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 Spain
- Examples of estimation based in surveysData and thought…
Spanish Observatory on Drugs
Julia Gonzalez
Rosario Sendino
Noelia Llorens
Begoña Brime
Aurora Ruiz
Elena Alvarez (speaker)
Problematic Drug Use
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…
INTRODUCTION. OBJETIVE. METHOD. RESULTS. DISCUSSION.
Population
Drug users
Problematic
users
Approachof
ofproblematic
problematicusers...
users...
Approach
Thedrug
druguse
useisiscausing,
causing,the
the
The
users(or
(orothers),
others),negative
negative
users
physical,psychological
psychologicalor
orsocial
social
physical,
consequencesor
orhight
hightrisk
riskof
of
consequences
havingthem.
them.
having
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”
INTRODUCTION. OBJETIVE. METHOD. RESULTS. DISCUSSION.
Population
Drug users
Problematic
users
It is useful to identified
problematic user to oriente and
implement policies (prevention,
treatment, social needs, harm
reduction, economics and human
resources). Focus in target population.
?
y
n
a
m
w
o
?
H
e
l
i
f
o
r
P
It is possible to estimate the
number and some characteristics of
problematic users.
It is necessary define criteria,
criteria based
in evidences, consensus and practical
issues, in order to improve the
comparability. Multidisciplinary work.
INTRODUCTION. OBJETIVE. METHOD. RESULTS. DISCUSSION.
Type of drug
alcohol, cocaine, cannabis, heroine…
prevalence…
Users characteristic
Health situation, previous pathologies,
pregnancy, age…
Pattern of use
Frequency, chronicity, route of administration
intensity, (how much -gr./hour),
“poliproblematics”…
Some aspects to take into account
Consequences for users or
others
Physic, psychological, social..
Accidents, infections, mental
diseases…
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: Direct or indirect estimations… surveys, scales, combinated methods…
Standardization of definitions, methodologies and analysis comparability
INTRODUCTION. OBJETIVE. METHOD. RESULTS. DISCUSSION.
Information sources in Spain
1) SURVEYS
General pop.
Survey (15-64 y.o)
2) DRUG INDICATORS
Hospital
emergencies
annual since 1987
5279 (2011)
Student survey
(14-18 y.o)
Drug
Mortality
Annual since 1983
706 (2010)
Others: Prison,
specific population...
Treatment Demand
indicator
Annual since 1987
79.295 (2011)
3) EXTERNAL SOURCES. Supply indicators, etc.
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.
infectious
diseases
Annual since
1986
Problem
drug use
Annual since
2007
INTRODUCTION. OBJETIVE. METHOD. RESULTS. DISCUSSION.
Main Methods for PDU estimates in Spain
80
76,6
73,6
Last year prevalence. Spain 2010/2011.
70
60
50
40,2
32,4
40
30
20
EDADES
(15-64 a.) 2011
General population
survey
2011(15-64 y.o)
ESTUDES
(14-18
a) 2010
Student survey
2010.
(14-18 y.o)
26,4
9,6
2,2 2,6
0,7 1,7
0,6 1,6
0,4 2,1
Alcohol
AUDIT scale.
General Population
Survey 2009.
Cannabis
PDU scales (CAST. SDS.
DSM-IV. M-CIDI)
Students surveys.
2006. 2008. 2010. 2012.
Cocaine
Direct estimation
(frequency and age).
General Population
surveys. 2009 y 2011.
Alucinógenos
Anfetaminas
Éxtasis
Cocaína
Cannabis
Tabaco
Alcohol
0
0,1 0,6
Heroína
10
Heroine
Indirect estimation.
Multiplier method
GPS & TDI
From 2006 to 2011.
Source: Spanish Observatory on Drugs
INTRODUCTION. OBJETIVE. METHOD. RESULTS. DISCUSSION.
OBJETIVE
Estimation of cocaine problematic drug users in Spain, using general
population survey, based in frequency and age (vulnerability)
METHOD
Source of
information
General population survey 2011.
Criteria
1) Frequency based
No clear
consensus,
How many times in a period of time (month/year) do a person consume?.
no evidence
based criteria
15-64 y.o. National coverage. Face to face questionnaire. 22, 128 questionnaires.
Person (15-64 y.o.) who used cocaine 30 days or more within the last 12 months OR
who 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 OR
who used cocaine 10 d or more within the last 30 days .(More than 20 y.o)
INTRODUCTION. OBJETIVE. METHOD. RESULTS. DISCUSSION.
COCAINE PROBLEMATIC DRUG USE, SPAIN 2011
Using GPS: frequency (frequency + age)
31 807 073
Population (15-64 y.o.)
Cocaine users
Problematic
users
Life time: 8.8% n= 2 787 281
Last year: 2.2% n= 348 410
Last 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
Source: Spanish Observatory on Drugs
INTRODUCTION. OBJETIVE. METHOD. RESULTS. DISCUSSION.
PREVALENCE VS PROBLEMATIC DRUG USE
Problematic drug use (%). Spain 2009 & 2011.
Based in frequency & age in GPS (15-64 y.o).
40
2009
2011
37,4
31,2
20
10
15,0
17,9
4,0 4,7
0
CP alg. vez
PU
life time
CP Ult. año
PU
last year
CP Ult. mes
PU last month
Cocaine prevalence (%) in general population
(15-64 y.o). Spain 1999-2011.
