Chapter 6 - Users and uses: form, practice, context

Use patterns in other countries

Obviously, use patterns are not immediately comparable from one country to another, not only because of cultural differences but because the systems for collecting data on use patterns do not all measure the same things in the same way, or even for the same time period. In Europe, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is gradually working toward uniformization of data collection in the various countries of the Union with a view to improving comparability. Nonetheless, significant differences among countries remain.

In spite of these reservations, it is interesting to compare use patterns among the various countries. We will begin by looking at the situation in the United States, the United Kingdom, France, and the Netherlands, and then attempt to compare some of the indicators selected.

 

United States

In the United States, two major surveys have been conducted for a number of years: a general population survey conducted by the Department of Health and Social Services, and the University of Michigan Monitoring the Future study of cohorts of graduates conducted for the National Institute on Drug Abuse (NIDA).

The 2000 general population survey[1][16] shows that 6.3% of Americans 12 years and over used illegal drugs during the past month, and 4.8% (4.7% in 1999) consumed cannabis. Overall, 14 million Americans are considered current users of illegal drugs, i.e., consumers in the past month. Among this group of users, 76% are consumers of marijuana and 59% of marijuana only.

The estimated number of new users in 1999 was 2 million, compared to 2.6 million in 1996 and 1.4 million in 1990. Two thirds of the new consumers were between 12 and 17 years of age, the others in the 18-25 age group. Average age at the first experiment with cannabis was 17 in 1999, compared to about 19-20 at the end of the 1960s.

Frequency of consumption among current users increased between 1999 and 2000: in 1999, 31.6% consumed cannabis 100 days or more during the preceding year, compared to 34.7% in 2000. Finally, the distribution by age group follows the expected trends, as shown in the following chart.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The Monitoring the Future 2000[2][17] survey gives use patterns beginning in 1986 for cohorts of young graduates between 19 and 32 years of age. The following figure summarizes the data.

 

 

 

In 2000, lifetime prevalence in the 31-32 age group was 73% for all illegal drugs, 68% for marijuana.

 

United Kingdom

In the United Kingdom, the British Crime Survey[3][18] has measured illegal drug use patterns every two years since the early 1980s. Since establishment of the EMCDDA, Drugscope,[4][19] the United Kingdom correspondent, annually reports use patterns and related indicators.

The percentage of respondents between the ages of 16 and 59 who consumed an illegal drug during the last year in the United Kingdom rose from 9.9% in 1994 to 10.7% in 2000. The figures for cannabis are 8.4% and 9.4% respectively. Lifetime prevalence of cannabis use in the 16-29 age group climbed from 34% in 1994 to 44% in 2000. As a function of age, the use patterns over the last year are as follows:

 

··               16-19 years of age: from 29% in 1994 to 25% in 2000;

··               20-24 years of age: from 23% in 1994 to 27% in 2000;

··               25-29 years of age: from 12% in 1994 to 17% in 2000.

 

In all instances, consumption by men is greater than consumption by women.

The report notes that the most significant change is in consumption of cocaine by young men in the 16-29 age group (up from 1.2% to 4.9%).

 

France

The work of the Observatoire français des drogues et de toxicomanies (OFDT) [French monitoring centre for drugs and drug addiction] has greatly improved monitoring and understanding of trends in France. The OFDT publishes a bi-annual report on use patterns and related indicators (e.g., seizures, enquiries, applications for treatment) and a series of studies and technical reports on specific issues. In its 2002 report, the OFDT[5][20] gives the following figures on cannabis consumption:

 

··               Lifetime prevalence: 21.6% of adult population (18-75)

··               Occasional use (at least once in the past year): 6.5%

··               Repeated use (at least ten times within the past year): 3.6%

··               Regular use (ten times per month and over): 1.4 %

More than twice as many men as women experiment with marijuana; in the 18‑34 age group, 40.5% of men have tried it. The proportion of experimenters drops with age. Repeated consumption is reported by 14.6% in the 18-25 age group, compared to 1.6% in the 26 and over age group. The OFDT reports that the percentage of the adult population (18-34 age group) who have experimented with cannabis continues to rise due to increased “trivialization” of cannabis. Among adolescents, consumption has risen significantly. In 1993, 34% of boys and 17% of girls reported having consumed cannabis by the age of 18, compared to 59% and 43% respectively in 1999. The OFDT report goes on to say that experimentation with cannabis has become standard behaviour for young people in late adolescence.

