The value of harm reduction for injection drug use: A clinical and public health ethics analysis

Vearrier, Laura

doi:10.1016/j.disamonth.2018.12.002

Cited by 42 publications

(48 citation statements)

References 110 publications

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“…In 2010, when the then French Minister of Health introduced the idea of creating a supervised injection facility in Paris [ 31 , 32 ], she (a) carefully avoided using the common French expression – “salles de shoot” – that would have been likely to deter other members of her government from supporting the project, and she (b) used two expressions that would logically have convinced them to show at least some measure of support: she presented supervised injection facilities as a first step to stopping illicit drug consumption – in French, a “premier palier pour arrêter la consommation de drogue” – and as the best way to move towards an abstinence policy – “la meilleure façon de passer à une politique de sevrage.” Despite her assertions being ethically sound [ 33 ], supported by current scientific evidence [ 2 , 7 ], by the French National Institute for Medical Research [ 34 ], by positive reports from neighboring countries (e.g., Switzerland, Germany, and the Netherlands), and that they would have been in line with recommendations from the European Union [ 35 ], her project was vocally opposed by fellow party members.…”

Section: Discussionmentioning

confidence: 99%

French People’s positions on supervised injection facilities for drug users

Sastre

Mullet

2020

Subst Abuse Treat Prev Policy

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Background Supervised injection facilities have been set-up in many countries to curb the health risks associated with unsafe injection practices. These facilities have, however, been met with vocal opposition, notably in France. As harm reduction policies can only succeed to the extent that people agree with them, this study mapped French people’s opinions regarding the setting-up of these facilities. Method A sample of 318 adults--among them health professionals--were presented with 48 vignettes depicting plans to create a supervised injection facility in their town. Each vignette contained three pieces of information: (a) the type of substance that would be injected in the facility (amphetamines only, amphetamines and cocaine only, or amphetamines, cocaine and heroin), (b) the type of staff who would be working in the facility (physicians and nurses, specially trained former drug users, specially trained current drug users, or trained volunteers recruited by the municipality), and (c) the staff members’ mission (to be present and observe only, technical counselling about safe injection, counselling about safe injection and hygiene, or counselling and encouragement to follow a detoxification program). Results Through cluster analysis, three qualitatively different positions were found: Not very acceptable (20%), Depends on staff and mission (49%), and Always acceptable (31%). These positions were associated with demographic characteristics--namely gender, age and political orientation. Conclusion French people’s positions regarding supervised injection facilities were extremely diverse. One type of facility would, however, be accepted by a large majority of people: supervised injection facilities run by health professionals whose mission would be, in addition to technical and hygienic counselling, to encourage patrons to enter detoxification or rehabilitation programs.

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Section: Discussionmentioning

confidence: 99%

French People’s positions on supervised injection facilities for drug users

Sastre

Mullet

2020

Subst Abuse Treat Prev Policy

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“…Although less studies on the effectiveness of these measures have been conducted inside prison than in the community, results are transferrable and European recommendations exist [ 10 , 44 – 51 ]. Furthermore, equivalence and continuity of care are key principles guiding the implementation of health and social interventions in prisons [ 45 , 49 , 52 , 53 ] and providing relevant services to people in prison benefits public health in general [ 45 , 54 , 55 ]. Despite this, harm reduction interventions have been implemented in prisons with a significant delay compared to community or have in some countries not been introduced at all [ 14 , 56 – 59 ].…”

Section: Introductionmentioning

confidence: 99%

The state of harm reduction in prisons in 30 European countries with a focus on people who inject drugs and infectious diseases

Stöver

Tarján²,

Horváth³

et al. 2021

Harm Reduct J

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Background People who inject drugs are often imprisoned, which is associated with increased levels of health risks including overdose and infectious diseases transmission, affecting not only people in prison but also the communities to which they return. This paper aims to give an up-to-date overview on availability, coverage and policy framework of prison-based harm reduction interventions in Europe. Methods Available data on selected harm reduction responses in prisons were compiled from international standardised data sources and combined with a questionnaire survey among 30 National Focal Points of the European Monitoring Centre for Drugs and Drug Addiction to determine the level of availability, estimated coverage and policy framework of the interventions. Results Information about responses to health harms in prisons is limited and heterogeneous. Cross-country comparability is hampered by diverging national data collection methods. Opioid substitution treatment (OST) is available in 29 countries, but coverage remains low (below 30% of people in need) in half of the responding countries. Needle and syringe programmes, lubricant distribution, counselling on safer injecting and tattooing/piercing are scarcely available. Testing for infectious diseases is offered but mostly upon prison entry, and uptake remains low in about half of the countries. While treatment of infections is mostly available and coverage is high for human immunodeficiency virus (HIV) and tuberculosis, hepatitis B and C treatment are less often provided. Health education as well as condom distribution is usually available, but provision remains low in nearly half of the countries. Post-release linkage to addiction care as well as to treatment of infections is available in a majority of countries, but implementation is often partial. Interventions recommended to be provided upon release, such as OST initiation, take-home naloxone and testing of infections, are rarely provided. While 21 countries address harm reduction in prison in national strategic documents, upon-release interventions appear only in 12. Conclusions Availability and coverage of harm reduction interventions in European prisons are limited, compared to the community. There is a gap between international recommendations and ‘on-paper’ availability of interventions and their actual implementation. Scaling up harm reduction in prison and throughcare can achieve important individual and public-health benefits.

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“…In Australia, the situation is more concerning, indeed, in 2016, more than 40% of the population over 14 years old reported a drug use during their lifetimes and more than 15% during the month preceding the survey (Day et al, 2018 ). Illicit drugs are a global public health issue, since both their acute and chronic consumption have pernicious impacts on the consumer's health (Crowley et al, 2017 ; Joye et al, 2017 ; Vearrier, 2019 ). For instance, it is estimated that almost 10,000 overdose deaths occurred in Europe in 2017 (EMCDDA, 2019 ).…”

Section: Introductionmentioning

confidence: 99%