1. E. Alvarez - Estimation of Problematic Drug Use in Spain. E. Alvarez... · Estimation of...
Transcript of 1. E. Alvarez - Estimation of Problematic Drug Use in Spain. E. Alvarez... · Estimation of...
Spanish Observatory on Drugs
Julia GonzalezRosario Sendino
Noelia LlorensBegoña Brime
Aurora RuizElena Alvarez (speaker)
Prevalence and patterns of drug use among general population. GPS
Indicator. Annual Expert Meeting 2013.
18-19 June 2013 - EMCDDA (Lisbon)
Estimation of Problematic Drug Use in SpainEstimation of Problematic Drug Use in Spain
-- Examples of estimation based in surveysExamples of estimation based in surveys--
Data and thought…
� INTRODUCTION � Concept and aspects to take into account � Source of information and methods, in Spain
� EXAMPLES � Cocaine PDU estimation based in surveys (frequency & age/vulnerability)
Objective. Methods. Results.
� Cannabis PDU base in surveys (scales). Objective. Methods. Results.
� DISCUSSION� Utility of surveys to estimate PDU, combination of different methods…
Problematic Drug Use
Population Population
INTRODUCTION. OBJETIVE. METHOD. RESULTS. DISCUSSION.OBJETIVE. METHOD. RESULTS. DISCUSSION.
EMCDDA
Until 2012: “problem drug use is injecting drug use or regular and/or long-term use of opiates, cocaine and/or amphetamines”
2013: focuses on “high-risk drug use. Drug use that is causing actual harm (negative consequences) to the person (including dependence but also other health, psychological or social problem) or is placing the person at a high probability/risk of suffering such harms”
Approach of problematic users...
The drug use is causing, the
users (or others), negative
physical, psychological or social
consequences or hight risk of
having them.
Approach of problematic users... Approach of problematic users...
The drug use is causing, the The drug use is causing, the
users (or others), negative users (or others), negative
physical, psychological or social physical, psychological or social
consequences or consequences or highthight risk of risk of
having them. having them.
Drug Drug usersusers
ProblematicProblematic
usersusers
� It is useful useful to identified
problematic user to oriente and
implement policies (prevention,
treatment, social needs, harm
reduction, economics and human
resources). Focus in target population.
� It is possiblepossible to estimate the
number and some characteristics of
problematic users.
� It is necessary define criteriadefine criteria, based
in evidences, consensus and practical
issues, in order to improve the
comparability. Multidisciplinary work.
INTRODUCTION. OBJETIVE. METHOD. RESULTS. DISCUSSION.OBJETIVE. METHOD. RESULTS. DISCUSSION.
Population Population
Drug Drug usersusers
ProblematicProblematic
usersusers
How many?
How many?
Profile?Profile?
Some aspects to take into accountSome aspects to take into accountType of Type of drugdrug
alcohol, cocaine, cannabis, heroine…prevalence…
UsersUsers characteristic characteristic Health situation, previous pathologies, pregnancy, age…
Pattern of use Pattern of use Frequency, chronicity, route of administrationintensity, (how much -gr./hour), “poliproblematics”…
INTRODUCTION. OBJETIVE. METHOD. RESULTS. DISCUSSION.OBJETIVE. METHOD. RESULTS. DISCUSSION.
Consequences for users or Consequences for users or others others
Physic, psychological, social..Physic, psychological, social..
Accidents, infections, mental Accidents, infections, mental diseasesdiseases……
SOURCES OF INFORMATION:SOURCES OF INFORMATION: available information or new indicators.
Surveys (general population, specific group…) treatment centers, traffic offenses, judicial system,
mortality, emergencies facilities, social services, infectious diseases registries, etc.
