Injection of new psychoactive drugs in Romania multi-indicator analysis Psycho-Sociologist Lavinus Sava - RNAA LISBON 26-27 October 2013
Romania, 2012 2012 stabilization of drug phenomenon in Romania, both in terms of demand and supply (after 3 years of changes: reorganizing the NAA and the NPS outburst) The (epidemic) outbreak of HIV infection among the IDUs notified since two years ago continues. (31% of all new reported HIV infected cases comes from the IDUs National Comision for fighting against AIDS, within Health Ministry) The NPS still the main problem in sight for the antidrug public policy system.
DATA SOURCES Recent studies/projects PDU estimates Key and core indicators (TDI, DRID, DRD, non-fatal drug emergencies) Supply indicators ROUTINE MONITORING of the implementing of the National program of measures to combat the marketing and use of new psychoactive substances / products harmful to health
PDU estimates 2011 - an estimated number of 19,265 (95% CI: 14,564 26,296) problem drug users in Bucharest (1967 clients of treatment services for intensive use of opioids, NPS, cocaine and amphetamines) 2012-1110 cases of IDUs in treatment (heroin- 823/ 74,2% cases and NPS- 247/25,8% cases reporting almost all the use of metamphetamihe-like substance called PURE) 4
NAA/ARAS/CARUSEL PROJECT The NAA set up a harm-reduction pilot project in 2012, distributing 142 500 syringes to the IDUs from Bucharest, using the facilities of two partner NGOs : ARAS and CARUSEL. The analysis of the data collected through this program (may- december 20120) indicates: 1326 IDUs registered (60% by ARAS, 40% by Carusel) 3934 contacts to the NSP units (87,4% to the 3 drop-in centers and 12,6% to the mobile outreach teams) an average of 3 contacts/client. 78% of the clients are male clients. the most prevalent age group was the 25-34 years one. all of the clients registered are IDUs, 3,4% declare themselves sex workers, 15,7% are homeless, almost 1% are street children and 47% are roma people 51% are NPS injecting users, 44% are heroin users and 5% injects both NPS &Heroin. 5
Lifetime prevalence of illicit drugs droguri ilicite/ NPS -data from studies (2010-2011)- ESPAD 2011 16 years SPS 18 years YPS 15-34 years GPS 2010 15-34 years Any drug /substance 10 23,2 11,7 9,5 From which SNPP 5,3 9,5 6,0 4,1 COCAINE 2 1,6 0,5 0,5 AMPHETAMINE 3 1,4 0,4 0,1 HEROIN 1 0,3 0,8 0,4
* Risks Assessment of the use of new psychoactive substances among children and young people in Romania, 2011 1.Behaviour patterns of the legal highs intensive users: age: 11-40 years old (significant use at children < 15 years old); high visibility of use; socially integrated youngsters coming from normal families; low adressability to medical/social services. 2. Frequency of use 42,5% - first drug used is NPS /daily basis use, 24,2% -once at every 3 days, 25% - between 4 and 10 uses in the past 30 days, 8,3% < 4 uses in the past 30 days. 3.Poly-drug use 55,9% - have used some other legal products in the past 30 days. (1 of 10 respondents declares frequent use of illicit drugs either). They also use : alcohol, heroin, amphetamine, cocaine, diazepam, valium, rofedex, marijuana, prenadez, tusin. 4. History of use Varies between 1 and 31 months, with an average of 13 months, most frequent answer recorded is 24 months, or 2 years. 5.Administration route Smoking, followed by injecting and sniffing. NPS patterns of use(1)* 7
TDI 2012 3501 clients were assisted in 2012 (in and out patient treatment) for alcohol, tobacco and illicit drugs & NPS use (3362 in 2011): illicit drugs- 1528/43,64% and NPS 685 /19,56% (36% of them are registered as injecting users). 232 convicted drug users were assisted in prison (227 for illicit drugs & NPS use) 8
2012 reversed trend - heroin users are more prevalent; The NPS are less used as primary drug and more like a secondary one, together with alcohol and cannabis. (23,7% cases of NPS as secondary drug) Sex: higher percentage of male users for backslidings (51,1% vs. 38,7%),also for assistance provided to them in opiate use (39,5% vs. 32,2%), NPS use (36,2% vs. 17,8%) and canabis use (12,9% vs. 6,1%) User s age the most of those assisted for NPS use in 2012 were from the 15-29 years age group (75,9%). Onset age - the most prevalent onset age is 15-19 years for the opiates users and 20-29 years for NPS ; It raises the percentage of the < 15 years opiates first time users and < 19 years NPS first time users. 9
Illicit and NPS admissions by usual route of administration (%)) Incidence a decreasing trend of the injecting use and sniffing and increase of the smoking/inhalling and oral use. 10
