Harm reduction service delivery to people who use drugs during a public health emergency

Harm reduction service delivery to people who use drugs during a public health emergency: Examples from the COVID-19 pandemic in selected countries

Virtually every country of the world has been faced with the COVID-19 pandemic. As learning developed as to how to combat transmission of the virus, countries increasingly resorted to national ‘lockdowns’ during the first wave of the pandemic from around March to June 2020. After coming out of the first wave of COVID-19, countries have used local, regional and national ‘lockdowns’ to once again prevent further transmission during the second wave and similar approaches are expected in the future in the event of further waves of the pandemic hitting countries until every country can vaccinate a high proportion of their population. For those people who are highly drug dependent, with a resulting compromised immune system, COVID-19 presents a serious threat to life regardless of age. Governments, non-governmental (NGOs) and communitybased organisations (CBOs) working to support people who use drugs, and other vulnerable and marginalised people in society, have had to react rapidly to the massive increase in COVID-19 transmission across countries and continents. The ten case studies presented here provide a snapshot of the responses of specific organisations and communities who work with people who use drugs and some other marginalised groups around the world, including Afghanistan, Australia, the Czech Republic, Kenya, Poland, Russia, Spain, Switzerland, Ukraine and the United Kingdom.

Extended: We are looking for consultants to conduct the assessment of the fulfillment of HIV related sustainability commitments given by the national governments in the context of country transition from the Global Fund’s support to national funding

We are looking for the consultants to conduct the assessment of the fulfillment of HIV related sustainability commitments given by the national governments in the context of country transition from the Global Fund’s support to national funding in the following countries: Bosnia and Herzegovina, Georgia, Montenegro, North Macedonia and Serbia

Background

Being a partner of the Alliance for Public Health, the All-Ukrainian Network of PLWH 100% Life and other regional and national partners in the implementation of the Global Fund funded regional HIV project “Sustainability of services for key populations in Eastern Europe and Central Asia”, the Eurasian Harm Reduction Association (EHRA) is aimed at the improving the financial sustainability and allocative efficiency of HIV programs in EECA countries.

To contribute to this objective, EHRA is planning to conduct the assessment of the fulfillment of HIV related sustainability commitments given by the governments of 5 EECA countries in the context of their transition from the Global Fund‘s support to national funding. It is expected that based on the results of such assessment the key civil society regional and national partners working in those selected countries, will be able to adjust their advocacy efforts and actions to improve the financial sustainability and allocative efficiency of HIV national programs.

For that purposes in 2020 EHRA has developed a methodology and tools to conduct such assessment on a periodic basis.

EHRA is looking for 5 national consultants (1 per each country) to help with conducting such assessments in Bosnia and Herzegovina, Georgia, Montenegro, North Macedonia, and Serbia.

In Bosnia and Herzegovina and North Macedonia, the assessments will be conducted retrospectively, taking into account that the implementation of the last Global Fund HIV grants ended in these countries in 2016 and late 2017 respectively.

 Key tasks to be conducted by the consultants

 The consultants are expected to conduct in each of 5 countries the national assessment process in accordance with the Assessment Guide “Benchmarking Sustainability of the HIV Response in the Context of Transition from Donor Funding” to be provided by EHRA. The assessment process should include the next stages:

  1. Scoping: Identify and collect a set of strategic and programmatic documents, including national laws and regulations relevant to the transition process through desk review and interviews with key stakeholders.
  2. Conduct a review of those documents with the purpose to identify the government’s commitments with regards to transition; formulate and group commitments per the guidance provided by EHRA. The consultant should also identify where public/government’s commitments are deficient to properly address transition challenges or to be monitored.
  3. Coordinate and work with the national reference group to be composed of community representatives and national experts and engage them in (i) selecting priority commitments for the monitoring; (ii) define formulation of commitments if those are not sufficiently elaborated in public documents; and (iii) elaborate additional commitments if considered absolutely necessary for transition process monitoring.
  4. Collect data through desk research and/or key informant interviews aimed to measure progress for the selected set of commitments.
  5. Input selected indicators into the Transition Monitoring Tool to calculate the score; and,
  6. Write an analytical report to summarize the findings.

A Sample Outline of the National Report is provided in Annex 5 to the Assessment Guide. The report should include contextual sections, findings, and conclusions for each of the assessed commitments as well as general conclusions and recommendations for key national stakeholders.

