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The long-term picture shows clear improvement overall and illustrates the impact that providing the appropriate services can have. Historically, a main driver for drug policy and responses in respect to heroin, particularly injecting use, was the need to reduce HIV risk behaviour and transmission. There is an overall stagnation in demand for heroin, driven in a large part by both a decline in recruitment into heroin use and the enrolment of many of those with heroin problems into treatment services. Injecting as the main route of administration has declined from 28 % in 2006 to 20 % in 2013.
In addition to the therapeutic benefits of treatment provision, Europe’s overall high rate of treatment coverage, estimated at 50 % of cases or more, is likely to make the European Union a smaller and potentially less attractive market for those supplying this drug.
Formulating effective responses to reduce overdose deaths remains a key policy challenge in Europe. Recent outbreaks and the situation in a few European countries underline the need for continued vigilance and ensuring that service provision levels are adequate. It remains that the misuse of benzodiazepines in combination with opioids is associated with elevated risk of drug overdose.
Efforts also are still needed to address the relatively high rates of hepatitis C infection still found among injecting drug users. Here, new and effective treatments are becoming available, although treatment costs are high.
Developments in this area include the introduction of targeted strategies, the provision of naloxone programmes and prevention initiatives targeting high-risk groups. Some countries have a long-established practice of providing ‘supervised drug consumption rooms’, with the intention of engaging with hard-to-reach drug users and reducing drug-related harms, including overdose deaths. Nonetheless, The EMCDDA report notes, however, that in some countries, and with support at European level, efforts are being made to improve the situation.
As heroin dependence is a chronic condition, a specific issue is that the services provided need to adapt to the needs of an ageing cohort, and provision of an appropriate health and social service response for this group is therefore a growing challenge for drug services. A history of poor health, bad living conditions, tobacco and alcohol use, and age-related deterioration of the immune system make these users quite susceptible to a range of chronic health problems. Among these are cardiovascular and lung problems resulting from chronic tobacco use and injecting drug use and long-term use of other substances, including alcohol or misuse of benzodiazepines among high-risk drug users. More...
