Country Overview Guidelines

 

Country Overview Guidelines

Revised April 2016

Table of contents

Introduction.. 3

What is a Country overview ?. 3

What is the purpose of a Country Overview ?. 3

What is the periodicity ?. 3

What is the basic structure of the Country Overview ?. 3

What is the average lenght of the Country Overview ?. 3

What are the aims of these guidelines ?. 3

Where are the Country Overviews published?. 3

1.     Social Demographic overview... 4

2.     Drug use among the general population and young people.. 5

3.     Prevention.. 5

4.     High-risk drug use (formerly – Problem drug use) 6

5.     Drug treatment demand.. 7

6.     Drug related infectious diseases.. 7

7.     Drug related deaths.. 8

8.     Treatment responses.. 8

9.     Harm reduction responses.. 9

10.       Drug markets and drug related offences.. 10

11.       National drug laws.. 10

12.       National drug strategy.. 11

13.       Coordination mechanism in the field of drugs.. 11

15.       Drug related research  (optional) 11

16.       List of references.. 12

Use the “Harvard System” for reporting references. Terminology and Glossary of Terms   12

 

Introduction

What is a Country overview ?

A Country Overview is a structured synopsis of the trends and characteristics of the national drug problem and responses to it. Country Overviews are available for the 28 EU Member States, Norway and Turkey, as well as for IPA beneficiaries, selected ENP countries and countries within CADAP project. See link http://www.emcdda.europa.eu/publications/country-overviews.

What is the purpose of a Country Overview ?

The main purpose of the Country Overview is to provide policy makers, researchers, journalists and the general public with a brief synopsis of data, trends and core characteristics of the state of the national drug problem and responses to it. As such it is not intended to be used for comparison of data across Member States, which is provided by other EMCDDA-designed products.

What is the periodicity ?

For 28 EU Member states, Norway and Turkey the reporting period of each Country Overview is based on the latest National Reports, Standard Tables and Standard Questionnaires submitted by National Focal Points on a yearly basis. For other countries, drafting of the country overview and periodicity for updates is agreed on bilateral bases.

What is the basic structure of the Country Overview ?

The structure of the Country Overview is based on a standard reporting template which is made up of 15 chapters. Chapter 1 to chapter 9 gives an overview on the drug situation and the (public) health, social and legal responses to drug use in the country. Chapter 10 to chapter 15 give an overview on drug markets, law and coordination mechanism, drug-related public expenditures, as well as research developments in the field of drugs.

What is the average lenght of the Country Overview ?

In total the Country Overview should be approximately 8 to 10 pages long.

What are the aims of these guidelines ?

These guidelines aim to provide a clear and structured step-by-step process to facilitate the process of drawing up the first Country Overview. Furthermore, these guidelines aim to ensure that all country overviews have a consistent structure and outline.

What functions undertake the EMCDDA before publishing Country Overviews?[1]

The country overviews should be prepared in English. The EMCDDA will provide following services: crosschecking of information in the country overview by Reitox and External partners unit; proofreading of English language (agreed on bilateral basis) and publishing of Country Overview on the EMCDDA website by Communication Unit.

Where are the Country Overviews published?

The EU Country Overviews are published on the EMCDDA website through the following link:

http://www.emcdda.europa.eu/publications/country-overviews. The location and format of publishing the country overviews for third countriesa will be agreed on bi-lateral basis.

1.  Social Demographic overview

Aim: To provide a general demographic data overview about the country

Year

Country data

EU (28 countries) –filled in by the EMCDDA

Source

Surface area

Population

Eurostat for EU and selected IPA countries only; For others – national or other sources

GDP per capita in Purchasing  Power Standards(2)

Eurostat for EU and selected IPA countries only; For others – national or other sources

Total expenditure of social protection (%GDP) (if not available for non-EU countries  Inequality of income distribution)

Eurostat for EU and selected IPA countries only; For others – national or other sources

Unemployment rate

Eurostat for EU and selected IPA countries only; For others – national or other sources

Unemployment rate of population aged <25 years

Eurostat for EU and selected IPA countries only; For others – national or other sources

Prison population rate (per 105 of national population)

Council of Europe, SPACE I 2010

At risk poverty rate

Eurostat (SILC) for EU and selected IPA countries only; For others – national or other sources

2.  Drug use among the general population and young people

Aim: To provide a brief overview on drug use in the general population, in the school population and in youth population in general, and drug use among specifically defined  groups (such as clubbers / dance partygoers), respectively.