Cocaine prevalence (%) in student (14-18 y.o)
Spain 1994-2010.
10
10
8
6
4
Life
time vez
alguna
Last
year
último
año
Last
mont
último mes
8
Prevalence results by them self doesn't
show a complete picture.
6
4
2
2
0
2010
2008
2006
2004
2002
2000
1998
1996
0
1999 2001 2003 2005 2007 2009 2011
1994
%
30
Continuity
Among people ever using cocaine:
1 out of 4 consumed last year
1 out of 7 consumed last month.
Source: Spanish Observatory on Drugs
INTRODUCTION. OBJETIVE. METHOD. RESULTS. DISCUSSION.
Cross indicator analysis. COCAINE.
25000
20000
.
DRD cocaine with or without any other susbstances (nº)
death
NºNºdefunciones
Hospital emergency detected cocaine (nº)
NºNºurgencias
hosp se detecta
cocaína
hospital emergencies
when
cocaine is detected
Seizures (kg/10)
Incautaciones (Kg/10)
NºFirst
cocaine
first treatment
treatments
for cocaine
(nº)
Nº primeros
tratamiento
por cocaína
prevalence
(%) 15-64
y.o.
lastmonth
monthúltimo
prevalence
y.o.
(%)
%Last
consumo
mes 15-64
15-64
años
Last
month
prevalence
14-18
y.o.
(%)
month
prevaelnce
(%) 14-18
y.o.
%Last
consumo
último
mes 14-18
años.
4
3,5
3
2,5
15000
2
10000
1,5
1
5000
0,5
0
0
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Source: Spanish Observatory on Drugs
INTRODUCTION. OBJETIVE. METHOD. RESULTS. DISCUSSION.
OBJETIVES
Psychometric evaluation of scales. European project on course.
Estimation of cannabis problematic drug use (14-18 y.o). Spain, 2006-2012.
METHOD
Year
2006
2008
2010
2012
Scale
CAST
SDS
DSM-IV
CAST
CAST
SDS
M-CIDI
CAST
N survey
26,454
30,183
31,967
26,000
N CAST (valid questionnaires
last year)
3,569
7,173
6,303
In process
Source of information
Student survey. 14-18 y.o
National coverage. self-administered questionnaires (45 min.)
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.
INTRODUCTION. OBJETIVE. METHOD. RESULTS. DISCUSSION.
CANNABIS PROBLEMATIC DRUD USERS (CAST) SPAIN, 2010.
Population (14-18 y.o.)
Cannabis
last year users
2 254 505
595 189
(26.4% of total population)
Problematic
drug user
Problematic users.
15.3% among last year users.
4.6% among total population.
Source: Spanish Observatory on Drugs
INTRODUCTION. OBJETIVE. METHOD. RESULTS. DISCUSSION.
CANNABIS PDU TRENDS (CAST), SPAIN 2006, 2008, 2010
CAST results. Percentage of non problematic/low/high risk among
cannabis last year users (14-18 y.o).
100%
80%
13,3
14,3
15,3
20,7
18,6
19,9
66,0
67,1
64,8
60%
Increase trends in
cannabis problematic
drug use in teenagers.
40%
20%
0%
2006
no
Noproblemático
problematic
2008
Low riesgo
risk
bajo
2010
alto
riesgo
High
risk
Year
2006
2008
2010
% of cannabis high risk users among population 14-18 y.o.
3.3
3.7
4.6
Nº of cannabis high risk users among population 14-18 y.o
73, 534
81, 080
100,340
INTRODUCTION. OBJETIVE. METHOD. RESULTS. DISCUSSION.
Cannabis prevalence (14-18 y.o).
Spain 1998-2010.
Number of cannabis treatment
demands. Spain, 1996-2011.
45
10.000
40
8.000
First treatment
35
30
6.000
25
4.000
2.000
Alguna
vez en la vida
Life time
Last year
Últimos
12 meses
Last mont
Últimos
30 días
% hospital emergencies related to drug
when cannabis is present. Spain 1998-2011.
2011
2010
2009
2008
2007
2006
2005
2010
2004
2008
2003
2006
2002
2004
2001
2002
2000
2000
1996
1998
1999
0
10
1998
15
Previous treatments
1997
20
Treatment episodes in < 18 years (%)
different drugs. Spain, 2005-2011
45
90
40
80
35
70
60
30
50
25
40
20
30
20
15
10
10
2011
2010
2009
2008
2007
2006
2005
2011
2010
2009
2008
2007
2006
2005
2004
2002
2001
2000
1999
1998
0
Source: Spanish Observatory on Drugs
INTRODUCTION. OBJETIVE. METHOD. RESULTS. DISCUSSION.
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. Survey
with small sample. High risk-social stigma. Out of sampling frame…
Surveys are a possible tool:
tool
- Available (more cost effective than create new indicator).
- Robust (quality and trends).
- Flexible (periodic modules, adapt to needs).
INTRODUCTION. OBJETIVE. METHOD. RESULTS. DISCUSSION.
PDU concept
Population
Drug users
PDU
It is useful
It is possible
Continue working in… define criteria, methods and source of information
SURVEYS POSSIBLE TOOL
Spanish Observatory on Drugs. www.pnsd.mspsi.es
cendocupnd@mspsi.es