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The lifetime drug use ratio between men and women is 3 to 1. The highest prevalence is met in the age group and in the Greater Athens area as compared with the second largest city Thessaloniki , the other urban, and the semi-urban and rural areas. It is noted, however, that since there has been no repeat survey of a representative general population sample. Twice as many male Drug use increases with age: lifetime prevalence increases from 7. Drug use is significantly higher in the cities of Athens and Thessaloniki Irrespective of the drugs used, boys use drugs in significantly higher proportions compared to girls Table 2. In , one in every 10 students aged The male to female ratio was 2 to 1 for current use Recent and current use increases significantly by age. Finally, twice as many students in Athens and Thessaloniki than students in other areas report recent and current use Table 2. Boys repeated cannabis use in significantly higher proportions compared to girls Repeated cannabis use as opposed to times use increases after the age of Finally, students in Athens and Thessaloniki repeat cannabis use in significantly higher proportions compared to other areas For cannabis in particular, following the decline recorded from to , prevalence rates increased between and Figure 2. The increase in cannabis prevalence also applies to trying the substance 1 or 2 times 1. Among the countries that participated in the survey, only in Cyprus and Finland were the rates similar to the Greek ones. As shown in Figure 9. More specifically, the number of individuals returned to the levels of and the number of cases to the levels of The latest available data are for the year Figure 9. Of a total of 45 convicts, 1 4. The overwhelming majority Figure 9. In the period under consideration there has been no significant variation in the distribution of convicts by gender and drug-related offence. It is pointed out that the two regions where most of the offences were committed were again Macedonia and Attica in the years , too. The sentences imposed for drug use, dealing and trafficking are prison sentences exceeding one year, and This figure is similar to the ones reported in This permits the estimation of the 'hidden population' of people who are problem drug users but did not happen to be recorded by any of these sources in the year in question. Because of this method of estimation, the definition of a problem drug user is someone who may eventually attend the treatment services because of his or her use of opiates. The lack of data in the appropriate form from other sources that might record problem drug users, such as the Police, is regrettable as it prevents checking and possible improvement of our current estimates. Table 4. Taking into account that in the average age for initiation of injection drug use was estimated at Kondilis, et al. Epub Apr In , a total of HIV cases were attributed to injecting drug use, with this route of transmission representing The number of tests conducted in in the three different data and the demographic characteristics of the IDUs tested are presented in Table 6. In , data reported from all sources showed a sharp increase in the number of IDUs diagnosed with HIV and a significant increase in the HIV prevalence in this population reaching levels as high as 4. Among the HIV positive cases in , Finally, In , prevalence rates ranged between Compared to , in HCV infection rates remained stable in data source 1 national sample , but increased significantly in data sources 2 national sample and 3 Athens sample Figure 6. Whereas tuberculosis incidence continued its declining trend according to the Hellenic Centre for Disease Control and Prevention, reported new cases of tuberculosis decreased by In August , 52 units operated across the country, while it is estimated that 13 additional units will be ready to operate in next months Micha Most of the units are hosted in hospitals and staffed by the existing????? Most of the treatment slots were offered in OST units 6,, Compared to , in the treatment capacity increased by In addition, 4, In , there has been a 9. A total of 6, individuals 9 were offered OST services, As it is shown in Figure 5. More specifically, in the total number of clients in OST increased by 8. In admissions increased by Injecting use prior to admission was reported by 4, clients in treatment in the reporting year data for 55 of the 61 structures. More specifically, 4, clients As for the modes of exit from treatment programmes, 2, clients Figure 5. There is also an increase by 8. Last year, the increase in capacity was commensurate with the increase in the number of clients As for the mean power, there is an increase by 9. Most notably, enhancement of research and use of research data for policymaking, evaluation of activities and identification of the evidence-based practices in addiction management at the national level, as well as use of international best practice in evaluation, setting across-the-board criteria for the evaluation of agencies and, finally, evaluation of the National Plan against Addictions itself. The increase in the number of units and the increase in the number of clients in treatment, doubled by the decrease in staff and pay cuts, indicated that the system was already overstretched and could take no more tension. The scientific and humanitarian importance of this decision aside, there will also be savings, since it is well-known that a user in prison costs 4 to 8 times more than a user in treatment. This is no oxymoron. The annual report stated that the demand reduction system in Greece has a very solid