Dagmar Hedrich

The effectiveness of opioid maintenance treatment in prison settings: a systematic review.

AIMS To review evidence on the effectiveness of opioid maintenance treatment (OMT) in prison and post-release. METHODS Systematic review of experimental and observational studies of prisoners receiving OMT regarding treatment retention, opioid use, risk behaviours, human immunodeficiency virus (HIV)/hepatitis C virus (HCV) incidence, criminality, re-incarceration and mortality. We searched electronic research databases, specialist journals and the EMCDDA library for relevant studies until January 2011. Review conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Twenty-one studies were identified: six experimental and 15 observational. OMT was associated significantly with reduced heroin use, injecting and syringe-sharing in prison if doses were adequate. Pre-release OMT was associated significantly with increased treatment entry and retention after release if arrangements existed to continue treatment. For other outcomes, associations with pre-release OMT were weaker. Four of five studies found post-release reductions in heroin use. Evidence regarding crime and re-incarceration was equivocal. There was insufficient evidence concerning HIV/HCV incidence. There was limited evidence that pre-release OMT reduces post-release mortality. Disruption of OMT continuity, especially due to brief periods of imprisonment, was associated with very significant increases in HCV incidence. CONCLUSIONS Benefits of prison OMT are similar to those in community settings. OMT presents an opportunity to recruit problem opioid users into treatment, to reduce illicit opioid use and risk behaviours in prison and potentially minimize overdose risks on release. If liaison with community-based programmes exists, prison OMT facilitates continuity of treatment and longer-term benefits can be achieved. For prisoners in OMT before imprisonment, prison OMT provides treatment continuity.

Guidelines for the Treatment of Hepatitis C Virus Infection in Injection Drug Users: Status Quo in the European Union Countries

Treatment guidelines are considered to be an important tool in steering patients to medical treatment. This study was conducted to analyze guidelines for the treatment of hepatitis C virus (HCV) infection in injection drug users (IDUs) in the European Union (EU) countries as a component of treatment access. National and international databases, expert contacts, professional societies, and health administrations were approached to acquire guidelines. According to their quality standard, guidelines were divided into expert opinions, semiofficial guidelines, official guidelines, and consensus processes. Recommendations for the treatment of HCV infection in IDUs vary substantially, from lack of recommendations and outright treatment disapproval to recommendations for treatment under specified circumstances. Recent guidelines that apply qualified process procedures that include literature research tend to be more permissive. Qualified guideline processes in each EU country and subsequently renewed pan-European guidelines are needed.

Associations Between Availability and Coverage of HIV-Prevention Measures and Subsequent Incidence of Diagnosed HIV Infection Among Injection Drug Users

HIV-prevention measures specific to injection drug users (IDUs), such as opioid substitution treatment and needle-and-syringe programs, are not provided in many countries where injection drug use is endemic. We describe the incidence of diagnosed HIV infection in IDUs and the availability and coverage of opioid substitution and needle-and-syringe programs in the European Union and 5 middle- and high-income countries. Countries with greater provision of both prevention measures in 2000 to 2004 had lower incidence of diagnosed HIV infection in 2005 and 2006.

From margin to mainstream: The evolution of harm reduction responses to problem drug use in Europe

Since the 1960s, illicit drug use in Europe has been marked by the serious health consequences of drug injecting, in particular of heroin. The present article discusses the development of two major harm reduction interventions conducted in Europe to reduce heroin injection and its detrimental consequences, namely opioid substitution treatment and needle exchange programmes. Data collected by the EMCDDA, the specialized EU drug monitoring agency, show that these interventions have progressively become part of the common response in Europe for reducing problems related to drug injecting. The data illustrate the emergence in the mid-1980s of these measures as ‘new’ public health responses to injecting drugs and HIV/AIDS, a process that was preceded by intensive discussions between stakeholders at national and local level. Data also indicate that the scaling up of the measures was not immediate, but happened only about a decade later, during the 1990s—and predominantly in the Western part of the European region. While current social, cultural and legal responses to drug use in EU Member States remain diverse, a recent assessment of national priorities and approaches in preventing infectious diseases and drug-related deaths showed a considerable trend towards a convergence of policies across the whole region. This is discussed in relation to strategic guidance and target-oriented action plans that emerged at the level of the European Union since the late 1990s, concluding that European policy consensus was mediated by EU guidance, while not originating from it.

