Terms of Reference for the consultant to develop methodology to analyze the implementation of the national plans for transition

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

Continue reading “Terms of Reference for the consultant to develop methodology to analyze the implementation of the national plans for transition”

Сall for applications to receive technical assistance for organizations, that want to increase their organizational capacity

EHRA announces a call for applications to receive technical assistance (TA) for organizations, that want to increase their organizational capacity to be more competitive and successful in receiving available state funding[1].

Continue reading “Сall for applications to receive technical assistance for organizations, that want to increase their organizational capacity”

National campaigns tender results

The Eurasian Regional Consortium – Eurasian Harm Reduction Association (EHRA), Eurasian Coalition on Male Health (ECOM), and Eurasian Women’s Network on AIDS – within the open call has identified 4 national partners to develop and implement the CHASE THE VIRUS, NOT PEOPLE! campaign at the national level in the countries of the Eastern Europe and Central Asia region.

The winners of the tender: partnership of the Community Engagement, Human Rights and Gender Equality Working group and Real World, Real People NGO (Armenia), Public Association “Legal Center “Zan Talaby” (Kazakhstan), Public Organization for the fight against AIDS (Azerbaijan), «Parni PLUS» (Russia).

The assignment is implemented in the framework of the Eurasian Regional Consortium project “Thinking outside the box: overcoming challenges in community advocacy for sustainable and high-quality HIV services”, funded by the Robert Carr Fund for civil society networks. The national campaigns will be developed and implemented by the end of 2019.

EHRA statement: HIV2020

Eurasian Harm Reduction Association (EHRA) supports the HIV2020 Conference in Mexico City, which will be held July 6-8, 2020.

We want to recall, that against the recommendations of community advocates worldwide, including the national networks of people living with HIV in the U.S., the International AIDS Society (IAS) chose the U.S. as the site for its next International AIDS Conference in 2020. This decision creates a dilemma for many in the global HIV movement.

An alliance of global key population-led networks, networks of people living with HIV, treatment activists has formed to organize an alternative international Conference – HIV2020: Community Reclaiming the Global Response. Event is scheduled to take place in Mexico City, July 6-8, 2020. This community-led event is going to provide a safe alternative for individuals who cannot or will not enter the U.S. in 2020 or who cannot afford to attend AIDS2020. It will also offer new opportunities to reaffirm the leading role communities play in the global HIV response.

The event will focus on presentations and debates that are important to showcase the work and research conducted by people living with HIV. This will guarantee that our voice will be heard all over the world, including the U.S.

For EHRA it is important to make the voice of the EECA communities to be heard on such an important global arena without additional travel barriers.


Extended: Terms of Reference for a national consultant on legal analysis of cases of human rights violations against women who use drugs in Russia

 The Eurasian Harm Reduction Association (EHRA) as part of the three-year multi-country project “Sustainability of Services for Key Populations in Eastern Europe and Central Asia” (#SoS_project), implemented by the Alliance of Public Health Charitable Foundation in consortium with the All-Ukrainian Network of People Living with HIV (100% Life), the Central Asian Association of People Living with HIV and the Eurasian Key populations Health Network, regional networks, governmental and non-governmental organizations, and a number of technical partners, announces an open tender for a consultant for legal analysis of interviews collected in Russia to implement Objective 2 of the project – to reduce the most important human rights and gender barriers to accessing HIV prevention and care services.

Gathering data on human rights violations among people who use drugs, their analysis, ensuring follow-up, and reporting to the UN human rights treaty bodies will help remove barriers to access to HIV prevention and care services for people who use drugs in EECA countries. In addition, mentoring and technical assistance to partners from national communities will help build community capacity in collecting data on human rights violations and understanding the follow-up system for its systematic and effective use.

The collection of data on cases of human rights violations against women who use drugs in Russia will serve as the evidence base for advocating for amendments to existing national legislation aimed at respecting and protecting the rights of people who use drugs, and will become the basis for subsequent submission of reports to the UN human rights treaty bodies.

Tasks of the consultant and expected results:

  1. To get acquainted with the interviews collected by EHRA, to identify the main patterns, trends and types of problems that women who use drugs face.
  2. To analyze to what extent the identified problems are a consequence of the Russian legislation on drugs, and where there are cases of discrimination and / or abuse by representatives of state and other structures.
  3. To prepare a descriptive 10-15 pages report.


