Результаты комплексного мониторинга наркологической ситуации среди подростков Москвы

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Introduction

One of the objectives of the Anti-Drug Strategy of the Russian Federation until 2030, approved by Decree of the President of the Russian Federation dated November 23, 2020 № . 733, is to improve the drug situation monitoring system, increase the efficiency and objectivity of research in the field of drug control, in addition, the document states that the legal regulation of drug trafficking and anti-drug activities should be carried out taking into account the analysis of the drug situation. It is important to note that the childhood and adolescence period has high risks of starting non-medical use of psychoactive substances (PAS), including alcohol and nicotine-containing products, which is a serious health risk due to the increasing risks of drug addiction [1–4].

The basis of the concept of assessing the “narcological situation”, in contrast to the “drug situation”, approved by the Decree of the Government of the Russian Federation of 20.06.2011 № . 485, is the paradigm of creating its multi-component structure for integrating information on various health risk factors. The purpose of monitoring the drug situation at the local, regional and federal levels is to ensure dynamic observation of the prevalence of substance abuse and drug-related diseases. A comprehensive analysis of the dynamics of medical and social indicators most clearly reveals the negative outcomes and consequences of non-medical use of psychoactive substances [5, 6].

The use of psychoactive substances among teenagers and young people remains an acute medical and social problem both in Russia and abroad. National and international studies are regularly conducted to assess the scale of this problem and identify the main factors influencing the use of psychoactive substances. The data obtained during such studies make it possible to determine trends in the use of psychoactive substances, conduct comparative cross-country analysis, and develop modern preventive strategies and recommendations for preserving the health of the younger generation.

The main international projects in the area under study include the following works.

The WHO Health Behaviour in School-Aged Children (HBSC) study covers 44 countries in Europe and North America and is conducted every four years through a survey of 1500–4000 adolescents in each country. It aims to collect comprehensive data on adolescent health, including risk factors associated with substance use. It is important to note that Russia also participated in the project from 1990 to 2018, and according to the results of the latest study (2017–2018), the rates of alcohol and nicotine-containing substance use showed a downward trend, but the number of 15‑year-olds consuming alcohol and nicotine remained high: 59% tried alcohol, 28% smoked cigarettes, and 13% used cannabis. The most pronounced increase in alcohol and nicotine consumption occurred in the 13–15 age group [6–9].

An important international study is the European School Survey Project on Alcohol and Drugs (ESPAD), in which more than 40 countries are participating, with around 100000 students taking part in the latest round of the survey, answering an anonymous questionnaire in the 2019 surveys [6]. The ESPAD project was first implemented in 1995 and was aimed at studying trends in alcohol, tobacco and drug use among students, with the frequency of the study being once every four years. It should be noted that the study was conducted in Russia as a whole in 2007, with Moscow taking part in the project in 1999, 2003 and 2011.

According to ESPAD data for 2019, there is a noticeable decrease in the prevalence of alcohol consumption among 15–16‑years old. The average rate of having ever tried alcoholic beverages is 79%, with 47% of respondents reporting drinking alcohol in the last month.

Positive dynamics were also observed in relation to tobacco smoking. If in 1995, 68% of teenagers experimented with smoking at least once in their lives, then in 2019 this figure dropped to 42%. Daily smoking shows a similar downward trend from 20% in 1999 to 10% in 2019. Experts largely attribute the decrease in involvement in tobacco smoking to preventive programs, anti-drug policies, and informing young people about the dangers of tobacco.

The study also found that despite progress in reducing alcohol and tobacco use, there was a worrying rise in cannabis use. Surveys showed that 16% of students reported having tried cannabis at least once in their life, and 7% reported using cannabis in the past 30 days.

The 2019 ESPAD highlights that the increasing popularity of electronic cigarettes and vaping deserves special attention. In a number of countries, up to 40% of adolescents indicate experience of using such devices, while the level of awareness of potential health risks is generally insufficient. A similar situation is observed with regard to new psychoactive substances [10].

The new type of drug threat that the world is facing is also mentioned in various international UN reports. According to the UN Office on Drugs and Crime, the number of new psychoactive substances identified by authorities around the world in 2019 reached 950, while in 2009 the total number of new psychoactive substances identified was 166 [11].

