of  the  countries.  In  France,  for  example,  the  RMS  programme  (Réseau  Micro-Structures) 
provides  care  for  all  kinds  of  addicted  patients  by  physicians,  social  workers  and 
psychologists.  

Nevertheless, it seems that the implementation of this policy still needs development, since it 
appears that providing a fully integrated system of care for drug users remains a challenge. 

3.3. 

Recommendation point 3 – Quality assurance, monitoring and evaluation 

Not all Member States see quality assurance, monitoring and evaluation as the task of national 
government. However, they subscribe in general to the need for greater emphasis on and use 
of scientific evidence in harm reduction practice. In countries with a federal or decentralised 
structure,  tasks  are  divided  among  the  different  levels  of  competence.  In  others,  quality 

4 

Tools and equipment needed to prepare or administer drugs 

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assurance,  monitoring  and  evaluation  are  seen  as  a  task  for  independent  scientific 
organisations.  

See Figure 4, Annex II. 

Assessment,  monitoring  and  evaluation  of  harm  reduction  services  and  facilities  in  the 
Member States 

The  majority  of  Member  States  (19)  report  policy  decisions  to  be  specifically  based  on 
scientific evidence of effectiveness. Several have research and evaluation projects to examine 
harm reduction interventions (e.g. substitution programmes, outreach work, needle exchange). 
For  example,  Germany  reports  an  evaluation  of  substitution  treatment  (methadone  and 
heroin).  Lithuania  reports  its  “Blue  Bus”  needle  exchange  project,  which  is  assessed  on  a 
monthly  basis  and  also  by  performing  client  surveys.  In  Hungary,  the  National  Institute  for 
Drug Prevention has developed a database ‘SZIP’ to make scientific evidence of effectiveness 
broadly available, i.e. by combining programme information and scientific research. Slovakia 
reported  that  the  results  of  international  research  are  systematically  being  used  for  the 
development of interventions and policies. 

In  general,  Member  States  do  agree  with  the  need  for  assessments  at  the  initial  stage  of 
programmes  but  often  do  not  make  it  a  condition  in  the  selection  of  programmes  and 
interventions.  In  Ireland,  however,  a  baseline  assessment  determined  the  hepatitis  B 
vaccination coverage among drug users in order to design a pilot project to improve infectious 
disease preventive care for IDUs. 

The development of evaluation protocols for the evaluation of interventions is a task often 
considered to be one for scientific institutions dealing with quality evaluation. However, some 
Member  States  such  as  the  Czech  Republic  and  Denmark  have  developed  protocols  and 
guidelines  as  part  of  their  drugs  policy.  In  Cyprus,  for  example,  the  Anti-Drug  Council’s 
scientific  committee  has  developed  specific  guidelines  for  drug  treatment  centres  to  ensure 
minimum quality standards. In Greece a policy includes evaluation in every programme. This 
part of the Recommendation is reported as being implemented in 12 countries. 

Fourteen  Member  States  have  a  policy  in  place  that  aims  to  support  the  development  of 
evaluation  quality  criteria.  Such  policies  are  often  at  an  early  stage  of  development.  In 
Finland,  for  example,  the  Drug  Policy  Action  Programme  2004-2007  calls  for  the 
development  of  a  quality  framework  for  drug  service  providers.  EMCDDA  has  produced 
several manuals and monographs on quality and evaluation5, but countries do not specifically 
refer to their use. 

Twenty-three  Member  States  report  compliance  with  the  five  key  EMCDDA  indicators6. 
However,  some  do  not  yet  implement  all  five.  Every  year,  EMCDDA  provides  feedback  to 
individual countries on the quality of their input and possible deficiencies in their information. 
National reports are usually published on national websites.  

Nineteen Member States emphasise that the results of evaluation contribute to the refining 
and  development  of  drug  prevention  policies.  The  countries  report  that  the  evaluation  of 
national drug strategies and action plans is gaining increasing importance, but only a limited 

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Available at http://publications.eu.int/others/sales_agents_en.html 
http://www.emcdda.europa.eu/?nnodeid=1365 

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number of them seem to carry out systematic evaluation to assess the effectiveness of specific 
target  harm  reduction 
interventions.  Many  evaluation  schemes  do  not  specifically 
interventions but rather the wider field of drug demand reduction. In Poland, for instance, an 
evaluation of drug therapy programmes for women in prisons to prevent relapses has resulted 
in  the  inclusion  of  new  objectives  within  the  National  Programme  for  Drug  Prevention.  In 
Portugal, the National Drug Strategy ‘Horizonte 2004’ has been evaluated both internally and 
externally,  leading  to  new  recommendations  such  as  the  further  development  of  existing 
initiatives  to  improve  risk  reduction  and  harm  minimisation  systems  (e.g.  substitution 
programmes, syringe exchange, campaigns for the use of condoms). 

