Abstract Current data on the prevalence of prior illicit drug use among the prison population in ... more Abstract Current data on the prevalence of prior illicit drug use among the prison population in Europe is scarce. The aim of this study is to identify the prevalence of illicit drug use prior to incarceration, as reported by studies conducted in 30 European countries. A comprehensive literature review was conducted from the 5–31 of March 2018 using the databases Cochrane Library, Embase, MEDLINE, PsychINFO and PubMed. After the deletion of duplications, 2607 articles meeting the eligibility criteria for review were identified. In total, 26 studies from 12 different countries have been included in this review. The review found that the lifetime prevalence of illicit drug use before imprisonment ranged from 30 to 93%; last year prevalence from 51 to 69%; last 6 months prevalence from 13 to 75% and last month prevalence from 58 to 62%. The prevalence of illicit drug use was especially high among women. The rates varied across the 26 studies although high prevalence values are reported in most studies and variations are partly related to methodological differences in the reviewed studies. The high levels of prior involvement with drugs, necessitates prisons to develop clear strategies to deal with illicit drug use.
Study objective—To describe the prevalence and patterns of use of crack and cocaine hydrochloride... more Study objective—To describe the prevalence and patterns of use of crack and cocaine hydrochloride among heroin users in Spain. To explore if the expansion of heroin smoking is accompanied by a similar phenomenon for cocaine. Design—Cross sectional study in 1995. Face to face interviews using a structured questionnaire. Setting—Three cities with diVerent prevalences of heroin use by smoking: high (Seville), intermediate (Madrid), and low (Barcelona). Participants—909 heroin users, 452 in treatment and 457 out of treatment. Main results—Last month prevalence of crack use was 62.3% in Seville, 19.4% in Madrid, and 7.7% in Barcelona. Most users in Madrid (86.5%) and Barcelona (100%) generally prepared their own crack, usually with ammonia as alkali; in Seville most users (69.7%) bought preprocessed crack. The proportion of users who began taking cocaine (crack or cocaine hydrochloride) by smoking has increased progressively since the seventies, rising to 74.1% in Seville, 61.5% in Madri...
This chapter provides an overview of drug use in prison. It is centered on illicit drug use in Eu... more This chapter provides an overview of drug use in prison. It is centered on illicit drug use in Europe, where the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) has been collecting aggregated data from various sources for 15 years. It also reviews, based on published literature, data from the four other global regions. A total of 59 studies from 31 countries in the five world regions were included for analysis. Results show that the prevalence of drug use varies greatly between studies. Lifetime prevalence of any illicit drug use in prison ranges between 2% to 76% worldwide with, in most cases, cannabis being the most frequently reported substance. More recent (past-month) illicit drug use is reported by <1% to 65% of inmates, while <1% to 39% report injecting illicit drugs during their stay in prison. Alcohol use in prison is reported in a few studies only, varying between 2% to 77% while the prevalence of current tobacco smoking ranges between 4% to 90%. In ...
Purpose This paper aims to describe the impact of the COVID-19 containment measures on the provis... more Purpose This paper aims to describe the impact of the COVID-19 containment measures on the provision of drug treatment and harm reduction services in European prisons in15 countries during the early phase of the pandemic (March –June 2020). Design/methodology/approach The paper is based on a mixed method research approach that triangulates different data sources, including the results of an on-line survey, the outcome of a focus group and four national case studies. Findings The emergence of COVID-19 led to a disruption in prison drug markets and resulted in a number of challenges for the drug services provision inside prison. Challenges for health services included the need to maintain the provision of drug-related interventions inside prison, while introducing a range of COVID-19 containment measures. To reduce contacts between people, many countries introduced measures for early release, resulted in around a 10% reduction of the prison population in Europe. Concerns were expresse...
Interventions to tackle the supply of drugs are seen as standard components of illicit drug polic... more Interventions to tackle the supply of drugs are seen as standard components of illicit drug policies. Therefore drug market-related administrative data, such as seizures, price, purity and drug-related offending, are used in most countries for policy monitoring and assessment of the drug situation. International agencies, such as the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and the UN Office of Drugs and Crime, also monitor and report on the drug situation cross-nationally and therefore seek to collect and make available key data in a uniform manner from the countries they cover. However, these data are not primarily collected for this purpose, which makes interpretation and comparative analysis difficult. Examples of limitations of these data sources include: the extent to which they reflect operational priorities rather than market changes; question marks over the robustness of and consistency in data collection methods, and issues around the timeliness of ...
