Bonjour, l'un des pbs de Stalingrad est qu'il s'agit de populations désocialisées, souvent d'origine étrangère, et pour beaucoup en grande difficulté psychosociale.
Et du coup n'ayant pas beaucoup de structuration sociale. Comme à East Hastings à Vancouver
. Dans le temps ces populations utilisaient surtout l'alcool
mais le crack
peuvent être plus rapides et moins chers.
Du coup il y a evidemment un marché juteux qui attire les dealers.
Donc tout est là pour rendre la situation ingérable.
Plusieurs organismes ont écrit sur la RdR
dans ces populations. Je propose un texte qui donne des exemples de solution. Notamment les salles de consommation en Hollande, dont l'une heberge 20 résidents qui peuvent consommer dans le salon (page 113).
Plusieurs exemples, dont un au Bresil dans ce texte montrent l'efficacité du "Housing First". Quand on loge et nourrit ces personnes on peut obtenir une diminution des consommations. Mais exiger une diminution des consommations avant de loger est inefficace. Bref il s'agit d'un problème social avant tout !
Paris a connu bien des situations similaires depuis la Cour des Miracles (ainsi nommée par ce qu'une fois dans cet abris les mendiants aveugles et handicapés guérissaient immédiatement). Les essais de regulation musclée ont échoué et seule l'amélioration progressive de la lutte contre la pauveté a pu résoudre le problème. Mais pas définitivement on le voit bien.
La deuxieme ref donne une idée de ce que pourrait être la régulation des consommations de stimulants, qui serait une solution complémentaire.
Evidemment toutes ces actions demandent un financement, mais la repression absorbe des sommes importantes sans resoudre le probleme. Un financement à la hauteur de l'enjeu pourrait regler le probleme sanitaire, tout en tendant une main à des populations désocialisées, notamment à la suite des conflits et inégalités sociales variés, et en nous permettant d'avoir une attitude conforme à nos valeurs démocratiques (oui, contrairement à ce qu'on pourrait penser ce n'est pas seulement un discours de langue de bois. Les nombreuses associations sur le terrain montrent que chez "les gens" ces valeurs démocratiques sont bien présentes). Amicalement
nb = les textes sont en anglais, je peux sur demande en traduire quelques uns.https://www.gpdpd.org/fileadmin/media/m … mplete.pdf
voir page 113 et suivantes
Salles de Consommation
Drug consumption rooms are professionally supervised healthcare facilities where drug users can consume drugs in safer conditions. They seek to attract hard-to-reach populations of users, especially marginalised groups and those who use on the streets or in other risky and unhygienic conditions. One of their primary goals is to reduce morbidity and mortality by providing a safe
environment for more hygienic use and by training clients in safer use. At the same time, they seek to reduce drug use in public and improve public amenity in areas surrounding urban drug markets. A further aim is to promote access to social, health and drug treatment facilities.’ — (EMCDDA 2018c,
5.7 Princehof, Ripperdastraat and SchurmannstraatImage 26: Amsterdam, Enschede & Rotterdam, The NetherlandsThe Netherlands
The Netherlands is a coastal country in Western Europe. According to the United Nations database, the country had a population of 17 million people in 2017 (United Nations 2018). The Netherlands is part In contrast to Drug Consumption Rooms (DCR) abroad – mainly servicing PWID – the Dutch facilities primarily target PWUD who smoke their substances. Typically, Dutch DCRs target long-term problematic users of freebase cocaine
and heroin (and metha
-done), with only small numbers of people who inject or snort their substances. Moreover, there is very limited use of other substances at these services. In this chapter drug consumption rooms in the Netherlands will be discussed, through the study of three exemplary locations: Princehof in Amsterdam and Ripperdastraat in Enschede, two very different DCRs, but both strongly integrated with other PWUD services, and the Schurmannstraat in Rotterdam, an intensive supported housing facility with a drug consumption room in the living room for their 20 residents. An approach to Drug Consumption Rooms in the Netherlandshttps://www.psychoactif.org/forum/2020/ … 485_1.htmlhttps://transformdrugs.org/assets/files … s-2020.pdf
Salles de consommation
Drug consumption roomsDrug consumption rooms (DCRs, also variously known as overdose
preven-tion sites/centers and supervised injection
/drug consumption facilities) are professionally supervised healthcare facilities where individuals can use drugs in safer and more hygienic conditions.17 The three primary goals of DCRs are to reduce morbidity and mortality by providing a safe
environment and training people who use drugs in safer use, to reduce public drug use and improve public amenity in open drug scene areas, and to promote access to social, health and drug treatment facilities.18Although DCRs have mostly targeted people who inject drugs, they increasingly also focus on people who smoke or snort their drugs.19 In a 2017 inventory among 43 DCRs, 41 facilities offered spaces for safe injection
, 31 also offered spaces for smoking, with 22 DCRs also facilitating spaces for sniffing. 34 of these DCRs allowed for at least two different means of drug administration (inject, snort or smoke), either in separate spaces or in the same room. In this same inventory, stimulants — including amphetamines
, crack cocaine
, and cathinones
— seemed to be the substances most commonly used, irrespective of route of administration.20Almost just as common is the use of heroin, followed by a combination of opiates and stimulants (speedballing). DCRs that provide spaces for both injection
and inhalation, are likely to facilitate a transition from injection
to less risky forms such as smoking.
