Estimation of drug dependence and problem drug use in EU

Estimation of drug dependence and problem drug
use in EU: role and contribution of the European
Monitoring Center for Drugs and Drug Addiction
Dominique Lopez, Lucas Wiessing, Congres Annuel de la SFT, 24th of October 2006
Problem Drug use – what we are looking for?
• PDUs are core group of health and social problems,
large impact on society
• Mostly a small proportion of all drug use
• Often later part of heavy drugs ‘careers’
• High morbidity, mortality (overdose, diseases)
• Difficult to measure, but highly policy relevant
Dominique Lopez, Lucas Wiessing – Congrès de la SFT, 23 et 24 octobre 2006, Paris – Copyright © SFT – Tous droits réservés
PDU indicator – objectives
• To estimate the prevalence of PDU/IDU in EU
member states (cross-sectional, comparative)
• To follow trends over time (serial prevalence
estimates, trends in incidence)
• If possible with additional funding: to understand risk
mechanisms, drug careers and relationship with
interventions (harm reduction, treatment)
Dominique Lopez, Lucas Wiessing – Congrès de la SFT, 23 et 24 octobre 2006, Paris – Copyright © SFT – Tous droits réservés
EMCDDA Definition – PDU (1)
• Is defined as: “injecting drug use or long/regular
use of heroin, cocaine and /or amphetamines”
•
•
•
Ecstasy and cannabis are not included
•
Recent changes in drug use patterns
discussion (poly-use, stimulants etc)
No direct relationship with ICD or DSM classifications
Global definition, results will vary according to exact
estimation method and data used
under
Dominique Lopez, Lucas Wiessing – Congrès de la SFT, 23 et 24 octobre 2006, Paris – Copyright © SFT – Tous droits réservés
PDU indicator – concept (1)
• Drug possession and/or
countries prosecuted
drug use in most
• Drug users who are visible
• Open scenes, addicts in treatment, prison, drug-deaths, etc.
• Drug users who are not visible - hidden
population
• Unproblematic socially integrated drug users
• Users at the start of their career
• Estimating the hidden population
• Using available data and applying an appropriate model
Dominique Lopez, Lucas Wiessing – Congrès de la SFT, 23 et 24 octobre 2006, Paris – Copyright © SFT – Tous droits réservés
PDU indicator – concept (2)
•
Multiplier Methods
• Extrapolation from treatment data
• Extrapolation from police data
• Extrapolation from drug-related deaths data
• Extrapolation from HIV/AIDS data
•
•
•
Capture-Recapture (2, 3 or more samples)
Multivariate Indicator Method
Other (demographic method, truncated Poisson, case
finding, nomination etc.)
Dominique Lopez, Lucas Wiessing – Congrès de la SFT, 23 et 24 octobre 2006, Paris – Copyright © SFT – Tous droits réservés
Dominique Lopez, Lucas Wiessing – Congrès de la SFT, 23 et 24 octobre 2006, Paris – Copyright © SFT – Tous droits réservés
UK 2003 CM
Sweden 2003 TP
Finland 2002 CR
Slovakia 2002 MI
Slovenia 2001 CR
Portugal 2000
Poland 2002 CM
Austria 2002 CR
The Netherlands 2001
Malta 2004 CR
Luxembourg 2000 CR
Latvia 2004 MM
Cyprus 2004 TP
Italy 2004
Ireland 2001 CR
Spain 2000 TM
Greece 2004 CR
Germany 2004
Denmark 2001 CR
Czech Republic 2004 TM
Rate per 1 000
Estimates of the prevalence of problem drug use, 2000-2004
(rate per 1000 population aged 15-64)
14
12
10
8
6
4
2
0
Estimates of the prevalence of injecting drug use, 2000-2004
(rate per 1000 population aged 15-64)
7
6
4
3
2
Dominique Lopez, Lucas Wiessing – Congrès de la SFT, 23 et 24 octobre 2006, Paris – Copyright © SFT – Tous droits réservés
Norway 2002 MM
UK 2001 CM
Finland 2002 CM
Portugal 2000 HM
Portugal 2000 MM
Austria 2002 CR
Luxembourg 2000 HM
Cyprus 2004 TP
Greece 2004 CR
Germany 2000 HM
0
Germany 2000 MM
1
Czech Republic 2004 TM
Rate per 1 000
5
Trends in the prevalence of problem opioid use, rate per 1000 population
aged 15-64
9
8
7
6
5
4
3
2
1
0
1995
1996
1997
1998
1999
2000
Austria
Czech Republic
Germany
Greece
Italy
Luxembourg*
Netherlands
Spain
2001
2002
2003
2004
Ireland
Dominique Lopez, Lucas Wiessing – Congrès de la SFT, 23 et 24 octobre 2006, Paris – Copyright © SFT – Tous droits réservés
PDU – Current issues
• Strengthen capacity, commitments and
resources for ongoing PDU monitoring
• Develop better estimates for: IDUs,
Stimulants, (other drugs?)
• Reach conclusion on PDU definition
• Reduce number of recommended methods
• Decide how to deal with poly-problematic use
• Development of minimal requirements at
national level?
Dominique Lopez, Lucas Wiessing – Congrès de la SFT, 23 et 24 octobre 2006, Paris – Copyright © SFT – Tous droits réservés