C-EHRN’s Response to Mayor Halsema’s Call for Redefining Drug Policy

On January the 5th, 2023, Femke Halsema, Mayor of Amsterdam, published an opinion in The Guardian on the need for a global shift in our current approach to drug policy. In the article, Mayor Halsema backs up her call by announcing an international conference this month exploring alternatives to prohibition, with a strong focus on drug market regulation. At C-EHRH, we fully support this call, joining Mayor Halsema in this step forward as partners in the event.

Currently, there is a growing consensus that the so-called war on drugs has not only failed in its own goals but has been a vast drain on public resources and often actively counterproductive. $100 billion is spent on global drug law enforcement every year, whereas just $131 million is spent on harm reduction (1). This means that we spend more than 750 times the amount on punitive responses than we do on life-saving services for people who use drugs.

Punitive responses are not only ineffective at reducing drug use and sales. The ongoing criminalization, stigmatization, and marginalization of people who use drugs and the refusal to consider regulated approaches to drug markets to control the toxic supply has made drugs riskier, incentivized higher-risk behaviours, created obstacles to adequate health and human-rights-based care services, fuelled organized crime and violence against marginalized communities and contributed to insecurity and devastating public health crisis. 

Recently, there have been notable shifts in the global public debate towards transformative drug policy change. In September 2023, the UN High Commissioner for Human Rights released a landmark report recommending that States consider the regulation of drugs to tackle the links with organized crime and insecurity. Also, the UN has recognized the criminalization of drugs as “proven to have negative health outcomes” and to “counter established public health evidence.” (2) The EU Drug Strategy 2021-25 has highlighted the importance of drug policy based on public health (3) and the Global Commission on Drug Policy has called for the decriminalization of drug use as an essential precursor to ending HIV and viral hepatitis as public health threads (4).

Mayor Halsema’s opinion article not only continues this paradigm shift from ideological and punitive approaches towards policies based on evidence, health, and human rights, but It also exemplifies the leading role that cities can play in bridging the disconnection between discourse and policy action by focusing on how – and not if – regulation of the drug market can be achieved.  

We at C-EHRN fully support this initiative and celebrate Mayor Haselma’s commitment to continuing the city’s legacy of innovation and cooperation among European cities to develop more pragmatic and less prohibitionist drug policies. 

Mitigating harm is not easy. A key message from the 2023 European Drug Report analysis is that the impact of illicit drug use is now seen almost everywhere in our society (5). As a civil society organization working in policy and harm reduction, representing more than 360 members, we know that without bold and broader social and health reforms, decriminalization and legal drug regulation alone won’t fully ensure people’s well-being. Equally, without a solid commitment to embedded and prioritized principles of social justice, equity and human rights, we risk replicating inequities and injustice. 

For this reason, as partners of the conference, C-EHRN appreciates this opportunity to further cooperation, to be innovative and ambitious, to do things differently and better, and to help repair the harms of past policy failings. Key elements in achieving this ambition include:

Improving access to and availability, coverage, and quality of Harm Reduction services
Many harm reduction organizations operate on the front lines, providing crucial services to marginalized communities affected by drug use. Despite their significant impact, these organizations often face legal challenges and lack formal recognition. To enhance the effectiveness of harm reduction efforts, it is imperative to advocate for the legal recognition of these civil society organizations as official service providers. This recognition could take the form of legislative measures that explicitly acknowledge and validate the role of harm reduction organizations as part of a balanced drug policy, ensuring they receive the support and resources needed to carry out their vital work. Additionally, establishing social contracting mechanisms can formalize partnerships between these organizations and relevant authorities, fostering collaboration and sustainability.

Implementing equity programs that facilitate and empower marginalized communities
Recognizing the disproportionate impact of drug policies on marginalized communities, it is crucial to implement equity programs aimed at addressing systemic inequalities. These programs should go beyond the surface level and actively empower marginalized communities by providing equal access to healthcare, education, and employment opportunities. Also, they are given equal opportunities to shape and implement policies and programs, recognizing their wealth of knowledge, experience, and leadership. 

