Provision of harm reduction and drug treatment services in custodial settings – Findings from the European ACCESS study

<p><i>Aims</i>: The aim of the study was to survey the availability, coverage and quality of harm reduction and drug treatment services delivered to drug users in prisons across Europe. <i>Methods</i>: A survey was conducted between 2012 and 2013 among the 29 European countries. An electronic semistructured questionnaire was sent to the national institutions responsible for prison services, and 27 countries responded. In addition, good practice interventions for drug offenders have been collated by 15 national experts covering 15 European countries. The interventions were described and assessed as to their quality through using European monitoring centre for drugs and drug addiction (EMCDDA) standard tools for reporting and quality assessment. <i>Findings</i>: Drug treatment including detoxification and opioid substitution treatment (OST) is available in prisons of most European countries. However, OST is unavailable in five countries. Almost all countries provide prison-based harm reduction measures to prevent and treat infectious diseases among prisoners. Especially, testing and treatment for HIV and tuberculosis are provided, while other measures, such as the distribution of condoms or bleach, and especially needle and syringe programmes are still rare. <i>Conclusions</i>: Access to and coverage of OST in prisons is higher in countries with a long history of OST provision, while in countries that introduced OST more recently the scale of OST is usually lower. Access to hepatitis C treatment is often limited in prisons due to the lack of drug abstinence or a health insurance.</p

Different phases of ATS use call for different interventions: a large qualitative study in Europe.

BACKGROUND: Amphetamine-type stimulants (ATS) are globally widely used. Scientific literature generally defines four phases of substance use (initiation, continuation, increase and decrease); however, there is limited understanding of what influences these different phases of ATS use. The ATTUNE study investigated which factors shape individual phases of use, or ATS use patterns. In this article, we report on these phases into and out of ATS use, and propose a set of recommendations for prevention, harm reduction and treatment of the different phases of ATS use. METHODS: Qualitative, semi-structured interviews (n = 237) were conducted in five different European countries with participants who had used ATS, varying from a few times in a lifetime to daily. RESULTS: Amphetamine and MDMA were the most commonly used ATS. Yet, types of ATS used differed between the countries. We found that people who use ATS have various motives for and dynamic patterns of ATS use with alternating phases of increase, continuation, decrease and sometimes dependence. Cessation was pursued in different ways and for diverse reasons, such as mental health problems and maturing out. Availability seemed not an issue, regardless of the type of ATS, phase or country. CONCLUSIONS: These findings demonstrate that tailor-made interventions are needed for the diverse types of people who use ATS and different phases or patterns of ATS use, to reduce possible harms of use. We recommended a set of interventions for the different ATS phases. These include drug checking services, peer-led information, self-management of ATS use, mental health support to help people cope with stressful life events and prevent uncontrolled use, and follow-up support after treatment

Female Drug Users in European Prisons - Best Practice for Relapse Prevention and Reintegration

The 12-month study bases upon a multi-site research and provides an overview on current prison policy and practice directed to adult female drug users in European prisons. One of the main objectives of the study was to fill the information gap as regards 1. the prevalence of this specific prison population and 2. the availability of drug services for this population across Europe. The second main objective was to investigate female drug users in selected prisons of the five participating European study centres with regard to their utilisation of available drug services in order to assess prison programmes due to “best practice” for relapse prevention. The participating study centres were;- Hamburg and Bremen, Germany; Barcelona, Spain; Glasgow, Scotland; Warsaw, Poland; and Vienna, Austria. To conduct the project, a multi-method research strategy was developed which consists in structured questionnaires with Ministries of Justice and with adult female drug users in prison, document analyses and oral information from prison authorities and service providers. This executive summary presents the major results of the literature review database generated from the “Prison Services Survey Questionnaire” among the Ministries of Justice of all 25 European Union member states, database generated from the structured questionnaires with 185 adult female drug using prisoners, which have been interviewed face-to-face in altogether ten prisons of the five participating centres

Female Drug Users in European Prisons - Best Practice for Relapse Prevention and Reintegration

The 12-month study bases upon a multi-site research and provides an overview on current prison policy and practice directed to adult female drug users in European prisons. One of the main objectives of the study was to fill the information gap as regards 1. the prevalence of this specific prison population and 2. the availability of drug services for this population across Europe. The second main objective was to investigate female drug users in selected prisons of the five participating European study centres with regard to their utilisation of available drug services in order to assess prison programmes due to “best practice” for relapse prevention. The participating study centres were;- Hamburg and Bremen, Germany; Barcelona, Spain; Glasgow, Scotland; Warsaw, Poland; and Vienna, Austria. To conduct the project, a multi-method research strategy was developed which consists in structured questionnaires with Ministries of Justice and with adult female drug users in prison, document analyses and oral information from prison authorities and service providers. This executive summary presents the major results of the literature review database generated from the “Prison Services Survey Questionnaire” among the Ministries of Justice of all 25 European Union member states, database generated from the structured questionnaires with 185 adult female drug using prisoners, which have been interviewed face-to-face in altogether ten prisons of the five participating centres

