{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T03:02:08Z","timestamp":1760151728437,"version":"build-2065373602"},"reference-count":24,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2022,4,15]],"date-time":"2022-04-15T00:00:00Z","timestamp":1649980800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Acci\u00f3n Estrat\u00e9gica en Salud (AES), project AES PI19\/00982","award":["PI19\/00982"],"award-info":[{"award-number":["PI19\/00982"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Acknowledgement of the prevalence of recreational opioid use (PROU) is key to the planning and evaluation of care services. However, in Spain, the prevalence of PROU in recent years is unknown. The objective of this study was to estimate the PROU between 2005 and 2019 in the general populations of six Spanish cities. A benchmark-multiplier methodology was used to estimate the PROU population size. The benchmark used was overdose deaths from recreational opioid use in Spain\u2019s six most populated cities. The multiplier was the overdose death rate in a cohort of heroin users. Linear regression was used to estimate the trend of the PROU estimate over the set period of years. In 2005, the PROU was 4.78 (95%CI 3.16\u20137.91) per 1000 people. The estimated trend decreased, with the two lowest values being 2.35 per 1000 in 2015 and 2.29 in 2018. In 2019 the PROU was 2.60 per 1000 (95%CI 1.72\u20134.31), 45% lower than in 2005. While the decline in the PROU continues, its deceleration over the last four years calls for increased vigilance, especially in light of the opioid crisis in North America that has occurred over the last few years.<\/jats:p>","DOI":"10.3390\/ijerph19084815","type":"journal-article","created":{"date-parts":[[2022,4,16]],"date-time":"2022-04-16T07:42:41Z","timestamp":1650094961000},"page":"4815","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Estimating the Prevalence of Recreational Opioid Use in Spain Using a Multiplier Method"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8487-7384","authenticated-orcid":false,"given":"Jos\u00e9","family":"Pulido","sequence":"first","affiliation":[{"name":"Departamento de Salud P\u00fablica y Materno-Infantil, Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain"},{"name":"CIBER en Epidemiolog\u00eda y Salud P\u00fablica (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0309-181X","authenticated-orcid":false,"given":"Albert","family":"Sanchez-Niubo","sequence":"additional","affiliation":[{"name":"Department of Social Psychology and Quantitative Psychology, Faculty of Psychology, University of Barcelona, 08035 Barcelona, Spain"},{"name":"CIBER en Salud Mental (CIBERSAM), Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4371-7293","authenticated-orcid":false,"given":"Noelia","family":"Llorens","sequence":"additional","affiliation":[{"name":"Delegaci\u00f3n del Gobierno Para el Plan Nacional Sobre Drogas, Ministerio de Sanidad, Gobierno de Espa\u00f1a, 28008 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan","family":"Hoyos","sequence":"additional","affiliation":[{"name":"Departamento de Salud P\u00fablica y Materno-Infantil, Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain"},{"name":"CIBER en Epidemiolog\u00eda y Salud P\u00fablica (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6257-3213","authenticated-orcid":false,"given":"Gregorio","family":"Barrio","sequence":"additional","affiliation":[{"name":"CIBER en Epidemiolog\u00eda y Salud P\u00fablica (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain"},{"name":"Escuela Nacional de Salud, Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Jose","family":"Belza","sequence":"additional","affiliation":[{"name":"CIBER en Epidemiolog\u00eda y Salud P\u00fablica (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain"},{"name":"Escuela Nacional de Salud, Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7051-0730","authenticated-orcid":false,"given":"Luc\u00eda","family":"Cea-Soriano","sequence":"additional","affiliation":[{"name":"Departamento de Salud P\u00fablica y Materno-Infantil, Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0583-1618","authenticated-orcid":false,"given":"Ariadna","family":"Angulo-Brunet","sequence":"additional","affiliation":[{"name":"Faculty of Psychology and Education Sciences, Universitat Oberta de Catalunya, Rambla del Poblenou, 08018 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1760-9472","authenticated-orcid":false,"given":"Luis","family":"Sordo","sequence":"additional","affiliation":[{"name":"Departamento de Salud P\u00fablica y Materno-Infantil, Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain"},{"name":"CIBER en Epidemiolog\u00eda y Salud P\u00fablica (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,4,15]]},"reference":[{"key":"ref_1","unstructured":"UNODC (2022, April 01). World Drug Report 2021. Available online: https:\/\/https:\/\/www.unodc.org\/unodc\/en\/data-and-analysis\/wdr2021.html."},{"key":"ref_2","unstructured":"US Department of Health and Human Services (2017). Assessment of Abuse Potential of Drugs, Food and Drug Administration Guidance for Industry; Food and Drug Administration Center for Drug Evaluation and Research (CDER)."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1002\/ejp.1728","article-title":"Is Europe Facing an Opioid Epidemic: What Does European Monitoring Data Tell Us?","volume":"25","author":"Seyler","year":"2021","journal-title":"Eur. J. Pain"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1111\/j.1360-0443.2008.02451.x","article-title":"Problematic Heroin Use Incidence Trends in Spain","volume":"104","author":"Fortiana","year":"2009","journal-title":"Addiction"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"S\u00e1nchez-Niub\u00f2, A., Aalen, O.O., Domingo-Salvany, A., Amundsen, E.J., Fortiana, J., and R\u00f8ysland, K. (2013). A Multi-State Model to Estimate Incidence of Heroin Use. BMC Med. Res. Methodol., 13.","DOI":"10.1186\/1471-2288-13-4"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1080\/03007995.2019.1684251","article-title":"The Evolution of Opioid-Related Mortality and Potential Years of Life Lost in Spain from 2008 to 2017: Differences between Spain and the United States","volume":"36","author":"Salazar","year":"2020","journal-title":"Curr. Med. Res. Opin."