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Official websites use. Share sensitive information only on official, secure websites. For commercial re-use, please contact journals. Excess all-cause mortality is a key indicator for assessing direct and indirect consequences of injection drug use and data are warranted to delineate sub-populations within people who inject drugs at higher risk of death. Our aim was to examine mortality and factors associated with mortality among people who inject drugs in Estonia. Retrospective cohort study using data from people who inject drugs recruited in the community with linkage to death records. Standardized mortality ratios were used to compare the cohort mortality to the general population and potential predictors of death were examined through survival analysis Cox regression. The cohort include a total of people who inject drugs recruited for cross-sectional surveys using respondent driven sampling between and in Estonia. A cohort with follow-up through was formed with linkage to national causes of death registry. The all-cause mortality rate in the cohort was Being HIV positive, injecting mainly opioids fentanyl , living in the capital region and the main source of income other than work were associated with greater mortality risk. While low-threshold services have been available for a long time for people who inject drugs, there is still a need to widen the availability and integration of services, particularly the integration of HIV and opioid treatment. Up-to-date data are needed on cause-specific mortality and identification of risk factors among people who use drugs to assess the effect of, and tailor prevention, care and harm reduction efforts for reducing morbidity and mortality. The most recent systematic review on this topic 2 located three cohorts from Central Europe and no studies were found from Eastern Europe. There, potent illicitly produced fentanyl derivatives have largely replaced prescription opioids and heroin, driving a widespread epidemic of opioid-related deaths. In Estonia, studies conducted among people who inject drugs PWID , highlight the strong connection between injection fentanyl use, 5—7 overdose risk 8 , 9 and HIV in this population, 10 but the cumulative impact remains unquantified. The widespread fentanyl injection in Estonia, which has resulted in a two-decade-long epidemic of high HIV seroprevalence 10 and significant overdose mortality, 8 , 9 predates the situation in North America by two decades. We report findings from a retrospective cohort study on all-cause mortality, causes of death and factors associated with mortality among community-recruited people who inject drugs in Estonia. These surveys used respondent driven sampling for subject recruitment. Participants received pre- and post-test HIV counselling. Data on the Estonian personal identification code PIC was collected. Demographic data for age and sex were collected. Variables for analysis were selected from those used in mortality studies of people who inject drugs which appear to be prognostic indicators. There were indicators concerning: educational attainment years of education ; main source of income work versus other, including social benefits, theft, etc. The primary outcome—survival time—was time since the first injection to death. Follow-up time person-years was calculated from the year of participating in the source studies to the date of death or at censoring if they remained alive until 4 April Dates and causes of death were obtained from the Estonian Causes of Death Registry ECD , a population-based registry that covers the entire country. ECD captures all deaths registered in Estonia and information collected includes a diagnostic code ICD for the underlying cause of death and the nature of injury. Causes of death among people who inject drugs were grouped into ICD code combinations recommended by Santo et al. PIC, as single unique identifier, was used to link source survey data with mortality data. For baseline characteristics, means were calculated for continuous variables and percentages for categorical variables using the data collected at the recruitment into respective cross-sectional studies. We used all-cause crude mortality rates to determine absolute risk of mortality and all-cause age and sex standardized mortality ratios to compare the cohort mortality to the general population. Mortality was calculated using person-time methods. To calculate crude mortality rates CMR , we summed the number of deaths by category and calculated a rate per person years. To compare the cohort mortality to the general population, we calculated standardized mortality ratios SMR using year age bands stratified by gender. Population data were obtained from Statistics Estonia, the Estonian government agency responsible for producing official statistics regarding the country. Summary statistics were used to describe people who inject drugs. Survival curves of the cohort were constructed using the Kaplan—Meier method for left-truncated data. We used the normal log-rank test to compare survival between groups of people who inject drugs i. The proportional hazard assumption was evaluated by Schoenfeld residuals. We used