Julian Vicente

The drug situation in Europe: an overview of data available on illicit drugs and new psychoactive substances from European monitoring in 2015

AIM A central task for the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is to produce an annual report of the latest data available on drug demand and drug supply in Europe. This paper is intended to facilitate a better understanding of, and easier access to, the main quantitative European level data sets available in 2015. METHODS The European reporting system formally covers all 28 European Union (EU) Member States, Norway and Turkey and incorporates multiple indicators alongside an early warning system (EWS) on uncontrolled new psychoactive substances (NPS). While epidemiological information is based largely on registries, surveys and other routine data reported annually, the EWS collects case-based data on an ongoing basis. The 2015 reporting exercise is centred primarily on a set of standardized reporting tools. RESULTS The most recent data provided by European countries are presented, including data on drug use, drug-related morbidity and mortality, treatment demand, drug markets and new psychoactive substances, with data tables provided and methodological information. A number of key results are highlighted for illustrative purposes. Drug prevalence estimates from national surveys since 2012 (last year prevalence of use among the 15-34 age band) range from 0.4% in Turkey to 22.1% in France for cannabis, from 0.2% in Greece and Romania to 4.2% in the United Kingdom for cocaine, from 0.1% in Italy and Turkey to 3% in the Czech Republic and the United Kingdom for ecstasy, and from 0.1% or less in Romania, Italy and Portugal to 2.5% in Estonia for amphetamine. Declining trends in new HIV detections among people who inject drugs are illustrated, in addition to presentation of a breakdown of NPS reported to the EU early warning system, which have risen exponentially from fewer than 20 a year between 2005 and 2008, to 101 reported in 2014. CONCLUSIONS Structured information is now available on patterns and trends in drug consumption in Europe, which permits triangulation of data from different sources and consideration of methodological limitations. Opioid drugs continue to place a burden on the drug treatment system, although both new heroin entrants and injecting show declines. More than 450 new psychoactive substances are now monitored by the European early warning system with 31 new synthetic cathinones and 30 new synthetic cannabinoid receptor agonists notified in 2014.

The EMCDDA/Pompidou Group Treatment Demand Indicator Protocol: A European Core Item Set for Treatment Monitoring and Reporting

Over the last decades inside and outside of Europe, treatment-based data have been used in epidemiological research on drugs and drug abuse. They offer information on hidden populations and allow to follow socially stigmatised behaviour. As this type of research can be done on rather low budgets, there are long-term projects run in many countries. Experts from the national systems in several EU member states have been working together to develop a common standard on the basis of the Pompidou Group (PG) Definitive Protocol. The items and basic definitions of the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)/PG Treatment Demand Indicator Protocol are described, which plays an important role in the process of harmonisation of data collection for the EMCDDA. Implementation strategies are described, and future steps are discussed.

ESPAD report 2015 results from the European School Survey Project on Alcohol and Other Drugs.

The main purpose of the European School Survey Project on Alcohol and Other Drugs (ESPAD) is to collect comparable data on substance use among 15- to 16-year-old students in order to monitor trends ...

Trends in overdose deaths from drug misuse in Europe: what do the data tell us?

