Heike Zurhold

Cocaine Use in Europe – A Multi-Centre Study: Patterns of Use in Different Groups

Aim: The study investigates patterns of cocaine powder and crack cocaine use of different groups in nine European cities. Design, Setting, Participants: Multi-centre cross-sectional study conducted in Barcelona, Budapest, Dublin, Hamburg, London, Paris, Rome, Vienna, and Zurich. Data were collected by structured face-to-face interviews. The sample comprises 1,855 cocaine users out of three subgroups: 632 cocaine users in addiction treatment, mainly maintenance treatment; 615 socially marginalized cocaine users not in treatment, and 608 socially integrated cocaine users not in treatment. Measurements: Use of cocaine powder, crack cocaine and other substances in the last 30 days, routes of administration, and lifetime use of cocaine powder and crack cocaine. Findings: The marginalized group showed the highest intensity of cocaine use, the highest intensity of heroin use and of multiple substance use. 95% of the integrated group snorted cocaine powder, while in the two other groups, injecting was quite prevalent, but with huge differences between the cities. 96% of all participants had used at least one other substance in addition to cocaine in the last 30 days. Conclusions: The use of cocaine powder and crack cocaine varies widely between different groups and between cities. Nonetheless, multiple substance use is the predominating pattern of cocaine use, and the different routes of administration have to be taken into account.

Cocaine Use in Europe – A Multi-Centre Study

An increase in the use of cocaine and crack in several parts of Europe has raised the question whether this trend is similar to that of the USA in the 1980s. However, research in the field of cocaine use in Europe has been only sporadic. Therefore, a European multi-centre and multi-modal project was designed to study specific aspects of cocaine and crack use in Europe, in order to develop guidelines for public health strategies. Data on prevalence rates were analysed for the general population and for specific subgroups. Despite large differences between countries in the prevalence of cocaine use in the general population, most countries show an increase in the last few years. The highest rate with a lifetime prevalence of 5.2% was found for the United Kingdom, although with a plateau effect around the year 2000. With regard to specific subgroups, three groups seem to show a higher prevalence than the general population: (1) youth, especially in the party scene; (2) socially marginalized groups, such as homeless and prostitutes or those found in open drug scenes; (3) opiate-dependent patients in maintenance treatment who additionally use cocaine. Specific strategies need to be developed to address problematic cocaine use in these subgroups.

Drug Consumption Rooms in Hamburg, Germany: Evaluation of the Effects on Harm Reduction and the Reduction of Public Nuisance

In order to evaluate the impact of consumption rooms (CRs) on the promotion of health among drug users and the reduction of the public nuisance of drug use, a study examining CRs in three countries was carried out in 2000. The study, supported by the European Commission, examined CRs in Rotterdam (The Netherlands), Innsbruck (Austria), and Hamburg (Germany). This paper evaluates the findings from the study of Hamburg CRs. In order to get evidence-based information on the effects of CRs, 616 drug users in the Hamburg drug scene or in the vicinity of low-threshold institutions were investigated with a standardized questionnaire. Qualitative problem-centered interviews were also carried out with staff members of the CRs, and representatives from the community, including neighborhood residents, business people, police, and politicians. Research findings show that the Hamburg CRs reached the target group of drug users who practice risky behaviors and engage in public drug use. Findings also show that the Hamburg CRs lead to positive changes in health-related behavior for drug users. In addition, the findings indicate that the Hamburg CRs played an important role in the reduction of public disturbances in the vicinity of open drug scenes.

