Last week our Head of Policy, Roberto Perez Gayo, participated in the Congress organised by UNAD ‘La red de atención a las adicciones’ in Oviedo, Asturias, to reflect on current developments and challenges in the provision of care and support to people who use drugs in Spain.

Under the banner “A journey through the pathways to addiction care with a gender perspective”, the Congress dedicated an important space to examine the public health challenge posed by synthetic opioids. Together Mireia Ventura, director of Energy Control -ABD‘s Analysis Services, and Roberto Perez Gayo participated in the panel “Nitazenes and other synthetic drugs: a rigorous analysis for drug dependence care professionals”.

In their presentation, the pair of speakers demonstrated how scientific evidence dismantles the media alarm about some substances, such as fentanyl. Nitazenes, on the other hand, were highlighted as a reality already present in some countries, where synthetic substances are beginning to be used as adulterants of other drugs, considerably increasing the risk of overdose due to their consumption. Faced with such risks, both Perez Gayo & Ventura highlighted the role of harm reduction, and more specifically of supervised consumption rooms and drug checking services to identify emerging trends in the drug market and increase care and protection for marginalised and underserved people who use drugs.

The event was also attended by different institutional representatives such as the Government Delegate for the National Plan on Drugs, Joan Ramón Villalbí Hereter, and the General Director of Public Health and Mental Health Care of the Health Service of the Principality of Asturias, Ángel José López Díaz. During his speech, the Government Delegate for the National Plan on Drugs referred to the first responses that were given to addictions, recognising that they came “from civil society” in the form of the first organisations of family members of people who use drugs. Villalbí praised the role of those first organisations, which “started their work to find each other” and “helped public administrations not to make mistakes and to do better” in the face of the consequences of drug consumption.

Following the event, Perez Gayo & Ventura gave an interview to Agencia EFE, a leading news agency in Spanish, which gained coverage in several news platforms including infobae and deia.

Photo credit: UNAD

Based on the results of the voting process, the following candidates have been elected: Magdalena Bartnik, Irena Molnar, Aura Roig and Marios Atzemis.

C-EHRN would like to take the opportunity to thank all the members who submitted an application. Also, to emphasize the high level of expertise and the excellence of applications received for this election.

In the coming days, the newly elected members will participate in their first Advisory Committee Meeting. In this event, they will have the opportunity to meet the current remaining members and to connect with those who leave their seats.

C-EHRN would like to invite you all to join us in congratulating the four new committee members. We are truly excited to start working with them!

The City Reports are the final segment of Correlation – European Harm Reduction Network (C-EHRN)’s Civil Society-led Monitoring of Harm Reduction 2023 Data Report. These concise harm reduction ‘case studies’ highlight either innovative practices or urgent issues demanding immediate attention in five different European cities. The reports will serve as advocacy tools to engage decision makers at all levels, either by showcasing best practices or as an urgent call to action. We asked the primary author, Alice Pomfret, about the process of preparing the reports, and how harm reduction organisations can use them in their advocacy efforts. Read the interview below!

Why did you decide to dedicate a volume of the 2023 monitoring report to the city reports?

The city reports are highly qualitative in nature, and they really zoom in to one particular issue or practice to provide a more nuanced understanding of the local context. We have found that traditional methods such as surveys and questionnaires, while great for capturing large amounts of data, are not so effective at achieving that level of depth. The city reports offer selected focal points an opportunity to authentically tell their story and shed light on issues that are unique to their cities. We hope that this will raise greater awareness of the particular issue, strengthening their advocacy efforts and ultimately leading to positive change.

How did you choose the cities that were included in the report series?