Tailored initiatives, taking into account the unique challenges faced by these communities, can contribute to breaking the cycle of marginalization perpetuated by current drug policies. By prioritizing equity, cities can pave the way for inclusive, just, and effective harm-reduction strategies that consider the specific needs of diverse populations.

Prevent the emergence of monopolies and corporate capture.
As drug policies evolve, there is a risk of corporate interests dominating the landscape, potentially leading to monopolies that prioritize profit over public health. It is essential to proactively prevent such scenarios by implementing regulatory frameworks that ensure a diverse and competitive landscape. Measures should include strict regulations on market entry, preventing undue influence from powerful corporations. By actively engaging in policy discussions, harm reduction advocates can contribute to shaping regulations that prioritize public health, prevent monopolies, and uphold the principles of equity and justice in the evolving landscape of drug policy.

(1) Provost, C. et al (2023) Aid for the war on drugs. London, Harm Reduction International. https://hri.global/wp-content/uploads/2023/09/HRI_Aid-for-the-War-on-Drugs_Final-1.pdf
(2) https://www.who.int/en/news-room/detail/27-06-2017-joint-united-nations-statement-on-ending-discrimination-in-health-care-settings
(3) https://www.emcdda.europa.eu/system/files/attachments/13642/Council%20of%20the%20EU%20%282020%29%20EU%20Drugs%20Strategy%202021-25.pdf
(4) https://www.globalcommissionondrugs.org/ahead-of-world-aids-day-global-commission-on-drug-policy-new-report-says-the-hiv-and-hepatitis-epidemics-cannot-be-ended-without-drug-policy-reform-and-the-real-participation-of-people-who-use-drugs
(5) https://www.emcdda.europa.eu/publications/european-drug-report/2023_en

Discover Correlation’s new visual identity!

We decided it was time to update our visual identity so it could better reflect our values and forward-looking approach! Find out about the concept behind our new logo and visuals!

Shapes
Community – The Circle
Given that Correlation is a European civil society network in the field of drug use, harm reduction, and social inclusion, we focus on the concept of community and the importance of civil society in fulfilling the needs of those affected by social and health inequalities.
Considering that, a graphic system with a circle as a basic unit was developed, resembling the semantic tension between the individual and the whole, and representing a point, data on a graphic, that gives us the knowledge to act. Our circle represents the community and at the same time, all those inside it and the infinite possibilities to build the collective.

Diversity – Polygons
One of the main points of the European community project is the respect and enhancement of our diversity. Therefore our circle is accompanied by polygons (rectangles, triangles, and so on) to create a modern, clean, simple yet meaningful layout throughout the different graphic applications (such as business cards, dossiers and research documents).

Colours: blue with a vibrant secondary colour palette
Health & Diversity
Following the idea of diversity and the infinite possible layouts that we can develop with the polygons system, we can also “create” a non-limited colour palette with vibrant colours, which we use together with a main/basic colour on the blue scale, as it is related to health and wellness in our society.

Logo: the Hug
Working around the meaning of community, we used the idea of creating different abstract forms with the diverse shapes to form a symbol/anagram that represents the intersection between different individuals. The design also enables variations for focal points and specific C-EHRN projects.

The design was developed by Jesús Roman.

Highlights from the Civil Society Forum on Drugs Plenary Meeting

The Civil Society Forum on Drugs (CSFD) Plenary Meeting, organised by the European Commission (DG Home) on November 14-15, 2023, gathered 40 CSFD Members in Brussels. Chaired by C-EHRN’s Director, Katrin Schiffer, the meeting also included Iga Jeziorska, C-EHRN’s Research Officer, representing Youth Organisations for Drug Action [YODA] within the CSFD Core Group.

