Estimation of Problematic Drug Use in Spain - Examples of estimation based in surveys- Data and thought

Transcription

1 Prevalence and patterns of drug use among general population. GPS Indicator. Annual Expert Meeting June EMCDDA (Lisbon) Estimation of Problematic Drug Use in Spain - Examples of estimation based in surveys- Data and thought Spanish Observatory on Drugs Julia Gonzalez Rosario Sendino Noelia Llorens Begoña Brime Aurora Ruiz Elena Alvarez (speaker)

2 Problematic Drug Use 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

3 Population Drug users Problematic users Approach of of problematic users... The drug use is is causing, the users (or (or others), negative physical, psychological or or social consequences or or hightrisk of of having them. 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

4 Population Drug users Problematic users It is useful to identified problematic user to orienteand implement policies (prevention, treatment, social needs, harm reduction, economics and human resources). Focus in target population. How many? It is possibleto estimate the number and some characteristics of problematic users. Profile? It is necessary define criteria, based in evidences, consensus and practical issues, in order to improve the comparability. Multidisciplinary work.

5 Type of drug alcohol, cocaine, cannabis, heroine prevalence Users characteristic Health situation, previous pathologies, pregnancy, age Some aspects to take into account Consequences for users or others Physic, psychological, social.. Pattern of use Frequency, chronicity, route of administration intensity, (how much -gr./hour), poliproblematics Accidents, infections, mental diseases 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: Direct or indirect estimations surveys, scales, combinated methods Standardization of definitions, methodologies and analysis comparability

6 1) SURVEYS General pop. Survey (15-64 y.o) Student survey (14-18 y.o) Others: Prison, specific population... Information sources in Spain Strengths of periodic surveys: Periodic and long series: biennale from Big sample: 20,000 a 30,000 Complete questionnaire (50 min): basic + special modules. International comparability. 2) DRUG INDICATORS Hospital emergencies Drug Mortality Treatment Demand indicator infectious diseases Problem drug use annual since (2011) Annual since (2010) Annual since (2011) Annual since 1986 Annual since ) EXTERNAL SOURCES. Supply indicators, etc.

7 Main Methods for PDU estimates in Spain ,6 73,6 40,2 32,4 Last year prevalence. Spain 2010/ ,6 26,4 EDADES (15-64 a.) 2011 General population survey 2011(15-64 y.o) Student survey (14-18 y.o) ESTUDES (14-18 a) ,2 2,6 0,7 1,7 0,6 1,6 0,4 2,1 0,10,6 Alcohol Tabaco Cannabis Cocaína Éxtasis Anfetaminas Alucinógenos Heroína Alcohol AUDIT scale. General Population Survey Cannabis PDU scales (CAST. SDS. DSM-IV. M-CIDI) Students surveys Cocaine Direct estimation (frequency and age). General Population surveys y Heroine Indirect estimation. Multiplier method GPS & TDI From 2006 to Source: Spanish Observatory on Drugs

8 INTRODUCTION. OBJETIVE. METHOD.. RESULTS. DISCUSSION. OBJETIVE Estimation of cocaine problematic drug users in Spain, using general population survey, based in frequency and age (vulnerability) METHOD Source of information General population survey y.o. National coverage. Face to face questionnaire. 22, 128 questionnaires. Criteria No clear consensus, no evidence based criteria 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 OR who used cocaine 10 days or more within the last 30 days 2) Frequency & age (vulnerability) 20 years old?? Phisic/psycic/socialvulnerability. 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 OR who used cocaine 10 d or more within the last 30 days.(more than 20 y.o)

9 COCAINE PROBLEMATIC DRUG USE, SPAIN 2011 Using GPS: frequency (frequency + age) Population (15-64 y.o.).) Cocaine users Problematic users Life time: 8.8% n= Last year: 2.2% n= Last month: 1.1% n= ( ) Can be considerer cocaine PDU IN Spain in 2011: 0.39% (0.41%) of population 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 Source: Spanish Observatory on Drugs

10 PREVALENCE VS PROBLEMATIC DRUG USE % Problematic drug use (%). Spain 2009 & Based in frequency & age in GPS (15-64 y.o) , ,7 17,9 15,0 31,2 37,4 Continuity Among people ever using cocaine: 1 out of 4 consumed last year 1 out of 7 consumed last month. 0 CP alg. vez CP Ult. año CP Ult. mes PU life time PU last year PU last month Cocaine prevalence (%) in general population (15-64 y.o). Spain Cocaine prevalence (%) in student (14-18 y.o) Spain Life alguna timevez Last último year año Last último mont mes 8 Prevalence results by them 6 self doesn't 4 show a complete picture Source: Spanish Observatory on Drugs

11 Cross indicator analysis. COCAINE DRD cocaine with or without any other susbstances (nº) Nº Nº defunciones death Hospital emergency detected cocaine (nº) Nº Nº urgencias hospital emergencies hosp se detecta when cocaína cocaine is detected Seizures (kg/10) Incautaciones (Kg/10) Nº cocaine first treatment Nº primeros First treatments tratamiento for cocaine por cocaína (nº) % Last consumo last month último prevalence mes (%) y.o. años (%) y.o. Last Last month prevaelnce prevalence (%) y.o. (%) y.o. % consumo último mes años.. 4 3,5 3 2, , , Source: Spanish Observatory on Drugs

12 INTRODUCTION. OBJETIVE. METHOD.. RESULTS. DISCUSSION. OBJETIVES Psychometric evaluation of scales. European project on course. Estimation of cannabis problematic drug use (14-18 y.o). Spain, METHOD Year Scale CAST SDS DSM-IV CAST CAST SDS M-CIDI CAST N survey 26,454 30,183 31,967 26,000 N CAST (valid questionnaires last year) Source of information 3,569 7,173 6,303 In process Student survey y.o National coverage. self-administered questionnaires (45 min.) CAST-Cannabis Abuse Screening Test. 6 items. Measure social & healthconsequences 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.

13 CANNABIS PROBLEMATIC DRUD USERS (CAST) SPAIN, Population ( y.o.).) Cannabis last year users Problematic drug user (26.4% of total population) Problematic users. 15.3% among last year users. 4.6% among total population. Source: Spanish Observatory on Drugs

14 CANNABIS PDU TRENDS (CAST), SPAIN 2006, 2008, 2010 CAST results. Percentage of non problematic/low/high risk among cannabis last year users (14-18 y.o). 100% 80% 60% 40% 20% 13,3 14,3 15,3 20,7 18,6 19,9 66,0 67,1 64,8 Increase trends in cannabis problematic drug use in teenagers. 0% no No problemático problematic bajo Low riesgo risk alto High riesgo risk Year % of cannabis high risk users among population y.o Nº of cannabis high risk users among population y.o 73, , ,340

15 Cannabis prevalence(14-18 y.o). Spain Number of cannabis treatment demands. Spain, First treatment Life time Alguna vez en la vida Últimos Last year 12 meses Últimos Last mont 30 días Previous treatments % hospital emergenciesrelated to drug when cannabis is present. Spain Treatment episodes in< 18 years (%) different drugs. Spain, Source: Spanish Observatory on Drugs

16 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 pictureusing 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. Survey with small sample. High risk-social stigma. Out of sampling frame Surveys are a possible tool: -Available(more cost effective than create new indicator). -Robust(quality and trends). -Flexible(periodic modules, adapt to needs).

17 PDU concept Population Drug users PDU It is useful It is possible Continue working in define criteria, methods and source of information SURVEYS POSSIBLE TOOL Spanish Observatory on Drugs.