Increase of opioid use in Finland when is there enough key indicator data to state a trend?

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Mikko Turunen
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1 Increase of opioid use in Finland when is there enough key indicator data to state a trend? Martta Forsell, Finnish Focal Point Esityksen nimi / Tekijä 1

2 Martta Forsell Master of Social Sciences Senior officer in the statistical department of Institute of Health and Welfare Partly working for the Finnish Focal Point for six years No conflict of interest Esityksen nimi / Tekijä 2

3 Opioid use is increasing in Finland.

4 When is there enough key indicator data to state a trend?

5 Trends of opioids use in Europe

8 Trends of opioids use in Europe Increasing in Finland when decreasing everywhere?

10 Trends of opioids use in Europe Increasing in Finland when decreasing everywhere? Or is Finland 40 y or 20 years late?

12 Some heroin consumption in Finland only in the late 90s. Opioid use in Finland is iv-use of buprenorphine together with other medicinal products.

13 Trends of opioids use in Europe Increasing in Finland when decreasing everywhere? Or is Finland 40 y or 20 years late? Or 10 years ahead?

14 General population surveys (GPS) substances used in the lifetime Heroin or morphine Heroin or morphine Heroin Heroin Heroin Other opioids (as Subutex) Buprenorphine Buprenorphine Methadone Methadone Pekka Hakkarainen Leena Metso Karoliina Karjalainen Other opioids (as tramadol, fentanyl, codein, oxicodone, morphine) Other opioids (as tramadol, fentanyl, codein, oxicodone, morphine)

15 Lifetime prevalance for any opioid misuse % year olds Esityksen nimi / Tekijä 15

16 General population surveys are not supposed to detect problem drug use trends Esityksen nimi / Tekijä 16

17 Problem drug use (PDU) Päivi Partanen (Capture-recapture) Jukka Ollgren (Capture-recapture) + Lots of experts give and explain the source data

18 Capture-recapture 2-4 sources, all independent from the KI data Hospital discharge registry Police registies New Hepatits C cases 2012 data with Baynesian averaging Opiod users 2012: (Min) (max) (Min) 0,38 % - 0,45 % (max) opiod problem users

19 Lifetime prevalance for any opioid misuse % year olds ,4% PDU Esityksen nimi / Tekijä 19

20 Problem opioid users, capture-recapture % X Max Opioidit opioidit min opioidit max Min Opioidit Lähde: Ollgren ym 2014; Partanen ym

21 Problem opioid users, capture-recapture % X opioidit min Max Opioidit opioidit max Poly. (opioidit min) Min Poly. (opioidit max Opioidit Lähde: Ollgren ym 2014; Partanen ym

24 Problem opioid users, capture-recapture % X opioidit min Max Opioidit opioidit max Poly. (opioidit min) Min Poly. (opioidit max Opioidit Lähde: Ollgren ym 2014; Partanen ym

25 Trend analyse on problem drug use studies is doubious Treatment demand data is collected every year Esityksen nimi / Tekijä 25

26 Treatment demand indicator (TDI) Airi Partanen Martta Forsell Voluntary data collection, coverage is not known Includes also continuous clients

27 Drug clients reporting opioids use, share (%) from all reported drug clients (incl. continuous clients) %

28 Huumehoidon tiedonkeruun kattavuutta ei tiedetä, lomakkeiden määrä vähenee Asiakkaita 7,000 6,000 5,000 Paljon hoitoa (matalat indikaatiot), kiinnostava aihe Yksiköitä , Yksiköitä 3, Asiakkaita 2, , Esityksen nimi / Tekijä 28

29 Huumehoidon tiedonkeruun kattavuutta ei tiedetä, lomakkeiden määrä vähenee Asiakkaita Paljon hoitoa (matalat indikaatiot), kiinnostava aihe Yksiköitä 7,000 6, Hoito ja tiedon tuotanto keskittyy F11 ympärille , , Yksiköitä 3, Asiakkaita 2, , Esityksen nimi / Tekijä 29

30 Drug clients reporting opioids use, share (%) from all reported drug clients (incl. continuous clients) % In facilities specializing drug treatment (and provide the data) less and less treatment is given to non-opioid clients

31 TDI data is only on those in treatment Are there any absolute numbers? Esityksen nimi / Tekijä 31

32 Drug related deaths (DRD) General mortality register Statistics Finland Special registry Erkki Vuori Ilkka Ojanperä Pirkko Kriikku Drug findings in post-mortem toxicogy, regardless the cause of death - nationally - high rate

33 Opioid (heroin + buprenorphine+ methadone) findings in post-mortem toxicogy

34 This study may indicate that opioid use is increasing in Finland and further monitoring is needed.

35 GPS prevalence HRDU problem opioid users TDI treatment DRD deaths

36 This study may indicate that opioid use is increasing in Finland and further monitoring is needed. Why? How to stop this trend?

37 Thank you

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