On July 24, 2020 the European Commission published a Communication to the European Parliament, the Council, the European Economic and Social Committee and the Committee of the Region on the EU Drug Agenda and Action Plan (2021-2025). The EU Drug Agenda is an important milestone, which will set out the political framework, priorities and actions for implementing EU drugs policy over the next 5 years. As such it should respond to the challenges and needs in the area of drug policy and practice, build on previous efforts and relevant policy documents and allow sufficient opportunities for input and participation from civil society experts in the field.
C-EHRN acknowledges the ongoing commitment and engagement of the European Commission to ensure a balanced and evidence-based drug policy approach on national, European and international level. We also appreciate that the previous Drug Strategy/ EU Drug Action Plan and the new EU Drug Agenda include relevant areas of drug supply and drug demand reduction. Nevertheless, we do have critical remarks and comments, which address both the process of developing the agenda, as well as the structure and content of the current document.
Whilst previous EU Drug Strategies and EU Drug Action Plans were adopted as Council Decisions, based on consultation with EU Member States, civil society and other relevant stakeholders, the current EU Drug Agenda was published as EC Communication, without being discussed beforehand by the Horizontal Drug Group and the EU MS. The Agenda as such is a fait accompli, and does not offer further opportunities for input or amendments. We believe, that this will not only limit the relevance of this policy document, but also lower the impact and level of implementation in the EU MS.
Prior to the development of the new EU Drug Agenda, the EC has commissioned an external agency to evaluate the impact and implementation of the previous EU Drug Strategy and Action Plan, in which relevant stakeholders, including civil society representatives and experts were given the opportunity to provide input. As such, the evaluation report provides relevant information, which should inform the development of a follow-up policy document. Unfortunately, the evaluation report was only published together with the EU Drug Agenda, which made it impossible for experts and civil society to review the report and provide input, based on its findings and conclusions. This seems like a missed opportunity and does not do justice to the efforts made in regard to the evaluation.
Although, we appreciate that the Agenda includes relevant areas in drug demand reduction, we are concerned about the structure and order of priorities in the Agenda. The previous Strategy included a clear division between drug demand and drug supply reduction and linked these with cross cutting issues, including coordination, international cooperation, information and research. By doing so, both policy areas were addressed separately, without being prioritized, while the cross-cutting issues ensured a balanced and coordinated approach.
The new EU Drug Agenda does not separate the two policy areas, but mentions three overarching strands – A. Enhancing Security – disrupting drug markets, B. Preventing and awareness raising and C. Addressing drug related harms – and a total of 8 priorities (and related sub-priorities).
The priority areas under A. clearly address security issues, crime prevention and drug-market control, while the priorities under B. and C. are mingled with interventions addressing drug supply and drug demand reduction. An example: Prevention in the area of drug demand and drug supply reduction are combined under priority 5 and include as well the need to reduce stigma. This combination of topics seems random and not logical. While crime prevention should be addressed in priority A., the need to reduce stigma should be mentioned as overarching priority and principle, to be addressed in all three priority areas.
Although, we acknowledge and appreciate that harm reduction has become a separate priority area, we feel that the structuring of the current agenda puts drug demand reduction and harm reduction in particular on a less prominent place. The majority of priorities focuses on drug supply reduction, drug market control and crime prevention, followed by drug demand reduction measures and harm reduction.
Strategic priority nr. 7 addresses the need to “increase the efficiency of risk and harm reduction interventions to protect the health of drug users and the public”. However, related priority areas do not address relevant challenges in the area of harm reduction, including the need to increase coverage and access to harm reduction services, lack of funding and overdose prevention.
Strategic priority nr. 8 addresses the need for a balanced approach in prisons, but does not refer to harm reduction interventions at all. The WHO recommends the provision of harm reduction services in prison and there is evidence that the continued access to harm reduction services contributes to the health and well-being of people who use drugs and can reduce the overdose risk after the release from prison.
We deplore, that the Agenda does not acknowledge sufficiently the important role of civil society in developing and implementing drug policy. This is particularly concerning because
The EU Drug Agenda addresses the specific needs of people who use drugs and links barriers to access treatment to demographic, situational or personal factors. Unfortunately, the Agenda does not refer to barriers, caused by stigma and criminalization of drug use – although these are important drivers for social exclusion and discrimination and increase social, health and economic inequalities.
The EU has championed in promoting and defending an evidence- and human rights-based drug policy approach. This has been of particular relevance in the international drug policy debate and during the negotiations at the CND. We therefore deplore that the four guiding principles in the Agenda do not refer to these efforts and relevant international human rights documents – including the Universal Declaration of Human Rights, the International Guidelines on Human Rights and Drug Policy and the 2016 UNGASS Outcome Document.
