The characteristics of heroin users admitted to drug treatment in the years 2008-2010 in Poland Marta Struzik, Michal Kidawa Reitox National Focal Point Poland The Treatment Demand Indicator (TDI) 12th Annual Expert Meeting Background • Number of treatment centres under TDI pliot project: 2008 – 33 (13 outpatient, 18 inpatient, 1 detoxification ward, 1 substitution treatment program) 2009 – 26 (13 outpatient, 13 inpatient) 2010 – 21 (9 outpatient, 11 inpatient, 1 detoxification ward) • Total number of clients: 2008 – 2082 2009 – 1426 2010 – 1342 Data limitations • Coverage in the years 2008 - 2010: around 15%, • The number and type of treatment centres is changing, • Caution must be made while analyzing trends, • In order to formalize the new TDI system the Polish parliament adopted a national law which includes the obligation of data collection by the treatment facilities. The law must be followed by an ordinance which is ready but not yet adopted by the Ministry of Health. Numbers of heroin users admitted to treatment 700 651 all clients 643 600 first-time clients 500 388 400 Percentages of heroin users 300 admitted to treatment 200 50% 112 all clients 48% 100 62 45% first-time clients 53 40% 0 2008 2009 2010 35% 31% 30% 27% 25% 20% 17% 16% Total: 2008 (2082 all) 15% 2009 (1426 all) 10% 8% 5% 2010 (1342 all) 0% 2008 2009 2010 Percentages of heroin users by type of treatment centre 100% 0 18% 80% 33% 22% 0 67% 60% 3% detoxification inpatient 40% substitution 57% 67% outpatient 16% 20% 0 17% 0% 2008 2009 2010 Type of heroin used 2008 2009 heroin; heroin; 77,1% 79,6% methadone; other 0,8% other methadone; opioids; 6,0% opioids; 6,4% 0,8% kompot kompot (Polish (Polish heroin); heroin); 16,1% 13,1% 2010 heroin; 85,1% other opioids; 3,9% kompot methadone; (Polish 1,4% heroin); 9,6% Gender of clients 2008 2009 male; 80% male; 78% female; 20% female; 22% 2010 male; 83% female; 17% Type of heroin used among males 100% 5,50% 4,6% 3,8% 10,0% 13,60% 12,6% 1,4% 80% 1% 0,7% 60% 40% 80% 82,1% 84,8% 20% 0% 2008 2009 2010 heroin methadone kompot (Polish heroin) other opioids Type of heroin used among females 100% 7,8% 4,5% 12,8% 8,1% 80% 26,6% 15,1% 0,9% 1,2% 60% 0,0% 40% 86,5% 65,6% 70,9% 20% 0% 2008 2009 2010 heroin methadone kompot (Polish heroin) other opioids Age at first heroin use 60% 52,6% 50,8% 50,0% 2008 2009 2010 50% 40% 30% 27,5% 26,0% 24,3% 20% 11,7% 10,3% 10% 8,1% 7,6% 7,7% 4,3% 6,8% 1,8% 1,8%2,2% 0,8% 1,4% 1,0% 0% not <15 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-65 >=65 known/missing Age at regular heroin use 50% 47,3% 45% 42,8% 41,1% 2008 2009 2010 40% 35% 34,4% 32,7% 30% 29,5% 25% 20% 15% 13,8% 11,3% 10% 5,8% 8,6% 4,9% 4,5% 5% 4,4% 3,1% 3,4% 2,1% 2,0% 1,0% 1,5% 1,1% 0,8% 0% not <15 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-65 >=65 known/missing Age at heroin treatment admission 45% 40,4% 40% 39,2% 2008 2009 2010 35,5% 35% 29,9% 30% 25% 20,6% 20,0% 20% 20,4% 16,8% 14,6% 15% 10% 8,1% 7,7% 5,7% 6,2% 5,2% 5% 4,6% 4,0% 3,1% 3,2% 2,8% 1,3% 2,2% 2,3% 1,8% 1,2% 0,8% 0,9% 0% 0,2% <15 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-65 >=65 Time between first heroin use and entering treatment 40% 35% 30% 25% 2008 20% 2009 15% 2010 10% 5% 0% <1 1 2 3 4 5 6 7 8 9 10 11 to 15>15 not known/missing Time between regular heroin use and entering treatment 25% 20% 15% 2008 2009 10% 2010 5% 