Author: DPNSEE

Western Balkans Civil Society Presents Analysis of the EU Drugs Strategy 2026 – 2030

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Civil society organisations from the Western Balkans have published a health- and human rights-based analysis of the EU Drugs Strategy 2026 – 2030, examining its relevance and implications for South East Europe, including both EU Member States and EU candidate countries.

The analysis is developed from the perspective of organisations working on public health, harm reduction, human rights, and social inclusion, and aims to contribute constructively to policy dialogue at national, regional, and EU levels. It highlights the importance of treating drug policy primarily as a health and social issue, rather than a punitive or security-led one.

Key messages from the analysis

The document underlines that the EU Drugs Strategy 2026 – 2030 provides an important opportunity to strengthen evidence-based, humane, and rights-centred drug policies across South East Europe. Civil society organisations emphasise in particular:

  • The central role of the right to health, human dignity, and non-discrimination in drug policy
  • The need to recognise harm reduction as an essential pillar, including access to services such as opioid agonist therapy, needle and syringe programmes, and overdose prevention
  • The importance of addressing stigma and discrimination, which remain major barriers to accessing healthcare and social services
  • Ensuring continuity of care, especially in prisons, detention settings, and during transitions back into the community
  • The value of meaningful participation of civil society and people with lived experience in policy design, implementation, and monitoring

Relevance for South East Europe

The analysis stresses that drug-related challenges are cross-border and shared across South East Europe, making regional cooperation essential. The EU Drugs Strategy offers a common framework that can help reduce policy fragmentation, strengthen public health systems, and promote closer cooperation between EU Member States and candidate countries.

For EU candidate countries in the Western Balkans, the Strategy also supports alignment with EU standards in the areas of public health, human rights, and governance, contributing to accession-related reforms. For EU Member States in South East Europe, it reinforces health-centred approaches, supports more effective use of resources, and helps reduce pressure on criminal justice systems.

A call for balanced implementation

Civil society organisations underline that the impact of the EU Drugs Strategy will depend on its implementation. The analysis calls for a comprehensive and balanced Action Plan that translates strategic commitments into concrete measures, with adequate funding, clear health-focused indicators, and strong human rights safeguards.

The analysis is intended as a contribution to ongoing discussions with policymakers, EU institutions, and regional partners, and as a tool for advocacy, dialogue, and cooperation in building more inclusive, healthier, and safer societies across South East Europe.

 

The analysis is available here>>>.

 

What do we do with the new EU Drugs Strategy?

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DPNSEE participated in the EU Civil Society Forum on Drugs (CSFD) meeting held in Brussels on 8 and 9 December. Our Executive Director Milutin Milošević, who is a member of the CSFD Core Group, joined colleagues working on drug policy from across Europe for two days of exchanges with the European Commission (DG HOME, DG SANTE, DG JUST, DG HERA and DG ENEST).

The key topic of the agenda was the new EU Drugs Strategy, presented only 4 days before the meeting. The Forum contributed to the strategy on several occassions during the year. 40% of our recommendations were accepted, including the one on basing the Strategy on the European Union values which was the DPNSEE proposal.

CSFD members commented that even though the Strategy is a solid document, concerns remain that it remains unbalanced, with a strong focus on supply reduction, security, and crime prevention, which risks sidelining health- and human-rights-based approaches. We also raised our concerns about the Strategy placing harm reduction under the heading of preparedness, health, security, harm, international cooperation, and EU coordination and partnerships, rather than recognising it as a core public health intervention.

DPNSEE signed a joint letter coordinated by the International Drug Policy Consortium (IDPC), published on 10 December 2025, together with 83 other civil society organisations. The statement urges EU Member States to:

  • Reprioritise harm reduction, restoring it as a strategic priority under the Health pillar of the Strategy.
  • Adopt a comprehensive Action Plan covering all aspects of drug policy, instead of focusing solely on combating ‘drug trafficking’.
  • Integrate human rights guidance across all pillars of the Strategy, drawing on international frameworks such as the UN System Common Position on Drugs, the International Guidelines on Human Rights and Drug Policy, and OHCHR recommendations.
  • Include a strategic priority on policy innovation, allowing Member States to explore alternatives to criminalisation and punishment.

