26 research outputs found
Prevalence of Problem Drug Use and Injecting Drug Use in Luxembourg: A Longitudinal and Methodological Perspective.
To estimate the prevalence of problem drug use (PDU) and injecting drug use (IDU) in Luxembourg and analyze trends between 1997 and 2009. To assess the feasibility
of prevalence estimations based on drug use surveillance systems. Methods: Serial multi-method PDU/IDU prevalence estimations based upon capture-recapture, Poisson
regression, multiplier and back-calculation methods. Comparative analysis of methods and assessment of their robustness to variations of external factors. Results: National PDU
and IDU prevalence rates were estimated at 6.16/1,000 (95% CI 4.62/1,000 to 7.81/1,000) and 5.68/1,000 (95% CI 4.53/1,000 to 6.85/1,000) inhabitants aged 15â64 years, respectively.
Absolute prevalence and prevalence rates of PDU increased between 1997 and 2000 and declined from 2003 onwards, whereas IDU absolute prevalence and prevalence rates witnessed an increasing trend between 1997 and 2007. Conclusions: Drug use surveillance systems can be valuable instruments for the estimation and trend analysis of drug
misuse prevalence given multiple methods are applied that rely on serial and representative data from different sources and different settings, control multiple counts and build upon standardized and sustained data collection routines. The described institutional contact indicator revealed to be a useful tool in the context of PDU/IDU prevalence estimations
and thus contributes to enhancing evidence-based drug policy planning
A hepatitis A, B, C and HIV prevalence and risk factor study in ever injecting and non-injecting drug users in Luxembourg associated with HAV and HBV immunisations
<p>Abstract</p> <p>Background</p> <p>In Luxembourg, viral hepatitis and HIV infection data in problem drug users (PDUs) are primarily based on self-reporting. Our study aimed to determine the prevalence of HAV, HBV, HCV and HIV infections in ever injecting (IDUs) and non-injecting drug users (nIDUs) including inherent risk factors analysis for IDUs. Secondary objectives were immunisation against HAV and HBV, referral to care and treatment facilities as well as reduction in risk behaviour.</p> <p>Methods</p> <p>A nationwide, cross-sectional multi-site survey, involving 5 in-, 8 out-treatment and 2 prison centres, included both an assisted questionnaire (n = 368) and serological detection of HIV and Hepatitis A, B, C (n = 334). A response rate of 31% resulted in the participation of 310 IDUs and 58 nIDUs.</p> <p>Risk factors such as drug use, sexual behaviour, imprisonment, protection and health knowledge (HAV, HBV status and immunisations, HCV, HIV), piercing/tattoo and use of social and medical services were studied by means of chi2 and logistic models.</p> <p>Results</p> <p>Seroprevalence results for IDUs were 81.3% (218/268, 95%CI=[76.6; 86.0]) for HCV, 29.1% (74/254, 95%CI=[25.5;34.7 ]) for HBV (acute/chronic infection or past cured infection), 2.5% (5/202, 95%CI=[0.3; 4.6]) for HIV-1 and 57.1% (108/189, 95%CI=[50.0; 64.1]) for HAV (cured infections or past vaccinations). Seroprevalence results for nIDUs were 19.1% (9/47, 95%CI=[7.9;30.3]) for HCV, 8.9% (4/45, 95%CI=[0.6;17.2]) for HBV (acute/chronic infection or past cured infection), 4.8% (2/42, 95%CI=[-1.7;11.3]) for HIV-1 and 65.9% (27/41, 95%CI=[51.4;80.4]) for HAV. Prisoners showed the highest rates for all infections. Age, imprisonment and setting of recruitment were statistically associated with HCV seropositivity. Age, speedball career and nationality were significantly associated with HBV seropositivity. Only 56% of the participants in outpatient centres collected their serology results and 43 doses of vaccine against HAV and/or HBV were administered.</p> <p>Conclusions</p> <p>Despite the existing national risk-reduction strategies implemented since 1993, high prevalence of HCV and HBV infections in injecting drug users is observed. Our study showed that implementing risk-prevention strategies, including immunisation remains difficult with PDUs. Improvement should be looked for by the provision of field healthcare structures providing tests with immediate results, advice, immunisation or treatment if appropriate.</p
Social and economic inequalities in fatal opioid and cocaine related overdoses in Luxembourg: A caseâcontrol study
L'état du phénomÚne de la drogue au Grand-Duché de Luxembourg rapport 2006.
