Drug-related harms and treatments
This is the fourth and final post in a short series on the 2016 European Monitoring Centre on Drugs and Drug Addiction (EMCDDA) annual drugs report. This post summarises some of the report’s key findings about trends in drug-related harms and (mainly treatment) responses.
Routes into treatment
In 2014, 45 % of clients entering specialised drug treatment in Europe were either self-referred or referred by a family member, although this varied by drug (see graphic below) and by country.
Overall, a quarter of treatment entrants were referred by health services and 17 % by the criminal justice system. Intriguingly, of all treatment clients, cannabis clients were the most likely to be referred by the criminal justice system.
Although opioid use remains the main reason for people entering drug treatment across Europe, almost one third of people seeking specialist help now do so for their cannabis use.
The EMCDDA reports that the long-term decline in the number of new HIV diagnoses among injectors in the European Union continues. In 2014, the average rate of newly reported HIV diagnoses attributed to injecting drug use was 2.4 per million population, which is less than half that for 2005 (5.6 per million), although there were higher rates in a number of countries, particularly Estonia and Latvia.
In more good news, there were only 1 236 newly reported drug injection-related HIV diagnoses in the European Union in 2014, the lowest
number reported for more than a decade. Nevertheless, localised outbreaks in new HIV infections among people who inject drugs were documented in Ireland, Scotland and Luxembourg in 2015.
Changes in drug use patterns, particularly increased stimulant injection, and high levels of marginalisation have been common factors in a number of these recent HIV outbreaks.
The health challenges of new psychoactive substances
New substances have been associated with a range of serious harms in Europe including acute poisonings and deaths. There are also harms associated with patterns of drug injection, in particular with stimulants such as mephedrone, alpha-PVP, MDPV and pentedrone.
Mass poisonings, although rare, can place heavy demands on healthcare systems. In one such incident, reported in Poland in 2015, synthetic cannabinoids were linked to over 200 hospital emergency presentations in less than a week. Regular readers will be aware that emergency admissions of prisoners related to their use of Spice and other forms of synthetic cannabis are increasingly common in England and Wales.
Since early 2014, serious harms associated with the use of a new substance have led to 34 public health alerts being issued by the EMCDDA to members of the EU Early Warning System. Over this period, seven new substances were risk-assessed. Most recently, concerns have arisen around new opioids such as acetylfentanyl, which has been associated with 32 deaths. Many fentanyls (the drug on which Prince fatally overdosed) are highly potent, and may be sold as heroin to unsuspecting users, thus posing a high risk of overdose and death.
Increases in overdose deaths
In Europe, drug overdose continues to be the main cause of death among drug users, and over three-quarters of overdose victims are male (78 %). Most EU countries reported an increasing trend in overdose deaths from 2003 until around 2008/09, when overall levels first began to decline.
However in 2014 it is estimated that at least 6 800 overdose deaths occurred in the European Union. This represents an increase from the revised 2013 figure and, as in previous years, the United Kingdom (36 %) and Germany (15 %) together account for a large part of the total.
Dispiritingly, increases are evident in the most recent data from a number of countries with relatively robust reporting systems, including Ireland, Lithuania and the United Kingdom. There may also be upward trends in Sweden and Turkey.
The report includes a chilling statistic which indicates the true risks of opioid use with European users 5-10 times more likely to die than their peers.