Increasing linkage to care and adherence to treatment for hepatitis C among people who inject drugs

Hepatitis C virus (HCV) infection is a major public health threat due to disease burden and risk of complications and death. Injecting drug use is the most likely mode of HCV transmission reported in the EU/EEA and accounted for 49% of acute and 61% of chronic infections in 2018. Compared to other drug-associated blood-borne viral infections, HCV is the most prevalent one among people who inject drugs (PWID) across Europe. Prevalence of HCV antibody among PWID estimated from nationally representative samples ranged between 15% and 86% during 2018–2019. The prevalence of current infections measured by HCV-RNA (or antigen) tests ranged from 15% to 64% between 2013 and 2019 in six countries with available data. PWID are therefore considered as a priority population in prevention, testing, linkage to care and treatment, and prevention of re-infections to achieve HCV elimination.

Following advances in treatment for hepatitis C (HCV), optimizing linkage to care and adherence to treatment of people who inject drugs became of pivotal importance. An ECDC/EMCDDA stakeholders survey in 2018 indicated that two components of the cascade of care, linkage to care and adherence to treatment, were priority areas for inclusion in the updated guidance, planned for publication in 2022. The systematic review Interventions to increase linkage to care and adherence to treatment for hepatitis C among people who inject drugs: A systematic review and practical considerations from an expert panel consultation was commissioned with the aim to evaluate the effectiveness of interventions on HCV linkage to care and adherence to treatment among people who inject drugs.

Available evidence suggests that integrated, people-centered approaches may improve engagement throughout the continuum of HCV care among people who inject drugs. For progressing HCV elimination efforts, interventions should be implemented in colocation with harm reduction and counselling activities and in combination with additional services, including opioid substitution treatment, directly observed therapy, peer support and/or contingency management.

Highlights of the review include:

  • Integrated care and cooperation between service providers optimize the HCV care continuum among people who inject drugs.
  • Results suggest that people who inject drugs with HCV infection can be effectively linked and treated with direct-acting antivirals regimens in settings outside of hospital.
  • Interventions that facilitate HCV care must be implemented at settings where people who inject drugs are already accessing services.
  • The experts’ reflections complement the findings of the literature review and inform public health practice by considering the heterogeneity of health systems and national regulatory frameworks.
  • Higher quality studies investigating interventions addressing the entire care cascade from testing to cure and prevention of reinfections among highly vulnerable populations are urgently needed.

To read the full article, follow this link>>>.

 

Expert update on drug-related infectious diseases

The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) gathered the Drug-related infectious diseases (DRID) expert network to share the latest developments on drug-related infectious diseases in Europe and to identify steps needed to improve the production, availability and use of public health-oriented information at the European level.

The DRID network brings together national experts nominated by national focal points of the EU Member States, Norway and Turkey, as well as institutional partners (ECDC, WHO, Correlation). The meeting also welcomed experts from the Western Balkans (IPA7 project), the European Neighbourhood Policy countries (EU4MD project), Georgia, the United Kingdom, Australia and the United States. Participating experts come from ministries of health, public health institutes, drugs agencies, health services, universities, research institutes and civil society.

The group held an online meeting on 26-27 October 2021, focusing on:

  • The direct impact of COVID-19 on people who use drugs and the COVID‑19 vaccination campaign among this group;
  • A review of recent HIV trends and outbreaks, as well as infectious endocarditis linked to injecting drug use with a focus on risk factors and control measures in place;
  • Country experiences in the elimination of viral hepatitis as a public health threat among people who inject drugs (PWID) and related EMCDDA projects, with a focus on harm reduction and the continuum of care.

The report section on Outbreaks includes some interesting information from South East Europe.

