The state of harm reduction in prisons in 30 European countries with a focus on people who inject drugs and infectious diseases

Abstract Background People who inject drugs are often imprisoned, which is associated with increased levels of health risks including overdose and infectious diseases transmission, affecting not only people in prison but also the communities to which they return. This paper aims to give an up-to-date overview on availability, coverage and policy framework of prison-based harm reduction interventions in Europe. Methods Available data on selected harm reduction responses in prisons were compiled from international standardised data sources and combined with a questionnaire survey among 30 National Focal Points of the European Monitoring Centre for Drugs and Drug Addiction to determine the level of availability, estimated coverage and policy framework of the interventions. Results Information about responses to health harms in prisons is limited and heterogeneous. Cross-country comparability is hampered by diverging national data collection methods. Opioid substitution treatment (OST) is available in 29 countries, but coverage remains low (below 30% of people in need) in half of the responding countries. Needle and syringe programmes, lubricant distribution, counselling on safer injecting and tattooing/piercing are scarcely available. Testing for infectious diseases is offered but mostly upon prison entry, and uptake remains low in about half of the countries. While treatment of infections is mostly available and coverage is high for human immunodeficiency virus (HIV) and tuberculosis, hepatitis B and C treatment are less often provided. Health education as well as condom distribution is usually available, but provision remains low in nearly half of the countries. Post-release linkage to addiction care as well as to treatment of infections is available in a majority of countries, but implementation is often partial. Interventions recommended to be provided upon release, such as OST initiation, take-home naloxone and testing of infections, are rarely provided. While 21 countries address harm reduction in prison in national strategic documents, upon-release interventions appear only in 12. Conclusions Availability and coverage of harm reduction interventions in European prisons are limited, compared to the community. There is a gap between international recommendations and ‘on-paper’ availability of interventions and their actual implementation. Scaling up harm reduction in prison and throughcare can achieve important individual and public-health benefits.

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The State of Harm Reduction in Prisons in 30 European Countries with a Focus on People Who Inject Drugs and Infectious Diseases

10.21203/rs.3.rs-74083/v1 ◽

2020 ◽

Author(s):

Heino Stöver ◽

Anna Tarján ◽

Gergely Horvath ◽

Linda Montanari ◽

Dagmar Hedrich

Keyword(s):

Health Education ◽

Infectious Diseases ◽

Harm Reduction ◽

People Who Inject Drugs ◽

Prison Population ◽

European Countries ◽

Policy Framework ◽

Opioid Substitution Treatment ◽

Monitoring Centre ◽

International Agencies

Abstract Background: People who inject drugs are often imprisoned which is associated with increased levels of health risks including overdose and infectious diseases affecting the prison population and the community where they return to. Information about responses to this in prisons is limited and heterogeneous in Europe. The paper aims to give a comprehensive, up-to-date overview of the availability, coverage and policy framework of prison-based harm reduction interventions. Methods: Systematic review of international agencies’ data sources and data collection were conducted in 2018 followed by a questionnaire survey in 30 European countries through the Reitox National Focal Points of the European Monitoring Centre for Drugs and Drug Addiction.Results: Opioid substitution treatment (OST) is available in 29 countries, but coverage remains below 30% of people in need (low) in half of the countries. Needle and syringe programmes, bleach and lubricant distribution, counselling on safer injecting and tattooing/piercing are scarcely available (in 3/8/9/9/10 countries respectively), and often with low coverage. Testing of drug related infectious diseases (DRID) are provided however typically only upon entry, with a last year population coverage remaining low in about half of the countries. While DRID treatment is available, its coverage is mostly reported high for Human Immunodeficiency Virus (HIV) and Tuberculosis, but lower for Hepatitis B and C (HCV). Health education on DRID, HIV health promotion programmes, and condom distribution are usually provided but at low levels in nearly half of the countries. Post-release linkages to addiction, HIV and HCV care is available in 22/25/17 countries, but implementation is often partial. Other upon-release interventions as OST initiation, take-home naloxone, health education, DRID testing are rarely provided. Harm reduction in prison is addressed in national strategic documents in 21 countries while interventions upon release in only 12. Conclusions: Availability and coverage of harm reduction interventions in prisons is limited and delayed compared to community implementation in European countries. There is a critical gap between international recommendations, on-paper availability and the actual implementation of these interventions. Most people will return to the community, therefore interventions in prison and throughcare should be scaled up for individual and public health benefits.

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Opioid substitution treatment uptake among people who inject drugs: The findings of two consecutive bio-behavioral surveillance surveys in Iran

10.21203/rs.3.rs-24098/v1 ◽

2020 ◽

Author(s):

Mehran Nakhaeizadeh ◽

Zahra Abdolahiniya ◽

Hamid Sharifi ◽

Ali Mirzazadeh ◽

Mohammad Karamouzian ◽

...

