A brief introduction of project „Dr ug services in prison and subsequent care”. Co-operation with prison service – borders, limits, possibilities, problem areas. Co-operation with other bodies (probation officers, courts, medical institutions), co- operation with network of services, case management. Specifics of work with meth- amphetamine users versus work with hero- in users. Intensive direct post-penitentiary and subsequent care – willingness versus obligation – risks, chances. Olga Škvařilová is a special pedagogue with specialization on deliquents and work in penal institutions, psychotherapist, dance and motion therapist, who has been working in the field of drug addicts since 1993, in the field of specialization on work with people in conf lict with law since 1997. She is the initiator of creation of Drug services in prison in the Czech Republic, chairwom- an of specialized Section of Drug Services in prison of Association of non-government organizations specialized on prevention and treatment of drug addictions in the Czech Republic from 2003 do 2007. She current- ly works as a manager of Drug services in prison and subsequent care in civil associa- tion Sdružení Podané ruce. She is a member of working group „ Prison system – anti- drug programmes in prisons“ of the project Twinning Phare 2000 – „Reinforcement of national anti-drug policy“ RVKPP Office of the Government of the Czech Republic, elaboration of proposal of co-operation between the Prison Service and NNO, 2001 – 2003 Prague, expert international work in the framework of TWINNING PROJECT Support to the implementation of the National Programme for the Fight Against Drugs 2004-2008, Czech - Slovak - German co-operation.
Research to develop dexamphetamine substitution treatment for stimulant users began in Australia in 1995. Two small feasibility trials showed that suitable subjects could be recruited, dexamphetamine substitution treatment provided safely to the experimental condition, appropriate repeated measures could be taken and follow up carried out. Numerous attempts to attract funding for a definitive trial were unsuccessful. In 2006, in response to steadily increasing amphetamine use and adverse con- sequences, state authorities invited two NSW hospitals to develop stimulant treatment pro- grammes (STP) based on psychosocial interventions but with dexamphetamine substitu- tion treatment permitted for some suitable treatment-refractory patients who satisfied stringent inclusion criteria. 214 patients made contact with the STP across both sites in the first six months. At baseline, all patients of the STP were stimulant dependent as measured by the Severity of Dependency Scale. Most were self referred (52%). A preliminary evaluation demonstrated that the STP attracted, retained and benefited people who badly needed help. Critical steps involved triage, in-take, assessment, counseling interventions and counseling plus pharmacotherapy. At follow-up, half had abstained from stim- ulants for at least one month (n=12/24, 50%). Mean stimulant use decreased from 16 to 3.5 days per month. All except five patients reduced their stimulant use to nil or once weekly in the month before follow-up (19/24, 79%). At 6 months follow-up, twothirds (16/24, 67%) reported being no longer dependent on stimulant drugs. The majority (80%) of clients had a history of one or more mental health problems with depression being the most common (70%), followed by anxiety (39%) and drug related psychosis (35%). Kessler 10 Distress Scale nearly significantly decreased at follow-up (K10 mean = 20.92 ± 6.32) compared to baseline (K10 mean= 34.33 ± 7.28) (t [df:23]= 8.35, p=0.000). At baseline 96% (n=23/24) reported elevated distress on the K10. At followup, half of patients reported low levels of distress (K10 total= 1-19, 50%). Of the 24 patients who attended follow up, significant and clinically important reductions were seen in drug use, severity of dependence, distress, mental health problems, crime and social functioning. All except one patient (23/24, 96%) said that they had experienced ‚good‘ to ‚excellent‘ changes in their life. No patients reported any adverse effects from receiving STP treatment. Three patients participated in dexamphetamine substitu- tion. These patients stabilized rapidly, dem- onstrated improvements in health and social functioning, and reported decreased illicit methamphetamine use. Simple, inexpensive and effective non-pharmacological treatment attracts, retains and benefits many stimulant users. Dexamphetamine substitution treatment for a treatment refractory minority warrants further investigation. Dr. Alex Wodak is a physician and has been Director of the Alcohol and Drug Service at St. Vincent‘s Hospital in Sydney, Australia since 1982. He has a major interest in prevention of HIV among injecting drug users, treatment of drug users, health aspects of prisons and drug policy reform. Dr. Wodak is President of the Australian Drug Law Reform Foundation and was President of the International Harm Reduction Association from 1996 to 2004. He helped establish the first needle syringe programme and the first medically supervised injecting centre in Australia (when both were pre-legal) and often works in developing countries on HIV control among injecting drug users.