According to the World Drug Report 2022, 5.6% of the world’s population aged 15 to 64 used drugs, up 20% from a decade earlier, and cannabis remains the most commonly used drug [12].

The problem of new psychoactive substances is also acute for Russia, as evidenced by the analytical study conducted by V.V. Krizhanova, in which the author assesses the results of the implementation of the state anti-drug policy until 2020. The study noted a change in the structure of primary morbidity associated with an increase in the use of new synthetic or designer drugs among adolescents and young adults up to 39 years of age. The author concludes that over the past 20 years, there has been a trend toward a decrease in the incidence of drug-related disorders among children and adolescents under 18 years of age, however, he emphasizes that the trend toward a decrease in incidence among adolescents and young people may prove unstable [13].

In connection with the above, regular comprehensive monitoring of the drug situation among adolescents and young people remains extremely important for the timely identification of risk factors and the development of targeted preventive programs and methods. Systematic collection and analysis of data allows us to formulate effective strategies aimed at reducing the level of substance use, strengthening the health of adolescents and young people, and creating conditions for their favorable development.

Materials and methods

1. The study material is provided by the data of the federal statistical observation form № . 37 “Information on patients suffering from alcoholism, drug addiction, toxicomania” and the federal statistical observation form № . 11 “Information on diseases with drug addiction disorders” in Moscow. The statistical research method used was the creation of dynamic series of indicators of primary incidence of mental disorders and behavioral disorders associated with the use of psychoactive substances in adolescents aged 15–17 years from 2016 to 2023, calculation of growth rates and proportional indicators of the structure of appeals by psychoactive substance groups [14–19].

Collection, creation of the database and analysis were carried out using the program Microsoft Office Excel 2016. The calculation of the growth coefficient was carried out using the formula in percentages:% = (B-A)/A*100, where A = Initial value, and B = Final value.

2. The research material was the answers of first-year students of Moscow colleges during preventive examinations, taking into account their consent, to the questions of the author’s anonymous questionnaire dedicated to the study of healthy lifestyles among young people.

The questionnaire was developed on the basis of the “European School Research Project on Alcohol and Drugs in the Russian Federation”, conducted in the Russian Federation in 2007 [20] and consisted of the following thematic blocks: a) Socio-demographic questions and questions about health preservation; b) Questions related to the use of alcoholic beverages and their availability; c) Questions related to the use of nicotine and availability. The questionnaire also included a question about the availability of narcotics.

The first survey was conducted among students of Moscow medical colleges in the 2016–2017 academic year (n=1626, of which 17% were boys and 83% were girls).

The second survey was conducted among students of the College of Architecture, Design and Reengineering in the 2022–2023 academic year (n=182, 58% boys, 42% girls).

Most respondents were minors at the time of filling out the questionnaire. Data accumulation, their subsequent adjustment, systematization and analysis were carried out in Microsoft Office Excel 2016 spreadsheets, as well as in a “Google form”.

3. The research material was based on the results of in-depth interviews with experts — specialists from the drug addiction service in Moscow, working in the field of prevention of addictive behavior among children, adolescents and young people, and having significant experience in conducting preventive examinations for the purpose of early detection of illegal use of psychoactive substances among students. The study used data from an interview script devoted to an expert assessment of the drug addiction situation among adolescents and young people in Moscow.

The interviews were conducted in the 2022–2023 academic year and involved eight respondents with more than 1000 preventive interventions: five psychiatrists-narcologists (two men, with 11 and 8 years of experience, and three women with 24, 12, and 11 years of experience) and three medical psychologists (women with 16, 7, and 5 years of experience).

Results and discussion

1. Primary incidence of drug-related disorders among adolescents aged 15–17 in Moscow for 2016–2023 according to state statistics

Due to the peculiarity of the development of drug addiction, the indicator of primary appeal (those who sought drug addiction help for the first time in their lives) is the most informative for studying current trends in the development of drug addiction disorders among adolescents.

The primary incidence rate of drug addiction disorders includes dependence syndromes on alcohol, narcotic drugs, non-narcotic drugs (other toxic substances) and harmful use (use with harmful consequences) of all listed psychoactive substances, excluding nicotine). Over the period 2016–2023, there was a clear downward trend in the indicator from 468.8 to 196.6 per 100 thousand adolescents, the growth rate was 58% (Figure 1).

