1. Collaboration between the national EWS and treatment service providers in Hungary Anna Péterfi Hungarian National Focal Point TAIEX seminar Zagreb, 27-28 May 2013

2. Content Collaboration with the main partners of NEWS Available data on NPSs Monitoring problems

3. Content Collaboration with the main partners of NEWS Available data on NPSs Monitoring problems

4. Main partners of NEWS Police HQ Hungarian Institute for Forensic Sciences Office of Health Authorisation and Administrative Procedures Toxicological laboratories Forensic medicine institutes National Institute of Pharmacology Specialised drug treatment units Needle and syringe programmes Harm reduction services operating in recreational setting &

5. Partnership with forensic medicine institutes (1) Laboratories: Institute for Forensic Medicine and its network Forensic departments of 3 universities Data: Information on drug related deaths

6. Partnership with forensic medicine institutes (2) Means of obtaining information: special registry of drug-related mortality annual meeting for forensic experts NEWS membership – reporting for Progress and Final Reports, ad-hoc requests informal working group on NPSs related deaths NFP provides: access to EDND possibility for exchanging information and experience

7. Special registry on drug related mortality data collection has a legal background type of reporting: annual data providers: institutes of forensic medicine, university departments of forensic medicine responsible institution: National Centre for Addictions method: online reporting of case based data anonymous unique identifier – connection with other indicators – client’s path

8. Partnership with specialised drug treatment centres (1) Treatment units: treatment units providing specialised drug treatment (direct contact with 15 units, indirect contact with ≈90-100 units) Data: information on patterns of use, risk behaviours, treatment needs and responses, drug prices information related to substance groups rather than individual substances

9. Partnership with specialised drug treatment centres (2) Means of obtaining information: treatment demand indicator data collection qualitative studies (since 2011) drug prices studies NFP provides: monthly overview on new substances and related information alerts on high purity substances and intoxications possibility for exchanging information and experience

10. Partnership with needle and syringe programmes (1) Programmes: all (29) organisations providing needle and syringe programmes in the country Data: information on street names, patterns of use, risk behaviours, injected substances information related to substance groups rather than individual substances

11. Partnership with needle and syringe programmes (2) Means of obtaining information: annual data collection on clientele of NSPs annual meeting for NSP service providers Informal working group on NPS-related deaths NFP provides: monthly overview on new substances and related information alerts on high purity substances and intoxications possibility for exchanging information and experience annual report on NSPs in Hungary

12. Content Collaboration with the main partners of NEWS Available data on NPSs Monitoring problems

13. Self-reported data ESPAD study 2011: mephedrone life time prevalence 6% treatment (TDI) data: increasing proportion enters treatment due to ‘other stimulants’

14. Treatment data Proportion of users of heroin, amphetamine and other stimulants among clients already treated before (first chart) and among clients starting treatment for the first time (second chart) (not in QCT), between 2007 and 2011 (%) Source: National Centre for Addictions and Hungarian NFP

15. Self-reported data ESPAD study 2011: mephedrone life time prevalence 6% treatment (TDI) data: increasing proportion enters treatment due to ‘other stimulants’ increasing proportion of IDUs inject cathinones (NSP, DRID and TDI data)

16. IDUs in data on needle and syringe programmes Distribution of NSP clients by the primary substance injected, between 2009 and 2011 (%) Source: Hungarian National Focal Point further increase in 2012

17. Self-reported data ESPAD study 2011: mephedrone lifetime prevalence 6% treatment (TDI) data: increasing proportion enters treatment due to ‘other stimulants’ increasing proportion of IDUs inject cathinones (NSP, DRID and TDI data) qualitative studies among treatment units since 2011: increasing treatment demand due to cathinones treatment demand develops rapidly different treatment needs, increasing risk behaviours

18. Confirmed data proportion of NPS in seizures increases proportion of cathinones detected in injecting equipment increases → confirms trends observed in self-reported data

19. Content of injecting equipment Source: Hungarian Institute for Forensic Sciences

20. Confirmed data proportion of NPS in seizures increases proportion of cathinones detected in injecting equipment increases → confirms trends observed in self-reported data decreasing number of fatal overdose with ‘classic’ substances

21. No. of reported death cases opiate + other drugs (alcohol, benzodiazepines) few „methadone only” cases Source: National Centre for Addictions and Hungarian National Focal Point No detected direct death due to NPSs until 2012

22. Confirmed data proportion of NPS in seizures increases proportion of cathinones detected in injecting equipment increases → confirms trends observed in self-reported data decreasing proportion of fatal overdose with ‘classic’ substances already 4 deaths (fatal intoxications) associated with NPSs in 2012

23. Content Collaboration with the main partners of NEWS Available data on NPSs Monitoring problems

24. problems of detection lack and delay of reference materials scarce knowledge on metabolism, pharmacological features of NPSs inflexible data collections tools, definitions used substance unknown underreporting misinterpretation of data limitations of self reported data

25. Attempts to handle monitoring problems extend NEWS (harm reduction and treatment services) improve data collection tools put higher emphasis on cross indicator analysis combine quantitative and qualitative information clarify data limitations improve information dissemination tools put higher emphasis on informal partnership facilitate horizontal partnership between NEWS members learn from the experience of other countries

26. Thank you for your attention! Hungarian National Focal Point peterfi.anna@oek.antsz.hu www.drogfokuszpont.hu