0% <1 1 2 3 4 5 6 7 8 9 10 11 to 15>15 not known/missing Freguency of heroin use 90% 85,7% 80% 69,3% 70% 60% 52,8% 50% 2008 40% 2009 2010 30% 26,3% 20% 15,2% 11,3% 10,0% 10% 2,5% 4,7% 7,5% 4,7% 2,1% 2,2% 3,1% 2,8% 0% not not used in the once a week or 2-6 days per daily known/missing last 30 days less week Route of heroin administration 80% 75,9% 70% 66,8% 61,9% 60% 50% 2008 40% 2009 29,4% 30% 2010 24,9% 18,4% 20% 10% 3,4% 6,2% 2,1% 4,8% 3,9% 1,4% 0,2% 0,5% 0,5% 0% not known inject smoke/inhale eat/drink others Heroin use and drug injection 45% 41,8% 43,1% 41,0% 40% 36,3% 38,1% 35% 33,2% 30% 25% 21,9% 2008 20,4% 20% 2009 15% 13,5% 2010 10% 5,4% 5% 3,6% 1,6% 0% not ever injected but currently injecting never injected known/missing not currently Needles and syringes sharing among users injecting drugs 45% 44,2% 40,1% 40% 34,2% 36,3% 35% 34,4% 31,2% 30% 26,5% 25% 2008 20% 2009 17,2% 15,2% 15% 2010 10% 8,3% 7,3% 5,0% 5% 0% not ever shared but currently shared never shared known/missing not currently HIV status (self – reported) 2008 2009 tested in the last tested in the last tested in the last 12 months - last 12 months - last 12 months - last result negative; tested in the last result not known result negative; 29,3% 12 months - last ; 0,8% tested - positive result not known 31,5% result; 10,2% ; 1,2% not tested in the last 12 months ; tested - positive not tested in the 45,7% not known; last 12 months ; result; 8,0% not known; 26,4% 32,9% 14,0% 2010 tested in the last 12 months - last result negative; 67,50% tested - positive result; 5,60% not known; 7,80% not tested in the tested in the last last 12 months ; 12 months - last 17,90% result not known ; 1,20% HCV status (self – reported) 2008 2009 tested in the last tested in the last tested in the last tested in the last 12 months - last 12 months - last 12 months - last 12 months - last result negative; result not known result negative; result not known 18,1% ; 1,3% 14,40% ; 1,50% not tested in the not tested in the tested - positive last 12 months ; last 12 months ; result; 28,40% 29,90% 41,6% tested - positive result; 23,3% not known; not known; 15,8% 25,80% 2010 tested in the last 12 months - last not tested in the result not known last 12 months ; tested in the last ; 6,5% 15,1% 12 months - last result negative; not known; 30,8% 13,9% tested - positive result; 33,6% Opioid substitution treatment 2008 2009 no ; 84,0% no ; 72,5% yes; 22,7% yes; 14,2% not known; not known; 4,8% 1,8% 2010 no ; 68,0% yes; 31,7% not known; 0,3% ICD-10 diagnosis 90% 81,6% 80% 70% 59,2% 60% 57,3% 2008 50% 42,5% 2009 40% 39,3% 2010 30% 20% 17,7% 10% 0,9% 0,3% 0,2% 0,2% 0,2% 0,3% 0% 0,0% 0,0% 0,3% 0,2% 0,0% 0,0% not known F11 F13 F15 F19 others Summary • Age of first heroin use – 15-24 • Age of regular heroin use– 15-24 and 25-29 • Age of heroin treatment admission - 25-34 • Over 60% users inject heroin, • Around 40% of heroin users injected any other drugs in the past, • Around 40% of heroin users inject any other drugs currently, • Around 30% of heroin users ever shared needles and syringes, but not currently, • Less than 10% of heroin users is currently sharing needles and syringes, • Up to 10% of heroin users declare positive result of HIV test, • Up to 30% of heroin users declare positive result of HCV test, Thank you! 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