Highlights from the Civil Society Forum on Drugs Plenary Meeting

The Civil Society Forum on Drugs (CSFD) Plenary Meeting, organised by the European Commission (DG Home) on November 14-15, 2023, gathered 40 CSFD Members in Brussels. Chaired by C-EHRN’s Director, Katrin Schiffer, the meeting also included Iga Jeziorska, C-EHRN’s Research Officer, representing Youth Organisations for Drug Action [YODA] within the CSFD Core Group.

The event revolved around discussions across four pivotal working groups and their activities and included a separate meeting with the Horizontal Working Party on Drugs (Horizontal Drug Group – HDG), consisting of EU Member State representatives, in which the CSFD could exchange information and views with the Commission and the Member States.

Under EU Drug Policy working group, coordinated by Iga Jeziorska, the CSFD conducted surveys to assess the EU Drug Strategy’s implementation. Ongoing data collection aims to shape a forthcoming report in 2024.

Adria Cots Fernandez helmed the International Drug Policy group, providing regular contributions to the HDG ahead of Commission on Narcotic Drugs (CND) meetings, organizing an informative webinar on the new EMCDDA Mandate, and facilitating an advocacy training session with the presence of two HDG members.

Addressing Civil Society Involvement in Drug Policy at a national level, the team chaired by Péter Sárosi conducted comprehensive case studies in Finland, Ireland, Greece, and Hungary. The case studies, with the financial support of C-EHRN and in cooperation with the Rights Reporter Foundation, aimed to assess the implementation of the Quality Standards for Civil Society Involvement in Drug Policy, developed by CSFD in 2021. These studies utilized structured discussions with civil society representatives and decision-makers.

The Emerging and Cross-Cutting Issues group, led by Milutin Milosevic, delved into crucial topics like gender perspectives in drug policy, mental health, and decriminalization efforts. The Paper and CSFD Contribution to enhance the Gender perspective and the position paper on People Who Use Drugs and Mental Health can be accessed on CSFD’s website.

In addition to these focal areas, the CSFD provided input to the European Commission and the Horizontal Drug Group on pivotal issues such as the new EMCDDA Mandate, the ongoing evaluation of the EU Drug Strategy, to which it wants to contribute actively, and concerns regarding the EU Roadmap on drug trafficking.

Throughout the discussions, the CSFD emphasized the need for a balanced approach in drug policy, stressing the significance of addressing health and social dimensions alongside supply reduction efforts and encouraging the European Commission to develop a roadmap for expanding access to drug demand and harm reduction. This approach aims to foster comprehensive and inclusive drug policies across Europe.

Comprising 45 civil society organizations, the Civil Society Forum on Drugs (CSFD) is an expert group of the European Commission and serves as a platform for informed dialogue between the European Commission and the European civil society, actively contributing to the formulation and implementation of drug policies through practical advice.

Insights from HepHIV2023 Conference: Addressing Stigma, Testing, and Integration in HIV and Hepatitis Services

The HepHIV2023 conference, held in Madrid, Spain, from 13th to 15th November, convened a diverse array of stakeholders committed to advancing the fight against HIV, viral hepatitis and sexually transmitted infections (STIs). The event was organized by EuroTEST, and our Senior Policy Officer, Roberto Pérez Gayo, also participated in its organising committee. The conference spotlighted pivotal themes in the realm of infectious diseases, with a focus on integrated testing, technological advancements, and equitable service delivery.

Rafaela Rigoni, C-EHRN’s Scientific Officer, offers key takeaways from the conference, emphasizing critical issues surrounding HIV, and highlighting the conference’s focus on testing, migration, and stigma.

Stigma emerged as a central point of discussion, drawing attention to the multifaceted dimensions impacting individuals living with HIV (PLHIV) and at-risk communities. The targets for 2025 established by UNAIDS to ensure that less than 10% of these groups would be subjected to stigma and discrimination spurred collaborative efforts to develop monitoring mechanisms. Notably, the collaboration between the European Centre for Disease Prevention and Control (ECDC), European AIDS Treatment Group (EATG) and AIDS Action Europe led to the creation of an instrument based on the HIV Stigma Index to measure stigma.

Insights in a recently published report using the HIV stigma survey showed that despite participants generally rating their overall quality of life as satisfactory, there is a prevalent connection between stigma and depression. This critical correlation between stigma and mental health, particularly depression, emphasises the need for enhanced mental health services tailored to the unique needs of the population living with HIV.

