On this info page Drugreporter provides regular updates about resources and news on how harm reduction service providers respond to the COVID-19 Epidemic.
This pandemic is a serious threat to harm reduction services that are underfunded, overloaded and have no political support in many countries. Professionals, peers and volunteers working at harm reduction services need to be protected too, with special equipment and training to prevent infections and burning out. If harm reduction services close down, the most vulnerable people of our society will have no connection to the health care system and loose essential support to stay alive. (Click here for useful resources!)
REPORTS FROM EUROPEAN CITIES (in chronological order)
How can service providers tackle the problems coming with the Covid-19 epidemic across Europe? You can see some examples below! If you would like to share your experiences, please send an email to sarosip(at)rightsreporter.net!
Núria Calzada, Energy Control
The Mayorship Decree, signed on March 15, right after a national state of emergency was announced due to the COVID-19 pandemic, ensures access to essential services such as health care, social services, security, public transportation and information to the public.
The City Council of Barcelona has implemented a series of emergency measures to respond to the epidemic, such as maintaining health care, special care for the vulnerable groups, such as elderly and homeless people, women who became victims of sexual violence. Although personal consultations are suspended, victism can still report abuse to the Barcelona Office for Non-Discrimination and at the Labor Rights Defense Points. The Immigrant and Refugee Care Service (SAIER) maintains basic services to deal with emergency cases.
Last Friday, City Council expanded its efforts to shelter those in need. It assigned several buildings as shelters for vulnerable families, such as the Fira de Barcelona pavilion, a building that can accommodate one thousand people, as well as 200 tourist apartments. The Council also created three new facilities for the homeless.
A pioneer service was opened in the city to support homeless people who use drugs. Its shelter can accommodate 70 homeless persons (men and women), living with alcoholism and other dependences. This group of people are normally rejected by other social services. A key goal is to improve care for people who use illegal substances. The service facilitates accommodation, food and hygiene. It has a safe & supervised consumption room. Its work is coordinated with other urban treatment services (called CAS) and services of the Homeless Assistance Network (XAPSLL). The program is situated in a ‘youth hostel‘, provided by the Pere Tarrés Foundation. It is managed by ABD, the NGO that runs Energy Control.
Other harm reduction services in Barcelona are increasingly distribute food and water besides injecting equipment, smoking paraphernalia, naloxone and condoms. Programs encourage clients to take more equipment and manage it for a longer time without physical contact with services. New cellphone recharging points were created to ensure that drug users are not cut off from their social network.
Meanwhile, the drug checking services and other activities of Energy Control are suspended temporarily but the team still works continously. “We closed the lab,” says Núria Calzada, “so we are trying to work in alternative ways, for example we do thin layer chromatography in our office, testing a few urgent samples (collected by the consumption rooms and Metzineres). We are requesting authorization to access the laboratory or, if that doesn’t work, transfer the High-Performance Liquid Chromatography (HPLC) to our office.”
A brief summary of the situation of drug services in the city
- Opening time shortened
- Interdisciplinary team continues to work
- Telephone consultation is being provided to all scheduled patients, with assessment of their clinical status, treatment evaluation and emotional support.
- There are no face-to-face consultations/therapeutic sessions, except emergencies.
- Group and family therapies, blood and urine tests have been suspended.
- Methadone is dispensed every day, except for Monday and Wednesday afternoons.
- Directly observed drug therapy is provided.
- Referral to/from other health services works, with prior information on those services (complete clinical report, with diagnostic axes and individualized therapeutic plan).
- Crisis interventions are provided if needed.
- General Health Support is available.
- Same service hours
- Interdisciplinary team continues to be maintained
- Identifying/prioritising clients at risk of being infected with COVID-19
- Isolation, assessment and hospital referral spaces if necessary
- Medical care
- Rooms in operation respecting distances
- Increased access to showers and hygienic tools
- More food to counteract fewer social kitchens
- Psychological and social care
HARM REDUCTION SHELTER
- 24 hours (30 women – 40 men)
- Isolated spaces
- Consumption rooms
- Harm reduction – treatment for alcoholism
- Health care
- Psychosocial support and activities
- Food and overnight stay
Réka Szabó, HepaGo
Due to the increase in the injecting use of new psychoactive stimulants and the limited access to sterile needles, there was a rapid growth of Hepatitis C infections among people who use drugs in Hungary between 2011 and 2014. After the closure of he major NSPs, thousands of people who live with HCV were left behind – with no access to HCV treatment. Réka Szabó’s new initiatie, HepaGo aims to bridge this gap and help these people to receive treatment, in co-operation with hepatologist doctors. Unfortunately the COVID-19 epidemic had a negative impact on this project as well. “We had to stop the admissions to treatment because our clients were sitting in overcrowded waiting rooms in the same hospital that treats COVID-patients,” says Ms. Szabó. “Now we try to navigate clients through telephone on how to manage their lives.”
