1. e. alvarez - estimation of problematic drug use in spain. e. alvarez... · estimation of...

Spanish Observatory on Drugs

Julia GonzalezRosario Sendino

Noelia LlorensBegoña Brime

Aurora RuizElena Alvarez (speaker)

Prevalence and patterns of drug use among general population. GPS

Indicator. Annual Expert Meeting 2013.

18-19 June 2013 - EMCDDA (Lisbon)

Estimation of Problematic Drug Use in SpainEstimation of Problematic Drug Use in Spain

-- Examples of estimation based in surveysExamples of estimation based in surveys--

Data and thought…

� 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…

Problematic Drug Use

Population Population

INTRODUCTION. OBJETIVE. METHOD. RESULTS. DISCUSSION.OBJETIVE. METHOD. RESULTS. DISCUSSION.

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”

Approach of problematic users...

The drug use is causing, the

users (or others), negative

physical, psychological or social

consequences or hight risk of

having them.

Approach of problematic users... Approach of problematic users...

The drug use is causing, the The drug use is causing, the

users (or others), negative users (or others), negative

physical, psychological or social physical, psychological or social

consequences or consequences or highthight risk of risk of

having them. having them.

Drug Drug usersusers

ProblematicProblematic

usersusers

� It is useful useful to identified

problematic user to oriente and

implement policies (prevention,

treatment, social needs, harm

reduction, economics and human

resources). Focus in target population.

� It is possiblepossible to estimate the

number and some characteristics of

problematic users.

� It is necessary define criteriadefine criteria, based

in evidences, consensus and practical

issues, in order to improve the

comparability. Multidisciplinary work.





usersusers

How many?

How many?

Profile?Profile?

Some aspects to take into accountSome aspects to take into accountType of Type of drugdrug

alcohol, cocaine, cannabis, heroine…prevalence…

UsersUsers characteristic characteristic Health situation, previous pathologies, pregnancy, age…

Pattern of use Pattern of use Frequency, chronicity, route of administrationintensity, (how much -gr./hour), “poliproblematics”…


Consequences for users or Consequences for users or others others

Physic, psychological, social..Physic, psychological, social..

Accidents, infections, mental Accidents, infections, mental diseasesdiseases……

SOURCES OF INFORMATION: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:METHODS: Direct or indirect estimations… surveys, scales, combinated methods…

Standardization of definitions, methodologies and analysis �comparability

General pop. Survey (15-64 y.o)

Problem drug use

Annual since

2007

annual since 1987 5279 (2011)

Annual since 1983 706 (2010)

Annual since 198779.295 (2011)

Treatment Demand indicator

Drug Mortality

Hospital emergencies

1) SURVEYS

Strengths of periodic surveys:

� Periodic and long series: biennale from 1994-2010.

� Big sample: 20,000 a 30,000

� Complete questionnaire (50 min): basic + special modules. International comparability.

2) DRUG INDICATORS

3) EXTERNAL SOURCES. Supply indicators, etc.

Information sources in Spain Information sources in Spain

infectious diseases

Annual since 1986


Student survey (14-18 y.o)

Others: Prison, specific population...

76,6

40,2

9,62,2 0,7 0,6 0,4

26,4

0,1

73,6

32,4

2,6 1,7 1,6 2,1 0,60

10

20

30

40

50

60

70

80

Alc

ohol

Tabaco

Cannabis

Coca

ína

Éxt

asi

s

Anfe

tam

inas

Alu

cinógenos

Hero

ína

EDADES (15-64 a.) 2011

ESTUDES (14-18 a) 2010

Last year prevalence. Spain 2010/2011.

CannabisPDU scales (CAST. SDS. DSM-IV. M-CIDI) Students surveys. 2006. 2008. 2010. 2012.

CocaineDirect estimation (frequency and age). General Population surveys. 2009 y 2011.

AlcoholAUDIT scale. General Population Survey 2009.

HeroineIndirect estimation. Multiplier method GPS & TDIFrom 2006 to 2011.

Main Methods for PDU estimates in SpainMain Methods for PDU estimates in Spain

Source: Spanish Observatory on Drugs


General population survey 2011(15-64 y.o)Student survey 2010. (14-18 y.o)

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 ORwho used cocaine 10 days or more within the last 30 days

2) Frequency & age (vulnerability)

20 years old ?? Phisic/psycic/social vulnerability. 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 ORwho used cocaine 10 d or more within the last 30 days .(More than 20 y.o)

Criteria

No clear consensus,

no evidence based criteria

General population survey 2011.

15-64 y.o. National coverage. Face to face questionnaire. 22, 128 questionnaires.

Source of information

Estimation of cocaine problematic drug users in Spain, using general population survey, based in frequency and age (vulnerability)

OBJETIVE

METHOD

INTRODUCTION.INTRODUCTION. OBJETIVE. METHOD. RESULTS. DISCUSSION.. RESULTS. DISCUSSION.

Population (15Population (15--64 64 y.oy.o.).)

CocaineCocaine usersusers


usersusers

31 807 07331 807 073

Life time: 8.8% n= 2 787 281 Last year: 2.2% n= 348 410Last month: 1.1% n= 348 410

124 083 (130 537)

Can be considerer cocaine PDU IN Spain in 2011:

� 0.39% (0.41%) of population 15- 64 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

COCAINE PROBLEMATIC DRUG USE, SPAIN 2011

Using GPS: frequency (frequency + age)

INTRODUCTION. OBJETIVE. METHOD. INTRODUCTION. OBJETIVE. METHOD. RESULTS.RESULTS. DISCUSSION.DISCUSSION.


