Trends in injecting drug use in Europe Linda Montanari, Bruno Guarita and Danica Thanki Annual Expert Meeting on Drug-Related Infectious Diseases Lisbon, 15-17 October
Overview of the presentation 1) Information sources 2) Injecting behaviours 3) Trends in drug injection 4) Conclusions 2
1 Information sources
EMCDDA information sources on drug injection and related data TDI: number of clients injecting (clients injecting primary drug as main administration route / clients currently or ever injecting any drug - last month before entering treatment) HRDU: estimates on injecting drug users (any substance with no medical prescription - last 12 months optional by substance) DRID: drug injectors (current or ever injectors) SYRINGE AVAILABILITY: Needle and syringe programmes (NSP types and sites available, syringe provision, utilization of NSP) 4
2 Injection behaviours: most recent data
Estimates of the prevalence of injecting drug use (rate per 1 population aged 15 64), 27 12 (last study available) 12 1 8 6 4 2 Spain 211 TM Netherlands 28 TM Cyprus 213 TP Croatia 212 MM Hungary 28/9 CM Greece 212 CR Norway 211 MM UK 24/11 CM Belgium 211 HM Czech Rep. 212 TM Luxembourg 29 OT Estonia 29 CR Cases per 1 population aged aged 15-64 Source: 214 EMCDDA Data and Statistics
All clients by route of administration of primary drug in 212 1% Other Other Other Sniffing Other Other Sniffing 75% Eating / Inhaling Sniffing Sniffing 5% Smoking Smoking Eating / Inhaling Eating / Inhaling Eating / Inhaling 25% 6595 38% Smoking Smoking % 2865 Smoking 18% 645 3 7% 4% Opioids (17573) Cocaine (62553) Stimulants (41319) Cannabis (118433) Other (3344) Source: 214 EMCDDA Data and Statistics 7
All clients entering treatment by injecting behavior and primary drug in 212 1% Never injected, 37% 75% Never injected, 6% 5% Never injected, 86% 25% (36 657) 25% % 5% (2 172) 1% (4 533) 24% (5 419) 17% (3 788) 39% (57 579) Cocaine Amphetamines Opioids Ever injected, but not currently Currently injecting Never injected Source: 214 EMCDDA Data and Statistics 8
Opioid injection by country -212- Source: 214 EMCDDA Data and Statistics 9
Cocaine injection by country 212- Source: 214 EMCDDA Data and Statistics 1
Stimulants (other than cocaine) injection by country -212- Source: 214 EMCDDA Data and Statistics 11
3 Trends in drug injection
Trends in injecting prevalence estimates 6 5 4 3 2 Croatia * Cyprus * Czech Republic Greece Hungary Norway Spain United Kingdom 1 27 28 29 21 211 212
Short term trends in injecting drug use 14
Long term trends in % of current injectors among drug clients in EU 3 (2-211) 4 35 34% 3 25 2 15 1 22% 15% 1% All Treatments First Treatments 5 2 21 22 23 24 25 26 27 28 29 21 211 Source: Estimating trends in injecting drug use in Europe using national data on drug treatment admissions Technical Report No temporal trends identified in EE, LT, PL, RO, NO 15
Long term trends of drug used by injection among new clients by primary rug in EU 3 (2-211) 1% 9% 8%.4 4.5 2 2.3 15.2 4 7% 6% 5% 4% 92.7 78.8 Other drugs* Other stimulants Cocaine Opioids 3% 2% 1% % 2 21 22 23 24 25 26 27 28 29 21 Source: Estimating trends in injecting drug use in Europe using national data on drug treatment admissions Technical Report No temporal trends identified in EE, LT, PL, RO, NO 16
Trends of new clients entering treatment by primary drug, 26 to 212 (%) 45% 4% 35% 3% 25% 2% 15% 1% 5% % 26 27 28 29 21 211 212 Opioids Cocaine Stimulants Cannabis Other Source: 214 Data and statistics DK and PT: data 211; LT: all clients 17
Trend in current drug injection among NEW treatment clients (21-211) Indicators Nº countries with Significant Decrease in Drug Injection Nº countries with Significant Increase A) N. drug injectors 7 (DK, SP, NL, PT, SI, SK, FI) B) % drug injectors out of all clients 12 (DK, IE, GR, SP, HR, IT, CY, LV, AT, SI, SK, UK) C) Rate drug injectors * 1, population 15 years and over 8 (DK, IE, SP, NL, PT, SI, SK, FI) (TK) 1 D) N. drug injectors per treatment centre 1 (BG, IE, GR, SP, FR, CY, NL, SI, FI, SE) (CZ, IT) 2 Source: Estimating trends in injecting drug use in Europe using national data on drug treatment admissions Technical Report - No temporal trends identified in EE, LT, PL, RO, NO 18
Trend in drug injection: country differences New and all clients between 21 and 211 Summary of indicators A, B, C, D 6 5 4 3 2 1 CZ MT TK -1-2 -3-4 -5 FI NL HR CY GE GR* HU LU BG IT* LV PT UK AT FR SE -6-7 -8 SP DK IE SK SI Source: Estimating trends in injecting drug use in Europe using national data on drug treatment admissions Technical Report - No temporal trends identified in EE, LT, PL, RO, NO 19
Young and new injectors among DRID samples 23-25 Proportion of new IDUs Proportion of young IDUs 8.% 7.% 6.% 5.% 4.% 3.% 29-212 2.% (studies with available data on 1.% new injectors).% Source: 214 EMCDDA Data and Statistics
Disposed syringes National trends diverse 6 5 4 3 2 1 28 29 21 211 212 7 6 5 4 3 2 1 5 45 Austria 4 Czech Republic 35 Finland * 3 Greece 25 Latvia 2 Malta 15 UK (N. Ireland) 1 Hungary 5 28 29 21 211 212 5 45 4 35 3 25 2 15 1 5 Portugal Romania Slovenia * Spain UK (Scotland) Lithuania Luxembourg Netherlands * Poland * Slovakia * 35 3 4 35 12 EU trend 25 2 15 1 5 28 29 21 211 212 3 25 2 15 1 5 Belgium Estonia Hungary Norway * Croatia Lithuania Sweden * 11 1 9 8 7 6 5 4 28 29 21 211 212
Indexed EU trends in important standard data sets related to injecting 14 12 1 8 6 price index of heroin purity index of heroin DRD EU-28 syringes injecting prevalence among all heroin TDIs 4 2 26 27 28 29 21 211 212 22
4 Conclusions
Conclusions Decrease in drug injection in Europe overall Following similar decrease in heroin use Injecting still mainly concerns heroin Decrease of young people injecting drug Recruitment of new injectors seems low Need to monitor specific phenomena: injecting stimulants and NPS, national or local (especially cities) situations Data limitations (increasing and changes in reporting coverage, differences in drug treatment system and others) 24
Acknowledgements Gregorio Barrio, Ana Sarasa, Luis de La Fuente, Maria Jose Bravo EMCDDA: Julian Vicente, Isabelle Giraudon, Dagmar Hedrich, and others National Focal Points 25