The empirical and methodological comparative value of the rapid assessment of drug use patterns

International Journal of Drug Policy 11 (2000) 181–191

The empirical and methodological comparative value of therapid assessment of drug use patterns�

Robert Power *Department of Sexually Transmitted Diseases, Uni6ersity College London, The Mortimer Market Centre, London, UK

Accepted 27 October 1999

Abstract

This paper examines the comparative value of rapid assessment in the field of illicit drug use. Three aims of rapidassessment are highlighted: one, to collect quality data to inform policy and practice; two, to encourage amulti-method research approach; and three, to promote and support greater local involvement and ownership of theproject itself. A number of manuals and guidelines have been produced for rapid assessment. A key issue to address,therefore, is the extent to which a structured and standardised approach can provide sufficient flexibility to take intoaccount the political, social and cultural differences in the respective countries in which assessment takes place. Usingthe empirical experience derived from four rapid assessment projects, a four-phase strategy is outlined: developinginfrastructure and formative evaluation; research training and mapping exercises; data collection; and report writingand dissemination. In place of the current reactive approach, we need more strategic thinking at the macro-level. Toenable comparison between projects we should move towards basic methodological standardisation, but this shouldbe accomplished without stifling the sociological imagination, which is a crucial ingredient to successful rapidassessment. © 1999 Elsevier Science B.V. All rights reserved.

Keywords: Rapid assessment; Methods; Croatia; Czech Republic; Egypt; Viet Nam

www.elsevier.com/locate/drugpo

1. Introduction

Rapid assessment endeavours to provideinformative snapshots of social phenomena.When employed with some measure of con-sistency, such work has potential compara-

tive value. This method of data collection hasbecome increasingly popular in the era ofAIDS and has been used in a wide number ofcountries around the world, not least of all inthe context of illicit drug use. The recentspecial issue of the United Nation Drug Con-trol Programme (UNDCP) Bulletin on Nar-cotics (1996) on rapid assessments of druguse received contributions from Ethiopia, Bo-livia, Vietnam, Nepal, the Czech Republic,Kenya, Cameroon and Slovenia. Yet anyone

� All the views expressed in this article are those of theauthor and do not necessarily reflect those held by theUNDCP or any other organisation.

* Fax: +44-171-388-4179.E-mail address: [email protected] (R. Power)

0955-3959/00/$ - see front matter © 1999 Elsevier Science B.V. All rights reserved.

PII: S 0955 -3959 (99 )00065 -1

R. Power / International Journal of Drug Policy 11 (2000) 181–191182

who has followed this work over the lastdecade or so will be aware of the variedquality of the data produced and the dis-parate methods employed. In an endeavourto rectify this situation a number of manualshave been produced (WHO, 1998; UNOD-CCP, 1999). However, those with first-handexperience of carrying out rapid assessmentprojects will be able to recount a host ofobstacles to frustrate strict adherence to setmethodologies and time-lines.

It is the primary purpose of this article toexamine some of the practical and methodo-logical issues specific to rapid assessment andto suggest a flexible model which permitsmeaningful data collection, allows compari-son, and lays the pathway to intervention orresponse. In so doing I will address a numberof central questions. For instance, how viable(and how desirable) is it to prescribe a rigor-ous comparative methodology to guide theimplementation and execution of rapid as-sessment projects? To a purist the answer tothis question might seem simple: standardisemethods, improve validity and reliability, en-hance comparability. To the practitioner, theresearcher in the field, such a stance may beneither practical nor appealing. As I willargue and illustrate below, the often uniqueenvironments in which rapid assessment takesplace requires a range of skills and aptitudes(from the ethnographic to the diplomatic)that are as valuable as the best tested re-search manual.