Moreover, the survey shed light on the alarming prevalence of self-stigma, indicating that individuals harboured negative perceptions about themselves, along with instances of stigma from family and friends. Notably, healthcare settings emerged as hotspots for heightened stigma. Those reporting lower life quality consistently reported more profound experiences of stigma, highlighting the pressing need for targeted interventions to address and mitigate these challenges. The need to understand the experiences of different key populations and research the intersectionality around stigma was highlighted.

The conference didn’t solely focus on HIV; the first attempts to develop a monitoring instrument to measure HCV-related stigma are also underway by ECDC, and C-EHRN was invited to be part of an expert group with an advisory role, fulfilled by our Senior Scientific Officer.

 

More about HepHIV

The conference brings together stakeholders from all levels of the health system, from community organisations to health care providers and policymakers to present and discuss new approaches for testing and linkage to care for HIV, viral hepatitis, sexually transmitted infections (STIs) and tuberculosis (TB), highlighting programmatic/ implementation issues and adaptation of testing services in response to emerging public health issues.  Frontline workers constituted the majority of participants, highlighting the practical implications of the discussions for those directly involved in service delivery.

In summary, the conference illuminated the complexities surrounding stigma, emphasized the critical intersections between mental health and stigma, and underscored the importance of tailored interventions. Moreover, it highlighted the imperative need for integrated testing approaches and the adaptation of services to address emerging public health challenges. 

SEMID-EU’s Findings on Migration, Homelessness and Drug Use in Amsterdam

On the 9th of November, a meeting organised by two SEMID-EU project partners, C-EHRN and Mainline, took place in Villa Buitenlust, Amsterdam with relevant local actors in the field of migration, homelessness and drug use. This gathering sought to address the multifaceted challenges encountered by migrants who use drugs and experience homelessness throughout Europe, with a specific focus on Amsterdam. The event aimed to share the findings and materials of the SEMID-EU project and prompt discussion on the situation in Amsterdam.

SEMID-EU is a project specifically designed to fill gaps in knowledge and practice on drug use in migrant populations. By gaining a better understanding of the needs of migrants who use drugs in Europe, it aims to improve policies and responses that affect these groups to increase their access to high-quality healthcare, drug treatment, harm reduction and (re)integration services. The focus of SEMID-EU has been on marginalised migrants, for whom institutional, structural, social and personal barriers stand in the way of the fulfilment of their basic human rights.

The key results at an Amsterdam level underlined the importance of collaboration between relevant stakeholders to support services for migrants who use drugs. In Amsterdam, homelessness is a big problem intra-European and Spanish-speaking migrants who use drugs are dealing with. Research conducted in SEMID-EU reveals the significant advantages individuals experience through drug consumption rooms, shelters and support services aimed at fulfilling their fundamental needs. However, the capacity of these services is sometimes too limited. For example, the occasional shelter does help but does not tackle the uncertainty and stress of homelessness. Without a safe and stable environment to sleep, long-term substance dependency aid (when requested) is impossible. Migrants who use drugs struggle to access (social) housing, employment, and healthcare services, and the need for insurance to access healthcare that depends on formal residence is an especially big issue.

Among the group of Maghreb Arabic-speaking refugees, there is a reported lack of support services available to help with procedures of migration, laws, drugs and drug dependency services, financial support and mental health services. However, the most prominent support services needed are mental health services, necessary to cope with the trauma that originated in their countries of origin and at refugee camps and are too often not offered.

Low-threshold (harm reduction) services serve as crucial connections for migrants who use drugs, acting as a gateway to other essential healthcare and support services. Nevertheless, these services need greater support from funding bodies due to their frequent capacity constraints. Within the discussion, there was a clear emphasis on the necessity for national cohesion in the Netherlands to adopt human-rights-centred responses to homelessness, ensuring adequate housing solutions for individuals in need.

Plenty of resources that can support the expansion of availability and quality of services for migrants who use drugs are going to be made available soon on both Mainline’s and Correlation’s websites. Of these, the following are already available:

SEMID-EU is coordinated by Mainline, an organisation based in Amsterdam whose mission is to improve the health and social position of people who use drugs, without primarily aiming to reduce drug use and out of respect for the freedom of choice and possibilities of the individual.

Other partners involved in the SEMID-EU project are Ghent University, ISGlobal – Barcelona Institute of Global Health, Positive Voice, Fixpunkt e.V., Gaïa Paris and C-EHRN.

Drug Checking and Harm Reduction Discussed at the 12th International Club Health Conference

Liverpool, UK, gave place to the 12th International Club Health Conference from the 1st to the 3rd of November, a conference committed to fostering a healthy nightlife economy. Among the attendees were Daan van der Gouwe from Trimbos Institute and Rafaela Rigoni, the Scientific Officer at C-EHRN.

