Public drug policies Catalonia

Transcription

1 Public drug policies Catalonia Public Health Agency of Catalonia Xavier Majó Roca

2 Catalonia Barcelona Territory: km2 Population: M Own language and culture

3 1. What s happened in Catalonia in the 80s 90s? 3

4 Mortality evolution by cause in Catalonia, Men and women aged 20 to 39 4

5 AIDS cases by transmission groups Catalonia

6 Costs of HCV, HBV, HIV for 10 EU countries prior to HCV combination therapy

7 2. Why? 7

8 Costs of HCV, HBV, HIV for 10 EU countries prior to HCV combination therapy

9 People on Methadone Annual breakdown

10 Needle Exchange Programme Coverage

11 Intervention Programme on Substance Abuse 11

12 What s the intervention modelin Catalonia? Public health perspective Public Health and Human Rights Perspective: Health maintenance and improvement of life quality Motivation to change (Proschaska and Di Clemente model) Diversity of services. Empowering drug users Magic and religious rituals Moral paradigm Healthcare model Health public model

13 The programme on Substance Abuse The Programme on Substance Abuse of the Government of Catalonia is in charge of drug policy planning, implementation and evaluation in the Region of Catalonia in Spain. Main objectives of the Programme: Surveillance of drug use and abuse and the morbimortality related to the use of drugs Definition of policies to deal with the problems related to drug consumptions and to treat people with substance disorders Financing drug resources to prevent, treat and reduce the harm related to drug use Evaluate the measures implemented in Catalonia.

14 Introducció Planning Tools MENTAL HEALTH DIRECTOR PLAN Assessment, planification and coordination tool about: Mental health promotion Prevention and treatment of mental and substance disorders and Prevenció i el tractament de les malalties associades amb la salut mental i les addiccions, Millora de la qualitat de vida dels afectats. PREVENTION PLAN IN CATALONIA DRUGS USE AND ASSOCIATED PROBLEMS Recull l estratègia nacional de prevenció del consum de drogues i problemes associats a Catalunya

15 Intervention areas Harm Reduction Harm reduction Based on a Public Health Model Programs: To prevent the risk of infectious diseases and overdoses between people who inject drugs. Working areas:; HR programs (NSP, OST, Overdose Prevention, DCRs, outreach work, HIV/HCV testing and access to treatment, Treatment Coordination of the Drug addiction care and treatment network (XAD). Prevention PROGRAM ON SUBSTANCE ABUSE Epidemiology Prevention programs: To reduce the prevalence of drug consumption. To delay the onset age of drug consumption. To avoid risky behaviors of experimental, occasional and regular drug users. Minimize the harms associated on drugs addiction. Working areas: community, family, working, education, leisure, health. Drug Dependence Information System in Catalonia (SIDC): Monitoring drug care centers (including HR services) School and household surveys Drug related Mortality Drug related Emergencies Infectious disease prevalence among PWID

16 Drug addiction care and treatment network Drop in centres: 16 (12 Drug Consumption room) Mobile Units: 6 (3 with DCR) Street work: 11 Detox units: 11 Beds: 65 Drug treatment centres 59 Therapeutic C. Units: 20 Places: 596 Dual Diagnosis Units: 5 Crisis Units: 1 Social rehabilitation centres: 12 day centres and 21 social rehabilitation schemes 140 Places on rehabilitation apartments 16

17 7 Key interventions ECDC & EMCDDA GUIDANCE. Prevention and control of infectious diseases among people who inject drugs. October Access to syringes and injecting material 2. Treatment for drug addiction: Opiates substitution treatment 3. Vaccinations 4. Screening of infections 5. Treatment of Infectious diseases 6. Health Education: safer injection, safer sex, BBV prevention,. 7. Combined interventions adapted to drug users and to the local conditions: outreach work, drop in centres, drug consumption rooms,... 17

