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Where is Catalonia ?Territory: 32.000 km2Population: 7.000.000Own language and culture
Barcelona
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Causality of deaths among men and women between 29 and 39 years in Catalonia 1983-2003
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ECDC & EMCDDA GUIDANCE. Prevention and control of infectious diseases among people who inject drugs. October 2011
7 Key interventions1. Access to syringes and injecting
material2. Treatment for drug addiction: Opiates
substitution treatment3. Vaccinations4. Screening of infections5. Treatment of Infectious diseases6. 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,...
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Effectiveness depends on Coverage
You need good coverage and accessibility
Percentage of opioid-dependent people on OST
Low 20% Mid 40% High
WHO, UNODC, UNAIDS TECHNICAL GUIDE for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users2012 REVISION
Number of needles–syringes distributed per PWID per year
Low 100 Mid 200 High
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11
2698
3709
5116
6274
73207915
8480 84418334885889458931
500
1500
2500
3500
4500
5500
6500
7500
8500
9500
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
PEOPLE ON MMT
Annual breakdown
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Coverage of NSP. Syringes distributed from 1993 to 2011
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Law 20/1985 of July the 25th, on prevention and treatment of addictive behaviour:
– Drug addiction is an ordinary disease – It does not make differences between
legal and illegal drugs regarding care provision
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REACH A HIGH LEVEL POLITICAL CONSENSUS:
• Not use drugs for political aims what prevent from getting stuck in ideological (and moral) discussions and focus on scientific based and pragmatic approaches
Two parliamentarian (1996 and 2006) agreements passed by unanimity of all political parties
Pre contemplation
Contemplation
Preparation
Action
Maintenance
Relapse
Stage of Changes
Prochaska J.O. & DiClemente C.
Harm reduction
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– Opioid substitution therapy: Methadone– Syringe exchange programmes – Prisons: NSP and methadone in all prisons and all wings– Outreach work: Street work, Mobile units, Peer involvement,…– Low threshold centres (drop in) with social and health care– Supervised consumption rooms – BBV tests & counselling (rapid tests) + HBV/HVA vaccinations– Access to HIV and hepatitis treatment– Health care workshops for active drug users: Safe injecting, safer
sex, overdose prevention and response– Promotion and support of drug users and patient organisations– Heroin trial
HARM REDUCTION INTERVENTIONS IN CATALONIA
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People on Substitution TherapyYearly breakdown
High coverage: > 60% of opiate drug users
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SPAIN: NUMBER OF PEOPLE ON METHADONE AND PERCENTAGE OF THE TOTAL INMATE POPULATION
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Syringes distributed from 1993 to 2011 in Catalonia
Mid coverage: just over 100 syringes x IDU x year
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X
NSP in Prisons: Starting up year by prison in Catalonia
Overdose prevention programme2009-2013
Professionals trained
Drug users trained
Kits distributed
HRS 614 2049 4383
DTC 162 891 897
TTCC 231 1798 0
TOTAL 1.007 4738 5280
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Drug addiction care and treatment network
Drop in: 14 (10 Drug Consumption room.)Mobile Units: 6 ( 3 DCR)Street work: 8(DCR: 13)
Drug treatment centres
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Therapeutic C.Units: 18Places: 392
Detox units: 11Beds: 64
Dual Diagnosis Units: 6Crisis Units: 1
Social rehabilitation centres:28 day centres and social rehabilitation schemes18 rehabilitation apartments132 Places on rehabilitation apartments
Safe consumption rooms
Number of consumptions 2007 - 2014
Safe consumption rooms
Number of people 2007 - 2014Between 37-44% are foreigners
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Some impacts of these strategies
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757113613
41681881
1093 1429
257 8660
2000
4000
6000
8000
10000
12000
14000
No
mb
re u
su
ari
s
Heroin Cocaine
Admissions to treatment for the first time
Admissions to treatment
Drug users in treatmentEstimation of problem drug users
Retention in treatment of opiate users in the city of Barcelona
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1993 1998 2002 2008 20120
10
20
30
40
50
60
70
80
90
Injecting risk Behaviours (last 6 months)
Injected with an used syringe Passed on a used syringeShared paraphernalia
%
Injecting drug users attending Harm reduction facilities
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HIV infection cases by transmission route. Catalonia 2001-2013
La estimación de la incidencia del VIH entre nuevos inyectores (que hace 5 años o menos que se inyectan) es de 8,71/100 casos por año y de 25,6/100 en el caso del VHC. (Folch C, 2012)
Prevalence among IDU recruited from Harm Reduction Facilities (antibody test – HIV & HCV)
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AIDS cases by transmission route. Catalonia 1981-2013Acces to ARV treatment
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Mortality by overdose in the city of Barcelona, 1990-2012
0
20
40
60
80
100
120
140
160
180
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
2012 s
et
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18
15
,7
11
,3
10
,7
9,6 9
8,3
5
33
,7
31
,8
28
,1
24
,3
21
,7
20
,8
19
,6
0
5
10
15
20
25
30
35
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Prevalence of antibodies of HIV & HCV in the Catalan prisons: 2006-2012
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14 drop in centres
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13 supervised consumption rooms (2 with smoking room)
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6 mobile units
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8 street work teams
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6 teams provide health prevention trainings:
•Safer sex,
•Safe injecting,
•Overdose prevention
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What we learned
– Addiction is a chronic disease (diabetes, asthma, hypertension,...)
– Treatment is effective but only abstinence based treatment: Low contact and retention in treatment
– Injecting drug users are exposed to very important health risks (HIV, Hepatitis C & B, overdoses,...)
– Success in care with a drug users is not only abstinence– The longest the time you are in contact with the drug user
the better the outcome: Put in place services & strategies to keep in touch with them
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Challenges we face now
• We need Heroin Assisted Treatment• NSP in prisons still face a big opposition: Low
coverage• Access to hepatitis C treatment• Drug users stigmatisation (Nimby attitudes still
impinge the implementation of services and programmes)
