natgillin/translations-raw huggingface dataset:
See Figure PDU-3 (part i) in the 2006 statistical bulletin.) See footnote (70).)
173) Glej prikaz PDU-3 (del i) v Statističnem biltenu 2006.174) Glej opombo (70).
Chapter 6: Opioid use and drug injection a small group of opioid users (less than 7 %) are younger
Poglavje 6: Uživanje opioidov in vbrizgavanje drog
The proportion of clients seeking treatment for heroin use varies between countries. Based on the most recent data available, countries can be classified into three groups according to the proportion of drug users seeking treatment who report problem use of heroin, as follows:
Med državami, v katerih precejšen del uživalcev opiatov uporablja druge snovi kot heroin, sta Madžarska, kjer je zelo razširjeno uživanje domačih izdelkov iz vrtnega maka, in Finska, kjer največ uživalcev opiatov zlorablja
Most opioid clients report having used these drugs for the first time between the age of 15 and 24 years, with around
17 7 zdravljenju na splošno traja od 5 do 10 let ter da se ocenjuje, da med začetkom uživanja in rednim uživanjem droge mine od 1,5 do 2,5 leta (Finsko nacionalno poročilo), se lahko sklepa, da uživalci opiatov ponavadi redno uživajo drogo od 3 do 7 let, preden si prvič poiščejo specialistično zdravljenje.
Most opioid users, like users of other drugs, seek treatment in an outpatient setting; however, in comparison with cocaine and cannabis clients, a higher proportion of opioid clients are treated in inpatient centres.
Večina uživalcev opiatov, tako kot uživalci drugih drog, se zdravi v izvenbolnišničnih programih, vendar pa se v primerjavi z uživalci kokaina in konoplje v bolnišničnih centrih zdravi večji delež uživalcev opiatov.
Across Europe, among new opioid clients seeking treatment in outpatient centres and for whom the route of administration is known, just over half are injecting the drug.
V Evropi si med novimi uživalci opiatov, ki se želijo zdraviti v izvenbolnišničnih centrih in za katere je znan način uživanja, malo več kot polovica drogo vbrizgava.
In general, levels of injecting are higher among opioid users seeking treatment in the new Member States (above 60 %) than in the EU-15 Member States (below 60 %), with the exception of Italy and Finland, where the proportion of opioid injectors among clients is 74 % and 79.3 % respectively.
Na splošno so ravni vbrizgavanja med uživalci opiatov, ki se želijo zdraviti, višje v novih državah članicah (več kot 60 %) kot v 15 starih državah članicah EU (manj kot 60 %), razen Italije in Finske, kjer je delež injicirajočih uživalcev opiatov 74 % oziroma 79,3 %.
The proportion of injectors among opioid clients is lowest in the Netherlands (13 %) and highest in Latvia (86 %) (182).
Delež injicirajočih uživalcev opiatov je najnižji na Nizozemskem (13 %), najvišji pa v Latviji (86 %) (182).
Treatment of opioid dependence
Zdravljenje odvisnosti od opiatov
Most countries with significant numbers of new heroin clients each year (except Germany, where the reporting base has been extended) report that there has been a decrease in the last 4–5 years, although not among clients who have previously been in treatment.
Večina držav, v katerih se vsako leto znatno poveča število novih uživalcev heroina (razen Nemčije, kjer se je razširila osnova za poročanje), poroča o zmanjšanju v zadnjih štirih do petih letih, vendar ne med uživalci, ki so se zdravili že prej.
The number of repeat requests has generally not declined, and in most countries the total number of treatment demands for heroin has remained roughly stable.
Število ponovnih povpraševanj po zdravljenju se na splošno ni zmanjšalo in v večini držav je skupno število povpraševanj po zdravljenju zaradi heroina ostalo približno nespremenjeno.
Notable exceptions are Germany and the United Kingdom, where total reported requests have increased.
Opazni izjemi sta Nemčija in Združeno kraljestvo, kjer se je povečalo zabeleženo skupno število povpraševanj.