The  evaluation  training  programmes  for  different  levels  and  target  groups  have  been 
implemented in 14 Member States. The NFPs are frequently mentioned as (co-)organisers of 
such  training  programmes,  but  these  programmes  are  not  reported  to  be  part  of  the  regular 
curricula  for  professionals  in addiction  care.  However,  in  the  Czech  Republic,  for  example, 
quality  standards  for  addiction  treatment  services  have  been  developed  and  implemented 
within  a  training  programme  for  professionals,  and  in  Austria  quality  assurance  and 
evaluation forms part of the curricula for drug-specific further education. 

Fourteen  Member  States  reported  having  a  policy  in  place  to  enable  all  actors  and 
stakeholders  to  be  involved  in  the  evaluation  process,  but  very  few  present  concrete 
examples  of  participation  and  involvement.  In  the  Netherlands,  for  instance,  a  system  of 
‘client  councils’  for  patients  in  health  care,  including  addiction  care,  has  been  created.  In 
Spain, the involvement of stakeholders in evaluation is a priority in the National Action Plan 
on Drugs. 

Bi- and multi-lateral programmes involving several Member States have been developed, and 
21 report that they have a policy to encourage exchange and collaboration with others. It 
appears that there is now more cooperation between them and even with third countries. They 
are also cooperating with the Commission, through e.g. the Community Programme on Public 
Health,  to  exchange  skills  and  experiences  within  the  EU.  The  EU  Phare  Twinning 
Programme7 has been an important tool for enhancing the collaboration between the old and 
the new countries joining EU in 2004. Seven countries indicate that the Recommendation has 
been an important tool in developing this kind of activity. 

See Figure 5, Annex II. 

4. 

(1) 

CONCLUSIONS 

All Member States have policies and actions in place that to a large extent reflect the 
measures recommended in the Recommendation and in most of the new countries the 
document is considered as an important support for policy development. It has also 
served  as  a  benchmark  for  the  implementation  of  harm  reduction  interventions.  As 
the level of implementation is variable within and between countries, it is important 
to  continue  developing  harm  reduction  measures  and  implementing  harm  reduction 
services/facilities as part of an integrated system of prevention and care. 

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http://ec.europa.eu/enlargement/key_documents/phare_legislation_and_publications_en.htm. 

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(2) 

(3) 

(4) 

(5) 

(6) 

(7) 

Almost all Member States have a policy in place to promote appropriate integration 
between  health  services  (including  mental  health  services  and  social  care)  and 
specialised harm reduction services. These efforts to integrate programmes within the 
general health care system need to be intensified and continued. 

Methadone  and  buprenorphine  substitution  treatments  supported  by  psychosocial 
care are available in all Member States, and availability has increased considerably 
over the past decade. However, the extent to which the provision meets the estimated 
need varies between countries. The accessibility, coverage and sustainability of these 
services should be ensured.  

Data on the availability of harm reduction services/facilities collected by EMCDDA 
are comprehensive and of a high quality. However, information on the accessibility 
and  the  utilisation  of  such  facilities,  with  a  particular  focus  on  at-risk  populations, 
should  be  further  improved  in  order  to  obtain  an  overview  of  the  situation  in  the 
different  countries  with  clear  indications  on  coverage  as  a  core-element  in  policy 
evaluation. In addition, the gap in compliance with the five key EMCDDA indicators 
needs to be addressed. 

Almost all Member States have implemented measures to prevent infectious diseases 
among  drug  users  in  prisons.  However,  harm  reduction  interventions  in  prisons 
within  the  European  Union  are  still  not  in  accordance  with  the  principle  of 
equivalence  adopted  by  UN  General  Assembly8,  UNAIDS/  WHO9  and  UNODC10, 
which  calls  for  equivalence  between  health  services  and  care  (including  harm 
reduction) inside prison and those available to society outside prison. Therefore, it is 
important  for  the  countries  to  adapt  prison-based  harm  reduction  activities  to  meet 
the  needs  of  drug  users  and  staff  in  prisons  and  improve  access  to  services.  The 
continuity  of  these  services,  including  quality  and  access,  should  be  ensured  after 
release from prison. 

