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.

 

For more information, visit:

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>>>.

 

European Drugs Winter School 2022

The European Drugs Winter School 2022 (EDWS), organised by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and the University Institute of Lisbon (ISCTE-IUL) will be held from 14th to 25th of February 2022. EDWS prepares professionals and students to meet the complex policy challenges that face Europe and the World in the field of drugs.

This edition will have a special focus on Cannabis: practice, policies and debates in the EU and beyond.

The Winter School will be delivered through online and remote instruction. Following the success of the first Winter School, live sessions with experts and practitioners will be held from early afternoon until late afternoon (Lisbon Time, GMT +1 to GMT +3/4). Individual small exercises will be given and assessed every day, and an exam will be offered to those who wish to earn the credits. Virtual tours to field work will be included.

Candidates’ Profile include university students (undergraduate, graduate and postgraduate), researchers, professionals and administrators interested in or working in the drugs field, including participants from the EMCDDA’s network of focal points in 30 countries, or from programmes being developed by the EMCDDA with third countries (e.g. Western Balkans, North Africa, Eastern Europe).

Bursaries are available for Western Balkan region and European Neighbourhood Policy!

Professionals, academics and experts from the Western Balkan region and European Neighbourhood Policy countries will have an opportunity to participate in the 2022 European Drugs Winter School (EDWS), thanks to scholarships offered through two EMCDDA projects: the Instrument for Pre-accession Assistance (IPA7) and EU4Monitoring Drugs (EU4MD). The scholarships will cover the course fees. All candidates from those regions who apply in the first phase (deadline 5th of December) will be eligible.

Deadline for applications: 5 December 2021 (Early Bird) | 23 January 2022 (Final).

Deadline for scholarship applications: 5 December 2021.

The EDWS will be followed by the European Drugs Summer School (EDSS) from 27 June to 8 July. Scholarships (covering course fees) are also available.

If interested, find more information following this link>>>.

 

 

FAQ on drug overdose deaths in Europe

The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) created a specific webpage which answers to the questions most often asked about drug overdose deaths in Europe. Also known as drug-induced deaths, they are deaths directly attributable to the use of illicit drugs. The information presented here is based on the latest data from the Member States of the European Union and the EMCDDA affiliates Norway and Turkey. It draws on contributions from specialists from these countries, as well as on information provided by European countries in the annual reporting exercise to the agency.

This page aims to raise awareness on the nature and scale of the drug overdose deaths problem in Europe. This topic does not receive sufficient attention, despite the high number of lives lost, the dramatic consequences for families and communities and the fact that all of these deaths are, in principle, preventable and avoidable.

The latest European Drug Report (EMCDDA, 2021a) estimated that over 5 100 deaths involving one or more illicit drugs were reported in 2019 in the European Union. This estimate rises to more than 5 700 deaths when Norway and Turkey are included. Men accounted for three quarters of drug-induced deaths. All of these deaths were premature, predominantly affecting people in their thirties and forties.

The webpage is available following this link>>>.