Transcript Hovedtittel tema

Heavy or problematic drug use,
heavy and problematic to define?
Iceland 23-25 August 2010,
Nordic Alcohol and Drug Researchers’ Assembly
Ellen J. Amundsen,
The Norwegian Institute for Alcohol and Drug Research
www.sirus.no
Content
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Background
Existing definitions
Existing figures for Europe and the Nordic countries
Aspects of a definition
Explore a dataset
Outline points of discussion for a definition of hard
/heavy/problem drug use
Existing definitions, EMCDDA
• Injecting drug use
• Long-duration/ regular use of opioids, cocaine and/or
amphetamines
• Problem opioid (heroin) use
• ---• What is long duration?
• What is regular use?
• Should the definition encompass substitution
treatment and prescribed opiates?
• What about other drugs and polydrug use?
• What about use of benzodiazepines/tranquilizers?
Existing figures 2003-2008
30 European countries
• 21 presented estimates of overall problem drug use,
including Denmark, Sweden and Finland
• 14 presented estimates of prevalence of injecting
drug use, including Denmark and Norway
• 15 presented estimates of problem opioid use,
including Finland (opioids) and Norway (heroin)
Aspects of hard use
• The type and frequency of drug used
• Use of treatment and services
• Harmful consequences: Physical, dependence, social
Study in Arendal, 42 000 inhabitants
• Study population. Persons 18 years or older who had
used amphetamines, cocaine, heroin or other
opiates/opioids last 12 months
• Estimated to 450-500 persons
• 45 interviews
• Questionnaire content: Drug use (amphetamines,
cocaine, heroin, other opiates/opioids + other
substances), frequency and amount, severity of
dependence scale, use of local services,
marginalization.
Results Arendal I
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One third women,
Age 18 to more than 50
Network size: 4 to 500
Ever use: 98 % Amphetamines, cocaine 82 %, heroin
80 %, other opiates or opioids 89 %
• Injecting: Ever 82 %, last 12 months 69 %, last 30
days 64 %
• Almost daily use last 12 months: 20 % A, 4 % C, 9 %
H, 42 % other O.
• 27 % used prescribed opiates/opioids daily
Results Arendal II: Five main groups
• Group 1: Persons who had used acho daily/almost
daily the last 12 months, some of which were using
prescribed opioids
• Group 2: Persons (not in group 1) who had used
acho 1-3 times a week last 12 months
• Group 3: Persons (not in group 1 or 2) who had used
acho more than 8 times last 30 days
• Group 4: Persons (not in group 1 or 2 or 3) - young
persons with a short history of drug use
• Group 5: Persons (not in group 1 or 2 or 3) - older
persons with a longer history of drug use, who did not
use drugs regularly
Points for discussion of a definition of
hard drug use
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Type of drug?
Frequency of use? More than 2-3 times a month?
Just weekend use?
Shall persons in substitution treatment be included?
Or just those who in addition use other specific
drugs?
Use of services?
Role of individual dependence scales?
Role of marginalization?
Role of potential to quit?
Thank you!!
Ellen J. Amundsen, The Norwegian Institute for Alcohol and
Drug research/SIRUS, [email protected]
www.sirus.no
Severity of dependence scale
reference period 12 months
1. Did you think your use of (named drug) was out of
control?
2. Did the prospect of missing a fix (or dose) or not
chasing make you anxious or worried?
3. Did you worry about your use of (named drug)?
4. Did you wish you could stop?
5. How difficult did you find it to stop, or go without
(named drug)?
4 point scale for items 1 to 4 (never/almost never,
sometimes, often, always/nearly always), for item 5
(not difficult, quite difficult, very difficult, impossible)
Nutt et al. 2007 A rational scale to assess
the harm of drugs of potential misuse
1. Heroin
2. Cocaine
3. Barbiturates
4. Street methadone
5. Alcohol
6. Ketamine
7. Benzodiazepines
8. Amphetamines
9. Tobacco
10. Buprenorphine
11. Cannabis, solvents, 4-MTA, LSD, Methylphenidate,
Anabolic steroids, GHB, Ecstacy, Alkyl nitrates, Khat