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.

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.

Rafaela Rigoni on Civil Society-led Monitoring for Harm Reduction @ISSDP 2023

The 2023 Conference of the International Society for the Study of Drug Policy (ISSDP) took place in Leuven, BE between the 30th of May – the 1st of June 2023, gathering around 250 participants including researchers, academics and some civil society organizations.

As part of the event, Rafaela Rigoni, C-EHRN’s Scientific Officer presented the Civil Society-led Monitoring for Harm Reduction, one of C-EHRN’s most significant achievements from recent years, with the title Frontline perspectives: Civil society-led monitoring of harm reduction in Europe.

Rafaela discussed the crucial role of civil society organisations (CSOs) in the development and implementation of measures to reduce the harms of drug use and in monitoring and evaluating program policies. Her presentation analysed the challenges and experiences in building a framework to monitor the implementation of harm reduction in Europe from the viewpoint of frontline harm reduction workers.

She presented the monitoring framework developed by C-EHRN’s research group since 2018, which collects data on the accessibility and acceptability of harm reduction services, hepatitis C care for people who inject drugs, and drug trends. The monitoring tool operates through a network of Focal Points, harm reduction services in 36 European cities in 34 different countries.

Mapping the situation on a city level, the approach provides the foundations for the critical evaluation of harm reduction implementation against European policy goals and reflects the CSO’s perspectives, which is critical for optimising the local planning of services and developing effective and respectful drug policies.

 

Curious about the results of last year’s monitoring? Check out the Monitoring Data Report and the Executive Summary!

Fostering Community Knowledge

Before its 2022 Annual Data Report launch, C-EHRN is excited to share the first in a series of new publications we have prepared with our Network members and experts.

Communities of people who use drugs have for decades, and before the establishment of mainstream health services, designed and implemented some of the most effective evidence-based harm reduction interventions, such as needle-exchange programs, peer-delivered naloxone and community-based drug checking. However, research collaborations between people who use drugs and academic stakeholders often remain scarce, undervalued, and misinterpreted.

The involvement of harm reduction professionals and community members in research is often limited to serving as interviewees or a gateway to access other, often hard-to-reach participants. Consequently, community members may feel that their meaningful involvement is virtually missing, and research data results in evidence which dismisses the knowledge, experiences, and needs of the communities that are the focus of studies and hence, those who should benefit the most.

The first publication in this new series, Fostering Community Knowledge. Community-based Harm Reduction Research argues the need for inclusion in research of people who use drugs and explores its challenges and potential avenues. With this publication, C-EHRN is also launching a complementary Policy Brief that highlights key areas of consideration and provides recommendations.

INHSU 2022 Day 1 – Key Reflections

 

We are excited to be attending the INHSU 2022 conference in Glasgow, and want to share some key reflections and images from day 1 (October 18th) as shared by Graham Shaw and Roberto Perez.

At the opening, the Scottish Government’s Minister for Public Health, Women’s Health and Sport, Maree Todd, stated that Scotland was close to halving viral hepatitis C (HCV) prevalence and by as much as 60-70% in some parts of the country. However, she also noted that HCV incidence remains high.

Jason Wallace of the Scottish Drugs Forum (SDF), speaking on behalf of the community of people with lived and living experience, outlined the main points from the statement developed by the community forum the previous day. Of particular note was that research must be controlled by the community, including the early involvement of the community in developing all aspects of a research proposal, as well as ownership of research data. He also stressed that poly drug use is the norm, not the exception. The community also demands a defined role of volunteers as well as to be paid equally for being employed in research work, as well as a clear pathway for peer workers to progress in drug-related programmes, together with proper supervision and support within such organisations.

In Andrew McAuley’s presentation, he spoke of the increasing global trend in drug-related deaths (DRD) which have roughly doubled over the past 30 years and exponentially increased since 2014 and that this trend has further climbed since the COVID-19 pandemic, with the USA and Scotland the stand-out leaders in the rate of DRD. Medically Assisted Therapy (MAT), also known as Opioid Agonist Therapy (OAT), Take-Home Naloxone (THN) were notable responses to opioid-related prevention of deaths and Direct Acting Antivirals (DAA) for the treatment of HCV. Drug Consumption Rooms (DCRs) and Drug Checking Services (DCS) are also key to the prevention of DRD but that there are gaps in evidence.

