27.10.17
Harm Reduction 24/7: The supply of harm reduction materials via vending machines for drug users in North Rhine-Westphalia, Germany.
Prof. Dr. Daniel Deimel Lisbon Addictions, 26.10.2017
Declaration of conflicts
“I have no conflicts of interest.”
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Overview § German national drug strategy § Harm reduction measures for drug users in North Rhine-Westphalia § Needle and syringe vending machine programme in North Rhine-Westphalia § Harm Reduction 24/7: study design § Harm Reduction 24/7: first results § Outlook
German national drug strategy The strategy aims to help individuals avoid or reduce their consumption of licit and illicit substances, as well as addictive behaviours. Four pillars: 1. Prevention 2. Counselling, treatment and help in overcoming addiction 3. Harm reduction measures 4. Supply reduction. EMCDDA: Germany. Country Drug Report 2017
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Key facts: harm reduction measures in North Rhine-Westphalia
NRW: 17.538.251 inhabitants.
§ 10 drug consumption rooms with 96 consumer places. § Local needle and syringe programmes. § 110 syringe vending machines in public areas. § Heroin-assisted treatment. § Methadone maintenance programmes including psychosocial support. § Outreach work. § Emergency shelter.
Landesstelle Sucht, 2015; IT.NRW, 2011
Key facts: drug-related deaths 1600 1400
1394
1449
1331
1226
1237
1200
986
1000
944
1002
1333
400
3,9
4 3,5
1032
2,9
3 2,5
800 600
4,5
2 374
380
344
1,5 289
200
216
204
198
184
182
204
2011
2012
2013
2014
2015
2016
0
1,6 1,1
1
0,7
0,5 0
2007
2008
2009
2010
Germany
North Rhine-‐Westphalia
Germany Cologne
Essen
Düsseldorf Dortmund
Drug related deaths per 100.000 inhabitans (2016)
Germany: increase in drug-related deaths in past five years. ...but North Rhine-Westphalia: stable overall. ...but local differences in the cities of North Rhine-Westphalia.
Bundeskriminalamt (BKA), 2016
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Key facts: drug-related harms Results of the DRUCK-study (n = 2.077; RKI 2016) § Up to 54% of PWID were hepatitis C positive. § 5-22% of PWID reported that they used needles and/or syringes from other PWIDs in the last 30 days. § 32-44% of PWID reported that they used other injecting equipment (e.g., water, filters) from other PWIDs. § There is a lack of knowledge about the risks of HCV from using the same water or filter. § PWID are also a vulnerable group for HIV (RKI 2017) RKI 2016; DOI: 10.17886/rkipubl-2016-007.2 RKI 2017; DOI: 10.17886/EpiBull-2017-051
Needle and syringe vending machine programme in North Rhine-Westphalia (NRW) History – 1989: On the background of the HIV epidemic, the first methadone maintenance programme and the syringe vending machine programme was established in North Rhine-Westphalia.
Aidshilfe NRW, 2012
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Needle and syringe vending machine programme in NRW project webpage: www.saferuse-nrw.de
Today: Locations of 110 needle and syringe vending machines
61 operators
Needle and syringe vending machine programme in NRW Ministry of health NRW
• political decision makers • financial support for programme coordination • financing of new vending machines
NGO:
• • • •
programme coordination / management advising local operators shipment of harm reduction materials technical support
61 local drug counselling and HIV organisations
• application of new machines by the local administration • filling the machines with new syringes and harm reduction materials • organise the disposal of used syringes
Meyer & Schmidt, 2011
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NSP vending machines in NRW Two types of
vending machines are available.
Space for used needle/syringe disposal
The price for one machine is 850 €.
The syringe vending machine programme in NRW materials and prices every p
ackage
1 Needle 12mm 1 Syringe 1 Filter
1x skin creme 1x alcohol swab 1x vitamin C powder 1x saline
1 Needle 16mm 1 Syringe 1 Filter
1 Needle 20mm 1 Syringe 1 Filter
1x Stericup 1x alcohol swab
1 Condom 1 Lubricant
0,50 €
1 Needle 25mm 1 Syringe 1 Filter
4x aluminium foil 1x alcohol swab bombon & drinking straw
1 Condom
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Harm reduction 24/7: study design Online ques3onnaire Experience of vending machine operators in NRW (n = 36) response rate: 59%
Systema3c Review Evidence of needle and syringe vending machine programmes. (n = 60 papers)
Online ques3onnaire Experience and requirements of drug users with needle and syringe vending machines. Starts from November 2017
first results
Harm reduction 24/7: first results Delivered needles/syringes to drug users in NRW. 2014-‐2016 2.500.000 2.187.554 2.000.000
1.921.391
1.885.867
1.500.000
1.000.000
500.000
0
138.765
131.352
121.042
6,4%
7,2%
6,0%
2014
2015 Total delivered syringes
2016
Delivered syringes by vending machines
Data from Aidshilfe NRW 2017
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Harm reduction 24/7: first results Proportion of delivered syringes by vending machines: cluster 1 102,00% 100,00%
High rates in rural areas without harm reduction services.
100%
100%
Kreis Düren
Märkischer Kreis
97%
98,00% 96,00% 94,00% 92,00%
90,30%
90,00% 88,00% 86,00% 84,00% Kreis Siegen-‐Wi]genst.
Stadt Oberhausen
Proportion of delivered syringes by vending machines: cluster 4
Lower rates in urban areas with established harm reduction services.
9,00% 7,50% 8,00% 6,50% 6,50% 5,90% 6% 7,00% 5% 5,10% 6,00% 4,20% 5,00% 2,70% 4,00% 3,00% 1,20% 1,40% 1,40% 2,20% 2,00% 1,00% 0,00%
8,30%
Data from Aidshilfe NRW 2017
Harm reduction 24/7: first results Is there 24/7 access to harm reduction materials in your local city? (n = 34)
38%
62%
yes
no
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Harm reduction 24/7: first results Groups
n
%
Heroin users
28
82,4
Cocaine users
15
44,1
Amphetamine/methamphetamine users
5
14,7
Anabolic users
1
2,9
Substituted heroin users
1
2,9
8
23,5
Unkonown / not stated
(n = 34; multiple answers were possible)
Harm reduction 24/7: first results Problems.
Before implementing a new vending machine: 24% of operators reported problems with local council, police and/or local residents.
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Harm reduction 24/7: first results Problem: Disposal of used needles/syringes: Many are not taking needles/syringes back to machines for disposal.
Disposal of used needles/syringes 18 16
16 14 12 10 8
8 6 4
3 2
2
1 0
0
1 very good
2
3
4
5
6 insufficient
Harm reduction 24/7: first results Were the machines damaged? 15% 53%
32%
yes 6 5
no
unknown
5
4
3
3
3 2
2
2
1
1
1
0 1
2
3
4
5
6
0
0
0
7
8
9
1
10 more than 10
Number of damaged per year
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Outlook: Needle and syringe vending machines provide 24/7 access for needles/ syringes and other harm reduction materials. The programme in NRW has been successfully operating since 1989. But there is a lack of comprehensive coverage for harm reduction materials especially in rural areas. Targeted resources are needed for priority groups, e.g. MSM, refugees. There are no needles and syringe programmes or provision of other harm reduction materials in prisons in NRW.
Thank you for your kind aKen3on! Contact
Collaborating partners
Prof. Dr. Daniel Deimel Catholic University of Applied Sciences NRW Department Aachen Robert-Schuman-Str. 25 52066 Aachen E-Mail:
[email protected]
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