Updated indicators to evaluate harmful drug use, in particular polydrug use.

BACKGROUND: Drug use indicators that are capable of measuring the individual levels of harm following drug use, and in particular poly-drug use, have previously been proposed, based on individual drug and frequency of use data and expert rankings of harms related to various substances. These indicators allow the estimation of risk profiles for selected groups of individuals and comparisons, both over time and between populations. Recent advances regarding the ranking of drug use harms allow a refinement of these indicators, separating the effects on self and others. We define updated indicators and compare their performance to previous ones on datasets related to the Italian ESPAD longitudinal data set. A new harm-to-self drug use indicator is shown to correlate strongly with the previous poly-drug use indicator; and another new indicator, defined as harm-to-others, is introduced and commented upon. Using further ESPAD survey information related to personal behaviour, it is shown that high values of poly-drug use indicators are linked to specific behaviours related to interest in school, relationship with parents and use of leisure time. CONCLUSION: These results are consistent with previous analyses based on surveys among high school students in Italy.