The EU Agenda mentions that resources should be directed proportionally towards the strategic priorities, areas and interventions that are most likely to lead to fulfilling the objectives of the EU Agenda and refers as well to the different EU funding sources. However, the Agenda does not include criteria, which can inform the distribution of these resources. It also omits the establishment of a coordination mechanism, which would ensure a balanced approach and create synergy, cooperation and responsibilities between the different EU Programmes, including the ESF+, EU4Health, Justice Programme, Horizon Europe, Cohesion Policy Fund, Digital Europe, Rights and Values Programme and Erasmus+.
We understand, that the EC Communication on the Drug Agenda is currently discussed by the European Commission, the Member States and the European Parliament and we therefore hope that the document will be adapted and take above mentioned concerns into account.
October 2020
Correlation – European Harm Reduction Network
Contact: kschiffer@correlation-net.org
Correlation – European Harm Reduction Network would like to invite you to the Online Dialogue that is organizing on the 23rd of September 15-16:30h, around the topics of drug use, harm reduction, outreach services, and meaningful participation of people with lived experience in the Netherlands.
This event takes place as an activity of the European project Peer2Peer, which aims to reinforce the capacity for outreach of Civil Society Organizations by upscaling cooperation with peers.
The Dialogue will count with presentations by Sara Woods, Leonie Brendel, Hayley Murray, Luis Rubio Reparaz and Roberto Perez Gayo, among others. Also, it will generate a space for dialogue and exchange in which attendants will have the opportunity to participate in the discussion.
Registration is open for policy-makers, reserachers, social & health professionals in the field of outreach work, harm reduction, community memebers & drug users organizations, as well as representatives from other maginalized and underserved communities. More information at rpgayo@correlation-net.org.
This event is organized with the support of MAINline, and the MDHG.
We are looking forward to welcoming you!
C-EHRN Team
Since the unprecedented COVID-19 pandemic crisis took off, marginalised communities in Europe, who are underserved with respect to healthcare, are facing even tougher situations.
The NLO initiative, which aims to improve the healthcare access for those communities, has published a briefing paper to explain to policymakers and governments the particular challenges and impacts of the COVID-19 pandemic.
The paper has highly rich and influential topics whose focus intercross so interestingly.
The following are its key highlights about which current challenges as well as recommendations are shared:
People experiencing homelessness,
Undocumented migrants,
Sex workers,
Drug use and harm reduction,
LGBTI people,
People living with HIV,
and Prisons.
The briefing paper, “COVID-19 in marginalised groups: challenges, actions and voices” not only presents the voices and actions of marginalised communities and civil society organisations currently working on the frontlines but also recommends solutions.
The European Association of the Lever, a major player in the field of hepatitis and lever diseases, launched a policy paper which recommends that all barriers to the uptake of the continuum of care by PWID need to be removed by changing policies and discrimination that hinder access, including the criminalisation of minor, non-violent drug offences. and to adopt an approach based on public health promotion, respect for human rights and evidence.
“The major barrier to appropriate access to hepatitis C care is political resistance to harm reduction services, as well as laws and policies which criminalize 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'”
said co-author Dr Mojca Maticic, Slovenia.
Download the lay summary of the policy paper
Download the full policy paper
Every year, the month of July sets our focus primarily on viral hepatitis and the thousands of lives it claims every day. It is the number one life-threatening infectious disease of which its victims are mostly unaware; especially among the underserved and vulnerable communities, we work for.
On this very day, the World Hepatitis Day, worldwide campaigns are held in the hope of Finding the Missing Millions and assuring the linkage between testing, treatment and care. It is imperative not only to enable these services to communities but also to re-gain the trust they lack toward the healthcare services.
To reach the ambitious target of eliminating hepatitis C globally by 2030, community centres, harm reduction and low threshold services have a crucial role to play.
To inspire and challenge you with its essential stories, we would like to recommend you to read and study our Good Practice Examples of hepatitis C interventions which is the first of its kind with a focus on civil society organisations in Europe.
We hope that you can practice your best to support the cause and that it is paying off.
Please find the Collection HERE.
CAZAS is a harm reduction organization works with People Who Use Drugs and other marginalized communities since 1998 in Podgorica, Montenegro. During COVID19, the organization maintains its services, addressing the needs of their communities, despite many limitations they face. Aiming to exchange good practices, encourage others to individually contribute, to adjust and listen to the needs of target groups, CAZAS shares with us a storytelling video about their work and the harm reduction services they have been developing.
Dublin has outperformed even best-case scenarios for COVID-19 mortality among homeless and drug using populations, according to a new report released today (Wednesday 1 July) from the London School of Economics (LSE) and the Ana Liffey Drug Project. The paper – Saving Lives in the time of COVID-19 – Case Study of Harm Reduction, Homelessness and Drug Use Dublin, Ireland – reveals that a pragmatic and well-coordinated government response alongside housing provision and the expansion of harm reduction services, saved lives and ensured the protection of a vulnerable group.