  1. The first draft of the report – by December 10, 2019;
  2. The final report, taking into account comments from EHRA – by December 20, 2019.

Consultant Requirements:

The submitted applications will be evaluated by the selection committee of the Eurasian Harm Reduction Association. The following criteria will be used to evaluate the bids (the maximum possible number of points is 100):

  1. The applicant is an employee or permanent consultant of a Russian organization working in the sphere of harm reduction and / or protection of human rights (25 points);
  2. Legal education (25 points);
  3. Relevant work experience (references to documents or relevant analytical materials should be provided in the application) (50 points).

Cost of services:

The amount of the contract may not exceed $1,000 (paid upon completion of work and the provision of a final report to EHRA).

How to apply:

Applicants must submit their CV and application (letter of interest) in free form to maria@harmreductioneurasia.org, the subject of the letter is “Consultant RUS”, the deadline for submission is before 24:00 EET November 4, 2019. The CV and application should clearly reflect the competency of the candidate necessary to complete this task, as well as include the proposed number of working days necessary to implement the assignment.

General terms:

Interested consultants should pay attention to the following conditions:

  • EHRA will sign an agreement with the winner of the competitive selection. The contract will define a detailed work plan and payment terms.
  • The winner of the competitive selection agrees to provide confirmation of their daily rates before signing the contract.
  • EHRA reserves the right (but does not commit itself to obligations) to enter into negotiations with one or more applicants in order to obtain clarifications or additional information, as well as to agree on the timing of work.

If you have any questions or need clarification regarding this ToR, please contact Maria Plotko at maria@harmreductioneurasia.org no later than October 30, 2019.

Terms of Reference

Invitation to participate in the Tender for the selection of Editors

Eurasian harm reduction Association (further EHRA) announces a tender for the selection of editors for a long-term cooperation with EHRA.

Based on the results of the tender, EHRA will select several consultants, with whom EHRA will conclude long-term contracts.

More information about the Association and specifics of the work you can find on our website http://harmreductioneurasia.org

Type and subject of the tender:

As part of its work, EHRA requires quality editing and proofreading of various types of documents, reports and publications:

in English language,

in Russian language.

As a result of the tender, consultants with the highest amount of points for each of the following category of work will be chosen:

– (ER) editing texts in Russian language,

– (EE) editing texts in English language.

Requirements to participants of the tender / evaluation criteria:

Essential requirement for the participants of the contest:

– Category (ER) – the Russian language must be native to the candidate (native speaker);

– Category (EE) – the English language must be native to the candidate (native speaker).

General requirements for the participants of the contest.

To assess the tender applications, the following criteria will be used (maximum amount of points for each criterion):

  • Experience of editing in the fields of public health, human rights, harm reduction etc. – maximum 20 points.
  • Quality of the completed test task – maximum 50 points.

Text for Category (ER)

Text for Category (EE)

  • Education: diploma in linguistics, philology or other related fields; special certifications, etc.: maximum 20 points.
  • Price of editing of a page of text (1800 characters with spaces) maximum 10 points.

The maximum possible amount of points            100 points

Participants must submit:

  1. A cover letter in a free format (no more than in 1 pages), which should include:
  • information for which category of work (ER, EE) the documents are submitted;
  • indication of the cost of services, i.e. editing of a page of text in EURO (1800 characters with spaces);
  1. Completed test task in Word-format (.doc, .docx).
  2. CV in a free format;
  3. Copies of diplomas and certificates, as well as links on the examples of the previous editing.

ATTENTION! If these documents are not provided in full, such application in not considered for evaluation.

Application deadline – 1 p.m., September 30, 2019, Vilnius local time. Please send your documents at julia@harmreductioneurasia.org

Special conditions:

Upon the completion of the tender procedures, EHRA will sign long-term contracts with the selected number of Consultants on a fixed cost of services per unit basis in EURO (page of text, 1800 characters with spaces). Further work will be carried out based on the needs of EHRA and according to the timeline and other conditions, which will be decided upon in each individual case.

The submission of documents for participation in the tender does not impose on EHRA any additional obligation to conclude a contract.

Mari Chokheli, Chair of the Steering Committee of EHRA: “We often talk about the “community” and “experts.” In five years, I would like to see a strong community of experts, who defend their rights and engage in all the decision-making processes. I would like to make it real, not just a slogan or a formality.”

