苯丙胺类兴奋剂在德国和欧洲的应用和治疗

背景和目的:概述苯丙胺类兴奋剂(ATS)如苯丙胺、甲基苯丙胺、摇头丸等在欧洲和德国的流行、消费模式和防治措施。在德国使用的非法物质中,大麻至今仍然是消费最广泛的非法药物。值得一提的数据是持续使用12月可卡因的为0.6%,苯丙胺为0.4%,摇头丸和迷幻蘑菇均为0.4%。海洛因、LSD、快克和可卡因的消费仍然限于在特定和更小范围的人群。2007年欧洲校园成瘾药物和其他药物调查项目的结果(the European School Survey Project on Addiction and other Drugs,ESPAD)显示,28%被调查的学生曾经尝试过某种非法药物(大麻、苯丙胺类、摇头丸、LSD、可卡因、快克或海洛因)(Krausetal.2008)。非法药物终生消费率(除了大麻)自2003年以来仍然几乎没有变化(10.0%vs.10.2%).在非法药物中(不包括大麻),苯丙胺类(6%)是最常被尝试的药物(一生中至少一次)。但是,与其它物质比较,苯丙胺类在德国的流行仍然不是非常广泛。闲暇和夜生活等中的药物滥用的预防措施仍然很缺乏。在一些城市(大多数是大城市),青少年中心,药物咨询机构或当地政府的团体项目已经制定了预防措施。他们通过网站或者传单宣传娱乐场所物质滥用的危害。在节日、聚会、夜总会或迪斯科舞厅的这些行动旨在提供药物滥用预防的信息。苯丙胺、甲基苯丙胺和摇头丸是欧洲最常用的非法药物。可卡因使用者的绝对数量可能更高,但就地理分布而言在许多国家一些合成药物仍然是继大麻后最常用的非法物质。而且,在一些国家苯丙胺的使用仍旧是药物滥用问题的重要部分,在治疗需求中占相当大的比例。最近的人群调查提示,欧洲各国家苯丙胺终生使用率(成年人,15-64a)在0到11.7%之间变化。平均3.5%的欧洲成年人报告曾经使用过至少一次苯丙胺。去年药物使用大大降低,欧洲人加权平均数为0.5%。据估计大约1千2百万欧洲人尝试过苯丙胺,大约2百万人在过去的一年使用过药物。要求对苯丙胺类为主的药物使用进行治疗的报道在大多数欧洲国家相对较少,主要在瑞典(34%),芬兰(23%),拉脱维亚(16%)和葡萄牙(11%)占相当大的比例。另四个国家(比利时,丹麦,德国,荷兰)的比例在6%和10%之间,其他国家的比例小于3%。在娱乐场所的药物滥用可提供一个研究使用苯丙胺类和摇头丸等行为的窗口。在这些场所药物滥用的估计数据特别高,多数药物使用发生在周末和假日。安全俱乐部指南旨在减少药物相关问题的发生机会,包括免费提供冷水、快速急救和宣传预防措施。国家专家提供了在夜总会这些措施的实施情况。总的说来,欧洲夜生活场所仅采用有限的预防和减少健康风险和药物使用的简单措施。宣传预防工作在19个国家中的少数夜总会开展。苯丙胺类的使用者通常在门诊药物服务机构获得治疗。在苯丙胺使用历史较为严重的国家中这样的门诊药物服务专门治疗这种类型的药物问题。大多数问题苯丙胺使用者可以在精神诊所或医院接受住院治疗。本文将介绍预防和治疗的方案。

ATS USE AND TREATMENT IN GERMANY AND EUROPE

Background and Objectives:Overview on the prevalence and consumption patterns on amphetamine type substances (ATS) like amphetamines,methamphetamines,ecstasy in Europe and Germany and measures of prevention and treatment.Regarding the use of illicit substances in Germany Cannabis remains the by far most frequently consumed illicit drug. Values worth mentioning (last 12 month use) are furthermore only reached by cocaine (0.6%),amphetamines (0.5%),ecstasy and mushrooms (both 0.4%). The consumption of heroin,LSD and crack remained limited to specific and much smaller groups. The results of the European School Survey Project on Addiction and other Drugs (ESPAD) were presented in 2007. According to these results,28% of the pupils surveyed reported to have tried any illicit drug (cannabis,amphetamines,ecstasy,LSD,cocaine,crack or heroin) once in their lifetime (Kraus et al. 2008). The lifetime-prevalence of the consumption of illicit drugs though,(except for cannabis) has remained almost unchanged since 2003 (10.0% vs. 10.2%). Among the illicit drugs (excluding cannabis),amphetamines (6%) were the most commonly tried drugs (at least once in a lifetime). All in all however,it is assumed that methamphetamines,in comparison with other substances,are still not very prevalent in Germany. As for non-organized leisure time,drug prevention measures-and especially those relating to nightlife-continue to be scanty. In some (mostly larger) cities though,party projects-offered and carried out by scene initiatives-have established themselves. They are often linked with youth centres or drug counselling facilities or other party projects at local government level. On their websites and through media like flyers,they inform about the risks of consumption (especially) of scene-related substances. These initiatives often work at ground level at festivals,parties or events of clubs or in discotheques to provide information on drug prevention. Almost all initiatives offer online-counselling for users on their websites. Regarding the European situation amphetamines (a generic term that includes both amphetamine and methamphetamine) and ecstasy are among the most commonly consumed illicit drugs in Europe. In terms of the absolute numbers,cocaine use may be higher,but its geographic concentration means that for many countries,some form of synthetically produced drug remains the second most commonly used illicit substance after cannabis. Moreover,in some countries,use of amphetamines constitutes an important part of the drug problem,accounting for a substantial proportion of those in need of treatment. Recent population surveys indicate that lifetime prevalence of the use of amphetamines in Europe varies between countries,from zero to 11.7% of all adults (15-64 years). On average,3.5% of all European adults report having used amphetamines at least once. Last year use of the drug is much lower,with a weighted European average of 0.5%. The estimates suggest that around 12 million Europeans have tried amphetamines,and about 2 million have used the drug during the last year.The number of reported treatment demands relating to the use of amphetamine as the primary drug is relatively small in most European countries,and accounts for a sizeable proportion of reported treatment entries mainly in Sweden (34%),Finland (23%),Latvia (16%) and Hungary (11%). Four other countries (Belgium,Denmark,Germany,Netherlands) report between 6% and 10% of treatment entries from clients citing amphetamine as their primary drug;elsewhere the proportion is less than 3%Studies of drug use in recreational settings where young people congregate and which are sometimes associated with drug use,such as dance events or music festivals,can provide a window on the behaviour of those using amphetamines and ecstasy. Estimates of drug use in these settings are typically high,but are not generalisable to the wider population,and much of the drug use tends to occur on weekends and during holiday periods. Safe-clubbing guidelines aim to reduce opportunities for drug-related problems to occur and include the accessibility of free cold water,immediate availability of first aid and outreach prevention work. Reports on the availability of such measures,in nightclubs with sufficiently large target populations for the intervention to be implemented,were provided by national experts. Overall,it shows the limited availability of simple measures to prevent or reduce health risks and drug use in European nightlife settings. Outreach prevention work is reported to be available in the majority of relevant nightclubs only in a minority of nightclubs in 19 countries.Amphetamines users generally receive treatment in outpatient drug services which,in countries with histories of significant levels of amphetamines use,can be specialised in treating this type of drug problems. Treatment for the most problematic amphetamine users may be provided in inpatient drug services or in psychiatric clinics or hospitals. Prevention and treatment rogrammes will be presented.