C-EHRN’s Response to Mayor Halsema’s Call for Redefining Drug Policy

On January the 5th, 2023, Femke Halsema, Mayor of Amsterdam, published an opinion in The Guardian on the need for a global shift in our current approach to drug policy. In the article, Mayor Halsema backs up her call by announcing an international conference this month exploring alternatives to prohibition, with a strong focus on drug market regulation. At C-EHRH, we fully support this call, joining Mayor Halsema in this step forward as partners in the event.

Currently, there is a growing consensus that the so-called war on drugs has not only failed in its own goals but has been a vast drain on public resources and often actively counterproductive. $100 billion is spent on global drug law enforcement every year, whereas just $131 million is spent on harm reduction (1). This means that we spend more than 750 times the amount on punitive responses than we do on life-saving services for people who use drugs.

Punitive responses are not only ineffective at reducing drug use and sales. The ongoing criminalization, stigmatization, and marginalization of people who use drugs and the refusal to consider regulated approaches to drug markets to control the toxic supply has made drugs riskier, incentivized higher-risk behaviours, created obstacles to adequate health and human-rights-based care services, fuelled organized crime and violence against marginalized communities and contributed to insecurity and devastating public health crisis. 

Recently, there have been notable shifts in the global public debate towards transformative drug policy change. In September 2023, the UN High Commissioner for Human Rights released a landmark report recommending that States consider the regulation of drugs to tackle the links with organized crime and insecurity. Also, the UN has recognized the criminalization of drugs as “proven to have negative health outcomes” and to “counter established public health evidence.” (2) The EU Drug Strategy 2021-25 has highlighted the importance of drug policy based on public health (3) and the Global Commission on Drug Policy has called for the decriminalization of drug use as an essential precursor to ending HIV and viral hepatitis as public health threads (4).

Mayor Halsema’s opinion article not only continues this paradigm shift from ideological and punitive approaches towards policies based on evidence, health, and human rights, but It also exemplifies the leading role that cities can play in bridging the disconnection between discourse and policy action by focusing on how – and not if – regulation of the drug market can be achieved.  

We at C-EHRN fully support this initiative and celebrate Mayor Haselma’s commitment to continuing the city’s legacy of innovation and cooperation among European cities to develop more pragmatic and less prohibitionist drug policies. 

Mitigating harm is not easy. A key message from the 2023 European Drug Report analysis is that the impact of illicit drug use is now seen almost everywhere in our society (5). As a civil society organization working in policy and harm reduction, representing more than 360 members, we know that without bold and broader social and health reforms, decriminalization and legal drug regulation alone won’t fully ensure people’s well-being. Equally, without a solid commitment to embedded and prioritized principles of social justice, equity and human rights, we risk replicating inequities and injustice. 

For this reason, as partners of the conference, C-EHRN appreciates this opportunity to further cooperation, to be innovative and ambitious, to do things differently and better, and to help repair the harms of past policy failings. Key elements in achieving this ambition include:

Improving access to and availability, coverage, and quality of Harm Reduction services
Many harm reduction organizations operate on the front lines, providing crucial services to marginalized communities affected by drug use. Despite their significant impact, these organizations often face legal challenges and lack formal recognition. To enhance the effectiveness of harm reduction efforts, it is imperative to advocate for the legal recognition of these civil society organizations as official service providers. This recognition could take the form of legislative measures that explicitly acknowledge and validate the role of harm reduction organizations as part of a balanced drug policy, ensuring they receive the support and resources needed to carry out their vital work. Additionally, establishing social contracting mechanisms can formalize partnerships between these organizations and relevant authorities, fostering collaboration and sustainability.

Implementing equity programs that facilitate and empower marginalized communities
Recognizing the disproportionate impact of drug policies on marginalized communities, it is crucial to implement equity programs aimed at addressing systemic inequalities. These programs should go beyond the surface level and actively empower marginalized communities by providing equal access to healthcare, education, and employment opportunities. Also, they are given equal opportunities to shape and implement policies and programs, recognizing their wealth of knowledge, experience, and leadership. 

Tailored initiatives, taking into account the unique challenges faced by these communities, can contribute to breaking the cycle of marginalization perpetuated by current drug policies. By prioritizing equity, cities can pave the way for inclusive, just, and effective harm-reduction strategies that consider the specific needs of diverse populations.

Prevent the emergence of monopolies and corporate capture.
As drug policies evolve, there is a risk of corporate interests dominating the landscape, potentially leading to monopolies that prioritize profit over public health. It is essential to proactively prevent such scenarios by implementing regulatory frameworks that ensure a diverse and competitive landscape. Measures should include strict regulations on market entry, preventing undue influence from powerful corporations. By actively engaging in policy discussions, harm reduction advocates can contribute to shaping regulations that prioritize public health, prevent monopolies, and uphold the principles of equity and justice in the evolving landscape of drug policy.