EHRA presents a series of conversations with people whose names and roles in harm reduction are well known in the region of Central and Eastern Europe and Central Asia, and beyond. They will share with us the most valuable – their experiences, thoughts, memories.

Marina (Mari) Chokheli is the Chair of the Steering Committee of the Eurasian Harm Reduction Association (EHRA) and Coordinator of Harm Reduction and Access to Medicine Programs, Open Society Georgia Foundation (OSGF). She has been working for OSGF since 2010 and actively engaged in various areas related to public health, harm reduction and access to Medicines: community mobilization; strengthening and capacity building of community organizations and activists, promoting human rights of vulnerable groups; drug policy and promoting humane and efficient law enforcement policies and practices affecting vulnerable groups; advocating, developing and launching of the first National Hepatitis C treatment programs in Prison and for general population in Georgia.

And what’s more, she is an amazingly sincere, attentive and responsive person.

Mari, when and how did you come to work in harm reduction?

– (Smiling) Sometimes you do not even feel as time goes by. It has been a long time, about twelve years ago. I worked in human rights sphere and often interacted with PUD living with HIV who stayed in places of confinement. They needed methadone programs and access to treatment. Even back then I realized that harm reduction is not just about the right to health, it is an integral part of the rights of all people (though we still have to prove it in many countries of our region). I started searching for information, subscribed to the regional ITPC mailing list. Though it was focused on HIV, it also contained discussions on the strategic litigation in the European Court of Human Rights, in particular on access to medical services.

Now, thanks to social media, finding information is not a problem, but then you could only look through mailing lists and websites. Nothing else. Needless to say, I did not know about any organizations working in harm reduction in Georgia. I met them later, through different conferences and international networking events. That was my first experience.

Did you have a chance to work in a national harm reduction organization in Georgia?

– I worked with court proceedings, strategic litigation, dealt with constitutional cases, in particular those which further went to the European Court of Human Rights. As soon as I changed the area of my activities, I saw a relevant vacancy in the Open Society Georgia Foundation. In fact, I had several job offers, but I chose OSGF as it is a place where you always remain an activist. Sure, there is a strategy, there is a certain structure, but still you are free in your planning, you are involved in processes at all levels, you work directly with activists and learn about the relevant needs and issues first-hand from them. Besides, in OSGF there are opportunities to learn and gain experience. If you want to suggest something new and innovative within or beyond the existing strategy – you are welcome! It is a very favorable environment. 

Sometimes we pilot projects with no significant resources: we initiate those projects and strive to make a certain problem visible, mobilize activists and resources to solve it. Gradually, other people join us, we have more allies, we raise funding. That is when we can step aside. When you work in OSGF, you are not just a donor, who only reads reports, plans strategies and announces calls for proposals. You are involved in all the processes from planning to implementation.

Do you still work there?

– Yes, I am a Coordinator of Harm Reduction and Access to Medicine Programs.

Great! Mari, taking into account your workload, we are especially glad to see you as the Chair of the EHRA Steering Committee! How did your relations with the Association develop?

– I have an extensive experience of working with EHRA. Our roads often crossed, sometimes even not within a particular project, but within different initiatives. There are many creative ideas in our region. I like it when you have some idea at your country level and EHRA already develops the same idea at the regional level.

Could you give an example, please.

– Maybe because I come from the human rights sphere, I have always thought that building partner relations between human rights organizations and harm reduction organizations (first of all at the local level) is kind of a cornerstone. So we continued this work, also in the area of strategic litigation. It really helped us to make a few steps ahead. Firstly, because we had more supporters. Secondly, because with the same advocacy efforts strategically you prove to the state that it is mistaken, that it violates your rights. Thus, you manage to achieve systematic changes at the precedent level.

So we raised the issue of advocacy. In your opinion, how different is this process at the national and regional levels?

– It is a difficult question. On the one hand, each country has its peculiarities and specificities. The approach that works in Georgia could fail in another country, and vice versa. On the other hand, regional advocacy campaigns often make your position stronger and help you to further plan your activities. When the messages relevant to your country are presented under a common “umbrella,” it makes them stronger!

