01. j. wisselink - treatment demand crack trends in the ... · 1 episode 28% 2 episoden 25% >=3...

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



• 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



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



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




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




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


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



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%




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




1 episode

28%

2 episoden

25%

>=3 episodes

47%

Episodes in treatment 2012 (n=5.828)




< 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)




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



Trends CrackRegional spread

1994 2003 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



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





• 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





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





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





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)



Work in progress

• Fine tuning method

• Analysis overlap with heroïne TDI data

• Comparison with more PDU fielddata



Conclusion

• Combining Field data and institutional data

contributes to a more complete picture

• TDI data can be used for PDU estimates

Thank you for your attention

[email protected]

Thank you for your attention

[email protected]

01. j. wisselink - treatment demand crack trends in the ... · 1 episode 28% 2 episoden 25% >=3...

Documents