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See detailDES INÉGALITÉS SOCIALES AUX DÉCÈS PAR SURDOSE AU SEIN DES USAGERS DE DROGUES ILLICITES
Origer, Alain UL

Doctoral thesis (2015)

Illicit and licit drugs’ misuse poses a serious threat to the health, safety and well-being of mankind. Social and health correlates of drug misuse are numerous and many of these can be reduced or avoided ... [more ▼]

Illicit and licit drugs’ misuse poses a serious threat to the health, safety and well-being of mankind. Social and health correlates of drug misuse are numerous and many of these can be reduced or avoided by improved prevention and intervention strategies. Our research analyses the association between socioeconomic inequalities and drug-related mortality. Four complementary studies have been conducted and the following results are to be stressed. Absolute national prevalence and prevalence rates of problem drug users have been increasing between 1997 and 2000 and declining from 2003 onwards. Luxembourg, with 6.16 problem drug users per 1,000 inhabitants aged between 15 and 64 years, is ranking among the 5 Member states showing the highest prevalence within the EU. In terms of drug-related mortality, 1.7 and 2.2 acute overdoses per 100,000 inhabitants have been registered nationally in 2011 and 2012, respectively. At EU level, Luxembourg stood for one of the highest fatal overdose rates in 2000, whereas in 2009 its prevalence fell below the EU average rate. Gender revealed to be a risk factor of drug-related mortality. We showed that the burden of deaths caused by fatal overdoses on the general national mortality was significantly higher for men compared with women. However, it appeared that female overdose victims whiteness remarkably different drug use patterns and trajectories than their male peers. Also, the time window between the onset of illicit drug use and its fatal outcome revealed to be shorter for women versus men included in our study. Early intervention in female drug users, routine involvement of first line health care providers and increased attention to poly- and psychotropic prescription drugs’ use might contribute to preventing premature drug-related death and reducing gender differences. Social and economic status of drug users impact on the occurrence of fatal overdoses. However, actual and self-referred socioeconomic characteristics of drug users may have a greater predictive value than the parental socioeconomic situation. Individual socioeconomic achievements seem to be more determinant in this context than trans-generational social status baggage. Our results suggest that measures aiming at improving educational levels, promoting vocational training and facilitating socio-professional (re)integration of drug users should, beyond their general objective of social insertion, completing conventional harm reduction strategies in order to increase their impact on public health, and eventually on the prevention of drug-related mortality. Our final study explored the cumulative effect of socioeconomic disadvantages on the probability of dying from an overdose of illicit drugs. Results showed that the risk of fatal overdoses increases proportionally with the accumulation of socioeconomic disadvantages and that, likewise in general morbidity and mortality, a social gradient seems also to be at stake when it comes to overdose-related mortality. These results suggest that any measure aiming at reducing social disparities may have a positive and dynamic impact that, even if isolated or targeted, counter the negative cumulative effect in terms of survival. Harm reduction services should integrate socially supportive offers, not only because of their general aim of social reintegration but crucially in order to meet their most important objective, that is to reduce drug-related mortality. This said, social parameters should not be seen as independent determinants and even more so should the concept of social inequalities be widened when applied to drug-related mortality. Although, the social status seems to hold a major role here, family, social and societal environments, as well as migration and acculturation contexts, also with a view on gender disparities, are at play in the attempt to explain differences in terms of morbidity and mortality. The future challenges for research will lie in the capacity to take into account the various demographical and societal mutations that next generations will experience and the way they will, or will not, succeed to share resources and distribute wealth in a ‘ healthy ’ way. [less ▲]

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See detailSocial and economic inequalities in fatal opioid and cocaine related overdoses in Luxembourg: A case–control study
Origer, Alain UL; Le Bihan, Etienne UL; Baumann, Michèle UL

in International Journal of Drug Policy (2014), 25

Background: To investigate social and economic inequalities in fatal overdose cases related to opioid and cocaine use, recorded in Luxembourg between 1994 and 2011. Methods: Cross-examination of national ... [more ▼]

Background: To investigate social and economic inequalities in fatal overdose cases related to opioid and cocaine use, recorded in Luxembourg between 1994 and 2011. Methods: Cross-examination of national data from law enforcement and drug use surveillance sources and of forensic evidence in a nested case–control study design. Overdose cases were individually matched with four controls, when available, according to sex, year of birth, drug administration route and duration of drug use. 272 cases vs 1056 controls were analysed. Conditional logistic regression analysis was performed to assess the respective impact of a series of socioeconomic variables. Results: Being professionally active [OR = 0.66 (95% CI 0.45–0.99)], reporting salary as main legal income source [OR = 0.42 (95% CI 0.26–0.67)] and education attainment higher than primary school [OR = 0.50 (95% CI 0.34–0.73)] revealed to be protective factors, whereas the professional status of the father or legal guardian of victims was not significantly associated to fatal overdoses. Conclusions: Socioeconomic inequalities in drug users impact on the occurrence of fatal overdoses. Compared to their peers, users of illicit drugs with lower socioeconomic profiles show increased odds of dying from overdose. However, actual and self-referred socioeconomic characteristics of drug users, such as educational attainment and employment, may have a greater predictive value of overdose mortality than the parental socioeconomic status. Education, vocational training and socio-professional reintegration should be part of drug-related mortality prevention policies. [less ▲]

