In most countries of the CEECA region, opioid substitution therapy (OST) and sterile needle/syringe programmes (NSP) – key components of an evidence-based and comprehensive harm reduction (HR) programme – continue to operate under COVID-19 quarantine measures. Such work requires flexibility, readiness for mutual partnerships and strong advocacy by community and harm reduction activists. Unfortunately, the practice of amnesty of prisoners for drug-related crimes because of COVID-19 quarantine requirements has not been implemented in the region.
Key changes in harm reduction services include the following:
Provision of take–home OST. For many countries of the region, OST medications have been made available to take home for the first time, for periods of 5 to 14 days and sometimes up to one month. The opportunity to get take-home OST (both buprenorphine and methadone) became available to all clients in every country of the region except for Azerbaijan, Belarus and Kazakhstan. Initially, there were difficulties in some countries in enrolling new clients onto such programmes. Some countries developed partnerships, such as mobile outpatient clinics, to deliver OST medications and, often, together with antiretroviral therapy (ART) drugs to clients in remote locations.
Harm reduction works remotely. In all countries of the region, organisations have managed to deliver a range of commodities such as– sterile needles and syringes, masks, disinfectant, hygiene materials, naloxone, tests, and information materials for people who use drugs (PWUD). As a result of the restriction in movement caused by COVID-19, such service providers have found it necessary to deliver sufficient supplies at one time to cover the needs of an individual for 1-2 weeks. Often, materials are provided by mobile outpatient clinics, including social workers delivering such assistance by use of their own car or through use of a courier. Organisations have arranged online counselling for clients and, wherever possible, HIV testing through self-test kits delivered to clients. In providing such remote services, social workers and psychologists have needed to urgently develop additional skills and the management of organisations have had to introduce a flexible system of monitoring for the new service modalities.
Providing the essentials – food and shelter. For a large number of problematic users of psychoactive substances, quarantine restrictions and curfews have restricted access to temporary accommodation and made it impossible for them to earn money to find drugs. Responding to such basic needs, some organisations have re-planned budgets (as has been the case, for example, for EHRA members in Czechia, Kazakhstan, Montenegro, and Slovakia), or organised crowdfunding campaigns to be able to feed those in need (as undertaken by the Pink House in Bulgaria). In some countries, partnerships have been established to make it possible to provide shelter to PWUD and women who are victims of violence. In Azerbaijan and Kazakhstan, harm reduction organisations have helped their clients to receive specific assistance for unemployed people in connection with COVID-19.
Partnership in the integration of services. In most countries, the crisis situation has prompted medical centres and non-governmental organisations (NGOs) of various types to partner in the daily provision and delivery of necessary preventive materials, substitution therapy and ART drugs, and food supplies to clients, especially in remote areas.
Flexibility of services in response to changes in the drug scene. Due to the closure of international borders as a result of COVID-19, the drug scene has changed in many countries, with access to some drugs becoming more difficult, resulting in people having to use everything that they can find, including various prescription drugs mixed with alcohol. Many clients need advice to reduce harm in using new psychoactive substances (NPS), as well as help to prevent overdose. In some countries, such as Kazakhstan, Lithuania, and Serbia, such consultations are already under development. In Prague, because crystal methamphetamine is less available, community organisations have pushed for the introduction of substitution therapy for stimulant users.
Risk of service interruption due to deficiencies in the supply chain. The closure of international borders has also led to a disruption in the supply of substitution therapy medications in Moldova; similar risks exist in other countries. In addition, government authorities responsible for OST and other harm reduction programmes in several countries have not issued a tender for the purchase of medications from public organisations providing harm reduction services; this is particularly critical in Bulgaria and Montenegro.
As Ala Iatco, the EHRA Steering Committee member from Moldova, has noted: “Now we need to transform the harm reduction system. In different countries, the situation is different and depends on many factors, but the pandemic is not only a crisis but also a chance to move new services forward.” Online discussions organised by the Steering Committee of the Eurasian Harm Reduction Association (EHRA) were held between April 14 and April 23, 2020, with 51 members of the Association in seven sub-regional groups concerning the state of harm reduction programmes during the COVID-19 pandemic in 22 countries of the Central and Eastern Europe and Central Asia (CEECA) region. During discussions, members of the Association identified the main tasks of national and regional advocacy to overcome the crisis at the national and regional levels.
 Information was also updated as of 19 May 2020.