Drug injecting is rare and stigmatised by the public and, on the whole, by drug users themselves. But, despite this, it accounts for most of the severe health consequences of drug use in Europe today. So says the EU drugs agency, the EMCDDA, in the latest edition of its Drugs in focus series out today.

Entitled ‘Drug injecting challenges public health policy’, this briefing aimed at EU policy-makers examines some of the current trends in drug injecting and associated policy responses. It says many interventions employed to reduce it reflect the rapid evolution in policy perspectives and public opinion in many parts of Europe over the last 10 years – particularly the increasing acceptance of harm- reduction measures as integral to comprehensive public health policy on drugs.

‘Certain aspects of this approach are more controversial than others’, the briefing explains. ‘Some are experimental or still to be evaluated, while others are firmly established and evidence based.’

It adds that much of the responsibility for reducing drug-related health damage lies locally. So it is hoped that this briefing will be of particular interest to local decision-makers and service-providers, as well as policy-makers at national and European level.

The message from the briefing is clear: EU Member States must act to reduce the public health consequences of drug injecting.

‘No easy task’

In the briefing, Mike Trace, Chairman of the EMCDDA Management Board, says: ‘Studying drug injecting is no easy task, largely due to its hidden nature and low prevalence in the general population. Why and how people decide to engage in such dangerous behaviour is difficult for most of us to understand. But we must understand it and respond with effective education and prevention measures.’

The agency says there are probably between half and one million drug injectors in the EU today, excluding those who inject occasionally or who have injected in the past. This represents less than 0.4% of the population aged 15-64, and no more than 5% of the estimated 18 million who use illegal drugs each year.

However, it is associated closely with marginality and stigma – concentrated in communities with high levels of social deprivation, and in individuals with multiple problems of physical and mental health and social and personal behaviour.

The need to understand and study the phenomenon are underscored in the briefing by Georges Estievenart, EMCDDA Director, who says: ‘Drug injecting spread very quickly in western countries in the 1970s and 1980s, and now seems to be extending rapidly in other regions of the world. But in the 1990s, some western countries reported falls in injecting. This may imply room for improvement and intervention – if the nature of such changes can be understood.’

The challenges for policy-makers

Today’s briefing says reducing drug-related health damage is a priority for public health policy – and a key target of the EU drugs strategy 2000-04. It says the following issues need to be addressed by policy-makers:

Though rare, drug injecting has a major public health impact, is closely linked to marginalisation, and despite decreases in some countries, is increasing in others.

Drug injecting underlies most cases of HIV, hepatitis and overdose death among drug users in Europe. Public health policies to reduce health damage must therefore give top priority to reducing injecting and related risks.

Continued drug injecting and risky behaviour, and renewed rises in overdoses and drug-related infectious diseases in some countries, indicate the need for greater efforts to reduce injecting and risk among drug injectors. These efforts must be based on evidence and on understanding the realities of local drug-use patterns.

Interventions must be part of a comprehensive public health approach that addresses broad issues of social exclusion as well as balancing local needs.

A range of responses adapted to local circumstances has been found useful to reduce transmission of infectious diseases. These include outreach and information, needle exchange, substitution treatment and, more controversially, injection rooms. Evidence suggests such responses do not increase drug use or drug-injecting, as some fear.

Drug injecting substantially increases the risk of overdose – especially after release from prison and among the most marginalised people. Some, perhaps many overdoses are preventable.