Luis Royuela

Khat use and monitoring drug use in Europe: the current situation and issues for the future.

AIM OF THE STUDY To review the information available on the use of khat (Catha edulis) in the EU, and to assess the future use of this drug and related substances. MATERIAL AND METHODS Khat is not controlled by international law and it has not been systematically included in the list of illicit drugs monitored in the EU. The current principal source of information on khat use in Europe is the early-warning system set up to monitor new and emerging drugs. Further information was obtained from official national reports to the EMCDDA and from the scientific literature. RESULTS Across Europe, the use of khat is low. Khat use is limited to countries with immigrant communities from countries where khat use is common (such as Ethiopia, Somalia and Kenya). Information on the prevalence of khat use in the general population is scarce. Data on seizures provide an insight on the situation, though these may be difficult to interpret. The most recent estimates suggest that Europe accounts for about 40% of the khat seized worldwide. CONCLUSION The shortage of data on the use and patterns of use of khat in Europe does not allow an evaluation of the needs for health and social interventions in communities in which the drug is used. But seizures of the plant are increasing in the EU, and more synthetic derivatives of the pharmacologically active ingredients of the plant (cathine and cathinone) are appearing on the market. Some of these, like mephedrone, have significant potential for future diffusion, and are likely to play a greater role on the European drug scene of the future.

Use of supervised injection facilities and injection risk behaviours among young drug injectors

AIMS To study the use of supervised injection facilities (SIFs) as a predictor of safer injecting practices. DESIGN Cross-sectional study conducted with face-to-face interview using a structured questionnaire with computer-assisted personal interviewing. Dried blood spot samples were collected for human immunodeficiency virus (HIV) and hepatitis C virus (HCV) antibody testing. SETTING All participants were street-recruited by chain referral methods in Madrid and Barcelona. PARTICIPANTS A total of 249 young heroin drug injectors recruited by the ITINERE cohort study in two Spanish cities with SIFs. MEASUREMENTS The main outcome measures were self-reported injecting behaviours and SIFs attendance. RESULTS SIF users were more marginalized socially than non-users. They were also more often regular injectors (weekly or more versus sporadic) [odds ratio (OR) = 4.9, 95% confidence interval (CI): 2.7-8.8], speedball users (OR = 2.5, 95% CI: 1.5-4.3) and anti-HCV-positive (OR = 3.1, 95% CI: 1.4-7.1). In the logistic regression analysis, using SIFs was associated independently with not borrowing used syringes (OR = 3.3, 95% CI: 1.4-7.7). However, no significant association was found between SIF use and not sharing injection equipment indirectly (OR = 1.1, 95% CI: 0.5-2.2). CONCLUSIONS SIFs attract highly disadvantaged drug injectors who engage none the less in less borrowing of used syringes than non-users of these facilities. The risks of indirect sharing should be emphasized when counselling SIF attendees.

Differences in severity of heroin dependence by route of administration: the importance of length of heroin use

To explore differences in the severity of heroin dependence by route of administration, we interviewed 909 heroin users in three Spanish cities. Dependence was measured with the severity dependence scale (SDS). No major differences in the severity of heroin dependence were detected among users with 5 or more years of heroin use (long-term users), but differences were found among newer users (SDS mean scores, 7.3 in heroin injectors; 7.9 in smokers and 4.6 in sniffers; P = 0.006), especially those with fewer than 3 years of use. Similar differences by route of administration were found when frequency of heroin use (days/month) was considered rather than severity of dependence. However, in the latter case major differences were also found among long-term users. These findings suggest that the route of administration probably influences the rate of progression to dependence but has little influence on the long-run level of dependence. They also help explain some aspects of the transition between routes of heroin administration, which is occurring in different areas.

Ten Years of Monitoring Illicit Drug Use in Prison Populations in Europe: Issues and Challenges

The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) has been collecting aggregated data on illicit drug use among European prison populations for over a decade. Additional studies were identified in a literature search. Together, these sources yielded 53 studies reporting data during the period 2000 to 2008. Analysis of these studies reveals that the available data are scarce and patchy, with large variations in methodology. This diversity hampers comparison, and may, in part, account for the wide range of prevalence estimates for drug use and drug injecting, both prior to imprisonment and while in prison. This article concludes that a common instrument to measure drug use and its consequences in European prison populations is needed.

Estimación de la mortalidad atribuible al consumo de drogas ilegales en España

Fundamento y objetivo En Espana se descono-ce el impacto del consumo de drogas ilegalesen la mortalidad general. Se pretende cuantifi-carlo para 1994-2000 SUJETOS Y METODO Se sumaron las muertes de-bidas al virus de la inmunodeficiencia humana(VIH) en consumidores de drogas inyectadas ylas directamente relacionadas con drogas ile-gales (DRDI), extraidas del Registro Generalde Mortalidad (RGM). Posteriormente se corri-gieron multiplicandolas, respectivamente, porla proporcion de casos de sida atribuibles a in-yeccion de drogas y por la subestimacion delas muertes DRDI en el RGM, que se obtuvocomparando en varias zonas el RGM con unregistro especifico RESULTADOS En Espana, la mortalidad por dro-gas ilegales descendio desde maximos de22,7 por 100.000 habitantes de 15-49 anos(el 16,4% de todas las muertes) en 1996 has-ta 8,9/100.000 en 2000 (el 7,8% de todaslas muertes), lo que explica un 58% del des-censo de la mortalidad general. En 2000, envarones de 15-49 anos la mortalidad DRDI su-peraba a la debida por el VIH en consumidoresde drogas inyectadas CONCLUSIONES El uso de drogas ilegales conti-nua siendo en Espana una causa importantede mortalidad juvenil. La intoxicacion agudaes ya probablemente la primera causa demuerte por drogas ilegales

