Synthetic Opioid key responses
- Mapping evidence-based key responses to synthetic opioids and their implementation strategies
- Field-tested Toolkit with seven implementation guides
That's a double-edged sword: Exploring the integration of supervised consumption services within community health centres in Toronto, Canada
Supervised consumption services (SCS) have been integrated into community health centres in Toronto. We draw on qualitative interviews and ethnographic observations to examine the implementation contexts of these SCS. Participants’ perspectives on the integration of SCS within CHCs were mixed. Some participants identified the benefits of integrated SCS such as convenience and access to other health and social services. However, others identified negative consequences of integration, including building design, lack of privacy and anonymity, and limited hours of operation. These perspectives highlight the ways in which contextual factors affect the experiences of clients in accessing SCS, and suggest that various factors need to be considered in order to improve service uptake.
The Canadian government's treatment of scientific process and evidence: Inside the evaluation of North America's first supervised injecting facility
Although the recommendations of scientific review bodies have traditionally been free of political interference in Canada, there have recently been growing concerns raised about Canada's new federal government's treatment of scientific processes and evidence. This concern is relevant to the scientific evaluation of Canada's first medically supervised safer injecting facility (SIF), which opened in Vancouver in 2003, where illicit injection drug users can inject pre-obtained illicit drugs under the supervision of nurses. This commentary describes what may be a serious breach of international scientific standards relating to the Canadian government's handling of the SIF's scientific evaluation, and the circumstances which eventually led to a moratorium on SIF trials in other Canadian cities. Although the primary focus of this discussion should remain on the health of the people using the SIF, it is hoped that the publication of the information contained in this report will lead to greater public scrutiny of the Canadian government's handling of addiction research and drug policy, and provide lessons for researchers, drug policy-makers, and affected communities in other settings.
Country mission Finland: HIV, sexually transmitted infections, and hepatitis B and C
The ECDC country visit to Finland in October 2012 aimed to review the national strategies and programmes for HIV and STI; to discuss the current situation with respect to HIV and STI prevention and control including surveillance, partner notification and populations at risk; and to address the current situation with respect to hepatitis B and C.
The main emphasis of the country mission was, however, on the prevention and control of HIV.
The country visit was conducted in Helsinki over three days and consisted of meetings with several institutions and organisations. In addition to representatives from the Ministry of Social Affairs and Health, meetings included representatives from the National Institute for Health and Welfare, the Criminal Sanctions Agency and various nongovernmental organisations.
Drug Consumption Rooms: Civil Society Monitoring of Harm Reduction in Europe, 2019. Data Report
As C-EHRN is conducting separate data collection on existing DCRs, only two questions this issue were included in the present monitoring survey. The first question asked if respondents knew of any - professional or political - new initiatives to start DCRs in their country; the second question was about the national legal framework allowing for, or hindering, DCR pilot.
Drug consumption rooms: Comparing times, spaces and actors in issues of social acceptability in French public debate
BACKGROUND:In October 2016, the first French drug consumption room (DCR) opened in Paris. We propose to examine the process through which this issue has been framed as a matter of public concern, after being ignored for almost 20 years. Our analysis of the controversy on DCRs investigates how public conversations on harm reduction evolve according to the time period (from the 1990s to the present), scale of discourse (local vs. national), and involved actors (politicians, professionals, local residents, and drug users).
METHODOLOGY: Our methodology includes analyses of media content: we reviewed 1735 articles published between 1990 and 2017. Our theoretical approach is in line with the sociology “des épreuves” derived from pragmatic sociology and controversy analysis. This approach goes beyond interactionism by attempting to place situations back into broader sociological realities. We also pay special attention to governance, a political lens that focuses on local aspects of negotiations and on the implication of a variety of actors.
RESULTS: While the current debate on DCRs in France draws on constraints and resources already present in the harm reduction debate of the 1980s, it also repositions itself by avoiding moral argumentation and featuring less confrontation in the professional sphere. Today, we can see that the center of this tense debate has shifted from the professional sphere to the political and residential spheres. Most often, residents advance concerns that are not directly related to drug users themselves, but that derive from their apprehension of living in a displaced and stranded neighborhood. The public conversation leaves little room for drug users, even though they are the primary stakeholders of harm reduction and play a crucial role in DCR advocacy.