As a result of quick decisive action from all sectors, only 63 homeless people in Dublin were diagnosed with COVID-19 and there was one COVID related death, a fraction of what had been predicted.
Once it was recognised that one of the main deterrents to compliance with isolation and shielding was substance use, harm reduction services were quickly expanded in Dublin. These included improved access to methadone treatment; improved access to naloxone; and the home delivery of prescription drugs. The report finds the extension of these services was significant in protecting homeless people from COVID-19.
The authors note that prior to the outbreak of the virus, these services were limited by regulatory obstacles which were rapidly removed in response to coronavirus. They suggest COVID-19 acted as a catalyst for change in the delivery of harm reduction measures, with decisions that would normally take months or years effected within days and weeks. For example, prior to the COVID-19 crisis, GMQ Medical (a primary care service for homeless people in Dublin) had a treatment waiting time of 12-14 weeks due to a cap on the number of
patients/hostels it could recruit.
However, in response to the virus, national contingency guidelines were issued allowing for the expansion of service leading to reduced waiting times for access to treatment. Other drug treatment clinics also agreed to take on homeless patients resident in hostels in their catchment areas. As a result, waiting times dropped overnight from 12-14 weeks to 2-3 days.
The authors applaud this action and strongly recommend these practices continue in the future. Commenting, paper co-author and Executive Director of the International Drug Policy Unit at LSE, Dr John Collins said: “Ireland has shown itself as a policy innovator during the COVID-19 crisis and has outperformed even best case scenarios for mortality among homeless and drug using populations in Dublin.
As some countries tentatively emerge from the first wave of COVID-19, it is important to take stock of lessons learned. “This report highlights how Dublin’s success emerged from a variety of factors including a sense of national emergency, pragmatic and well-coordinated government policy, the provision of housing, the expansion of harm reduction services and the bravery of front line service providers. These policies are replicable across the world and in many cases merely represent a reduction in barriers to service provision, rather than a radical departure from existing approaches.
“Secondly, this report highlights some long term policy lessons from COVID-19. It is clear that innovations, made under emergency conditions, should not be allowed to roll back as and when the virus recedes. COVID-19 has meant that policy barriers in Ireland that may have taken years to reduce have been pushed aside in a matter of weeks. If these gains are kept in place, aside from the lives saved during the COVID-19 pandemic, they will more than likely continue to save lives long into the future.”
Dr Austin O’Carroll, Clinical Lead for Homelessness in Dublin said: “As the COVID pandemic approached there was a palpable fear amongst the homeless population and those who provided services to them. Homeless people, who have the worst health indices in the Western World and who either sleep rough or live in shared accommodation, found themselves in a precipitously dangerous and vulnerable situation.
“If action was not taken immediately, we envisioned the epidemic sweeping across the sector causing multiple hospitalizations and a high death rate. The housing, homeless health and harm reduction agencies came together under the combined leadership of the health and housing public agencies. Their response was swift, highly co-ordinated and extremely effective. It responded to a public health emergency by addressing all the social determinants of health including accommodation, physical and mental health service provision, psychological support and addiction treatment.
“The sector was very happily surprised by not only the low rate of infection and negligible death rate, but also by the noticeable improvement in general health and wellbeing in the homeless population. This served as a timely reminder that there are inextricable links and vicious circles between housing and health, housing and substance use and health and substance use.”
Tony Duffin, CEO of Ana Liffey Drug Project said: “Thanks to the determined effort of all those involved, during the first wave of COVID-19 in Ireland, the number of COVID infections amongst people who use drugs and who are homeless in Dublin was lower than had been anticipated.
“As highlighted by this paper, a Harm Reduction approach has been, and will continue to be, an important element of the public health response to COVID-19 for this cohort; it is crucial to help stop the spread of the virus and to reduce drug-related harm.”
Saving Lives in the time of COVID-19 – Case Study of Harm Reduction, Homelessness and Drug Use Dublin, Ireland was authored by Dr Austin O’Carroll, Clinical Lead for Homelessness in Dublin; Tony Duffin, CEO of Ana Liffey Drug Project; and Dr John Collins, Executive Director of LSE’s International Drug Policy Unit.
For a copy of the report, please visit: http://www.lse.ac.uk/united-states/Assets/Documents/Harm-Reduction-in-the-time-of-COVID19.pdf
Rethinking drug policies is now an absolute necessity for our health and for harm reduction services to coexist. However, this can only be done by prioritising the needs and voices of people who use drugs, by respecting their fundamental rights, by ensuring that they are able to meet their health and social needs and by systematically and meaningfully involving them in the development of health strategies and programmes.
In this regard, the COVID-19 crisis started an unprecedented movement of progressive reforms. To keep this movement up, alongside several other organisations, we have signed a statement to address the need to maintain services developed during the COVID-19 pandemic.
