Rehabilitation in a Dutch Way: Learning to Take Responsibility for Yourself and for Others

Author: Olesya Kravchuk, AFEW International

The ferry boat brings people to the island Texel in the Netherlands several times per day. Just a few minutes’ walk from the ferry stop there are several cosy houses. Near one of the houses, there is a hedge, behind which there are three goats. They are not afraid of visitors, and immediately come up to you and check you out. Residents of the house clean its territory and cook dinner. It is the usual Dutch routine, but the atmosphere is somehow different…

For more than 40 years already de Skuul Foundation (Stichting de Skuul) has been working on the island. It is an independent institution that specialises in assisting in the rehabilitation of people who take drugs. They also help those who have alcohol and gambling addictions.

“The fact that our residents are on the island creates a special atmosphere. In this way, they stay in a neutral environment,” says Aglaia Westra who works as a therapist at the Foundation. She has been working here for six years. “There are usually 16 residents who live here, and they live in a mini-society. They form the groups of eight people, and everyone has a task for every day. Someone, for example, goes to buy food, someone cleans the territory, and someone cooks food. That is how they learn to take responsibility for themselves and for others.”

The main thing is not to lose touch with reality

The clients of the Foundation come here after the referral of their general practitioner. De Skuul is financed via the insurance companies, local government and business representatives. In order to get into the rehabilitation programme, you need to go through the detox programme already at home. The first four weeks of their stay in De Skuul, its residents stay only on the island. After four weeks you can (and even have to) go home for the weekend. Foundation employees say that it is very important not to lose touch with reality. During the rehabilitation programme, its participants work with a psychotherapist. They also have visiting teachers who teach them singing, drawing and other crafts. The programme starts every day at 9 am and lasts until five in the evening. In the evening, the Foundation’s residents live their normal lives: they jog, read and walk by at the Wadden Sea that surrounds the island.

There are also rules here: violence and cruelty, drugs and alcohol, and mobile phones are prohibited. It is necessary to respect others and to be present during all activities within the rehabilitation programme. Violation of these rules leads to the end of rehabilitation.

“We have group sessions. Usually, it starts with one person is talking, and it becomes more like a monologue,” tells Aglaya. “We believe that everyone builds their own way while experiencing their own feelings and emotions. We use the principle of self-help and trust residents in how they lead their lives and what they do in their free time. The most important thing is that we teach responsibility. It is like a kindergarten, where you can try everything and learn again.”

The period after rehabilitation is harder than the period before it

The Foundation’s clients say that they came here to get acquainted with themselves again and to get away from their addiction. They say only good things about the rehabilitation programme. The hardest part starts when you return back home.

“I came here only yesterday,” says Linda from the Netherlands (the name is changed) with the tears in her eyes. “This is not my first rehabilitation programme, and I very much hope that this programme will help me. Working with yourself during the rehabilitation period is not that hard. Then you follow the same pattern at home. Later though it comes the time when you go back to your old habits. I think it very important to combine treatment with reality, and de Skuul is doing this.”

Every year about 50 people are being treated in the Foundation. On average, de Skuul accepts one new person per week. Each resident stays in the programme on average for 3-6 months. Each resident himself decides when his rehabilitation ends. After the programme, if necessary, ex-residents can always call Foundation employees and ask for help. Every six weeks, former residents come to the Foundation if they want to share their experiences and hear the stories of others.

Treatment based on commitment and not punishment

The rehabilitation centre Kentra24 in the city of Sint-Oedenrode in the Dutch province of Brabant is located in an old monastery. On the windows here, there is old religious stained glass, and in the inner monastery courtyard you can meet your new friends. Young people between the ages of 12 and 24 years old who cannot control their stimulants or gambling addiction have their rehabilitation here. The rehabilitation programme includes preventive, outpatient, clinical and online assistance. At the same time here there can be 40 clients for whom about 80 employees provide services. Not all customers in the centre spend nights here, some only have a daily programme. Both boys and girls are undergoing rehabilitation.

“Most of our clients are in the centre voluntarily, but sometimes someone comes after a court decision,” says Judith who works in the centre. “We want the parents of young people who have treatment with us to be also involved in the rehabilitation process. But those adolescents who are already over 18 decide themselves how much they want to involve their parents.”

There are four groups of clients in the centre. The first group is those who undergo a detox, and all the other groups are undergoing rehabilitation. Young clients of the centre have four phases of rehabilitation: zero phase is the most strict one, the third phase is the one during which there is more freedom. For example, during the zero phase it is impossible to leave the territory of the centre, but in the third phase this can already be earned as a reward. Moving to the next phase is possible by showing good behaviour and progress in the rehabilitation process. Usually, the clients stay in the centre for 3-4 months.

