Monitoring quality and coverage of harm reduction services for people who use drugs: a consensus study.

BACKGROUND AND AIMS: Despite advances in our knowledge of effective services for people who use drugs over the last decades globally, coverage remains poor in most countries, while quality is often unknown. This paper aims to discuss the historical development of successful epidemiological indicators and to present a framework for extending them with additional indicators of coverage and quality of harm reduction services, for monitoring and evaluation at international, national or subnational levels. The ultimate aim is to improve these services in order to reduce health and social problems among people who use drugs, such as human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection, crime and legal problems, overdose (death) and other morbidity and mortality. METHODS AND RESULTS: The framework was developed collaboratively using consensus methods involving nominal group meetings, review of existing quality standards, repeated email commenting rounds and qualitative analysis of opinions/experiences from a broad range of professionals/experts, including members of civil society and organisations representing people who use drugs. Twelve priority candidate indicators are proposed for opioid agonist therapy (OAT), needle and syringe programmes (NSP) and generic cross-cutting aspects of harm reduction (and potentially other drug) services. Under the specific OAT indicators, priority indicators included 'coverage', 'waiting list time', 'dosage' and 'availability in prisons'. For the specific NSP indicators, the priority indicators included 'coverage', 'number of needles/syringes distributed/collected', 'provision of other drug use paraphernalia' and 'availability in prisons'. Among the generic or cross-cutting indicators the priority indicators were 'infectious diseases counselling and care', 'take away naloxone', 'information on safe use/sex' and 'condoms'. We discuss conditions for the successful development of the suggested indicators and constraints (e.g. funding, ideology). We propose conducting a pilot study to test the feasibility and applicability of the proposed indicators before their scaling up and routine implementation, to evaluate their effectiveness in comparing service coverage and quality across countries. CONCLUSIONS: The establishment of an improved set of validated and internationally agreed upon best practice indicators for monitoring harm reduction service will provide a structural basis for public health and epidemiological studies and support evidence and human rights-based health policies, services and interventions

Ekonomická analýza drogových trhů

Práce se zabývá ekonomickou teorií, výzkumem a ekonometrickými modely v oblasti nabídkové strany drogových trhů. Meta-analýza literatury ukazuje na základní východiska ekonomické teorie, které se v drogových trzích uplatňují, stejně jako na ekonomické teorie, které se k drogovým trhům explicitně vztahují. V oblasti empirického výzkumu rozděluje drogové trhy na primární, které jsou určeny zemědělskou produkcí surovin na výrobu nelegálních drog v rozvojových zemích, a na koncové, na kterých se v západním světě nelegální drogy z různých oblastí světa střetávají. Třetí rovinou výzkumných prací jsou modely drogových trhů, které pracují s minimálními daty a které poskytují predikce pro drogové politiky. Práce přináší základní doporučení pro výzkum drogových trhů, zarámované do metodologie ekonomické vědy, kontextu dostupných dat, základních výzkumných otázek a možností primárního výzkumu

Snižování rizik u transakcí na trhu s marihuanou v České republice a v USA - instituce přátelství

BACKGROUND: Economists depict illicit markets as violent, due to the lack of centralized property rights enforcement. At the same time, the importance of friendship networks and drug sharing is a recently documented feature of the marijuana market. Recent studies show an increased role of acquiring marijuana through friends, especially in settings where drug policy is rather punitive. This thesis extends this research into the norms that marijuana users attribute to their definition friendship. To do this, the thesis conceptualizes friendship as a type of institution that reduces the transaction costs on the market, and like that, it limits the decision making of marijuana market players. DATA: Marijuana market patterns in the Czech Republic and North-Central Florida were analyzed via both qualitative and quantitative research methods. For the purpose of the qualitative study, 44 (resp 66) study participants were marijuana users and retailers recruited at North-Central Florida (resp in the Czech Republic), with the use of respondent-driven sampling. Inclusion criteria into the study was the use of marijuana in the last 12 months. Semi-structured interviews, that took 80 minutes on average, followed an interview guide focused on marijuana use, sharing, purchases, sales and growing, with extensive probes on activities of respondents` "friends", as they defined them. As for the quantitative data, marijuana market modules from two representative general population surveys on substance use were used (CS 2008, NSDUH). METHODS: Qualitative data were analysed with the use of inductive analysis, and were framed into institutional economics theory. Quantitative data were analyzed with the use ordinary logit models. FINDINGS: The study has shown remarkable impact of drug policies on cannabis markets via comparison between the Czech Republic and the U. S. (North-Central Florida). The study findings suggest that users' definitions of friendship include expectations for behavior that sustain the distribution chain within the marijuana markets. Respondents provided definitions of friendship that contained norms on marijuana sharing and reciprocation, purchases for friends, and introduction to the dealer - for whom the term "friend" has been used as a synonym in most cases. In quantitative analysis, acquistion through a friend made significant reduction of price at last purchase in the U. S., approaving the hypothesis that friendship can be an effective institution to reduce transaction costs on the market. In the Czech Republic, such analysis was inconclusive. This demonstrates that the importance of friendship might be higher in countries where drug prohibition is more severe. CONCLUSIONS: Punitive drug policy provides incentives to shrinking the market into social networks, and like that, it imposes harms on users in terms of decreasing control over their substance use can criminal risks (larger amounts purchased, and the risk of detection to regular citizens, who serve as middlemen on the market without an intention to make profit). For more precise estimates, further surveys shall distinguish between different modalities of friendship, and between different product types