 Deliverables:

1.A. Repository and mapping of documents relevant to the transition process (placeholders) and containing the government’s obligations with regards to transition (intentional or officially approved).

1.B. Repository of commitments, which the country (relevant public/governmental agencies) has committed to implement in support of transition of HIV response.

  1. Filled in Transition Monitoring Tool.
  2. Analytical Report on the results of the assessment of the fulfillment of HIV related sustainability commitments given by the national government in the context of the country transition from the Global Fund’s support to national funding.

The language of the resulted documents should be English.

The total contract cost for the work of one consultant under this ToR should not exceed 3,000 USD (including all taxes). 

Full ToR please find here

How to apply

The individual consultants are invited to submit their CV and the Letter of Interest by e-mail referenced under title “Consultant to conduct the assessment of transition related commitments in [name of the country you are interested to conduct the assessment in]” to ivan@harmreductioneurasia.org by COB 22 of January 2021 24:00 EET.

New words in 2020

Looking back over the past year, the Eurasian Harm Reduction Association has found that several words have become solidly integrated into everyday use.

We have learnt a lot this year and we have a lot to look forward to in the New Year, 2021. You can call us eternal optimists, but we believe that we will make it through the difficulties, safe and strong! May we all have a strong spirit and new achievements!

This year we really want to greet everyone personally and wish something unique and unusual. We have hidden our wishes in a gift, and it takes only one click to receive it!

Online Training: “Access to comprehensive care for women who use drugs in case of violence”

In November 2020, EHRA launched the ‘Access to comprehensive care for women using drugs in case of violence’ project aimed at increasing access to legal, psychosocial (including psychiatric) services and shelters for women who use drugs in case of violence.

The project is implemented in collaboration with the Alliance for Public Health as part of the Multi-country Project “Sustainability of Services for Key Populations in Eastern Europe and Central Asia” (aka #SoS_project) and funded through the COVID-19 Response Mechanism (C19RM) of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

On 10, 11 and 14 December 2020, the project held an online training on ‘Organising Care for Women who Use Drugs and are Victims of Gender-Based Violence’.

The training programme included the following topics:

Women who use drugs and women from other social groups in situations of gender-based violence, domestic violence, intimate partner violence. Needs, problems, existing services.
Gaps in government services and NGO services for women who use drugs.
Provision of services for women who use drugs in situations of violence by organizations and harm reduction organizations.
Build partnerships with organizations working to provide services to women in situations of violence. Fragmented analysis of potential partners.
Safety issues for women who use drugs and female staff members assisting in situations of gender based violence/ intimate partner violence.
Thirty-seven participants registered for the training. During the three days the maximum number of participants was 18, and the minimum number was 10. Participants were from the following countries: Georgia, Netherlands, Kazakhstan, Kyrgyzstan, Moldova, Serbia, Slovakia, Russia, Ukraine.

The experience of the participants in working with issues of women who use drugs and survivors of violence varied greatly: from impressive (e.g. Harm Reduction Network, Kyrgyzstan) to almost zero (e.g. ReGeneration, Serbia).

The next step in the project is to work with partner organizations through grants in 5 countries – Serbia, Macedonia, Kazakhstan, Russia and Ukraine. Activities in the countries will be as follows:

Documenting cases of violations of the rights of women who use drugs in case of violence; documenting their situation with access to psychosocial and legal services and shelters, crisis centres.
Advocacy, both at the level of decision makers and at the level of individual shelters, to change the rules and practices of shelters to accommodate women who use drugs in case of violence.
Train shelter staff to work with women who use drugs and collaborate with harm reduction programs.
Improve the quality of shelter services for women who use drugs and survivors of violence.
Also, recommendations on the provision of comprehensive services for women who use drugs and survivors of violence, including shelters/crisis centres, psychosocial and legal services, have already been initiated and will be developed in 2021 as part of the project.

We hope that the recommendations will be useful to country partners as well as to other organizations and groups seeking to improve access to comprehensive support for women who in case of violence.