CONCLUSION: Our work reveals that the controversy about DCR is the product of complex interactions between different kinds of actors harm reduction professionals, political actors at the local and national levels, local residents, and drug users. Comparing different instances of public debate reveals the specific limitations and potentials for change in French drug policy.
‘Enjoying the kick’: Locating pleasure within the drug consumption room
BACKGROUND: Harm reduction policy and praxis has long struggled to accommodate the pleasures of alcohol and other drug use. Whilst scholars have consistently highlighted this struggle, how pleasure might come to practically inform the design and delivery of harm reduction policies and programs remains less clear. The present paper seeks to move beyond conceptual critiques of harm reduction’s ‘pleasure oversight’ to more focused empirical analysis of how flows of pleasure emerge, circulate and, importantly, may be reoriented in the course of harm reduction practice.
METHODS: We ground our analysis in the context of detailed ethnographic research in a drug consumption room in Frankfurt, Germany. Drawing on recent strands of post-humanist thought, the paper deploys the concept of the ‘consumption event’ to uncover the manner in which these facilities mediate the practice and embodied experience of drug use and incite or limit bodily potentials for intoxication and pleasure.
RESULTS: Through the analysis, we mapped a diversity of pleasures as they emerged and circulated through events of consumption at the consumption room. Beyond the pleasurable intensities of intoxication’s kick, these pleasures were expressed in a range of novel capacities, practices and drug using bodies. In each instance, pleasure could not be reduced to a simple, linear product of drug use. Rather, it arose for our participants through distinctive social and affective transformations enabled through events of consumption at the consumption room and the generative force of actors and associations of which these events were composed.
CONCLUSION: Our research suggests that the drug consumption room serves as a conduit through which its clients can potentially enact more pleasurable, productive and positive relations to both themselves and their drug use. Acknowledging the centrality of pleasure to client engagement with these facilities, the paper concludes by drawing out the implications of these findings for the design and delivery of consumption room services.
FAQ: Supervised Injecting Facilities
What is a supervised injecting facility (SIF)? What is being proposed in Dublin inner city centre? Why are these services being proposed for Dublin inner city centre? Who is providing the service and where will the service be located? When will the service be opened? What is the legal status of these services? ...
Feasibility study on drug consumption rooms in Belgium - Étude de faisabilité de salles de consommation à moindre risque en Belgique
[English version below] Les usagers de drogues illicites (UDI) font l'expérience d'un vaste ensemble de dommages liés à cette consommation de drogues. Dans le monde entier, les Etats ont, depuis de nombreuses années, développé diverses options politiques en matière de drogues qui visent à réduire de tels dommages, lesdites politiques de Réduction des risques (Csete et al., 2016; Strang et al., 2012). Cette composante désigne les politiques, les programmes et les pratiques visant principalement la réduction des conséquences négatives connexes à l'usage de drogues psychoactives, légales ou illégales, sur les plans sanitaire, social et économique, sans pour autant viser la réduction de la consommation elle-même. La Réduction des Risques est basée sur un modèle de santé publique dont l'objectif premier est d'améliorer l'état de santé et de bien-être des usagers de drogues tout en réduisant les dommages pour la population et la société. Il s'agit donc d'un complément aux approches qui visent la prévention et la réduction de l'usage de drogues en général (EMCDDA, 2010). Des organisations internationales considèrent les interventions de Réduction des risques comme des good practices. Celles-ci incluent les traitements de substitution aux opiacés, les programmes d'échange et d'accès aux seringues et aux aiguilles, ou les traitements par délivrance d'héroïne contrôlée. L'une des interventions spécifiques de Réduction des Risques sont les salles de consommation à moindre risque (SMCR), que l'on définit comme des lieux reconnus légalement, offrant