The situation of Harm Reduction in Spain: a qualititive approach incluying PWUD

Abstract submitted by an ENDCR Member, thematically linked to other Members submissions

The situation of Harm Reduction in Spain: a qualititive approach incluying PWUD.

Aranda-Rodríguez, E; Rovira-Guardiola, J; Altell-Albajes, G.

Background

Harm Reduction (HR) in Spain began in the 1980s with a focus on reducing deaths from opioid overdoses and HIV/AIDS-related issues. Within an international and locally prohibitionist context, the initial strategies were implemented to address these serious problems and gain community acceptance. The undeniable effectiveness of these strategies has allowed Spain to expand the typology and number of HR strategies, making it a European reference. However, since then, there has not been a thorough review to assess whether the characteristics of People Who Use Drugs (PWUD) and the forms they use substances have changed, and consequently, whether existing strategies still provide adequate responses to their needs.

Methods

Qualitative, descriptive, and exploratory study. The theoretical framework was constructed based on 6 interviews with HR experts. Two in-person Focus Groups (FG) were conducted with PWUD (13 participants, mostly women), and two remote FG were formed with professionals (both long-term career and recently involved in HR). A total of 39 individuals participated, representing 7 different regions of Spain. Participation was voluntary after signing the consent form.

Results

The study identified that the actually applied Public Health model requires the incorporation of an intersectional approach to social justice, aiming to highlight different axes of inequality and oppression influencing substance use and promoting the guarantee of basic rights for PWUD. It was observed that HR strategies are effective for men, white individuals, Spanish nationals, and opioid injectors. However, other communities, substances, and forms of use are not receiving adequate attention to their needs. There is a reported need to adapt strategies to the increasing use of crack and inhaled methamphetamine, especially among women and LGBTQ+ individuals. Participating HR professionals reported experiencing severe episodes of violence in their workplaces and witnessing burnout in their teams.

Conclusions

For almost 50 years, Spain has implemented effective HR strategies in some regions; however, PWUD continue to see their basic rights violated simply due to their substance use. Existing programs do not provide adequate responses to non-privileged communities, increasing their vulnerability. The rise in the use of inhaled stimulants presents new challenges in HR. Efforts should be made to promote good mental health and prevent burnout among professionals for effective and quality support.