The team of social workers, psychologists and hepatologists are coordinated online and receive online supervision. The newly established program helped several people to undergo treatment, 4 of them have already been cured, 10 people are being treated. The problem is with the 9 new people who were supposed to start treatment now – they could not do so because of the epidemic. “It is a big challenge to reach out and motivate clients with so low coverage of harm reduction programs,” she says. “After this madness is over I will try to make some fundraising.” After the epidemic, RRF and HepaGo will cooperate in producing a film about the program.
Kakha Kvashilava, Georgian Harm Reduction Network (via Beatrix Vas, CEU)
All of the harm reduction services keep operating but with new rules of delivering the services. Clinics are open and clinicians are available, working conditions are “business as usual”.
Georgian Harm Reduction Network uninterruptedly continues to provide quick blood tests for HIV, Hep C and Hep B. Moreover, they are giving away short stocks of clean needles, syringes, condoms and Naloxone, amount enough for a week.
Methadone substitution treatment operates on a regular basis. The Government has made an emergency decision to allow treatment providers to give people already prescribed the treatment 5-day stock of the substance at once. If the patient requests a supply for more days than that, clinics can decide on a case-by-case basis. Government communication around this has been unclear.
Non-governmental initiatives launched targeted campaigns such as the Mandala Harm Reduction youth project who started home-delivering drug testing kits for free.
Dominik Jasekova, Odyseus
The closure of all shops including shopping centres have grave consequences on people who live on the street: they are left without access to running water. Access to food is scarce. It is mandatory to wear mask in Slovakia and some marginalised people who don’t have masks cannot even enter the stores. People who made their living from begging are now left without any income. Lack of food and water are the biggest problem so the harm reduction NGO Odyseus started to provide food on the street.
From this week on, the city of Bratislava started their own outreach program. They created a main point of distribution of masks and food to people who live on the street (drug users and non-users). Brochures with information about other services provided by NGOS are also distributed among clients. “We still work as before the crisis,” says Jasekova. “Our drop-in is open but with limited capacity and safety measures.”
Nanna Gotfredsen, Danish Street Lawyers
Street corona-testing started this weekend in the two largest cities, Copenhagen and Aarhus, run by the regional hospitals. So far two persons (both are homeless migrant people from Copenhagen) found to be positive for COVID-19. Many others tested negative.
This morning we secured private funding for the Users’ Academy project of the drug users’ union, using their HepC-testing bus to test people for COVID-19. Many people who use drugs trust this user union a lot more than the public health system. They are concerned that testing positive for COVID-19 carries the risk of a forced quarantine. The Minister of Health and the Minister of Social Affairs finally sent a letter yesterday to all municipalities reminding them that withdrawal treatment, OST and other harm reduction services are “critical interventions”, even during quarantine. “I’m still not confident if this will happen in practice,” says Nanna Gotfredsen. “The COVID-19-guidelines from the health board is really bad (it recommends to prescribe buprenorphine, which doesn’t work for most users here.” (Source of picture)
SKOPJE, North Macedonia
Bogdan Kolev, HOPS
After the outbreak of the coronavirus pandemic, harm reduction services of HOPS- Healthy Options Project Skopje were modified but all clients are still covered. Drop-in centers are closed, but each service has a separate telephone number and contact person that responds to the client needs (Social service +38975437090, Legal service +38975423316, Medical service and exchange sterile injection kit +38975769948.)