GPS is one of the Five EMCDDA Key Indicators, providing prevalence of drug use in the general population.

[*]          Provide a brief overview of surveys undertaken on drug use among the general population for the specified population – e.g. residing in a specific city, region or the whole country) quoting target population, year of survey, sample size (net) (response rate only in occasions of very low responses), drug use prevalence (lifetime, last year, last month), patterns of use, attitudes to drug use and trends (focusing on 15-34 years old group) in anything above if available. Following figures are usually cited: three most frequently used drugs during lifetime, last year and last month among 15-34 years olds and 15-64 years olds. 

[*]          Prevalence of new psychoactive substances if available.

[*]        Provide a brief overview of surveys undertaken on drug use among young people such as the ESPAD schools survey project and the HBSC (WHO) School Survey on health behavior among school-aged children. If other school surveys were undertaken in the country, quote target (age) group and geographic coverage, year, etc. (see above).  

Data cited:

·         life time prevalence of three most frequent drugs 15-64 and 15-34 y.o.

·         last year prevalence of three most frequent drugs 15-64 and 15- 34 y.o

·         last month prevalence of three most frequent drugs 15-64 and 15-34  y.o.

·         gender distribution for main substance (usually cannabis) 15-34 y.o

·         three most prevalent drugs among 15-16 y.o (usually ESPAD, HBSC or national level study)

·         cannabis life time use among 15-16 y.o by gender(usually ESPAD, HBSC or national level study)

·         prevalence of drugs in recreational settings (if available)

·         prevalence of NPS (if available)

3.  Prevention

Aim: To provide a concise overview of the prevention interventions at national level on three main areas of intervention, namely: universal prevention, selective and indicated prevention

[*]        Provide a general brief description and new development on substance use and other risk behaviour prevention and indicate which sectors (governmental, NGO, private) are involved in each prevention interventions / complex programs. Also describe how prevention is organised (funds and responsibilities).

[*]        A brief description of the prevailing universal prevention interventions that address the entire population (such as: national, local community, school, neighborhood) with programmes aimed at preventing or delaying the abuse of illegal drugs accompanied by a brief description of what approach is being used, such as development of health lifestyle skills, or information dissemination and evaluation. Focus mostly on intervention whose contents (what is actually being done and delivered) are reported.

[*]        A brief description of the selective prevention intervention that target subsets of the total population that are deemed to be at risk for substance abuse by virtue of their membership in a particular population segment, e.g. children of adult alcoholics, dropouts, or students who are failing academically, or youth in night entertainment setting. If such information is available, please state whether such activities are evaluated and what approach is being used.

[*]        A brief description of indicated prevention interventions specifically targeted at individuals who are exhibiting early signs of substance abuse (but not ICD-10 criteria for addiction) and other problematic behavior. Please state whether such activities are evaluated and what approach is being used.

[*]        Main results of new national research especially regarding effectiveness and outcome of interventions. Mention the existence standards or guidelines, if any.

4.  High-risk drug use (formerly – Problem drug use)

Aim: To provide an overview on high-risk drug use (HRDU)

Until 2012, the EMCDDA defined problem drug use as injecting drug use (IDU) or long duration/regular drug use of opiates, cocaine and/or amphetamines. Ecstasy and cannabis were not included in this category. However, in 2012 a new concept of ‘high-risk drug use’ was adapted.  View details here http://www.emcdda.europa.eu/activities/hrdu .

The term ‘high-risk drug use’ means ‘recurrent drug use that is causing actual harms (negative consequences) to the person (including dependence, but also other health, psychological or social problems) or is placing the person at a high probability/risk of suffering such harms.  It is measured as the use of psychoactive substances by high-risk pattern (e.g. intensively) and/or by high-risk routes of administration in the last 12 months. Please describe:

[*]        Estimates to describe high risk drug use: ‘high-risk opioid use’ or former ‘problem opiate use’ and ‘injecting drug use’  (if none of them available, can be substituted by ‘problem drug use estimate’ but in this case should describe the national definition applied for the estimate);

[*]        Frequent and high risk cannabis use among 15-64 years olds (daily cannabis use in last month from general population studies);

[*]        High-risk use of cocaine, methamphetamine or other substances (if more prevalent at national level)

Data cited:

·         estimated number of high-risk opioid use’ or former ‘problem opiate use’ and ‘injecting drug use’

·         Trend in the estimated number

·         Estimated prevalence of daily cannabis users (if available)

5.  Drug treatment demand

Aim: An overview of the population of drug users entering or in treatment

The Treatment Demand Indicator (TDI) is one of the Five EMCDDA Key Indicators, describing the population of drug users in treatment[2].

