Drug-related infectious diseases in Europe

Excerpts from the EMCDDA press release

Testing for drug-related infectious diseases among people who inject drugs (PWID) is crucial if international health targets are to be met. This is among the conclusions of a new EMCDDA report Drug-related infectious diseases in Europe. The update, from the agency’s drug-related infectious disease network, stresses that early diagnosis through testing, and improving links to treatment and care, are crucial steps towards reaching global health goals.

Launched during European Testing Week (15–22 May), the report offers an overview of drug-related infectious diseases among PWID in Europe, including the prevalence and incidence of HIV and viral hepatitis. It also tracks progress on health targets and showcases successfully implemented evidence-based interventions. It underlines the need to ramp up prevention and testing and signals that European countries are lagging behind when it comes to treating hepatitis C virus (HCV) and HIV among PWID.

HIV and chronic viral hepatitis are highly prevalent among people who inject drugs, being transmitted through the sharing of injecting equipment, such as needles and syringes. Addressing the needs of this group is critical to achieve the UN Sustainable Development Goal of Good Health and Well-being (SDG 3), which calls for ending the AIDS epidemic and combatting viral hepatitis as a public health threat by 2030 (SDG 3.3).

Besides data which include SEE countries which are EU members, there is a small update from neighbouring countries within the Instrument for Pre-accession Assistance 7 and EU4Monitoring Drugs project:

The Instrument for Pre-accession Assistance (IPA) 7 technical cooperation project comprises six beneficiary countries: Albania, Bosnia and Herzegovina, Kosovo (1), Montenegro, North Macedonia and Serbia. Data on PWID and other key populations in the region are available from RDS seroprevalence studies: Albania, Kosovo and North Macedonia have conducted such surveys in the past 3 years; Bosnia and Herzegovina, Montenegro and Serbia are planning to collect data in 2020. There were no HIV-positive cases among PWID in recent surveys conducted in Kosovo or North Macedonia (Mikikj, 2017); older HIV prevalence estimates among PWID ranged between 0 % in Bosnia and Herzegovina in 2015 (Skocibusic et al., 2016) to 2 % in Serbia in 2013 (IPH Serbia, 2013). Most recent HCV infection prevalence estimates ranged from 23.8 % in Kosovo to 72 % in North Macedonia. All six beneficiaries are signatories of the Dublin Declaration.

To read full report, follow this link>>>

 

Impact of COVID-19 on drug services

EMCDDA press release

In a new study published today Impact of COVID-19 on drug services and help-seeking in Europe the EMCDDA reports signs of a drop in the availability of drug services during the pandemic and in the numbers of those seeking help. But the study also provides insight into how services have adapted and innovated during the fast-changing crisis in ways that could be carried forward into the future.

The report is the first in a series of briefings resulting from an EMCDDA ‘trendspotter’ study, launched in April to explore the impact of COVID-19 on the drug situation and responses to it. The agency’s trendspotter methodology explores emerging drug-related trends by rapidly collecting and triangulating data from a variety of sources to allow for timely assessments of topics of concern. Due to national emergency restrictions, the method was adapted to suit online investigation and the study designed to be carried out in successive waves (1). The findings released today stem from the first wave of the investigation which focused on drug services.

Results highlight that COVID-19 and national lockdowns have led to reduced availability and provision of treatment and harm-reduction services in most European countries. Emerging evidence suggests that, like other healthcare providers, drug services are facing a range of challenges including: staffing shortages; access to personal protective equipment; and managing infected clients and staff vulnerability to infection.

Preliminary findings from the study show that drug services are adapting and innovating during COVID-19, with similar characteristics reported across Europe. With face-to-face counselling curtailed during containment, telemedicine by phone or video has been embraced as an alternative across European drug services. Providers of opioid substitution treatment (OST) have also acted rapidly to change the way in which they provide medication (e.g. mobile OST) and respond to new treatment demands (e.g. new induction procedures), while most countries have relaxed regulations on take-home OST for stable patients (e.g. prescribing for larger quantities or longer periods).

Harm-reduction services have also been swift to adapt, playing a key role in providing frontline support during the crisis. This includes: increasing outreach work and needle- and syringe-exchange activities; providing shelter management for homeless and marginalised groups; maintaining drug consumption room services (in situ or mobile) and moving some interventions online (e.g. drug checking).

The briefing presents a snapshot of how the demand for specialised treatment evolved between January 2020 and March 2020, providing a first insight on the impact of COVID-19 on help-seeking behaviour. Data show that there was some drop in demand for treatment services during this period for reasons including closure or restricted access to treatment centres and clients’ inability to reach centres due to confinement measures. But this was partially compensated by remote technology and modified interventions.

