Drug Consumption Rooms in Porto, Portugal: Public Health Response to Drug Use

Drug consumption rooms in Porto, Portugal: listening to the concerned voices Paula Meireles Paula Meireles (paula.meireles@ispup.up.pt), Diogo Costa, Ana Aguiar, Filipa Quinteiros, Henrique Barros Institute Institute of of Public Public Health Health of of the the University University of of Porto Porto 26 October 26 October 2017, Lisbon 2017, Lisbon Portugal | Lisbon Addictions 2017 Portugal | Lisbon Addictions 2017 Presented by: Name goes here

Disclosure of Conflicts of Interest I have no conflict of interest with any corporate organizations relating to this presentation. This study was partially funded by the Porto Municipality and supported through Unidade de Investiga o em Epidemiologia - Instituto de Sa de P blica da Universidade do Porto (EPIUnit) (POCI-01-0145-FEDER-006862; Ref. UID/DTP/04750/2013); the PhD Grant SFRH/BD/112867/2015 (Paula Meireles) co-funded by the FCT and the POCH/FSE Program. INTRODUCTION INTRODUCTION OBJECTIVES METHODS RESULTS DISCUSSION CONCLUSION

Public health response to drug use Harm reduction Outreach Peer education Health promotion Provision of clean injecting equipment Opioid substitution treatment Drug consumption rooms Law no. 30/2000 of November 29 drugs decriminalization in Portugal INTRODUCTION INTRODUCTION OBJECTIVES METHODS RESULTS DISCUSSION CONCLUSION

HIV epidemic in Portugal among drug users Decriminalization NSP Generalization of Tx HIV cases (1983-2014): distribution of cases associated to drug use and diagnosis year. Source: INSA, 2015. Negreiros, 2001; IPDT, 2001; Negreiros & Magalh es, 2009; Ribeiro, 2014 (SICAD) INTRODUCTION INTRODUCTION OBJECTIVES METHODS RESULTS DISCUSSION CONCLUSION

We aimed to: Assess the acceptability of a supervised drug consumption facility by People Who Use Drugs (PWUD) and by the general population resident in Porto INTRODUCTION OBJECTIVES OBJECTIVES METHODS RESULTS DISCUSSION CONCLUSION

PWUD Two-round capture-recapture Formative assessment Interviews with stakeholders Visits to places Training to the research team (peers and researchers) Capture-recapture at five open drug scenes at Porto Counting Interview sociodemographics, drug use habits, healthcare use, and opinions about drug consumption rooms INTRODUCTION METHODS METHODS OBJECTIVES RESULTS DISCUSSION CONCLUSION

PWUD sampling through capture-recapture Population definition: any months months and and visited use use drugs drugs any person person who least one one of of the who has the five five open has used used illicit open drug illicit drugs drugs in in the drug scenes, scenes, either the previous previous 12 either to to buy buy or 12 to visited at at least or to Spatial distribution of the open drug scene neighborhoods where capture Spatial distribution of the open drug scene neighborhoods where capture- -recapture occurred recapture occurred INTRODUCTION METHODS METHODS OBJECTIVES RESULTS DISCUSSION CONCLUSION

General population PWUD Telephone interviews to EPIPorto Two-round capture-recapture Formative assessment cohort participants Interviews with stakeholders 1 attempt of contact (not known to be Visits to places lost to follow-up and last address at Training to the research team (peers and Porto) researchers) 535 contacted of whom 482 (90.3%) Capture-recapture at five open drug scenes accepted to participate (younger and at Porto more educated) Counting Interview sociodemographics, drug use habits, healthcare use, and opinions about drug consumption rooms (Ramos, et al. Ann Epidemiol 2004; 14: 437-441) INTRODUCTION METHODS METHODS OBJECTIVES RESULTS DISCUSSION CONCLUSION

PWUD number of participants CAPTURE 1 (C1) CAPTURE 2 (C2) Jan 4th (Wednesday) Jan 7th (Saturday) 472 individuals contacted 276 individuals contacted 20 refused 1 not eligible 12 refused 2 not eligible C1=255 C2=458 R=137 118 321 N. of individuals=C1+C2-R= 576 Flowchart of contacts during capture-recapture exercise. INTRODUCTION RESULTS RESULTS OBJECTIVES METHODS DISCUSSION CONCLUSION

