Long-Term Opioid Agonist Treatment Participation after First Treatment Entry is Similar across 4 European Regions but Lower in Non-Nationals

Heroin users in opioid agonist treatment (OAT) show markedly reduced heroin consumption, less crime and a lower mortality rate. However, the extent of long-term OAT participation over subsequent treatment episodes remains unclear. We analysed the annual proportion of patients in treatment (at least 1 day) since the start of first OAT in 4 European regions: Barcelona (BA) 1996-2012: 8,602 patients; Czech -Republic (CZ) 2000-2014: 4,377 patients; Netherlands (NL) 1994-2014: 33,235 patients, Zurich (ZU) 1992-2015: 11,795. We estimated the long-term decline of treatment need due to mortality or abstinence and also a "nuisance" short-term decline until the equilibrium level of cycling in and out of OAT is reached to obtain the adjusted treatment participation value. The adjusted treatment participation was around 50% (BA: 47.4-51.4%; CZ: 49.8-53.9%; NL: 52.3-54.0%; ZU: 46.4-49.3%), and the annual decline of treatment need was close to 4%. Non-nationals (NL patients with a migrant background) showed substantial lower adjusted treatment participation (rate ratio BA: 0.059-0.343; NL: 0.710-0.751; ZU: 0.681-0.797; CZ: n.a.). Our method may provide a policy-relevant indicator of long-term provision, quality and access to OAT following first treatment

Gender and regional differences in client characteristics among substance abuse treatment clients in the Europe.

Aims: To assesses the extent of the gender gap among the treated population of drug users across Europe. Methods: This analysis reports data on 363,170 clients from 4647 treatment units in 23 countries (22 European Union member states and Switzerland). Findings: Overall, males outnumber females by four, but the gender ratio varies not only by geographical region/country, but also by drug. In the majority of countries, the most common primary problem drug is opioids, and the overall gender ratio mirrors the gender ratio of opioid users. In some countries, a considerable proportion of treated drug users have cannabis and stimulants (cocaine/amphetamines/ methamphetamines) as primary problem drugs. Stimulants other than cocaine and other drugs have lower, while cannabis has a higher than overall male-to-female gender ratio. Conclusions: The very high male-to-female gender ratios may reveal differential access to treatment. Our findings highlight the need to assess access to treatment for women problem drug users and to make women-focussed programmes more available to increase the proportion of women in drug treatment programmes across Europe

A comparison of trends in wastewater‐based data and traditional epidemiological indicators of stimulant consumption in three locations

To compare long-term trends in wastewater data with other indicators of stimulant use in three locations and to test the reliability of estimates based on one week of sampling.Comparison of trends in quantities ('loads') of stimulants or their metabolites in wastewater with trends in other indicators of stimulant use (e.g. treatment, police, population survey data).Populations in Oslo (Norway), South-East Queensland (Australia) and Eindhoven (The Netherlands).Wastewater data were modelled for MDMA (3,4-Methyl​enedioxy​methamphetamine), benzoylecgonine (a metabolite of cocaine), amphetamine and methamphetamine in Oslo; benzoylecgonine in Eindhoven; and methamphetamine in South-East Queensland. Choice of stimulants modelled in each region was primarily determined by availability of useable data.In Oslo, wastewater data, driving under the influence of drugs statistics and seizure data all suggested increasing MDMA use between 2009 and 2017. In South-East Queensland, there was an estimated 31.1% (95%CI 29.4-32.9%) annual increase in daily loads of methamphetamine in wastewater between 2009 and 2016, compared with a 14.1% (95%CI 10.9-17.3%) annual increase in seizures. Some of the increase in wastewater can be explained by increased purity. In Eindhoven, there was no evidence of a change in cocaine consumption from wastewater, but a reduction was observed in numbers in treatment for cocaine use from 2012 to 2017. In approximately half the cases examined in Oslo, credible intervals around estimates of annual average loads from a regression model versus estimates based on a single week of sampling did not overlap.Long-term trends in loads of stimulants in wastewater appear to be broadly consistent with trends in other indicators of stimulant use in three locations. Wastewater data should be interpreted alongside epidemiological indicators and purity data. One week of wastewater sampling may not be sufficient for valid inference about drug consumption

Legislative History: Resolve, Regarding Legislative Review of Chapter 101: MaineCare Benefits Manual, Chapter III, Section 97, Private Non-medical Institution Services, a Major Substantive Rule of the Department of Human Services (HP1391)(LD 1867)

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