When questioned on the ‘new normal’ for drug services in Europe post-COVID-19, many of the experts surveyed were in favour of maintaining some of the service changes rapidly introduced in recent months. The use of telemedicine was the most cited example, being seen as a useful complement to face-to-face services in the future. Coordination between public, private and non-governmental actors during the crisis was also welcomed by respondents and seen as particularly beneficial for services users.

As confinement procedures are eased, drug services will be expected to maintain a broad range of health protection measures, adapt their routines and reinforce contingency planning in case of a second wave. Negative economic forecasts for national economies raise particular concerns over potential budget cuts for drug services and greater marginalisation of certain social groups. Nevertheless, many survey respondents remained hopeful that the innovation and collaboration seen in recent months would remain positive features of drug services in Europe in the foreseeable future.

To read the study follow this link>>>

Mini-European Web Survey on Drugs

In order to investigate and rapidly document the current impact of the COVID-19 epidemics and national responses in the EU Member States on changes in patterns of drug use, harms and service provision, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is carrying out a study using an adapted version of the trendspotter methodology across EU Member States, of which this survey on Impact of COVID-19 on patterns of drug use, harms and drug services in the European Union forms a part. The Mini European Web Survey on Drugs: COVID-19 is part of this snapshot and is being conducted across Europe. The aim is to gather information about how patterns of drug use may have changed in Europe due to COVID-19.

Since the outbreak of COVID-19 across Europe and subsequent national responses to contain and mitigate the epidemic (self-isolation, quarantine, confinement, lockdowns), information has emerged about unprecedented challenges for services providing care to people who use drugs in the community and in prisons. Anecdotal information also indicates that there may have be changes in drug use patterns and in how people are obtaining their drugs. Understanding and sharing information on the consequences of COVID-19 and national response measures on harms deriving from the lack of access to care and how services have adapted as a response may help services improve their responses.

The information collected is entirely confidential and will be kept safely. The questionnaire is also anonymous – although there are a few broad questions about general situation to help understand how different groups of people who use drugs have been affected by the COVID-19 restrictions and how services have responded in different parts of Europe. This will help the sharing of good practice and improved preparedness in the future.

To contribute to the survey, follow this link>>>

COVID-19 and people who use drugs

What specific risks are people who use drugs (PWUD) likely to face during the COVID-19 pandemic? What services will they need? How will professionals working with this group adapt on the frontline? These are among the questions raised and answered in a new EMCDDA briefing.

The briefing offers information about:

  • Context – the coronavirus outbreak (COVID-19) in the EU
  • What are the particular risks for people who use drugs (PWUD) during the COVID-19 pandemic?
  • Underlying chronic medical conditions are associated with some forms of drug use and increase the risk of developing severe illnesses
  • The risk of drug overdose may be increased among PWUD who are infected with COVID-19
  • Sharing drug-using equipment may increase the risk of infection
  • Crowded environments increase the risk of exposure to COVID-19
  • Risks of disruption in access to drug services, clean drug-using equipment and vital medications
  • Implementing prevention measures against transmission of COVID-19 in settings used by PWUD
  • Guaranteeing continuity of care during the pandemic
  • Ensuring service continuity
  • Service provider protection during the pandemic – important interventions to consider

The briefing is available at the EMCDDA website following this link>>>

A day for side events

While plenary session was open for governmental speeches and the Committee of Whole worked on texts of resolutions, the second day of the CND 2020 was for civil society organisations mainly dedicated to side events.

Side events

Young people use drugs – Bridging the gap between Human Rights and Key Affected Populations

Organized by Students for Sensible Drug Policy

International guidelines on human rights and drug policy, produced by UNODC, have a just a few paragraphs on children who have right to protection from drugs and women who use drugs which human rights should be protected, but don’t have reference on young people who use drugs.

The Barcelona declaration (which “declares that the War On Drugs is a war on Womxn Who Use Drugs”), Par4digma coalition of youth lead organisations from across the world transforming drug policy and Youth and Incarceration/Forced Treatment (rehabilitation) in Nigeria, where this method is employed to patients that are treated as “harmful”, were presented. Presenters also called that the sanctions against drug use should be based on the economic situation of the user.

Improving outreach and multidisciplinary approach towards people who use drugs and people in recovery in Western Balkan countries

Organized by Serbia, and Association Izlazak, Preporod/Rebirth, Proslavi Oporavak/Celebrate Recovery and World Federation Against Drugs

Results of the regional project “Choose Recovery” which is a joint cooperation between World Federation Against Drugs and three civil society organisations in the Balkan region: Izlazak, Celebrate Recovery and Preporod, were presented. The three organisation are working within the recovery field and providing support services to active users, individuals in recovery and members of their families, and they are actively involved in shaping drug policies in their countries.

