Mental health, human rights and legislation

Mental health is growing as a public health priority and human rights imperative, and an increasing number of countries are wishing to adopt or reform legislation related to mental health. However, laws on mental health, currently often fail to address discrimination and human rights violations including in mental health care settings. In order to support countries in this area, the World Health Organization and the Office of the High Commissioner for Human Rights have jointly developed the publication entitled “Mental health, human rights and legislation: guidance and practice”.

The Guidance proposes new objectives for law, including setting a clear mandate for mental health systems to adopt a rights-based approach. It outlines legal provisions required to promote deinstitutionalization and access to good quality, person-centred community mental health services. It highlights how laws can address stigma and discrimination and provides concrete measures on how to eliminate coercion in mental health services in favour of practices that respect people’s rights and dignity.

The Guidance also provides key information on how to adopt a human rights-based approach when reviewing, adopting, implementing and evaluating mental health related laws, and includes a practical checklist enabling countries to assess whether their laws align with current human rights standards.

The Guidance is available following this link>>>.

 

Digital Skills Training Course

As part of the BOOST project (where DPSNEE is an associate partner), a Digital Skills Training Course for harm reduction organisations working in the area of HIV and viral hepatitis will be held over the course of 4 weeks, between February 26th and March 23rd, 2024. This course has been conceptualised by the organisations involved in the Working Package 3 of BOOST, and will be implemented by NGO Re Generation, our member organisation.

This training course is aimed at building the capacity of community-based & community-led harm reduction organisations to use digital tools in the area of HIV and viral hepatitis services to improve the quality and accessibility of communicable disease prevention, testing, linkage to care and treatment, as well as the monitoring of these services.

The call is open for applications from representatives of community-based & community-led harm reduction organizations working in the area of HIV and viral hepatitis which are members of the networks C-EHRN, EHRA, EuroNPUD and DPNSEE. Please note that trainees are required to commit to the entire process and actively participate in the training course and the follow-up sessions. Additionally, they should be motivated to implement the training skills & content in their work.

Applications are welcome by January 19th following this link>>>! Successful applicants will receive more detailed information about the training program and agenda during the last week of January.

 

Drug consumption rooms in Europe

From the Correlation website

The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and Correlation – European Harm Reduction Network (C-EHRN) have published the latest overview on the situation of drug consumption rooms (DCRs) in Europe. The purpose of the report is to encourage evidence-based discussions around DCRs and the implementation of varied DCR models in Europe.

The report is based on a mixed-methods approach, including a review of documents published by EMCDDA and C-EHRN up to 2020, together with a structured literature search for new peer-reviewed (MEDLINE) and grey publications, including relevant health and public-order outcomes of drug consumption rooms and covering the most recent years (2020 and 2021).

DCRs are a fundamental health and social response that fosters the well-being of people who use drugs by providing hygienic and safer spaces where to use substances in the presence of trained social workers and/or healthcare professionals. DCRs are usually located in areas where there is an open drug scene and where injecting in public places is common. The primary target group for DCR services are people who engage in drug use patterns that can result in dangerous health outcomes.

According to the report, in 2022, there were over 100 DCRs operating globally, with services in several EU countries such as Belgium, Denmark, France, Germany, Greece, Luxembourg, the Netherlands, Norway, Portugal and Spain, as well as in Switzerland, Australia, Canada, Mexico and the USA.

Primarily, DCRs aim to prevent drug-related overdose deaths, reduce the risks of disease transmission through the use of unhygienic supplies and/or their sharing, and connect people who use drugs with support, health and social services. Besides this, they can also aim to minimise public nuisance.

In the report, two main operational models of DCRs in Europe are described: integrated DCRs, operating within low-threshold facilities, where the supervision of drug use is just one of the services offered, and specialised DCRs, offering a narrower range of services directly related to supervised consumption.

As frontline, low-threshold services, DCRs can support the monitoring of new and emerging local trends. For example, it has been found that in Europe, injecting heroin is less common in recent years, while the use of synthetic opioids and stimulants has increased in some countries. Over the years, following a dynamic drug landscape, many harm reduction services, including DCRs, have adapted to the needs of local clients. For example, some DCRs have started providing services for smoking as well as injecting and allowing the consumption of a wider range of substances within the facility.

