EMCDDA Joint session TDI-PDU Meeting 25 September 2013 Treatment demand crack trends in the Netherlands Jeroen Wisselink
EMCDDA Joint session TDI-PDU Meeting25 September 2013
Treatment demand crack trends in the Netherlands
Jeroen Wisselink
Overview
2Treatment demand crack trends in the
Netherlands 1994-2012
• Introduction
• Trend TD Crack 1994-2012 (Jeroen Wisselink)
• Estimating the Prevalence of Crack Dependence:
Three City study in the Netherlands (Maarten Cruyff)
• From Three City estimates to NL estimates using TDI data
• Conclusions
• Discussion
Introduction
3Treatment demand crack trends in the
Netherlands 1994-2012
• Definition
– Primary or secondary drugproblem = crack
(Registration route of administrations secondary drug since 2006)
• Underestimation:
– Crack is seldomly registered as crack but ‘found’ as cocaïne + route
of admission smoking or injecting:
– 33% cocaine route of admission is unknown
Trends CocaineNetherlands 1994-2012
4Treatment demand crack trends in the
Netherlands 1994-2012
0
2000
4000
6000
8000
10000
12000
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Trend treatment demand primary drug cocaine
by route of administration
Unknown
Sniffing
Smoking/Injecting
Trends CrackNetherlands 1994-2012
5Treatment demand crack trends in the
Netherlands 1994-2012
0
1000
2000
3000
4000
5000
6000
7000
8000
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Trend treatment demand primary or other drug crack
Trends CrackNetherlands 1994-2012
6Treatment demand crack trends in the
Netherlands 1994-2012
0
1000
2000
3000
4000
5000
6000
7000
8000
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Trend treatment demand crack and polydrug use
Singular use Primary multiple use Secundary multiple use
7Treatment demand crack trends in the
Netherlands 1994-2012
Trends CrackNetherlands 1994-2012
0%
10%
20%
30%
40%
50%
60%
70%
80%
Primary multiple use Secundary multiple use Total
Proportion Crackpatients with Opiates as other drugproblem
(n=4.908)
8Treatment demand for GHB in the Netherlands
Trends CrackNetherlands 1994-2012
0
5
10
15
20
25
30
35
40
45
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Aged distribution and mean age 1994-2012
55+
25-55
<25
Mean age
Trends CrackNetherlands
Characteristics 2012
9Treatment demand crack trends in the
Netherlands 1994-2012
Demography 2012
Number of people 5.828
Male : Female 82:18
Mean Age 41.7
Age 25- 3.2%
Age 55+ 9.1%
Percentage of native Dutch clients 55%
Number per 100,000 inhabitants 52
Characteristics
% of total in addiction care 8.8%
Substance problem Single : Multiple 16:84
% First treatment 5%
Trends CrackNetherlands 1994-2012
10Treatment demand crack trends in the
Netherlands 1994-2012
0
1000
2000
3000
4000
5000
6000
7000
8000
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
All Treatment
First Treatment
11Treatment demand crack trends in the
Netherlands 1994-2012
Trends CrackNetherlands 1994-2012
1 episode
28%
2 episoden
25%
>=3 episodes
47%
Episodes in treatment 2012 (n=5.828)
12Treatment demand crack trends in the
Netherlands 1994-2012
Trends CrackNetherlands 1994-2012
< 1 month
0%
1-3
month
0%
3-12
month
7% 1-2 yr
9%
2-3 yr
8%
>3 yr
76%
Total time in treatment 2012
(n=5.828)
3273,6
2336,5
2918,1 2968,51
0
1000
2000
3000
4000
5000
6000
Secundary
multiple use
Singular use Primary multiple
use
Total
Me
an
tota
ld
ay
sin
tre
atm
en
t
Mean total days in treatment 2012 (n=5.828)
13Treatment demand crack trends in the
Netherlands 1994-2012
Trends CrackNetherlands 1994-2012
Injection behaviour
0,0%
5,0%
10,0%
15,0%
20,0%
25,0%
0
10
20
30
40
50
60
70
80
90
100
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
20
10
20
11
20
12
Single use Crack trend Injecting
behaviour
# Last year % Last year % Last month
0%
5%
10%
15%
20%
25%
0
50
100
150
200
250
300
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
20
10
20
11
20
12
Total crack trend Injecting
behaviour
# Last year % Last year % Last month
14Treatment demand crack trends in the
Netherlands 1994-2012
Trends CrackRegional spread
1994 2003 2012
15Treatment demand crack trends in the
Netherlands 1994-2012
Trends CrackRegional spread
Estimating the Prevalence of Crack Dependence
Using Capture-Recapture with Institutional and
Field Data: A Three-City Study in the Netherlands
(Maarten Cruyff)
• Amsterdam
• Den Haag
• Rotterdam
16Treatment demand crack trends in the
Netherlands 1994-2012
Using TDI data for extrapolating
3 city estimate prevalence crack
• Method
– Selecting TDI data in same period
– Compare TDI data for 3 cities vs. rest of NL
– Using the ratio 3 Cities : Rest of NL of the TDI crack
data to extrapolate the estimation of the Field study
17Treatment demand crack trends in the
Netherlands 1994-2012
Using TDI data for extrapolating
3 city estimate prevalence crack
• 13 Institutes
• + 200 Locations
• Also in rural area’s
Assumption:
No reason to doubt threshold to treatment differs in 3 cities
in comparison with rest of NL
18Treatment demand crack trends in the
Netherlands 1994-2012
Using TDI data for extrapolating
3 city estimate prevalence crack
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
20
10
20
11
20
12
Treatment demand Crack by region
3 cities
Rest of NL
Ratio constant in time
3 cities : Rest of NL
1 : 2
19Treatment demand crack trends in the
Netherlands 1994-2012
Using TDI data for extrapolating
3 city estimate prevalence crack
Maybe other difference between 3 cities and Rest of
NL in TDI data?• Using different crack definition:
– (only primary drug vs. primary or other drug = crack)
• Extrapolation crack with cocaine route of administration unknown
Hardly influences the ratio.
3 cities: rest of NL 1 : 1.96-2.08
20Treatment demand crack trends in the
Netherlands 1994-2012
Using TDI data for extrapolating
3 city estimate prevalence crack
Assumptions:
• Threshold to treatment same in 3 cities and rest of NL
• Probability of crack being registered as cocaine unknown is the
same for 3 cities and rest of NL
Estimate crack prevalence Netherlands:
Estimate 3 City Study Mulitplier Estimate Netherlands
6.659 (5.891-7.761) 2,96-3,08 19.577 - 20.510
(17.437-23.904)
21Treatment demand crack trends in the
Netherlands 1994-2012
Work in progress
• Fine tuning method
• Analysis overlap with heroïne TDI data
• Comparison with more PDU fielddata
22Treatment demand crack trends in the
Netherlands 1994-2012
Conclusion
• Combining Field data and institutional data
contributes to a more complete picture
• TDI data can be used for PDU estimates