1. Elena Gomes de Matos, Tessa-Virginia Hannemann,
Josefine Atzendorf, Ludwig Kraus, Daniela Piontek
II Lisbon Addicitions Conference
24-26 October 2017, Lisbon
New drug use trends in Germany? The use of new psychoactive substances and methamphetamine in six federal states

2. Trends in drug use subject to changes and trends
Background
Trends in drug use subject to changes and trends
Lately discussed: New psychoactive substances (NPS), methamphetamine
Lack of epidemiological studies covering a broad geographical range
Regional variation in prevalence? 2

3. Background
Aim: Assess distribution of NPS and methamphetamines in 6 German federal states 3

4. Methods Hamburg Northrhine- Westphalia Saxony Thuringia Hesse Bavaria4

5. Methods Epidemiological Survey of Substance Abuse (ESA)
Adults aged years
Sample sizes: Bavaria (n = 1,916), Hamburg (n = 1,125), Hesse (n = 1,151), North Rhine-Westphalia (n = 2,008), Saxony (n = 1,897), Thuringia (n = 1,543)
Self-administered paper-and-pencil and online questionnaires, telephone interviews 5

6. Prevalence rates by federal states
Methods
Prevalence rates by federal states
Factors associated with lifetime use (logistic regression analyses)
Predictors: federal state, sex, age, education, consumption of alcohol, tobacco and cannabis 6

7. Results: NPS prevalence rates
Thuringia
Hesse
Bavaria
Northrhine-
Westphalia
Hamburg
Saxony LT
3.9
12 M
1.4
30 T
0.0 LT
2.7
12 M
1.3
30 T
0.0 LT
2.5
12 M
0.9
30 T
0.1 LT
3.4
12 M
1.4
30 T
0.1 LT
2.3
12 M
0.8
30 T
0.0 LT
2.2
12 M
0.7
30 T
0.0 7

8. Results: NPS prevalence rates
Thuringia
Hesse
Bavaria
Northrhine-
Westphalia
Hamburg
Saxony LT
3.9
12 M
1.4
30 T
0.0 LT
2.7
12 M
1.3
30 T
0.0 LT
2.5
12 M
0.9
30 T
0.1 LT
3.4
12 M
1.4
30 T
0.1 LT
2.3
12 M
0.8
30 T
0.0 LT
2.2
12 M
0.7
30 T
0.0 8

9. Results: NPS prevalence rates
Thuringia
Hesse
Bavaria
Northrhine-
Westphalia
Hamburg
Saxony LT
3.9
12 M
1.4
30 T
0.0 LT
2.7
12 M
1.3
30 T
0.0 LT
2.5
12 M
0.9
30 T
0.1 LT
3.4
12 M
1.4
30 T
0.1 LT
2.3
12 M
0.8
30 T
0.0 LT
2.2
12 M
0.7
30 T
0.0 9

10. Results: NPS prevalence rates
Thuringia
Hesse
Bavaria
Northrhine-
Westphalia
Hamburg
Saxony LT
3.9
12 M
1.4
30 T
0.0 LT
2.7
12 M
1.3
30 T
0.0 LT
2.5
12 M
0.9
30 T
0.1 LT
3.4
12 M
1.4
30 T
0.1 LT
2.3
12 M
0.8
30 T
0.0 LT
2.2
12 M
0.7
30 T
0.0 10

11. Results: Forms of NPS consumption11

12. Results: Methamphetamine prevalence rates
Thuringia
Hesse
Bavaria
Northrhine-
Westphalia
Hamburg
Saxony LT
0.9
12 M
0.4
30 T
0.3 LT
0.3
12 M
0.2
30 T
0.0 LT
1.7
12 M
0.8
30 T
0.2 LT
2.0
12 M
0.3
30 T
0.0 LT
0.7
12 M
0.0
30 T LT
1.1
12 M
0.4
30 T
0.0 12

13. Results: Methamphetamine prevalence rates
Thuringia
Hesse
Bavaria
Northrhine-
Westphalia
Hamburg
Saxony LT
0.9
12 M
0.4
30 T
0.3 LT
0.3
12 M
0.2
30 T
0.0 LT
1.7
12 M
0.8
30 T
0.2 LT
2.0
12 M
0.3
30 T
0.0 LT
0.7
12 M
0.0
30 T LT
1.1
12 M
0.4
30 T
0.0 13

