Drug policy varies greatly among European countries, despite common foundations in UN treaties or EU strategies. In this article I’ll review syringe service programs (SSPs) in four East-Central European countries—the Czech Republic, Slovakia, Poland and Hungary, collectively known as the Visegrád Group—to show how politics impact harm reduction.

The Civil Society Forum on Drugs, an expert group of the European Commission, published a report a year ago on the implementation of services for people who use drugs (PWUD). The report reveals discrepancies in the accessibility and quality of 12 examined interventions, with the greatest contrast for SSPs found among the Visegrád Group.

Asked to rate accessibility of SSPs in their country, surveyed Czech professionals in the field gave a high score: 8.9 out of 10. Poland returned a medium score of 4.7. Professionals in Slovakia (3.5) and Hungary (just 1.8) gave low scores for SSP access.

Analysis of annual reports of SSPs shows that they are available in 65 percent of Czech cities, 21 percent of Hungarian cities, 15 percent of Slovak cities and only 7 percent of cities in Poland.

According to European Monitoring Center for Drugs and Drug Addiction data and information acquired directly from the services, 2017 numbers for sterile syringes distributed per PWUD were: 199 in the Czech Republic, 184 in Slovakia, 65 in Hungary and only 35 in Poland.

Where do these dramatic differences come from?

My experiences in drug policy and harm reduction research in the region suggest that the internal functioning of SSPs is similar. They hire similarly educated personnel, adhere to similar values and principles and have congruent procedures.

But criminal law around drugs varies greatly. In the Czech Republic, possession of small amounts constitutes an administrative offence, subject to a small fine. In Hungary, even drug 

 is punishable by up to two years in prison.

So it seems plausible to seek reasons for access discrepancies 

This article was originally published by Filter, an online magazine covering drug use, drug policy and human rights through a harm reduction lens. Follow Filter on Facebook or Twitter, or sign up for its newsletter. This article is based on the findings of Iga Kender-Jeziorska’s study—”Needle exchange programmes in Visegrad countries: a comparative case study of structural factors in effective service delivery”—published in Harm Reduction Journal in September 2019. Harm Reduction Journal is an open-access, peer-reviewed publisher of research into drugs and many intersecting areas. Filter is proud to partner with Harm Reduction Journal to help bridge the gap between research and public understanding.

Politics and harm reduction: Four Visegrád countries’ syringe access stories

By Corrinne Burns / The Pharmaceutical Journal

Scotland’s first heroin-assisted treatment service has launched in Glasgow city centre. But a pharmacist involved in designing the service has said a drug consumption room is ”urgently needed” to run alongside it.

The Enhanced Drug Treatment Service (EDTR), which is licensed by the Home Office, will provide diamorphine to patients with heroin addiction who have not responded to other forms of treatment.

Patients are currently being recruited to the service, which is expected to be fully operational by the end of December 2019. Patients will administer the drug themselves, on-site, under supervision from clinical staff, and must commit to attending the clinic twice a day, seven days a week. Up to 50 patients will be able to use the service at any one time.

In addition to receiving diamorphine, service users will be offered addiction counselling and support with social welfare issues including housing and benefits advice.

Scotland has the highest level of drug-related deaths in the EU, and the nation’s drug-related death rate per head of population is almost three times that of the UK as a whole. Recent data from National Records for Scotland show that in 2018, 1,187 drug-related deaths were recorded in the country. A third of those deaths (33%) were in the Greater Glasgow & Clyde NHS Board area.

Scotland's first heroin-assisted treatment service launched in Glasgow

Drug policy and feminist movements have rarely been connected - but they should be.
Over the past two years, AWID has been working closely with communities of women who use drugs to build solidarity and learn from each other. We learned several things through this process. The war on drugs is clearly a feminist issue because it disproportionately affects historically oppressed groups already at a higher risk of violence and repression. It is critical for feminist movements to understand the gendered, racial and class aspects of repressive drug policies, including the criminalization and stigmatization of people who use drugs. We also need to do more to build solidarity and connections with drug policy and harm reduction movements.

Our new report “Feminist movements and women resisting the war on drugs” documents our experience of how feminists can learn from, support and engage with communities of women who use drugs.

What a world without the war on drugs would look like

The article below brings together writers from across different movements and regions. We asked each of them to reflect on what a world beyond the war on drugs would look like in the contexts they work and live in. Imagining a world beyond the war on drugs visibilises the hugely destructive impact the war on drugs has on communities around the world and encourages us to start reimagining a world beyond stigma, criminalisation, incarceration and violence. The contributions below bring perspectives from Indigenous and other communities using psychoactive plants for healing purposes, workers who cultivate and harvest illegalised crops, Black feminists who organise against the prison system and criminalisation, and women who explore pleasure and cognitive autonomy through using drugs. All of these communities are impacted by repressive drug policies in different ways, but all of them also know that to achieve justice, we need to see an end to the war on drugs.

