Heroin Trends in SwitzerlandEtienne Maffli, Addiction Switzerland, Lausanne

The Treatment Demand Indicator (TDI) 12th

Annual Expert Meeting, Lisbon, sept. 20-21 2012

Background Switzerland

• Confederation including 26 micro states

• Highly decentralised structure in health supply

• National data collection challenging

• Data quality problems regarding participation

and conformity with standards

• Data triangulation from different data sources

useful for assessing trends

Data sources available for assessing heroin trends

• General population surveys

• School surveys

• Mortality data

• Police data

• Treatment monitoring data

Results from general population surveys:

Lifetime prevalence of heroin use among 15-24

old residents

ESS 1992-2007: n (15-24 y.) between 1410 and 1801 (non weighted); percentages based on less

than 30 cases are displayed in brackets; values based on less than 10 cases are not displayed,

according to the rules of the SFS0. CoRolAR 2011: n (15-24 y.) = 3334 (non weighted)

Results from the HBSC school survey:

Lifetime prevalence of opiate use* among

male and female pupils aged 15

0,7% 0,8% 0,7%1,1%

0,6%0,9%

0,1%

0,9%

0,1%1,0% 0,8% 0,7%0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

10%

1986 1994 1998 2002 2006 2010

boys

girls

HBSC 1986-2010: n (15 y.): boys: between 533-1591; girls: between 625-1602

*Question: did you take at least once following substances? …heroin, opium…

Results from mortality register:

Drug-related deaths* (numbers by age 1995-2009)

* ICD-10: F11-F129 F14-F169 F19-F199 X42-X429 X62-X629 Y12-Y129

No single diagnose trends due to changing rules in managing diagnoses

1995

1997

1999

2001

2003

2005

2007

2009

0

20

40

60

80

100

120

Total: 171

Total: 376

0

20

40

60

80

100

120

2009

1995

Results from police data:

Heroin-related reports (numbers 1990-2011)

0

5 000

10 000

15 000

20 000

25 000

for use

* * *

* Including also other opiates than heroinSource: Swiss Federal Statistical Office

Results from treatment monitoring act-info:

Share of primary drugs (1997-2010)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Cannabis

Cocaine

Opiates

Participating facilities without heroin prescription and gp’s

Other drugs considered, but not displayed (range all others drugs: 5.4%-10.9%)

Results from treatment monitoring act-info:

Share of new clients (opiates clients 2004-2010)

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

2004 2005 2006 2007 2008 2009 2010

males

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

2004 2005 2006 2007 2008 2009 2010

females

n (males): 505-712 n (females): 164-234

Results from treatment monitoring act-info:

Age at admission (opiates clients 2004-2010)

2004

2006

2008

2010

0%

5%

10%

15%

20%

25%

30%

<15 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 >74

0%

5%

10%

15%

20%

25%

30%

2004

2010

30

32

34

36

2004 2005 2006 2007 2008 2009 2010

mean agen ranging between 1747 and 2641

Results from treatment monitoring act-info:

Injecting past 6 months (opiates clients 2004-2010)

0%

10%

20%

30%

40%

50%

60%

70%

2004 2005 2006 2007 2008 2009 2010

males

females

Total valid n ranging between 534 and 795

Conclusions

• Comprehensive approach helps understanding the situation and prevents for premature statements

• Results suggest lowering attraction for heroin till about 2002 after a peak in the early 90s

• Since 2002, no clear trend can be identified regarding incidence (stagnation)

• Injecting still common among heroin users

• Aging cohort of users having started during the peak (around 1990) can be traced

• Estimating numbers and not only tendencies seem still challenging in the current Swiss data landscape