A multi-state model to estimate incidence of heroin use

Background: Existing incidence estimates of heroin use are usually based on one information source. This study aims to incorporate more sources to estimate heroin use incidence trends in Spain between 1971 and 2005. Methods: A multi-state model was constructed, whereby the initial state "heroin consumer" is followed by transition to either "admitted to first treatment" or to "left heroin use" (i.e. permanent cessation or death). Heroin use incidence and probabilities of entering first treatment ever were estimated following a back-calculation approach. Results: The highest heroin use incidence rates in Spain, around 1.5 per 1,000 inhabitants aged 10-44, occurred between 1985 and 1990; subdividing by route of administration reveals higher incidences of injection between 1980 and 1985 (a mean of 0.62 per 1.000) and a peak for non-injectors in 1990 (0.867 per 1,000). Conclusions: A simple conceptual model for heroin users' trajectories related to treatment admission, provided a broader view of the historical trend of heroin use incidence in Spain

Majority and minority

-I denne rapporten presenteres resultater fra en stor kartlegging av skoleelever i 16 kommuner utenfor storbyene. Størrelsen på materialet gjorde at det ble mulig å analysere alkoholbruk og ulike faktorer knyttet opp til alkoholbruk også blant minoriteter. Rapporten beskriver tre grupper med forskjellig bakgrunn: ungdom med to foreldre født i vestlig land (N=19460), ungdom med to foreldre født i ikke-vestlige land og som ikke oppga å være muslimer (N=244), og ungdom som oppga å være muslimer uavhengig av foreldrenes fødeland (N=241). Det var store forskjeller i hvor ofte ungdom fra de tre gruppene drakk alkohol. Ungdom med vestlig bakgrunn drakk hyppigere enn de to andre gruppene, og 61 % i denne gruppen rapporterte å ha drukket alkohol siste år. I gruppen med ungdom med ikke-vestlig bakgrunn var det 55 % som har drukket alkohol siste år, og i gruppen med muslimer var det 32 % som rapporterte dette. Spesielt muslimske jenter drakk sjelden. Det var også klare forskjeller om ungdom rapporterte at de hadde drukket alkohol slik at de ble beruset. 47 % av de med vestlig bakgrunn, 34 % av de med ikke- vestlig bakgrunn og 22 % av muslimsk ungdom rapporterte at de noen gang hadde vært beruset. Lavest alkoholbruk blant ungdom med muslimsk bakgrunn og høyest blant vestlige tilsvarer situasjonen i Oslo. Ungdom er fortsatt sterkt knyttet til og avhengig av foreldre eller andre omsorgspersoner, og en rekke forhold ved familien har vist seg å være knyttet til ungdommers alkoholbruk Vi fant at de aller fleste, uansett bakgrunn, rapporterte om interesserte foreldre som involverte seg i både skole og fritid, brukte tid på ungdommen, og som både forstod dem og var glade i dem. I alle gruppene fant vi at jo høyere foreldrenes alkoholbruk var og jo mer liberale holdninger til alkohol de hadde, jo mer drakk ungdommene. Ungdom med ikke-vestlig eller muslimsk bakgrunn rapporterte om lavere bruk og strengere holdninger til alkohol hos foreldrene enn ungdom med vestlig bakgrunn. Den hyppigst rapporterte måten å skaffe seg alkohol på var å kjøpe eller få av andre over 18 år. Blant ungdomskoleelever var det vanligst å ta eller stjele alkohol hjemme. Det var få forskjeller i hvordan ungdom med ulik bakgrunn skaffet seg alkohol. En forskjell var at muslimsk ungdom i mindre grad skaffet seg alkohol hjemme.This report presents results from a large survey among students mainly 14-19 years old living in municipalities outside big cities. Due to the size of the survey it was possible to analyses alcohol use and its consequences even in minority populations with non-western background. Three groups were studied: students with two western born parents, mainly Norwegian, (N=19460), students with two parents born in non-western countries and who were not Muslim (N=244), and students who reported to be Muslim, regardless of parent’s birthplace (N=241). There were large variations in alcohol use in the three groups. Students with western background drank more frequently than youth in the two other groups and 61 % reported to have drunk alcohol last year. Among non-western/non-Muslim 55 % had drunk alcohol last year while the figure for Muslims was 32 %. Muslim girls reported very low levels of alcohol use. Drinking to intoxication was also more common among westerners, 47 % reported such behaviour ever while comparable figures for non-western were 34 % and for Muslims 22 %. This is in accordance with studies in big cities. The students in the age group studied are still attached to their parents and dependent on their care and support. Many family related conditions have been shown to be associated with alcohol use among adolescents. In this study most students, regardless of background, reported about parents who where interested in what they were doing, both in school and during leisure time. Parents spent time with them, understood and loved them. Students drank more alcohol the more their parents drank and the more liberal parents were regarding alcohol use in all three groups. Students with non-western and Muslim background reported lower levels of use and more strict attitudes regarding alcohol use than youth with western background. The most common way of getting access to alcohol for the students was to get it or buy it from persons older than 18 years. Among 14-16 years olds the most common access was to pinch alcohol at home. There was no major difference between groups in how they accessed alcohol. Regardless of background, the majority meant that use of narcotics/drugs constituted a larger problem than use of alcohol, a misconception regarding the situation in Norway

