The Drug Situation in Europe: An Overview of Data Available on Illicit Drugs & New Psychoactive Substances from European Monitoring in 2015

Aim

A central task for the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is to produce an annual report of the latest data available on drug demand and drug supply in Europe. This paper is intended to facilitate a better understanding of, and easier access to, the main quantitative European level data sets available in 2015.

Methods

The European reporting system formally covers all 28 European Union (EU) Member States, Norway and Turkey and incorporates multiple indicators alongside an early warning system (EWS) on uncontrolled new psychoactive substances (NPS). While epidemiological information is based largely on registries, surveys and other routine data reported annually, the EWS collects case-based data on an ongoing basis. The 2015 reporting exercise is centred primarily on a set of standardized reporting tools.

Results

The most recent data provided by European countries are presented, including data on drug use, drug-related morbidity and mortality, treatment demand, drug markets and new psychoactive substances, with data tables provided and methodological information. A number of key results are highlighted for illustrative purposes. Drug prevalence estimates from national surveys since 2012 (last year prevalence of use among the 15–34 age band) range from 0.4% in Turkey to 22.1% in France for cannabis, from 0.2% in Greece and Romania to 4.2% in the United Kingdom for cocaine, from 0.1% in Italy and Turkey to 3% in the Czech Republic and the United Kingdom for ecstasy, and from 0.1% or less in Romania, Italy and Portugal to 2.5% in Estonia for amphetamine. Declining trends in new HIV detections among people who inject drugs are illustrated, in addition to presentation of a breakdown of NPS reported to the EU early warning system, which have risen exponentially from fewer than 20 a year between 2005 and 2008, to 101 reported in 2014.

Conclusions

Structured information is now available on patterns and trends in drug consumption in Europe, which permits triangulation of data from different sources and consideration of methodological limitations. Opioid drugs continue to place a burden on the drug treatment system, although both new heroin entrants and injecting show declines. More than 450 new psychoactive substances are now monitored by the European early warning system with 31 new synthetic cathinones and 30 new synthetic cannabinoid receptor agonists notified in 2014.

Below:  Newly diagnosed HIV cases related to injecting drug use: trends in number of cases

Below:  Number and categories of new psychoactive substances notified to the EU Early Warning System

Full article at:   http://goo.gl/IPDeEc

By:   Jane Mounteney, Paul Griffiths, Roumen Sedefov, Andre Noor, Julián Vicente and Roland Simon

European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal

^*Correspondence to: Jane Mounteney, European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal. E-mail: Jane.mounteney@emcdda.europa.eu  

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The Management of Opiate Use Disorders in France: Results of an Observational Survey of General Practitioners

When opioid-agonist treatments were approved in France in 1995, opiate use disorders began to be managed and treated by general practitioners (GPs), who have since then been encouraged to treat substance use disorders (SUDs) for heroin and other illegal substances. The objective of this study was to describe rates of: 1) SUDs in general practices in France; 2) characteristics of GPs treating SUDs; and 3) clinical practices surrounding SUDs. To place these data in the context of SUD treatment, we also gathered information from practicing SUD specialists.

Between December 2011 and January 2012, a nationally representative sample of GPs and SUD specialists were interviewed by phone, using a 12-item questionnaire that covered number of SUD patients, types of SUDs, and treatments. Data collected were confidential, and analysis was blinded with regard to physician identity.

Forty-four percent of GPs and 68 % of specialists were included in the analysis. The mean number of patients estimated to have been seen at least once in the previous year was 3036 for GPs and 920 for specialists. Ninety-six percent of GPs reported having patients with SUDs. Tobacco, alcohol, and psychoactive drugs were the SUDs most frequently encountered by GPs, whereas tobacco, alcohol, heroin, and cannabis were most frequently encountered by specialists. Forty-three percent of GPs saw at least one patient with a heroin use disorder (HUD), and 82 % of GPs treating patients with HUDs had prescribed an opioid-agonist treatment during the previous 12 months.

The results of this study suggest that a large number of GPs now treat patients with opiate use disorders and that doctors appear to be convinced of the benefits of opioid-agonist therapy and have overcome their initial concerns. This represents a significant change in practice patterns since the introduction of opioid-agonist treatments in France.

Below:  Percent GPs who prescribed opioid-agonist treatment in the previous 12 months

Full article at:  http://goo.gl/rslqxY

By: Pierre Poloméni, Claude Bronner, Fréderic Fry, Bruno Ravoninjatovo, and Mélina Fatseas

Hôpitaux Universitaires Paris Seine St Denis, Site René Muret, Avenue du Dr Schaeffner, Sevran, 93270 France

2 rue de Haslach, 67200 Strasbourg, France

CSAPA Dune, Parvis de la préfecture, Immeuble les Oreades, 95000 Cergy, France

151 Bis rue de Courcelles, 51100 Reims, France

Laboratoire de psychiatrie, Département d’addictologie, Centre hospitalier Charles Perrens, 146 bis, rue Léo Saignat, Bordeaux, 33076 France

Pierre Poloméni, Phone: + 33 (01) 41 52 56 76, Email: rf.phpa.bmr@inemolop.erreip.

Contributor Information.

Corresponding author.

 

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Risk-Taking Behaviours & HIV Infection among Sex Workers in Portugal

Sex workers (SW) are key populations at an increased risk of HIV infection. This study aimed to characterise risk-taking behaviours and assess HIV prevalence among SW in Portugal.

A cross-sectional survey was conducted with 1040 SW using a participatory research approach. SW were recruited in sex-work locations and community-based organisation offices. Data were collected through a questionnaire with trained interviewers. An HIV rapid test was performed in 213 respondents.