The International journal on drug policy, Jan 16, 2018
The importance of illicit drug price data and making appropriate adjustments for purity has been ... more The importance of illicit drug price data and making appropriate adjustments for purity has been repeatedly highlighted for understanding illicit drug markets. The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) has been collecting retail price data for a number of drug types alongside drug-specific purity information for over 15 years. While these data are useful for a number of monitoring and analytical purposes, they are not without their limitations and there are circumstances where additional adjustment needs to be considered. This paper reviews some conceptual issues and measurement challenges relevant to the interpretation of price data. It also highlights the issues with between-country comparisons of drug prices and introduces the concept of affordability of drugs, going beyond purity-adjustment to account for varying national economies. Based on a 2015 European data set of price and purity data across the heroin and cocaine retail markets, the paper demons...
BACKGROUND To explore if cocaine or heroin smoking was positively associated to acute respiratory... more BACKGROUND To explore if cocaine or heroin smoking was positively associated to acute respiratory complications (ARC). SUBJECTS AND METHODS We collected data from medical records for 717 cocaine users who were attended in 14 hospital emergency rooms. The association was studied by logistic regression. RESULTS The most frequent ARC were respiratory infections and complications with chest pain or dyspnea. Cocaine smokers (OR = 3.3; CI 95% = 1.5-6.9) and cocaine sniffers (OR = 2.5; CI 95% = 1.1-5.6) had greater risk of ARC than cocaine injectors. Heroin smokers (OR = 3.5; COI 95% = 1.8-7.0) and heroin sniffers (OR = 2.8; CI 95% = 1.4-5.6) had greater risk of ARC than non heroin users. CONCLUSIONS These results suggest that cocaine or heroin smoking increases the risk of ARC.
The clinical records of patients attended at emergency hospitals in fifteen hospitals in Madrid, ... more The clinical records of patients attended at emergency hospitals in fifteen hospitals in Madrid, Valencia and Gran Canaria during 1994 were retrospectively analyzed. Seventy-three emergencies related to the consumption of design drugs, hallucinogens or amphetamines (100 times lower than because of opiates or cocaine) were recorded. Apart from the responsible drug for the emergency visit, in most cases the usual consumption of other substances was mentioned. Acute psychopathological reactions predominated. Three patients were admitted and five were derived to other hospitals; the remaining patients improved and were discharged. The number of emergencies on account of these drugs is relatively low, with a proportion of less than one in 10,000 emergencies attended in these areas and might not radically change if the current predominant consumption pattern is maintained.
Resumen Objetivos: Conocer la prevalencia de infección por VIH y de conductas de riesgo para esta... more Resumen Objetivos: Conocer la prevalencia de infección por VIH y de conductas de riesgo para esta infección entre inyectores de drogas de Madrid, Sevilla y Valencia. Estudiar los principales factores asociados a dichas conductas. Material y métodos: Se entrevistó cara-a-cara a 821 inyectores captados durante 1994 y 1995 entre los usuarios recientes de tres programas de intercambio de jeringas, preguntando por las conductas de riesgo durante los 30 días anteriores a la entrevista. Se utilizaron métodos estadísticos bivariados y técnicas de regresión logística. Resultados: Durante el mes anterior a la entrevista, un 13,8% en Valencia, un 18,1% en Madrid y un 26,9% en Sevilla usó jeringas ya utilizadas por otros, la mayor parte (73%-88%) sin desinfectarlas previamente con un método eficaz. El uso del preservativo siempre durante el período de referencia fue de un 50% en Sevilla, un 42,5% en Madrid y 34,2% en Valencia. La prevalencia de infección por VIH varió entre un 30,1% en Sevilla y un 43,2% en Madrid. En el análisis multivariante los factores más fuertemente asociados con recibir jeringas usadas fueron: dar jeringas usadas (OR = 12,2), residir en Sevilla (OR = 6,6) y ser VIH positivo (OR = 4,6) y los más fuertemente asociados con no usar sistemáticamente el preservativo fueron: desconocer el estado serológico frente al VIH (OR = 4,1), recibir jeringas usadas (OR = 3,7) y ser VIH negativos (OR = 3,3). Conclusiones: En España persiste un riesgo elevado de transmisión del VIH entre los inyectores de drogas (alta prevalencia de infección y de conductas de riesgo), por lo que deben aumentar de forma importante y urgente los programas destinados a reducirlo. Palabras clave: Inyectores de drogas. Infección por VIH. Conductas de riesgo. Diferencias geográficas. Summary Objective: To determine the prevalence of HIV infection and risk-taking behavior for infection