The downward trend in the primary appeals of adolescents for this can be explained by a 69% decrease in the alcohol consumption rate. Over the entire analyzed period, the share of primary appeals among adolescents with alcohol disorders prevailed and only in 2020–2021 the indicator the rate of primary treatment for alcohol disorders was almost equal to the rate of primary treatment for adolescents caused by drug and non-narcotic substance use, then in 2022 the rate of treatment for alcohol disorders increased slightly, and then decreased in 2023 to the level of 2021, and again exceeded the level of primary appeals for drugs and other psychoactive substances. The indicator of primary appeals of adolescents with drug-related disorders caused by drug use and substance abuse per 100 thousand adolescents showed a decrease of only 9%.

The syndrome of dependence on psychoactive substances in teenagers has its own peculiarity. When teenagers abuse psychoactive substances, it does not have time to form yet, and its indicators are significantly lower than the indicators of use with harmful consequences. During the analyzed period, the primary incidence rate of drug addiction increased threefold, and alcoholism increased slightly from 0.7 to 0.9 per 100 thousand adolescents, with the highest value of these two indicators observed in 2022 (Figure 2).

Over the entire analyzed period, the structure of drug consumption among adolescent users was dominated by substances belonging to the group “other drugs and their combinations”, which most likely includes new synthetic or designer drugs, with the peak in use also in 2022 (Figure 3).

It is important to note the pronounced trend of decreasing injection drug use by adolescents by 97% (Figure 4). 

Fig. 1. The dynamics of primary incidence (total, excluding nicotine) of drug-related disorders among adolescents aged 15–17 in Moscow for 2016–2023 (per 100 thousand teenagers)

Fig. 2. The dynamics of primary appeals among adolescents aged 15–17 with addiction syndrome in Moscow for 2016–2023 (per 100 thousand teenagers) 

Fig. 3. Structure of primary treatment among adolescents aged 15–17 years with drug dependence syndrome (drug addiction) by types of drugs in Moscow for 2016–2023 (per 100 thousand adolescent population) 

Fig. 4. The dynamics of injection drug use among adolescents aged 15–17 years out of the total number of drug users in Moscow for 2016–2023 (per 100 thousand teenagers)

At the same time, for the period 2018–2023, according to the results of preventive medical examinations for the early detection of illegal use of psychoactive substances, in accordance with the order of the Ministry of Health of Russia dated 06.10.2014 No. 581n, the use of cannabinoids was most frequently detected. It is also important to emphasize that, over the entire analyzed period of professional examinations, the largest share of identified cases of illegal use of psychoactive substances occurred in medium-sized professional organizations (colleges), which had not yet sought specialized assistance (Table 1).

Table 1
Structure of substances identified based on the results of professional medical examinations of students for 2018–2023 in Moscow (in absolute numbers)

Parameters	2018	2019	2020	2021	2022	2023
TOTAL, including:	68	52	17	18	10	41
opioids	5	3	0	0	1	0
cannabinoids	55	43	10	0	8	25
sedatives and hypnotics	1	3	0	0	0	0
stimulants (including cocaine)	2	2	3	0	1	2
hallucinogens	0	0	0	0	0	0
other psychoactive substances (including volatile solvents)	0	0	0	0	0	14
two or more narcotic drugs and (or) psychotropic substances/	5	1	4	0	0	0

Overall, over the period 2016–2023, the majority of adolescents who sought drug addiction treatment for the first time were diagnosed with harmful use (use with harmful consequences). The largest proportion of adolescents sought treatment with harmful alcohol use, and this indicator decreased by 69% over the analyzed period. The decrease in the rate of primary treatment for harmful drug use was less pronounced and amounted to 25%, the increase in primary treatment for harmful use of non-narcotic psychoactive substances amounted to 24% with a peak value of the indicator in 2022 (Figure 5). 

