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SPEED LIMITS SPEED LIMITS HARM REDUCTION FOR PEOPLE WHO USE STIMULANTS HARM REDUCTION FOR PEOPLE WHO USE STIMULANTS Rafaela Rigoni Joost Breeksema Sara Woods A-SpeedLimits_Cover_Hoofdrapport170x240.indd 1 07-08-18 13:56 www.mainline.nl A-SpeedLimits_Cover_Hoofdrapport170x240.indd 2 07-08-18 13:56 Rafaela Rigoni Joost Breeksema Sara Woods Foreword Harm reduction as a concept, being defined as “pol- These worrisome developments require urgent icies, programmes and practices that aim primarily responses by governments, civil society and interna- to reduce the adverse health, social and economic tional organizations - including in the field of harm consequences of the use of legal and illegal psy- reduction. One of the objectives of the Global choactive drugs without necessarily reducing drug Partnership on Drug Policies and Development consumption” (Harm Reduction International, 2018), (GPDPD), implemented by the Deutsche has gained significantly in importance worldwide Gesellschaft für Internationale Zusammenarbeit since the United Nations General Assembly Special (GIZ) GmbH on behalf of the Federal Ministry of Session (UNGASS) on the World Drug Problem in Economic Cooperation and Development (BMZ), is April 2016. This is reflected in an increased common seeking to enhance the evidence basis for develop- understanding and commitment at the global, ment- and health-oriented drug policies. regional and national levels for health-oriented drug policies. In the light of the recent developments in global patterns of drug use, GPDPD has commissioned However, the concept of harm reduction is still Mainline with a comparative study on existing widely understood as a strategy addressing injec- evidence and case studies on harm reduction for tion drug use and the harms and risks associated stimulants, a still under-researched area of global with this route of administration. Harm reduction drug policy for which there is a major international services for people who use stimulants (PWUS) demand. The present two-fold study “Speed Limits are less common despite the constant rise in the – Harm reduction for people who use stimulants” prevalence of stimulant use at a global scale: The significantly contributes to closing the gap of seizures of amphetamine-type-stimulants increased knowledge about which existing harm reduction globally by 20 per cent in 2016, the latest available interventions are effective for people who use stim- data. In the same period, the share of seized ulant drugs. It is the first study to comprehensively amphetamines rose by 35 per cent and the seizures and systematically compile a literature review on of methamphetamine reached the record high of 158 various types of stimulants, routes of administration tons, displaying an increase of 12 per cent. Cocaine and harm reduction strategies, together with the has reached unprecedented levels of purity and presentation of different case studies at a global availability on global markets with a 60 per cent rise level, including regions of the Global South. in seizures since 2012, while also the cultivation of coca in South America has reached historical levels (UNODC 2018). In its first part, the study broadly examines the existing research and literature on the issue in order to build the findings and recommendations on the state-of-the-art evidence on stimulant use and harm reduction strategies. The second part presents seven case studies from five continents, focusing on learning experiences and best practices from highly diverse interventions with varying legal, societal and cultural framework conditions. The study clearly shows that the available research and evidence basis on stimulant use and appropri- ate harm reduction strategies is still weak. There is a clear need for more comparative research on this issue in order to address the current steep rise in stimulant use, to making sure it is properly addressed by evidence-based drug policies and available best practices of successful harm reduction strategies. We hope this groundbreaking study serves as a much-needed element in this process. Daniel Brombacher Head of Project, Global Partnership on Drug Policies and Development (GPDPD), Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH Acknowledgements It is with immense gratitude that we acknowledge We also owe our deepest gratitude to Machteld the contribution of all harm reduction organisations, Busz, Mainline’s director, for reviewing chapters PWUS and harm reduction professionals to this of the report and for providing valuable input and report. Thank you for sharing your time, dilemmas guidance throughout the research process. and experiences with us. This research would have remained a dream had it Besides the authors, two other