foundation. This year, this is being proven. The bill has two axes, one being the non-criminal treatment of users, and two foreseeing a new coordinating scheme. Cannabis cultivation for personal use is defined as a minor offence. Home Greece. Prevalence of Illicit Drug Use Among Youth in Greece, 'According to the most recent data : 'Any illicit drug use 1 : almost one in every 6 students aged Trends in Prevalence of Cannabis Use Among Youth 'Over time, with the exception of cannabis, there is no significant variation in the lifetime prevalence of any substance use. Sentences for Drug Convictions in Greece, 'The maximum sentences imposed for drug use, possession or cultivation of a small quantity for personal use is prison sentences of one year. Prevalence of Problem Drug Use in Greece, 'The probable number of problem drug users in Greece continues to be estimated every year by the internationally recommended 'capture-recapture' method, based on the annual data from the Treatment Demand Indicator. Rise in Problem Drug Use in Greece Attributable to Eurozone Economic Downturn 'According to the latest data from the Greek Documentation and Monitoring Centre for Drugs, the number of persons with problematic drug use heroin as the primary addictive substance rose by Treatment Utilization in Greece, 'In , the total capacity of the treatment units main treatment phase was 7, slots data for 75 of the 78 treatment units Figure 5. Clients Entering Treatment, Primary Drug, and Outcomes 'Most of the clients 6, report opioids as their primary drug, followed at a great distance by cannabis and cocaine 93 data for 57 of the 61 structures. Growth in Treatment Capacity 'In the period , the capacity of treatment programmes steadily increased. National Drug Strategy Laws and Policies 'The National Plan against Addictions for the period , which was prepared by the Committee, takes into consideration the constraints imposed by the economic crisis and consequent fiscal austerity and attempts to streamline expenditure. National Plan Against Addictions 'The National Plan against Addictions for the period , which was prepared by the Committee, takes into consideration the constraints imposed by the economic crisis and consequent fiscal austerity and attempts to streamline expenditure. Expansion, New Initiatives, and the Economic Crisis 'Hope in went hand in hand with the awareness that the economic crisis was deepening and fiscal austerity would spread. Greek Drug Law Reform 'The most important developments in the drugs legislation were introduced in

Greece on crossroads of international heroin trade

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Official websites use. Share sensitive information only on official, secure websites. Email: xleventelis yahoo. Pandemic and the globally applied restriction measures mainly affect vulnerable population groups, such as patients with opioid use disorders. Towards inhibiting SARS-Cov-2 spread, the medication-assisted treatment MAT programs follow strategies targeting the reduction of in-person psychosocial interventions and an increase of take-home doses. However, there is no available instrument to examine the impact of such modifications on diverse health aspects of patients under MAT. Keywords: buprenorphine, COVID pandemic, medication-assisted treatment, methadone, opioid addiction, questionnaire. Patients with opioid use disorders OUDs constitute a highly vulnerable population group. Indeed, the restriction and social distancing measures adopted by societies to decelerate the COVID pandemic significantly affect their lives through intensifying medical and psychiatric co-morbidity Volkow, ; Williams et al. This global public health crisis has induced serious changes in the implemented programs of medication-assisted treatment MAT , since it led to crucial modifications in the delivery of medical care and in the regimen i. In particular, there has been a trend observed by the patients with OUDs to offer and buy illicit substances from the black market Baillargeon et al. Moreover, economic and health disparities, inadequacy of supportive environment, homelessness, imprisonment, psychological trauma, stigma, and barriers that impede access to treatment due to restrictive measures have resulted in the adoption of unsafe practices that disturb the management and administration of MOUD Vasylyeva et al. Consequently, relapse to opioids and further impairment of the already problematic quality of life QoL of patients with OUDs have been observed; however, reliable tools for the assessment of such situations under extreme periods, such as the COVID pandemic crisis, are lacking Leventelis et al. Several uni- and multidimensional scales and tools have been developed to describe and assess specific problems on the procedure of substance use, such as the desire for using, the disorders due to use, or the severity of health problems contributed to substance use Marsden et al. However, in most of the cases, the existing tools fail to include in their evaluation all potential dimensions of human behavior Terwee et al. Regarding the impact of the pandemic on mental health, diverse tools have been developed for the assessment of psychological destruction Akan, , fear Zolotov et al. Referring to patients with OUDs under MAT, most of the available studies have been focused mainly on the description of the emotional states of the patients affected by COVID, creating tools for the detection of worries or fear i. However, the need for the development of a questionnaire that will consider the alterations in the MAT programs dictated by the pandemic through the incorporation of the appropriate and accurate questions