title: Harm reduction interventions for drug injectors or heroin users in Spain: expanding coverage as the storm abates.
abstract: OBJECTIVE
  To show the utility of analysing time trends of need and coverage of needle-exchange programmes (NEPs) and opioid substitution treatment (OST) to assess harm reduction policies targeting drug injectors or heroin users.
  
  
  METHODS
  Multiple methods applied to secondary data.
  
  
  METHODS
  Spain.
  
  
  METHODS
  Thousands of drug injectors or heroin users included in administrative registers, surveys and published studies during 1987-2010.
  
  
  METHODS
  Coverage for the general population was calculated as the ratio between interventions provided (obtained directly from the sources) and interventions needed (estimated by multiple methods), and as the difference between the two. Timeliness was estimated by time elapsed between year of highest need and year in which coverage reached a reference level.
  
  
  RESULTS
  In 2010 NEPs provided 138 syringes per drug injector [95% confidence interval (CI) 100-223], covering 25.7% (95% CI 18.3-43.3) of their need. OST coverage was 60.3% (95% CI 44.3-94.2). Syringe and OST provision increased between 1991 and 2001 and then declined. Syringe and OST coverage also increased substantially during this period and then stabilized, due mainly to decreases in drug injection or heroin use. Medium-level coverage for both syringes and OST was not achieved until 2000, 8 years after the peak in need (1992).
  
  
  CONCLUSIONS
  In Spain, the expansion of harm reduction interventions was greatly delayed, although the concomitant decrease in heroin and injecting drug use led to reasonable coverage after 2000. A longitudinal measurement of need and coverage provides insight into the timeliness and potential population impact of interventions, enabling better assessment of their adequacy.
authors.affiliation: National School of Public Health, Carlos III Health Institute, Madrid, Spain.
authors.forename: Gregorio
authors.initials: G
authors.lastname: Barrio
authors.forename: María J
authors.initials: MJ
authors.lastname: Bravo
authors.forename: M Teresa
authors.initials: MT
authors.lastname: Brugal
authors.forename: Mercedes
authors.initials: M
authors.lastname: Díez
authors.forename: Enrique
authors.initials: E
authors.lastname: Regidor
authors.forename: María José
authors.initials: MJ
authors.lastname: Belza
authors.forename: Luis
authors.initials: L
authors.lastname: de la Fuente
mesh_terms: D003430:Cross-Sectional Studies; D040261:Harm Reduction; D006293:Health Promotion / Q000600:supply & distribution*; D006301:Health Services Needs and Demand; D006556:Heroin Dependence / Q000534:rehabilitation*; D006801:Humans; D018671:Needle-Exchange Programs / Q000706:statistics & numerical data / Q000600:supply & distribution; D013030:Spain; D015819:Substance Abuse, Intravenous / Q000534:rehabilitation*