Italy Country Drug Report 2019

Harm reduction

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.

Harm reduction interventions

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.

Availablity of selected harm reduction responses in Europe
Country Needle and syringe programmes Take-home naloxone programmes Drug consumption rooms Heroin-assisted treatment
Austria Yes No No No
Belgium Yes No Yes No
Bulgaria Yes No No No
Croatia Yes No No No
Cyprus Yes No No No
Czechia Yes No No No
Denmark Yes Yes Yes Yes
Estonia Yes Yes No No
Finland Yes No No No
France Yes Yes Yes No
Germany Yes Yes Yes Yes
Greece Yes No No No
Hungary Yes No No No
Ireland Yes Yes No No
Italy Yes Yes No No
Latvia Yes No No No
Lithuania Yes Yes No No
Luxembourg Yes No Yes Yes
Malta Yes No No No
Netherlands Yes No Yes Yes
Norway Yes Yes Yes No
Poland Yes No No No
Portugal Yes No No No
Romania Yes No No No
Slovakia Yes No No No
Slovenia Yes No No No
Spain Yes Yes Yes No
Sweden Yes No No No
Turkey No No No No
United Kingdom Yes Yes No Yes

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Methodological note: Analysis of trends is based only on those countries providing sufficient data to describe changes over the period specified. The reader should also be aware that monitoring patterns and trends in a hidden and stigmatised behaviour like drug use is both practically and methodologically challenging. For this reason, multiple sources of data are used for the purposes of analysis in this report. Caution is therefore required in interpretation, in particular when countries are compared on any single measure. Detailed information on methodology and caveats and comments on the limitations in the information set available can be found in the EMCDDA Statistical Bulletin.