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‘AN ENTIRE GENERATION
of injectors in the Netherlands
switched to non-injecting,’ independent drugs consultant John-
Peter Kools told delegates in the
Route transition interventions:
public health gains from preventing or reducing injecting
session.
Only 9 per cent of problem drug users were currently injecting in
the Netherlands, but 20 years ago it had been a very different story.
The Dutch ‘heroin epidemic’ had begun in the mid-1970s with
‘bohemians and hippies’ before expanding to unemployed youth,
Surinamese migrants and people from other European countries with
stricter drug laws. By 1985 there were 25,000 people using drugs in
the Netherlands, 9,000 of them in Amsterdam. Forty per cent of the
Dutch drug users were injecting, he said, along with 70 per cent of
the migrants from other European countries. However, just 5 per
cent of the Surinamese injected.
There was also 30 per cent HIV prevalence among IDUs in
Amsterdam, he said. ‘There was a distinct watershed between the
injectors, who considered themselves the “real drug users”, and the
non-injectors, who were seen as “sissies”. Health interventions
aimed at prevention and cessation of injecting were needed, but the
question was could it be done without alienating clients?’
However, the move from injecting to non-injecting did not begin
with workers, he stressed – rather it was started among drug users
themselves. ‘The health promotion workers just recognised it, but it
was then strengthened by health organisations.’ One organisation
even produced a magazine with health advice which contained high
quality aluminium foil alongside articles on smoking heroin.
‘This was an eye opener to a new trend for the injecting
communities,’ he said. A range of campaigns began with the
objective of enforcing and accelerating existing trends of transition
away from injection, with some needle exchange services providing
aluminium foil. By 1995, field research showed that half of former
injectors had moved away from injecting. ‘The reasons were often
very practical,’ he said. ‘Lots of people had vein problems and other
logistical problems that led them to other ways of consuming drugs.
People preferred smoking for very practical reasons but felt that it
brought huge benefits after a while, like self respect and more
socialising.’ There were also peer support campaigns, such as a
mobile counselling programme with outreach workers funded by the
Ministry of Health.
‘In a decade an entire generation of injectors stopped,’ he said. ‘It
just went on and on. Injection prevalence has halved.’ Only 4 per
cent of Amsterdam drug users were current injectors, with 20 per
cent reporting ‘lifetime’ use. HIV prevalence had fallen from 8.5 per
cent to virtually zero, and the number of fatal overdoses had also
drastically decreased.
A key element was the importance of a stable heroin market with
stable purity, he said, as well as the presence of the non-injecting
Surinamese as role models – ‘they were the main street dealers and
were considered cool’. Another factor was the increasing popularity
of crack – ‘an instant hit that can be smoked.’
‘Interventions to promote route transmission can be developed,’ he
told delegates. ‘The challenge of the future is to get route transition onto
the harm reduction agenda, not only in richer countries in Western
Europe but in transitional and developing countries.’
6 –
Daily Update
– DAY TWO – Tuesday 27 April 2010
Generational shift – the move away
from injecting in the Netherlands
HAVE YOUR SAY!
If you have something you want to share please come along
to the speakers’ corner in the main exhibition hall and put
your name down to speak – on any subject you choose!
John-Peter Kools: ‘The challenge of the future
is to get route transition onto the harm
reduction agenda, not only in richer countries
in Western Europe but in transitional and
developing countries.’