Addiction Research Centres and the Nurturing of Creativity. Monitoring the European drug situation: the ongoing challenge for the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)
Paul Griffiths, EMCDDA, Scientific Division, Cais do Sodré, 1249-289 Lisbon, Portugal. E-mail: email@example.com
The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is the designated hub for drug-related information in the European Union. The organization's role is to provide the European Union (EU) and its Member States with a factual overview of European drug problems and a common information framework to support the drugs debate. In order to achieve its mission, the EMCDDA coordinates and relies on a network of 30 national monitoring centres, the Reitox National Focal Points. The Centre publishes on a wide range of drug-related topics, across epidemiology, interventions, laws and policies. Every November, the EMCDDA publishes its Annual Report, providing a yearly update on the European drug situation, translated into 23 EU languages. In line with its founding regulation, the EMCDDA has a role acting as an interface between the worlds of science and policy. While not a research centre in the formal sense, the results the Centre generates serve as catalysts for new research questions and help to identify priorities. Current challenges facing the agency include continuing to increase scientific standards while maintaining a strong institutional role, as well as supporting European efforts to identify, share and codify best practice in the drugs field.
THE EUROPEAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION (EMCDDA) IN THE EUROPEAN CONTEXT
The EMCDDA is the designated hub for drug-related information in the European Union. Established formally in February 1993, the agency became technically active from 1995 onwards. It is one of approximately 30 European Community decentralized agencies, created in response to a need for more geographical devolution and the difficulties of coping with technical or scientific tasks that require specialist expertise. The agencies cover many different technical specialisms, but three in particular are worth noting, as their remit means that they often work closely with the Drugs Monitoring Centre. These are the London-based European Medicines Agency (EMA), the Hague-based Europol and the Stockholm-based European Centre for Disease Control (ECDC).
The EMCDDA's role is to provide the EU and its Member States with a factual overview of European drug problems. This central objective has guided the work of the agency throughout its life, although the specific focus of work has evolved considerably. In the early days of the Centre's life the priority was to establish a monitoring framework and a set of common reporting tools. Later, EU enlargement and the need to incorporate 12 new countries into the system became a key concern. More recently, and prompted by a review of the EMCDDA's founding regulation, greater importance has been given to the identification and transfer of best practice, identifying new trends and extending monitoring activities to cover more effectively the range of demand and supply reduction activities utilized by EU Member States to respond to drug problems.
The idea of setting up a European monitoring centre was proposed in a ‘milestone’ letter sent by French President François Mitterand in October 1989 to his 11 fellow heads of state and the European Commission . As a response to this letter, an ad hoc political group with representatives from every Member State was set up, known as the European Committee to Combat Drugs (CELAD). In 1990, CELAD asked the Commission to conduct a feasibility study into the setting-up of a European Drug Monitoring Centre, with a decision made to establish a centre in June 1991 and the Regulation finally coming in force in October 1993. A decision to base the agency in Lisbon was made subsequently, and Georges Estievenart became the EMCDDA's first director, supported by Richard Hartnoll as Head of Epidemiology and Margareta Nilson as Head of Demand Reduction activities. In addition, work undertaken in the Pompidou Group of the Council of Europe preceded the creation of the EMCDDA. Experts reporting on the first multi-city study of drug misuse in Europe carried out between 1982 and 1986 suggested the establishment of a European epidemiological centre that could act as liaison with national centres and monitor the drug situation Europe-wide .
In the early years, the EMCDDA work plan prioritized the development of common data collection tools, standard protocols and laying the foundations for five key epidemiological indicators (general population surveys; problem drug use; treatment demand; drug-related deaths and mortality; and drug-related infectious diseases) [3,4]. The choice of indicators was influenced by both scientific and pragmatic factors, including: the work already developed by the Pompidou Group; the need to cover the most important aspects of the drug situation; and an assessment as to what was realistic to implement at the European level. It is also important to note that the key indicators are composite rather than single measures that describe relatively broad information domains. These building blocks have been crucial in facilitating what is now referred to as a ‘common language’ for European Member States to compare national conditions and develop an understanding of the European drug situation. Today the key indicators remain a central pillar of the Centre's work and, although not legally binding, their implementation is an explicit goal of the EU drug action plan (2009–12).