What is also important is that at the national level you focus on your own experience, knowledge, resources (in particular, intellectual resources). At the regional level, you also embrace other people’s experience – both positive and negative. After analyzing this information, you go to implementation. When we had tenders for the Hepatitis C program in Georgia, we in OSGF learned from our Ukrainian colleagues how they plan such procedures in their country and we also cooperated with the Egyptian activists, who wrote a similar program and have already done something like what we were doing. We were equipped with information, which greatly influenced the outcome. Regional advocacy is not easy, but it is very strong!

You said the work “campaign.” Last year, at the International AIDS Conference in Amsterdam there was a campaign initiated by the key populations networks from EECA called ‘Chase the Virus, not People!’ Why do you think such advocacy activities are important and do you think this campaign should be continued?

– This campaign showed itself, its goal is vital. Regional campaigns are very important in general, especially in the context of countries transitioning to domestic funding. The only thing I would consider is that, when we develop advocacy messages, we should try to make them clear not only to us, not only to those who work in harm reduction, but also to people who are, let’s say, out of this topic: economists, lawyers, politicians, etc. Everyone! This is what I would consider in future. Unfortunately, there are very few examples in countries or regions, where the message would cover all the population, touching the hearts of various people.

Is it important for the community networks to cooperate in such a format?

– Sure, of course! It took us a long time to reach common ground, but leaving behind some nuances, we all have one goal – to survive and live full lives! That is why I think it is important for us to unite within such campaigns and networks. Our voice is to be heard.

We are having this conversation within the EHRA five-year strategic planning meeting. That is why I have two questions to you. What objectives set forth in the previous strategy did EHRA achieve and what it did not? And what should be included into the new strategy?

– During this meeting, we had a lot of discussions with the EHRA Steering Committee and Secretariat – not only about our achievements, but also about the things we failed to achieve. I think it is a right approach, when, planning your future, you analyze and take into account all the lessons learnt. The work that we did was not easy.  Transformation of the Association was a crucial task. I am glad to say that it was a success as well as our regional advocacy. EHRA clearly realized the goals and needs of every country, helping to bridge the gaps. Gradually, strengthening the community, conducting assessments, overcoming barriers and analyzing what works well led to the next step – advocacy, specifically advocacy together with the community. This is what we have been doing and I would surely continue these efforts.

As for our next mission, I believe that it should be very ambitious, even cosmic! When you go beyond what you think is real, you achieve more. In my work, I often follow the rule: “Plan as much as possible to get what you want.”

“We often talk about the “community” and “experts.” In five years, I would like to see a strong community of experts, who defend their rights and engage in all the decision-making processes. I would like to make it real, not just a slogan or a formality.” It depends not only on funding – programs can be implemented even with fewer resources. We have learned something, we already have some knowledge. The main thing is providing access to quality services. Everything should be based on the vital needs. I will give an example: in most countries, naloxone nasal spray is not available, while injecting naloxone is sold by prescriptions, and we are talking about the medicine used in case of overdoses and which save lives!

What does harm reduction mean to you?

– For me, harm reduction means that a person should have everything he or she needs to stay safe, to stay alive, with the feeling of dignity and all human rights. Harm reduction is a program, which is always aimed at risk reduction and care, though it may change depending on the drug scene and the situation in society, on the new psychoactive substances appearing, etc. However, the basic harm reduction package should be: a) needs-based, b) individual.

Mari, with the schedule you have

– (Laughing) I have none!  Working at the weekend and exchanging emails with colleagues at 3 a.m. is my usual routine. But I am lucky: I spend my whole life where I want to be, I wake up in the morning – and I am happy to go to work, meet new people, learn new things, and do what brings me moral satisfaction. My work is more than just complying with my job description.

So your work is your lifestyle? How do you manage not to burn out?

– The best way to relax for me is going to the mountains for a couple of days. Turning my phone and internet off. When I look at the nature, look at those magnificent mountains, all my problems seem so tiny… It is a great feeling! You re-assess everything. All your troubles, all the things inside you that you are not happy with – it all goes away. Even if I stay in the mountains for just three days, I have a feeling that I had a four-week vacation. My strength comes back to me, the puzzle in my head puts together, and I can clearly see my priorities. Mountains help me to stay true to myself. No matter what.

