Co-ordination, monitoring and evaluation of drug policies. Bob Keizer. Senior Drug Policy Advisor. Trimbos-instituut

Transcription

1 Co-ordination, monitoring and evaluation of drug policies Bob Keizer Senior Drug Policy Advisor Trimbos-instituut

2 What is drug policy? Interdependencies and incompatibilites politics science practice Trimbos-instituut

3 Current situation Politics: ad hoc, no knowledge, top down, emotional Science: no budget, no programming, ivory tower Practice: lack of capacity, knowledge, quality; no signals to politics, science Trimbos-instituut

4 Dangers Drug policies can be inefficient, inconsistent, incredible Widening gap between citizen policy Trimbos-instituut

5 Co-ordination of drug policies Identifying, improving and bridging elements politics science practice Trimbos-instituut

6 Priorities for policy makers Raise awareness amongst politicians, scientists, practitioners of interdependencies Improve communication; stop inventing wheels: improve transfer of knowledge Create intellectual space (discussions, innovation) Co-ordinate policy cycle Trimbos-instituut

7 Policy Cycle Political decisions Monitoring Evaluation Innovation/research implementation Trimbos-instituut

8 Co-ordination of co-ordination International drug policy makers National drug policy makers Local/regional policy makers Trimbos-instituut

9 International policy makers: Need input from national policy makers Must be independent Must provide national policy makers with workable tools Trimbos-instituut

10 International drug policies: who does what? EU: HDG, Action Plan, EMCDDA, Europol Council of Europe: Pompidou Group UN: CND, UNODC, INCB WHO Trimbos-instituut

11 National Policy makers Need input from local/regional level Intellectual leadership Must provide local/regional level with adeqate tools Trimbos-instituut

12 Local/regional policy makers Need the input from day-to-day practice Must be facilitated to do their work Must be taken seriously Trimbos-instituut

13 Experiences in the Netherlands The ideal form of policy making? National coordination (AWUD) Monitoring and reserach Local responsibilities Trimbos-instituut

14 Conclusions on co-ordination Collect and balance signals from politics, science, practice Pay attention to policy cycle Pay attention to all levels Pay attention to all parties Pay attention to interdependencies and incompatibilities Trimbos-instituut

15 Role of Monitoring in Drug policy Contribution to process of policy making by assessing practice Basis for evaluation Basis for innovation, research Inform poltics Trimbos-instituut

16 Monitoring What? Prevalence Mortality/morbidity Criminality Seizures Public nuisance/public order Quality of drugs Etc. Trimbos-instituut

17 How to manage streams of Drug use Quality Criminality Seizures etc information? coordination Trimbos-instituut

18 Goals: National Drug Monitor (The Netherlands) Promote quality and cohesiveness Improve planning Co-ordinate streams of information Trimbos-instituut

19 Objectives & tasks of the NDM Acting as a co-ordinating body for monitoring projects on substance use. Promoting standardisation of methods. Compiling data from a variety of drug use indicators. Reporting to national authorities and international organisations (e.g. EMCDDA, UN). To advise on gaps in data. Trimbos-instituut

20 Organisation of the NDM EMCDDA Ministry of Health, Welfare and Sports Ministry of Justice Monitoring projects on use, treatment demand, health, market, criminality Bureau NDM at Trimbos Institute Co-ordinator Permanent staff Editorial Board Data collection Draft reports Final reports Comments and advice Scientific Committee Chair Members Working Group Infectious Diseases Working Group Prevalence Estimates of Problem Use Working Group Drug-Related Deaths Trimbos-instituut

21 Annual Report of the NDM Facts and figures on the use of cannabis, cocaine, opiates, ecstasy & amphetamine, alcohol and tobacco in the Netherlands Based on five epidemiological key indicators of the EMCDDA: 1. Use in the general population and youth 2. Prevalence of problem use 3. Treatment demand 4. (Infectious) Diseases 5. Mortality 6. Price/purity Since 2002, also data on drug-related criminality International comparisons Trimbos-instituut

22 Monitoring Sources (1) Inventory of surveys and registrations in the field of alcohol and drugs in 2004 (Ti/NDM and IVO) Result: 60 monitors Theme Number of monitors Use and problem use 24 Treatment demand 13 Morbidity & mortality 7 Drugs market 3 Law enforcement & criminal justice 13 Report (in Dutch): Cruts, Lempens, Ketelaars, Van Laar, Van de Mheen (2004): and Trimbos-instituut