Focal points were invited to nominate themselves to be involved in the City Reports, and following a series of meetings, five cities were selected. This selection process involved extensive discussions with the focal points themselves, leading to a collaborative decision of the cities to be featured. A mix of capital cities and smaller cities were chosen to reflect a variety of contexts, populations and needs. We also thought about geographical variation to ensure coverage across regions. Additionally, we took into account whether the situation that they wished to share were examples of innovative practices or urgent problems to ensure that the reports were balanced in that respect too. It was important for us to strike a balance between positive and negative aspects so that we don’t just focus on the ‘doom and gloom’ and celebrate some harm reduction wins along the way.

Which methods did you use to collect the data for the city reports?

Semi-structured interviews were conducted with various stakeholders, including community representatives, policymakers, harm reduction service providers, and other relevant actors. Depending on the city, interviews were either conducted in the local language by the focal point, then translated into English, and analysed by myself. Or, where respondents were comfortable interviewing in English, I would conduct and analyse the interviews myself. I also gathered extensive literature on the topic to supplement the interviews.

How can harm reduction organisations make use of the city reports?

The reports have been designed to function as concise and easily accessible advocacy tools, aimed at engaging decision makers at various levels. They achieve this by either showcasing best practices, offering inspiration for other cities, or by highlighting an urgent problem that requires immediate attention and action. We purposely tried to keep these reports short and to the point, so that they are more likely to actually be read by decision-makers. The design of the report was influenced by input from the focal point, aligning them closely with their specific needs and goals. However, other harm reduction organisations can definitely use the reports. For instance, to benchmark their own city against other cities’ approaches, or alternatively, if they are experiencing challenges similar to those highlighted in a report, they can use them as resources to strengthen their own advocacy initiatives.

C-EHRN will also establish and implement a tailored Advocacy Mentorship Programme to increase the advocacy capacities of focal points and support the dissemination of C-EHRN reports and activities at the local and national policy-making levels. This will include a tailored advocacy training coordinated by the Rights Reporter Foundation and follow-up mentorship support for focal points who were involved in the City Reports for 2023. It will also involve a video being produced, with the findings presented at the European Harm Reduction Conference in December, which is really exciting!

Have you noticed any significant differences among the cities and if so, would you describe what these were?

What’s been really interesting to see across cities is how local and national politics play out differently when it comes to supporting harm reduction efforts. For instance, in Esch-sur-Alzette in Luxembourg, harm reduction initiatives, including the implementation of drug consumption rooms (DCRs), are a key part of the National Drug Strategy. So, any pushback against DCRs usually comes from the local level, so the city municipalities. Whereas in Warsaw, we see greater engagement from the local policymakers, at least at the district level, whereas decision makers higher up, whether at the city level or national level, seem to prioritise drug policy or harm reduction less. A similar dynamic can also be seen in Amsterdam, where the city government is extremely progressive, openly criticising the failures of the war on drugs, and advocating for drug regulation. Yet at the national level, the stance on drug policy remains much more in this prohibitionist paradigm.

Following a new format, Correlation – European Harm Reduction Network’s Civil Society-led Monitoring of Harm Reduction in Europe 2023 Data Report is launched in 6 volumes: Hepatitis C Care, Essential Harm Reduction Services, New Drug Trends, Mental Health of Harm Reduction Staff, TEDI Reports and City Reports (Warsaw, Bălţi, Esch-sur-Alzette, London, Amsterdam). The Executive Summary can be accessed here.

In 2023, C-EHRN dedicated a segment of its Civil Society Monitoring of Harm Reduction in Europe report to the mental health of harm reduction workers for the first time, an area of pressing importance that has barely been discussed in relevant literature so far. To accompany the publication The Mental Health Challenges Faced by Harm Reduction Staff, we bring an interview with the primary author, Laoise Darragh below.

Why did you decide to dedicate a chapter of the 2023 monitoring report to the mental health of harm reduction staff?

There were a number of factors. During the development of the monitoring report last year, the mental health of staff was something that kept coming up on a more informal basis, as well as that there was a lot more attention given to the mental health of frontline workers after the COVID-19 pandemic. It took quite a toll on frontline workers, but there was nothing at all on harm reduction staff as a particular group that might need specific support or may face specific challenges. When we conducted a literature review, there was almost nothing. I think that was the main driver.

