transitions from injecting opportunities to do more?

1. transitions from injecting opportunities to do more? nnef, southampton central hall 18th march, 2010 neil hunt

2. Intervention without understanding is interference

3. Overview • Some background • Some old news • Some new news? • Some discussion

4. Some background

5. The way individual people use heroin, amphetamines, cocaine etc varies with time People change the ways they use their drugs and do not always remain faithful to one method. Some people use heroin, cocaine and amphetamines for years and never inject Some people switch to injecting Injectors sometimes switch away from injecting (partially or fully) (For example see Griffiths et al 1994, Darke et al 1994, Pizzey and Hunt 2008) 5

6. Some parts of Europe have seen population-level reversals in the popularity of injecting • The Netherlands • (See Grund, Jean-Paul & Blanken, Peter. 1993. From chasing the dragon to chinezen. Rotterdam, the Netherlands: IVO;  Lindenburg et al 2006) • Spain (Madrid and Seville, but not Barcelona) • (see Bravo pp 6-8) in Understanding Initiation of Injection Drug Use. Proceedings Paper – Part One, Findings from Etiological Studies. November 1- 2, 2007, Université de Sherbrooke ~ Longueuil, Quebec)

7. Intervention points Decrease incidence of injecting/prevent new cases (Psycho-educational programmes/Break the Cycle/OST) Increase ‘outcidence’* i.e. accelerate the rate at which people wholly or partially stop injecting *a made-up word coined by Richard Hartnoll

8. Some old news • Opioid Substitution Treatment • Social marketing • Chasing campaign - HOT • Smoking Brown - Lifeline • Foil

9. Methadone (and buprenorphine) reduce injecting • First month of MMT a quarter of IDUs stop injecting (from 97 to 72). 49/72 continuing injectors had reduced their injecting frequency. 67 had been injecting at least once per day. Only 17 were still doing so a month into treatment (Strang et al 1997) • Higher daily doses are associated with a greater likelihood of cessation of injecting (Capelhorn et al 1993) • Stopping injecting is also associated with the nature and intensity of other non-pharmacological treatment factors (Ball and Ross 1991) • …and MMT reduces injecting in prisons too (Stallwitz and Stöver 2007)

10. Chasing campaign - HOT/Smoking Brown - Lifeline

11. Foil distribution (Pizzey and Hunt 2008) As many of you know, I could talk about this at length but…

13. Some new news? • Social marketing to prevent initiation among Canadian street youth has unplanned impact on current injectors • Drug consumption rooms • ITEP/BTEI • ‘New’ Recovery

14. Social marketing Elise Roy and colleagues Montreal, Canada Evaluation of a Media Campaign Aimed at Preventing Initiation Into Drug Injection Among Street Youth. Drugs: Education, Prevention and Policy (2007) 14, 5,401- 414

15. Social marketing campaign targeting street youth

19. Lighters • Pre paid calling cards • Chocolate • Water

20. Pros and Cons • Some IDUs felt that the fear-based messages and images are too harsh and confrontational, and concerns were expressed that the campaign could be stigmatizing • Other IDUs felt that such intervention was pertinent and useful, making them reflect on their own injecting • Could a different campaign aimed at IDUs retain the Pros but lose the Cons?

21. Drug Consumption Rooms • Weekly use of safe injecting facility roughly doubles likelihood of entering detox • Wood et al 2006, Attendance at safer injecting facilities and use of detoxification services. New England Journal of Medicine

22. ITEP/BTEI • A “non pharmacological treatment factor”? • ‘Nodal Link Mapping’ - potential maps (guided/free/hybrid) • Injecting pros and cons • Injecting alternatives • Injecting lapse/relapse

24. New Recovery: new opportunities to reduce injecting? • New context and new zeal • We’ve never had this proportion of people who inject engaged in treatment • We’ve never had this level of service coverage before • We’ve never had a treatment workforce this size before • Recovery is within the national treatment strategy in a way it has never been before • A recovery renaissance with a more mature engagement between harm reductionists and the recovery movement • We…and no other country…have never been here before • Are there new opportunities that a recovery orientation overlaying a harm reduction based treatment system can now bring?

26. Some discussion (with apologies to Mick Webb)

27. Thank you