Ensuring sustainability of services for key populations in the EECA region: initial expert meeting to take stock of budget advocacy efforts was organized 9-11th of December 2020

At 9–11th of December 2020 budget advocacy, sustainability and transparency regional and national experts gathered online to take stock of what has been achieved over the past few years – taking into account the realities of the transition of HIV responses for key populations from donor support to national funding, limited donor resources for the Eastern Europe and Central Asia (EECA) region, and new economic and public health challenges including the COVID-19 pandemic. The dialogue aims to explore whether and how to budget advocacy efforts have impacted state budget funding for HIV services for key populations in the region, what critical elements of budget advocacy have made a difference, and what donors should take next steps to support further efforts by CSOs in budget advocacy for key population HIV services to be fully covered by national budgets in the region. The crises caused by the COVID-19 pandemic have significantly altered situations and contexts and added new urgency to the need to understand how to influence budget decisions effectively. There are huge risks associated with adjustments and replanning of all public health funding that many countries are doing in response to the crises because these changes could lead to lack of funding for HIV responses among key populations.
This meeting is part of the broader regional dialogue and analysis organized by the Eurasian Harm Reduction Association (EHRA) in partnership with Open Society Foundations; the Global Fund to Fight AIDS, Tuberculosis and Malaria; and the Eurasian Coalition on Health, Rights, Gender and Sexual Diversity (ECOM) and supported by the Robert Carr Fund for civil society networks.
This rare gathering of experts is part of ongoing efforts in the region to safeguard and improve people’s health and rights vulnerable to and living with HIV and other stigmatized conditions. Sustainability of services is the ultimate goal, with the transition from external to domestic funding being the process through which countries move as donor support decreases and then stops.
International donors have been withdrawing from support for HIV and other health programs in EECA for several years. Many countries no longer receive or are eligible for, funding from the Global Fund to Fight HIV, Tuberculosis and Malaria (Global Fund). Among other significant funders over the years, the UK Department for International Development (DFID) ended its support in the region several years ago, the US President’s Emergency Plan for AIDS Relief (PEPFAR) provides only small amounts of funding in a few countries, and the Dutch Ministry of Foreign Affairs, the German Agency for International Cooperation (GIZ) and the French 5% Initiative no longer consider the region a priority. Most of these funders provided critical financial and technical support for HIV prevention and other services for key populations, including people who inject drugs, men who have sex with men (MSM) and sex workers. The programs usually cannot survive international donor withdrawals unless they have access to domestic funding, especially from the public sector.

Budget advocacy work and transition experiences across EECA have varied in terms of overall success and the actions taken by civil society advocates, governments and donors to plan for and respond to donor withdrawals. The three-day initial meeting of the dialogue, which was held online and had more than 40 participants each day, included several comprehensive presentations of transition-related activities regionally and at the national level. The five-country examples from Kazakhstan, Kyrgyzstan, Ukraine, Moldova and North Macedonia highlighted different activities and methods used to secure the sustainability of funding for HIV response services specifically for key population – before, during and after transition processes. They served as the basis for group discussions about opportunities and challenges for this type of work across the region. The online meeting concluded with participants proposing suggestions and recommendations for priority actions to promote and ensure investment in health and social services for key populations in EECA.
During January – March 2021 the regional analysis and dialogue “Taking stock of budget advocacy efforts to date in EECA region” will continue with Budget advocacy effort and impact mapping for the past three years in the EECA region and Consultation to develop recommendations for regional partners on investment into sustainability of HIV- services for key affected populations, which is planned to organize in March 2021.
The key lessons learned on a national and regional level, methodical tools for analysis and preliminary recommendations from the initial meeting could be found in the detailed report (download the meeting report)

The submission to the Committee on Economic, Social and Cultural Rights (CESCR) ahead of Lithuania’s Periodic Review

The submission to the Committee on Economic, Social and Cultural Rights ahead of Lithuania’s Periodic Review was submitted on behalf of the Eurasian Harm Reduction Association (EHRA), Harm Reduction International (HRI), the Association of Women Affected by HIV/AIDS and Their Family Members “Demetra”, Coalition “I Can Live”, Support Foundation “Rigra” and youth-led NGO “Young Wave”.

Focusing on the right to health, this submission is highlighting the failure of the Government of Lithuania to implement the State program on drugs, tobacco and alcohol control for 2018–2028 in line with its obligations under the International Covenant on Economic, Social, and Cultural Rights (ICESCR), with particular attention to:

  • Repressive drug policy as a barrier to achieving the realization of the highest attainable standard of physical and mental health for people who use drugs in Lithuania
  • Access to health services for people who use drugs in prison
  • Lack of health care, harm reduction and psychological support services in the community (outside prisons) for people who use drugs.

