HARM REDUCTION Bogotá November 2008 The Czech Republic in the heart of Europe The British vs. American Models in history nDrug addiction is illness nMedical model: based on controlled dispensation of drugs to addicts nServices are primaraly Harm reduction orianted nIn favour of prescribing common drugs (e.g. Diamorphin/heroin) as part of treatment nDiscussing liberalisation of cannabis and permit its medical use n n n nDrug use is a criminal activity nCriminal justice model: based on repression and punishment nServices are primaraly abstinence orianted nNeedle exchange programs are not on official agenda nPrescribing drugs (e.g. heroin) as part of treatment is an “undesirable development” n“War on drugs” nHarsh punishment even for minor possesion of cannabis n The American Model The British Model Percentage drug use in the UK (16-24 year-olds) n 1997 2002/3 2003/4 2004/5 2005/6 2006/7 nAny drug 31.8 28.5 28.3 26.5 25.2 24.1 nCannabis 28.2 26.2 25.3 23.6 21.4 20.9 nCocaine 3.2 5.2 5.4 5.1 5.9 6.1 nEcstasy 5.1 5.8 5.5 4.9 4.3 4.8 nAmphetamines 9.9 3.8 4.0 3.2 3.3 3.5 nHallucinogens 3.4 2.2 2.9 3.0 3.4 3.1 nLSD 3.2 0.9 0.9 0.5 0.9 0.7 nHeroin 0.3 0.2 0.4 0.2 0.2 0.2 nMethadone 0.1 0.2 0.3 0 0.1 0.1 1 Source: Home Office Statistics Bulletin, Crime in England and Wales 2006/07 Percentage drug use in the US (16-24 year-olds) n 2001 2002 2003 2004 2005 nAny drug 53.9 53.0 51.1 51.1 50.7 nCannabis 49.0 47.8 46.1 45.7 45.3 nCocaine 3.7 3.8 3.6 3.7 3.7 nEcstasy 11.7 10.5 8.3 7.5 7.1 nMethamphetamines - 6.7 6.2 6.2 6.3 nLSD 10.9 8.4 5.9 4.6 3.9 nHeroin 1.8 1.7 1.5 1.5 1.6 nTranquilizers 10.3 11.4 10.2 10.6 10.9 nInhalants 13.0 11.7 11.2 10.9 9.9 1 Source: NIDA report, 2006, Lifetime prevalence European model today nIntegrating both abstinence and Harm Reduction model = services run different programs = indication for sevices/interventions depend on: —Good assassment of individual client situation = case management – work with a care plan in the community —Possibility of (clients) choice nClient has a right to be the co-author nDrug demand reduction policy/strategy has to reflect the need of: —Service Users —Service Providers —Service Donars nFunding being redirected from drugs suply reduction to drug demand reduction n European model - Pragmatic measures for prevention of HIV-AIDS among IDUs nEarly secondary prevention – dealing with the syndrom of the hidden population (low number of problematic drug users come to services alone nPragmatic policy - harm-reduction orientated (including prescribing programmes, out reach work and low threshold services) nNetworking - working with/through differences nCommunity cooperation nMultidisciplinary approach nInformation campaign aimed at -Drugs awareness = lowering risk behaviour -Challenging the public attitude towards IDUs and HIV positive people n n — Theoretical backround n nDrug problem is bio-psycho-social (BPS) problem n nOut of 100% of people who tried drugs, only 10% get to chronical stage n nThere are two significant subgroups n —Primary mental health problems — —Socialy deprivated and/or excluded group — Theoretical backround BPS model nAssessment – proces of drug problem development: n —History of a drug use n —Stages of drug problem — —Development of awareness of the drug problem n —Comorbid problems n —Indication to efective intervention n n n Theoretical backround – BPS model nWhat do we work with when we say a drug problem? Is it only drug addiction? —Withdrawal – physical addiction —Craving - psychological —Flashbacks —Overdoses —Social context issues – changes in traditional social structure = family, education, job situation, peer enviroment/socialising —Chaotic life style —Criminal behavior —Risky behavior in drug use, sex… —“Spiritual emptyness…” — Theoretical backround – forms of interventions nMedical n nPsychological n nEducational n nSocial n nSelf-support n nSpiritual Specific services n nSpiritual support n nSkills learning center – regarding a job market n nPrison services n nSelf help groups, users forum n nTraining institute – IES n Our values… nRegard for human life nAssistance and support for people nPrimary human ethical principles based on the European culture nTolerance, respect and equal opportunities nOpenness nTrust nInnovation and creativity nProfessionalism and professional ethics nTeam work nTransparency nPerseverance and courage n n…and the determination to survive each day as it comes Network of Services – working with a drug user is a process nPrevention Centre nLow threshold centre Drop-in centre (inc. Club “Sklenik”) nStreet work/out reach (inc. Synthetic drugs prevention) Prevention and HR Treatment Other services nDay care “Elysium” (inc. Methadone programme) nPsychiatric clinic nTherapeutic community nAfter-care centre nSkills learning and supporting enployement n n nI.E.S. (Institute for Education and Supervision) nDrug services in prison nSkills learning center nPastoral (spiritual) care Professor Michael Gossop MD “The urgent need to respond to the threat of HIV and AIDS has radically altered the drugs agenda. The rhetoric of United States and some other countries may continue to promote the discredited ideals of the “war against drugs” and “zero tolerance”, but living with drugs has now become an imperative.”