In 2011, an HIV outbreak among PWID was detected in Athens, Greece (Paraskevis et al., 2011). After a combination of prevention and ‘seek-test-treat’ interventions were implemented (including scaled-up NSP, testing, linkage to AOT and antiretroviral treatment (ART), HIV incidence declined (Sypsa et al., 2017) from 7.8/100 person-years in 2012 to 1.7/100 person-years in 2013. However, preliminary data from the latest round of the ARISTOTLE study, conducted in 2018-20 (Roussos et al., 2021) among 681 PWID who were included in previous rounds, suggest that HIV prevalence increased from 14.2 % (2012-13) to 22 % (2018-20). While incidence estimates never returned to their 2011-12 levels, they ranged from 1.52 to 2.04/100 person-years, indicating ongoing transmission. The prevalence of homelessness (25.6 %) and cocaine injecting (28.1 %) had increased over the period. Predictors of seroconversion included lower education, larger network size and daily drug use. The authors concluded that the current level of prevention and treatment services was below levels that would be required to bring transmission down to pre-outbreak levels. They also noted that the COVID‑19 pandemic has severely impacted HIV prevention services for PWID, which could increase the risk of HIV transmission in this population. The study team conducted a similar study in Thessaloniki, the second-largest city in the country, where 1 101 PWID were recruited during 2019-20. They found high HIV incidence among the study population, suggesting that an outbreak was occurring at a time when COVID‑19 controls measures were in place. The authors highlighted that immediate interventions were required to control transmission.

Following the DRID meeting, national experts from three additional EU countries have reported signals of increased HIV transmission among people who use drugs. In Sofia, Bulgaria, reports indicate that the pandemic seems to have worsened a situation that was already deteriorating with respect to harm reduction funding. According to data from the laboratory at the State Psychiatric Hospital for Treatment of Drug Addiction and Alcoholism in Sofia, reported by the national expert, the positivity rate for HIV infection among PWID in the capital of Bulgaria was significantly higher in 2019-20 (12.8-14.5 %) than in the previous years (when positivity rates were between 3-6 %). A parallel increase in HBV positivity (HBsAg) was also noted from 2019 (5.9 %) to 2020 (7.6 %). This comes after the Global Fund ended its financial support to harm reduction services in 2017. It consequently led to a disruption in needle and syringe programmes, and a reduction by more than half in the number of PWID being tested annually. The National Centre of Public Health and Analysis is organising a meeting with stakeholders and decision-makers to initiate legal changes in order to ensure sustainable financial support for harm reduction services.

The national expert from Slovenia reported that, by November 2021, four new HIV diagnoses among PWID were reported to the National Institute of Public Health among a total number of 28 reported new HIV diagnoses during 2021. This raised concerns that HIV infections might have started to spread more during the COVID‑19 pandemic among PWID in the country. Since 1986, when HIV reporting became mandatory in Slovenia, a total of 29 HIV infections among PWID have been reported, and such a high number of cases (four) were reported only once before, in 1996. The importance of reaching a good coverage of harm reduction services for PWID was re-emphasised.

To read full report from this meeting and get the information from expert update, follow this link>>>.

 

European Web Survey on Drugs 2021

From the EMCDDA press release

The EU drugs agency (EMCDDA) published today results of the European Web Survey on Drugs. The survey ran between March and April 2021 in 30 countries (21 EU and 9 non-EU) when many populations were under COVID-19-related lockdowns. Targeted at people aged 18 and over who have used drugs, the survey aims to improve understanding of patterns of drug use in Europe and help shape future drug policies and interventions.

Close to 50 000 adults (48.469) responded to the survey from 21 EU Member States and Switzerland. Cannabis was the drug used most, with 93% of survey respondents reporting to have used it in the previous 12 months and with little variation between countries. MDMA/ecstasy (35%), cocaine (35%) and amphetamine (28%) were the next most reported illicit substances, with the order of the three drugs varying by country. Around a third of respondents (32%) reported using more (herbal) cannabis and 42% using less MDMA/ecstasy.

The survey revealed that one fifth (20%) of the sample reported using LSD in the last year, 16% using new psychoactive substances (NPS) and 13% using ketamine. Heroin use was reported by 3% of respondents. Although the sample reporting heroin use was small, over a quarter of these respondents (26%) reported using this drug more during the period studied.