Fig. 5. The dynamics of primary incidence of drug abuse among adolescents aged 15–17 years (with harmful consequences) in Moscow in 2016–2023 (per 100 thousand teenagers)

2. Prevalence of use of various methods of nicotine delivery, as well as alcohol, among underage first-year students of Moscow colleges in 2017 and 2023

To study the prevalence of cigarette use, other methods of nicotine delivery, and alcohol, questions about the amount of use, age of first try, and availability of these groups of psychoactive substances and drugs were included in the corresponding section of the questionnaire.

Based on the results of an analysis of anonymous survey data from first-year college students in Moscow for 2017 and 2023, a large proportion of students were found to have experience of drinking alcohol, smoking cigarettes and e-cigarettes (vaping), including their systematic use (more than 40 times during their lifetime). It should be noted that a significant increase in the systematic use of electronic cigarettes (vaping) was observed among students in 2023, which may indicate an increase in the consumption of this group of psychoactive substances among the young population, along with the continued volume of cigarette consumption.

In both periods, the highest proportion of students had their first e-cigarette use at age 9 and younger, with a more noticeable upward trend in first e-cigarette use among students in 2023, starting at age 9 and younger, and a marked increase from age 12.

A study of the first alcohol samples to the state of intoxication (severe intoxication) showed that among students in 2017, the upward trend in the indicator began at age 14 and peaked at age 16 and older. Among students in 2023, a marked increase in the indicator was also observed from age 14, but the peak value occurred at age 15.

A study of the availability of various psychoactive substances, including drugs, among students showed a general trend of decreasing opportunities to acquire them, however, the proportion of students who could acquire psychoactive substances if they wanted to remained high, including nasvay and drugs, which more than 1/3 of students could acquire if they wanted to in both periods.

Let us consider the survey results described in more detail.

In both 2017 and 2023, a large proportion of students with experience of smoking cigarettes was observed, while during the analyzed period of time, no significant differences were observed (43.6% and 44.2%, respectively), including in comparison with the indicator of students who smoked cigarettes 40 times or more (17.7% and 18.1%, respectively). It is important to note that students who have had smoking experience more than 40 times require special attention, as this indicator may indicate systemic smoking and an increased risk of developing addictive behavior (Table 2).

The results of comparing the responses for the analyzed periods determined a trend of increasing consumption of electronic cigarettes (vape), as the proportion of students who smoked an electronic cigarette at least once in their lives increased from 35.7% to 46.7%, while a significant increase in the proportion was observed among students who smoked electronic cigarettes (vape) 40 times or more from 5.4% to 24.2%.

The proportion of students who had experience using nasvay in both periods did not exceed 5%.

The proportion of students who had no experience of drinking alcohol in both periods was less than 1/3, while in 2023 the rate of drinking alcohol almost reached 70%. The rate of students who drank alcohol 40 times or more did not change significantly and averaged 14%.

Table 2
Use of various methods of nicotine and alcohol delivery among Moscow college students during their lifetime (as a percentage (%)  of the entire sample of respondents in 2017 and 2023)

Method of delivery of nicotine and alcohol	2017(n=1626)	2023(n=182)	Changes 2023/2017
Cigarettes
Used:	43,6	44,2	0,6
40 and more	17,7	18,1	0,4
Electronic cigarettes (vape)
Used:	35,7	46,7	11
40 and more	5,4	24,2	18,8
Nasvay
Used:	2,2	4,4	2,2
40 and more	0,5	0,5	0
Alcohol
Used:	60,3	67,5	7,2
40 and more	14,9	13,2	-1,7

The analysis of the rate of first cigarette tries among students in 2017 and 2023 has a number of similar features: among both groups, about 4% had the experience of first tries at the age of 9 years or younger, at 12 years old in both groups there was a peak of first tries, the second peak was noted at the age of 14 years, and the third peak in both groups occurred at the age of 16 years and older (Table 3).

The indicator of the age of the first samples had its own peculiarities. It will play a role if among students in 2017 the indicator did not reach 1% until the age of 13, and the subsequent increase with the peak value of the first samples at the age of 16 and older, then among students in 2023 the indicator of the first samples of 1% was already at the age of 9 and younger. and a more pronounced increase in the indicator has been observed since the age of 12, reaching a peak at the age of 16 and older.