among intravenous drug users in Madrid, Seville, and Valencia (Spain). To study the main factors associated with such behavior. Material and methods: Personal interviews were carried out with 821 intravenous drug users recruited in 1994 and 1995 among recent participants in threee needle-exchange programs. Subjects were asked about their risk-taking behavior in the 30 days preceding the interview. Bivariate statistical methods and logistical regression techniques were used. Results: In the month before the interview, 13.8% of the subjects in Valencia, 18.1% in Madrid, and 26.9% in Seville used needles that had been used by other people, usually (73-88%) without disinfecting them effectively. Condom use during the reference period was 50% in Seville, 42.5% in Madrid, and 34.2% in Valencia. The prevalence of HIV infection ranged from 30.1% in Seville to 43.2% in Madrid. Multivariate analysis showed that the factors most closely associated with accepting used needles were: needle sharing (OR = 12.2), residence in Seville (OR = 6.6), and HIV positivity (OR = 4.6). The factors most closely associated with not using condoms systematically were: ignorance of personal HIV serological state (OR = 4.1), needle sharing (OR = 3.7), and HIV negativity (OR = 3.3). Conclusions: The risk of HIV transmission among intravenous durg users in Spain is high (infection and risk-taking behavior have a high prevalence), so programs designed to reduce this risk should be increased quickly.
Background and objective: To evaluate access to sterile syringes and its association with injecti... more Background and objective: To evaluate access to sterile syringes and its association with injection risk behaviour in Madrid and Barcelona. Materials and methods: Cross-sectional community study by computer-assisted personal interview in 465 young heroin injectors between 2001 and 2003. Results: Some 4.2% had not obtained any free sterile syringes in the previous 12 months. In Madrid 32.1% had obtained all their sterile syringes free of charge (ASSF), versus 44.6% in Barcelona (p < 0.01). Not sharing (not using syringes used by someone else and not front/backloading) was associated with obtaining ASSF (OR = 1.69) and with sporadic injection (OR = 1.83). Not reusing one's own syringes was associated with the same two variables (OR = 4.02 and OR = 2.50, respectively). Conclusions: Access to sterile syringes is very high in Madrid and Barcelona, although the two cities have different approaches. The acquisition of all syringes free of charge should be facilitated, especially among frequent injectors.
ABSTRACT Key points • A history of drug use is common among European prisoners, with levels dispr... more ABSTRACT Key points • A history of drug use is common among European prisoners, with levels disproportionately high compared to the general population. • Health problems, especially communicable diseases and psychiatric co-morbidity, are especially prevalent among prisoners using drugs. • The mortality risk in the first weeks after release from prison is extremely high. • Relevant differences are reported between European countries in drug use and drug-related problems among prisoners. • In European countries, valid and comparable data on drug use and related consequences among prisoners are still scarce and harmonization work is needed.
Resumen Objetivos: Estudiar las prácticas de riesgo de inyección de drogas, en especial compartir... more Resumen Objetivos: Estudiar las prácticas de riesgo de inyección de drogas, en especial compartir indirectamente material de inyección (CIMI), y de las conductas sexuales de riesgo. Métodos: Estudio transversal. Entrevista cara a cara de 1.638 usuarios de programas de intercambio de jeringas (PIJ). Se investigaron varias formas de CIMI (coger droga diluida en una jeringa usada ajena, meter la aguja en el recipiente donde se introdujeron otras usadas y reutilizar el líquido de limpieza de otros). Resultados: El 16% en Galicia, el 4,7% en Madrid, el 17,6% en Sevilla y el 13,2% en Valencia se inyectó con jeringas usadas ajenas (p < 0,001). Con variaciones geográficas, la prác
The European Monitoring Centre for Drugs and Drug Addiction (EMCD-DA) has been collecting aggrega... more The European Monitoring Centre for Drugs and Drug Addiction (EMCD-DA) has been collecting aggregated data on illicit drug use among European prison populations for over a decade. Additional studies were identified in a literature search. Together, these sources yielded 53 studies reporting data during the period 2000 to 2008. Analysis of these studies reveals that the available data are scarce and patchy, with large variations in methodology. This diversity hampers comparison, and may, in part, account for the wide range of prevalence estimates for drug use and drug injecting, both prior to imprisonment and while in prison. This article concludes that a common instrument to measure drug use and its consequences in European prison populations is needed.
