THE DANISH HARM REDUCTION MODEL

THE DANISH HARM REDUCTION MODEL

OUTLINE 1. Drug use and drug prblems in Denmark. 2. Danish drug plicy. 3. Danish harm reductin plicy. 4. Drug cnsumptin facilities.

DANISH DRUG POLICY Drug plicy can be seen as part f the distributin and management f risks and resurces in sciety (Benit 2003; Hubrg & Bjerge 2011). The Danish welfare state has a cmprehensive scializatin f scial risks and redistributin f resurces t prevent and alleviate scial inequality and scial marginalizatin. But what abut Danish drug plicy? Hw des it affect the distributin f risks and resurces in Denmark?

DRUG USE IN IN DENMARK (SOURCE: NATIONAL BOARD OF HEALTH, 2014) Used cannabis 1994 (n=2521) 2000 (n=6878) 2005 (n=4440) 2008 (n=2219) 2010 (n=5748) 2013 (n=5013) Last mnth 2,4 4,3 4,0 3,5 3,5 4,6 Last year 7,4 9,8 8,4 9,1 8,9 12,2 Ever 37,2 42,4 46,1 45,1 41,5 44,2 Used ther drugs 1994 2000 2005 2008 2010 2013 Last mnth 0,2 1,2 1,1 1,1 0,9 1,0 Last year 0,5 3,4 2,7 3,6 2,4 2,6 Ever 4,4 11,3 13,5 13,4 12,5 13,6

DRUG USE AND SOCIO-ECONOMIC STATUS Cannabis use past 30 days and sci-ecnmic status (15-79 lds, Center fr Drug and alchl research, 2011) 5

PROBLEMATIC DRUG USERS AND DRUG USERS IN TREATMENT Prblematic drug users: 33.000 (2009) Injecting drug users: 13.000 (2009) Treatment registered: 16.200 (2011) Substitutin treatment registered: 7.050 (2011) (Surce: Natinal Bard f Health, 2014)

DRUG PROBLEMS AND SOCIO-ECONOMIC STATUS Sci-ecnmic status f peple in drug treatment 2011 (n=5.686) Emplyed 10% Unemplyment benefit 3% Scial assistance 44% Disability pensin 11% Other/n infrmatin 31% Own dwelling 53% 7

DRUG-RELATED 1985-2014 (NATIONAL BOARD OF HEALTH, 2015)

MODERN DANISH DRUG POLICY 1955: Law n Euphriant Substances criminalizes pssessin f illicit drugs fr wn use. Sick middle/upper class mrphinists and deviant /criminal underclass euphmaniacs. 1960s-1970s: Demand fr and use f illicit drugs cnstructed and treated as a nrmal scial prblem. 1969: Increased criminal penalties fr prfessinal drug ffences accmpanied by depenalizatin f pssessin f illicit drugs fr wn use. A dual drug plicy as idelgical basis fr Danish drug plicy: Supply reductin trugh criminal justice plicy Demand reductin thrugh welfare plicy: scial refrm, preventin, (scial) treatment

HARM REDUCTION POLICY 1970s-1980s: grwing ppulatin f ld prblematic drug users excluded frm r nt seeking drug treatment and excluded frm scial services fr marginalized citizens. 1984: Natinal Advisry Cuncil n Drug Plicy recmmends a change f treatment plicy frm primarily abstinence-riented scial treatment t graduated gals: Reduce burdens/harms and increase resurces f drug users. Prvide help, care and treatment t active drug users. Methadne maintenance treatment accepted as treatment instrument. Harm reductin/graduated gals as a means t cmbat scial exclusin f drug users.

ZERO-TOLERANCE 2004: New drug legislatin repealed de-penalizatin f pssessin f illicit drugs fr wn use and intrduced zer-tlerance plicy n pssessin f drugs. Exempted: pr addicted drug users can get cautin instead f fine.

HEROIN ASSISTED TREATMENT (HAT) Debated frm early 1990s t 2009 when new legislatin allwed HAT n prir trial. HAT in fur Danish cities. Evaluatin 2013 (NBH): 252 clients 2010-2012 70 clients left treatment Psitive results: Significant reductin f risk-behaviur and use f illicit drugs Significant reductin f infectins etc. Reduced criminal activities Imprved scial cnditins

HEROIN ASSISTED TREATMENT (CONT.) Initially nly intravenus herin, but since 2013 als tablets. Patients experience a calmer everyday life when nt having t wrry abut getting drugs. Patients find treatment t restrictive all cnsumptin f herin at clinics under supervisin. Staff emphasise clinical set up and supervisin t distinguish treatment frm mere drug destributin. Less emphasis n scial treatment.