Whereas the immediate goal of any rapidassessment project is to collect quality data toinform policy makers and drugs workers, thisshould not belie two more general objectives.First, to encourage and nurture a flexiblemulti-method approach. Second, to encour-age and promote more local involvement andownership of the projects. The role of theinternational consultant (which has oftenbeen central) should become more supportive

and less directive. Indeed, this has been myown experience over the years. My first rapidassessment project, undertaken for UNDCPin Vietnam, was virtually a single-handedendeavour, bolstered by excellent and enthu-siastic locally trained interviewers and co-op-eration from an NGO (Power, 1996). In theCzech Republic, a collaboration between theNational Drugs Commission and the Insti-tute of Psychology at the Charles University,Prague, provided a basis which ensured theproject accrued status within the country it-self (Tyrlic et al., 1996). Most recently, inCroatia and Egypt, ‘‘national scientific com-mittees’’ have been established to guide andmonitor the research. These committees,which comprise researchers, practitioners,politicians and other relevant parties, are cru-cial in maintaining the momentum of therapid assessment, in some cases ensuring itssurvival and translating its findings into pol-icy and practice.

Ideally, in-country researchers should man-age and supervise the project. In reality it isoften the case that the needed research capac-ity and experience are lacking, that otherpriorities intervene and that external supervi-sion is desirable. In general, be they interna-tional consultants or locally recruitedprofessionals, we need to train and encouragerapid assessment researchers who have thepatience and social skills of an ambassador,the scientific rigour of an epidemiologist andthe sociological imagination of anethnomethodologist.

In short, we must recognise the inherentparadoxes in rapid assessment. We mightwish for some kind of standardised instru-ment and methods, but the uniqueness (polit-ical, cultural, spatial, temporal) of eachproject requires considerable flexibility. Wemight desire more indigenous control andownership of the projects, but the resourceand skill base is often absent. Yet much has

R. Power / International Journal of Drug Policy 11 (2000) 181–191 183

been learnt over the years. Rapid assessmentsof drug use patterns have been valuable bothindividually and collectively. To illustratethese points I will draw on my own experi-ences of rapid assessment work for theUNDCP in Vietnam (1993), the Czech Re-public (1995), Croatia (1997–98) and Egypt(1998–99). What has evolved in practice is afour-phased strategy for rapid assessment,which provides a viable and flexible model ofaction research.

2. Developing infrastructure and formativeevaluation

The first phase (which approximates to aformative evaluation) includes both researchand administrative tasks. The main researchobjectives are to assess in-country researchcapacity, identify existing data and monitor-ing sources, and collate relevant surveys andother studies. On the administrative side, thekey aim is to identify and assess partners toform both a ‘‘steering/management’’ groupand a research team. Table 1 reviews thestrategies adopted in the respective projects.A key task for phase one is to begin toestablish an infrastructure for project man-agement. It is here that the qualities of tact,diplomacy and compromise come into play.Those identified as key players at this firststage in the project might not materialise asthe most appropriate partners. Changes inpersonnel and institutions might take placeduring the course of the work. Nonetheless,the establishment of the management teamwill have both a pragmatic and political di-mension. Many competing agencies may beinterested in the rapid assessment and thisfirst stage of the work needs to balance therequirements of the project with local politi-cal imperatives. My experience has been thatpatience and diplomacy will lead to the evo-

lution of a balanced ‘‘steering group’’, onewhich includes researchers, clinicians andpoliticians. This group represents individualswho will make the project possible, bothacademically and administratively. Where theproject is to span a number of research sites,as was the case in my four examples, it isimportant to include representatives fromeach site on the steering group. In three ofthe four countries, the UNDCP had an officeor representative already in situ. This meantadministrative issues ran more smoothly, theselection of partners was well informed, andprogress (as well as barriers) could be closelymonitored.

Of equal importance is enlisting the activesupport of a research institution. It is thisinstitution or group of institutions which willtake the major responsibility for implement-ing the fieldwork and analysing the data. InVietnam, an experienced NGO was selectedin the absence of a viable research institute.In the other three cases university depart-ments collaborated on the rapid assessment.The precise discipline of the institution is lessimportant than its ability to contact thetarget group and work within the flexiblemethodological paradigm of rapid assess-ment. In the Czech Republic the partner wasthe Institute of Psychology at Charles Uni-versity; in Croatia, the Ivo Pilar Institute ofApplied Social Science, and in Egypt, theMedical School at Cairo University.

