Estimating the size of the heroin market

• Author: Singleton, Nicola; Kalamara, Eleni; Noor, André
• Pages: 29-33

TECHNICALREPORTIEstimatingthesizeofthemainillicitretaildrugmarketsinEurope:anupdate

29

5Estimatingthesizeoftheheroinmarket

HeroinisthemainopioidusedinEurope,althoughinafewcountriesotheropioidsarequiteimportant,for

exampleinFinlandandEstoniaotheropioidsdominatethemarket(EMCDDA,2019).However,mostofthe

informationavailableonfrequencyofuseandamountsusedrelatestoheroinsothatinthesemarketsize

estimates,aswasthecaseinthepreviousestimatespublishedin2016,wefocusonestimatesforheroinuse.

Becausethosedependentonheroinandotheropioidstendtoconsumethedrugsfrequently,themarketfor

opioidsisanimportantone.However,itisrecognisedthatalargeproportionofopioidusersleadchaoticlives

andareunlikelytobewellrepresentedinGPSandthereforedifferentdatasourcesneedtobeusedto

estimatethesizeofthismarket.

AlthoughanattemptwasmadewithintheEWSDinSwitzerlandtoinvestigatethepotentialofusingonline

surveystogatherinformationonpatternsofusefromheroinusersthiswasunsuccessful.Thereforethe

methodsusedtoestimatetheretailmarketsizeforheroininthisroundofestimationremainthesameasused

inthepreviousroundpublishedin2016,althoughthedatasourceshavebeenupdated.

5.1Numberofheroinusers

Basicapproach

Nosinglesourceofdataforthenumberofeitherheroinorotheropioidusersforallcountriesisavailableat

theEMCDDA,soacombinationofdifferentdatacollectionshastobeused.Inthelightofthemanygapsinthe

dataitwasdecidedtofocusagainsolelyonanestimateofthemarketsizeforheroin,aswasdoneinthefirst

iterationofthemarketsizeestimates.Forthisanestimateofthenumberofheroinusersineachcountryis

requiredandsincemostpeoplewhouseheroinarefrequent,oftendependentusers,anestimateof‘highrisk

heroinusers’islikelytobethebestapproximation.

OneoftheEMCDDA’skeyindicatorsistheproblemdruguseindicator.Withinthisindicator,dataonthe

numberofhighriskopioidusersarepartofthecoredataset.Insomecases,countriesspecifythemainopioid

drugusedandthen,ifthatisheroin,ahighriskheroinuserestimateisavailableinsteadofanhighriskopioid

userestimate.Thiswasthecaseforsixcountries(Czechia,France,Greece,Hungary,Italy,Spain).

Wheretherewerenoestimatesofhighriskheroinusersavailable,itwasnecessarytoimputethisbasedon

highriskopioiduserestimatesincombinationwithtreatmentdata(TDI),ifavailable.Ifthisinformationwas

notavailable,otherdatasourcessuchasoverallhighriskdruguseestimatesorestimatesofthenumberof

peoplewhoinjectdrugshadtobeused.InsomecasespublisheddatafromsourcesotherthanEMCDDAdata

collectionshadtobeused,asdescribedinthesectiononimputationprocedures.

Inestimatingthesizeoftheheroinmarketanimportantfactortotakeintoaccountiswhetherornotthe

individualisintreatment,becausewhileintreatmentheroinconsumptionisconsiderablyreduced.Assome

peoplemaybeintreatmentforlongperiodsoftime,particularlyiftheyareinOST,thisisanimportant

consideration.Nevertheless,asignificantproportionwill‘topup’withheroinevenwhileintreatment,sothose

intreatmentcannotbeexcludedfromtheestimationprocess.McSweeneyandSkrine(2013)investigatedthe

impactofOSTonheroinuseandestimatedthattherewasa70%reductionintheamountofpureheroin

consumedwhilepeoplewereretainedinOST.Sincemanyofthemethodsusedtoestimatethenumbersof

highriskopioidusersutilisetreatmentdatainsomewayaspartoftheestimationprocess,theestimatesmay

includepeopleinOST.Thereducedheroinusebythisgroupthereforeneedstobetakenaccountofinsome

waywhenestimatingheroinmarketsize.However,ifthehighriskopioiduserestimatesdonotincludepeople

inOSTitwillbenecessarytomakesurethosearealsoincludedinthemarketsizeestimationprocess.