From opiates to methamphetamine: good practices and challenges of building new harm reduction responses

Various parts of the world have seen the rise of stimulant use. The last World Drug Report estimates that, globally, around 34.2 million people have used an amphetamine-type substance in the past year, and its use seems to be on the increase. In Asia, especially, ATS are the dominant drugs of choice, and since 2009, methamphetamine prevalence has overtaken heroin prevalence. Despite these changes, most harm reduction services still focus predominantly on people who inject opioids and find challenging to include People who Use Stimulants (PWUS), leaving many marginalised stimulant users underserviced. This presentation builds upon a newly-implemented outreach program assisting methamphetamine users in Indonesia to address some of the challenges and the good practices in responding to stimulant use. Notably, it analyses the challenges arising from being the first harm reduction project focusing on stimulants in the city (Jakarta) and the region of South East Asia. The case is part of a broader research - ‘Speed limits: harm reduction for people who use stimulants’- focused on reviewing evidence on harm reduction for PWUS. The project described here, Karisma’s shabu outreach, reaches out to people who use methamphetamine since mid-2016. The outreach team and the peer educators provide PWUS with oral information and leaflets on methamphetamine, mental health issues, drug use and dependence, and the impacts of meth use on health. The team also distributes safer smoking kits. One of the lessons learned from this project is that the most important when promoting harm reduction to a ‘new’ population is to know the area, the population of users and their characteristics, so to build an approach. Meaningfully involving PWUS and including people with lived experience in the team were crucial elements to achieve engagement. PWUS assisted by the programme are very satisfied, and especially value the information received and the kits distributed. Moreover, service users feel the project offers them a place to be heard and to be able to use their experience to help other PWUS. Pioneering a project with a population not assisted before, also requires extra effort in networking, sensitising partners, and building services integration. A challenge here is that services are not yet prepared to assist the population and their needs. Working with mental health problems linked to meth use is especially difficult, as PWUS tend not to recognise their symptoms as mental health-related. Moreover, the specific context of strict drug regulations and law enforcement also requires extra efforts and time in building trust with PWUS. This may entail a compromise between the reach of the project (and lowering the costs per capita) and the quality of assistance and time needed to bond with PWUS in an initial phase.