For DPNSEE, a very important session was the one on Co-Operation in the Field of Drugs with the Candidate Countries and Challenges in EU Accession Process. DG ENEST presented their work, which, when we talk about Western Balkans, was exclusively on drug supply reduction. DPNSEE presented positions of the CSFD, indicating again the nees for balanced approach and the need to re-define the accession acquis in the area of drugs.

Several other important issues were at the agenda:

  • DG JUST presented the EU Civil Society Strategy. We discussed its relevance in times of shrinking civic space.
  • The EU Drugs Agency (EUDA) again presented only ideas about a civil society engagement plan. We provided feedback that meaningful participation should go beyond the development of a digital platform (CONNECT) for exchange and that it takes too long time to define the way that EUDA and civil society will frame out co-working actions.
  • CSFD member organisations discussed and agreed on priorities for upcoming activities

On the second day, CSFD members met with the Horizontal Working Party on Drugs, representing all EU Member States. Discussions with Member States and the European Commission included the EU Drugs Strategy, drug services in prisons, shrinking civic space in Europe, upcoming dialogues with third countries, and international drug policy. The Danish Presidency and the incoming Cypriot Presidency also delivered specific inputs.

The meeting was important for continuing civil society engagement and contributing our perspectives on health-, harm reduction-, and human-rights-based approaches in EU drug policy discussions.

CSFD strongly indicated that:

  • The new EU Drugs Strategy raises concerns regarding the prioritisation of supply reduction, security, and crime prevention over health, harm reduction, and human rights.
  • Civil society participation needs to remain an important avenue for providing feedback on EU drug policy.
  • Ensuring meaningful involvement of civil society is crucial both within the EU and in cooperation with candidate countries.

The new EU Drugs Strategy

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On 4 December 2025 the European Commission presented a new EU Drugs Strategy and an Action Plan against drug trafficking. The Commission states that the two documents set out a comprehensive EU response to the security, health, social and environmental challenges linked to the trafficking and use of illicit drugs.

The EU Drugs Strategy takes a multi-dimensional and whole-of-society approach, focused on 5 key areas:

  • Enhancing preparedness and response to drug related threats, with improved data collection, monitoring, early warning and rapid response measures at EU and national level. The EU Drugs Agency (EUDA) with its new, stronger mandate, will play a key role in supporting Member States by identifying new psychoactive substances, issuing rapid alerts, and assessing the risks posed by highly potent synthetic opioids.
  • Protecting public health, by strengthening prevention, treatment and reintegration measures, including under the Healthier Together initiative. The EUDA will support Member States with practical guidance and awareness-raising activities.
  • Strengthening security, with stricter rules against organised crime and an evaluation of the existing Framework Decision on drug trafficking by 2026. Key actions include strengthening public-private cooperation to improve the detection of drugs smuggled through postal and parcel delivery services into the EU, as well as a new EU Ports Strategy to enhance the security and resilience of our ports and supply chains against drug trafficking.
  • Measures to prevent drug-related harm focused on protecting young people from recruitment into organised crime (e.g. through a new EU toolbox and a new EU action plan on protecting children against crime), as well as reducing harm caused to society, local communities and the environment, including support from the EUDA on harm reduction intervention and crime prevention measures.
  • Stronger partnerships with third countries to reinforce and expand international alliances, and increase operational cooperation, technical assistance and capacity building. Global cooperation is essential to tackle trafficking networks that operate across borders and rapidly adapt their routes and methods. The Commission and Member States will also step up engagement with civil society and the private sector.

The EU Drugs Strategy 2026–2030 represents a progressive framework grounded in health, human rights, and evidence. However, the operational focus of the EU Action Plan against Drug Trafficking risks overshadowing the broader, balanced objectives of the Strategy.