The discussions revolved around topics such as the prevention of harmful substance use, addressing violence and mental health issues associated with substance use, promoting diversity and inclusion, and implementing harm reduction measures in nightlife settings.

Drug checking – an essential service that is still underdeveloped or nonexistent in many European countries – has been discussed in several sessions. Existing drug-checking services predominantly focus on recreational drug use, leaving a significant gap in monitoring and understanding new drug trends. Drug checking plays a vital role in obtaining a reliable overview of emerging drug patterns, to which Daan van der Gouwe’s presentation in a parallel session dedicated to interventions and innovation aimed to draw attention. 

While introducing the preliminary results on new drug trends detected by C-EHRN’s Focal Points as part of C-EHRN’s Civil Society-led Monitoring of Harm Reduction in Europe, the necessity of extending drug-checking services to individuals with more vulnerable patterns of high-risk drug use, particularly those who frequent harm reduction facilities, was also emphasized.

The conference highlighted that there is a pressing need for advancements in technology and service offerings to facilitate timely and low-threshold testing of substances commonly used by more vulnerable groups, including crack cocaine and heroin.

Participate in the Delphi Panel on the research “Harm reduction | Construction and Validation of a Collaborative Practice Model”

Do you work in Harm Reduction? Do you have experience in research or harm reduction interventions? This PhD research aims to systemise and analyse collaborative interventions with people who use drugs and substance use services, focusing on creating and validating an integrated harm reduction model. This is the first step towards identifying an international network of experts in harm reduction to integrate a Delphi Panel including social workers, medical doctors, psychologists, peers and nurses who work in harm reduction services.

Interested? You can submit your availability to join the expert group until the 6th of November through this Survey. Participation is voluntary and all responses will be kept anonymous and integrated only in the results of the PhD research.

A Step Towards Informed Discourse on Harm Reduction Services in Finland

In Finland, three organizations, including the A-Clinic Foundation, C-EHRN’s focal point in Helsinki, organised a drug consumption room simulation recently to inform the dialogue around supervised drug consumption sites, inviting media representatives and parliament members. We asked Annuska Dal Maso, the head of street work at A-Clinic Foundation, to tell us about the event. Read her account of the forward-looking initiative below!

“The A-Clinic Foundation, in collaboration with the Diakonissalaitos and Tukikohta ry, organized a drug consumption room simulation on October 24, 2023. This marked Finland’s first-ever drug consumption room simulation, aiming to showcase how a consumption room operates and the services it provides.

Currently, there is an active debate in Finland regarding supervised drug consumption facilities. A citizens’ initiative for legislative changes is currently under consideration in the parliament. However, public discourse has long been plagued by misinformation about these facilities. To engage in a proper dialogue on this subject, it is essential that all parties have accurate information. With this in mind, we organized the consumption room simulation to simulate what supervised drug consumption spaces could practically look like in Finland. We invited representatives from the media and members of parliament with their assistants. We conducted a total of three simulations, each lasting two hours, with 8 to 14 participants in each session.

We constructed a miniature model of our low-threshold meeting place, resembling what a consumption room in Finland could be like. Our services included an injection/smoking room, health counselling, distribution of clean supplies, substance identification, a doctor, a nurse, social guidance, and peer support. We created role characters for the visitors based on real-life scenarios, allowing them to play the role of potential consumption room users. These characters represented individuals who might use a consumption room. The simulation was carried out based on the legislative proposal currently under consideration in the parliament.

Our main message was to convey that a consumption room is not just about a space where visitors use drugs, but it is part of a broader service offering harm reduction work. The consumption room is just one component of this service package. There is a lot of misinformation circulating about consumption rooms, and through the simulation, we aimed and also succeeded in correcting these misconceptions.

The simulation received an exceptionally positive reception. Members of parliament and their assistants provided positive feedback on the event, and the media wrote the following articles on the topic:

https://yle.fi/a/74-20056575

https://www.hs.fi/kaupunki/art-2000009943350.html

https://www.mtvuutiset.fi/videot/klipit/prog20728247

https://www.helsinginuutiset.fi/paikalliset/6303427

https://www.iltalehti.fi/kotimaa/a/092c31a9-b721-4410-adfe-6a173c0735ea

https://svenska.yle.fi/a/7-10044086

https://www.mediuutiset.fi/uutiset/mu/feb0a063-f162-4ed6-98b5-da5c6df892c3

INHSU Highlights on Drug Consumption Rooms

During the 11th International Conference on Health and Hepatitis in Substance Users (INHSU 2023), our team actively participated in the discussion surrounding supervised drug consumption sites.