Cox regression to determine predictors of all-cause mortality. In multivariable Cox proportional hazard regression analysis, age was used as a time scale to account for left-truncation in the data. One of the predictor variables HIV status displayed evidence of violation of the proportional hazards assumption having a time-varying effect. Therefore, the multivariable model was stratified by this variable HIV status. Given that stratification by a non-proportional variable precludes estimation of its strength and its test within the Cox model, the follow-up time was spilt and fitted additional Cox models for two time-periods. The assumptions of the proportional hazards were tested and were not violated. A compilation of the final sample for this analysis is presented in Supplementary figure. From July to April , a total of people who inject drugs participated in the source studies. If there were duplicate entries, we kept the first occurrence. The resulting cohort included participants. Data on sociodemographic and behavioural characteristics are shown in Supplementary annex 1. The median follow-up duration per study subject was 3. Observed all-cause mortality rate in this cohort was Mortality among people who inject drugs significantly exceeded that of the Estonian general population SMR Excess mortality was particularly prominent in the younger age group aged 20— SMR The univariable analyses Supplementary annex 1 showed that being HIV positive was associated with the highest risk of death. Injecting opioids, living in the capital region, age and calendar time of first injection, prison experience and reporting other than paid work as the main source of income were associated with higher mortality risk Supplementary annex 1. Being a female was associated with a lower risk of death. The median survival time for people who inject drugs was Factors in the multivariable analysis independently associated with mortality are presented in figure 2. Causes of death and factors associated with all-cause death, multivariable stratified by injecting time analysis. Analyses on causes of death showed that there were more drug use-related deaths among those who had injected for less than fifteen years table 2. In this study, we show high risk of excess mortality and observed notable risk factors for all-cause mortality among people who inject drugs in Estonia. To the best of our knowledge, this is the first study investigating the risk of dying among people who inject drugs in countries in Europe that are witnessing explosive injection drug use, illicit fentanyl use and related HIV epidemics since the turn of the century. The crude all-cause mortality reported in this study In earlier studies, other than gender and HIV infection, higher mortality has also been attributed to increasing age among people who inject drugs. Mortality of PWID in Estonia was almost twelve times higher than the general population and remained elevated across all age groups. The excess mortality was higher among women and in the younger age-group. These findings reflect the age and gender differences in mortality of the general population younger age groups in comparison to older, and females in comparison to males have lower mortality in the general population. We saw a clear diverging pattern of factors contributing to all-cause death risk by the duration of injection drug use. Among people who inject drugs with a shorter injection career, injecting opioids was the sole significant contributor increasing risk of death. In studies from elsewhere in Europe, high mortality rates among people who inject drugs coincided with a reported high number of drug overdoses. Most of the overdose deaths have been caused by fentanyl and fentanyl derivates which have been the most common form of opioids used in Estonia. Since —, overdose deaths declined, potentially related to decreased availability of fentanyl derivates and a scaling-up of interventions e. Fentanyl use led to Estonia having the highest fatal drug overdose rate in Europe up to In Estonia, fentanyl emerged in , swiftly replacing heroin in the illicit drug market. Between and , 3-methylfentanyl dominated confiscations. Until , only fentanyl and 3-methylfentanyl were detected by the Estonian Forensic Science Institute. Although, there was a fentanyl drug market drought in , recent years have seen the emergence of a new type of synthetic opioids called nitazenes proto-, meto-, isotonitazen , not infrequently mixed with xylazine veterinary drug for sedation, anaesthesia, muscle relaxation, analgesia. These changes have led to a sharp increase in drug-related overdose mortality since A similar fentanyl-overdose situation has developed in the USA. Over the last several decades, the USA has experienced different waves of opioid-related overdose deaths. First was the opioid prescription analgesic wave roughly — , followed by a heroin wave roughly — , followed by the fentanyl wave roughly to the present. The similarity between the USA and Estonian situations indicates there are needs for greater treatment for opioid use disorder and for greater distribution of naloxone in the community in both countries. Although drug treatment is considered a protective measure