EHRA submitted report to the UN Committee on Civil and Political Rights for the adoption of lists of issues on Ukraine

On the 30th of August, 2019 EHRA together with Canadian HIV/AIDS Legal Network and Charitable Organization «Charitable Fund «Ukrainian Network of People who Use Drugs» (VOLNA) submitted the report to the 127th session of the UN Committee on Civil and Political Rights for the adoption of lists of issues on Ukraine. The report draws the Committee’s attention to the Violations of Articles 2, 7, 9 and 10 of the International Covenant on Civil and Political Rights as part of drug enforcement in Ukraine.

In 2018, every seventh person convicted in Ukraine (10,144 of 73,659 people convicted of criminal offences) was convicted of drug crimes; of those, 8,513 people (84%), were convicted of crimes of simple possession for personal use (Article 309 of the Criminal Code); of those, 6,482 (76%) were convicted for possession of narcotics in miniscule amounts that ranged from 0.005 to 1.00 gram of heroin.[1] People who use drugs and especially people who live with drug dependence are vulnerable to discrimination based on this chronic health condition, arbitrary arrest and ill-treatment by police. When people with drug dependence are criminally prosecuted for possession of small amounts of narcotic drugs for personal use, this amounts to detention solely on the basis of drug use or drug dependence.

According to the 2019 Report of the UN High Commissioner for Human Rights, people who use drugs face an increased risk of torture and ill-treatment [in detention]. In some cases, law enforcement officials deliberately take advantage of the pain and suffering associated with withdrawal syndrome elicit forced confessions while people who use drugs are deprived of their liberty. Human rights mechanisms concluded that the use of withdrawal symptoms to obtain information or confessions, to punish or to intimidate or coerce may amount to torture.[2]

Suggested items for the List of Issues with respect to Ukraine

  • Please provide information about measures the State Party has adopted to protect people with chronic drug dependence from discrimination and ill-treatment, taking into account tough drug laws and high rates of criminalization of people who use drugs in Ukraine.
  • Please provide information about measures the State Party has adopted to ensure access of prisoners with drug dependence and HIV to essential medicines and HIV prevention services that are equivalent to those available in the community.


[1] Official courts’ statistics for 2018. Online: https://court.gov.ua/inshe/sudova_statystyka/rik_2018

[2] Human rights in the administration of justice. Report of the United Nations High Commissioner for Human Rights. A/HRC/42/20. 30 July 2019. Para 6.

Terms Of Reference For Development of “Chase the Virus, Not People!” National Campaigns

Eurasian Harm Reduction Association (EHRA) is looking for national partners (country consortia, NGOs, community organizations and initiative groups) to develop and implement the CHASE THE VIRUS, NOT PEOPLE! campaign at the national level in 3 countries of the Eastern Europe and Central Asia region.

The assignment is implemented in the framework of the Eurasian Regional Consortium project “Thinking outside the box: overcoming challenges in community advocacy for sustainable and high-quality HIV services”, funded by the Robert Carr civil society Networks’ Fund.

Campaign was launched at AIDS2018 in Amsterdam, the Netherlands, in July 2018. The regional communities’ networks, who joined forces in the campaign represent key populations affected by HIV: people living with HIV, women living with HIV, youth and teenagers, affected by HIV, people who use drugs, sex workers, men who have sex with men, trans people. The campaign emphasized the common needs of all key population groups and focuses on overcoming the discrimination, stigmatization and criminalization of key populations as a key condition for an effective response to the HIV epidemic in EECA countries.

Aim of the campaign:

To strengthen the voice and influence of national activists at the national level in articulating their advocacy priorities and drawing the attention of target audiences to the problems of key populations in relation to the catastrophic HIV/AIDS epidemic in the EECA region, in particular the impact of stigma, discrimination and criminalization on effective response measures to HIV/AIDS epidemic and mortality reduction.



to develop and implement the national campaign under the slogan “Chase the virus, not people!” with specific advocacy objectives in the framework of the regional campaign.

EHRA is issuing 3 grants in 3 countries accordingly to the winners in the open competition (NGO, community organization or initiative groups).

AIM (sample, to be adjusted per country needs):

To strengthen partnerships between national key populations organizations and activists to draw attention of key steakholders and decision makers to the impact of stigma, discrimination and criminalization on effective response measures to HIV/AIDS epidemic and mortality reduction in the country

Grant sum – 2,000 Euro per country.