23 Drug use stable between 2001 and 2005 LAST YEAR PREVALENCE (%) among population years Cannabis Cocaine Ecstasy * Amphetamine LSD Heroin Source: National prevalence Surevy on substance use, IVO Trimbos-instituut

24 International comparison Recent (% last year) use of CANNABIS among young adults (15-34 years old) in the EU and USA. Source: EMCDDA 25 US EU - average Greece Bulgaria Lithuania Sweden Poland Portugal Finland Hungary Latvia Ireland Slovakia Netherlands Norway Estonia Austria Italy Denmark EU average Germany UK (E&W) Cyprus Czech Republic France Spain US Trimbos-instituut

25 International comparison Recent (% last year) use of COCAINE among young adults (15-34 years old) in the EU and USA. Source: EMCDDA 6.0 US EU - average Greece Czech Republic Latvia Lithuania Portugal France Hungary Finland Bulgaria Slovakia Cyprus Netherlands Estonia Poland Austria Germany Norway Denmark Ireland EU average Italy UK (E&W) Spain US Trimbos-instituut

26 International comparison Recent (% last year) use of ECSTASY among young adults (15-34 years old) in the EU and USA. Source: EMCDDA EU - average US Greece Poland Italy France Portugal Lithuania Bulgaria Denmark Norway Finland Austria Germany Latvia EU average Ireland Slovakia US Hungary Netherlands Spain Cyprus Estonia UK (E&W) Czech Republic Trimbos-instituut

27 International comparison Number of problem hard drug users per 1000 inhabitants of yrs , Greece Germany Netherlands France Sweden Finland Ireland Austria Spain Portugal Denmark Italy Luxembourg UK Source: EMCDDA Trimbos-instituut

28 Stabilisation/decrease in cannabis use among pupils Last month prevalence (%) Boys Girls Age: years. Source: National School Survey, Trimbos Institute Trimbos-instituut

29 Cannabis: Stable Use Prevalence in population is stable (no changes in 1997, 2001 and 2005) Last year prevalence 5,4% European average 7% Age at onset: Among ever users jaar: 16,4 jaar No change between 1997 en 2005 Trimbos-instituut

30 Cocaine: stabilisation? Prevalence of cocaine use in population of years is stable (no changes in 1997, 2001 and 2005) Last year prevalence (2005): 0,6% European average: 1,3% Incidence of new users decreased from 0.4% in 2001 to 0.1% in 2005 But: continuing popularity in some scenes (crack: marginalised hard drug; cocaine powder in nightlife scene). Trimbos-instituut

31 Ecstasy Increase in use among population (15-64 yrs) between ; stable between Last year : 1,2% European average : circa 1% Treatment demand remains low 293 primary ecstasy clients: less than 1% of all drug clients 781 secondary ecstasy clients Proportion of female clients increased from 19% in 2000 to 31% in 2005 Trimbos-instituut

32 Amphetamine Prevalence in population is stable and low between 1997, 2001 and 2005 Last year prevalence 0,3% European average 0,7% Trimbos-instituut

33 Number of problem hard drug users Opiates: (midpoint: 34,000) Most opiate users also use crack Percentage injectors: 10-15% Trimbos-instituut

34 Treatment demand Number of clients by primary drug Alcohol Opiates Cocaine Amphetamine Ecstasy Cannabis Source: LADIS 2005, IVZ Trimbos-instituut

35 Cannabis: Increase treatment demand Number Primary Secondary Source: LADIS Trimbos-instituut

36 Increase cannabis and cocaine Number of clients Cocaine primary Cocaine secundary Cannabis primary Cannabis secundary Source: LADIS, IVZ Trimbos-instituut

37 Amphetamine: Increasing treatment demand Number Primary Secondary Source: Ladis Trimbos-instituut

38 Cocaine: Decrease in treatment demand after long term increase Number Primary Secondary Source: Ladis Trimbos-instituut

39 Decrease opiate clients Number of clients 20,000 18,000 16,000 Primary Secondary 14,000 12,000 10,000 8,000 6,000 4,000 2, Source: LADIS, IVZ Trimbos-instituut

40 Decrease in proportion of young opiate clients 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% >=40 yrs yrs yrs Source: LADIS, IVZ Trimbos-instituut

41 Infectious diseases Among drug users who have ever injected Prevalence of HIV: 0-26% Prevalence of HBV: 35% - 67% Prevalence of HCV: 47% - 79% Strong decline in HIV incidence Trimbos-instituut

42 Infectious deseases Borrowing needles or syringes has decreased (but still between 8 and 30% of the IDUs did so in the past 6 months) Sexual risk behaviour remains worrisome Trimbos-instituut