At this stage, tentative discussions takeplace about the key direction of the rapidassessment. What research has been com-pleted, is current, or is planned? Where arethe gaps in knowledge? What, if any, moni-toring systems are in place? How can we bestuse the rapid assessment resources? In Viet-nam, it was clear that very little researchexisted on illicit drug use. In the Czech Re-public and Egypt much of the work was ofan epidemiological and quantitative variety,

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Table 1Rapid assessment strategy in study sites

Egypt (1998–99)Vietnam (1993) Czech Republic (1995) Croatia (1997–98)

Amphetamines (pervitin),‘‘Blackwater’’; pharmaceuticalMain drugs Poly-drug, heroin, LSD, ec- ‘‘Bango’’ (marijuana), phar-maceutical drugs, heroin, al-heroin, LSD, ecstasy stasy, amphetaminesused drugs (Dolargan [pethidine],coholSeduxen)

Heroin, amphetamines; lower Heroin and amphetaminesInjecting from ‘‘common pot’’ Amphetamine and heroin;Injectinglower sharing rates at needlepractices sharing rates at needle ex-

change sitesexchange sitesDrop-in centres and pilotState drug treatment centres, Drug treatment centres dis-Treatment for Part of psychiatric services;

linked to law enforcement persed around country; pilot some NGO activityneedle exchangedrug useneedle exchange

Risk activity No syringe exchange; povertyIncreased risk behaviour atCommercial sex work; poorCommercial sex work; mobileneedle and syringe hygiene; sites with no outreach or‘‘shooting galleries’’; endemichigh level of sharing; am-sharing of all injecting equip- needle exchange

ment phetamine useSurveys and epidemiologyNational AIDS Committee Drug treatment centres at 10Monitoring Data from 81 districts re-

sites using Pompidou surveysystems ported to National DrugCommission


with little tradition of qualitative methodsand research. In Croatia, where a multi-method, multi-discipline research culture ex-isted, the need was to broaden this to othervenues around the country and to focus oncommunity-derived samples of drug users.

It is also during this phase that decisionscan be made about potential research sites.Spreading the research geographically hastwo particular advantages. First, regionalvariations are noted. Second, research train-ing is more widely disseminated. In Vietnamwe chose one site in the north of the country(Hanoi), another in the South (Ho Chi MinhCity). In the Czech Republic the sites weremixed spatially, but also according to theircharacteristics. Hence, drug use in the capital,Prague, could be compared with smallertowns (Brno, Olomouc) and the more indus-trial sites (Ostrava, Usti). A similar approachwas adopted in Croatia (Zagreb, Zadar, Split,Pula) and Egypt (Cairo, Quena, Ismailia,South Sinai, Gharbia).

3. Research training and mapping exercises

The main objective of the second phase isto provide training in the rapid assessmenttechniques and to develop the research tools.In Vietnam, where the whole rapid assess-ment took place over a continuous 5-weekperiod, training was conducted in each of thetwo sites. In the other examples, training washeld over a 2-day period in the respectivecapitals (Prague, Zagreb and Cairo), withinterviewers travelling from the field sites.

This 2-day, one-site training has the advan-tage of allowing us to provide a thoroughtraining in rapid assessment methodologyand also to conduct preliminary focus groupsto identify key patterns and trends of druguse at the various sites. We were able tosketch out preliminary social mappings of

drug trends at the relevant research sites andbegin to identify the appropriate intervieweesto conduct the research.

It also meant that those workers attendingthe 2-day workshops were equipped to trainadditional interviewers at their relevant cen-tres. Where possible, questionnaires were pi-loted and the second day of the workshopwas used to refine and develop the question-naire and other research instruments, such astopic guides for city profiles and mappingexercises.

The training workshops have the addedvalue of bringing together workers in the fieldwho may not regularly meet, enabling themto discuss key research (and other) questions.They were also able to lobby politicians andadministrators from the capital. As can beseen from Table 1, the range of methods havebeen consistent across the four cases with amulti-indicator approach using a variety ofqualitative and quantitative methods. Thus,participant observation, the use of indigenousfieldworkers and semi-structured interviewsand focus groups have formed the core of theresearch strategy. Some form of social map-ping of drug patterns has taken place in eachof the studies, along with illustrative casestudies. Although it is important to be flex-ible in methodologies and be conscious of theresearch skills and tradition in any particularcase, a multi-indicator approach, such as out-lined in Table 1, gives the needed breadthand scope for the rapid assessment.

