The Information System
on Treatment Demand in EU
EMCDDA
Linda Montanari, Buenos Aires, 22-24 October 2003
CICAD/OAS, Demand Reduction Experts Group Meeting
Mission of the EMCDDA
• To provide the Community and the EU
Member States with objective, reliable
and comparable information concerning
drugs and drug addiction and their
consequences
• Further information:
http://www.emcdda.eu.int/
Tasks
Collecting and analysing
existing data
Improving datacomparison methods
Areas
Situation
Responses
Impact
Disseminating data and
information
Map of EU Member States, Norway, acceding and candidate countries
Situation analysis: Working methods
•
•
•
•
•
Key indicators
Core data and developing areas
Expert groups
Reporting guidelines
Analytical project groups
Key indicators
A common language for describing the drug situation
• Extent and patterns of drug use in the general
population
• Prevalence of problem drug use
• Drug-related deaths and mortality among
drug users
• Treatment demand
• Drug-related infectious diseases
Core data and developing areas
• Crime
• Arrest Data
• Drug Related Crime
• Drug Markets & Availability
• Perceived availability
• Seizures
• Price & Purity
• Social Exclusion
• Youth and vulnerability
• New Trends
Treatment Demand Indicator
TDI
• One of the 5 key Indicators at the EMCDDA
• Provide information on the people demanding
treatment in the specialised drug services in Europe
• Further information:
• http://www.emcdda.eu.int/situation/themes/demand_treatment.shtml
What is the objective?
• To provide comparable, reliable and
anonymous information on:
•
•
•
•
Number of people treated for their drug use
Characteristics and Profile of clients
Patterns of use
Trends over time
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
Which questions
Information in TDI: 20 items
the TDI answer to?
What drug
treatment?
• Treatment contact details
What
characteristics of
clients?
• Socio-demographic information
Which substances /
Patterns of use?
• centre type, time of treatment, source of
referral
• gender, age, living and labour status,
education, nationality
• Drug related information
• primary and secondary drug, substitution
treatment, route of administration, frequency
of use, age at first use
Guidelines
• A joint EMCDDA/Pompidou Group protocol
(TDI protocol), with definitions and guidelines
for data collection
TDI Protocol
http://www.emcdda.org/multimedia/project_reports
/situation/treatment_indicator_report.pdf
How data are collected?
• 23 excel sheets (cross tabulations) inserted in a
central EMCDDA database (EISDD)
• By centre type: outpatient, inpatient, low threshold,
GPs, prison, others
• By each country (29):
15 Member States
+ Norway
+ 10 acceding countries
+ 3 candidate countries
What are the main resources?
• Network: one expert identified in each country by the
NFP
• Working group in most of the countries involving
professionals from the treatment centres at national level
• European annual expert meeting: the state of progress
and future perspectives
• Small thematic working group (e.g. data coverage and
cannabis data in 2003)
Some Results
Clients admitted to drug treatment in
2001:
trends and patterns of use
Percent of new clients admitted to treatment
by main drug in 2001
50.0
41.6
40.0
30.0
24.8
23.5
20.0
10.0
3.9
3.9
0.8
0.0
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th
Source: 2002 Reitox National Reports; Standard Table 3; 2001 data
All Centre Types; N.cases: 34 768 (new clients)
Countries included: Dk, Ge, Gr, Sp, IR (2000 data), Nl, FI, Sw
Weighted average on the total numbers of new clients by country
Percent of new clients
by main drug
Sweden (n.482)
Finalnd (n.741)
Netherlands (n.4700)
Ireland * (n.1981)
Spain (n.17591)
Greece (n.2019)
Germany (n.5970)
Denmark (n. 1284)
0%
Opiates
Cannabis
20%
Cocaine
40%
Stimulants
60%
80%
Hallucinogens
Others
Source: REITOX National Reports - Standard Table 3 –2001 data
(*) 2000 data – All centre types
100%
% of new clients admitted to treatment for
opiates, cocaine, cannnabis in some EU countries
- 1996 to 2001 80.0
70.0
60.0
50.0
Opiates
40.0
Cocaine
30.0
Cannabis
20.0
10.0
0.0
1996
1997
1998
1999
2000
2001
(n.35411) (n.31746) (n.32885) (n.33614) (n.29482) (n.30402)
Source: Reitox National Reports; Standard Table 4; All Centre Types
Countries included: Dk, Ge, Gr, Sp, Nl, Sw
Average weighted on the number of clients by country
Percent of new outpatient clients in some
country by source of referral
Self referred
Sweden
(n. 689)
Fam ily/
friends
Finland
(n. 488)
Other drug treatm ent
centres
Netherlands
General practitioner
(n. 4700)
Ireland *
Hospital/other m edical
source
(n. 1258)
Greece
Social services
(n. 831)
Germany
(n. 5970)
0%
20%
40%
60%
80%
100%
Court/
probation/
police
Other
Source: Reitox National Reports 2002 – TDI data -Outpatient
Treatment Centres –
Valid per cent, n = 13 936 cases, new clients - * Ireland: 2000 data
Mean age of clients in treatment in 2001
•Opiates and Cocaine between 20-29 and 30-39
•Stimulants and cannabis between 15-19 and 20-29
Denmark
Germany
Greece
Spain
Italy
Luxembourg
The Netherlands
Finland
Sweden
United Kingdom
New clients
(n = 83571)
All clients
(n.337842)
27.8
24.0
26.6
29.3
29.0
21.8
30.7
22.9
31.0
n.a.
