2.50
Hdl Handle:
http://hdl.handle.net/10143/39414
Title:
Hva nå? Evaluering av prøveordning med sprøyterom
Authors:
Olsen, Hilgunn; Skretting, Astrid
Citation:
SIRUS-rapport 7/2007
Additional Links:
http://www.sirus.no/internett/narkotika/publication/397.html

Full metadata record

DC FieldValue Language
dc.contributor.authorOlsen, Hilgunn-
dc.contributor.authorSkretting, Astrid-
dc.date.accessioned2008-10-22T08:57:40Z-
dc.date.available2008-10-22T08:57:40Z-
dc.date.issued2008-01-
dc.identifier.citationSIRUS-rapport 7/2007en
dc.identifier.issn1502-8178-
dc.identifier.urihttp://hdl.handle.net/10143/39414-
dc.description.abstractNORSK SAMMENDRAG: Oslo kommune åpnet sprøyterom 1. februar 2005, etter at Stortinget i desember 2004 vedtok en midlertidig lov om en prøveordning med sprøyterom. Forskerne Astrid Skretting og Hilgunn Olsen ved SIRUS har på oppdrag av Helse- og omsorgsdepartementet evaluert prøveordningen. I de første to driftsårene var det 383 brukere av sprøyteromsordningen. Av disse brukte 2/3 tilbudet i gjennomsnitt to ganger eller mindre per måned, mens bare 10 prosent brukte tilbudet mer enn seks ganger per måned. Det ble i gjennomsnitt satt 24 injeksjoner per dag. - Et viktig formål med ordningen var å vurdere effekten av straffrihet for en brukerdose heroin. Politiet har støttet lojalt opp om ordningen, så dette må sies å ha fungert, sier Astrid Skretting. - En annen målsetting var å bidra til økt verdighet for tungt belastede heroinmisbrukere. I den grad det er mulig å måle dette, må en kunne si at sprøyteromsordningen har bidratt til økt verdighet både på et allment og et individuelt nivå. Den gir et signal om anerkjennelse av hjelpebehov til alle sprøytemisbrukere. For den enkelte bruker kan den konkrete hjelpen som gis og måten de blir møtt på, sies å bidra til økt verdighet. Målsettingen om helse- og sosialfaglig oppfølging er derimot i begrenset grad oppfylt. Vi har ikke grunnlag for å si om prøveordningen har bidratt til færre overdoser eller overdosedødsfall, sier Skretting. Brukerne gir uttrykk for stor tilfredshet med tilbudet. De oppgir trygghet for politi og vektere når de injiserer, og at de lærer å injisere slik at de får mindre skader, som grunner til at de oppsøker sprøyterommet. Evalueringen peker på en rekke dilemmaer det må tas stilling til ved en eventuell permanent sprøyteromsordning: Skal det bare være tillatt å injisere heroin eller bør det også gis adgang til å røyke heroin, som innebærer mindre risiko for skader og overdoser? Skal det ikke tillates å injisere andre narkotiske stoffer enn heroin, så lenge det er få rene heroinmisbrukere i Norge? Kan en sprøyteromsordning tolkes som et signal om at samfunnet aksepterer bruk av narkotika? Er sprøyterom en riktig bruk av samfunnets ressurser og hvor langt skal samfunnet strekke seg for å imøtekomme rusmiddelmisbrukeres behov for ulike tjenester? Oslo kommune og Sosial- og helsedirektoratet får i rapporten kritikk for at sprøyterommet ble åpnet uten nødvendige forberedelser. Mangelfull opplæring av personalgruppa og lokaler som ikke tilfredsstilte kravene i forskriften, førte til store belastninger for de ansatte. Evalueringen gir ingen anbefaling om prøveordningen bør gjøres permanent. Den påpeker imidlertid at en eventuell permanent sprøyteromsordning må stille krav til kommunene som ønsker å etablere et slikt tilbud. Lokalene må være hensiktsmessige og ivareta de ansattes sikkerhet. De ansattes opplæring og arbeidsforhold må også ivaretas på en bedre måte enn i prøveordningen.en
dc.description.abstractENGLISH SUMMARY: A proposal to pilot a public injecting room was put before the Norwegian parliament (Stortinget) for the first time in 1999. The idea went back and forth between different governments and parliaments. The Director General of Public Prosecutions warned legislators that before a supervised injecting room could be established, the law would have to be amended. A provisional act sanctioning the pilot scheme was adopted by parliament (Drug Injection Rooms Act),25 together with a set of regulations in December of 2004. SIRUS was asked to evaluate the scheme. Oslo City Council was authorized by the Directorate for Health and Social Affairs to pilot the supervised injecting centre. Oslo City Council opened the centre, located in the centre of Oslo, on February 1, 2005. A specific group of injectors was singled out as the centre target group, “heavy heroin users aged 18 and over”. The objectives of the scheme were: • to assess the effect of impunity for possession and use of drugs in a certain area defined elsewhere: • to help heavy drug users build a sense of self-esteem (dignity); • to facilitate contact between the social and health services and drug users; • to prevent the spread of infectious diseases; and • reduce overdose rates and overdose fatalities Two years later, 409 persons had registered as clients of the centre, of whom 383 used the facility on one or more occasions. Of these 383, 71 per cent were male and 29 per cent female; 23 per cent were 30 or younger, 41 per cent 31–40 and 37 per cent 40 or above. In these two years, 17,226 injections were administered, that is, an average of 24 injections every day. There is wide variation in the frequency with which registered clients used the facility. Only 10 per cent used the centre more than six times per month. Two thirds used it only once or twice per month after registering as clients. Injection doses of 0.2–0.25 grams were reported by 80 per cent of the clients. The drug was predominantly injected into the arm (64 per cent), followed by groin (19 per cent), leg (15 per cent) and neck (2 per cent). Clients reported safety as their primary reason for using the facility. Other important reasons included the sense of security at the facility, learning how to inject more safely, supervision in the event of an overdose, and knowledge that they could administer the drug without worrying about the police or security guards moving them on. The clients of the injecting centre express in the main satisfaction with the facilities provided. Virtually none have any complaints about advice on how to inject, how they were treated by staff or about the equipment provided. They would like to see opening hours extended, and an opportunity to inject pills with the heroin. The police have given their full support during the trial. Impunity has undoubtedly worked insofar as