The position of the civil society organisations working in drug policy is that in order to fully realise the Strategy’s objectives, the EU should develop a comprehensive Action Plan that:

  • Integrates all pillars of the Strategy: health, human rights, prevention, treatment, harm reduction, research, and coordination.
  • Ensures balanced resource allocation: funding and attention should support both supply reduction measures and public health initiatives.
  • Promotes multi-stakeholder engagement: including civil society, local authorities, health professionals, and community organisations.
  • Strengthens evidence-based approaches: ensuring that interventions are guided by research, data, and continuous evaluation.
  • Maintains human rights safeguards: enforcement and public health measures must adhere to rights-based standards, preventing disproportionate or discriminatory impacts.

A balanced Action Plan would ensure that drug policy remains people-centred, equitable, and effective, addressing both the public health and security dimensions without privileging one at the expense of the other.

To access the new EU Drugs Strategy follow this link>>>.

The EU Action Plan against drug trafficking is available here>>>.

An interesting dialogue on evidence and recommendations on decriminalisation

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Together with our project partners C-EHRN, EHRA, EuroNPUD, the Drug Policy Network South East Europe hosted a Webinar on Decriminalisation of drug use and possession for personal use on 4 December 2025. The aim of the webinar was to present and discuss a policy brief developped in scope of the BOOST project.

The webinar was held in English and Russian. 32 participants from various European countries participated – experts, activists, and policymakers. They demonstrated that the true threat to European safety is not the substances themselves, but a punitive system that costs taxpayers billions, fuels organized crime, and destroys lives.

Marios Atzemis, DPNSEE Board member, presented the policy brief ondecriminalization, highlighting its importance for health, dignity, and human rights, and shared personal experiences on the impact of criminalization.

The fiscal and moral bankruptcy of criminalization

The conversation at the webinar began not with ideology, but with hard accounting. For years, governments in Central and Eastern Europe and Central Asia (CEECA) have claimed they “cannot afford” comprehensive harm reduction services. New data presented by EHRA Executive Director Ganna Dovbakh exposed this as a fiscal lie.

Presenting an updated 2025 comparative analysis of criminalization costs, Dovbakh revealed a staggering gap: in many CEECA countries, imprisoning one person for a drug offense costs the state up to 19 times more than providing that same person with a full package of health and social services (including Opioid Agonist Treatment and harm reduction) in the community.

 

A full regional comparison and country profiles are available following this link>>>.

But the cost is not merely financial; it is human. To expose this reality, Maria Plotko (EHRA) unveiled “Drug Policy and Economic, Social and Cultural Rights in the CEECA Region” a vital new resource developed by EHRA in partnership with the Helsinki Foundation for Human Rights (HFHR).

Designed to inform the upcoming UN CESCR General Comment, this report acts as a roadmap for civil society, documenting how punitive policies violate rights far beyond the traditional scope of health. The findings-based on consultations across 19 countries reveal a system of “invisible punishment”:

  • Right to Work: Administrative fines often lead to total wage garnishment, forcing people out of the formal economy, while rigid OAT schedules and workplace testing prevent stable employment.
  • Right to Family: In countries like Uzbekistan and Tajikistan, mandatory testing is required before marriage, and people with a history of drug use are often barred from adopting children.
  • Social Security & Housing: “Drug registries” create a catch-22 where individuals are denied state support or housing eligibility based on their status.

The Netherlands: Fixing the “Back Door” Paradox

John-Peter Kools of the Trimbos Institute provided a critical reality check on the famous “Dutch Model.” He clarified that the Netherlands does not have full de jure decriminalisation, but rather a 50-year-old policy of “tolerance.”

While this separation of markets (coffee shops) successfully decriminalised consumption, it left a dangerous legal gap: the supply chain remained illegal (the “back door” problem). This created a paradox where sale is tolerated, but production is criminal, empowering organized crime.