DCR evaluation presents specific challenges, but currently available evidence support the positive impact of DCRs on the access to healthcare and harm reduction services among people who use drugs, and especially groups that are not reached enough by these services. DCRs do not increase crime in the areas where they are located and, instead, contribute to decrease of public drug use. Evidence also shows how DCRs contribute to reducing drug-related deaths.

In addition, an expert panel recently concluded that DCRs foster safer injecting practices and therefore can contribute to reduce the transmission rate of communicable diseases among people who inject drugs.

Among other measures to reduce cases of fatal and non-fatal overdose, the EU Drugs Action Plan 2021–2025 calls for DCRs to be introduced, maintained or enhanced ‘where appropriate and in accordance with national legislation’.

The report concludes that, despite the challenges encountered in conducting research in this setting, more studies are needed to support the work of DCRs by showing their contributions to reducing both individual and community harms.

Read the joint EMCDDA and C-EHRN Report on DCRs in Europe following this link>>>.

 

A very successful regional campaign

The Drug Policy Network South East Europe (DPNSEE) coordinated the „Eliminate Violence Against Women Who Use Drugs – EVAWUD“ campaign in South East Europe, together with its 25 member organisations from 11 countries of the region. The campaign lasted from 25 November and lasted until 10 December 2023.

The campaign started in early November with informing the member organisations and inviting them to participate. The press release, originally prepared by the Women and Harm Reduction International Network (WHRIN) and adjusted by DPNSEE, was translated into local languages of the region and distributes to media and institutions >>>. DPNSEE also prepared and distributed a document with key facts related to women and drug use.

From more than 30 social networks accounts (Facebook, Instagram and Twitter) of partners in the region, 70+ posts, stories and photos were shared. They reached arounf half a million users who interacted seeing reacting, commenting and reposting. Most of these posts were at the DPNSEE Instagram account.

DPNSEE organised a meeting dedicated to eliminating violence against women who use drugs on Friday 8 December 2023 in the Palace of Serbia, in Belgrade, with the support from the Office for Combating Drugs of the Government of Serbia. It was the opportunty to share thoughts and experiences in working on this important issue.

Participants came from several intitutions, including ministries on human and minority rights and social dialogue and health, the Institute for Public Health and UNODC representatives for South East Europe, and civil society organisations.

The meeting was very well covered by the media in Serbia (N1 >>>, Beta >>>, Danas >>>, Radio 021 >>>, NasloviNet >>>).

Other media from the region also reported about the issue of women who use drugs: Vijesti (MNE) >>>, TRN (RNM) >>>, Telma (RNM) >>> , SMK (RNM) >>>, CIN (MNE) >>>, IMA (RNM) >>>.

Thanks to media and social networks, we estimate that we reached out to more than half a million people. We regret that we didn’t have funds to pay te adverts at the social networks. With them, we should have had 10 times wider reach.

Eliminate Violence Against Women Who Use Drugs

The Drug Policy Network Southe East Europe organised a meeting dedicated to eliminating violence against women who use drugs on Friday 8 December 2023 in the Palace of Serbia, in Belgrade, with the support from the Office for Combating Drugs of the Government of Serbia. It was the opportunty to share thoughts and experiences in working on this important issue.

Participants came from several intitutions, including ministries on human and minority rights and social dialogue and health, the Institute for Public Health and UNODC representatives for South East Europe, and civil society organisations.

Ivana Joksimović, the Assistant Minister for human rights and social dialogue spoke about human rights of marginalised and discriminated communities. Milutin Milošević, the DPNSEE Executive Director presented the EVAWUD campaign to eliminate violence against women and gender diverse people who use drugs and presented some results from recent surveys published by DPNSEE.

Irena Molnar from ReGeneration shared about their program on improving the competencies of employees in social protection through examples of activities aimed at working with women who have survived violence and are drug users and young people at risk. Nebojša Djurasović from Prevent, the DPNSEE President, presented their experiences in working with the shelter for sex workers in Novi Sad.

The discussion showed a shared determination to continue fostering and protecting human rights of women and gender diverse people who use drugs in Serbia.