The present report on the drug situation in the Grand Duchy of Luxembourg has been compiled for the European Monitoring Centre for Drugs and Drug Addiction
FROM SOCIAL INEQUALITIES TO OVERDOSE MORTALITY IN USERS OF ILLICT DRUGS
Illicit and licit drugsâ misuse poses a serious threat to the health, safety and well-being of mankind. Social and health correlates of drug misuse are numerous and many of these can be reduced or avoided by improved prevention and intervention strategies.
Our research analyses the association between socioeconomic inequalities and drug-related mortality. Four complementary studies have been conducted and the following results are to be stressed.
Absolute national prevalence and prevalence rates of problem drug users have been increasing between 1997 and 2000 and declining from 2003 onwards. Luxembourg, with 6.16 problem drug users per 1,000 inhabitants aged between 15 and 64 years, is ranking among the 5 Member states showing the highest prevalence within the EU.
In terms of drug-related mortality, 1.7 and 2.2 acute overdoses per 100,000 inhabitants have been registered nationally in 2011 and 2012, respectively. At EU level, Luxembourg stood for one of the highest fatal overdose rates in 2000, whereas in 2009 its prevalence fell below the EU average rate.
Gender revealed to be a risk factor of drug-related mortality. We showed that the burden of deaths caused by fatal overdoses on the general national mortality was significantly higher for men compared with women. However, it appeared that female overdose victims whiteness remarkably different drug use patterns and trajectories than their male peers. Also, the time window between the onset of illicit drug use and its fatal outcome revealed to be shorter for women versus men included in our study. Early intervention in female drug users, routine involvement of first line health care providers and increased attention to poly- and psychotropic prescription drugsâ use might contribute to preventing premature drug-related death and reducing gender differences.
Social and economic status of drug users impact on the occurrence of fatal overdoses. However, actual and self-referred socioeconomic characteristics of drug users may have a greater predictive value than the parental socioeconomic situation. Individual socioeconomic achievements seem to be more determinant in this context than trans-generational social status baggage. Our results suggest that measures aiming at improving educational levels, promoting vocational training and facilitating socio-professional (re)integration of drug users should, beyond their general objective of social insertion, completing conventional harm reduction strategies in order to increase their impact on public health, and eventually on the prevention of drug-related mortality.
Our final study explored the cumulative effect of socioeconomic disadvantages on the probability of dying from an overdose of illicit drugs. Results showed that the risk of fatal overdoses increases proportionally with the accumulation of socioeconomic disadvantages and that, likewise in general morbidity and mortality, a social gradient seems also to be at stake when it comes to overdose-related mortality.
These results suggest that any measure aiming at reducing social disparities may have a positive and dynamic impact that, even if isolated or targeted, counter the negative cumulative effect in terms of survival. Harm reduction services should integrate socially supportive offers, not only because of their general aim of social reintegration but crucially in order to meet their most important objective, that is to reduce drug-related mortality.
This said, social parameters should not be seen as independent determinants and even more so should the concept of social inequalities be widened when applied to drug-related mortality. Although, the social status seems to hold a major role here, family, social and societal environments, as well as migration and acculturation contexts, also with a view on gender disparities, are at play in the attempt to explain differences in terms of morbidity and mortality.
The future challenges for research will lie in the capacity to take into account the various demographical and societal mutations that next generations will experience and the way they will, or will not, succeed to share resources and distribute wealth in a â healthy â way.Les abus de drogues licites et illicites posent dâimportants dĂ©fis en termes sociaux, Ă©conomiques, de sĂ©curitĂ© et de santĂ© publiques. Si les consĂ©quences nĂ©fastes pour lâindividu et pour la collectivitĂ© sont nombreuses, elles peuvent en partie ĂȘtre rĂ©duites ou Ă©vitĂ©es par des meilleures stratĂ©gies de prĂ©vention, de promotion de la santĂ© et dâintervention.