METHODS:METHODS: Direct or indirect estimations… surveys, scales, combinated methods…
Standardization of definitions, methodologies and analysis �comparability
General pop. Survey (15-64 y.o)
Problem drug use
Annual since
2007
annual since 1987 5279 (2011)
Annual since 1983 706 (2010)
Annual since 198779.295 (2011)
Treatment Demand indicator
Drug Mortality
Hospital emergencies
1) SURVEYS
Strengths of periodic surveys:
� Periodic and long series: biennale from 1994-2010.
� Big sample: 20,000 a 30,000
� Complete questionnaire (50 min): basic + special modules. International comparability.
2) DRUG INDICATORS
3) EXTERNAL SOURCES. Supply indicators, etc.
Information sources in Spain Information sources in Spain
infectious diseases
Annual since 1986
INTRODUCTION. OBJETIVE. METHOD. RESULTS. DISCUSSION.OBJETIVE. METHOD. RESULTS. DISCUSSION.
Student survey (14-18 y.o)
Others: Prison, specific population...
76,6
40,2
9,62,2 0,7 0,6 0,4
26,4
0,1
73,6
32,4
2,6 1,7 1,6 2,1 0,60
10
20
30
40
50
60
70
80
Alc
ohol
Tabaco
Cannabis
Coca
ína
Éxt
asi
s
Anfe
tam
inas
Alu
cinógenos
Hero
ína
EDADES (15-64 a.) 2011
ESTUDES (14-18 a) 2010
Last year prevalence. Spain 2010/2011.
CannabisPDU scales (CAST. SDS. DSM-IV. M-CIDI) Students surveys. 2006. 2008. 2010. 2012.
CocaineDirect estimation (frequency and age). General Population surveys. 2009 y 2011.
AlcoholAUDIT scale. General Population Survey 2009.
HeroineIndirect estimation. Multiplier method GPS & TDIFrom 2006 to 2011.
Main Methods for PDU estimates in SpainMain Methods for PDU estimates in Spain
Source: Spanish Observatory on Drugs
INTRODUCTION. OBJETIVE. METHOD. RESULTS. DISCUSSION.OBJETIVE. METHOD. RESULTS. DISCUSSION.
General population survey 2011(15-64 y.o)Student survey 2010. (14-18 y.o)
1) Frequency based
How many times in a period of time (month/year) do a person consume?.
Person (15-64 y.o.) who used cocaine 30 days or more within the last 12 months ORwho used cocaine 10 days or more within the last 30 days
2) Frequency & age (vulnerability)
20 years old ?? Phisic/psycic/social vulnerability. Implement prevention in early ages.
Persons (15-20 y.o) who used cocaine 10 d or more within the last 12 month AND who used cocaine from 1 to 3 d within in the last 30 days PLUS persons (21 to 64 y.o.) who used cocaine 30 days or more within the last 12 months ORwho used cocaine 10 d or more within the last 30 days .(More than 20 y.o)
Criteria
No clear consensus,
no evidence based criteria
General population survey 2011.
15-64 y.o. National coverage. Face to face questionnaire. 22, 128 questionnaires.
Source of information
Estimation of cocaine problematic drug users in Spain, using general population survey, based in frequency and age (vulnerability)
OBJETIVE
METHOD
INTRODUCTION.INTRODUCTION. OBJETIVE. METHOD. RESULTS. DISCUSSION.. RESULTS. DISCUSSION.
Population (15Population (15--64 64 y.oy.o.).)
CocaineCocaine usersusers
ProblematicProblematic
usersusers
31 807 07331 807 073
Life time: 8.8% n= 2 787 281 Last year: 2.2% n= 348 410Last month: 1.1% n= 348 410
124 083 (130 537)
Can be considerer cocaine PDU IN Spain in 2011:
� 0.39% (0.41%) of population 15- 64 y.o.
� 4.5% (4.7%) of (15- 64 y.o.) life time prevalence users
� 17.0% (17.9%) of (15- 64 y.o.) last year prevalence users
� 35.6% (37.5%) of (15- 64 y.o. last month prevalence users
COCAINE PROBLEMATIC DRUG USE, SPAIN 2011
Using GPS: frequency (frequency + age)
INTRODUCTION. OBJETIVE. METHOD. INTRODUCTION. OBJETIVE. METHOD. RESULTS.RESULTS. DISCUSSION.DISCUSSION.