Keyword(s):

Health Outcomes ◽

Harm Reduction ◽

People Who Inject Drugs ◽

Substitution Treatment ◽

Urban Centers ◽

Opioid Substitution Treatment ◽

Behavioral Surveillance ◽

Opioid Drugs ◽

History Of ◽

Opioid Substitution

Abstract Background Opioid substitution treatment (OST) uptake has been associated with multiple positive health outcomes among people who inject drugs (PWID). This study evaluated the pattern of OST uptake among PWID in two consecutive national bio-behavioral surveillance surveys (2010 and 2014) in Iran. Methods Data were obtained from two national bio-behavioral surveillance surveys (N2010 = 1,783 and N2014 = 2,166) implemented using convenience sampling at the harm reduction facilities and street venues in 10 geographically diverse urban centers across Iran. Multivariable logistic regression model was used to determine the correlates of OST uptake for 2014 survey and adjusted odds ratios (AORs) and 95% confidence intervals (CI) were reported. Results The prevalence of OST uptake decreased from 49.2% in 2010 to 45.8% in 2014 (P-value = 0.033). OST uptake varied across the studied cities ranging from 0.0%-69.3% in the 2010 survey and 3.2%-75.5% in the 2014 survey. Ever being married (AOR = 1.40; 95% CI: 1.12, 1.75), having a history of incarceration (AOR = 1.56; 95% CI: 1.16, 2.09), and human immunodeficiency virus (HIV) sero-positivity (AOR = 1.63; 95% CI: 1.08, 2.5) were associated with OST uptake. Conversely, PWID who reported using only non-opioid drugs (AOR = 0.43; 95% CI: 0.26, 0.71) and those who reported concurrent use of opioid and non-opioid drugs (AOR = 0.66; 95% CI: 0. 0.51, 0.86) were less likely to uptake OST. Conclusions Although OST uptake among PWID in Iran is above the 40% threshold defined by the World Health Organization, there remains significant disparities across urban centers in Iran. Importantly, the OST services appear to be serving high risk PWID including those living with HIV and those with a history of incarceration. Evaluating service integration including mental health, HIV and hepatitis C virus care, and other harm reduction services may support the optimization of health outcomes of opioid substitution treatment across Iran.

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Opioid substitution treatment as HIV prevention among people who inject drugs: Focus on developing country settings

PsycEXTRA Dataset ◽

10.1037/e628452012-097 ◽

2012 ◽

Author(s):

Atul Ambekar

Keyword(s):

Hiv Prevention ◽

Developing Country ◽

People Who Inject Drugs ◽

Substitution Treatment ◽

Opioid Substitution Treatment ◽

Opioid Substitution

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The Lethal Burden of Survival

Contemporary Drug Problems ◽

10.1177/0091450918784953 ◽

2018 ◽

Vol 45 (3) ◽

pp. 208-226 ◽

Cited By ~ 1

Author(s):

Aleksandra Bartoszko

Keyword(s):

Harm Reduction ◽

Patient Involvement ◽

Treatment Modalities ◽

Opioid Substitution Treatment ◽

Ethnographic Fieldwork ◽

Medication Side ◽

Choice Of Treatment ◽

Drug Free ◽

Opioid Substitution

Patients in opioid substitution treatment (OST) in Norway are assigned a treatment modality based on their risk profiles, with an emphasis on overdose risk. One of several medications may be administered, including methadone, buprenorphine, buprenorphine–naloxone, and occasionally morphine. OST patients who are not satisfied with the assigned treatment are required to negotiate with OST staff to switch treatment modalities. During these negotiations, some inherent paradoxes arise: (1) OST contains both a harm reduction approach and an ideology that emphasizes abstinence and a drug-free life and (2) legal requirements for patient involvement in the choice of treatment clash with the clinicians’ intrinsic suspicion toward patients’ knowledge, experience, and pharmacological preferences. Drawing upon a year of ethnographic fieldwork, I discuss in this article how OST simultaneously reduces and reproduces risks. OST medications are primarily designed to manage withdrawal, with the patient’s survival as the priority rather than quality of life. But this corporeal focus combined with a mantra of harm reduction reduces patients to their physiology. Consequently, many OST patients live in a chronic survival modus—“I am surviving, not living”—which complicates their ability to acquire new social roles. As they struggle with medication side effects, poor health, isolation, and a need for recognition, many abandon their rehabilitation plans and disengage further from society. Thus, OST can produce a new kind of vulnerability, creates new subjects at risk, and by extension maintains risk of diversion, polydrug use, and overdose.

