Encuesta a personas admitidas a tratamiento por abuso o dependencia de heroína o cocaína, 2003-2004 / Survey carried out among patients entering treatment because of heroine and cocaine addiction, 2003-2004

Objetivos. Conocer las características sociodemográficas, patrones de consumo, prácticas de riesgo e infección por el virus de la inmunodeficiencia humana (VIH) y utilización de recursos sanitarios entre los consumidores de heroína o cocaína admitidos a tratamiento. Material y métodos. Estudio transversal realizado entre los años 2003-2004 de una muestra sistemática de 2.610 pacientes admitidos a tratamiento ambulatorio por abuso o dependencia de la heroína o la cocaína, en todas las Comunidades Autónomas españolas, excepto País Vasco y Navarra. Se aplicó un cuestionario precodificado mediante una entrevista cara a cara. Resultados. Un 80,3% de los pacientes eran hombres. La edad media fue de 32,7 años. Un 42,5% estaba desempleado y con frecuencia obtenía dinero de la familia, pareja, ayudas sociales y actividades delictivas. La vía de administración más frecuente de la heroína era la pulmonar. Era frecuente el policonsumo, así como el uso de drogas entre hermanos, pareja, convivientes y amigos. Un 43,3% se había inyectado drogas alguna vez en la vida, un 23,4% lo había hecho en el último año y, de ellos, un 21,4% había utilizado jeringas previamente usadas por otros. Un 30,2% de los pacientes había utilizado siempre preservativo en las relaciones sexuales con parejas esporádicas en el último año. Un 12,9% de los pacientes tenía una serología positiva para el VIH al ser admitido para el tratamiento, cifra que alcanzaba el 26,8% entre los que se habían inyectado drogas alguna vez. Con respecto a la encuesta realizada en 1996 ha disminuido el uso de la inyección como vía de administración de la heroína y ha aumentado la vía pulmonar. Entre los que se inyectan ha disminuido bastante la práctica de compartir jeringuillas (en 1996 un 34% había utilizado el último año jeringas usadas por otros, frente a un 20,1% en 2003-2004) y la prevalencia de infección por el VIH (el 32% en 1996 frente al 30,1% en 2003-2004). Conclusiones. Aunque se han producido algunos cambios positivos respecto a la encuesta de 1996 entre los admitidos a tratamiento por el consumo de heroína, esta encuesta pone de manifiesto la necesidad de implementar diversos tipos de actuación desde una perspectiva social y de prevención de las infecciones de transmisión sanguínea y sexual en estos grupos de consumidores

Objetive. To know the sociodemographic characteristics, consumption patterns, major risk behaviors in HIV transmission, prevalence of HIV infection, and utilization of health resources among cocaine and heroine drug users entering treatment Methods. A cross-sectional survey consisting of a personal interview was conducted on a systematic sample of 2610 admitted to outpatient drug treatment during 2003-2004 in all Spanish autonomous regions, except for Basque Country and Navarra. Results. Among all participants, 80.3% were males. Mean age was 32.7 years. A 42.5% was unemployed and frequently got money from family, partner, social support and criminal activities. The most frequent route of heroin administration was smoking. Most drug users consumed several drugs. Siblings, partners, flatmates and friends of participants usually consumed drugs. Among all participants, 43.0% had ever injected drugs, and 23.4% had injected drugs during the year before treatment admission. From these last-year injectors, 21.4% had taken used syringes from others. From all participants, just 30.2% had always used a condom during previous year when they had a sexual intercourse with a casual partner. At admission, 17.9% reported that they were HIV positives. This rate was higher among ever injectors (29.4%). Comparing these results with a similar survey carried out in 1996, the use of intravenous drugs is less common among heroin drug users, as well as the use of syringes used previously by others (34% in 1996 had taken used syringes during the last year versus. 20.1% in 2003-2004). HIV infection rate has also decreased slightly in this period. Conclusions. Although some positive changes have occurred since 1996 among patients admitted to heroin treatment, this survey shows that is necessary to carry out different measures in order to improve social situation and prevention of HIV transmission

[Evolution of the prevalence of HIV infection and risk behavior of drug injection among intravenous drug users infected or not infected by HIV in 3 Spanish cities. Working Group of Physicians of the World for the monitoring of HIV infection and risk behaviors in intravenous drug users]. / Evolución de la prevalencia de infección por VIH y de prácticas de riesgo de inyección entre inyectores de drogas infectados o no por el VIH de tres ciudades españolas. Grupo de Trabajo de Médicos del Mundo para la monitorización de la infección por VIH y las prácticas de riesgo en usuarios de drogas inyectables.

