Des ONG italiennes développent un guide sur la réduction des risques

Italian NGOs have developed an advocacy guide on harm reduction after an in depth debate at the three days summer school promoted by Forum Droghe and Coordinamento Nazionale Comunità di Accoglienza (CNCA). The Advocacy Guide is a response to the present difficulties of the Italian low threshold network, threatened by cuts to the welfare budget and the government’s “tough on drugs” policies.

At the beginning of September, a three days summer school on Harm Reduction took place in Florence, promoted by Forum Droghe and CNCA. It was attended by 160 drug addiction professionals working in low threshold facilities.

The initiative aimed at reconsidering both the twenty years history of Harm Reduction and the most innovative experiences and developments. The present difficulties of the harm reduction approach in Italy were discussed in the light of the “tough on drugs” policies endorsed by the government.

The situation of harm reduction facilities can be summarized as follows. Since the late 1990s, a network of low threshold facilities has been developed in Italy, ranging from drop-in centres (open in day time), night shelters, street units, outreach work in entertainment settings. From a study carried out by CNCA in 2009, 157 facilities were registered over the whole country, most of which are outreach units for street drug users. The large majority of these services and interventions are run by NGOs and they are usually funded as “experimental projects” only on a yearly basis (or for a couple of years at most). Though most of these facilities have been funded as projects for several times (but still temporarily), this “experimentation” has never led to a final inclusion of the low threshold interventions in the “mainstream” network of the public drug addiction services (Servizi Tossicodipendenze, SERT). Unlike the harm reduction interventions, SERT can rely on a permanent funding from the National Health System resources. As a consequence, the salaries (and the social “status”) of professionals working in the field of Harm Reduction are lower than the ones of the staff employed in the drug addiction public services.

In recent years, harm reduction has been under the government’s attack and the very term “harm reduction” has been eliminated from the official documents, the wording “Prevention of drug related pathologies and deviant behaviours” taking its place. In the guidelines issued by the National Drug Department in 2009, the so called “prevention of related pathologies”, especially methadone maintenance, is admitted but only as a “preliminary” step to drug free treatments. As a result of the “moral” rhetoric as well as of the cuts to the welfare budget due to the present financial crisis, the Harm Reduction network is at risk in many areas of the country: a significant number of interventions are expected to run out of funding in the next months and perhaps some facilities will be closed. The outreach work in the youth entertainment settings is the most at risk.

Following the three days debate, an “Advocacy Guide to harm reduction in Italy” has been worked out, to underline the principles of Harm Reduction policies, to point out the efficacy and efficiency of HR interventions, to advocate the development of the present low threshold network as well as the extension of the harm reduction model to new fields of intervention.

Among the main points:

• Harm reduction is to be seen as a comprehensive approach to drug policies, including the reduction of the harm from the prohibitionist legislations.
• Evaluation is a stronghold in the way to innovative drug policies. After publishing the First and Second White Book on the Fini Giovanardi law, Forum Droghe and CNCA will continue to evaluate the 2006 Italian drug legislation and its unintended consequences. Panels of experts will be promoted to elaborate a different legal framework and to advocate the decriminalisation of drug use and milder penalties for drug crimes.
• The harm reduction network needs to be further developed, with a special concern to drug users in prisons: HIV prevention should be introduced while methadone programs (methadone maintenance treatments especially) should be more widely available.
• The harm reduction network needs adequate and stable funding. Harm reduction professionals deserve permanent positions and higher wages to match the ones of the staff employed in the Drug Addiction Public Services (SERT). Forum Droghe and CNCA will advocate the strengthening of the HR network from the government, the Regions and the Municipalities.
• Harm reduction moves beyond the disease paradigm and the traditional “top-down” approach towards a “user-centred” one. As such, harm reduction can innovate in the area of prevention as well as of therapy, beyond the low threshold typical interventions. Forum Droghe and CNCA commit themselves to test and validate innovative interventions, with the aim to reach the underserved majority of substance users with less severe problems who avoid existing treatments (as well as those with more severe problems who are not ready to give up use but are willing to take control on their drug use).

Click here to read more on the presentation in Italian.

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