Nos travaux de recherche portent sur lâanalyse des liens entre la mortalitĂ© liĂ©e Ă lâusage de drogues et les inĂ©galitĂ©s socio-Ă©conomiques observĂ©es au sein dâusagers de drogues illicites. Quatre Ă©tudes complĂ©mentaires ont Ă©tĂ© menĂ©es, dont les rĂ©sultats suivants mĂ©ritent dâĂȘtre mis en exergue.
La prĂ©valence nationale de lâusage de drogues a connu une hausse entre 1997 et 2000 pour amorcer une tendance Ă la baisse depuis 2003. Toutefois, le Grand-DuchĂ© de Luxembourg, avec 6,16 usagers problĂ©matiques de drogues illicites sur 1.000 habitants ĂągĂ©s entre 15 et 64 ans, se place parmi les 5 Etats membres de lâUnion europĂ©enne prĂ©sentant les taux de prĂ©valence les plus Ă©levĂ©s.
En matiĂšre de mortalitĂ© associĂ©e aux drogues, 1,7 et 2,2 surdoses aiguĂ«s pour 100.000 habitants ont Ă©tĂ© enregistrĂ©es respectivement en 2011 et en 2012. Une comparaison internationale montre quâen 2000 le taux de surdose au Luxembourg Ă©tait parmi les plus Ă©levĂ©s dans lâUE, alors que depuis 2009, ce mĂȘme taux se situe en dessous de la moyenne europĂ©enne.
Le genre figure parmi les facteurs de risque en matiĂšre de mortalitĂ© des usagers de drogues. Nos travaux ont permis de montrer que si la charge de mortalitĂ© relative aux surdoses fatales est plus Ă©levĂ©e chez les hommes, les femmes, victimes de surdose, affichent des profils de consommation dissemblables Ă ceux des hommes. La fenĂȘtre temporelle dâintervention entre le dĂ©but de lâusage de drogues et son issue fatale est plus courte chez les femmes, comparĂ©es aux hommes. Des mesures dâinterventions et de dĂ©tection prĂ©coce et une implication accrue des services de santĂ© de premiĂšre ligne et de gynĂ©cologie sont Ă prĂ©coniser pour contribuer plus efficacement Ă prĂ©venir des dĂ©cĂšs prĂ©maturĂ©s liĂ©s Ă lâusage de drogues et Ă rĂ©duire les disparitĂ©s de santĂ© liĂ©es au genre.
Un autre rĂ©sultat majeur issu de nos travaux est quâil existe une relation inverse entre le statut socio-Ă©conomique dâusagers de drogues et la probabilitĂ© de dĂ©cĂšs par surdose. Toutefois, les facteurs et les accomplissements socio-Ă©conomiques individuels prĂ©sentent une valeur prĂ©dictive plus Ă©levĂ©e que la position socio-Ă©conomique parentale, laissant supposer que lâacquis social et Ă©conomique propre prime sur un bagage trans-gĂ©nĂ©rationnel, jugĂ© dĂ©favorisant. Une des recommandations dĂ©rivĂ©es de ces rĂ©sultats est que les mesures qui visent Ă amĂ©liorer le niveau dâĂ©ducation et de formation professionnelle et Ă faciliter lâintĂ©gration socio-professionnelle dâusagers de drogues devraient, au-delĂ de leur objectif dâinsertion sociale, venir complĂ©ter les stratĂ©gies conventionnelles de rĂ©duction de risques en vue dâaccroitre leur impact en termes de promotion de la santĂ© et, en fin de compte, sur la prĂ©vention de la mortalitĂ© associĂ©e aux drogues.