Overall, however, the percentage of treatment demands accounted for by heroin (all and new requests) has fallen; in the case of new demands it has declined from about two thirds to around 40 % between 1999 and 2004 in the face of increases in demands for cannabis and cocaine treatment (178).
Vendar pa se je skupaj odstotek povpraševanj po zdravljenju zaradi heroina (vsa povpraševanja in nova povpraševanja) zmanjšal, glede na povečanje povpraševanj po zdravljenju zaradi konoplje in heroina se je v primeru novih povpraševanj zmanjšal s približno dveh tretjin na približno 40 % med letoma 1999 in 2004 (178).
The EU drug strategy 2005–12 places a high priority on improving the availability of and access to treatment and it calls on Member States to provide a comprehensive range of effective treatments.
Strategija EU na področju drog 2005–2012 daje veliko prednost izboljševanju razpoložljivosti zdravljenja in dostopa do njega ter poziva države članice, naj zagotovijo obsežno ponudbo učinkovitih zdravljenj.
Historically, residential treatment represented an important setting for the treatment of problem opioid users.
V preteklosti je bilo bolnišnično zdravljenje pomemben način zdravljenja problematičnih uživalcev opiatov.
However, the increasing diversity of treatment options and, in particular, the considerable expansion of substitution treatment has meant that the relative importance of residential care has declined.
Vendar pa se je zaradi vedno večje izbire možnosti zdravljenja in zlasti znatnega širjenja nadomestnega zdravljenja zmanjšal sorazmerni pomen bolnišnične oskrbe.
It has been previously reported that the population of clients requesting treatment for opioid use is an ageing one, and this trend continued in 2004.
Že prej se je poročalo, da se populacija uživalcev, ki se želijo zdraviti zaradi uporabe opiatov, stara, in v letu 2004 se je ta trend nadaljeval.
Nearly all opioid users seeking treatment are over 20 years old, and almost half of them are over 30.
Skoraj vsi uživalci opiatov, ki se želijo zdraviti, so starejši od 20 let, in skoraj polovica jih je starejša od 30 let.
Data available at European level show that only
Podatki, ki so na voljo na evropski ravni, kažejo, da je malo uživalcev (manj kot 7 %) mlajših od 20 let, ko si prvič poišče pomoč (179).
Data on the relative availability of different types of treatment for opioid problems in Europe are currently
Občasno se poroča o zelo mladih osebah (starih manj kot 15 let), ki se želijo zdraviti zaradi uživanja
See Table TDI-10 in the 2006 statistical bulletin.) www.communitycare.co.uk) See Table TDI-11 in the 2006 statistical bulletin.)
V Turčiji je metadon uradno registriran za zdravljenje odvisnosti od opiatov, vendar niso poročali o nobenem primeru zdravljenja.
Annual report 2006: the state of the drugs problem in Europe limited. In response to an EMCDDA questionnaire, experts in most (16) Member States indicated that substitution treatment is the principal form of treatment available.
Letno poročilo 2006: stanje v zvezi s problemom drog v Evropi sporna, sistem ZN je leta namreč 2004 sprejel skupno stališče o nadomestni vzdrževalni terapiji (SZO/UNODC/UNAIDS, 2004) in junija 2006 je SZO vključila metadon in buprenorfin na svoj seznam nujnih zdravil.
Some countries (Germany, Spain, the Netherlands and the United Kingdom) also have heroin prescription programmes, although the number of patients receiving this kind of treatment is very small compared with other forms of drug substitution (probably constituting less than 1 % of the total).
na ta način zelo majhno v primerjavi z drugimi oblikami nadomeščanja drog (verjetno jih je manj kot 1 % vseh).
This form of treatment remains controversial and is generally provided on a scientific trial basis for long-term users in whom other therapeutic options have failed.
Ta oblika zdravljenja je še vedno sporna in se v glavnem izvaja na podlagi znanstvenega preskušanja za dolgotrajne uživalce, pri katerih druge terapevtske možnosti niso bile uspešne.
A recent review of the effectiveness of drug dependence treatment in preventing HIV transmission found that behavioural interventions can enhance the positive effects of substitution treatment on HIV prevention, whereas the effectiveness of psychological therapy alone is variable.