It may sound strange, but the real designers of the „designed drugs“ are the legal authorities. As long as legal highs distributors will avoid selling illegal drugs, the best and common goods at the 24/7 stores will be fit and not included in the CSA. About a year is needed in order to add a substance to the CSA. This process starts with a forensic iden- tification of a new material in seized exhibits, mostly in capsules or tablets. Forensic identification needs well equipped lab, and up-to-date arsenal of standard materials ready for comparison. A professional proof about the psychotropic effects of the substance is also necessary. The final straight start with the parliament committee recommendation for control of the substance takes 2 months. Taking the opportunity to get rid of their old stock, distributors make „summer sale“ during that period and a new generation of legal highs is designed and prepared. Considering the limits of the new version of CSA just pub- lished, a family of new legal highs is born on the 24/7 shelves. Sophisticated wording of the CSA, using different legal possibilities of control, and cooperation between states in enforcement and in CSA wording, must play a crucial factor in the role of drug enforcement. This work presents how consideration of chemical aspects can play a powerful tool for pushing the legal highs distributors to a corner. Ehud (Udi) Wolf: PhD - The Hebrew University of Jerusalem, the Dept. of Inorganic and Analytical Chemistry. Thesis: „New catalysts for the reduction of NOx and the oxidation of CO 2 ). MsC, Chemistry - The Hebrew University of Jerusalem. BsC Chemistry - The Hebrew University of Jerusalem. Employee Chief Superintendent, the Israel National Police, Head of the Analytical Lab, DIFS. Fields of Expertise: Drugs and material identification (using chemical methods and analytical equipments - XRD, XRF, GC, MS, IR etc).
BACKGROUND: Injection drug use contin- ues to drive the HIV epidemic in Ukraine, the most affected country in Europe. 99,813 cases of HIV were reported by 11/2006, 64.7% of whom were IDUs. The drugs injected include opiate extract and home-made stimulants. METHODS: This is a secondary data analysis from a cross-sectional study investigating the HIV/HCV spread and risk factor patterns in IDU population in Vinnitsya, Ukraine. 315 IDUs were recruited in 2005 using snowball sampling technique. Quantitative data was collected using the Risk Assessment Battery (RAB), Form 90, and locally-specific demo- graphic questionnaire. Qualitative data on stimulant use practices was also collected. RESULTS: All 315 participants had history of injecting opiates in the past year. 40.3% reported injecting stimulants in their life- time (St+); males were using more often than females (43.9% vs. 25%, p=0.01). 23.3% of the sample injected stimulants in the past 30 days (ns. difference by gender). Stimulant injec- tion practices differed from those of opiates - former (‘vint’, ‘jeff’, ‘mul’ka’) were cooked by users for themselves or by an experienced peer who cook for drug, whereas opiates are often cooked by dealers for sale in large amounts. Stimulant recipes varied in complexity, acting substance (catinone, ephedrone, methamphet- amine), and their precursor (phenylpropa- nolamine, ephedrine, norephedrine, teophe- drine) which could be obtained illegally or extracted from over-the-counter medications (“Effect”, “Coldact”, “Actifed”). Potassium permanganate, known to cause severe encephalopathy, is used in majority of the recipes. HIV risk was significantly higher in the St+ group (drug risk score 8.4±4.4 vs 6.8±4.3, p=0.001; sex risk score 5.4±1.7 vs 4.7±2.1, p=0.005). Use of syringe exchange programs was more frequent in the St+ group (p=0.005). Prevalence of HCV and HIV was higher in stimulant users (76.9% vs. 72.1% and 16.5 vs. 12.9%, accordingly), but difference did not reach the level of statistical significance. CONCLUSIONS: Intravenous stimulant use is common in Ukraine. Differences in injec- tion practices between stimulants and opiates have implications for HIV risk. Ease of preparation and low cost contribute to rapid expansion of stimulant use in Ukraine and should be considered for prevention efforts.