Dramatic failure of the strategy to achieve a ‘drug-free world’

The International Drug Policy Consortium (IDPC) launched today Off track: Shadow report for the mid-term review of the 2019 Ministerial Declaration on drugs – which exposes the dramatic failure of the current United Nations (UN) strategy to achieve a ‘drug-free world’ and the devastating consequences of the ‘war on drugs’ that it underpins. Released ahead of the mid-term review of the 2019 Ministerial Declaration on drugs, the report urges the international community to engage in urgent reform. Using wide-ranging data from UN, government, academic and civil society sources, the report represents the only comprehensive evaluation of global drug policy, and illustrates its system-wide collapse:

  • Despite billions spent every year to curb drug markets and availability, the number of people who use drugs increased from 271 to 296 million in four years, reaching a historic record.
  • The latest global estimates on drug use-related deaths reached 494,000 in 2019 alone (the latest global data available), with a surge in overdose deaths.
  • The number of people executed for drug offences, in flagrant violation of international law, rose by 213% between 2019 and 2022.
  • Fuelled by punitive drug laws, the number of people incarcerated worldwide rose from 10.74 million to 11.5 million between 2018 and 2023 – with more than 2 million imprisoned for drug offences.
  • Globally, only one in five people with drug dependence have access to treatment.
  • The shocking disparity in access to controlled medicines continues, with over 82% of the global population having access to less than 17% of the world’s morphine.

Launch of the report in the Vienna International Centre

To access the report, follow this link>>>.

 

Campaign to Eliminate Violence Against Women Who Use Drugs

With the International Campaign for the Elimination of Violence Against Women UNiTE, a UN
initiative of 16 days of activism, the Women and Harm Reduction International Network (WHRIN)
and Drug Policy Network South East Europe (DPNSEE), with campaign partners YouthRISE,
EuroNPUD and EWNA call for an end to all forms of violence against women and gender diverse
people who use drugs. The EVAWUD campaign highlights the need to end violence against women
and gender diverse people who use drugs and improve drug policies from a feminist, human rights
and harm reduction perspective.

Women and gender diverse people who use drugs are subject to extreme levels and a wide range of violence due to patriarchal norms combined with punitive prohibition of some drugs. State-driven stigma, criminalization, harmful gender norms, and corruption drive substantive health and safety harms. These act as barriers for women and gender diverse people who use drugs accessing critical harm reduction and gender-based violence (GBV) services.

Women and gender diverse people who use drugs experience GBV at up to 25 times the rate experienced by women in the general public. This violence includes, (but is not limited to) extra judicial killing, capital punishment, forced and coerced sterilisation and abortion, rape, sexual harassment, loss of child custody, bashings, imprisonment for personal possession or use, penalisation for drug use in pregnancy, along with other types of gendered violations, stigma and discrimination.

Woman and gender diverse people who use drugs around the world can face arbitrary detention, extortion, police violence, torture and ill-treatment, with well over a third of women in prison for drug offences and with the incarceration of women for drug offences spiking globally by 53% since 2000.

Due to the so-called “war on drugs”, survivors have little recourse and often no support, particularly in cases of violence from police, prison guards and compulsory ‘treatment’ centre staff. The experiences of violence against women who use drugs are even more extreme for those facing intersecting oppressions such as women of colour, sex workers, or trans women. Additionally, young people face more barriers to accessing essential health and harm reduction services due to policies and laws on age restrictions, affecting young women and gender diverse people.

WHRIN and DPNSEE and partners note that, by collaborating with groups of women and gender diverse people who use drugs and documenting peer led actions and services, the appropriate responses to these inequities and violations are clear.

Meaningful community involvement must feature as the cornerstone to all good practice responses in developing GBV services. As the criminalisation of drug use stands as a primary barrier between women and gender diverse people who use drugs and attainment of human rights including the right to safety, access to harm reduction and other essential health services.

Decriminalisation which removes all sanctions and punishment, including coerced or court-imposed treatment programs, for all people who use drugs, and all types of drugs is also imperative. Properly implemented decriminalisation will reduce the stigma and violence associated with the “war on drugs”.

Expansion of harm reduction and inclusion of violence prevention and mitigation, and gender sensitive, affirming and age-appropriate support services are also critical. It is also noted that sexual and reproductive health is now promoted as an additional essential service that should be incorporated within the harm reduction suite of services for people who use drugs, and that best practice service delivery integrates comprehensive GBV services.