(1) Provost, C. et al (2023) Aid for the war on drugs. London, Harm Reduction International. https://hri.global/wp-content/uploads/2023/09/HRI_Aid-for-the-War-on-Drugs_Final-1.pdf
(2) https://www.who.int/en/news-room/detail/27-06-2017-joint-united-nations-statement-on-ending-discrimination-in-health-care-settings
(3) https://www.emcdda.europa.eu/system/files/attachments/13642/Council%20of%20the%20EU%20%282020%29%20EU%20Drugs%20Strategy%202021-25.pdf
(4) https://www.globalcommissionondrugs.org/ahead-of-world-aids-day-global-commission-on-drug-policy-new-report-says-the-hiv-and-hepatitis-epidemics-cannot-be-ended-without-drug-policy-reform-and-the-real-participation-of-people-who-use-drugs
(5) https://www.emcdda.europa.eu/publications/european-drug-report/2023_en

Becoming Peer. Learning from Nightlife

To mark the launch of our latest publication, ‘Becoming Peer. Learning from Nightlife’, C-EHRN recently hosted an online dialogue meeting with the authors (Tait Mandler and Roberto Perez Gayo) and other experts in the field of nightlife harm reduction and peer work (Hayley Murray, researcher at Wageningen University and Lynn Jefferys, operations manager at EuroNPUD). The participants of the dialogue, who have diverse backgrounds and living experiences, including those from nightlife, research, substance use, care provision, policy and advocacy or community self-organising of people who use drugs, delved into the ways through which innovative forms of meaningful involvement, health, and evidence can emerge in their respective fields of work.

Becoming Peer was born with the intention of offering a toolbox for reimagining harm reduction, drawing from concepts, experiences and practices from nightlife and other so-called “recreational settings”. The publication invites stakeholders to acknowledge the value of each other’s expertise in developing effective harm reduction practices. Through discussions of common but contested concepts, the authors invite the reader to question and unsettle power imbalances between different actors, practices, and forms of knowledge, making space for more effective community-based responses to arise.

 

Who is considered a “peer”?

Peer workers are generally understood to be people with first-hand experience of a specific activity or setting, and the word ‘peer’ points to similarities and shared status. However, being a “peer” worker does not necessarily mean being in a position equivalent to that of people in similar roles or those on the receiving end of interventions. Peer workers have different positionalities, and asymmetries stand between people with lived and living experiences. To cultivate meaningful peerness, it’s central to recognise and use the generative potential of differences to create new strategies for mutual respect and equality among all stakeholders – including peer workers, researchers and policymakers.

 

Who decides what “healthy” looks like?

Widespread models of health see health as the responsibility of the doctor or the medical establishment, while the patient engages passively, as a “consumer” or as the target of health promotion campaigns. However, from the early history of harm reduction, we learn that health can be understood as a dynamic community practice:

What if health is an activity, not so much a definition of the state of the body? […] However we define it, health emerges in practices of care. And so again, in nightlife harm reduction, there’s a lot of emphasis on ways in which people care for each other. (Tait Mandler, researcher at Wageningen University)

Health can be redefined as a whole concept from the position of people who use drugs, who have long been cast in the position of the “unhealthy”. Being healthy means different things to different people, and it is limiting to define it only within the healthy/unhealthy binary.

Health to someone can mean that they feel at their best. And if feeling at their best means dancing under the influence of drugs in the sand and surrounded by a community who cares about them, then that should also be part of health. (Hayley Murray, researcher at Wageningen University)

Participants of the meeting discussed the importance of trust in successful peer support, which can originate from having a shared experience with a certain substance, a similar background or presentation, and from simply knowing that the other party will not be judgmental, shocked or stigmatising and prepared to tend to one’s needs.

Building trust is really centered on using non-stigmatizing, strengths-based language and creating places for people to have safe conversations around drugs, in an anti-oppression, non-carceral framework. People need to know that you’re a person who isn’t going to be shocked when they say something about GHB or heroin, for example. (Lynn Jefferys, operations manager at EuroNPUD)

 

What counts as evidence?

Harm reduction projects that promote their own version of health from the community often have to produce evidence to show the impact of their work, whether for funding or to affect policy. There is a hierarchy that frames certain types of evidence, such as randomised control trials and statistical analysis, as the most convincing. On the other hand, lived experiences and personal stories are often discredited or taken less into account. 

