26 October 2017 Lisbon Portugal Lisbon Addictions 2017 Paula Meireles paulameirelesispupuppt Diogo Costa Ana Aguiar Filipa Quinteiros Henrique Barros Institute of ID: 760864
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Slide1
Drug consumption rooms in Porto, Portugal: listening to the concerned voices
26 October 2017, Lisbon – Portugal | Lisbon Addictions 2017
Paula Meireles
(
paula.meireles@ispup.up.pt
)
, Diogo Costa, Ana Aguiar, Filipa Quinteiros, Henrique Barros
Institute
of
Public
Health
of
the
University
of
Porto
Slide2I 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 Investigação em Epidemiologia - Instituto de Saúde Pública 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.
Disclosure of Conflicts of Interest
Slide3Harm reduction OutreachPeer educationHealth promotionProvision of clean injecting equipmentOpioid substitution treatment Drug consumption roomsLaw no. 30/2000 of November 29 – drugs decriminalization in Portugal
Public
health
response to
drug
use
Slide4HIV
epidemic in Portugal among drug users
HIV cases (1983-2014): distribution of cases associated to drug use and diagnosis year. Source: INSA, 2015.
NSP
Decriminalization
Generalization
of
Tx
Negreiros, 2001; IPDT, 2001; Negreiros & Magalhães, 2009; Ribeiro, 2014 (SICAD)
Slide5We 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
Slide6PWUD
Two-round capture-recaptureFormative assessmentInterviews with stakeholdersVisits to placesTraining to the research team (peers and researchers)Capture-recapture at five open drug scenes at PortoCounting Interview – sociodemographics, drug use habits, healthcare use, and opinions about drug consumption rooms
Slide7PWUD – sampling through capture-recapture
Spatial distribution of the open drug scene neighborhoods where capture-recapture occurred
Population definition: any person who has used illicit drugs in the previous 12 months and visited at least one of the five open drug scenes, either to buy or to use drugs
Slide8General population
Telephone
interviews to EPIPorto cohort participants 1 attempt of contact (not known to be lost to follow-up and last address at Porto)535 contacted of whom 482 (90.3%) accepted to participate (younger and more educated)
(
Ramos, et al. Ann Epidemiol 2004; 14: 437-441)
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
Slide9276
individuals
contacted
20
refused
1 not eligible
12
refused
2 not eligible
472 individuals contacted
CAPTURE 2 (C2)Jan 7th (Saturday)
CAPTURE 1 (C1)Jan 4th (Wednesday)
R=137
C1=255
C2=458
118
321
N.
of
individuals
=C1+C2-R= 576
Flowchart of contacts during capture-recapture exercise.
PWUD –
number
of
participants
Slide10PWUD – Age and sex
Slide11PWUD – Drug use habits
Substances used in the previous yearn (%)(categories non-mutually exclusive)Crack-cocaine547 (95.0)Heroine363 (63.0)Cannabis233 (40.5)Methadone or Buprenorphine190 (33.0)Ecstasy12 (2.1)Amphetamines9 (1.6)LSD6 (1.0)Consumption at open drug scenen (%)No34 (5.9)Yes533 (92.5)No information9 (1.6)
Time
since
last
consumption
n (%)
On
the
same
day
412 (71.5)
On
the
previous
day
132 (22.9)
Between 2 to 7 days
20 (3.5)
Between 8 to 30 days
6 (1.0)
More
than
30
days
5 (0.9)
Days
per
week
visiting
that
place
n (%)
Less
than
1
day
17 (3.0)
1 to 5
days
137 (23.8)
6 to 7
days
388 (67.4)
No information
34 (5.9)
Slide12General population – Age and sex
Slide13Witnessed drug consumption
Witnessed drug consumption paraphernalia
General
population
– Description of participants
Slide14General 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
Slide15PWUD
97.7% agree89.1% would use it
Agreement with the implementation of a drug consumption room
Slide16PWUD
97.7% agree89.1% would use it
General population
@Porto69.1% agree or strongly agree16.8% neither agree or disagree14.1% disagree or strongly disagree@area of residence (among those that did not disagree @Porto)42.5% agree25.1% neither agree or disagree32.4% disagree (NIMBY-like reaction)
Agreement with the implementation of a drug consumption room
Slide17Opinions the location of a drug consumption room
Slide18Quite 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
Slide19Acknowledgments
André TadeuAna Isabel RibeiroCarla MoreiraDaniel SimõesRita BaptistaSandra SousaVítor MoraisCátia FerreiraSérgio RodriguesRui CoimbraRui SalvadorCláudio SérgioHumbertoJoãoAngélicaCarlosLuísChrisDoraArianaRaquel RebeloTeresa SousaFilipe MirandaVirgínia Silva
All
men and women who live or lived the use of drugs, for the generosity, openness and honesty with which they welcomed usAll participants of EPIPorto cohorts who, over the years, have been informing us about the city's health and its determinants
Other
NGOs
:
Slide20paula.meireles@ispup.up.pt
Thank
you
for
your
attention
!
Slide21Assumption:Measure taken to avoid violating the assumptionThe population that we intend to study is closed.Definition of a short time (3 days) between visits.Clear definition of the boundaries of the selected sites.Individuals captured in both samples can be matched;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.Capture in the second sample is independent 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.Each person in the population should have an equal chance of being included in the sample;Involvement of the community in the operational definition of the populationInclusion of peers in the research team, who were allocated to the site they knew bestThe 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).The sample size for each capture is large enough to be meaningful.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.
Capture-Recapture
Formative
assessment