Insights into shared and specific features of intensive drug use in Europe

Transcription

1 DANICA KLEMPOVA & FRANK ZOBEL Overview Insights into shared and specific features of intensive drug use in Europe Introduction Describing the European Union drug situation has always been a challenge for epidemiologists and researchers. The EU countries differ in their histories and, to a certain extent, cultures. Drug prevalence and patterns of use are different, too, and the countries approach the drug problem in different ways. Fifteen to twenty years ago, it was difficult to make comparisons of data from different EU countries, as these either didn t exist or were based on different methods and/or definitions. However, this task is now much easier, thanks to ongoing work together on building a reliable and comparable system of data collection and reporting. The EU countries have since made a great deal of progress in data availability, in drawing up and implementing common definitions and methods and in obtaining and reporting comparable results. The research question underpinning this article is: can we talk about an EU drug situation when describing intensive and problem forms of drug use? As a first exploration of this This overview is an extension of a book chapter by Zobel and Götz (2010). While the book chapter dealt with European drug use, our focus is on intensive and problem drug use. Acknowledgements We would like to thank the Reitox national focal points, the European Information Network on Drugs and Drug Addiction, for providing most of the underlying data and infor mation, and our colleagues at the European Monitoring Centre for Drugs and Drug Addiction EMCDDA, who worked on guidelines development, and data collection and analysis for the referenced EMCDDA publications. NORDIC STUDIES ON ALCOHOL AND DRUGS V O L

2 complex question, the article examines drugs data and identifies different phenomena, some of which are specific to a certain country, while others are shared by a group of countries or even by the entire European Union. Methods The European Monitoring Centre for Drugs and Drug Addiction EMCDDA, an EU agency collecting and analysing data on the drug situation and responses by the Member States to drug use, today collaborates with more than 30 countries 1. The collaborating Reitox network is made up of national focal points or nationallevel monitoring centres. Data is reported to the EMCDDA in standard tables, structured questionnaires and yearly national reports. Common guidelines for data collection are developed and regularly updated in collaboration with national experts. EMCDDA collects data on the five key epidemiological indicators drug use in the general population, problem drug use 2, treatment demand indicator, drug-related infectious diseases and drug-related deaths 4 and other important data sets. Recently, the key indicators have been reviewed in an implementation assessment, which shows a great deal of progress made by the Member States over the past 10 years. The implementation is supported by the EU Drugs Action Plan. Specific phenomena The available data suggest that there are drugs phenomena limited to certain countries only. These include: Illicit buprenorphine use as a major element of a country s problem drug use picture Buprenorphine is a synthetic opioid used in detoxification and substitution treatment. Sometimes, this drug is misused. The reported levels of its illicit use vary between countries. These are, not surprisingly, higher in the countries where buprenorphine is the predominant drug offered in opioid substitution treatment (as opposed to methadone in most other cases). The Czech Republic estimated that there were 4250 problem buprenorphine users in 2007 (with a 95% confidence interval ). In this country, problem buprenorphine use has gradually replaced a considerable proportion of the problem heroin use in the past few years, without actually increasing the overall prevalence of problem opioid use (Mravčík et al. 2008). The misuse of buprenorphine was also reported to be relatively high in France. This showed in admissions to treatment, too, as 7 percent of all entering clients identified this substance as the primary reason for their treatment (EMCDDA 2009). The exceptional case is that of Finland, where buprenorphine is responsible for virtually all treatment demands related to opioids. Overall, it was recorded as the primary drug in 41 percent of all treatment demands (EMCDDA 2009). Although not necessarily the cause or sole cause of death, buprenorphine abuse was detected in 97 drug-related deaths out of 229 in The number of buprenorphine findings in death cases has risen from 7 in 2000 to nearly 100 in more recent years (Rönkä and Virtanen ). Opioids use by new groups of users For several years, the French TREND system of qualitative and quantitative studies 96 NORDIC STUDIES ON ALCOHOL AND DRUGS V O L