New to the 2021 round was the participation of the agency’s partners from the Western Balkans, through an EMCDDA technical assistance project (IPA7).

Over 2 000 adults (2 174) from Albania, Kosovo*, Montenegro, North Macedonia and Serbia responded to the survey. Most respondents (91%) reported using cannabis in the previous 12 months, followed by cocaine (38%), MDMA/ecstasy (22%) and amphetamine (20%). Again, around a third of respondents (32%) reported using more (herbal) cannabis and 34% using less MDMA/ecstasy.

Almost one in six (17%) respondents reported using NPS in the last year, while 9% reported use of LSD. Use of both heroin and methamphetamine was reported by 8% of respondents.

Home was reported as the most common setting for drug use during the period (85% of respondents in the EU-Switzerland survey and 72% in the Western Balkans), a pattern accentuated by COVID-19 lockdowns and closure of nightlife venues. Motivation for the use of different substances sheds some light on these results. The most commonly reported motivations for cannabis use were relaxation, getting high and aiding sleep, while for MDMA/ecstasy, they were its euphoric and socialising effects.

 

For more information, visit:

Traineeship available at the EMCDDA

The European Drug Agency (EMCDDA) has 8 traineeship positions available to work with them next year. This is the opportunity to gain valuable work experience in one of the areas of the EMCDDA’s work.

Traineeship is available in 8 different areas of the agency’s work:

The deadline for applications is 10 January 2022.

The Call for traineeship is available following this link>>>.

 

European Drugs Winter School 2022

The European Drugs Winter School 2022 (EDWS), organised by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and the University Institute of Lisbon (ISCTE-IUL) will be held from 14th to 25th of February 2022. EDWS prepares professionals and students to meet the complex policy challenges that face Europe and the World in the field of drugs.

This edition will have a special focus on Cannabis: practice, policies and debates in the EU and beyond.

The Winter School will be delivered through online and remote instruction. Following the success of the first Winter School, live sessions with experts and practitioners will be held from early afternoon until late afternoon (Lisbon Time, GMT +1 to GMT +3/4). Individual small exercises will be given and assessed every day, and an exam will be offered to those who wish to earn the credits. Virtual tours to field work will be included.

Candidates’ Profile include university students (undergraduate, graduate and postgraduate), researchers, professionals and administrators interested in or working in the drugs field, including participants from the EMCDDA’s network of focal points in 30 countries, or from programmes being developed by the EMCDDA with third countries (e.g. Western Balkans, North Africa, Eastern Europe).

Bursaries are available for Western Balkan region and European Neighbourhood Policy!

Professionals, academics and experts from the Western Balkan region and European Neighbourhood Policy countries will have an opportunity to participate in the 2022 European Drugs Winter School (EDWS), thanks to scholarships offered through two EMCDDA projects: the Instrument for Pre-accession Assistance (IPA7) and EU4Monitoring Drugs (EU4MD). The scholarships will cover the course fees. All candidates from those regions who apply in the first phase (deadline 5th of December) will be eligible.

Deadline for applications: 5 December 2021 (Early Bird) | 23 January 2022 (Final).

Deadline for scholarship applications: 5 December 2021.

The EDWS will be followed by the European Drugs Summer School (EDSS) from 27 June to 8 July. Scholarships (covering course fees) are also available.

If interested, find more information following this link>>>.

 

 

FAQ on drug overdose deaths in Europe

The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) created a specific webpage which answers to the questions most often asked about drug overdose deaths in Europe. Also known as drug-induced deaths, they are deaths directly attributable to the use of illicit drugs. The information presented here is based on the latest data from the Member States of the European Union and the EMCDDA affiliates Norway and Turkey. It draws on contributions from specialists from these countries, as well as on information provided by European countries in the annual reporting exercise to the agency.