In the United States, methamphetamine (MA) is currently the number one drug for treatment admissions in pregnancy constituting 25% of all admissions. Since 2000, the number of pregnant admissions for MA has almost tripled. Population rates of MA, however, have slightly decreased over this time frame. We propose to construct a dynamic model of methamphetamine use during preg- nancy from drug treatment admission and population level survey data. We will analyze the Treatment Episode Data Set (TEDS), an administrative data set that captures at least 70% of all known treat- ment admissions in the US and the National Survey of Drug Use and Health (NSDUH), a computer assisted anonymous annual population based survey. Demographic, geographic and substance use data will be collected for the over 200,000 pregnant TEDS admissions from 1994 - 2006. Logistic regression models will be constructed by year to characterize risk factors associated with treatment admission for MA during pregnancy. The NSDUH will be investigat- ed to see if, among the population of repro- ductive-aged women surveyed, a cohort of MA users might be identified in the years prior to treatment admission. Ideally drug trends should be visible in national survey data. We hope that by identifying a trend retrospectively, lessons for possible prospec- tive identification will be discovered. More specifically, we will be able to assess etio- logic factors associated with MA use such as the time-course from drug initiation to treat- ment admission as well as the role of other substances. As pregnant women occupy a unique place in drug treatment, an understanding of drug trends is essential to plan an appropriate policy response. Mishka Terplan is an OB/Gyn on faculty at the University of Chicago. He has a background in anthropology and a MPH in Epidemiology from the University of North Carolina. His research interests are in drug use in women in general, in pregnancy in particular. His research methods fall into two general catego- ries: 1) systematic reviews and meta-analyses (he has authored the only Cochrane reviews on the efficacy of various treatment interven- tions for pregnant women in drug and alcohol treatment), and 2) secondary data analyses of pre-existing, often publically available data bases. Currently he is investigating gendered differences in drug use and treatment pat- terns. Most of what is known about addiction is derived from research on men. Gendered differences exist for all substances but may be more pronounced with methamphetamine, a drug that historically was given preferen- tially to women.
The US crack cocaine „epidemic“ can be understood as a moral panic. Unlike prior drug waves, it featured a large proportion of pregnant and mothering women. Central to this period was the image of the „crack baby“ - a physically and emotionally damaged being brought into the world by an irresponsible even reprehensible woman. Currently meth- amphetamine (MA) is the most common drug used by pregnant women admitted into treat- ment in the US accounting for over 25% of all admission. In terms of total numbers, MA use among pregnant women today roughly equals the rate of crack use two decades ago. Unlike crack, there appears to be no moral panic concerning MA in pregnancy. There are no „ice babies“, no federal hearings on perinatal drug use, and no overblown media reports. What accounts for this silence? Is this development „positive“? For example, there is not the unjust removal of „exposé“ newborns with notification child protective services that was part of the crack panic. Or is it „negative“? For example, without public attention are the needs of pregnant MA users going unmet? Have we learned from the mistakes of crack, or is a moral panic needed for policy change? We propose a discussion that will include: 1) what constitutes a moral panic, 2) an analysis of policy formation, 3) popular and scientific literature on both cocaine and MA in order to explore the current absence of a panic surrounding MA use. Mishka Terplan is an OB/Gyn on faculty at the University of Chicago. He has a background in anthropology and a MPH in Epidemiology from the University of North Carolina. His research interests are in drug use in women in general, in pregnancy in particular. His research methods fall into two general categories: 1) systematic reviews and meta-analyses (he has authored the only Cochrane reviews on the efficacy of various treatment interventions for pregnant women in drug and alcohol treatment), and 2) se- condary data analyses of pre-existing, often publically available data bases. Currently he is investigating gendered differences in drug use and treatment patterns. Most of what is known about addiction is derived from research on men. Gendered differenc- es exist for all substances but may be more pronounced with methamphetamine, a drug that historically was given preferentially to women.
