Italy, Drug Use In

In Italy, the impact of illicit drug use was first felt on a broad scale during the mid-1960s. The patterns in Italy were similar to those seen in other European countries. They seemed to be associated with the contestation by young people of existing political and social situations. As in the United States at the same time, this phase was influenced by the cultures of the East—especially those of the Indian subcontinent, Southeast Asia, and the Middle East—in all of which some amount of drug use was not illegal. Cannabis sativa, the HEMP plant that produced MARIJUANA, GANJA, HASHISH, and other variants, was particularly unhampered by legislation there and was enjoyed by locals and outsiders, some of whom found ways to smuggle it into the West, where in many instances it was illegal.

In addition, the OPIOIDS (especially HEROIN) began to be used illicitly, and by the 1970s serious consequences ensued. By then, the countercultural movement and its abuse of illicit drugs had lost most of its original idealistic principles. Abusers were simply in search of ever more and ever stronger psychotropic effects. Moreover, criminal organizations took charge of the illicit drug trade, not only to increase their profits but also to control and direct the political and social development of the youth of Italy. For the most part, users became abusers who were physically dependent on their drug, so their behavior could be controlled by the suppliers.

In the 1980s, the drug scene changed, with various control measures and less heroin available. In addition, with less heroin being sold, longer intervals occurred between drug doses for many users. Such modified habits led to decreased tolerance and increased overdosing, with ensuing deaths. For these reasons, the number of heroin addicts in Italy decreased—then, in the mid-1980s, COCAINE emerged as the new illicit drug problem. The CRACK and FREEBASE forms were especially harmful among young ADOLESCENTS. More detailed data are contained in the annual reports of the National Health Council (1985-1991) and the reports of the Department of Social Affairs (1991-1993).

LEGISLATION

At the beginning of the drug-abuse phenomenon of the 1960s, the legislation in force had been passed in 1954. It proved to be insufficient for coping with emerging conditions; it did not take into consideration the political-cultural trends, the scientific knowledge of the day, or the increasingly important role of public health.

New legislation in 1975 was characterized by such innovative elements as the nonpunishment of the addict found to be in possession of a moderate quantity of illicit drugs. The quantity was to be examined and quantified, and it was to be considered in relationship to the physical and psychological needs of the addict. Unfortunately, this individualistic approach was poorly applied, which made the law useless.

The regulations approved in 1990 improved the state's power of both repressive action and intervention, and it defined a daily mean dose to separate administrative offenses from crimes. The objective was to recover and rehabilitate drug addicts. A 1993 referendum, however, repealed the prohibition on personal drug use and canceled references in the regulations to the daily mean dose.

TREATMENT FACILITIES

In accordance with national policy guidelines, a network of facilities was set up and various links were established with rehabilitation, law enforcement, and judicial structures. This process was worked out with public support; the aim has been to sustain every initiative to reduce the availability and demand for drugs.

Of the addicts served by the facilities, almost all are heroin abusers, some not yet dependent. Starting by weaning them from heroin with METHADONE, the facilities provide integrated and custom-designed programs founded mainly on nonpharmacological support.

A wide range of resources are available; 576 public facilities and 276 residential communities and sociorehabilitative structures (public, private, and voluntary—most of them situated in northern Italy). Voluntary services continue to increase in importance both in number and in regional distribution. The effectiveness of the facilities has been proved, since trained personnel and good records provide such statistics on trends (see Table 1).

SEIZURES OF ILLICIT DRUGS

Various trends can be seen by studying the records of seized drugs. Some decreasing trends have been recorded for MORPHINE in 1982, for heroin in 1981 and 1985, and for cocaine in 1984. Irregular trends emerged for Cannabis products: a 128-per-cent increase in 1981, a decreasing trend until 1985, and two huge increases in 1986 and in 1989 (see Table 2). The decision to standardize descriptions of drug seizures by reference to the percent of the primary drug instead of the raw weight of the primary drug seized should improve the accuracy of record keeping (see Table 3).

DRUG ABUSE-RELATED DEATHS

Drug abuse-related deaths also show irregular trends. Most deaths could be attributed to heroin overdoses or to accidents while injecting it. After 1980, two large increases in the death rate occurred, first in 1982 and then in 1984, followed by a steady rise into 1986. From 1986 to 1988, the "empiric" mortality rate nearly doubled; it subsequently remained steady until 1991 and then dropped until 1994 (see Table 4), except among the elderly, for whom the rate increased.

ALCOHOL ABUSE

ALCOHOL use in Italy strongly differs from drug use for historical, traditional, behavioral, and cultural reasons; supply and distribution are also different, since alcohol is free from legal restrictions. Wine is the most frequently used alcoholic beverage. Although a gradual displacement in wine consumption occurred during the 1980s, with substitution of other liquors and beers, still the total amount of alcohol (percent of ethanol) consumed remained almost constant.

ALCOHOLISM is mainly a problem of chronic abuse by adults over the age of 40. It is mainly a problem in northern Italy. Since the 1980s, however, increasing numbers of young people are abusing liquors and beer. Alcoholism has also become complicated by the combining of alcohol with psychotropics (e.g., tranquilizers), especially by women over 40.

Driving-license regulations have, since 1988, included a test that measures the breath concentration of alcohol. The alcohol level must not be over 8 grams per liter (g/l), approximately that of other countries of the European Economic Community.

(SEE ALSO: Britain, Drug Use in; Netherlands, Drug Use in; Sweden, Drug Use in)

BIBLIOGRAPHY

AVICO, U., & CAMONI, L. (1994). IX course on "activity aims, valuation of facilities and other structures for addicts' treatment." Boll. Farmacodipendenze e Alcoolismo, 17(2):7-120.

AVICO, U., & CAMONI, L. (1994). Multicity study on drug misuse: Rome and Italy: 1993. In Pompidou Group, Up-to-date report of the epidemiology expert on drug problems. Strasbourg: Council of Europe.

AVICO, U., ET AL. (1992). Droga e tossicodependenza (Drugs and addiction). Brescia: CLAS International. (In Italian).

AVICO, U., ET AL. (1983). Prevalence of opiate use among young men in Italy, 1980 and 1982. Bull. Narc., 35(3):63-71.

MACCHIA, T., MANCINELLI, R., BARTOLOMICCI, G., & AVICO, U. (1990). Cocaine misuse in selected areas: Rome. Ann. Ist. Super. Sanità, 26(2):189-196.

WHO. PROGRAMME ON SUBSTANCE ABUSE. (1993). Deaths related to drug abuse. Report of a WHO consultation, WHO-PSA/93.14, Geneva.

USTIK AVICO