International harm reduction indicators are still not reached: Results from the second round of a cross-sectional study on drug paraphernalia distribution in Germany, 2021

Author: Franziska Hommes, Amrei Krings, Achim Dörre, Esther Neumeier, Dirk Schäffer, Ruth Zimmermann

Theme: Epidemiology & Public Health Research Year: 2023

To prevent the transmission of blood-borne infections, the World Health Organization (WHO) has set a target of 300 annually distributed sterile needles and syringes per person who inject drugs (PWID) as a hepatitis elimination indicator. We aimed to measure this indicator in Germany in 2021 and to analyze changes from the distribution in 2018 to inform harm reduction programmes.

We conducted a repeated cross-sectional study of low-threshold drug services in Germany. We assessed the type and quantity of distributed drug paraphernalia and the number of supplied PWID in 2021 via an online and paper-based questionnaire. We descriptively analyzed cross-sectional data from 2021 and estimated progress towards the WHO target for participating services in 2018 and 2021.

Of 1760 distributed questionnaires, 534 were returned. N=204 drug services in 15/16 of Germany’s federal states confirmed drug paraphernalia distribution. In 2021, syringes (97% of services), needles (96%) and vitamin C (90%) were most frequently distributed. Pre-cut aluminium foil (79%), crack pipes (28%) and sniff tubes (43%) were distributed less frequently. On average, distribution of 127 needles and 85 syringes per PWID was reported. 2/15 states reached the WHO target for needles and one for syringes. Among the responding services, we found a median reduction of distributed syringes by 18% and by 12% for needles compared to 2018.

The current national estimates for drug paraphernalia distribution seem far from meeting the WHO target. An impact of the COVID-19 pandemic on prevention behaviour, and an underestimation due to missing responses cannot be excluded. Increased smoking rather than injecting drugs may also have impacted the demand for needles and syringes. Germany should expand harm reduction services and find alternative ways of distribution to overcome regional supply gaps. Further investigation of determinants of adequate distribution is essential to reduce blood-borne infections in PWID.

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