The rate of the first alcohol samples before feeling intoxicated (which may already indicate a pronounced toxic effect on the body) among students in 2017 exceeded the value of 1% at the age of 12, and starting at the age of 14, there was a marked increase with a peak of 18.4% at the age of 16 and older.

Among the students of 2023, the indicator at the age of 9 and younger was already more than 1% and showed an upward trend by the age of 10, a marked increase in the indicator was observed from the age of 14 with a peak of 18% at the age of 15.

Table 3
Age of first trials of various methods of nicotine and alcohol delivery among students of Moscow colleges (as a percentage (%)  of the entire sample of respondents in 2017 (n=1626) and 2023 (n=182))

Parameters	Age of first samples in years/
	≤ 9	10	11	12	13	14	15	≥16
Cigarettes in 2017 (%)	4	2,4	1,8	4,3	3,5	7,7	7,2	13,4
Cigarettes in 2023 (%)	4,9	2,1	3,8	7,1	4,3	10,9	4,3	7,6
Electronic cigarettes (vape) in 2017 (%)	0,1	0,3	0,3	0,7	1,6	4	6,6	18,6
Electronic cigarettes (vape) in 2023 (%)	1	1	1,6	3,2	5,4	8,2	8,2	11,4
Felt alcoholic intoxication 2017 (%)	0,6	0,3	0,4	1,6	1,1	3,8	5	18,4
Felt alcoholic intoxication 2023 (%)	1,6	3,3	0,5	3,8	2,7	12	18	8,2

A study of the availability of various surfactants, including drugs, among students has identified a general trend towards an increase in the proportion of responses indicating the inability to purchase cigarettes, e-cigarettes, alcohol, and drugs (Table 4).

Table 4
Availability of different delivery methods for nicotine, alcohol (bottles of strong alcoholic beverage (about 500 ml), drugs (as a percentage (%) of the entire sample of respondents in 2017 (n=1626) and 2023 (n=182))

Parameters	Cigarettes		Electronic cigarettes (vape)		Nasvay		Alcohol		Drugs
	2017	2023	2017	2023	2017	2023	2017	2023	2017	2023
Impossible	11	26,4	9,6	25,8	21,5	39,6	11	28	28,9	44,5
Very difficult	2,6	3,3	6,4	4,9	22,1	7,6	13,4	6,5	25,7	13,7
Quite difficult	3,8	6,5	7,7	6,5	6,9	12,1	14,3	9,3	8,3	6,1
Pretty simple	25,6	20,3	26,1	15,9	8	6	18,2	18,7	5,4	5,5
Very simple	48,3	30,2	38,6	34,1	13,6	7,1	31,7	22,5	7,6	6,6
Don’t know	8,6	13,2	11,6	12,6	27,9	27,5	11,4	14,8	24,1	23,6

Despite this, among the students (2017 and 2023), there was a pronounced proportion of those who could purchase: cigarettes (80.3% and 60.3%), electronic cigarettes (78.8% and 61.4%), alcohol (77.6% and 57.0%). It is noteworthy that more than 1/3 of the respondents in both periods answered that they could purchase a product that was prohibited for sale on the territory of the Russian Federation (50.6% and 32.8%). It should also be noted that the proportion of students who replied that they could purchase drugs with similar data to ours (47% and 31.9%).

3. Expert assessment of the drug treatment situation in Moscow among adolescents and youth in the period 2022–2023.

The majority of experts assessed the drug treatment situation in Moscow by choosing the criterion “serious”, and two noted the criterion “risk of deterioration”.

According to experts, the assessment of the debut of the first surfactant samples in Moscow had the following trends: cigarettes — in the period of 8–10 years; alcohol — in the period of 10–13 and 14–15 years; drugs — in the period of 14–15 and 18 years.

According to experts, the reasons why teenagers and young people begin to abuse various surfactants are based on risk factors such as stress and the inability to overcome it, the desire to quickly get positive emotions, family traditions and destructive families, lack of affordable leisure activities, “psychological illiteracy” — a lack of understanding of their feelings, states, emotions, thoughts., lack of interpersonal skills, infantilism and adolescent maximalism.

The results of interviewing experts led to the conclusion that measures to prevent addiction among adolescents and young people require: an increase in the number of specialized specialists and a systematic improvement of their competencies; further development of interdepartmental interaction between all subjects of prevention; standardization of preventive work; implementation of practices supported by proven effectiveness.