Le dernier volet de notre recherche a permis de montrer que lâaccumulation de dĂ©savantages socio-Ă©conomiques augmente proportionnellement la probabilitĂ© de mortalitĂ© par surdose et quâune dynamique de gradient social semble ĂȘtre Ă lâĆuvre, non seulement pour la santĂ© en gĂ©nĂ©ral, mais Ă©galement en matiĂšre de mortalitĂ© associĂ©e Ă lâusage de drogues illicites. Ces rĂ©sultats suggĂšrent que toute mesure qui vise Ă rĂ©duire les disparitĂ©s sociales peut avoir un impact positif et dynamique, qui mĂȘme lorsquâil est isolĂ© ou ciblĂ©, sâoppose Ă lâeffet cumulatif nĂ©gatif en termes de chances de survie dâusagers de drogues. Les stratĂ©gies de rĂ©duction des risques et dommages liĂ©s aux drogues devraient, au-delĂ des offres bas-seuil, inclure des mesures dâaide et dâassistance sociales, non seulement dans une optique de (rĂ©)intĂ©gration sociale, mais Ă©galement afin de rĂ©duire la mortalitĂ© liĂ©e Ă lâusage de drogues.
Les paramĂštres sociaux ne doivent toutefois pas ĂȘtre considĂ©rĂ©s de façon isolĂ©e. Lorsque les dĂ©savantages socio-Ă©conomiques sâaccumulent, le risque de mortalitĂ© par surdose augmente et ce de façon graduelle. Au-delĂ des facteurs de risque de surdose, la notion dâinĂ©galitĂ©s sociales de santĂ© mĂ©riterait davantage dâapprofondissements en matiĂšre de mortalitĂ© liĂ©e Ă lâusage de drogues illicites. Si la position sociale semble jouer un rĂŽle primordial, il ne faut pas perdre de vue que les environnements familial, social et culturel, tout comme les contextes dâimmigration et dâacculturation, Ă©galement dans une optique dâinĂ©galitĂ©s de genre, contribuent aux diffĂ©rences observĂ©es au niveau de la mortalitĂ© liĂ©e aux drogues.
Le défi futur en matiÚre de recherche consistera à tenir compte des changements démographiques et des mutations sociétales que connaßtront les générations à venir et de la façon dont elles réussiront à partager les ressources et à distribuer la richesse de maniÚre « saine »
Grand Duchy of Luxembourg. 2009 National drug report (2008 data). New developments, trends and in-depth informatino on selected issues.
Surdoses et inĂ©galitĂ©s sociales. Mieux comprendre les dĂ©cĂšs liĂ©s Ă lâusage de drogues pour mieux agir
Les abus de drogues posent dâimportants dĂ©fis en termes sociaux, Ă©conomiques, de sĂ©curitĂ© et de santĂ© publique. Quel est le profil socio-Ă©conomique des consommateurs ? Quelles sont les diffĂ©rentes trajectoires familiales, professionnelles et sociales dâusagers de drogues victimes de surdose fatale ? Quel est lâimpact des inĂ©galitĂ©s sociales dans la survenue de surdoses impliquant des drogues illicites? Quel rĂŽle pourrait avoir la rĂ©duction des inĂ©galitĂ©s sociales ? Quel enjeu pour les stratĂ©gies de prĂ©vention et de rĂ©duction des risques ? Un ensemble de
recherches originales menĂ©es au Luxembourg, sâappuyant sur des mĂ©thodologies innovantes et une revue de littĂ©rature scientifique abondante, ont analysĂ© les liens qui existent entre mortalitĂ©s par surdose de drogues illicites et inĂ©galitĂ©s socio-Ă©conomiques dâusagers suivis durant dix-huit ans. Les pistes de rĂ©flexion mises en avant dans cet ouvrage permettent de mieux saisir comment les consĂ©quences nĂ©fastes pour lâindividu, sa famille et la collectivitĂ© peuvent ĂȘtre en partie Ă©vitĂ©es ou rĂ©duites grĂące Ă la mise en place de stratĂ©gies adaptĂ©es de prĂ©vention, de
programmes de promotion de la santĂ© et dâinterventions psycho-socioĂ©ducatives. Cet ouvrage fournit des Ă©lĂ©ments de rĂ©flexion aux dĂ©cideurs politiques, aux intervenants spĂ©cialisĂ©s en toxicomanie, aux professionnels de santĂ© et du social pour pouvoir mieux dĂ©cider et agir.AcadĂ©mi
2007 National report on the state of the drugs phenomenon by the EMCDDA National Focal Point. Grand Duchy of Luxemburg: new developments, trends and in-depth informatino on selected issues.