OBJECTIVE: To know the evolution of HIV prevalence and risk behavior practices of drug injection in three spanish cities on the basis of the serologic status of injecting drug users. METHODS: Cross-sectional surveys among users in syringe interchange programmes. RESULTS: HIV prevalence (self-reported) decreased in Madrid from 50% (1992) down to 41% (1996) (p = 0.01) and did not change in Seville and Valencia from 1994 to 1996. Among HIV-positive injecting drug users, a decrease was observed in the practice of giving and taking used syringes in the three cities, although this decrease reached a statistically significance (p = 0.006) only for giving in Valencia from 1994 to 1996 and was almost significant (p = 0.08) for taking in Madrid from 1993 to 1996. Among HIV-negative injecting drug users, no decreases were observed in the practice of giving and taking used syringes and even a significant increase in giving syringes in Seville was recorded (p = 0.01) from 1994 to 1996. CONCLUSIONS: HIV prevalence among injecting drug users is stabilized or decreasing in the three studied cities. The prevalence of injecting risk behavior evolves differently according to the serologic status.

Evolución de la prevalencia de infección por VIH y de prácticas de riesgo de inyección entre inyectores de drogas infectados o no por el VIH de tres ciudades españolas / Evolution of the prevalence of HIV infection and risk behavior of drug injection among HIV+ and HIV- drug users in three spanish cities

Fundamento. Conocer la evolución de la prevalencia del virus de la inmunodeficiencia humana (VIH) y las prácticas de riesgo con drogas por vía intravenosa en tres ciudades españolas según el estado serológico de los inyectores. Métodos. Encuestas transversales a usuarios de programas de intercambio de jeringuillas. Resultados. La prevalencia de VIH (autoinformada) descendió en Madrid del 50 por ciento (1992) al 41 por ciento (1996) (p = 0,01) y no se modificó en Sevilla y Valencia entre 1994 y 1996. Entre los inyectores de drogas infectados por el VIH disminuyó la práctica de dar y la de recibir jeringuillas usadas en las tres ciudades, aunque este descenso sólo alcanzó significación estadística (p = 0,006) para dar en Valencia entre 1994-1996 y la rozó (p = 0,08) en Madrid para recibir entre 1993-1996. Entre los no infectados por el VIH no se aprecian descensos en la práctica de recibir ni en la de dar jeringuillas usadas, registrándose incluso un incremento significativo de dar en Sevilla (p = 0,01) entre 1994-1996.Conclusiones. La prevalencia del VIH entre inyectores de drogas está estabilizada o en descenso en las ciudades estudiadas. La prevalencia de prácticas de riesgo de inyección evoluciona diferencialmente según el estado serológico (AU)

[Drug injection method risky for transmission of blood-borne diseases: are we careful enough?]. / Estamos estudiando adecuadamente las prácticas de inyección de drogas que implican riesgo de transmisión de enfermedades por vía parenteral?

In the last 20 years, research on the determinants of the HIV epidemic among drug users has focused mainly on studies of risk behaviour for drug injection. Studies involving human behaviour present special methodological problems. This paper presents a review of 1) the most important features that make this field different from the study of blood-borne diseases in other populations, and 2) the basic variables used in epidemiology to analyse injecting risk behaviour. Alternatives to improve research planning and results are proposed based on collaborating with other disciplines and improving the methodological resources of epidemiology.

[Epidemiology of designer drug use in Spain]. / Epidemiología del consumo de drogas de diseño en España.

BACKGROUND: To provide epidemiological information on the extent of design drug use in Spain, the characteristics of users, and the types of substances consumed. MATERIALS AND METHODS: We analyzed two surveys on drug use carried out in 1993 and 1994 (one in the general population older than 15 years and the other in heroin and/or cocaine users who were not in treatment) as well as data on designer drug seizures confiscated by the General Police Headquarters and Ministry of Health laboratories. RESULTS: According to the general population survey, 4.5% of persons 16-40 years of age have tried design drugs at some time, 2.1% more than once, and 0.6% are current users. Design drug use is associated with age of 20-24 years and use of crack (odds ratio [OR] = 28.6), cannabis (OR = 12.5), cocaine (OR = 7.6) or heroin (OR = 3.8). According to the survey of heroin/cocaine users, 25% of cocaine users have used design drugs in the last 30 days, 11% of heroin users, and 18% of those who use both substances. Use is associated with the use of hallucinogens (OR = 4.8), non-use of the injected route (OR = 2), and having been interviewed in recreational areas (OR = 1.8). Police data reflect a stability in the quantities of amphetamines confiscated, a large increase in those of MDMA, and an absence of MDA and MDEA. Ministry of Health laboratories show an increase in confiscations of amphetamines and the presence of MDA, MDMA and MDEA in all years and areas studied, as well as the appearance of MBDB in 1994. CONCLUSIONS: The occasional use of different design drugs has spread to some degree among young people, varies considerably by geographic region, and is associated with the use of other legal and illegal substances, specially stimulants.

[Patterns of cocaine use among cocaine users who do not use heroin recruited outside of treatment centers]. / Patrones de uso de cocaína en un grupo de consumidores de esta droga sin consumo de heroína captados fuera de los servicios asistenciales.

