High-risk drug use and treatment

Cited from Drugnet Europe No 88, October–December 2014

‘Continuity and change: high-risk drug use and drug treatment in Europe’ was the focus of a series of events held at the EMCDDA in September 2014. Two parallel expert meetings, dedicated to the agency’s treatment demand key indicator (TDI) and to the problem drug use indicator (PDU), preceded a broader, common event open to specialists from outside the two expert groups.

While the two key indicator expert meetings explored important technical issues related to the implementation of these tools, the conference-style meeting focused on data- and multi-indicator analyses and monitoring drug treatment (as an epidemiological data source and a response to the drugs problem). Issues debated included trends and developments in high-risk opioid use; ageing drug users; vulnerable populations; high-risk use of stimulants, benzodiazepines and cannabis; treatment outcomes; and evaluating best practice.

Drug-related harms and responses

Cited from Drugnet Europe No 88, October–December 2014

Latest evidence in the area of drug overdose and HCV and HIV infections among drug users was among the topics discussed during a week of events organised by the EMCDDA in October 2014. Two EMCDDA expert meetings, dedicated to the agency’s drug-related deaths and mortality key indicator (DRD) and the drug-related infectious diseases key indicator (DRID), were preceded by a satellite event focusing on the role of take-home naloxone in reducing opioid-related fatalities.

Epidemiologists, clinicians, public health practitioners and representatives of civil society shared perspectives with the Reitox national focal points and international organisations. Among the issues highlighted was Europe’s hepatitis C virus (HCV) epidemic among people who inject drugs and the need for scaling up treatment. Treatment coverage for HCV is very low in Europe, compared to levels stipulated in current guidelines. But the potential to tackle the problem exists: effective HCV treatments have been available for some years and new treatments are being released. These, together with harm reduction measures, can contribute to the prevention of new infections and help control the epidemic.

Also raised at the meetings were the resurgence in heroin-related deaths in some European countries and new HIV infections related to the injection of stimulants.

Four new drugs to be placed under control

Cited from Drugnet Europe No 88, October–December 2014

On 25 September 2014, EU Ministers adopted a European Commission proposal to control four new psychoactive substances (NPS) currently raising health concerns in Europe. With the decision, the substances 25I-NBOMe, AH-7921, MDPV and methoxetamine will be subject to control measures and criminal penalties throughout the EU.

In April 2014, the extended EMCDDA Scientific Committee examined the four drugs and submitted its risk-assessment reports to the European Commission and the Council of the EU. On the basis of these, the Commission recommended to the Council on 16 June that the drugs be submitted to control measures, given that severe toxicity has been associated with their use.

The final decision entered into force the day after its publication in the Official Journal of the European Union on 1 October 2014. Member states now have one year to take the necessary measures to subject those substances to control measures and criminal penalties, as provided for under their legislation (complying with their obligations under the 1971 United Nations Convention on Psychotropic Substances).

Two other new psychoactive substances causing health concerns in Europe were risk-assessed by the EMCDDA extended Scientific Committee on 16 September 2014. The first of these is 4,4′-DMAR, a derivative of aminorex with psychostimulant properties, which has been available on the drug market since at least December 2012. The second is MT-45, a synthetic opioid investigated in the 1970s for its analgesic properties and detected for the first time on the European drug market in October 2013. Respectively, a total of 31 and 28 deaths have been associated with these drugs and, in all cases, the presence of the substance in biological samples was analytically confirmed.

Pregnancy and opioid use: strategies for treatment

Cited from Drugnet Europe No 88, October–December 2014

Illicit opioid consumption during pregnancy brings with it the risk of an increase in obstetric complications for the mother as well as a range of potential dangers for the child, both before and immediately after birth. The primary goal when treating opioid dependence in pregnant women is to stabilise the patient. Psychosocially-assisted opioid substitution treatment is the preferred first-line therapy for this group and several combinations of substitution medicines and psychosocial approaches are available. A newly-published EMCDDA Paper reviews methadone, buprenorphine and slow-release oral morphine, used in a range of combinations with cognitive behaviour approaches and contingency management, and identifies the strengths of each medicine and method.

Available in English at: www.emcdda.europa.eu/publications/emcdda-papers