An HCLU film
We are at the first meeting of the European Harm Reduction Network in
Marseille, France.
The harm reduction activists, professionals and policy makers gathered
to discuss the challenges and problems ahead of
the Harm Reduction Movement in Europe.
I know the impact of harm reduction.
In my country, drug users have a job, have a home, are in treatment.
If they use, they do it in the safe environment of a consumption room.
Last year, in 2010,
the entire country of the Netherlands
there was only one infected person with HIV.
Reported one new case of HIV among drug users.
In an entire country.
30 years ago that was 30% of all infected drug users.
Same rates about overdoses
that has dramatically gone down.
If we want to talk about evidence of our harm reduction,
that battle has been won, we don't need to talk about evidence.
It has become European policy.
Although harm reduction has become mainstream,
there are still huge challenges ahead.
That's one of the issues that we're gonna discuss
Over the next days.
We witnessed the imagines of new populistic policies and
and serious budget cuts
I think in all countries of Europe.
This year we went to the European parliament
there was a hearing on public health issues,
and we asked the members of the European Parliament
what can they do to support harm reduction on the European level.
One member of the parliament answered:
"Now we're struggling for keeping together
the European Union, so we really
don't have this issue in the agenda."
One of the major problems is to keep this issue on the agenda.
Harm reduction works.
I mean it works everywhere, and it works also in France.
We have basically reduced the prevalence of HIV among people who inject
from 40% to 11% today.
I mean the result has been really imediate,
in terms of overdose related to heroin,
the reduction has been by 80%.
That is an absolutely amazing success
in terms of public health.
And also, in terms of criminality,
the drug-related crime also has
decreased by 80%.
All these are the major successes of harm reduction in France
and I'm happy to say, that still today
the French harm reduction system is still largely
publicly supported for the long term.
We're very happy about what we got in the 90's,
right now we're basically trying to save the system.
A lot of NGOs are facing very severe
problems because of the budget cuts.
We still do not have safe consumption rooms,
Even though in some neighbourhood
they would be really lifesaving for many people.
We still do not have any needle exchange in French prisons,
even though we know from Switzerland, for instance, right next door
that it's really simple to implement.
We have a French government that has some populist tendencies,
that actually like to blame some people
for the problem of, the social problem that we're facing today,
and drag users are really an easy target.
The simple use of drugs in France
can be very harshly punished.
The using intention of drugs in France can be punished
from 1 to 10 years in prison,
and fines ranking up in the thousands -
- or even millions, if you look at the law.
And this law is actually applied, we have
tens of thousands of people who are
facing serious problems, because they're just users.
And just stopping that oppression of drug users
because it costs a lot of money, it costs a lot of police time for
arresting poor people basically,
and just stopping that will actually save
a lot of very needed governmental cash,
that could actually be used to develop a social program.
Dr. Heino Stöver
President of Akzept e.V.
Director of Institute of Addiction Research in Frankfurt am Main
I think we do have achieved quite
a lot, although not sufficient.
Consisting of needle exchange programs
all over the country.
In 200 cities there are automats outside,
publicly available, 24 hours, 7 days.
We do have some 80.000 drug users
in substitution treatment.
There is heroin assisted treatment available,
We do have some 25 drug consumption rooms,
in 18 cities in Germany.
In 2010 only 3.2%
of all the diagnosed HIV cases were drug related.
And this is quite
the lowest figure we ever had
in the last 20 years.
And this is I think the most
striking success.
Another success is that drug users
get older and older.
Germany is quite heterogeneous,
and very diverse,
and there are huge treatment gaps
from north to south and from east to west.
Most of the people in prisons
will not have access opiate substitution treatment.
Only a tenth of those in the community.
Only 3% to 5% of those who are in need of this treatment will receive it.
There's only 1 out of 20 prisons
who offer needle exchange program
and automats.
And other services like Naloxon on release
to prevent overdosage after release
are non-existent.
The most important policy action would be
decriminalization.
A drug policy reform
which is badly needed
at the moment it's completely untouched.
to the whole area.
Although we have got
a quarter of a million drug related
offenses year-by-year.
One hundred thousand of them
only for the possession of small quantities
for personal use of cannabis.
Oslo has a very-very
large amount of overdose deaths,
one of, actually the cities in Europe
with most overdose deaths per capita.
In Oslo, there is one consumption room,
and that's the only consumption room in Norway.
It is a very important harm reduction measure.
But the consumption room still has a very small capacity.
It has opening hours
that are quite rigid and
it's not open for a very long time.
We have a lot of harm reduction measures.