Source: Spanish Observatory on Drugs
4,0
15,0
31,2
4,7
17,9
37,4
0
10
20
30
40
CP alg. vez CP Ult. año CP Ult. mes
%
2009 2011
0
2
4
6
8
10
1999 2001 2003 2005 2007 2009 2011
alguna vez último añoúltimo mes
Cocaine prevalence (%) in general population
(15-64 y.o). Spain 1999-2011.
Problematic drug use (%). Spain 2009 & 2011.
Based in frequency & age in GPS (15-64 y.o).
Continuity
Among people ever using cocaine:
1 out of 4 consumed last year
1 out of 7 consumed last month.
INTRODUCTION. OBJETIVE. METHOD. INTRODUCTION. OBJETIVE. METHOD. RESULTS.RESULTS. DISCUSSION.DISCUSSION.
Source: Spanish Observatory on Drugs
PREVALENCE VS PROBLEMATIC DRUG USE
Life timeLast yearLast mont
PU life time PU last year PU last month
0
2
4
6
8
10
1994
1996
1998
2000
2002
2004
2006
2008
2010
Cocaine prevalence (%) in student (14-18 y.o)
Spain 1994-2010.
Prevalence results by them self doesn't Prevalence results by them self doesn't
show a complete picture.show a complete picture.
0
5000
10000
15000
20000
25000
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
0
0,5
1
1,5
2
2,5
3
3,5
4DRD cocaine with or without any other susbstances (nº)
Hospital emergency detected cocaine (nº)
Seizures (kg/10)
First treatments for cocaine (nº)
last month prevalence 15-64 y.o. (%)
Last month prevalence 14-18 y.o. (%)
Cross indicator analysis. COCAINE.
Nº defunciones
Nº urgencias hosp se detecta cocaína
Incautaciones (Kg/10)
Nº primeros tratamiento por cocaína
% consumo último mes 15-64 años
% consumo último mes 14-18 años.
.
INTRODUCTION. OBJETIVE. METHOD. INTRODUCTION. OBJETIVE. METHOD. RESULTS.RESULTS. DISCUSSION.DISCUSSION.
Source: Spanish Observatory on Drugs
Nº death
Nº hospital emergencies when cocaine is detected
Nº cocaine first treatment
Last month prevalence (%) 15-64 y.o.
Last month prevaelnce (%) 14-18 y.o.
CAST- Cannabis Abuse Screening Test. 6 items. Measure social & health consequences for user and others. SDS-Severity of Dependence Scale. 5 items. Measure dependence. DSM-IV-American Psychiatric Association. 5 items for abuse and 13 for dependence. DSM-IV criteria. M-CIDI- Munich Composite International Diagnostic Interview.
CASTCASTSDSM-CIDI
CASTCAST SDS DSM-IV
Scale
Student survey. 14-18 y.oNational coverage. self-administered questionnaires (45 min.)
Source of information
26,000
In process
31,967
6,303
30,183
7,173
26,454
3,569
N survey
N CAST (valid questionnaires last year)
Year 2012201020082006
INTRODUCTION. INTRODUCTION. OBJETIVE. METHODOBJETIVE. METHOD. RESULTS. DISCUSSION.. RESULTS. DISCUSSION.
Psychometric evaluation of scales. European project on course.
Estimation of cannabis problematic drug use (14-18 y.o). Spain, 2006-2012.
OBJETIVES
METHOD
Population (14Population (14--18 18 y.oy.o.).)
Cannabis Cannabis
lastlast yearyear usersusers
ProblematicProblematic
drug drug useruser
2 254 5052 254 505
595 189 (26.4% of total population)
Problematic users.
15.3% among last year users. 4.6% among total population.
