Drug use, related risk behaviour and harm reduction interventions utilization among injecting drug users in Estonia: implications for drug policy
Date
2012-08-28
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Abstract
Uimastite tarvitamine, eriti nende süstimine, on Eestis terav probleem. Hinnanguliselt on Eestis ligi 10 000 süstivat narkomaani – enamasti noored (keskmiselt 24−27-aastased) venekeelsed mehed Tallinnast ja Ida-Virumaalt. Peamiselt süstitakse fentanüüli ja amfetamiini, üsna levinud on mitme aine koostarvitamine.
Süstiv narkomaania põhjustab nii ühiskonnale kui ka üksikisikutele rohkesti kulutusi. Sellega kaasnevad enneaegsed surmad HIVi ja üledooside tõttu. Samuti tõstab see tervishoiu- (nt narkomaaniaravi, HIVi/AIDSi, C- ja B-hepatiidi ravi) ja sotsiaalkulutusi (nt riigitoetused), samuti õiguskaitseorganite kulutusi. Probleemi tõsidus viitab jätkuvale vajadusele ennetuse ja kahjude vähendamise teenuste järele.
Käesolev uuring annab teavet riskirühma vajadustest, millega tuleb teenuste planeerimisel arvestada. On teada, et ligi veerand süstivatest narkomaanidest alustab süstimist 15-aastaselt ja nooremalt, noorimad on 9−10-aastased. See on oluline rahvatervise probleem, mille lahendamiseks tuleb hinnata olemasolevaid sekkumisi ning välja töötada uusi, mis väldiksid või lükkaksid lastel/noortel edasi uimastite tarvitamise alustamist.
Ulatuslikku HIVi ja C-hepatiidi levimust Eestis põhjustab enamasti süstimisvarustuse jagamine süstivate narkomaanide vahel. Et vähendada HI-viirusega nakatumise ohtu ning piirata verega edasikanduvate nakkushaiguste levikut, võib ühe meetodina rakendada muude manustamisviiside propageerimist süstivate narkomaanide hulgas. Samuti tuleb puhaste süstalde kättesaadavus võimalikult lihtsaks teha. Lisavõimalusi pakub koostöö apteekritega, kes on nõus osalema riskikäitumist vähendavate teenuste pakkumisel, eriti piirkondades, kus süstiv narkomaania on enam levinud.
Kokkuvõtteks: uimastipoliitika tuginemine tõenduspõhisele teabele ei kõrvalda uimastite tarvitamise probleemi, kuid tõenduspõhisus aitab valida efektiivsemaid sekkumisi ja suunata piiratud ressursse sinna, kus neid enim vajatakse.
Drug abuse, especially injecting drug use, is a significant problem in Estonia. There are over 10 000 injecting drug users, living mainly in Tallinn and in the north-eastern part of Estonia. The majority of injecting drug users are Russian speaking young (mean age 24 to 27 years) males. The main drugs injected are fentanyl and amphetamine, also poly-drug use is prevalent. Injecting drug use is associated with several health and social costs. It leads to premature deaths due to HIV and overdoses. In addition causing health related costs (e.g. treatment of dependence disorder and infectious diseases – HIV, HCV) and social costs (e.g. state benefits, criminal justice system and police arrests). The extent and severity of Estonian injecting drug use problem, affecting both injecting drug users and the wider community, underscores the need for the continuous provision of preventive and harm reduction interventions. Current study builds knowledge base needed for developing and tailoring the prevention and harm reduction programs to the needs of the target population in Estonia. We documented that approximately quarter of injecting drug users have started younger than 15 years old, and the youngest were 9 to 10 year olds. This is a significant public health concern which reflects the need for effective responses to stop young people from starting drug use, including injecting drug use, or at least delay the age of starting drug use. As HIV and other blood borne infections transmission through sharing of drug injection equipment is prevalent, promoting the substitution of non-injecting drug use for injecting drug use could be a new important method to reduce the spread. Furthermore, besides syringe exchange programs, engaging pharmacies in high drug use areas or pharmacists willing to be public health educators could be one option to expand syringe access in combination with other harm reduction services. In conclusion, basing drug policy on scientific evidence will not eliminate the drug use problem, but evidence-based approaches have the potential to reduce harms more effectively, and redirect the limited financial resources where they are needed most.
Drug abuse, especially injecting drug use, is a significant problem in Estonia. There are over 10 000 injecting drug users, living mainly in Tallinn and in the north-eastern part of Estonia. The majority of injecting drug users are Russian speaking young (mean age 24 to 27 years) males. The main drugs injected are fentanyl and amphetamine, also poly-drug use is prevalent. Injecting drug use is associated with several health and social costs. It leads to premature deaths due to HIV and overdoses. In addition causing health related costs (e.g. treatment of dependence disorder and infectious diseases – HIV, HCV) and social costs (e.g. state benefits, criminal justice system and police arrests). The extent and severity of Estonian injecting drug use problem, affecting both injecting drug users and the wider community, underscores the need for the continuous provision of preventive and harm reduction interventions. Current study builds knowledge base needed for developing and tailoring the prevention and harm reduction programs to the needs of the target population in Estonia. We documented that approximately quarter of injecting drug users have started younger than 15 years old, and the youngest were 9 to 10 year olds. This is a significant public health concern which reflects the need for effective responses to stop young people from starting drug use, including injecting drug use, or at least delay the age of starting drug use. As HIV and other blood borne infections transmission through sharing of drug injection equipment is prevalent, promoting the substitution of non-injecting drug use for injecting drug use could be a new important method to reduce the spread. Furthermore, besides syringe exchange programs, engaging pharmacies in high drug use areas or pharmacists willing to be public health educators could be one option to expand syringe access in combination with other harm reduction services. In conclusion, basing drug policy on scientific evidence will not eliminate the drug use problem, but evidence-based approaches have the potential to reduce harms more effectively, and redirect the limited financial resources where they are needed most.
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Keywords
narkomaania, narkopoliitika, Eesti, drug policy, drug abuse, Estonia