We have both a lot of cafés
where drug addicts can come and get food,
we have needle exchange...
The substitution treatment has grown,
before it used to be rigid system,
there has been a softening of the system,
which is very-very good.
Spain has a tradition of harm reduction about 15 years ago.
Barcelona has 7 consumption rooms,
more or less maybe 15 drop-in centers,
We have a lot of teams of outreach work in the streets
These consumption rooms change
picture on the street?
Like there are less drug users using on the streets
and going more to consumption rooms?
Does it have an effect like that?
Yes, of course. I think that these kind of
resources are very-very effective.
And now we need to work
for their Hepatitis.
70% of the injecting drug users
is infected by Hepatitis C.
We have a decree of law that frameworks the harm reduction intervention in Portugal.
So that's a great achievement.
With decriminalization,
we start to look at the user
not as a criminal person,
but as a person with a disease.
Some people from the Portuguese State
and from the Portuguese government
they could look at harm reduction you know...
as a philosophy that believes,
accepts, and tries to work with the drug user.
Not as a sick person,
but as a citizen.
The state has instrumentalized
NGOs from civil society
to do a great hell of a job,
with you know, a few amount of money.
For sure, between 3% and 5%,
of the Portuguese budget stayed
to the drug field
is only dedicated to harm reduction.
Between 3 and 5%.
And I'm being generous with the numbers.
Even though harm reduction is officially recognized,
it is not directly supported by the state.
With one exception,
which is the Ministry of Justice,
National Prison Administration
which introduced funding for
for syringe exchange programs
and opiate substitution treatment in prisons.
Most harm reduction services are
are based in Bucharest.
Even though we have scaled up
the needle exchange programs
and substitution treatment in Bucharest,
the access is still low compared to
the full population of drug users.
Especially opiate users.
Well, I think the main success is
they're still existing, there's some harm reduction which is existing.
I can't even speak about the scaling up,
because in the last years they were closed,
some of the projects have been closed.
And because of the budget cuts,
and the situation we have
we just don't know what we'll do in the next year.
People are going to prison, and serving in prison
for very small dosages.
The IHRA made a Global State of Harm Reduction Report
a few year ago, and it mentioned Hungary.
as a good example,
which has a very progressive,
harm reduction-oriented drug strategy.
And last year,
our new government just rejected this progressive
drug strategy.
And now they are in drafting of a new drug strategy
based on zero tolerance approach.
In Poland, there is access
to the opiate substitution treatment.
But it is still very limited.
There is a big region, a geographical region of Poland,
where is no opiate substitution treatment.
We have also needle exchange programs.
They're in two of the biggest cities,
Kraków, and Warsaw.
Last year we... The parliament approved a new law,
which opened a little
little window of opportunity,
because in cases where somebody possesses a small amount of drug
the prosecutor can abandon the idea to start a prosecution.
This is a really small liberalization.
80 million złoty, approximately 40 million dollars
are spent for that very restrictive law.
What have you achieved in terms of harm reduction in the past in Ireland?
The HIV within IDUs (Injecting Drug User) is falling,
Hepatitis C within the IDUs is obviously rising,
and obviously services are being curtailed back.
I'd love to see drug consumption rooms in Ireland.
I do actually rolled out to have had a national Hepatitis C strategy,
again, that's not there at the moment.
National overdose prevention strategy as well.
The UK is one of the birthplaces of harm reduction in Europe,
and the world.
Particularly with the initial projects in Liverpool,
that then spread across the rest of the United Kingdom.
And through the 80's and 90's we had very successful harm reduction programs,
And it a was a very strong awareness
that these programs should be driven by
public health, and the need to prevent HIV and other blood bourne viruses.
The way we have set up our drug services in the UK
I think stifles innovation.
It makes for a very bureaucratic response.
And this is not helpful, when drug scenes are changing very-very fast.
What do you think about the smaller coalition partner's idea
to decriminalize drug use?
I think it's very positive that we
now have two political parties in the UK
that are talking about drug law reform very openly.
Which is the liberal-democrat party,
which is part of the government,
but also the first green MP from Brighton is now also talking about
the need for drug law reform very seriously.
My hope is that actually the financial crisis
may actually be the thing that says
"This is not about ideology, this is not about morality,
this is about funding."
And prohibitionist models are very-very expensive,
and leads to growing costs as you
do more damage to the health of people who use drugs.
So I hope that we actually may persuade people that
of all time, it's in the middle of a crisis that you go for the
best value from any model, witch is harm reduction.
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HCLU, 2011