The social epidemiology of alcohol and drug use among Israeli school-aged children: Recent developments and current challenges Prof. Yossi Harel-Fisch Chief Scientist Israel Anti-Drug Authority (IADA) & Director, International Research Program on Adolescent Well-Being and Health, School of Education, Bar Ilan University, Israel Presentation at the MedSPAD Round Table, LISBON ADDICTION, 24-26 October, 2017

Population surveys: Children and youth Every two years IADA conducts a school-based survey of a national representative sample of about 15,000 students ages 11-17 ( grades 6th-12th). The survey is based on: The World Health Organization - Health Behavior in School-aged Children (WHO-HBSC) School-based Survey The European School Survey Project on Alcohol and other Drugs (ESPAD) Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017 www.hbsc.biu.ac.il Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

Develop evidence-based policy Learn from success Using HBSC-ESPAD Develop evidence-based policy Learn from success Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

Recent developments in Israel Israel traditionally has been a relatively low-rate substance-use country However, during the past several years, Israel has experienced significant changes in three areas related to psychoactive substances: Problem drinking Cannabis use Emerging NPS Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

Alcohol “Binge Drinking” Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017 Binge drinking: Percent of 6th, 8th and 10th grade Israeli students who drank five or more alcohol drinks during one occasion at least once during the past 30 days: by gender and survey year Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017 ד"ר יוסי הראל-פיש - ממצאים HBSC 1994-2007

Children 11 years old – weekly drinking Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017 ד"ר יוסי הראל-פיש - ממצאים HBSC 1994-2007

The national strategy to reduce the problem of alcohol: 2010-2016 Implementing a comprehensive national strategy Building partnerships with relevant agencies Developing consistent and coherent messages Implementing effective national media campaign Developing, passing and enforcing new legislation Implementing a wide variety of school-based programs Implementing comprehensive community-based intervention strategies at the local settings Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

Binge drinking: Percent of 6th, 8th and 10th grade Israeli students who drank five or more alcohol drinks during one occasion at least once during the past 30 days: by gender and survey year Findings show: Significant increase of binge drinking rates from 6.5% in 1994 to over 20% in 2009. However, from the implementation of the national alcohol strategy in January 2010 and till the end of 2011 – findings show a significant decrease in rates from over 20% in 2009 to 10.7% in 2014. These trends are similar for both genders. Yossi Harel-Fisch, PhD Chief Scientist, Israeli Anti-Drugs Authority The period prior to the implementation of a national alcohol strategy 1994 - 2009 Implementation of the national Alcohol strategy - 2010-2011 Data source: HBSC-Israel, 1994-2014 Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017 ד"ר יוסי הראל-פיש - ממצאים HBSC 1994-2007

Percent of 11, 13 and 15 years old adolescents who got drunk at least once during the past 12 months, by country Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

Use of Canabis )Marijuana, Hashish, Grass) Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

Cannabis related developments in Israel during the past 4-5 years Medicalization, Legalization, De-criminalization Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017 The unintended consequences of these developments where: Decline in the perception of risk followed by an increase in the rates of Cannabis use Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017 Use of Cannabis: Percent of students grades 10th-12th who ever used Cannabis : by gender and year of survey Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017 Percent of 10th grade students (age 15) who used cannabis at least once during the past 12 months: by country - HBSC 2014 Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017 Use of Cannabis by adults NESDA – Adults 18-65 years of age December 2016 Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

Dramatic increase in reported cannabis use Percent of Israeli adults 18-40 who used cannabis at least once during the past 30 days Trends: 1998-2016 Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017 Dramatic increase in reported cannabis use Adults 18-40 years of age, Israel 2009 – 2016 Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017 In sum The push for MM use and the public debate regarding legalization have resulted in a dramatic increase in cannabis use among the Israeli population. Israel has moved from a low-rate to a high-rate country. The new situation creates a challenge to adapt new prevention, education and treatment strategies accordingly. An evaluation research system, is being developed, including the implementation of the various GPS annually. The Israeli experience might be valuable for other low-rate countries who are undergoing similar public debates regarding MM and legalization. Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

need to take responsibility Youth and young adults need to take responsibility To learn how to influence fun instead of seeking fun under the influence Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017 Thank you!!! Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

New Psychoactive Substances Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

Synthetic Cannabinoids שמור Synthetic Cannabinoids Sold in Israel under different nicknames such as: "Mabsuton", "Mr. Nice Guy", "Spice", "Sabbaba“, "Lemon Grass“, “Drum”…

The emerging NPS in Israel Marketed at 24/7 convenience stores and at party settings Sexy names: Mabsuton, Nice Guy, Hagigat, Hertzel gives you wings, La La Land, etc. Colorful attractive wrappings Visible declaration “Legal Substance” (…Legal highs) Attractive to young people because: Perceived as legal Cheep Accessible and available Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017 As a consequence of the implementation and enforcement of the new 2013 NPS law: No open marketing or sales of NPS Marketing and sales went underground Marketing via internet - mainly “dark net” Price increased Perception of risk and illegality increased Rates decreased Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017 Current prevalence Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

Percent of 11th-12th grade students who used NPS an least once during the past 12 months by gender and year of study נתוני ה-HBSC Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017

Substance use: Percent of students grades 6th-12th that used the following substances at least once during the past 12 months, by type of substance, gender, age group and sub-population 2014 Gender Age Group Sub-population Total בנים בנות י' יא' יב' יהודי ערבי Cannabis 15.4 5.2 7.9 8.8 14.1 9.8 12.0 10.2 Medications (pills) with out prescriptions 7.8 5.3 6.6 6.5 12.2 Inhaling (air-condition gas, laughing gas, glue, tipex, turpentine, etc.) 10.7 8.0 11.0 9.0 8.2 14.9 9.3 NPS 7.6 2.0 4.8 4.2 5.4 3.3 11.6 Gat or Gat juice 11.2 2.3 3.9 8.6 Ecstasy or L.S.D 1.3 3.0 6.1 2.8 4.5 Crack, Cocaine, Opium, Heroin, Persian Coke 1.2 5.6 2.4 13.0 4.4 שיעור טעות הדגימה המירבית : 1.3%, עבור רמת ביטחון של 95% Prof. Yossi Harel-Fisch, LISBON ADDICTION 24-26, Oct. 2017