Nedavna proučitev učinkovitosti zdravljenja odvisnosti od drog pri preprečevanju prenosa virusa HIV je pokazala, da lahko vedenjske intervencije okrepijo pozitivne učinke nadomestnega zdravljenja pri preprečevanju prenosa virusa HIV, medtem ko je učinkovitost psihološke terapije same spremenljiva.
Abstinence-based treatment showed good outcomes with regard to HIV prevention for those who remain in treatment for three months or more (Farrell et al., 2005).
Zdravljenje na podlagi abstinence je pokazalo dobre rezultate, kar zadeva preprečevanje prenosa virusa HIV pri osebah, ki so ostale na zdravljenju tri mesece ali več (Farrell et al., 2005).
Monitoring methadone provision
Spremljanje oskrbovanja z metadonom
Methadone is a controlled drug according to Schedule I of the 1961 Single Convention on Narcotic Drugs, and levels of domestic consumption are monitored annually by the INCB.
Zdaj je na voljo dovolj dokazov, ki močno govorijo v prid koristnosti nadomestnih programov, v katerih uporabljajo zdravila, kot sta metadon ali buprenorfin.
There is now a robust evidence base for the value of substitution programmes using drugs such as methadone or buprenorphine. Studies have shown that substitution therapy is associated with decreased use of illicit drugs, reduced rates of injecting, a reduction in behaviours associated with a high risk of spread of HIV or other infectious diseases, such as sharing of equipment, and improvements in both social functioning and general health.
Študije so pokazale, da je nadomestna terapija povezana z zmanjšano uporabo prepovedanih drog, nižjimi ravnmi vbrizgavanja, upadom vedenja, povezanega z velikim tveganjem za širjenje virusa HIV ali drugih nalezljivih bolezni, kot je izmenjavanje pripomočkov, in izboljšanjem družbenega delovanja ter splošnega zdravja.
Research has also suggested that levels of criminal activity may be reduced and that sufficient provision of substitution treatment may have an impact on the number of drugrelated deaths.
Raziskave so pokazale tudi, da se lahko znižajo ravni kriminalne dejavnosti in da lahko zadostno zagotavljanje nadomestnega zdravljenja vpliva na število smrti, povezanih z drogami.
Optimum outcomes depend on timely entry into the programme, sufficient duration and continuity of substitution treatment, and adequate doses of medication.
Najboljši rezultati so odvisni od pravočasne vključitve v program, ustreznega trajanja in nepretrganosti nadomestnega zdravljenja ter ustreznih odmerkov zdravil.
Excluding the Czech Republic and France, where high-dose buprenorphine treatment (HDBT) is reported to be the most common option, more than 90 % of treatments in all other countries were with methadone.
Metadon je nadzorovana droga v skladu s seznamom snovi v tabeli I Enotne konvencije o mamilih iz leta 1961 in Mednarodni nadzorni svet za droge letno spremlja ravni domače porabe.
The EU and the USA together account for 85 % of the world’s methadone consumption, and methadone consumption in these countries has shown a steady increase over the last decade.
Po podatkih Centra je bilo po najnižji oceni v državah članicah EU, na Norveškem, v Bolgariji in Romuniji med letom vključenih v nadomestno zdravljenje več kot 500 000 oseb (glej tabelo 4 v letnem poročilu 2005).
Amounts consumed stabilised in both regions between 1997 and 2000, but there has been a
Razen Češke in Francije, kjer se poroča, da je najbolj pogosto zdravljenje z visokimi odmerki buprenorfina, se pri več kot 90 % zdravljenj v vseh drugih državah uporablja metadon.
While methadone continues to be the most commonly prescribed substitution treatment in Europe, treatment options are still expanding, and buprenorphine is now available in 19 EU countries, Bulgaria and Norway, although it is not clear whether it is officially approved for maintenance treatment in all countries where it is reported to be used.
