Increase of opioid use in Finland when is there enough key indicator data to state a trend? Martta Forsell, Finnish Focal Point 28.9.2015 Esityksen nimi / Tekijä 1
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 28.9.2015 Esityksen nimi / Tekijä 2
Opioid use is increasing in Finland.
When is there enough key indicator data to state a trend?
Trends of opioids use in Europe
Trends of opioids use in Europe Increasing in Finland when decreasing everywhere?
Trends of opioids use in Europe Increasing in Finland when decreasing everywhere? Or is Finland 40 y or 20 years late?
Some heroin consumption in Finland only in the late 90s. Opioid use in Finland is iv-use of buprenorphine together with other medicinal products.
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?
General population surveys (GPS) substances used in the lifetime 1998 2002 2006 2010 2014 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)
Lifetime prevalance for any opioid misuse % 3 2.5 15-64 year olds 2 1.9 1.5 1.4 1 0.5 0.3 0.5 0.6 0 1998 2002 2006 2010 2014 28.9.2015 Esityksen nimi / Tekijä 15
General population surveys are not supposed to detect problem drug use trends 28.9.2015 Esityksen nimi / Tekijä 16
Problem drug use (PDU) Päivi Partanen (Capture-recapture) Jukka Ollgren (Capture-recapture) + Lots of experts give and explain the source data
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) 12 700-15 100 (max) (Min) 0,38 % - 0,45 % (max) opiod problem users
Lifetime prevalance for any opioid misuse % 3 2.5 15-64 year olds 2 1.9 1.5 1.4 1 0.5 0.3 0.5 0.6 0,4% 0 1998 2002 2006 2010 2012 2014 PDU 28.9.2015 Esityksen nimi / Tekijä 19
Problem opioid users, capture-recapture % 0.5 0.45 0.4 0.35 0.3 0.25 0.2 0.15 X Max Opioidit opioidit min opioidit max Min Opioidit 0.1 0.05 0 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 Lähde: Ollgren ym 2014; Partanen ym. 2007. 28.9.2015 20
Problem opioid users, capture-recapture % 0.5 0.45 0.4 0.35 0.3 0.25 0.2 0.15 X opioidit min Max Opioidit opioidit max Poly. (opioidit min) Min Poly. (opioidit max Opioidit 0.1 0.05 0 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 Lähde: Ollgren ym 2014; Partanen ym. 2007. 28.9.2015 21
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Problem opioid users, capture-recapture % 0.5 0.45 0.4 0.35 0.3 0.25 0.2 0.15 X opioidit min Max Opioidit opioidit max Poly. (opioidit min) Min Poly. (opioidit max Opioidit 0.1 0.05 0 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 Lähde: Ollgren ym 2014; Partanen ym. 2007. 28.9.2015 24
Trend analyse on problem drug use studies is doubious Treatment demand data is collected every year 28.9.2015 Esityksen nimi / Tekijä 25
Treatment demand indicator (TDI) Airi Partanen Martta Forsell Voluntary data collection, coverage is not known Includes also continuous clients
Drug clients reporting opioids use, share (%) from all reported drug clients (incl. continuous clients) % 80 75 70 65 60 55 50 45 40
Huumehoidon tiedonkeruun kattavuutta ei tiedetä, lomakkeiden määrä vähenee Asiakkaita 7,000 6,000 5,000 Paljon hoitoa (matalat indikaatiot), kiinnostava aihe 5 793 166 Yksiköitä 180 160 140 120 4,000 100 Yksiköitä 3,000 79 66 80 Asiakkaita 2,000 2 688 2 089 60 40 1,000 20 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 0 28.9.2015 Esityksen nimi / Tekijä 28
Huumehoidon tiedonkeruun kattavuutta ei tiedetä, lomakkeiden määrä vähenee Asiakkaita Paljon hoitoa (matalat indikaatiot), kiinnostava aihe Yksiköitä 7,000 6,000 166 Hoito ja tiedon tuotanto keskittyy F11 ympärille 180 160 5,000 5 793 140 120 4,000 100 Yksiköitä 3,000 79 66 80 Asiakkaita 2,000 2 688 2 089 60 40 1,000 20 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 0 28.9.2015 Esityksen nimi / Tekijä 29
Drug clients reporting opioids use, share (%) from all reported drug clients (incl. continuous clients) % 80 75 70 65 60 55 50 45 40 In facilities specializing drug treatment (and provide the data) less and less treatment is given to non-opioid clients
TDI data is only on those in treatment Are there any absolute numbers? 28.9.2015 Esityksen nimi / Tekijä 31
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
Opioid (heroin + buprenorphine+ methadone) findings in post-mortem toxicogy 200 180 160 140 120 100 80 60 40 20 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
This study may indicate that opioid use is increasing in Finland and further monitoring is needed.
GPS prevalence HRDU problem opioid users TDI treatment DRD deaths
This study may indicate that opioid use is increasing in Finland and further monitoring is needed. Why? How to stop this trend?
Thank you