The session on supervised drug consumption facilities on October 18th, organized by the Global Commission on Drug Policy, emphasized the crucial role of these facilities in providing a safe space within challenging environments, examining different layers of paradoxes surrounding these facilities. Our senior policy officer, Roberto Perez Gayo, participated alongside other panellists from The School for Advanced Studies in Social Sciences, Brown University School of Public Health and Ares do Pinhal. You can read some key points from the Global Commission on Drug Policy session on Supervised drug consumption facilities from the 18th of October in the INHSU 2023 Daily News.

In another significant session on October 19th, we engaged in discussions about different European Drug Consumption Room (DCR) models and best practices. C-EHRN co-organised the session with the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and Ares do Pinhal, and we presented work alongside other organizations – Metzineres and Společnost Podané ruce.

The European Network of Drug Consumption Rooms (ENDCR) brings together a variety of services from different countries. This session aimed to promote knowledge exchange and cooperation among European experts in the field of DCRs. After an overview of European drug consumption rooms, an introduction to different DCR models and presentations of existing service models, a facilitated group discussion took place, followed by space for questions.

Joint statement for a human rights perspective in EU Anti-Trafficking Directive Amendments

On EU Anti-trafficking Day, various organizations including C-EHRN are urging the Council, European Parliament and Commission to prioritize a human rights perspective in the trialogue negotiations on amending Directive 2011/36/EU on preventing and combating trafficking in human beings and protecting its victims.

The European Commission proposed criminalizing the use of services connected to trafficking in human beings with the knowledge that the person is a victim, and the Council suggested adding an element of intentional use of such services. However, the FEMM and LIBE Committees took a different stance by approving a report last week, considered the final position of the European Parliament. The report distinguishes between the “purpose” of exploitation and does not require knowledge or intention in the use of services of people who are the objects of exploitation of the prostitution of others or other forms of sexual exploitation. Furthermore, the Parliament recommends Member States consider criminalizing clients of sex workers.

Such measures could overreach criminal law, deter reporting of trafficking cases, erode victim rights, and fail to target the true perpetrators. We, the organizations signing the statement, oppose to differentiating between types of human trafficking in the directive and to removing the knowledge requirement for the use of services to be a criminal offence, as it may worsen the situation for victims. Buyers often assist victims in escaping exploitation, and criminalization would deter such assistance. Additionally, the report’s call to criminalize all clients of sex work lacks evidence that it combats trafficking. The approach is stigmatizing and potentially conflating sex work with trafficking. We call for measures that empower all victims, ensure access to services, implement labour rights, and provide secure residence status.

Assessing the Impact: European Testing Week’s Influence on HIV and Hepatitis Testing Coverage

The article “The use and impact of European Testing Week regional awareness campaigns to increase HIV and viral hepatitis testing coverage” has recently been published in the journal HIV Medicine. Based on insights from the special survey among previous European Testing Week participants, it assesses the impact of the campaign.

The article has been submitted on behalf of the European Testing Week Working Group, of which Correlation – European Harm Reduction Network is also part.

Position Paper | People Who Use Drugs and Mental Health

This World Mental Health Day, in a significant stride towards prioritising the mental health of individuals who use drugs, the Civil Society Forum on Drugs (CSFD) has sent its position paper to the EU Spanish Presidency, the Horizontal Working Party on Drugs, and the European Commission. The paper, titled “People Who Use Drugs and Mental Health“, emphasises the urgent need to address the often neglected intersection of mental health and substance use within the European context.

The paper addresses the complexity of the relationship between mental health conditions and substance use. Mental health conditions are influenced by social determinants such as inequality, discrimination, violence, and homelessness, factors which disproportionately affect people who use drugs. Furthermore, specific subpopulations, including women, young people, ethnic minorities, and indigenous groups, face unique challenges in accessing appropriate services for their mental health and substance use needs. These disparities highlight the pressing need for a comprehensive and inclusive approach to addressing these issues from a person-centred, holistic perspective. The paper also calls for specific terminology reform, promoting the use of the term ‘comorbidity’ to describe the existence of both mental health conditions and substance use.

The paper concludes with a number of recommendations related to this issue, urging for a comprehensive review of current shortcomings in accessibility, inclusivity and sustainability of care. The CSFD welcomes the introduction of this topic within the political agenda, as these issues have historically been disregarded and warrant urgent consideration. The CSFD’s position paper serves as a call to action, urging policymakers, healthcare providers, and society at large to recognize and address the critical issues surrounding mental health and substance use. By adopting these recommendations and working together, we can strive for a more inclusive and compassionate approach to mental health care for all, particularly those who use drugs and face complex challenges.