EHRA technical support – EHRA representative’s participation in development of the national campaign (country visit for 1-day mentorship session; on-line technical support to the national campaign organizer).

Terms of project realization – till the end of 2019.


  • Be registered in one of the countries of the Eastern Europe and Central Asia region;
  • Work with/represent/provide services/advocate for the needs of key populations on the national level;
  • Share the aim and objectives of the regional campaign “Chase the virus, not people!”;
  • Describe the problem statement for advocacy within the national campaign;
  • Identify the goal of the national campaign;
  • Demostrate the previous experience in realization of advocacy/communication campaigns (if any).

To apply for the assignment the organization or individual has to submit to natalia@harmreductioneurasia.org till COB September 20, 2019 the following documents:

Description of the organizational experience to follow the above described requirements,

Letter of interest (not less than 500 words and not more than 1500 words),

Timeline of campaign development and implementation with the brief description of stages and terms.

The submitted applications will be evaluated by the selection committee of the Eurasian Regional Consortium. The following criteria will be used to evaluate the bids (the maximum possible number of points is 100):

  • Work experience with key populations (20);
  • Problem statement (20);
  • Clear and achievable goal of the campaign (30);
  • Realistic and clear timeline of the campaign (30).

Before submission of the application, please read carefully ToR for national partners.

The Magic Bracelet

Author: Olga Belyaeva, Advocacy Manager, EHRA

When I heard someone knocking on my hotel room’s door and shouting “She is dying!!!” I was in the bathroom. Just five minutes ago, I entered my room, took my coat and shoes off and… ran out straight away with Naloxone.

After that memorable meeting in Scotland, I carry it with me all the time.  

Glasgow. July 2018. My 45th birthday. “You know, we have a very serious problem with overdoses – those were almost the first words I heard from Stephen Malloy, part of the team of the European Network of People Who Use Drugs. I nodded and a routine though came across my mind: “Back at home, in Vilnius, up to 12 people are found dead in bad months. Under the guise of heroin, people are sold a mix of morphine and methadone together with fentanyl.”   

Looking at me attentively, Stephen went on: “My country has done very well with offering OST (methadone, buprenorphine) but everyone knows more MUST be done. People need easy access and doses that are suitable to them. There will be a small ‘Heroin Assisted Treatment’ program beginning in September 2019. and in time, if it is allowed to grow, it will change so many lives for the better; IT WILL SAVE LIVES.”

So here it is,” Stephen was holding an oblong narrow yellow box in his hand. “Are you ready to take it with you?”  I recognized it: once I saw such a box at a conference. It was convenient and stylish, with Naloxone inside. I said “Sure!” and took the box. “Then put this bracelet on. People will know that you have naloxone with you, if you overdose and they find you. They will be able to help you and you will be able to help others.”  Stephen watched me carefully, assessing my decision: was I really ready?

I put the bracelet on, found a place for the Naloxone box in my belt bag, where I already had my wallet, my phone and my beads. Then I continued my three-day work at the meetings on overdose response.

One of the meetings was dedicated to the topic of 48 hours after prison. There was a discussion with the experts in overdose theory on what should be done first: Naloxone injection and then artificial respiration or first artificial respiration and then Naloxone? My logic told me that first Naloxone is to be injected, which will help to ensure artificial respiration. “That’s a question of life, so it needs a correct answer. When I go to Ukraine, I will have to go and visit Vasiliy, he is an emergency doctor in the city of Dnepr. He saved my life more than once, so I believed him. He will tell what is to be done. He will also teach me how to do it,” I was thinking, packing my things to go to the EHRA headquarters in Vilnius.

Railway station. Stephen and Nicole’s birthday present – Scottish red and green check scarf – kept me warm. Standing at the platform, we gave each other goodbye hugs, listening to our heartbeats.  Making myself comfortable in my seat with a book, I realized that my eyes were constantly coming back to the yellow bracelet.  The sounds of the train, its rhythmic swing combined with polite and quiet travel companions – it all gave me a chance to think why it happened like this: I had 30 years of opoiod use behind me, but Naloxone became part of the things I always consciously carry with me only three days ago.