What a world without the war on drugs would look like
Imagine a world beyond the war on drugs, beyond stigma, criminalisation, incarceration and violence. Communities growing opium as a medicine and for traditional and cultural use. Black youth and women constructing new models of drug policy and repairing the damage caused by the war on drugs. Care through harm reduction is provided to individuals and communities who have suffered violence. Imagine a world where women and all people enjoy autonomy over their bodies and minds. Where people can choose their own path and receive the medical care it entails.

We asked contributors from across different movements and regions to reflect on what a world beyond the war on drugs would look like in the contexts they work and live in.

A world beyond the war on drugs

The three regional networks: Correlation – European Harm Reduction Network, Eurasian Harm reduction Network and Drug Policy Network South East Europe were informed by our members organisations about the situation with sustainability of harm reduction services in Bosnia Herzegovina which is characterised by lack of strategy, policy and funding caused by the delay in establishing national Government for more than a year after the elections, withdrawal of international donors and misunderstandings and low level of cooperation between the governmental institutions and civil society, but also inside the civil society sector providing harm reduction services. The national Strategy for prevention and control of HIV and AIDS has ended (2016) and the Transition plan, developed by the Country Coordinating Mechanism during implementation of The Global Fund funded programme has not been implemented. As a result, the harm reduction services are closed in Sarajevo, Mostar, Bihać and Banja Luka and exist only in Zenica and Tuzla relaying on voluntary work of unpaid Staff and with all supplies already on minimum.

The three Networks expressed our deep concern about the situation and willingness to give contribution to finding solution and ensuring both quick response to the urgent needs and building a sustainable solution. We are ready to provide non-partisan support in identification and advocacy for the best possible approaches to urgently start provision of services to the populations of people who use drugs, sex workers and prisoners and other affected populations and to properly advocate for the sustainability of governmental funding.

The urgent action we are taking is to explore opportunities for emergency bridging funding to ensure survival of existing harm reduction services in the country. The situation is alarming and requires direct action and mobilisation of the international community. The three network have limited resources, so we are now contacting some of our partners and donors, explaining the situation and calling for immediate and urgent support. This could include short-term funding and technical support to ensure a minimum of harm reduction services. So far, we have a promise from the Open Society Foundations for a small grant which would cover basic need for the month of November.

Emergency situation concerning the sustainability of harm reduction services in Albania, Bosnia and Herzegovina, Bulgaria and Romania

European countries are starting to legalise cannabis for recreational use – or at least discussing the option of doing so. However, it is important to recognise that the pace of change has slowed in some countries, with Italy’s decision to ban sales of ‘cannabis light’ products with up to 0.2% THC in May 2019 a notable example.

And we should not assume that Europe and North America will follow similar legislative timelines. It took Canada almost 20 years to legalise recreational use after allowing medicinal, whereas in Europe, countries that have only recently legalised medicinal use are now steaming ahead with plans for recreational use. Once Luxembourg successfully becomes the first European country to legalise recreational cannabis use, it won’t be long before other European countries follow suit.

Recreational cannabis legalisation in Europe – Countries to watch

Manila, Philippines - A day after she was stripped of her post as head of the Philippines' anti-drugs council, Vice President Leni Robredo came out fighting.

"They may have taken away my position but they cannot take away my determination to stop the killings, hold the responsible to account and win the campaign against illegal drugs," Robredo told the media.

"If they think this is the end, they don't know me very well. I am just beginning," she added.

Robredo said she plans to reveal her findings from the 19 days she spent as one of two people leading ICAD, the inter-agency committee managing and coordinating the government's centrepiece policy to crack down on illegal drugs.

"When I took on this post, I asked, 'Are you ready for me?' Now, my question is, 'What are you afraid I will find out? What are you afraid the people will know?'"

'Are you afraid?': Philippines' Robredo defiant over drugs war

Aleksander Levin, Co-chair of the EHRA Steering Committee: “Public officials who define the drug policy wear cardboard crowns from the Burger King and think that they rule the world. In the old tale, just one phrase of a small boy about the emperor with no clothes was enough for everybody to wake up”.

EHRA presents a series of interviews with people whose names and roles in harm reduction are well known in the CEECA region and beyond. They will share the best that they have with us: their experience, ideas and memories.