},{"key":"ref_7","first-page":"397","article-title":"Two methods to analyze trends in the incidence of heroin and cocaine use in Barcelona [Spain]","volume":"21","author":"Melis","year":"2007","journal-title":"Gac. Sanit."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1093\/eurpub\/ckq076","article-title":"Estimating the Prevalence of Drug Injection Using a Multiplier Method Based on a Register of New HIV Diagnoses","volume":"21","author":"Oliva","year":"2011","journal-title":"Eur. J. Public Health"},{"key":"ref_9","unstructured":"Observatorio Espa\u00f1ol de Las Drogas y Las Adicciones (2020). Informe 2018. Alcohol, Tabaco y Drogas Ilegales En Espa\u00f1a. Encuesta Sobre Uso de Drogas En Ense\u00f1anzas Secundarias En Espa\u00f1a (ESTUDES), 1994\u20132020, Ministerio de Sanidad, Consumo y Bienestar Social, Delegaci\u00f3n Para El Plan Nacional Sobre Drogas."},{"key":"ref_10","first-page":"505","article-title":"More than thirty years of illicit drugs in Spain: A bitter story with some messages for the future","volume":"80","author":"Brugal","year":"2006","journal-title":"Rev. Esp. Salud. Publica"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"108229","DOI":"10.1016\/j.jsat.2020.108229","article-title":"Prevalence of High-Risk Drug Use and Coverage of Opioid Substitution Treatment and Needle and Syringe Programs in Lithuania in 2015\u20132016: A Multi-Method Estimation Study","volume":"122","author":"Thanki","year":"2021","journal-title":"J. Subst. Abuse Treat."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1093\/oxfordjournals.aje.a117472","article-title":"Use of capture-recapture to estimate the prevalence of opiate addiction in Barcelona, Spain, 1989","volume":"141","author":"Hartnoll","year":"1995","journal-title":"Am. J. Epidemiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.jsat.2012.11.002","article-title":"Trends of Heroin Use and Heroin Injection Epidemics in Europe: Findings from the EMCDDA Treatment Demand Indicator (TDI)","volume":"45","author":"Barrio","year":"2013","journal-title":"J. Subst. Abuse Treat."},{"key":"ref_14","unstructured":"European Monitoring Centre for Drugs and Drug Addiction (2021). Drug-Related Deaths and Mortality in Europe: Update from the EMCDDA Expert Network, Publications Office of the European Union. Available online: https:\/\/www.emcdda.europa.eu\/system\/files\/publications\/13762\/TD0221591ENN.pdf."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1159\/000377626","article-title":"Lethality of Opioid Overdose in a Community Cohort of Young Heroin Users","volume":"21","author":"Espelt","year":"2015","journal-title":"Eur. Addict. Res."},{"key":"ref_16","first-page":"54","article-title":"Bootstrap Methods for Standard Errors, Confidence Intervals, and Other Measures of Statistical Accuracy","volume":"1","author":"Efron","year":"1986","journal-title":"Stat. Sci."},{"key":"ref_17","first-page":"385","article-title":"Emergencies related to recreational drug abuse in Spain compared to emergencies attended in 3 European areas","volume":"30","author":"Yates","year":"2018","journal-title":"Emergencias"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"916","DOI":"10.1016\/j.scitotenv.2017.07.126","article-title":"Five-Year Monitoring of 19 Illicit and Legal Substances of Abuse at the Inlet of a Wastewater Treatment Plant in Barcelona (NE Spain) and Estimation of Drug Consumption Patterns and Trends","volume":"609","author":"Mastroianni","year":"2017","journal-title":"Sci. Total Environ."},{"key":"ref_19","first-page":"15","article-title":"The Epidemiology of Heroin and Other Narcotics: Selected Themes of the Discussion","volume":"16","author":"Rittenhouse","year":"1977","journal-title":"NIDA Res. Monogr."},{"key":"ref_20","unstructured":"European Monitoring Centre for Drugs and Drug Addiction (2004). EMCDDA Key Epidemiological Indicator: Prevalence of Problem Drug Use, EMCDDA. Available online: https:\/\/www.emcdda.europa.eu\/system\/files\/publications\/321\/Guidelines_Prevalence_Revision_280704_b-1_124620.pdf."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"108367","DOI":"10.1016\/j.drugalcdep.2020.108367","article-title":"Tramadol Non-Medical Use in Four European Countries: A Comparative Analysis","volume":"217","author":"Iwanicki","year":"2020","journal-title":"Drug Alcohol Depend."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"477","DOI":"10.2147\/CEOR.S85213","article-title":"Estimating the Health Care Burden of Prescription Opioid Abuse in Five European Countries","volume":"7","author":"Shei","year":"2015","journal-title":"Clinicoecon Outcomes Res."},{"key":"ref_23","unstructured":"Mart\u00ednez Or\u00f3, D.P. (2019). Opioides En Espa\u00f1a. Ni Repunte de Hero\u00edna Ni Crisis de Opioides a La Americana, Episteme, Investigaci\u00f3n e Intervenci\u00f3n Social."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.addbeh.2017.01.014","article-title":"Prevalence and Correlates of Fentanyl-Contaminated Heroin Exposure among Young Adults Who Use Prescription Opioids Non-Medically","volume":"68","author":"Macmadu","year":"2017","journal-title":"Addictc Behav."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/8\/4815\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:54:45Z","timestamp":1760136885000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/8\/4815"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,15]]},"references-count":24,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2022,4]]}},"alternative-id":["ijerph19084815"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19084815","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2022,4,15]]}}}