Abstract: The EMCDDA Trendspotter case study on Fentanyl in Europe was undertaken during September and October 2012. It culminated in an expert meeting in Lisbon on 9-10 October 2012. The aim of the study was to increase understanding of the availability and illicit use of fentanyl in Europe, with a specific focus on: the extent and patterns of use; illicit production and diversion; harms and deaths; and, responses to the problem. Twelve experts from 10 EU Member States (Bulgaria, Czech Republic, Germany, Estonia, Greece, Italy, Slovakia, Sweden, Finland, United Kingdom) attended the meeting, presenting their experiences and contributing to an analysis of the topic, providing insights from law enforcement, forensics, treatment, research and monitoring, and drug user perspectives.

Abstract: Background and Aims: Substance users are at high risk of viral (HBV and HCV) and alcoholic liver disease leading in some to progressive fibrosis and cirrhosis. Users in rehabilitation programs often lack information about health risks related to substance use and ways for prevention and treatment and often postpone medical workup and treatment. The aims were: 1. To improve knowledge and awareness about the epidemiology, mode of acquisition, natural history, diagnosis and treatment of chronic viral hepatitis B and C in persons participating in substance use rehabilitation programs in southern Switzerland. 2. To identify users with liver disease and fibrosis or cirrhosis using ALT and Fibroscan testing, and 3. To offer personalized counseling on diagnostic workup and treatment for persons with significant fibrosis or cirrhosis in order to prevent progression to cirrhosis and its complications. Methods: Substance use rehabilitation programs were contacted and offered an educational event, held by an MD, with information on epidemiology, mode of acquisition, natural history, diagnosis and treatment of chronic alcoholic and viral hepatitis B and C. Participants interested were given the possibility to undergo ALTtesting, Fibroscan® testing as well a consultation with a hepatologist, free of charge. Results: Eleven Institutions were involved in the program, 7 offering residential and 4 daytime rehabilitation programs. A total of 136 users and 22 health care workers attended the educational sessions. 82 of whom (60.3%) participated in the ALT/Fibroscan screening program. The mean age was 43.9 years (65 male and 17female users). 45% had abnormal ALT levels. The mean was 89.6 IU/ml. Only 17% had normal liver elasticity, 83% had abnormal values compatible with fibrosis assessed by Fibroscan (>4.0 KPa). 21.9% had at least moderate (F2-F4) fibrosis (>8.0 KPa) and 10.9% had values indicating the presence of cirrhosis (>16 KPa, F4).The running costs in terms of personnel and materials of this pilot program were slightly more than 100 Swiss Francs per participant. Conclusions: The results confirm a high burden of liver disease in substance users in rehabilitation programs in our region. The interest and adherence to the program was excellent with 60.3% of those participating in the educational event undergoing voluntary ALT and Fibroscan® testing followed by counseling. Significant liver disease was found in more that 4/5 of the participants. More than 10% had results compatible with cirrhosis. Similar programs can be adapted to other high-risk settings for liver disease at reasonably low costs.

Abstract: An HIV “explosion” has occurred among injecting drug users (IDUs) in many countries in the developed and developing world. The paper describes the establishment of the International Drug Users Network (IDUN) at a meeting of representatives of IDU groups in Melbourne, Australia in March 1992. Representatives from IDU groups in Australia, New Zealand, Germany, the Netherlands, Nepal and the USA attended the meeting, which resulted in a communications network being set up for exchange of information and ideas on HIV prevention among IDUs, increasing recognition of IDUs’ human rights, activities and policies of IDU groups, and effects of drug and HIV policies on injecting drug users. The paper will detail the first year of IDUN’s operations, suggest new directions for the network and provide recommendations for authorities trying to prevent HIV among IDUs.