Clients can also contact the services through all social media platforms (Facebook, Twitter, Instagram, website) where all updates related to COVID 19 virus prevention are published from the government of North Macedonia and from the WHO. Mobile outreach teams operate every day, where previously contacted clients are visited in front of their homes. Depending on the needs of the clients, the team consists of an outreach worker and a social worker, an outreach worker and a doctor, or an outreach worker and a lawyer. There are maximum two people included in one team, since we’re following government recommendations (two people per vehicle). Outreach teams each day distribute sterile equipment (needles, syringes, distilled water, condoms, lubricants), food and hygiene kits to the most vulnerable (HOPS collaborates with other charities, plans humanitarian action to collect food and hygiene kits). Our outreach teams provide information related to the coronavirus to their clients and how to protect their health (such as recommendations from INPUD). Once a week a medical person (doctor) must be part of the outreach team to assess the general health of the population and to respond promptly if necessary.
Opiate Substitution Therapy centers are open and clients receive their medicine regularly. The staff at the methadone centers have increased the degree of caution and prevented more patients (therapy being raised one at a time) and fully followed the recommendations for protective equipment by the government of North Macedonia and WHO.
“So far our team has been working bravely, unhindered, and dedicated to all those in need. We thank them for their empathy and sacrifice in these strange times, says Bogdan Kolev from HOPS Skopje.
Larissa Maier, UCSF
Three supervised injection site closed down in Zurich on March 18, because physical distancing was not possible. On March 19, an outdoor emergency facility was opened to continue the service. The transition was successful, most people who inject drugs have access to live-saving services.
AMSTERDAM, The Netherlands
Katrin Schiffer, Regenboog Foundation
Stichting De Regenboog Groep in Amsterdam facilitates extra shelter for homeless people in Amsterdam in the fight against Covid-19
The municipality of Amsterdam will open 273 shelters for homeless people in the city in the coming days to prevent them from becoming a source of contamination for Covid-19.
Additional 100 night shelter places will be made available in a sports hall in Amsterdam West Stichting de Regenboog Groep will provide the nightshelter services with professionals and volunteers.
Another 173 existing reception places, including 23 places for families, will be created on different locations in the city to minimize the risk of contamination with the coronavirus. These places will be made available in different hostels in the city.
At present, Amsterdam has more than 6,000 shelter places for the homeless during 365 days a year and 445 temporary places in the specific facilities during the winter time.
Although the city council calls for 24-hour shelter, this is not advised by the Municipal Health Service. ” If you put large groups of people together all day, the chance of contamination is greater than being outside or at a walk-in facility. , says the local councilor for social affairs in Amsterdam.
PRAGUE, Czech Republic
David Pesek, Sananim
The global pandemic of COVID 19 affects all aspects of people’s lives and it has a very strong impact on those most at risk, namely people who use drugs. There are much less opportunities for the most vulnerable regarding how to make a living. As Prague is very touristic place, the most vulnerable people used to beg for money from tourists. There are no tourists now. Everywhere are tough restrictions. People have less money, but the substances are getting more expensive and shorages start to develop in the market. “We are expecting less precursors to make crystal meth (famous pervitin in Czech Republic) and are afraid of the return of dangerous new psychoactive substances,” says David Pesek.
Clients of OST programs are facing a difficult challenge: how to economise on prescription medication, taken home in bigger amount than before the crisis. “The government has a strict message: ‘Stay at home with your close relatives!’,” says Pesek. “But how hard it is to comply for people who have no home, and often not even close relatives?” There is a crisis plan to create outdoor shelters where homeless people can camp in tents, with access to some hygienic and other facilities. But the situation of homeless people is alarming.
Drug services that are often the only facilities available for these people had to introduce some safety measures. These restrictions also apply at the Harm Reduction facility, the drop-in centre of SANANIM, where they implemented a set of measures to response to the current situation. They discontinued the provision of all interventions that would involve group meetings. They switched to phone or online counseling and therapy with clients . They had to suspend testing for infectious diseases. “This is really disturbing,” says Pesek. “Lets hope we can restart testing soon again!” They had to adjust the needle and syringe program to the situation and give away more harm reduction material. In addition to sterile needles and syringes, they distribute tissues, respirators, more food, fliers with information about the pandemic and preventing infections etc.
AMSTERDAM, The Netherlands
Katrin Schiffer, Regenboog Foundation
The situation is critical with regard to homeless people. Some day shelters were closed down, because they were too crowded and the city of Amsterdam tries to divide and send people to different smaller shelters. The Regenboog Foundation opened a shelter in Amsterdam for homeless people with approximately 40 beds. Some cities have created specific shelters for homeless people who are infected with COVID-19. Some cities offer places in empty hotels to prevent people from staying on the street. The overall situation is worrying,” says Ms. Schiffer. “It is difficult to find buildings to use them as shelters because of the bad real estate market.”