International policy on the prevention of HIV and other health problems among drug users should b... more International policy on the prevention of HIV and other health problems among drug users should be guided by scientific evidence. However, it has frequently been argued that Needle Exchange Programs (NEPs) have negative effects such as facilitation of injection of illicit drugs, without providing evidence to support this hypothesis. Since the early 1980s Spain has experienced a severe HIV epidemic among drug injectors. A delayed but comprehensive implementation of harm reduction programs has taken place since the early 1990s. This paper assesses trends between 1991 and 2004, both in the number of sterile syringes exchanged or delivered by NEPs or other programs to improve injectors&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; access to sterile injection material, and in the number of injectors admitted to first treatment for heroin or cocaine dependence, as a proxy for trends in the number of new drug injectors in Spain. The results show increased access to sterile syringes and a sharp decrease in the number of new drug injectors, suggesting that NEPs have not promoted drug injection. A positive overall transition from injecting to smoking was also observed in the most frequent route of heroin or cocaine administration.
Aim of the study: To review the information available on the use of khat (Catha edulis) in the EU... more Aim of the study: To review the information available on the use of khat (Catha edulis) in the EU, and to assess the future use of this drug and related substances. Material and methods: Khat is not controlled by international law and it has not been systematically included in the list of illicit drugs monitored in the EU. The current principal source of information on khat use in Europe is the early-warning system set up to monitor new and emerging drugs. Further information was obtained from official national reports to the EMCDDA and from the scientific literature. Results: Across Europe, the use of khat is low. Khat use is limited to countries with immigrant communities from countries where khat use is common (such as Ethiopia, Somalia and Kenya). Information on the prevalence of khat use in the general population is scarce. Data on seizures provide an insight on the situation, though these may be difficult to interpret. The most recent estimates suggest that Europe accounts for about 40% of the khat seized worldwide. Conclusion: The shortage of data on the use and patterns of use of khat in Europe does not allow an evaluation of the needs for health and social interventions in communities in which the drug is used. But seizures of the plant are increasing in the EU, and more synthetic derivatives of the pharmacologically active ingredients of the plant (cathine and cathinone) are appearing on the market. Some of these, like mephedrone, have significant potential for future diffusion, and are likely to play a greater role on the European drug scene of the future.
Journal of Epidemiology & Community Health, 1998
Study objective-To describe the prevalence and patterns of use of crack and cocaine hydrochloride... more Study objective-To describe the prevalence and patterns of use of crack and cocaine hydrochloride among heroin users in Spain. To explore if the expansion of heroin smoking is accompanied by a similar phenomenon for cocaine. Design-Cross sectional study in 1995. Face to face interviews using a structured questionnaire. Setting-Three cities with diVerent prevalences of heroin use by smoking: high (Seville), intermediate (Madrid), and low (Barcelona). Participants-909 heroin users, 452 in treatment and 457 out of treatment. Main results-Last month prevalence of crack use was 62.3% in Seville, 19.4% in Madrid, and 7.7% in Barcelona. Most users in Madrid (86.5%) and Barcelona (100%) generally prepared their own crack, usually with ammonia as alkali; in Seville most users (69.7%) bought preprocessed crack. The proportion of users who began taking cocaine (crack or cocaine hydrochloride) by smoking has increased progressively since the seventies, rising to 74.1% in Seville, 61.5% in Madrid, and 28% in Barcelona in 1992-1995, with the earliest increase in Seville. The factors associated with crack use were: residence in Seville (odds ratio (OR) =16.3), cocaine hydrochloride use mainly by smoking (OR=5.0), by sniYng (OR=2.7) or by injecting (OR=2.5), heroin use mainly by smoking (OR=2.8) and weekly use of cannabis (OR=1.9). Conclusions-In Spain smoking cocaine may be progressively diVusing from the south west to the north east, similar to what has happened with smoking heroin, but beginning later in time. The factors associated with smoking cocaine are basically ecological or cultural in nature (characteristics of the available drugs and the main route of heroin administration in each city).
Journal of Epidemiology & Community Health, 1995
Study objective-To describe temporal and geographical variations in mortality from acute reaction... more Study objective-To describe temporal and geographical variations in mortality from acute reactions to opiates or cocaine and the demographic and toxicological characteristics of persons who died from these in major Spanish cities between 1983 and 1991. Design-Descriptive study. Data were obtained retrospectively from pathologists' reports.
