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HARM REDUCTION RESPONSES TO DRUGS IN THE EUROPEAN UNION – FROM MARGIN TO MAINSTREAM 8th Annual Meeting of the European Red Cross / Red Crescent Network on HIV/AIDS, Krakow – 25 – 28 September 2004 Presentation by Dagmar Hedrich (EMCDDA) CONTENTS • EMCDDA : role and function • EU Strategy and policy recommendations to reduce health-related harm Needle and syringe programmes: • Situation in the EU Member States • Trends and challenges EMCDDA: ROLE AND FUNCTION “to provide the Community and its Member States with objective, reliable and comparable information at European level concerning drugs and drug addiction and their consequences”. INSTITUTIONAL CONTEXT European Council Council of the Union EU Commission Parliament DRUG INJECTING: A CHALLENGE FOR PUBLIC HEALTH • Problem drug use (PDU): injecting and/or long duration, regular use of opiates, cocaine, amphetamines • average 4-7 per 1.000 adults EU • Heroin epidemic in western Europe since 1970s: high health and social burden EU DRUG STRATEGY 2000 – 2004 TARGET 2: « To reduce substantially over five years the incidence of drug-related health damage (such as HIV, hepatitis B and C, and tuberculosis) and the number of drug-related deaths » COUNCIL RECOMMENDATION of 18 JUNE 2003: • Member States should, in order to provide for a high level of health protection, set as public health objective the prevention of drug dependence and the reduction of related risks, and develop and implement comprehensive strategies accordingly. (Council Recommendation 2003/488/EC) EU recommendations to reduce healthrelated harm: • • • • • Prevention of drug use and injecting Treatment, incl substitution treatment Outreach and peer-to-peer education Prophylactic measures against inf diseases Voluntary screening, vaccination,treatment • Equivalence of services in prisons Harm Reduction, historically • emerged in the 1980s / HIV/Aids context • shift of response paradigm: •reaching out to vulnerable populations •abstinence no precondition for help • Most countries acknowledge harm reduction as important response strategy Number of clients in substitution treatment in EU-15 Clients (Source: Reitox NFPs) 450000 400000 350000 300000 250000 200000 150000 100000 50000 0 391000 351000 265000 207000 73400 1993 1995 1997 Year 2000 2002 Breakdown of clients in substitution treatment (2000) 77000 3700 Methadone 1500 Buprenorphine 1000 Dihydrocodeine Heroin Slow-release morphine 268000 NEEDLE AND SYRINGE PROGRAMMES: • Development and current situation When did needle exchange start? • 1984: 1st NSP Amsterdam • 1986: England • 1988 - 1989: Spain, Germany, Norway, Flemish BE, Poland, France, Ireland • 1990 - 1993: Austria, Slovenia, Czech Rep., Portugal • 1994 – 1999: Slovakia, Italy, French BE, Hungary, Finland, Lithuania, Estonia, Latvia • 2001: Flanders, Northern Ireland Number of syringes, some examples: • Engl/Scot/Wales: 27 million est.for 1997, incl. sales (Parsons, 2002) • 2002: FR report 11.9 million incl. sales; Portugal 2.7 million; Poland 450.000; Sweden 220.000; Bulgaria 270.000; Lithuania 370.000; Latvia 95.000; Geographical coverage • all countries, increasing coverage of exchange points, but gaps in rural areas Trends NSPs • Increasing pharmacy involvement • Legal obstacles to paraphernalia distribution removed (water, filters, acid) • ‘safer use’ training (few locations) • “one-stop services” incl. medical care • peer-outreach & secondary needle exchange Challenges infectious diseases: - Reduce levels of injecting - Intensify voluntary testing, immunisation and treatment inf diseases - Reach sufficient coverage peerapproaches! Challenges public health in general: • Address marginalised populations • Develop long-term strategy prevention healthrelated harm • Expand capacity, quality and coverage • Involve civil society, NGOs http://www.emcdda.eu.int [email protected]