BACKGROUND: In Spain cocaine use, although relatively widespread, has produced few health problems, most likely because there is a preponderance of non-intensive intranasal use. To obtain data in this regard, we investigated the history and patterns of use in a group of cocaine users. SUBJECTS AND METHODS: Cross-sectional survey carried out in 1993 among 381 cocaine users (289 men and 92 women) who did not use heroin and had not received treatment for drug dependence, recruited by non-probabilistic sampling outside of treatment centers in 35 Spanish cities. The results are presented separately for men and women. RESULTS: The persons interviewed predominantly took cocaine sporadically, during the weekend, in moderate amounts (less than 0.4 g/day) and by the intranasal route. For only 7.2% was it very difficult or impossible to give up cocaine. These characteristics had persisted throughout the users' history; few users (18.1%) had taken cocaine more than 3 times a week in any period or had used a main route other than the intranasal route (10.8%). The proportion of those interviewed who used other drugs, mainly alcohol, tobacco and cannabis, was larger than in the general population in the same age group; interviewees also had a higher educational level and a lower level of unemployment. Women used cocaine, alcohol and tobacco in smaller amounts than men, and a smaller proportion of women stated that it was very difficult or impossible to give up cocaine. CONCLUSIONS: In Spain, the cocaine users who do not use heroin have better educational and employment levels than general population, and generally they use cocaine sporadically, in moderate amounts and by the intranasal route. These circumstances may contribute to explain the relative scarcity of health problems associated to cocaine use.

[Emergencies associated with the consumption of designer drugs, hallucinogens and amphetamines treated at 15 Spanish hospitals in 1994. Work Group on the Study of Emergencies due to Psychostimulants]. / Urgencias relacionadas con el consumo de drogas de diseño, alucinógenos y anfetaminas atendidas en quince hospitales españoles durante 1994. Grupo de Trabajo para el Estudio de las Urgencias por Psicoestimulantes.

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.

[Risk behaviors for HIV transmission among the recent clients of a syringe-exchange program in Madrid, 1993]. / Conductas de riesgo para transmisión del VIH entre los usuarios recientes de un programa de intercambio de jeringas en Madrid, 1993.

OBJECTIVE: To determine the prevalence of the major risk behavior in HIV transmission (syringe sharing and failure to use condoms) and associated factors among drug injectors recruited for a syringe exchange program (PIJ) in the city of Madrid. METHODS: Cross-section study. All the information was obtained in 1993 through structured interviews with 441 users who had injected drugs during the previous month and had resorted to the PIJ five times, at most. The reference period for drug use and risk behaviour was the month prior to the interview. The statistical analysis included bivariate methods and logistical regression techniques. RESULTS: 29.2% shared syringes (18% passing and 21.7% taking used syringes) and of those that had sexual intercourse (49.4%), 42.5% always used a condom. 89.5% had an HIV antibody test and of those that knew the results, 48.6% were HIV-positive. Multivariate analysis showed that the association between certain behaviour patterns was significant; i.e., taking used syringes and: passing used syringes (odds ratio -OR- = 6.1; 95% confidence interval -CI- = 3.0-12.5), being HIV-positive (OR = 4.1; CI = 1.8-9.1), being unaware of HIV antibody test status (OR = 4.2; CI = 1.7-10.2) and having used intravenous drugs for 5-9 years (OR = 2.9; CI = 1.1-7.9); the association was significant between passing used syringes and: using a mixture of heroin and cocaine (OR = 2.7; CI = 1.1-6.4) and being unaware of HIV antibody test status (OR = 2.5; CI = 1.1-6.0). In the sample as a whole, the association between not using condoms ever and consuming cocaine (OR = 1.7; CI = 1.1-2.9) or crack (OR = 3.0; CI = 1.5-5.9) was significant; furthermore, among those that had sexual intercourse, the association was significant between not using condoms ever and: having been in jail (OR = 2.9; CI = 1.3-6.4), injecting drugs 2-4 times a day (OR = 2.4; CI = 1.0-5.8), having sexual intercourse with drug injectors (OR = 2.6; CI = 1.2-5.9) and having intercourse with two or more partners (OR = 0.4; CI = 0.2-0.9). CONCLUSIONS: The prevalence of HIV infection and risk behavior in the transmission of this virus remain high among drug injectors in Madrid. The habit of sharing syringes is still common, especially among HIV-positive drug injectors (a high percentage take used syringe) and among those who are unaware of their HIV antibody test status. The use of condoms is less frequent among those who have sexual intercourse with other drug injectors or with only one partner.

The epidemiology of cocaine use in Spain.

Trends and patterns of cocaine use in Spain are described with the aid of different information sources such as population surveys, the State Information System on Drug Abuse, and anthropological studies. In recent years the magnitude of cocaine supply indicators has increased greatly. High levels of last-month prevalence of cocaine use have been detected among the general population--consistently higher than those for heroin-- and cocaine consumption among heroin users has increased. Although the frequency of some health problems related to cocaine use--treatment admissions, hospital emergency admissions--has increased, it is still 30 times less than for heroin. Various hypotheses to explain these discrepancies are discussed.