Among  the  Member  States  there  is  increasing  awareness  of  the  need  to  develop 
research-based,  fact-driven  policies  and  to  implement  evidence-based  activities, 
including those to prevent and reduce health-related harm. To critically evaluate such 
measures, improved monitoring and in-depth research should become an integral part 
of  overall  policy  to  prevent  and  reduce  drug-related  harm,  as  reflected  in  the 
Recommendation, the EU Drugs Strategy 2005-2012 and the EU Drugs Action Plan 
2005-2008. 

A  range  of  different  methodologies  to  assess,  monitor  and  evaluate  harm  reduction 
services and facilities are currently in use among Member States. It is therefore for 
them  to  discuss  and  exchange  information  on  best  practice  with  regard  to  such 
methods in order to develop standardised approaches and tools for the collection of 
objective, reliable and comparable information.  

(8) 

Finally,  it  is  of  utmost  importance  to  ensure  synergies  between  policies  and 
initiatives  with  health-related  aspects  and  possible  links  to  drug  use  (e.g.  mental 

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http://www.pogar.org/publications/garesolutions/a45-111-90e.pdf 
http://data.unaids.org/Publications/IRC-pub01/JC277-WHO-Guidel-Prisons_en.pdf 
http://data.unaids.org/pub/Report/2006/20060701_hiv-aids_prisons_en.pdf.  

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health,  alcohol,  HIV/AIDS  prevention,  drug  dependence  at 
drugs/medicines and driving). 

the  workplace, 

5. 

FOLLOW-UP OF THE 2003 COUNCIL RECOMMENDATION 

The reporting on the implementation of the Recommendation covers a period of 1.5 to 2 years 
at most. This period is still quite limited to produce a reliable picture of the influence of the 
Recommendation on national harm reduction policies, services and facilities. In addition, new 
countries have joined the EU during the reporting period (2004). 

As  a  consequence  this  Report  could  be  primarily  seen  as  a  baseline  measurement  for  the 
implementation of the Council Recommendation. It can also function as a baseline overview 
on  existing  harm  reduction  measures  in  the  EU  for  the  evaluation  of  the  EU  Drugs  Action 
Plan 2005-2008.  

The Commission aims to repeat this exercise in the framework of the next EU Action Plan on 
Drugs 2009-2012, in order to examine if the implementation of policies, services and facilities 
regarding  harm  reduction  has  progressed.  The  Commission  will  then  be  in  a  position  to 
consider, together with the Member States, if there is a need for further recommendations.  

Furthermore,  the  Commission  will  continue  to  develop  initiatives  on  areas  that  are  closely 
related  to  the  Council  Recommendation  and  that  take  actively  into  account  policies  and 
practices that might be of significant influence to the achievement of its main activities. Two 
specific health actions relating to drug prevention are included in the EU Action Plan 2005-
2008 (actions 12 & 13.2): 

•  a proposal for a Council Recommendation on drugs and prisons; the prison population has 
a high proportion of drug users, and prison settings are an urgent issue with regard to drug 
use and especially IDUs; 

•  a report on the situation regarding drug treatment and the exchange of good practice across 
the EU; more than half a million persons are receiving substitution treatment in Europe. 

The Public Health Programme  

The  Community  Public  Health  Programme  includes  actions  on  drug  prevention  aiming  at 
tackling health determinants, which are multi-dimensional issues linked to a number of major 
health problems. 

The Drugs Prevention and Information Programme 2007-2013  

Activities will support the implementation of the EU Drugs Strategy by funding projects and 
activities in the field of drug demand reduction, including harm reduction. 

Work on drug demand reduction should be linked to the following areas: 

•  HIV/AIDS prevention 

Drug injection is a major vehicle for HIV/AIDS transmission. The Communication from the 
Commission to the Council and the European Parliament on combating HIV/AIDS within the 

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European Union and in the neighbouring countries, 2006-200911, sets out an action plan for 
work on HIV prevention and recognises the need for synergies with key prevention activities. 
One key point is the development of tailor-made training curricula for professionals involved 
in services (prevention, treatment, and care) for people living with HIV/AIDS and populations 
particularly  vulnerable  to  HIV/AIDS  (including  intravenous  drug  users  and  migrants).  In 
addition, the HIV/AIDS Think Tank has become a fruitful forum for exchanging experiences 
and information among partners.  

