In Italy, the need to contain the spread of human immunodeficiency virus (HIV) among injecting heroin users in the early 1990s resulted in the establishment of outreach programmes and low-threshold centres, and the provision of clean injecting equipment and drug treatment. This was the beginning of a shift towards ‘contacting and taking into care’ those who were not receiving treatment from drug treatment services. This harm reduction-focused approach was further consolidated in a state-regional agreement in 1999, which added harm reduction to the range of services provided by the public drug addiction system. A recent step was the inclusion, by decree of the President of the Council of Ministers of 12 January 2017, of harm reduction services among the essential levels of healthcare (LEA), thus guaranteeing harm reduction services to all citizens in Italy.
The range of harm reduction services and initiatives in Italy remains heterogeneous and diverse. Some outreach programmes and projects exist at local levels and are operated by both public drug dependency service units (Ser.Ds) and accredited private social and health organisations, together with specific projects funded through regional funds. These usually include needle and syringe programmes (NSPs), information dissemination and counselling.
The level of provision of harm reduction services in Italy is uneven in scope and reach, with harm reduction programmes more developed in the northern and central regions of the country, and mainly located in the larger cities. Harm reduction interventions are delivered through mobile units, drop-in centres, reception units and outreach programmes, and by public and private outpatient treatment services. A recent study indicated that naloxone, which in Italy is an over-the-counter drug, is given out by a large number of harm reduction units, mostly in northern Italy. The provision of naloxone is combined with individual counselling on safer use and overdose management.
Ser.Ds play an important role in the early diagnosis of infectious diseases among people who inject drugs and their referral to treatment services. Collaborations between Ser.Ds and local hospitals have been established to facilitate referral and optimise management of infectious diseases among this group, using a multidisciplinary approach.
|Country||Needle and syringe programmes||Take-home naloxone programmes||Drug consumption rooms||Heroin-assisted treatment|