Drug treatment demand

The connection between injection drug use and (imminent) epidemics of infectious diseases among users urges us to reconsider the addiction treatment and drug abuse control policies in the early and middle 90s. It was concluded that even if the risks associated with illegal drug use were not entirely preventable, proper harm-reduction strategies could reduce them considerably.

These approaches have gained increasing support over the last decade, while more conventional psychiatric approaches have appeared ineffective, expensive and counterproductive. The drug treatment demands increased considerably in the period from 1991 to 2001. The Methadone maintenance programs are the most common exemplars of harm reduction as an approach to health care of drug users in Slovenia.

The Drug Treatment Demand (DTD) Project and the use of the Pompidou Group Treatment Demand protocol to collect data on drug treatment demand is one of the most important projects in the field of drug reporting systems. It also monitors treatment demand trends. Some additional questions on sexual risk behavior (numbers of partners, condom use and prostitution - trading sex for drugs or money), hepatitis infection and criminal behavior were added to the list of information collected by PG questioner. Also, we collect more detailed

information on injecting risk behavior, including “currently and ever shared other injecting equipment”.

The DTD Project has worked successfully in the network of the centers for prevention and treatment of illicit drug use for more than six years. Actually we started to collect first data on the pilot base in 1991 in the cities of Ljubljana and Koper. Most of this time we have done our best to improve data quality and comparability of treatment demand data and to provide annually descriptive data reports for the different cities and the country. Starting in 2002, the new PG/EMCDDA questioner on treatment demands has been introduced and the risk behavior list of questions has been revised. The DTD data on drug users entering treatment centers for drug addiction represent the basis for planning activities of these centers. The planners and providers of health care use these data to identify the types of patients opting for specific activities and to formulate incentives for the treatment of individual sub-groups. Furthermore, the data indirectly show the changing patterns of the more problematic drug use among the population. It is therefore necessary to differentiate between the data on the users who seek drug-abuse treatment for the first time and those who have already undergone the treatment. The ratio between first and repeat treatments is an accurate indicator of drug use incidence. The collected data are also a

Also, this project had a strong impact on our training efforts in drug use epidemiology and information systems. Therefore the DTD project allowed to establish a human network that will be maintained with the extension of this project to other drug treatment facilities.

In the period from 1996 to 2000 drug users most commonly sought treatment because of the heroin use (92.4% in the year 2000) and because of other drugs to a considerably lesser extent. Most were male (77.3 %), with a mean age of 24.7 years for male and 22.7 years for female. In recent years the proportion of cases for stimulant (cocaine, amphetamines), ecstasy and cannabis have increased, although at low levels. Combinations of illicit drugs, alcohol and benzodiazepines are common. Injection drug use that prevails among the treated drug users is associated with a high risk of local infections, necrosis, breakdown of the circulatory system, generalized septicemia, overdose and many potentially fatal infectious diseases, such as HIV and hepatitis B and C infection.

The proportion of treated current injectors (injecting last month) who reportedly sharing needles and syringes during the month before the treatment demand has decreased and reached 18.2 % in 1996. After that it has increased up to 30.

4 % in 1998 and went back to 25.8 % and 28.1 % in 1999 and 2000

respectively. However, no upward trends in reported HIV incidence rates and HIV prevalence among treated drug users have been observed.

In the period from 1996 to 2000 the prevalence of HIV infection has consistently remained below 1% among the tested drug users. During the same period the prevalence of HBV detected among drug users demanding treatment for the first time ranged from 0 to 3% and the prevalence of HCV was between 9 to 13

% (for data for injecting drug users only see the “information on the prevalence oh HIV, HCV and HBV among injection drug users”).

The coordinator always checks individually reported data variable by variable.

Data check routines and internal consistency checks were developed (together with the PG experts). The comments and reactions about unclear information are exchanged by phone or mail. This process allows better data quality in reporting. It serves as a training opportunity as well.

Of course there is a limitation of this sort of surveillance, regarding validity of self-reported information. There are also missing values on some variables. But during the course of the project the data quality improved remarkably.

Up till now the analyses of drug use, injecting risk behavior and sexual risk behavior trends (e.g. development of heroin use in the reduction of injecting, needle sharing and condom use behaviors, introduction of new drugs on the scene, the prevalence of HIV and hepatitis etc.) were the most challenging outcomes of this project. The trend analyses of TD data, combined with information from qualitative research will be the most important task in the future. Since the questionnaire has been revised in 2002, additional guidelines will be developed.

Figure 3.1.1. Drug treatment demand, Slovenia, 2000 (N=946)

Problem drug use Current living status –

with partner

opiates) 14,2 % 27,5 % Risk behaviour vedenje Primary drug use

daily

49,7 % 64,2 % Currently injecting (last month)

56,4 % 61,3 % Primary drug use -

age <15 years 6,2 % 8,2 % If injecting, shared past

month 11,3 % 13,5 %

Mean age of primary

drug use 18,9 18,6 Ever injected 83,8 % 72,1 %

If ever injected, ever shared

47,5 % 35,3 % First injecting age < 20

years 42,9 % 39,8 %

Source: Nolimal D., Vegnuti M., Belec M., Institute of Public Health of the Republic of Slovenia in collaboration with 16 outpatient drug treatment centres, April, 2001