Zsuzsanna Elekes - Adrienn Nyírády
International indicators and databases
Ez a tantárgyi prezentációs anyag az Európai Unió támogatásával, az Európai Szociális Alap társfinanszírozásával valósult meg, a TAMOP- 4.1.2-08/2/A/KMR-0043 "A szociálpolitikus és szociális munkás képzés
megújítása az ELTE és a BCE együttműködésében (SZOCMEG)"
projekt keretében.
Illicit Drugs
information sources:
• Annual Reports Questionnaire (ARQ)
• international institutions (Interpol, Europol etc.)
Global data
World Drug Report
http://www.unodc.org/unodc/en/data-and-analysis/WDR- 2009.html
• international institutions (Interpol, Europol etc.)
• local researches
• estimates
• extrapolation
Information sources:
European data
Annual Report of the EMCDDA
http://www.emcdda.europa.eu/stats09
Information sources:
• comparable key indicators with
standardized data collection and analysis
methods
5 key indicators:
1. General populations surveys 2. Problem drug use indicator 3. Treatment demand indicator 3. Treatment demand indicator
4. Drug related death and mortality
5. Drug related infictious deseases
General Population Surveys measures:
• prevalence and distribution of the consumption of different drugs in the general population, and in relevant subgroups of the population (e.g. young people, urban areas);
people, urban areas);
• socio-demographic characteristics and patterns of
drug use among those using drugs at present or in
the past, including initiation and cessation of use,
intensity of use, and others;
• correlates of drug use such as lifestyles, other
health factors, health status, mental health, social function;
• the attitudes and perceptions of different population groups with respect to drug use, (perception of risks or availability);
• and importantly, changes over time and across
countries in these parameters .
Lifetime prevalence rate of amphetamines – 15-34
and 15-24 years (EMCDDA)
Last 12 months prevalence rate of cannabis in 15-34
years old population (EMCDDA)
• The PDU indicator captures information on the more problematic patterns of drug use that are not effectively captured by the ‘Drug use in the general population’ indicator, such as frequent or prolonged use of heroin, amphetamines or cocaine (or the injecting of such drugs).
Problem Drug Use indicator:
(or the injecting of such drugs).
• The purpose of this key indicator is to obtain reliable and comparable measures of the
prevalence of problem drug use and injecting drug
use at local and national level across Europe.
Definition of the target population:
• If a person uses heroin or other opiates he or she is always classified as opiate user regardless
whether other drugs are taken as well.
• • If no opiates are used then the person is a non-
• • If no opiates are used then the person is a non- opiate user. He or she can then be classified as cocaine user (disregarding other drugs) or,
• if no cocaine is used, as amphetamine user.
Methods of PDU:
The Multiplier Method
• In the context of problem drug use the total population of drug users T is unknown (partly hidden population). Given a sample of size B of the population in question
(benchmark) and the probability c for someone of this
unknown population to be member of the sample, the total population T can be estimated from
population T can be estimated from T = B / c
– B: the number of identified problem drug users (sample or benchmark)
– c: a parameter giving the probability of a problem drug user (unknown target population) to be member of the identified sample B
Capture-Recapture Method
• The capture-recapture method combines data from
different sources, e.g., the health system and the criminal system. Each problem drug user is either in both samples or only in the health data base or only in the criminal data base or in none of the two data bases.
• The number of problem drug users found in the data bases can be arranged in a table as can be seen in table below.
Obviously, the number of those being in none of the two data bases cannot be observed and has to be estimated from the remaining cells of the table.
Example of the simplest form of a capture-recapture analysis
Accordingly, the total number of problematic drug users is estimated as
N=a+b+c+(b*c/a).
Multivariate Indicator Method
• The prevalence of problem drug use in a country may be estimated by relating a set of drug use indicators, which are available in all regions of a country, to prevalence estimates in a few regions (calibration population).
• The indicators may be directly (e.g. mortality, morbidity, arrest) or indirectly related to drug use (e.g. population density, unemployment rate, housing density). Typically, analyses are based on prevalence rates and indicator rates per 100,000 inhabitants.
Estimated number of problem drug users/1000
inhabitants
• The TDI provides a uniform structure for reporting on the number and the characteristics of clients referred to
specific drug treatment facilities. TDI collects information on clients at, or close to, their point of entry into treatment facilities for problems with one or more drugs. A core
dataset of 20 items are collected anonymously about each
Treatment demand indicator
dataset of 20 items are collected anonymously about each presenting client concerning their social characteristics, treatment contact details and drug profile. The TDI
Measures the yearly uptake of treatment facilities by those entering treatment for their drug use and by those
entering treatment for the first time.
Purpose of the indicator:
• providing a measure of treatment demand
• providing an indicator of trends in problem drug use
• assessing the minimum need for resources
• offering a perspective on the availability of treatment facilities
facilities
• identifying patterns in the use and uptake of treatment facilities
• planning and evaluating services for drug users
• estimating prevalence, when used alongside other datasets
Primer drug used by new clients
• Infectious diseases are among the most serious
health consequences of injecting drug use, and can lead to important healthcare costs. IDUs can act as a 'core group', or pocket of infection, that may
pose a risk of spread to the general population.
The key infections among IDUs that are monitored
Drug-related infectious diseases key indicator
The key infections among IDUs that are monitored
by the EMCDDA are HCV, HBV and HIV, which are
the main causes of the infectious disease burden
related to injecting drug use in the EU.
