The 4th European Harm Reduction Conference took place in Bucharest on 21-23 November, 2018. Please watch the video report we made at the event – and read about some of the messages we could take home.
1. Austerity and populism: sustainability of social change is not guaranteed
In the 2000s the coverage of harm reduction programs was far from adequate in most European countries, but we thought we were on the right track to scale up services in the long run. Nobody expected that 10 years later many professionals would look back at that period as a kind of golden age, with growing frustration about a present where resources are scarce and political support for harm reduction is waning in many countries. The great divide was the global crisis in 2008. Funding cuts for social and health care in the name of austerity had an impact even in economically more advanced countries, not to mention growing economic despair, homelessness, and other related problems. This anxiety created a fertile soil for populist movements, some of them questioning not only harm reduction as an approach to drugs but the principles of equality, solidarity, and human rights. This setback reminded us that even though harm reduction has achieved huge success since its beginnings in the 80s, the sustainability of social change is not guaranteed, and the fight is far from over.
Watch and share our video below!
2. Crisis in the East: the weakness of the EU
The crisis had the most devastating consequences in Greece and some of the new, Eastern members of the EU, with fewer resources and weaker democratic institutions. In some of these countries the Global Fund nurtured harm reduction programs until the economic crisis hit and rich donor countries decided to cut back its budget. After becoming ineligible for GF funding, harm reduction services collapsed rapidly, showing the vulnerability and fragility of the systems of care that are solely dependent on international support. But there were huge budget cuts even in those countries where there was a national funding scheme for harm reduction services, such as Slovakia and Hungary. Tens of thousands of injecting drug users, most of them living in deep poverty, remained without access to any kind of services, becoming invisible with their suffering and tragedies. Outbreaks of HIV and hepatitis C reminded decision makers what happens when you cut back harm reduction – but they did not care. The European Union was successful in creating emergency legislation to ban new substances (with questionable impact on the drug markets) but it was unable to create a rapid response to drug-related public health emergencies. Despite the nominal approval of the EU’s progressive drug strategy and action plan, many member states continued to pursue their repressive, abstinence-only drug policy agendas, and did not scale up support for harm reduction.
3. Overdose preparedness is a must
The overdose epidemic in North-America (watch our latest movie from Canada!) is being watched with growing concern by people who use drugs and professional helpers in Europe. Apart from Estonia, a country that has been suffering the consequences of fentanyl-related overdoses, we don’t see an overdose epidemic in our continent. However, the example of a local outbreak in Glasgow shows that this situation can change rapidly. Fentanyl derivatives provide a lucrative business opportunity for drug traffickers: they are easily smuggled and highly profitable. Europe must be prepared for a possible overdose epidemic. Although some policy makers believe that by banning new substances they can protect society from these drugs, we know this is an illusion. We are not prepared at all! The good news is that we know what works to prevent overdoses: Providing people who use drugs (and their friends/families) with Naloxone, an antidote for heroin overdose, and training them how to use it. Creating safer spaces where people can use drugs under supervision and care (drug consumption rooms). Making drug checking programs available for people who use drugs. Integrating overdose prevention into recovery and rehab programs – and into prisons. We would learn at the conference that in many European countries access to Naloxone is restricted, and only a minority of countries provide access to drug consumption rooms and drug checking.
4. More support is needed to mainstream innovations
Although still only a few European cities have drug consumptions rooms, naloxone distribution and drug checking services, we see that where they exist they prove to be effective to save lives – and save money. This is a typical harm reduction story: pioneers introduce services when there is absolutely no evidence for their effectiveness but there is a desire to help to save lives. They first meet with lots of hostility and fear from the neighbourhood, skepticism from decision makers and professionals. But with time, they slowly become part of the mainstream. They are now mentioned in the EU Action Plan on Drugs, service providers, together with the EMCDDA, are now working to standardise them. There are now 10 European countries operating drug consumption rooms and their numbers are growing. New facilities were opened in France in recent years. There are now discussions to open new rooms in Portugal, Greece, and Finland. Drug checking services, as part of a comprehensive psycare package, are now available in most big electronic dance festivals in Western Europe, helping to avoid poisoning. But the road to mainstreaming innovations is way too long: many people die because we don’t respond fast enough to the rapid changes in illicit drug markets. This is especially true for the Eastern part of Europe, where governments and professionals are stubbornly resistant to innovation.
5. Criminal justice reform: the elephant in the room
Unlike in the US, there is no war on drugs with mass incarceration in Europe. Still, most harm reduction programs work to reduce the harms which are caused first and foremost by criminalisation and stigmatisation. There was a session on alternatives to coercive sanctions where we could see how brave activists try to work with law enforcement to mitigate the harms caused by police abuse. That’s necessary but far from enough: we need legislative reforms. Many countries have now decriminalised drug use but the black market, operated by criminal organisations, makes people highly vulnerable to harm. Drug laws are often enforced and used by the powerful to discipline and repress the poor and marginalised communities. At the EU level, this issue is still an elephant in the room: everybody knows it is essential but nobody wants to address it because of its political sensitivity. Harm reduction is too often limited to a set of social and public health interventions to make it more acceptable for the politicians and the public. But without reforming drug laws our efforts to reduce the harms of drug use are just scratching the surface. There are several options to regulate and control the market between total prohibition and free-market legalisation: we should explore them.
6. Needs of vulnerable groups often overlooked
European societies show great ethnic, religious, and cultural diversity. But regardless of these differences, what makes them common is that in each society drug-related harms, including criminalisation, hit vulnerable, marginalised communities hardest. In Western Europe it’s mostly the migrants and refugees, in Eastern Europe the socially excluded minorities such as the Roma in Central Europe or the Russians in the Baltics. You find these people among injecting drug users and prisoners in much greater number than their proportion in the population would suggest. However, they are often invisible for harm reduction programs, which are not present at those settings where they are located, or they are not culturally appropriate for them. And this is not only true for minorities but for women, young and ageing drug users, men who have sex with men, and prisoners. All these groups have specific needs. Services should be made available for them where they are, whether in urban ghettos, in gay saunas, or on the Dark Web. We could learn about several innovative harm reduction interventions in these settings – again, these innovations should be explored and mainstreamed.
7. Community involvement makes harm reduction sustainable
A welcome development at the conference was a very strong presence of community activists. The European Network of People Who Use Drugs is now doing a lot to train activists in countries where there is no community involvement at all. As someone from one of those countries I always feel frustration about the reluctance of professional service providers to recognise how important is it to invest in mobilising their clients and their families. This not only makes services more effective but provides an enormous help in changing public attitudes. And if there is something we can learn from history, it is that harm reduction programs are vulnerable and fragile without being embedded in the communities that surround them.
8. Showing the facts as advocacy is not good enough
If we talk about changing political decisions and public attitudes, we should rethink our current approach to advocacy. We invest too much energy in producing and presenting the evidence about the effectiveness and cost-effectiveness of harm reduction programs. This is of course necessary – but to expect that decision makers will change their minds just because we have shown them the evidence is somewhat naive. Changing prejudices is not a rational, mathematical exercise. It is about interests. It is about privileges. It is about strong emotions. We must provide evidence in the form of credible, simple’s and emotional human stories about the benefits of harm reduction. This, again, is not possible without strong community involvement.