Bridging the Gap between Needs and Services

1
Bridging the Gap between Needs and Services
Towards Evidence-based Drug Policy In Poland
Issue Matching Needs and Services in
Environments of Rapid Change Experience has shown
that drug use patterns can change rapidly,
leading to equally dramatic increases in the
spread of bloodborne diseases like HIV, HBV and
HCV. The provision of drug abuse prevention,
harm reduction and treatment services should be
based on evidence of the current patterns and
geographical distribution of risk. In the course
of a Rapid Policy Assessment and Response
Intervention in the city of Szczecin and
surrounding rural areas, we uncovered evidence
that Polands programs to prevent and reduce
drug-related harm may not be responsive to
rapidly changing current conditions
Sobeyko J (1), Leszczyszyn-Pynka M (2), Duklas T
(7), Parczewski M (2), Bejnarowicz P (1),
Chintalova-Dallas R (4), Lazzarini Z (4)(6), Case
P (5), Burris S (3)(6). (1) Infectious Disease
Prevention Association of Western Pomerania, (2)
Department of Infectious Diseases Hepatology,
Pomeranian Medical University, Szczecin, (3)
Temple University Beasley School of Law, (4)
University of Connecticut Health Center, (5)
Fenway Community Health Center, (6) Center for
Law and the Publics Health at Georgetown and
Johns Hopkins Universities, (7) Association for
Health Promotion and Social Risks Prevention
TADA

• Implications and Recommendations
• The Community Action Board and research team
  discussed the findings in light of their existing
  knowledge and experiences in addressing drug use
  in the region.
• Drug policy is oriented to large cities the
  needs in rural areas need to be urgently assessed
  and addressed in terms of both mandates and
  resources.
• Patterns of drug use in rural areas are not
  properly diagnosed most policies are based on
  information from larger cities where outreach
  workers collect necessary data.
• NGOs, the primary providers of outreach
  services, have traditionally been city-based and
  city-focused they are not geared to providing
  services in rural areas and will require funding
  assistance to do so.
• The Polish National Office for Counteracting
  Drug Addiction needs to
• support and be guided by more frequent and rapid
  research
• work with the criminal justice system to promote
  better coordination of available treatment
  services with court processes and to educate
  judges and prosecutors about the benefits and
  availability of treatment.
• The Szczecin city and regional administrations
  and NGOs should work together to further
  delineate the risk to rural populations and to
  institute needed services.
• Poland has a low rate of HIV infection among
  IDUs, which is mostly due to the swift
  introduction of prevention, harm reduction and
  treatment programs for opiate use in early 90s.
  An equally timely response is required now.