Abstract Current data on the prevalence of prior illicit drug use among the prison population in ... more Abstract Current data on the prevalence of prior illicit drug use among the prison population in Europe is scarce. The aim of this study is to identify the prevalence of illicit drug use prior to incarceration, as reported by studies conducted in 30 European countries. A comprehensive literature review was conducted from the 5–31 of March 2018 using the databases Cochrane Library, Embase, MEDLINE, PsychINFO and PubMed. After the deletion of duplications, 2607 articles meeting the eligibility criteria for review were identified. In total, 26 studies from 12 different countries have been included in this review. The review found that the lifetime prevalence of illicit drug use before imprisonment ranged from 30 to 93%; last year prevalence from 51 to 69%; last 6 months prevalence from 13 to 75% and last month prevalence from 58 to 62%. The prevalence of illicit drug use was especially high among women. The rates varied across the 26 studies although high prevalence values are reported in most studies and variations are partly related to methodological differences in the reviewed studies. The high levels of prior involvement with drugs, necessitates prisons to develop clear strategies to deal with illicit drug use.
Study objective—To describe the prevalence and patterns of use of crack and cocaine hydrochloride... more Study objective—To describe the prevalence and patterns of use of crack and cocaine hydrochloride among heroin users in Spain. To explore if the expansion of heroin smoking is accompanied by a similar phenomenon for cocaine. Design—Cross sectional study in 1995. Face to face interviews using a structured questionnaire. Setting—Three cities with diVerent prevalences of heroin use by smoking: high (Seville), intermediate (Madrid), and low (Barcelona). Participants—909 heroin users, 452 in treatment and 457 out of treatment. Main results—Last month prevalence of crack use was 62.3% in Seville, 19.4% in Madrid, and 7.7% in Barcelona. Most users in Madrid (86.5%) and Barcelona (100%) generally prepared their own crack, usually with ammonia as alkali; in Seville most users (69.7%) bought preprocessed crack. The proportion of users who began taking cocaine (crack or cocaine hydrochloride) by smoking has increased progressively since the seventies, rising to 74.1% in Seville, 61.5% in Madri...
This chapter provides an overview of drug use in prison. It is centered on illicit drug use in Eu... more This chapter provides an overview of drug use in prison. It is centered on illicit drug use in Europe, where the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) has been collecting aggregated data from various sources for 15 years. It also reviews, based on published literature, data from the four other global regions. A total of 59 studies from 31 countries in the five world regions were included for analysis. Results show that the prevalence of drug use varies greatly between studies. Lifetime prevalence of any illicit drug use in prison ranges between 2% to 76% worldwide with, in most cases, cannabis being the most frequently reported substance. More recent (past-month) illicit drug use is reported by <1% to 65% of inmates, while <1% to 39% report injecting illicit drugs during their stay in prison. Alcohol use in prison is reported in a few studies only, varying between 2% to 77% while the prevalence of current tobacco smoking ranges between 4% to 90%. In ...
Purpose This paper aims to describe the impact of the COVID-19 containment measures on the provis... more Purpose This paper aims to describe the impact of the COVID-19 containment measures on the provision of drug treatment and harm reduction services in European prisons in15 countries during the early phase of the pandemic (March –June 2020). Design/methodology/approach The paper is based on a mixed method research approach that triangulates different data sources, including the results of an on-line survey, the outcome of a focus group and four national case studies. Findings The emergence of COVID-19 led to a disruption in prison drug markets and resulted in a number of challenges for the drug services provision inside prison. Challenges for health services included the need to maintain the provision of drug-related interventions inside prison, while introducing a range of COVID-19 containment measures. To reduce contacts between people, many countries introduced measures for early release, resulted in around a 10% reduction of the prison population in Europe. Concerns were expresse...
Interventions to tackle the supply of drugs are seen as standard components of illicit drug polic... more Interventions to tackle the supply of drugs are seen as standard components of illicit drug policies. Therefore drug market-related administrative data, such as seizures, price, purity and drug-related offending, are used in most countries for policy monitoring and assessment of the drug situation. International agencies, such as the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and the UN Office of Drugs and Crime, also monitor and report on the drug situation cross-nationally and therefore seek to collect and make available key data in a uniform manner from the countries they cover. However, these data are not primarily collected for this purpose, which makes interpretation and comparative analysis difficult. Examples of limitations of these data sources include: the extent to which they reflect operational priorities rather than market changes; question marks over the robustness of and consistency in data collection methods, and issues around the timeliness of ...