The report on the Drug Situation in the G. D. of Luxembourg has been prepared on behalf of the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), a decentralised agency of the European Union. It has been edited by the Luxembourgish focal point of the EMCDDA and provides an overview of current developments regarding the political and legal framework, the epidemiological situation, demand reduction interventions and selected key issues of current interest in the fields of drugs and drug addiction
Suicide attempts prior to fatal drug overdose in Luxembourg from 1994 to 2011
Educational Objectives: This study may help participants to recognize factors influencing suicidal behavior that should be assessed or monitored in the context of substance use.
Purpose: To assess the prevalence of lifetime suicide attempts in opiate and cocaine related (FOD) cases. To analyze associations between suicide attempts and socio-demographic, life and substance use profiles of FOD victims . Methods: A triangulation approach allowed to cross-examining data from national law enforcement sources, the national drug use surveillance system (RELIS) and of forensic and toxicological evidence. Bivariate statistical analysis was performed by means of Chi-square ÏÂČ tests as well as logistic regression analysis of the association between suicide attempts and selected variables. Results: Prior to death, 16.8% of FOD victims reported a single suicide attempt, 37% multiple attempts and 46.2% declared none. No associations were found between suicide attempts and the following variables: sex, age, nationality, penal past (including prison stays), educational, occupational status and income of victims, occupational status of parents and detection of psychotropic prescription drugs in post mortem toxicological analysis. After adjustment for sex and age, FOD victims who showed one or more lifetime suicide attempts were more likely to have experienced non-fatal overdoses [AOR = 5.755 (95% CI 1.633 â 20.278), and (licit or illicit) substance abuse of one or both parents [AOR = 2.859 (95% CI 1.250 â 6.539), p=0.013]. The greater likelihood of unmarried FOD victims to witness suicide attempts (ÏÂČ:4.573; p=0.032), compared with married decedents, was no longer observed after sex-age adjustment. Conclusion: Suicide attempts are frequent in fatal drug overdose victims and a strong association has been observed between the former and the frequency of non-fatal overdoses experienced by decedents included in our sample. Family contexts may be at stake when it comes to explain the likelihood of suicide attempts in victims of fatal drug overdose. The fact that substance abuse in parents was positively linked to suicide attempts in FOD victims suggest that increased attention should be paid to family histories in the prevention of drug overdoses and suicide, and the link between both. Our findings could inspire further research, building upon bigger study samples and prospective cohort designs, allowing to collecting more in-depth data on the social and family support experienced by FOD victims
Opiate and cocaine related Fatal Overdoses in Luxembourg from 1985 to 2011: a time-stratified
To describe trends in the national prevalence of fatal overdose (FOD) cases related to opiates and cocaine use between 1985 and 2011. To analyse male/female differences in FOD victims according to various time periods. Methods. A triangulation approach was chosen to cross-examining data from national law enforcement sources, the national drug use surveillance system (RELIS) and of forensic and toxicological evidence. Data have been stratified according to 3 time periods covering each 9 successive years in order to increase the visibility of long term variations and trends. Statistical analysis of male/female differences according to socio-demographic and forensic data as well as drug use trajectories was performed. Results. National FOD prevalence has been decreasing from the beginning of this century to reach a historically low rate of 1.71 cases/100,000 inhabitants in 2011. The burden of deaths caused by FOD on the general national mortality showed to be higher for men compared with women. Furthermore, the pathways towards a FOD revealed to be different for male and female victims referred to various aspects including age of decedents, criminal records, drug use trajectories, drug use patterns and the involvement of psychotropic prescription drugs.
Conclusions. The time window for intervention between the onset of drug use and its potential fatal outcome might be shorter for women compared with men. Further research should address dynamics between socio-economic status of victims and various cultural components to assess their possible impact on drug overdose induced mortality. Early intervention in female drug users and increased attention to poly and psychotropic prescription drugs use should be considered in health promotion programmes and relevant research outcomes routinely provided to first line general health care providers to accelerate access to appropriate treatment if required and eventually contribute to prevent premature death and reduce gender inequalities