is indisputable. The above-mentioned alterations were implemented under the concept that the spread of COVID should also be prevented in MAT programs to protect the members of the vulnerable population who attend them. Towards this direction, specific adjustments in the MAT administration procedures were made. The most important were the confinement of the daily face-to-face visits of the patients in the MAT programs to take their medication, the enhancement of the number of the take-home doses i. All these changes may negatively affect the procedure of successful maintenance treatment, thus preventing rehabilitation via increase of craving. Interestingly, methadone and buprenorphine, along with counseling and psychosocial services offered by MAT programs, aim to the high adherence of patients to treatment. In parallel, this MAT practice intends to reduce illegal substance use and overdose mortality rates, as well as to inhibit aggressive and drug-seeking behaviors Joseph et al. To our knowledge, there is no available tool regarding the assessment of the pandemic impact on the management and administration of MOUD and on several health and social parameters that pertain to MAT patients as evaluated by the patients themselves Harris et al. This is an important matter, since examined from the patient perspective, a major context for the observed impact of the pandemic-related changes on mental and clinical parameters could guide research and public health policies to address specific issues as they have been stressed by the patients themselves Harris et al. It is expected that such a questionnaire, which is oriented toward patients under MOUD, will offer valuable insight concerning the impact of restriction measures applied globally in the COVID era, as well as in similar crises that will potentially arise in the future, on the trajectory to retention to maintenance treatment, and, finally, rehab and social reintegration. The concept for this action was to prevent the patients from visiting them every day, thus preventing the coronavirus spread. To that end, the MAT programs were rapidly adapted in the new reality, regarding both the procedures of medication administration and psychosocial support. Nevertheless, enhancement of medication diversion, misuse, and overdose were often noted, highlighting serious issues emerged from the management of MOUD and retention to treatment due to the COVID pandemic Corace et al. The main query of this study was to develop a questionnaire that will offer to professionals the ability to evaluate the management and administration of MOUD, namely methadone and buprenorphine, in patients under MAT programs during a period of public health crisis that is the COVID pandemic. On the basis of the theoretical background and the referred concerns, 35 items concerning mood, substance administration, pandemic measures, sociability, accessibility to therapeutic programs, biopsychosocial support, and wellness were created from scratch and were initially proposed. The chosen type of measurement was a 5-point Likert scale ranging from 1 i. The readability of the questionnaire was reviewed by a Greek linguist. Then, 50 patients were invited to assess the language clarity and readability of the items and to identify potential difficulties with questionnaire completion. It evaluates the discomfort of an individual who suffers from various health problems and their effects on his everyday activities. The validity and reliability of the Greek version were high with test-retest reliability coefficients, Spearman's r-value in the range of. The HCQ is a multidimensional self-administered instrument and has been used to measure the cravings of opioid-addicted patients during the COVID pandemic. Based on the literature, the appropriate number of participants is recommended to be equal to 10 times the number of the items of the questionnaire DeVellis, In our case, participants are an adequate population. A total of questionnaires were returned and used for the analysis. All patients were completely informed about the purpose and objectives of the experiment. The confidentiality of personal data was fully ensured, whereas each patient signed a consensus form before participating in the study. According to the inclusion criteria, the patients should be aged over 20 years, they should be long-term users of opioid substances experiencing physical and mental dependence, and they should be active members in MAT programs during at least two quarantine periods during the COVID pandemic. Patients with severe psychopathology and serious pathological problems, which impaired attending the program, were excluded from the study. All patients completed the three above-mentioned instruments, i. Mean doses of methadone and buprenorphine were equal to Principal component analysis PCA was chosen as an extraction method using Varimax rotation. The Kaiser-Meyer-Olkin procedure for measuring sample adequacy was applied. The cutoff point for factor loadings was. Scales with reliabilities greater than or equal to. Discriminant construct validity was evaluated by comparing COVID impact questionnaire factors between the two substitutes using the Student t -test. All reported p values are two-tailed. In total, patients under MAT Their mean age was In addition, The mean age at first use was Moreover, 1. Furthermore, Exploratory factor analysis was conducted with Varimax rotation, suggesting six factors, as presented in Table 3. The KMO value was. All loadings were above. All six factors combined explained The results of the exploratory factor analysis with Varimax rotation and descriptive statistics of the factors emerged. All