Núria Calzada, Energy Control
The main problem is how to help homeless people who use drugs, who cannot isolate and have specific needs at shelters. Service providers now working on creating specific safe places/emergency shelters for homeless people who use drugs.
Marija Mijovic, Juventas
The government has introduced new measures, for example a ban on leaving the city of residence, with the exception of work-related trips with a special employer certificate. The opening hours of shops have been shortened. Juventas is still providing services for people who use drugs, sex workers and former prisoners:
1. Distribution and exchange sterile injecting equipment (needles, syringes, cookers, alcohol, tourniquets, distilled water) every day except weekend from 17h to 21h, and outreach once a week from 20 to 22h. We are now doing outreach just in Podgorica, and in this week we have distributed bigger amount of equipment to our clients outside Podgorica , due to the new measures- ban of traffic between cities. We will distribute more, if needed.
2. Distribution of condoms and lubricants, in above mentioned working hours.
3. Washing and drying clothes service, every working day from 17h to 21h.
4. Online consultations and consultations over the phone, with our peer workers, social workers, doctor and psychologist.
5. Lunch packages with essential groceries, once a week.
Marianela Kloka, Praksis
Opiate Substitution Treatment
OKANA is the only public organization that provides OST. As we are told by them, due to the pandemic, they provide take home medications (1 or 2 weeks for buprenorphine and 1 week for methadone), except those clients who have already been prescribed medication for a longer period of take home. Extra measures are already taken to provide substitutes in case all OKANA staff gets sick. The daily turnout of clients is about 20-25% of the pre-epidemic level. They can enter the OST clinics one by one or in small groups. Hygienic equipment is available and has been already distributed, the organization has asked the Ministry of Health for more supplies. For the time being, zero infections have been reported from clinics. There is a stable distribution point in the center of Athens that provides materials for safer use from 10:00-14:00 through a special construction that allows no physical contact. They try to do the same in Thessaloniki (second bigger city in Greece).
With regard homeless people it is important to underline that Greece has few if no shelters accepting homeless people who use drugs daily. We are informed that different organizations (including OKANA) work with the Municipality of Athens and the Municipality of Thessaloniki in order to provide shelters for active drug users who are homeless. If this plan works, OKANA plans to provide OST directly there to all those in need.
Doctors of the World are working with homeless people in general, distributing kits with soap, antiseptic gel, masks and gloves. They have active hotline for information and they distribute a 2-pager leaflet with information for COVID-19 in Greek. They underline that homeless people almost disappeared after EODY issued lockdown and banned the soup kitchens. The NGO PRAKSIS is doing outreach work in Athens on a daily basis, using street workers, providing material for safer use (syringes, cookers, etc.), gloves, masks, antiseptic wipes and information leaflets in 5 languages. STEPS do outreach work daily in Athens, using the mobile unit and distributes leaflets with information about COVID-19 in 5 languages, soap, gloves, syringes, cookers, gauze, antiseptic wipes, antiseptic gel, food, water, sleeping bags and blankets. They underline that street work is very difficult because people who use drugs are under constant persecution by the state.
Community of People Who Use Drugs
The network of people who use psychoactive substances (PENUPS) provides all information published by International and European bodies through their online community, parts of which are translated to Greek. They are in a process of publishing leaflets in Greek for their peers.
4 outreach groups are working on the streets, handing out sterile injecting equipment, condoms and survival packages with food, water, hygienic tools etc. Professionals are concerned about the possibility that a shortage in food and medicines can occur due to restrictions on transportation and the closure of several food charities and shelters. A shelter for women was closed but clients can come and take food and other basic support tools to survive on the streets.
Marian Ursan, Carousel
Carousel continues its mobile outreach program and it seems people need support now more than ever. In addition to the usual materials they distribute, they included additional packages with food and disinfectants. They offer information about COVID-19, about the importance hygiene and guidance about how to fill out official papers. They orient people to shelters and even take them when necessary. Last night Carousel started the field activity much earlier, it has been obvious to them since last week that they will have a lot of work to do. Even so, it was almost morning until the team could get home. “I won’t tell you what is happening on the streets, or how much police and army I’ve met, not even how scared everybody is,” says Marian Ursan from Carousel. “What I can say is that the reality I saw, as I experienced it, is completely different from what’s on TV. There are still people left behind, completely vulnerable. And COVID-19 is only in the end of the list of threats.”