Medtem ko je terapija z metadonom še vedno najbolj pogosto predpisano nadomestno zdravljenje v Evropi, se možnosti zdravljenja še vedno širijo in buprenorfin je zdaj na voljo v 19 državah EU, na Norveškem in v Bolgariji, čeprav ni jasno, ali je uradno odobren za vzdrževalno terapijo v vseh državah, v katerih poročajo, da naj bi ga uporabljali.
Considering that high-dosage buprenorphine treatment was introduced in Europe only 10 years ago, the drug’s popularity as a therapeutic option has developed remarkably quickly (see Figure 1) (184).
Glede na to, da je bilo zdravljenje z visokimi odmerki buprenorfina v Evropi uvedeno šele pred desetimi leti, je to zdravilo postalo presenetljivo hitro priljubljeno kot terapevtska možnost (glej Prikaz 1) (184).
) In Cyprus, the use of methadone in detoxification treatment is reported since 2004 and the beginning of a methadone maintenance treatment pilot project has been announced, but no cases in treatment have been reported.
EU in ZDA imata skupaj 85 % svetovne porabe metadona in v zadnjem desetletju je poraba metadona v teh državah stalno rasla.
In Turkey, methadone is officially registered for the treatment of opioid dependency, but no treatment cases have been reported.
Porabljene količine so se med letoma 1997 in 2000 ustalile v obeh regijah, vendar so se od takrat v Združenih državah naglo povečale.
those of the USA (185
Trenutno so ravni porabe metadona v EU približno pol manjše od porabe v ZDA (185).
As a rule, noticeable increases in consumption figures follow the introduction of this treatment option at national level.
Metadon in buprenorfin se uporabljata tudi za zdravljenje abstinenčnega sindroma zaradi prenehanja uživanja opiatov, pri čemer je terapevtski cilj pomagati posamezniku doseči abstinenco, tako da v določenem obdobju prejema vedno manjše odmerke, ki mu pomagajo čimbolj omiliti težave pri abstinenčnem sindromu.
For example, in France, the widespread implementation of methadone substitution treatment in 1995
Nekatere države (Nemčija, Španija, Nizozemska in Združeno kraljestvo) imajo tudi programe predpisovanja heroina na recept, čeprav je število pacientov, ki se zdravijo
Recently, signs of a stabilisation in levels of methadone consumption can be observed in the statistics for Denmark, Spain, Malta, the Netherlands, and possibly Germany.
V zadnjem času so opazni znaki ustalitve ravni porabe metadona iz statističnih podatkov za Dansko, Španijo, Malto, Nizozemsko in morda Nemčijo.
This matches reported trends in the number of clients in treatment (see Chapter 2).
To ustreza zabeleženim trendom glede števila oseb na zdravljenju (glej poglavje 2).
Chapter 7Drug-related infectious diseases and drugrelated deaths
Poglavje 7Z drogo povezane nalezljive bolezni in smrtni primeri
Drugrelated infectious diseases
Nalezljive bolezni, povezane z drogami
In Portugal, an apparent decline in newly diagnosed cases of HIV among IDUs recorded previously is called into question by the 2004 data, which reveal an incidence of HIV infection of
Za povezavo med vbrizgavanjem drog in prenosom nalezljivih bolezni obstajajo trdni dokazi.
In the United Kingdom, the incidence of HIV among IDUs has slowly increased but is now stable at just under 2.5 cases per million population per year.
Študije kažejo tudi na povezavo med uporabo drog in zelo tveganim spolnim vedenjem, kar kaže na vedno večji pomen povezovanja intervencij na področju uporabe drog s strategijami javnega zdravstva, namenjenimi spolnemu zdravju.
In Ireland, the incidence increased during the late 1990s to a peak of 18.3 cases per million per year in 2000, fell to 9.8 per million in 2001, and subsequently increased to 17.8 cases per million in 2004.
V smislu spremljanja na evropski ravni se podatki o nalezljivih boleznih redno zbirajo iz uradnih obvestil, pri čemer je lahko vbrizgavanje drog zabeleženo kot dejavnik tveganja, in med posebnimi študijami populacij uživalcev drog v različnih okoljih.