18 Harm Reduction interventions in Catalonia Opioid substitution programme: people Syringe exchange programme (also in prisons): syringes/year Outreach work: Street work, Mobile units, Peer involvement, Low thereshold centres (drop in) with social and health care. Blood Borned Viruses tests & counselling (rapid tests) + HBV/HVA vaccinations. Access to HIV and Hepatitis treatment Supervised drug consumption rooms: syringes/year Training in a more hygienic consumption, safer sex... Action plan in drug trafficking and consumption areas Access to Health care system for all drug users Heroin trial Overdose Prevention Programme professionals trained users trained and naloxone vials distributed. Promotion and support of drug users and patient organisations 18

19 1 Opioid Sustitution Therapy Programme (OST) People in OST Programme Where? Source: Subdirecció General de Drogodependències. Departament de Salut CAS Drug treatment centres Primary care centers Mental Health care centers Harm Reduction Hospitals Community pharmacies Therapeutic communities Prisons 2 nd centers Meeting, Barcelona, June 1 st and 2 nd June,

20 2 Syringe Exchange Programme Evolution of the amount of distributed syringes Where? CAS Drug treatment centres Primary care centers Harm Reduction centers Hospitals Community pharmacies Prisons 20

21 2 Injecting risk Behaviors (last 6 months) % Injected with an used syringe Passed on a used syringe Shared paraphernalia Injecting drug users attending Harm Reduction facilities 21

22 3 Outreach work: Street work Professionals, mainly social workers, that work outdoors, in areas of consumption and socially deprivate. 11 Street work teams working in situ with active drug users who don t go to harm reduction resources. Actions: Dynamise the project "Snowball". Pickup of injection material in public spaces. Coordination and referral to social and health resources. Health education. 22

23 3 Outreach work: Mobile units Main objective: bring the social health services closer to the consumption areas and with high risk exclusion. 6 Mobile Units (3 with Drug Consumption Room) Actions: multiple actions and plans Opioid substitution therapy (OST) Consumption rooms Exchange syringes programme (PIJ) Place for health care Socio-educational care Monitoring the HIV, hepatitis C and tuberculosis treatment Preventing overdose by opioids and/or psychostimulants 23

24 4 Low thereshold centres (drop in) with social and health care Social and health services for active drug users Main objective: minimize the damages and risks related to drug use 16 centres 10 Actions: Social care Consumption room Syringe exchange programmes Opioid substitution therapy HIV, TBC and HC screening Health education Prevention of opiate and psychostimulants overdoses 24

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26 5 Access to HIV and hepatitis treatment Main objective: Prevent, diagnose and facilitate the access to the treatment to those drug users infected by HIV and HCV. Actions: Training to professionals and users Edition of professional guides and awareness materials aimed at drug users. Awareness campaigns aimed to the general public. Monitoring of prevalence Early diagnosis (quick tests) Better Treatment for Ageing Drug Guidelines User to increase access to 2 nd Meeting, Barcelona, June 1 st and 2 nd June, Hepatitis 2017 C treatment for drug users 26

27 5 Prevalence among IDU recruited from Harm Reduction Facilities (antibody test HIV & HCV) The estimation of HIV incidence among new drug injectors (injecting during 5 years or less) is 8,71/100 cases/year and 25,6/100 in HCV cases (Folch C, 2012). 27

28 5 HIV diagnoses by transmission groups. Catalonia

29 6 Supervised drug Consumption Rooms Installations where people can consume with some privacy and under supervision of one or more professionals, who can help if necessary. Objectives: Preventing contagious diseases among its users. Preventing overdose. Facilitate the contact and the work with active drug dependence Facilitate the access to the treatment. Total: 12 9 in fix installations (2 with smoking room) + 3 in mobile units. 8 29

30 6 Supervised drug Consumption Rooms Material procured for the supervised consumption: Sterile syringe Distilled water Cup Filter Smart Alcohol pads 30

31 6 Supervised drug Consumption Rooms Number of CONSUMERS % are foreigners Better Injectors Treatment for Smokers Ageing Drug User 31