The event revolved around discussions across four pivotal working groups and their activities and included a separate meeting with the Horizontal Working Party on Drugs (Horizontal Drug Group – HDG), consisting of EU Member State representatives, in which the CSFD could exchange information and views with the Commission and the Member States.

Under EU Drug Policy working group, coordinated by Iga Jeziorska, the CSFD conducted surveys to assess the EU Drug Strategy’s implementation. Ongoing data collection aims to shape a forthcoming report in 2024.

Adria Cots Fernandez helmed the International Drug Policy group, providing regular contributions to the HDG ahead of Commission on Narcotic Drugs (CND) meetings, organizing an informative webinar on the new EMCDDA Mandate, and facilitating an advocacy training session with the presence of two HDG members.

Addressing Civil Society Involvement in Drug Policy at a national level, the team chaired by Péter Sárosi conducted comprehensive case studies in Finland, Ireland, Greece, and Hungary. The case studies, with the financial support of C-EHRN and in cooperation with the Rights Reporter Foundation, aimed to assess the implementation of the Quality Standards for Civil Society Involvement in Drug Policy, developed by CSFD in 2021. These studies utilized structured discussions with civil society representatives and decision-makers.

The Emerging and Cross-Cutting Issues group, led by Milutin Milosevic, delved into crucial topics like gender perspectives in drug policy, mental health, and decriminalization efforts. The Paper and CSFD Contribution to enhance the Gender perspective and the position paper on People Who Use Drugs and Mental Health can be accessed on CSFD’s website.

In addition to these focal areas, the CSFD provided input to the European Commission and the Horizontal Drug Group on pivotal issues such as the new EMCDDA Mandate, the ongoing evaluation of the EU Drug Strategy, to which it wants to contribute actively, and concerns regarding the EU Roadmap on drug trafficking.

Throughout the discussions, the CSFD emphasized the need for a balanced approach in drug policy, stressing the significance of addressing health and social dimensions alongside supply reduction efforts and encouraging the European Commission to develop a roadmap for expanding access to drug demand and harm reduction. This approach aims to foster comprehensive and inclusive drug policies across Europe.

Comprising 45 civil society organizations, the Civil Society Forum on Drugs (CSFD) is an expert group of the European Commission and serves as a platform for informed dialogue between the European Commission and the European civil society, actively contributing to the formulation and implementation of drug policies through practical advice.

Insights from HepHIV2023 Conference: Addressing Stigma, Testing, and Integration in HIV and Hepatitis Services

The HepHIV2023 conference, held in Madrid, Spain, from 13th to 15th November, convened a diverse array of stakeholders committed to advancing the fight against HIV, viral hepatitis and sexually transmitted infections (STIs). The event was organized by EuroTEST, and our Senior Policy Officer, Roberto Pérez Gayo, also participated in its organising committee. The conference spotlighted pivotal themes in the realm of infectious diseases, with a focus on integrated testing, technological advancements, and equitable service delivery.

Rafaela Rigoni, C-EHRN’s Scientific Officer, offers key takeaways from the conference, emphasizing critical issues surrounding HIV, and highlighting the conference’s focus on testing, migration, and stigma.

Stigma emerged as a central point of discussion, drawing attention to the multifaceted dimensions impacting individuals living with HIV (PLHIV) and at-risk communities. The targets for 2025 established by UNAIDS to ensure that less than 10% of these groups would be subjected to stigma and discrimination spurred collaborative efforts to develop monitoring mechanisms. Notably, the collaboration between the European Centre for Disease Prevention and Control (ECDC), European AIDS Treatment Group (EATG) and AIDS Action Europe led to the creation of an instrument based on the HIV Stigma Index to measure stigma.

Insights in a recently published report using the HIV stigma survey showed that despite participants generally rating their overall quality of life as satisfactory, there is a prevalent connection between stigma and depression. This critical correlation between stigma and mental health, particularly depression, emphasises the need for enhanced mental health services tailored to the unique needs of the population living with HIV.

