Download HR responses to drugs in the EU

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]