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

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Title: 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
Publics Health at Georgetown and Johns Hopkins
Universities
Background Amphetamines are the second 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
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.
Infectious Diseases Prevention Association for
Western Pomerania Region
Department of Infectious 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.
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