Moreover, the survey shed light on the alarming prevalence of self-stigma, indicating that individuals harboured negative perceptions about themselves, along with instances of stigma from family and friends. Notably, healthcare settings emerged as hotspots for heightened stigma. Those reporting lower life quality consistently reported more profound experiences of stigma, highlighting the pressing need for targeted interventions to address and mitigate these challenges. The need to understand the experiences of different key populations and research the intersectionality around stigma was highlighted.

The conference didn’t solely focus on HIV; the first attempts to develop a monitoring instrument to measure HCV-related stigma are also underway by ECDC, and C-EHRN was invited to be part of an expert group with an advisory role, fulfilled by our Senior Scientific Officer.

 

More about HepHIV

The conference brings together stakeholders from all levels of the health system, from community organisations to health care providers and policymakers to present and discuss new approaches for testing and linkage to care for HIV, viral hepatitis, sexually transmitted infections (STIs) and tuberculosis (TB), highlighting programmatic/ implementation issues and adaptation of testing services in response to emerging public health issues.  Frontline workers constituted the majority of participants, highlighting the practical implications of the discussions for those directly involved in service delivery.

In summary, the conference illuminated the complexities surrounding stigma, emphasized the critical intersections between mental health and stigma, and underscored the importance of tailored interventions. Moreover, it highlighted the imperative need for integrated testing approaches and the adaptation of services to address emerging public health challenges. 

SEMID-EU’s Findings on Migration, Homelessness and Drug Use in Amsterdam

On the 9th of November, a meeting organised by two SEMID-EU project partners, C-EHRN and Mainline, took place in Villa Buitenlust, Amsterdam with relevant local actors in the field of migration, homelessness and drug use. This gathering sought to address the multifaceted challenges encountered by migrants who use drugs and experience homelessness throughout Europe, with a specific focus on Amsterdam. The event aimed to share the findings and materials of the SEMID-EU project and prompt discussion on the situation in Amsterdam.

SEMID-EU is a project specifically designed to fill gaps in knowledge and practice on drug use in migrant populations. By gaining a better understanding of the needs of migrants who use drugs in Europe, it aims to improve policies and responses that affect these groups to increase their access to high-quality healthcare, drug treatment, harm reduction and (re)integration services. The focus of SEMID-EU has been on marginalised migrants, for whom institutional, structural, social and personal barriers stand in the way of the fulfilment of their basic human rights.

The key results at an Amsterdam level underlined the importance of collaboration between relevant stakeholders to support services for migrants who use drugs. In Amsterdam, homelessness is a big problem intra-European and Spanish-speaking migrants who use drugs are dealing with. Research conducted in SEMID-EU reveals the significant advantages individuals experience through drug consumption rooms, shelters and support services aimed at fulfilling their fundamental needs. However, the capacity of these services is sometimes too limited. For example, the occasional shelter does help but does not tackle the uncertainty and stress of homelessness. Without a safe and stable environment to sleep, long-term substance dependency aid (when requested) is impossible. Migrants who use drugs struggle to access (social) housing, employment, and healthcare services, and the need for insurance to access healthcare that depends on formal residence is an especially big issue.

Among the group of Maghreb Arabic-speaking refugees, there is a reported lack of support services available to help with procedures of migration, laws, drugs and drug dependency services, financial support and mental health services. However, the most prominent support services needed are mental health services, necessary to cope with the trauma that originated in their countries of origin and at refugee camps and are too often not offered.

Low-threshold (harm reduction) services serve as crucial connections for migrants who use drugs, acting as a gateway to other essential healthcare and support services. Nevertheless, these services need greater support from funding bodies due to their frequent capacity constraints. Within the discussion, there was a clear emphasis on the necessity for national cohesion in the Netherlands to adopt human-rights-centred responses to homelessness, ensuring adequate housing solutions for individuals in need.

