Uncategorised – Page 5 – European Harm Reduction Network

The fight for a Drug Consumption Room in Slovenia

With the words of our Focal Point in Slovenia, Katja Krajnc:

“In Slovenia, we still don’t have official DCR. Initial ideas of opening DCR in Ljubljana date from the middle of 90s. In 2004 NGO Stigma filed an official application for opening drug consumption room to the Governmental Office for Drugs, who unfortunately did not materialise the idea at the time. Shortly after, the Office was abolished and became a small part of Ministry of health. Four years later, in 2008 NGO Stigma (together with other NGOs and Union of non-governmental organisations working in the field of drug use and harm reduction) filed an amendment to Criminal Law to the Ministry of Internal Affairs, which led to change in Criminal Law in 2012. The new amendment states that provision of place for drug use is still criminal offence. However, if an organisation provides treatment programmes or a controlled space for drug use, it is no longer considered criminal offence. It is though obligatory that the programme is under the control of relevant medical institution.

In 2013, the Governmental Commission for Drugs confirmed a document, prepared by the National Institute for Public Health in cooperation with NGOs. This document determined theoretical and practical aspects of opening DCR in Slovenia. This document became a base for DCR to be one of Slovenian Nacional Programme priorities for Drugs, 2014 – 2020, and to be implemented in the Action Plan, 2015 – 2016.

After almost two-decades-long advocacy efforts and legal background setting, in 2015, the local NGO Stigma initiated the drug consumption room (DCR) pilot project in Ljubljana, funded for 18 months by the Ministry of Health.We planned to research the need for DCR from drug users’ perspective and prepare evaluation tool for the second part of the project when the DCR would be open for six months. Unfortunately, the opening never happened. Due to lack of finances, we could recruit only one person – medical staff for full and create a network of organisations and institution in Ljubljana, including Community Center, Emergency Unit, Toxicology Center, and all other stakeholders who could assist in effective emergency response in a critical moment as fast as possible. When we rented one close to the city centre and bought equipment for DCR, we faced another problem, new bureaucratic requirements. Financial plan for the pilot project was presented to and approved by the Governmental Commission on Drugs, with the estimated cost of approximately 80.000euros per year for operating the DCR, including the employment of two medical staff. For 2015-2016, NGO Stigma received 42.500, euros from the Ministry of Health. Accordingly, we decided to shorten the project’s duration to six months and hire only one medical staff. In February 2016, one month before the opening, Ministry of health who granted the pilot in the first place, requested us to get the project checked at the National Medical Ethics Committee which is already part of their entity. The Committee received our project proposal the same month, but then needed two years to decide whether to approve or trefuse the project, which would be ending in November 2016. Their decision stated: “The Committee does not oppose the initiative, according to established practices in other environments, to offer drug users injecting drugs under professional supervision in a clean, calm environment without any hurry or pressure”…BUT …“In safe drug injecting room, users would use drugs that were obtained illegally and without quality control, which is seen as indirect cooperation in illegal activities and such prevents the Committee to issue ethical agreement”.

In the meantime, another bureaucratic problem arose. Ministry of Health started to investigate in an Agency which could provide “supervision”, which is written in Criminal Code – so that DCR could be ”under the control” of a medical institution. However, they could not find an appropriate Agency that could meet the conditions. Therefore, they instead decided to set up a group of experts that could take on the supervising role. This official decision was written and recorded at a Governmental Commission for Drugs session in February 2016.

It is now January 2021, and the group of experts is still not confirmed. That is why in Slovenia, we do not have an official DCR.

Regarding the data in Solidify, this information refers to the fact that the meeting of experts’ took place in Ljubljana.”

Drug Consumption Rooms in the Netherlands – latest developments

The first formal drug consumption room was run by an addiction treatment service and opened in 1994 in Maastricht, The Netherlands. Since then and lasting about ten years, the number of drug consumption rooms increased, primarily aiming to reduce drug-related nuisance in the streets and public spaces.