PWUD Age and sex INTRODUCTION RESULTS RESULTS OBJECTIVES METHODS DISCUSSION CONCLUSION

PWUD Drug use habits Substances used in the previous year n (%) Time since last consumption n (%) (categories non-mutually exclusive) On the same day 412 (71.5) Crack-cocaine 547 (95.0) On the previous day 132 (22.9) Heroine 363 (63.0) Between 2 to 7 days 20 (3.5) Cannabis 233 (40.5) Between 8 to 30 days 6 (1.0) Methadone or Buprenorphine 190 (33.0) More than 30 days 5 (0.9) Ecstasy 12 (2.1) Days per week visiting that place n (%) Amphetamines 9 (1.6) Less than 1 day 17 (3.0) LSD 6 (1.0) 1 to 5 days 137 (23.8) Consumption at open drug scene n (%) 6 to 7 days 388 (67.4) No 34 (5.9) No information 34 (5.9) Yes 533 (92.5) No information 9 (1.6) INTRODUCTION RESULTS RESULTS OBJECTIVES METHODS DISCUSSION CONCLUSION

General population Age and sex INTRODUCTION RESULTS RESULTS OBJECTIVES METHODS DISCUSSION CONCLUSION

General population Description of participants Witnessed drug consumption paraphernalia Witnessed drug consumption

General population Agreement with potential consequences of a drug consumption room Percentages do not add up to 100 due to respondents who reported don t know or did not answer INTRODUCTION RESULTS RESULTS OBJECTIVES METHODS DISCUSSION CONCLUSION

Agreement with the implementation of a drug consumption room PWUD 97.7% agree 89.1% would use it INTRODUCTION RESULTS RESULTS OBJECTIVES METHODS DISCUSSION CONCLUSION

Agreement with the implementation of a drug consumption room PWUD General population @Porto 69.1% agree or strongly agree 16.8% neither agree or disagree 14.1% disagree or strongly disagree 97.7% agree @area of residence (among those that did not disagree @Porto) 42.5% agree 25.1% neither agree or disagree 32.4% disagree (NIMBY-like reaction) 89.1% would use it INTRODUCTION RESULTS RESULTS OBJECTIVES METHODS DISCUSSION CONCLUSION

Opinions the location of a drug consumption room INTRODUCTION RESULTS RESULTS OBJECTIVES METHODS DISCUSSION CONCLUSION

Quite high support to the drug consumption rooms both from the PWUD and the general population although some resistance maybe be expected 32.4% NIMBY-like reaction Different opinions regarding the preferred location of such facility INTRODUCTION CONCLUSION CONCLUSION OBJECTIVES METHODS RESULTS DISCUSSION

Acknowledgments Other NGOs: Andr Tadeu Ana Isabel Ribeiro Carla Moreira Daniel Sim es Rita Baptista Sandra Sousa V tor Morais C tia Ferreira S rgio Rodrigues Rui Coimbra Rui Salvador Cl udio S rgio Humberto Jo o Ang lica Carlos Lu s Chris Dora Ariana Raquel Rebelo Teresa Sousa Filipe Miranda Virg nia Silva All men and women who live or lived the use of drugs, for the generosity, openness and honesty with which they welcomed us All participants of EPIPorto cohorts who, over the years, have been informing us about the city's health and its determinants

Thank you for your attention! www.ispup.up.pt paula.meireles@ispup.up.pt FOLLOW ISPUP ON SOCIAL MEDIA

Capture-Recapture Formative assessment Assumption Assumption: : Measure Measure taken taken to to avoid avoid violating violating the the assumption assumption The population that we intend to study is The population that we intend to study is closed closed. . Definition of a short time (3 days) between visits. Clear definition of the boundaries of the selected sites. Choice of a useful, unique and easy to remember object. Collection of sufficient sociodemographic and behavioral information that allows, in the worst case scenario, a probabilistic linkage between recaptures. Individuals captured in both samples can be Individuals captured in both samples can be matched; matched; Capture in the second sample is independent Capture in the second sample is independent of sample in the first; of sample in the first; Choose from two different days of the week (working day and weekend). Inclusion of a question that simulates a third round. Involvement of the community in the operational definition of the population Inclusion of peers in the research team, who were allocated to the site they knew best The entire team received clear instructions to: Contact all members of the population they meet; Avoid selecting those who know each other, or who seem more friendly or available; Proceed in the same way in the second round (do not select those remembered to have answered the first one). Each person in the population should have an Each person in the population should have an equal chance of being included in the sample; equal chance of being included in the sample; Method applied in all hotspots identified during the formative assessment and during peak hours. We sought to survey as many individuals as possible in each of the rounds. The sample size for each capture is large The sample size for each capture is large enough to be meaningful. enough to be meaningful.