The 31st of August marks the International Overdose Awareness Day, a day to amplify the voices fighting to end overdose and to remember those who have passed away due to overdose. In support of initiatives making efforts on this path, we bring some of the latest updates.

Highlights include:

the European Network of Drug Consumption Rooms,
research on the effectiveness of the Scottish “How to Save a Life” mass media campaign addressing the rising number of drug-related deaths,
the efforts made in Athens in overdose prevention,

along with some additional resources that came our way in August.

New members can now join the European Network of Drug Consumption Rooms

C-EHRN hosts the International Network of Drug Consumption Rooms since 2007. In the past years, it became obvious that more cooperation is needed at the European level to support the development of high-quality DCRs. As an answer to this need, the European Network of Drug Consumption Rooms (ENDCR) began to take shape. At the beginning of 2023, we developed the Terms of Reference for the ENDCR, a network aiming to support capacity-building and advocacy activities and to create a platform for mutual support.

We invite organisations in the WHO Europe Region operating or planning to implement a DCR to apply for membership by reading the Terms of Reference and sending an email to administration@correlation-net.org, indicating their interest in joining the network. Once contacted, we can provide a membership confirmation survey link.

Scottish Naloxone Distribution and Mass Media Campaigns: A Blueprint for Overdose Prevention

Recent Scottish research offers insights into addressing drug overdoses through effective strategies. Two studies delve into the roles of naloxone distribution and mass media campaigns in preventing overdose-related deaths. Scotland’s “How to Save a Life” (HTSAL) campaign, addressing increasing drug-related deaths, aimed to raise awareness and expand naloxone distribution.

The first study reveals that the campaign significantly boosted community naloxone availability. However, sustainability post-campaign requires consideration. The second study shows the campaign’s success in enhancing public understanding of drug-related deaths and naloxone while highlighting that responses to overdose need comprehensive coverage. Scotland’s proactive HTSAL campaign sets an example for similar regions, highlighting the importance of ongoing investment to sustain overdose prevention efforts beyond campaign periods.

Athens Recognized at International Summit for Naloxone Accessibility

In March 2023, Athens was amongst the 5 cities recognized for public health achievements at the Partnership for Healthy Cities Summit convened in London by Bloomberg Philanthropies, World Health Organization, Vital Strategies, and Mayor Sadiq Khan of London. The recognition was gained for the steps taken to enhance the availability of naloxone within community-based initiatives and among medical practitioners. Additionally, the city has initiated research into the factors leading to mortality among people who inject drugs to gain deeper insights into the effects of the overdose crisis.

Marios Atzemis, Harm Reduction Officer at Positive Voice, C-EHRN’s focal point in Athens, underlined the importance of recognising those who played a crucial role in the progress, including Professors Angelos Hatzakis and Vana Sypsa, the Hellenic Scientific Society for the Study of AIDS, STDs and Emerging Diseases and George Kalamitsis, chair of the Hellenic Liver Patient Association “Prometheus”. He also added: “We are tired of losing friends and peers from deaths that could be prevented and we strongly support the participation of the directly affected communities in the design, implementation and delivery of programs, services and policies that are addressed to them. We also strongly support and encourage the collaboration of all the stakeholders and the key populations in the drug field as it happened to the naloxone case.”

Read about SAVE LIFE, an inspiring initiative from Denmark

SAVE LIFE is a crucial component of HealthTeam for the Homeless (SundhedsTeam) in Copenhagen, who are also C-EHRN’s focal point. It focuses on outreach health efforts for marginalized people and people who experience homelessness. Since 2010, SAVE LIFE has developed training in lifesaving in combination with the opioid antidote naloxone. Originally in Vesterbro, Copenhagen, the project expanded across rural and urban areas in three phases. Training includes nasal spray naloxone use, overdose recognition, and life-saving assistance. The first cross-municipal project began in 2013, with some municipalities engaged for a decade. Since 2020, SAVE LIFE has coordinated nationwide training in municipalities with a substitution treatment.

Project materials and resources are available on their website, and reports and scientific articles can be accessed here. For inquiries, contact Henrik Thiesen at gg63@kk.dk or alkodoktor@dadlnet.dk.

Additional Resources

Manual | Safer Consumption Spaces

Access the DCR manual with guidance and resources for the implementation, operation and improvement of drug consumption rooms.

Article | Tales from New York. ‘We should learn from the drug treatment approach here’

Read Tony Duffin’s inspiring article about the work of OnPoint, Overdose Prevention Centres and what we can learn from the drug treatment approach in NYC.

Webinar | Report Launch: Aid for War on Drugs

Date: 12 September
Organised by: Harm Reduction International
Registration here.

