Get to know the work of Drogenberatung e.V. Bielefeld | Interview with Jan-Gert Hein

Drogenberatung e.V. Bielefeld joined Correlation – European Harm Reduction Network as a Member and Focal Point supporting the data collection for the Civil Society Monitoring of Harm Reduction in Europe in 2023. Below we bring an interview with Jan-Gert Hein, a member of the board of directors, to introduce the work of the organisation and why they find it relevant to be part of our Network.

Could you tell me about the work of your organisation?

The Drogenberatung has been running for about 50 years already. We are running several facilities that offer services for people who use drugs. We have different advice centres in Bielefeld and also in a town in a more rural area around Bielefeld called Detmold.  Besides these, we run a drug consumption room (DCR) that is connected to an advice centre and a doctor’s office that offers opiate substitution. In one of our advice centres in Bielefeld, we have an office for prevention work as well. We also have an advice centre that works on a more structural level and is focused on gambling addiction in North Rhine-Westphalia.

What harm reduction activities do you carry out?  

The biggest one is the DCR we are running where we have about 40,000 consumption processes per year. We also do street work where we offer syringe exchange programs and deliver harm reduction material to people who want our help. In terms of harm reduction, we are also running a very low-threshold hepatitis C detection program. People can get a PCR test for hepatitis in our DCR, and know if they are hepatitis C positive and if it needs to be treated.

What populations do you focus on? 

Our main focus is on people who use drugs, not only in the Bielefeld area but also in Detmold. We also work in several prisons around here, there is also a big group of clients we are focusing on. Most of them are currently using drugs or are relatives of people who use drugs. We also work with people who used drugs before but quit.

Would you tell us more about the work that you do in prisons?

In Germany, prisons have to offer advice to people from outside of prisons, they have to work together with drug advice centres and organisations like ours. We work in several prisons with different structures. Some of them are closed, but some of them have an open structure. Inside the prisons, we offer general advice. We inform people about harm reduction services outside of prison, but also of methods they can use inside the prison.

Another basic thing we do is to help people get into therapy. In Germany, there’s a law that offers the option to do therapy instead of staying in prison if a person commits a crime because of an addiction. That needs to be clarified by the court. If that happens, people have the option to do therapy and leave prison. We help people to get out of prison and into therapy.

Are there any other interventions that are not directly harm reduction-related that you would like to highlight? 

I think the biggest standout in our facility, the Drogenhilfezentrum (drug aid help centre) is that we combine different aspects of our work there. We combine treatment with the doctor’s office and care options for people with the possibility to get food, drinks, relax and rest. Besides that, we offer a drug consumption room and an option to seek advice. So we have an inclusive offer that people can use.

When we look around in Germany, we see that this concept works out, to have it all in one place so people don’t have to visit different facilities to get the help they need. Combining these key factors, treatment, care, and advice, is a very effective way to promote health for people who use drugs and especially for people who are experiencing homelessness. That’s what makes us kind of unique, and we have very good experiences with having everything in one place.

Is there any aspect you are especially proud of and would like to share about?

The Drogenberatung itself has been running, as I said, for about 50 years already. We started with opiate substitution in the 80s and we have a really good network in Bielefeld that is run by the Drogenberatung. I think what makes us special is that we are a really good networker. We have networks with prisons, with doctors, with people from almost every community. That is something we really benefit from as an organisation.

We have a really good network around Germany as well, we also keep in contact with other organizations which are not in or around Bielefeld. That’s how we got in contact with the European Harm Reduction Network, for instance.

Why do you find it relevant to be part of the Correlation – European Harm Reduction Network?

Our motivation to join the network was that we noticed that networking is everything, especially in fields of work where you don’t have that many organizations or structures you can rely on. I think that is something that the harm reduction network provides, to seek information and talk to people who have the same struggles as you do. That is something I look forward to.

I’m excited about meeting everyone else and getting in contact because it’s on us. In Germany, we have a far-right party that did well in state elections last year and we see that our work is getting politically and therefore financially under pressure. I think that is something that a good network can help you to endure.

What does harm reduction mean to you?

