HARM REDUCTION RESPONSES TO DRUGS IN THE EUROPEAN UNION – FROM MARGIN TO MAINSTREAM 8 th 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 EU Commission Council of the Union Parliament European Council

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 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 health- related 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

NEEDLE AND SYRINGE PROGRAMMES: Development and current situation

When did needle exchange start? 1984: 1st NSP Amsterdam 1986: England : Spain, Germany, Norway, Flemish BE, Poland, France, Ireland : 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 ; Sweden ; Bulgaria ; Lithuania ; Latvia ; 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  peer- approaches!

Challenges public health in general: Address marginalised populations Develop long-term strategy prevention health- related harm Expand capacity, quality and coverage Involve civil society, NGOs