The impact of economic recession on drug users and drug treatment

Transcription

1 The impact of economic recession on drug users and drug treatment Designing and implementing responsive drug policies under fiscal constraints: the case of Greece Meni Malliori Assoc. Prof. of Psychiatry Athens University Medical School September 2014 Lisbon Page 1

2 Health policy implementation under austerity measures Austerity measures affects determinants of health such as, nutrition, housing, education and employment, but also austerity measures, increase existing inequalities increase discrimination and social exclusion. deteriorate physical and mental health (drug use) Page 2

3 Impact of the austerity measures on drug use and drug policies 1. DRUG USE 1.1 Trends in drug use 1.2 Trends in health consequences 1.3 Trends in criminality 1.4 Trends in social exclusion 2. DRUG POLICIES 2.1 Impact on availability and funding of services 2.2 Impact on accessibility of services 2.3 Impact on quality

4 Impact of austerity measures on drug use 1. Risk of earlier onset of drug use 2. Increasing prevalence of injecting use 3. More Relapses 4. Risk taking patterns 5. Overdosing particularly among vulnerable groups 6. Increasing incidence of poly-drug use 7. Increased criminality Page 4

5 Policy responses The economic crisis is linked with social and political crisis which lead to decisions. However the impact of the economic crises is asymmetric, as often doesn t affect the whole country or all population groups, but only some regions, towns or sub-populations, usually the most vulnerable. «The Greek experience: example of a country facing austerity measures» Page 5

6 National Policy Plan 1. Prevention activities 2. Treatment-Coverage of treatment needs 3. Harm Reduction Services 4. Other Interventions (prisons, safe drug use, alternative to imprisonment facilities) Response to the HIV/PWID epidemic

7 Coverage of treatment needs In 2010, 74 therapeutic programs were existing in Greece, providing all treatment modalities. These include 25 opioid substitution units, 43 psychosocial interventions (drug-free) programs and six drug-free programs implemented in the prison settings. A little more than users were treated in all these agencies in Page 7

8 HIV cases among People Who Inject Drugs In Greece, a country with low prevalence of HIV, the epidemic -as monitored by the surveillance system of the Hellenic Centre for Disease Control and Prevention (HCDCP)- has been prevalent for more than a decade, mainly among the group of men who have sex with men. By the end of 2010, data of a serious increase of HIV infections among PWID were documented, for the first time during the epidemiological surveillance period. Page 8

9 HIV cases among People Who Inject Drugs The first annual epidemiological assessment of the situation after the first outbreak of the epidemic among PWIDs, showed an annual increase of positive HIV diagnoses in people who inject drugs by almost 1.500% in This was also the situation for 2012 and Page 9

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11 National Policy Plan-Priorities Main targets of the new National Drug Policy Plan: 1. Increase of treatment availability with new OST units within state hospitals, in order to eliminate the waiting list and to reduce the risks among PWID 2. Increase of existing health promotion interventions of low threshold services (NSP/Needle Syringe programs in collaboration with NGOs) 3. Targeted harm reduction interventions and actions for specific drug populations Page 11

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13 2.2. Needles-syringes and condom distribution in Athens Metropolitan area Page 13 The annual coverage per year per addict increased from 7 needles to 140

14 SUPERVISE DRUG-USE FACILITY The launching of drug consumption rooms was primarily based on the need to control problematic drug use, which was associated with overdoses and the transmission of blood borne viruses. At the same time the consumption rooms offered an alternative to drug use that was made in public. Page 14

15 Public Awareness Campaign Campaign targeted among others to highlight the necessity of the harm reduction programmes and the fact that their implementation is of equal importance as compared to other interventions within the treatment system Response to the HIV/PWID epidemic

16 Police-staff Training in Drug Related Issues Interventions for the cooperation and interaction between treatment and police systems: police staff sensitization to drug related problems Response to the HIV/PWID epidemic

17 Pilot Project for Measures Alternative to Imprisonment Implementation of measures alternative to imprisonment as an effective way to reduce crime and other substance-related problems including HIV risk Response to the HIV/PWID epidemic

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19 Pilot OST in Prison Interventions for HIV prevention in prisons The first OST programme in Greek prison started in September 2014 Response to the HIV/PWID epidemic

20 DRUG USERS IN PRISON Prisons are an important component of the overall response to drug problems. Prisons offer drug users an opportunity to reflect and engage with health/drug services. Prison Services have become a leader in engaging new patients into drug treatment.

21 DRUG USERS IN PRISON Prisons should be viewed as part of the continuum of care for drug using clients. The building of trust and links between prisons and the wider community offers prisoners the best chance of success on release. Drug Treatment developments in prisons are contributing to a reduction in the incidence of post release overdoses.

22 Drug treatment Saves lives Prevents from diseases Reduces crime and deaths

23 Drug treatment is cost-effective NICE: drug dependence treatment is cost -effective In drug dependence treatment saved for the NHS and averted over 300 deaths at a value of NTA, Why invest, How drug treatment and recovery services work for individuals, communities and society, 2012

24 WHO estimated a return of 7 to 12 times the cost for pharmacologically assisted treatment (OST) Crime Justice costs Crime Justice costs + Health costs WHO, Joint UN Programme on HIV/AIDS (UNAIDS) and UNODC. Position Paper: Substitution Maintenance Therapy in the Management of opioid dependence and HIV prevention, 2004

25 In California, return on investment for treatment was estimated at 7:1 Cost - $ per person Benefit + $ per person for society Ettner S.L. et al, Cost benefit in the California Treatment Outcome Project: does substance abuse treatment pay for itself?, Health Research and Educational Trust 41 (2005):

26 Economic Recession and Policy responses (1) 1. Ensuring essential services 2. Decide about priorities 3. Combating stigma, discrimination and social exclusion of drug users 4. Investing in building social support and recovery networks 5. Strengthening national and international cooperation

27 Economic Recession and Policy responses (2) 6. Assistance to address the impact of austerity measures in countries faced with economic crises 7. Investing according to cost effectiveness 8. Involvement of patients in the therapeutic contracts 9. Less war on Drug more human approaches 10. Less ideology more science

28 Athens University Medical School Thanks for your attention MENI MALLIORI Assoc. Prof. of Psychiatry