Harm reduction is the basic pillar of our work because if we can’t reduce harm, people endanger themselves. Harm reduction is the first thing that needs to happen for people to get more options. Harm reduction is the first step, not only when we look at the population in Bielefeld, but also if we look into prisons and other settings. It is the first step of everything.

Recording – City Report Launch | Civil Society Monitoring of Harm Reduction in Europe

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

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.

Panellists:

 

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.

City Report – Warsaw. A critical review of the harm reduction landscape in the district of Praga

Despite a recent boom in gentrification, Praga – one of eighteen districts comprising the city of Warsaw, is witnessing an escalating problem with homelessness, street drug use, and drug-related violence. OAT services in Warsaw have been purposefully accumulated in the Praga district, with the aim of concentrating service users in one spot, away from the city centre. People who use drugs in Praga are subject to fear, intimidation and acts of violence, with around 1200 individuals accessing OAT services in Praga alone. An increase in migration in recent years has increased pressure on these services and the profile and needs of service users has changed significantly. Local residents’ discontent and hostility towards people who use drugs has led to opposition against further treatment and harm reduction centres, fueling further support for punitive responses. The report urges policymakers in Warsaw to take drug policy seriously, calling for collaborative efforts that prioritise health, safety, and human rights for people who use drugs.

 

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.

EFUS Security, Democracy and Cities Conference

On the 20th and 21st March, our Policy and Project Support Officer, Arianna Rogialli, attended the EFUS Security, Democracy and Cities Conference in Bruxelles and took part in the panel discussion on Drugs and Harm Reduction moderated by Laurent Maisse, Deputy Director of Transit ASBL and together with Nadia Zourgui, Deputy Mayor of Strasbourg and José Martinez Espasa, Chief Commissioner of the Gandia Local Police.

The session focused mainly on the challenges that cities face when providing support to people who use drugs, people who are experiencing mental health challenges or other marginalised populations while coordinating different social support services and communicating to the public about them.

During the session, C-EHRN emphasised its dedication to organising collaborative initiatives with city-level actors in the harm reduction field, including mayors, policymakers, and civil society. We also highlighted the urgent need to eliminate barriers to accessing mental health support services and to support and fund low-threshold services that can better reach and assist people who use drugs and are experiencing mental health challenges. Furthermore, we drew attention to the importance of funding harm reduction services. We also shared best practices for effective communication about harm reduction and neighbourhood cooperation between harm reduction services, residents, and business owners.

During the second day of the conference, we had the opportunity to visit the drug consumption room Gate, which is a member of the European Network of Drug Consumption Rooms [ENDCR], and the day and accommodation centre operated by Transit ASBL. Alongside the drug consumption room, Gate offers weekly drug-checking services, opportunities for testing for communicable diseases and community activities.

 

Recording – Roundup Webinar | Civil Society Monitoring of Harm Reduction in Europe

 

The video is the recording of the webinar organised to celebrate the core publications for the C-EHRN Civil Society-led Monitoring of Harm Reduction in Europe that took place on the 7th of March.

The event brought together four volumes of the 2023 Data Report:


Moderator: Rafaela Rigoni (C-EHRN)

Speakers:
Iga Jeziorska (C-EHRN) – Essential Harm Reduction Services
Tuukka Tammi (THL) – Eliminating Hepatitis C in Europe
Daan van der Gouwe (Trimbos) – New Drug Trends
Guy Jones (TEDI) – Drug Checking Observations and European Drug Checking Trends via TEDI

 
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.

Essential Harm Reduction Services: Report on policy implementation for people who use drugs

In 2023, C-EHRN and its members assessed the state of essential harm reduction services in European cities for the fourth time as part of the Civil Society-led Monitoring of Harm Reduction In Europe, with 35 cities responding to our survey in 30 countries. You can now download the resulting publication, Essential Harm Reduction Services: Report on Policy Implementation for People Who Use Drugs, and read the interview with Iga Jeziorska, C-EHRN’s Senior Research Officer and the primary author below.

Which type of harm reduction services are most lacking in the cities that contributed to the report?