Yet, the tacit, embodied knowledge and the everyday experience of people who use drugs constitute a precious “living archive” of information. Becoming Peer advocates for the recognition and respect for the expertise of people who use drugs in the harm reduction field and their involvement in developing innovative, community-based strategies and interventions.

As long as evidence is equated with expert knowledge or only seen as useful when produced through particular scientific methods there can be no meaningful peerness […]. An archive, on the other hand, doesn’t prefigure how it is used, doesn’t dictate what’s useful and what’s not. Archives don’t foreclose the future—they allow it to be open ended. (Mandler, T. & Perez Gayo, R. (2023) Becoming Peer: 25)

Joint Report on Drug Consumption Rooms in Europe

The EMCDDA and Correlation – European Harm Reduction Network (C-EHRN) have published today the latest overview on the situation of drug consumption rooms (DCRs) in Europe. The purpose of the report is to encourage evidence-based discussions around DCRs and the implementation of varied DCR models in Europe.

DCRs are a fundamental health and social response that fosters the well-being of people who use drugs by providing hygienic and safer spaces where to use substances in the presence of trained social workers and/or healthcare professionals. DCRs are usually located in areas where there is an open drug scene and where injecting in public places is common. The primary target group for DCR services are people who engage in drug use patterns that can result in dangerous health outcomes.

According to the report, in 2022, over 100 DCRs were operating globally, with services in several countries such as Belgium, Denmark, France, Germany, Greece, Luxembourg, the Netherlands, Norway, Portugal and Spain, as well as in Switzerland, Australia, Canada, Mexico and the USA.

Primarily, DCRs aim to prevent drug-related overdose deaths, reduce the risks of disease transmission through the use of unhygienic supplies and/or their sharing, and connect people who use drugs with support, health and social services. Besides this, they can also aim to minimise public nuisance.

In the report, two main operational models of DCRs in Europe are described: integrated DCRs, operating within low-threshold facilities, where the supervision of drug use is just one of the services offered, and specialised DCRs, offering a narrower range of services directly related to supervised consumption.

As frontline, low-threshold services, DCRs can support the monitoring of new and emerging local trends. For example, it has been found that in Europe, injecting heroin is less common in recent years, while the use of synthetic opioids and stimulants has increased in some countries. Over the years, following a dynamic drug landscape, many harm reduction services, including DCRs, have adapted to the needs of local clients. For example, some DCRs have started providing services for smoking as well as injecting and allowing the consumption of a wider range of substances within the facility.

DCR evaluation presents specific challenges, but currently available evidence supports the positive impact of DCRs on the access to healthcare and harm reduction services among people who use drugs, and especially groups that are not reached enough by these services. DCRs do not increase crime in the areas where they are located and, instead, contribute to a decrease in public drug use. Evidence also shows how DCRs contribute to reducing drug-related deaths.

In addition, an expert panel recently concluded that DCRs foster safer injecting practices and therefore can contribute to reducing the transmission rate of communicable diseases among people who inject drugs.

Among other measures to reduce cases of fatal and non-fatal overdose, the EU Drugs Action Plan 2021–2025 calls for DCRs to be introduced, maintained or enhanced ‘where appropriate and in accordance with national legislation’.
The report concludes that, despite the challenges encountered in conducting research in this setting, more studies are needed to support the work of DCRs by showing their contributions to reducing both individual and community harms.

Read the joint EMCDDA and C-EHRN Report on DCRs in Europe here.
Read the EMCDDA Report Release here.

 

SEMID-EU: Migration and access to (Harm Reduction) Services

Several risk factors expose migrants in Europe to high-risk drug use. These include traumatic experiences, disengagement with society, unemployment and poverty. Services and municipalities throughout the European Union are faced with the urgent challenge to address these migrants’ needs.

A better understanding of the needs of vulnerable migrants who use drugs could improve local responses throughout Europe. In the SEMID-EU project, coordinated by Mainline, seven partners across Europe worked to improve the (harm reduction) services access for migrants. This project focuses on filling knowledge and practice gaps in drug use and migration in Europe, aiming to improve the wellbeing of vulnerable migrants who use drugs by improving knowledge and understanding among policymakers and practitioners and strengthening capacities of healthcare and support services working with these groups.

C-EHRN created several resources for this project, including a Policy Brief and several Fact Sheets, which you can download below.
Find out more about the other activities and results of the project here.

Dealing With Drugs Conference Amsterdam

On the 26th of January, the conference ‘Dealing With Drugs – cities and the quest for regulation’ will take place in Amsterdam.

Mayor of Amsterdam Femke Halsema is the host of the conference: “Together with many cities in the world, the beautiful city of Amsterdam struggles with the effects of drug-related crime. The objective of this international conference is to explore how -and not if- further regulation of the drug market can provide a solution.” 

