Cook & Stoicescu - Harm Reduction in Europe - Mapping Coverage and Civil Society Advocacy.pdf

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Harm Reduction in Europe:
mapping coverage
and civil society advocacy
Contents
Acknowledgements
Abbreviations and Acronyms
Foreword by João Castel-Branco Goulão
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5
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seCtion one
introduction
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seCtion two
Drug use, drug-related harms and harm
reduction in europe
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2.1 Drug use
2.2. Drug-related harms
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14
2.3 Summary of findings: Harm reduction
responses, barriers and civil society
advocacy priorities
15
2.4 Emerging advocacy issues for Europe 16
seCtion three
sub-regional responses
3.1 Eastern Europe
3.2 North Europe
3.3 South Europe
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20
30
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Harm Reduction in Europe: mapping coverage and civil society advocacy
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Acknowledgements
Harm Reduction in europe: mapping coverage and
civil society advocacy
written by Claudia stoicescu and Catherine Cook
Acknowledgements
EuroHRN would like to acknowledge the invaluable
contribution of the following individuals and
organizations in providing information for their specific
countries:
statistical data
The European Monitoring Centre for Drugs and Drug
Addiction
north europe:
Verein Wiener Sozialprojekte (Austria)
Free Clinic (Belgium)
Gadjuristen (Denmark)
A-Clinic Foundation (Finland)
akzept (Germany)
Irish Needle Exchange Forum (Ireland)
Citywide Drugs Project (Ireland)
Correlation Network (Netherlands)
Randi Ervik, Assistant Professor, Diakonhjemmet
University College (Norway)
Swedish Drug Users Union (Sweden)
Infodrog (Switzerland)
Contact Netz (Switzerland)
The UK Harm Reduction Alliance (United Kingdom)
south europe:
Agência Piaget para o Desenvolvimento (Portugal)
Association Francaise pour la Reduction des Risques
(France)
Auto Support des Usagers de Drogues (France)
Itaca Association (Italy)
Associación Benestar i Desenvolupament (Spain)
Asociación de Pacientes Dependientes a Opiáceos
(Spain)
Creu Roja/Red Cross (Spain)
Groupement Romand D’Etudes des Addictions
(Switzerland)
eastern and Central europe:
Stop AIDS Association (Albania)
Association Margina (Bosnia-Herzegovina)
Initiative for Health Foundation (Bulgaria)
Udruga Terra (Croatia)
Sananim (Czech Republic)
Convictus Eesti (Estonia)
The Hungarian Civil Liberties Union (Hungary)
Labyrinth (Kosovo)
Dialogs (Latvia)
Coalition I CAN LIVE (Lithuania)
HOPS-Healthy Options Project Skopje (Macedonia)
Juventas (Montenegro)
Polish Drug Policy Network (Poland)
Romanian Harm Reduction Network (Romania)
Veza (Serbia)
Odyseus (Slovakia)
Stigma (Slovenia)
thanks also to the following individuals for
reviewing sections of the report:
Eberhard Schatz, Cinzia Brentari, Larisa Abrickaja,
John-Peter Kools, Diana Castro, José Queiroz, Christine
Haberkorn, Fabrice Olivet, Dagmar Hedrich, Thierry
Charlois, Lucas Wiessing, Annie Kuch, Maria Phelan, Rick
Lines, Marta Pinto, Gabriel Moshenska.
Information for text boxes featured throughout the
report was provided by several contributors who are
acknowledged within each text box.