43 Slight decrease deaths by opiate overdose Number of deaths Total drugs Opiates Source: Causes of Death Statistics, Statistics Netherlands Trimbos-instituut

44 Cocaine deaths (underlying causes) Number Source: Causes of death Statistics, Statistics Netherlands Trimbos-instituut

45 International comparison overdose mortality 6,0 5,0 4,0 3,0 2,0 1,0 0,0 Number per 100 thousand inhabitants Netherlands Germany Sweden Finland United Kingdom Norway According to the same selection of ICD-10 codes. Source: EMCDDA Trimbos-instituut

46 Main source: Drugs markets THC-monitor based on cannabis samples in coffee shops Monitor on (recreational) drugs delivered by consumers (e.g. ecstasy, cocaine, amphetamine) Trimbos-instituut

47 % THC in cannabis 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% Dutch-grown marihuana 8.6% 11.3% 15.1% 18.1% 20.4% 17.7% 17.5% 16.0% Imported marihuana 5.0% 5.3% 6.6% 6.2% 7.0% 6.7% 5.5% 6.0% Imported hashish 11.0% 12.1% 17.5% 16.6% 18.2% 16.9% 18.7% 13.3% Source: DIMS, Trimbos Institute Trimbos-instituut

48 Increase THC content until 2004, stabilisation in % 25% 20% 15% 10% 5% 0% Dutch marihuana 9% 11% 15% 18% 20% 18% 18% Imported marihuana 5% 5% 7% 6% 7% 7% 6% Imported hashish 11% 12% 18% 17% 18% 17% 19% Source: DIMS, Trimbos Institute Trimbos-instituut

49 Ecstasy market Most pills (90%) sold as ecstasy contain MDMA, MDEA and/or MDA Proportion of high dose (>140 mg MDMA) pills decreased in 2006 % 100% 80% 60% 40% 20% 0% >140 mg mg mg mg mg Increase in 2006 of percentage off ecstasy pills containing mcpp Trimbos-instituut

50 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Drugs markets composition of pills sold as ecstasy No psychoactive substance Other psychoactive substance Amphetamine MDMA (-like) plus other Only MDMA (-like) Source: DIMS, Trimbos Institute Trimbos-instituut

51 MDMA content in ecstasy pills Percentage of ecstasy pills by dose (mg) 100% 80% 60% 40% >140 mg mg mg mg 1-35 mg 20% 0% Source: DIMS, Trimbos Institute Trimbos-instituut

52 Cocaine market: Increase adulterants % of cocaine powders adulterated with phenacetine Source: DIMS Trimbos-instituut

53 Seizures in The Netherlands, 2005 Cannabis (kg) : Nederwiet (plants): nursery gardens dismantled Cocaine (kg): Heroin (kg): 900 XTC (powder/paste): 400 XTC (tablets): Amfetamine (powder/paste): Trimbos-instituut

54 Early Warning Systems National level: Drug information monitoring system THC monitor Seizures National Assessment Committee Trimbos-instituut

55 Streams of information National sources National Assessment Committee Focal Point EMCDDA (Early Warning System) European Commission Trimbos-instituut

56 Criteria for assessment Individual health risks Public health risks Social risks Possible consequences of prohibition Options for control Trimbos-instituut

57 Experiences with Monitoring (1) Improving quality of policy, by : - Overall assessment of situation - Measuring effects of policy, identyfying inter-relationships of measures Trimbos-instituut

58 Experiences with monitoring (2) Monitoring must be a structural activity, takes time and money Monitoring needs political support Support of researchers is necessary Separate monitoring and political policymaking Trimbos-instituut

59 Experiences with monitoring (3) Products must be geared to the needs of target groups Collect as much data as possible or limit the number of data? Trimbos-instituut

60 Role of evaluation in drug policy(1) Only possible on basis of adequate monitoring Independent? Must be realistic Trimbos-instituut

61 Evaluation (2) Assessment of policy; cost-effectiveness Starting point for innovation, research Starting point for political debate Starting point for next policy cycle Trimbos-instituut

62 Policy Cycle Political decisions Monitoring Evaluation Innovation/research implementation Trimbos-instituut

63 conclusions Co-ordination, Monitoring and evaluation are indispensible elements of drug policy Takes time, money and political will Trimbos-instituut

64 Recommendations for policy makers Be reliable, be realistic Listen, observe and communicate Invest in knowledge Respect political opinions but separate these from the facts! Trimbos-instituut

65 More information NDM: EMCDDA: Trimbos-instituut