Emerging drug use related research needs:
claims, realities, needs, deficits and visions ...
Identifying Europe's information needs for effective drug policy
EMCDDA, 6-8 May 2009, Lisbon
Michael
1 IFT
Farrell2,
Gerhard Bühringer1,3
Ludwig
John Marsden2, Tim Pfeiffer-Gerschel1, Daniela Piontek1,
Krystallia Karachaliou1, Jutta Künzel1, Garry Stillwell2
Kraus1,
Institut für Therapieforschung, München
2 National
Addiction Centre, London
3 Technische
Universität, Dresden
1. Between claims and reality in Europe
1.1 Claims
“ Information, research and evaluation are key elements of an overall
EU drug policy“ (EU Drugs Strategy, 2005-2012)
• Better understanding of the drug problem and the development of an
optimal response
• Improving the understanding of the drug problem “through more and
better coordinated research” (EU Council, 2008)
“To make the EU the most dynamic and competitive knowledgebased economy by 2010” (Lisbon Strategy, 2000)
• Research and development policy is one of the EU priorities to boost
employment and growth and to maintain its social model
• Increasing Healthy Life Years is vital
• “Well-designed social and environmental policies are themselves key
elements in strengthening Europe's economic performance“ (European
Parliament, 2005)
2
1. Between claims and reality in Europe
1.2 Reality I: Drug use in Europe
Drug use (DU; past month)
• 12 million cannabis users (3.6%)
• 1.5 million opioid users (0.4%)
• 1.5 million cocaine users (0.4%)
Drug-related infectious diseases
• 40 % of IDUs are Hepatitis C infected
Drug-induced deaths
• between 6,500 and 8,500 (minimum estimate!)
Treatment demand
• 360,000 cases in various types of care
Drug-related public expenditure
• EUR 34 billion
• 0.3% of combined GDP of all EU Member States
3
1. Between claims and reality in Europe
1.3 Reality II:Drug
Low and
prominence
of European DU research
Alcohol Dependence
Author affiliation 2004-2007 in the journal “Drug and Alcohol Dependence”
(pp: population size)2
Canada, 4%
Australia, 10%
pp: 4%
1
Selected MS (4),
13%
pp: 6%
pp: 38%
pp: 53%
USA, 73%
1 Germany,
Italy, Netherlands, UK,
2
Ritter, 2008, pers. com.; modified
4
1. Between claims and reality in Europe
1.4 Reality III: Stakeholders for DU research and monitoring
MS 1
Responsible
for research,
transfer and
health/
social service
for DU
MS 26
MS 2
Differences in
• problem situation
indicators
• problem views
• research structures
• research priorities
• funding structures
MS 27
• research programmes
• research budgets
• research utilisation
• publication languages
• access to research outcome
EMCDDA
Monitoring DU and
European responses
Complimentary
role (“added
value”)
DG JLS
„Drugs prevention
and information“
programme
(2007 – 2013)
DG Sanco
“Second Programme
of Community action
in the field of health”
(2008 – 2013)
DG RTD
Framework 7 Progr.
(2007 – 2013),
„Health“ as major
theme
5
1. Between claims and reality in Europe
1.5 The core questions
Will the current structure guarantee research activities to provide the
knowledge base needed for a fully informed and evidence based drug
policy all over Europe?
Will the current structure, with the given complex system of interests
and responsibilities, lead Europe to the top of DU related research in
the world?
6
2. Needs for Europe: research activities and
research management
2.1 Research
Why do some people start DU
and others not?
Why do some people stop
after experimental use and
others not?
Why do MS differ in DU
incidence and prevalence?
Why do some DU stop without
formal interventions, others
not?
What is the role of social
context factors?
Why do some people abstain
after treatment, others not?
Questions
Time/Age
Onset experimental use regular DU
severe chronic DU
Reduction
/Cessation
Early vulnerability
• Genetic factors
• Personality factors
• Childhood trauma
Acute risk factors
• Person factors
• Family conditions
• Social
environment
• Cultural factors
Reduction/
cessation
• Patient factors
• Social context
factors
• Treatment factors
Vulnerabilityand risk
factors
(examples)
7
2. Needs for Europe: research activities and
research management
2.1 Research (continued)
•
•
•
•
To reduce rates of onset and progression
To delay age of onset and progression
To early detect and terminate DU
To reduce negative individual and social consequences
Understanding
drug use
Basic
Epideresearch miology
Demand
reduction
Prevention
Treatment
Supply reduction
Drug
supply
• Range of natural and social sciences
• Need for interdiscplinarity
Interdiction
Targets
Policy analysis
Policy
Legal
Frame
works
Research
areas
Disciplines
8
2. Needs for Europe: research activities and
research management
2.2 Research management
An effective management of DU related research in Europe has to be
based on:
(1) Monitoring of DU indicators and related vulnerability and risk factors
(2) Regular analysis of DU problems and related research needs
(3) Priorisation of research activities
(4) Funding programmes and structures
(5) Research outcome analysis and evaluation
(6) Transfer into practice (implementation and evaluation)
(7) Fast feedback to all system components: “adaptive learning system”
(8) Financial resources
(9) Scientific and management resources for planning, implementation,
monitoring and evaluation
Need for a more structured process to prioritize, monitor and
analyse research activities and research outcome between MS, EC
and scientific community?
9
3. Deficits
3.1 Research fields
Topics for improvement
• Understanding drug use: risk and protective factors,
mechanisms of action, long-term studies on onset and course of
DU
• Demand reduction: prevention
• Supply reduction: law enforcement evaluation
• Policy analysis: effects and efficiency of public policies
• General: Cooperation of medical and social sciences
Source: e.g., EMCDDA Selected Issues on Research, 2008; EC, 2007
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3. Deficits
3.2 Research infrastructure
Topics for improvement
• Qualified research staff
• (Interdisciplinary) research networks in MS
• European research networks
• Sustained funding of networks
• European scientific community
• European research organisations
• Involvement of the scientific community in the analysis of
research needs
Source: e.g., EMCDDA Selected Issues on Research, 2008; EC, 2007
11
3. Deficits
3.3 Research management
Topics for improvement
• Linkage of drug action plans and research planning
• Coordinated research prioritisation between public authorities
and scientific community in MS
• Systematic analysis of research outcome, in order to adapt drug
policy and future research needs
• Linkage of research outcome and MS drug policy and vice versa
• Coordination of MS and EC research programmes
• Lack of continuity of funding
• Research funding beyond epidemiology and monitoring (some
new MS)
Source: e.g., EMCDDA Selected Issues on Research, 2008; EC, 2007
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4. A 2020 vision for Europe to take the lead
in DU related research
Yes, we can!
(and want?)
(1) A commitment of MS, EC and scientific community for a
comprehensive research initiative
Who cares for (2) An agreement of MS and EC on DU problem analyses,
targets, research priorities and budgets
what?
(3) Coordinated research funding programmes at MS and
EC level
Specialists to (4) A process of constant analysis and adaption of research
needs/priorities based on research outcome analyses
the front
and evaluations of new challenges
Scientists of (5) A European research society and European scientific
community
Europe, unite!
Money makes (6) Financial resources
For research funding
the world go
For research capacity building
round!
For research outcome transfer and evaluation
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