Changing pattern of drug abuse among patients entering treatment in Lazio, Italy, between 1996 and 2003: Transition from heroin to cocaine use

Aim: This study describes temporal changes of the pattern of substance abuse among drug users in treatment in Lazio, Italy. Methods: We used individual data from the surveillance system of drug users of the Lazio region. We measured temporal changes in: the number of drug users in treatment, main and any substance of abuse, and mode of referral to treatment. Results: Among new clients, the proportion of heroin use decreased from 78.2% in 1996 to 37.6% in 2003 ( p < 0.0001), while cocaine use increased from 4.1% in 1996 to 30.1% in 2003 ( p < 0.0001). In 2003, any use of cocaine was reported by 43.1% of new cases as compared to 38.9% taking heroin, 36.8% cannabis and 5.3% other substances, 41.9% using more than one substance. In 2003, 37.7% of new patients were referred to treatment by the police as compared to 10.4% in 1996. Conclusions: Heroin use has been replaced by cocaine among people coming to treatment centres for the first time. The main mode of access to treatment of new cocaine and cannabis users occurred through mandatory referral by the police. Routine surveillance systems of treatment demand are essential to monitor temporal trends of patterns of drug use in order to plan proper treatment strategies.