against mortality among people who inject drugs, 2 , 32 the low coverage observed in our study and other studies from Estonia 33 , 34 do not show a population-based effect. This finding potentially indicates that the positive impact of ART remains largely inaccessible for people who inject drugs in Estonia. The argument is further confirmed by our subgroup analysis showing no difference in mortality among those on ART in comparison to those who are not. These results may indicate to stigmatization, lack of integrated services and suboptimal HIV care. Surveys have shown that ART adherence among people who inject drugs in Estonia is relatively high, based on self-reports. These results are similar to other studies where higher mortality risk among people who inject drugs was associated with unemployment and the inability to work due to disability. Living in the capital region was also a factor associated with a doubled mortality risk. Regional differences in risk structure among people who inject drugs are well known. Higher numbers of mortality of people who inject drugs may be driven by opioid use, higher age and lower drug treatment coverage. The main strengths of this study include its large sample size, long follow-up period, valid measurement laboratory confirmed for HIV verification and linkage to the national causes of death registry using personal identifiers. Our study benefits from rigorous measures for key variables, i. We were able to control for the relevant known confounders region, age, education, source of income, prison experience, receiving opioid agonist treatment OAT. We are aware of biases based on analysis on non-random samples. There are, however, limitations to our study. To minimize selection bias errors, we used the left truncation method to diminish the possibility of excluding from the sample people who had died before the source studies were conducted. Still, mortality among PWID who have been injecting for several decades may be overestimated, as our sample does not account for individuals who have ceased injecting. Secondly, some errors caused by self-reported questions may exist as people may give socially desirable answers. Thirdly, HIV coinfection, particularly coinfection with HCV, information was not available for all study participants; therefore, these factors could not be considered in the data analyses. However, these limitations seem unlikely to have caused the clear patterns observed in this study. Our findings show the impact of drug policy and practice. A SMR of 12 underscores the significant impact of illicit drug use on excess mortality, emphasizing it as a major public health concern. Although the low-threshold services for people who use drugs have been available for a long time in Estonia, there is a need to improve the services. To reduce harms caused by injecting illicit drugs, is important to make the services for people who inject drugs more accessible by integrating infectious disease care and substance use treatment. It is also important to increase the coverage of the services. To decrease mortality there is a need to integrate services provided to PWID, particularly the integration of HIV and opioid treatment. There are legal restrictions on sharing a de-identified data. According to legislative regulation and data protection law in Estonia, the authors cannot publicly release the data received from the health data registers in Estonia. More information about data availability: maris. This section collects any data citations, data availability statements, or supplementary materials included in this article. As a library, NLM provides access to scientific literature. Eur J Public Health. Find articles by Sigrid Vorobjov. Find articles by Don Des Jarlais. Collection date Apr. Open in a new tab. 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.

Injection Drug Use Frequency Before and After Take-Home Naloxone Training

How can I buy cocaine online in Kohtla-Jarve

These datasets underpin the analysis presented in the agency's work. Most data may be viewed interactively on screen and downloaded in Excel format. All countries. Topics A-Z. The content in this section is aimed at anyone involved in planning, implementing or making decisions about health and social responses. Best practice. We have developed a systemic approach that brings together the human networks, processes and scientific tools necessary for collecting, analysing and reporting on the many aspects of the European drugs phenomenon. Explore our wide range of publications, videos and infographics on the drugs problem and how Europe is responding to it. All publications. More events. More news. We are your source of drug-related expertise in Europe. We prepare and share independent, scientifically validated knowledge, alerts and recommendations. About the EUDA. Amphetamine, methamphetamine and, more recently, synthetic cathinones are all synthetic central nervous system stimulants available on the drug market in Europe. On this page, you can find the latest analysis of the drug situation for synthetic stimulants in Europe, including prevalence of use, treatment demand, seizures, price and purity, harms and more. European Drug Report — home. The