Borut Brah, Stigma
Since the beginning of the COVID-19 epidemic hit Slovenia, all drop-in centres are closed (by the decision of the Ministry of Labour, Family and Social Affairs). In Ljubljana the Association for Harm Reduction Stigma continues to distribute sterile injecting equipment. Mobile outreach work (van) continues to operate in cities in the central part of Slovenia. IDUs have access to sterile injecting equipment but security measures are introduced: clients and staff has to keep 1.5 m distance from each other. All other information and counseling services are available via telephone or online. The greatest challenge is to support homeless people because they have nowhere to go (all daily care programs are closed, as well as public toilettes, due to safety reasons). There are ongoing negotations with local authorities and ministries on how to deal with this situation.
Night shelters and safe houses for women are still open. However, it is very problematic that staff and clients have no access safety masks. The use disinfectants is mandatory.
OST is working, users get their take home medicine for a week. Some even for two weeks. One of the problems is closure of public transportation, which means that some persons cannot reach the OST clinics. For some of them, Association for harm reduction Stigma can deliver their methadone.
Drug testing, performed by Association Drogart, is open, but in smaller scale as before and with more safety measures.
Peter Sarosi, RRF
A new website was created as a civil society initiative that lists all online and offline services available for people who use drugs in Hungary. The Ministry changed the rules of the mandatory treatment programs that serve as an alternative of criminalisation for those offenders who were arrested because of drug possession for personal use. People are not required to show up in person at the treatment sites and they can continue consultations online. OST programs are open but try to supply patients with prescriptions through phone/email to reduce physical contacts.
Marie Debrus, Médecins du Monde France
After service providers met with the representatives of the Ministry of Health and the national drug agency, a new decree was issued about OST programs. According to this decree, clients can take home their medications for one month. It also made it easier to renew the prescriptions. To minimise the number of visits, doctors can send the prescription by fax to the pharmacists.
Mart Kalvet, Lunest
All substitution treatment providers continue providing services, but at some facilities the opening hours have been reduced. Patients can receive their medicine for longer periods of time, and are encouraged to agree on specific fixed times for visiting the centers in order to reduce the number of possible contacts. Substitution treatment centers that previously had very strict rules about issuing take-home methadone have changed their rules; people get their medicine for longer periods of time (3–5 days), and are able to purchase their prescription medicines for up to two months in advance. NSPs are open; mobile exchange services are also operational (with shortened opening hours). Larger than usual quantities of injecting equipment is given out; previous restrictions to amounts of syringes etc. do not currently apply. The work of day centers (drop-in centers) has been curtailed — measures for diminishing the spread of COVID-19 have been implemented, and most consultations are carried out online or by phone. These rules are set in place because clients include people with chronic diseases who are therefore in a risk group. The National Institute of Health Development is trying to be as flexible as possible, operating under the assumption that all services must remain available. Only a few HIV testing service providers have closed down because all of the resources of the hospitals in which they operate have been directed towards testing for COVID-19. In such cases, the Institute will see to it that at least one HIV testing facility per region (county) remains open and is able to provide testing services. Harm reduction services are facing the same problems as the rest of the country with regards to personal protection equipment. There are widespread issues with procuring face masks (but not gloves or disinfectants); where possible, face masks are issued to workers. Currently, no face masks are distributed to people who do not display COVID-19 symptoms. Providing face masks to health care workers and service providers is considered a priority.
Núra Calzada, Energy Control
Metzineres, an organisation of women who use drugs, published a booklet with useful harm reduction information, available on instragram – click on the picture below to read it! You can download PDFs here: Part-1 and Part-2.
Energy Control published a leaflet for prevention measures in the ChemSex community during the Covid-19 epidemic, available here.
Adriana Curado, GATS
The mobile drug consumption room in Lisbon continues its work, with reduced working hours and staff. They allow one client at a time inside the van, and the team wears protective equipment (mask, gloves and gown). They also maintain nursing care and social support for urgent situations. Distribution of injecting and smoking materials is also ensured.
