1. Polydrug use challenges – European experience International Conference: New trends in drug use: facts and solutions, Parliament of the Republic of Vilnius - 5 November 2009 Dagmar Hedrich, Deborah Olszewski (EMCDDA)

2. Polydrug use — patterns and responses Polydrug use, widespread in Europe Combined use of different substances is ‘responsible for, or complicates, most of the problems we face’ Increases risks and complicates treatment delivery Alcohol present in almost all polydrug use repertoires ‘Selected issue’ — overview of this behaviour in: schoolchildren (15–16 years) young adults (15–34 years) problem drug users

3. Reasons and context of polydrug use To maximise effects of the substances consumed, To balance, control or ameliorate negative effects of other substances, To replace, one drug with another either because of price, availability, legality, fashion, Expanding drugs market – more and wider range of drugs available, incl. prescription drugs, Facilitated communication within and between social networks, exchange of experiences about drugs and their effects (internet, mobile phones, large music events, gatherings).

4. Polydrug use — health problems Added or potentialising effects; drug interactions may lead to increased toxicity; Long-term heavy alcohol use causes liver damage (and causes impairment of metabolism of substances); Effects of certain substances can increase risk behaviour with other drugs; e.g. alcohol consumption impairs capacity to judge other drug taking; Accidents and injuries due to the added effects of multiple substances; Most drug-induced deaths caused by consumption of more than one substance.

5. Analysis of polydrug use among schoolchildren (15-16 years old) Data source Data on drug use among 15-16 year old school students: contained in a central ESPAD database of European School Surveys) - anonymous, individual data from over 76,000 students in 22 countries (2003) Definition of polydrug use for this analysis: the use of two or more substances by a single individual during the 30 days prior to survey; Cigarette smoking is included.

6. Prevalence level groups 22 countries (n=765411) Source: 15-16 year old ESPAD school students, 2003

7. Prevalence by use of single substances (in last 30 days) among > 76,000 adolescents, by country group Substance Prevalence full range % Low prev.Medium prev.High prev. Alcohol20 - 81 50.865.373.1 Binge alc.15 - 60 34.638.451.8 Cigarettes18 - 46 26.740.536.3 Cannabis0 - 20 2.27.615.0 Ecstasy0 - 3 0.50.81.3 Hallucinogenic mushrooms 0 - 20.3 0.8 LSD or other hallucinogens 0 - 10.3 0.6 Amphetamine0 - 1 0.40.80.9 Cocaine0 - 10.40.30.6 Heroin0 - 10.30.20.3

8. Three main types (last 30 days prevalence): A type – use both alcohol and cigarettes but not use cannabis or other illegal drugs B type - use cannabis + alcohol or cigarettes but not ecstasy, amphetamines, heroin or cocaine C type - use ecstasy or cocaine, or amphetamines, or LSD or heroin + cannabis and alcohol or cigarettes

9. Polydrug use — schoolchildren Of schoolchildren (15–16 years) surveyed in 22 countries: 20 % reported use in the last month of alcohol with cigarettes 6 % cannabis with alcohol and/or cigarettes 1 % cannabis with alcohol and/or cigarettes plus at least one other illicit drug (ecstasy, cocaine, amphetamines, LSD or heroin) Polydrug use can increase the risk of toxic effects and is associated with a greater risk of developing long-term problems

10. Analysis of polydrug use among young adults (15-34 years old) Data Sources: special data collection on age group 15-34 years old from recent general population surveys in nine EU Member States - national samples range from 1.753 - over 10.000 Definition of polydrug use for this analysis: the use of two or more substances by a single individual during 12 months prior to survey; Definition frequent/heavy alcohol use: drinking 6 glasses of more of an alcoholic drink during the same occasion daily, almost daily or every week during the past 12 months; Cigarette smoking not included.

11. Last 12 month prevalence of cannabis, cocaine and frequent/heavy alcohol (single substance) use Country and survey date Freq/heavy alcohol CannabisCocaine Base sample Ireland* (2006/7)30.310.42.91989 Denmark (2008)18.613.33.41744 UK** (2007/8)9.915.4510,021 Germany (2006)9.2121.53306 Spain (2007/8)7.519.65.19443 Cyprus (2006)5.93.60.91753 France (2005)5.316.71.210,855 Portugal (2007)26.71.24765 Italy (2007)1.820.93.14243 16-30 unweighted ** Frequent/heavy alcohol : drinking 6 glasses of more of an alcoholic drink in the same occasion daily, almost daily or every week

12. Polydrug use — young adults Among young adults (15–34 years), polydrug use can reflect established patterns of substance use, potentially carrying long-term health problems, but also acute risk- taking during leisure time; Frequent or heavy alcohol users in this age group were between two and six times more likely to have used cannabis in the last year than the general population; And between two and nine times more likely to have used cocaine during that period (last year). [note: small numbers]

13. Polydrug use — problem drug users Particularly prevalent among problem drug users Can aggravate their already difficult health conditions, leading to increased risk-taking and sometimes severe consequences In a recent analysis, over half (57 %) of those entering treatment reported problems with at least two different drugs Toxicology reports following fatal overdoses often show the presence of more than one substance Management of polydrug use among problem drug users is a complex task

14. Polydrug use — problem drug users Three polydrug use profiles among clients entering treatment: - heroin + cocaine: marginalised population, use of various additional substances common; - cocaine, cannabis, alcohol: referred from CJS, family or social network pressure; - cannabis + alcohol: young group, living with family of origin, integrated.

15. Polydrug use — responses Pharmacological and psychosocial treatment interventions have shown to reduce polydrug use; Alcohol is extremely common in all polydrug profiles – staff should be qualified to address alcohol use; Tobacco and alcohol: market policies like pricing, sales restrictions have impact (e.g. delaying initiation of use of substances); Prevention in recreational settings: harm reduction measures.

16. Key role of alcohol Alcohol involved in all polydrug use patterns; It is almost always the first drug with strong psychoactive and mind-altering effects used by young people; It is widely available and ever-present and thus poses a challenge for prevention of harm and learning responsible use.