During the 1990s the number of drug-related deaths (acute poisonings) in the United Kingdom increased rapidly. Between 1993 and 2000 the number of deaths doubled from 864 to 1662 [1,2], precipitating the recognition that reducing drug misuse deaths was a public health priority [3]. The UK Advisory Council on the Misuse of Drugs recommended the creation of a new surveillance indicator to follow overdose trends, which was incorporated into the government’s drugs strategy. A target was set to reduce deaths related to drug misuse by 20% by 2004 compared to a 1999 baseline [4]. As more than three-quarters of drug-related poisonings in the United Kingdom are opiate-related, expanding drug treatment options, especially methadone maintenance for problem opiate users, was seen as a critical overdose prevention measure [5]. UK and European indicators of drug-related deaths include deaths certified as due to drug use or misuse and include acute poisonings (overdose deaths) based on routine mortality statistics; the indicators exclude other deaths that may have been caused directly or indirectly by drug use but which cannot be attributed readily to drug use within routine statistics (such as infections, other injuries or chronic diseases) [1]. Early signs were very encouraging. Between 2001 and 2004, the government investment in specialist drug treatment doubled to over £250 million annually [6]. The volume of methadone prescriptions increased markedly, and there was a drop in the estimated number of deaths per 1000 patient-years treated with methadone [7]. The number of drug misuse deaths fell from 2001, and by 2003 the reduction in drug-related deaths had almost reached the target. However, in 2004 and 2005 there were sharp increases in drug misuse deaths, due largely to heroin overdose, meaning the government’s target was not met [8,9]. The European context is presented in Fig. 1, which compares trends in overdose deaths in selected European countries with similar population sizes [10]. The figure shows drug misuse deaths per million population from 1993 to 2005 for England and Wales, Italy, Germany and Spain (Madrid, Barcelona, Valencia, Bilbao, Seville and Zaragoza only) based on routine mortality statistics. The drug-poisoning mortality rate in these six Spanish cities probably overestimates the rate for Spain overall, but is likely to provide an accurate representation of trends over time. By 2004/05 the drug misuse mortality rates in England and Wales was one of the highest in Europe. However, case definition and data extraction from mortality statistics varies between countries despite there being a common European definition [11], which may explain, in part, the difference in the size of the mortality rates between countries. There have been no changes in the compilation of statistics over time. More illuminating, therefore, and a salutary reminder to policy makers in England and Wales, is the difference in trends over time. In none of the other selected European countries did the overdose mortality rate double during the 1990s. Instead the evidence suggests that mortality rates declined in Spain and Italy and were stable in Germany. In addition, the other selected countries all achieved substantially greater reductions in drug-related deaths than England and Wales between 1999 and 2004/05, with Germany and Italy exceeding a 20% reduction and Spain (six cities) reducing the drug-related mortality rate by 17%. Surveillance of deaths related to drug misuse is important for measuring the impact of interventions and for planning future harm minimization strategies, but it cannot answer more fundamental questions. What are the main drivers of drug overdose trends? Is the risk of overdose changing? Clearly, the number of overdose deaths is related to the interplay between changes in the size of the drug-using population and to their overdose mortality risk, with the latter related to other factors such as the proportion of IDU in treatment or changes in drug administration. The increase in overdose deaths during the 1990s in England and Wales was driven largely by increases in the prevalence of heroin use [2,8]. We have hypothesized that the reduction in overdose deaths from 2001 may have been the result of the rate of increase in treatment superseding any increase in the prevalence of drug misuse, and reducing the overall risk of overdose death [6,12]. However, in the United Kingdom since 1993 there has been no investment in large-scale longitudinal studies that could test this hypothesis and monitor whether the overall risk of overdose is declining, or the emergence or decrease of other forms of mortality among drug users. There have been a few, mainly city-based, studies in Europe [13], but the mortality patterns can be changing substantially and quickly [14–17] and large-scale cohort studies are needed in different European countries that can provide comparable information about overdose risk. Interpreting mortality statistics and trends in drug use is complex, and unlikely to lead to any firm conclusions without information on overdose risk. The figure shows that trends in overdose deaths vary between countries, implying differences in either the numbers of heroin EDITORIAL doi:10.1111/j.1360-0443.2007.02102.x

Trends of heroin use and heroin injection epidemics in Europe: findings from the EMCDDA treatment demand indicator (TDI).