One of the more serious health consequences of the use of illicit drugs, and in particular of drug injection, is the transmission of HIV and other infectious diseases, notably hepatitis C and B. The relationship between drug injecting and the transmission of infection is well established.
uživalci drog povečala (čeprav z nizke stopnje) z ocenjenega 2,3 primera na milijon prebivalcev v letu 2003 na 2,9 primera v letu 2004.
Reducing drug injecting and the sharing of injecting equipment has therefore become a primary goal of public health interventions in this area.
Kljub temu da se to v glavnem ujema z razpoložljivimi podatki iz študij (glej spodaj), je treba opozoriti, da so novi sistemi poročanja na začetku pogosto nezanesljivi.
Studies also point to a relationship between drug use and high-risk sexual activity; this suggests a growing importance in linking drug use interventions with public health strategies aimed at sexual health.
Na Portugalskem je navidezno zmanjšanje novo ugotovljenih primerov okužbe z virusom HIV med injicirajočimi uživalci drog, ki je bilo predhodno zabeleženo, postalo vprašljivo zaradi podatkov iz leta 2004, ki kažejo, da je pojavnost okužbe z virusom HIV 98,5 primera na milijon prebivalcev, kar je največ v EU (186).
In terms of monitoring at the European level, data on infectious disease are collected by regular notification sources, where drug injecting may be recorded as a risk factor, and during special studies of drug-using populations in different settings.
Na Irskem se je pojavnost povečevala proti koncu devetdesetih let in dosegla najvišjo vrednost 18,3 primera na milijon na leto v letu 2000, se zmanjšala na 9,8 primera na milijon v letu 2001 in se nato povečala na 17,8 primera na milijon v letu 2004.
HIV outbreaks related to injecting drug use occurred as recently as 2001 in Estonia and Latvia, and 2002 in Lithuania.
Izbruhi virusa HIV, povezani z vbrizgavanjem drog, so se v Estoniji in Latviji pojavili nedavno, in sicer leta 2001, v Litvi pa 2002.
Since then rates have strongly declined; a decline in the rates of newly reported cases is to be expected after an initial epidemic phase as an endemic level of infection becomes established (see below).
Od tedaj so se stopnje precej zmanjšale, po začetni epidemični fazi se namreč pričakuje zmanjšanje stopenj novo prijavljenih primerov, ko se vzpostavi endemična stopnja okužbe (glej spodaj).
HIV seroprevalence among tested IDUs
Seroprevalenca HIV med testiranimi injicirajočimi uživalci drog
Seroprevalence data from IDUs (percentage infected in samples of IDUs) are an important complement to HIV case reports.
Podatki o seroprevalenci med injicirajočimi uživalci drog (odstotek okuženih v vzorcih injicirajočih uživalcev drog) so pomembno dopolnilo k prijavljenim primerom okužbe z virusom HIV.
Repeated seroprevalence studies and routine monitoring of data from diagnostic tests can support conclusions drawn from case reporting data and can provide more detailed information on specific regions and settings.
Zaporedne seroprevalenčne študije in redno spremljanje podatkov iz diagnostičnih testov lahko podprejo zaključke, ki izhajajo iz podatkov o prijavljenih primerih, in zagotovijo podrobnejše informacije o posameznih regijah in okoljih.
However, prevalence data come from a variety of sources and, in some cases, may be difficult to compare; thus, they should be interpreted with caution.
Vendar pa podatki o seroprevalenci prihajajo iz različnih virov in jih je v nekaterih primerih težko primerjati, zato jih je treba razlagati pazljivo.
At present, most countries report low rates of newly diagnosed HIV infection attributed to injecting drug use.
V zadnjem času večina držav poroča o nizkih stopnjah novo ugotovljenih okužb z virusom HIV zaradi vbrizgavanja drog.
Countries that have maintained consistently low rates of HIV infection among injecting drug users (IDUs) provide an opportunity to explore what factors can account for this, a question posed by the current EU drug action plan and currently a focus of an EMCDDA coordinated study.
Države, ki dosledno ohranjajo nizke ravni okužb z virusom HIV med injicirajočimi uživalci drog, omogočajo priložnost raziskati, kateri dejavniki lahko prispevajo k temu.