It was found to be particularly valuable inthe training to allow representatives fromeach site to present a brief overview of theprofile of drug use in their respective cities.This not only provided useful research mate-rial for the rapid assessment, but also meantknowledge and experience was passedamongst the group. Interesting nuances ofbehaviour can be identified, such as at theCairo training, where injecting practices in


the capital differed from other areas. Simi-larly in the Czech Republic, outreachersworking at the emerging dance scene in Os-trova learned much from the experiences oftheir colleagues in Prague. In Croatia, theresearchers from Split were able to imparttheir extensive knowledge of accessing streetdrug users with workers from other sites.

The training workshop also allows for dis-cussion of relevant samples and sample sizes.Considerable time is often spent discussingways to locate and interview drug users notin treatment settings, as this is often unfamil-iar and commonly synonymous with policesurveillance.

As can be seen from Table 1, semi-struc-tured interviews were conducted with samplesof drug users at each site within each casestudy. In Vietnam, 60 interviews were con-ducted in both Ho Chi Minh City and Hanoi.In Egypt, 690 interviews were completed overfive sites, 279 from four sites in Croatia and115 from five sites in the Czech Republic.Throughout the periods of the study, focusgroups and in-depth interviews were used toexplore and clarify issues arising from thesemi-structured interviews. In this sense aninductive grounded theory approach is usedas an integral aspect of the research strategyand ongoing data analysis. Considerationalso needs to be given to the potential forquota sampling. This proved to be the case inCroatia where there was considerable con-cern over both heroin use and non-heroinuse, with the decision being to collect a sam-ple comprising 75% heroin users and 25%non-heroin users. Similarly, what is consid-ered a problematic drug user in one countrymay differ in another. In Egypt, a predomi-nantly Moslem country, there was concernaround alcohol, as this substance is specifi-cally outlawed by the Koran. To ensure cul-tural sensitivity, alcohol was included in ourassessment of drug problems.

4. Data collection

As part of the multi-method approach, ex-perience has shown the value of conductingthe semi-structured interview prior to themore qualitative and investigative research.The qualitative work can then be used toexplore and clarify issues evolving from thesemi-structured survey.

As can be seen in Table 2, the drug pat-terns across the study sites show both similar-ities and differences. For example, the maindrugs used are related to demand, but also tolocal traditional production patterns. So, inVietnam, ‘‘blackwater opium’’ (the residualof the opium produced for smoking) ischeaply and easily accessible and has beenused by drug injectors in Vietnam for manyyears. In the Czech Republic, it is the locallyproduced amphetamine, pervitin, which is thedrug mainly used. In Egypt, ‘‘bango’’ (mari-juana-type plant) has been smoked for manycenturies and is still the most popular drug.In Croatia, the emergence of heroin, alongwith other drug use, results from the re-open-ing of the Balkan trade route and the social,economic and political turmoil produced byyears of war. The use of pharmaceuticaldrugs is most clearly evidenced in those coun-tries where the pharmaceutical industry islargely unregulated. In Vietnam, many of thedrug users reported using a wide range ofpharmaceutical drugs, including tranquillisersof uncertain origin or components, such asthose generically referred to as ‘‘Thai’’ or‘‘Chinese’’ tranquillisers. Furthermore, phar-macists were reported as hoarding stocks ofvalium which had passed their ‘‘sell-by-date’’,as these were especially popular withinjectors.

It is at this phase of data collection that aconscientious local project manager is essen-tial. Key workers need to be appointed ateach site, responsible for collecting the data

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Table 2Drug patterns in study sites

Egypt (1998–99)Vietnam (1993) Czech Republic (1995) Croatia (1997–98)

Secondary data analysis fromParticipant observation; indige- Secondary data analysis fromMain methods Secondary data analysisSananim, Public Health Ser- from Pompidou and othernous fieldworkers; semi-struc- existing surveys; indigenous fiel-

tured interviews (120); focus dworkers; city profiles; focussurveys; mapping-indige-vice, Police Presidium; indige-groups; case studies; cognitive nous fieldworkers; nous fieldworkers; focus groups; semi-structured inter-

groups; case studies; semi- views (696); depth interviews;semi-structured interviewsmaps; depth interviews(115); focus groups; depth in- structured interviews (279); case studiesterviews depth interviewsIllicit drug users (treatment Illicit drug users (treatment andIllicit drug users (treatmentIllicit drug users (treatment andSamples

non-treatment samples); two and non-treatment samples); non-treatment samples); six sitesand non-treatment sam-sites ples); four siteskey informants; five sitesUNDCP Regional Office; Rapid Assessment Steering National RAP Scientific Com-Rapid Assessment Board; Re-Project man-