Aleksander (Sasha) Levin is a Co-chair of the Steering Committee of the Eurasian Harm Reduction Association (EHRA), Specialist on Drug Policy & Information Officer at the Eurasian Network of People Who Use Drugs (ENPUD) and DUNews team member. He graduated from the Journalism Department of the Moscow State University. After graduation, he worked as a journalist in Russian mass media for over a decade. He has been involved in harm reduction since 2002. He held workshops and implemented informational activities in international and Russian CSOs, including the Eurasian Harm Reduction Network (now the Eurasian Harm Reduction Association), Russian Harm Reduction Network, UNAIDS, etc. In 2007, Sasha started working on awareness raising and advocacy in a Russian self-organization of drug users called Kolodets. In 2007–2008, he guided the development and drafting of the manifesto of drug users from the countries of Eastern Europe and Central Asia “Nothing for us without us”. He also worked in Andrey Rylkov Foundation for Health and Social Justice (ARF) as an outreach worker in Harm Reduction Moscow project. For five years, he was a school social psychologist. In 2017, he returned into harm reduction and became a member of the ENPUD Secretariat.

Sasha, you came into harm reduction after ten years of working in mass media. How did it happen and why?

– Firstly, there is no past. You cannot touch the past, put it in your wardrobe or take it to the dry cleaner’s. There is only a track of the past in our memory, in the memories of other people, in videos and photos, etc. However, there is no past on its own.

– Secondly, there is always a million ways to explain the turning points in our lives, and they are all basically right. They are like outfits, which one can put on depending on the occasion and situation. I will repeat again that all those ways are right. Provided that you do not have a goal to lie in order to sugarcoat your life or trick someone. There is no one line in life. It is not a train from a kids’ cartoon, which strictly follows its pre-determined route to get from point A to point B, with various stories happening with it on its way. Everything is much more complicated. Our life consists of many coincidences in each particular point and is basically a chain of events not related to each other, which finally define the fate of an individual.

– Let’s talk about the love at first sight. Do you believe in it?

– Sure, it exists, but people call it this way to make things easy. In fact, the first sight depends on your mood in this particular moment, in this part of the day, on how far you see, on whether you have a partner, on what you have eaten and drunk, on your body temperature and heart rhythm, on the music playing in your earphones and so on. For instance, you will hardly fall in love listening to a song commemorating the Great Patriotic War, but if you are listening to You’re My Heart, You’re My Soul by Modern Talking – the chances are pretty high. So if one element is missing, there magic will be gone and your life will take a different turn.

'Public officials who define the drug policy wear cardboard crowns from Burger King and think they rule the world' - Interview with Aleksander Levin

ESTONIA HAS a lot going for it. The tiny Baltic state of 1.3m people has been touted as the most advanced digital society in the world; it boasts an adult literacy rate of 99.8%; it is sporty too, with more Olympic medals per person than any country bar neighbouring Finland. But Estonia also comes top in another, less cheerful statistic: a higher proportion of its citizens die from drug overdoses than in any other European country. Illegally acquired prescription drugs—chiefly fentanyl and other opioids—are the principal cause of these deaths.

According to the latest European Drug Report, published by the European Monitoring Centre for Drugs and Drug Addiction, an EU agency, Estonia suffered 110 drug-induced deaths in 2017 (the most recent data available), equivalent to 130 deaths for every 1m people aged 15 to 64. Sweden and Norway came second and third, with 92 and 74 deaths per million, respectively. The average was 23 across the EU, which means that Estonians are nearly six times as likely to die from drug overdoses as their European counterparts. (America’s opioid blight is far worse even than Estonia’s: its toll was 210 per million; in Scotland the figure is estimated at 218 per million.)

Estonia’s drug of choice, fentanyl, is a synthetic opioid, typically used to treat cancer patients suffering from severe pain. It is 50 to 100 times stronger than morphine. It is also cheap. The drug costs less to make, distribute—and thus buy—than heroin. Frequently cut with other substances, such as cocaine and heroin, often without the user’s knowledge, each hit can be like a game of Russian roulette.

Estonia is still fighting the epidemic. After peaking in 2012, deadly overdoses began to fall, possibly owing to increased use of naloxone, a medication that reverses the effects of opioid overdoses. But since 2015 deaths have crept up once more (see chart). Why Estonia’s death toll is so much higher than the rest of Europe’s, and why northern Europe is worse afflicted than the south, is unclear. Estonia’s opioid-prescription rate is among the lowest in OECD countries; Spain prescribes more opioids than several northern countries with far higher death rates.

How Estonia became the drug-overdose capital of Europe

Events in Uganda this week highlight how drug policies continue to be used as a mechanism for social control and the criminalisation of marginalised communities.

Shortly after midnight on November 11th, 127 people were arrested at Ram Bar, one of the few LGBTQIA+ friendly bars in Kampala. The arrests were made by the Ugandan police, army officials, and Local Defense Units who rounded off everyone and took them to the central police station. At the time of writing over 60 people are still confirmed to be in police custody.