We estimate trends and geographical differences in the heroin epidemic in the European Union plus Croatia and Turkey by analyzing aggregated data on first heroin treatment admissions (cases) during 2000-2009. In 2005-2009 the proportion of drug injectors was higher in Central and Eastern European countries (CEECs) than in Western European countries (WECs), whereas the opposite occurred with mean age at first heroin use and first treatment. During this period, the number of cases, cases per center, and proportion of injectors in WECs declined, whereas mean age at first treatment and first heroin use increased. The opposite occurred in Turkey, except for proportion of injectors, while trends were less clear in the other CEECs. In the 7 WECs with data, trends in 2000-2005 and 2005-2009 were similar. This suggests that the number of recent-onset heroin users and heroin injectors may have declined some years before the study period, especially in WECs.

Cocaine-Related Health Emergencies in Europe : A Review of Sources of Information, Trends and Implications for Service Development.

Background: Cocaine-related health consequences are difficult to observe. Data on drug users in health-emergency settings may be a useful source of information on consequences that are not visible via other information sources. Methods: Thirty European countries submit an annual national report on the drug situation to the EMCDDA. All reports for the period 2007–2010 were analyzed, with particular attention given to auditing cocaine-related mentions. Analysis was also performed in order to identify sources and case definitions, assess coverage, audit cases and, where possible, to identify long-term trends. Results: Considerable heterogeneity existed between countries in their approach to recording drug-related emergencies, with only Spain and the Netherlands having established formal indicators. The highest annual numbers of cocaine-related episodes were reported by the UK (3,502), Spain (2,845) and the Netherlands (1,211). A considerable (2- to 3-fold) increase in the numbers of cocaine-related episodes has been reported since the end of the 1990s in these countries; these increases peaked in Spain and England around 2007/08. Conclusions: The analysis reported here suggests the need to develop more standardized approaches to monitoring drug-related emergencies. It points to the potential value of developing effective referral links between the emergency and specialized drug services working with cocaine users.

Estimating the total mortality among problem drug users

This papers objective is to develop a method to estimate the total mortality among problem drug users. The total mortality is given by a base rate of mortality not related to drugs and the deaths that are directly and indirectly related to drugs. A fatal poisoning by drugs (overdose) is directly related to drugs, whereas a casualty due to a drug-related disease or a drug-related accident is indirectly related to drugs. As an example of a method to estimate the total mortality, the results from a cohort study among methadone patients in Amsterdam were projected on the whole population of problem drug users in The Netherlands. Due to differences between the problem drug users in Amsterdam and the rest of the country, adjustments were required. It was found that an initial estimation did not require adjustment for injection behavior and gender but did require adjustment for age and the percentage of HIV infection. In a first unadjusted estimation, the total number of deaths among problem drug users in The Netherlands in 2001 was estimated at 606 deaths. After adjustment for age, the estimated mortality decreased to 573 deaths, and after adjustment for HIV infection, this estimation again decreased to 479 deaths. From the ultimately estimated mortality, 11% was considered to be not related to drugs, 23% was attributed directly to drugs, and 66% was attributed indirectly to drugs. The number of direct deaths, as estimated by this method, falls in the same order of magnitude as the number extracted from the Causes of Death Statistics, when selecting cases according to the Drug-Related Deaths Standard as established by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). Further cross-validation with other measures will be needed to assess the accuracy of the method, the limitations of which are discussed with respect to stipulating directions for future research.

Stimulant use among clients entering drug treatment in Europe

The aim of this article is to explore the prevalence of primary illicit stimulant use among people who enter drug treatment in Europe. Drawing on information provided by European Union treatment centres in 2009 (excluding Latvia, Lithuania, Portugal and Norway), the European Monitoring Centre for Drug and Drug Addiction showed data in relation to the analysis of two of the most problematic drugs: cocaine and stimulants other than cocaine. The analysis reached three conclusions: the primary use of stimulants (cocaine and amphetamines) among clients entering treatment appears to be widespread throughout Europe; stimulant use including different forms of stimulants varied from country to country and two geographical patterns emerge across Europe: North-Eastern European countries show high levels of prevalence of problematic use of amphetamines and methamphetamines, while South-Western countries report high levels of problematic use of cocaine.

Patología dual: una perspectiva europea

Editorial of vol 29-1.