Group; Research team (Ivo mittee; Research team (Cairosearch team (Charles Univer-agement CARE InternationalPilar Institute)sity, Prague) University)

Dissemination Report and findings to Na- Report and planned book;Report distributed; article in National workshop‘‘Bulletin on Narcotics’’ planned national workshoptional Drug Commission; arti-

cle in ‘‘Bulletin on Narcotics’’Outcome Informed six-site outreach in- Informed National Drug Pol- Complements National National workshop and rapid

assessment to inform drug pre-Drug Strategy; improvetervention icy; continuity of Rapid As-skills of outreachers ventionsessment Board and outreach

training


and passing it on to the central project man-ager. Extensive fieldnotes should be collectedalongside illustrative case studies. Each site isalso encouraged to build up a city (or local-ity) profile to summarise the data from theperspective of the researchers. At the sametime local monitoring data can be used toprovide a backdrop for the rapid assessment.In the Czech Republic, the data collected bythe 81 Offices of Hygiene were used as anepidemiological source of information. Simi-larly, in Croatia, the data collected for thePompidou study helped inform and comple-ment the original data from the rapidassessment.

These data are continually monitored andanalysed. As and when deemed necessary,additional focus groups and ethnography cantake place to clarify issues and fill gaps inknowledge. It is the role of the project man-ager in collaboration with the rapid assess-ment project team and the internationalconsultant to draw together all these sourcesof information and to encourage and assistthe project fieldworkers in the collection ofthese data.

As can be noted from Table 2, rapid as-sessments have a role to play in informingrisk reduction programmes. In Vietnam, theinjecting from the common pot of ‘‘blackwa-ter opium’’ constituted a major HIV andhepatitis risk. Drug dealers who controlledthe single syringe used in most shooting gal-leries rarely allowed others to use their ownneedles and syringes. Portions of drugs weredrawn from a ‘‘common pot’’ (where thedrug was prepared for use) and injected intoone drug user after another, with the con-comitant health risks. Rapid assessment hasthe potential to identify high risk scenariosand corroborate international evidence. Inboth the Czech Republic and Croatia thedata showed lower sharing rates at needleexchange sites compared with other sites. Not

surprisingly, the most common risk activityidentified in the rapid assessment projects wasdrug injecting and the risk of infectious dis-ease. Data confirmed seemingly universalhigh risk characteristics and scenarios, nota-bly the link between consumption patterns,rituals and injecting, the use of shooting gal-leries, the purchasing of drugs away fromhome, and the connection between commer-cial sex work and injecting drug use.

We were also able to compare and contrastrisk activity. For example, in Vietnam andthe Czech Republic it was clear there was alink between commercial sex work and inject-ing drug use. Street injecting scenes wereidentified in Vietnam. In the Czech Republicand Croatia high risk injecting activity wasmost likely to take place at sites where therewas no needle exchange scheme or outreach.

During data collection we can continue toassess in-country research capacity, both interms of research skills and capabilities andexisting monitoring systems. Where available,baseline data can be analysed both for re-gional variation and also for national trends.In each of the four cases we encouraged theresearch teams to plot local drug use profilesand to look across other categories such asinjecting practices and attitudes and experi-ences of treatment. Qualitative data on drugtreatment histories are beneficial in matchingservice needs to the target population. An-other element in assessing risk activity wasthe mapping of treatment services in order toidentify gaps for targeted interventions.

5. Report writing and dissemination

A considerable body of knowledge is nowbeing collated from rapid assessment projectsaround the world. In any study the need fora comprehensive official report is paramount,as it is this which can be used to encourage


and promote changes in policy and practice.The report analyses and records existing andpast researches into illicit drug use in therespective countries. An overview of thetreatment system and an examination of thelegal situation regarding drug use (includingthe role and practice of law enforcement) isimportant to contextualise the rapid assess-ment findings. Conduits for change (such asnational drug commissions in Prague and thenational drug strategy in Croatia) should beidentified.

