Transcript Use of synthetic drugs

Change in paradigm
useful for Scotland?
• Victor Everhardt
• Head Prevention Unit
• [email protected]
2025
Half the problem
• 50% prevalence rate:
– young people that drink alcohol?
– The general population that use drugs?
– Last month, life time?
• Only 200 drug related death?
• Prevalence rate of HIV/Aids among idu?
• Half of the current idu’s are changing the
dragon?
2025
War or Peace?
• Roll back option, drug free society
• Containment, Mr Costa (UNODC)
• Layers of defence strategy: preventtreat-reduce health & social damage
Modesty
• On the outcome of a Drug policy
• On the contribution of Prevention
• On treatment opportunities for a chronic
disease like drug use
WHO recommendations (alcohol)
• Integrated approach
• Price
• Availability
What about effectiveness of a
drug policy
• Integrated approach?
• Price? (XTC - precursors)
• Availability? (The Taliban)
Integrated approach
Models of coordination structure
some examples
• France: MILDT
• Hungary: State secretary
• Sweden: National board
• The Netherlands: Ministry of Health
Integrated approach
Strategy and Action plans
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All over in the EU
Mid term reviews
Realistic goals reached?
Evaluation process: only two examples
Hungary (on the process) & Portugal
(midterm)
Drug Policy
Portugal
• The strategy has had a positive impact in
many ways:
– There has been an increase in the numbers of drug
users attending prescribing services.
– The number of drug users with AIDS decreased
absolutely and relatively to the total number of people
with AIDS.
– Drug related deaths more than halved from 369 in
1999 to 152 in 2003.
Drug Policy
Portugal
• “The evaluation of the strategy,which
remains ongoing, has proved coherent
and useful; in the past evaluative work
was more dependent on the scientific
interests of local university departments
rather than on trying to construct a
robust and global evidence base”.
Drug Policy
Portugal
• Challenges for the future
1.Ensuring that quality treatment is also available for
those with different drug use profiles than the traditional
problematic heroin user.
2 Re-affirming the importance of drug prevention work,
which has been somewhat overlooked in some areas since
the increased focus on treatment and harm reduction.
A National Drug Monitoring
system
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Every year an update of facts & figures
Basis for a realistic political debate
Basis for adjusting it’s strategy
Basis for new topics for research
From Policy Paper to Practice
• Quality and Professional attitude
• Salary and other rewards
• Long term or short term commitment of
the money suppliers
• Cooperation and Equality between
partners
• Management of expectations
Cyclic quality model
Practice in Europe
• No steady influx of money (financing of
projects in stead of long term
commitment)
• Ideology and no real Pragmatism
• Too strong belief in the benefits of
prevention
Scotland, opportunities for a
paradigm shift
• High Prevalence rate
• Absence of a (new) national strategy and
action plan on drugs
Scotland, opportunities for a
paradigm shift 2
• Drug related deaths in Scotland: 420.
– 10 x rate of The Netherlands
• Prevalence rate of heroin users in
Scotland: 50.000
– 5 x rate of The Netherlands
Recent (last year) use of cocaine
among young adults (15–34
years)
Trends in recent (last year)
amphetamine + ecstasy use in
young adults (15–34 years)
Trends in recent use (last year)
of cannabis among young adults
(aged 15–34)
What is needed
• Formulating of realistic goals with clear
ambitions
• Investment in:
–
–
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a: monitoring and evaluation
b: the workforce & quality of the work process
c: long term commitment of the investors
d: a clear coordination structure
Belief in prevention
• Too strong belief in the benefits of
prevention
• Lessons from Portugal: Re-affirming the
importance of drug prevention work,
which has been somewhat overlooked in
some areas since the increased focus on
treatment and harm reduction.
Assumptions
• Knowing is doing
• Fear facilitates behaviour change
• Not using drugs is a question of strong
will / character
• Drug use is per se negative
Findings from evaluation of
school-based (primary)
prevention (1)
• Substantial effect on knowledge
• Some programs have small effect on substance use
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At best 8 – 10% reduction
These effects decrease over time and have disappeared
after 2 / 3 years
Thus, best effect delay in onset
• Most (about 75%) prevention programs do not have an
effect on substance use
→ DARE programme (Drug Abuse Resistance Education),
• Best programs focus not only on information about the
substances, but also on the reasons for using, peer
pressure, and generic life skills
Findings from evaluation of
school-based (primary)
prevention (2)
Some evidence on effectiveness of following components:
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Interactive methods (with a focus on discussion among students
themselves, use of peer leaders, role playing, in stead of non-interactive
presentation of knowledge by teachers);
The social influence model as a theoretical basis of the prevention
program (this model says that prevention may be inoculation to peer
pressure to use substances);
Adding generic life skills (such as social skills, cognitive skills, problem
solving skills) to a curriculum);
Programs led by 'peer leaders' have a larger effect than programs led by
adults, but only on the short term;
Cognitive behavioural programs have larger effects;
Programs aimed at the school environment have larger effects than
curriculum only programs.
Findings from evaluation of other
forms of (primary) prevention (2)
• Mass media campaigns seem to have little or
no effect on substance use, knowledge about
substances and attitudes towards substance use
• Mass media campaigns effective in agenda
setting but not in behaviour change
• Fear-based campaigns in-effective or even
counterproductive
What do we know?
• Knowledge is essential but does not result in
behaviour change
• Prevention can delay onset
• Fear does not help
• Lifetime prevalence is high – prevalence of
regular use is relatively low
• Experimenting and – to a lesser degree - regular
substance use of legal and illegal substances
widespread among young people
What can we conclude?
• People love / believe in primary
prevention even it is not really effective
• People reject / don’t believe in evidence
that primary prevention is not effective
• The traditional concept of primary
prevention is belief-based
What can we do?
• More realistic approach: Drug prevention
as stepped approach aiming at:
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Media advocacy
Supporting abstinence
Delaying onset
Mindful / sensible coping with drugs
Reduction of frequency / dosage
Limiting possible health damage
→ Risk management / harm reduction