Elena Gomes de Matos, Tessa-Virginia Hannemann, Josefine Atzendorf, Ludwig Kraus, Daniela Piontek II Lisbon Addicitions Conference 24-26 October 2017, Lisbon New drug use trends in Germany? The use of new psychoactive substances and methamphetamine in six federal states

Trends in drug use subject to changes and trends Background Trends in drug use subject to changes and trends Lately discussed: New psychoactive substances (NPS), methamphetamine Lack of epidemiological studies covering a broad geographical range Regional variation in prevalence? 2

Background Aim: Assess distribution of NPS and methamphetamines in 6 German federal states 3

Methods Hamburg Northrhine- Westphalia Saxony Thuringia Hesse Bavaria 4

Methods Epidemiological Survey of Substance Abuse (ESA) Adults aged 18-64 years Sample sizes: Bavaria (n = 1,916), Hamburg (n = 1,125), Hesse (n = 1,151), North Rhine-Westphalia (n = 2,008), Saxony (n = 1,897), Thuringia (n = 1,543) Self-administered paper-and-pencil and online questionnaires, telephone interviews 5

Prevalence rates by federal states Methods Prevalence rates by federal states Factors associated with lifetime use (logistic regression analyses) Predictors: federal state, sex, age, education, consumption of alcohol, tobacco and cannabis 6

Results: NPS prevalence rates Thuringia Hesse Bavaria Northrhine- Westphalia Hamburg Saxony LT 3.9 12 M 1.4 30 T 0.0 LT 2.7 12 M 1.3 30 T 0.0 LT 2.5 12 M 0.9 30 T 0.1 LT 3.4 12 M 1.4 30 T 0.1 LT 2.3 12 M 0.8 30 T 0.0 LT 2.2 12 M 0.7 30 T 0.0 7

Results: NPS prevalence rates Thuringia Hesse Bavaria Northrhine- Westphalia Hamburg Saxony LT 3.9 12 M 1.4 30 T 0.0 LT 2.7 12 M 1.3 30 T 0.0 LT 2.5 12 M 0.9 30 T 0.1 LT 3.4 12 M 1.4 30 T 0.1 LT 2.3 12 M 0.8 30 T 0.0 LT 2.2 12 M 0.7 30 T 0.0 8

Results: NPS prevalence rates Thuringia Hesse Bavaria Northrhine- Westphalia Hamburg Saxony LT 3.9 12 M 1.4 30 T 0.0 LT 2.7 12 M 1.3 30 T 0.0 LT 2.5 12 M 0.9 30 T 0.1 LT 3.4 12 M 1.4 30 T 0.1 LT 2.3 12 M 0.8 30 T 0.0 LT 2.2 12 M 0.7 30 T 0.0 9

Results: NPS prevalence rates Thuringia Hesse Bavaria Northrhine- Westphalia Hamburg Saxony LT 3.9 12 M 1.4 30 T 0.0 LT 2.7 12 M 1.3 30 T 0.0 LT 2.5 12 M 0.9 30 T 0.1 LT 3.4 12 M 1.4 30 T 0.1 LT 2.3 12 M 0.8 30 T 0.0 LT 2.2 12 M 0.7 30 T 0.0 10

Results: Forms of NPS consumption 11

Results: Methamphetamine prevalence rates Thuringia Hesse Bavaria Northrhine- Westphalia Hamburg Saxony LT 0.9 12 M 0.4 30 T 0.3 LT 0.3 12 M 0.2 30 T 0.0 LT 1.7 12 M 0.8 30 T 0.2 LT 2.0 12 M 0.3 30 T 0.0 LT 0.7 12 M 0.0 30 T LT 1.1 12 M 0.4 30 T 0.0 12

Results: Methamphetamine prevalence rates Thuringia Hesse Bavaria Northrhine- Westphalia Hamburg Saxony LT 0.9 12 M 0.4 30 T 0.3 LT 0.3 12 M 0.2 30 T 0.0 LT 1.7 12 M 0.8 30 T 0.2 LT 2.0 12 M 0.3 30 T 0.0 LT 0.7 12 M 0.0 30 T LT 1.1 12 M 0.4 30 T 0.0 13