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See detailSocioeconomic inequalities in fatal opiate and cocaine related overdoses: Transgenerational baggage versus individual attainments
Origer, Alain UL; Bucki, Barbara UL; Baumann, Michèle UL

in European Health Psychologist (The) (2014)

Background. To determine socioeconomic inequalities in opiates and cocaine related Fatal OverDose (FOD) cases and their implications in terms of preventive measures. Methods. Cross-examination of law ... [more ▼]

Background. To determine socioeconomic inequalities in opiates and cocaine related Fatal OverDose (FOD) cases and their implications in terms of preventive measures. Methods. Cross-examination of law enforcement and healthcare data sources and of forensic evidence in a nested case-control study design. FOD cases were individually matched with 4 controls, according to sex, year of birth, drug administration route and duration of drug use. 272 cases vs. 1,056 controls were compared through conditional logistic regression. Findings. Being professionally active [OR=0.662 (95% CI 0.446–0.985)], reporting salary as main income source [OR=0.417 (95% CI 0.258–0.674)], and education attainment higher than primary school [OR=0.501 (95% CI 0.344-0.729)] revealed to be protective factors, whereas parental professional status was not associated to FOD. Discussion. Compared to their peers, drug users with lower socioeconomic profiles show increased odds of FOD. However, actual and self-referred socioeconomic characteristics of drug users, impacting on daily life quality, such as educational attainment, employment and revenue, appeared to be more predictive of FOD than transgenerational factors such as the parental socioeconomic status. Thus, motivational interventions aimed at socio-professional reintegration should be given due attention in dedicated harm prevention policies. [less ▲]

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See detailOpiate- and Cocaine-Related Fatal Overdoses in Luxembourg from 1985 to 2011: A study on Gender differences
Origer, Alain UL; Lopes da Costa, S; Baumann, Michèle UL

in European Addiction Research (2014), 20

We analyzed gender differences in national Fatal OverDose (FOD) cases related to opiates and cocaine use between 1985 and 2011 (n=340). Methods Cross-examination of national data from law enforcement and ... [more ▼]

We analyzed gender differences in national Fatal OverDose (FOD) cases related to opiates and cocaine use between 1985 and 2011 (n=340). Methods Cross-examination of national data from law enforcement and drug use surveillance sources and of forensic evidence. Bi-variate and logistic regression analysis of male/female differences according to socio-demographics, forensic evidence and drug use trajectories. Results The burden of deaths caused by FOD on the general national mortality was higher for men (PMR/100 = 0.55) compared with women (PMR/100 = 0.34). Compared with their male peers, women were younger at the time of death (t=3.274; p=.001) and showed shorter drug use careers (t=2.228; p=.028). Heroin use was recorded more frequently in first drug offences of female victims [AOR=6.59 (95% CI 2.97–14.63)] and according to forensic evidence, psychotropic prescription drugs were detected to a higher degree in females [AOR=2.019 (95% CI 1.065–3.827)]. Conclusion The time window between the onset of illicit drug use and its fatal outcome revealed to be shorter for women versus men included in our study. Early intervention in female drug users, routine involvement of first line general health care providers and increased attention to poly and psychotropic prescription drugs’ use might contribute to prevent premature drug-related death and reduce gendered specificities. [less ▲]

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See detailSuicide attempts prior to fatal drug overdose in Luxembourg from 1994 to 2011
Origer, Alain UL; Baumann, Michèle UL

in Moussaoui, Driss; Figueira, Maria Luisa (Eds.) The bio-psycho-social model: The future of psychiatry. (2013)

Educational Objectives: This study may help participants to recognize factors influencing suicidal behavior that should be assessed or monitored in the context of substance use. Purpose: To assess the ... [more ▼]

