Prevalence of opiate use among young men in Italy, 1980 and 1982

Title

Prevalence of opiate use among young men in Italy, 1980 and 1982

Details

Author: U. AVICO, F. POCCHIARI, P. ZUCCARO, L. DONATO, F. MARIANI
Pages: 63 to 71
Creation Date: 1983/01/01

Prevalence of opiate use among young men in Italy, 1980 and 1982

U. AVICO
F. POCCHIARI
P. ZUCCARO
Istituto Superiore di Sanità, Rome, Italy L. DONATO
F. MARIANI
National Research Council, Pisa, Italy

ABSTRACT

An epidemiological study on opiate use among young men undergoing examination for army draft was carried out in 1980 and 1982. The following six cities and surrounding provinces were selected for the study : Bologna, Florence, Genoa, Milan, Rome and Turin. There were 15,266 respondents in 1980 and 15,874 in 1982. For each respondent, a urine sample was tested for the presence of opiates and a questionnaire on demographic and socio-economic variables was completed. The study revealed 247 opiate cases with a prevalence rate of 1,618 per 100,000 in 1980, and 339 opiate cases with a prevalence rate of 2,136 per 100,000 in 1982. The number of opiate cases and demographic and socio-economic characteristics of respondents varied greatly from province to province. The group of unemployed respondents had significantly higher prevalence rates than the other occupational groups. A methodology was used that made it possible to estimate the number of opiate abuse cases that did not come to the attention of the authorities. On the basis of the study it was estimated that there were 68,000 opiate users in 1980 and 92,000 in 1982 in the entire country.

Introduction

At the end of 1979, the Minister of Health requested the Istituto Superiore di Sanità (ISS) in Rome and the National Research Council (CNR) in Pisa to carry out epidemiological research in order to facilitate an assessment of the extent of drug abuse in Italy. In response to this request, ISS and CNR set up a research project on drug dependence, which was carried out within the framework of the special project on Biomedical Engineering of CNR. 1 The project was designed to meet the following objectives :

1 This project was carried out with financial assistance from the General Management of Social Medicine Services of the Ministry of Health.

  1. To assess opiate use among young males undergoing their first medical examination for army draft;

  2. To develop a methodology for the screening of opiate abuse for use by local health authorities by examining urine samples;

  3. To compare the results of screenings research with the data reported by the Drug Enforcement Administration (DAD) and the regional health authorities;

  4. To estimate the number of opiate users in Italy in 1980 and 1982.

Method

The study was carried out among young men undergoing medical examination for army draft from selected geographical areas of Italy in 1980 and 1982. Urine was collected and analysed for the presence of opiates, and results were compared with known data from other sources, such as those obtained by DAD [ [1]] . Data on demographic and socioeconomic characteristics of respondents were obtained by means of a questionnaire.

The areas covered by the study were the cities and surrounding provinces of Bologna, Florence, Genoa, Milan, Rome and Turin. They were selected on the basis of prevalence rates of drug abuse, as reported by DAD indicating a high risk of opiate abuse.

Samples of urine, collected at the time of examination for army draft, were placed in special airtight containers, each labelled with a number taken at random. This number was also put on the questionnaire, which had been previously completed, in order to match the test results on opiate presence in the urine with the demographic and social data of the subjects. Subjects were guaranteed anonymity regarding the individual data obtained in this survey. The samples were stored at a temperature of 4° - 8° C.

The analyses of urine for the presence of opiates (morphine, its derivatives and metabolites), were carried out using a 125 iodine-morphine radioimmunoassay (RIA) method and by measuring gamma radiation in bound fraction. A value of 20 ng/mi was chosen as the threshold level for morphine in urine, as that value was found to be sufficiently discriminating. A detailed methodology of the analysis is described elsewhere [ [2]] . Positive opiate samples and 10 percent negative opiate samples were further examined by using immunological and radioimmunological methods. The quantity of opiates was examined by means of gas-chromatography and tritiated morphine RIA. (The urine samples were analysed in 1980 by the Institute for Forensic Medicine at the University of Padua and the Bufalini Hospital in Cesena and in 1982 by ISS.)

Results

Population studied

Table 1 shows the distribution of population in the provinces and cities included in the study.

Table 1

Total population in the provinces and cities studied, 1980

 

Number of inhabitants

Name of city and province

Province

City

Bologna
939668 481120
Florence
1201459 464020
Genoa
1077092 795027
Milan
4061978 1706268
Rome
3705876 2897505
Turin
2383146 1181567
Total
13369219 7525507

Table 2 shows the number of respondents in 1980 and 1982 by province and age. The great majority of respondents in 1980 were 18 years of age (95.6 per cent), while a very small number (4.1 per cent) were in the 19 - 25 age group. The distribution of respondents by age in 1982 was similar to the age distribution in 1980 with 94.2 per cent of respondents being l 8 years old or younger and 5 per cent in the 19 - 25 age group.