To solve this, Kools highlighted the Netherlands’ bold new step: The Controlled Cannabis Supply Chain Experiment. Currently rolling out in 10 cities, this pilot legalises the entire chain from production to sale. “Decriminalisation of use is not enough,” Kools noted. “Without regulating the supply, you leave the market to criminal networks.” He emphasized that local innovations – cities leading the way – are often the precursors to necessary national reform.

Croatia’s Drug Decriminalization Experience

Sanja Mikulić, from the Institute for Public Health, presented Croatia’s experience with drug decriminalization, noting that possession forpersonal use is treated as a misdemeanor punishable by fine or treatment, with a significant reduction in criminal cases and less pressure on the justice system. She highlighted that th eapproach has led to more flexible procedures, reduced stigma, and easier rehabilitation, while alsosaving budget funds. The presentation concluded with positive effects of decriminalization, including reduced cases in criminal courts and more focus on serious drug-related crimes.

The warning from Portugal: why decriminalization is no longer enough

For two decades, Portugal has been the global poster child for reform. However, Joana Canêdo, a researcher and activist from Lisbon, delivered a critical warning: stagnation is dangerous.

While the 2001 decriminalization model famously reduced HIV rates and overdoses, Canêdo described the current system as a “prohibitionist variant.” The “Dissuasion Commissions,” once hailed as innovative, have become bureaucratic bottlenecks. Approximately 90% of those referred to them are non-problematic users (mostly of cannabis) who do not need treatment yet are subjected to a coercive administrative process.

Crucially, because the market remains illegal and unregulated, the system is struggling to adapt to new trends like crack cocaine. With recent political shifts in Portugal, aggressive policing and stop-and-search tactics have returned. The lesson for the rest of Europe is clear: Decriminalization without legal regulation and continuous investment in services will eventually hit a wall.

The pragmatic revolution: Czechia

However, the most significant innovation is occurring in Czechia. Dr. Jana Michailidu detailed the country’s revolutionary approach to “Psychomodulatory Substances” (such as Kratom and semi-synthetic cannabinoids).

Faced with a surge in new psychoactive substances, Czech politicians initially tried bans. When those bans failed immediately with new chemical analogues appearing weeks later, the government pivoted. They passed legislation creating a strict regulatory market. These substances are not banned, but neither are they unregulated. They are sold only to adults in licensed stores, with strict controls on dosage and packaging.

“We managed to convince conservative politicians that regulation protects children better than bans” Dr. Michailidu explained. By taking the market out of the shadows, the state can control access – something prohibition has never achieved.

In her closing remarks, Ganna Dovbakh dismantled the metric favored by the new EU Strategy: the “kilogram seized.” She termed this the “Kilogram Fallacy.” Seizures are merely an indicator of police activity, not policy success. “You stop one route, ten more appear. You ban one substance; laboratories produce ten new ones. We are fighting a fire with a leaking hose” she argued.

 

Webinar on decriminalisation

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Policy Webinar under the BOOST Project

4 December 2025 | 14:30–16:00 CET

Registration link | https://us02web.zoom.us/j/89055986872

Languages: English and Russian

 

Background and Rationale

Decriminalisation is defined as the removal of criminal sanctions for certain activities related to drug use and possession for personal use. Several actors in the field of drug policy have indicated that a punitive approach is counterproductive to achieving the health and welfare of humankind. There is no evidence that criminalisation of use, possession for personal use, and other related behaviours has positive impacts in terms of reducing both drug demand and supply.