The ones that are not that well established are those not related to the prevention of infectious diseases as closely as needle and syringe programmes and are not aiming to minimise injecting use like opioid substitution treatment does. Namely, drug consumption rooms and drug checking are lacking in Europe overall the most. This underdevelopment of DRCs and drug checking may become a serious problem, especially in the context of the opioid crisis that we might be facing very soon.

Another problematic issue is harm reduction services in prison. Except for opioid agonist treatment (OAT), this is also an area where there are very big gaps in the service provision in terms of harm reduction. OAT is officially available in prison in most cities, but that doesn’t mean that it is easily accessible everywhere. We know that in Budapest, Hungary, for example, it is theoretically available, but there are no records of people using the service, and definitely not because there are no people who use opioids in prisons.

What would you highlight regarding the barriers in the outreach of harm reduction services based on the findings?

Funding, lack of political will and lack of or insufficient involvement of people who use drugs in services were reported as the main barriers to reaching out to specific subgroups of people who use drugs. Of course, all of these aspects are related to one another. Funding is an evergreen topic which is always there, and the lack of or insufficient funding is a direct consequence of the lack of political will. If there was political support for harm reduction, there would have been funding as well.

 

Are there any main differences in the availability, accessibility and quality of the services between the cities of the focal points?

On the one hand, we have opioid agonist treatment, needle distribution programs and all of the infectious diseases-related services, such as testing and treatment. These are well-developed in general in terms of availability, accessibility and quality.

On the other hand, there are some more innovative services that maybe, as I said before, are not that much connected, at least in the minds of the general public and the policymakers, with direct prevention of infectious diseases. These services that go beyond the ‘traditional’ harm reduction and focus primarily (but not exclusively) on overdose prevention are the drug consumption rooms (DCRs) and drug checking. These are in general more available in Western European countries. Snorting kits, kits for smoking, and fentanyl strips are also less available and accessible.

There are no DCRs in Central-Eastern Europe and Western Balkans. They are quite well developed as a network in Germany, Switzerland, Spain and maybe two other countries. In some countries, such as Greece or Portugal, there are one or two services. Drug checking is similar. There is a clear division between Central-Eastern Europe and Western Balkans on the one hand and Western Europe on the other,  in terms of service scope, service accessibility, low versus high threshold of various services, and the very service existence in the first place.

Harm reduction is chronically underfunded everywhere, but that means something different in the West and in Eastern-Central Europe and Western Balkans. In the East and Southeast, underfunded means that an insufficient number of services are operating or – in extreme cases – they are not funded for several months in a year because there are gaps between grants. Underfunded in the West seems to mean mostly that services don’t have enough funds to develop the offer, scale up activities and broaden their scope. We can also see that in the West, in general, services are more integrated into the health and social care systems, and in the East, they are more standing alone. One of the worrying phenomena that we observed this year, however, is the extremely low availability and accessibility of social integration services, such as housing, income generation and employment, and legal support. Furthermore, for the two latter types of services, we’ve observed significant deterioration in availability over the last couple of years.

We also know from the previous Monitoring edition that there are divisions between the urban and rural areas. Services are focused and concentrated in big cities, and they are lacking in the countryside. The question is also to what extent they are needed in the rural areas, as we also know that the concentration of people who use drugs is also in bigger cities. Some level of services is necessary in rural areas, but what level of availability and accessibility is necessary is something that would require additional assessment.

 

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

We are trying to follow the requests of the Focal Points in terms of the focus and to make our assessments address the topics that are important to people at any given moment.

When it comes to using the report in advocacy efforts, harm reduction organisations can use it to highlight cities and countries that can serve as good practice examples, like Bern or Amsterdam, with holistic, integrated services. The report is a general overview of the situation in Europe, and it can serve as a starting point in orienting oneself in what’s happening in different cities.

In the context of talking to policymakers, the report – in conjunction, for example, with the European Drug Strategy, which calls for scaling up harm reduction services – can help to showcase the gaps in harm reduction services at the city level compared to what is declared by a country or a city in official policy documents. This can potentially be quite a powerful tool in helping organisations in their advocacy efforts.

 

What do you think is the added value of civil society-led monitoring in comparison with other types of monitoring done by major agencies?

