1. No category

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.
Huumehoidon Pompidou-tiedonkeruu / Martta Forsell
When is there enough key indicator
data to state a trend?
Huumehoidon Pompidou-tiedonkeruu / Martta Forsell
Trends of opioids use in Europe
Huumehoidon Pompidou-tiedonkeruu / Martta Forsell
Huumehoidon Pompidou-tiedonkeruu / Martta Forsell
Huumehoidon Pompidou-tiedonkeruu / Martta Forsell
Trends of opioids use in Europe
• Increasing in Finland when
decreasing everywhere?
Huumehoidon Pompidou-tiedonkeruu / Martta Forsell
Huumehoidon Pompidou-tiedonkeruu / Martta Forsell
Trends of opioids use in Europe
• Increasing in Finland when
decreasing everywhere?
• Or is Finland 40 y or 20 years late?
Huumehoidon Pompidou-tiedonkeruu / Martta Forsell
Huumehoidon Pompidou-tiedonkeruu / Martta Forsell
Some heroin consumption in Finland
only in the late 90s.
Opioid use in Finland is iv-use of
buprenorphine together with other
medicinal products.
Huumehoidon Pompidou-tiedonkeruu / Martta Forsell
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?
Huumehoidon Pompidou-tiedonkeruu / Martta Forsell
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
Other opioids
(as tramadol,
fentanyl,
codein,
oxicodone,
morphine)
Other opioids
(as tramadol,
fentanyl,
codein,
oxicodone,
morphine)
•
•
•
Pekka Hakkarainen
Leena Metso
Karoliina Karjalainen
Huumehoidon Pompidou-tiedonkeruu / Martta Forsell
Lifetime prevalance for any opioid misuse
15-64 year olds
%
3
2.5
1.9
2
1.4
1.5
1
0.5
0.5
0.6
0.3
0
1998
28.9.2015
2002
2006
Esityksen nimi / Tekijä
2010
2014
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
Huumehoidon Pompidou-tiedonkeruu / Martta Forsell
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
Huumehoidon Pompidou-tiedonkeruu / Martta Forsell
Lifetime prevalance for any opioid misuse
15-64 year olds
%
3
2.5
1.9
2
1.4
1.5
1
0.5
0.5
0,4%
0.6
0.3
0
1998
28.9.2015
2002
2006
Esityksen nimi / Tekijä
2010
2012 2014
PDU
19
Problem opioid users, capture-recapture
%
0.5
0.45
0.4
0.35
0.3
Max
opioidit min
Opioidit
0.25
opioidit max
0.2
X
Min
Opioidit
0.15
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
opioidit min
Max
opioidit max
Opioidit
0.25
Poly. (opioidit min)
0.2
X
Min
Poly. (opioidit max)
Opioidit
0.15
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
28.9.2015
22
28.9.2015
23
Problem opioid users, capture-recapture
%
0.5
0.45
0.4
0.35
0.3
opioidit min
Max
opioidit max
Opioidit
0.25
Poly. (opioidit min)
0.2
X
Min
Poly. (opioidit max)
Opioidit
0.15
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
Huumehoidon Pompidou-tiedonkeruu / Martta Forsell
Drug clients reporting opioids use,
share (%) from all reported drug clients (incl. continuous clients)
% 80
75
70
65
60
55
50
45
40
Huumehoidon Pompidou-tiedonkeruu / Martta Forsell
Huumehoidon tiedonkeruun kattavuutta ei tiedetä,
lomakkeiden määrä vähenee
Paljon hoitoa (matalat indikaatiot),
kiinnostava aihe
Asiakkaita
Yksiköitä
7,000
180
166
160
6,000
140
5 793
5,000
120
4,000
100
Asiakkaita
79
3,000
Yksiköitä
80
66
60
2 688
2,000
2 089
1,000
40
20
0
0
2000
28.9.2015
2001
2002
2003
2004
2005
2006
2007
2008
2009
Esityksen nimi / Tekijä
2010
2011
2012
2013
28
Huumehoidon tiedonkeruun kattavuutta ei tiedetä,
lomakkeiden määrä vähenee
Paljon hoitoa (matalat indikaatiot),
kiinnostava aihe
Hoito ja tiedon tuotanto
166
keskittyy ’F11’ ympärille
Asiakkaita
7,000
Yksiköitä
180
160
6,000
140
5 793
5,000
120
4,000
100
Asiakkaita
79
3,000
Yksiköitä
80
66
60
2 688
2,000
2 089
1,000
40
20
0
0
2000
28.9.2015
2001
2002
2003
2004
2005
2006
2007
2008
2009
Esityksen nimi / Tekijä
2010
2011
2012
2013
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
Huumehoidon Pompidou-tiedonkeruu / Martta Forsell
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
Huumehoidon Pompidou-tiedonkeruu / Martta Forsell
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
Huumehoidon Pompidou-tiedonkeruu / Martta Forsell
This study may indicate that
opioid use is increasing in Finland
and further monitoring is needed.
Huumehoidon Pompidou-tiedonkeruu / Martta Forsell
GPS prevalence
TDI treatment
HRDU problem opioid users
DRD deaths
Huumehoidon Pompidou-tiedonkeruu / Martta Forsell
This study may indicate that
opioid use is increasing in Finland
and further monitoring is needed.
Why?
How to stop this trend?
Huumehoidon Pompidou-tiedonkeruu / Martta Forsell
Thank you
Huumehoidon Pompidou-tiedonkeruu / Martta Forsell