Questions for the list of issues

In view of the mentioned above, we recommend that the Committee considers including the following questions in the List of Issues that will be presented to Lithuania:

  1. Please indicate the steps taken to review and change legislation criminalizing personal drug use and assess the impact of repressive regulation on prison overcrowding.
  2. Please provide information on how does the government plan to introduce new harm reduction interventions and increase the accessibility of currently available harm reduction services in prison.
  3. Please provide information on how does the government plan to ensure sustainability of funding, availability and (expansion of the coverage of) the following services for people who use drugs:

a) Introduction of community HIV testing;

b) Scale up of antiretroviral therapy

c) Scale up of opioids substitution therapy

d) Expansion of low-threshold services,

e)Distribution of Naloxone

f) Implementation of harm reduction services in the penitentiary system

Please see submission here

In progress: Drug consumption rooms in Croatia

FLIGHT

Life Quality Improvement Organization “FLIGHT” or just “FLIGHT” (in Croatian: LET) was registered in early 2003 and has been implementing needle exchange programs since its beginning. Besides direct work with people who use drugs, FLIGHT was always focused on promoting the effectiveness of harm reduction programs, conducting research, developing publications, working at EU level at number of networks, including the EU Civil society Forum. FLIGHT is the only organization providing programs for sex workers, twice per week at night hours in the center of Zagreb.

Organization has 4 staff members, including two social workers and two outreach workers, and has been implementing so called mobile outreach (with two vehicles) and has established 22 sites where users can come and exchange their used needles and syringes with the new ones, as well as ZAGREB ZOVI- where we deliver syringes to the users that live outside of those 22 sites.

Could you please share, why you decided to focus on drug consumption rooms as harm reduction service in Croatia?

Drug consumption rooms were included as a possibility or one of the measures in the National guidelines on harm reduction. So, we thought that now was a great moment to work and develop more detailed information on it, because governmental bodies are planning a review of the guidelines. And it would be great if drug consumption rooms are better explained in the guidelines.

During the project, you conducted a needs assessment among PWUD in Croatia. Could you please share the main results from this assessment? How people are reacting to the suggestion to start opening DCRs in Croatia?

We collected responses from 120 people who use drugs from 5 cities. Most of them are in favour of safe injecting rooms. During needs assessment, 80% of them answered that DCRs are needed. What is more, they would like additional services to be provided in DCRs, such as: opportunity to get a coffee or soup. Also, it would be useful to have an access to psychosocial counselling. The only issue, that might occur with opening the site is the local neighbourhood and its residents, who wouldn’t be happy about DCR.

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Another activity which was implemented by you – development of the policy paper on safe consumption rooms. Could you please share what this policy paper includes and for whom it’s developed?

This policy paper provides answers if DCRs should be opened in Croatia and what are the main obstacles. It includes a theoretical basis about injection rooms, data on injection rooms in Europe, analysis of legislation, and recommendations for further work. It will be used for the development of new Guidelines on harm reduction in Croatia. The policy paper will be presented to representatives of national and local authorities to raise the issue of DCRs opening.

Are there any legal barriers to open DCRs in Croatia? If yes, could you briefly share what they are, and are there any possibilities to overcome it.

According to the existing criminal legislation in the Republic of Croatia, it is not possible to implement a harm reduction program that includes the establishment and operation of drug injection. Criminal Code, Article 191 criminalizes venues that enable consumers to use drugs. We were working together with a lawyer in producing the analysis and came to conclusion that there are two options: 1) an Ireland model- they made a lex specialis on DCR in 2017 or 2) change the Criminal code (Article No. 191)- where the questionable issue in providing the venue for injecting is raised. In that specific article all types of assisting in injecting drugs are mentioned and some would argue that even existing needle and exchange programs are illegal, there has been a national consensus since 1996 that giving new equipment to users wouldn’t be seen as assisting in drug use. There are adjusting national documents such as strategy on drug abuse and HIV prevention that mention harm reduction in a positive manner. But the issue of “venue” remains problematic.

What do you think should be the next steps in starting/ promoting safe consumption rooms in Croatia? And what should be civil society’s role in all this?

We need to continue to lobby and raise awareness on the positive aspects of the DCRs. NGOs that implement harm reduction programs are very important in raising awareness and educating other stakeholders.