Cedric Charvet, the author of this recently published article on a particular issue on DCRs of Rausch magazine (in German), states that ‘being homeless’ has become a more critical criterion for more DCRs again. He points out that other facilities are being implemented for those who are not homeless, such as housing projects where the use of drugs is allowed.

Cedric is a senior harm reduction specialist and the manager of one drug consumption room in Amsterdam, The Netherlands He also promotes the establishment of DCRs in Europe via us, Correlation – European Harm Reduction Network (C-EHRN), International Network Drug Consumption Rooms (INDCR) and European Forum Urban Security (EFUS).

His article will broaden your knowledge on DCRs and their final state in The Netherlands and the world.

Dominique Schori

Dominique Schori has many years of practical experience in the field of harm reduction. He has had extensive responsiblities for numerous projects addressing recreational drug users as well as in the field of dug consumption rooms.

Our partner report on synthetic cannabinoids which you can find here, is also authored by Dominique.
Read his interview below, to get to know his journey through harm reduction world and his current focus.

1) Can you tell us about your background?
Originally, I did a nursing education and worked for several years in harm reduction services (e.g. a center for heroin assisted treatment). After my studies of philosophy and history, I was in charge of numerous harm reduction projects on a national level for Infodrog (the Swiss Office for the Coordination of Addiction Facilities) and was also the national focus point for Correlation in Switzerland.

Since summer 2020, I have been managing Saferparty Streetwork for the City of Zurich, a service that focuses on harm reduction for recreational drug users.

2) How would you describe your work in general?
Our service consists of three areas: The Drug Information Center Zurich (DIZ) with stationary and mobile drug checking, a streetwork project aiming to consult young adults as well as teens in the topics of recreational drug use and a low-threshold consulting office. Our professional attitude is characterized by low threshold and acceptance orientation and we constantly try to align ourselves with the changing challenges.

3) What drives you personally to work in your area of work?
Every contact with people, especially in this setting, is full of surprises. No day is like the other. Many consumers have a vast expertise, which is why I often learn at least as much from them as they may learn from me. I also like the fact that in my job I am able to work with a wide variety of organisations and people at different levels (from peer projects to federal authorities).

4) What is your current focus?
At the moment we are mainly concerned with cannabis samples, which since the beginning of the year are very often mixed with synthetic cannabinoids and when purchased are wrongly sold as regular illegal weed (See report).

5) Why do you think that your current focus is important?
Because the effects of the use of synthetic cannabinoids can be very dangerous, and our new cannabis drug checking helps to reduce the risk of overdoses. In addition, our findings underline the value of drug checking for monitoring the illicit drug market at a level where it affects the health of users. Finally, because we want to empower cannabis users (users of psychoactive substances in general) to make autonomous and informed decisions.

6) Harm reduction is still underfunded in many countries, even if there is enough evidence that it works and is cost effective. Why is that?
Personally, I think this might be because the political discourse about harm reduction is still partly dominated by the opinion that this approach is a kind of “surrender” to addiction. The assessment of drug use and drug trafficking is considerably biased by historical stereotypes and is still partly treated as a moral-philosophical rather than a health/social issue. For this reason, the pressure for legitimacy and the demand for efficacy/evidence may be higher than is the case with other approaches.

In the 1990s, the city of Zurich had to experience with its open drug scene (“needle park”) that a 3-pillar policy consisting of repression, prevention and (abstinence-oriented) therapy alone is not sufficient.

7) Please tell us what harm reduction means to you.
To see the world with pragmatic rather than moral “glasses”. People make decisions (good or bad) and take more or less big risks in these decisions. With regard to substance use, I think it should be less about whether I personally approve or condone consumption but more about accepting that there are people who choose to consume, regardless of the legal framework.

Perrine Roux

Perrine Roux is the main author of the recently published article “Implementation and evaluation of an educational intervention for safer injection in people who inject drugs”, as a result of the EU funded Eurosider project of which we are also a proud partner.

International Journal of Drug Policy has been hosting the article which describes a multi-country mixed methods study “Individually Tailored Support and Education for Safer Injection” in harm reduction services including needle and syringe programmes in four different European countries.

Read the article here after getting to know Perrine via her interview below!

1) Can you tell us about your background?
After a 2-year post-doc at the Substance Use Research Center of Columbia University (NYC), I got a permanent position as researcher in public health at the French National Institute for Medical Research (INSERM). I coordinate several projects related to access to care and prevention for drug users, using mixed-method and multidisciplinary approach. Today, I am leading a team at the SESSTIM research unit on community-based research on HIV and harm reduction

2) How would you describe your work in general?
Research activities are composed with the setting up research projects mainly with the community, the follow-up of the projects, the valorization of data and the dissemination of these findings to scientific community but also users’ community and general population. It is also a continuous reflection on the methodological approaches that we used to adapt them to our focus.

3) What drives you personally to work in your area of work?
Doing research is to me a creative and collective work. By gathering data from field experience, from science and with a bit of intuition, we develop research projects that participate in a better knowledge to improve people who use drugs’ life conditions.

4) What is your current focus?
My current focus is to adapt harm reduction responses to people who use drugs: people who inject drugs (education, adequate HR tools, drug consumption room), recreational drug users (drug checking, online prevention, cannabis), chemsex (adaptation of HR tools), HR in Africa…

5) Why do you think that your current focus is important?
HR should be consolidated by adapted drug policy but also should be continuously updated according to new drugs and patterns of use.

6) Harm reduction is still underfunded in many countries, even if there is enough evidence that it works and is cost effective. Why is that?
Because policy is not driven by evidence but more by ideology and drug use is seen as a deviant behavior mobilizing funds for repression and not prevention or care. Drug policy has to be built on evidence and has to change.

7) Please tell us what harm reduction means to you.
A pragmatic and human approach to help people who face risks due to their behaviors, especially dedicated to people who use drugs but also suitable in other domains.

A simple idea turning into insightful exchanges: European Harm Reduction Sessions

As the days passed by and we finally accepted the ugly truth of needing to postpone the 5th European Harm Reduction Conference to 2021, replacing it with online harm reduction sessions gave our minds fresh blood. On 5 November, we kicked off the sessions.
Were you there? It was a blast!

The day-long major session was divided into four sub-sessions, focusing on highly actual and exciting topics with a worldwide list of game-changer speakers, all specialised in their fields. The first session was on “COVID-19 and its impact on harm reduction in Europe”. Some of its highlights, just to tease your curiosity, were:

Nicole Simone, from WHO Europe, giving an update on the status of the COVID vaccine and how WHO is working with COVAX global alliance (led by WHO, GAVI and CEPI) to facilitate the equitable access and distribution of vaccines to protect people in all countries.

Alexis Goosdeel, from EMCDDA, giving an update on the negative impacts of COVID-19 on continuity of care and accessibility, and its positive effects on innovation, digital innovation, flexibility and renewed relationship with the clients.

Mat Southwell, from EuroNPUD, mentioning how the widely-expected good behaviour and absence of diversion has challenged fundamental assumptions in drug services.

Prof Jeffrey Lazarus, from ISGlobal on behalf of “Nobody Left Outside”, highlighting how closures of services took governments by surprise, and the major role of NGO’s being to engage with local, regional and national governments to ensure harm reduction services can stay open.

Dr Mojca Maticic, from the University of Ljubliana, pointing out how caring for patients with the liver disease during the pandemic should involve greater personalisation and flexibility; and how treatment for HCV and HBV should continue according to guidelines.

Ricardo Baptisa, from UNIT, noting that the COVID-19 crisis is an opportunity to put drug policy and harm reduction on the agenda and to ensure science is driving policy.