Cocaine and crack use and dependence in Europe – experts view on an increasing public health problem

Background: The spread of cocaine and crack use in Europe poses a challenge to the European health-care systems. The assessment of the extent of the problem as well as the support needs of the users require involving all relevant parties in research and future planning. Method: Within the framework of a European multi-center and multi-modal research project, experts of nine European cities were interviewed according to a standardised structural interview protocol. Results: Cocaine use is considered to be on the increase in Europe. The prevalence rates vary substantially between countries and the problem emerges in different target groups in distinct patterns of use. Although cocaine and crack specific risks can be diagnosed, health risks follow basically the general risks of illicit drug use. Proposals for future planning include the broadening of the existing services and the implementation of evidence-based approaches to the problem. Conclusion: In dealing with the cocaine problem in Europe, a comprehensive public health approach is appropriate. An overall strategy should include preventive, harm reductive as well as rehabilitative measures. Consequently, cross-national guidelines should be established and their implementation as well as evaluation should be monitored.

Women in prison: Responses of European prison systems to problematic drug users

Problematic drug use in prison remains a pervasive and increasing concern throughout the European Union (EU) in terms of costs to the individual, community and the state. Drug‐related problems in prison seem to be more prominent among female prisoners, as a high proportion of them are problematic drug users whose use continues in prison. Assuming that women’s drug use is an indication of need for treatment and health care, it becomes increasingly interesting how the European penal institutions differ in their response to this need. For this reason, a survey of the prison drug services for adult female drug users has been carried out among the Ministries of Justice of all 25 EU member states. The main purpose of the survey was to gain comprehensive and systematic information on the prevalence of female problematic drug users in European prisons and the availability of treatment and healthcare services. Altogether, 27 European countries and autonomous regions completed the questionnaire developed for this survey. The results of the data analyses indicate that there is poor availability and quality of data relating to the extent of problematic drug use in women’s prisons and, where it is available, it seems to underestimate the proportion of female problematic drug users in prisons. However, most of the European countries provide a range of different harm‐reduction and drug treatment services to respond to the reported health and rehabilitation problems of female problematic drug users. At the same time, however, it is evident that there is a need for further action in some countries, due to their low provision of prison drug treatment and healthcare services for this group. This article is based upon the European research project ‘Female drug users in European prisons’, which was conducted between 2003 and 2004 and funded by the AGIS Programme, Directorate General Justice and Home Affairs, of the European Commission.

What Affects Reintegration of Female Drug Users After Prison Release? Results of a European Follow-Up Study

The main objective of this follow-up study is to explore factors influencing the success or failure of women in reintegrating after their release from prison. Female drug users in five European cities were tracked after being released from prison. Out of 234 female prisoners contacted in prisons, 59 were included in the follow-up study. Structured questionnaires were given out and statistical group comparisons were conducted. The authors found that receiving preparation for release significantly supports a successful reintegration. On the other hand, living with a current drug user and initiating regular heroin use at an early age of less than 18 years are major barriers to successful reintegration.

Provision of harm reduction and drug treatment services in custodial settings – Findings from the European ACCESS study

Abstract Aims: The aim of the study was to survey the availability, coverage and quality of harm reduction and drug treatment services delivered to drug users in prisons across Europe. Methods: A survey was conducted between 2012 and 2013 among the 29 European countries. An electronic semistructured questionnaire was sent to the national institutions responsible for prison services, and 27 countries responded. In addition, good practice interventions for drug offenders have been collated by 15 national experts covering 15 European countries. The interventions were described and assessed as to their quality through using European monitoring centre for drugs and drug addiction (EMCDDA) standard tools for reporting and quality assessment. Findings: Drug treatment including detoxification and opioid substitution treatment (OST) is available in prisons of most European countries. However, OST is unavailable in five countries. Almost all countries provide prison-based harm reduction measures to prevent and treat infectious diseases among prisoners. Especially, testing and treatment for HIV and tuberculosis are provided, while other measures, such as the distribution of condoms or bleach, and especially needle and syringe programmes are still rare. Conclusions: Access to and coverage of OST in prisons is higher in countries with a long history of OST provision, while in countries that introduced OST more recently the scale of OST is usually lower. Access to hepatitis C treatment is often limited in prisons due to the lack of drug abstinence or a health insurance.