Issue: ATS including methamphetamine tablets and increasingly crystal methamphetamine are the leading drugs of abuse in Thailand, Laos and Cambodia according to the recent UNODC report „Patterns and Trends of ATS in East Asia and the Pacific, 2006“. In addition to individual health con- sequences of ATS use, increasing numbers of ATS users are being either incarcerated or sent to military style boot camp in Thailand, Laos and Cambodia. Methods: Johns Hopkins and Chiang Mai University conducted a cross-sectional study among 1189 young ATS users. Participants were surveyed about their recent drug use, sexual behaviours and incarceration, and biological samples were obtained to test for sexually transmitted and viral infections. There are ongoing investigations to ascertain similar correlates in Laos and Cambodia where ATS use and the law enforcement response are similar. Results: 22% of participants reported ever having been incarcerated. In multivari- ate analysis, delinquent behaviours, including frequent public drunkenness, starting to use illicit drugs at an early age and involvement in the drug economy, and high-risk behaviours, including tattooing, injecting drugs and unprotected sex, were associated with a history of incarceration. HIV, HCV and HSV infection were also associated with incarceration. Conclusions: This group is being exposed to environments that put them at increased risk of infection and harmful practices. Considering the number of rehabilitation type centres being rapidly constructed across Thailand, Laos and Cambodia, this situation has serious implications for HIV, reproductive health, mental health and human rights of young ATS users and the broader community. This situation provides ongoing urgent challenges for the drug treatment policy and implementation community in the region. Alternatives to incarceration need to be explored for young ATS users. Nick has been based with the Johns Hopkins School of Public Health collabo- rative research projects with Chiang Mai University, Thailand, for the last 7 years working on a variety of research concerning drug use and HIV in South East Asia. The majority of the research explores the implica- tions for individual and public health of the rise and rise of recreational methampheta- mine use among young people in Thailand, Laos and Cambodia. The research has tri- alled peer based harm reduction responses for methamphetamine users. In addition, Nick has been the lead technical consultant for Family Health International exploring HIV risk environments associated with the Thai prison system and also with UNICEF in Laos to conduct research into the feasibility of community based responses to metham- phetamine use that aim to keep young people out of detention/rehabilitation centers. He is currently Johns Hopkins‘ Field Director on a new methamphetamine research project that is exploring the role that community mobilisation may play in reducing HIV trans- mission and methamphetamine use in rural Northern Thailand. Nick is currently the Technical Director for AusAID on a regional project in Thailand, Laos and Cambodia that is seeking to improve the research capacity around issues of methamphetamine use. The project brings together key stakeholders from public security and public health to discuss the issue of methamphetamine research and response specifically in the context of incarceration of methamphetamine users, drug treatment, HIV/STI prevention and treatment. He is also a consultant to OSI on a project investigating issues of drug treatment for methamphetamine users in South East Asia and the implications for human rights and HIV prevention.
In California, USA the number of treatment admissions for methamphetamine use more than quadrupled between fiscal years 1992/93 and 2005/06, causing methamphetamine to surpass alcohol as most common primary drug among people admitted to publicly funded substance abuse treatment. In fiscal year 2005/06 over 50,000 people were treated for methamphetamine use statewide. The landscape for treating meth- amphetamine users in California changed with voter approval of the Substance Abuse and Crime Prevention Act of 2000 (SACPA), which gave non-violent drug offenders the option of accepting community-based treat- ment in lieu of incarceration or parole/ probation supervision without treatment. Since the law’s implementation in 2001, the number of methamphetamine users entering treatment through SACPA has risen every year. In fiscal year 2005/06, approxi- mately 23,000 methamphetamine users were admitted, which accounted for more of the SACPA population than all other drugs combined (57%). Methamphetamine users entering treatment through SACPA had higher overall treatment completion rates than users of cocaine, marijuana, and heroin, but not alcohol. However, multivariate regression results illuminate the complex relationships between completion and variables such as treatment modality, race, employment, and homelessness. Time in treatment was comparable between methamphetamine users and users of other drugs. Implication of the findings for outcome measurement, policies, services, and research will be discussed. D a r re n Ura d a ( P h . D . i n P s yc h o l o g y, University of Southern California, 2000) is the Principal Investigator on California’s evaluation of the Substance Abuse and Crime Prevention Act (SACPA, also known as Proposition 36), and has been involved in evaluating SACPA since 2001. Dr. Urada also served as Principal Investigator on a conference grant to promote substance abuse research, treatment best practices, and cooperation among participants from 22 countries around the Middle East, Africa, and Europe. Previously he served in vari- ous roles for the California State Treatment Needs Assessment Program, for a study on substance abuse and welfare reform, the California Treatment Outcome Project, meta-analytic studies on substance abuse and HIV/AIDS, research on treatment expansion, and as a volunteer in a treatment clinic. He also serves as External Communications Director for the UCLA Integrated Substance Abuse Programs (UCLA ISAP). Dr. Urada has worked for UCLA ISAP for over 10 years.