4,0

15,0

31,2

4,7

17,9

37,4

0

10

20

30

40

CP alg. vez CP Ult. año CP Ult. mes

%

2009 2011

0

2

4

6

8

10

1999 2001 2003 2005 2007 2009 2011

alguna vez último añoúltimo mes

Cocaine prevalence (%) in general population

(15-64 y.o). Spain 1999-2011.

Problematic drug use (%). Spain 2009 & 2011.

Based in frequency & age in GPS (15-64 y.o).

Continuity

Among people ever using cocaine:

1 out of 4 consumed last year

1 out of 7 consumed last month.



PREVALENCE VS PROBLEMATIC DRUG USE

Life timeLast yearLast mont

PU life time PU last year PU last month

0

2

4

6

8

10

1994

1996

1998

2000

2002

2004

2006

2008

2010

Cocaine prevalence (%) in student (14-18 y.o)

Spain 1994-2010.

Prevalence results by them self doesn't Prevalence results by them self doesn't

show a complete picture.show a complete picture.

0

5000

10000

15000

20000

25000

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

0

0,5

1

1,5

2

2,5

3

3,5

4DRD cocaine with or without any other susbstances (nº)

Hospital emergency detected cocaine (nº)

Seizures (kg/10)

First treatments for cocaine (nº)

last month prevalence 15-64 y.o. (%)

Last month prevalence 14-18 y.o. (%)

Cross indicator analysis. COCAINE.

Nº defunciones

Nº urgencias hosp se detecta cocaína

Incautaciones (Kg/10)

Nº primeros tratamiento por cocaína

% consumo último mes 15-64 años

% consumo último mes 14-18 años.

.



Nº death

Nº hospital emergencies when cocaine is detected

Nº cocaine first treatment

Last month prevalence (%) 15-64 y.o.

Last month prevaelnce (%) 14-18 y.o.

CAST- Cannabis Abuse Screening Test. 6 items. Measure social & health consequences 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.

CASTCASTSDSM-CIDI

CASTCAST SDS DSM-IV

Scale

Student survey. 14-18 y.oNational coverage. self-administered questionnaires (45 min.)

Source of information

26,000

In process

31,967

6,303

30,183

7,173

26,454

3,569

N survey

N CAST (valid questionnaires last year)

Year 2012201020082006

INTRODUCTION. INTRODUCTION. OBJETIVE. METHODOBJETIVE. METHOD. RESULTS. DISCUSSION.. RESULTS. DISCUSSION.

Psychometric evaluation of scales. European project on course.

Estimation of cannabis problematic drug use (14-18 y.o). Spain, 2006-2012.

OBJETIVES

METHOD

Population (14Population (14--18 18 y.oy.o.).)

Cannabis Cannabis

lastlast yearyear usersusers


drug drug useruser

2 254 5052 254 505

595 189 (26.4% of total population)

Problematic users.

15.3% among last year users. 4.6% among total population.

CANNABIS PROBLEMATIC DRUD USERS (CAST) SPAIN, 2010.



4.6 3.73.3% of cannabis high risk users among population 14-18 y.o.

100,34081, 08073, 534Nº of cannabis high risk users among population 14-18 y.o

201020082006Year

CAST results. Percentage of non problematic/low/high risk among cannabis last year users (14-18 y.o).

Increase trends in

cannabis problematic

drug use in teenagers.

66,0 67,1 64,8

20,7 18,6 19,9

13,3 14,3 15,3

0%

20%

40%

60%

80%

100%

2006 2008 2010

no problemático bajo riesgo alto riesgo

CANNABIS PDU TRENDS (CAST), SPAIN 2006, 2008, 2010


No problematic Low risk High risk

10

15

20

25

30

35

40

45

1998 2000 2002 2004 2006 2008 2010

Alguna vez en la vidaÚltimos 12 mesesÚltimos 30 días

10

15

20

25

30

35

40

45

1998

1999

2000

2001

2002

2004

2005

2006

2007

2008

2009

2010

2011

0

10

20

30

40

50

60

70

80

90

2005

2006

2007

2008

2009

2010

2011

% hospital emergencies related to drug

when cannabis is present. Spain 1998-2011.

Cannabis prevalence (14-18 y.o).

Spain 1998-2010.

Treatment episodes in < 18 years (%)

different drugs. Spain, 2005-2011

0

2.000

4.000

6.000

8.000

10.000

19

96

19

97

19

98

19

99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

20

08

20

09

20

10

20

11

Number of cannabis treatment

demands. Spain, 1996-2011.

First treatment

Previous treatments



Life timeLast yearLast mont

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 picture using 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. Surveywith small sample. High risk-social stigma. Out of sampling frame…

� Surveys are a possible toolSurveys are a possible tool: - Available (more cost effective than create new indicator). - Robust (quality and trends). - Flexible (periodic modules, adapt to needs).

INTRODUCTION. OBJETIVE. METHOD. RESULTS. INTRODUCTION. OBJETIVE. METHOD. RESULTS. DISCUSSION.DISCUSSION.

It is useful

It is possible



PDUPDU


PDU concept PDU concept

SpanishSpanish ObservatoryObservatory onon DrugsDrugs. . www.pnsd.mspsi.eswww.pnsd.mspsi.es [email protected]@mspsi.es

Continue working in… define criteria, methods and source of information

SURVEYS POSSIBLE TOOL

1. e. alvarez - estimation of problematic drug use in spain. e. alvarez... · estimation of...

Documents