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>>>.

 

Regulating cannabis in EU: current policies and laws

The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) published document Cannabis laws in Europe: questions and answers for policymaking which provides an overview of current policies and laws at the EU level and in individual Member States. The speed and scale of cannabis policy change and the potential impact of these policies on public health and safety, has prompted the EMCDDA to publish this report

This publication answers some of the more frequently asked questions raised in discussions about cannabis legislation. While the primary focus is on the use of cannabis for recreational purposes, relevant legislation for other uses, including medical and commercial cannabis-derived products such as cosmetics, wellness products and foods, is included in order to provide the necessary context for various policy initiatives.

While the primary focus of this report is on the use of cannabis for recreational purposes, relevant legislation for other uses is included in order to provide the necessary context for various policy initiatives. Written for a broad audience, the report aims to give brief answers to some of the more frequently asked questions raised in discussions about cannabis legislation. These have been grouped into five parts:

  • Why is defining cannabis important?
  • What are countries’ international obligations to control cannabis?
  • How do EU countries respond to illegal use and supply of cannabis?
  • Is there a trend towards cannabis regulation — and if so why?
  • What laws cover medical and commercial cannabis-derived products?

This document is available at our Resource Centre following this link>>>, or at the EMCDDA website>>>.

 

Updated national drug situation overviews for North Macedonia and Serbia

From the EMCDDA webpage

The EU drugs agency (EMCDDA) published updated national drug situation overviews for North Macedonia and Serbia. These reports are the result of an 8-month online capacity-building exercise, organised with the support of the Austrian Reitox national focal point Gesundheit Österreich (Austrian National Public Health Institute).

The report on the Republic of North Macedonia provides a top-level overview of the drug situation in the country, covering drug supply, use and public health problems as well as drug policy and responses. It brings together the most recent data available by the end of May 2022.

The report on Serbia provides a top-level overview of the drug phenomenon in this country, covering drug supply, use and public health problems as well as drug policy and health and social responses. The report contributes to a better understanding of the drug situation in Europe and is targeted at national and international audiences, including government, civil society, researchers and funders.

The reports are available following these links – North MacedoniaSerbia.

 

EMCDDA closing conference of two cooperation projects

The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) hosted the closing conference of its international cooperation projects with the Western Balkans and European Neighbourhood Policy (ENP) region. The two-day event was held on 21 and 22 November 2022, in the margins of Lisbon Addictions 2022, Europe’s largest conference in the area of addictions.

The objective of the two projects is to familiarise the project beneficiaries with EU policies and working methods and to prepare them for consolidated and structured reporting to the EMCDDA.

Under the theme ‘Drugs beyond EU borders: emerging trends and preparedness’, the event focused on cross-border drug-related health and security threats in the Western Balkans and on drug markets and emerging drug-related challenges in the ENP region.

Over 80 participants – from 18 partners, EU institutions and other bodies – attended the meeting (in Lisbon and online) to discuss the results of this cooperation. Among others, experts took a look at the preparedness of health and security services in the regions to address the emerging threat of cocaine trafficking and use. DPNSEE Executive Director Milutin Milošević was among the speakers in the Moderated panel discussion: How prepared are the partners for emerging cocaine trafficking and use?

The meeting also provided a platform for partners to present work undertaken in the framework of the projects aimed at improving knowledge on the drug situation in the region and at scaling up responses.

In cooperation with the Portuguese national focal point (SICAD), the meeting concluded with onsite visits to: a commission for the dissuasion of drug use; a judicial police forensic laboratory; a community-based harm reduction programme; a low-threshold mobile unit for methadone distribution and a drug consumption room.

Visit to the GAT drop-in centre in Mouraria, run by the peers from the population of people who use(d) drugs

EMCDDA new analysis on the drug situation in the Western Balkans

From the EMCDDA webpage

Drug-related health and security threats in the Western Balkans are highlighted in a new report published by the EU drugs agency (EMCDDA). Released in the framework of the agency’s latest Instrument for Pre-accession Assistance project (IPA7), funded by the EU, the report provides the latest picture of the drug situation in the region.

