Divergent Patterns of Amphetamine Use in the City and Rural Areas in Northwest Poland

1. Divergent Patterns of Amphetamine Use in the City and Rural Areas in Northwest Poland Discussion:: Data from this project suggest that there may be differences in drug use patterns, characteristics of users, knowledge of risks, and availability of prevention and treatment services between the Polish city of Szczecin and the surrounding region and rural area that could be increasing the risk of transmission of HIV and other bloodborne infections. We found evidence of use of amphetamines, specifically injected amphetamines, in the countryside that was unknown to local authorities. Moreover, the local users interviewed in the RRA displayed less knowledge of the risk of injecting amphetamines, more barriers to access to sterile syringes, and more unsafe injection practices, than did users interviewed in Szczecin. This is unsurprising given the reported lack of outreach to drug users, HIV education, operation of a SEP, or other harm reduction programs, or even (non-alcohol) drug treatment programs in the RRA. The data, although limited, on lower age of initiation of use of amphetamines in the RRA are also worrisome. They suggest that young teens and even pre-teens may be at significantly increased risk of bloodborne diseases in an environment that is currently poorly equipped to address their needs. These data, based on a rapid policy assessment model (RPAR), indicate a need for more comprehensive assessment of the behaviors of rural drug users, the barriers to knowledge and safe injection practices, and the needs of local authorities to address the problem. It is hoped that initiation of one or more local RPARs in the area around Szczecin will be the next step in providing this information. Sobeyko J (1), Leszczyszyn-Pynka M (2), Parczewski M (2), Burris S (3)(6), Lazzarini Z (4)(6), Case P (5), Chintalova-Dallas R (4). (1) Infectious Disease Prevention Association for Western Pomerania, Poland (2) Department of Infectious Diseases & Hepatology Pomeranian Medical University, Szczecin, (3) Temple University Law School, (4) University of Connecticut Health Center, (5) Fenway Community Health Center, (6) Center for Law and the Public’s Health at Georgetown and Johns Hopkins Universities Background: Amphetamines are thesecond most commonly used drugs in Northwest Poland (after marijuana). Policy research conducted in the region points to important differences between the Polish city of Szczecin and regional towns and rural areas (RRAs) that surround it in drugs used, modes of administration, and user characteristics. These differences raise concern that bloodborne diseases, including HIV and Hep C could spread rapidly in rural areas. Results:See Table: Patterns of Drug Use, Characteristics of Users and Local Programs Infectious Diseases Prevention Association for Western Pomerania Region Methods:Rapid Policy Assessment and Response (RPAR) is an intervention that mobilizes local knowledge and capacity to fight HIV/AIDS among sex workers, injection drug users, and members of other marginalized populations at the city level. In RPAR, a research team from a site city works with a Community Action Board (CAB) to collect three kinds of data: laws and written policies relevant to health risks in the target populations; existing data on the epidemiological situation and the operation of the criminal justice system; and qualitative interviews with police, judges, prosecutors, drug users, sex workers and others who can describe how the laws are put into practice. The data collection and interpretation are guided by the CAB, which develops an action plan and final report. The Szczecin RPAR was begun in January, 2005 and concluded with a final report in March, 2006. The CAB included representatives of law enforcement (the police, judiciary, prisons), both public and private drug treatment providers, health care (physicians, nurses) and social welfare agencies (Family Support office). Existing laws and formal policies in ten domains relevant to drug policy and health (including harm reduction, drug treatment and prevention) were collected. To determine how these laws were being put into practice, three focus groups were conducted, and the team interviewed 24 people in law enforcement, health care and social services, as well as 14 IDUs. Department ofInfectious Diseases&Hepatology Pomeranian Medical University, Szczecin Conclusions: 1. Data on use of amphetamines, rapid progression to injection as a mode of administration, and users’ lack of knowledge of risks, suggests possible that drug use in rural areas is different from that in the city of Szczecin. 2. Significant barriers exist to safe injection practices, in the form of reduced access to sterile syringes (through SEPs or sale in pharmacies). 3. These same factors point to increased risk of transmission of HIV and other bloodborne diseases among drug users in RRAs. 4. Local officials may be unaware of the scope of injection practices and related risks. 5. Local drug use prevention and treatment programs are not designed to address needs of IDUs. 6. Use of the RPAR assessment and response model may help localities respond to changing drug use situation. This research was supported by NIDA/NIH Grant # 5 R01 DA17002-02 PI: LAZZARINI, ZITA . The findings and conclusions expressed are those of the authors and not necessarily of NIH, NIDA, or the US Government. The development of RPAR was supported by the International Harm Reduction Development Program of the Open Society Institute in 2001-2002. The limitations of our methodology: Our findings are based on interviews from purposively selected informants and by the information provided by our CAB, supported where possible by epidemiological statistics and secondary sources. The data must be viewed with appropriate caution. Given the experience of rural amphetamine use in other areas, however, and the potentially rapid spread of bloodborne disease among injectors, they should be taken seriously and followed up with more sustained research and intervention work.