it, in legal terms, is actually possible to run the injecting facility, despite the inability of staff to satisfy themselves that clients are only bringing one heroin dose onto the premises. Impunity has had an unintended side effect however, in that possession of small quantities of heroin is decriminalised even further in the centre of Oslo. Insofar as it is possible to operationalize the concept of dignity, it could be said that the injecting room has had a positive effect on the dignity of the group in question. The pilot scheme has enhanced the dignity of drug users in a wider sense, by acknowledging the need to inject drugs in as risk free an environment as possible. The courteous manner of the staff has also been beneficial in that sense as well. Healthcare and welfare counselling have been provided in 8 per cent of all visits. This care depends, however, on adequate staffing. Suitable premises where staff and clients can talk privately would improve the centre’s ability to provide care. Given the limited data it is difficult to say whether the scheme reduced infection or contamination rates. Clients are obliged to follow strict rules of hygiene, however. They are also given practical advice on the best way of administering an injection, with least risk of developing physical problems such as inflammation and abscesses. Injection training was given in 13 per cent of all injection visits, and to 81 per cent of the clients on one or more occasions. One would expect clients to practice what they learned when they inject outside the facility. Clients became more aware of the need for good standards of hygiene, they said. 0.6 per cent of injections resulted in an overdose, and 18 per cent of clients experienced an overdose while at the injecting room. None of these incidents were fatal. There is no evidence that the scheme has caused a general reduction in overdose rates or overdose fatalities. To avoid risk of overdose, there would have to be sufficient capacity to supervise most of the injections administered in the city. Staff turnover has been high. After an initial period of enthusiasm, poor physical and psycho-social working conditions resulted in high levels of sick leave absence and resignations. Many members of staff felt at risk and that responsibility for preventing overdoses was too onerous. It was also exhausting having to observe at close quarters clients’ self-destructive behaviour. They felt let down by their employer, and have had limited access to professional advice and counselling. Oslo City Council and Alcohol and Drug Addiction Service started the scheme without the necessary preparations, according to the staff. Personnel training was inadequate. The Directorate for Health and Social Affairs is blamed for giving the City authorities the green light. The Directorate should have realized that the premises were below the standards required in the regulations, and that personnel lacked appropriate training. If the scheme becomes a permanent fixture, more suitable premises must be found. The injecting room must be large enough to allow a certain amount of space between staff and injecting clients. The facility must have two exits, and an effective ventilation system. Opening hours should cater to the needs of the clients. Care of staff must be given high priority. More should be done to ensure as safe an environment as possible for staff. This includes not only the architectural layout of the facility, but the psycho-social aspects of working conditions. Consideration should be given, if the facility becomes a permanent service, to locate it in a “health centre“ for drug users. Supervised injecting rooms come with their own set of paradoxes/dilemmas Several issues need to be addressed: • Since injecting heroin is more likely to result in an overdose than smoking it, it could be seen as a paradox that the Norwegian trial only allows the drug to be injected. • As long as the number of exclusive heroin users in Norway is so low, it could be a paradox that the only drug clients may inject is heroin . • It could also be a paradox that the injecting facility may in fact be contributing to the perpetuation of drug abuse. • An injecting facility will find it difficult to cope with clients suffering from mental illness and aggressive behaviour. It could therefore be a dilemma that the people most in need of a drug injecting facility may have to be kept out. • Administering an injection in the neck or groin is more likely to cause physical injury than in the arm. Whether a future injecting facility centre should allow clients to administer injections in the neck or groin is therefore something of a dilemma. • A desire to keep drug addicts off the streets could be an argument in favour of an injecting facility, but it might put the health aspect in the shade. • By running an injecting facility, the authorities may indirectly be seen as condoning drug use. • The Health Personnel Act requires staff in an public injecting room to notify the child welfare authorities when clients are caring for children, the social services if clients are pregnant, and the police if clients have been driving while impaired by drugs/alcohol. This may create a dilemma for staff, because by notifying the authorities they risk alienating the client. • As long as the public injecting room is a scarce “commodity”, there is no guarantee that users with the greatest need will be admitted. Whether the “first come, first served” principle should be applied, or other criteria, is yet another dilemma. • And is it wise to spend public resources on an injecting centre, and how far should society go in attending to the various types of assistance needed by drug users?-
dc.language.isonoen
dc.publisherSIRUSen
dc.relation.ispartofseriesSIRUS-rapporten
dc.relation.ispartofseries2007/7en
dc.relation.urlhttp://www.sirus.no/internett/narkotika/publication/397.htmlen
dc.subjectVDP::Samfunnsvitenskap: 200en
dc.subject.meshSubstance-Related Disordersen
dc.subject.meshSubstance Abuse, Intravenousen
dc.subject.meshHeroin Dependenceen
dc.subject.meshHarm Reductionen
dc.subject.meshEvaluation Studiesen
dc.subject.meshNorwayen
dc.titleHva nå? Evaluering av prøveordning med sprøyteromno
dc.typepeer revieweden
dc.typeReporten
dc.contributor.departmentNorwegian Insitute for Alcohol and Drug Researchen
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