The drafting of the report should involveas many members of the management group/steering committee as possible. In the Croat-ian report a number of leading figures in thedrugs field wrote chapters on their under-standing and analysis of drug trends in thecountry. Such essay-like chapters are valu-able for scene setting, make the rapid assess-ment more culturally relevant and sensitive,and also gain credence for the study in rela-tion to policy makers. In the Egyptian report,two members of the scientific committeewrote a background paper on the ways inwhich drugs have been used and understoodover many centuries in Egypt.

However, the main focus of the report is tocompare and contrast the research sites andto endeavour to provide an overview of druguse patterns for the country as a whole. Suchrapid assessments allow us gradually to buildup a global picture of drug use patterns in awide variety of countries and contexts. Thereport can also review the methodologies,outlining any difficulties or barriers to imple-menting the research. In Zagreb we ran afeedback seminar with the indigenous field-workers who described their experiences andmade useful comments on the practice andimplementation of the research methods.

The report can make recommendations un-der a number of categories and at this pointit is clearly important to seek the advice and

recommendations of the rapid assessmentteam such as the Scientific Committee inEgypt, the Steering Group in Croatia, theRapid Assessment Board in the CzechRepublic.

Across the four examples, recommenda-tions have been made on many facets of drugprevention. These include perceived demandfor additional treatment facilities, the needfor collaboration between agencies, the devel-opment of the NGO sector, the need for anexpanded outreach or community-based in-tervention to reach those drug users who arenot using the current services, the desire for amore routinized monitoring system of druguse, the need for harm minimisation interven-tions (such as syringe exchange), the expan-sion of mass media or other public ortargeted information projects. In the CzechRepublic came the recommendation for therapid assessment board to continue underanother name, so highly was its contributionvalued. As noted earlier on, one of the mainadded values of rapid assessment is the bring-ing together of a variety of interested individ-uals and parties to work on drug abuseissues. In this light, both in Croatia andEgypt, national workshops have beenplanned to disseminate and discuss the find-ings. In both these countries it has beendecided to publish a detailed book from therapid assessment, as distinct from the reportto the UNDCP. Prior to the writing of thereport, there is always the possibility of con-ducting confirmatory focus groups with drugusers or professionals to examine the findingsand clarify and confirm some issues whicharise from the data collection and analysis. InEgypt a national workshop was held at whichthe rapid assessment findings were presentedand participants took place in workshops anddiscussion groups which fed into the finalreport.


Another key part of this phase of the re-search, though often outside the remit of therapid assessment itself, is the outcome fromthe project. As noted earlier, not only doesthe rapid assessment add to our broaderknowledge of drug trends both regionally,nationally and globally, but also allows forthe development of needed interventions andpolicy changes in the particular countries. InVietnam a six-sited outreach intervention wasdeveloped. In the Czech Republic the rapidassessment has become a part of the nationaldrug policy and in Croatia the rapid assess-ment has complemented the current andemerging national drug strategy. In Egypt thenational workshop referred to above exam-ined the results from the rapid assessment inthe context of the evolving national pro-gramme for drug prevention.

6. Assessing rapid assessment

We should not expect more from a rapidassessment than it can deliver. It is not apanacea. Its outcome, especially in terms ofpolicy and practise response, can never beguaranteed. Rapid assessment often takesplace in volatile, transient social, economicand political conditions. What rapid assess-ment can deliver will be dependent uponmany local factors ranging from the aca-demic (research capability) and political (sup-port and encouragement from thegovernment) to the practical (resources avail-able) and institutional (infrastructure). Everyrapid assessment will be unique and a mainindicator of success will be the skill of theteam to harness and employ available humanand research resources and to respond tochanging agendas and circumstances.

As the case examples have shown, a consis-tent multi-indicator approach can beadopted, utilising a range of comparable

methods. This mix of qualitative and quanti-tative techniques allows us to make compari-sons between and within countries and alsopermits sufficient flexibility to make best useof existing skills and resources.