Results: Methamphetamine prevalence rates Thuringia Hesse Bavaria Northrhine- Westphalia Hamburg Saxony LT 0.9 12 M 0.4 30 T 0.3 LT 0.3 12 M 0.2 30 T 0.0 LT 1.7 12 M 0.8 30 T 0.2 LT 2.0 12 M 0.3 30 T 0.0 LT 0.7 12 M 0.0 30 T LT 1.1 12 M 0.4 30 T 0.0 14

Results: Methamphetamine prevalence rates Thuringia Hesse Bavaria Northrhine- Westphalia Hamburg Saxony LT 0.9 12 M 0.4 30 T 0.3 LT 0.3 12 M 0.2 30 T 0.0 LT 1.7 12 M 0.8 30 T 0.2 LT 2.0 12 M 0.3 30 T 0.0 LT 0.7 12 M 0.0 30 T LT 1.1 12 M 0.4 30 T 0.0 15

Results NPS Meth-amphetamine OR Federal state Bavaria 1.13 1.28   NPS Meth-amphetamine OR Federal state Bavaria 1.13 1.28 Hamburg 0.99 0.62 Hesse 0.88 0.86 North Rhein-Westphalia 1.11 0.37 Saxony 1.15 2.04* Thuringia 0.79 1.96* Sex (female) 0.78 Age 0.97* Education Medium 0.44* 0.35* High 0.29* 0.26* Alcohol consumption (g/week)a 1.03 1.01 Tobacco consumption (12 months) 2.94* 4.89* Cannabis consumption (12 months) 3.87* 6.39* 16

Results: Methamphetamine prevalence rates Thuringia Hesse Bavaria Northrhine- Westphalia Hamburg Saxony LT 0.9 12 M 0.4 30 T 0.3 LT 0.3 12 M 0.2 30 T 0.0 LT 1.7 12 M 0.8 30 T 0.2 LT 2.0 12 M 0.3 30 T 0.0 LT 0.7 12 M 0.0 30 T LT 1.1 12 M 0.4 30 T 0.0 17

Discussion: NPS More prevalent than any illicit drug except cannabis In international comparison rather low consumption prevalence “Risk factors” similar to other illicit drugs (younger age, low education, use of tobacco and cannabis) No indications for differences between federal states Constant update of medical staff (e.g. emergency department, GP) regarding new NPS trends and symptoms on a national basis 18

Discussion Rarely used in adult general population Agglomeration in Saxony and Thuringia Proximity to Czech border (production sites) 19

Results: Methamphetamine prevalence rates Thuringia Hesse Bavaria Northrhine- Westphalia Hamburg Saxony LT 0.9 12 M 0.4 30 T 0.3 LT 0.3 12 M 0.2 30 T 0.0 LT 1.7 12 M 0.8 30 T 0.2 LT 2.0 12 M 0.3 30 T 0.0 LT 0.7 12 M 0.0 30 T LT 1.1 12 M 0.4 30 T 0.0 20

Discussion Rarely used in adult general population Agglomeration in Saxony and Thuringia Proximity to Czech border (production sites) Known from clinical populations (treatment data) Not an “everyday drug” throughout population Serious health risks Training for medical institutions on symptoms and challenges of methamphetamine in affected regions Selective and indicative prevention and intervention; nationwide prevention campaigns not recommended 21

Thank you for your attention!

Background & aims Methods Results Discussion Background and aims Background Methamphetamine (Crystal Meth) Globally most widespread illicit drug except cannabis (yet less common than e.g. in USA) Higher potency and longer half-life period than amphetamine Long-term effects (e.g. cardiovascular diseases, mental problems) Indications of higher consumption in federal states close to Czech Republic Background & aims Methods Results Discussion 23

Background & aims Methods Results Discussion Variables & instruments NPS & methamphetamine Prevalence (lifetime, 12-months, 30-days) Consumption frequency last 12 months (methamphetamine) Consumption forms last 12 months (NPS) Clinical relevant consumption using the Severity of Dependence Scale (SDS) Alcohol, tobacco, cannabis (last 12 months) Sociodemographic variables (sex, age, education) Background & aims Methods Results Discussion 24