The EMCDDA's primary role was established in its founding regulation, that of providing the EU and its Member States with objective, reliable and comparable information on drugs and drug addiction and their consequences. The agency works currently with all 27 EU Member States, Norway by special agreement, and five candidate countries. Although the Centre is allowed to monitor policy developments in Europe it is not empowered to evaluate national policies independently. In 2006, the Centre's role was broadened, to collect, register and analyse information on ‘emerging trends in polydrug use’, including combined use of licit and illicit psychoactive substances, provide information on best practice in Member States and facilitate exchange of such practice between them. This extension in remit can be seen to reflect both the changing policy debate and the reality of the drug problem. The last EU drug strategy placed a greater emphasis on best practice, reflecting a policy move to sharing an evidence base in Europe. There is also more focus on stimulants, cannabis and polydrug use, in response to a broadening-out of the European drug problem from an earlier focus on heroin and injecting. The EMCDDA is also required to develop tools and instruments to facilitate the Member States' and the Commission's monitoring and evaluation of their respective drug policies and strategies. This last point suggests a reduction in the anxiety that some countries had when the agency was established, that a European body would criticize domestic drug policies. The recast regulation also broadened the scope of the Centre's technical assistance, which was extended to certain non-Community countries such as the candidates for EU accession and the countries of the western Balkans.
THE EU ACTION PLANS AND THE ROLE OF THE EMCDDA
The EU drug strategy (2005–12) has thus far been operationalized through two action plans (2004–08 and 2009–12), each with a number of specific objectives and indicators. Within this framework, the EMCDDA participates in the definition of the assessment tools and indicators, contributes to the drafting of annual thematic progress reports and assists the Commission in its evaluation.
The EMCDDA has also been given a central role in the detection and assessment of new drugs in the European Union, and unlike other areas of the Centre's work, the Early Warning System (action on new drugs) has operated under a Council decision. This provides a formal legal channel at European level for the identification, risk assessment and possible control of new psychoactive substances that pose a similar risk to those scheduled under the Drug Control Conventions.
Currently the EMCDDA is managed by a Directorate headed by Wolfgang Götz; has a Management Board and Scientific Committee to advise and assist in the decision-making process; and a number of working units to run the Centre and deliver its output (reports, briefings, etc.). The EMCDDA's scientific division is divided into four units—prevalence consequences and data management (EPI) unit; supply reduction and new trends (SAT) unit; interventions, best practice and scientific partners (IBS) unit; and policy, evaluation and content coordination (POL) unit. The scientific units rely on the support of two other units that collaborate closely: the Reitox and international cooperation (RTX) unit, which is responsible for the national network of focal points and the communication (COM) unit. Administration and information technology issues are covered by two further units.
The Management Board is the main decision-making body of the EMCDDA. It meets at least once a year and consists of one representative from each Member State, two representatives from the European Commission and two representatives designated by the European Parliament. A key structural support for the EMCDDA is the Scientific Committee, which comprises 15 scientists recruited by open competition and based upon their scientific excellence and independence. The Committee comments on the scientific work programmes and acts as a formal point of reference for scientific opinion and guidance.
In order to achieve its mission, the EMCDDA coordinates and relies on a network of 30 national monitoring centres, known as the Reitox network of National Focal Points (NFPs). This includes centres in all 27 EU Member States, the candidate countries Croatia and Turkey, and Norway (who participates in EMCDDA activities under special agreement). These focal points gather and submit country data according to common data-collection standards and tools. NFPs report annually, providing quantitative core data sets and qualitative information to the EMCDDA, most of which is made available in the annual reporting exercise.
As of June 2010, the EMCDDA employs approximately 100 staff representing 18 different European nationalities. The multi-lingual working environment makes the EMCDDA a dynamic, exciting and at times challenging place to work. While the Centre's main working language is English, all staff must speak a minimum of two EU languages and all are encouraged to learn a third. Scheduling a ‘lunch’ meeting at the Centre can be an interesting cultural challenge, resulting in an appointment any time between 11.00 a.m. and 4.00 p.m. Approximately 60% of staff have scientific duties, and come from a wide range of backgrounds.
