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.
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:
- Users are eager and would like this kind of service
- Analysis was provided and will be included in the National guidelines on harm reduction
- Capacities of FLIGHT and BENEFIT organizations have been developed and
- We are talking and promoting harm reduction and its efficiency.
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?
- 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
- 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.
- 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.
- 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
– development of new concepts, plans, materials on NPS
November 27, 2020, Vilnius
The Eurasian chapter of the Global State of Harm Reduction 2020 was presented and published today in Russian language.
This is the seventh edition of the Global State of Harm Reduction Report 2020, prepared by the Harm Reduction International, now in the year when public health took a leading position in the world news. COVID-19 and response measures introduced around the world continue to disrupt our lives. The report provides the most up-to-date information on existing programs, the situation with HIV, viral hepatitis and tuberculosis among people who use drugs, as well as analysis of harm reduction programs in the context of the COVID-19 epidemic. The parts of the report describing the situation in the Central, Eastern Europe and Central Asia region were gathered and summarized by the Eurasian Harm Reduction Association (EHRA).
A short summary of the report is presented to the public during an online discussion today. In total, the region is home to approximately 3 million people who inject drugs, 66% of whom are living in Russia and 77% in Russia and Ukraine together.
Syringe exchange programs operate in 27 of the 29 countries in the region, except Turkmenistan and Bulgaria. Unfortunately, the programs experience problems in many countries, particularly with sustainable funding, especially in transitioning from donor to domestic funding sources. The report shows challenges in unit cost, scope and quality of harm reduction services over the past two years.
Opioid Agonist Treatment (OAT) programs are implemented in 26 of the 29 countries in the region, except Russia, Uzbekistan and Turkmenistan. Unfortunately, we can state that most people who use drugs in the region live in countries where OAT programs are prohibited. In the transition of OAT programs from donor support to domestic funding, the biggest challenges are the availability and coverage, quality, and sustainability of program funding.
The key problem areas for harm reduction implementation in the CEECA region are as follows:
- Decrease in funding
- Lack of political support
- Pressure on civil society
As a result, we see low coverage of harm reduction services and poor quality of programs.
The report provides detailed information on the situation with HIV, TB, hepatitis, and COVID-19 response programs for people who use drugs in the CEECA region. It provides an analysis of the programs, as well as challenges in accessing services.
The report provides an opportunity to learn about innovative harm reduction practices being implemented in the countries of the region. Substitution therapy for amphetamine users, kits for smoking and oral use, drug checking, safe consumption rooms, harm reduction for women who use drugs and for new psychoactive substance users, as well as for those who use drugs in Chemsex practices (LGBTQI, sex workers) are all being actively implemented in the region by the community- and harm reduction organizations.
EHRA sincerely thanks its colleagues who helped us prepare this report through individual interviews and verification of data from countries and the region.