un environnement hygiéniquement sûr, où des individus peuvent consommer les drogues qu'ils ont obtenues préalablement, sans jugement moral, et sous la supervision d'un personnel qualifié. Bien que les SMCR peuvent varient quant à leurs procédures opérationnelles et leurs modèles de fonctionnement, leurs objectifs sont similaires. La finalité générale des SMCR est d'entrer en contact avec les populations d'UDI les plus à risque et de répondre à leurs problèmes, principalement les usagers injecteurs et ceux qui consomment en public. Pour cette population, les SMCR visent à réduire les risques de transmission d'infections, ainsi qu'à diminuer les problèmes de morbidité et de mortalité liés aux overdoses et aux autres dommages associés à l'usage de drogues en milieu non-hygiénique ou peu sûr. En plus de ces objectifs sanitaires, les SMCR visent également à réduire les nuisances liées à l'usage de drogues dans des lieux publics et de diminuer la présence de seringues et d'aiguilles usagées sur la voie publique, ainsi que d'autres problèmes d'ordre public en relation avec les scènes ouvertes de consommation de drogues. Ainsi, les SMCR visent à diminuer les conséquences négatives de l'usage de drogues illicites, tant au plan individuel que social. DRUGROOM │ 4 De tels services de Réduction des Risques sont opérationnels depuis 1986. En 2017, l'Europe compte 90 SMCR officielles dans huit pays: au Danemark, en Norvège, en Espagne, en Suisse, et dans les quatre pays voisins de la Belgique: en France, en Allemagne, au Luxembourg et aux Pays-Bas. Des preuves scientifiques substantielles ont été obtenues au cours des trente dernières années à propos de l'efficacité des SMCR. Malgré des différences opérationnelles, on a montré des effets positifs des SMCR tant pour les UDI que pour la population générale, en particulier lorsqu'elles sont intégrées dans le tissu des autres services d'assistance locale. En outre, la fréquentation et l'utilisation des SMCR ont été associées à une réduction significative des accidents par overdose et des problèmes liés à l'échange de seringues usagées, des blessures par injection, sans pour autant engendrer une augmentation du nombre d'UDI et sans affecter les taux de rechute. Les SMCR constituent aussi un point d'entrée important vers les services de soins et autres services sociaux pour usagers de drogues. Sur le plan social, la mise en place de SMCR a permis d'améliorer l'ordre public en réduisant la présence de déchets liés à l'injection sans pour autant avoir augmenté la criminalité associée à l'usage de drogues. Ainsi, les SMCR ont été évaluées comme ayant atteint leurs objectifs de santé et de sécurité publique, et trouvent donc leur place dans l'ensemble des services destinés aux UDI (Kennedy, Karamouzian, & Kerr, 2017; Potier et al., 2014). Cependant, malgré l'abondance de preuves scientifiques, la mise en place de SMCR reste un sujet très controversé, bien que ce soit à l'agenda politique d'un grand nombre de pays dans le monde (par ex. en Irlande, en Ecosse, ou aux Etats-Unis). Pourtant, à ce jour, il n'existe pas de SMCR en Belgique. La Cellule Générale de Politique Drogues a publié un document de travail en 2016 à ce sujet (CGPD, 2016). Ce document s'interroge sur la faisabilité et les conditions préalables à remplir pour la mise en place de SMCR en Belgique, avec une attention spécifique aux besoins et aux aspects organisationnels, budgétaires et légaux. Une des sept conclusions finales du document était qu'une étude de faisabilité était nécessaire si l'on voulait mettre en place de telles SMCR. C'est donc dans ce contexte que la Politique Scientifique Fédérale (BELSPO) a commandité, pour la première fois, une recherche évaluant cette faisabilité en Belgique. ----------------------------------- People who use illicit drugs (PWUD) experience a wide range of drug-related harms. Worldwide, countries have been converging on a core of drug policy options aimed at reducing these drug-related harms for many years, including harm reduction (Csete et al., 2016; Strang et al., 2012). This latter component, harm reduction, refers to policies, programmes and practices that aim primarily to reduce the adverse health, social and economic consequences of the use of legal and illegal psychoactive drugs, without necessarily reducing drug consumption. Harm reduction is grounded within a public health model, which primarily aims to improve the health and well-being of drug users alongside reducing community and societal level harms, and complements approaches