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- Title
Harm reduction interventions for drug injectors or heroin users in Spain: expanding coverage as the storm abates.
- Authors
Barrio, Gregorio; Bravo, María J.; Brugal, M. Teresa; Díez, Mercedes; Regidor, Enrique; Belza, María José; de la Fuente, Luis
- Abstract
ABSTRACT Aims To show the utility of analysing time trends of need and coverage of needle-exchange programmes (NEPs) and opioid substitution treatment (OST) to assess harm reduction policies targeting drug injectors or heroin users. Design Multiple methods applied to secondary data. Setting Spain. Participants Thousands of drug injectors or heroin users included in administrative registers, surveys and published studies during 1987-2010. Measurements Coverage for the general population was calculated as the ratio between interventions provided (obtained directly from the sources) and interventions needed (estimated by multiple methods), and as the difference between the two. Timeliness was estimated by time elapsed between year of highest need and year in which coverage reached a reference level. Findings In 2010 NEPs provided 138 syringes per drug injector [95% confidence interval (CI) 100-223], covering 25.7% (95% CI 18.3-43.3) of their need. OST coverage was 60.3% (95% CI 44.3-94.2). Syringe and OST provision increased between 1991 and 2001 and then declined. Syringe and OST coverage also increased substantially during this period and then stabilized, due mainly to decreases in drug injection or heroin use. Medium-level coverage for both syringes and OST was not achieved until 2000, 8 years after the peak in need (1992). Conclusions In Spain, the expansion of harm reduction interventions was greatly delayed, although the concomitant decrease in heroin and injecting drug use led to reasonable coverage after 2000. A longitudinal measurement of need and coverage provides insight into the timeliness and potential population impact of interventions, enabling better assessment of their adequacy.
- Subjects
SPAIN; HIV infection risk factors; THERAPEUTIC use of narcotics; ANALGESICS; NEEDLE sharing; DRUG overdose risk factors; INTRAVENOUS drug abuse; CONFIDENCE intervals; REPORTING of diseases; HEROIN; LONGITUDINAL method; RESEARCH methodology; MEDICAL needs assessment; NEEDLE exchange programs; HEALTH outcome assessment; QUESTIONNAIRES; RESEARCH funding; TIME; SECONDARY analysis; HARM reduction; INTRAVENOUS drug abusers; TREATMENT effectiveness; DESCRIPTIVE statistics; PREVENTION
- Publication
Addiction, 2012, Vol 107, Issue 6, p1111
- ISSN
0965-2140
- Publication type
Article
- DOI
10.1111/j.1360-0443.2011.03759.x