DPNSEE and WHRIN, EuroNPUD, YouthRISE and ENWA call for an end to the “war on drugs”, to end this violence against women and gender diverse people who use drugs. Legislation and legal principles, procedures, policies, programmes and practices relating to criminal justice must be reviewed to determine if they are adequate to prevent and eliminate violence against women and gender diverse people who use drugs. If they are found to have a negative impact, they must be modified in order to ensure that people who use drugs enjoy fair and equal treatment.

Please join us in ensuring adequate resources and legislative frameworks uphold the safety and human rights of women and gender diverse people who use drugs.

 

Community Manifesto for HIV Long-Acting Injectable PrEP in Europe

More than 40 global and regional civil society organisations endorsed a community manifesto calling for the introduction of long-acting injectable PrEP in Europe.

Oral PrEP has had a significant impact on population HIV incidence, especially in gay and bisexual men and other men who have sex with men (GBMSM), in high-income settings.

Oral HIV PrEP is highly efficacious when taken as prescribed, and is largely acceptable as an HIV prevention technology in those who use it. Oral PrEP has been a significant new addition to combination HIV prevention approaches, along with condoms, PEP, and treatment-as-prevention.

However, significant barriers to accessing oral PrEP remain and these barriers result in significant health inequalities. Further, taking a (daily) oral medication is not an acceptable or feasible method of HIV prevention for many who could benefit from PrEP. The development of multi-methods of PrEP will increase adherence as well as PrEP acceptability and choice, and thereby improve uptake of PrEP regionally and globally.

New formulations of PrEP have been studied, with a number of highly effective methods becoming approved for use. These include vaginal-ring formulations, and long-acting injectable PrEP. ViiV’s long-acting formulation of cabotegravir PrEP (LA-CAB) has been approved in, Australia, Botswana, Malawi, South Africa, US, and Zimbabwe and has been submitted for regulatory approval to the EMA and in over 10 countries thus far. Recent voluntary licensing agreements have been agreed, enabling generic LA-CAB to be manufactured and prescribed in over 90 countries, subject to pending regulatory approvals. However, due to a dearth of manufacturing facilities, drug stock is currently limited until new plants become fully functional in 2025.

This document results from a consensus meeting held in Paris in March 2023 between regional and international HIV prevention organisations and activists including: AIDES; AIDS Action Europe; AVAC; Coalition PLUS; EATG; Fundacja Edukacji Spolecznej; GSSG – Germany’s Charitable Foundation Sexuality and Health; and PrEPster at The Love Tank CIC.

To find out more, access the Manifesto, follow this link>>>.

 

Mental Health and Substance Use

On the 10th of October, on World Mental Health Day, the Civil Society Forum on Drugs (CSFD) sent its position paper People Who Use Drugs and Mental Health to the EU Spanish Presidency, the Horizontal Working Party on Drugs, and the European Commission.

The paper addresses the complexity of the relationship between mental health conditions and substance use. Mental health conditions are influenced by social determinants such as inequality, discrimination, violence, and homelessness, factors which disproportionately affect people who use drugs. Furthermore, specific subpopulations, including women, young people, ethnic minorities, and indigenous groups, face unique challenges in accessing appropriate services for their mental health and substance use needs. These disparities highlight the pressing need for a comprehensive and inclusive approach to addressing these issues from a person-centred, holistic perspective. The paper also calls for specific terminology reform, promoting the use of the term ‘comorbidity’ to describe the existence of both mental health conditions and substance use.

The paper concludes with a number of recommendations related to this issue, urging for a comprehensive review of current shortcomings in accessibility, inclusivity and sustainability of care. The CSFD welcomes the introduction of this topic within the political agenda, as these issues have historically been disregarded and warrant urgent consideration. The CSFD’s position paper serves as a call to action, urging policymakers, healthcare providers, and society at large to recognize and address the critical issues surrounding mental health and substance use. By adopting these recommendations and working together, we can strive for a more inclusive and compassionate approach to mental health care for all, particularly those who use drugs and face complex challenges.

Read CSFD’s position paper here>>>.

Marija Mijović, member of the DPNSEE Board, who contributed to the document, translated it into Montenegrin (also easy to read by those speaking Bosnian, Croatian and Serbian). You can access the document Osobe koje koriste droge i mentalno zdravlje following this link>>>.