Educational Objectives: This study may help participants to recognize factors influencing suicidal behavior that should be assessed or monitored in the context of substance use. Purpose: To assess the prevalence of lifetime suicide attempts in opiate and cocaine related (FOD) cases. To analyze associations between suicide attempts and socio-demographic, life and substance use profiles of FOD victims . Methods: A triangulation approach allowed to cross-examining data from national law enforcement sources, the national drug use surveillance system (RELIS) and of forensic and toxicological evidence. Bivariate statistical analysis was performed by means of Chi-square χ² tests as well as logistic regression analysis of the association between suicide attempts and selected variables. Results: Prior to death, 16.8% of FOD victims reported a single suicide attempt, 37% multiple attempts and 46.2% declared none. No associations were found between suicide attempts and the following variables: sex, age, nationality, penal past (including prison stays), educational, occupational status and income of victims, occupational status of parents and detection of psychotropic prescription drugs in post mortem toxicological analysis. After adjustment for sex and age, FOD victims who showed one or more lifetime suicide attempts were more likely to have experienced non-fatal overdoses [AOR = 5.755 (95% CI 1.633 – 20.278), and (licit or illicit) substance abuse of one or both parents [AOR = 2.859 (95% CI 1.250 – 6.539), p=0.013]. The greater likelihood of unmarried FOD victims to witness suicide attempts (χ²:4.573; p=0.032), compared with married decedents, was no longer observed after sex-age adjustment. Conclusion: Suicide attempts are frequent in fatal drug overdose victims and a strong association has been observed between the former and the frequency of non-fatal overdoses experienced by decedents included in our sample. Family contexts may be at stake when it comes to explain the likelihood of suicide attempts in victims of fatal drug overdose. The fact that substance abuse in parents was positively linked to suicide attempts in FOD victims suggest that increased attention should be paid to family histories in the prevention of drug overdoses and suicide, and the link between both. Our findings could inspire further research, building upon bigger study samples and prospective cohort designs, allowing to collecting more in-depth data on the social and family support experienced by FOD victims. [less ▲]

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See detailOpiate and cocaine related Fatal Overdoses in Luxembourg from 1985 to 2011: a time-stratified
Origer, Alain UL; Baumann, Michèle UL

in Health Issues and Populations in Health Promotion (2013)

To describe trends in the national prevalence of fatal overdose (FOD) cases related to opiates and cocaine use between 1985 and 2011. To analyse male/female differences in FOD victims according to various ... [more ▼]

To describe trends in the national prevalence of fatal overdose (FOD) cases related to opiates and cocaine use between 1985 and 2011. To analyse male/female differences in FOD victims according to various time periods. Methods. A triangulation approach was chosen to cross-examining data from national law enforcement sources, the national drug use surveillance system (RELIS) and of forensic and toxicological evidence. Data have been stratified according to 3 time periods covering each 9 successive years in order to increase the visibility of long term variations and trends. Statistical analysis of male/female differences according to socio-demographic and forensic data as well as drug use trajectories was performed. Results. National FOD prevalence has been decreasing from the beginning of this century to reach a historically low rate of 1.71 cases/100,000 inhabitants in 2011. The burden of deaths caused by FOD on the general national mortality showed to be higher for men compared with women. Furthermore, the pathways towards a FOD revealed to be different for male and female victims referred to various aspects including age of decedents, criminal records, drug use trajectories, drug use patterns and the involvement of psychotropic prescription drugs. Conclusions. The time window for intervention between the onset of drug use and its potential fatal outcome might be shorter for women compared with men. Further research should address dynamics between socio-economic status of victims and various cultural components to assess their possible impact on drug overdose induced mortality. Early intervention in female drug users and increased attention to poly and psychotropic prescription drugs use should be considered in health promotion programmes and relevant research outcomes routinely provided to first line general health care providers to accelerate access to appropriate treatment if required and eventually contribute to prevent premature death and reduce gender inequalities. [less ▲]

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See detailPrevalence of Problem Drug Use and Injecting Drug Use in Luxembourg: A Longitudinal and Methodological Perspective.
Origer, Alain UL; Baumann, Michèle UL

in European Addiction Research (2012), 18

To estimate the prevalence of problem drug use (PDU) and injecting drug use (IDU) in Luxembourg and analyze trends between 1997 and 2009. To assess the feasibility of prevalence estimations based on drug ... [more ▼]

To estimate the prevalence of problem drug use (PDU) and injecting drug use (IDU) in Luxembourg and analyze trends between 1997 and 2009. To assess the feasibility of prevalence estimations based on drug use surveillance systems. Methods: Serial multi-method PDU/IDU prevalence estimations based upon capture-recapture, Poisson regression, multiplier and back-calculation methods. Comparative analysis of methods and assessment of their robustness to variations of external factors. Results: National PDU and IDU prevalence rates were estimated at 6.16/1,000 (95% CI 4.62/1,000 to 7.81/1,000) and 5.68/1,000 (95% CI 4.53/1,000 to 6.85/1,000) inhabitants aged 15–64 years, respectively. Absolute prevalence and prevalence rates of PDU increased between 1997 and 2000 and declined from 2003 onwards, whereas IDU absolute prevalence and prevalence rates witnessed an increasing trend between 1997 and 2007. Conclusions: Drug use surveillance systems can be valuable instruments for the estimation and trend analysis of drug misuse prevalence given multiple methods are applied that rely on serial and representative data from different sources and different settings, control multiple counts and build upon standardized and sustained data collection routines. The described institutional contact indicator revealed to be a useful tool in the context of PDU/IDU prevalence estimations and thus contributes to enhancing evidence-based drug policy planning. [less ▲]

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