European questionnaire on drug use among prisoners (EQDP).

This is the final version of the questionnaire on drug use among prisoners at European level. The questionnaire is the results of several years of work in the field of drugs and prison, which has included the agreement on a methodological framework or monitoring drug and prison in Europe, the analysis of existing questionnaires and a discussion among high level experts from several European countries and international organizations. Table of contents: • General information • Substance use outside and inside prison • Substance injecting and other health risk behaviours • Health status • Use of health and addiction service

Incarceration history and risk of HIV and hepatitis C virus acquisition among people who inject drugs: a systematic review and meta-analysis

Background People who inject drugs (PWID) experience a high prevalence of incarceration and might be at high risk of HIV and hepatitis C virus (HCV) infection during or after incarceration. We aimed to assess whether incarceration history elevates HIV or HCV acquisition risk among PWID. Methods In this systematic review and meta-analysis, we searched MEDLINE, Embase, and PsycINFO databases for studies in any language published from Jan 1, 2000 until June 13, 2017 assessing HIV or HCV incidence among PWID. We included studies that measured HIV or HCV incidence among community-recruited PWID. We included only studies reporting original results and excluded studies that evaluated incident infections by self-report. We contacted authors of cohort studies that met the inclusion or exclusion criteria, but that did not report on the outcomes of interest, to request data. We extracted and pooled data from the included studies using random-effects meta-analyses to quantify the associations between recent (past 3, 6, or 12 months or since last follow-up) or past incarceration and HIV or HCV acquisition (primary infection or reinfection) risk among PWID. We assessed the risk of bias of included studies using the Newcastle-Ottawa Scale. Between-study heterogeneity was evaluated using the I2 statistic and the P-value for heterogeneity. Findings We included published results from 20 studies and unpublished results from 21 studies. These studies originated from Australasia, western and eastern Europe, North and Latin America, and east and southeast Asia. Recent incarceration was associated with an 81% (relative risk [RR] 1·81, 95% CI 1·40–2·34) increase in HIV acquisition risk, with moderate heterogeneity between studies (I2=63·5%; p=0·001), and a 62% (RR 1·62, 95% CI 1·28–2·05) increase in HCV acquisition risk, also with moderate heterogeneity between studies (I2=57·3%; p=0·002). Past incarceration was associated with a 25% increase in HIV (RR 1·25, 95% CI 0·94–1·65) and a 21% increase in HCV (1·21, 1·02–1·43) acquisition risk. Interpretation Incarceration is associated with substantial short-term increases in HIV and HCV acquisition risk among PWID and could be a significant driver of HCV and HIV transmission among PWID. These findings support the need for developing novel interventions to minimise the risk of HCV and HIV acquisition, including addressing structural risks associated with drug laws and excessive incarceration of PWID

Model projections on the impact of HCV treatment in the prevention of HCV transmission among people who inject drugs in Europe"

Prevention of hepatitis C virus (HCV) transmission among people who inject drugs (PWID) is critical for eliminating HCV in Europe. We estimated the impact of current and scaled-up HCV treatment with and without scaling up opioid substitution therapy (OST) and needle and syringe programmes (NSPs) across Europe over the next 10 years. We collected data on PWID HCV treatment rates, PWID prevalence, HCV prevalence, OST, and NSP coverage from 11 European settings. We parameterised an HCV transmission model to setting-specific data that project chronic HCV prevalence and incidence among PWID. At baseline, chronic HCV prevalence varied from <25% (Slovenia/Czech Republic) to >55% (Finland/Sweden), and <2% (Amsterdam/Hamburg/Norway/Denmark/Sweden) to 5% (Slovenia/Czech Republic) of chronically infected PWID were treated annually. The current treatment rates using new direct-acting antivirals (DAAs) may achieve observable reductions in chronic prevalence (38-63%) in 10 years in Czech Republic, Slovenia, and Amsterdam. Doubling the HCV treatment rates will reduce prevalence in other sites (12-24%; Belgium/Denmark/Hamburg/Norway/Scotland), but is unlikely to reduce prevalence in Sweden and Finland. Scaling-up OST and NSP to 80% coverage with current treatment rates using DAAs could achieve observable reductions in HCV prevalence (18-79%) in all sites. Using DAAs, Slovenia and Amsterdam are projected to reduce incidence to 2 per 100 person years or less in 10 years. Moderate to substantial increases in the current treatment rates are required to achieve the same impact elsewhere, from 1.4 to 3 times (Czech Republic and France), 5-17 times (France, Scotland, Hamburg, Norway, Denmark, Belgium, and Sweden), to 200 times (Finland). Scaling-up OST and NSP coverage to 80% in all sites reduces treatment scale-up needed by 20-80%. The scale-up of HCV treatment and other interventions is needed in most settings to minimise HCV transmission among PWID in Europe. Measuring the amount of HCV in the population of PWID is uncertain. To reduce HCV infection to minimal levels in Europe will require scale-up of both HCV treatment and other interventions that reduce injecting risk (especially OST and provision of sterile injecting equipment

