EMCDDA 2010-2012 Work Programme Key Issue 1: Key Indicators 30th Meeting of Scientific Committee

1. 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

2. 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)

3. 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

4. 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

5. 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, PDU-DRD+DRID) • With supply indicator • With interventions • Balance between treatment needs and treatment provision

6. 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-, - gender- • incidence and quitting… • Perception of availability

7. 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

8. 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)

9. 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

10. 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

11. 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)

12. 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

13. 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

14. 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

15. 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

17. 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