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Evaluating the impact of global fund withdrawal on needle and syringe provision, cost and use among people who inject drugs in Tijuana, Mexico: a costing analysis

BMJ Open ◽

10.1136/bmjopen-2018-026298 ◽

2019 ◽

Vol 9 (1) ◽

pp. e026298 ◽

Cited By ~ 10

Author(s):

Javier A Cepeda ◽

Jose Luis Burgos ◽

James G Kahn ◽

Rosario Padilla ◽

Pedro Emilio Meza Martinez ◽

...

Keyword(s):

Harm Reduction ◽

Global Fund ◽

People Who Inject Drugs ◽

Harm Reduction Programme ◽

Needle And Syringe Programmes ◽

Costing Study ◽

The Cost ◽

The Impact ◽

Geographical Locations ◽

Needle And Syringe Programme

ObjectiveFrom 2011 to 2013, the Global Fund (GF) supported needle and syringe programmes in Mexico to prevent transmission of HIV among people who inject drugs. It remains unclear how GF withdrawal affected the costs, quality and coverage of needle and syringe programme provision.DesignCosting study and longitudinal cohort study.SettingTijuana, Mexico.ParticipantsPersonnel from a local needle and syringe programme (n=6) and people who inject drugs (n=734) participating in a longitudinal study.Primary outcome measuresProvision of needle and syringe programme services and cost (per contact and per syringe distributed, in 2017 $USD) during GF support (2012) and after withdrawal (2015/16). An additional outcome included needle and syringe programme utilisation from a concurrent cohort of people who inject drugs during and after GF withdrawal.ResultsDuring the GF period, the needle and syringe programme distributed 55 920 syringes to 932 contacts (60 syringes/contact) across 14 geographical locations. After GF withdrew, the needle and syringe programme distributed 10 700 syringes to 2140 contacts (five syringes/contact) across three geographical locations. During the GF period, the cost per harm reduction contact was approximately 10-fold higher compared with after GF ($44.72 vs $3.81); however, the cost per syringe distributed was nearly equal ($0.75 vs $0.76) due to differences in syringes per contact and reductions in ancillary kit components. The mean log odds of accessing a needle and syringe programme in the post-GF period was significantly lower than during the GF period (p=0.02).ConclusionsWithdrawal of GF support for needle and syringe programme provision in Mexico was associated with a substantial drop in provision of sterile syringes, geographical coverage and recent clean syringe utilisation among people who inject drugs. Better planning is required to ensure harm reduction programme sustainability is at scale after donor withdrawal.

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Health programmes and services addressing the prevention and management of infectious diseases in people who inject drugs in Canada: a systematic integrative review

BMJ Open ◽

10.1136/bmjopen-2020-047511 ◽

2021 ◽

Vol 11 (9) ◽

pp. e047511

Author(s):

Katrina Bouzanis ◽

Siddharth Joshi ◽

Cynthia Lokker ◽

Sureka Pavalagantharajah ◽

Yun Qiu ◽

...

Keyword(s):

Infectious Disease ◽

Drug Use ◽

Infectious Diseases ◽

Harm Reduction ◽

Bacterial Infections ◽

People Who Inject Drugs ◽

Integrative Review ◽

Future Research ◽

Structural Factors ◽

Health Programmes

ObjectivesPeople who inject drugs (PWID) experience a high burden of injection drug use-related infectious disease and challenges in accessing adequate care. This study sought to identify programmes and services in Canada addressing the prevention and management of infectious disease in PWID.DesignThis study employed a systematic integrative review methodology. Electronic databases (PubMed, CINAHL and Web of Science Core Collection) and relevant websites were searched for literature published between 2008 and 2019 (last search date was 6 June 2019). Eligible articles and documents were required to address injection or intravenous drug use and health programmes or services relating to the prevention or management of infectious diseases in Canada.ResultsThis study identified 1607 unique articles and 97 were included in this study. The health programmes and services identified included testing and management of HIV and hepatitis C virus (n=27), supervised injection facilities (n=19), medication treatment for opioid use disorder (n=12), integrated infectious disease and addiction programmes (n=10), needle exchange programmes (n=9), harm reduction strategies broadly (n=6), mobile care initiatives (n=5), peer-delivered services (n=3), management of IDU-related bacterial infections (n=2) and others (n=4). Key implications for policy, practice and future research were identified based on the results of the included studies, which include addressing individual and systemic factors that impede care, furthering evaluation of programmes and the need to provide comprehensive care to PWID, involving medical care, social support and harm reduction.ConclusionsThese results demonstrate the need for expanded services across a variety of settings and populations. Our study emphasises the importance of addressing social and structural factors that impede infectious disease care for PWID. Further research is needed to improve evaluation of health programmes and services and contextual factors surrounding accessing services or returning to care.PROSPERO registration numberCRD42020142947.

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