Synthetic Opioid key responses
- Mapping evidence-based key responses to synthetic opioids and their implementation strategies
- Field-tested Toolkit with seven implementation guides
International Consensus Statement on the Role of Nurses in Supervised Consumption Sites
BACKGROUND AND OBJECTIVE: Supervised consumption sites (SCS) have been implemented in Europe, North America and Australia, reaching a total of 158 sites worldwide. In addition to reducing harms and preventing overdoses and overdose deaths, SCS act as a point of service for people who use drugs to access much needed health care services. Registered nurses who work in SCS provide care, support, education, and resources to reduce health risks and improve health. It has been clearly established that these interventions fall within the legislated scope of practice of registered nurses but the actual role of nurses in SCS remains poorly defined and understood, especially by decision-makers, employers, health care providers, and the broader community.
MATERIAL AND METHODS: To address this significant practice, policy and research gap, a consensus statement was developed based on information generated by 17 content experts from 10 countries namely, Canada, Spain, Australia, France, Denmark, Norway, Ireland, Switzerland, Germany, and Scotland. The statement was developed from “the ground up” by gathering information on three content areas: nursing practice in SCS, training, and needs. This information was summarized, and then submitted to two rounds of voting using a modified Delphi method to build consensus.
RESULTS: The final content of the consensus statement is comprised of five sections: 1) Philosophy of care, 2) Framework, 3) Nursing role, 4) Training requirements, and 5) Needs of nurses.
CONCLUSION: This consensus statement is a first step toward a better understanding of the role of nurses in SCS. There is an immense responsibility on nurses in this setting, as the majority of people who access SCS face many barriers in accessing other health and social services, even when their need for those services may be critical. For these reasons, it is essential to better prepare nurses for these realities. It is our hope that this first international consensus statement can serve as a foundation to guide practice, policy, research, and operational decisions in SCS.
Legislating for Health and Human Rights: Model Law on Drug Use and HIVAIDS - Supervised drug consumption facilities
This model law resource is designed to inform and assist policy-makers and advocates as they approach the task of reforming or making laws to meet the legal challenges posed by the HIV epidemic among people who use drugs.
Module 4 contains a prefatory note which outlines the rationale for and benefits of supervised drug consumption facilities and which describes relevant international laws and policies, including human rights obligations. Module 4 provides model law that can be put in place to make such facilities effective interventions in protecting the health and well-being of individuals who use drugs, advancing public health more generally, and benefiting communities affected by public drug use. Module 4 concludes with a list of recommended resources.
Making the case for supervised injection services
More than 90 supervised injection services (SIS) operate globally, most within eight European countries, one in Australia, and two in Vancouver, Canada. SIS are legally sanctioned spaces where people can inject illegal drugs, typically heroin or cocaine, under the supervision of trained health staff and without fear of prosecution. These services allow safer injection, are associated with decreased overdoses, facilitate referrals for drug treatment, and benefit public order. In response to the increase in opioid use and associated harms, activists and officials in Canada, the USA, Scotland, and Ireland are exploring supervised injection services, but implementation is controversial.
Mobilizing drug consumption rooms: inter-place networks and harm reduction drug policy
This article discusses the learning and politics involved in spreading Drug Consumption Rooms (DCRs) globally. DCRs are health facilities, operating under a harm reduction philosophy, where people consume illicit drugs in a supervised setting. Approximately 90 are located in almost 60 cities in 11 countries. They are intensely local attempts to improve the lives of specific populations and urban neighborhoods. DCRs are also global models that travel. This article examines the relationship between DCRs as facilities that are fixed in place and DCRs as globally-mobilized models of drug policy and public health practice. Drawing on research from seven countries, we apply concepts from the policy mobilities literature to analyze the travels of the DCR model and the political strategies involved in the siting of these public health service facilities. We detail the networked mobilization of the DCR model from Europe to Canada and Australia, the learning among facilities, the strategies used to mold the DCR model to local contexts, and the role of DCR staff in promoting continued proliferation of DCRs. We conclude by identifying some immobilities of DCRs to identify questions about practices, principles and future directions of harm reduction.
Online census of Drug Consumption Rooms (DCRs) as a setting to address HCV: current practice and future capacity
Drug consumption rooms (DCRs) and supervised injecting facilities (SIFs) target the most vulnerable people who use drugs (PWUD) – particularly people who use opioids, people who inject drugs (PWID), people who use drugs heavily or high-risk drug users (HRDI). While decreases in risky injecting behaviours are an outcome of DCR use, HCV prevention and treatment in these settings haven’t been adequately described. There are no international DCR standards for HCV practice and surveys are yet to address HCV prevention, treatment or sero-prevalence status of DCR clients. This online survey provides a ‘snapshot’ of DCR clients’ HCV status; approaches to HCV in DCRs, and what DCRs need to expand these services.
Fifty-one responses were collected from representatives of the 92 operating DCRs in Australia, Canada, Denmark, France, Germany, Luxembourg, Netherlands, Norway, Spain and Switzerland participated in the survey; thus over half of the DCRs were directly represented (55 %) and several respondents had filled the survey on behalf of several DCR’s within their organisation. All countries where DCRs are operated were represented.