Purpose and Objectives

  • Introduce the BOOST policy brief on decriminalisation to stakeholders across Europe: policymakers, community-led organisations, practitioners, funders
  • Present the evidence and recommendations on what works and where challenges remain when discussing about and adopting decriminalisation
  • Discuss why we need decriminalisation and what arguments can help and how to achieve this goal?
  • Enable dialogue among stakeholders decriminalisation: barriers, enablers, local contexts
  • Mobilise institutions, experts, communities and civil society networks to use the brief as an advocacy tool

Programme

Time Segment
14:30 – 15:37 Opening & overview – Milutin Milošević, DPNSEE Executive Director, Moderator
14:38 – 14:45 The BOOST project: General information and advocacy interventions – Igor Gordon, Program Team Lead, EHRA
14:45 – 14:55 The BOOST policy paper “Decriminalize! drug use and possession for personal use” – Marios Atzemis, DPNSEE Board member
14:55 – 14:05 Presentation of the new documents related to decriminalisation and human rights violations – Ganna Dovbakh, Executive Director and Maria Plotko, Senior Program Officer, EHRA

·      Updated Criminalisation Cost country profiles and regional comparison for CEECA

·      Regional CEECA report on CESCR rights violations of people who use drugs
15:05 – 15:15 Experts from countries implementing decriminalisation – John-Peter Kools, Trimbos institute, The Netherlands
15:15 – 15:22 Experts from countries implementing decriminalisation – Sanja Mikulić, Institute for Public Health, Croatia
15:23 – 15:30 Experts from countries implementing decriminalisation – Joana Canêdo, Portugal
15:30 – 15:38 Experts from countries implementing decriminalisation – Dr. Jana Michailidu, Czechia
15:40 – 15:55 Questions and answers
15:55 – 16:00 Closing – Ganna Dovbakh, EHRA Executive Director and EU Civil Society Forum on Drugs Chairperson

 

Struggle and Hope Beyond the Numbers

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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

 

A strategy for stronger engagement, protection and support to civil society organisations

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The European Commission adopted two important documents: the European Civil Society Strategy and the European Shield of Democracy. Together, both documents create a framework for stronger, more open and resilient European democracies and contribute to greater participation of citizens and civil society organizations in public processes.

The European Civil Society Strategy is aimed at strengthening the role, protection and long-term sustainability of civil society organizations. Key measures of the strategy include:

  • Establishment of a civil society platform for structured dialogue with the EU
  • Creation of an online Knowledge Hub on civic space
  • Measures for the protection of civil society organizations
  • Strengthening of financial support, including the AgoraEU program

The European Democracy Shield establishes a set of measures to strengthen the resilience of democratic systems in the EU. Key measures include:

  • Protection of information space
  • Strengthening free elections and independent media
  • Increasing social resilience: media and digital literacy, civic education, participatory tools, civic-tech hub, EU democracy guide
  • Establishment of the European Center for Democratic Resilience

More about the strategy is available following this link>>>.

 

10 Years of Work and Achievements

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The Drug Policy Network South East Europe was formally registered at the Serbian Business Registers Agency on 15 October 2015. Over a decade, DPNSEE has expanded to include 26 member organisations from 11 countries in South East Europe, covering Albania, Bosnia and Herzegovina, Bulgaria, Croatia, North Macedonia, Greece, Kosovo*, Montenegro, Romania, Serbia and Slovenia. These members are key service providers and advocates working in prevention, harm reduction, treatment, rehabilitation and social reintegration.

Key Areas of Work

  1. Policy Dialogue and Advocacy

DPNSEE has established a sustained track record of facilitating government – civil society dialogues on drug policy, first convened in 2018 and repeated in 2020 and 2023 in Belgrade – creating a recognised regional platform for constructive exchange between policymakers and civil society actors. These events have strengthened mutual understanding and contributed to more inclusive policy processes.

  1. Public Health and Harm Reduction

The Network and its members are deeply involved in promoting harm reduction as a public health priority, including through regional research, policy analysis and advocacy. DPNSEE’s Resource Centre collects and shares a comprehensive repository of drug policy documents, including materials on harm reduction, criminal law, human rights, and service models across the SEE region.

DPNSEE also participates in UNODC-led projects supporting continuity of HIV prevention, treatment and harm reduction services among key populations – including people who use drugs and refugees from Ukraine, Russia and Belarus – with coordinated regional implementation alongside member organisations.

