Increase of opioid use in Finland — when is there enough ... · Increase of opioid use in Finland — when is there enough key indicator data to state a trend? ... (as tramadol,

28.9.2015 1

Increase of opioid use in Finland —when is there enough

key indicator data to state a trend?Martta Forsell, Finnish Focal Point

Esityksen nimi / Tekijä

Martta Forsell

• Master of Social Sciences

• Senior officer in the statistical department ofInstitute of Health and Welfare

• Partly working for the Finnish Focal Point for six years

• No conflict of interest

28.9.2015 Esityksen nimi / Tekijä 2

Opioid use is increasing in Finland.

Huumehoidon Pompidou-tiedonkeruu / Martta Forsell

When is there enough key indicator data to state a trend?


Trends of opioids use in Europe






• Increasing in Finland when decreasing everywhere?




• Or is Finland 40 y or 20 years late?



Some heroin consumption in Finland only in the late 90s.


Opioid use in Finland is iv -use of buprenorphine together with other medicinal products.



• Or is Finland 40 y or 20 years late?

• Or 10 years ahead?


General population surveys (GPS) –substances used in the lifetime


1998 2002 2006 2010 2014

Heroin ormorphine

Heroin ormorphine

Heroin Heroin Heroin

Other opioids(as Subutex)

Buprenorphine Buprenorphine

Methadone Methadone

Other opioids(as tramadol, fentanyl, codein,oxicodone, morphine)

Other opioids(as tramadol, fentanyl, codein,oxicodone, morphine)

• Pekka Hakkarainen• Leena Metso • Karoliina Karjalainen

Lifetime prevalance for any opioid misuse15-64 year olds

0.30.5 0.6

1.4

1.9

0

0.5

1

1.5

2

2.5

3

1998 2002 2006 2010 2014


%

General population surveys are not supposedto detect problem drug use trends …


Problem drug use (PDU)

• Päivi Partanen (Capture-recapture)

• Jukka Ollgren (Capture-recapture)

+ Lots of experts give and explain the source data


Capture-recapture

• 2-4 sources, all independent from the KI data – Hospital discharge registry– Police registies– New Hepatits C cases

• 2012 data with Baynesian averaging

Opiod users 2012: • (Min) 12 700 - 15 100 (max)

• (Min) 0,38 % - 0,45 % (max) opiod problem users


Lifetime prevalance for any opioid misuse15-64 year olds

0.30.5 0.6

1.4

1.9

0

0.5

1

1.5

2

2.5

3

1998 2002 2006 2010 2014


%

2012 PDU

0,4%

Problem opioid users, capture-recapture

28.9.2015 20

0

0.05

0.1

0.15

0.2

0.25

0.3

0.35

0.4

0.45

0.5

1996 1998 2000 2002 2004 2006 2008 2010 2012 2014

opioidit min

opioidit max

Max Opioidit

Min OpioiditX

%

Lähde: Ollgren ym 2014; Partanen ym. 2007.


28.9.2015 21

0

0.05

0.1

0.15

0.2

0.25

0.3

0.35

0.4

0.45

0.5

1996 1998 2000 2002 2004 2006 2008 2010 2012 2014

opioidit min

opioidit max

Poly. (opioidit min)

Poly. (opioidit max)

Max Opioidit

Min OpioiditX


%

28.9.2015 22

28.9.2015 23


28.9.2015 24

0

0.05

0.1

0.15

0.2

0.25

0.3

0.35

0.4

0.45

0.5

1996 1998 2000 2002 2004 2006 2008 2010 2012 2014

opioidit min

opioidit max

Poly. (opioidit min)

Poly. (opioidit max)

Max Opioidit

Min OpioiditX


%

Trend analyse on problem drug use studies is doubious …


Treatment demand data is collected every year

Treatment demand indicator (TDI)

• Airi Partanen

• Martta Forsell

• Voluntary data collection, coverage is not known

• Includes also continuous clients


Drug clients reporting opioids use, share (%) from all reported drug clients (incl. continuous clients)

40

45

50

55

60

65

70

75

80


%

Huumehoidon tiedonkeruun kattavuutta ei tiedetä, lomakkeiden määrä vähenee


166

79

66

5 793

2 688

2 089

0

20

40

60

80

100

120

140

160

180

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

YksiköitäAsiakkaita

Yksiköitä

Asiakkaita

Paljon hoitoa (matalat indikaatiot), kiinnostava aihe

Huumehoidon tiedonkeruun kattavuutta ei tiedetä, lomakkeiden määrä vähenee


166

79

66

5 793

2 688

2 089

0

20

40

60

80

100

120

140

160

180

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

YksiköitäAsiakkaita

Yksiköitä

Asiakkaita

Hoito ja tiedon tuotanto keskittyy ’F11’ ympärille

Paljon hoitoa (matalat indikaatiot), kiinnostava aihe

Drug clients reporting opioids use, share (%) from all reported drug clients (incl. continuous clients)

40

45

50

55

60

65

70

75

80


%

In facilities specializing drugtreatment (and provide the data)

less and less treatment is givento non-opioid clients

TDI data is only on those in treatment…


Are there any absolutenumbers ?

Drug related deaths (DRD)

General mortality register – Statistics Finland

Special registry• Erkki Vuori • Ilkka Ojanperä • Pirkko Kriikku


Drug findings in post-mortem toxicogy, regardless the cause of death

- nationally- high rate

Opioid (heroin + buprenorphine+ methadone) findings in post-mortem toxicogy

0

20

40

60

80

100

120

140

160

180

200

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013


opioid use is increasing in Finland


This study may indicate that

and further monitoring is needed.

GPS prevalence


HRDU problem opioid users

TDI treatment DRD deaths

opioid use is increasing in Finland


This study may indicate that

and further monitoring is needed.

Why? How to stop this trend?

Thank you


Increase of opioid use in Finland — when is there enough ... · Increase of opioid use in Finland — when is there enough key indicator data to state a trend? ... (as tramadol,

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