route transition interventions encouraging switching from injecting and preventing its adoption
Workshop goals Briefly review a range of interventions that aim to reduce injecting Reflect on the ethics of intervention in this area of practice Discuss opportunities to develop services in Wales that: - Draw on our existing evidence and understanding
- Are relevant to the needs of people in Wales
- Might realistically be adopted within your service
Decrease incidence of injecting i.e. things that prevent or delay people from starting Increase outcidence i.e. increase the rate at which people wholly or partially stop injecting
Are our interventions right and proper?
Ethical considerations Are our interventions based on the goals and concerns of: - people who inject/those at risk of starting to or…
- someone else’s agenda?
Will our programmes increase stigma and discrimination? Does a focus on transitions interventions divert attention, energy & resources from more important work? Other unintended consequences?
Preventing initiation Psycho-educational programmes e.g. Casriel et al 1990, 1992, Roy et al in progress Break the Cycle e.g. Hunt et al 1998; PSI Uzbekistan, Kyrgyzstan, Viet Nam; “One shot” New South Wales; UNICEF/Aksion Plus/Stop AIDS, Albania; Scottish HCV strategy (in progress); “BTC/CTC (Change The Cycle)” Canada (in progress) Opioid substitution treatment – Timely OST for heroin dependent chasers/sniffers can prevent escalation to injecting Unintended consequences? OST can also be used to promote injecting if you make injecting an eligibility criterion for treatment!
Social marketing e.g. “It’s good to chase” HOT, East London; “Smoking Brown”, Lifeline Foil distribution e.g. Pizzey and Hunt 2008 Opioid Substitution Treatment…again
In first month of methadone treatment 25% stop injecting and a further 70% inject less often (Strang et al 1997) Higher doses are associated with stopping injecting (Capelhorn et al 1993) Effectiveness depends on the nature and intensity of other non-pharmacological treatment factors (Ball and Ross 1991) Methadone maintenance reduces injecting in prisons (Stallwitz and Stöver 2007) Do we currently provide our services in a way that optimises these outcomes?
Further opportunities? Social marketing aimed at Montreal street youth Drug consumption rooms ITEP/BTEI ‘New recovery’
Results Powerful, positive impact with the target population (non-injecting street youth) Unintended consequence – Some injectors also found the campaign useful because it caused them to reflect on their injecting Some injectors felt that the fear-based messages and images are too harsh and confrontational and expressed concerns that the campaign could be stigmatizing
Shortened injecting careers? Weekly use of safe injecting facility roughly doubles likelihood of entering detox. ‘Quarantine’ effect Can DCRs reduce mixing of people who inject with non-injectors and decrease the social transmission of injecting? Wood et al 2006, Attendance at safer injecting facilities and use of detoxification services. New England Journal of Medicine
ITEP/BTEI A “non pharmacological treatment factor”? ‘Nodal Link Mapping’ - potential maps (guided/free/hybrid) - Injecting pros and cons
- Injecting alternatives
- Injecting lapse/relapse
New Recovery: new opportunities to reduce injecting? New context and new zeal - We’ve never had this proportion of people who inject engaged in treatment
- We’ve never had this level of service coverage before
- We’ve never had a treatment workforce this size before
- Recovery is now central to our national strategies
- A recovery renaissance with a more mature engagement between harm reductionists and the recovery movement
- No-one has ever been here before
Are there new opportunities that a recovery orientation overlaying a harm reduction based treatment system can now bring?
Recovery Walk, Cardiff 10th September, 2011
Small groups
Which, if any, interventions seem to have most potential for: Actually being implemented
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