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 15–64 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

L'état du phénomène 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 drugs’ 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 drugs’ 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 ‘ healthy ’ way.Les abus de drogues licites et illicites posent d’importants défis en termes sociaux, économiques, de sécurité et de santé publiques. Si les conséquences néfastes pour l’individu et pour la collectivité sont nombreuses, elles peuvent en partie être réduites ou évitées par des meilleures stratégies de prévention, de promotion de la santé et d’intervention. Nos travaux de recherche portent sur l’analyse des liens entre la mortalité liée à l’usage de drogues et les inégalités socio-économiques observées au sein d’usagers de drogues illicites. Quatre études complémentaires ont été menées, dont les résultats suivants méritent d’être mis en exergue. La prévalence nationale de l’usage de drogues a connu une hausse entre 1997 et 2000 pour amorcer une tendance à la baisse depuis 2003. Toutefois, le Grand-Duché de Luxembourg, avec 6,16 usagers problématiques de drogues illicites sur 1.000 habitants âgés entre 15 et 64 ans, se place parmi les 5 Etats membres de l’Union européenne présentant les taux de prévalence les plus élevés. En matière de mortalité associée aux drogues, 1,7 et 2,2 surdoses aiguës pour 100.000 habitants ont été enregistrées respectivement en 2011 et en 2012. Une comparaison internationale montre qu’en 2000 le taux de surdose au Luxembourg était parmi les plus élevés dans l’UE, alors que depuis 2009, ce même taux se situe en dessous de la moyenne européenne. Le genre figure parmi les facteurs de risque en matière de mortalité des usagers de drogues. Nos travaux ont permis de montrer que si la charge de mortalité relative aux surdoses fatales est plus élevée chez les hommes, les femmes, victimes de surdose, affichent des profils de consommation dissemblables à ceux des hommes. La fenêtre temporelle d’intervention entre le début de l’usage de drogues et son issue fatale est plus courte chez les femmes, comparées aux hommes. Des mesures d’interventions et de détection précoce et une implication accrue des services de santé de première ligne et de gynécologie sont à préconiser pour contribuer plus efficacement à prévenir des décès prématurés liés à l’usage de drogues et à réduire les disparités de santé liées au genre. Un autre résultat majeur issu de nos travaux est qu’il existe une relation inverse entre le statut socio-économique d’usagers de drogues et la probabilité de décès par surdose. Toutefois, les facteurs et les accomplissements socio-économiques individuels présentent une valeur prédictive plus élevée que la position socio-économique parentale, laissant supposer que l’acquis social et économique propre prime sur un bagage trans-générationnel, jugé défavorisant. Une des recommandations dérivées de ces résultats est que les mesures qui visent à améliorer le niveau d’éducation et de formation professionnelle et à faciliter l’intégration socio-professionnelle d’usagers de drogues devraient, au-delà de leur objectif d’insertion sociale, venir compléter les stratégies conventionnelles de réduction de risques en vue d’accroitre leur impact en termes de promotion de la santé et, en fin de compte, sur la prévention de la mortalité associée aux drogues. Le dernier volet de notre recherche a permis de montrer que l’accumulation de désavantages socio-économiques augmente proportionnellement la probabilité de mortalité par surdose et qu’une dynamique de gradient social semble être à l’œuvre, non seulement pour la santé en général, mais également en matière de mortalité associée à l’usage de drogues illicites. Ces résultats suggèrent que toute mesure qui vise à réduire les disparités sociales peut avoir un impact positif et dynamique, qui même lorsqu’il est isolé ou ciblé, s’oppose à l’effet cumulatif négatif en termes de chances de survie d’usagers de drogues. Les stratégies de réduction des risques et dommages liés aux drogues devraient, au-delà des offres bas-seuil, inclure des mesures d’aide et d’assistance sociales, non seulement dans une optique de (ré)intégration sociale, mais également afin de réduire la mortalité liée à l’usage de drogues. Les paramètres sociaux ne doivent toutefois pas être considérés de façon isolée. Lorsque les désavantages socio-économiques s’accumulent, le risque de mortalité par surdose augmente et ce de façon graduelle. Au-delà des facteurs de risque de surdose, la notion d’inégalités sociales de santé mériterait davantage d’approfondissements en matière de mortalité liée à l‘usage de drogues illicites. Si la position sociale semble jouer un rôle primordial, il ne faut pas perdre de vue que les environnements familial, social et culturel, tout comme les contextes d’immigration et d’acculturation, également dans une optique d’inégalités de genre, contribuent aux différences observées au niveau de la mortalité liée aux drogues. Le défi futur en matière de recherche consistera à tenir compte des changements démographiques et des mutations sociétales que connaîtront les générations à venir et de la façon dont elles réussiront à partager les ressources et à distribuer la richesse de manière « saine »

Surdoses et inégalités sociales. Mieux comprendre les décès liés à l’usage de drogues pour mieux agir

Les abus de drogues posent d’importants défis en termes sociaux, économiques, de sécurité et de santé publique. Quel est le profil socio-économique des consommateurs ? Quelles sont les différentes trajectoires familiales, professionnelles et sociales d’usagers de drogues victimes de surdose fatale ? Quel est l’impact des inégalités sociales dans la survenue de surdoses impliquant des drogues illicites? Quel rôle pourrait avoir la réduction des inégalités sociales ? Quel enjeu pour les stratégies de prévention et de réduction des risques ? Un ensemble de recherches originales menées au Luxembourg, s’appuyant sur des méthodologies innovantes et une revue de littérature scientifique abondante, ont analysé les liens qui existent entre mortalités par surdose de drogues illicites et inégalités socio-économiques d’usagers suivis durant dix-huit ans. Les pistes de réflexion mises en avant dans cet ouvrage permettent de mieux saisir comment les conséquences néfastes pour l’individu, sa famille et la collectivité peuvent être en partie évitées ou réduites grâce à la mise en place de stratégies adaptées de prévention, de programmes de promotion de la santé et d’interventions psycho-socioéducatives. Cet ouvrage fournit des éléments de réflexion aux décideurs politiques, aux intervenants spécialisés en toxicomanie, aux professionnels de santé et du social pour pouvoir mieux décider et agir.Académi

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 χ² 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 – 20.278), and (licit or illicit) substance abuse of one or both parents [AOR = 2.859 (95% CI 1.250 – 6.539), p=0.013]. The greater likelihood of unmarried FOD victims to witness suicide attempts (χ²:4.573; 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