  1. Research, Knowledge Sharing and Capacity Building

DPNSEE produces policy briefings, regional assessments and position papers (e.g., on decriminalisation and service gaps) and organises webinars, workshops and training to strengthen skills and knowledge among civil society actors. It collaborates with European networks such as the Correlation – European Harm Reduction Network (C-EHRN) on joint projects like BOOST, which supports advocacy and community-led efforts to improve harm reduction services.

  1. International Engagement

The Network is a member of influential international bodies including the European Union’s expert group Civil Society Forum on Drugs, the International Drug Policy Consortium (IDPC) and the Vienna NGO Committee on Drugs, linking SEE civil society voices into global policy forums such as the UN Commission on Narcotic Drugs. DPNSEE is accredited by the United Nations Economic and Social Council (ECOSOC), which enables attenddance and engagement in key UN policy-making fora such as the UN General

Assembly, the UN Human Rights Council, and the UN Commission on Narcotic Drugs.

Notable Achievements (2015 – 2025)

  • Institutional Establishment: Formal creation and expansion into a major regional civil society network with 26 member organisations from 11 countries.
  • Sustained Policy Dialogue: Successfully organised a series of high-level regional government–civil society dialogues (2018, 2020, 2023) that have contributed to trust-building and policy cooperation.
  • Regional Knowledge Hub: Development of a comprehensive Resource Centre for policy documents and country-level information, supporting advocacy and research.
  • Strategic Projects: Active participation and implementation of regional and international initiatives on harm reduction, HIV and public health programming, including projects supported by UNODC and the EU.
  • Global Policy Engagement: Representation and advocacy at international platforms, strengthening civil society influence in global drug policy debates.
  • HIV prevention: DPNSEE has made a significant regional contribution to HIV prevention by supporting and coordinating harm-reduction and community-led responses for people who use drugs, including through regional projects and partnerships that strengthened service continuity, cross-border cooperation, and alignment with public-health standards.
  • Youth engagement and prevention: DPNSEE has supported youth-focused prevention and participation by promoting evidence-based drug education, engaging young people and youth-led organisations in policy discussions, and strengthening civil society capacities to address the specific needs and vulnerabilities of young people in the SEE region.

Impact

Over the past decade, DPNSEE has played a crucial role in shifting drug policy debates in South East Europe towards approaches that prioritise health, human rights and community involvement. Through sustained networking, research, advocacy and multi-stakeholder dialogue, the Network has advanced inclusive governance, contributed to policy learning, and supported the strategic visibility and effectiveness of civil society in policy formulation and implementation across the region.

Policy Webinar: Universal Health Coverage for People Who Use Drugs

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On 10 October 2025 (World Mental Health Day), the Eurasian Harm Reduction Association hosted a regional webinar under the EU4Health-funded BOOST project.

The webinar brought together speakers from WHO Europe, regional community networks and frontline services in Czechia, Lithuania and Romania. Participants joined from across Europe and neighbouring regions, including civil society organisations, community leaders, harm reduction professionals, clinicians and policymakers.

UHC that excludes PWUD is not universal

Opening the webinar, Ganna Dovbakh, Executive Director of EHRA, underlined that UHC cannot be called universal if it systematically excludes people who use drugs. She highlighted that in many countries, people who use drugs face a combination of criminalisation, stigma, fragmented services and poverty, which keeps them at the margins of health systems even where UHC frameworks formally exist.

Stela Bivol, from the WHO Regional Office for Europe, provided the global and regional policy context. She stressed that there is “no health without mental health” and no UHC without including people who use drugs and people with mental health and substance use conditions. She outlined WHO guidance on integrating mental health and substance use care into primary care, HIV and hepatitis services, and harm reduction, including the updated mhGAP recommendations and the new WHO clinical guidance on mental health and HIV.