The Czech Republic has experienced meth use as the major drug problem in the country since as early as 1983. As a consequence, drugs services in the Czech Republic are well tuned in to meth users as the main client group. What is the Czech experience indicating? The differences between methamphetamine and opiates use are considerable. Methamphetamine users often suffer metal health difficulties such as paranoia, severe sleeping disorders, anxieties, and induced psychosis, emotional instability and engage themselves in different kinds of risk behaviour to heroin users. In contrast with opiate use, application is less frequent. It is a close drug scene, users often do not go out in the day, needles are in some groups exchanged once every two weeks in larger amounts by a „group agent“, who is also a user. These patterns of behaviour make work difficult for outreach services as the contact has to be done in the evening and it often involves visiting the users in their homes. It also indicates a need to build the trust of the „agent“, and even consider employing him or her to do needle exchange and to carry out some basic HR education among other users. Regarding treatment, both outpatient and residential, a key question is whether a specialised treatment services should be in place for the meth users, or whether treatment programs should simply be adapted. In any case, it is an imperative that service staff is trained to be able to deal with paranoia, induced psychosis and other mental health related issues. The debate at hand is what is more effective and feasible in methampheta- mine treatment: to develop specialised serv ices or to adapt current ones by training the teams to become truly multidisciplinary. Jindrich Voboril is the founder and Chief Executive of the 2nd largest NGO in the Czech Republic working in drug use treatment and prevention. He has been in this line of work for over 20 years and has played an active role at developing and realizing national drug strategies with the Czech National Drug Commission. He counts with an MA in Education from the University of Olomouc and a Pg Dip on Drug Use and Addictions from the Liver pool John Moores University, as well as counseling and psychotherapeutic training and experience. He is currently a lecturer in Drug Interventions at the Masarykova University in Brno and on Adictology at the Medical Faculty of the Charles University in Prague. Jindrich has worked for the Soros Foundation and for the European Commission as an international consultant in Afghanistan, where he prepared and delivered a training course on HR for medical and other professionals, and carried out an in-depth feasibility study on Social Protection.
Research on substance abuse prevalence among patients in public health sexually transmitted disease (STD) clinics indicate that as many as 20% of patients with STD show symptoms of alcohol or drug abuse but only 1% ever receive treatment. Additionally recent studies of men who have sex with men who present for STD testing in urban US public health clinics, indicate a strong correlation between HIV/ other STD and methamphetamine use. This presentation will report findings from a pilot study and the first six months of an implementation study that is using SBIRT (screening, brief intervention and referral to treatment) within New York City STD clinics to encourage and empower patients, including a significant cohort of MSMs using methamphetamine, to implement harm reduction, mediate risk behaviors and access treatment and/or other services as needed. The intervention model has been adapted from SBIRT to include a brief motivational intervention designed to be used within this setting. The program is a unique collaboration between the New York City Dept. of Health, the New York State Office for Alcohol and Substance Abuse Services, the federal Center for Substance Abuse Treatment, the New York City Lesbian, Gay, Bisexual and Transgender Community Center and local treatment and community-based drug and HIV/AIDS services providers. Barbara E. Warren Psy.D., CASAC, CPP is the Director for Organizational Development, Planning and Research for the Lesbian, Gay, Bisexual and Transgender Community Center of New York City, a position she has held for the past six years. For fourteen years, Dr. Warren was the Center’s Director of Mental Health and Social Services. Dr. Warren holds a doctorate in counseling psychology from the Florida Institute of Technology‘s School of Psychology and is also a credentialed alco- holism and substance abuse counselor and a credentialed substance abuse prevention professional in New York State. She has over 30 years of experience in the development and implementation of mental health, sub- stance abuse and social service programs in community based settings. In 1988, she was hired as the founding director of the Center‘s Project Connect, one of the first LGBT- identified alcohol and drug abuse preven- tion and intervention programs in the coun- try. In addition to her work in the area of direct services, Dr. Warren has represented the Center and the needs of the LGBT communities in an advocacy and policy capacity and has been active in the funding and poli- cy initiatives of the New York State Network of Lesbian, Gay, Bisexual and Transgender Health and Human Services Providers the National Association of Lesbian and Gay Community Centers and is on the Board of the National Coalition for LGBT Health. As a consultant she has worked with a number of city, state and federal agencies including the New York State Department of Health, the New York State Office of Alcoholism and Substance Abuse Services, the Federal Centers for Substance Abuse Prevention, Substance Abuse Treatment and, as the first Community Co-Chair of New York City‘s HIV Prevention Planning Group, with the Federal Centers for Disease Control and Prevention. Since 2001, Dr. Warren has overseen the Center’s crystal methamphetamine prevention and intervention initiative and has been active nationally in methamphetamine prevention, treatment and policy.
