improving drd information multi-indicator coherence
TRANSCRIPT
Improving DRD information
Multi-indicator coherence analysis
(Introduction)
European DRD expert meeting 2018
EMCDDA, Lisbon 8-9 November 2018
Julian Vicente & Isabelle Giraudon
Rational for this work
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• Deaths caused by acute toxicity of drugs – relevant public
health problem
� 9.000 deaths in the EU in 2016
� Mainly related with opioids
• Worrying that despite all efforts
�EU numbers do not decrease and, in some countries,
continue to increase
• Considered one of Public Health priorities of EMCDDA
strategy 2025
Rational for this work (focus on opiate DRD)
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• Need of good quality DRD data to inform policies and
interventions and to monitor their progress
• DRD have an important policy/political impact
• Several countries report DRD underestimation, and is suspected
in some others
• Not yet a common approach to underestimation issues
• Existence a range of opioid indicators expected to (broadly)
correlate � gain insight in DRD… and in other indicators
Objective of the work (focus on opiate DRD)
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• This project aim to improve DRD data
• By helping to identify existence, scale and factors of
underreporting
• By combination of several opioid indicators and assessing their
consistency
• Using as benchmark opioid DRD (overdoses, poisonings, drug-
induced)
Opioid DRD among general population Annual N deaths/100000 people 15-64
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Building in previous work (best estimations) E.g. EMCDDA and Millar & McAuley (2017) / webminar PDU / DRD 2011
Source: EMCDDA and Millar & McAuley (2017
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Correlation [DRD- HROU]
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Number HROU users � (+/-) Number opioid DRD
Assuming - other factors being equal
- Protective factors (including treat + Harm R)
- Risk factors
- Correct identification and reporting DRD
Opiate DRD mortality among HROU(EU average 5.5 DRD deaths/1000 HROU)
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0.0
5.0
10.0
15.0
20.0
25.0
30.0
Rate DRD-O/1000 HROU
Example: Estimated a normal/low DRD reporting (numerator) � the denominator should be small – yes, they
have very low prevalence of HROU [0.55/1000 and 0.26/1000 - EU30 average 3.38/1000 ] 8-12 times
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0.0
5.0
10.0
15.0
20.0
25.0
30.0
Rate DRD-O/1000 HROU
National differences when
using HROU as population at risk
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• Differences may be real ----- risk/protective factors
- most HROU injectors (versus) most HROU non-injectors - (x 3-4)
- most HROU are in OST (versus) most HROU not in OST - (x 4-8)
- other factors (age, opioid used, alcohol, purity issues, risk situations –
prison release, drop out of treatment-, harm reduction)
• It may be methodological factors
It might be that HROU is outdated and/or too big- too small
It might be that DRD are overestimated/underestimated
Approach in this meeting
and (eventual) follow up
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• Multiple opioid indicators - analyse consistency
• Using DRD as benchmark
Estimate “expected” contrast with “reported”
� A consistency analysis with all countries (Julian)
� A country by country analysis (Isabelle)
� (Eventual) follow up with some countries
Approach in this meeting
and (eventual) follow up
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• Opioid indicators ------------- analyse consistency
• Using DRD as benchmark
“Expected” DRD “Reported “ DRD ?- HROU
- Risk fact
- Prot. fact
- Methods
GMR
SMR
- Methods
Approach in this meeting
and (eventual) follow up
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• Opioid indicators ------------- analyse consistency
• Using DRD as benchmark
“Expected” DRD “Reported “ DRD ?- HROU
- Risk fact
- Prot. fact
- Methods
GMR
SMR
- Methods
Approach in this meeting
and (eventual) follow up
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• Opioid indicators ------------- analyse consistency
• Using DRD as benchmark
“Expected” DRD “Reported “ DRD ?- HROU
- Risk fact
- Prot. fact
- Methods
GMR
SMR
- Methods
Session structure; Two broad components
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• Multi-indicator general model – (assumptions)
� on published data (mainly EMCDDA SB)
� following a logical interrelations (HROU – OST – TDI/IV – DRD)
� Identification of coherences – including underreporting (and
others)
• Focused analysis in a selected number of countries
� with suspected underreporting based on additional data sources or
studies (cohort-capture-recapture, additional DRD registries).
� Combination of similar indicators with national data.
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Thank you for your attention!
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