Designed by Mark Joyce
Published by
european Harm Reduction network
www.eurohrn.eu
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Abbreviations and Acronyms
AIDs
ARt
Ats
BMt
CLAt
Csos
DCR
euroHRn
GFAtM
GP
HAt
HBV
HCV
HIV
IDU
MMt
nIRoA
nsP
osF
ost
PeD
RtI
tB
UnICeF
UnoDC
UnAIDs
WHo
Acquired immunodeficiency syndrome
Antiretroviral treatment
Amphetamine-type stimulants
Buprenorphine maintenance treatment
The Latin European Harm Reduction Conference
Civil society organisations
Drug consumption room
European Harm Reduction Network
The Global Fund to Fight AIDS, Tuberculosis and Malaria
General practitioner
Heroin-assisted therepy
Hepatitis B
Hepatitis C
Human immunodeficiency virus
Injecting drug use
Methadone maintenance treatment
Non-injecting routes of administration
Needle-syringe exchange programme
Open Society Foundations
Opioid substitution therapy
Performance enhancing drugs
Route transition interventions
Tuberculosis
United Nations Children’s Fund
United Nations Office for Drugs and Crime
Joint United Nations Programme on HIV/AIDS
World Health Organisation
Harm Reduction in Europe: mapping coverage and civil society advocacy
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Foreword by João Castel-Branco Goulão
In the late 1990s Portugal was faced with serious
challenges in relation to problematic drug use and
drug dependency. Action was required and a number
of innovative measures were adopted to meet these
challenges. In particular, there was a focus on those people
who, for many reasons, including social marginalization,
were not turning to conventional treatment services, or
for whom those services were not effective.
In the first instance, it was necessary to address
a main reason people may not want to come forward.
Thus, a new law was adopted which decriminalized
drug consumption and centres instead on the need for
therapeutic evaluation, rehabilitation and reducing drug
related harms.
This step led to the approval of a legal framework
that emphasised comprehensive harm reduction
interventions and which took effect with the Decree Law
183/2001 of 21st June.
Law reform alone, however, is not enough.
The multi-faceted dimension of the issue and the
interaction between diverse areas of public services
(Protection Services, Education, Employment, Housing,
amongst others) demand holistic approaches – and
partnership. When it comes to harm reduction, civil
society organizations, with their specific local knowledge
and relationships with those most at risk, are often the
most appropriate entities to implement these types of
interventions.
This has long been recognized in Portugal and,
over the past decade, the Institute for Drugs and Drug
Addiction (Instituto da Droga e da Toxicodependência,
IDT), has defined as one of its priorities the creation of
the National Network of Harm Reduction by establishing
partnerships with civil society organizations. According
to an independent evaluation of Portugal’s National
Strategy in the Fight against Drugs (1999-2004), harm
reduction, based on this partnership with civil society
organizations, was considered one of the key strengths
of the framework.
Today, the strategic response to drug-related harms
in Portugal remains largely based on the creation of
partnerships between the public and social sectors.
This public-social partnership (which also includes
the private sector) has enabled positive results not just in
relation to drug use or health harms, but across a wide
range of important areas; and not just to individuals, but
to communities:
A reduction in drug-related crimes, and a greater
sense of security in the community
A reduction in discarded drug paraphernalia in the
community
A reduction in risk behavior and the subsequent
reduction in the transmission of infectious diseases
– central to our public health priorities
Improved data quality and research on the
prevalence and incidence of various infectious
diseases among people who use drugs, which in
turn informed programmes.
The constant dynamic interaction between the IDT
and civil society organizations clearly translates into added
value with gains for both sides. These gains are in turn
fostering an increased knowledge and understanding of
drug use and related harms in Portugal. It is a partnership
that has informed the best means of intervention, and
enabled partner organizations to achieve better results.
From an economic point of view, and considering
the current financial crisis, the existence of this network
of partners enables the implementation of a greater
number of evidence-based solutions in the field, with a
decreased cost burden to each entity given that costs are
being spread amongst them.
I cannot, as President of the IDT and National
Coordinator for issues involving Drugs, Drug Addiction
and Alcohol Abuse, commend highly enough the
fundamental role of civil society in reducing drug related
harms for the benefits of individuals and society.
This report represents a window into where we are
in addressing drug use and related harms, and which
factors continue to challenges effective responses. It
also provides a valuable insight into how civil society
organisations are contributing to the reduction of drug
related harms across Europe. To all policy makers and
politicians who are as interested as I am in meeting the
challenges we continue to face in relation to drugs, I urge
you to read it, learn from it, and support this vital work.
João Castel-Branco Goulão
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