An estimated mean 71% of SIF/DCR clients had been tested for HCV and about 58% were HCV positive. Most DCRs provided HCV testing onsite (67%); of these majority tested via blood samples (65%) and several used finger prick (31%) or saliva (31%). Several DCRs referred to offsite HCV testing (75%). Only four European DRCs provided HCV treatment onsite at the time of the survey; twowere providing DAAs (“new treatment”) and two were providing both interferon and DAAs treatments. The majority of SIFs/DCRs referred clients offsite for treatment (96%). Several offered disease self-management support (50%) or monitoring liver health (24%). Overall, DCRs reported that HCV support (94%), new treatments (92%) or treatment with interferon (50%) were available for their clients at other services.
To provide further HCV-related services, DCR indicated that they need more staff time (51%) and staff training (45%), that they would have to expand staff qualifications (30%) and that further funding for equipment and services would be needed (38%). A change in national HCV treatment guidelines for active drug users was also identified as a need (23%). When it comes any additional funding, the respondents indicated they would use it on employing additional medical staff (52%), develop client education (52%) or on additional staff training (46%).
DCR involvement in HCV prevention and treatment is crucial. SIFs/DCRs should to be supported to provide an entry point to HCV treatment as they are working on the frontline with the most marginalised PWID and are capable of removing barriers to HCV treatment in this population. Also, options for colocation of HCV services at DCRs or provision of HCV treatment onsite should be considered.
Public Health and Public Order Outcomes Associated with Supervised Drug Consumption Facilities: a Systematic Review
Purpose of Review Supervised drug consumption facilities (SCFs) have increasingly been implemented in response to public health and public order concerns associated with illicit drug use. We systematically reviewed the literature investigating the health and community impacts of SCFs.
Recent Findings Consistent evidence demonstrates that SCFs mitigate overdose-related harms and unsafe drug use behaviours, as well as facilitate uptake of addiction treatment and other health services among people who use drugs (PWUD).
Further, SCFs have been associated with improvements in public order without increasing drug-related crime. SCFs have also been shown to be cost-effective.
Summary This systematic review suggests that SCFs are effectively meeting their primary public health and order objectives and therefore supports their role within a continuum of services for PWUD. Additional studies are needed to better understand the potential long-term health impacts of SCFs and how innovations in SCF programming may help to optimize the effectiveness of this intervention.
RETRACTED: The impact of medically supervised injection centres on drug-related harms: A meta-analysis
This article has been retracted at the request of the Editor-in-Chief of the International Journal of Drug Policy.
In light of two critical reviews received by the International Journal of Drug Policy after publication (available on request), and additional commissioned independent assessments, the International Journal of Drug Policy has retracted the following paper from publication: May, T., Bennett, T. and Holloway, K. (2018) The impact of medically supervised injection centres on drug-related harms: A meta-analysis, 59: 98-107.
This action is supported by the authors’ acknowledgement of methodological weaknesses linked to the pooling of diverse outcomes into a single composite measure (authors’ response to critical reviews also available on request from the Editor). The authors have acknowledged that these analyses should not have been undertaken in this way and resulted from honest human error in the use of methods. Accordingly, the authors acknowledge that the combined effect size reported in the original paper should be discounted. Given that the composite measure was a key finding reported by the original paper, the decision to retract the paper from publication had been made, including with the consent of the authors. The journal acknowledges that the peer review process did not pick up on the specific methodological weaknesses identified post publication. The International Journal of Drug Policy takes its peer review process extremely seriously. It is for this reason that the International Journal of Drug Policy commissioned an independent assessment of the original paper in addition to the original peer review reports in order to assess whether to retract the paper.
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ORIGINAL PAPER:
BACKGROUND: Medically Supervised Injection Centres (MSICs) are legally-sanctioned facilities where users can consume pre-obtained drugs under medical supervision. Although there is a substantial body of research exploring their effectiveness, there have been few attempts to quantify outcomes across studies. In order to determine the impact of the body of research as a whole, outcomes from studies were synthesised using meta-analysis.
METHODS: Literature sources were identified through searches in four bibliographic databases. Inclusion in the final review was dependent on the study meeting certain eligibility criteria, including a minimum of pre-test, post-test, control group designs. Data were extracted and pooled in a meta-analysis using both fixed and random effects methods.
RESULTS: Eight studies met the inclusion criteria. Overall, MSICs had a significant, but small, positive effect on outcomes based on the fixed effect analysis and no effect based on random effect analysis. The results of the independent outcome analyses showed that MSICs had a significant favourable result in relation to drug-related crime and a significant unfavourable result in relation to problematic heroin use or injection. MSICs were found to have no effect on overdose mortality or syringe/equipment sharing.
CONCLUSION: Whilst the effectiveness of the early versions of MSICs remains uncertain, this should not rule out continuing to test and develop MSICs in locations where public injecting and other drug-related harms are a major problem. It is important, however, that evaluation research publishes replicable data to enable future meta-analyses and to expand the body of knowledge in the field.
Salles de consommation à moindre risque : les preuves et la pratique
Depuis une dizaine voire une vingtaine d’années, les salles de consommation à moindre risque (SCMR) font partie intégrante des stratégies de traitement de la dépendance aux drogues et de réduction des risques dans plusieurs pays en Europe de l’Ouest, en Amérique du Nord et en Australie. Cependant, une majorité de pays ne les ont pas encore mis en place.
Ce rapport de synthèse présente le contexte, l’histoire et les objectifs des SCMR et analyse les preuves disponibles quant à leur impact. La deuxième partie de ce rapport fournit un aperçu des SCMR dans différents pays, avec un accent particulier placé sur les concepts utilisés pour développer ces espaces en fonction du contexte politique, culturel et social de chaque pays.
