On the 8th of May 2024, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) organised a webinar to inform discussions on drug consumption rooms (DCRs). With the participation of our Head of Policy, Roberto Perez Gayo, the discussion reviewed current DCR models & three well-established examples from different European countries.
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
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!
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.
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.
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.
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!
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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
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.
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.
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.
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.
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.
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.
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.
To monitor new drug trends in Europe and complement the information gained through focus group discussions, C-EHRN’s 2023 Civil Society-led Monitoring of Harm Reduction in Europe includes two reports via the Trans European Drug Information Network (TEDI), drawing from data collected from drug checking services.
The snapshot report contains information from the first two quarters of 2023 for each drug where significant drug checking data exists in Europe. These are amphetamine, cocaine, ketamine, MDMA, methamphetamine, heroin, and general pages for benzodiazepine sedatives, novel stimulants and novel opioids. The multi-year report contains data since 2018 and aims to show the changes in drug markets over time.
Download the snapshot report and the multi-year report and read the interview with Guy Jones, TEDI’s data manager and the primary author below!
Drug checking services are an invaluable tool that are able to both monitor trends while also responding in real-time to mitigate the health impacts that emerging trends may have. They have unique insight into new trends as they can talk directly to service users to understand the real drivers of new consumption patterns and understand whether people are deliberately seeking out a new drug or if it is simply being added by manufacturers.
2023 has seen the market recover to pre-COVID trends of increasing strength of some drugs, presenting a significant risk that service users regularly underestimate.
Alongside this, there is major concern about the potential for changes in the heroin supply from Afghanistan and whether this could lead to a move to synthetic opioids as was seen in North America over the last decade.
Not really. Europe has a fairly consistent supply throughout the continent, however, there are consumption patterns that exist more in certain countries, such as a slightly higher prevalence of amphetamine in Eastern Europe.
When I first started working in the field, I never expected that we would find ourselves in a position where the major threat in the cocaine supply was because it was so strong and unadulterated.
The reports are often extremely interesting to service users and they can serve as an invaluable starting point for discussions about risk from adulteration but also about the role that tolerance plays in a service user’s experience of a drug.
Data is extremely useful for “calibrating” qualitative observations to help us understand whether they are accurate reflections of reality and tuning how we collect qualitative data to get more accurate information, faster.
Not a chart, but a number from the snapshot report. The median heroin sample contains just 17% purity, with huge variation. This variation already creates a risk for people who use heroin but it also means that organised groups wouldn’t have much to do to create a product that is much stronger and substitutes heroin for synthetic opioids. Experience shows us that law enforcement won’t reduce the health risk from this.
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.
