Univariable associations between a history of incarceration and HIV and HCV prevalence among people who inject drugs across 17 countries in Europe 2006 to 2020 - is the precautionary principle applicable?

BackgroundPeople who inject drugs (PWID) are frequently incarcerated, which is associated with multiple negative health outcomes.AimWe aimed to estimate the associations between a history of incarceration and prevalence of HIV and HCV infection among PWID in Europe.MethodsAggregate data from PWID recruited in drug services (excluding prison services) or elsewhere in the community were reported by 17 of 30 countries (16 per virus) collaborating in a European drug monitoring system (2006-2020; n = 52,368 HIV+/-; n = 47,268 HCV+/-). Country-specific odds ratios (OR) and prevalence ratios (PR) were calculated from country totals of HIV and HCV antibody status and self-reported life-time incarceration history, and pooled using meta-analyses. Country-specific and overall population attributable risk (PAR) were estimated using pooled PR.ResultsUnivariable HIV OR ranged between 0.73 and 6.37 (median: 2.1; pooled OR: 1.92; 95% CI: 1.52-2.42). Pooled PR was 1.66 (95% CI 1.38-1.98), giving a PAR of 25.8% (95% CI 16.7-34.0). Univariable anti-HCV OR ranged between 1.06 and 5.04 (median: 2.70; pooled OR: 2.51; 95% CI: 2.17-2.91). Pooled PR was 1.42 (95% CI: 1.28-1.58) and PAR 16.7% (95% CI: 11.8-21.7). Subgroup analyses showed differences in the OR for HCV by geographical region, with lower estimates in southern Europe.ConclusionIn univariable analysis, a history of incarceration was associated with positive HIV and HCV serostatus among PWID in Europe. Applying the precautionary principle would suggest finding alternatives to incarceration of PWID and strengthening health and social services in prison and after release ('throughcare').

Cannabis Use among People Entering Drug Treatment in Europe: A Growing Phenomenon?

This paper explores European and national trends in specialised drug treatment entry for cannabis-related problems. The analysis is based on data for the years 2003-2014 from 22 European countries. Between 2003 and 2014, the overall number and proportion of primary cannabis-related first-time entrants increased significantly. A joinpoint regression analysis indicates that the overall increase of cannabis treatment entries is continuous, although country-related differences are observed. Possible explanations for the increase and different time trends are discussed including an increase in cannabis prevalence and cannabis-related problems, changes in risk perception, increases in cannabis potency, changes in referral practices and increased availability and accessibility of treatment services.

Hepatitis C among injecting drug users is two times higher in Stockholm, Sweden than in Rotterdam, the Netherlands.

This study assessed risk behavior and preventive measures for hepatitis C among injecting drug users in Rotterdam, the Netherlands (452 participants, 2002-2003) and Stockholm, Sweden (310 participants, 2004-2006), two cities with contrasting drug policies. Uni- and multivariate logistic regression models were used. We found that the prevalence of hepatitis C was almost two times higher in participants from Stockholm than in participants from Rotterdam, even after adjustment for sex sharing paraphernalia (adjusted relative risk: 1.92, 95% confidence interval: 1.60-2.29). Follow-up comparative studies are needed to determine if policies with structured health programs can decrease transmission of hepatitis C.

Monitoring drug trends in the digital environment-New methods, challenges and the opportunities provided by automated approaches.

Developments in information technology have impacted on all areas of modern life and in particular facilitated the growth of globalisation in commerce and communication. Within the drugs area this means that both drugs discourse and drug markets have become increasingly digitally enabled. In response to this, new methods are being developed that attempt to research and monitor the digital environment. In this commentary we present three case studies of innovative approaches and related challenges to software-automated data mining of the digital environment: (i) an e-shop finder to detect e-shops offering new psychoactive substances, (ii) scraping of forum data from online discussion boards, (iii) automated sentiment analysis of discussions in online discussion boards. We conclude that the work presented brings opportunities in terms of leveraging data for developing a more timely and granular understanding of the various aspects of drug-use phenomena in the digital environment. In particular, combining the number of e-shops, discussion posts, and sentiments regarding particular substances could be used for ad hoc risk assessments as well as longitudinal drug monitoring and indicate "online popularity". The main challenges of digital data mining involve data representativity and ethical considerations.

The Experience of the Treatment Demand Indicator in Europe: A Common Monitoring Tool Across 30 Countries.

OBJECTIVE: The article describes an epidemiological indicator called Treatment Demand Indicator (TDI). The TDI aims to provide professionals and researchers with a common European methodology for collecting and reporting core data on drug users in contact with treatment services. The article discusses the implementation of the TDI in the European countries and describes the main results, limitations, and future perspectives. METHOD: The TDI provides a common format for reporting data on clients entering treatment as a result of their drug use and related problems during each calendar year. Its technical protocol defines which clients should be reported at European level and represents the minimum common set of items each national monitoring system should be able to report to the European Monitoring Centre for Drugs and Drug Addiction. RESULTS: In 2015, 29 European countries reported data on 467,811 clients entering drug treatment from 6,846 drug treatment units. Most clients were men in their 30s and had problems related to heroin or cannabis use; patterns of drug use differed geographically. Over the past decade, clients' profiles and drug use patterns changed from young heroin injectors seeking treatment to drug clients with diversified drug use patterns and profiles. CONCLUSIONS: The TDI is the largest drug dataset in Europe, and its data is increasingly used in European and national data analysis. The use of a common drug-treatment-monitoring tool across a group of countries provides a useful instrument for policymakers, professionals, and managers working in the drug treatment field.

Trends of heroin use and heroin injection epidemics in Europe: findings from the EMCDDA treatment demand indicator (TDI).

We estimate trends and geographical differences in the heroin epidemic in the European Union plus Croatia and Turkey by analyzing aggregated data on first heroin treatment admissions (cases) during 2000-2009. In 2005-2009 the proportion of drug injectors was higher in Central and Eastern European countries (CEECs) than in Western European countries (WECs), whereas the opposite occurred with mean age at first heroin use and first treatment. During this period, the number of cases, cases per center, and proportion of injectors in WECs declined, whereas mean age at first treatment and first heroin use increased. The opposite occurred in Turkey, except for proportion of injectors, while trends were less clear in the other CEECs. In the 7 WECs with data, trends in 2000-2005 and 2005-2009 were similar. This suggests that the number of recent-onset heroin users and heroin injectors may have declined some years before the study period, especially in WECs.