Transcript cannabis users_london

Building an indicator
system around the
French young cannabis
users’ services program.
Ivana Obradovic
OFDT
3 avenue du Stade
de France
93218 Saint-Denis
La Plaine cedex
Tel : 01 41 62 77 16
Fax : 01 41 62 77 00
www.ofdt.fr
French Monitoring Centre for Drug Addiction
Lifetime prevalence of cannabis use
among adolescents aged 17
60
50
47
40
38
50
55
53
53
46
47
46
41
30
25
20
17
10
0
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Source : INSERM 1993; CADIS-OFDT 1997; ESPAD 1999 INSERM-OFDT-MENRT; ESCAPAD 2000, OFDT;
ESCAPAD 2002-2003, OFDT ; ESCAPAD 2005, OFDT
male
female
A newly launched governmental program

The priority of the current five-year Drug Strategy (2004-2008) :
reduce cannabis use among young people.
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A press campaign focused on the risks of cannabis use.

Specific services targetting young cannabis users and their
families.

An additional funding of 3 M€ (£2,100,000) distributed to existing
treatment units to provide counselling (2005).
 Aim of the program : develop & disseminate a brief intervention
technique for cannabis use disorder to be used by primary
healthcare providers.
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An « original » adolescent clinic setting : an intervention framework
including check-up and follow-up throughout 5 sessions.
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Facilitate access to treatment : care provision ranging from
counselling and assessment to advice and throughcare;
Ensure that provision is built around the needs of young people
(motivational therapy);
Build service and workforce capacity;
Strengthen accountability.
The development of an evidence base of
an effective program
 The need for an appropriate outcome-monitoring tool over the
first year of activity :
 What are the characteristics of the target population?
 How is targeted work with cannabis-dependent clients
provided across all areas ?
 What works?
 A monitoring work carried out to assess the effectiveness of this
new setting :
 A monthly indicator system : scrutinize the numbers of clients
& the proportions of cannabis users and relatives.
 A national survey which is to be repeated next year : describe
the clients, map professional practices and evaluate the
effectiveness of the program.
Methodology and response rate
 Designed to examine :
the profile of check-up-seeking cannabis users;
 the care provision delivered to them in this clinic setting;
 the practices developed by healthcare providers.
Participants and setting :
 4,200 study cases : cannabis users (70%) or relatives (30%).
 3,000 cannabis outpatients aged 10 to 56 years recruited
between March 2005 and April 2005 and followed until
June 2005.
Data collection methodology : in-person interviews carried
out by practitioners.
Data processing : cases were retained only if respondents
provided data on the frequency of cannabis use.
Response rate : 90% of cannabis users’ specific services.
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Results (1): Client characteristics
 Sociodemographic assessments :
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85% are 14- to 25-year-old clients / 15% are older
A large majority of male clients (80%)
Lower proportions of school-attending individuals than in
the general population at 18
***
 Frequency of cannabis use : 64% are daily or near-daily
cannabis users and 36% are occasional users
 Patterns of cannabis use :
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The age of onset for regular cannabis use most frequently occurs
during early adolescence (before age 15).
Regular cannabis use is frequently intertwined with alcohol use.
***
 Referral : 40% are justice referees; 30% referred by a family
member, friend or relative; 30% are self-referred (frequent
abuse or dependence diagnosis)
Results (2) : Justice referees
 Compared to self-referred clients, highest proportions of male
individuals
 related to the predominance of men among arrested drug
offenders.
 Justice referees are more likely to be young adults (aged 19 to 25)
than minors (x2).
 More likely to be out of school or unemployed than self-referees
and family-referred clients (x2).
***
 Justice referees are more likely to report moderate cannabis use.
 Their follow-up is shorter than other clients’: most interventions
are interrupted after 1st contact (end of intervention or dropout).
Results (3) : Dropout rates
 About 30% of clients drop out of the program.
 Remarkably high rates after 2nd contact (55%):
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Related to longer waiting times (7 days after 1st contact, 15 after 2nd)
Reaches its highest point among occasional users
 Higher for young adults (19- to 25-year-old cannabis users) than
for minors.
Determining factors :
 Significant impact of the therapist on program completion :
medical practitioners retain significantly more clients than educators.
 Difference in client retention among GPs and other medical
therapists (psychologists or nurses), particularly at 1st contact
 Waiting times and access : a 1-week-long waiting time between 1st
and 2nd visit increases the likelihood of a drop out (x 3)
Results (4): Professional practices
 Administration of screening tests :
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A half (47%) of these care providing services only use
substance-abuse screening tests (CAGE, ALAC, CRAFFT, etc.)
40% use internal screening tests (< 10 cannabis users
monthly)
13% do not use any.
 Diagnostic criteria :
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Daily use is the discriminating factor to be classified as
cannabis-dependent rather than in abuse.
Impact of the therapist : GPs tend to classify cannabis
use as being at least « at risk » rather than moderate
(x4)
Discussion
 These findings provide good supportive evidence for the
relevance of the program :
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Target population of youths reached.
One third of self-referees.
 They help identify the gaps in policy delivery :
 Pointing out predictors of dropout : a key information to find better
ways of retaining people in the program
 Single-substance focus may be potentially misleading
 They also raise a number of issues :
 What outreach strategies have to be developed to attract female
clients?
 Are the scoring procedures sufficiently streamlined ? A specific need
for standard screening methods easy to incorporate in office routines.
Conclusion
 Diversified data undoubtedly useful to
improve policy delivery
 … unless / even though they are used to
back up a political message
 Do research interest and media planning
intentions inevitably go together ?
Limitations
 Work relying on self-reports of drug use
 Generalizability
 Completion and dropout rates : imprecise proxies for the
check-up process … only a prelude to research on what occurs
during the «black box» of health care.
 See full report in French on our website : www.ofdt.fr
Regular use of cannabis at 17
compared to regular use of licit drugs
Use of tobacco on a daily basis
≈ 1/3 of adolescents at 17
40,2
40,0
39,0
38,1
33,6
37,2
female
32,2
16,0
20
15
10
21,2
18,8
male
17,7
17,7
14,6
6,1
7,5
2000
2001
2002
2003
2004
2005
use of tobacco on a
daily basis
6,8
15,0
6,5
6,3
6,1
5,5
5
0
5,2
14,6
regular use of alcohol
2000
2001
2002
2003
2004
2005
35
30
25
41,9
2000
2001
2002
2003
2004
2005
45
40
Regular use of alcohol & regular use of cannabis :
- A male-fronted phenomenon
- The merging of regular use of cannabis & alcohol
regular use of
cannabis
Reference : Annual youth survey ESCAPAD 2005, French monitoring centre for drugs addiction.