The International journal on drug policy, Jan 16, 2018
The importance of illicit drug price data and making appropriate adjustments for purity has been ... more The importance of illicit drug price data and making appropriate adjustments for purity has been repeatedly highlighted for understanding illicit drug markets. The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) has been collecting retail price data for a number of drug types alongside drug-specific purity information for over 15 years. While these data are useful for a number of monitoring and analytical purposes, they are not without their limitations and there are circumstances where additional adjustment needs to be considered. This paper reviews some conceptual issues and measurement challenges relevant to the interpretation of price data. It also highlights the issues with between-country comparisons of drug prices and introduces the concept of affordability of drugs, going beyond purity-adjustment to account for varying national economies. Based on a 2015 European data set of price and purity data across the heroin and cocaine retail markets, the paper demons...
BACKGROUND To explore if cocaine or heroin smoking was positively associated to acute respiratory... more BACKGROUND To explore if cocaine or heroin smoking was positively associated to acute respiratory complications (ARC). SUBJECTS AND METHODS We collected data from medical records for 717 cocaine users who were attended in 14 hospital emergency rooms. The association was studied by logistic regression. RESULTS The most frequent ARC were respiratory infections and complications with chest pain or dyspnea. Cocaine smokers (OR = 3.3; CI 95% = 1.5-6.9) and cocaine sniffers (OR = 2.5; CI 95% = 1.1-5.6) had greater risk of ARC than cocaine injectors. Heroin smokers (OR = 3.5; COI 95% = 1.8-7.0) and heroin sniffers (OR = 2.8; CI 95% = 1.4-5.6) had greater risk of ARC than non heroin users. CONCLUSIONS These results suggest that cocaine or heroin smoking increases the risk of ARC.
The clinical records of patients attended at emergency hospitals in fifteen hospitals in Madrid, ... more The clinical records of patients attended at emergency hospitals in fifteen hospitals in Madrid, Valencia and Gran Canaria during 1994 were retrospectively analyzed. Seventy-three emergencies related to the consumption of design drugs, hallucinogens or amphetamines (100 times lower than because of opiates or cocaine) were recorded. Apart from the responsible drug for the emergency visit, in most cases the usual consumption of other substances was mentioned. Acute psychopathological reactions predominated. Three patients were admitted and five were derived to other hospitals; the remaining patients improved and were discharged. The number of emergencies on account of these drugs is relatively low, with a proportion of less than one in 10,000 emergencies attended in these areas and might not radically change if the current predominant consumption pattern is maintained.
Resumen Objetivos: Conocer la prevalencia de infección por VIH y de conductas de riesgo para esta... more Resumen Objetivos: Conocer la prevalencia de infección por VIH y de conductas de riesgo para esta infección entre inyectores de drogas de Madrid, Sevilla y Valencia. Estudiar los principales factores asociados a dichas conductas. Material y métodos: Se entrevistó cara-a-cara a 821 inyectores captados durante 1994 y 1995 entre los usuarios recientes de tres programas de intercambio de jeringas, preguntando por las conductas de riesgo durante los 30 días anteriores a la entrevista. Se utilizaron métodos estadísticos bivariados y técnicas de regresión logística. Resultados: Durante el mes anterior a la entrevista, un 13,8% en Valencia, un 18,1% en Madrid y un 26,9% en Sevilla usó jeringas ya utilizadas por otros, la mayor parte (73%-88%) sin desinfectarlas previamente con un método eficaz. El uso del preservativo siempre durante el período de referencia fue de un 50% en Sevilla, un 42,5% en Madrid y 34,2% en Valencia. La prevalencia de infección por VIH varió entre un 30,1% en Sevilla y un 43,2% en Madrid. En el análisis multivariante los factores más fuertemente asociados con recibir jeringas usadas fueron: dar jeringas usadas (OR = 12,2), residir en Sevilla (OR = 6,6) y ser VIH positivo (OR = 4,6) y los más fuertemente asociados con no usar sistemáticamente el preservativo fueron: desconocer el estado serológico frente al VIH (OR = 4,1), recibir jeringas usadas (OR = 3,7) y ser VIH negativos (OR = 3,3). Conclusiones: En España persiste un riesgo elevado de transmisión del VIH entre los inyectores de drogas (alta prevalencia de infección y de conductas de riesgo), por lo que deben aumentar de forma importante y urgente los programas destinados a reducirlo. Palabras clave: Inyectores de drogas. Infección por VIH. Conductas de riesgo. Diferencias geográficas. Summary Objective: To determine the prevalence of HIV infection and risk-taking behavior for infection