Niamh Eastwood of Release UK outlined the various aspects of how the war on drugs has failed and how non-white people were clearly being targeted by law enforcement agencies who use the war on drugs as an excuse to stop-and-search non-white people around nine times more often than they do with white individuals. However, advocacy continues to push for the decriminalisation of drug use and possession for personal use, including the cost savings arising from decriminalisation. A picture from the presentation is included below.

Impact of the Russian invasion on ART and OAT access by PWID in Ukraine

Jack Stone of the University of Bristol outlined the impact of disruptions to services for people who inject drugs due to the Russian invasion of Ukraine. Modelling shows that short-term closures of interventions could have a substantial impact on the increase in HIV infections even though OAT and ART access continued to increase outside of conflict areas but reduced in the areas invaded by Russia, partly a result of a drop-off of NGO service provision in such Russian-controlled areas of Ukraine. Images from the presentation are included below.

‘What the fresh hell is this?’

Presented by Garth Mullins, the producer of the Crackdown podcast based in the USA. The session discussed the ever developing emergence of new substances promoted through the consequences of prohibitionist policies, as seen originally in the early 20th century in the USA with alcohol. Particular focus was given to ‘benzo-dope’ and how naloxone responses to overdose only impact the ‘dope’ component and not the benzo’s, leaving people with severe memory loss from a few hours to several days. Contributors provided their own ‘benzo-dope’ overdose experiences, including Jason Wallace of the Scottish Drugs Forum who said that Benzos were implicated in an ever increasing number of drug-related deaths. Angela McBride of the South African Network of People who Use Drugs outlined the impact of alcohol and cigarette prohibition in South Africa during COVID-19 lockdowns but that such experience has been easily forgotten. Sione Crawford of Harm Reduction Victoria, Australia as well as Mat from the Canadian Association of People who Use Drugs (CAPUD) all noted the need for a safe supply to reduce overdose events and continued failure to provide a safe supply of substances will allow the black market to prevail and the resultant high levels of drug-related deaths.

HCV care models

Several different examples of HCV care models were presented from South Africa, Iran and Scotland. In all three countries, services were based within the community through building relationships and keeping each step as simple as possible; such an approach helps to reduce the level of stigma and discrimination experienced by people who inject drugs. In Dundee, Scotland, building such relationships helped move from confrontation to cooperation, such as in interactions with a local pharmacy, as well as the inclusion of other health interventions, such as wound care. In Rafsanjan, Iran, a local entrepreneur helped to fund a local response to provide HCV testing and treatment, with the local community identifying an unused bus that was repurposed and used as a mobile HCV unit. The local service was linked with the University of Medical Sciences and this model of micro-elimination of HCV is now being considered for implementation throughout the country. In South Africa, it was noted that advocacy can result in positive change in service provision and SANPUD capacitates fellow networks and organisations to pressure decision-makers for change to allow improved access to HCV testing and treatment services.

Individual choice

The choice of which opioid maintenance approach is appropriate for the individual was discussed within the context of Switzerland and Australia. A relatively wide range of options are available in Switzerland. The process of supporting an individual includes the person’s preferences as to which opioid agonist should be tried, with examples given for various substances available in Zurich and Arud. The future directions beyond medical treatment were also outlined within the context of the changing legislative environment. Key elements of effective OAT were presented together with approaches to the continued use of other substances by an individual.

In Australia, choice is often associated with not being chained to a pharmacy as well as the endemic stigmatisation of people who use drugs. In addition, there are social aspects to using substances and the medicalisation of treatment often negates this component and options also include the continued use of drugs. Also stressed during the discussion was the apparent fear held by prescribes of being held liable if an individual overdoses and the belittling view of people who use drugs held by legislators that results in unreasonable and excessively tight controls being in place for opioid maintenance.

The social sciences perspective of individual choice was reviewed and the key factors that influence individual preferences were outlined. Considerations that ‘professionals’ can make to facilitate choice by the individual were also provided.