3 aimed at identifying new and emerging trends has noted the spread of drug use into increasingly diverse social groups. This also applies to heroin and substitution drugs, which have broken the previous cultural taboo and now appear in new groups such as socially well-integrated population groups and those attending the techno music scene (French national focal point 2008). Opioids use in recreational settings is otherwise relatively rare (see, for example, EMCDDA 2006). Phenomena concerning groups of countries Amphetamines Data on drug seizures by police and in general population surveys suggest a certain dichotomy in the predominance of a particular group of stimulants in the drugs markets of the European countries. Those with lower figures of cocaine indicators typically have higher values in amphetamines indicators and sizeable populations of problem users of amphetamines. These are northern and central European countries (see Figure 1). The percentage of clients entering treatment and citing cocaine or amphetamines as primary drugs out of all clients requesting treatment suggests that the role played by cocaine or amphetamines in the overall picture might be smaller or greater (see differing pie chart slices in Figure 1), but the treatment data nevertheless tends to confirm a picture of two distinct groups of countries. Amphetamine and methamphetamine have been used in Europe to different ex- Figure 1. The relative dominance of different stimulant drugs in drugs seizures and general population surveys data (background colour) in EMCDDA countries and the share of cocaine and amphetamines clients among all clients entering drug treatment (slices of pie chart). Source: EMCDDA NORDIC STUDIES ON ALCOHOL AND DRUGS V O L

4 tents, with a long-term predominance of amphetamine overall. However, this may now be changing, with increasing occurrence of methamphetamine on the drug scene in northern Europe. Historically, the only European country with a significant methamphetamine problem use was the former Czechoslovakia (Griffiths et al. 2008). Most of the users were localised in the current Czech Republic. However, since 1999, their occurrence, which has been sparse up to this year, started to increase in the drug treatment data. The trend peaked in 2004, then levelling off. Finland, Sweden and Norway have a relatively long history of populations of heavy amphetamine injectors, but this substance has in the past few years been gradually partially replaced by methamphetamine. This is indicated mainly by drug seizures data, police data and, increasingly, by other data sources. The Baltic countries (mainly Latvia and Estonia) have sizeable and, in recent years, growing populations of primary amphetamines users among their injectors (Talu et al. 2008; Pūgule et al. 2008). Problem cocaine use Several data sources suggest that problem cocaine use similarly concentrates in certain countries in the western and southern parts of the EU. Spain, the Netherlands, Italy, Ireland, Cyprus and the UK have the highest shares of primary cocaine users entering drug treatment (see Figure 1) 5. Estimates of the population of problem cocaine users exist in Italy and Spain, ranging from 3.8 to 6 per 1000 inhabitants aged Crack cocaine use in Europe is relatively rare as a whole and limited to some cities. Significant seizures and treatment demands are reported from the UK (EM- CDDA 2009). It was estimated that there were problem crack cocaine users per 1000 inhabitants aged in England in (Hay et al. 2008). Common phenomena Problem opioid use There are an estimated 1.4 million problem opioids users in the EU, amounting to around cases per 1000 inhabitants aged (EMCDDA 2009). Problem opioid use as a major element of the picture of the drug situation is common in all EU countries, and opioid users are the most common clients in drug treatment within the European Union. Those entering drug treatment due to opioids in a given year constitute around 55 percent of all clients. Moreover, opioid users constitute most of the cases of direct drug-induced deaths (over 85 percent in half of the reporting countries) and drug-related infectious diseases (EMCDDA 2009). The opioid problem is likely to continue to be topical in the near future, too. The decreasing trend in opioids indicators (drug-related deaths, seizures of heroin, new demands for drug treatment and others), evident until 2003, has now ceased. Recently, there have even been some signs of increase. The numbers of drug-induced deaths and heroin seizures began to rise in Drug treatment demands with heroin as a primary drug have increased both in number and proportion from 2004 in 10 reporting countries, while the overall number of primary heroin users entering treatment has grown between 2002 and 2007 according to an analysis based on a sample of 19 countries which provided data. Similar increases are common 98 NORDIC STUDIES ON ALCOHOL AND DRUGS V O L