Purpose:
• The purpose of this key indicator is to obtain valid, reliable and comparable measures of HIV, HBV and HCV infection among drug users, and in particular: (a) to measure levels of infection (prevalence) in IDU populations and key sub- groups; and (b) to monitor trends over time (increases or decreases in prevalence) among these groups. This is to inform identification of priorities for preventing further inform identification of priorities for preventing further infections, forforecasting healthcare needs and costs, and for monitoring the impact of preventive interventions. Key subgroups are young or new IDUs as changes in prevalence among these is often a reflection of changes in the rate of occurrence of new infections (incidence) among IDUs
overall.
HIV prevalence rate among IV drug users
4.0
3.7-3.9 / [12.0]
12.0
[12.5]
6.6-14.6 / [22.0]*
2.4 / [0.3-0.4]
4.5 / [8.9-29.7]*
[0.0-2.7]
[0.3-
[0.4]
[2.6-5.2]*
0.0-2.7 / [0.0]
3.7-3.9 / [12.0]
9.7-36.2 / [20.8-34.9]*
12.2 / [13.7-23.0]
13.9 / [1.3-39.9]
0.0 / [0.0]
5.0 / [0.0-6.3]
12.0-19.2
0.4 / [0.0]
[0.0]
[0.7]
[0.0-1.1]
[0.0]
Hepatitis C prevalences among IV drug users
67.0
[75.0]
[72.3]
[55.97-68.33]
[15.3-56.6]
[27-74]
[68]
[90.5]*
[83.0]*
79.0*
52 / [29.7]*
44.2-61.2 / [23.6-75.8]
[59.1-73.3]
65.1 / [42.1-97.2]
14 / [30]
34.4 23 / [50-56]
22.5 [45.8]
[47.6-80.4]
[47.4]
[60.0]*
• Mortality, directly or indirectly related to drug use, in
particular to the more intensive and harmful forms of use, is one of the main causes of death among young people in many European countries.
• The EMCDDA indicator comprises at present two
complementary components. The first and core component is national, population-based statistics on deaths directly
Drug related deaths indicator
is national, population-based statistics on deaths directly attributable to use of drugs of abuse (drug-induced deaths, poisonings or overdoses). The second component is
estimations of the overall and cause-specific mortality among problem drug users (through mortality cohort studies).
Purpose:
• to provide information on the health impact of drug use in the community, in particular to highlight and measure the most extreme consequences of drug taking;
• to identify risky patterns of use (e.g. injection or polydrug use) and risk among the most vulnerable groups of
problem drug users;
• An overview of the drug-related deaths and mortality
• An overview of the drug-related deaths and mortality
among drug users (DRD) key indicator 5 of 10 to identify new risks such as those of new substances or combination of substances, or contaminated or adulterated batches
;
• to help to monitor trends in prevalence of specific drug problems with an elevated risk such as
injecting heroin use;
• in combination with other information, to estimate prevalence of problem drug use (multiplier
estimation);
• to help in hypothesis-generating in relation to
• to help in hypothesis-generating in relation to reasons why rates or characteristics of drug related deaths differ between and within
countries .
Number of direct death case per 1 million
inhabitants
Average age of direct death cases
United Nations Office on Drugs and Crime http://www.unodc.org/
On-line database on illicit drug seizures
Alcohol
Sources of information:
• Global status report on alcohol. Substance Abuse Department, Social Change and Mental health, WHO. www.who.int
• International Guide for Monitoring Alcohol Consunption and Related Harm www.who.int
• http://www.who.int/whosis/en/
• Studies done primarily in the developed countries have
found that per capita consumption is a fairly reliable proxy for the percentage of heavy drinkers in a population, in the absence of national survey data
• Particularly for alcohol-related problems that arise from chronic heavy drinking, such as alcoholic liver cirrhosis,
Per capita alcohol consumption
chronic heavy drinking, such as alcoholic liver cirrhosis, but also in some countries for other problems such as traffic crashes and suicide, per capita consumption estimates can predict the prevalence of the roblem,
although time lags and variation by culture as a result of differences in patterns of drinking will also be found.
• Per capita consumption figures should be
developed for the major categories of alcoholic beverages available within a country. Most
international sources limit these to beer, distilled spirits and wine.
• Different alcoholic beverages have different
relationships with different types of alcohol-
related harm.
• Total estimated alcohol consumption in a country in a given year equals to total alcohol production plus alcohol imports minus alcohol exports (in that year).
• Data sources:
– The Food and Agriculture Organization (FAO) publishes the most complete set of statistics available on production and trade of beer, complete set of statistics available on production and trade of beer, wine and distilled spirits
.
– United Nations Statistical Office has recorded statistics on these commodities since the 1950s.
– World Drink Trends
Unrecorded sources of alcohol include:
• home production (especially spirits),
• alcohol intended for industrial, technical and medical uses, and
• beverages with alcohol levels below the legal definition.
Unrecorded alcohol consumption is estimated to be at least two-thirds of all alcohol consumption in
the Indian subcontinent, about half of the
consumption in Africa and about one-third in
Eastern Europe and Latin America.
• If estimates can be obtained of the extent of consumption of duty-free alcohol and of home or informally-produced alcohol, of consumption overseas, of the extent of tourism, of the volume of imported alcohol re-exported to other
countries, and of the amount of stockpiled goods released to the market, the ideal formula for estimating adult per capita consumption would then be:
