In the context of strained healthcare systems and shifting priorities, mainly due to the COVID-19 crisis, it is essential to ensure that the importance of efforts to eliminate HCV is not forgotten. If anything, the current pandemic should underline the need for widespread and effective public health responses whilst decision-makers must critically keep on prioritising HCV.

We were one of the official partners of the 3rd EU HCV ELIMINATION POLICY SUMMIT, which took place in late March and ended up with a Call-to-Action.

The Call-to-Action was signed up by 16 initial networks, group and calls, among others, to make hepatitis C elimination in Europe an explicit and adequately resourced public health priority. What is remarkable from the viewpoint of C-EHRN is that significant institutions, hepatitis patient groups, and community networks call for decriminalisation of drug use for the first time.

“Remove barriers to people who inject drugs (PWID) accessing care, including decriminalisation. Political resistance to harm reduction services is a major barrier to appropriate access to hepatitis C prevention services for PWID, as are laws and policies which criminalise drug use, drug possession, and drug users. [12] In line with community statements and the European Association for the Study of the Liver’s (EASL) policy statement, [12] we, therefore, call for the decriminalisation of minor, non-violent drug offences and call for political support for harm reduction services in all European countries.”

following the statement of the European Association for the Study of the Lever: https://easl.eu/news/policy-statement-drug-use-hep-c/

“The major barrier to appropriate access to hepatitis C care is political resistance to harm reduction services, as well as laws and policies which criminalise drug use, drug possession, and drug users themselves. To reach the desired WHO goal, combining decriminalisation of personal drug consumption and integrated interventions that include hepatitis C testing and treatment should be implemented”.

Again, meanwhile, harm reduction and drug policy reform activists argue for many years for these measures, it is crucial to get support from the broader public health audience regarding one of the main barriers for people who use drugs to access adequate health services.

Eberhard Schatz
C-EHRN, April 2021

The Drug Policy Network South-East Europe (DPNSEE) have completed their analysis of the data on drug-induced deaths in Serbia 2008 – 2019. They have also recently published their report, in Serbian and presentation, in Serbian and English.

Their collected data are highly trustworthy yet not satisfyingly in-depth despite their various resources, and there are still no data about the influence of coronavirus on Serbia’s reported cases. However, the Analysis worryingly points out that more deaths could potentially be expected due to additional risk of overdose and intoxication caused by mental health problems, usage of any available drug at-reach, mixing them also with alcohol and legal drugs, lack of support, basic income and proper nutrition, etc.

Besides, even though naloxone is luckily legally used in Serbia, only by emergency ambulance staff, civil society organisations’ proposal on widening its availability has sadly been rejected.

Read the DPNSEE article
Read the presentation

Building a fairer, healthier world
Today we celebrate World Health Day 2021, with its motto ‘Building a fairer, healthier world’ during an unprecedented global pandemic. COVID-19 has hit all countries hard, with no exception. However, its impact has been most felt on those communities which were already in a vulnerable position. During this period, People Who Use Drugs were less likely to have access to quality health care services and more likely to experience adverse consequences as a result of the measures implemented to contain the pandemic, which has not only been unfair but preventable.

With this reality as its context, C-EHRN has recently published the Civil Society-led Monitoring of Harm Reduction in Europe 2020. This report gathers data on the experiences of harm reduction service providers and People Who Use Drugs at ground level in 34 European countries/cities via C-EHRN Focal Points. Through this publication, C-EHRN brings forward the voices and experiences of the front line regarding the implementation of drug policies and harm reduction. In this way, C-EHRN contributes to monitoring existing social and health inequities in Europe and supporting People Who Use Drugs to access quality services when and where they need them.

On this World Health Day, C-EHRN would like to take the opportunity to highlight the importance of timely and reliable data collection through the lens of civil society organisations and communities as a means towards assessing inequities and taking actions that have an impact.

Essential Harm Reduction Services in Europe
The Civil Society-led Monitoring of Harm Reduction in Europe 2020 shows that, although Europe represents one of the world’s regions with the greatest number of harm reduction services, geographic gaps and an uneven distribution of services continue to exist. Almost half of the countries worldwide where Needle and Syringe Exchange Programme and Opioid Substitution Treatment are available, are in Europe. Besides, ten out of twelve countries with officially sanctioned drug consumption rooms are European. Nevertheless, coverage of harm reduction services in Europe is still insufficient, especially to some sub-groups of people who use drugs such as women who use drugs, gay, bisexual and other men who have sex with men, people who use stimulants or non-injecting methods of drug use, people experiencing homelessness, and migrants in Western Europe. Stigma and discrimination against people who use drugs still hinder their access to care.

Hepatitis C & People Who Use Drugs
Despite the fact that people who inject drugs account for most new cases of hepatitis C virus (HCV) infections in Europe, HCV testing and treatment for people who inject drugs remains insufficient. Even though people who inject drugs are part of guidelines for testing and treatment in most European countries, there are barriers to its access in practice. HCV treatment may be only prescribed by specialists (as in 9 out of 34 cities partaking the Monitoring) or may not be possible outside of a specialised healthcare system (7/34). People who are currently using drugs might be prohibited to access HCV treatment, or it may be available only for those engaged in an Opioid Substitution Treatment programme.

Overdose Prevention
Overdose prevention also needs to improve in Europe. Drug overdose is a major cause of death in Europe, especially among young people. Naloxone, a life-saving drug able to revert an opioid overdose, is available in 80% of the cities partaking C-EHRN Monitoring. However, in the majority of cities it is available primarily to the medical staff at hospitals, ambulances, or in harm reduction services. Naloxone and take-home naloxone must also be widely available to harm reduction staff, and directly to people who use drugs, and their families and friends. Besides, most overdose response training and prevention campaigns focus on people who use opioids only, leaving unattended the increasing number of people who use stimulants and other New Psychoactive Substances. Stigmatisation and criminalisation of people who use drugs remain a challenge to overdose prevention since several people do not call for help or report an overdose in fear of punishment.

COVID-19
Particularly during the COVID-19 pandemic, people who use drugs reported an increase in police harassment and violence and difficulties to access basic needs due to lack of informal work and/ or tourism/ lack of money in general. On the other hand, some cities finally saw an increase in housing availability for people in situation of homelessness, and Opioid Substitution Treatment access became easier for many. These positive trends show that, with the right political will, services can be upscaled and threshold can be lowered, so more people who use drugs can be integrated into care, and the human rights of people who use drugs can be supported and secured.

This is our second civil society-led monitoring of harm reduction report. With more than one hundred contributors and Focal Points from 34 European countries involved, the report aims to make a necessary and useful contribution to the development of drug policy in the region.

Compared to 2019’s report, the information provided in 2020, brings to the forefront of the situation in particular cities or regions showing the experiences of harm reduction providers on the ground. We also bring direct perspectives of people who use drugs. This significant approach will hopefully provide an understanding of the successes and challenges of drug policy and harm reduction implementation.

Hereby, we would like to thank all contributors for their great work and commitment.

We will use the insights and information collected in this report within our advocacy efforts to strengthen harm reduction policies in Europe and, we hope that you will do the same at a regional and national level.

Monitored Focus Areas:
Participation of Civil Society Organisations in policymaking
Essential Harm Reduction Services
Hepatitis C
Overdose Prevention
Highlights in New Drug Trends
COVID-19 and Harm Reduction

Read the Report

Europe represents one of the regions of the world with the greatest number of harm reduc­tion services.

There is no other region in the world where more than 90% of the countries have at least one NSP or OST site, and more than 90% of the countries reference harm reduction in their national drug policies. Nevertheless, stigma and discrimination against people who use drugs continue to exist, and much is needed in terms of supporting and securing access to services and human rights to all different groups of people who use drugs.

More such data can be exclusively found in the executive summary of the report.

The Executive Summary will soon be available in the following languages, including specific data per respective country:
Czech, French, Italian, German, Portuguese, Spanish, Romanian, and Russian (in alphabetical order)

Read the Executive Summary

This month, Richard Braam, an independent researcher, completed the evaluation report on our work, accomplished in 2020. It has not only given us even more ideas for our future plans but also a great reminder of our efforts from a most challenging year. Below are a few of the affirming, confrontational and thought-provoking quotes from the Report.

“As a homeless service network, we are very much looking forward to continuing the collaboration as we think that there is a big need for capacity training on HR and drug use related topics among our members, which are (mainly) homeless services.”

“It has been a difficult year, very hard. The situation caused by COVID has caught us unprepared, therefore the effort has been double. From our institution, we appreciate all the support received from CN, the effort in the construction of bridges of COVID and harm reductions knowledge. The fact of being able to share has not only given us new points of view, but has also been able to reinforce our work.”

“Coming from a small country and introducing a new concept such as harm reduction applied to all drugs is a bit challenging, but your reports and outreach helps a lot to further strengthen my arguments :)”.

“What I have seen of your statements, I always agree with the message and find them well formulated. However, Europe can feel very abstract/distant in our daily work.”

Read the Report here

C-EHRN is partnering in a new EU project on Further Enhancing the Implementation of
Quality Standards in drug demand reduction in the EU (FENIQS-EU)

The project will focus on the actual application of quality standards and factors stimulating/hindering implementation. By identifying good practice examples and successful implementation models and strategies, key stakeholders (e.g. policymakers, service providers, end-users) will have access to do’s and don’ts for implementing quality standards in various areas of Drug Demand Reduction.

An implementation toolkit will be developed and field-tested, tailored to specific groups of stakeholders and presented in an accessible and comprehensible way to guarantee optimal utilisation.

Country representatives and civil society organisations will be involved throughout the project to maximise these stakeholders’ ability to share examples of good practice and implement the project’s recommendations in daily practice and at the local level.

The project starts in April 2021 and is led by the University of Gent, Belgium.
More information to follow.

With the words of the chair of our Steering Committee and the Program Director at ARAS in Romania, Alina Bocai:

“Since the end of the Global Fund Programmes on HIV in 2010, despite existing evidence on an HIV-concentrated epidemic among people who inject drugs (PWID) in Bucharest, Romania, there were minimal resources allocated to sustain HIV prevention services for PWID and no formal mechanism was developed for subcontracting the harm reduction services performed by civil society organisations. Insufficient and sporadic funding has been allocated by the Social Department of the Municipality of Bucharest and other districts’ municipalities of the capital city to NGOs. Still, the funding was rather focused on social assistance instead of health, it reached a deficient number of PWID (as the primary requirement was to have a nominal reporting system of clients based on ID copies), and it did not cover the entire costs of the harm reduction package. Central authorities such as the Ministry of Health have never funded HIV prevention services for key populations (including PWID) but has always counted on external financial aid (e.g. the Global Fund for HIV and TB grants) and NGOs as service providers in this field. In the last ten years, this resulted in variations in coverage, variations in the service package components, and, finally, many service delivery interruptions. The COVID-19 pandemic posed additional pressure on ARAS’ harm reduction services, leading to difficulties in running outreach activities and establishing direct contacts with PWID and increased programme costs caused by the COVID-19 protection equipment.

There is neither central or local government funding earmarked for HIV prevention services for key populations, including PWID, nor a funding mechanism for NGOs. Consequently, in early February, ARAS – the leading service provider in this field since 2001 with annual coverage of around 3,500 PWID – publicly announced the closure of its mobile unit service (as of 31 December 2020) due to the lack of funds. Additionally, the drop-in centre for vulnerable populations run by ARAS has also reduced its harm reduction activities for the same reason significantly. Carusel, the other service provider, is still on the market. They are reaching yet small numbers of PWID annually and currently face massive pressure from a higher number of clients. Also, syringes and needles are hardly accessible through the pharmacies’ network. 

The closure of these services has been brought to the attention of central and local authorities, national media and political leaders. National authorities came out with the same excuses we have heard for 20 years, either by blaming the small national/local budget available for health/social services or by accusing the legislation that does not explicitly provide the responsibility of the state to fund such services or the lack of an appropriate funding mechanism.”

Photo credit: Daniel Herard

The international strategy of criminalising the cultivation, manufacture, distribution and consumption of certain psychoactive substances has failed to achieve a ‘drug-free world’. Women are negatively and disproportionally affected by this policy approach.
Still, we think, there is a need to address the lack of attention on the experience of women, trans and gender-diverse people and the challenges accessing appropriate services, the stigmatisation and marginalisation resulting from engagement in illegal drug markets, as well as the violence they are exposed to.

For a more inclusive and fair world, for us all.
#IWD2021

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A couple of reads you might find interesting:
The Impact of Global Drug Policy on Women: shifting the Needle [open access]
Read here

2021 Report on gender equality in the EU
The commission has published its report, showing how the negative impact of the COVID-19 pandemic on women, as the pandemic has exacerbated existing inequalities in almost all areas of life.
Read here

Gender Equality Strategy Monitoring Portal [a resource]
The Commission will launch today this Monitoring Portal, to better track progress in the Member States.
Read here

On the A-gender: Community monitoring tool for gender-responsive harm reduction services for women who use drugs
The On the A-Gender: Community Monitoring Tool for Gender-Responsive Harm Reduction Services for Women who use Drugs aims to be a resource for community advocates to begin documenting, evidencing, and addressing the unacknowledged and unaddressed needs of women who use drugs. By doing so, community advocates can begin to identify areas and locales where gender-responsive services are severely lacking or identify services and programmes that can provide examples of good practice and be scaled up. The tool acknowledges the diversity and intersectionality of women who use drugs — including sex workers, lesbian and transwomen.
Read here

The Barcelona Declaration
In 2019, in February more than 40 womxn from Europe and Central Asia met in Barcelona to work together on intersectional feminism, drug policy, harm reduction and human rights, where the Barcelona Declaration was initiated.
Read here

The International Alliance of Women who Use Drugs
Read here