[*]          Provide figures on the total number of treatment units existing in the country (optional are the figures of outpatient and inpatient units) and a figure of the reporting treatment units (optional are the figures of outpatient and inpatient units reporting TDI).

[*]        Provide figures about drug users entering in treatment centers during a given year:

o    Those who start treatment in the given year for the first time in their lives (never previously treated),

o    All clients entering treatment in the given year.

[*]        List all important sociodemographic information, drug use patterns and treatment related data about those two groups of patients in a comprehensive way: proportion (rate and number) of males and females in each group; mean age of treatment clients in both groups (also by main drug (if available)); three most frequent primary drugs reported by each group.

[*]        If treatment entrant or/ treatment prevalence data reflecting the EMCDDA definition is not available then show “registered patients,” or whatever treatment-related indicator exists nationally. Describe ways how the people can fall under that registration; if possible, break down according to those ways categories; if more types of data for Treatment Demand Indicator is available, define each of them explaining differences in definition compared to the key indicator as defined by EMCDDA.

Data cited:

·         total number of treatment units and reporting treatment units

·         number of all clients in treatment, number of new clients in treatment (Please note that treatment system should be described in the section ‘Treatment response’)

·         proportion of female/male clients among new/all treatment clients

·         mean age of treatment clients (all and new)

·         three most frequent drugs reported among new treatment and all treatment clients

6.  Drug related infectious diseases

Aim: An overview of drug related infectious diseases such as HIV/AIDS, HCV and  HBV among drug users

Drug Related Infectious diseases (DRID) is one of the Five EMCDDA Key Indicators.

[*]        HIV/AIDS and HCV in drug users should be described as a minimum; use standard UNAIDS reporting format well known to HIV-centre in your country (socio- demography; ways of transmission; stages of the disease; trends.

[*]        If applicable, please indicate number of new and total number of known HIV-seropositive[3] drug users and those confirmed as positive.

[*]        Please give a figure of new HBV and HCV cases notified among people who use drugs (PWID) and percentage of injecting-related HBV and HCV cases.

[*]        Indicate if any seroprevalence study in the population of drug users was performed and if so, than how the population was (city district, city, region, nation). Please indicate the figures, if available, of HIV, HCV, HBV prevalence among PWID in national (or subnational) samples.

[*]        If available, include data on other diseases related to drug use in your country (such as; Tuberculosis, Sexually Transmitted Diseases, etc.).

Data cited:

·         new HIV cases notified among PWID (% of total number of notified HIV cases)

·         Prevalence of HIV among PWID in national samples (or sub-national samples)

·         Prevalence of HBV in national samples (or sub-national samples)

·         new HBV cases among PWID

·         new HCV cases among PWID

7.  Drug related deaths

Aim: An overview of the number of drug related deaths.

Drug Related deaths (DRD) is one of the Five EMCDDA Key Indicators.

[*]        Show the number of known fatal overdoses, proportion of males and females among those cases; proportion of cases which fall under age of 25 years and proportion of cases with opiate presence.

[*]        Indicate your assessment of the quality of input data that is, the standard practice with unnatural deaths (who issues the death certificate?), proportion of the deceased by unnatural death undergo autopsy and proportion who are checked for presence of illegal drugs in body tissues and/or fluids. Which substances were found?

[*]        State, if any (cohort) studies on mortality of drug users were performed in your country.

[*]          Include key concerns for DRDs

[*]          Describe most recent developments or new developments on monitoring and reporting on DRDs (new formats; progress in reporting; links between registries etc.

Data cited:

·         Number of drug related death (if available, over several years)

·         Proportion of males/females among DRD cases

·         Proportion of DRD cases under age of 25 years

·         Proportion of DRD with opiate presence

·         Average age of deceased victims

8.  Treatment responses

Aim: Brief overview on drug treatment comprising of institutional framework, availability of treatment services, substitution treatment and the legal framework on substitution treatment.