The second sub-session focused on the launch of the Special Edition of the Harm Reduction Journal, aiming to examine new dimensions in harm reduction in 2020, with the hope being to potentially broaden the harm reduction approach beyond drug use to other issues to which harm reduction is a successful approach.

The day continued with the question “different approaches for decriminalisation – what works?”, organised by EHRA. The widely spread background of speakers served perfectly to the aim of the session which was to discuss five different approaches to decriminalisation, applied in 5 countries and their impact on lives of people who use psychoactive substances and society.

And finally, we completed the day with a significant amount of participants tuning in to listen to Professor David Nutt alongside other fascinating experts talking about how the war on drugs has failed and discussing how best to engage with both the decision-makers and the public who hold them to account to promote an ethical rationalisation of drug policy.

Following up to our collaboration, we interviewed one of the session moderators, Adam Holland. Adam is a public health doctor, a drug policy researcher and one-time filmmaker as he puts it. You can read the interview HERE.

All the links to the session recordings we summed up in a newsletter which can be read HERE.
Watch and share them if you please.

Our second Harm Reduction Session took place on 26 November, where we created room for discussions on the challenges and good practice examples for effective take-home naloxone distribution in Europe.

Webinar fulfilled its aim in discussing the current challenges and critical factors, which hinder the effective and broad implementation of THN programmes and the new ways forward, with professionals, researchers and People Who Use Drugs (PWUDs). The exchange provided insights and information on the development of practice and policy recommendations.

The session can be watched HERE.

We are now only a couple of days away from our last harm reduction session of the year, due 16 December, 15:00-16:30 CET, with the focus “Challenges and opportunities to monitor new drug trends by civil society organisations (CSO)”

Will you be joining us?
REGISTER HERE

Adam Holland

Adam Holland is a public health doctor, a #drugpolicy researcher and one-time filmmaker as he puts it. Adam primarily works on the ethical implications of and evidence for drug policy and harm reduction interventions. We collaborated with Adam for our very first European Harm Reduction session, replacing the 5th European Harm Reduction Conference. Watch his warm hello from a “fairly” grey Bristol and read about his passion in his interview.

1) Can you tell us about your background?

I work as a public health doctor in the UK, in training to become a public health consultant. Before specializing in public health, I worked in clinical medicine, and studied philosophy and the history and philosophy of science. During my public health training I have become particularly interested in harm reduction approaches and the empirical and ethical arguments for drug policy reform.

2) How would you describe your work in general?

During our training we work on various public health issues but much of my work has revolved around harm reduction and drug policy, in local government and academia, looking at the evidence for different approaches and the barriers to their introduction.

3) What drives you personally to work in your area of work?

A key consideration working in public health is that prevention is better than cure. For example, if you can stop someone contracting a blood borne virus by ensuring the provision of sterile injecting commodities, that can reduce the suffering and costs related to contracting the virus and its treatment. Another important aspect is the social determinants of health. Most of the time, the political and socioeconomic contexts that people live in have a much more profound effect on their health than how good their local hospital is and policy-related harm is just as much of a public health issue as drug-related harm. Promoting ideas like these, to me, seems like a good reason to go to work in the morning (or in the pandemic era, to go to the desk on the other side of my bedroom).

4) What is your current focus?

I recently made a short documentary, Putting UK Drug Policy into Focus, about some of the problems with a criminal justice approach to drugs. This was launched at the European Harm Reduction Conference, which is how I ended up working with the excellent Correlation Network.

5) Why do you think that your current focus is important?

In democratic societies, the electorate can give politicians the mandate to change policy or hold them to account if they do not. For many people, the arguments for drug policy reform and harm reduction are not as easily understood as the metaphor promoted by the war on drugs rhetoric of drugs as an enemy that needs to be fought. This isn’t helped by the fact that most people get their information about drugs and drug policy from the popular media, which sometimes sensationalizes issues to sell newspapers. More work is needed to provide information to the public to reduce the stigma faced by people who use drugs, to highlight the benefits of a harm reduction approach and drug policy reform, and to facilitate the introduction of less harmful and more helpful policies and interventions.