Why? With the daily use of opiates, which were cooked correctly using high-quality materials, overdoses were rare in our group. Usually they happened after the forced “treatments.” Since about 2005, if you hear someone had an overdose in Dnepr (Ukraine), the response would be: “He was lucky to survive.” Naloxone ampules were available in mobile clinics and from outreach workers since 2003. However, it was the first time in my life when I wore a bracelet saying “I have Naloxone.” We always tried to avoid carrying Naloxone ampules with us so that the police would not start working on us because of it: “Hey, Naloxone, so you’re a drug addict!” Then the standard scenario would follow: taking a bribe and letting us go for a while. Another scenario could be turning the life of the person and the family upside down, if they needed to show better “crime detection rate.” Quietly and invisibly, the bracelet started raising my level of consciousness about overdoses.  It became a part of me. I only take it off when I have my aikido practice. The rest of the time, I have the bracelet on my arm, which means I have Naloxone in my bag and my bag – on my belt.

The approach to have Naloxone “always at hand” helped me to save a person’s life at the hotel. I covered three floors – and 40 seconds after I heard someone knocking on my door, Naloxone was already doing its work in the body and helped us to keep our dear friend alive. We did artificial respiration, poured water, and our team of two people + naloxone helped to save our friend’s life. We prayed for Stephen and Nicole. I realized that I do not have practical reanimation skills, which work automatically. At the same time, wearing a bracelet saying “I have Naloxone” means that I have to be 100% sure about the things I am doing. So I still had the question: what should come first – Naloxone or artificial respiration? My trip to Dnepr was not coming soon, but the question was vital. So we invited a practitioner, an emergency care doctor to come to the EHRA office, share his experience and tell us what to do.

“After death, pinned pupils are seen only in people who died of opiate overdose. Sometimes it can also be an effect of cerebral hemorrhage, but in this case one pupil is constricted and the other is not,” told us an emergency care doctor from Vilnius. That is how easy it is to collect data and see how many people actually die of opiate overdose, who those people and their family members are and what can be done. Those are the things to be done:

First, 70% of people die as they are not able to breathe. When a person is unconscious, his tongue base goes down and closes the air passages.  What to do: put your hand on the person’s forehead, throw the head a little back and put the jaw down. Often you will hear a deep breath.  There are three ways to determine if the person is breathing: eye, ear next to the person’s mouth and watching the person’s chest. With your eye, you will always feel the air moving, with your ears you will hear it and the chest will help you to see it. A person makes 14-16 breaths per minute. So we wait for 10-15 seconds to see if we can hear or feel the person breathing or see the chest moving.

Second, we must fill the lungs with oxygen. “While an amputated limb or finger can be stitched back to the body even after three hours, a brain cell left without oxygen for four minutes, dies and this process is irreversible.” We breathe in 21% of oxygen, breathe out – 17%. So that’s what we need to do straight away: hold the nose and carefully breathe the air into the person’s lungs twice. This air will be enough to save the brain so that we have four minutes to inject Naloxone and ensure artificial respiration.

Third, make an intramuscular injection of Naloxone.

Fourth, artificial respiration: we press the chest 30 times and let go, going 4-6 centimeters deep, while breathing. You can watch the practical learning session by the emergency care doctor.

…Summer 2019. “Thank you, Stephen. Girls from the Narcofeminist movement and your Naloxone saved my friend’s life. As for the bracelet, it is a magic one. It helped me realize that I need to develop my skills to help people in different overdose scenarios.” When we met at the Harm Reduction International conference in Porto, we hugged each other tightly, not letting go for a while. 

Besides, I realized that consciousness means personal responsibility in action. People in our countries cannot carry Naloxone safely as they may have problems with police. Considering this, talented Sergey Bessonov and Dima Shvets came up with a way of how to make boxes and Naloxone packs, which are convenient to keep in a glove compartment in a car or at home. There is even an “excise label” to store the box until there is an emergency. They make those boxes for people, with love and understanding. They are stylish, nicely sized and pleasant to hold. Such boxes are made in the social dormitory of Ranar Charitable Foundation in Kyrgyzstan.

The yellow box, which came to me from Scotland, has already renewed its stock of Naloxone and now has other helpful things as well. The last thing I got from a friend of mine were tablets, which help in case of MDMA overdose.  In the center, there is a syringe with Naloxone. 

If someone needs help, I am ready.

“90% of successful reanimations are the ones when someone did something,” says the emergency care doctor.

 August 30-31, 2019