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A MAINLINE-GIZ STUDY
With the support of the Global Partnership on Drug Policies and Development (GPDPD), a project implemented by Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, a team of three Mainline researchers conducted a study into effective harm reduction interventions for stimulant users. The study includes a review of the evidence for different harm reduction strategies for stimulants and a detailed description of seven good practices in different world regions.
The need
As most harm reduction interventions are funded under the umbrella of HIV, most of the research and project funding also goes to analyse the effectiveness of HIV/AIDS strategies. This means that both programmes and the evidence focus on those drug users who inject their drug and they leave out those who smoke, snort or swallow. The people who can benefit from harm reduction interventions are most often injecting opioid users, and harm reduction often becomes associated with heroin use alone. At the same time, people using stimulants may face somewhat different problems, regarding health as well as psychosocial and legal circumstances. As this leaves many marginalised stimulant users underserviced, there is a need for the harm reduction field to broaden the scope and to structurally include stimulant users.
What we know
The body of available research conducted on effective harm reduction for stimulant users provides some basic insights. We understand the chemical structures of stimulants and how they stimulate the central nervous system. We can categorise stimulants into cocaine, amphetamines, meth-amphetamines, methcathinones and cathinones. There is abundant information about the attributes and effects of stimulants:
They increase wakefulness, focus and confidence; they can elevate someone’s mood and provide feelings of power; they decrease fatigue and appetite. They can also produce nervousness or anxiety and, in some cases, psychosis and suicidal thoughts (e.g. Holman, 1994; EMCDDA, 2007; Hildrey et al., 2009; Pates and Riley, 2009).
What we don’t know enough yet is which harm reduction strategies have been developed worldwide for different contexts and types of stimulants user, and which of those strategies are being positively evaluated. The harm reduction field would greatly benefit from more practical guidance to establish interventions for stimulant users in specific contexts. This study aims to fill that need.
What we study
The present study:
Implementation of the research started on 1 September 2017 and was finalised in August 2018.
Here you can find the final report and the executive summary.
View the final presentation.
Contact (lead researcher): Rafaela de Quadros Rigoni: r.rigoni@mainline.nl
Nepal
Mainline was asked to review the current harm reduction programmes in Nepal from the perspective of women who inject drugs. Based on interviews with women we formulated recommendations to improve service delivery.
Netherlands, Belgium, Spain, Greece, Germany, France
Several risk factors increase the vulnerability of (new) groups of migrants to engage in problematic drug use. These risk factors include traumatic experiences, disengagement with society, unemployment and poverty. Services and municipalities throughout the European Union are faced with the urgent challenge to address these migrants’ needs.
Burkina Faso, Burundi, Egypt, Kenya, Marocco, Mozambique, Nigeria, South Africa, Uganda, Zimbabwe
Mainline is a partner in the Love Alliance programme. The Love Alliance brings together organisations led by communities most affected by HIV and AIDS.
Vietnam
In 2021 and 2022, SCDI in Vietnam and Mainline can continue to strengthen and expand the available harm reduction offer for people who use meth-amphetamines. After establishing the regional field lab in 2019 and 2020 we now have the opportunity to push this innovative initiative to the next level. One important element: to improve and expand the community mental health response. Moreover, the skills that were built in Hanoi's field lab are ready to be further disseminated across the South East Asian Region.
United Kingdom, Finland, Greece, Estonia, Serbia, Portugal, the Netherlands
Harm reduction approaches are rarely applied in a recreational sports setting. And why would we - sport equals health, right? Not always. Research shows that the use of performance and image-enhancing drugs (PIEDs) is quite common in various recreational sport scenes. And for those people who use frequently and in high doses, harm reduction can make a big difference.
Brazil
Mainline is starting a two-year project in Recife, Brazil, together with LANPUD, and the Free School for Harm Reduction (ELRD). The project aims to expand harm reduction and HIV care and support for young people who use crack cocaine.
Global
The use of drugs during sex is a growing worldwide phenomenon among men who have sex with men (MSM). Mainline has built a unique track record while working in the frontline of the Dutch 'chemsex' scene. Now, we also apply this expertise in an international context.
Zimbabwe
Mainline have been asked to assess the drug scene in five provinces in Zimbabwe. A team of three researchers worked in close collaboration with the Zimbabwe Civil Liberties Drug Network throughout 2022. The goal: to gain an insight into which drugs are commonly used and to recommend health interventions.
Kenya
Women who use drugs in Kenya face violence every day: At home. On the streets. By the police. In their communities. A unique study - conducted in Mombasa, Kenya - sheds light on the tough realities these women encounter. Urgent action is needed.
Zambia
Harm reduction is new in Zambia. Mainline was asked to estimate how many people inject drugs in the country and to map the already existing harm reduction and HIV services for people who use drugs. Based on this information, we drafted practical service guidelines. In doing so, Mainline hopes to have contributed to the introduction of harm reduction in Zambia.
Indonesia
Prisons in Indonesia are overcrowded and health services are limited. Is quality prison health too expensive? Not according to findings from Atma Jaya University, who applied the method of 'economic modelling' to prison health services, including drug dependency programmes. The findings fed important advocacy messages to improve the prison system in 2021. Moreover, Atma Jaya - via a 2021 implementation study - succesfully introduced motivational interviewing into the prison setting: an evidence-based method to assist people who are dependent on drugs and would like to reduce or quit their drug use.
Iran
Iran is renowned for its harm reduction programme. It was one of the first countries in this geographical region to adopt a harm reduction approach. Government supports and funds the programme. But the drug scene in Iran has changed over the past 20 years. More people are using stimulant drugs and, due to economic circumstances, more people who use drugs have become homeless. Mainline sets out to see whether the current programme in Tehran still fits the needs of the local people who use drugs.
South Africa
Women Who Use Drugs face additional problems compared to their male counterparts. The harm reduction field far too often neglects the needs of women. To some extent, the same is true for peer workers: incredibly valuable staff in any impactful service. How can local services make sure that peer workers are valued, supported and living up to their full potential? And how can access for women who use drugs be improved?
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