14. Results: Methamphetamine prevalence rates
Thuringia
Hesse
Bavaria
Northrhine-
Westphalia
Hamburg
Saxony LT
0.9
12 M
0.4
30 T
0.3 LT
0.3
12 M
0.2
30 T
0.0 LT
1.7
12 M
0.8
30 T
0.2 LT
2.0
12 M
0.3
30 T
0.0 LT
0.7
12 M
0.0
30 T LT
1.1
12 M
0.4
30 T
0.0 14

15. Results: Methamphetamine prevalence rates
Thuringia
Hesse
Bavaria
Northrhine-
Westphalia
Hamburg
Saxony LT
0.9
12 M
0.4
30 T
0.3 LT
0.3
12 M
0.2
30 T
0.0 LT
1.7
12 M
0.8
30 T
0.2 LT
2.0
12 M
0.3
30 T
0.0 LT
0.7
12 M
0.0
30 T LT
1.1
12 M
0.4
30 T
0.0 15

16. Results NPS Meth-amphetamine OR Federal state Bavaria 1.13 1.28
NPS
Meth-amphetamine OR
Federal state
Bavaria
1.13
1.28
Hamburg
0.99
0.62
Hesse
0.88
0.86
North Rhein-Westphalia
1.11
0.37
Saxony
1.15
2.04*
Thuringia
0.79
1.96*
Sex (female)
0.78
Age
0.97*
Education
Medium
0.44*
0.35*
High
0.29*
0.26*
Alcohol consumption (g/week)a
1.03
1.01
Tobacco consumption (12 months)
2.94*
4.89*
Cannabis consumption (12 months)
3.87*
6.39* 16

17. Results: Methamphetamine prevalence rates
Thuringia
Hesse
Bavaria
Northrhine-
Westphalia
Hamburg
Saxony LT
0.9
12 M
0.4
30 T
0.3 LT
0.3
12 M
0.2
30 T
0.0 LT
1.7
12 M
0.8
30 T
0.2 LT
2.0
12 M
0.3
30 T
0.0 LT
0.7
12 M
0.0
30 T LT
1.1
12 M
0.4
30 T
0.0 17

18. Discussion: NPS More prevalent than any illicit drug except cannabis
In international comparison rather low consumption prevalence
“Risk factors” similar to other illicit drugs (younger age, low education, use of tobacco and cannabis)
No indications for differences between federal states
Constant update of medical staff (e.g. emergency department, GP) regarding new NPS trends and symptoms on a national basis 18

19. Discussion Rarely used in adult general population
Agglomeration in Saxony and Thuringia
Proximity to Czech border (production sites) 19

20. Results: Methamphetamine prevalence rates
Thuringia
Hesse
Bavaria
Northrhine-
Westphalia
Hamburg
Saxony LT
0.9
12 M
0.4
30 T
0.3 LT
0.3
12 M
0.2
30 T
0.0 LT
1.7
12 M
0.8
30 T
0.2 LT
2.0
12 M
0.3
30 T
0.0 LT
0.7
12 M
0.0
30 T LT
1.1
12 M
0.4
30 T
0.0 20

21. Discussion Rarely used in adult general population
Agglomeration in Saxony and Thuringia
Proximity to Czech border (production sites)
Known from clinical populations (treatment data)
Not an “everyday drug” throughout population
Serious health risks
Training for medical institutions on symptoms and challenges of methamphetamine in affected regions
Selective and indicative prevention and intervention; nationwide prevention campaigns not recommended 21

22. Thank you for your attention!

23. Background & aims Methods Results Discussion
Background and aims
Background
Methamphetamine (Crystal Meth)
Globally most widespread illicit drug except cannabis (yet less common than e.g. in USA)
Higher potency and longer half-life period than amphetamine
Long-term effects (e.g. cardiovascular diseases, mental problems)
Indications of higher consumption in federal states close to Czech Republic
Background & aims Methods Results Discussion 23

24. Background & aims Methods Results Discussion
Variables & instruments
NPS & methamphetamine
Prevalence (lifetime, 12-months, 30-days)
Consumption frequency last 12 months (methamphetamine)
Consumption forms last 12 months (NPS)
Clinical relevant consumption using the Severity of Dependence Scale (SDS)
Alcohol, tobacco, cannabis (last 12 months)
Sociodemographic variables (sex, age, education)
Background & aims Methods Results Discussion 24