What then of rapid assessment for thefuture? We should be moving towards gener-ating local expertise and research capacityand informing interventions. For example,Medicine Sans Frontieres (Holland) in Russiais using Rapid Assessment and Response tohelp oblasts (administrative authorities) pre-pare proposals for harm minimisationprojects (Burrows et al., 1998). Clearly, anytool that can assist in the identification andtargeting of interventions for drug preventionand health risk behaviour should be com-mended. As far as possible, rapid assessmentshould aim to provide recommendations torespond to indigenous drug problems. Onceagain these need to be realistic and attain-able. Any suggested interventions shouldreflect the data, but must also take account ofthe existing legal and political climate. In thisrespect (as was the case in Vietnam), short-term, mid-term and long-term goals can berecommended.

Undoubtedly, the execution of rapid as-sessment has improved over the last 10 yearsand it has augmented our understanding ofdrug use. Yet, inevitably, there is room forimprovement, with a number of matters inneed of resolution. For one, we need to bemore proactive in encouraging the sustain-ability of either the research or the resultantintervention after the funding for rapid as-sessment ceases. This means a greater com-mitment on the part of donors and hostnation alike. One positive step in this direc-tion would be continuity and evolution of therapid assessment management team. This isparticularly pertinent in countries where thereis an under-developed NGO sector. One wayforward would be to retain some members of


the research team (both academics and prac-titioners) as a point of continuity for imple-menting recommendations. On a relatedmatter there should be ongoing support forthe research and monitoring endeavours,which, in resource-poor countries, oftenflounder once the rapid assessment resourceshave been depleted. Joint ventures betweendonors, government and NGOs would bewelcome here.

More thought needs to be given to therapid assessment research strategy at themacro-level. The current pattern is largelyreactive, with potential and emerging trouble-spots (often political and economic) beingidentified and rapid assessment resources be-ing mobilised accordingly. Strategic thinking(such as combining evidence and knowledgeof the link between drug production patterns,markets and consumption) could lead to amore rational and informed identification ofarenas for rapid assessment. This might evenlead to a shift away from single country rapidassessment towards a more zonal approach.Another strategy would be to adopt themodel of the Community EpidemiologyWorking Group of the National Institute onDrug Abuse in the USA. Sentinel centrescould provide rapid assessment data as andwhen called upon. With the use of moderninformation technology an exchange of dataand the cumulating of a bank of informationcould result. This would be of widespreadbenefit at the international, national and re-gional levels.

Lastly, let us return to the question con-cerning the standardisation of rapid assess-ment. I have touched on this matter aboveand can summarise it as follows. We shouldprogress to an agreed format for rapid assess-ment, based on best practice in this field aswell as on standards set in the broader arenaof social science and epidemiology. This

means we can set validation checks in ourwork (such as triangulation and the use oftested monitoring instruments). We can evengo further and produce standards of mini-mum competency to be assessed by externalvalidators. It might be argued that if we donot move towards some form of standardisa-tion then rapid assessment will have littlecomparable or lasting value. With this inmind, any such standardisation must notstifle the potential for the collection of theserendipitous, nor the identification and ob-servation of the unusual. Along with therigour of the social science methodologistshould come the flair of the anthropologist.Fortunately, rapid assessment encompassesboth precision and flexibility. As such it islikely to continue to add much to our under-standing of drug use and the need for well-in-formed and clearly targeted responses.

References

Bulletin on Narcotics. Special Issue: Rapid Assessmentof Drug Abuse, XLVIII. New York: United Na-tions, 1996.

Burrows D, Rhodes T, Trautmann F, Bijl M, StimsonGV, Sarankov Y, Ball A, Fitch C. Responding toHIV infection associated with drug injecting in East-ern Europe. Drug and Alcohol Review1998;17:453–63.

Power R. Rapid assessment of the drug injecting situa-tion at Hanoi and Ho Chi Minh City, Vietnam.Bulletin on Narcotics 1996;XLVIII:35–53.

Tyrlic P, Zuda T, Bem P, Power R. The drug usesituation in the Czech Republic. Bulletin on Nar-cotics 1996;XLVIII:89–99.

United Nations Office for Drug Control and CrimePrevention. Guidelines: Drug Abuse Rapid Situa-tion Assessments and Responses. Vienna: UNOD-CCP, 1999.

World Health Organization. The Rapid Assessmentand Response Guide on Injecting Drug Use.Geneva: WHO, 1998.

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The empirical and methodological comparative value of the rapid assessment of drug use patterns

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