corrected item-total correlations were above. The internal consistency reliability was acceptable for all factors. More specifically, Cronbach's alpha was. The present study reports for the first time the development and validation of a psychometric instrument i. According to the factor analysis, six factors are involved in the management and administration of MOUD in MAT patients during the pandemic crisis. Research findings indicate that patients with OUDs have experienced the consequences of the COVID pandemic and the subsequent restriction measures to a large extent, facing increased stress, isolation, and sense of insecurity combined with serious health problems due to opioid use Tracy et al. Moreover, parameters that exacerbate the negative impact of COVID, such as social stigma, lack or confinement in the availability of the services i. Mood, stress, craving, and drug use are strongly interrelated as craving seems to be increased in the presence of both stressful conditions and drug cues Preston et al. In addition, recent data have revealed that COVID stress syndrome could highly motivate an individual who belongs to a vulnerable group e. Similarly, individuals who used drugs occasionally before the pandemic crisis increased the dosage to cope with self-isolation induced by the restriction measures Taylor et al. Sociability has been associated with substance use mainly in male adults, while it is positively related to the availability of healthcare services Chen et al. It should be noted that it has been demonstrated that the social network constitutes a crucial factor regarding the outcome of a therapeutic program, whereas the development of social relations within the therapeutic programs can increase the possibilities for rehabilitation Neale et al. On the contrary, the fact that opioid-addicted patients are a stigmatized and marginalized population, the lack of availability of treatment and the absence of attractive therapeutic programs are considered serious barriers to engagement and retention in treatment Nunes et al. Unfortunately, to our knowledge there are no instruments to address the role of these factors on the management of MOUD as pinpointed by the patients themselves. This study partly deals with this gap in the literature. Crises including the COVID pandemic have been associated with social isolation, depression, and anxiety Chiappini et al. These are the main consequences of the pandemic since the psychosocial support offered from MAT programs allows continuous monitoring of the treatment program, especially when the patients visit the premises of relevant organizations daily, which is not the case during the pandemic Leventelis et al. Noteworthy, intense social support has been associated with higher retention and completion of treatment Dobkin et al. Based on the findings by factor analysis, accessibility to the therapeutic programs plays a pivotal role affecting opioid maintenance treatment and, in conjunction with negative mood and social distancing, influences the retention in treatment and risk of overdose Joudrey et al. This becomes necessary since, according to the scarce literature, the results regarding the impact of COVID measures on the management of MOUD by patients themselves are ambiguous. Either a rise in overdose death rates Kelley et al. It must be pointed out that this study comes with the following limitations. Finally, this study represents the validation of a promising tool; nevertheless, its strengths and limitations could be modified after the process of revalidation regarding other categories of patients with OUDs. Given the high potential for fatal overdose in patients experiencing OUDs, an urgent need arises to understand how this population has experienced the changes that have been made following the pandemic crisis in the assessment of addiction treatment. It can also serve as a useful and comprehensive method for clinicians, helping to better identify patient needs and those being at high risk for relapse and fatal overdose due to extreme social circumstances that will putatively arise in the future. Data availability: The data used to support the findings of this study are available from the corresponding author upon request. Petros T. Aristidis S. As a library, NLM provides access to scientific literature. Nordisk Alkohol Nark. The development and validation of the pandemic medication-assisted treatment questionnaire for the assessment of pandemic crises impact on medication management and administration for patients with opioid use disorders Christonikos Leventelis Christonikos Leventelis 1 Organization Against Drugs, Athens, Greece; Nursing Department, University of Peloponnese, Panarcadian Hospital Erythrou, Tripoli, Greece. Find articles by Christonikos Leventelis. Find articles by Alexandra Katsouli. Find articles by Vasileios Stavropoulos. Find articles by Anna Karasavvidou. Find articles by Panagiotis Papadopoulos. Find articles by Petros T Barmpas. Find articles by Sotiris Tasoulis. Find articles by Aristidis S Veskoukis. Find articles by Maria Tsironi. Open in a new tab. Item Not at all A little Moderate Much Very much Did the pandemic and the social distancing measures implemented affect… 1 Expressing problems regarding your health? Item Mood Substance administration and pandemic measures Sociability Accessibility to therapeutic programs Biopsychosocial support from therapeutic programs Wellness 1. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Your need to get additional support regarding health issues by your MAT program? Finding protective equipment e. The magnitude of drug i.

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