Table 2

Distribution of respondents by province and age, 1980 and 1982

 

Number of respondents, 1980

Number of respondents, 1982

Province

Total

18 years of age or younger

Total

18 years of age or younger

Bologna
1857 1691 1673 1559
Florence
1983 1850 2215 2047
Genoa
1358 1302 1731 1582
Milan
4208 4068 4806 4418
Rome
2867 2725 2850 2772
Turin
2993 2952 2599 2577
Total
15266 14588 15874 14955
Prevalence rates of opiates

Table 3 shows the prevalence rates (per I 00,000) of cases where urine was found to contain opiates. The number of positive opiate cases in 1980 was 247, with a prevalence rate of 1,618 per 100,000, while in 1982 the number was 339, with a prevalence rate of 2,136. This finding clearly indicated a substantial increase in the number of opiate cases in 1982 compared with 1080.

In 1980, Florence had the highest rate (2,068), followed by Bologna (1,993), Milan (1,949), Rome ( 1,291), Turin (1,169) and Genoa ( 1,105). In 1982, the highest rate was in Milan (2,663), followed by Florence (2,348), Genoa (2,080), Bologna (1,973), Turin (1,924) and Rome (1,404). With regard to age, the highest prevalence rate of opiate cases was found in the 19 - 25 age group in both 1980 and 1982. In 1980, the prevalence rate in this group was 3,704 as compared with 1,522 in the group of 18-year-old males. In 1982, the prevalence of opiate cases in the 19 - 25 age group was 4,623 as compared with 2,013 in the age group of 18-year-old or younger respondents.

Comparison of data on presence of opiates in urine with data on drug abuse reported by other sources in 1980

With the exception of Florence, there was a relatively good correlation between data obtained in this survey and data on drug abuse in the 18 - 25 male age group reported by DAD and regional health authorities in 1980.

The authors observed that there was a threshold prevalence level below which drug abuse was not perceived as a problem by the public authorities.

This threshold level for males in the 18 - 25 age group was approximately 1,000 per 100,000. In another study of men and women between the ages of 14 and 40 years, the threshold level was approximately 240 per 100,000.

Demographic and social characteristics of respondents

Data on demographic and social characteristics, including marital status, education, employment, occupation and residence were obtained by means of a questionnaire. These data were matched with the data obtained by urine testing.

Education

Table 4 shows the prevalence rates of opiate cases among respondents with primary school or secondary school education in 1980. The prevalence rate in both groups varied greatly according to province. Among respondents with secondary school education, the highest prevalence of opiate cases was in Florence, Bologna and Milan. Among respondents with primary school education, the highest prevalence of opiate cases was found in Rome, Milan and Genoa, but the number of cases was too small to draw any reliable conclusions.

Table 3

Distribution of respondents with positive opiate tests, 1980 and 1982

 

1980

1982

 

Number

Prevalence rate per 1oo.ooo

Number

Prevalence rate per 1oo.ooo

Province

Total

18 years of age or younger

Total

18 years of age or younger

Total

18 years of age or younger

Total

18 years of age or younger

Bologna
37 30 1993 1774 33 32 1973 2053
Florence
41 35 2068 1892 52 48 2348 2345
Genoa
15 14 1105 1075 36 34 2080 2149
Milan
82 75 1949 1844 128 103 2663 2331
Rome
37 33 1291 1211 40 36 1404 1299
Turin
35 35 1169 1186 50 48 1924 1863
Total
247 222 1618 1522 339 301 2136 2013

Table 4

Prevalence rates of opiate cases in relation to educational level in the 18-year-oId group, 1980

 

Primary School Education

Secondary School Education

Province

Number of respondents

Number of cases with opiate-positive urine

Rate per 100.000

Number of respondents

Number of cases with opiate-positive urine

Rate per 100.000

Bologna
110 1 909 1578 29 1838
Florence
117 1 855 1712 34 1986
Genoa
133 3 2256 1166 11 943
Milan
132 4 3030 3890 71 1825
Rome
186 6 3226 2525 27 1069
Turin
295 1 339 2648 34 1284
Total
973 16 1644 13519 206 1524
Occupation

With regard to occupation, the respondents were classified into three major groups : students, employed and unemployed. Table 5 shows that in each of these groups the prevalence of opiate cases varied markedly from province to province in 1980. For example, among students in Bologna the prevalence rate was over four times higher than in Genoa. In the group of employed in Florence the prevalence rate was approximately twice as high as in Bologna, while in the unemployed group the prevalence rate was highest in Milan, where it was over three times higher than in Rome.

The group of unemployed respondents had a significantly higher prevalence rate (2,785) per l 00,000 than the group of employed respondents (1 ,593). A similar pattern was found in all provinces with the exception of Rome. In the group of students the prevalence rates for all provinces, except Bologna, were smaller than in the other two occupational groups. The prevalence rate of the whole student group was l,256. Therefore the highest prevalence rate, with regard to occupation, was in the unemployed group and the lowest was in the student group, with the group of employed respondents falling between the two but nevertheless much closer to the group of students.