among intravenous drug users in Madrid, Seville, and Valencia (Spain). To study the main factors associated with such behavior. Material and methods: Personal interviews were carried out with 821 intravenous drug users recruited in 1994 and 1995 among recent participants in threee needle-exchange programs. Subjects were asked about their risk-taking behavior in the 30 days preceding the interview. Bivariate statistical methods and logistical regression techniques were used. Results: In the month before the interview, 13.8% of the subjects in Valencia, 18.1% in Madrid, and 26.9% in Seville used needles that had been used by other people, usually (73-88%) without disinfecting them effectively. Condom use during the reference period was 50% in Seville, 42.5% in Madrid, and 34.2% in Valencia. The prevalence of HIV infection ranged from 30.1% in Seville to 43.2% in Madrid. Multivariate analysis showed that the factors most closely associated with accepting used needles were: needle sharing (OR = 12.2), residence in Seville (OR = 6.6), and HIV positivity (OR = 4.6). The factors most closely associated with not using condoms systematically were: ignorance of personal HIV serological state (OR = 4.1), needle sharing (OR = 3.7), and HIV negativity (OR = 3.3). Conclusions: The risk of HIV transmission among intravenous durg users in Spain is high (infection and risk-taking behavior have a high prevalence), so programs designed to reduce this risk should be increased quickly.
Background and objective: To evaluate access to sterile syringes and its association with injecti... more Background and objective: To evaluate access to sterile syringes and its association with injection risk behaviour in Madrid and Barcelona. Materials and methods: Cross-sectional community study by computer-assisted personal interview in 465 young heroin injectors between 2001 and 2003. Results: Some 4.2% had not obtained any free sterile syringes in the previous 12 months. In Madrid 32.1% had obtained all their sterile syringes free of charge (ASSF), versus 44.6% in Barcelona (p < 0.01). Not sharing (not using syringes used by someone else and not front/backloading) was associated with obtaining ASSF (OR = 1.69) and with sporadic injection (OR = 1.83). Not reusing one's own syringes was associated with the same two variables (OR = 4.02 and OR = 2.50, respectively). Conclusions: Access to sterile syringes is very high in Madrid and Barcelona, although the two cities have different approaches. The acquisition of all syringes free of charge should be facilitated, especially among frequent injectors.
ABSTRACT Key points • A history of drug use is common among European prisoners, with levels dispr... more ABSTRACT Key points • A history of drug use is common among European prisoners, with levels disproportionately high compared to the general population. • Health problems, especially communicable diseases and psychiatric co-morbidity, are especially prevalent among prisoners using drugs. • The mortality risk in the first weeks after release from prison is extremely high. • Relevant differences are reported between European countries in drug use and drug-related problems among prisoners. • In European countries, valid and comparable data on drug use and related consequences among prisoners are still scarce and harmonization work is needed.
Resumen Objetivos: Estudiar las prácticas de riesgo de inyección de drogas, en especial compartir... more Resumen Objetivos: Estudiar las prácticas de riesgo de inyección de drogas, en especial compartir indirectamente material de inyección (CIMI), y de las conductas sexuales de riesgo. Métodos: Estudio transversal. Entrevista cara a cara de 1.638 usuarios de programas de intercambio de jeringas (PIJ). Se investigaron varias formas de CIMI (coger droga diluida en una jeringa usada ajena, meter la aguja en el recipiente donde se introdujeron otras usadas y reutilizar el líquido de limpieza de otros). Resultados: El 16% en Galicia, el 4,7% en Madrid, el 17,6% en Sevilla y el 13,2% en Valencia se inyectó con jeringas usadas ajenas (p < 0,001). Con variaciones geográficas, la prác
The European Monitoring Centre for Drugs and Drug Addiction (EMCD-DA) has been collecting aggrega... more The European Monitoring Centre for Drugs and Drug Addiction (EMCD-DA) has been collecting aggregated data on illicit drug use among European prison populations for over a decade. Additional studies were identified in a literature search. Together, these sources yielded 53 studies reporting data during the period 2000 to 2008. Analysis of these studies reveals that the available data are scarce and patchy, with large variations in methodology. This diversity hampers comparison, and may, in part, account for the wide range of prevalence estimates for drug use and drug injecting, both prior to imprisonment and while in prison. This article concludes that a common instrument to measure drug use and its consequences in European prison populations is needed.