Plenty of resources that can support the expansion of availability and quality of services for migrants who use drugs are going to be made available soon on both Mainline’s and Correlation’s websites. Of these, the following are already available:

SEMID-EU is coordinated by Mainline, an organisation based in Amsterdam whose mission is to improve the health and social position of people who use drugs, without primarily aiming to reduce drug use and out of respect for the freedom of choice and possibilities of the individual.

Other partners involved in the SEMID-EU project are Ghent University, ISGlobal – Barcelona Institute of Global Health, Positive Voice, Fixpunkt e.V., Gaïa Paris and C-EHRN.

Drug Checking and Harm Reduction Discussed at the 12th International Club Health Conference

Liverpool, UK, gave place to the 12th International Club Health Conference from the 1st to the 3rd of November, a conference committed to fostering a healthy nightlife economy. Among the attendees were Daan van der Gouwe from Trimbos Institute and Rafaela Rigoni, the Scientific Officer at C-EHRN.

The discussions revolved around topics such as the prevention of harmful substance use, addressing violence and mental health issues associated with substance use, promoting diversity and inclusion, and implementing harm reduction measures in nightlife settings.

Drug checking – an essential service that is still underdeveloped or nonexistent in many European countries – has been discussed in several sessions. Existing drug-checking services predominantly focus on recreational drug use, leaving a significant gap in monitoring and understanding new drug trends. Drug checking plays a vital role in obtaining a reliable overview of emerging drug patterns, to which Daan van der Gouwe’s presentation in a parallel session dedicated to interventions and innovation aimed to draw attention. 

While introducing the preliminary results on new drug trends detected by C-EHRN’s Focal Points as part of C-EHRN’s Civil Society-led Monitoring of Harm Reduction in Europe, the necessity of extending drug-checking services to individuals with more vulnerable patterns of high-risk drug use, particularly those who frequent harm reduction facilities, was also emphasized.

The conference highlighted that there is a pressing need for advancements in technology and service offerings to facilitate timely and low-threshold testing of substances commonly used by more vulnerable groups, including crack cocaine and heroin.

Participate in the Delphi Panel on the research “Harm reduction | Construction and Validation of a Collaborative Practice Model”

Do you work in Harm Reduction? Do you have experience in research or harm reduction interventions? This PhD research aims to systemise and analyse collaborative interventions with people who use drugs and substance use services, focusing on creating and validating an integrated harm reduction model. This is the first step towards identifying an international network of experts in harm reduction to integrate a Delphi Panel including social workers, medical doctors, psychologists, peers and nurses who work in harm reduction services.

Interested? You can submit your availability to join the expert group until the 6th of November through this Survey. Participation is voluntary and all responses will be kept anonymous and integrated only in the results of the PhD research.

A Step Towards Informed Discourse on Harm Reduction Services in Finland

In Finland, three organizations, including the A-Clinic Foundation, C-EHRN’s focal point in Helsinki, organised a drug consumption room simulation recently to inform the dialogue around supervised drug consumption sites, inviting media representatives and parliament members. We asked Annuska Dal Maso, the head of street work at A-Clinic Foundation, to tell us about the event. Read her account of the forward-looking initiative below!

“The A-Clinic Foundation, in collaboration with the Diakonissalaitos and Tukikohta ry, organized a drug consumption room simulation on October 24, 2023. This marked Finland’s first-ever drug consumption room simulation, aiming to showcase how a consumption room operates and the services it provides.

Currently, there is an active debate in Finland regarding supervised drug consumption facilities. A citizens’ initiative for legislative changes is currently under consideration in the parliament. However, public discourse has long been plagued by misinformation about these facilities. To engage in a proper dialogue on this subject, it is essential that all parties have accurate information. With this in mind, we organized the consumption room simulation to simulate what supervised drug consumption spaces could practically look like in Finland. We invited representatives from the media and members of parliament with their assistants. We conducted a total of three simulations, each lasting two hours, with 8 to 14 participants in each session.