A multi-state model to estimate incidence of heroin use

Background Existing incidence estimates of heroin use are usually based on one information source. This study aims to incorporate more sources to estimate heroin use incidence trends in Spain between 1971 and 2005. Methods A multi-state model was constructed, whereby the initial state “heroin consumer” is followed by transition to either “admitted to first treatment” or to “left heroin use” (i.e. permanent cessation or death). Heroin use incidence and probabilities of entering first treatment ever were estimated following a back-calculation approach. Results The highest heroin use incidence rates in Spain, around 1.5 per 1,000 inhabitants aged 10–44, occurred between 1985 and 1990; subdividing by route of administration reveals higher incidences of injection between 1980 and 1985 (a mean of 0.62 per 1.000) and a peak for non-injectors in 1990 (0.867 per 1,000). Conclusions A simple conceptual model for heroin users’ trajectories related to treatment admission, provided a broader view of the historical trend of heroin use incidence in Spain

Estimation of cocaine consumption in the community: a critical comparison of the results from three complimentary techniques

Objectives: A range of approaches are now available to estimate the level of drug use in the community so it is desirable to critically compare results from the differing techniques. This paper presents a comparison of the results from three methods for estimating the level of cocaine use in the general population. Design: The comparison applies to; a set of regionalscale sample survey questionnaires, a representative sample survey on drug use among drivers and an analysis of the quantity of cocaine-related metabolites in sewage. Setting: 14 438 participants provided data for the set of regional-scale sample survey questionnaires; 2341 drivers provided oral-fluid samples and untreated sewage from 570 000 people was analysed for biomarkers of cocaine use. All data were collected in Oslo, Norway. Results: 0.70 (0.36-1.03) % of drivers tested positive for cocaine use which suggest a prevalence that is higher than the 0.22 (0.13-0.30) % ( per day) figure derived from regional-scale survey questionnaires, but the degree to which cocaine consumption in the driver population follows the general population is an unanswered question. Despite the comparatively lowprevalence figure the survey questionnaires did provide estimates of the volume of consumption that are comparable with the amount of cocaine-related metabolites in sewage. Per-user consumption estimates are however highlighted as a significant source of uncertainty as little or no data on the quantities consumed by individuals are available, and much of the existing data are contradictory. Conclusions: The comparison carried out in the present study can provide an excellent means of checking the quality and accuracy of the three measurement techniques because they each approach the problem from a different viewpoint. Together the three complimentary techniques provide a wellbalanced assessment of the drug-use situation in a given community and identify areas where more research is needed

sj-docx-1-nad-10.1177_14550725231195413 - Supplemental material for No decline in drug overdose deaths in Norway: An ecological approach to understanding at-risk groups and the impact of interventions

Supplemental material, sj-docx-1-nad-10.1177_14550725231195413 for No decline in drug overdose deaths in Norway: An ecological approach to understanding at-risk groups and the impact of interventions by Ellen J Amundsen, Anne-Karine M Melsom, Bjørn O Eriksen and Maja-Lisa Løchen in Nordic Studies on Alcohol and Drugs</p