Dagmar Hedrich, EMCDDADagmar Hedrich, EMCDDADagmar Hedrich, EMCDDADagmar Hedrich, EMCDDAInternational Conference - Harm Reduction in Europe: Practice, problems and perspectives, 29-30 May 2008, Vilnius
Preventing and reducing drug-related harm in Europe
Reitox Network
30 European Countries
CY
NO
SE
FI
UKIR
ESPT
DE
FR
NL
BE
PL
LT
LV
EE
CZ
SK
HU
RO
TR
IT
MT
BG
AT
DK
HR
SI
EL
LU
EMCDDA member states Candidates countries
Monitoring tools• Yearly national reports according to guidelines• Routine monitoring: regular surveys, registry data• EU key-indicators, data-tables and questionnaires
• Research evidence: empirical evidence from RCTs, cohort and outcome studies, qualitative research; meta-analyses.
• Assessments by national expert group panels
OutlineOutlineOutlineOutline
• Historical development: NSP + OST
• European policy framework
• Availability, trends, coverage
• Current issues
Historical development• From late 1960s: increases in heroin use and
injecting in Europe
• Serious health consequences: HIV/AIDS, overdose
• Late 1980s – during 1990s: variety of harmreduction approaches develop, incl. OST andNSP
1990s� European dimension of response
• Intensified exchange at EU level• Focus on public and individual health• Evidence-based responses• Definition of measurable targets• Monitoring as basis for policies
Policy framework
• EU drugs strategy 2005-2012• based on consensus and reflecting national policies• not legally binding but strong incentive to reach agreed targets
• EU Action Plan 2005-2008• Objectives: to increase availability and access to treatment and
harm reduction; and to improve coverage and quality• To share best science based practice
• 2003 Council Recommendation (18 June)• Recommends measures to prevent and reduce health-related harm
NeedleNeedleNeedleNeedle and syringe programmes (and syringe programmes (and syringe programmes (and syringe programmes (NSPsNSPsNSPsNSPs))))• Year of introduction NSPs; • Types of programmes and number of NSP-
points; • Number of syringes given out and collected;• Role in nat. response to infectious diseases;• Combination with which other measures.
0
5
10
15
20
25
1965 1970 1975 1980 1985 1990 1995 2000
no. countr
ies p
rovid
ing
Methadone Needle/syringe programmes
Introduction of OST and of needle Introduction of OST and of needle Introduction of OST and of needle Introduction of OST and of needle and syringe programmes (and syringe programmes (and syringe programmes (and syringe programmes (NSPsNSPsNSPsNSPs))))
Rated as a priority response
0
9
9
9
17
22
26
35
39
43
78
IEC - pee r education
Condom promotion
Routine scree ning high risk groups
Safe r injecting training
Hepatits vaccination
Easy access programmes to inf.dis. treatment
Outreach health education
Voluntary inf.dis. counse lling and testing
One to one IEC counse lling
Information, education, communication (IEC)
Needle and syringe programmes
% of responding countries (see notes)
Year of official introduction of methadone and Year of official introduction of methadone and Year of official introduction of methadone and Year of official introduction of methadone and buprenorphine maintenance treatmentbuprenorphine maintenance treatmentbuprenorphine maintenance treatmentbuprenorphine maintenance treatment
0
5
10
15
20
25
30
1965 1970 1975 1980 1985 1990 1995 2000 2005
cu
mu
lati
ve n
um
ber
of
co
un
trie
s p
rovid
ing
MM
T a
nd
HD
BT
MMT
HDBT
Countries introducing MMT
in 1967 - 1986, between 1987
and 1996, and more recently
Countries introducing HDBT
1996 – 1997
1998 - 2000
2001 - 2006
Estimated number of opioid substitution treatments Estimated number of opioid substitution treatments Estimated number of opioid substitution treatments Estimated number of opioid substitution treatments in EUin EUin EUin EU----15151515, , , , 1993199319931993----2006200620062006
0
100000
200000
300000
400000
500000
600000
700000
1993 1995 1997/1998 2001/2002 2003 2005 2006
Clie
nts
in
su
bs
titu
tio
nMinimum Minimum Minimum Minimum estimate: estimate: estimate: estimate:
Ratio of opioid maintenance treatment clients to estimated numbeRatio of opioid maintenance treatment clients to estimated numbeRatio of opioid maintenance treatment clients to estimated numbeRatio of opioid maintenance treatment clients to estimated numbers of rs of rs of rs of problem opioid users in 2005/6 problem opioid users in 2005/6 problem opioid users in 2005/6 problem opioid users in 2005/6
(in 7 EU countries, Norway and Croatia)(in 7 EU countries, Norway and Croatia)(in 7 EU countries, Norway and Croatia)(in 7 EU countries, Norway and Croatia)
0
10
20
30
40
50
60
70
80
90
SK FI
EL
NO CZ
MA IT
UK
Engl. D
E
HR
Current practice OSTCurrent practice OSTCurrent practice OSTCurrent practice OST
Medications in use Medications in use Medications in use Medications in use • 70% methadone• Buprenorphine: share increasing• Buprenorphine/naloxone• Heroin prescription
Legal frameworksLegal frameworksLegal frameworksLegal frameworks• Methadone or buprenorphine legally authorised in
all countries;• Limited range of other substances also authorised• Laws control prescription, handling, dispensing
Current issues: OSTCurrent issues: OSTCurrent issues: OSTCurrent issues: OST
• Proven efficacy - but need to maintain quality with increasing numbers in treatment
• Exchange of best practice – guidelines, training
• Stabilisation of health – but need for further measures to achieve social reintegration
Current issues: NSPCurrent issues: NSPCurrent issues: NSPCurrent issues: NSP
• Improved documentation and monitoring of:• Range of services provided at low-threshold
harm reduction agencies;• Characteristics service users incl. risk
behaviours;• Level of service quality, e.g. risk education.
To sum up:• Late 80s and over the 1990s:
• Adoption of measures to prevent and reduce harm indicateimportant shifts in response to drug use in the EU;
• 2000: increased European intergovernmental cooperation;
• EU drugs strategies as common platform;
• Diversity and differences in emphasis remain;
• European consensus mediated by EU guidance.
The EU response:• Comprehensive and balanced approach• Public health oriented
“Reaching drug users and staying in contact”
• Acceptance of need for repeated treatment and for preventing and minimising health-related consequences
• Treatment shift from residential � outpatient, due to new models of care
• Diversified and responsive to the needs and interestsof different stakeholders
• Integration into general health care.
Further information OST & NSPFurther information OST & NSPFurther information OST & NSPFurther information OST & NSP
• Annual ReportAnnual ReportAnnual ReportAnnual Reportwww.emcdda.europa.euwww.emcdda.europa.euwww.emcdda.europa.euwww.emcdda.europa.eu
• Legal frameworks http://http://http://http://eldd.emcdda.europa.eueldd.emcdda.europa.eueldd.emcdda.europa.eueldd.emcdda.europa.eu////
• Statistical Bulletin Tables: http://www.emcdda.europa.eu/stats07/HSRhttp://www.emcdda.europa.eu/stats07/HSRhttp://www.emcdda.europa.eu/stats07/HSRhttp://www.emcdda.europa.eu/stats07/HSR
www.emcdda.europa.eu
