Gerhard Bühringer 1,3 Michael Farrell 2, Ludwig Kraus 1, John Marsden 2, Tim Pfeiffer-Gerschel 1, Daniela Piontek 1, Krystallia Karachaliou 1, Jutta Künzel.

Gerhard Bühringer1,3 Michael Farrell2, Ludwig Kraus1, John Marsden2, Tim Pfeiffer-Gerschel1, Daniela Piontek1,

Krystallia Karachaliou1, Jutta Künzel1, Garry Stillwell2

1 IFT Institut für Therapieforschung, München 2 National Addiction Centre, London 3 Technische Universität, Dresden

Emerging drug use related research needs: claims, realities, needs, deficits and visions ...

Identifying Europe's information needs for effective drug policyEMCDDA, 6-8 May 2009, Lisbon

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1. Between claims and reality in Europe1.1 Claims

“To make the EU the most dynamic and competitive knowledge-based economy by 2010” (Lisbon Strategy, 2000)

• Research and development policy is one of the EU priorities to boost employment and growth and to maintain its social model

• Increasing Healthy Life Years is vital

• “Well-designed social and environmental policies are themselves key elements in strengthening Europe's economic performance“ (European Parliament, 2005)

“ Information, research and evaluation are key elements of an overall EU drug policy“ (EU Drugs Strategy, 2005-2012)

• Better understanding of the drug problem and the development of an optimal response

• Improving the understanding of the drug problem “through more and better coordinated research” (EU Council, 2008)

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1. Between claims and reality in Europe1.2 Reality I: Drug use in Europe

Drug use (DU; past month)• 12 million cannabis users (3.6%)• 1.5 million opioid users (0.4%)• 1.5 million cocaine users (0.4%)

Drug-related infectious diseases• 40 % of IDUs are Hepatitis C infected

Drug-induced deaths• between 6,500 and 8,500 (minimum estimate!)

Treatment demand• 360,000 cases in various types of care

Drug-related public expenditure• EUR 34 billion• 0.3% of combined GDP of all EU Member States

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1. Between claims and reality in Europe1.3 Reality II: Low prominence of European DU research

Author affiliation 2004-2007 in the journal “Drug and Alcohol Dependence”

(pp: population size)2

USA, 73%

Selected MS (4), 13%

Australia, 10%

Canada, 4%

pp: 53%

pp: 38%

pp: 4%

pp: 6%

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1 Germany, Italy, Netherlands, UK, 2 Ritter, 2008, pers. com.; modified

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1. Between claims and reality in Europe 1.4 Reality III: Stakeholders for DU research and monitoring

MS 1 MS 27MS 2

Responsible for research, transfer and health/social service for DU

Differences in • problem situation indicators• problem views• research structures • research priorities• funding structures

• research programmes• research budgets• research utilisation • publication languages• access to research outcome

„Drugs prevention and information“ programme (2007 – 2013)

“Second Programme of Community action in the field of health” (2008 – 2013)

Framework 7 Progr. (2007 – 2013), „Health“ as major theme

EMCDDAMonitoring DU and

European responses

DG JLS DG Sanco DG RTDComplimentary

role (“added value”)

MS 26

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1. Between claims and reality in Europe 1.5 The core questions

Will the current structure, with the given complex system of interests and responsibilities, lead Europe to the top of DU related research in the world?

Will the current structure guarantee research activities to provide the knowledge base needed for a fully informed and evidence based drug policy all over Europe?

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2. Needs for Europe: research activities and research management

2.1 Research

Questions

Time/Age

Reduction/Cessation

Vulnerability- and risk factors (examples)

Reduction/cessation• Patient factors• Social context

factors• Treatment factors

Acute risk factors• Person factors• Family conditions• Social environment• Cultural factors

Early vulnerability• Genetic factors• Personality factors• Childhood trauma

Why do some DU stop without formal interventions, others not?What is the role of social context factors?Why do some people abstain after treatment, others not?

Why do some people start DU and others not?Why do some people stop after experimental use and others not?Why do MS differ in DU incidence and prevalence?

Onset experimental use regular DU severe chronic DU

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2. Needs for Europe: research activities and research management

2.1 Research (continued)

Targets

Research areas

• To reduce rates of onset and progression• To delay age of onset and progression• To early detect and terminate DU• To reduce negative individual and social consequences

Understanding drug use

Demand reduction

Supply reduction Policy analysis

Basic research

Epide-miology

Preven-tion

Treat-ment

Drug supply

Interdic-tion

Policy Legal Frame works

Disciplines• Range of natural and social sciences • Need for interdiscplinarity

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2. Needs for Europe: research activities and research management

2.2 Research management

An effective management of DU related research in Europe has to be based on:

(1) Monitoring of DU indicators and related vulnerability and risk factors(2) Regular analysis of DU problems and related research needs(3) Priorisation of research activities(4) Funding programmes and structures(5) Research outcome analysis and evaluation(6) Transfer into practice (implementation and evaluation)(7) Fast feedback to all system components: “adaptive learning system”

(8) Financial resources (9) Scientific and management resources for planning, implementation, monitoring and evaluation

Need for a more structured process to prioritize, monitor and analyse research activities and research outcome between MS, EC and scientific community?

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3. Deficits3.1 Research fields

Topics for improvement• Understanding drug use: risk and protective factors,

mechanisms of action, long-term studies on onset and course of DU

• Demand reduction: prevention• Supply reduction: law enforcement evaluation• Policy analysis: effects and efficiency of public policies• General: Cooperation of medical and social sciences

Source: e.g., EMCDDA Selected Issues on Research, 2008; EC, 2007

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3. Deficits3.2 Research infrastructure

Topics for improvement• Qualified research staff• (Interdisciplinary) research networks in MS• European research networks• Sustained funding of networks• European scientific community• European research organisations• Involvement of the scientific community in the analysis of

research needs

Source: e.g., EMCDDA Selected Issues on Research, 2008; EC, 2007

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Topics for improvement• Linkage of drug action plans and research planning• Coordinated research prioritisation between public authorities

and scientific community in MS• Systematic analysis of research outcome, in order to adapt drug

policy and future research needs• Linkage of research outcome and MS drug policy and vice

versa• Coordination of MS and EC research programmes• Lack of continuity of funding• Research funding beyond epidemiology and monitoring (some

new MS)

Source: e.g., EMCDDA Selected Issues on Research, 2008; EC, 2007

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3. Deficits3.3 Research management

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4. A 2020 vision for Europe to take the lead in DU related research

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Yes, we can! (and want?)

(1) A commitment of MS, EC and scientific community for a comprehensive research initiative

Who cares for what?

(2) An agreement of MS and EC on DU problem analyses, targets, research priorities and budgets

(3) Coordinated research funding programmes at MS and EC level

Specialists to the front

(4) A process of constant analysis and adaption of research needs/priorities based on research outcome analyses and evaluations of new challenges

Scientists of Europe, unite!

(5) A European research society and European scientific community

Money makes the world go round!

(6) Financial resourcesFor research fundingFor research capacity buildingFor research outcome transfer and evaluation