We have updated the website www.smanjenje-stete.com as well as our main website www.udruga-let.hr and will continue to promote the need for DCRs. Policy paper and leaflets will be available for raising awareness and I will be speaking at the national conference and presenting the work we have done with support from the Robert Carr Foundation and EHRA.

We have now access to international documents provided by our international speaker at the conference and desk review we did.As each developmental project it might take time to open a DCR but at least we have a good starting point:

  1. Users are eager and would like this kind of service
  2. Analysis was provided and will be included in the National guidelines on harm reduction
  3. Capacities of FLIGHT and BENEFIT organizations have been developed and
  4. We are talking and promoting harm reduction and its efficiency.

Text me on Telegram: online peer-to-peer consultations in Kazakhstan

Forum of people who use drugs (PWUD) Kazakhstan

Forum of people who use drugs (PWUD) Kazakhstan is a civil forum, a community of people who use drugs and their supporters, activists and experts in the field of drug policy, who areunited by  common goals and interests. The mission of the Forum is to mobilize people who use drugs for joint action and structural changes in Kazakhstan drug policy in accordance with the interests and needs of the PWUD, based on standards of human rights and fundamental freedoms, as well as standards of medical care and social support for the PWUD recommended by the World Health Organization (WHO). Currently, the Forum has 21 people - these are activists from 7 regions of Kazakhstan.

How did you decide to focus on the topic of peer-to-peer consultants? Why is this topic relevant in Kazakhstan?

Starting from 2014, there is a growth of the NPS market in Kazakhstan. Compared to other Central Asia countries, Kazakhstan has the highest number of NPS reported. More about NPSs in Kazakhstan can be found in the report “New psychoactive substance use in the Republic of Kazakhstan: Research results.

Most harm reduction services in Kazakhstan are oriented at opiate users, although the drug scene is changing: the opiate market is slowly disappearing. As a result, fewer people with opioid dependence are registered each year, while NPS appear on the market. With the changing drug scene, outreach work to support people with opioid dependence has become less effective.  Activists from the community of PWUD in their 30s are those who have been clients of harm reduction programs and started to use synthetics. Young people aged 12-30 who have never tried opiates now snort and smoke, prefer to smoke NPS, and mix substances with tramadol and stimulants (part of this group are directly related to darknet advertising, distribution, etc.) and then switch to injecting.

No one in Kazakhstan has previously implemented projects aimed at supporting people who use NPS in the online platforms. This topic was also new for us, but we already had little experience in consulting people who use NPS on social networks (Telegram) as volunteers in darknet. The project became an opportunity for us to do it more professionally and qualitatively with the ability to pilot its results to all interested parties to expand the package of services and subsequent implementation of the online consultation componentfor PWUD at the country level.

What is an online peer-to-peer consultation? How does it work? Tell us more about how you do these consultations.

Online peer consultation is the work in a variety of online formats:
-publications, posts with information on safe drug use that we collect and prepare ourselves (types of NPS, characteristics, effects, consequences of use; poly-drug use);
– thematic photos, GIFs, videos;
– trip-reports (when people share their personals stories related to substance use). It is a great  material, and it is always interesting to read it. It can also inform people about the negative consequences of using a substance they are trying for the first time;
– peer-to-peer psychological support is a support without shaming or blaming person, with the opportunity to share personal experience;
– referral to specialized professionals (psychologist, addictologist, infectious diseases specialist);
– online lawyer of the Forum of PWUD Kazakhstan;
– consultations on HIV/ AIDS, hepatitis, STIs;
– HIV testing;
– consultations on access to social and medical services;
– informing about the activities of PWUD Kazakhstan Forum, ENPUD, EHRA – organizations that support PWUD in the region;
– invitations to participate in open discussions, online webinars for PWUD;
– invitation to participate in the campaigns with the international community of PWUD;
– referrals, accompanying, personal face-to-face meetings;
– thematic surveys (HIV, hepatitis, on the content of the channel).

What problems did you face, when you started to provide online consultations?

The difficulties that we faced, when we started to provide online consultations are the distrust and closeness of users of Telegram channels. Even now for people who use NPS it is difficult to trust and understand that there are people in Kazakhstan, who are providing harm reduction services, who are openly speaking at one’s own risk about themselves, their experience of drug use, and support you psychologically. The difficulty is in the communication and personal contacts because some help implies private meetings, for example, social accompanying, and this kind of activity is excluded by the rules of Telegram users.