The report offers a top-level analysis of drug markets, their drivers, facilitators and consequences, as well as an overview of drug policy and the law, drug use, harms and responses. It concludes with a regional overview of each of the major drug types, focusing on use, production and trafficking. Additional challenges, such as corruption, violence and the internationalisation of organised crime networks are also considered.

The findings are based on EMCDDA data collected through structured questionnaires and complemented by information from studies, focus groups and scientific literature. It appears that drug-related information is overall relatively limited in the region, although this varies, to some extent, between the partners concerned.

The report presents a summary of ‘key findings’, including:

  • Available data show that overall drug use in the region appears to be lower than in the neighbouring EU, although notable differences in patterns of use can be observed between the Western Balkan partners. There is an ongoing need to better monitor harms associated with opioid and cocaine use in the region, as evidence suggests that use of these substances is evolving in ways that could have important implications in future.
  • Harm reduction services operate in all of the partners, but the provision of interventions appears to be generally insufficient and is often dependent on international funding. Data point to an overarching need in the region to increase the provision of treatment and other services for people with drug problems. In particular, responses targeting harmful patterns of use for non-opioid drugs appear to be currently underdeveloped, while, at the same time, demand for such responses may be growing.
  • Western Balkan criminal networks appear to have become key actors in both the regional and EU drug markets. This partly reflects the geographical position of the Western Balkans, which lie at the intersection of a number of major drug trafficking routes (e.g. Balkan route for heroin), but also, potentially, some emerging routes for other drugs, including cocaine. These criminal networks have a significant impact on security, governance and the rule of law in the region.
  • Some criminal networks from the Western Balkans have adopted a new business model of direct involvement in cannabis production within the EU. Their presence in a number of EU countries, primarily associated with indoor production facilities, has been noted. Patterns of cannabis cultivation in the region are shifting and diversifying. Significantly less cannabis is cultivated outdoors in Albania than in the past, while large-scale cannabis cultivation sites have been recorded in other parts of the Western Balkan region.
  • Violence associated with competition for drug markets and control of trafficking routes is a significant security threat. A number of homicides in the EU and elsewhere have been linked to Western Balkan criminal networks involved in the drug trade, particularly the cocaine business.

The report is available following this link>>>.

 

How to respond to drug-related problems among migrants, refugees and applicants for international protection in Europe

Migration has had an increasing impact on European policymaking over the past decade, in the wake of what has been called the ‘refugee migration peak’. In addition to an influx of refugees, European countries have experienced relatively new intra-European migration flows, while health and social disparities persist among populations with longer-established migration patterns.

This publication “Responding to drug-related problems among migrants, refugees and ethnic minorities in Europe”, produced by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), presents the available prevalence studies of illicit substance use among migrants and ethnic minorities and discusses their limitations, as well as looking at prevalence and risk factors for substance use among refugees.

Two subsections focus on specific issues among non-refugee third-country nationals and Roma. Section 2 of this paper summarises risk and protective factor mechanisms in an ecosocial framework, while sections 3 and 4 are the core of this paper, and focus on social responses targeting migrant and ethnic populations in prevention, treatment and harm reduction, as well as highlighting broader responses which support these interventions. Finally, sections 5 and 6 conclude the report with a discussion of major challenges in addressing drug-related problems among these populations and examine some possible implications for policy and practice.

You can download this document following this link>>>.

 

Increasing linkage to care and adherence to treatment for hepatitis C among people who inject drugs

Hepatitis C virus (HCV) infection is a major public health threat due to disease burden and risk of complications and death. Injecting drug use is the most likely mode of HCV transmission reported in the EU/EEA and accounted for 49% of acute and 61% of chronic infections in 2018. Compared to other drug-associated blood-borne viral infections, HCV is the most prevalent one among people who inject drugs (PWID) across Europe. Prevalence of HCV antibody among PWID estimated from nationally representative samples ranged between 15% and 86% during 2018–2019. The prevalence of current infections measured by HCV-RNA (or antigen) tests ranged from 15% to 64% between 2013 and 2019 in six countries with available data. PWID are therefore considered as a priority population in prevention, testing, linkage to care and treatment, and prevention of re-infections to achieve HCV elimination.