Marija Mijovic, Juventas
There is limited access to masks, they are only available in some pharmacies. Juventas prepared bottles with alcohol disinfectants for their clients because their transport got stuck at the Serbian border and they do not have information about when it will be released. Coffee shops, reastaurants all closed, people are asked to stay at home as much as possible, just to go out to buy food and medicines. Taxi services stopped, as well as domestic and interanational train and bus lines.
PRAGUE, Czech Republic
Jiri Richter, SANANIM
“Eureka, I shouted and tears of happiness and relief were flocking down my face. Finally we got masks for us and clients! But tears of happiness will soon turn into tears of despair. There were only 100 of them!!! They are disposable and they are useless for protection from infections! There are about 200 people working in all SANANIM services and there are over 2.500 clients in direct contact with pensioners who are the most fearless population. So we continue to produce the textile masks for ourselves and our clients (like in most countries).” (Jiry Richter, SANANIM)
Marta Borges, ISS created flyers with Covid-19 information in Portuguese language.
Nanna W. Gotfredsen, Street Lawyers
Critical interventions are open, that is, DCRs and OSTs. Take home medication is given for a longer period (generally 2 weeks) in some municipalities but not everywhere. Advocates are still pushing for this (as they push for having outreach doctors offering treatment for withdrawals and OST to the majority of users who are not connected with the treatment system). Service providers are still waiting for announcements from the national health board regarding the acceptance of take-home OST for longer periods. Major NSPs are still open (but no information about smaller cities where NSPs are often connected with drop-in centers, of which some are closed). The main shelters are open but with safety measures. Some smaller night shelters are closed but emergency-night shelters are being opened and specific quarantine-shelters are set up for homeless people too, at least in Copenhagen. Many smaller drop-in centers that provide food for homeless people are closed now. Alchemist (famous restaurant recently given 2 Michelin stars, now closed) offered to hand out food for street people through services for the homeless. Service providers are planning to set up a bus that was used to screen street people for TB to test clients for Covid-19. They are also working on creating a street-based/outreach service for people struggling with withdrawals. Services hand out crackpipes (“TAKE CARE – DONT SHARE”), and pink cards explaining that people have the right to treatment in case of withdrawals and a black card with Covid-19 safety information.
Rafaela De Quadros Rigoni, Mainline
After people lined up in front of the coffe shops authorities allowed them to stay open. Shelters remain open across the country. Many municipalities choose to temporarily close their walk-in center so that homeless people can stay during the day. In Utrecht, a municipal building is available for homeless people who are infected with the coronavirus, where shelter and care can be arranged if necessary. Not all cities are that far yet. (According to Volkskrant)
Núra Calzada, Energy Control
Magda Bartnik, Prekursor Foundation
The OST programs are open – safety measures were introduced (one-by-one entry and one-on-one contact, distance with clients, staff members have to wear masks and gloves, ensure disinfection before entrance). OST patients receive methadone for 2 weeks period. Two existing harm reduction drop-in centres (in Warsaw and Cracow) were closed, due to government decision to introduce quarantine laws. They continue to operate outreach NSP programs, distribute sterile equipment and offer support and assistance on the ground. Clients receive needles and syringes for 4 weeks. Online and over a phone consultations are planned to start this week. Drop-in Centre in Cracow still distributes sterile needles, with minimal personal contact. Homeless shelters are open but with minimum staff and services and all facilities are implementing strict safety measures.
Lauren Collard, Fédération Addiction
In France drop-in centers and care centres have not been closed yet. But the collective actions (e.g. group meetings) are all cancelled and only one-on-one counselling/services are open. “We are currently negotiating with our health ministry to guarantee the continuity of OSTs prescription for the weeks to come,” says Ms. Collard. “It should be possible (I’m careful here) as the government ensured continuity in accessing medicine for chronic diseases.” The staff of harm reduction services work on securing the situation for homeless people, who are the most at risk population.
Harm reduction centers are still open but with restrictions: drop-in/chill areas are closed, socialisation is not allowed, opening hours are shortened. OST centers remained opened for the time being.