drug situation in Europe up to Drug supply, production and precursors. Synthetic stimulants. Heroin and other opioids. New psychoactive substances. Other drugs. Injecting drug use in Europe. Drug-related infectious diseases. Drug-induced deaths. Opioid agonist treatment. Harm reduction. Historically, amphetamine use has always been the most common, with the availability of methamphetamine and synthetic cathinones being more limited in most countries. This could have important implications. Synthetic drug production trends can be extremely dynamic, and consumers may view different stimulants as functionally equivalent and be amenable to trying new products based on their availability in the market. There are concerns about increased threats to health and social problems that may be associated with the more widespread availability and use of these substances. At the same time, current information tools are generally not sufficiently developed to track trends in use or related problems associated with changing patterns of synthetic stimulant use. Improving our ability to monitor and respond more rapidly to developments in this area is therefore likely to be a growing priority for the future. Methamphetamine and synthetic cathinones are chemically similar to amphetamine, but are not necessarily equivalent in respect to the risk they pose to public health. The more widespread use of cathinones, for example, is a relatively new development, and we currently lack a robust evidence base to understand the potential health risks of this phenomenon or what might constitute appropriate interventions. Methamphetamine is available in high-purity forms that are smokable and there are particular health concerns associated with the use of this drug by this mode of administration. All of these substances may also be available in similar-looking powders or pills, meaning consumers may be unaware of what particular stimulant or mixture of substances they may be consuming, and these drugs can also be found in tablets marketed as MDMA. This means that forensic and toxicological analysis is particularly important for understanding both consumption trends and adverse health outcomes. A more general concern is that all of the stimulants discussed here are also, to some extent, associated with behaviours that can pose high risks to health and mortality, which include overdoses, acute and chronic mental health problems and infectious diseases. There are also particular concerns about the injecting of stimulants, which has been associated with a higher risk of HIV transmission. This could be explained by more frequent use, sharing of injecting material and risky sexual behaviours among people who inject stimulants. In the last decade, six large European cities, across five countries, have reported localised HIV outbreaks associated with stimulant injecting, mainly among marginalised people who inject drugs involved in open drug scenes. Syringe residue analysis conducted by the ESCAPE network between and confirm the presence of stimulants, such as amphetamine and synthetic cathinones, in many injecting drug scenes. Reports from the Euro-DEN Plus sentinel hospital emergency network in highlight the role that synthetic stimulants can play in acute drug toxicity presentations to emergency departments. While methamphetamine is less commonly used and is less visible in available data sources, there are growing signals that the production of the drug is increasing in Europe and that the drug is diffusing to more countries. Historically, the use of this drug has been most commonly observed in Czechia and Slovakia and, more recently, some neighbouring countries. While not representative of the general population, data from wastewater analysis indicate that two thirds of the 59 European cities with data for and saw an increase in the methamphetamine residues detected. Available data on the production and trafficking of these stimulants reveal the changing dynamics of the illicit stimulant trade. While the number of dismantled amphetamine production laboratories in Europe remained constant at about between and , the quantity of the drug seized in Europe fell by two thirds in It has been suggested that this fall in seizures may be indicative of a decline in production, possibly resulting from producers switching to other stimulants, such as methamphetamine, that can be highly profitable when trafficked to non-EU markets. In the most recent data, a decline was also observed in the quantity of methamphetamine seized in Europe, alongside a relatively stable number of drug production sites being detected, which included medium- and large-scale sites operating at a capacity that suggests production for export markets. Overall, however, data availability issues as well as the likely impact of the pandemic on both market developments and reporting mean that caution is needed in interpreting the information available, and more work is needed to track production trends and analyse their implications for both public health and security. The information available does suggest, however, that synthetic cathinones are increasingly trafficked to Europe from India in large shipments. At the same time, they are