C-EHRN and the European Network of Drug Consumption Rooms are currently undertaking an assessment and census of Drug Consumption Rooms (DCRs) in Europe, collecting essential information on existing DCRs through an online survey which can be filled out by the 15th of September. The answers will provide valuable information on the functioning and establishment of DCRs, benefiting others who are looking into setting up a DCR worldwide. The completion is voluntary and confidential and takes approximately 20-30 minutes.

A report of the survey will be published on C-EHRN’s website at the end of the year and presented at our partner meeting in December, providing an overview of the current DCR landscape in Europe, including information on locations, functioning, types of services, target groups and consumed substances.

Click here to access the survey.

In 2022, we started to intensify our cooperation with drug consumption rooms in Europe and worked together on a number of activities. C-EHRN prepared ‘Safer Consumption Spaces’, a manual to support organisations with guidance and resources in the implementation, operation and improvement of DCRs. We also organised a technical meeting in cooperation with the EMCDDA in 2022 and 2023, and a session during the ‘Symposium on DCRs’ organised by the Pompidou Group in 2023. At the beginning of 2023, we developed the Terms of Reference for the ENDCR, a network aiming to support capacity-building and advocacy activities and to create a platform for mutual support.

A conversation with Péter Sárosi

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. Currently, four case studies are being conducted in Ireland, Hungary, Greece, and Finland to assess the implementation of these standards.

THE CASE STUDIES

Péter Sárosi, the executive director of the Rights Reporter Foundation and head of the Civil Society Involvement Working Group of CSFD, explained that two focus group discussions are being held in each country, one involving decision-makers and another involving civil society representatives. The Chatham House Rule ensures confidentiality and open discussion, and the conversations address the 9 overarching quality criteria described in the Quality Standards for Civil Society Involvement in Drug Policy and how these are applied in the respective countries and cities. “In June, we went to the first country [Ireland]. In July, we visited Athens. We are now working on the Hungarian one and the Finnish visit will be at the end of August.”

Péter noted active participation in Ireland and Greece, highlighting the importance of such dialogues to build openness and mutual trust between civil society and governments. “This project is really useful for the organizations in those countries because it creates some channels or forums to speak about very sensitive issues for civil society and also for decision-makers. […] It was really interesting to see the different perspectives of the two parties.” He also observed a need for more dialogue on general subjects like what is civil society and its role, as there are many misunderstandings.

Another lesson learnt was that the level of efficiency and quality of the government’s communication with NGOs is not necessarily better in the case of more formal systems. “Sometimes the informal channels can work very well. And sometimes you have formal channels which don’t work very well. […] If you have an official forum to discuss with governments, it doesn’t necessarily mean that it’ll create a good quality involvement of civil society.”

The case studies will offer valuable insights, including positive and negative examples from different mechanisms in the selected countries, with forward-looking examples like the Citizens’ Assembly on Drug Use in Ireland.

Besides some of the progressive examples of Ireland and Finland, where governments are more open to civil society voices, lessons can be learned from Hungary and Greece. In Greece, despite the not-so-developed government system, civil society advocacy had a very positive impact. A drug consumption room and a specific shelter for homeless people who use drugs were created and take-home Naloxone is being provided to prevent drug overdoses. In Hungary, where there is no existing dialogue between the government and civil society, there are still some positive developments at the city level in Budapest, which is an example on how civil society can still use local mechanisms when there are no available national ones.

Drug demand and harm reduction quality standards support achieving high-quality programmes and services, ensuring that interventions are delivered well. However, their implementation can be a headache for service providers. The good news is that the helpful quality standard implementation toolkit developed under the FENIQS-EU project is now available online, giving guidance through every step of the implementation process!

Besides the first section clarifying the basic concepts of quality standards, the toolkit includes a chapter on the key factors for a successful implementation. This is followed by a section dedicated to guiding service providers through each step of the way, also discussing the possible barriers and challenges they might face when putting quality standards into practice. The final two sections provide some inspiring examples, including good practices and accounts of service providers from all over Europe.

The toolkit can be found on the FENIQS-EU project’s website both in an easy-to-navigate online and in a downloadable pdf format, accompanied by video tutorials for each chapter.

At the meeting of the Horizontal Working Party on Drugs on the 11th of July, Iga Jeziorska, Correlation’s research officer spoke about the position of people who use drugs in a mental health context on behalf of the Civil Society Forum on Drugs, bringing some recommendations on improving their access to care.