Stela also drew attention to gender and intersectionality: women who use drugs, migrants, sex workers and LGBTIQ+ people often experience combined stigma, violence and rights violations that further reduce their access to care. Emergencies, such as the war in Ukraine, intensify mental health needs while disrupting services, making integration and task-sharing even more critical.

Communities as essential health actors

From the perspective of people who use drugs, Ligia Parodi (EuroNPUD) described UHC as “an empty promise” when people who use drugs are excluded by design through punitive drug policies and institutional discrimination. She stressed that fear of punishment, surveillance and institutional violence keeps people away from health services, and that many deaths and harms are the direct result of political choices.

Ligia highlighted community-led and peer-led initiatives, including BerLUN in Germany, Young Wave in Lithuania, and CASU and the women’s group MUSA in Portugal, which provide navigation, mutual support and advocacy on minimal budgets. These examples show that peers are already acting as health workers and system navigators, yet remain largely invisible and underfunded in UHC plans.

She called for decriminalisation, stable funding for community-led services, and meaningful participation of people who use drugs in decision-making bodies at national and EU levels, as well as in monitoring the quality and accessibility of UHC for key populations.

Integrated models from Czechia, Lithuania and Romania

The webinar showcased practical examples of integrating harm reduction and addiction care within UHC systems.

Radek Jurnikl (SANANIM, Czechia) presented a multidisciplinary outreach and low-threshold programme in Prague that combines social work, psychological support, nursing, psychiatric input and close collaboration with hospitals. The team provides street outreach, harm reduction services and on-site hepatitis C testing and treatment, as well as “hospital outreach” to ensure that patients discharged from hospital are immediately connected to OAT, shelter and follow-up support.

From Lithuania, Giedrius Likatavičius described the work of the Republican Centre for Addictive Disorders, which combines inpatient and outpatient care and runs an OAT programme with a dedicated budget line for people without health insurance. Social workers and nurses are embedded in low-threshold services to link clients to treatment and to HIV and hepatitis services. Lithuania’s model shows how mixed funding and dedicated lines for uninsured people can improve access, although stigma and weak financial incentives still limit decentralisation of OAT to primary care.

Monica Dan (ARAS, Romania) provided a contrasting picture from a more restrictive context. ARAS has offered harm reduction and OAT for decades, but services remain underfunded and not fully free of charge. Recent cuts to health insurance pathways have reduced access to treatment for many people who use drugs. At the same time, civil society must constantly resist new punitive legal initiatives. Monica underlined that without enabling legal frameworks and sustainable financing, even strong community-based services cannot deliver true UHC.

From evidence to advocacy

In the second half of the webinar, EHRA presented the joint BOOST advocacy strategy and the new policy brief: Advancing Universal Health Coverage for People Who Use Drugs in Europe, which translate these experiences into policy demands. The brief calls for harm reduction, OAT and mental health services to be explicitly included in UHC benefit packages; for peer navigators and low-threshold models to be recognised and funded; and for EU institutions to create or adapt funding mechanisms that reach community-led organisations.

Participants discussed the risk of over-medicalisation, the need to address self-medication and trauma, and the mental health needs of outreach workers and activists themselves. There was broad agreement that integrated and community-linked models are technically feasible and cost-effective, but remain politically fragile without decriminalisation, sustainable financing and meaningful community participation.

The webinar forms part of BOOST’s broader regional work on health, harm reduction and human rights. EHRA and partners will now use the policy brief and webinar outcomes to inform advocacy towards EU institutions, national governments and donors, ensuring that people who use drugs are not left behind in Europe’s push towards universal health coverage.

The recording from the webinar is available below

https://youtu.be/TQpJ3t5 KL_s

 

Farewell Nena

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Our dear friend and colleague, president of the HELP association, Nevenka Mardešić, left us 21 September.

We will remember her for her kindness, humanity, cheerfulness and selflessness, courage and struggle, with which she enriched many lives.

Sincere condolences to the family.