[*]        Provide a brief overview of the drug treatment institutional framework comprising of policy, organisation and financing.

o    Policy: Is there a national drug treatment policy, action plan and what are its objectives?

o    Organisation: At what level is drug treatment coordinated (national/federal/local level)? Who is responsible for coordination of drug treatment if anyone (national/regional/local government body, public health system)?

o    Financing: Who provides funding for different kinds of drug treatment? Are health insurance schemes (mandatory / governmental / private) covering it (or only some drug treatment modalities, or none)?

[*]        Provide a brief overview on the availability of drug treatment (approx. 5 lines).

o    State the availability of different types of treatment available in the country according to:

ü  Outpatient and inpatient treatment centers

ü  Outpatient psychosocial treatment;

ü  Inpatient psychosocial treatment;

ü  Opioid Substitution Treatment,

ü  Detoxification treatment,

ü  Rehabilitation / resocialisation (describe the lengths and types of it).

Special attention should be paid to:

[*]        Brief description of treatment for specific target group drug (e.g.: migrants, adolescents etc.)

[*]        Brief (up to 10 lines) description of substitution treatment (if not available, state it and briefly describe discussion/s about its introduction or its absence):

o    Methadone and/or buprenorphine, year of introduction of treatment which each substance;  

o    A brief description of the legal framework and practice of substitution treatment initiation (who is allowed to initiate substitution treatment, e.g.: any medical doctor or only specialised medical doctors or only doctors in specialised treatment centres). Is this stipulated in the national law or guidelines (quote law or guidelines);

o    If available, include the number of patients/clients in substitution treatment for the year of reporting and trends (by substitution drug, if possible). Is there any substitution register existing?

Data cited:

·         number of all clients on OST, number of clients on MMT and HDBT

9.  Harm reduction responses

Aim: An overview on harm reduction responses and the sectors which are involved in harm reduction

[*]        Describe the number, coverage and modalities of harm reduction responses (needle/syringes exchange/distribution, education of users about safer ways of drug use, number of harm reduction sites and NSP[4] sites in the country.

[*]        If available: describe the number of harm reduction beneficiaries in the country and the origin of the number (methodology how it was reported / estimated).

[*]        If possible, provide estimated number of needles/syringes distributed to the injecting drug users.

[*]        State which sectors (governmental, NGOs, private) are involved in treatment responses and how.

Data cited:

·         Number of syringes distributed (most recent year)

·         Number of HR clients

·         Number of units providing NSP (fixed locations, pharmacies, vending machines, units providing only outreach and mobile units)

10. Drug markets and drug related offences

Aim: To provide overview of major trafficking routes, drug related offences, and street price and purity of drugs.

[*]              A brief description of major drug trafficking routes (from and towards the country).

[*]              Major developments such as first discovery of clandestine laboratory, or seizures of cannabis plantations.

[*]              The quantity per drug in terms of number of seizures and quantity of seizures by drug, with particular focus to number and quantities of following drugs seizures: cannabis resin, herbal cannabis, heroin, cocaine, amphetamine, ecstasy. If some of drugs are not significant for the national market, they could be excluded, while if another illicit drug, to is more prevalent in the national market, it should be described as well.

[*]              Price and purity per drug at street level.

[*]        Provide available trends for on drug law offences (relevant for third countries only):

(police) arrests,
cases brought to court,
sentenced criminals,
inmates;

for each of the above, state source of the data, numbers and trends; where important, some socio-demographic data of offenders may be shown.

[*]              If available, please cite three most prevalent drugs related to all drug offences

Data cited:

·         total number of drug related offences registered

·         three most prevalent drugs related to all drug offences, by order of importance

·         number of cannabis resin seizures

·         quantities of cannabis resin seizures

·         number of herbal cannabis seizures

·         quantities of herbal cannabis seizures

·         number of heroin seizures

·         quantities of heroin seizures

·         number of cocaine seizures

·         quantities of cocaine seizures

·         number of amphetamine seizures

·         quantities of amphetamine seizures

·         number of ecstasy seizures

·         quantities of ecstasy seizures

11. National drug laws

Aim: An overview of national drug laws related to drug use, drug trafficking and possession of drug/s

[*]        What are penalties for different types of drug crimes?

[*]        Is use or possession regarded as a criminal offence or decriminalised?

[*]        Describe any important milestones in the law (changes of law)

[*]        Are laws and penalties the same for all illegal drugs, or are different drugs classified differently (similarly to UK, Belgium or other countries)? What is the position of cannabis in this context?

12. National drug strategy

Aim: An overview of  the national drug strategy

[*]        Does your country have a national drug strategy?