also produced in Europe, notably in Poland, which accounted for 14 of the 15 laboratories dismantled in Given the volumes of precursor chemicals seized and the interception of unregulated alternative chemicals, it appears likely that large-scale production for both the European and other markets may be taking place. In summary, as the use of illicit stimulants can lead to a range of health problems, these substances continue to represent a challenge for monitoring efforts, policymakers and service providers in Europe. More frequent injecting associated with stimulant use and the potentially much more severe health complications from injecting and smoking methamphetamine mean that any increase in consumption, especially among vulnerable groups, could represent a growing challenge for harm reduction and emergency health services. Prevalence data presented here are based on general population surveys submitted to the EMCDDA by national focal points. For the latest data and detailed methodological information please see the Statistical Bulletin Prevalence of drug use. Graphics showing the most recent data for a country are based on studies carried out between and Mean daily amounts of amphetamine and methamphetamine in milligrams per population. Sampling was carried out over a week in March and April Apart from the map, data are for all treatment entrants with amphetamine or methamphetamine as the primary drug — or the most recent year available. Data in the map are for or the most recent year available: Czechia, Spain, France, ; Netherlands, For amphetamine, data for Sweden and Norway relate to clients citing stimulants other than cocaine as primary drug. Data on entrants into treatment are for or the most recent year available. Trends in treatment entrants are based on 22 countries. Only countries with data for at least 5 of the 6 years are included in the trends graph. Missing data were imputed with values from the previous year for Spain and France and Germany Because of disruptions to services due to COVID, data for and should be interpreted with caution. Price and purity: mean national values — minimum, maximum and interquartile range. Countries vary by indicator. Show source tables. Back to list of tables. Homepage Quick links Quick links. GO Results hosted on duckduckgo. Main navigation Data Open related submenu Data. Latest data Prevalence of drug use Drug-induced deaths Infectious diseases Problem drug use Treatment demand Seizures of drugs Price, purity and potency. Drug use and prison Drug law offences Health and social responses Drug checking Hospital emergencies data Syringe residues data Wastewater analysis Data catalogue. Selected topics Alternatives to coercive sanctions Cannabis Cannabis policy Cocaine Darknet markets Drug checking Drug consumption facilities Drug markets Drug-related deaths Drug-related infectious diseases. Recently published Findings from a scoping literature…. Penalties at a glance. Frequently asked questions FAQ : drug…. FAQ: therapeutic use of psychedelic…. Viral hepatitis elimination barometer…. EU Drug Market: New psychoactive…. EU Drug Market: Drivers and facilitators. Statistical Bulletin home. Quick links Search news Subscribe newsletter for recent news Subscribe to news releases. This make take up to a minute. Once the PDF is ready it will appear in this tab. Sorry, the download of the PDF failed. A more recent version of this page exists: Synthetic stimulants — the current situation in Europe European Drug Report On this page, you can find the latest analysis of the drug situation for synthetic stimulants in Europe, including prevalence of use, treatment demand, seizures, price and purity, harms and more This page is part of the European Drug Report , the EMCDDA's annual overview of the drug situation in Europe. Table of contents Search within the book. Search within the book Operator Any match. Exact term match only. List of tables Table 1 prevalence of amphetamines use Table 2 prevalence of amphetamines use, trends Table 3 amphetamines in wastewater Table 4 clients entering treatment Table 5 amphetamines entrants as a share of all first-time treatment entrants Table 6 trends in all entrants for synthetic cathinone users Table 7 seizures Table 8 price and purity Table 9 trends in quantities of amphetamine and methamphetamine seized Table 10 trends in number of amphetamine and methamphetamine seizures Table 11 indexed trends retail price and purity Table. Table 2. Prevalence of drug use in Europe, trends Country Country code Geographical scope Substance Recall period Age Austria AT National Table 3. Masaryk Water Resesrch institute, p. Table 4. Percentages except where otherwise stated. Trends in all entrants for synthetic cathinone users Country Poland France 33 Spain 16 37 43 84 Other countries 34 31 39 57 72 Table 7. Table 8. Table 9. Table Indexed trends retail price and purity, amphetamine and methamphetamine Substance Index Amphetamine Price: retail 94 97 97 94 88 80 81 79 Amphetamine Purity: retail 80 91 Methamphetamine Purity: retail 89 89 89 97 98 92 Main subject. Target audience. Publication type. European Drug Report main page. On this page. Forensic Toxicology Labs.

How can I buy cocaine online in Kohtla-Jarve