This page aims to raise awareness on the nature and scale of the drug overdose deaths problem in Europe. This topic does not receive sufficient attention, despite the high number of lives lost, the dramatic consequences for families and communities and the fact that all of these deaths are, in principle, preventable and avoidable.

The latest European Drug Report (EMCDDA, 2021a) estimated that over 5 100 deaths involving one or more illicit drugs were reported in 2019 in the European Union. This estimate rises to more than 5 700 deaths when Norway and Turkey are included. Men accounted for three quarters of drug-induced deaths. All of these deaths were premature, predominantly affecting people in their thirties and forties.

The webpage is available following this link>>>.

 

Changes at the drugs market in the Western Balkans

To improve understanding of the impact of the pandemic and associated measures on the drug market in the Western Balkans, the European Drugs Agency (EMCDDA) published ad hoc publication Illicit drug markets and supply in the Western Balkans: Impact of COVID-19.

This report provides the main results of studies conducted using the trendspotter methodology to explore the impact of the pandemic and associated measures on the drug markets and supply in the Western Balkans.

Reported here are the findings of a rapid multidisciplinary expert opinion study to review the possible impact of COVID-19 on the operation of the drug market. The current situation is extremely dynamic.

The findings of the study should be interpreted with caution as they are based substantially on expert opinions gathered from law enforcement sources between September and October 2020, when the research was conducted. In general, very limited statistical or research data is available in the Western Balkan region on drug markets during this period. Therefore, the conclusions are necessarily preliminary and will require review as more data sources become available.

To read the report, please follow this link>>>.

 

European Drug Report 2021 presented

From the EMCDDA press release

The EU drugs agency (EMCDDA) publishes its European Drug Report 2021: Trends and Developments, the latest annual review of the drug situation in Europe. Based on data from 29 countries (EU 27, Turkey and Norway), the report offers new insights into the health and security implications of a complex and evolving drugs problem and of a drug market resilient to COVID-19 disruption.

The report warns of the risks to public health posed by the availability and use of a wider range of substances, often of high potency or purity. It also describes how organised crime groups have intensified illegal drug production inside Europe to evade anti-trafficking measures, creating environmental, health and security risks. Drawing on the latest EMCDDA rapid assessment study, the report explores the recent effects of the COVID-19 pandemic on drug markets, use and services.

Presenting findings from the latest EMCDDA trendspotter study, the report illustrates how the drug market continues to adjust to COVID-19 disruption, as drug traffickers adapt to travel restrictions and border closures.

Key findings from the report include:

  • Cannabis use remains stable at high levels, but increased THC content raises health concerns — Rise observed in the THC content of cannabis resin (average range: 20%–28%). Health alerts warn of cannabis adulterated with highly-potent synthetic cannabinoids.
  • Record cocaine seizures, a worrying signal of potential for increased health harms — A record 213 tonnes were seized in 2019 (up from 177 tonnes in 2018). Cocaine purity has increased and more people are entering treatment for the first time. Preliminary seizure data in 2020 suggest availability has not declined in the pandemic.
  • Stable amphetamine demand makes domestic production near consumers profitable — Alongside the dismantling of production facilities in 2019, chemicals used to manufacture amphetamine were also seized in the EU, including 14 500 litres of BMK and 31 tonnes of MAPA (up from 7 tonnes in 2018).
  • Methamphetamine production and trafficking highlight potential for increased use in Europe — Both large-scale and smaller production facilities are being detected in Europe and large quantities of the drug are being transhipped through the EU to other markets.
  • Risks to health from supply of high-strength MDMA products — In addition to increases in the average MDMA content in tablets and the purity of powders, products with very high levels of MDMA are also being detected. Preliminary data from 2020 suggest there was less interest in this drug during periods of lockdown.
  • Harmful potent new psychoactive substances continue to emerge — Among these are new synthetic cannabinoids and new synthetic opioids. A total of 46 new psychoactive substances (NPS) were reported for the first time in Europe in 2020, bringing the total number monitored by EMCDDA to 830.
  • Are less commonly used drugs posing increasing challenges for public health? — These drugs include hallucinogens, ketamine and GHB. Worryingly, intensive patterns of use are reported in some settings.
  • Large heroin seizures signal potential for increased use and harms — Large volumes of heroin are still being seized in the EU (7.9 tonnes in 2019), raising concerns around the possible impact on levels of use.
  • Organised crime groups intensify illegal drug production within Europe — A total of 370 illegal laboratories were dismantled in 2019.
  • Drug law offences increase, with cannabis possession and supply predominant — An estimated 1.5 million drug law offences were reported in the EU in 2019; 82% were related to use or possession for personal use.
  • First-time treatment clients for heroin use continue to inject less — Although injecting drug use has been declining in Europe for the past decade, it remains a major cause of drug-related harms.
  • Scaling up treatment and prevention is required to reach HIV and HCV Sustainable Development Goals — Increased access to integrated testing and treatment services is an important part of reaching targets.
  • Overdose deaths driven by opioids and other drugs highlight need for service development — High-risk substance use and polydrug use continue to fuel drug-induced deaths in Europe.

