Download EMCDDA 2010-2012 Work Programme Key Issue 1: Key Indicators

EMCDDA 2010-2012 Work Programme
Key Issue 1: Key Indicators
30th Meeting of Scientific Committee
J Vicente (together with D Olszewski, D Klempova, L Montanari,
Isabelle Giraudon and L Wiessing
Lisbon, 15 June 2009
General issues: purpose of KIs
• To monitor the drug situation
• Complemented by supply side data
• Demand side data
• Prevalence and patterns of drug use
• Consequences of different patterns of use
• Mirroring responses data (mainly demand reduction)
KIs – how do they work?
• Domains of indicators (possibility of a number of
subindicators)
• E.g. PDU – DRD
• Protocols/guidelines developed over time in
collaboration with national experts
• Standard reporting instruments
• Work to be done, but already solid basis
Cross cutting issues 2010-2010
• Quality assessment formalised with detailed criteria –
to be continued
• Common KI gateway
• Need to keep them updated according to evolution of
drug use patterns and problems
•
•
•
•
•
Stimulants (in particular cocaine)
Cannabis heavy use –dependence
Polydrug use
Combined use of licit and illicit substances
Expansion of treatment, in particular OST
Common aims for 2010-2012
• Each indicator
• Improve quality, reliability, validity – comparability
• Timeliness
• Increase analysis in order to address relevant public health
and policy questions
• Across indicators
• Cross analysis of indicators (e.g. PDU-TDI, PDUDRD+DRID)
• With supply indicator
• With interventions
• Balance between treatment needs and treatment provision
Prevalence and patterns of drug use among the
general population.
• Probabilistic samples of adults, school students and other
populations + non-probabilistic samples of selected
populations
• Improve quality, methodology and comparability of existing
national surveys
• Develop methods to add value to existing information
•
•
•
•
focused analysis on polydrug use,
on patterns of use –frequency of use-, - genderincidence and quitting…
Perception of availability
Prevalence and patterns of drug use among
the general population
• Collaboration with other international projects (ESPAD, HBSC,
European Health Survey, European Social Survey)
• Creation of ad-hoc thematic working groups – policy relevant
topics (mentioned above and licit + illicit substances, mental
health, )
• As possible – harmonisation of national databases and focused
joint analysis of a limited number of national surveys by
interested groups of experts
Prevalence of problem, Intensive and risky forms
of drug use
• Indirect statistical methods to estimate prevalence (e.g.
capture-recapture, multiplicative)
• based on existing information sources (treatment, law enforcement,
low threshold services, etc) of hidden populations
• Consolidate and improve existing methods –promote
regular application at national level
• Develop estimations for relevant groups of uses not well
captured at present
• because limitations of sources (e.g. cocaine, pharmaceutical
opiates)
• conceptual issues (e.g. cannabis dependence)
Prevalence of problem, Intensive and risky forms
of drug use
• Produce estimations for specific relevant groups –including
their eventual overlap - (POU, IDU, PSU – PCoU-, PCaU…)
• Develop/improve incidence estimations
• Explore new sources and methods (hospital emergencies,
combination with GPS –cannabis dependence-,...)
• Analyse studies of out of treatment populations (e.g. law
enforcement, homeless) to gain insight on characteristics and
need of PDU
• Help to estimate “Treatment need” and close cooperation
with TDI indicator and working group
Drug-related infectious diseases (DRID)
• Established surveillance of HIV, HCV and HBV
infection among injecting drug users (IDUs):
• Seroprevalence data (specific studies and routine settings)
• Notifications (case reports) in collaboration with ECDC / WHO
• New: Behavioural data (e.g. needle sharing, testing uptake)
• Continue improvement of existing monitoring tools
and DRID protocol – in collaboration with ECDC,
WHO and UNAIDS
• Start developmental work on other infections among
IDUs/PDUs such as STIs, TB, HAV
Drug-related infectious diseases (DRID)
• Developmental work on more advanced analyses
(statistical and mathematical modelling) – EU
network of modellers and epidemiologists
• Develop procedures for rapid alerts on health threats
related to DRID, e.g. deaths due to bacterial
contamination of drugs (with ECDC)
• Developmental work on monitoring incidence of
infectious diseases among IDUs (cohort studies and
new testing algorithms)
Drug-related deaths and mortality among drug
users
• National reporting systems based on notification of number (and
characteristics) of cases of drug-induced deaths –”overdoses”
[main focus]
• National/local studies on mortality among drug users (overall
and cause specific)
• Maintain and improve the notification system, increasing its
reliability and validity.
• Particular attention to deaths induced by substances other than
opiates (e.g. cocaine), by substitution opiates and polydrug
nature of almost all deaths
Drug-related deaths and mortality among drug
users
• Reinforce work on mortality cohort studies to capture the
whole range of mortality (as an indicator of health
damage) among drug users
• Explore specific causes of death indirectly related to drug
use (e.g suicide, injuries, long term consequences –
infectious diseases, cardiovascular)
• Initiate a comprehensive mapping of mortality (intensity
and patterns) related to different forms of drug use – as
indicator of health damage
TDI Indicator
• What is the purpose?
• Indirect indicator of trends in problem drug use
• Identification of patterns of drug use
• Basis for other methodologies on problem drug use prevalence
estimation
• Identify patterns of use of services and plan and
evaluation of services
TDI is the core information source on people with drug problems in
Europe
• Already existing: a common protocol implemented in most MS
• A developed data collection system
Information in the TDI: 18 items
• Treatment contact details
• centre type, time of treatment, source of referral
• Socio-demographic information
• gender, age, living and labour status, education
• Drug related information
• primary and secondary drug, route of administration, frequency of
use, age at first use
Information Needs
Agency
Agency
Agency
Agency
Agency Agency
Agency
Agency
Referral, Client Details, Initial Assessment
Clinical Management, Full Assessment
[prescriptions, interventions]
AGENCY
Outcomes
Local Organisational Units
Local Health Authorities REGIONAL
Health Depts
EMCDDA
UNODC
NATIONAL/
INTERNATIONAL
On-going revision
• Adapt to changing patterns of drug use and drug problems
(increase of cocaine admissions and cannabis admission)
• Decrease of new admissions due to opiates (many users
stabilised in OST for long time)
• Increasing relevance of polydrug use
• Need to improve data collection to conduct relevant analysis
while not overburden experts and NFP
• Coordination with the broader EMCDDA Treatment Information
Strategy