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Promoting transition to smoking in the UK: panel discussion
John Peter Kools, Consultant on Drug Use, HIV and Harm Reduction, Amsterdam, Netherlands, Matthew Southwell, The Gold Standard Team, Jon Derricott, Exchange Supplies and Rachael Pizzey, Turning Point, Somerset

	Matthew Southwell: View powerpoint presentation
	Rachael Pizzey: View powerpoint presentation
	Listen to the speeches

Abstracts

John Peter Kools
This presentation will provide an overview of experiences in The Netherlands with promoting route transition away from injecting. It will describe autonomous trends among opiate and stimulant users from injecting towards non-injecting drug use in the early 1990s. This trend in the drug using community was initially recorded in 1992 and became the basis for a range of health interventions to promote route transition away from injecting.

The presentation will describe the context of injecting drug use behavior in The Netherlands, environmental conditions, public health responses and a range targeted interventions in order to stimulate and facilitate route transition away from injecting. A range of health interventions and social marketing methods were used to strengthen existing developments of transition (e.g. explicit instruction materials, community outreach work, peer support work, a video with testimonials of former injectors). A key element in the inventions was the availability and provision of aluminum foil.
Immediate and long-term health and social benefits were an important motive for drug users to switch away from injecting. Transition to non-injecting provided also significant additional self-management
opportunities.

By the end of the 1990s the development was nearly ended. Within a couple of years an entire generation of drug users made a sustained behavioral change on an area that was earlier not considered amendable to intervention: the mode of drug administration.

A combination of full range of health interventions (OST, NSPs, consumption rooms, community outreach, peer support, social marketing etc.) can lead to significant individual and public health benefits. Promoting route transition may be a significant innovation in the prevention of BBVs, overdoses and other injecting related harm and provide an additional heath strategy in developed countries like The Netherlands, but also in other regions in the world that are currently facing high or rising rates of injecting prevalence.

Matthew Southwell
In the 1990s spontaneous trends away from injecting were identified in Amsterdam, New York and London. People who inject drugs were making choices to switch to non-injecting routes of administration for some or all of the time. These shifts were driven at the individual level by a desire to:

• avoid blood borne viruses
• increase self-control
• improve health

Importantly these individual trends were made possible by the increased purity and reduced price of drugs.

Route Transition Interventions (RTIs) focussed on two potential points of entry:

• preventing transitions to injecting
• encouraging transitions away from injecting

Reducing the overall pool of people injecting drugs remains a valid policy objective. However, it is important that RTIs do not add to the stigma and discrimination experienced by people who inject drugs.

This workshop will explore some of the principles and working practices of the early pioneers of RTIs. The importance of the meaningful participation of people who snort, smoke and inject drugs in the design, delivery and review of RTIs will be promoted as an ethical and quality safeguard. This workshop will argue that RTIs need to be better focused and deployed if their potential is to be realised.

Rachael Pizzey
In her presentation Rachael will look at some of the reports in the UK which have evidenced moving people away from injecting as best practice; the alternatives to injecting, some of the main points of her paper (with Neil Hunt) on the use of foil to promote the transitions away from injecting and offer advice on how workers can apply interventions whether they are able to provide foil or not.

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Biographies

John-Peter Kools is an independent consultant on drug use, HIV and harm reduction. He studied Political Science 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. He is a member of the Board of Directors of the International Harm Reduction Association (IHRA) and Health Connections International (HCI.)

Matthew Southwell is the founder of the Healthy Options Team (HOT) that was one of the early pioneers of route transition interventions. He led the development teams behind HOT's It's Good to Chase Campaign, developed the Up Your Bum approach and promoted the concept of PIN2PIPE for people injecting crack. He has also been a champion of the Stand Your Ground concept, which seeks to foster positive identities and resilience strategies among people who smoke or snort drugs.

Mat was an early harm reduction worker who went on to manage drug treatment, drugs education and community drug services. In 1999 he made public his own use of drugs and has since been involved in a range of drug user groups and networks. Mat's work as a practitioner, manager and activist is founded on approach that respects people's right to high quality information, choice and self-determination.

Rachael Pizzey qualified as a nurse in London and specialised in working with people with HIV and AIDS. She has been working for Turning Point in Somerset since 1995 and has always taken an active interest in injecting drug use and harm reduction. She published her paper ‘Distributing foil from needle and syringe programmes (NSPs) to promote transitions from heroin injecting to ‘chasing’: an evaluation’ with Neil Hunt in 2008.

Jon Derricott
Jon is a former nurse working in drug treatment services and co-founder of Exchange Supplies.  He’s a writer and trainer and was a lead author and producer of the Harm Reduction Works campaign materials.