Sasha Gurinova, Deutsche AIDS Hilfe
Harm Reduction services shall not be closed yet. There are some regulations to insure safety of workers and clients (no limits on requesting paraphenalia, distance between chairs etc.). The organisation of German drug users, JES, issued a letter to change the practice of OST services. The amended Narcotics Prescription Ordinance offers the possibility of supplying OST close to home, e.g. in pharmacies as well as the distribution through outpatient centers (also by non-medical staff). JES recommends to expand supply and bring it close to home for clients. This reduces the risk of this patient group and also frees urgently needed capacities in health care. DAH published recommendations for prison settings.
Eliza Kurcevic, EHRA
The opening hours of NSP services are shortened, special measures are introduced (masks and medical gowns), premises are disinfected each 2 hours, more needles and syringes are distributed (previously it was 5, now 15 are given to people). The OST program at the Republican Center for Addictive Disorders decided to issue methadone for 7 days for all patient.
Nevenka Mardesic, HELP
In Croatia the NGO HELP (Split), LET (Zagreb), Terra (Rijeka) and Institut (Pula) work with limited services. NSPs are still open with minimum staff and services. Advices and consultations are provided online or over the phone/mobile. Mobile units provide food, needle, syringes and condoms on the street using all safty measures wit very limited contacts with clients. OST is still working with no limitation, for now.
José Queros, APDES
Harm reduction teams follow the restrictions introduced by health authorities on limiting personal contacts and interactions. Therefore teams like GIRUGaia changed the schedule of its Methadone and Combined Therapeutic Program. Service providers face problems, such as the shortage of medication, such as liquid methadone, that is being replaced by pills. Another problem is the lack of availability of Naloxone, due to the fact that professionals were advised to avoid daily contact with drug users.
Marija Mijovic, Juventas
The NGO Juventas did not shut down its drop-in centre but it decided limit personal contacts with people who visit. Field work is not cancelled but all safety measures are going to be implemented. Clients who are in need for psyhosocial support will be assisted in the drop-in centre but with safety measures. For those who are not in dire need, they will continue provide consultations online or over the phone.
Peter Sarosi, RRF
There is no national policy or guidance on harm reduction services during the Covid-19 epidemic, service providers make their own decisions. Some of the drop-in centers have already closed down, most group meetings and consultations are cancelled, new admissions are rejected. The Artéra needle and syringe program decided to stay open in Budapest, with some restrictions (drop-in area closed, hand sanitizing). Clients who are referred to treatment centers by the police as an alternative of prosecution are concerned that they cannot fulfill the requirements and will be prosecuted. The Ministry said they are working to solve this problem. OST programs remain open for the time being.
The Ministry of Human Resources published guidelines for low threshold services during the Covid-19 epidemic. Unfortunately the guideline does not mention needle and syringe programs at all. Guidelines for OST are still missing.
Núra Calzada, Energy Control
Energy Contol closed all services, including the international drug checking service. Drug Consomption Rooms and needle and syringe programs are still open but with minimum staff and services. Shelters provide food on the street , outdoor, because they have closed the dining room. Contingency plans for the prevention and care of contagion are being implemented. Federations recommend to close down cannabis social clubs.
Nicoleta Dascalu, ARAS
The drop-in and the outreach services are closed – active IDUs who used to come to these services received last week syringes for 3 weeks. The two methadone centres are still open in their normal schedule and are preparing to give methadone for a longer period (6 to 13 days), with a prescription, but they are waiting for the methadone pills to come (there are some delays at the supplier). On Monday, the Romanian President declares a state of emergency – for the moment, we do not know what this will mean, but, if it restricts the right of circulation, this will raise serious problems for the people coming to the methadone services.
Rafaela De Quadros Rigoni, Mainline
The drop in centers and DCRs (at least from De Regenboog Group) will remain open. Since the Dutch government just announced stricter measures for Covid-19 yesterday, more will be known in the next days. Most drug checking labs, however, are closing. The coffeeshops were closed as well (along with bars and restaurants).
Tessa Windelinckx, Free Clinic
The OST and NSP operated by Free Clinic stay open with minimum staff. Staff members have to wear face masks (and gloves), use alcogel to sanitise the hands of everyone who enters the services. They introduced one-by-one entry. “On Friday I did needle exchange outside, in the open air,” says Ms. Windelinckx.