CANNABIS PROBLEMATIC DRUD USERS (CAST) SPAIN, 2010.
INTRODUCTION. OBJETIVE. METHOD. INTRODUCTION. OBJETIVE. METHOD. RESULTS.RESULTS. DISCUSSION.DISCUSSION.
Source: Spanish Observatory on Drugs
4.6 3.73.3% of cannabis high risk users among population 14-18 y.o.
100,34081, 08073, 534Nº of cannabis high risk users among population 14-18 y.o
201020082006Year
CAST results. Percentage of non problematic/low/high risk among cannabis last year users (14-18 y.o).
Increase trends in
cannabis problematic
drug use in teenagers.
66,0 67,1 64,8
20,7 18,6 19,9
13,3 14,3 15,3
0%
20%
40%
60%
80%
100%
2006 2008 2010
no problemático bajo riesgo alto riesgo
CANNABIS PDU TRENDS (CAST), SPAIN 2006, 2008, 2010
INTRODUCTION. OBJETIVE. METHOD. INTRODUCTION. OBJETIVE. METHOD. RESULTS.RESULTS. DISCUSSION.DISCUSSION.
No problematic Low risk High risk
10
15
20
25
30
35
40
45
1998 2000 2002 2004 2006 2008 2010
Alguna vez en la vidaÚltimos 12 mesesÚltimos 30 días
10
15
20
25
30
35
40
45
1998
1999
2000
2001
2002
2004
2005
2006
2007
2008
2009
2010
2011
0
10
20
30
40
50
60
70
80
90
2005
2006
2007
2008
2009
2010
2011
% hospital emergencies related to drug
when cannabis is present. Spain 1998-2011.
Cannabis prevalence (14-18 y.o).
Spain 1998-2010.
Treatment episodes in < 18 years (%)
different drugs. Spain, 2005-2011
0
2.000
4.000
6.000
8.000
10.000
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
20
10
20
11
Number of cannabis treatment
demands. Spain, 1996-2011.
First treatment
Previous treatments
INTRODUCTION. OBJETIVE. METHOD. INTRODUCTION. OBJETIVE. METHOD. RESULTS.RESULTS. DISCUSSION.DISCUSSION.
Source: Spanish Observatory on Drugs
Life timeLast yearLast mont
Some thought based in our experience… different scenarios ���� dif. answers ���� dif. methods.
�Conceptual definition depend of situation, drug, user characteristic, pattern of use….
�Look for a complete picture using multiples sources and different indicators. Available information. Triangulation of the information. Problematic use!!
�Look for right sources & methods.
Are survey a good methods for estimate problematic use?Surveys can't answer “everything” but… yes “many things”Part of the puzzle to understand drug use? First step to oriented specific studies? .
� Methods : - General population/specific population. - Scales (AUDIT, CAST, DSM-V…). - Frequency of use, age, others. - Surveys + other indicator.
� Some limitation: classics surveys limitations. Drug with low prevalence. Surveywith small sample. High risk-social stigma. Out of sampling frame…
� Surveys are a possible toolSurveys are a possible tool: - Available (more cost effective than create new indicator). - Robust (quality and trends). - Flexible (periodic modules, adapt to needs).
INTRODUCTION. OBJETIVE. METHOD. RESULTS. INTRODUCTION. OBJETIVE. METHOD. RESULTS. DISCUSSION.DISCUSSION.
It is useful
It is possible
Population Population
Drug Drug usersusers
PDUPDU
INTRODUCTION. OBJETIVE. METHOD. RESULTS. DISCUSSION.OBJETIVE. METHOD. RESULTS. DISCUSSION.
PDU concept PDU concept
SpanishSpanish ObservatoryObservatory onon DrugsDrugs. . www.pnsd.mspsi.eswww.pnsd.mspsi.es [email protected]@mspsi.es
Continue working in… define criteria, methods and source of information
SURVEYS POSSIBLE TOOL