Following advances in treatment for hepatitis C (HCV), optimizing linkage to care and adherence to treatment of people who inject drugs became of pivotal importance. An ECDC/EMCDDA stakeholders survey in 2018 indicated that two components of the cascade of care, linkage to care and adherence to treatment, were priority areas for inclusion in the updated guidance, planned for publication in 2022. The systematic review Interventions to increase linkage to care and adherence to treatment for hepatitis C among people who inject drugs: A systematic review and practical considerations from an expert panel consultation was commissioned with the aim to evaluate the effectiveness of interventions on HCV linkage to care and adherence to treatment among people who inject drugs.

Available evidence suggests that integrated, people-centered approaches may improve engagement throughout the continuum of HCV care among people who inject drugs. For progressing HCV elimination efforts, interventions should be implemented in colocation with harm reduction and counselling activities and in combination with additional services, including opioid substitution treatment, directly observed therapy, peer support and/or contingency management.

Highlights of the review include:

  • Integrated care and cooperation between service providers optimize the HCV care continuum among people who inject drugs.
  • Results suggest that people who inject drugs with HCV infection can be effectively linked and treated with direct-acting antivirals regimens in settings outside of hospital.
  • Interventions that facilitate HCV care must be implemented at settings where people who inject drugs are already accessing services.
  • The experts’ reflections complement the findings of the literature review and inform public health practice by considering the heterogeneity of health systems and national regulatory frameworks.
  • Higher quality studies investigating interventions addressing the entire care cascade from testing to cure and prevention of reinfections among highly vulnerable populations are urgently needed.

To read the full article, follow this link>>>.

 

Expert update on drug-related infectious diseases

The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) gathered the Drug-related infectious diseases (DRID) expert network to share the latest developments on drug-related infectious diseases in Europe and to identify steps needed to improve the production, availability and use of public health-oriented information at the European level.

The DRID network brings together national experts nominated by national focal points of the EU Member States, Norway and Turkey, as well as institutional partners (ECDC, WHO, Correlation). The meeting also welcomed experts from the Western Balkans (IPA7 project), the European Neighbourhood Policy countries (EU4MD project), Georgia, the United Kingdom, Australia and the United States. Participating experts come from ministries of health, public health institutes, drugs agencies, health services, universities, research institutes and civil society.

The group held an online meeting on 26-27 October 2021, focusing on:

  • The direct impact of COVID-19 on people who use drugs and the COVID‑19 vaccination campaign among this group;
  • A review of recent HIV trends and outbreaks, as well as infectious endocarditis linked to injecting drug use with a focus on risk factors and control measures in place;
  • Country experiences in the elimination of viral hepatitis as a public health threat among people who inject drugs (PWID) and related EMCDDA projects, with a focus on harm reduction and the continuum of care.

The report section on Outbreaks includes some interesting information from South East Europe.

In 2011, an HIV outbreak among PWID was detected in Athens, Greece (Paraskevis et al., 2011). After a combination of prevention and ‘seek-test-treat’ interventions were implemented (including scaled-up NSP, testing, linkage to AOT and antiretroviral treatment (ART), HIV incidence declined (Sypsa et al., 2017) from 7.8/100 person-years in 2012 to 1.7/100 person-years in 2013. However, preliminary data from the latest round of the ARISTOTLE study, conducted in 2018-20 (Roussos et al., 2021) among 681 PWID who were included in previous rounds, suggest that HIV prevalence increased from 14.2 % (2012-13) to 22 % (2018-20). While incidence estimates never returned to their 2011-12 levels, they ranged from 1.52 to 2.04/100 person-years, indicating ongoing transmission. The prevalence of homelessness (25.6 %) and cocaine injecting (28.1 %) had increased over the period. Predictors of seroconversion included lower education, larger network size and daily drug use. The authors concluded that the current level of prevention and treatment services was below levels that would be required to bring transmission down to pre-outbreak levels. They also noted that the COVID‑19 pandemic has severely impacted HIV prevention services for PWID, which could increase the risk of HIV transmission in this population. The study team conducted a similar study in Thessaloniki, the second-largest city in the country, where 1 101 PWID were recruited during 2019-20. They found high HIV incidence among the study population, suggesting that an outbreak was occurring at a time when COVID‑19 controls measures were in place. The authors highlighted that immediate interventions were required to control transmission.