One of the added values is trust and the hands-on experience of our Focal Points, and the related kind and detail of the information collected. Civil society organisations are close to people who use drugs, and people who use drugs trust them enough to share honest information. For example, from the point of view of drug checking, this means that we can have very detailed information on how people use drugs, what drugs they use, in what contexts, etc. This is in sharp contrast, for example, to wastewater analysis that can tell us how much cocaine is in the wastewater but cannot provide information about the people who used it and the circumstances, if they used it at all.

For our monitoring, we collect data in a way that is contextualised. This is quite different from data collected, for example, by the national Reitox focal points that focus on the existence of services and perhaps the number of services.

On the other hand, when we ask to what extent particular types of services are available to specific communities and to what extent they are accessible, we implicitly include the element of the needs. That is this contextualisation of data that I mentioned, which includes additional information. For example, seven services existing in one city can mean something completely different than the same number of services in another city because the needs are different, and this is what we address with our monitoring. This is one of the main values of C-EHRN monitoring compared to other data.

Another point is focus on the city level. Most data is collected by European agencies and country governments is collected at the national level. Our data is collected at the city level, which is important primarily because the implementation of drug policies is done mostly at the local level in European countries.

We are also quite timely with our data. We are now at the beginning of 2024, and we are reporting on the data between 2022 and June 2023, a bit over one year of delay in reporting. This is also something that makes us different, less bureaucracy and resulting quicker data processing give us the possibility of being quicker with our reporting.

 

Would you pick one graph that you find significant and explain why it is relevant?

All of them are significant in their own way. What I would suggest is Figure 9 on service delivery for ageing people who use drugs, a category that we introduced last year.  Ageing people who use drugs are becoming a more and more significant group among the clients of harm reduction services all over Europe. The people for whom the first harm reduction services were established in the 1980s are ageing, and there is an increasingly recognised need for developing and adjusting services to their needs, which significantly differ from those of the other subgroups, and there hasn’t been sufficient focus on them so far.

Another question that we asked last year for the first time is the extent of involvement of people who use drugs in service governance, service implementation and evaluation. There are very few cities where people with living and lived experience are involved in the governance of services. They are involved in implementation and, to some lesser extent, in evaluation but not really in the governance of organisations and services. This is something that we need to keep monitoring. The debate about community involvement, community empowerment and community-led services is very lively across the continent, but we are still not there yet in terms of practice of harm reduction services functioning. We should keep a close eye on this and possibly combine the monitoring with capacity-building efforts to improve the involvement of people with lived and living experiences in services.

 

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.

#CEHRNAthens22 Article and Video by DrugReporter

During the #CEHRNAthens22 meeting, DrugReporter made an informative video of the visit to the drug consumption room OKANA.

Péter Sárosi has written an informative article about his experience at the CEHRN Athens meeting earlier this month, alongside a video showing an inside look at the OKANA drug consumption room.

The Organisation Against Drugs (ΟΚΑΝΑ) was established pursuant to Law 2161/93 which was passed unanimously by the Greek Parliament, and has been operational since 1995 as a legal person that is governed by private law and reports to the Ministry of Health and Social Solidarity.

Its constituent instrument stipulates that OKANA shall:

  • plan, promote, coordinate and implement a national policy on prevention, treatment and rehabilitation of drug addicts
  • address the drug problem at a national level, provide valid and documented information, and raise public awareness
  • establish and effectively manage prevention centres, treatment units and social and professional reintegration centres

OKANA has always endeavoured to combine the roles of national coordinator and services and programmes provider in the fields of prevention, treatment and reintegration.

We are thankful to OKANA for inviting us to have a look at their way of working, and showing us their innovative technology used on site. Their drug consumption room is the first of its kind in Greece, and we hope sharing the amazing work they are doing will bring new opportunities for more, much needed, drug consumption rooms to open in Greece.

Statement: Harm Reduction Must Go On!

Correlation – European Harm Reduction Network and the Eurasian Harm Reduction Association, together with the Rights Reporter Foundation, published a joint position on the continuity of harm reduction services during the COVID-19 crisis.

Download the English, Russian, German, Portuguese, Spanish, Polish, Hungarian, Czech, Montenegrin PDF version here!