Background & aims Methods Results Discussion Figure 1. Consumption of new psychoacitve substances based on lifetime (LT), 12 months (12 M) and 30 days (30 T). n unweighted number. % weighted percent. Figure 2. Consumption of methamphetamine based on lifetime (LT), 12 months (12 M) and 30 days (30 T). n unweighted number. % weighted percent. Background & aims Methods Results Discussion 25

Results Sachsen Thüringen Hessen Bayern Nordrhein-Westfalen HH 26

Background & aims Methods Results Discussion NPS Lifetime prevalence between 2.2 % (Bavaria) and 3.9 % (Hamburg) Maximum 12-month prevalence 1.4 % (Hamburg, Saxony); consumption in last 30-days only in Saxony and Thuringia (0.1 %) Equal lifetime prevalence across federal states Lower consumption with higher age and education Higher consumption associated with alcohol and cannabis use Background & aims Methods Results Discussion 27

Background & aims Methods Results Discussion Methamphetamine Lifetime prevalence highest in Saxony (2.0 %) and Thuringia (1.7 %) and Bavaria (1.1 %) 12-month prevalence between 0.8 % (Thuringia) and 0.4 % (Bavaria, Hamburg); consumption in last 30-days only in Hamburg (0.3 %) and Thuringia (0.2 %) Higher consumption risk in Saxony and Thuringia Lower consumption with higher age and education Higher consumption with tobacco and cannabis use Background & aims Methods Results Discussion 28

Background & aims Methods Results Discussion   NPS Methamphetamine OR 95 % CI Federal state Bavaria 1.13 [0.81; 1.58] 1.28 [0.68; 2.40] Hamburg 0.99 [0.65; 1.50] 0.62 [0.29; 1.33] Hesse 0.88 [0.59; 1.33] 0.86 [0.29; 2.55] North Rhein-Westphalia 1.11 [0.73; 1.70] 0.37 [0.10; 1.37] Saxony 1.15 [0.76; 1.73] 2.04* [1.15; 3.62] Thuringia 0.79 [0.54; 1.17] 1.96* [1.13; 3.39] Sex (female) 0.78 [0.53; 1.13] [0.43; 1.41] Agea 0.97* [0.96; 0.99] [0.95; 0.99] Educationb Medium 0.44* [0.27; 0.73] 0.35* [0.16; 0.80] High 0.29* [0.18; 0.49] 0.26* [0.10; 0.67] Alcohol consumption (g/week)a 1.03 [1.01; 1.04] 1.01 [1.00;1.03] Tobacco consumption (12 months) 2.94* [1.90; 4.54] 4.89* [2.58; 9.28] Cannabis consumption (12 months) 3.87* [2.50; 5.98] 6.39* [3.20; 12.76] Note. Controlled for interview type (written, telephone, online). OR: Odds Ratio. 95 % CI: 95 % Confidence interval. Reference of variable federal states was average of all included federal states. a. Continuous variables. b. Reference category: „low education“. * p < .05. Background & aims Methods Results Discussion 29

Background & aims Methods Results Discussion NPS – consumption forms Herbal mixtures most widespread and highest in Bavaria (90.9 %) and Saxony (89.6 %) Crystals/pills most common only in North Rhein-Westphalia (84.3 %) Liquids least popular in all states except Saxony Table 2. NPS consumption forms in six federal states.   Bavaria Hamburg Hesse NRW Saxony Thuringia n % Herbal mixtures 17 90.9 15 77.7 7 77.0 12 71.5 14 89.6 Crystals/pills 6 48.1 9 57.8 60.0 84.3 10 86.0 67.5 Liquids 38.3 31.7 4 37.0 55.8 86.9 39.2 Note. NRW North Rhein-Westphalia. n unweighted number. % weighted percent. Multiple responses allowed. Background & aims Methods Results Discussion 30

Results Methamphetamine – frequency Table 3. NPS consumption forms in six federal states. 31

Background & aims Methods Results Discussion Methamphetamine – frequency and clinical relevant consumption Frequency Frequency varied across federal states At least 10 times consumption highest in Thuringia (7 out of 15) and Saxony (3 out of 4) Clinical relevant consumption In total nine persons with clinical relevant consumption across federal states Most prevalent in Thuringia (5 persons) Background & aims Methods Results Discussion 32