5 in most EU countries, coinciding with an intensified opium production in Afghanistan. It is possible that the two are linked through an increased availability of heroin on the European drug market (EMCDDA 2009). Though worrying, these increases are still far from the steep increases of the 1980s and 1990s. Discussion and conclusions To describe the EU drug situation is a challenge. Not only are there shared features (such as problem opioid use), but also regional phenomena (such as the distribution of stimulants markets across Europe) or phenomena specific to certain countries only (such as illicit buprenorphine use as a major element of the national drug situation picture or heroin use by attendants of techno parties). The reasons for the observed differences are not clear and would therefore deserve further research. The contributing factors may include markets and availability (or low availability of alternative substances) which can, in turn, be related to geographical location, traditions and historical reasons, culture and fashion. The relative importance of these factors in the resulting national pictures is unknown. Moreover, the diversity of metadata tags attached to different countries, which would describe the specificities in data collection and those national factors which have to be taken into consideration when interpreting the data, contribute to the complexity associated with sketching a single picture of the EU drug situation. It is, thus, not possible at present to fully answer the question whether there is a unified EU drug situation or not. However, with increasingly comparable methodologies related to the implementation of the EMCDDA indicators, the drugs epidemiology is getting closer to the answer. Danica Klempova European Monitoring Centre for Drugs and Drug Addiction Cais do Sodré Lisbon, Portugal Danica.Klempova@emcdda.europa.eu Frank Zobel European Monitoring Centre for Drugs and Drug Addiction Cais do Sodré Lisbon, Portugal Frank.Zobel@ emcdda.europa.eu NOTES 1) The figure includes all EU countries, the candidate countries of Croatia and Turkey, and Norway. 2) Problem drug use is defined as injecting drug use or long-duration/regular use of opioids, cocaine and/or amphetamines. 3) For more information on the key epidemiological indicators, see europa.eu/themes/key-indicators. 4) EMCDDA uses the term amphetamines to denote a group of drugs including both amphetamine and methamphetamine. 5) The EMCDDA Statistical bulletin table provides even more updated percentages. NORDIC STUDIES ON ALCOHOL AND DRUGS V O L

6 REFERENCES European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) (2006): Annual report 2006: Selected issues. Selected issue 3: Developments in drug use within recreational settings. Lisbon European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) (2008): Annual report 2008: the state of drugs problem in Europe. Lisbon European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) (2009): Annual report 2009: the state of drugs problem in Europe. Lisbon French national focal point: National report 2008 to the EMCDDA (2008): France. Paris Griffiths, P. & Mravčík, V. & Lopez, D. & Klempova, D. (2008): Quite a lot of smoke but very limited fire: the use of methamphetamine in Europe. Drug and Alcohol Review 27 (3): Hay G. & Gannon, M. & MacDougall, J. & Millar, T. & Williams, K. & Eastwood, C. & McKeganey, N. (2008): National and regional estimates of the prevalence of opiate use and/or crack cocaine use 2006/07: a summary of key findings. Research Report 9, Home Office, November pdf Downloaded 27/01/2010. Mravčík, V. & Chomynová, P. & Orlíková, B. & Pešek, R. & Škařupová, K. & Škrdlantová, E. & Miovská, L. & Gajdošíková, H. & Vopravil, J. (2008): National report (2007 data) to the EMCDDA: The Czech Republic. National monitoring centre for drugs and drug addiction, Secretariat of the government council for drug policy coordination. Prague Pūgule, I. & Sīle, L. & Trapencieris, M. & Pērkone, S. & Kairišs, A. & Bārbale, R. (2008): 2008 National Report (2007 data) to the EMCDDA by the Reitox National Focal Point. Latvia: new development, trends and in-depth information on selected issues. Riga: Public Health Agency Rönkä, S. & Virtanen, A. (eds.) (2008): Finland Drug Situation New development, trends and in-depth information on selected issues. National Report to the EM- CDDA by the Finnish National Focal Point, STAKES. Helsinki. Available online: att_86775_en_nr_2008_fi.pdf Talu, A. & Abel-Ollo, K. & Vals, K. & Ahven, A. (2008): National report 2008 to the EMCDDA: Estonia. National Institute for Health Development, Tallinn Uusküla, A. & Rajaleid, K. & Talu, A. & Abel, K. & Rüütel, K. & Hay, G. (2007): Estimating injection drug use prevalence using state wide administrative data sources: Estonia Addiction Research and Theory 15 (4): Zobel, F. & Götz, W. (2010, forthcoming): Drug use in Europe: specific national characteristics or shared models? In: Hunt, G. & Millet, M. & Bergeron, H. (eds.): Drugs and culture: understanding patterns of use and regulation. Ashgate. 100 NORDIC STUDIES ON ALCOHOL AND DRUGS V O L