32 6 Supervised drug Consumption Rooms Number of CONSUMPTIONS Injections Better Treatment Smoked for Ageing consumptions Drug User 32

33 7 Training: Health care workshops for active drug users 6 teams provide health prevention trainings: Overdose prevention Safer sex, Safe injecting, 55 sessions/year More than 200 different users/year 34

34 8 Action plan in drug trafficking and consumption areas Demarcated areas or urban areas (neighborhood or set of streets) where there is all kind of consumptions in public places, mainly heroin and cocaine. Girona: 16 PIX points 1 HRS Often these areas are near traffic areas. Lleida: 1 HRS + 4 PIX points Reus: 2 HRS + 22 PIX points Constantí: 1 HRS + 1 PIX points Barcelona: 14 HRS + 70 PIX points El Prat de Llobregat: 2 HRS L Hospitalet de Llobregat: 1 HRS + 11 PIX points HRS: Harm Reduction Services: Harm Reduction Centers, Street work and/or Movbile units PIX points: Syringe Exchange programme (PIX) integrated in pharmacies, primary care centers, treatment centers, hospitals and Creu Roja Badalona: 1 HRS + 20 PIX points Sant Adrià de Besos: 1 HRS Gavà: 1 HRS + 4 PIX points 35

35 9 Access to Health System for all drug users. Immigrants without documentation. Guarantees access to public health and resources to treat drug addiction Active drug users by sex ( ) Women Men 36

36 0 Heroin Trial 37 37

37 11 Overdose prevention programme Programme to train drug users on overdose prevention and response. Drug users are trained by professionals in Drug Care Centres. Once trained, they are provided with a kit with naloxone professionals trained users trained naloxone vials distributed. 38

38 11 Mortality by acute adverse reaction to drugs. Barcelona

39 Drug user population Do get they older? 40

40 Admissions to treatment by main drug Treatment admissions by main drug % 12% 46% 14% 19% 4% Alcohol: 46% Cocaine: 19% Cannabis: 14% Heroine: 12% HEROÏNA COCAÏNA TABAC CÀNNABIS ALCOHOL ALTRES starts of treatment (2016) 41

41 Admissions to treatment by age Admissions to treatment by age de 71 a 99 anys 159 de 61 a 70 anys 706 de 51 a 60 anys 1893 de 41 a 50 anys de 31 a 40 anys de 26 a 30 anys de 18 a 25 anys de 11 a 17anys % males % females 52% over 40 y/o 42

42 Harmreduction services HRC users by age % 13% Over 40 y/o: % 35% 51% Under 39 years old y/o y/o Over 60 y/o HRC users 49% HRC users are over 40 y/o 43

43 Harmreduction services HRC users by residence statuts % 2% 3% 0% 3% 9% Houses, floors, apartments Homeless Occupied houses 41 % without or unstable residence 27% 54% Unstable accomodation Pensions,hotel,hostels Prison Another institutions Others, unknown xxxx % of them are more than 40 y/o 44

44 Visits in HRS by age visits (2016) 86 % males and 14 % females) Number of visits to HRS by age under 29 y/o 9% y/o 19% y/0 20% y/o y/o y/o 20% 14% 18% % visits: =+40 y/o 45

45 Drug users and homeless in Catalonia persons with unstable accomodation 31% (11.500) of them are homeless 40% of them with a mental disorder or addiction

46 Challenges Knowing more about the health and socials problems associated with the age becomes a priority: drugs users and/or people in treatment get older It s necessary to develop an specific attention plan for old drug users on an integral perspective. Nowadays the subject of this current European project is a challenge in Catalonia and surely in Spain: We have more and more ageing drug users (pick of the epidemic 80-90s) Many have chronic diseases (HIV / HCV epidemics), lack of education, not having worked much in their lifetime, Social benefits are very low in Catalonia: Only a rent of a month for people who have not worked. No housing, no food subsidies Support from parents. who are dying Economic crises means cuts on social benefits Positive thing: universal access to the health system, regardless of legal situation and tax contribution.

47 Thank you