Research on the Danish heroin assisted treatment programme

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1 Research on the Danish heroin assisted treatment programme Katrine Schepelern Johansen Anthropologist, PhD Post.doc, Department of Anthropology, University of Copenhagen

2 Treatment with heroin in Denmark Heroin can only be taken as injection (iv or im) Clients should be able and willing to come twice a day To take the injection under supervision And to make the injection themselves The heroin can be given up to two times a day morning and afternoon and clients will receive additional methadone for the night

3 Treatment with heroin in Denmark The medical treatment with heroin should be supplemented by psycho-social treatment Clients will need to go through 10 to 14 days of supervised methadone treatment to adjust their dose before being transferred to the heroin

4 This presentation Status on the treatment, no. of clinics, no. of clients The research project A few preliminary findings from the clinics

5 Status for now Three clinics opened two planned for august 2010 Clients enrolled since the start of March 24 clients, 18 on heroin Of these 18 two are back on methadone for a short period of time People are not queuing up in front of the clinics to get free heroin

6 The research program The international research has focused on documenting effect What about the clients perspective on the heroin and the treatment?

7 The research program The international research has focused on documenting effect What about the clients perspective on the heroin and the treatment? The everyday life and institutional culture of the clinics? Which challenges and problems are the staff meeting?

8 Research questions How is the treatment planned, organized and executed? What are the effects of the treatment on clients and health economically? What are the clients perceptions of the treatment? What are staffs perceptions on the treatment? How is the compliance of the clients? How does the group of clients change and where do the clients come from?

9 Methods quantitative dimension Questionnaires concerning self reported quality of life: EQ-5D and DUQOL-scale (Drug Users Quality Of Life) Data from the clinics (numbers, demographical data, referring institution, reasons for leaving the program etc.) Data collected by the National Board of Health Data from the national registers (hospitalization and criminality)

10 Methods qualitative dimension Field work in the clinics Participant observation Informal conversations with clients and staff Formal, open interviews with clients and staff Policy documents (discourses, positions etc.)

11 The clinics and the clients Two models for the clinics: Independent institution for heroin treatment Integration of heroin treatment in already existing drug treatment facilities

12 The clinics and the clients Two models for the clinics: Independent institution for heroin treatment Integration of heroin treatment in already existing drug treatment facilities Two categories of clients: Old, rather stabile clients who prefers heroin Clients with a continued use of street drugs that are injected, heroin as one among other drugs What about the hard to reach?

13 Dilemmas in the treatment Intoxicated clients in the clinics? The role of the psycho-social treatment

14 Intoxicated clients in the clinics? How much is acceptable? How can it be controlled? Heroin is (also) about getting intoxicated Other clients get envy Is it possible to combine treatment with pleasure?

15 The role of the psycho-social treatment How to work with clients that wants to enjoy their drugs in peace? The injection in itself takes up much time Who can do the psycho-social treatment?

16 Clients perspectives on the methadone before heroin Irritation, frustration, humiliation

17 Clients perspectives on the methadone before heroin Irritation, frustration, humiliation Unnecessary no one wants to die

18 Clients perspectives on the methadone before heroin Irritation, frustration, humiliation Unnecessary no one wants to die Increase the dose of heroin on the spot

19 Clients perspectives on the methadone before heroin Irritation, frustration, humiliation Unnecessary no one wants to die Increase the dose of heroin on the spot Some needs to raise money for heroin money they normally gets from selling their methadone

20 Building up expectations 19/3-10 Det bliver den længest wegent i hele mit lorte liv. Men jeg glæder mig helt vildt til på mandag. Mvh 21/ Søndag DAGEN FØR (Løsladelseskuller,) det er noget man får, dage op til ens løslades dato. (jule kuller) det er noget små børn fra 4 til år, får af at vente på at julemanden kommer den jule aften. Gu ved hvad det heder det vi har, så. Stof trang? Nej, for vi var sylig skæve alle timmer ca. Det ville blive en lang nat, Hvis jeg ikke hade haft 2 sovepiller til i aften. Og gud bevare danmark Hvis jeg sover for længe. Mvh

21 Building up expectations 19/3-10 It will be the longest week-end in my whole fucking life. But I really look forward to Monday. Best 21/ Sunday THE DAY BEFORE (To be excited before one gets released,) that is something you experience days before you get released from prison. (To be excited before Christmas) that is something small kids aged 4 to years, gets while waiting at Santa Claus Christmas eve. I wander what it is we are having? Craving? No, because we were really stoned all five of us. It will be a long night. If I hadn t had 2 sleeping pills for the night. And God save us all If I over sleep tomorrow. Best

22 Clients perspectives on the heroin Dissatisfied

23 Clients perspectives on the heroin Dissatisfied But clients stay in the program (for now)

24 Clients perspectives on the heroin Dissatisfied But clients stay in the program (for now) Boring and time consuming

25 Clients perspectives on the heroin Dissatisfied But clients stay in the program (for now) Boring and time consuming Satisfied, happy, relaxed..

26 Clients perspectives on the heroin Dissatisfied But clients stay in the program (for now) Boring and time consuming Satisfied, happy, relaxed.. Stabilized a more normal life

27 Clients perspectives on the heroin Dissatisfied But clients stay in the program (for now) Boring and time consuming Satisfied, happy, relaxed.. Stabilized a more normal life Fitting the treatment into the daily rutines

28 Clients perspectives on the heroin Dissatisfied But clients stay in the program (for now) Boring and time consuming Satisfied, happy, relaxed.. Stabilized a more normal life Fitting the treatment into the daily rutines You know what you got you do not know what you will have

29 Clients perspectives on the heroin Problems with the injection

30 Clients perspectives on the heroin Problems with the injection Staff worries to much

31 Clients perspectives on the heroin Problems with the injection Staff worries to much Clients are used to decide for themselves when it comes to heroin

32 Clients perspectives on the heroin Problems with the injection Staff worries to much Clients are used to decide for themselves when it comes to heroin Easier to get of the heroin than of the methadone

33 Thank you for your attention More information concerning the project on: Or

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