DES INÉGALITÉS SOCIALES AUX DÉCÈS PAR SURDOSE AU SEIN DES USAGERS DE DROGUES ILLICITES

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 ▲]

Social and economic inequalities in fatal opioid and cocaine related overdoses in Luxembourg: A case–control study

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 ▲]

Opiate and cocaine related Fatal Overdoses in Luxembourg from 1985 to 2011: a time-stratified

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 ▲]

Prevalence of Problem Drug Use and Injecting Drug Use in Luxembourg: A Longitudinal and Methodological Perspective.

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 ▲]