Snižování rizik u transakcí na trhu s marihuanou v České republice a v USA - instituce přátelství

BACKGROUND: Ekonomická teorie popisuje nelegální trhy, jako je násilné z důvodu nedostatku centralizovaného vymáhání vlastnických práv. Studie z poslední doby poukazují na význam přátelských vazeb na nelegálních drogových trzích, a to zejména v zemích, kde je drogová politika spíše represivní. Tato práce představuje přátelství jako instituci na drogovém trhu, která plní funkci snižování rizik. DATA: Data o marihuanovém trhu v České republice a na severu-centrální Floridě byly analyzovány pomocí kvalitativních i kvantitativních výzkumných metod. V rámci kvalitativní studie bylo realizováno 66 (ČR) a 44 (US) polo strukturovaných rozhovorů, které trvaly v průměru 80 minut. Rozhovory se zaměřovaly na užívání marihuany, její sdílení, nákup, prodeje a pěstování. Pokud jde o kvantitativní data, byly využity údaje z celopopulační studie užívání návykových látek (CS 2008, NSDUH ). METODA: Kvalitativní data byla analyzována s použitím indukčního analýzy a byla interpretována v rámci institucionální ekonomie a jejich teoretických východisek. Kvantitativní údaje byly analyzovány s použitím logit modelů. VÝSLEDKY: Studie ukázala významný vliv protidrogových politik na konopí trzích prostřednictvím srovnání mezi Českou republikou a USA (Severní Florida). Výsledky studie naznačují, že součástí definice přátelství mezi uživateli konopí jsou očekávání na chování v rámci distribučního řetězce na marihuanových trzích. Pravidla, která "přátelé" dodržovali, obsahovala normy týkající se sdílení a opětování marihuany, nákupy pro přátele a představení prodejce -- který byl rovněž označován za "přítele". V kvantitativní analýze v případě USA bylo prokázáno, že instituce přátelství může sloužit ke snižování transakčních nákladů, resp. ceny. V České republice srovnatelná analýza nepřinesla statisticky významné výsledky. V práci tak nebyla vyvrácena hypotéza, že význam přátelství může být vyšší v zemích, kde je drogová politika punitivnější. ZÁVĚR: Punitivní protidrogová politika poskytuje pobídky pro to, aby se uživatelé a prodejci konopí spoléhali na své sociální kontakty, které umožňují snižovat transakční náklady na nelegálním trhu. Tento způsob chování současně uvaluje škody na uživatele, u kterých je díky těmto mechanismům snižována kontrola nad vlastním užíváním omamných látek, a kteří podstupují značná trestně-právní rizika, aniž by v rámci trhu s konopím realizovali významnější zisky. Jedním ze závěrů studie je také to že by kvantitativní studie zaměřené na trh s konopím měly rozlišovat mezi různými druhy "přátelství" a měly by zahrnovat indikátor kvality.BACKGROUND: Economists depict illicit markets as violent, due to the lack of centralized property rights enforcement. At the same time, the importance of friendship networks and drug sharing is a recently documented feature of the marijuana market. Recent studies show an increased role of acquiring marijuana through friends, especially in settings where drug policy is rather punitive. This thesis extends this research into the norms that marijuana users attribute to their definition friendship. To do this, the thesis conceptualizes friendship as a type of institution that reduces the transaction costs on the market, and like that, it limits the decision making of marijuana market players. DATA: Marijuana market patterns in the Czech Republic and North-Central Florida were analyzed via both qualitative and quantitative research methods. For the purpose of the qualitative study, 44 (resp 66) study participants were marijuana users and retailers recruited at North-Central Florida (resp in the Czech Republic), with the use of respondent-driven sampling. Inclusion criteria into the study was the use of marijuana in the last 12 months. Semi-structured interviews, that took 80 minutes on average, followed an interview guide focused on marijuana use, sharing, purchases, sales and growing, with extensive probes on activities of respondents` "friends", as they defined them. As for the quantitative data, marijuana market modules from two representative general population surveys on substance use were used (CS 2008, NSDUH). METHODS: Qualitative data were analysed with the use of inductive analysis, and were framed into institutional economics theory. Quantitative data were analyzed with the use ordinary logit models. FINDINGS: The study has shown remarkable impact of drug policies on cannabis markets via comparison between the Czech Republic and the U. S. (North-Central Florida). The study findings suggest that users' definitions of friendship include expectations for behavior that sustain the distribution chain within the marijuana markets. Respondents provided definitions of friendship that contained norms on marijuana sharing and reciprocation, purchases for friends, and introduction to the dealer - for whom the term "friend" has been used as a synonym in most cases. In quantitative analysis, acquistion through a friend made significant reduction of price at last purchase in the U. S., approaving the hypothesis that friendship can be an effective institution to reduce transaction costs on the market. In the Czech Republic, such analysis was inconclusive. This demonstrates that the importance of friendship might be higher in countries where drug prohibition is more severe. CONCLUSIONS: Punitive drug policy provides incentives to shrinking the market into social networks, and like that, it imposes harms on users in terms of decreasing control over their substance use can criminal risks (larger amounts purchased, and the risk of detection to regular citizens, who serve as middlemen on the market without an intention to make profit). For more precise estimates, further surveys shall distinguish between different modalities of friendship, and between different product types

