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4. A. Malczewski Injection NPS challenging for response in Poland Artur Malczewski Reitox Focal Point- National Bureau for Drug Prevention Annual expert meeting on Drug-related deaths (DRD) and Drug-related infectious diseases (DRID) Lisbon 17/10/2014 Scope of the presentation • NPS epidemiological situation • NPS market • PWID and NSP programs • Census studies of NSP clients in 2008, 2010, 2012 • Seroprevalence study in Warsaw in 2014 • Challenges and suggestion NPS situation in Poland (surveys) • GPS 15-75 years old (2013, n=1000): 2% LTP • GPS 15-64 years old (2012, n=3900): 1,4% LTP • EB GPS 15-24 years old (2011,2014 n=500): 9% LTP , European average: 5% (2011) and 8% (2014). • Youth Survey 18-19 years old (n=1250): drop from 11,4% (2010) to 3,5% (2013) NPS overdoses and deaths • Medical intervention due to NPS overdoses in 2013: 1079 cases, in 2014 (from Jan. to Aug.): 1416 cases • 3 death cases in 2013 • 3 death cases in 2014 Respons to NPS – Sanitary Inspection Action • 2010: 7225 control actions, around 1400 shops closed • 2013: 779 control actions, 139 detected NPS shops • 2014 (till June): 333 control actions, 128 detected NPS shops but….. Now there are around 120 NPS shops in Poland Police seizures in 2013: NPS under Drug Law control • Mephedrone: 2939 grams • Salvia Divinorum: 1 gram • 4 MEC: 9558 grams • MDPV: 620 grams • Synthetic cannabinoids: 110 grams 10% 20% 30% 40% 50% 0% 20.2% 40.2% 14.8% 8.5% 6.9% 4.4% Other substances Framaceutical NBOMe cannabinoids Synthetic Cathinone 3.7% 3.5% 604 3.3% 2.6% 2.0% samples 2.0% 1.9% 1.7% 1.7% 1.5% 1.5% w 1.3% 1.3% 2013 1.3% 1.3% 1.1% 1.1% 0.9% 0.7% 0.7% 0.7% PWID and NPS • the number of injecting drug users ranged from 4 300 to 10 000 in 2012 (multiplier) • 1 500 PWID were in needle and syringe programmes in 2012 (12 programs, 10 cities) • Needles per persons: 89 in 2012 Census study • During a period of two weeks (from last November to first December 2008, 2010, 2012) staff members of low threshold programmes (needle and syringe exchange or drop-in centres for active drug users) held questionnaire interviews with all clients of a given programme (full sample). • Contacts were made through drug users in order to exchange the injecting equipment, give advice, support or simply have a talk. • The study was launched at the same time as in France. • The respondents’ identities were coded in order to prevent double counting and guarantee anonymity. Clients of NSP, LMP (n= from 730 to 350): census study 80 75 73 2008 70 2010 61 60 60 60 60 2012 52 50 50 48 44 45 44 44 45 40 40 40 36 33 30 30 30 23 20 20 13 12 12 10 10 10 8 10 6 5 5 5 4 4 2 2 3 1 1 0 0 0 Mephedrone using in 2012 (census study) • Users were mostly male (68%). • Mephedrone users were predominantly PWID in 2012 (90%). In 2010, this rate was far lower (40%). • Individuals who reported using mephedrone also used methadone (51%), heroin (49%), Polish home-made heroin (20%) and amphetamine(48%). • HIV + 66% (all 57% ); HCV 76% (all 78%). • 42% in substition treatment Alcohol, 13 others, 3 The most problematic substances (%) Cannabis, 3 Benzodiazepiny/Ba 2008 (n=730) rbiutrany, 4 Amphetamine , 17 Heroin , 62 Cannabis, 2 other, 4 hard to say, 5 Benzodiazepines, 2 Heroin , 40 Alcohol, 14 2012 NPS, 15 (n=350) Census study Amphetamine, 18 Injection of drugs (%) (Seroprevalence study in Warsaw 2014, n=96) 100 89.5 90 80 73.7 70 60 55.8 50 43.2 43.2 46.3 40 31.6 30 22.1 20 8.4 10 4.2 3.2 1.15.3 1.1 0 Heroin Methadone 4-MMC 3-MMC Polish heroin Stimulants (Mephedrone)(3-Methylmethcathinone)Methcathinone Lifetime prevalence Last 30 days prevalence HIV+ 14,7%; HCV 85,7% Challenges: • Nearly 80% of the respondents reported engaging in risky behaviours (sharing injecting equipment and unsafe sex). Being aware of the risk of infection did not contain such behaviour (Study in Warsaw, AIDS Social Committee) • Higher daily number of injections in the case of NPS compared to opiates • Easier access to NPS rather than opiates: shops, Internet selling • Low number of needle and syringe exchange programmes • Injecting user of e.g. NPS in substitution treatment programmes Suggestions/ideas: • Promotion of harm reduction programmes among local governments – EDPQS conference in Warsaw this month • Needle and syringe exchange programmes as drug counselling services • Establishing Integrated Assistance Centres to develop drop-in centres Thank you for your attention! [email protected].
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