The Report is available in various European languages including English (en) and those from our region Bulgarian (bg), Croatian (hr), Greek (el), Romanian (ro) and Slovene (sl).

 

European Drugs Summer School 2021

From the EMCDDA, we have received an update regarding the 2021 European Drugs Summer School (EDSS) – organised by the University Institute of Lisbon (ISCTE-IUL) in cooperation with the EMCDDA – which will take place online from 28 June until 9 July.

The course prepares professionals and students to meet the complex policy and practice challenges in the field of drugs. Involving scientific experts from the EMCDDA, university professors and policymakers, they provide a multi-disciplinary and inclusive approach to the study of the drugs problem in Europe and beyond.

The two-week course will focus on Vulnerable groups. Sessions will include lectures on the prevention of drug-related problems; social determinants of drug use and interventions for vulnerable groups (homeless, prisoners, migrants). Virtual study visits will be organised to one of the Portuguese commissions for dissuasion as well as a local harm reduction centre. During the course, students will participate in interactive workshops to discuss their own projects and views. The course will conclude with an open debate with guest speakers, followed by an exam for those wishing to obtain credits.

Also this time, the EMCDDA-IPA7 project will provide for some limited bursaries to applicants from the Western Balkan countries

Interested candidates should register before 7 June next, directly at the ISCTE-IUL web site by using the blue ‘Register Now’ button. Successful candidates will be informed about their bursary acceptance during the week of 14-18 June 2021.

For more information, please follow this link>>>.

 

The third trendspotter study on COVID-19 and drugs

Since early 2020, the COVID-19 pandemic has had a dramatic impact on the way we live, with European countries having to introduce unprecedented measures to protect public health. As with all areas of life, drug consumption, related harms and drug markets have been impacted, as have the services established to respond to drug-related problems. During the first weeks of the pandemic, the EMCDDA instigated two rapid assessment studies to identify the initial impact and implications of COVID-19.

The EMCDDA releases today the third in a series of rapid ‘trendspotter’ studies exploring the impact of COVID-19 on the drug situation and responses to it. Revisiting and reviewing findings from two studies in 2020 on the effects of the pandemic on drug use and services, the report identifies new trends and developments which may have implications for policy and practice.

The report explores the situation in the EU Member States from June 2020 to February 2021, particularly changes in drug markets, patterns of use, harms and drug services, both in the community and in prisons.

The EMCDDA’s trendspotter methodology examines emerging drug-related trends by rapidly collecting and triangulating data from a variety of sources to allow for timely assessments of topics of concern. Specifically, for this COVID-19 impact study, the methodology was adapted to suit online investigation, taking into account the national emergency restrictions on both the EMCDDA team and the study participants. The study was designed to be carried out in successive waves.

The new analysis draws on a range of sources, including: three online surveys, eight virtual facilitated groups, data and literature reviews.

To access the report, please follow this link>>>.