Hva nå? Evaluering av prøveordning med sprøyterom
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Original versionSIRUS-rapport. 169 p. Statens institutt for rusmiddelforskning, 2007
Spørsmål om etablering av sprøyteromble reist i Stortinget første gang i1999. Saken gikk fram og tilbake mellom Stortinget og skiftenderegjeringer i flere omganger. Riksadvokaten påpekte at etablering avoffentlig sprøyterom måtte hjemles i lov. Midlertidig lov og forskrift omprøveordning med lokaler for injeksjon av narkotika (sprøyteromsloven)ble vedtatt av Stortinget i desember2004. SIRUS fikk i oppdrag å evaluereprøveordningen.Oslo kommune fikk godkjenning fraSosial- og helsedirektoratet om åsette i gang prøveordning medsprøyterom. Oslo kommune åpnetsprøyterom i Tollbugata 3, 1. februar 2005.Målgruppa for sprøyteromsordningener "tungt belastede heroin-misbrukere som er fylt 18 år". Formålet med prøveordningen er å:•vurdere effekten av straffrihet for besittelse og bruk av narkotikapå et nærmere begrenset område,•bidra til økt verdighet for tungtbelastede narkotikamisbrukere,•gi økt mulighet for kontakt og samtaler mellom rusmiddel-misbrukere og hjelpeapparat,•bidra til å forebygge infeksjoner og smitte og•redusere antall overdoser og overdosedødsfall.I de første to driftsårene var det registrert 409 personer som brukere, ogav disse var det 383 som brukte sprøyteromsordningen en eller flereganger. Av de 383 var 71 prosent menn og 29 prosent kvinner, 23 prosentvar 30 år eller yngre, 41 prosent 31-40 årog 37 prosent var eldre enn 40 år.I de første to driftsårene ble det satt17 226 injeksjoner, det vil si etgjennomsnitt på 24 injeksjoner per dag. Det er store variasjoner i hvor oftede registrerte brukerne har brukt sprøyteromsordningen. Det er bare 10prosent som har brukt sprøyteromsordningen mer enn seks ganger igjennomsnitt per måned. 2/3 har i gjennomsnitt brukt tilbudet to gangereller mindre per måned i den tiden de har vært registret.80 prosent av brukerne rapporterte å skulle injisere 0,2 – 0,25 gram heroin(en "kvarting"). De fleste injeksjonene ble satt i arm (64 prosent).A proposal to pilot a public injecting room was put before the Norwegian parliament (Stortinget) for the first time in 1999. The idea went back and forth between different governments and parliaments. The Director General of Public Prosecutions warned legislators that before a supervised injecting room could be established, the law would have to be amended. A provisional act sanctioning the pilot scheme was adopted by parliament (Drug Injection Rooms Act),25 together with a set of regulations in December of 2004. SIRUS was asked to evaluate the scheme. Oslo City Council was authorized by the Directorate for Health and Social Affairs to pilot the supervised injecting centre. Oslo City Council opened the centre, located in the centre of Oslo, on February 1, 2005. A specific group of injectors was singled out as the centre target group, “heavy heroin users aged 18 and over”. The objectives of the scheme were:• to assess the effect of impunity for possession and use of drugs in a certain area defined elsewhere: • to help heavy drug users build a sense of self-esteem (dignity);• to facilitate contact between the social and health services and drug users;• to prevent the spread of infectious diseases; and• reduce overdose rates and overdose fatalities Two years later, 409 persons had registered as clients of the centre, of whom 383 used the facility on one or more occasions. Of these 383, 71 per cent were male and 29 per cent female; 23 per cent were 30 or younger, 41 per cent 31–40 and 37 per cent 40 or above. In these two years, 17,226 injections were administered, that is, an average of 24 injections every day. There is wide variation in the frequency with which registered clients used the facility. Only 10 per cent used the centre more than six times per month. Two thirds used it only once or twice per month after registering as clients. Injection doses of 0.2–0.25 grams were reported by 80 per cent of the clients. The drug was predominantly injected into the arm (64 per cent), followed by groin (19 per cent), leg (15 per cent) and neck (2 per cent). Clients reported safety as their primary reason for using the facility. Other important reasons included the sense of security at the facility, learning how to inject more safely, supervision in the event of an overdose, and knowledge that they could administer the drug without worrying about the police or security guards moving them on. The clients of the injecting centre express in the main satisfaction with the facilities provided. Virtually none have any complaints about advice on how to inject, how they were treated by staff or about the equipment provided. They would like to see opening hours extended, and an opportunity to inject pills with the heroin. The police have given their full support during the trial. Impunity has undoubtedly worked insofar as it, in legal terms, is actually possible to run the injecting facility, despite the inability of staff to satisfy themselves that clients are only bringing one heroin dose onto the premises. Impunity has had an unintended side effect however, in that possession of small quantities of heroin is decriminalised even further in the centre of Oslo. Insofar as it is possible to operationalize the concept of dignity, it could be said that the injecting room has had a positive effect on the dignity of the group in question. The pilot scheme has enhanced the dignity of drug users in a wider sense, by acknowledging the need to inject drugs in as risk free an environment as possible. The courteous manner of the staff has also been beneficial in that sense as well. Healthcare and welfare counselling have been provided in 8 per cent of all visits. This care depends, however, on adequate staffing. Suitable premises where staff and clients can talk privately would improve the centre’s ability to provide care.