25. Background & aims Methods Results Discussion
Figure 1. Consumption of new psychoacitve substances based on lifetime (LT), 12 months (12 M) and 30 days (30 T). n unweighted number. % weighted percent.
Figure 2. Consumption of methamphetamine based on lifetime (LT), 12 months (12 M) and 30 days (30 T). n unweighted number. % weighted percent.
Background & aims Methods Results Discussion 25

26. Results
Sachsen
Thüringen
Hessen
Bayern
Nordrhein-Westfalen HH 26

27. Background & aims Methods Results Discussion
NPS
Lifetime prevalence between 2.2 % (Bavaria) and % (Hamburg)
Maximum 12-month prevalence 1.4 % (Hamburg, Saxony); consumption in last 30-days only in Saxony and Thuringia (0.1 %)
Equal lifetime prevalence across federal states
Lower consumption with higher age and education
Higher consumption associated with alcohol and cannabis use
Background & aims Methods Results Discussion 27

28. Background & aims Methods Results Discussion
Methamphetamine
Lifetime prevalence highest in Saxony (2.0 %) and Thuringia (1.7 %) and Bavaria (1.1 %)
12-month prevalence between 0.8 % (Thuringia) and 0.4 % (Bavaria, Hamburg); consumption in last 30-days only in Hamburg (0.3 %) and Thuringia (0.2 %)
Higher consumption risk in Saxony and Thuringia
Lower consumption with higher age and education
Higher consumption with tobacco and cannabis use
Background & aims Methods Results Discussion 28

29. Background & aims Methods Results Discussion
NPS
Methamphetamine OR
95 % CI
Federal state
Bavaria
1.13
[0.81; 1.58]
1.28
[0.68; 2.40]
Hamburg
0.99
[0.65; 1.50]
0.62
[0.29; 1.33]
Hesse
0.88
[0.59; 1.33]
0.86
[0.29; 2.55]
North Rhein-Westphalia
1.11
[0.73; 1.70]
0.37
[0.10; 1.37]
Saxony
1.15
[0.76; 1.73]
2.04*
[1.15; 3.62]
Thuringia
0.79
[0.54; 1.17]
1.96*
[1.13; 3.39]
Sex (female)
0.78
[0.53; 1.13]
[0.43; 1.41]
Agea
0.97*
[0.96; 0.99]
[0.95; 0.99]
Educationb
Medium
0.44*
[0.27; 0.73]
0.35*
[0.16; 0.80]
High
0.29*
[0.18; 0.49]
0.26*
[0.10; 0.67]
Alcohol consumption (g/week)a
1.03
[1.01; 1.04]
1.01
[1.00;1.03]
Tobacco consumption (12 months)
2.94*
[1.90; 4.54]
4.89*
[2.58; 9.28]
Cannabis consumption (12 months)
3.87*
[2.50; 5.98]
6.39*
[3.20; 12.76]
Note. Controlled for interview type (written, telephone, online). OR: Odds Ratio. 95 % CI: 95 % Confidence interval. Reference of variable federal states was average of all included federal states. a. Continuous variables. b. Reference category: „low education“. * p < .05.
Background & aims Methods Results Discussion 29

30. Background & aims Methods Results Discussion
NPS – consumption forms
Herbal mixtures most widespread and highest in Bavaria (90.9 %) and Saxony (89.6 %)
Crystals/pills most common only in North Rhein-Westphalia (84.3 %)
Liquids least popular in all states except Saxony
Table 2. NPS consumption forms in six federal states.
Bavaria
Hamburg
Hesse
NRW
Saxony
Thuringia n %
Herbal mixtures 17
90.9 15
77.7 7
77.0 12
71.5 14
89.6
Crystals/pills 6
48.1 9
57.8
60.0
84.3 10
86.0
67.5
Liquids
38.3
31.7 4
37.0
55.8
86.9
39.2
Note. NRW North Rhein-Westphalia. n unweighted number. % weighted percent. Multiple responses allowed.
Background & aims Methods Results Discussion 30

31. Results Methamphetamine – frequency
Table 3. NPS consumption forms in six federal states. 31

32. Background & aims Methods Results Discussion
Methamphetamine – frequency and clinical relevant consumption
Frequency
Frequency varied across federal states
At least 10 times consumption highest in Thuringia (7 out of 15) and Saxony (3 out of 4)
Clinical relevant consumption
In total nine persons with clinical relevant consumption across federal states
Most prevalent in Thuringia (5 persons)
Background & aims Methods Results Discussion 32