DRID 2012 - increasing trend Alarming rise for HVB; Rise for HVC at high level (over EU average); Alarming rise for the HIV (over EU average). Posible causes: Harm-reduction services offer seriously diminished after the ending of some UN funded programmes. The injecting frequency increased because of the new patterns of use and swapping from opiates to NPS injecting use. Low rates of adresability to medical/social services. 11
HVB : Stabilization of the HVB prevalence among the male users (from 25,6% to 26%), but a significant increase of the HVB prevalence among the female ones (from 4,4% to 17,7%). the highest prevalence of HVB was registered among the IDUs from the 25-34 years age group (26,8%). HVC: 82,4% HVC prevalence in 2012 (68,5% in 2011) - România enters the top of the European countries with high prevalences of HVC. HVC prevalence is significantly higher among male users 85,4%, compared to the females 65,5%. It is also noticed an increase of the females HVC positive. It increases the HVC prevalence for al the IDUs age groups. 12
HIV: 89 cases (24,5%) of seropositives IDUs from all the 358 IDUs tested for HIV in the privious 6 months. - 3 times higher than one year before. the most spectacular increase of HIV prevalence is registered for the < 25 years age group (over 6 times higher compared to 2011) Health Ministry reports 231 new cases of HIV infected IDUs in 2012 (31% of all new HIV cases for all the risk cathegories). The increasing trend continues to maintain, showing a possible HIV epidemic outbreak in the near future. The BSS 2012 still in progress - preliminary data indicates an HIV prevalence among IDUs of 52,5%. 13
Medical Emergencies after the NPS use, 2012 more than 2/3 of teh emergencies registered for drugs use are for NPS. 90,5% of the cases are <34 years. 10 years NPS users registered by the emergency medical units. NPS reported for 10 of the 133 suicide attempts registered. NPS use related deaths are first time mentioned in 2012 by the emergency units (6 indirect deaths). Polydrug use * Injecting use Crosstabulation Injecting use Not injecting Injecting Total Polydrug use nu Count 756 240 996 % within Polydrug use 75,9% 24,1% 100,0% da Count 262 126 388 % within Polydrug use 67,5% 32,5% 100,0% Total Count 1018 366 1384 % within Polydrug use 73,6% 26,4% 100,0% 14
Geographical Spreading of the NPS Risk areas defined by the share of the non-fatal emergency related to NPS use
DRD, 2012 26 direct drug related deaths registered (all from Bucharest, all with positive toxicologic tests) 16 indirect related to drug use deaths registered 3 DDRD due to acute intoxication with NPS ; 2 IDRD were NPS are suspected, in association with some other illicit drugs. 40 35 30 25 20 15 10 5 0 2006 2007 2008 2009 2010 2011 2012 Decese direct asociate 21 32 33 32 34 15 26 Decese indirect asociate 3 2 1 3 15 26 16 Significant decrease of the average age when dying - 28,03 years for DDRD and 26,56 for IDRD 16
NPS influence on indirect death cases radical change of the pattern of the substances used and administration practices: -very frequent administration from 6 to 8 times a day, especially for the IDUs. -rapid change from ingestion/smoking to injecting use. high availability/low price/ legal status/ perceived as low risk drugs. relatively limited potency (low risk of immediate and lethal overdose compared with the illicit drugs)/ highly addictive. unknown composition, highly contaminated street doses, paraphernalia used in common with others, infectious pathology with acute evolutions. they are not generating death by themselves (only 3 direct drug related deaths recorded for NPS use in 2012) - generate accelerated pathologies that lead to death by medical complications not by overdose. 17
RESPONSES -impact of public policies controlling measures Several government decisions were adopted in order to put under national legal control the marketing and use of some NPS (43 of them were enlisted) but the most important in terms of impact is the Law 194/November 2011(to combat any operation with new substances susceptible of having psychoactive effects). The National program of measures to combat the marketing and use of new psychoactive substances / products harmful to health adopted in february 2011. The mixed inter-institutions controlling teams were set at local level, and their work within the framework of this program have led to some visible results. NAA & partner NGOs national and local NPS use prevention campaigns (THE ABSENT 2011; TOO REBEL TO BE LED (by drugs) 2012 NAA distributed to the partner NGOs from the RHRN 142 500 syringes and bought some other 800000 syringes to be distributed to the NSP in 2013.