The EMCDDA receives stable funding under Commission budget line B3-441 of the general budget of the European Union. In 2009, the EMCDDA's budget was approximately €15 million, a proportion of which is used to match fund the Reitox network.
ACTIVITIES AND ORGANIZATION
The Centre covers a wide range of drug-related topics, across epidemiology, interventions, laws and policies . Epidemiology of the drug situation includes the monitoring of the five key epidemiological indicators, and also supply and market information (price, purity, seizures) and new threats and developments (EU Early Warning System) . The core task of providing an annual assessment of the European drug situation, supported by technical working groups, comprises a large proportion of the Centre's activities. A number of areas are highlighted as requiring development in the current strategy. There is growing emphasis on the identification and dissemination of best practices, including the development of EU guidelines and standards for demand reduction programmes. Prisons are recognized as an increasingly important setting for implementation of drug-related interventions and a new focus has been given to this arena. The European drug situation continues to evolve dynamically, and monitoring emerging drug trends and complex drug problems is a prioritized area. The growing challenge presented by new substances and patterns of use requires drug-reporting systems to become more timely. More than 40 new psychoactive substances were reported in 2010 to the European Early Warning System, a twofold increase on the previous year. The EMCDDA has also traditionally collected data on drug supply, and there is growing policy interest in this area . It is anticipated that current collaborations with Europol and the European Commission are likely to lead to the development of politically endorsed European supply indicators in three key domains: supply reduction, drug-related crime and drug markets.
Clearly, the issue of comparability and standardization in approach has to be balanced by sensitivity to different social and political contexts at the Member State level. This issue extends beyond monitoring to the implementation of best practices, where common standards once again need to be adapted to local contexts to be relevant . The Centre has, over the years, developed experience in how these different contexts impact on the interpretation of data and the extent to which it can be compared or contrasted. The added value that the Centre can bring is this understanding which allows comparisons to be made even when data sets differ.
Every November, the EMCDDA publishes its Annual Report on the European drug situation, providing a yearly update which encompasses epidemiology, responses, laws, research areas and putting data into perspective . The Annual Report is translated into 23 EU languages. This flagship product is preceded by the publication of the Statistical Bulletin (mid-July), which gathers in tables and graphs the main figures on the European situation  and complemented by country overviews and publications on selected issues. Other publications include newsletters, policy briefings and comprehensive reports (Insights, Monographs) on specific drug-related topics. The EMCDDA website also continues to provide access to an increasing variety of information describing the Europe's drug situation, Community actions and research and practice developments.
THE EMCDDA AND THE SCIENTIFIC COMMUNITY
The EMCDDA is not a research centre in any formal sense. Its key audiences are defined as policy-makers, practitioners and research scientists as well as EU citizens. The EMCDDA has a broad contact network, with many hundreds of national experts and scientists and their respective research centres. The Centre interacts with the European scientific community to ensure the quality of the work and support the scientific discourse on drug use in Europe. Historically, publishing scientific papers has not been a priority of the EMCDDA; however, in recent years, strongly supported by the scientific committee, more scientific papers are being submitted and published. The Centre is committed to making its data resources as widely available as possible for secondary analyses. To provide a flavour of the broad range of the Centre's work, the following publications have been selected; each study summarizes the state of knowledge in a particular field.
- 1European Monitoring Centre for Drugs and Drug Addiction. Annual Report 2010: The State of the Drug Problem in Europe. Luxembourg: EMCDDA; 2010 .
- 2European Monitoring Centre for Drugs and Drug Addiction. Assessing Illicit Drugs in Wastewater. Potential and Limitations of a New Monitoring Approach. EMCDDA Insights. Luxembourg: EMCDDA; 2008 .
- 3Rhodes T, Hedrich D., editors. Harm Reduction: Evidence, Impacts and Challenges. EMCDDA Monograph. Luxembourg: EMCDDA; 2010 .