There was also a need for more qualitative research within the monitoring. That was something that focal points felt was quite important. I think this was the perfect topic to dive into in a more qualitative sense as well. It also gives the opportunity to advocate more for staff, because they’re kind of overlooked when the focus is mainly on clients.

What do you think the most pressing issues were regarding the mental health of harm reduction staff? What are the main challenges they face?

It’s a complicated web of challenges, but I would say that the most pressing factor would be the lack of political support in most of the cities. There’s a lot of stigmatization as well coming from local societies and from other services that are used by people who use drugs. This trickles down and instigates or influences all of the other challenges that staff face. The job itself can often be quite difficult, but it’s exacerbated by these unsupportive political environments, and that can cause difficulties in the relationships between services, between staff members and between staff and clients. I would say that that’s probably the most pressing issue.

Harm reduction staff should be able to have pride in their work. I think that can be very challenging for staff in a lot of cities given the stigmatization towards both clients and staff. Trying to combat that stigmatization, the organisation pushes that they are fighting against it as well, I think that was something that came up when we launched the report in the panel discussion. It’s nice for the workers to be able to feel that the organization is also fighting against that. It acknowledges the difficulties that press down on staff too.

What are the areas where the support is mostly missing or where change would be most urgently needed?

The political environment and in particular the lack of funding is probably the biggest change that we need to see. Organizations struggle with resources and being able to support their staff because all of the funding has to go on clients. Even for organizations that do have maybe more funding than others, there are usually specifications for the funding – that it can’t be spent on, for example, team-building exercises. It’s often not just the funding itself, but all of the specifications of the funding that can be quite challenging. I think that having more political support would trickle down into all of the other areas and alleviate some of those challenges as well.

Have you noticed any significant differences among the focal points from the different cities and if so, would you describe what these were?

Cities with more progressive policies and support from local communities were able to implement more support in terms of mental health for staff. It was interesting that the focal point from Switzerland, for example, was quite shocked by the lack of mental health support in some of the Eastern European countries, because they’ve had it for 20-plus years. It’s mandatory to have counselling opportunities for their staff, which is very different to what’s being experienced in Eastern European countries, where a lot of the time there’s none.

I think it was interesting that there were also quite a lot of similarities. All of the focal points mentioned that this is a really important topic and something that hasn’t been addressed in the past. It was interesting that no matter what the political situation was, there was a feeling that this was a really important topic to focus on going forward.

Despite the difficulties and barriers, including the lack of financial support, are there any best practices for organisational support that you would highlight?

We have a number of recommendations at the end of the report, some of which do depend on funding, but several which don’t, so that organizations can implement them no matter what their political situation or funding situation is. For example, trying to create a culture where there’s an openness to speak about mental health issues is really important. Having a mental health strategy is another one.

We have a member of staff working on more concrete guidelines for organizations which will come out at the end of the year and will highlight more specific things that organizations can bring in to support the mental health of their staff members no matter what their situation is. That’s quite exciting and I think it’ll be nice to have something more concrete in that sense as well.

Would you pick a quote from the report and explain why you find it relevant?

It’s very difficult to pick one. I have a couple here because it was quite a broad report and a number of different challenges and coping mechanisms came up.

One that highlights the importance of the issue is a quote from our focal point in Budapest:

“Everybody told [me] that yes, this is a very important issue now and especially in countries where resources are scarce and that organisations are stretched and all [of] these problems we have and so, I think it is a very relevant issue to focus on for the whole network.” (FP Budapest, p. 11.)

Another one is that

“It’s in the hands of politics. Because harm reduction workers are everywhere in every country, but depending on the political situation, their working situation changes accordingly. If the political situation is against harm reduction, it makes the work more difficult.” (FP Bern, p. 12.)

