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INSIDE VIEW DIMS played a vital role in the Dutch early warning system, operating as a key link between surveillance and prevention, identifying health risks and issuing‘ red alert’ warnings when necessary. By using direct information from people who use drugs and analysing what they bought on the street or online, the network could‘ provide an inside view on which drugs are circulating, what they cost at the consumer level, the purity, and which adulterants we’ re seeing’, she said. Building trust was essential, however,‘ because only when people who use drugs trust us will they attend the service and provide the necessary contextual information’.
Although drug checking wasn’ t new, credible evidence on the behavioural change it could lead to had been scarce until the last decade, said Helena Valente of Kosmicare in Portugal.‘ But things have been changing’, she said, with the US opioid crisis and the emergence of nitazenes in Europe pushing
‘ Only when people who use drugs trust us will they attend the service and provide the necessary contextual information.’
LAURA SMIT-RIGTER the research forward.‘ We can say with much more confidence that drug checking services are not only being used, they’ re being trusted.’
HEALTHIER BEHAVIOURS Information wasn’ t the only important thing, however.‘ It’ s the interaction people have with peers and professionals that play a key role in promoting safer and healthier behaviours,’ she said.‘ It’ s in this moment of dialogue, of trust and non-judgmental exchange, that a lot of the behavioural change starts to be incorporated. We’ re opening a door to people who otherwise would not have been reached by any other formal service.’
Kosmicare had contacted around 16,000 people in 2022, 75 per cent of whom said it was their first connection with any drug-related health service.‘ We reach a very diverse population, with different ages, different backgrounds, different patterns of use, and we can definitely tailor our interventions to their specific needs,’ she said. One of the ways Kosmicare had managed to significantly reduce levels of opposition to its services in the local community was through initiatives like painting local buildings, needle clean-ups, community laundries and nursing services that were open to anyone.‘ It really gave us a platform for community engagement and care.’ Harm reduction services, including drug checking, were‘ definitely most effective when they’ re embedded in communities from the beginning,’ she stressed.
OPENING DOORS‘ We’ ve spent almost a decade preparing the ground for drug-checking services in Croatia,’ said Lidija Vugrinec of the Croatian Institute of Public Health.‘ Today we still haven’ t opened the door, but we’ re almost there.’ Responses from law enforcement had so far not been positive, she said, but there had been intensive work to prepare an acceptable legal framework and protocols, with a pilot project in Zagreb set to be launched soon. The service
Kosmicare is a harm reduction peer support NGO founded in 2016. Before becoming an NGO, Kosmicare existed as a drugs information and testing service at the Portuguese music festival Boom.
would be based at the Croatian Institute of Public Health itself, with a separate private entrance –‘ not the perfect solution, but it’ s the only way we can launch. Persistence and exploring different opportunities does eventually pay off.’
A survey of 400 people in the target population had found high levels of interest, alongside the inevitable fear of legal consequences and lack of trust in the system. This meant the first challenges would be recruiting clients and building their trust, she said, as well as trying to ensure sustainable funding and raising awareness among law enforcement to gain their acceptance.
BE PREPARED In terms of the monitoring of adverse events, it was important to have strong communication links with hospitals, said Smit-Rigter.‘ So if people have already taken the drugs and had adverse effects we can link those to the substances they’ ve actually consumed. If they’ re still in possession of the drugs they can submit them so we can align the data, because toxicological research remains a challenge.’ Preparedness and defined protocols were vital, added Valente, as were effective networking and partnerships to disseminate information as quickly as possible.‘ It can’ t be isolated work.’
On a related theme, communicating the risks of adulterants meant always being clear and direct, stressed Ventura.‘ Try not to give too much information, and if the information is very scientific, adapt it into easy information.’
Testing in a timely manner was an ongoing challenge for services and also depended on the target population, said Smit-Rigter. For people who used drugs recreationally at festivals a few times a year it was easy to say‘ come in advance and a week later you’ ll have the results’, she stated, which was obviously not the case for those living on the street. There was also a fine balance between exaggerating the risks – which could make them appear less credible – and the danger of downgrading them, delegates heard.
When it came to securing funding in a landscape where there were numerous other priorities, it was again about communicating effectively with decision makers and trying to find the right balance, said Vugrinec.‘ In Croatia there are budget cuts, so it’ s not easy. But we present data from other countries that have had a positive experience, and we highlight the benefits of these services. There’ s no other way.’ DDN
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