Cannabis Decriminalization and the Age of Onset of Cannabis Use

This paper examines the effect of a change in drugs policy on the age of onset of cannabis use. We use 2012 survey data from the Czech Republic where in 2010 a law was introduced decriminalizing personal possession of small quantities of several illicit drugs, including cannabis. We estimate the effect of the policy change using a mixed proportional hazards framework that models the starting rate of cannabis use, i.e. the transition to first cannabis use. We find that the decriminalization of cannabis did not affect the age of onset of cannabis use

Annual report: the Czech Republic 2006 drug situation.

Commissioned each year by the EMCCDA and produced by the national focal points of the Reitox network, the National reports draw an overall picture of the drug phenomenon at national level in each EU Member State. These data are key information to the EMCCDA and are an important resource, among others, for the compilation of its Annual report

Hospitalization of children after prenatal exposure to opioid maintenance therapy during pregnancy: a national registry study from the Czech Republic

Background and Aims Our understanding of the long‐term safety of prenatal exposure to opioid maintenance treatment (OMT) is insufficient. We compared childhood morbidity (0–3 years) between OMT‐exposed and relevant comparison groups. Design Nation‐wide, registry‐based cohort study. Registries on reproductive health, addiction treatment, hospitalization and death were linked using identification numbers. Setting The Czech Republic (2000–14). Participants Children with different prenatal exposure: (i) mother in OMT during pregnancy (OMT; n = 218), (ii) mother discontinued OMT before pregnancy (OMT‐D; n = 55), (iii) mother with opioid use disorder, but not in OMT during pregnancy (OUD; n = 85) and (iv) mother in the general population (GP) (n = 1 238 452) Measurements Episodes of hospitalization were observed as outcomes. Information on in‐patient contacts, length of stay and diagnoses (International Classification of Diseases version 10) were assessed. Binary logistic regressions were conducted to estimate the associations between OMT exposure and the outcomes, crude and adjusted for the socio‐economic status and smoking. Findings No significant differences were found in the overall proportion of hospitalization among OMT‐exposed children, children of OMT‐D and children of women with OUD [54.1%, 95% confidence interval (CI) = 47.3–60.1%; 47.3%, 95% CI = 33.9–61.1%; 51.8%, 95% CI = 40.7%–62.6%], while the proportion was significantly lower (35.8%, 95% CI = 35.7–35.8%) in the GP. There were no significant differences in risk of specific diagnoses between OMT‐exposed children, children of OMT‐D and children of women with OUD. In the adjusted analyses, differences between OMT‐exposed and children in the GP were still present for infections and parasitic diseases (OR = 2.0, 95% CI = 1.4–2.7), diseases of the digestive system (OR = 1.7, 95% CI = 1.2–2.6) and diseases of the skin and subcutaneous tissue (OR = 1.9, 95% CI = 1.2–3.2). Conclusion This study did not find clear evidence for an increase in risk of morbidity during the first 3 years of life in children with prenatal opioid maintenance treatment exposure compared with children of women who discontinued such treatment before pregnancy or suffered from opioid use disorder without this treatment. Compared the general population, there appears to be an increased risk of hospitalizations for infectious, gastrointestinal and skin diseases

Annual report: the Czech Republic 2008 drug situation.

Commissioned each year by the EMCCDA and produced by the national focal points of the Reitox network, the National reports draw an overall picture of the drug phenomenon at national level in each EU Member State. These data are key information to the EMCCDA and are an important resource, among others, for the compilation of its Annual report