EMCDDA 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

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)

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

Cross cutting issues 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

Common aims for 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

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

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

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)

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

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

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)

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

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

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

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 Information in the TDI: 18 items

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