6) Harm reduction is still underfunded in many countries, even if there is enough evidence that it works and is cost effective. Why is that?

I think that a lot of it comes down to public opinion about drugs. By the very nature of their job, for the politicians who make decisions about funding, what the voters will think is never far from the top of their minds. They might assume, rightly or wrongly, that investment in harm reduction would not be popular amongst their voting base, as opposed to, for example, investing in the military or police. Again, public engagement is extremely important, to highlight that harm reduction is more effective in reducing harm and expenditure (which seems to be more important for many people) than arresting people for taking drugs. And, importantly, to counter the neo-liberal idea that becoming addicted to drugs is an individual choice which is nothing to do with wider society. Social and political factors determine the deck of cards that people choose from, and the consequences they face for those so-called choices.

7) Please tell us what harm reduction means to you.

For me, harm reduction is about focusing on what matters. Public health practitioners encourage people to think about how often they use drugs, both legal and illegal, as a means to the end of encouraging healthier lifestyles and reducing the risk of drug related harm. In contemporary drug policy, stopping people from using drugs has become an end in-and-of-itself leading to approaches that cause more harm than they prevent. Society has lost sight of what is important in drug policy – the harm reduction movement is how we get back on track.

Challenges and opportunities to monitor new drug trends by civil society organisations

The continued emergence of new substances and changing patterns of drug use requires new health and harm reduction responses. New approaches in this field are needed to regularly update existing data on new drug trends and drug using patterns.

This webinar will discuss experiences with experts from C-EHRN, EMCDDA and from Dublin, Zürich and Barcelona.

More information

Briefing paper: Partner Report – Synthetic cannabinoids

Since the beginning of 2020, the Drug Information Centre (DIZ) of the City of Zürich has been increasingly analysing cannabis samples which users believed that had been treated with synthetic cannabinoids. Our partner report, produced by the drug checking service of the City of Zurich, Switzerland, describes data collected by this service between January and August 2020.

Implementation and evaluation of an educational intervention for safer injection in people who inject drugs

As a result of the EU funded Eurosider project, C-EHRN was a partner in, the project group published an article in the International Journal of Drug Policy. The article describes a multi-country mixed-method study “Individually Tailored Support and Education for Safer Injection” in harm reduction services including needle and syringe programmes in four different European countries.

SO-PREP Project! | For a better Synthetic Opioid health system response in Europe

Are European countries well-prepared and equipped for a possible continued rise in Synthetic Opioid (SO) prevalence, use and incidents?

COVID-19 pandemic has shown us that most of them were not prepared for a national health emergency. Would it be any different for a potential synthetic opioids epidemic? Would they have the necessary strategic planning and resources to tackle it down?

SO-PREP is a two-year project which studies that to develop an evidence-based toolkit describing and recommending good practice monitoring and responses to SO in Europe.

The United States and Canada have both experienced an opioid crisis over the past decade, whilst Estonia is the only European country in which potent synthetic opioids and related problems have already been highly prevalent for the past 15 years. Could SO-PREP project partners classify the key factors that contributed to this, so that Europe possibly be more in control when it is its turn?

The partners are already busy with identifying experts from North America and Estonia and planning interviews with several vital stakeholders to map the SO health system response in Europe.

They are also finding out about the current nature and extent of Synthetic Opioid use and related harms in different European countries while analysing data around its scope and nature in Europe. To discover that, they are counting with the expertise of EMCDDA Reitox Focal Points, the latest EMCDDA workbooks 2017 and 2018, as well as our Focal Points.

So far, they have collected valuable data from 50 focal points in 37 European countries.
The first results of this in-depth research will be available by the end of the year. And the most useful, tailor-made toolkit they plan to develop, will accordingly convey all this identified and classified learning and information.

Check out the project website for timely updates and publications: www.so-prep-project.eu
and contact the project partners for your question and contributions.