Political Situation (Source: European Monitoring Centre for Drugs and Drug Addiction (EMCDDA))
A legal framework for a series of harm reduction measures, such as needle and syringe exchange and supervised injection rooms, was established in 2001 when the basic drug law of 1973 was amended. However, harm reduction interventions had already been initiated and developed prior to the new legal framework. The law amendment in 2001 allowed existing interventions to be maintained and further developed and new services such as drug consumption rooms and medically assisted heroin distribution to be implemented. The first and until now (2015) only injection room at the national level opened in July 2005 and has been integrated into the low-threshold emergency centre for drug users. Up to 2015 a total of 1 600 clients had signed the facility’s mandatory user contract, and more than 59 000 injections were supervised by trained staff during the year 2014. In 2012 the facility opened a room where drugs can be inhaled under supervision (blow room). A second supervised drug consumption room is planned in the southern part of the country for 2016/17.
Note from ABRIGADO: Luxembourg with a population of 550.000 citizens is the home of more than 2,200 problem drug users. And the realistic demand shows that more small DCR’s facilities (two in the main City and one in the north of the country) are required.
The set-up of a heroin-assisted treatment (HAT) programme is planned in the governmental programme and it is expected that HAT will be introduced as a complementary treatment option in 2015/16.
The National HIV/AIDS Action Plan for 2011–15 has been launched by the Ministry of Health. Its aims include the prevention of infectious diseases and harm reduction in drug-using populations. The elaboration of this plan has taken into consideration the recommendations of the external evaluation of the previous plan.
The national needle and syringe exchange programme in Luxembourg is decentralised and consists of five fixed sites, one of which was opened in 2014, drug counselling centres, drop-in centres for sex workers and at-risk populations, low-threshold services and four vending machines situated in the towns most affected by injecting drug use. Needle and syringe exchange is also provided at two prison-based sites. Apart from needles and syringes, testing for blood-borne infectious disease, vaccinations and counselling on safe use practices are also provided. In 2012 a mobile medical care unit was launched as additional service, facilitating the provision of primary medical care at low-threshold agencies. Approximately one-third of RELIS-indexed PWID obtain clean syringes mainly from pharmacies, and this proportion is estimated to have been stable in recent years.
The number of sterile syringes distributed in the framework of the national needle exchange programme has constantly increased since it was first implemented in 1993, when 76 000 syringes were distributed, reaching a peak in 2005 when some 435 000 syringes were given out. Syringe demand has significantly decreased in more recent years, and numbers fell to 192 000 in 2013.Luxembourg’s National Strategy and Action Plan on Drugs and Drug Addiction 2010–14 is comprehensive and its goal is to ensure a high level of health protection, public security and social cohesion. It focuses on both illicit and licit drugs, although it refers to separate thematic action plans (alcohol, tobacco, psychotropic medication, other addictions, etc.). The illicit drugs action plan covers two pillars: supply and demand reduction; and four transversal axes: risk, nuisance and harm reduction; information and evaluation; international cooperation and research; and horizontal coordination mechanisms. It includes 60 separate actions divided into seven fields: primary prevention; treatment and care; socio-professional reintegration; reduction of risks and damages; research/evaluation and information; supply reduction; and coordination and international relations.
The new strategy builds on the outcome of the external evaluation of the previous action plan and takes into consideration the EU Drugs Strategy 2005–12 and its Action Plan 2009–12. It is results-oriented and places a special focus on primary prevention, social reintegration, diversification and access to treatment, and quality management. There are 60 separate actions listed in the strategy and these are associated to those responsible for implementing them, financial requirements, defined timeframes and performance indicators. A criteria matrix was used to define the specific actions, projects or programmes that are set out.
Concept of the DCR
Starting from the DCR-regulation rules of Frankfurt (Germany) and inspired by many other foreign DCR's (especially Drop-in, Hamburg, Germany), our philosophy is based on the ideas of a low threshold- and acceptance oriented drug aid, which aims at harm reduction and safer use.
Some major goals are to respect the clients’ right to self-determination and to promote their self-responsibility. A factor of great importance is the bio-psycho-social perspective of the professional staff, because a purely medical point of view does not meet the individual needs and problems of the clients. Furthermore, it should be emphasized, that the main focus of the DCR is not drug consumption itself, but communication, as well as the establishment and expansion of interpersonal relations. In this way, the DCR becomes a drug communication room!
Our DCR is just one of many other offers of ABRIGADO. The DCR also represents a way of communication and building of relationships. Both, our DCR and the “Kontakt-Café”, need each other, to offer an effective service for our clients. For the individual problems of our clients, we need to develop with them together individual solutions.
Since the beginning of the DCR in 2005, the institution is controlled and developed by a group of key stakeholders (decision makers from: Ministry of health, Ministry of justice, Prosecutor, Police, city council, customs Administration and various partners). Based on the “Frankfurt model”, this group meets every two months. Here we have to give an account of the activities of ABRIGADO (statistics and situation analyses). This steering group, called “Montagsrunde” (Monday-group) is, besides the motivation of our employees, one of the important factors of success of our work.
The multidisciplinary team of the DCR contains: psychologists, social pedagogues, educators, sociologists and nursing staff.
Patrick Klein, Abrigado Luxembourg 2015