Susanna Ronconi. Forum Droghe
OSTs, drop-in centers and outreach interventions keep working during the epidemic wherever the local authorities did not explicitly close them. They introduced some safety measures, such as the respect of distance with clients. Where harm reduction programs had to close, social workers and peers try to continue the distribution of sterile needles and naloxone through infomal networks, always abiding to the rules set by local authorities. “Homeless people face the greatest problems,” says Ms. Ronconi. “Many night shelters are closed and the most vulnerable people are at high risks. The virus makes evident the classism of our society.”
Dominika Jasekova, Odyseus
For the last 2 weeks Odyseus ask all clients to sanitise hands. They hand out leaflets about Corona infections and consult with them about the risks and prevention methods. Staff members check the temperatures of clients. From today on, they are starting to handing out small dezinfecting gels. Later this week they will have masks – hopefully for the staff and clients too. The number of people inside drop-in has been limited. Today they are moving the services outdoor, in front of the building, because they don’t have windows in the drop-in. We were also dezinfecting all area of drop in every 30 minutes etc etc
“I hope we will be able to stay open and provide services,” says Ms. Jasekova. “It depends also on us, how we will manage to stay sane and healthy in these difficult times.”
Yuliya Georgieva, Centre for Human Policy
The Bulgarian Ministry of Health didn’t have a position on harm reduction services, they can make their own decision whether to stay open or close down. The NSP operated by Initiative for Health Foundation in Sofia decided to close down its services until the 29th of March. OST programs are still open, with necessary precautions (masks, disinfenctants, one-by-one admission to services). The situation may change if services decide to close down.
NOVI SAD, Serbia
Nebojsa Durasovic, Prevent
“During the last few weeks, we have been distributing larger quantities of sterile equipment in the field and at the drop-in,” says Mr. Durasovic. “As of today, the drop-in is closed due to a state of emergency.” All services were closed by presidential decree, except pharmacies and food stores.
Denis Dedajic, Margina
They implemented safety measures at the Margina drop-in centre in Zenica, which is the only NSP that remained open after the closure of the last Global Fund program ended. “Currently, none of our 1600 clients have any symptoms other than seasonal flu,” says Mr. Dedajic. “Our employees are the most exposed in the whole process. The warmer weather is coming and we are increasingly working in the field (although I don’t know how we are doing at all) and hopefully the epidemic will start to wane as huge efforts are being made to suppress or reduce it.”
Arild Knutsen, The Association for Humane Drug Policies
Both drug consumption rooms are temporarily closed. A lot of low threshold are either closed or work with limited services. For example, care services and overnight shelters. NSPs are (to Mr. Knuten’s knowledge) still handing out syringes, but they are concerned that the municipalities will restrict or close these services too. However, the Health Directory posted a warning on its web-site that to close services is against the law. All drug user organizations sent a letter of concern to the Minister of Health. “We wrote him that we support closing down the society in general,” says Mr. Knutsen, “but we emphasize closing down harm reduction services will have the opposite effect.”
PRAGUE, Czech Republic
David Pesek, Sananim
In the Czech Republic at the moment all NSP and OST programs are still open. According to Mr. Pesek, these 2 interventions are the most important to keep open, under any circumstances. “Running HR services is a must in this times,” says Mr. Pesek. “The rest of the services are not so seriously needed in the time of the pandemic. It is natural that people are getting infected and this will continue, for me its definitely not a reason to stop NSP or OST. We need to lower the risk as much as possible but at the end we can not stop interventions that are so important for people.”
The majority of one-on-one consultations are still open (counselling etc.). Sananim cancelled all group activities and meetings. It is mandatory to use desinfection before entrance to any facilities. They ventilate the rooms every 1-2 hours. They have to consider that many people who use drugs suffer from premature aging and are more vulnerable. Inpatient services banned any visits from outside. Outreach services are working with no restrictions. “Today Sananim organises crisis coordination meetings for its staff, so maybe things will change,” says Pesek.
Marta Pinto, researcher, Marta Borges, ISS, Adriana Curado, GATS
“I think every unit is doing what thinks best (besides common generic contingence plans like providing isolation rooms and so on),” says Ms. Pinto. According to her, now the negative consequences of the dismantling of SICAD, the government’s drug agency are obvious. No general guidelines are being provided about OST and each unit decides individually. But some services allow take home medications for longer periods (like a month). Most of them send prescriptions and other documents by phone/e-mail.
Peter Sarosi, Drugreporter