Also, The Office for Combating Drugs of the Government of the Republic of Serbia presented their work, emphasizing partnership with the civil society as one of the successes of their work.

Comprehensive and evidence-based approach in tackling the world drug problem

Organized by Croatia, and European Union and UNODC Division for Policy Analysis and Public Affairs

The slogan of the Croatian presidency “A strong Europe in a challenging world”

Croatian strongly recommends implementation of all universal conventions dealing with drugs.

After protocolled introductions from the Ambassador of Croatia and Executive Director of UNODC, State secretary in the Ministry of Health Tomislav Dulibić presented Croatian experiences in evidence-based approach to drug problem. He emphasized that Croatia introduced Minimum standards for prevention of addiction in the educational system, implemented a research project “Evaluation of drug treatment in the Republic of Croatia” and performed evaluation of treatment and distribution of substitution therapy.

Alexis Goosdeel underlined that EMCDDA cooperates with Croatia since 2002. They are an excellent experience of serious and comprehensive approach towards accession to EU in the area of drugs. EMCDDA collects data for a purpose, not for statistics.

Victor Sannes, deputy director in the Food, Health Protection and Prevention Directorate presented various projects from The Netherlands.

Gilberto Gerra, UNODC: 60% of countries of the World have health treatment of drug users under ministries of interior or justice!

Homelessness and substance use in city centres: Balanced and evidence-based policies

Organized by Greece, and Correlation – European Harm Reduction Network, Pompidou Group/Council of Europe and Santé Mentale et Exclusion Sociale – Europe

Dr Christos Koumitsidis, National Drug Coordinator, Greece: Homelessness in downtown Athens is an important challenge, exacerbated by factors such mental health conditions, substance use problems, the financial crisis and the influx of refugees fleeing war. These issues do not exist in isolation, they intersect and potentiate vulnerability. Homelessness is a common ground.

Katrin Prins-Schiffer, Correlation – European Harm Reduction Network / De Regenboog Groep: We see the same in the harm reduction and addiction sectors; usually homelessness is left behind. Only Finland has decreased homelessness. They have invested a lot in Housing First. All other countries report increases in homelessness. Part of the problem is that the housing market is under a lot of pressure, mostly because of a lack of affordable housing. We have 150,000 rent-controlled dwellings in Amsterdam; but this is not a lot for a city of 1.2 million; and it’s really hard to access these dwellings. In terms of reasons for homelessness, the majority are about impending evictions or end of renting contract, and leaving home after. There is an ‘integrated care system’ whereby local governments are responsible for housing and homeless care. In terms of the system’s main principles, it’s about focusing on the overall needs; not just drug use, homelessness or mental health. It’s a kind of self-sufficiency matrix including finances, housing, relationships, legal problems, community participation. This system is based on the needs on the individual, not on the organisation and its specific focus.

Victor Soto, SMES Europe: Why are people homeless? Policies (housing policies, health policies) and individual situations (mental conditions, traumatic events, etc.). So we need to address both dimensions. Homelessness is not a fixed category, it should be approach through different lines of action.

Pompidou Group: As the operational context was been changing, stakeholders in this field need to be flexible, in line with operational realities. Common guiding principles need to be developed and revised as practice develops. To develop these principles, we need to learn from each other: what works and what doesn’t, find common ground for cooperation and support.

Homelessness and substance use in city centres: Balanced and evidence-based policies

Organized by Greece, and Correlation – European Harm Reduction Network, Pompidou Group/Council of Europe and Santé Mentale et Exclusion Sociale – Europe

Dr Christos Koumitsidis, National Drug Coordinator, Greece: Homelessness in downtown Athens is an important challenge, exacerbated by factors such mental health conditions, substance use problems, the financial crisis and the influx of refugees fleeing war. These issues do not exist in isolation, they intersect and potentiate vulnerability. Homelessness is a common ground.

Katrin Prins-Schiffer, Correlation – European Harm Reduction Network / De Regenboog Groep: We see the same in the harm reduction and addiction sectors; usually homelessness is left behind. Only Finland has decreased homelessness. They have invested a lot in Housing First. All other countries report increases in homelessness. Part of the problem is that the housing market is under a lot of pressure, mostly because of a lack of affordable housing. We have 150,000 rent-controlled dwellings in Amsterdam; but this is not a lot for a city of 1.2 million; and it’s really hard to access these dwellings. In terms of reasons for homelessness, the majority are about impending evictions or end of renting contract, and leaving home after. There is an ‘integrated care system’ whereby local governments are responsible for housing and homeless care. In terms of the system’s main principles, it’s about focusing on the overall needs; not just drug use, homelessness or mental health. It’s a kind of self-sufficiency matrix including finances, housing, relationships, legal problems, community participation. This system is based on the needs on the individual, not on the organisation and its specific focus.