[*]        If yes, when was it approved?

[*]        By whom?

[*]        Time frame?

[*]        What are the objectives?

[*]        Is it the first national drug strategy?

[*]        Are there regional drug strategies?

[*]        Will it be evaluated?

13. Coordination mechanism in the field of drugs

Aim: A brief overview of the overall coordination mechanism in the field of drugs

[*]        Who is responsible for implementing the national drug strategy? If no strategy exists, is there any subject responsible for coordination of drug related intervention / policy? (governmental body, state institution, etc.)

[*]        Is this tasks shared by several institutions?

[*]        Is there an overall coordinating body or is this done by regional authorities?

[*]         Who will be responsible for the evaluation of the strategy / drug related intervention/s?

14. Drug related public expenditures (for EU, Norway and Turkey only)

Aim: A brief overview of the drug-related public expenditures

15.  Drug related research  (optional)

Aim: A brief overview of the on-going research in field of drugs

In this section please state main research institutions involved in the research on drugs and relevant funding institutions and sources for the research at the national level. Please describe the role of drug-related research in the context of a national drug strategy, and if applicable, indicate the role of a national drug observatory in implementation, execution or coordination of drug-related research activities in the country, including cooperation with the research institutions. If applicable, please name national or regional scientific journals publishing drug related research implemented in the country. Please describe main drug-related research projects (population based surveys, scientific studies in field of addiction or applied research activities (evaluation of programmes etc) ongoing or planned in the country (national or international).

If available, please provide links to electronic recourses (research institutes, scientific journals or research articles).

16.       List of references

Use the “Harvard System” for reporting references.
Terminology and Glossary of Terms

Clients

Refers to total number of clients during the course of the reporting year, preferably corrected for double-counting.

Detoxification treatment

It is a medically supervised intervention to resolve withdrawal symptoms. Usually it is combined with some psychosocial interventions for continued care. Detoxification could be provided as inpatient as well as a community-based outpatient programme.

Drug law offences (DLO)

'Reports' of offences against national drug legislation (use, possession, trafficking, etc.) reflect differences in law but also the different ways in which the law is enforced and applied, and the priorities and resources allocated to specific problems by criminal justice agencies. Please consult for details http://www.emcdda.europa.eu/stats11/dlo/methods  and also http://www.emcdda.europa.eu/policy-and-law .

Drug related death (DRD)

Refer to deaths happening shortly after consumption of one or more psychoactive drugs, and directly related to this consumption. Often these deaths are referred as ‘overdoses’, although equivalent concepts are also ‘deaths directly related to drug use’, ‘poisonings’ or ‘drug-induced deaths’. Please consult for details http://www.emcdda.europa.eu/activities/drd  .

Drug related infectious diseases (DRID)

This area develops indicators for more reliable and comparable monitoring of hepatitis B/C and HIV in injecting drug users. This is necessary for identifying priorities for preventing further infections, for forecasting health-care needs and costs, and for monitoring the impact of preventive interventions. Please consult for details http://www.emcdda.europa.eu/activities/drid .

Drug seizures data

EU countries provide data on the number of drug seizures and the quantities seized. Data are available for cannabis, heroin, cocaine, amphetamine, LSD and ecstasy.

Drug treatment

Treatment is any activity that directly targets individuals who have problems with their drug use and which aims to improve the psychological, medical or social state of those who seek help for their drug problems. This activity often takes place at specialised facilities for drug users, but may also occur in the context of in general services offering medical and/or psychological help to people with drug problems. Please consult for details and updates http://www.emcdda.europa.eu/activities/tdi .

EMCDDA Five key indicators

The EMCDDA five key indicators are:

prevalence and patterns of drug use among the general population (population surveys);
prevalence and patterns of high-risk drug use (statistical prevalence/incidence estimates and surveys among drug users);
drug-related infectious diseases (prevalence and incidence rates of HIV, hepatitis B and C in injecting drug users);
drug-related deaths and mortality of drug users (general population mortality special registers statistics, and mortality cohort studies among drug users);
demand for drug treatment (statistics from drug treatment centers on clients starting treatment).

General population surveys (GPS)

General population surveys aim to obtain comparable and reliable information on: the extent and pattern of consumption of different drugs in the general population; the characteristics and behaviors of users; and the attitudes of different population groups towards drug use. The information collected is then used to assess the situation, identify priorities and plan responses. Please consult for details http://www.emcdda.europa.eu/activities/gps .