Complacency should be avoided, however; neither Spain nor Italy, both of which have experienced HIV epidemics among IDUs, provides national HIV case reporting data, and this has a significant negative impact on the value of these data for describing the overall EU picture.
To je vprašanje, ki ga zastavlja trenutni akcijski načrt EU na področju drog, in je trenutno osrednji cilj študije, ki jo usklajuje Center.
Furthermore, data emerging from some countries are raising concerns that HIV infection may be increasing, at least among some populations of IDUs.
Vendar ne moremo biti zadovoljni, saj Španija in Italija, ki sta imeli epidemijo virusa HIV med injicirajočimi uživalci drog, ne posredujeta nacionalnih podatkov o prijavljenih primerih okužbe z virusom HIV, kar zelo negativno vpliva na pomen, ki ga imajo ti podatki za opisovanje celotne slike v EU.
The recent increases in HIV in some countries recorded in the case reporting data are mostly confirmed by the available seroprevalence data, although the latter would suggest that these are not the only countries in which increased vigilance is necessary.
Poleg tega podatki, ki prihajajo iz nekaterih držav, zaskrbljujoče kažejo, da se okužbe z virusom HIV morda povečujejo, vsaj med nekaterimi populacijami injicirajočih uživalcev drog.
In France, where HIV cases have been recorded only since 2003, there has been an increase in the incidence of HIV among IDUs (albeit from a low level), from an estimated 2.3 cases per million population in 2003 to 2.9 cases in
V Franciji, kjer se primeri okužbe z virusom HIV beležijo šele od leta 2003, se je pojavnost virusa HIV med injicirajočimi
In the Baltic states, the available seroprevalence data indicate that transmission among IDUs may still not be under control (Figure 10). In Estonia, a recent study suggests that prevalence in IDUs is increasing in one region (Tallinn: from
Nedavna povečanja števila okužb z virusom HIV v nekaterih državah, zabeležena v podatkih o prijavljenih primerih, so večinoma potrjena z razpoložljivimi podatki
Annual report 2006: the state of the drugs problem in Europe
V državah, ki so imele v preteklosti visoke stopnje okužbe z virusom HIV med injicirajočimi uživalci drog (Španija,
Figure 10: HIV prevalence in tested injecting drug users, 2003–04
Prikaz 10: Razširjenost virusa HIV pri testiranih injicirajočih uživalcih drog, 2003–2004
41 % of a sample of 964 in 2001 to 54 % of 350 in 2005) and exceptionally high in another (Kohtla-Järve: 90 % out of 100).
Številke v (oklepajih) so lokalni podatki.
In Spain and Italy, national data from case reporting are not available.
Barva kaže vmesno vrednost nacionalnih podatkov ali, če niso na voljo, lokalnih podatkov.
Data from routine diagnostic tests are difficult to interpret as they may be affected by different selection biases; however, they are a cause for concern in these countries.
Podatki za Italijo in Portugalsko vključujejo tiste, ki si droge ne vbrizgavajo, in verjetno prenizko ocenjujejo razširjenost pri tistih, ki si jo vbrizgavajo.
In Spain, HIV prevalence among young IDUs (under 25) tested in drug treatment was stable until 2002, at over 12 %, and among new IDUs (defined as injecting for less than two years) increased from 15 % to 21 % in 2000–01, suggesting a high incidence up to 2002.
Podatki deloma ali v celoti pred letom 2003 (Španija 2002–2003; Francija 2002–2003; Latvija 2002–2003; Nizozemska 2002) ali iz leta 2005 (Estonija).
In Poland, local studies suggest that HIV spread has continued at least until recently, based on high prevalence rates among young IDUs (15 % in 2002 in one region, 4–11 % in two other regions in 2004).
Za primarne vire, podatke iz študij in podatke pred letom 2003 ali po 2004, glej tabelo INF-8 v Statističnem biltenu 2006.
) See Figure INF-5 (part ii) and (part vi) in the 2006 statistical bulletin.
) Glej prikaz INF-5 (del ii) in (del vi) v Statističnem biltenu 2006.