Addictology in the world - digest

15.04.2010

ISSDP Panel: Methodological challenges faced by the global monitoring of drug situation

Publisher: MUDr. Tomáš Zábranský Ph.D. | Last update: 15.04.2010

The efforts of UNODC that is mandated to report on the regional and global trends are more than needed and highly welcome by everyone in the field. Major criticism concentrated so far on both the validity and reliability of the data gathered – especially those reported from some countries –, on the imputation of missing data as the very principle, on the way how trends are inferred based on this data, and on interpretations that are sometimes suspected to be driven less by the data (even in their poor quality) and more by political aspects both of international drug policies and of the internal UN politics.

As UNODC states their data gathering and analysis is based on scientific principles, the logical first step in improving the quality of its major product – the World Drug Report – and its acceptance in the global scientific community would be to implement the elements of independent, external peer review into the process. Albeit the nomination process should be carefully thought through so that it would not end up in another political body through which Member States would enforce their political interests, the potential of such improvement of the very nature of the process of data gathering and analysing would be immense.

In the following overview, I am concentrating on the problem drug use (PDU) and the methodological issues in its definition, estimations and aspects related to interpretation. However, I am quickly touching other aspects raised by the Background Paper of Dr. Angela Me.

The use of LYP

The current practice of UNODC to concentrate in their reports on the global estimates on the last year use prevalence (LYP) of five classes of drugs has little relevance for policy making process that would be based on the public health improvement as the primary objective; LYP is too vast category with too broad case definition and albeit – if the quality of the data would be good – it may inform about the availability of the given drug and/or the (social) acceptance of illegal drug use in the given population, it tells us nothing about the health consequences of the drug use in the population (note that „drug use“ per se is no illness in any of the current health classification systems). Moreover, the current practice to estimate LYP for the general population using an adjustment factor (regression coefficient based on mere ration between school- and general population) is dubious, not taking into account non-linearity of different “prevalences,” and cultural aspects that influence, e.g., the age of initiation of drug use in different societies, etc., which may be quite different between countries even in the same region, and  are subjected to dynamic changes. As such, the very method of imputation in its current shape used for indicator with limited usefulness is to be challenged and more focus on methods to estimate problem and/or injection drug use should be considered – also in the budgetary way. Where available, the data from school surveys should be homogenised and reported, and the use of extremely rough estimations based on poorly reliable data should be abandoned.

Problem drug use, and the global drug monitoring in general

“Problem drug use” as reported by UNODC

Obviously, the major problem is the use of different case definitions by different countries and their subsequent reporting as one indicator/category by the UNODC. Here, careful methodological work on the case definition with the countries using the Lisbon Consensus (2000) criteria seems as the only feasible plan.

The current approach of “heroin use equivalent” use for calculation of problem drug users is by its very root artificial and not based on reality, which is debilitating the very use of the “problem/atic (sic!) drug use” indicator. The interpretation of “heroin use equivalents” estimates has no sense even for a single country, and on the global level it is surreal, as there is hardly any practical use of it other than leagues of good, bad and the ugly. This is in striking contradiction

In my short presentation I am quickly mentioning possible approaches for estimation problem drug use as described by EMCDDA and by UNODC in its GAP programme and assessing their usefulness for different situations regarding the quality (and tradition) in gathering of drug-related data / monitoring drug situation.

Global monitoring of the drug situation: need for a shift in the paradigm

In the more general - but probably more important - part I am arguing that the approaches that use more (as it is the case with the imputation methods for LYP) or less (as it is the case with UNODC’s Harm Index) on data of poor, unknown or no quality is just another variation on the GIGO approach, and that it is inevitably detaching the global reporting from reality and thus, minimising its use for decision making / development of effective interventions. I show that substantially more attention should be paid on the national (and less so, regional) levels, where three parallel processes must be carefully followed by UN and other international donors:

  • the national- and regional levels training in use of relatively easy-to-use, straightforward and cheap methods how to monitor drug situation including different patterns of drugs use so that there would be achieved mutual comparability
  • the institutionalisation of national drug situation reporting to international institutions and bodies, and
  • establishing direct and explicit connection between regular reporting the data (and the UNODC’s assessment of the quality of such data) and the availability of international funding (from UN and other resources) of drug related projects in both demand- and supply reduction for the countries.

Obviously, such development would require substantial shift in the priorities of the UN and – more importantly – donor and recipient countries in this regard. UNODC would be the logical coordinator of such shift and in synchronisation of efforts of different donors – both public and private. However, much can be done in this regard without much institutional changes in the UNODC – i.e. at the national and regional levels using better the donor’s boards and similar bodies that often do exist already. UNODC should train its staff both in Vienna and in the field in consensus building in this regard.

Participation at the conference was supported by project „Další profesní vzdělávání pracovníků v adiktologickém výzkumu (Lifelong professional educationin addictollogy research) “, Number of the project: CZ.2.17/1.1.00/31458.

 


Top
ISSDP Panel: Methodological challenges faced by the global monitoring of drug situation Articles illustrations

  • Share this article
  • Sdílet