Together with an international group of fellow mayors, scientists, user groups, practitioners and policy makers, the mayor wants to explore the path toward a more rational drug policy. During this one-day conference, you can partake in different side sessions and experience a ‘pop-up XTC shop’.

If you’re interested in visiting the conference, the website provides more information about the program.

The available seats are limited, those who want to visit the conference are kindly asked to send an email to conferenceondrugs@amsterdam.nl, with their name, function and a brief description of why they are interested.

Highlights from our recent DCR Training in Brno, Czech Republic

Correlation – European Harm Reduction Network [C-EHRN] and the ENDCR [European Network of Drug Consumption Rooms] organised a drug consumption room (DCR) training in collaboration with the local organisation Podané Ruce, which recently opened a mobile DCR based in Brno (in September 2023). Roberto Perez Gayo, Head of Policy at C-EHRN, and Arianna Rogialli, Project and Policy Support Officer, visited Brno on the 30th of November and 1st of December 2023 to deliver the training program to the local organisation.

The DCR is currently open for injection only and allows for one person at a time (although this could be expanded to 2 or 3 injection spots in the future). DCR staff comprises two social workers. Podané Ruce has also been running an outreach needle distribution program in the same area for several years.

The DCR Trainings are a series of trainings designed and implemented by C-EHRN and the ENDCR which aims to assist organisations that have recently opened or plan to open a DCR. The training provides drug, harm reduction and other social & health-related professionals with resources and guidance for the implementation and operation of the first DCRs in their local context. Brno is the second location where DCR trainings are taking place, the first was Ljubljana in September 2023 [read about the training in Ljubljana here].

The training equipped its participants with tools and insights to contribute to the effective planning, establishment and operation of the mobile DCR in Brno. Building on a needs assessment consultation, the program focused on the topics and areas that are the most relevant to participants. Throughout the training, participants were introduced to different DCR models and approaches, with a focus on mobile DCRs, discussed case studies and best practices, and took part in collaborative exercises aimed at adapting service development to the needs of clients by defining user journey maps, needs and points of contact. Special attention was given to identifying strategies for the DCR to reach the local Roma community successfully. Moreover, the training included sessions aimed at supporting the DCR’s operational logistics, identifying suitable staffing and workforce models and establishing protocols.

The recent DCR training in Brno was a step towards empowering organizations in operating (mobile) DCRs. This initiative is a reflection of C-EHRN and the ENDCR’s ongoing commitment to support the implementation of DCRs, promote harm reduction, and enhance the overall well-being of local communities.

 

 

Critical partners: Level and Quality of Civil Society Involvement in the field of Drug Policy

This report has been developed by Correlation – European Harm Reduction Network (C-EHRN) in cooperation with the Rights Reporter Foundation (RRF). The report summarises the findings of a study conducted in 2023 which assessed the level and quality of civil society involvement in drug policies in four countries: Finland, Ireland, Greece and Hungary.

In 2021, the Civil Society Forum on Drugs (CSFD) established guiding principles for meaningful civil society involvement in decision-making regarding drug policy. These principles were published in the Quality Standards for Civil Society Involvement in Drug Policy. The four case studies assess the implementation of these standards.

Read the report

Expert & Member Meeting 2023

In December, Budapest gave place to C-EHRN’s Expert & Member Meeting, with more than 130 professionals gathering to discuss the key activities of the network!

To find out more about the event and C-EHRN’s key activities, watch the inspiring video by the Rights Reporter Foundation, and look at the summary of the event below.

On Monday the 4th, our focal points discussed the civil society monitoring of harm reduction in Europe process, ways to use the C-EHRN Monitoring data for advocacy purposes and getting familiar with a new data collection and visualisation tool for the C-EHRN monitoring activities. In the meantime, the partners of the Drug-Prep Project had insightful discussions on foresight research and other project activities.

 

A press conference also took place, introducing drug consumption rooms, drug checking in Europe and the example of Portugal’s health-based drug policy approach, sharing the message that “not only the richest countries in the world can implement efficient drug policies based on decriminalisation” (Marta Pinto, University of Porto). As a result, the conference gained coverage in RTL, one of Hungary’s most popular commercial TVs.

At the end of the day, some meeting participants visited Válaszút Misszió Drogkonzultációs Iroda, learning about their services and the Hungarian context.

Tuesday began with C-EHRN’s director, Katrin Schiffer, opening the official programme for all participants of the event, also introducing C-EHRN’s new visual identity which we launched with the event! During the plenary sessions, we discussed various topics including drug policy and harm reduction in Hungary, civil society monitoring and data collection, and some of the network’s main activities, including research on harm reduction in prison and harm reduction and gender.

