1. Heavy or problematic drug use, heavy and problematic to define? Iceland 23-25 August 2010, Nordic Alcohol and Drug Researchers’ Assembly Ellen J. Amundsen, The Norwegian Institute for Alcohol and Drug Research www.sirus.no

2. Content Background Existing definitions Existing figures for Europe and the Nordic countries Aspects of a definition Explore a dataset Outline points of discussion for a definition of hard /heavy/problem drug use

3. Existing definitions, EMCDDA Injecting drug use Long-duration/ regular use of opioids, cocaine and/or amphetamines Problem opioid (heroin) use ---- What is long duration? What is regular use? Should the definition encompass substitution treatment and prescribed opiates? What about other drugs and polydrug use? What about use of benzodiazepines/tranquilizers?

4. Existing figures 2003-2008 30 European countries 21 presented estimates of overall problem drug use, including Denmark, Sweden and Finland 14 presented estimates of prevalence of injecting drug use, including Denmark and Norway 15 presented estimates of problem opioid use, including Finland (opioids) and Norway (heroin)

5. Aspects of hard use The type and frequency of drug used Use of treatment and services Harmful consequences: Physical, dependence, social

6. Study in Arendal, 42 000 inhabitants Study population. Persons 18 years or older who had used amphetamines, cocaine, heroin or other opiates/opioids last 12 months Estimated to 450-500 persons 45 interviews Questionnaire content: Drug use (amphetamines, cocaine, heroin, other opiates/opioids + other substances), frequency and amount, severity of dependence scale, use of local services, marginalization.

7. Results Arendal I One third women, Age 18 to more than 50 Network size: 4 to 500 Ever use: 98 % Amphetamines, cocaine 82 %, heroin 80 %, other opiates or opioids 89 % Injecting: Ever 82 %, last 12 months 69 %, last 30 days 64 % Almost daily use last 12 months: 20 % A, 4 % C, 9 % H, 42 % other O. 27 % used prescribed opiates/opioids daily

8. Results Arendal II: Five main groups Group 1: Persons who had used acho daily/almost daily the last 12 months, some of which were using prescribed opioids Group 2: Persons (not in group 1) who had used acho 1-3 times a week last 12 months Group 3: Persons (not in group 1 or 2) who had used acho more than 8 times last 30 days Group 4: Persons (not in group 1 or 2 or 3) - young persons with a short history of drug use Group 5: Persons (not in group 1 or 2 or 3) - older persons with a longer history of drug use, who did not use drugs regularly

9. Points for discussion of a definition of hard drug use Type of drug? Frequency of use? More than 2-3 times a month? Just weekend use? Shall persons in substitution treatment be included? Or just those who in addition use other specific drugs? Use of services? Role of individual dependence scales? Role of marginalization? Role of potential to quit?

10. Thank you!! Ellen J. Amundsen, The Norwegian Institute for Alcohol and Drug research/SIRUS, eja@sirus.noeja@sirus.no www.sirus.no

11. Severity of dependence scale reference period 12 months 1.Did you think your use of (named drug) was out of control? 2.Did the prospect of missing a fix (or dose) or not chasing make you anxious or worried? 3.Did you worry about your use of (named drug)? 4.Did you wish you could stop? 5.How difficult did you find it to stop, or go without (named drug)? 4 point scale for items 1 to 4 (never/almost never, sometimes, often, always/nearly always), for item 5 (not difficult, quite difficult, very difficult, impossible)

12. Nutt et al. 2007 A rational scale to assess the harm of drugs of potential misuse 1.Heroin 2.Cocaine 3.Barbiturates 4.Street methadone 5.Alcohol 6.Ketamine 7.Benzodiazepines 8.Amphetamines 9.Tobacco 10.Buprenorphine 11.Cannabis, solvents, 4-MTA, LSD, Methylphenidate, Anabolic steroids, GHB, Ecstacy, Alkyl nitrates, Khat