Santé et prévention
274How to regulate stimulants7access to sterile equipment; ideally have access to other health and social services (including psychosocial support, medical services, addiction treatment, etc.).21 DCRs have strong potential to reach hard-to-reach people who use drugs.22 The DCR can connect them to health and social services, such as healthcare, drug treatment, referrals to legal services, housing programmes, helping address the harms associated with the broader risk environment
The problematic use of stimulants has been associated with poverty, unemployment, incarceration, homelessness and unstable housing.27Strategies and interventions that help with these issues therefore have the capacity to address several of the harms of problematic stimulant use.28 Homelessness specifically can be addressed through Housing First interventions.
276How to regulate stimulants7Housing First seeks to move people into permanent housing as quickly as possible. Permanent and stable housing is emphasised as a primary strat-egy for the care of homeless people, people with mental health problems, and people who use drugs. This is in contrast to treatment first, which demands people go through a series of stages, such as becoming abstinent, before they are ready for housing.The eight principles of housing first are:•Housing as a basic human right•Respect, warmth, and compassion for all clients•A commitment to working with clients for as long as they need•Scattered-site housing in independent apartments•Separation of housing and services•Consumer choice and self-determination•A recovery orientation•Harm reduction29An adequate supply of stable housing can be considered a harm reduction intervention in itself. Additionally, housing first interventions are related to decreases in drug use, higher quality of life, higher levels of autonomy, reduced stress and an increase in personal safety. For people who use stimulants, a stable housing situation provides the basis for stability, daily routines, privacy, and less stigmatisation, and leads to healthier eating and sleeping habits.A Canadian study found that 74% of the participants of housing first programmes said their drug use had decreased since they moved into housing; 33% had quit using drugs completely, and 41% had decreased
277Stimulant harm reductionA practical guidetheir use.30 In Brazil, Braços Abertos, a programme offering housing to people who use drugs helped 65% of participants to decrease their crack
consumption.31 In a housing first programme in Brazil, Atitude, 38% of participants said they quit crack
use after participating in the programme.32Finally, studies have shown that having a stable house can encourage people to choose less harmful routes of drug administration. In a study among young people injecting methamphetamine
in Canada, housing was found to be an important factor in facilitating cessation of injection
.33Similarly, studies in the US and India found a stable housing situation to be associated with decreased drug injection
Drop in Centers (CAARUD)
Drop-in CentresDrop-in centres (DICs) are an important low-threshold harm reduction service that is offered throughout the world. They function as places where people who use stimulants and other drugs can meet others, find a listening ear, access a range of information and, for some, attain a degree of distance from potentially problematic home or street environments.In practice, this means that DICs offer an informal social setting, responding to some basic needs (e.g. food, shelter from the cold, shower and clean clothes) and offer some additional services. These services can be as basic as offering an opportunity for social contact in a safe
environment, or offering (psychosocial) support to improve well-being or work on life changes. Drop-in centres can provide vulnerable people — be they people who use drugs, sex workers or homeless people — with a safe
and supportive environment, while stimulating them to make use of wider community resources or make changes in their lives.55DICs should be located near the communities of people who use drugs and involve members of the community in running the programme, offering services, and decision-making processes relating to service provision. A 2015 review on the impact of drop-in centres found them to contribute to a general improvement of overall wellbeing and health as well as ‘a range of benefits including reduced drug use, and reduced exchange of sex for drugs, as well as improvements in social participation/engagement, mental health, days housed (although no improvements securing permanent housing were found) and access to sexual and reproductive health services’.
Dernière modification par prescripteur (19 juin 2021 à 20:57)