Harm reduction social work with people who use drugs: a qualitative interview study with social workers in harm reduction services in Sweden.

BACKGROUND: Social work with people who use drugs (PWUD) has traditionally focused on abstinence and rehabilitation. In recent years, harm reduction has gained an increasingly more important role in social work with PWUD, and social workers are key professionals in many harm reduction services. This study investigates how social workers in harm reduction services for PWUD in Sweden understand the concept of harm reduction and how it relates to goals of rehabilitation, and how they assess and deal with dilemmas and challenges in everyday work. METHODS: The study is based on interviews with 22 social workers in harm reduction services for PWUD in the Scania region of Sweden. A thematic analysis in three steps was used in coding and processing the data. RESULTS: The social workers pointed to similar values between social work and harm reduction and argued for combining the two fields to improve services for PWUD. Three overarching principles for Harm Reduction Social Work (HRSW) were developed based on the social workers accounts: (1) Harm reduction is a prerequisite for rather than a counterpoint to rehabilitation and recovery, (2) motivational work must be non-mandatory and based on the client's goals, (3) a holistic perspective is crucial for Harm Reduction Social Work. Challenges in doing HRSW concerned restrictive laws, policies, and guidelines, resistance from managers, difficulties in setting boundaries between client autonomy and life-saving interventions, and the risk of normalizing high-risk behaviors. CONCLUSIONS: We use the concept of Harm Reduction Social Work to show how social work with PWUD can have a primary focus on reducing harm and risks, while at the same time it involves a holistic perspective that facilitates motivation and change. The suggested principles of HRSW can provide guidance in practical social work with vulnerable PWUD. Social workers can have important roles in most harm reduction settings and may act to enable recovery.

Police officers' attitudes and practices toward harm reduction services in Sweden - a qualitative study.

BACKGROUND: Since the 1980s, Swedish drug policy has combined a restrictive zero tolerance approach with the vision of a "drug-free society". However, in recent years, access to harm reduction services has increased through local initiatives and new national guidelines. The possible success of these services may be affected in part by police drug law enforcement. The aim of this study was to explore how Swedish police officers act toward and view harm reduction services in a national drug policy setting of zero tolerance toward drug use. METHODS: Applying a qualitative research design, we conducted 19 in-depth interviews with police officers who worked with drug law enforcement in Malmö. We conducted a qualitative textual analysis of the data. RESULTS: Officers largely supported harm reduction services and refrained from overtly enforcing drug laws in their vicinity. Officers engaged in boundary work that assigned the responsibility of care of marginalized people who use drugs (PWUD) to the health care system, while including policing of drug market problems, young PWUD and dealers in their own jurisdiction. Opioid substitution treatment was seen as positive, although diversion of medicines was pointed out as a problem. Needle exchange programs were seen as offering important public health services and a no-go zone for the police. Several officers wanted to carry naloxone on duty but requested more information about its use. CONCLUSION: The general support among police officers for harm reduction services is an indication of a changing drug policy landscape in Sweden. Drug policy should take police officers' views into consideration and there is a need for collaboration between police and harm reduction services. Further research should focus on how the police conduct boundary work since police actions may impact on the success of harm reduction services.

The impact of substitution treatment in prisons--a literature review.

Substitution treatment (ST) has established itself as a generally recognised type of treatment for opioid dependence worldwide. Although the number of countries providing ST in prison has slowly started to grow over the last years, its application in the custody setting remains controversial. ST in prison is mainly employed in form of detoxification. Maintenance treatment is provided in only a limited number of international prisons. This literature review is centred around the question: "What is known about the effectiveness of prison based ST?" Furthermore, it investigates how this knowledge can be applied to improve treatment scope and quality. Effectiveness, as defined by the examined studies, refers to short- and long-term reduction of drug use and relapse, reduction in drug use related risk behaviours, reduction in criminal conduct and recidivism, facilitating the manageability of drug using prisoners and improving their physical stabilisation. In this context, substitute dosage, treatment duration, patient retention rates, complementary psycho-social care and the effects of disrupting maintenance treatment when entering the institution are scrutinised. Results show that prison-based ST and especially prison-based methadone maintenance treatment (PMMT) can reduce drug use and injection in penal institutions. Moreover, PMMT provision can reduce injecting risk behaviours as well as drugs charges and re-admission rates. However, for PMMT to retain patients in treatment and reduce illegal drug use and criminal behaviour a sufficiently high dose of methadone (e.g., >60 mg) and the treatment duration lasting the entire period of imprisonment appear crucial. On the basis of the analysed results the authors recommend the provision of PMMT for individuals with long-standing opioid dependence and suggest major expansions of prison based ST in many countries.

A qualitative exploration of the impact of cultural and social factors on heroin use in Shetland (Scotland).

In order to gain a greater understanding of the impact of social and cultural factors on patterns of heroin use and use-related behaviors, in-depth interviews were carried out with 12 heroin users in Shetland. Analysis revealed the existence of a small, highly organized and highly covert heroin subculture. Within this group, users were predominantly older, and their use was reported as being relatively self-controlled and unproblematic in nature, especially by comparison to the heroin use associated with deprived urban areas. There were indicators, however, that this situation seemed to have entered a phase of change, reflected by descriptions of an increasing number of younger, less controlled heroin users. Within the theoretical framework of drug, set and setting, the importance of drug-using norms and rules among heroin users in both regulating and maintaining patterns of use, even through periods of change, was identified. Shetland, with its relative affluence, small size and geographical isolation constitutes an unusual setting for research into heroin use, which customarily has been viewed as an urban phenomenon. Thus it offers the opportunity to gain insight into the nature of heroin use and associated behaviors from a relatively novel perspective.