Results and Discussion

During the period 2016–2023, there was a decrease in the primary referral of adolescents aged 15–17 years for drug treatment to state specialized institutions in Moscow. At the same time, there was an increase in the number of adolescents who developed drug dependence syndrome, among whom the group of “other drugs and their combinations” prevailed, which may indicate an increase in the use of “new or designer drugs” among adolescents and their high narcogenicity (the ability to form addiction). This trend coincides with the UN data and the results of the analysis of Russia’s anti-drug policy until 2020 conducted by V.V. Kirzhanova [11–13]. In addition, data on the results of preventive medical examinations of students for the early detection of illicit surfactant use in Moscow showed that the most common surfactants were cannabinoids, which may also indicate the general trend of ESPAD in 2019 on the prevalence of adolescent use of cannabinoids, as well as data from the UN World Drug Report 2022 [10]. that cannabis was still the most used drug. It is important to note a pronounced positive trend in the reduction of injecting drug use by adolescents, which reduces the risks of HIV and hepatitis C spreading among the young population. An anonymous survey of students showed a large proportion of the child and adolescent population with experience in using cigarettes and alcohol, as well as a marked increase in the proportion of systematic e-cigarette users in a comparison of 2017–2023 data, which confirms the trend set by ESPAD for 2019, an increase in the popularity of electronic nicotine delivery methods among children and adolescents.

It is worth noting that the results of the 2017–2023 survey on cigarette smoking at least once in a lifetime were similar to the average ESPAD for 2019 (42%), while the rate of those who tried alcohol was less than the average ESPAD for 2019.

Attention is drawn to the continued availability of surfactants, including drugs, for adolescent youth.

The described assessment of the drug addiction situation among adolescents in Moscow for 2016–2023 confirms the conclusions made by V.V. Kirzhanova in Russia as a whole for 2010–2020 that the downward trend in drug addiction among adolescents and youth may be unstable, this also correlates with the assessment of the drug situation according to the experts interviewed [13].

Conclusion

Monitoring of the drug situation has shown the need for further development of comprehensive prevention among adolescents and youth in Moscow with the participation of all subjects of the prevention of the use of surfactants. Special attention should be paid to new methods (systems) of nicotine delivery, “new or designer” drugs, with an emphasis on preventive interventions starting at the age of 8 to eliminate the first sample of surfactants. Anti-drug preventive interventions should become standardized procedures based on evidence-based effectiveness and take into account the age characteristics of the persons being prevented.

In order to improve the drug treatment situation among adolescents and young people, it is advisable to conduct mandatory systematic multicomponent epidemiological research in all regions of the Russian Federation.

Об авторах

А. Ю. Абрамов

Российский университет дружбы народов

Email: shchepanskaya_lv@pfur.ru
ORCID iD: 0000-0001-7178-1260
г. Москва, Российская Федерация

А. О. Алексеенко

Российский университет дружбы народов; Городская клиническая больница № 52

Email: shchepanskaya_lv@pfur.ru
ORCID iD: 0000-0003-1663-617X
SPIN-код: 8926-4318
г. Москва, Российская Федерация

Е. А. Кошкина

Московский научно-практический центр наркологии Департамента здравоохранения города Москвы

Email: shchepanskaya_lv@pfur.ru
ORCID iD: 0000-0001-7694-8533
SPIN-код: 5950-5442
г. Москва, Российская Федерация

Д. И. Кича

Российский университет дружбы народов

Email: shchepanskaya_lv@pfur.ru
ORCID iD: 0000-0001-6529-372X
SPIN-код: 5622-0128
г. Москва, Российская Федерация

В. В. Аршинова

Московский государственный университет имени М.В. Ломоносова

Email: shchepanskaya_lv@pfur.ru
ORCID iD: 0000-0003-1125-3786
SPIN-код: 5049-6650
г. Москва, Российская Федерация

Л. В. Щепанская

Российский университет дружбы народов

Автор, ответственный за переписку.
Email: shchepanskaya_lv@pfur.ru
ORCID iD: 0009-0001-0948-0675
SPIN-код: 6247-7668
г. Москва, Российская Федерация

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