Only few people contacted the project lawyer. According to the results of a face-to-face survey, we realized that people simply do not trust such a service. It is something new for them, and it is difficult for people who use drugs to talk to a person with a legal background about personal use or to solve similar issues.

Please share your achievements in this small grant.

One of the most significant achievements of the project was the launch of three Telegram channels, where around 400 people subscribed. These are people who receive information on harm reduction,, what to do in case of overdose, receiving social, medical and legal assistance. The most important thing is that in case of any problems they know where and whom they can ask for help or advice.The audience also participated in two campaigns: on August 31 in the World Overdose Awareness Day and Support Don’t Punish (World Drug Day).

Users have also noted the value and necessity of the publications in the channels, as well as the existence of such content and the service in general.

Medical workers, the expert community, GFATM, representatives of international organizations in Kazakhstan also share this opinion. At the moment the information about piloting the service online – consultations were presented on two platforms, where all interested state parties (Kazakh scientific center of dermatology and infectious diseases, Republican Scientific and practical center of mental health,, CCM, etc.) and international organizations (UNAIDS, UNODC, GFATM, etc.) were present.

We mastered the skills of running Telegram channels, learned how to work through bot-support, and learned a lot of useful information while compiling and selecting material for publications. We gained experience in creating promotional materials focused on the needs of the community of people who use NPS.

Consultations and support for people who use NPS is also a new experience for us, and we are pleased with the result we got. Acceptance and trust is the most important thing.

Now that the project is over, people from other regions have joined the channels, and one of them asked us for support. Our consultant helped us to create a channel, and now we have another additional resource where we can talk about harm reduction.

Your recommendations for donors/government to promote this approach. What are the next steps?

  1. The Forum has planned further steps to improve and expand online services. For example, attracting funds to provide services of addictologist, psychologist, distribution of informational material on harm reduction. We submitted one grant application, now we are waiting for the results.

-Technical support (laptops, software to work with video, create promotional materials, etc.) is needed for the implementation of such projects;
– educational pieces of training, offline seminars;
– capacity building of the team, psychological support for online consultants;
– development of a security plan with the involvement of specialists as NPS attracts the attention of the police;
– organizational and personal security;
– IT security
– contacts of friendly lawyers, psychologists

  1. There is a need for intensive outreach work with NPS users. Access to prevention programs for new people will become more effective if information about services will be disseminated through Internet resources, pharmacies, mobile sites, nightclubs.
  1. It is not known precisely how many people are members of groups where sexual contacts are connected with the use of NPS. It is worth noting that offers of substance use in exchange for sexual services for girls are common in Тelegram channels. This type of “leisure” is popular.

The risks of HIV infection and other STIs are increasing significantly. Therefore, it is necessary to develop services aimed at the sexual and reproductive health of women who use synthetic substances, involving medical specialists (gynecologists, dermatovenerologists). It is essential to educate project consultants on specific topics of counseling, to provide lubricants, female condoms, etc. in larger quantities.

  1. Creation of an international online platform for communication on harm reduction for NPS users:

– Implementation of projects towards online consultation on NPS (sharing experience)
– Mobilization and support for people working with NPS issues
– trainings
– development of new concepts, plans, materials on NPS

Drug checking services in Serbia – To know what I am doing

Re Generation

NGO Re Generation is a youth-led, youth-based organisation working in the area of public health and human rights, focusing on specific issues related to vulnerable groups at risk regarding substance use. Re Generation is a specialised organisation contributing to fulfilling its aims through work on (drug) policy, research, education and advocacy concerning issues related to substance use and public health in Serbia. The foundation of the organisation has been contributing to actions toward setting a framework for different, innovative programs and views related to drug policies in Serbia with a focus on sustainable harm reduction programs, acknowledging and focusing on respect of human rights of vulnerable and marginalised populations in Serbian society. Throughout the years, the organisation has been actively participating in drug policy reform on the national and international level, advocating for improving public health and respect for the human rights of key target populations.

Re Generation is a team of 16 people, each and one contributing to the organisation based on their interest and specialisations. The organisation is led by the Assembly, which is a leading decision-making body and consists of all our members, employees, honorary engaged experts, volunteers and advisors.