People Who Use Drugs (PWUDs) can be considered as a risk group in the COVID-19 epidemic. They often live at the margins of society with low or no access to housing, employment, financial resources, social and health care, and face systematic discrimination and criminalisation in the majority of countries. Many of them have multiple health problems, which can increase the risk of a (fatal) COVID-19 infection (including long-term diseases such as COPD, HIV, TB, cancer, and other conditions which reduce the immune system). Harm reduction services are often the one and only contact point for PWUDs to access the health service. They provide health and social services as well as other basic support, and function as an essential link to other life-saving services. We call on local and national governments and international organisations introducing safety measures and to:

1. Ensure the continuity and sustainability of harm reduction and other low-threshold services for PWUDs during the COVID-19 epidemic. This includes, in particular, Opiate Substitution Treatment (OST), Heroin Assisted Treatment (HAT), Needle and Syringe Programs (NSP), naloxone provision, and continued access to Drug Consumption Rooms (DCRs). In addition, essential basic services need to be provided, including day and night shelter, showers, clothing, food, and other services. This is of particular importance to those who experience homelessness and/or live on the streets.

2. Provide adequate funding for harm reduction and other low-threshold service providers, and supply them with adequate equipment to protect staff and clients from infections (soap, hand sanitiser, disposable face-masks, tissues etc.).

3. Acknowledge the important and critical role of harm reduction and other low-threshold services in the COVID-19 pandemic and address the specific vulnerable situation of PWUDs and other related groups.

4. Develop specific guidelines and regulations for harm reduction services, with respect to the vulnerable situation of PWUDs and related target groups. These guidelines should be developed in close cooperation with involved staff and the affected communities, and build on international WHO guidelines, recommendations, and evidence and/or national COVID-19 regulations.

More specifically we call for the following:

5. OST and HAT should be maintained and take-home regulations should be established or extended for patients to have the opportunity to come for treatment rarely then ones a week. Access through pharmacies should be ensured.

6. NSP should provide PWUDs with larger amounts of needles, syringes, and other paraphernalia to minimise the number of contacts. Special bins for needles and syringes should be provided to collect used material at home.

7. Harm reduction services should provide COVID-19 prevention material and information for staff, volunteers, and service users, including soap, alcohol-based hand sanitisers that contain at least 60% alcohol, tissues, trash baskets, and disposable face-masks (if this is requested by national regulations), for people who show symptoms like fever, coughing, and sneezing.

8. Drop-in services, day shelters, and DCRs should advise and support PWUDs in preventing COVID-19 infections. Visitors should be made to sanitise their hands when entering and should stay no longer than is absolutely necessary. Kitchens can prepare take-away food to be eaten outdoors. All necessary measures should be made to increase social distancing among visitors/staff with all possible means, and rooms should be ventilated. Overcrowding in harm reductions services, shelters, and DCRs should be avoided, by establishing safety measures, e.g. minimising the duration of stay, maximum number of visitors, entering only once per day. People with permanent housing should be encouraged to stay at home and come only to pick up needles and other harm reduction paraphernalia and tools.

9. The health situation of PWUDs should be monitored closely. If someone shows symptoms, such as fever and coughing, face-masks should be provided and a medical check-up should be ensured. Cooperation agreements with public health services, related health units, and hospitals need to be established to ensure direct medical support, follow up care, and treatment.

10. Night shelters need to be made available for people experiencing homelessness, with a separation in place between those who are not infected and those who are infected and need to be quarantined but do not need specific medical care and treatment in hospitals. Night shelters have to comply with the overall safety regulations for COVID-19, and people should not be exposed to additional risks for infection through overcrowding and insufficient health care.

11. Group-related services, such as meetings and consultations, should be cancelled and postponed until further notice or organised as online services. New treatment admissions should be temporarily suspended. Coercive measures (e.g treatment referrals made by court/prosecutor/police, probation officer visits etc.) should be suspended. Mandatory urine sampling should be abolished.

12. Harm reduction services should establish a safe working environment and make sure that staff are well informed and protected against infection. Service providers should identify critical job functions and positions, and plan for alternative coverage by involving other staff members in service delivery.