Estimate of the extent of opiate abuse in Italy

The extent of opiate abuse in Italy was estimated using data from the following sources :

  1. Data reported by police and health authorities. An assessment of the data reported by police and health authorities indicated that there were approximately 15,000 opiate abusers in 1980. This figure showed a 36 per cent increase compared with the previous year. The number of opiate abusers was 25,000 in 1982, which was an increase of 67 per cent compared with 1980 ;

  2. Indirect estimate of the extent of opiate abuse based on data of opiate-related deaths. An index of 9.5 opiate-related deaths per year was computed to correspond to l ,000 opiate abusers. On this basis it was estimated that there were 21 ,000 opiate abusers in I 980, an increase of 10 per cent as compared with 1979. Using the same method, it was estimated that there were 26,000 opiate abusers in 1982, which was an increase of 23.8 per cent compared with 1980 ;

  3. Opiate abuse detected by urine tests during the survey. A certain number of opiate users who were not known to the authorities were detected by urine tests in this survey. Data on these cases made it possible to correct the estimates of the total number of opiate abusers in Italy derived by the two methods mentioned above ; a corrected number of 53,000 opiate users should be added to the estimates made above for 1980 and 67,000 for 1982.

Table 5

Prevalence rates of opiate cases in relation to occupation in the 18-year-old group, 1980

 

Students

Employed

Unemployed a

Province

Number of respondents

Number of cases with opiate-positive urine

Rate per 100.000

Number of respondents

Number of cases with opiate-positive urine

Rate per 100.000

Number of respondents

Number of cases with opiate-positive urine

Rate per 100.000

Bologna
897 22 2453 729 8 1097 65 - -
Florence
922 14 1 518 742 15 2022 186 6 3 226
Genoa
728 4 549 460 7 1 522 114 3 2632
Milan
1 729 27 1 562 2021 34 1 682 318 14 4402
Rome
1 509 10 663 1 002 20 1 996 214 3 1 402
Turin
1 378 13 943 1 322 16 1 210 252 6 2381
Total
7 163 90 1 256 6276 100 1 593 1 149 32 2785

aIncluding, however. those whose qualifications do not suit the job requirement.

These figures included the number of opiate-addicted persons as well as occasional and initial opiate users.

By adding the figures obtained on the basis of reported data as indicated under (a)above and corrections based on data obtained by the survey as indicated under (c)above, it was possible to estimate that there were 68,000 opiate abusers in 1980 and 92,000 in 1982. The figure for 1982 therefore showed an increase of 35 per cent over 1980.

Discussion

The population in six provinces included in the study represented 24 per cent of the total population of Italy and 39 per cent of the population in metropolitan areas. An assessment of the nature and extent of opiate abuse is necessary for appropriate planning and interventions. Such assessment presents, however, methodological difficulties. The study is intended to contribute to the development of an appropriate methodology for the estimate of the opiate-abuse problem. In a previous report [ [3]] the extent of the opiate-abuse problem was estimated based on drug-abuse data reported by the police and health authorities as well as on data on opiate related deaths and some other indicators.

The study uses a methodology that estimates the number of opiate abuse cases that were not recorded by institutions. The methodology was based on the so-called threshold prevalence rates, making it possible to estimate the number of those cases of opiate use who did not come to the attention of the authorities. The estimated number of unrecorded cases, in addition to the number of cases of opiate abuse reported by institutions, provided the possibility for more realistic assessment of opiate abuse in Italy. The error of such estimate was calculated to be + 20 per cent.

The prevalence rates of opiate cases as well as socio-economic characteristics of respondents considerably varied between provinces. Those variations indicated that the solution to the drug abuse problem should not be sought in a unitary approach for the entire country.

Acknowledgements

The research for the study was carried out in close co-operation with the Medical Corps of the Ministry of Defence and the Drug Enforcement Administration (DAD) of the Ministry of the Interior. Some of the data were obtained from both DAD and the regional health authorities. Radioimmunoassays were performed by : C. Baccini, A. Brocchi, A. Caricchia, G. Carlotti, R. Gentile, C. Giovannini, A. Minoprio, L. Musmeci, R. Pacifici and E. Pistocchi in the Istituto Superiore di Sanita, Rome.

References

01

National Institute of Health and National Research Council, "Prevalence of opiate users in subjects screened for army draft in 1980", Report to the Minister of Helath,1981, p.E.B.1.

02

National Institute of Health and National Research Council, "The determination of opiates in body fluids in subjects screened for army draft in 1980" ,Report to the Minister of Helath,1982, p.E.B.3.

03

National Institute of Health and National Research Council," Drug abuse in Italy-1977-1978-1979", Report to the Minister of Health 1980, p.E.B.0.