researchers contrib- not been for the generous support of the Global uted to chapters in this report. Dania Putri delivered Partnership on Drug Policies and Development valuable input for chapter 4.7.1 on plant-based (GPDPD, at Deutsche Gesellschaft für Internationale substitution. Chapter 5.4, on the COUNTERfit case, Zusammenarbeit (GIZ) GmbH). We greatly appreci- was written by Hayley Murray, who also conducted ated the opportunity to provide evidence-based a good part of the interviews for the case. We would information on harm reduction for stimulants. like to express our appreciation for their excellent contribution. Supported by the Global Partnership on Drug Policies and Development (GPDPD) implemented by the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH on behalf of the Federal Ministry for Economic Cooperation and Development (BMZ). http://www.gpdpd.org Disclaimer: This study reflects the combined results of a thorough literature review and the analyses and descriptions of seven cases of good practice harm reduction interventions for people who use stimulants in different world regions. The results do not necessarily reflect the positions of the German Federal Government. Cover design: Odilo Girod Printing: Ipskamp Printers Contents Foreword 1 5 Case studies 47 5.1 Atitude 48 Acknowledgements 3 5.2 Chem-Safe 59 5.3 Contemplation groups 70 Glossary 7 5.4 COUNTERfit 80 5.5 El Achique de Casavalle 91 1 Introduction 9 5.6 Karisma’s shabu outreach 101 1.1 Harm reduction in today’s world 9 5.7 Princehof, Ripperdastraat and 113 1.2 Traditional focus of evidence: 10 Schurmannstraat 1.3 Objectives of this study 10 6 Conclusion 123 2 Methodology 11 6.1 Lessons from the literature and the 124 2.1 Literature review 11 good practice cases 2.2 Seven good practice cases 12 6.2 Do we need specific harm reduction 126 2.2.1 Meaningful involvement 13 for stimulants? 6.3 Recommendations for follow up research 126 3 Context 15 and interventions 3.1 Amphetamine Type Stimulants 15 3.1.1 Methamphetamine 16 References 129 3.2 Cocaine 17 3.3 NPS and Cathinones 18 3.4 Potential risks and harms 18 3.4.1 Physical harm 18 3.4.2 Mental health harms 20 3.4.3 Social Harms 20 3.4.4 Risk Environment 20 Literature review 23 4 Literature review 25 4.1 Safer smoking kits 26 4.2 Prevention of sexual risks 28 4.2.1 Chemsex 28 4.3 Female focused interventions 30 4.4 Drug consumption rooms 31 4.5 Self-regulation 33 4.6 Housing first 34 4.7 Substitution 35 4.7.1 Plant based substitutes 35 4.7.2 Pharmaceutical agonist and 37 antagonists 4.8 Outreach & peer-based interventions 38 4.9 Drop-In Centres 39 4.10 Drug checking 40 4.11 Online interventions 41 4.12 Therapeutic interventions 43 6 Glossary 3-MMC 3-Methylmethcathinone DCR Drug Consumption Room 4-MMC 4-Methylmethcathinone DIC Drop-In Centre 4-MEC 4-Methylethcathinone DRA Dopamine Releasers ABD Asociación Bienestar y Desarrollo DRI Dopamine Reuptake Inhibitor (Spain) EDS Excited Delirium Syndrome ADHD Attention Deficit Hyperactivity EMCDDA European Monitoring Centre of Disorder Drugs and Drug Addiction AIDS Acquired Immuno Deficiency ENA National strategy on addictions Syndrome (Spain) ATS Amphetamine Type Stimulants FACT Flexible Assertive Community BI Brief Interventions Treatment BNN National Narcotics Agency FGD Focus Group Discussion (Indonesia) GBL Gamma-Butyrolactone CAPSAD Centres for Psychosocial Assistance GHB Gamma Hydroxybutyrate on Alcohol and other Drugs (Brazil) HBV Hepatitis B Virus CBD Cannabidiol HCV Hepatitis C virus CBT Cognitive Behavioural Therapy HIV Human immunodeficiency virus CCID Central City Improvement District ICW International Community of (South Africa) Women Living with HIV CDA Central Drug Authority IDPC International Drug Policy (South Africa) Consortium CM Contingency Management INPUD International Network of People CRA Community Reinforcement who Use Drugs Approach LBHM Community Legal Aid Institute CRAS Reference Centre for Social Work (Indonesia) (Brazil) LGBT Lesbian Gay Bi-sexual and CRAUDE Reference Centres for Drug users Transgender (Brazil) MBI Mindfulness Based Intervention CREAS Specialised Reference Centre for MDMA Methylenedioxymethamphetamine Social Work (Brazil) MI Motivational Interviewing CRISM Canadian Research Initiative in MIDES Ministry of Social Development Substance Misuse (Uruguay) CTADS Canadian Tobacco, Alcohol and MSM Men who have Sex with Men Drugs Survey 7 NDMP National Drug Master Plan SACENDU South African Community (South Africa) Epidemiology Network of Drug Use NGO Non-governmental organisation SACUDE Municipal Complex of Health NPS New Psychoactive Substances Culture and Sports (Uruguay) NSP Needle and Syringe Programmes SCUC Safer Crack Use Coalition (Canada) OECD Organisation for Economic SRCHC South Riverdale
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