Could you please share why you decided to focus on drug checking as a harm reduction service in Serbia?

We have been working in the recreational drugs area from the beginning. This helped us to observe changes in patterns of use, as well as substances used. In recent years, the emergence of NPS was quite visible, at the same time, the lack of harm reduction programs specifically for recreational users was more striking. As research on the use of NPS in Serbia showed the first reliable data focusing on users itself, we considered it as a basis to start a dialogue with the Government on how to improve services towards recreational users. It is beneficial for both country and users themselves.

Please, share what did you succeed to implement in the framework of the small grant project?

Through the implementation of the project, at first we got strategic support from the Office for combating Drugs of the Government of Serbia for program implementation. Then we held several consultations with state institutions, focusing on referent laboratory representatives that we first met, and discussed their needs in improving their work. Second, we consulted recreational users and representatives of CSOs on their opinions regarding drug checking services and NPS situation to better assess current problems, opinions and positions. After this we analyzed the policy about establishing drug checking services and designed Guidelines for improving Early Warning System (EWS) in Serbia, focusing on improvement of communication, research and cooperation, where a small part of the document is a proposal for services itself. We launched a webpage on our website, aiming to educate the broader public in what drug checking services are, adding up two interviews with our colleagues from Kosmicare and DrogArt to promote good practise examples to our followers! The project gave birth to a video on drug checking called #DAZNAMŠTARADIM (which means, to know what I am doing) that in short explained the purpose of Drug Checking and its benefits, that was watched more than 10.000 times by Serbian audience. The project ended up with two conferences, one for the government officials with the Office for Combating Drugs and ministry of health. During this section, we presented the guidelines. The second meet up for the community was broadcasted in social media and dedicated to the main question on drug use and mental health issue that increased due to Covid-2019 restrictions.

How these activities will help you in future advocacy for drug checking services?

Well, it is apparent that we needed reliable data to start the conversation, that was significantly supported with creating the Guidelines. The Guidelines that we made are just the starting point of the discussion that we wanted to initiate with the stakeholders. We are aiming to continue to work on them in the future, during the development of the next Drug Strategy as well as while creating the quality standards for harm reduction services in Serbia. We became more recognizable, visible and acknowledged not only from State institutions but also by the community. We believe that it is just the beginning of the development of services we all need.

One of your activities was to develop guidelines for drug checking. Could you please briefly explain what is this document about and for whom it is created?

The Guidelines for Improving Early Warning System and establishing drug checking services initially was planned to be a guide for setting drug checking services in recreational settings, analysing laws and drug policies and offer the guide based on evidence and best practices.

Through the detailed consultations with chosen stakeholders, we realised that our state, as well as the society and community, is not ready for such a leap into innovation. 

At the same time, we realised that what we have needs to be improved, and that is the Early Warning System for NPS. Then we created guidelines for enhancing the progress of research and data collection of NPS, capacity building and raising awareness on the benefits of drug checking. A small part was dedicated to proposing drug checking services as a tool that will help both community and Government Institutions. The document is only a basis for the conversation between community and state, as well as CSOs. The aim of it is to build an evidence-based response to NPS emergence and create services that will be focused on the protection of health and wellbeing of the (potential drug) users.

Did you face any challenges while implementing a small grant project? If yes – what kind of challenges and how they affected your work?

Implementation of project in the Covid-19 era was definitely a challenge, as communication with the state institution was really problematic. Some challenges in the framing of the Guidelines did exist. Still, open dialogue with all stakeholders and good cooperation and support from the Office for Combating Drugs in mitigating the difficulties really brought the best we can have in the current situation. Therefore, each activity was implemented without any changes.

What do you think should be the next steps in starting/ promoting drug checking in Serbia? And what should be the role of civil society in all this?

We initiated the conversation, but it’s tough to predict what will happen next. In the following months (hopefully) Serbia will start designing the new Strategy for Drugs, and together with that, it should bring the document such as Quality of standards for harm reduction services that will serve as a basis for service implementation in future. Both papers were at this point the basis of the future development that CSOs need to be more involved than before. In the past, the decision-makers involved the CSOs but at the consultation phases. I believe that cooperation should evolve if not to partnership level then definitely to a dialogue, where we will be recognized not as critiques of the Government but as equal partners. To my mind, only in such a way, the drug checking services are possible in future.