Recent trends in drug problems and service provision in Greece

Transcription

1 Recent trends in drug problems and service provision in Greece Anastasios Fotiou Epidemiology Unit The Greek Reitox focal point of the EMCDDA at the Understanding the dynamics, nature and scale of drug use in Europe lessons learnt and the challenges for the future Session 3 Basing policies and responses on a sound understanding of the drug problem the role and the value of monitoring Lisbon September 2015

2 Trends in drug problems in Greece ~ people (2.2 / 1000 people aged 18-64) abuse opiates ~1/3 are current injectors ~5 000 people enter treatment annually ~3/5 are past treatments ~9 000 people are in the main treatment phase, mainly in OST Opioids responsible for ~3/4 of the treatments offered annually Most entries in drug-free settings(also among opiate users). Long waiting lists for entry in OST in Athens. ~20% of PWID entering treatment report recent sharing of injecting equipment 65-73% the HCV antibody prevalence, higher in Athens and especially among first-ever treatments, young, and new injectors HIV prevalence of ~15%, an epidemic concentrated in Athens

3 In the case of Greece monitoring data are by no means the key drivers of large changes in service provision, but they are present when windows of opportunity emerge

4 I will 1. give two examples of large-scale changes in drug related service provision that took place in Greece during the last 3 or 4 years 2. explain the main drivers of these changes, and 3. illustrate the role of monitoring data in these processes

5 Example #1 The post-2010 expansion of OST

6 Example #2 The post-2011 expansion of NSP 30 Number of NSP units 400 Number of needle / syringe programs (NPs) Number of sterile syringes per current injector per year Number of sterile syringes per current injector per year

7 Example #2 The post-2011 expansion of NSP ODYSSEAS - the first supervised injection facility was established in Greece

8 The context prior to 2011 Harm reduction = a highly contested topic in a public discourse dominated by critics NSP: with low coverage and therefore a low profile OST: Popular among opioid users Should not be considered as treatmentmode ( therapy ) Sites that produce public nuisance Long waiting list for entry ( The List of Shame, a salient issue, opportunistically treated by the media, e.g., overdose deaths) Despite criticisms, OST was established as a necessary evil, but fears of community reactions coupled with budgetary cutbacks resulted in inertia

9 Two questions What have been the drivers of these changes? And, What has been the role of the monitoring data in these changes?

10 A window of opportunity in 2011 A sharp increase in the number of new HIV diagnoses involving injection drug use in Athens, in 2011 = an HIV outbreak HIV infections associated with injecting drug use, N HIV infections associated with injecting drug use, N % of HIV infections with injection drug use as the probable route of transmission 3,5 2,7 2,1 3,1 3, , , , , %of HIV infections with injection drug use as the probable route of transmission

11 Three conditions were right 1. New actors got involved (power scientific elites, e.g., UoA, EMCDDA, ECDC, NGOs) NSP 2. The issue became salient in the media 3. Key domestic NSP and OST policy advocates attached OST their old or new ideas to an emerging problem As a result, NSP and OST suddenly defined differently, they were re-framed: more harm reduction than therapy from being problems, they became (part of) the solutions ART

12 Monitoring data which gained salience Infectious diseases data (DRID) New HIV diagnoses HIV and HCV antibody prevalence in PWID and subgroups Behavioural data (DRID/TDI) Main substance of abuse New substances of abuse Years / frequency of injection Sharing of injecting equipment Condom use Treatment data (treatment) OST units and capacity OST waiting list / waiting time Harm reduction data NSP units, syringes and coverage Socio-demographic (TDI/DRID) Gender Age Homelessness Nationality High-risk drug users (HRDU) Recent estimates of HRDU HRinjectionDU Geographical stratification

13 In pursuit of sustainability As of 2015 Monitoring data have multiple new uses, meanings, and recipients, while also they have been handled in combined forms (multiindicator perspective) By contrast Due to underfunding interventions have been either scaled-down or discontinued from 2014 onwards

14 Thank you for your attention!

15 Supporting slides

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