Victor Soto, SMES Europe: Why are people homeless? Policies (housing policies, health policies) and individual situations (mental conditions, traumatic events, etc.). So we need to address both dimensions. Homelessness is not a fixed category, it should be approach through different lines of action.

Pompidou Group: As the operational context was been changing, stakeholders in this field need to be flexible, in line with operational realities. Common guiding principles need to be developed and revised as practice develops. To develop these principles, we need to learn from each other: what works and what doesn’t, find common ground for cooperation and support.

Bursaries for European Drugs Summer School

The University Institute of Lisbon (ISCTE-IUL) and the EU drugs agency (EMCDDA) will be joining forces once again next summer to hold the ninth European drugs summer school (EDSS) on ‘Illicit drugs in Europe: demand, supply and public policies’. This two-week course will take place in the Portuguese capital from 29 June to 10 July 2020.

Professionals, academics and experts from the Western Balkan region* will have an opportunity to participate in the EDSS this year, thanks to three bursaries being offered through the EMCDDA Instrument of Pre-accession Assistance 7 project (IPA7), which kicked off in July 2019. The aim of the three-year project, running until June 2022, is to ensure that the six IPA beneficiaries (1) are able to participate effectively in the activities of the EMCDDA and the Reitox network upon EU accession.

The bursaries will cover flights and EDSS fees.

The deadline for applications is 26 February 2020 and successful candidates will be notified by 9 March 2020.

To get more information and apply for the bursary follow this link>>>

 

* The six IPA beneficiaries are: Albania, Bosnia and Herzegovina, Kosovo*, North Macedonia, Montenegro and Serbia

Watch EDSS promotional video for more information

Changes in cannabis policies: insights from the Americas

The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) just published a new report “Monitoring and evaluating changes in cannabis policies: insights from the Americas“. This report provides an overview of the changes in cannabis policies in the Americas and the evidence emerging from evaluations of their impact. The focus of the report is shifted to recent changes to regulatory systems in the Americas that permit the consumption of cannabis by adults for non-medical, recreational purposes.

Over the past 50 years, several jurisdictions in Europe, Australia and the Americas have reduced the penalties associated with using or possessing small amounts of cannabis. As of December 2019, Canada, Uruguay and 10 US states have gone further and passed laws that license the production and retail sale of cannabis, mostly by private companies, to adults for non-medical – sometimes referred to as recreational – purposes. With discussions about alternatives to cannabis prohibition becoming more common in some parts of the world, there is a growing interest in learning from the cannabis policy changes in the Americas.

To learn more about these new cannabis regimes and their consequences, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) commissioned a review of the changes governing recreational cannabis policies in the Americas and an overview of preliminary evaluations. Findings from this research are intended to inform discussions about the development of a framework for monitoring and evaluating policy developments related to cannabis regulatory reform.

To download the report, follow this link>>>

EU Drug Markets Report 2019

Drug trafficking is a highly profitable commercial activity and remains a core business for organised crime groups across Europe today. Understanding the reality of the European drug market requires a holistic approach, following the supply chain from production and trafficking to distribution and sales.

Taking such an approach, two EU agencies – the EMCDDA and Europol – have joined forces to provide their third state-of-the-art overview of the European illicit drug market in the form of the EU Drug Markets Report 2019.

The analysis presented in this report spans numerous topics such as the links between drugs and other crimes, the licit economy and society more generally as well as the processes and players involved in the trade, from production and trafficking to distribution. Taking an evidence-based approach, the report reviews the markets for heroin, cocaine, cannabis, amphetamine, methamphetamine, MDMA and new psychoactive substances. It also provides action points to inform policy development at EU and national level. This publication is an essential reference for law enforcement professionals, policymakers, the academic community and indeed for anyone seeking up-to-date information and analysis on drug markets in Europe.

The latest data show that overall drug availability within Europe remains ‘very high’ and that consumers have access to a wide variety of high-purity and high-potency products at steady, or falling, prices. An important cross-cutting theme in the report is the environmental impact of drug production, including deforestation and the dumping of chemical waste, which can result in ecological damage, safety risks and high clean-up costs.