Reported HIV prevalence was 8%: 17.6% of man-to-woman transgenders, 7.4% of women and 5% of men. Of SW reportedly living with HIV, 52.2% reported ever injecting drug use. Inconsistent condom use with clients in the last month was higher among male SW (26.5%) and with non-paying partners in the last year was higher among women (71.3%). Among reported HIV-positive SW, the proportions of inconsistent condom use were high. In multivariate regression analysis, reported HIV infection remained significantly higher among transgenders, those older, working outdoors, having ever used psychoactive substances and earning ≤€1000 per month. Of those who had an HIV rapid test, 8.9% were reactive; 73.7% were unaware of their seropositivity.

The HIV infection burden in SW is high. Efforts to promote HIV testing must be sustained in order to reduce undiagnosed infection. The diverse risk profiles of SW must be addressed in targeted HIV interventions. Prevention interventions should be systematically implemented within most-at-risk subgroups of SW.

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By: Dias S1, Gama A1, Fuertes R2, Mendão L2, Barros H3.

• 1Instituto de Higiene e Medicina Tropical & CMDT, Universidade Nova de Lisboa, Lisboa, Portugal.
• 2GAT-Grupo Português de Activistas sobre o Tratamento de VIH/Sida Pedro Santos, Lisboa, Portugal.
• 3Institute of Public Health of University of Porto, University of Porto Medical School, Porto, Portugal.  

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Awareness Survey of So-Called Dappou Drugs or Kiken drugs (New Psychoactive Substances) among University Students in Japan

Spread of new psychoactive substances (NPS) is a worldwide problem. In Japan, NPSs with psychoactive ingredients are called as “dappou drugs” or “kiken drugs.” Their potential effect on the Japanese society cannot be ignored.

We conducted an awareness survey of So-called Dappou Drugs or Kiken Drugs among the students of Ibaraki University, a national university in Japan, in April 2014. 3976 students (2425 men, 1406 women and 145 unspecified) participated in this study. 2813 (70.7 %) respondents were aware of dappou drugs. Only 39.5 % of the respondents selected the option of “ingredients that cause delusions and/or hallucinations may be included” in dappou drugs. 23.4 % of the respondents selected “the number of (dappou drug) users requiring emergency hospitalization due to acute intoxication is increasing”. Of the respondents, 19 (0.5 %) reported that they had been invited to use dappou drugs previously, and 40 (1.0 %) had witnessed and/or heard of somebody close to them using the drugs. Those who drank alcohol every day and those who smoked had a higher chance of witnessing and/or hearing of somebody close to them using dappou drugs than those who did not drink or smoke, respectively.

Japanese university students do not have sufficient knowledge about dappou drugs or kiken drugs to protect themselves from potential drug misuse. It is both important and urgent to educate Japanese university students about the harmful effects of dappou drugs; in addition, it is important to provide such knowledge before the students are allowed to legally drink and smoke.

Full article at: http://goo.gl/e0lSVg

By: Yasuko Fuse-Nagase, Fukumi Saito, Toshie Hirohara, and Happei Miyakawa

University Health Center, Ibaraki University, 2-1-1 Bunkyo, Mito, Ibaraki 315-8012 Japan

College of Education, Ibaraki University, 2-1-1 Bunkyo, Mito, Ibaraki 315-8012 Japan

  

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A Review of Ethylphenidate in Deaths in East & West Scotland

Ethylphenidate is a psychostimulant and analogue of methylphenidate. Interestingly it is also produced as a metabolite from the co-ingestion of methylphenidate and alcohol (ethanol). In the UK, between April and June 2015, ethylphenidate and 6 other methylphenidate based novel psychoactive substances (NPS) were subjected to a temporary class drug order under the Misuse of Drugs Act 1971. Ethylphenidate is being abused by both novel and habitual drug users, more prominently in the East of Scotland. What is unknown in the literature is the contribution of ethylphenidate in deaths. 

A search was conducted for an 18 month period (July 2013 to December 2014) to identify cases where ethylphenidate was detected during post-mortem toxicological analysis. Nineteen cases were identified and these cases were examined with regards to case circumstances, pathology findings, toxicology results and adverse effects. 

The individuals ranged in age from 20 to 54 (median 37) and the majority were male (n=14) and from the East of Scotland (n=16), more specifically Edinburgh and surrounding area. Current or previous heroin abuse was a common theme in these cases (n=16) and injection was a common route of administration of "legal highs" or "burst". 

The concentration of ethylphenidate in the cases ranged from 0.008mg/L to over 2mg/L in post-mortem femoral blood (median 0.25mg/L, average 0.39mg/L). Other drugs commonly detected were benzodiazepines (n=15), followed by opiates (n=11, 4 of which were positive for 6-monoacetylmorphine) and then methadone (n=8). All 19 cases received a full post-mortem examination and there were 10 cases where drug toxicity was the sole or potentially contributory factor to the cause of death. 

Ethylphenidate was specifically mentioned in the cause of death for 5 cases, chronic intravenous (IV) drug use was named as part of the cause of death for 2 cases and in 6 cases there was evidence of complications and infections through IV drug use. As far as it is known to the authors, this is the first review of post-mortem cases involving the use of ethylphenidate in East and West Scotland. 

This study can be used as a guide for toxicologists and pathologists when interpreting cases which are positive for ethylphenidate.

Via: http://ht.ly/Ss6hN Purchase full article at: http://ht.ly/Ss6jI 

By: Parks C1, McKeown D2, Torrance HJ3.

• 1Forensic Medicine and Science, University of Glasgow, Glasgow G12 8QQ, United Kingdom.
• 2Forensic Medicine and Science, University of Glasgow, Glasgow G12 8QQ, United Kingdom
• 3Forensic Medicine and Science, University of Glasgow, Glasgow G12 8QQ, United Kingdom