Drugs, politics, media - agenda-setting process in pre-electoral period regarding the illicit drug issues

The thesis describes the theory of agenda-setting together with methodology of agenda-setting research, relationship between politics and the media, and the media picture of drugs and its determinants, with a goal to create basis for analysis of political agenda-setting into the media (MF DNES, Právo) in the period of three months prior to the parliamentary elections in the Czech republic in the years 1996, 1998, 2002 and 2006. Framing of the drug issues in the media, related to politics, is identified in the qualitative part of the analysis. Proportions of frames in the media and the political discourse are then analysed quantitatively. The conclusions of the thesis are that politics sets the drug agenda to the media in the pre-election periods, which was supported by the comparision of media and politics framing of drug issues, but not supported by the comparision of pre-election media frames and non-election periods. The qualitative study also discovered that in three of four pre-election periods the drug issues were of great importace both to the media and the politics, as for the legislation process in 1996 and 1998 and as for an electoral campaign of one political party in 2006

Ekonomická analýza drogových trhů

Práce se zabývá ekonomickou teorií, výzkumem a ekonometrickými modely v oblasti nabídkové strany drogových trhů. Meta-analýza literatury ukazuje na základní východiska ekonomické teorie, které se v drogových trzích uplatňují, stejně jako na ekonomické teorie, které se k drogovým trhům explicitně vztahují. V oblasti empirického výzkumu rozděluje drogové trhy na primární, které jsou určeny zemědělskou produkcí surovin na výrobu nelegálních drog v rozvojových zemích, a na koncové, na kterých se v západním světě nelegální drogy z různých oblastí světa střetávají. Třetí rovinou výzkumných prací jsou modely drogových trhů, které pracují s minimálními daty a které poskytují predikce pro drogové politiky. Práce přináší základní doporučení pro výzkum drogových trhů, zarámované do metodologie ekonomické vědy, kontextu dostupných dat, základních výzkumných otázek a možností primárního výzkumu

The use and construction of "Quality Adjusted Life Years (QALYS)" indicator in addictology

Psychiatrická klinika 1. LF a VFN v PrazeDepartment of Psychiatry First Faculty of Medicine and General University Hospital in PragueFirst Faculty of Medicine1. lékařská fakult

Monitoring quality and coverage of harm reduction services for people who use drugs : A consensus study

Background and aims: Despite advances in our knowledge of effective services for people who use drugs over the last decades globally, coverage remains poor in most countries, while quality is often unknown. This paper aims to discuss the historical development of successful epidemiological indicators and to present a framework for extending them with additional indicators of coverage and quality of harm reduction services, for monitoring and evaluation at international, national or subnational levels. The ultimate aim is to improve these services in order to reduce health and social problems among people who use drugs, such as human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection, crime and legal problems, overdose (death) and other morbidity and mortality. Methods and results: The framework was developed collaboratively using consensus methods involving nominal group meetings, review of existing quality standards, repeated email commenting rounds and qualitative analysis of opinions/experiences from a broad range of professionals/experts, including members of civil society and organisations representing people who use drugs. Twelve priority candidate indicators are proposed for opioid agonist therapy (OAT), needle and syringe programmes (NSP) and generic cross-cutting aspects of harm reduction (and potentially other drug) services. Under the specific OAT indicators, priority indicators included 'coverage', 'waiting list time', 'dosage' and 'availability in prisons'. For the specific NSP indicators, the priority indicators included 'coverage', 'number of needles/syringes distributed/collected', 'provision of other drug use paraphernalia' and 'availability in prisons'. Among the generic or cross-cutting indicators the priority indicators were 'infectious diseases counselling and care', 'take away naloxone', 'information on safe use/sex' and 'condoms'. We discuss conditions for the successful development of the suggested indicators and constraints (e.g. funding, ideology). We propose conducting a pilot study to test the feasibility and applicability of the proposed indicators before their scaling up and routine implementation, to evaluate their effectiveness in comparing service coverage and quality across countries. Conclusions: The establishment of an improved set of validated and internationally agreed upon best practice indicators for monitoring harm reduction service will provide a structural basis for public health and epidemiological studies and support evidence and human rights-based health policies, services and interventions