DRUG CONSUMPTION FACILITIES Debated frm early 1990s t 2012 when legislatin allwed drug cnsumptin facilities. Municipalities can establish drug cnsumptin facilities under authrizatin frm the Minister f Health. Requires agreement with lcal plice abut defining the area where prhibitin against pssessin f illicit drugs fr wn use will nt be enfrced fr users f the facilities. Tday drug cnsumptin facilities in three cities, largest facility in Cpenhagen.

FROM PROHIBITION ZONES (VESTERBRO, COPENHAGEN)

TO NON-ENFORCEMENT ZONE

POLICING THE DRUG SCENE The lcal plice and the municipality have made a partnership abut hw t regulate the drug scene at Vesterbr. A lcal plice unit is n call fr lcal residents and busniesses and regularly patrls the area. The main task is t maintain rder and prvide service, nt t enfrce the law. Includes plicing the drug scene itself, e.g. by remving aggressive and intimidating peple t allw all drug users t access the facilities.

A COMPREHENSIVE POLICY The drug cnsumptin facilities are part f a cmprehensive plicy t create c-existence between drug scene and cmmunity that includes a number f different measures. Increased fcus n remving drug related litter. Regular cleaning and disinfecting f drug places. Outreach scial wrkers. Lw threshld scial and health services. Regular meetings between residents, plice, scial wrkers, staff frm drug cnsumptin facility.

RESULTS OF DRUG CONSUMPTION FACILITIES Evaluatin by the Ministry f Health 2015 (natinal): 2012-2014: 4.372 unique users 2014 alne: 3.564 unique users. 2012-2014: 355.255 instances f drug cnsumptin 2014 alne: 199.075 instances. 301 verdses treated, nne fatal. Significant reductin f public drug use. 70-80% reductin f drug related litter (Cpenhagen). Issues abut lcatin f drug cnsumptin facilities.

REDUCED RISK BEHAVIOUR (KINNARD ET. AL 2014) (N=41, COPENHAGEN) 75.6% reprted reductin f injectin risk behaviur after pening f facility (less rushed injectin, fewer utdr injectins, n syringe sharing, cleaning skin mre ften). 58.5% reprted changing syringe dispsal practices. 61% f the uses had utdrs as main place f drug use befre the facility pened.

A rather regular grup that has made the facility their primary place f use (User evaluatin, Cpenhagen, 2013, n=56). Frequency f use f facility: Several times a day: 52.8% Once everyday: 7.5% A cuple f times a week: 20.8% A cuple f times a mnth: 3.8% N particular frequency: 15.1% Places f use: Facility: 52% Hme: 21.8% Public space: 21.8% Other: 3.6%

MUNICIPAL RESIDENT SURVEY, COPENHAGEN (2015) (N=435) Once a week r mre Few times a mnth Municipality f Cpenhagen, cmmunity survey (2015) Once a mnth r less Never Fund drugrelated litter Seen public injectin 21.7% 18.4% 31% 27% 31% 23.9% 28.6% 15.4% Seen drug dealing 45.9% 21% 16.1% 12.8% Experienced nuisance 33.6% 16.1% 19.1% 27.7%

MUNICIPAL SURVEY (CONT.) I feel safe in relatin t drug users There shuld be rm fr drug users Cmpletely disagree 14.9% 12.8% Disagree 16.3% 8.5% Neither agree nr disagree 25.5% 16.1% Agree 30.7% 35% Cmpletely agree 11.6% 26%

HARM REDUCTION IN A PROHIBITIONIST REGIME Drug use is tday less handled as a scial prblem and mre as either a mral prblem r a medical prblem deviant recreatinal drug users r sick prblematic drug users. Expanded drug treatment and entitlements as well as advanced harm reductin services (significant lcal differences) t help prblematic drug users. Increased criminalizatin f all ther than pr addicted drug users (and ften even thse als). Risk f criminalizatin fr pssessin f illicit drugs largest if yur are: yung unemplyed man wh live n scial benefits and have a criminal recrd (ften drug pssessin). Same segment mainly at risk f develping regular and smetimes prblematic use f illicit drugs.