Towards elimination of hepatitis B and C in European Union and European Economic Area countries: monitoring the World Health Organization’s global health sector strategy core indicators and scaling up key interventions

The World Health Organization ‘Global Health Sector Strategy on Viral Hepatitis 2016–2021’ aimed at the elimination of viral hepatitis as a public health threat provides a significant opportunity to increase efforts for tackling the epidemics of hepatitis B and hepatitis C virus infections across Europe. To support the implementation and monitoring of this strategy, core epidemiological and programmatic indicators have been proposed necessitating specific surveys, the systematic collection of programmatic data and the establishment of monitoring across the care pathway. European Union and European Economic Area countries already made progress in recent years implementing primary and secondary prevention measures. Indeed, harm reduction measures among people who inject drugs reach many of those who need them and most countries have a universal hepatitis B vaccination programme with high coverage above 95%. However, while a further scaling up of prevention interventions will impact on incidence of new infections, treating those already infected is necessary to achieve reductions in mortality. The epidemiological, demographic and socio-political situation in Europe is complex, and considerable diversity in the programmatic responses to the hepatitis epidemic exists. Comprehension of such issues alongside collaboration between key organisations and countries will underpin any chance of successfully eliminating hepatitis.

Human immunodeficiency virus among people who inject drugs: Is risk increasing in Europe?

In most European Union (EU)/European Economic Area (EEA) countries, between 2010 and 2012, reports of new human immunodeficiency virus (HIV) diagnoses among people who inject drugs have been stable or declining. HIV outbreaks in Greece and Romania, first reported in 2011, continue and economic conditions hinder provision of effective response coverage. When measured against some established thresholds, prevention coverage remains inadequate in at least one-third of EU/EEA countries. Urgent consideration to scale up prevention efforts is merited.

New psychoactive substances: Current health-related practices and challenges in responding to use and harms in Europe

BACKGROUND The availability of new psychoactive substances (NPS) in Europe has rapidly increased over the last decade. Although prevalence levels of NPS use remain low in the general European population, there are serious concerns associated with more problematic forms of use and harms in particular populations and settings. It has thus become a priority to formulate and implement effective public health responses. However, considerable knowledge gaps remain on current practices as well as on the challenges and needs of European health professionals who are responding to use and harms caused by these substances. The aim of this study was to explore current health responses to NPS, and highlight key issues in order to inform planning and implementation of adequate responses. METHODS This scoping study was based on a targeted multi-source data collection exercise focusing on the provision of health and drug interventions associated with NPS use and harms, in selected intervention settings across Europe. RESULTS Findings revealed that in the absence of specific evidence, health professionals across most intervention settings rely primarily on acquired expertise with traditional drugs when addressing NPS-related harms. This study also identified a gap in the availability and access to timely and reliable information on NPS to users and health professionals. Health professionals in sexual health settings and custodial settings in contact with certain risk groups reported particular challenges in responding to NPS-related harms. CONCLUSION Immediate investments are required in expanding substance identification capabilities, competence building among professionals and dissemination of risk information among relevant stakeholders. The risks of neglecting under-served risk populations and failure to address the information needs of health professionals and users on NPS harms in a context of rapid changing drug markets in Europe may have unforeseeable consequences at societal level.

Opioid maintenance in European prisons: is the treatment gap closing?

Opioid maintenance treatment (OMT) is effective in prison, as it is in the community. Of 30 European countries, 24 sanction prison OMT, but only eight provide coverage that matches average EU community levels. It is important to challenge negative perceptions of prison OMT and promote equivalence of care and continuity of treatment. The systematic review by Hedrich et al. in this issue [1] concludes that opioid maintenance treatment (OMT) is an effective treatment option for opioid-dependent prisoners that offers benefits similar to those reported in community settings.

Continued signs of resilience in the European drug market: Highlights from the EMCDDA’s 2016 European drug report

May 2016 saw the launch of the European Drug Report (EDR), the European Monitoring Centre for Drugs and Drug Addiction’s (EMCDDA) annual review of the European drug situation, incorporating situational and trend analysis, statistical data and individual country information (EMCDDA, 2016a). As in previous years (Mounteney & Griffiths, 2014; Mounteney, Zobel, & Griffiths, 2013), we present highlights from the report which can be accessed in its entirety at: www.emcdda.europa.eu. Overall, the 2016 analysis highlights a resilient European drug market, with recent survey data showing modest increases in the estimated prevalence of use of cannabis and stimulant drugs and the purity or potency levels of most illicit substances either high or increasing.