•  Alcohol prevention 

In  the  context  of  polydrug  use,  alcohol-related  harm  and  drug-related  harm  also  need  to  be 
seen in conjunction. The Commission Communication for an EU strategy to support Member 
States  in  reducing  alcohol-related  harm12  includes  the  promotion  of  effective  behaviour 
change among children and adolescents in schools and families and other appropriate settings 
as well as the reduction of road accidents related to alcohol and polydrug use. 

•  Mental health promotion 

Drug  use  often  coincides  with  mental  illness.  Improving  access  to  medical  and  psychiatric 
treatment for drug users remains an important challenge for public health policy. The Green 
Paper  on  Mental  Health  published  in  October  2005  by  the  Commission13  proposed  the 
development  of  a  strategy  on  mental  health  at  EU  level.  This  is  now  being  prepared  and 
should  coordinate  with  other  initiatives  under  different  Community  policies  such  as  the  EU 
Drugs Strategy 2005-2012. 

•  Civil society involvement 

Efforts must also be made to reduce the indirect damage that drug users can cause to others. 
Drug users need to be actively involved in these efforts. The Green Paper on Drugs Policy and 
Civil  Society  in  the  European  Union  adopted  by  the  Commission  in  June  200614  explored 
opportunities to improve the involvement of civil society. 

•  Drugs/medicines and driving15 

In  the  context  of  transport  policy  the  issue  of  polydrug  use  and  driving  is  being  addressed. 
The Commission is also co-funding a project called DRUID (DRiving Under the Influence of 
Drugs, alcohol and medicines) under the framework of the Sixth Framework Programme for 
research and technological development (FP6). 

•  Drug dependence at the workplace 

The Commission is currently preparing its Strategy on Safety and Health at Work 2007-2012. 
Concrete initiatives in support of specific public health actions addressing drug dependence at 
the workplace should be developed. 

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15 

http://eur-lex.europa.eu/LexUriServ/site/en/com/2005/com2005_0654en01.pdf 
http://eur-lex.europa.eu/LexUriServ/site/en/com/2006/com2006_0625en01.pdf. 
http://ec.europa.eu/health/ph_determinants/life_style/mental/green_paper/mental_gp_en.pdf 
http://eur-lex.europa.eu/LexUriServ/site/en/com/2006/com2006_0316en01.pdf 
Council Resolution of 27 November 2003 on combating the impact of psychoactive substances use on 
road accidents: Official Journal n° C 097 of 22/04/2004 p. 0001-0003 

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5.1. 

ANNEX I – Abbreviations and technical terms used  

TECHNICAL ANNEXES  

DRD 

EMCDDA 

IDU 

IEC 

NFPs 

UNAIDS 

WHO 

UNODC 

Drug-Related Death 

European  Monitoring  Centre  for  Drugs  and  Drug 
Addiction 

Injecting Drug User 

Information, Education, Communication 

National Focal Points 

Joint United Nations Programme on HIV/AIDS 

World Health Organization 

United Nations Office on Drugs and Crime 

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5.2. 

ANNEX II – Figures  

Figure 1 

Indexed long term trend in acute drug-related deaths in the EU, 1985 to 2004
Indexed: 1985 = 100%

)

%
0
0
1
=
5
8
9
1
(

%

x
e
d
n

I

300

250

200

150

100

50

INDEX

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004*

100

104,5

118,7

136,9

153,7

180,8

215,7

223,1

201,4

211,8

224,6

251,2

230,1

235,2

241,3

255,3

239,5

205,5

188,2

190,4

EMCDDA annual report 2006 

Notes: 

The new Member States and Candidate Countries are not included in this graphic due to the 
lack of retrospective data in most of them.  

Index: 1985=100%.  

A  few  countries  did  not  provide  data  for  some  years  (see  Statistical  Bulletin  2006  [Table 
DRD-2]).  To  correct  this  situation,  it  has  been  used  the  computation  method  defined  in  the 
report "European Monitoring Centre for Drugs and Drug Addiction (2001). Co-ordination of 
the implementation of the EMCDDA standard guidelines on the drug-related deaths in the EU 
Member States, and the collection and analysis of information on drug-related deaths. Project 
CT.99.RTX.04, Co-ordinated by the Trimbos Institute. Lisbon: EMCDDA. 