When it comes to access to care, people who experience the co-occurrence of psychiatric disorder and substance use disorder are faced with various barriers on different levels. The prioritisation of specialised, large mental health institutions, the limited amount of alternative, community-based care possibilities and insufficient funding for mental health services are some examples of systemic barriers.

Meanwhile, there is a lack of mental health professionals and the gaps in mental health education result in a lack of comprehensive understanding among practitioners. These are staff-related barriers, which also include the stigma that people who use drugs face when reaching out for care. At the same time, innovations in care services can not keep up with the changing drug markets and drug use patterns.

Besides the above, the low accessibility of the services also challenges access to care. On the one hand, there is a lack of knowledge on available mental health support, while on the other hand the costs and insurance policies, waiting times and necessary documents, and the lack of mental health support in low-threshold services also prevent many when it comes to trying to access care.

To counter these barriers, it is key to ensure the availability of mental health care services for people who use drugs outside the context of drug dependence treatment as well. Community-based service options, such as the integration of mental health care into community-based harm reduction services, would also increase the number of accessible services. Besides, the scaling-up of reintegration services could ensure the continuum of care.

The integration of mental health care and substance use services, and the availability of these at a primary health care level should also be a goal. Training and the establishment of multidisciplinary teams able to address a range of problems could support the promotion of person-centred approaches that can incorporate biological, psychological, and social factors and the complex interactions of these.

Investment in research and innovation in the field is of crucial importance, while continuous monitoring and evaluation of the effectiveness of interventions is also needed. Additionally, awareness-raising campaigns could help reduce stigma and improve health literacy.

The new website of BOOST, a project supporting community-based & community-led organisations in providing communicable diseases services, is now available online!

BOOST enhances the implementation of harm reduction interventions by supporting community-based and community-led services that work to counteract the prevalence of communicable diseases including HIV/AIDS and viral hepatitis.

Those interested can read about BOOST, its aims and activities on the new web platform. In later project phases, the resources produced throughout the project activities will also be published here, including an up-to-date overview of the quality of testing and linkage to care services offered by harm reduction organisations in the EU and selected neighbouring countries, good practice examples, webinars and training materials.

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. Neither the European Union nor the granting authority can be held responsible for them.

The European Monitoring Center for Drugs and Drug Addiction (EMCDDA) recommends the promotion of research and monitoring of drug use and health incidents in prisons. However, little or no research has been done on drug use in prison settings in the Netherlands in recent years.

International research shows that people in detention have used drugs substantially more often and are more likely to use drugs regularly. Incarcerated persons also experience drug-related problems more often than those not incarcerated. Drug use in prisons worldwide is relatively high. Yet, drug policies in prison mainly aim to combat the drug trade rather than provide care for those using drugs in prison.

In 2021, the Netherlands had nearly 30,000 people in detention across 29 penitentiary institutions. Understanding current drug use among people incarcerated in Dutch prisons is essential. In response, Correlation – European Harm Reduction Network (C-EHRN) and Trimbos Institute conducted an exploratory study in late 2022. The study, funded by the Ministry of Health, Welfare and Sport, investigated drug use in the Penitentiary Institution (PI) in Ter Apel.

Synthetic Cannabinoids (SCRAs)

The reason for the research in collaboration with Trimbos Institute is the continuous innovation in the way drugs and, in particular, synthetic cannabinoids (SCRAs) are smuggled into prison as impregnated on letter mail. There are signs of widespread synthetic cannabinoid use in Dutch prisons, which has been seen in foreign prisons for some time. One of the main reasons is that these substances are more difficult to detect than traditional drugs such as cannabis or cocaine. SCRAs impregnated on paper are odourless, and their use cannot be identified in conventional urine tests. The effects of SCRAs are similar to those of THC, making the user feel relaxed and intoxicated. However, the effects can vary considerably in strength and duration and can cause other side effects that can even be life-threatening in extreme cases.

Ter Apel

The qualitative research in the Penitentiary Institution Ter Apel is an initial exploration through a questionnaire distributed among employees and people in detention, as well as in-depth interviews held with key informants from the institution. The findings suggest high usage of SCRAs and inappropriate use of prescription pain, sleep and sedative medication, besides cannabis and alcohol use. Although drug use in the PI in Ter Apel does not seem to lead to visible significant safety or health incidents, likely, people in prison do not readily turn to the medical service for drug-related health problems, partly for fear of sanctions or stigmatization.

“The investigation results have made us realize that we have been looking at the subject of drugs for too long from a safety point of view only. We do our best to prevent drugs from being smuggled in one way or another. It is also important to look at drugs from the perspective of health, care and the professionalization of our employees.” – Laurens Huizenga, branch director PI Ter Apel.