Harm Reduction

The aims of a harm reduction approach are to reduce the incidence of drug use-related infections and overdose, and encourage active drug users to contact health and social services.

Indicative prevention

Indicated prevention aims to identify individuals who are exhibiting early signs of substance abuse (but not DSM-IV criteria for addiction) and other problem behavior and to target them with special interventions. Please consult for details http://www.emcdda.europa.eu/topics/prevention .

Inpatient treatment

Is treatment in which the patient spends the night in the treatment centre.

Outpatient treatment

Is treatment where the patient does not spend the night at the premises.

Prevention Intervention

Prevention intervention describes an activity that will be carried out in order to prevent substance use behavior. Prevention interventions can be realized in different settings and with different methods and contents. The duration can vary between one-off activities and long-term projects running for several months or more. Please consult for details http://www.emcdda.europa.eu/topics/prevention.

Price and purity information

Street prices of cannabis, heroin, cocaine, amphetamine, LSD and ecstasy in the different EU countries are provided in Euro. Also data on the potency of cannabis products and the purity of heroin (white and brown), cocaine products (cocaine and crack) and amphetamine are presented.

Problem drug use (High-risk drug use (HRDU))

Up to 2012 the EMCDDA defined problem drug use as injecting drug use (IDU) or long duration/regular use of opiates, cocaine and/or amphetamines. However, in 2012 a new definition of ‘high-risk drug use’ was adopted. This new definition includes ‘problem drug use’, but is broader (mainly in its inclusion of high-risk use of more substances) Please consult for details http://www.emcdda.europa.eu/activities/hrdu .

Selective prevention

Selective prevention strategies target subsets of the total population that are deemed to be at risk for substance abuse by virtue of their membership in a particular population segment, e.g. children of adult alcoholics, dropouts, or students who are failing academically. Please consult for details http://www.emcdda.europa.eu/topics/prevention

Substitution/Maintenance treatment

Substitution therapy (“agonist pharmacotherapy”, “agonist replacement therapy”, “agonist-assisted therapy”) is defined as the administration under medical supervision of a prescribed psychoactive substance, pharmacologically related to the one producing dependence, to people with substance dependence, for achieving defined treatment aims. Substitution therapy is widely used in the management opioid dependence. (Adopted from WHO/UNODC/UNAIDS position paper Substitution maintenance therapy in the management of opioid dependence and HIV/AIDS prevention, 2004).

Treatment centre

A drug treatment centre/programme is any facility that provides drug treatment (including interventions whose primary goal is detoxification; interventions whose primary goal is abstinence; substitution treatment; specialised/structured longer term drug programmes; interventions aimed at reducing drug-related harm if they are organised in the framework of planned programmes; psychotherapy/counselling; structured treatment with a strong social component; medically assisted treatment; non-medical interventions inserted in planned programmes; specific treatment in custodial settings towards drug users) to people with drug problems. Treatment centres can be specialised centres, focusing on the treatment of drug users, or included in bigger centres targeting different client groups (e.g. mental health patients, alcohol users, etc.). They can also be based within centres that are medical or non-medical, governmental or non-governmental, public or private.  (EMCDDA Treatment Demand Indicator Protocol version 3.0, 2011).

Treatment demand indicator (TDI)

This indicator measures the yearly uptake of treatment facilities by the overall numbers entering treatment for drug use, and by the numbers amongst these of people entering for the first time (treatment incidence). Information on the number of people seeking treatment for a drug problem provides insight into general trends in problem drug use and also offers a perspective on the organisation and uptake of treatment facilities. Treatment demand data come principally from outpatient clinics' treatment records. Please consult for details and updates http://www.emcdda.europa.eu/activities/tdi .

Universal prevention

Universal prevention strategies address the entire population (national, local community, school, and neighborhood) with messages and programmes aimed at preventing or delaying the abuse of alcohol, tobacco, and other drugs. Please consult for details http://www.emcdda.europa.eu/topics/prevention  

[1] Not relevant for 28 EU Member states, Norway and Turkey, as the process of preparation, validation and publishing of country overviews is different.

[2] Please refer to the newest guidelines on Treatment Demand Indicator: Standard protocol 3.0 for definitions

[3] that may be different from “confirmed HIV cases“ in some countries / situations

[4] There may be a difference between the number of harm reduction sites and the number of needle and syringe sites, which would depend on definition of harm reduction applied for the services in a country.