- 4European Monitoring Centre for Drugs and Drug Addiction: Europol. Cocaine: a European Union Perspective in the Global Context. Lisbon: EMCDDA, Europol; 2010 .
- 5Griffiths P., Sedefov R., Gallegos A., Lopez D. How globalization and market innovation challenge how we think about and respond to drug use: ‘Spice’ a case study. Addiction 2010; 105: 951–953 .
A valuable by-product of the Centre's work has been its role of providing a nurturing environment for researchers working in the drug field, providing a forum for European scientists to come together and share experiences and working practices. The technical working groups of the Centre provide a space for the development of new and innovative approaches, creating a critical mass on subjects examples of which include: indirect methods of prevalence estimation; wastewater monitoring for drug residues; the identification of new substances: supply reduction indicators; and human immunodeficiency virus (HIV) modelling approaches.
CHALLENGES AND ISSUES
A key challenge in terms of the EMCDDA's research-related activities is finding the balance between being a scientific centre and an intergovernmental organization. In many respects this involves some compromise between seeking scientific recognition and supporting political and policy processes. As a decentralized technical agency working only in the field of information, the Centre's value and worth come from attaining an independent and scientifically rigorous assessment of the drug situation. However, at the same time the Centre is also, through links to EU institutions and the Management Board, supporting the policy debate in Europe and can be drawn at times into a more political sphere. This has been the case on controversial topics such as harm reduction, but also in reporting, which may be deemed to show national governments in a poor light. This means that the scientific work of the Centre has to be sensitive to political ways of working at a transnational level in the European Community. At times it can feel like walking a tightrope, with the need to maintain scientific rigor on one hand and the need to engage with and maintain its institutional position in the policy and political debate on the other hand . The dangers are self-evident, and on occasion the EMCDDA has experienced the occasional wobble. However, overall, the Centre has been successful in maintaining its balance, as reflected in the most recent external evaluation which noted that the agency was well regarded by both its scientific and institutional partners.
The 2010–12 work programme calls for increased visibility to the scientific world by encouraging and supporting scientific publishing, both by EMCDDA staff and collaborating experts, in peer-reviewed journals. While access to data is not an obstacle, with many routine reporting obligations, finding the time to draft scientific papers can be a challenge. Moreover, the Centre is usually dealing with aggregated data and making national-level comparisons. This means that scientific papers focus more generally on secondary analysis rather than primary research. However, the expert groups supported by the Centre have been a catalyst for a number of more methodological and substantive papers addressing focused topics among a discrete number of countries. Work on drug-related mortality by the European COSMO Group is a good example of this .
An ongoing challenge for the Centre is one of striking the balance between consolidation and development in the face of limited resources. As with all EU agencies, the Centre needs to find creative ways to provide EU-level added value, and not replicate work better undertaken at national level. The challenges that the EMCDDA faces in terms of data relate both to the heterogeneity in quality of data collected and the multiplicity of national situations. Some national focal points are more developed, benefiting from strong national policy support and substantive funding, whereas others are struggling with national recognition or financial instability.
The EMCDDA has always prioritized a developmental and long-term approach, while not excluding the need to adapt to changing conditions. The indicators created 15 years ago were aimed mainly at monitoring heroin use and consequences related to it, and the progressive appearance of new substances in the intervening years has required extension of the monitoring remit. In this context, increased attention has been given to identifying new trends and threats as well as more complex forms of behaviour, such as those represented by patterns of polydrug use.
The EMCDDA has been a catalyst for change. Fifteen years ago, Europe's capacity for monitoring its drug problem was limited. National approaches to the topic varied greatly and there was a lack of reliable and comparable information at the European level. In other words, it was impossible to talk with confidence about patterns and trends in drug use across the EU. Data availability and quality has improved during recent years and an explicit commitment to evidence-based policy-making is better served by the available data. The current phase of the EMCDDA development is best characterized as one of consolidation and improvement. The challenge for the EMCDDA over the coming years is to continue to increase scientific standards while maintaining its central position as a science and policy interface.
Declaration of interest