Recommendations

In order to have a better understanding of substance use in Dutch prisons, more research is needed. Additionally, it is essential to gain better insights into the care needs of people in detention and the challenges faced by prison staff regarding drug use.
Such new research insights are necessary to implement more targeted and appropriate care and to improve access to addiction care.

The researchers advise keeping up-to-date and neutral information about drugs’ effects and health risks available to staff and people in detention. It is also desirable to have a broad and open discussion about substance use and SCRAs, particularly within the prison system.

For detailed information and more recommendations, read the research report.

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 the European Health and Digital Executive Agency (HaDEA). Neither the European Union nor the granting authority can be held responsible for them.

The European Health and Digital Executive Agency (HaDEA) brought together 5 exciting projects under the #EU4Health Programme at an online meeting on the 28th of June. The following projects were represented at the meeting:

BOOST;
CORE – COmmunity REsponse to End Inequalities;
EXPAND – EXPANDing access to Community-based testing for HIV, viral hepatitis and STIs in Slovenia;
REACH-OUT;
Crossing Countries, Crossing Communities (4C).

All 5 projects have received the Action Grant to enhance community-based services for HIV, AIDS, Viral Hepatitis & Tuberculosis. At the meeting, HaDEA aimed to foster collaboration and identify synergies among the projects.

We were proud to be present as the coordinators of the BOOST project and partners in the CORE project!

When it comes to addressing drug consumption and its associated risks, the stigma surrounding people who use drugs negatively impacts their access to support and health services. When stigmatised, people feel discouraged from seeking the care they need due to feeling judged and degraded.

Harm reduction services approach drug use in all its complexity, upholding the rights of people who use drugs while searching for evidence-informed strategies of care and support. Harm Reduction aims to empower and support people who use drugs in regaining agency and leadership, contributing to their meaningful participation in reducing the potential harm of their drug use. Among others, examples of strategies to reduce stigma and improve access to treatment and support services include advocating for and contributing to the decriminalisation of drug use or the implementation of alternatives to incarceration.

For the International Day against Drug Abuse and Illicit Trafficking, we have collected some updates from the harm reduction field touching on addressing stigma.

→ 2023 #SupportDontPunish Global Day of Action
June 26th marks the 11th #SupportDontPunish Global Day of Action. The Support. Don’t Punish. Campaign unites initiatives working towards sustainable alternatives to the ‘war on drugs’ and supporting strategies to drug- and drug-policy-related challenges that are based on solidarity and the rights of the communities they represent. The campaign aims to connect and visibilise these local efforts as part of a global movement.
Find out more here.

→ Recommendations for tackling stigma and discrimination – joint statement by the EUHPP Thematic Network
The European Health Policy Platform Thematic Network on HIV, TB, viral hepatitis, and STIs, led in collaboration with the EU Civil Society Forum, is working to involve non-governmental organizations in policy development, implementation, and sharing of information. They released a joint statement in June that has been supported by 40 European organizations.

The statement points out the gaps in addressing the needs of individuals affected by HIV/AIDS, viral hepatitis, and tuberculosis in the EU. It also provides recommendations to tackle the stigma and discrimination faced by key populations, including people who use drugs.
You can read the statement here.

→ Statement from UN experts addresses stigma and discrimination and calls for people-centred alternatives to the ‘war on drugs’
A recent statement by United Nations experts underscores the detrimental effects of stigmatization and urges the exploration of alternative approaches to address the global challenge of drug-related issues. The experts advocate for a comprehensive and restorative justice framework, alongside inclusive and community-based measures. By challenging the paradigm of the ‘war on drugs,’ they emphasize the importance of adopting a more compassionate and efficient response. For further insights, you can access their statement here.

→ New toolbox to initiate harm reduction in prisons will be available by October
A toolbox to give guidance on the application of harm reduction approaches in prisons is under development. The toolkit, developed by C-EHRN in consultation with relevant stakeholders and experts, will be launched in October and presented at the C-EHRN Member and Expert Meeting in Budapest in December.

→ Civil society involvement in Finland, Ireland, Hungary and Greece – What stage are we at?
In 2023, C-EHRN and the Rights Reporter Foundation will conduct a study to assess the level and quality of civil society involvement in four EU countries, Finland, Ireland, Hungary and Greece. The case studies will reflect on the application of quality standards based on the Quality Standards for Civil Society Involvement in Drug Policy, developed in 2021 as part of the Civil Society Forum on Drugs (CSFD) Project. The study will also address how CSO are involved in the implementation of drug policies in each country.

Overdose Awareness Day – Some of the latest updates in the fight to end overdose