The official justification for this mass arrest was for the use of banned substances, specifically the smoking of shisha and opium. In an interview with VOA, Patrick Onyango, the Kampala Metropolitan Police spokesperson, said police received intelligence that Ram Bar is a hub for the illicit use of controlled substances; the people arrested will be charged under the Tobacco Control Act (2015). Those found guilty for using shisha or opium can be fined $130 or imprisoned for up to six months.

However many on the ground including Frank Mugisha, the Executive Director of Sexual Minorities Uganda, argue that this is clearly an attack on the LGBTQIA+ community, with drug laws being utilised as a means to criminalise and intimidate. In an interview with VOA, he noted that Ram Bar is one of the few public spaces to do outreach with the LGBTQIA+ community and at the time of arrest, a health meeting and celebration was taking place.

An anonymous source desribes their experience of the arrest: "The whole time it was incredibly abusive, verbally and physically. I got slapped around, kicked and so did a bunch of others. They were saying very homophobic things – we are going to eradicate people like you, how dare you, you're making us look bad", Alice McCool reports.

Drug policies used to criminalise the LGBTQIA+ community in Uganda

The objective of this consultation is to gather stakeholders’ feedback on the EU Drugs Strategy 2013-2020 and the EU Action Plan on Drugs 2017-2020, as they are approaching the end of their cycle.
The consultation addresses all main policy areas of the Drugs Strategy, including drug demand and drug supply reduction and three cross-cutting themes, namely coordination, international cooperation and information, research and evaluation. Similar to the entire evaluation exercise, the consultation looks at the effectiveness, efficiency, relevance and coherence of the actions undertaken to cover the areas mentioned, as well as at the achieved EU added value.
A synopsis of the responses received will be included in the Staff Working Document that will be produced to summarise the findings of the evaluation. The final results of the evaluation will be used by the European Commission, the European Parliament, the Council and Member States in the future decision-making process regarding drug policy.

EU drugs strategy 2013-20 - Evaluation

Prominent members of the ruling Christian Democratic Union (CDU) have begun to openly discuss legalizing marijuana in Germany. The move would be a historic policy turn for the conservative party.

Germany's center-right Christian Democratic Union (CDU) is openly considering a momentous u-turn in the party's attitude to the legalization of cannabis.

"Cannabis could be freed for personal use, of course with controlled production and distribution," CDU interior policy spokesman Marian Wendt told the RND network on Friday. "The resources freed in the police and judiciary should be used to fight the illegal trade."

Wendt's statement came after the German government's drug commissioner, Daniela Ludwig, also signaled a more liberal new drug policy in the conservative party.

Ludwig, of the CDU's Bavarian sister party, the Christian Social Union (CSU), told the 

 newspaper earlier this week, "We need to stop with the ideologically charged black-or-white debates, because we won't get any further."

Instead, the new drug commissioner said the focus of drug policy should be on practicality. "At the end of the day, what is the best way to protect the health of people, especially young people, and which path makes the most sense for the situation in this country?"

Angela Merkel's party mulls legalising cannabis in Germany

This brief provides a preliminary synthesis of Canada’s experience with cannabis legalization in the first year of retail sales. The brief focuses on evidence available to indicate progress against the public health and safety objectives of the Cannabis Act.

Canada’s relationship with legal cannabis is evolving. The market is still developing, and the pending introduction of new product formats means that Canada can expect to see considerable changes in both retail and consumer behaviour at least into the next year.

The National Cannabis Survey* indicates that Canadians’ use of cannabis has been fluctuating both before and after legalization among both youth and adult age groups. However, the changes in use have varied by reporting quarter.

More people are trying cannabis following legalization. Since legalization, those trying cannabis for the first time are more likely to be older (e.g., 45 years of age and up) compared to those trying for the first time before legalization.

More information is needed to better understand the nature of any increases in use, including whether the older population is seeking products with higher CBD due to beliefs about possible health benefits.

The National Cannabis Survey also indicated a significant decrease in Canadians accessing cannabis directly from the illegal market or from friends and family following legalization.

Revenues from cannabis sales have been significantly lower than anticipated.

The legislated three-year review of the Cannabis Act provides an opportunity for critical review of the nature and implementation of the regulations, and to make course corrections.

Looking forward, priority areas for education about lower-risk use include the difference between ingested and inhaled products, and the effects of impairment on driving and in the workplace.

The Cannabis Act permitted the sale of cannabis within a legal regulatory system as of October 17, 2018.

The federal government is responsible for issuing production, processing, import/export, testing and research licences.

The provinces and territories are responsible for retail sales and distribution. Each province and territory established a unique approach, with considerable variation among them in terms of public versus private sales, licensing, number and distribution of retail stores, oversight bodies, pricing and taxation, supply, and places of consumption, for example.