Similar problems, divergent responses: drug consumption room policies in the UK and Germany

Abstract Drug consumption rooms (DCRs) enable the consumption of pre-obtained drugs under supervised conditions. While 24 DCRs exist in Germany, there are none in the UK despite similar levels of drug-related harms. The first official, German DCRs were introduced in Hamburg and Frankfurt in the mid-1990s. A key influence was the appearance of “open drug scenes” in such cities over this time, whereby large numbers of users congregated in parks or shopping centers. This led to powerful coalitions of politicians, police, and treatment agencies and DCRs were seen as a professional response to these problems. In the UK, there have been two high-profile recommendations for the piloting of DCRs, which have been rejected by the government for a number of reasons, including lack of evidence, legal problems, and negative media responses. In explaining the different situations in the two countries, key factors are the potential for city-level policies, the stigma attached to drug users in media reporting, and the historical development of open drug scenes. Chance has also played a part, particularly in the UK. Drug policy is rarely a government priority, and drug policy decisions are therefore affected by wider political goals and pressures in unpredictable ways.

Which individual, social and environmental influences shape key phases in the amphetamine type stimulant use trajectory? A systematic narrative review and thematic synthesis of the qualitative literature

Abstract Background and aims There is limited evidence on what shapes amphetamine‐type stimulant (ATS) use trajectories. This systematic narrative review and qualitative synthesis aimed to identify individual, social and environmental influences shaping key phases in the ATS use trajectory: initiation, continuation, increase/relapse and decrease/abstinence. Methods MEDLINE, PsycINFO, EMBASE, and PROQUEST (social science premium collection) were searched from 2000 to 2018. Studies of any qualitative design were eligible for inclusion. Extracted data were analysed according to four key phases within drug pathways, and then cross‐analysed for individual, social and environmental influences. Results Forty‐four papers based on 39 unique studies were included, reporting the views of 1879 ATS users. Participants were aged 14–58 years, from varied socio‐economic and demographic groups, and located in North America, Europe, Australasia and South East Asia. Reasons for initiation included: to boost performance at work and in sexual relationships, promote a sense of social ‘belonging’ and help manage stress. Similar reasons motivated continued use, combined with the challenge of managing withdrawal effects in long‐term users. Increased tolerance and/or experiencing a critical life event contributed to an increase in use. Reasons for decrease focused on: increased awareness of the negative health impacts of long‐term use, disconnecting from social networks or relationships and financial instability. Conclusions Amphetamine‐type stimulant users are a highly diverse population, and their drug use careers are shaped by a complex dynamic of individual, social and environmental factors. Tailored, joined‐up interventions are needed to address users’ overlapping economic, health and social care needs in order to support long‐term abstinence.

Programy przygotowujące do wyjścia na wolność i opieka postpenitencjarna dla kobiet uzależnionych od narkotyków odbywających karę pozbawienia wolności – perspektywa międzynarodowa

Abstract Introduction The psychological and social situation of incarcerated drug addicted women is described, as is the offer of pre- and post-release programmes. A literature review of this kind of programme evaluation studies indicates they are an important and necessary part of penitentiary system. Methods The article presents data from the study “Female Drug Users in European Prisons – best practice for relapse prevention and reintegration” (PI: Heike Zurhold, Centre for Interdisciplinary Addiction Research, University of Hamburg, project no: JAI/2003/AGIS/191) conducted in five European countries – Austria, Spain, Germany, Poland and Great Britain (Scotland). Results Female drug users need to overcome many social and psychological obstacles on leaving prison. They often suffer from many emotional, health, social and financial problems. The creation of pre- and post-release programmes that provide support and take into consideration the specific needs and deficits of that group is an important task of penitentiary institutions and non-governmental organisations cooperating with them. It seems that effective cooperation between different institutions and organisations is a key element helping to bridge prison life and life outside prison and accessing those individuals with an offer most tailored to their specific needs.