Throughout the afternoon’s parallel sessions, we also talked about infectious diseases in community-based settings in the context of the BOOST project, while a migration workshop took place through the SEMID-EU project, and those interested could find out about the application of foresight research in the context of the drugs field (Drug-Prep project). In the following sessions, the civil society involvement case studies conducted in 4 European countries were discussed, while we also spoke about drug consumption rooms and mental health.

Wednesday’s parallel sessions gave space for an engaging conversation about C-EHRN’s strategy for 2024-2028, while drug checking and the state of harm reduction in five European cities (Amsterdam, Bălţi, London, Esch-sur-Alzette and Warsaw) were also discussed.

The Semid-EU plenary delved into the needs and (harm reduction) service access of marginalised migrants who use drugs in the EU, after which we reflected on the outcomes of the time spent together at the member & expert meeting.

To capture the event, we bring you a collection of images below.

Discover Correlation’s new visual identity!

We decided it was time to update our visual identity so it could better reflect our values and forward-looking approach! Find out about the concept behind our new logo and visuals!

Shapes
Community – The Circle
Given that Correlation is a European civil society network in the field of drug use, harm reduction, and social inclusion, we focus on the concept of community and the importance of civil society in fulfilling the needs of those affected by social and health inequalities.
Considering that, a graphic system with a circle as a basic unit was developed, resembling the semantic tension between the individual and the whole, and representing a point, data on a graphic, that gives us the knowledge to act. Our circle represents the community and at the same time, all those inside it and the infinite possibilities to build the collective.

Diversity – Polygons
One of the main points of the European community project is the respect and enhancement of our diversity. Therefore our circle is accompanied by polygons (rectangles, triangles, and so on) to create a modern, clean, simple yet meaningful layout throughout the different graphic applications (such as business cards, dossiers and research documents).

Colours: blue with a vibrant secondary colour palette
Health & Diversity
Following the idea of diversity and the infinite possible layouts that we can develop with the polygons system, we can also “create” a non-limited colour palette with vibrant colours, which we use together with a main/basic colour on the blue scale, as it is related to health and wellness in our society.

Logo: the Hug
Working around the meaning of community, we used the idea of creating different abstract forms with the diverse shapes to form a symbol/anagram that represents the intersection between different individuals. The design also enables variations for focal points and specific C-EHRN projects.

The design was developed by Jesús Roman.

Inspiring Short Film on Ireland’s Health Led Approach to Drugs Use

In June 2023, Drugreporter visited Dublin where they interviewed key experts about Ireland’s drug policy developments. Through the resulting film, you can get to know the Ana Liffey Drug Project, a leading low-threshold harm reduction program in downtown Dublin, and learn about key issues of drug policy in Ireland through the lens of experts. The film also introduces the work of the Citizens’ Assembly on Drugs Use.

“The Citizens’ Assembly members worked hard and were engaged in a subject well known as a complex multifaceted policy topic. Theirs was an unprecedented effort of deliberative democracy by 99 citizens, supported by an independent Chairperson and a government secretariat, to consider the attendant issues related to drugs use in Ireland and to make recommendations to the Government.” (Tony Duffin, the CEO of Ana Liffey Drug Project)

To complement the film, Tony Duffin, CEO of Ana Liffey, shares a thought-provoking reflection on Ireland’s Citizens’ Assembly on Drugs Use. Dive deeper into the assembly’s recommendations and the transformative potential they hold in steering Ireland’s drug policies towards a more progressive, health-driven direction in the article on Drugreporter’s website.

The interviewed experts in the film are: Francesca Osborne, Saoirse Aitken, Tony Duffin, Damien Gagnevin, (Ana Liffey Drug Project), Jim Walsh (Drugs Policy and Social Inclusion Unit Department of Health), Andy O’Hara (UISCE Advocacy Service for People who use Drugs in Ireland), Anna Quigley (CityWide Drugs Crisis Campaign), Stacey Lyons (National Voluntary Drug and Alcohol Sector)

The production of the video has been co-funded by the European Union. Views and opinions expressed are however those of the author(s)only and do not necessarily reflect those of the European Union or HaDEA. Neither the European Union nor the granting authority can be held responsible for them.

Ana Liffey Drug Project | https://www.aldp.ie
Correlation European Harm Reduction Network | https://www.correlation-net.org
Drugreporter | https://www.drugreporter.net

Produced by the Rights Reporter Foundation – Drugreporter, 2023
Reporter | Péter Sárosi
Video | István Gábor Takács