International policy on the prevention of HIV and other health problems among drug users should b... more International policy on the prevention of HIV and other health problems among drug users should be guided by scientific evidence. However, it has frequently been argued that Needle Exchange Programs (NEPs) have negative effects such as facilitation of injection of illicit drugs, without providing evidence to support this hypothesis. Since the early 1980s Spain has experienced a severe HIV epidemic among drug injectors. A delayed but comprehensive implementation of harm reduction programs has taken place since the early 1990s. This paper assesses trends between 1991 and 2004, both in the number of sterile syringes exchanged or delivered by NEPs or other programs to improve injectors&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; access to sterile injection material, and in the number of injectors admitted to first treatment for heroin or cocaine dependence, as a proxy for trends in the number of new drug injectors in Spain. The results show increased access to sterile syringes and a sharp decrease in the number of new drug injectors, suggesting that NEPs have not promoted drug injection. A positive overall transition from injecting to smoking was also observed in the most frequent route of heroin or cocaine administration.
Aim of the study: To review the information available on the use of khat (Catha edulis) in the EU... more Aim of the study: To review the information available on the use of khat (Catha edulis) in the EU, and to assess the future use of this drug and related substances. Material and methods: Khat is not controlled by international law and it has not been systematically included in the list of illicit drugs monitored in the EU. The current principal source of information on khat use in Europe is the early-warning system set up to monitor new and emerging drugs. Further information was obtained from official national reports to the EMCDDA and from the scientific literature. Results: Across Europe, the use of khat is low. Khat use is limited to countries with immigrant communities from countries where khat use is common (such as Ethiopia, Somalia and Kenya). Information on the prevalence of khat use in the general population is scarce. Data on seizures provide an insight on the situation, though these may be difficult to interpret. The most recent estimates suggest that Europe accounts for about 40% of the khat seized worldwide. Conclusion: The shortage of data on the use and patterns of use of khat in Europe does not allow an evaluation of the needs for health and social interventions in communities in which the drug is used. But seizures of the plant are increasing in the EU, and more synthetic derivatives of the pharmacologically active ingredients of the plant (cathine and cathinone) are appearing on the market. Some of these, like mephedrone, have significant potential for future diffusion, and are likely to play a greater role on the European drug scene of the future.
Journal of Epidemiology & Community Health, 1998
Study objective-To describe the prevalence and patterns of use of crack and cocaine hydrochloride... more Study objective-To describe the prevalence and patterns of use of crack and cocaine hydrochloride among heroin users in Spain. To explore if the expansion of heroin smoking is accompanied by a similar phenomenon for cocaine. Design-Cross sectional study in 1995. Face to face interviews using a structured questionnaire. Setting-Three cities with diVerent prevalences of heroin use by smoking: high (Seville), intermediate (Madrid), and low (Barcelona). Participants-909 heroin users, 452 in treatment and 457 out of treatment. Main results-Last month prevalence of crack use was 62.3% in Seville, 19.4% in Madrid, and 7.7% in Barcelona. Most users in Madrid (86.5%) and Barcelona (100%) generally prepared their own crack, usually with ammonia as alkali; in Seville most users (69.7%) bought preprocessed crack. The proportion of users who began taking cocaine (crack or cocaine hydrochloride) by smoking has increased progressively since the seventies, rising to 74.1% in Seville, 61.5% in Madrid, and 28% in Barcelona in 1992-1995, with the earliest increase in Seville. The factors associated with crack use were: residence in Seville (odds ratio (OR) =16.3), cocaine hydrochloride use mainly by smoking (OR=5.0), by sniYng (OR=2.7) or by injecting (OR=2.5), heroin use mainly by smoking (OR=2.8) and weekly use of cannabis (OR=1.9). Conclusions-In Spain smoking cocaine may be progressively diVusing from the south west to the north east, similar to what has happened with smoking heroin, but beginning later in time. The factors associated with smoking cocaine are basically ecological or cultural in nature (characteristics of the available drugs and the main route of heroin administration in each city).
Journal of Epidemiology & Community Health, 1995
Study objective-To describe temporal and geographical variations in mortality from acute reaction... more Study objective-To describe temporal and geographical variations in mortality from acute reactions to opiates or cocaine and the demographic and toxicological characteristics of persons who died from these in major Spanish cities between 1983 and 1991. Design-Descriptive study. Data were obtained retrospectively from pathologists' reports.
Uploads
Papers by Luis Royuela