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Tuesday 27 April 2010 – DAY TWO –
Daily Update
– 7
‘WE KNOW THE FACTORS
that influence
whether people decide to inject,’ drugs
researcher and consultant Neil Hunt told the
conference. These included learning from, and
watching, existing injectors.
He described work he had been involved in
investigating whether the
Break the cycle
intervention – designed to prevent initiation of
injecting among vulnerable youth – would be
appropriate in Serbia, Moldova and Albania.
Serbia was ‘not a poor country but not a rich
one’, he said, where ‘people were very clear
about the incredibly poor quality of heroin’ –
around 2 per cent. ‘Novices would snort for a
while, and it wasn’t of a grade that was
smokable. If you have a drug that can only be
injected, you don’t have a situation of mixing
between injectors and non-injectors like in the
UK.’ It was also judged unrealistic to try and
diminish social exposure among two of the
most vulnerable populations in Serbia, street
children and Roma.
Moldova, meanwhile, was a poorer country
with the main injected drug home produced
heroin known as ‘shirka’. When the country’s
borders were first opened injecting was more
visible and had carried some kudos, but social
exposure to injecting had been reduced as it
was now seen in a much more negative light,
and there had also been increased police
oppression. Initiating others was seen as
highly taboo in Moldova – ‘it was almost
impossible to get people to talk about
initiation,’ he said. ‘It’s very unlikely that you’re
going to get conversations of the sort of quality
necessary for the intervention, so it seemed
the right decision not to proceed with it, and
services had other priorities.’
In Albania, meanwhile, a lot of injecting took
place in public areas, and services – while
often poorly resourced – had a strong ethos of
developing outreach work with peers from the
local community. Heroin purity was sufficiently
good to sustain sniffing, smoking or injecting,
he said, and therefore there was more mixing
between injecting and non-injecting heroin
users, making it a more appropriate
environment to offer
Break the cycle
.
‘Transition to injecting is not automatic,’ he
said. ‘We’re now in the process of translating
the campaign materials and testing them with
local injectors.’ The project had shown up
three very different drug situations, he
explained. ‘Overwhelmingly it’s the drug
market that’s the most influential factor for
whether the intervention is relevant or feasible,
and the intervention is by no means applicable
in all contexts. Low capacity for core harm
reduction work may mean people are less
willing to invest in marginal interventions like
Break the cycle
.’
Taking the initiative – preventing initiation
into injecting in Eastern Europe
‘THE FIRST THING YOU
HAVE TO REMEMBER
in
terms of drug policy at EU level
is that there’s a very weak legal
basis,’ Paul Griffiths of the
European Monitoring Centre for
Drugs and Drug Addiction
(EMCDDA) told delegates in the
Harm reduction in Europe
session. Most things were done
through cooperation, and the EU
was keen to act with one strong
voice at international level.
Harm reduction was a very
different landscape to 10-15
years ago, he said. Politically it
was less controversial and there
was a lot of EU interest in the
topic. EMCDDA had put together
a monograph,
Harm reduction:
evidence,
impacts
and
challenges
, which showed how
harm reduction had developed in
the EU throughout the 1980s and
90s initially through public health
concerns around HIV. However,
harm reduction was now seen as
part of EU policy and had very
much come into the mainstream.
The question of evidence
remained central, however –
‘what is it and how do we
interpret it’. Within the EU drugs
debate, HIV prevention remained
important but no longer had the
primacy it once had, while
debate was less parochial and
there was more acceptance of
national differences. Harm
reduction services remained
poorly developed in some
countries, however.
There had been an overall
decline in new, recorded
infections among injectors in the
EU and all EU countries now had
harm reduction programmes,
meaning that around 40 per cent
of people with opiate problems
now had contact with opioid
substitution treatment. Great
variation still existed between
services, however – ‘coverage
can be very patchy’, he said. In
Europe, overdose remained the
widest cause of morbidity and a
central policy concern at EU
level remained what measures
could be taken to address
overdose deaths.
The political debate in Europe
was now moving to focus on
new drugs, he told the
conference, alongside stimulant
use, non-injecting routes of
administration
and
youth
recreational drug use. ‘How do
we respond to new patterns of
drug use?’ was a key question. It
was also difficult to isolate the
effects of harm reduction
programmes or consider the
importance
of
combined
interventions, and there was still
a real need for studies of
effectiveness, he stressed.
Harm reduction now ‘mainstream’ EU policy
Neil Hunt: ‘Overwhelmingly
it’s the drug market that’s the
most influential factor for
whether the intervention is
relevant or feasible.’