Ten countries provided information for 2004 and six did not. Therefore, the figure for 2004 is 
provisional,  based  in  comparing  2003  and  2004  only  for  those  countries  with  data  for  both 
years. The trends for those countries that provided information can be seen in the figures with 

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trends by country. Number of cases per country per year are presented in Statistical Bulletin 
2006 [Table DRD-2]. 

The  EMCDDA  estimates  the  yearly  number  of  acute  DRDs  (overdoses)  in  the  EU  since 
1990 to be from 6500 to over 9000.  

Recently  published  estimates  show  that  a  substantial  proportion  of  mortality  among  young 
adults in some EU urban areas can be attributed to opioid use. In addition, HIV transmission 
is  continuing  to  be  a  concern  in  specific  injecting  groups  across  Europe,  although  most 
countries report low rates of newly diagnosed HIV infection attributable to drug injecting and 
estimate the HIV infection rates among injectors to be below 5%. A far more negative picture 
presents  itself  for  rates  of  infection  with  the  hepatitis  C  virus  (HCV),  which  remain  almost 
universally high among drug injectors.  

Since 2000, many EU countries have reported decreases in DRD numbers. In 2004, however, 
there  was  an  increase.  While  the  number  of  DRDs  is  still  far  too  high  from  a  longer-term 
public  health  perspective,  a  better  availability  of  drug  treatments  and  increased  coverage  of 
harm reduction services in recent years seem to have had an impact. 

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Figures from the background document on "prevention and reduction of health-related 
harm associated with drug dependence - an inventory of policies, evidence and practices 
in  the  EU  relevant  to  the  implementation  of  the  Council  Recommendation  of  18  June 
2003". 

The  document  is  available  in  print  (EN)  and  can  be  downloaded  (EN,  FR,  DE)  at  the 
following web address: http://ec.europa.eu/health/ph_determinants/life_style/drug_en.htm 

The Trimbos Institute extracted and analysed relevant data, in particular from the EMCDDA 
sources  (the  NFPs  coordinated  by  the  EMCDDA  confirmed  and  updated  the  information 
provided  for  the  Recommendation  point  2),  the  projects  funded  under  the  ‘Programme  of 
Community  action  on  the  prevention  of  drug  dependence’  and  the  ongoing  Public  Health 
Programme,  the  projects  funded  under  the  4th,  5th  and  6th  Framework  Programmes  for 
Research  and  Technological  Development  as  well  as  from  some  field  organisations,  the 
World Health Organization (WHO), the Pompidou Group (PG), and the Joint United Nations 
Programme on HIV/AIDS (UNAIDS). Finally, a literature review was conducted to identify, 
assess and summarise scientific evidence on harm reduction interventions and approaches. 

Figure 2  

Figure 5.3 - Availability of harm reduction services and facilities (R 2.6)

y
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Drug consumption rooms
Methadone detoxification
Rehabilitation centres
Buprenorphine treatment
Heroin prescription
Drug-free in & outpatient treatment
Drop-in centres/ shelters
Methadone maintenance
Naltrexone treatment

Harm reduction service or facility

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Figure 3 

y
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Figure 5.4 - Harm reduction services available in prison (R2.8)

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10

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5

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3

Methadone maintenance

Methadone detoxification

Buprenorphine treatment

Naltrexone treatment

Heroin prescription

Needle & syringe exchange
Drug paraphernalia

(free) condom distribution

Figure 4 

10

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Harm reduction service or facility

Figure 5.6 - 3rd CR - Recommendations adopted in policy by MS

Recommendation
is policy

Based on CR

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m
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Ki
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EU Member State

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Figure 5 

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Figure 5.7 - Implementation 3rd Council Recommendation

25

19

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Policy exists

Not task NatGov

Pending approval

No priority NatGov

Diverging answ er

Other reason

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5

0

3.7 Evaluation training
3.6 Evidence for policy
3.4 Evaluation quality criteria
3.3 Evaluation protocols
3.5 Data collection & dissemination
3.9 International cooperation
3.1 Effective interventions
3.8 Stakeholders & evaluation
3.2 Needs assessment

Proposed policy sub-recommendation

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