Following the DRID meeting, national experts from three additional EU countries have reported signals of increased HIV transmission among people who use drugs. In Sofia, Bulgaria, reports indicate that the pandemic seems to have worsened a situation that was already deteriorating with respect to harm reduction funding. According to data from the laboratory at the State Psychiatric Hospital for Treatment of Drug Addiction and Alcoholism in Sofia, reported by the national expert, the positivity rate for HIV infection among PWID in the capital of Bulgaria was significantly higher in 2019-20 (12.8-14.5 %) than in the previous years (when positivity rates were between 3-6 %). A parallel increase in HBV positivity (HBsAg) was also noted from 2019 (5.9 %) to 2020 (7.6 %). This comes after the Global Fund ended its financial support to harm reduction services in 2017. It consequently led to a disruption in needle and syringe programmes, and a reduction by more than half in the number of PWID being tested annually. The National Centre of Public Health and Analysis is organising a meeting with stakeholders and decision-makers to initiate legal changes in order to ensure sustainable financial support for harm reduction services.

The national expert from Slovenia reported that, by November 2021, four new HIV diagnoses among PWID were reported to the National Institute of Public Health among a total number of 28 reported new HIV diagnoses during 2021. This raised concerns that HIV infections might have started to spread more during the COVID‑19 pandemic among PWID in the country. Since 1986, when HIV reporting became mandatory in Slovenia, a total of 29 HIV infections among PWID have been reported, and such a high number of cases (four) were reported only once before, in 1996. The importance of reaching a good coverage of harm reduction services for PWID was re-emphasised.

To read full report from this meeting and get the information from expert update, follow this link>>>.

 

European Web Survey on Drugs 2021

From the EMCDDA press release

The EU drugs agency (EMCDDA) published today results of the European Web Survey on Drugs. The survey ran between March and April 2021 in 30 countries (21 EU and 9 non-EU) when many populations were under COVID-19-related lockdowns. Targeted at people aged 18 and over who have used drugs, the survey aims to improve understanding of patterns of drug use in Europe and help shape future drug policies and interventions.

Close to 50 000 adults (48.469) responded to the survey from 21 EU Member States and Switzerland. Cannabis was the drug used most, with 93% of survey respondents reporting to have used it in the previous 12 months and with little variation between countries. MDMA/ecstasy (35%), cocaine (35%) and amphetamine (28%) were the next most reported illicit substances, with the order of the three drugs varying by country. Around a third of respondents (32%) reported using more (herbal) cannabis and 42% using less MDMA/ecstasy.

The survey revealed that one fifth (20%) of the sample reported using LSD in the last year, 16% using new psychoactive substances (NPS) and 13% using ketamine. Heroin use was reported by 3% of respondents. Although the sample reporting heroin use was small, over a quarter of these respondents (26%) reported using this drug more during the period studied.

New to the 2021 round was the participation of the agency’s partners from the Western Balkans, through an EMCDDA technical assistance project (IPA7).

Over 2 000 adults (2 174) from Albania, Kosovo*, Montenegro, North Macedonia and Serbia responded to the survey. Most respondents (91%) reported using cannabis in the previous 12 months, followed by cocaine (38%), MDMA/ecstasy (22%) and amphetamine (20%). Again, around a third of respondents (32%) reported using more (herbal) cannabis and 34% using less MDMA/ecstasy.

Almost one in six (17%) respondents reported using NPS in the last year, while 9% reported use of LSD. Use of both heroin and methamphetamine was reported by 8% of respondents.

Home was reported as the most common setting for drug use during the period (85% of respondents in the EU-Switzerland survey and 72% in the Western Balkans), a pattern accentuated by COVID-19 lockdowns and closure of nightlife venues. Motivation for the use of different substances sheds some light on these results. The most commonly reported motivations for cannabis use were relaxation, getting high and aiding sleep, while for MDMA/ecstasy, they were its euphoric and socialising effects.

 

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Traineeship available at the EMCDDA

The European Drug Agency (EMCDDA) has 8 traineeship positions available to work with them next year. This is the opportunity to gain valuable work experience in one of the areas of the EMCDDA’s work.

Traineeship is available in 8 different areas of the agency’s work:

The deadline for applications is 10 January 2022.

The Call for traineeship is available following this link>>>.