“Problem, intensive drug use and polydrug use” Introduction Danica Klempova, Scientific Committee meeting, Lisbon, 17 November

The traditional Problem drug use key indicator To look at the most harmful, heavy forms of drug use Traditionally using indirect statistical methods (multipiers, CRC, MIM) to estimate the sizes of these – largely hidden – populations To assess needs and coverage of interventions Defined by (umbrella definition) drug-type (opioids, cocaine and amphetamines) and a broadly described behavioural pattern (injecting and/or long- term and/or regular) NOT BY PROBLEMS!

Changes in the drug situation and reaction to them Changing patterns of drug use in the past 15 years (stimulants, cannabis TDI) 2004 focused small expert meeting in Sintra Reporting by drug (POU, PSU) and IDU - overlapping categories Applying instruments within general population surveys (cannabis abuse and dependence)

Discussions about concepts… Traditional PDU – trends uninterrupted Intensive, frequent, long-term, dependent, harmful, abuse…(by drug and pattern of use) Polydrug use yes, but what kind (+question of alcohol) Substitution medication – distinguished

…have to be closely related to data sources Traditional data sources for the indirect estimates; improvement of data quality Novel data sources for indirect estimates (e.g. emergency room data, …) Out-of-treatment populations – focused studies in different settings (street, LTS,..) – e.g. RDS General population surveys for cannabis intensive/long- term/dependent use (other substances with high prevalence and lower stigmatisation of use)

Starting from concepts Starting from data sources

PDU Problem opioid users Problem cocaine users Problem amphetamine users Injecting drug users

“Problem, intensive and polydrug use” Problem opioid users Problem cocaine users Problem amphetamine users Heavy/long-term cannabis users e.g. Intensive, long-term or otherwise harmful cocaine users (ILH) And, and, and… Injecting drug users

“Problem, intensive and polydrug use” Problem amphetamine users Heavy/long-term cannabis users e.g. Intensive, long-term or otherwise harmful cocaine users (ILH) Injecting drug users Problem opioid users And, and, and… Problem cocaine users