And a third highlight:

“The harm reduction worker, he really believes that this matters and harm reduction is the right way to go in this politics of prohibition and criminalisation. And workers build relationships with people who are extremely marginalised in society and have a lot of stigma and prejudice against them. And these relationships are important for both people, both the clients and the workers.” (FP P Reykjavik, p. 26.)

What emerged from the report was the importance of building relationships, a number of different relationships between staff and clients, between staff members themselves, between staff and other services, and also political relationships. Developing professional networks on the local, national or international level is really important because it prevents workers from feeling isolated. It protects them against the stigmatization that they feel from other areas of society or politics. The last quote highlights that building relationships is important for not only the clients but also for the harm reduction staff.

How do you think that harm reduction organizations can use the report?

Apart from the recommendations and hopefully the guidelines that are going to be developed, I would hope that organizations can use the report as a tool to advocate for the importance of addressing the mental health of their staff. That they can share it with local or national policymakers, people who are involved in funding, other relevant stakeholders, or even colleagues working in other services, to highlight the need for increased support, less stigmatization and further resources for harm reduction staff and how that affects both staff and clients.

The report highlights that a holistic approach is needed to be able to help the situation, raising awareness of the topic of harm reduction. The harm reduction community in general is quite important too, as like I said, it’s something that people felt wasn’t spoken about before. Hopefully, they can use it for advocacy.

Then the guidelines, in a more practical sense. They’ll be able to pick out things at other organisations that maybe they hadn’t thought about in the past, best practices, from the report too, and implement them in their organization.

The World Hepatitis Summit (WHS) 2024, held from 9th to 11th April, spotlighted the pivotal role of community-led services in the global fight against hepatitis. Among the voices contributing to this discourse was Katrin Schiffer, director of the Correlation–European Harm Reduction Network (C-EHRN). Katrin’s participation in a plenary panel focusing on the power of community-led services in elimination underscored the significance of community-based monitoring activities in advancing the agenda of hepatitis elimination. Katrin’s presentation also underlined some of the main challenges faced in the C-EHRN Monitoring activities and approaches to overcome these.

At the core of WHS 2024 was a commitment to a multi-stakeholder, multi-sector public health approach, uniting diverse actors from civil society, policymakers, the private sector, and academia. Organised by the World Hepatitis Alliance with the support of the Ministry of Health of Portugal, the summit aimed to translate aspirations into action, driving tangible progress towards the elimination of hepatitis.

The session in which Katrin Schiffer participated explored the value of community-delivered services to the people they serve and to the health systems they support, highlighting best practices in the design and implementation of services, and how by working together communities and healthcare systems overcame the challenges of implementation to build trust and maximise impact. Katrin’s presentation focused on the importance of investing in civil society-based monitoring and data collection, introducing the C-EHRN Monitoring activities.

Why is it important to invest in civil society-based monitoring and data collection?

Civil Society Monitoring serves as a vital accountability mechanism, holding governments accountable by independently monitoring and collecting data, and examining the efficacy and impact of policies and programs.
It complements official data by providing up-to-date grassroots-level insights on developments and trends. The intention is not to duplicate existing data collection efforts from EU agencies such as the ECDC and the EMCDDA, but to complement that with civil society perspectives and information that may not be captured by official channels.
Civil Society Monitoring identifies gaps in services and policies, thus catalyzing targeted interventions. The data collected identifies gaps that may not be apparent from official data alone, which can be used to call for action and advocate for improving the implementation of programs and policies, based on the needs of the community, including people who use drugs.

What kind of challenges do we face when it comes to monitoring?

Challenge 1: Keeping a balance between science and community needs

Among the challenges is the delicate balance between scientific rigour and community needs. C-EHRN recognises that striking this equilibrium necessitates a nuanced approach that tailors monitoring methods to the unique needs and dynamics of the communities we work with.

It’s about finding the spot where monitoring methods meet scientific quality standards while being practical and feasible for those working directly in the field. The aim is that data collection is accurate, reliable, relevant, and done in a way that respects and responds to the needs of People Who Use Drugs, being meaningful to the communities we serve.