that seek to prevent or reduce the overall level of drug use (EMCDDA, 2010). International bodies identify harm reduction interventions as good practices, including opioid substitution treatment, needle and syringe (exchange) programmes, and heroin-assisted treatment (EMCDDA, 2010). One specific intervention includes drug consumption rooms1 (DCRs), defined as legally sanctioned facilities offering a hygienic environment where individuals can use pre-obtained drugs in a non-judgemental environment and under supervision of trained staff. Although DCRs vary in operational procedures and design, the aims of DCRs are similar across sites. The overall rationale for DCRs is reach out to, and address the problems of, specific high-risk populations of PWUD, especially injectors and those who consume in public. For this group, DCRs aim to reduce the risk of transmission of blood-borne infections, to reduce the likelihood of morbidity and mortality resulting from overdose, and to help people who use drugs avoid other harms associated with drug consumption under unhygienic or unsafe conditions. In addition to these health-oriented goals, DCRs also aim to contribute to a reduction in drug use in public places and the presence of discarded needles and other related public order problems linked with open drug scenes. In sum, DCRs aim to reduce both individual-level and public-level harms associated with illicit drug use. These harm reduction facilities have been operating since 1986; anno 2017, Europe counted 90 official DCRs in eight countries: Denmark, Norway, Spain, Switzerland, and Belgium’s four neighbouring countries: France, Germany, Luxembourg, and the Netherlands (EMCDDA, 2017). A substantial body of scientific evidence has accumulated over the past three decades to support the effectiveness of DCRs; although heterogeneous in design and operation, DCRs have demonstrated that they can 1 The term ‘drug consumption room’ is often used interchangeably with supervised injection facility (SIF), safe injection site (SIS), and medically supervised injection centre (MSIC). DRUGROOM │ 4 produce beneficial effects, both for PWUD and for the community, particularly when they are part of a wider continuum of local interventions. Moreover, (frequent) DCR use has been associated with reductions in overdose-related harms, syringe sharing and injection-related injuries, without increasing either the number of local PWUD or rates of relapse. DCRs also serve as important entry points to external drug treatment and other health and social services for PWUD. At the community level, the establishment of DCRs has contributed to improvements in public order through reductions in public drug use and publicly-discarded injection-related litter, and has not been associated with increases in drug-related crime. Collectively, the available evidence suggests that DCRs are effectively meeting their primary public health and order objectives and therefore supports their role within a continuum of services for PWUD (Kennedy, Karamouzian, & Kerr, 2017; Potier et al., 2014). Despite this abundance of evidence, implementation of DCRs remains highly controversial. Yet, the debate about implementing new DCRs remains high on the political agenda in a number of countries worldwide (e.g., Ireland, Scotland, United States). To date, Belgium does not offer a DCR to its drug using population. The General Drugs Policy Cell published a working paper in 2016 devoted to the topic of DCRs in Belgium (ACD, 2016). They sought to investigate the feasibility and preconditions for the implementation of DCRs in Belgium, with specific attention to needs, and organisational, budgetary and legal aspects. One of the seven final conclusions was that, if one wishes to implement a DCR, a prior feasibility study is essential. Against this background, the Belgian Science Policy Office (BELSPO) commissioned a first-ever study to assess the feasibility of DCRs in Belgium.
Jeudi de l’hémicycle - Compte-rendu de la matinée d’étude "salle de consommation à moindre risque : un dispositif utile, souhaitable et prioritaire. A quand, à Bruxelles ?"
Dans le cadre du Jeudi de l’Hémicycle, évènement porté par la société civile, et à l’initiative du groupe Ecolo et du Parlement francophone Bruxelles (PFB), le rendez-vous du 29 mars dernier était consacré aux impasses et aux solutions propres aux Salles de consommation à moindre risques (SCMR) et également à la réflexion autour d’un lancement en Région de Bruxelles Capitale. Un vrai débat de société