Findings Changing Patterns of Injection Drug
Use Injecting drug use, once a city problem
involving opiates, has moved out into the
countryside and now centers on amphetamine.
Findings The Gap is Unfolding Below the
Radar Policy-makers have not been fully aware of
the shift, which is not surprising given the lack
of any early warning mechanism.
Everybody uses drugs in pubs in Szczecin, but
they dont inject -- Regular drug user,
occasional injector Young people in small town
near Szczecin inject amphetamine using shared
equipment. They are not afraid of being infected
with HIV or Hepatitis because they are convinced
that risk of infection is related to the type of
drug home made heroin -- not to the way of its
administration. Injection drug user, using for
8 years
Infectious Diseases Prevention Association for
Western Pomerania Region
Interviews with service providers indicate that
drug abuse prevention and treatment agencies are
unaware of the potentially serious threat and
unprepared to address it effectively. There is a
drug use in our town but people do not inject.
Therapist from a small town In Szczecin, the
major focus of drug policy is party or club
drugs injected amphetamine in the surrounding
area is not a worry.
Findings Theres a Poor Match Between Needs and
Services Prevention, harm reduction and
treatment services needed for an injection-based
amphetamine epidemic are unavailable in the
countryside.
Methods Rapid Policy Assessment and Response
(RPAR) RPAR is an intervention that mobilizes
local knowledge and capacity to fight HIV/AIDS
among sex workers, injection drug users, and
members of other marginalized populations at the
city level. In RPAR, a research team from a site
city works with a Community Action Board (CAB) to
collect three kinds of data laws and written
policies relevant to health risks in the target
populations existing data on the epidemiological
situation and the operation of the criminal
justice system and qualitative interviews with
police, judges, prosecutors, drug users, sex
workers and others who can describe how the laws
are put into practice. The data collection and
interpretation are guided by the CAB, which
develops an action plan and final report. The
Szczecin RPAR was begun in January, 2005
research was completed in September and a final
report was released in March, 2006. The CAB
included representatives of law enforcement (the
police, judiciary, prisons), both public and
private drug treatment providers, health care
(physicians, nurses) and social welfare agencies
(Family Support office). Existing laws and formal
policies in ten domains relevant to drug policy
and health (including harm reduction, drug
treatment and prevention) were collected. To
determine how these laws were being put into
practice, three focus groups were conducted, and
the team interviewed 24 people in law
enforcement, health care and social services, as
well as 14 IDUs.
Syringe Access Young people in small towns are
not able to exchange equipment. There are no
syringe exchange programs. They have problems to
buy the in pharmacies as well. Injection drug
user, addicted for 18 years Young people
dont want to go to pharmacy because they are
afraid to be perceived as drug addicts. Though
their parents and neighbors are all addicted to
alcohol. Injection drug user, small town.
Some pharmacists are reluctant to sell
equipment to drug users. Two IDU informants
reported that pharmacists will claim to be out of
small-bore needles. Its not a problem for old
drug users to inject with a big needle, but its
still a problem for young kids Rural IDU, 26
years old. Meanwhile, the syringe exchange in
the city of Szczecin has seen a decrease in
clients based on ease of access to and low cost
of syringes, as well as a decline in injecting
drug use. There is no point in going to the
syringe exchange because we can buy syringes in
any pharmacy. Occasional IDU, Szczecin.
Syringes cost about 0.10 in a pharmacy.
Drug Treatment There are no programs designed
for drug addiction in small towns. We have
relevant therapy offer for drug addicts they
are treated together with alcohol addicts but
they are counseled individually twice a month.
Therapist from a small town. This reflects
health policy The national health service does
not pay for treatment of drug users here. We need
to treat them together with alcoholics, in the
same group, and try to get our money back. We
like people with multiple dependencies because
they are easier to get paid for. The law also
plays a role A Sobriety Law from the
Communist Era requires municipalities to provide
alcohol treatment. While the Law on
Counteracting Drug Addiction requires local
programs to combat drug abuse (Ch. 4), there is
no mandate to offer treatment.
Department of Infectious Diseases Hepatology
Pomeranian Medical University, Szczecin
Findings The Rise in Rural Amphetamine Injection
Poses a Threat to Health that Should Not Be
Treated Lightly We know from other countries
that amphetamine epidemics can cause serious
health and social problems. There is a risk for
rapid spread of bloodborne disease if HIV or
Hepatitis gets into a network of young injectors
underserved by prevention, treatment and harm
reduction services.
HIV Diagnoses (Poland)
HIV and Hepatitis do exist in the
population. HIV in the West Pomeranian
Voyvodeship has been stable since 2000 at 4/100
000 (stable since 2000)/ There were 600
diagnosed HIV infections between 1985 and
31.04.2005. 51 were attributed to IDU. 52 of
HIV people are co-infected with HCV and 8 with
HBV.
HIV Testing Few people in the rural areas are
getting tested for HIV. IDU_4 said that these
young people do not test as they are sure HIV is
not their problem. She also said it seemed
strange for her as they believe nobody is
infected but how can they know it if nobody has
ever been tested for HIV A physician who works
at the HIV testing center in Szczecin confirmed
that clients are asked about their place of
residence and the vast majority are from the
city. There are no testing sites in the rural
areas.
The limitations of our methodology Our findings
are based on interviews from purposively selected
informants and by the information provided by our
CAB, supported where possible by epidemiological
statistics and secondary sources. The data must
be viewed with appropriate caution. Given the
experience of rural amphetamine use in other
areas, however, and the potentially rapid spread
of bloodborne disease among injectors, they
should be taken seriously and followed up with
more sustained research and intervention work.
Incidence of HBV and HCV (Poland)
This research was supported by NIDA/NIH Grant 5
R01 DA17002-02 PI LAZZARINI, ZITA . The findings
and conclusions expressed are those of the
authors and not necessarily of NIH, NIDA, or the
US government.