To respond to this challenge, C-EHRN will comprehensively review our monitoring methodology this year. The objective is to develop an enhanced monitoring framework and a set of indicators linking to HCV and essential harm reduction services. This new framework will allow longitudinal and cross-sectional comparisons. An external scientific expert will support this review in close cooperation with our internal monitoring team, the focal points, and the scientific advisory board.

Challenge 2: Limited resources for monitoring

The data collection for the Civil Society Monitoring of Harm Reduction in Europe is realised with the support of the Focal Points (FP), members of the C-EHRN. They are the backbone of the monitoring and our network, serving as national reference points for gathering data and information about harm reduction-related issues.

Our Focal Points collect data on a voluntary basis, which is time-consuming and comes on top of their regular work, requiring commitment from both the individual Focal Points and the related organization, which is willing to support and invest additional resources. Therefore, resource constraints are a serious obstacle, impeding the scalability and sustainability of monitoring efforts.

The Focal Points also value their role as Focal Points, as being a Focal Point is more than collecting data and information:

FPs are provided with tools, information, and training to support their work and potential advocacy activities at the national and local levels.
The FP role can be used as a quality label and FPs can use the C-EHRN Focal Point Branding in their communication and advocacy.
Being a Focal Point means being part of a bigger community and providing the opportunity to exchange and share information with other members and FPs.
FPs can actively contribute to the focus and the methodology of the monitoring framework, ensuring that monitoring reports and results support their practical work.

Challenge 3: Sustainability of the Monitoring

Ensuring the longevity of monitoring initiatives requires diversifying funding streams and exploring alternative financing avenues. C-EHRN is supported by an Operating Grant from the EU4Health Programme, which has provided us with the means and resources to develop and implement network and monitoring activities in the past years. Although we hope for continued financial support, this remains uncertain. Against the backdrop of uncertain financial landscapes, the imperative of sustainable funding mechanisms cannot be overstated.

Challenge 4: Disseminating findings to the policy level

The dissemination of findings to the policy level emerges as a pivotal imperative. Beyond data collection, the ultimate goal is to effectuate policy change, bridging the gap between research outcomes and actionable policy insights. We aim to shed light on gaps in service delivery and emerging drug trends, ultimately driving positive change in policies and practices.

C-EHRN recognises that many of our focal points and members may not have the resources or expertise for advocacy work. This is why we are rolling out an Advocacy Mentorship Programme in 2024, an initiative providing support and training to effectively advocate for policy change at both local and national levels. From webinars to face-to-face trainings, we’re committed to building the advocacy skills of our community members.

In addition, we are launching a city initiative to foster collaboration and support between cities, policymakers, civil society representatives, and affected communities. This platform will serve as a space to address local challenges, explore practical solutions, and promote innovative drug policy approaches. By working together, we can amplify our advocacy efforts and drive real change in communities across Europe.

Stay tuned for the streaming of the session and delve deeper into the discourse shaping the global response to hepatitis! On this note, we’d also like to bring to your attention the Global hepatitis report 2024: action for access in low- and middle-income countries, launched by the World Health Organization on the 9th of April, which you can access here.

The video is the recording of the report launch webinar that took place on Tuesday, 9th April 2024.

Panellists:

Alice Pomfret (C-EHRN)
Machteld Busz (Mainline, Amsterdam, Netherlands)
Ala Iatco (The Union for Equity and Health, Bălţi, Moldova)
Martina Kap (Fondation Jugend- an Drogenhëllef, Esch-sur-Alzette, Luxembourg)
Shayla Schlossenberg (Release, London, UK)
Magdalena Bartnik (Prekursor Foundation for Social Policy, Warsaw, Poland)