Interestingly enough, the OFDT report allows for construction of a user typology and, without too great a stretch, identification of the warning signs of possible at-risk behaviour.

The following table shows frequency of consumption among young people in late adolescence.[6][21] In addition to the differences according to sex found in other epidemiological surveys, this table shows that fewer than one quarter of 17 year-old boys report occasional use, compared to one third of 19 year-olds. At the same time, the figure for boys, between the ages of 17 and 19, who abstain drops by 10 points.

 

 

Frequency of cannabis consumption by young people in late adolescence in 2000, by age, sex and type of consumption

Type of consumption	Definition	Girls, 17 yrs	Boys, 17 yrs	Boys, 18 yrs	Boys, 19 yrs
Abstinence   Experimental     Occasional   Repeated     Regular   Intensive	Never   Past consumption, but not in the last year   Between 1 and 9 times a year More than 9 times a year, less than 10 times a month Between 10 and 19 times a month 20 times or more a month	59.2   5.0     23.3   7.4     2.6   2.	49.9   5.4     20.9   9.3     6.4   8.0	45.1   6.5     19.9   9.9     6.2   12.4	39.8   8.2     19.4   10.1     6.8   15.8

 

 

The other interesting breakdown in the OFDT study–one that points to potential problems (and could be useful for preventive purposes) even though the report makes it clear that no equivalence was made between these profiles and risk–concerns circumstances of use. A separate category is created for those who smoke alone or in the morning or at noon. A near-perfect linear relationship can be seen between type and circumstances of use, as shown in the table below.[7][22]

 

Frequency of cannabis use, in the morning or alone, by young people in late adolescence, in 2000, by type of consumption

Type of use	Morning or noon	Alone
Occasional   Repeated   Regular   Heavy	Never       Occasionally           Often    57.2                   40.4                    2.4    17.9                   69.8                  12.3      4.7                   58.9                  36.4      1.1                   22.7                  76.1	Never         Occasionally        Often            81.9                16.2                  1.9          46.4                46.6                  7.0          19.9                60.2                 19.8            4.5                38.2                 57.3

 

 

The situation was explained by Jean-Michel Coste, Director of the Monitoring Centre in his testimony to the Committee:

 

I think it is extremely important to answer the concerns of authorities when, in matters of prevention, those authorities are looking for something whose objective is not only to prevent first use, but also to prevent going from regular use to use that turns into a problem. From the investigation point of view, it is important to define this idea of problematic use and grade the users. It is possible to do this by trying to find occasional users, those who use repeatedly or regularly and those who constitute a problem.

 

Right now, we are trying to define three user criteria. We are trying to see if the young person uses cannabis on an intensive or daily basis, if he often uses alone or uses often in the morning. If we get a combining of those three criteria, I think we can define something covering the notion of problematic use of cannabis. [8][23]

 

The Netherlands

The Netherlands is a country of particular interest because of the unique approach it adopted in 1976.[9][24] An epidemiological survey of use patterns of the general population was conducted in 1997; the results of a second (2001) survey are expected soon. For individuals between the ages of 15 and 64, the data show a lifetime prevalence of 19.1%, consumption in the preceding year of 5.5%, and consumption within the past month of 2.5%. First-time users in the preceding year account for 1% of the population, and average user age is 28. In the 15-34 age group, lifetime prevalence is 31.8% and use within the last year, 14.2%.

Among recent users (within the past month), frequency is distributed as follows:

··               Consumption on 1 to 4 days during the course of the month – 45%

··               Between 5 and 8 days – 14%

··               Between 9 and 20 days – 15%

··               Over 20 days – 26%

 

In addition, since 1984, the Netherlands has conducted surveys of students between the ages of 10 and 18. The data produced show a significant increase in lifetime use and current use (past month) as in the following charts (data for 12-18 age group only). [10][25]

 

 

As in the other studies, more boys than girls are consumers and prevalence increases with age: in the 16-17 age group, lifetime prevalence for boys is 43%, for girls 31%, with current use figures 22% and 11% respectively.