Prevalencia de prácticas indirectas de compartir material para inyectarse drogas en Galicia, Madrid, Sevilla y Valencia

Resumen Objetivos Estudiar las practicas de riesgo de inyeccion de drogas, en especial compartir indirectamente material de inyeccion (CIMI), y de las conductas sexuales de riesgo. Metodos Estudio transversal. Entrevista cara a cara de 1.638 usuarios de programas de intercambio de jeringas (PIJ). Se investigaron varias formas de CIMI (coger droga diluida en una jeringa usada ajena, meter la aguja en el recipiente donde se introdujeron otras usadas y reutilizar el liquido de limpieza de otros). Resultados El 16% en Galicia, el 4,7% en Madrid, el 17,6% en Sevilla y el 13,2% en Valencia se inyecto con jeringas usadas ajenas (p Conclusiones La prevalencia de CIMI es mayor que la de inyeccion con jeringas usadas. Para un porcentaje relevante, las unicas conductas de riesgo de inyeccion son las practicas de CIMI. Estas y el escaso uso del preservativo, especialmente con la pareja estable, pueden estar contribuyendo a la extension del virus de la inmunodeficiencia humana y al virus de las hepatitis C o B.

Drug supply indicators: Pitfalls and possibilities for improvements to assist comparative analysis

Interventions to tackle the supply of drugs are seen as standard components of illicit drug policies. Therefore drug market-related administrative data, such as seizures, price, purity and drug-related offending, are used in most countries for policy monitoring and assessment of the drug situation. International agencies, such as the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and the UN Office of Drugs and Crime, also monitor and report on the drug situation cross-nationally and therefore seek to collect and make available key data in a uniform manner from the countries they cover. However, these data are not primarily collected for this purpose, which makes interpretation and comparative analysis difficult. Examples of limitations of these data sources include: the extent to which they reflect operational priorities rather than market changes; question marks over the robustness of and consistency in data collection methods, and issues around the timeliness of data availability. Such problems are compounded by cultural, social and contextual differences between countries. Making sense of such data is therefore challenging and extreme care needs to be taken using it. Nevertheless, these data provide an important window on a hidden area, so improving the quality of the data collected and expanding its scope should be a priority for those seeking to understand or monitor drug markets and supply reduction. In addition to highlighting some of the potential pitfalls in using supply indicators for comparative analysis, this paper presents a selection of options for improvements based on the current EMCDDA programme of work to improve their supply-related monitoring and analysis. The conceptual framework developed to steer this work may have wider application. Adopting this approach has the potential to provide a richer picture of drug markets, at both national and international levels, and make it easier to compare data between countries.

Drug affordability–potential tool for comparing illicit drug markets

BACKGROUND The importance of illicit drug price data and making appropriate adjustments for purity has been repeatedly highlighted for understanding illicit drug markets. The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) has been collecting retail price data for a number of drug types alongside drug-specific purity information for over 15 years. While these data are useful for a number of monitoring and analytical purposes, they are not without their limitations and there are circumstances where additional adjustment needs to be considered. This paper reviews some conceptual issues and measurement challenges relevant to the interpretation of price data. It also highlights the issues with between-country comparisons of drug prices and introduces the concept of affordability of drugs, going beyond purity-adjustment to account for varying national economies. METHODS Based on a 2015 European data set of price and purity data across the heroin and cocaine retail markets, the paper demonstrates a new model for drug market comparative analysis; calculation of drug affordability is achieved by applying to purity-adjusted prices 2015 Price Level Indices (PLI, Eurostat). RESULTS Available data allowed retail heroin and cocaine market comparison for 27 European countries. The lowest and highest unadjusted prices per gram were observed for heroin: in Estonia, Belgium, Greece and Bulgaria (lowest) and Finland, Ireland, Sweden and Latvia (highest); for cocaine: the Netherlands, Belgium and the United Kingdom (lowest) and Turkey, Finland, Estonia and Romania (highest). The affordability per gram of heroin and cocaine when taking into account adjustment for both purity and economy demonstrates different patterns. CONCLUSION It is argued that purity-adjusted price alone provides an incomplete comparison of retail price across countries. The proposed new method takes account of the differing economic conditions within European countries, thus providing a more sophisticated tool for cross-national comparisons of retail drug markets in Europe. Future work will need to examine other potential uses of the drug affordability tool. LIMITATIONS The limitations of this measure reflect primarily the limitations of the constituent data; in addition to issues inherent in collecting accurate data on illicit markets, analysis that relies on data collected from multiple countries is susceptible to discrepancies in data collection practices from country to country.

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.

Acceso a jeringas estériles entre los jóvenes de Madrid y Barcelona que se inyectan drogas y su asociación con las prácticas de riesgo

Resumen Objetivo Evaluar el acceso a jeringas esteriles y su asociacion con practicas de inyeccion de riesgo en Madrid y Barcelona. Material y metodo Estudio transversal en la comunidad de 465 jovenes que se inyectan heroina, realizado entre 2001 y 2003, mediante entrevista asistida por ordenador. Resultados Un 4,2% no obtuvo jeringas esteriles gratuitas en los ultimos 12 meses. En Madrid, el 32,1% obtuvo todas las jeringas esteriles gratis (TJEG), frente al 44,6% de Barcelona (p Conclusiones En Madrid y Barcelona el acceso a jeringas esteriles es muy elevado, aunque con modelos diferentes. Debe facilitarse la obtencion de todas las jeringas esteriles gratis, especialmente entre los jovenes que se inyectan con mayor frecuencia.