Improving DRD information Multi-indicator coherence ...

Improving DRD information

Multi-indicator coherence analysis

(Introduction)

European DRD expert meeting 2018

EMCDDA, Lisbon 8-9 November 2018

Julian Vicente & Isabelle Giraudon

Rational for this work

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• Deaths caused by acute toxicity of drugs – relevant public

health problem

� 9.000 deaths in the EU in 2016

� Mainly related with opioids

• Worrying that despite all efforts

�EU numbers do not decrease and, in some countries,

continue to increase

• Considered one of Public Health priorities of EMCDDA

strategy 2025

Rational for this work (focus on opiate DRD)

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• Need of good quality DRD data to inform policies and

interventions and to monitor their progress

• DRD have an important policy/political impact

• Several countries report DRD underestimation, and is suspected

in some others

• Not yet a common approach to underestimation issues

• Existence a range of opioid indicators expected to (broadly)

correlate � gain insight in DRD… and in other indicators

Objective of the work (focus on opiate DRD)

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• This project aim to improve DRD data

• By helping to identify existence, scale and factors of

underreporting

• By combination of several opioid indicators and assessing their

consistency

• Using as benchmark opioid DRD (overdoses, poisonings, drug-

induced)

Opioid DRD among general population Annual N deaths/100000 people 15-64

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Building in previous work (best estimations) E.g. EMCDDA and Millar & McAuley (2017) / webminar PDU / DRD 2011

Source: EMCDDA and Millar & McAuley (2017

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Correlation [DRD- HROU]

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Number HROU users � (+/-) Number opioid DRD

Assuming - other factors being equal

- Protective factors (including treat + Harm R)

- Risk factors

- Correct identification and reporting DRD

Opiate DRD mortality among HROU(EU average 5.5 DRD deaths/1000 HROU)

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0.0

5.0

10.0

15.0

20.0

25.0

30.0

Rate DRD-O/1000 HROU

Example: Estimated a normal/low DRD reporting (numerator) � the denominator should be small – yes, they

have very low prevalence of HROU [0.55/1000 and 0.26/1000 - EU30 average 3.38/1000 ] 8-12 times

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0.0

5.0

10.0

15.0

20.0

25.0

30.0

Rate DRD-O/1000 HROU

National differences when

using HROU as population at risk

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• Differences may be real ----- risk/protective factors

- most HROU injectors (versus) most HROU non-injectors - (x 3-4)

- most HROU are in OST (versus) most HROU not in OST - (x 4-8)

- other factors (age, opioid used, alcohol, purity issues, risk situations –

prison release, drop out of treatment-, harm reduction)

• It may be methodological factors

It might be that HROU is outdated and/or too big- too small

It might be that DRD are overestimated/underestimated

Approach in this meeting

and (eventual) follow up

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• Multiple opioid indicators - analyse consistency

• Using DRD as benchmark

Estimate “expected” contrast with “reported”

� A consistency analysis with all countries (Julian)

� A country by country analysis (Isabelle)

� (Eventual) follow up with some countries

Approach in this meeting

and (eventual) follow up

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• Opioid indicators ------------- analyse consistency

• Using DRD as benchmark

“Expected” DRD “Reported “ DRD ?- HROU

- Risk fact

- Prot. fact

- Methods

GMR

SMR

- Methods

Approach in this meeting

and (eventual) follow up

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• Opioid indicators ------------- analyse consistency

• Using DRD as benchmark

“Expected” DRD “Reported “ DRD ?- HROU

- Risk fact

- Prot. fact

- Methods

GMR

SMR

- Methods

Approach in this meeting

and (eventual) follow up

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• Opioid indicators ------------- analyse consistency

• Using DRD as benchmark

“Expected” DRD “Reported “ DRD ?- HROU

- Risk fact

- Prot. fact

- Methods

GMR

SMR

- Methods

Session structure; Two broad components

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• Multi-indicator general model – (assumptions)

� on published data (mainly EMCDDA SB)

� following a logical interrelations (HROU – OST – TDI/IV – DRD)

� Identification of coherences – including underreporting (and

others)

• Focused analysis in a selected number of countries

� with suspected underreporting based on additional data sources or

studies (cohort-capture-recapture, additional DRD registries).

� Combination of similar indicators with national data.

emcdda.europa.eu

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julian.vicente@emcdda.europa.eu

isabelle.giraudon@emcdda.europa.eu

Thank you for your attention!

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