No. 10: Drug use amongst vulnerable young people

There is an urgent need to investigate and monitor drug use and vulnerability factors among young people who may be at significantly greater risk of developing chronic drug problems.   The 10th  in the EMCDDA’s series of policy briefings states that, while experimentation with drugs is increasingly widespread among young people in Europe, levels of drug use and the risks of developing drug-related problems are much higher among vulnerable groups.

Research has identified a range of risk factors for developing drug problems. Some risk factors are associated with characteristics of the individual while others are linked with family or neighbourhood characteristics. These factors are highly interconnected and are best understood as a ‘web of causation’.

According to the briefing, groups of young people vulnerable to developing drug problems – and settings where young people are most at risk – are rarely identified explicitly in national drug-prevention strategies. Universal, school-based prevention programmes are in place in most European countries. However, these do not address the specific needs of young people most vulnerable to becoming problem drug users. The briefing stresses that selective prevention that seeks to address the needs of vulnerable groups is a vital complement to universal prevention programmes. The briefing notes that recent European policy documents have called for targeted, evidence-based action to reduce risks, and notes exceptions to the universal approach to prevention, including Ireland’s Youthreach and Springboard projects.

In calling for selective intervention strategies, the policy briefing calls for:

·         information exchange between European countries on effective practice in addressing the needs of groups with specifically defined vulnerability factors;

·         effective targeted programmes, which avoid contributing to negative labelling,  through good communication between services and agencies and the insertion of drug prevention into umbrella social policies; and

·         rigorous evaluation of the outcome of selective prevention programmes to ensure that projects achieve their objectives and to check there are no unforeseen negative consequences. 

No. 11: Hepatitis C: A hidden epidemic

 Subtitled ‘a major challenge to public health’, the 11th policy briefing from the EMCDDA suggests that, although the total number of people within the EU infected with hepatitis C is unknown, it is likely that it exceeds one million and could be considerably higher. Hepatitis C is a highly infectious and potentially fatal disease that attacks the liver. Yet people who have contracted the virus often remain symptom-free for many years and most cases are undiagnosed.

On a positive note, the briefing records that, since the introduction of screening of blood and blood products for hepatitis C, transmission of the virus has been ‘dramatically reduced’. Injecting drug users are now the group at greatest risk of infection, accounting for up to 60–90 per cent of new infections.

The briefing argues for health promotions that discourage people from injecting drugs or that change their behaviour to reduce the risk of contracting the virus. Public and professional awareness of the disease also needs to be raised to encourage people at risk to come forward for testing and referral for treatment where appropriate. Referring to the drugs challenge posed by EU enlargement, the briefing states: ‘Young and new injectors are at high risk of contracting hepatitis C shortly after they begin injecting. Wherever injecting drug use is likely to increase, such as some of the new EU Member States, new epidemics of hepatitis C are likely to emerge.’

The briefing document identifies six policy priorities:

1.      It is important that policy-makers acknowledge the future impact of hepatitis C infection and place prevention and treatment of the disease high on the policy agenda.

2.      All EU States face escalating costs due to the hidden hepatitis C epidemic. Each year of delay in preventing new hepatitis C infections in the EU may lead to an increase in treatment costs of an additional 1.4 billion Euro.

3.      The risk of transmission of hepatitis C can be reduced through measures to alter high-risk behaviour such as sharing needles and other injecting equipment, as well as through action to reduce injecting drug use.

4.      There is a short window of opportunity for prevention with young and new injectors. It is vital that interventions are targeted at this group, and at new populations where drug injecting may be spreading, including in the new member states.

5.      Improved screening and monitoring systems for hepatitis C infection would help ensure that people needing treatment for hepatitis C are identified early. They would also enable both trends in hepatitis C infection and the effectiveness of preventative strategies to be monitored.

6.      There is a need to review treatment guidelines for hepatitis C and to develop strategies for interdisciplinary co-operation between hepatologists and addiction specialists to include drug users in treatment.