On 25 November 2025, the Eurasian Harm Reduction Association (EHRA), together with Correlation – European Harm Reduction Network (C-EHRN) and the Drug Policy Network South East Europe (DPNSEE), hosted a webinar to launch the new regional report “Beyond Numbers: Harm Reduction across South-Eastern Europe” (prepared by Irena Molnar et al) within the framework of the EU-funded BOOST project. The discussion brought together regional experts, practitioners, and community voices to examine the current state of harm reduction across 11 countries in South-Eastern Europe, with a strong focus on the Western Balkans.
Why “Beyond Numbers”
Speakers highlighted that regional data remain uneven, fragmented, and often outdated, making evidence-informed planning and advocacy difficult. The report responds to this gap by combining available quantitative sources with qualitative insights from service providers, peers, and people with lived/living experience, translating “coverage” into the realities of access, continuity, and quality on the ground.
Key findings presented from the report
In her presentation, Irena Molnar outlined a new comparative framework developed for the report, assessing each country across four domains:
- Service provision (e.g., OAT/OST, NSP, HIV/HCV testing, overdose prevention, prison-based interventions),
- Policy and financing (legal and funding environment, integration into health systems, community participation),
- Epidemiology (availability and recency of key indicators), and
- Data and monitoring (regular reporting, surveillance, transparency).
The findings reveal wide disparities in harm reduction system maturity across the region. While some countries maintain more comprehensive approaches, others face severe service gaps and closures—particularly after the withdrawal of external donor support, with shrinking coverage of needle and syringe programmes (NSP) and outreach in several settings. Across the region, services are frequently concentrated in capitals and larger cities, leaving rural areas and smaller communities with limited or no access. The report also underlines persistent challenges related to stigma and discrimination, weak institutional financing, and insufficient community involvement in policy design.
Country reflections: Slovenia, Bulgaria, North Macedonia
Country representatives echoed the report’s main messages and provided practical reflections:
- Slovenia noted that strong scores can mask implementation gaps: certain interventions exist “on paper” but remain inconsistently available in practice (e.g., wider access to take-home naloxone; delayed implementation of drug consumption rooms).
- Bulgaria highlighted progress driven largely by civil society innovation, municipal engagement, and crowdfunding—but warned about fragile sustainability when services depend on a very small number of organisations and lack systematic health-sector funding.
- North Macedonia described a dramatic reduction in national NSP coverage following donor withdrawal, leaving only limited outreach capacity and uncertainty about continuity—illustrating how funding instability translates directly into increased health risks and reduced access to care.
EU and regional perspectives: future opportunities
On the panel, the European Union Drugs Agency (EUDA) representative recognised major disparities in harm reduction coverage across Europe, including persistent gaps in take-home naloxone availability in parts of the region. EUDA highlighted its role in strengthening evidence and systems through capacity building, training, and improved monitoring, and announced plans to start mapping harm reduction services in the Western Balkans to better understand gaps and inform future programming.
EHRA emphasised that strong language in strategies must be matched by implementation, and pointed to the EU enlargement process as a potential lever to push for sustainable harm reduction and broader health responses in candidate countries. The discussion also acknowledged the difficult broader context—shrinking civic space and shifting political priorities—while stressing the urgency of coordinated advocacy and community-led monitoring.
The webinar concluded with a shared message: harm reduction in South-Eastern Europe continues to survive largely through civil society resilience and community leadership, but sustainable progress requires political commitment, stable financing, and stronger integration of harm reduction into public health systems.
The report is published at the EHRA webpage here>>>.
The report launch event is available online
https://youtu.be/TbkH6KfqHfI