SUPPLY INDICATORS NUMBER OF SEIZURES AND QUANTITIES 2012 2 significant seizures of NPS (synthetic cannabinoids JWH-018) originated from Spain and reaching Romania via France Germany Austria Hungariy 2012 significant decrease of the NPS quantities sized (1,5 Kg), compared to 2010 (125,14 kg) and 2011 (4,96 kg). SNPP Cantitate capturată Număr capturi kilograme comprimate 2010 2011 2012 2010 2011 2012 2010 2011 2012 Canabinoizi sintetici 57,024 2,865 1,079 0 0 0 379 115 21 Catinone 50,091 1,863 0,19 324 4 577 480 235 44 Piperazine 6,506 0,023 0,0001 15.094 1.050 89 74 19 19 Pirovalerone 1,800 0.0048 0,03 6 0 2 54 6 10 Triptamine 8,932 0,015 0,078 0 0 0 2 1 73 Mitragin 0,139 0,192 0 0 0 0 4 1 0 Salvinorin 0,648 0,0033 0 0 0 0 15 1 0 Dimetocaină 0 0 0,131 0 0 0 0 0 7 Tabel nr. 2-4: Confiscările de substanţe noi cu proprietăţi psihoactive (kg) în perioada 2010-2012 Sursa: Laboratorul central de analizăşi profil al drogurilor, Inspectoratul General al Poliţiei Române
ROUTINE MONITORING of the implementing of the National program of measures to combat the marketing and use of new psychoactive substances / products harmful to health EVOLUTION OF THE NUMBER OF IDENTIFIED /CONTROLLED DREAM-SHOPS FEBRUARY - MARch 2013 180 160 140 152 158 120 100 80 60 40 20 0 feb.11 132 69 apr.11 67 81 85 50 iun.11 79 58 44 46 aug.11 87 77 4941 oct.11 81 40 dec.11 85 Nr. magazine identificate 47 40 46 50 51 23 34 39 27 28 33 33 33 28 23 2526 13 12 13 14 10 10 10 8 6 8 9 9 1 1 1 0 feb.12 apr.12 iun.12 aug.12 oct.12 Nr. magazine controlate Decembrie 2012 feb.13 20
CONCLUSIONS 1.The new laws (Law no. 194/2011 and COM no. 103/2012) had great effect in stopping the trade of the NPS in the head-shops (all were closed), but the illicit market (on/line market) keep on supplying the consumers. 2. Significant decrease of NPS seizured in the last 2 years 3.INJECTING NPS use and the harm-related issues: High levels of prevalence for HIV and HBV/HVC among the injectors of the NPS. High numbers of the medical emergencies related to NPS use (2/3 of the emergency cases related to drug use were consequences of NPS use 67%) DRD to NPS use appeared (3 direct deaths in 2012 / 2 cases in 2011) 21
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