Differentiated choice of the best suitable agonist were discussed. The first priority has to be the preference of the person in treatment; subjective experience and side effects are often overlooked and not addressed.

Long acting full agonsists include;

Long acting partial agonist;

Key elements of effective OAT;

On Top Use of other Substances;

“How can professionals enable choice in OPT decision making?”

To the extent possible;

Key factors influencing patient preferences;

Systematic Review of Qualitative Research on Substance Use Among Refugees

A new study evaluating qualitative research on substance use and substance use disorders among refugees in terms of practitioners’ and substance users’ attitudes, beliefs and experiences.

The study looks at how the available qualitative research contributes to understanding the development, explanation, consequences and treatment of substance use among refugees. As well as this, the study also hopes to inform the best practises in qualitative interviewing techniques when working with refugees; as this group are vulnerable to stress triggers, and could potentially find the process traumatising.

Refugees are at high risk for substance use and substance use disorders and often face high barriers to treatment and interventions in host countries.

The study looks at a range of different populations, listed below, to try and gain a wide range of experiences and insight from around the world.

This figure from the paper illustrates the number of qualitative studies conducted among different refugee communities between 2008 and 2021.

Open Call: C-EHRN Expert Groups & Consultations

As part of our 2022 work plan, C-EHRN is working with different Expert Groups and will organize consultations addressing a variety of topics. With this open call, C-EHRN would like to invite all its members and partners to engage and participate in these Expert Groups and Consultations based on their interest and expertise in any of the following areas:

  1. Hepatitis & Drug Use
  2. Coverage of Harm Reduction in Europe
  3. New Drug Trends
  4. National Harm Reduction Networks
  5. Harm Reduction in Prison and other Custody Settings
  6. Integrated & People-centred Care Models
  7. Community-based & Community-led Research

If you wish to participate, we invite you to express your interest and share a brief description of your area of expertise [max. 100 words] through the following email: administration@correlation-net.org before the 31st of July 2022.

Key Principles of Harm Reduction in Homeless Settings

Check out the HR Key Principles, our key innovative output which translates the learnings of the HR4homelessness project into guidance for homeless and other services who support people in homelessness

The HR Key Principles translate the learnings from the ‘HR4homelessness’ Project, which brought together homeless and bustance use services, into guidance for homeless services to improve support provision for people who use drugs and/or alcohol.

For each of the seven principles, strategies for improving support provision are described as well as existing good practices. We provide suggestions for tools that can be helpful for staff and service users, suggestions for further reading and link you up to the respective training video(s). The seven principles are:

  1. Human Rights based service provision: HR aims at establishing quality of individual and community life and well-being – not necessarily abstinence of all drug use – as the criteria for successful actions and policies. HR calls for a non-judgmental, non-coercive access to support and care.
  2. Meaningful engagement of service users: HR engages and involves people with lived experience of homelessness and substance use in the development and evaluation of policies, services and programs that affect them. This is essential for achieving  good social and health outcomes and addressing unmet needs.
  3. Reduce risks and harm: HR focuses on reducing the harms related to substance use for the individual and the broader community. It takes into account factors that may exacerbate vulnerability such as trauma, incarceration history, racism, social disadvantage, housing status, age, sexual orientation and gender.
  4. Take on a pragmatic attitude: HR accepts that licit and illicit substance use is part of our world. HR reflects the idea that none of us will ever achieve perfect health behaviors and that ‘perfect’ health behaviors are impossible to define as they are shaped by social determinants and norms.
  5. Person Centered Services: HR services focus on responding to the needs, preferences and values of the individuals and communities they work with. This includes the recognition of the social conditioning of health outcomes, addressing power relationships between care providers and service users, and the promotion of communication and shared decision-making.
  6. Evidence-based services, strategies and policies which are relevant and effective to the communities they serve and which are regularly evaluated and, if necessary, adapted.
  7. Accountability: HR aims to minimize not only the negative health and social impacts associated with drug and alcohol use, but also the harms caused by respective policies, laws, services, and institutional practices. HR promotes processes and systems designed to hold individuals and groups in check for their decisions and actions.