Extrato do site do European Monitoring Centre for Drugs and Drug Addiction

(EMCDDA).

Methods and definitions: problematic drug use population

„Problem drug use‟ is defined by the EMCDDA as „injecting drug use or long duration
or regular use of opioids, cocaine and/or amphetamines‟. This definition specifically
includes regular or long-term use of prescribed opioids such as methadone but does not
include their rare or irregular use nor the use of ecstasy or cannabis. Existing estimates
of problem drug use are often limited to opioid and poly-drug use. As a reaction to
growing stimulants problem as well as growing number of cannabis-related treatment
demands, EMCDDA is currently examining the possibilities of breakdowns by main
drug, as well as the best way of estimating the population of problematic cannabis users.
Discussions with experts however didn‟t indicate a better option for the PDU definition
until now.

The methods used to produce prevalence estimates are based mainly on statistical
models using drug use related indicators and include mainly:

a simple multiplier method using police, treatment, mortality or HIV/HCV data;

capture–recapture methods;

extrapolation via multivariate indicator methods

The EMCDDA has produced guidelines for prevalence estimation both at local and at
national level. At local level the preferred method is a three-(or more)-sample capture-
recapture study (though other methods can be used) and detailed guidelines have been
produced: Methodological guidelines to estimate the prevalence of problem drug use on
the local level. At national level estimates are more difficult to obtain with capture-
recapture methods due to spatial heterogeneity of data sets, data availability and quality
problems. Draft guidelines have been developed, however, they are currently being
updated on the basis of the experience in the Member States.

Given the methodological improvements over the last few years, it seems possible to
distinguish between injecting drug users (estimates from overdose mortality or HIV
multipliers; these may be mainly current injectors) and the wider group of problem drug
users, which includes both injectors and non-injectors.

Available estimates are improving in number and quality, but there are still many
problems to be solved. There is no single method that can be applied in all the countries
to give truly comparable results and even if a standard method such as capture-recapture
can be used at local level, available datasets often differ so much that it would be
difficult to compare results across countries. Comparability problems also stem from
differences in the exact definition of the estimated target group, due to differences in
drug use patterns between countries.

Most EU countries were able to produce national estimates of problem drug use using
the agreed definition of problem drug use by 2005, although estimates of injecting drug
use remain scarce. Many of the available estimates are based on results from more than
one estimation method, thereby adding to their reliability.

In addition to local and national prevalence estimation, several countries have been able
to explore incidence estimation (time trends in numbers of new cases rather than static
estimates of all existing cases) and draft guidelines have been prepared based on two
different methods for estimating incidence. In 2005, a new project was started with the
aim to provide countries with more guidance and promote more collaboration between
them, as well as improvement of quality and implementation of incidence estimation.

Extrato do “Methodological Guidelines to Estimate the Prevalence of Problem Drug

Use on the Local Level” do European Monitoring Centre for Drugs and Drug Addiction
(EMCDDA).

Case Definitions

There are a range of terms that are applied, often interchangeably, to describe the illicit
use of drugs. Some terms are medical in nature, for example drug injecting or drug
dependence. It is clear that someone who injects drug can be classified as a drug injector
and medical opinion can define what dependence is, for example the International
Classification of Diseases (ICD10) codes refer to dependence syndrome as:

„A cluster of behavioural, cognitive and physiological phenomena that

develop after repeated substance use and that typically include a strong
desire to take the drug, difficulties in controlling its use, persisting in its use
despite harmful consequences, a higher priority given to drug use than other
activities and obligations, increased tolerance and sometimes a physical
withdrawal state. The dependence syndrome may be present for a specific
psychoactive substance, for a class of substances or for a wider range of
pharmacologically different psychoactive substances‟

The term „drug addiction‟ is often used interchangeably with „drug dependence‟. In
Spain, the SEIT information system additionally defines „drug abuse‟ as

„A non-adaptive model of psychoactive substance use, with continuous or

recurrent use, which does not meet the criteria for the diagnosis of
dependence of said substance‟

Other terms can be more subjective, for example „problem drug user‟. The Regional
Drug Misuse Databases within the United Kingdom use the following definition of a
problem drug user:
 „Any person who experiences social, psychological, physical or legal
problems related to intoxication and / or regular excessive consumption and /
or dependence as a consequence of his / her own use of drugs or chemical
substances.‟

This wider definition includes legal problems, albeit only in relation to intoxication,
dependence or excessive use. Laws on illicit drug use vary across Europe relating to the
consumption, possession or supply / trafficking of drugs, therefore the concept of a legal
problem relating to drugs will vary across the continent. Indeed, the inclusion of supply,
or even possession, within a „legal problem‟ classification could encompass those that
do not consume drugs, but only supply them to others.

Definitions such as problem drug use are often intrinsically linked to the nature of the
drugs that are being consumed. We therefore detail some of the drugs that are used
throughout Europe.