On January 26, 2024, the city of Amsterdam hosted a groundbreaking international conference on the legal regulation of drugs, spearheaded by Mayor Femke Halsema, a vocal advocate for drug policy reform. The event united policymakers, academics, and civil society representatives in acknowledging the failures and human rights violations caused by over fifty years of drug prohibition. Emphasising the importance of advancing effective and humane drug policies at the city level, the conference garnered support from several current and former mayors worldwide. While Amsterdam has long been at the forefront of decriminalisation and harm reduction efforts, discussions around legal regulation have been, until now, relatively limited. The conference underscored the importance of ensuring fair and socially just legal regulation, including reparations and affirmative action to those unfairly and disproportionately affected by the war on drugs, and the importance of guarding drug markets against excessive ‘corporate capture’. The event represents a turning point in drug policy reform, especially within policymaking circles, marking a significant stride towards drug policies grounded in health and human rights. At the city level, Amsterdam is taking the lead in proposing innovative approaches to drug regulation, moving the conversation beyond cannabis, and firmly placing the regulation of substances like cocaine and MDMA on the agenda.

In London, punitive drug policies are a driver of discriminatory policing and incarceration, evidenced by the number of drug possession offences that are unduly focused on Black, Asian and minority ethnic communities. Despite decreased overall police stop and search rates, racial disproportionality has increased, with Black individuals facing drug-related stop-and-searches at nine times the rate of white people. Additionally, Black individuals comprise a quarter of cannabis possession convictions, despite representing less than four percent of the population. The criminalisation of drug use in the UK also limits access to housing for people who require social accommodation, causing fear of eviction among people who use drugs. ‘Public Space Protection Orders’ further exacerbate this issue by penalising activities like rough sleeping and drug consumption, pushing marginalised individuals into deeper isolation and further marginalisation. These punitive measures fail to address underlying issues, amplifying the risks and harms faced by affected communities. This underscores the crucial necessity for harm reduction as a response to both drug-related risks and the harm caused by prohibition.

Esch-sur-Alzette, home to fewer than 40,000 people in Luxembourg’s south, reached a significant milestone in 2019 as the second city in the country to establish a drug consumption room. Contact Esch was based upon educational, medical, and social pillars, garnering strong support and success. The DCR’s effectiveness stemmed from robust political backing for harm reduction, effective collaboration among policymakers, NGOs, and local leaders, and the Ministry of Health’s objective to decentralise treatment and harm reduction services across Luxembourg. The Jugend-an-Drogenhëllef Foundation (JDF), the organisation behind Contact Esch, prioritised community involvement, fostering positive relations between locals and the initiative. Esch-sur-Alzette’s success in implementing a DCR, marked by minimal opposition and notable community support, can help to inspire other small-scale cities to implement DCRs, within and beyond Luxembourg.

In Bălţi, Moldova’s second-largest city, the prevalence of HIV and HCV among people who inject drugs in Bălţi is disproportionately high. Despite the presence of harm reduction services throughout Bălţi, accessibility to these services remains a key problem. Barriers, including inadequate psychosocial support, employment and travel constraints, and fear of discrimination, hinder participation in treatment and harm reduction services. A notably prominent barrier is the pervasive stigma and discrimination exhibited by healthcare staff towards key populations, deeply rooted within healthcare settings. Approximately one quarter of people who inject drugs avoid medical care and HIV/HCV testing due to fears about their drug use becoming known. This is linked to healthcare personnel disclosing sensitive medical information such as a person’s HIV status, which can lead to stigma, discrimination and even dismissal from employment. It also hinders access to HIV services and breeds mistrust in the wider health system. Legal restrictions criminalising HIV exposure and transmission, drug use, and certain sexual activities further obstruct safe behaviours and service access. Though a national network of specialist paralegals established in 2017 has helped to bring justice to affected individuals, addressing these issues at their core is crucial for systemic, lasting change.

C-EHRN at the UNAD Congress | Exploring Synthetic Opioids and Harm Reduction

We are happy to announce the New Advisory Committee Members 2024!

Interview with Alice Pomfret | City Reports