Seven ways to reduce infections among people who inject drugs

Joint guidance report from ECDC and the EMCDDA:

EMCDDA-ECDC joint guidance ad

Seven interventions, one aim: no infections among people who inject drugs. In a new guidance document out today, EU agencies ECDC and the EMCDDA have joined forces to identify seven interventions to reduce and prevent infectious diseases in this vulnerable population. Many European countries have achieved substantial progress in recent years in preventing drug-related infections. Drug injecting, however, remains a major cause of infectious diseases across Europe. The interventions proposed range from the supply of injection equipment, testing and vaccination to the treatment of infections and drug dependence. These are best applied in combination and ideally in the same venue for maximum effect.

In their guidance report, Prevention and control of infectious diseases among people who inject drugs, the agencies explore good public health practices that can support effective policies to reduce infections. Common blood-borne viruses in this group include HIV, hepatitis B and hepatitis C. These are mainly spread through the sharing of needles, syringes and drug preparation equipment or unprotected sexual contacts. Launching the report during a meeting of infectious disease experts in Lisbon today, the two agencies aim to support countries across Europe in their efforts to reduce infection risks.

EMCDDA Director Wolfgang Götz said: ‘Blood-borne infections can spread very rapidly among people who inject drugs, which in turn can lead to high treatment costs, lost productivity and human suffering. A central message in today’s report is that we now know how to prevent infections in this group. The challenge before us is to ensure that this understanding is translated into effective services. Europe can still do better in reducing the public health burden posed by these preventable diseases’.

’Prevention of infections among people injecting drugs is achievable and effective – if it is properly executed’, stresses ECDC Director Marc Sprenger. ‘That is why we need closer cooperation between all sectors of health care to win the trust of people who inject drugs and offer them health services as outlined in our joint guidance’.

The ECDC–EMCDDA joint publication is published together with a ‘Guidance in brief’ summary and with two technical reports providing a full assessment of the evidence (coming soon). The seven recommended interventions are:

INJECTION EQUIPMENT: Provide free access to clean drug injection equipment, including sterile needles and syringes, as part of combined multi-component prevention, harm-reduction, counselling and treatment programmes.

VACCINATION: Offer vaccinations for infections for which effective vaccines exist, such as hepatitis A, B, tetanus and influenza. For HIV-infected individuals, the pneumococcal vaccine is also recommended.

DRUG DEPENDENCE TREATMENT: Provide access to treatment, in particular substitution treatment for opioid users.

TESTING: Grant access to testing for HIV, hepatitis C and hepatitis B and other infections, including tuberculosis; ensure the link to treatment.

INFECTIOUS DISEASE TREATMENT: Provide antiviral treatment as clinically indicated for HIV-, hepatitis B- or hepatitis C-infected. Tuberculosis treatment is recommended for active cases, while prophylactic therapy should be considered for latent cases.

HEALTH PROMOTION: Provide health promotion focused on safer drug use and sexual behaviour to enable people to increase their ability to control and improve their health.

TARGETED DELIVERY OF SERVICES: Offer a range of services, delivered according to user needs and local conditions, such as drug treatment, harm reduction, counselling and testing and referrals to other medical services.