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Preventing or reducing injecting: a review of the evidence on route transitions and reflections on 20 years of promoting the transition away from injecting heroin in the Netherlands
Jamie Bridge, Project Development Officer, International Harm Reduction Association and John Peter Kools, Consultant on Drug Use, HIV and Harm Reduction, Amsterdam, Netherlands
Jamie Bridge
Abstract
This presentation aims to provide delegates with an overview of scientific evidence and documented practice that exists around the world on the issue of 'route transitions'.
A 'route transition' is said to occur when a person changes the method of drug administration that they predominantly use. For example, someone may shift from smoking a drug to injecting it instead, or may shift away from injecting their drugs and towards another method of consumption such as smoking, sniffing or ingestion. This latter change is known as a 'reverse transition', and has significant potential to reduce harm as non-injecting routes of administration are generally safer than injecting, albeit still associated with a level of drug-related harm.
There is evidence from around the world which demonstrates that different routes of administration are used, and that route transitions are a common phenomenon. Many of these studies go as far as identifying predictive factors for transitions (both to and from injecting), but this body of work has been poorly translated into harm reduction practice. This presentation will review this evidence, outline some of the policy responses and supportive statements from the UK and elsewhere, and identify some of the work on relative harms associated with different routes of administration. The presentation will conclude by reviewing some of the work being done to prevent transitions into injecting, and to encourage and assist reverse transitions (such as the provision of foil in needle exchanges). As there is possibly a certain level of injecting-related harm that cannot be prevented - route transition work must become a key priority for the harm reduction community.
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Biography
Jamie Bridge is the Project Development Officer at the International Harm Reduction Association (IHRA) based in London. He is also the Programme Manager for the IHRA conferences, and the Co-Deputy Chair of the UK National Needle Exchange Forum (NNEF). Jamie started work for IHRA in 2006. In that time, he has developed the organisation's website and online resources (www.ihra.net), coordinated the Global Alcohol Harm Reduction Network (GAHR-Net), and written and co-written a number of reports, policy essays, and articles. Prior to working for IHRA, Jamie worked in a needle exchange programme in Bedford, England. He has a BSc in Psychology from Warwick University and an MSc in Drugs Policy from Imperial College, London.
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John Peter Kools
Abstract
This presentation will provide an overview of experience in The Netherlands with promoting route transition away from injecting. It will describe an early autonomous trend among heroin and cocaine users from injecting towards non-injecting drug consumption in the early 1990s. This trend in the drug using community was initially recorded in 1992 by community outreach workers in Amsterdam and became the basis for a range of health promotion activities.
The presentation will describe various health interventions conducted by the NGO Mainline between 1992 and 2000 in order to strengthen this development of route transition. Various methods were used to strengthen and accelerate this development; articles in a health promotion magazine, outreach campaigns, a field survey among injectors, a video with testimonies of ex-IV users, nation-wide peer support campaigns and workshops drug workers. Crucial element in all inventions was the provision of aluminium foil. On two occasions foil was included in the magazine.
The strategy to promote non-injecting is very likely to have strengthened the movement of transition to non-injecting. Health was obviously an important consideration for drug users, and autonomous processes could be strengthened by tailored health promotion campaigns: monitoring and recognizing the existing early developments, re-enforcing it with clear-cut technical information, re-distributing it community-wide and supporting it through peer support work.
By the end of the 1990s the development seemed to be complete. Within a couple of years an entire generation of drug users in Holland changed their rituals and habits and moved away from injecting. The presentation will also elaborate on conditions of route transition and look at opportunities of similar health strategies in other settings.
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Biography
John-Peter Kools is an independent consultant on drug use, HIV and harm reduction. He studied Political Science at the Vrije Universiteit in Amsterdam. Since the mid-1980s, he has been involved in the development of the grassroots delivery of services and HIV interventions among injecting drug users. He was involved in starting the first needle exchange service in the Netherlands and early community-based HIV responses.
He is a founding member of the health promotion organisation Mainline, based in Amsterdam. Since 1996, he has primarily been involved in initiating and supporting HIV prevention services in Central and Eastern Europe and co-ordinated a multi-country programme on HIV, drug use and poverty reduction in Asia. Currently, John-Peter works on an independent basis for various drug use and HIV-related programmes in transitional and developing countries and has recently conducted an explorative study on substance use and HIV in sub-Saharan Africa. He is a member of the Board of Directors of the International Harm Reduction Association (IHRA) and Health Connections International (HCI).
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