Factors shaping different trajectories of amphetamine-type-stimulant use: a systematic review of qualitative research

Background Amphetamine-type stimulants, including amphetamine, methamphetamine, MDMA, and some novel psychoactive substances, are increasingly popular drugs in the UK and globally. Yet there is limited evidence on what shapes use of amphetamine-type stimulants across the life course. We aimed to systematically review and synthesise recent qualitative literature examining users' perspectives on which factors influence different trajectories of amphetamine-type-stimulant consumption. Methods We searched MEDLINE, PsycINFO, EMBASE, and ProQuest Social Sciences Premium Collection, between Jan 1, 2000, and Oct 31, 2016, for qualitative research exploring the views of amphetamine-type-stimulant users aged 13 years and older on factors shaping their drug use careers. Only peer-reviewed articles, readily available in the public domain, were retrieved for further review. Two reviewers independently screened potential papers and extracted key data. Thematic synthesis focused on identifying individual, social, and environmental factors relating to initiation, continuation, escalation, and desistance of amphetamine-type-stimulant use. The Critical Appraisal Skills Programme checklist was used to assess methodological quality. Findings We identified 1694 records, of which 42 papers met our inclusion criteria. 31 studies were rated as being of moderate methodological quality, nine high quality, and two low quality. The literature was internationally diverse, covering North and South America, Europe, Australasia, and southeast Asia. Participants were aged 14–58 years and from varied socioeconomic and demographic groups. Reasons for initiation included: to help manage the transition from opioids; to boost performance at work, college, in sexual relationships, or the home; to promote a sense of social belonging; and to help manage stress. Similar reasons motivated continued use of amphetamine-type stimulants, combined with the challenge of managing withdrawal effects in long-term users. Increased tolerance, experiencing a critical life event, or both contributed to an escalation in use. Reasons for desistance focused on: increased awareness of the negative health impacts of long-term use, particularly during pregnancy; disconnecting from social networks or relationships; and financial instability. Interpretation To our knowledge, this is the first review of qualitative international literature on amphetamine-type-stimulant use trajectories. The findings underline both the heterogeneous nature of these users, and the diverse social, economic, and individual factors that shape different patterns of use. This information will support the development of more tailored, evidence-based treatment and prevention services in the future. Funding This report is independent research commissioned and funded by the Department of Health's Policy Research Programme (Grant ATTUNE: Understanding the pathways for stimulant use; ref ST-0416-10001)

Using life course charts to assess and compare trajectories of amphetamine type stimulant consumption in different user groups: a cross-sectional study.

BACKGROUND: Amphetamine-type stimulants (ATS) are the second most commonly used illicit drugs in Europe and globally. However, there is limited understanding of what shapes patterns of ATS use over the life course. The ATTUNE project "Understanding Pathways to Stimulant Use: a mixed methods examination of the individual, social and cultural factors shaping illicit stimulant use across Europe" aims to fill this gap. Here we report initial findings from the life course chart exercise conducted as part of qualitative interviews with ATS users and nonusers. METHODS: Two hundred seventy-nine in-depth qualitative interviews were conducted with five ATS user groups (current and former dependent users;current and former frequent users;non-frequent users) and one group of exposed non-ATS users in five European countries (Germany, UK, Poland, Netherlands and Czech Republic). As part of the interviews, we used life course charts to capture key life events and substance use histories. Life events were categorised as either positive, neutral or negative, and associated data were analysed systematically to identify differences between user groups. RESULTS: Out of 3547 life events documented, 1523 life events were categorised as neutral, 1005 life events as positive and 1019 life events as negative. Current and formerly dependent ATS users showed more negative life events for the entire life course after age adjustment. Although some group differences could be attributed to the individuals' life course prior to first ATS use, most negative life events were associated with periods of ATS usage. A detailed analysis of the specific life domains reveals that dominantly, the social environment was affected by negative life events. CONCLUSIONS: For non-dependent, frequent and non-frequent ATS users, negative life events from the period of ATS use do not become obvious in our analysed data. Besides preventing a pathway into ATS dependency, the aim of an intervention should be to reduce the harm by for example drug testing which offers also the opportunity for interventions to prevent developing a substance use dependency. For the group of dependent ATS users, our study suggests holistic, tailored interventions and specialist treatment services are needed, as a single, simple intervention is unlikely to cover all the life domains affected