The report highlights the increasing importance of Europe, both as a target and drug-producing region, and shows how the violence and corruption, long seen in traditional drug-producing countries, are now increasingly evident within the EU. Among the wide-ranging consequences of the drug market presented in the analysis are its negative impacts on society (e.g. gang violence, drug-related homicide) and the strain on public institutions and governance. The drug market’s links to wider criminal activity (e.g. human trafficking, terrorism) are also explored, along with its negative repercussions on the legal economy (e.g. how money laundering associated with the drug trade undermines legitimate businesses).

To read full report, follow this link>>>

A short presentation of the main highlights from the EU Drug Markets Report 2019, targeting policy and practice is available in a separate document available here>>>

 

New issues for monitoring

Every year in autumn, The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) organises Reitox meeting – the European information network on drugs and drug addiction. The 8th Extended Reitox network meeting was held on 12 November in the EMCDDA premises in Lisbon, Portugal. It brought together representatives from circa 50 countries, including: the Heads of the 30 Reitox national focal points from the 28 EU Member States, Norway and Turkey; representatives from the 6 Western Balkan countries covered by the European Instrument for Pre-Accession Technical assistance project (IPA7) and representatives from 15 European Neighbouring Policy area countries.

This year’s meeting will be dedicated to the topic ‘New issues for monitoring’. The agenda included issues like Drug policy debates: how routine monitoring data used?, Introduction on new proposal of the UNODC Annual Reports Questionnaire (ARQ) and Cannabis: latest developments.

During the session on Prevention of infectious diseases, DPNSEE Executive Director Milutin Milošević presented Situation in the Western Balkan countries. Besides presenting the Network and briefly describing the type of data that are available to us, a detailed view on the situation in the Western Balkan countries was given including prevalence of HIV, HCV, HBV among people who inject drugs, provision of harm reduction services and access to treatment, barriers and challenges and relevant policies in the region.

Participation in the Reitox meeting was an excellent opportunity to present the potential of the Network for partnership and discuss modalities for further cooperation with EMCDDA and national drug agencies

Drug overdoses in Europe

Drug overdose deaths in Europe have risen for the fifth consecutive year, with a record 9 461 lives lost in 2017 (EU 28, Turkey and Norway). Reducing drug-related deaths is therefore a major public health challenge. Fighting this problem, the EU drugs agency (EMCDDA) launches today three new resources looking at drug overdoses in Europe and the interventions in place to prevent them.

Most overdose deaths in Europe are linked to the use of opioids (heroin or synthetic opioids), although cocaine, other stimulant drugs and medicines also play a role. In a new online resource, Prevention of drug-related deaths in Europe, the agency provides an overview on the issue and the risk factors involved.

Drug-induced deaths in the European Union, Norway and Turkey, 2017

The EMCDDA illustrates how overdose prevention can be addressed on three levels: reducing vulnerability to overdose (e.g. accessible treatment and services); reducing the risk of overdose (e.g. retention in opioid substitution treatment, prison aftercare and overdose risk assessments); and reducing the likelihood of fatal outcomes (e.g. take-home naloxone policies and supervision of drug consumption). Currently, 87 supervised drug consumption facilities exist in 8 EU Member States, Norway and Switzerland providing a safer drug-using environment.

While naloxone – a medicine used to reverse opioid toxicity – has been used in hospitals for over 40 years, it is also now available in the community in many countries. The EMCDDA launched its first overview of Take-home naloxone (THN) programmes in Europe.

Practical solutions have been found to allow non-medical personnel to receive and administer injectable naloxone and enable the distribution of the medication to the homes of potential bystanders. Some countries now make the emergency medication available without a prescription to, or have lifted prescription regulations for, specific establishments or those registered as formally trained. The resource summarises the different products used in THN programmes, including naloxone nasal spray, authorised in 2017 by the European Commission for marketing in all EU countries.

Where have drug-related deaths increased most over the last 10 years? Are women and men affected equally? What are the current concerns in Europe? These are some of the questions answered in new Frequently asked questions (FAQs): drug overdose deaths in Europe published on the EMCDDA website. These present the overdose situation and trends as well as a range of maps and graphics. The EMCDDA monitors closely alerts on harms related to fentanyl and its derivatives due to the very high toxicity of these substances and their potential to result in large clusters of incidents and deaths.

Through its Strategy 2025, the EMCDDA is committed to contributing to a healthier Europe. While opioids are involved in the vast majority of overdose fatalities, other substances (e.g. cocaine, benzodiazepines, synthetic cannabinoids) also contribute to the overdose burden and should not be neglected. The resources contribute to a better understanding of drug overdoses and responses to them in Europe to support sound policymaking in this area.