31.1
26.8
27.8
31.5
32.3
30.7
32.8
25.5
31.8
28.3
Source: REITOX National Reports - Standard Table 3 – 2001 data
All centre types
Gender distribution among new clients
in 2001
•Mainly males: 79.2 males / 20.8 females
•Differences between drugs:
•Opiates:
81.2 males / 18.8 females
•Cocaine:
85.0 males / 15.0 females
•Stimulants:
67.5 males / 32.5 females
•Cannabis:
85.8 males / 14.2 females
•Highest proportion of males in Spain (84.9), lowest in
Sweden (69.1)
Source: Reitox National Reports - Outpatient Treatment Centres
N. Cases: n. 29 133
Countries: Dk, Ge, Gr, Sp, Nl, Fi, Sw
Percent of new outpatient clients by
level of education in 2001
60
50
40
30
20
10
0
Never or not
completed
primary school
Primary
Secondary
Source: Reitox National Reports 2002 – TDI data -Outpatient Treatment Centres
Valid per cent, n = 29 493 cases, new clients
Countries: Dk, Ge, Gr, Nl, Sp, Fin, Sw
Higher
Percent of new outpatient clients by
labour status among in 2001
45
8.2% in general population
40
35
30
25
20
15
10
5
0
Regular
Student
Inactive
Unemployd
Source: Reitox National Reports 2002 – TDI data -Outpatient Treatment Centres
Valid per cent, n = 29 596 cases, new clients
Countries: Dk, Ge, Gr, Nl, Sp, Fin, Sw
Other
Age at first use of main drug among new
clients in some countries
100%
80%
49+
40 - 49
30 - 39
20 - 29
15 - 19
<15
60%
40%
20%
0%
Cannabis
(7322)
Opiates
(9373)
Cocaine
(7037)
Stimulants
(2985)
Source: 2002 Reitox National Reports – Outpatient Treatment Centres
Year covered: 2001
Countries covered: Dk, Ge, Gr, Sp, Fin, Sw
Frequency of use of main drug: % new clients in 2001
(last 30 days before starting treatment)
Daily
100%
80%
2-6 days per week
%
60%
Once a week or less
40%
20%
Not used in the past
month/
Occasional
0%
opiates
(n. 6980)
cocaine
(n. 4155)
stimulants
(n. 4723)
cannabis
(n. 6351)
Source: 2002 Reitox National Reports – TDI data – Outpatient Treatment Centres
Year covered: 2001
Countries covered: 2001: Dk, Ge, Gr, Nl, Fin, Sw
Route of administration among all and new
clients in some country in 2001
100%
80%
Others/
Not Known
Sniff
60%
40%
Eat/Drink
20%
0%
Smoke/Inhale
n=77 927 n=11 653 n=16 513 n=8 097
All
New
Opiates
All
New
Cocaine
n=6 208
n=2 669
All
New
Stimulants
Source: Reitox National Reports 2002 – TDI data -Outpatient Treatment Centres
Countries: Dk, Ge, Gr, Ir (2000 data), Nl, Sp, Fin, Sw, Uk (all clients)
Inject
Most used secondary drugs among new
clients in 2001 in some countries
35
30
85.1% use more than one drug
25
%
20
15
10
5
0
Opiates
Cocaine
Stimulants
Source: Reitox National Reports 2002 – TDI data -Outpatient Treatment Centres
Valid per cent, n. 25 824 using a secondar drug (n =30 344 total new clients)
Countries: Dk, Ge, Gr, Nl, Sp, Fin, Sw
Cannabis
Conclusions (1)
• Opiates main substance, followed by cannabis and cocaine
• Decrease of opiates users, increase cannabis and cocaine
• Clients are males in their 20s or 30s
• Clients demand treatment spontaneously or through family
• Social conditions are worsening than general population
• Clients start to use in the adolescence: earlier for cannabis
Conclusions (2)
• Polarization of frequency of use for opiates and cocaine
graduation for stimulants and especially cannabis
• Clients tend to inject opiates, sniff cocaine, eat stimulants:
less injection among new clients
• Polydrug use is apparent, with cannabis as main
secondary drug, followed by cocaine
• Relevant differences between countries
Further information on the 2003 EU drug
situation:
• http://annualreport.emcdda.eu.int/