We constructed a miniature model of our low-threshold meeting place, resembling what a consumption room in Finland could be like. Our services included an injection/smoking room, health counselling, distribution of clean supplies, substance identification, a doctor, a nurse, social guidance, and peer support. We created role characters for the visitors based on real-life scenarios, allowing them to play the role of potential consumption room users. These characters represented individuals who might use a consumption room. The simulation was carried out based on the legislative proposal currently under consideration in the parliament.

Our main message was to convey that a consumption room is not just about a space where visitors use drugs, but it is part of a broader service offering harm reduction work. The consumption room is just one component of this service package. There is a lot of misinformation circulating about consumption rooms, and through the simulation, we aimed and also succeeded in correcting these misconceptions.

The simulation received an exceptionally positive reception. Members of parliament and their assistants provided positive feedback on the event, and the media wrote the following articles on the topic:

https://yle.fi/a/74-20056575

https://www.hs.fi/kaupunki/art-2000009943350.html

https://www.mtvuutiset.fi/videot/klipit/prog20728247

https://www.helsinginuutiset.fi/paikalliset/6303427

https://www.iltalehti.fi/kotimaa/a/092c31a9-b721-4410-adfe-6a173c0735ea

https://svenska.yle.fi/a/7-10044086

https://www.mediuutiset.fi/uutiset/mu/feb0a063-f162-4ed6-98b5-da5c6df892c3

INHSU Highlights on Drug Consumption Rooms

During the 11th International Conference on Health and Hepatitis in Substance Users (INHSU 2023), our team actively participated in the discussion surrounding supervised drug consumption sites.

The session on supervised drug consumption facilities on October 18th, organized by the Global Commission on Drug Policy, emphasized the crucial role of these facilities in providing a safe space within challenging environments, examining different layers of paradoxes surrounding these facilities. Our senior policy officer, Roberto Perez Gayo, participated alongside other panellists from The School for Advanced Studies in Social Sciences, Brown University School of Public Health and Ares do Pinhal. You can read some key points from the Global Commission on Drug Policy session on Supervised drug consumption facilities from the 18th of October in the INHSU 2023 Daily News.

In another significant session on October 19th, we engaged in discussions about different European Drug Consumption Room (DCR) models and best practices. C-EHRN co-organised the session with the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and Ares do Pinhal, and we presented work alongside other organizations – Metzineres and Společnost Podané ruce.

The European Network of Drug Consumption Rooms (ENDCR) brings together a variety of services from different countries. This session aimed to promote knowledge exchange and cooperation among European experts in the field of DCRs. After an overview of European drug consumption rooms, an introduction to different DCR models and presentations of existing service models, a facilitated group discussion took place, followed by space for questions.

Participate in the Civil Society Forum on Drugs Survey on the EU Drug Strategy

Are you part of a Civil Society Organization working in Drug Policy? Your voice matters in shaping drug policies in the EU!

Participate in the Civil Society Forum on Drugs (CSFD) Survey on the implementation of the EU Drug Strategy and Action Plan 2021-2025 and share your knowledge on the implementation of drug policies. Your insights will contribute to the evaluation of the current situation regarding the accessibility and quality of key demand reduction and harm reduction programmes and interventions and help identify potential changes since the last assessment.

You can find the Survey here.

Responses can be submitted until the 30th of October 2023.

Your participation is voluntary. All responses will be kept anonymous and integrated into a report published on the website of the Civil Society Forum on Drugs (CSFD).

This survey continues the efforts of the Civil Society Forum on Drugs to monitor the implementation of EU drug policies from the perspective of civil society organisations. So far, the CSFD has published three reports on the topic:

With this survey, we aim to discover the extent of implementation of the EU Drug Strategy 2021-2025 in the EU Member States and beyond in the middle of its running period. We ask you to fill in the questionnaire providing answers according to your best expert knowledge.

If you have any questions, please contact Iga Jeziorska, the Chair of the Working Group on the EU Drug Policy, at: iga.kender-jeziorska@euro-yoda.org.