“Our treatment is based on commitment and not punishment. Each of our clients has his own goal and is working towards achieving this goal,” continues Judith. “If the goal is achieved, the client gets the reward. For instance, this can be some additional time online, or purchase of the new bike, or visit of the parents with a favourite pet, or additional phone call, and much more.”

Not to have an addiction is already a success

Each of those clients who stay in the centre overnight has their own private room, where other clients are not allowed. For communication, there is a joint living room with a kitchen, where clients prepare their own food. The rehabilitation programme also includes sports at the local gym, creative workshops, work on various projects, setting goals for the week and homework. There are rules: customers cannot freely use their phones or computers.

“I decided to come here because I realised that my life was going all wrong,” says 20-year-old Jan (the name is changed). “Because I used drugs, I started to close up and drifted away from my parents and my younger sister. It feels like I lost three years of my life. After the rehabilitation programme I plan to finish school, start working and living independently. It is my goal.”

The staff of the centre understands that after the rehabilitation programme some of their clients will still use drugs or alcohol and they are loyal to this.

“After all, the main thing is not to stop taking drugs, but to know why you are doing this,” says centre employee Steve. “If there is such understanding and after the programme a person will take drugs or alcohol sometimes, and not have an addiction – this is already a success.”

United Nations and World Leaders Condemned for Failure on Drug Policy, Health and Human Rights

Wednesday 1 May,  2019, Porto

As the 26th International Harm Reduction Conference comes to a close, hundreds of health professionals, academics, drug policy and human rights experts, frontline workers and people who use drugs released a statement calling on world leaders to urgently address the health and human rights crisis among people who use drugs.

Signatory NGOs shed light on the alarming public health emergency faced by people who use drugs. Between 2009 and 2015, the number of drug-related deaths rose by a worrying 60%. In 2015 alone, this culminated in a total of 450,000 deaths – an estimated 50 deaths every hour. The target to halve the incidence of HIV among people who inject drugs by 2015, set eight years ago, was spectacularly missed by 80%, and HIV prevalence increased by one third among people who inject drugs over the same period. Furthermore, globally, six in ten people who use drugs are living with hepatitis C, while 168,000 people who use drugs were reported to have died of an overdose in 2015 alone.

These health harms are preventable. The evidence, presented at the Conference this week, shows that harm reduction and human rights-centred drug policies can save lives, prevent the spread of HIV and hepatitis C, and promote the dignity and empowerment of people who use drugs. But this requires leadership from both governments and the UN.

Naomi Burke-Shyne, Executive Director of Harm Reduction International (HRI), said: ‘The evidence for harm reduction is indisputable. It is nothing short of disgraceful that governments continue to fail to support and invest in health services for some of the most marginalised people‘.

The joint NGO statement also expresses serious concerns over the ability of the UN Office of Drugs and Crime (UNODC) to adequately lead the UN response on this issue. By its very mandate and construction, the UNODC remains more attuned to the law enforcement response to drugs. As a result, UNODC leadership has consistently failed to unequivocally champion harm reduction, human rights and decriminalisation,and has lost further creditability with repeated silence in the face of egregious human rights violations. Today, people who use drugs continue to be victims of incarceration, compulsory detention, denial of access to healthcare, corporal punishment, institutionalised violence, stigma and discriminations, and – in the most extreme cases – extrajudicial killings.

In response to the vacuum of political leadership, NGOs conveying in Porto have called for global leadership to protect the human rights of a ‘population under attack’ and demanded that these unacceptable human rights abuses to come to an end.

Ann Fordham, Executive Director of the International Drug Policy Consortium (IDPC), stated: ‘With just over ten years left for countries to meet their global commitment to champion health, reduce inequalities, and provide access to justice for all, as enshrined in the UN’s Sustainable Development Goals, there has never been a more urgent need to strengthen political leadership at all levels. Faced with the current crisis, complacency can no longer be tolerated’. 

Source: https://idpc.net/

People who Use Drugs Deserve Love, Respect and Support

Author: Grana Ziia, AFEW-Kyrgyzstan

Sergey Bessonov from Bishkek is the head of the organization that protects the rights of people who use drugs (PWUD) – “Harm Reduction Network Association” (HRNA). Sergey himself used drugs in the past. However, he admits that everyone has the right to make his own choice whether to stop using drugs or not.

Now Sergey dedicates his life to the community of people who use drugs. In his interview with AFEW-Kyrgyzstan, Sergey is talking about the challenges of the community of people who use drugs in Kyrgyzstan, drug policy and his future plans. Below are some of Sergey’s thoughts in direct speech.

About the desire to be heard

For a long time, the problem of drug use was solved by using strict bans: prisons, fines, and information that PWUDs are no longer members of our society, that they are somehow bad, dangerous… I myself know a lot of people who died from the overdose, I saw people who spent most of their lives in prisons for using soft drugs. These people were left without work, housing and the possibility to live the life they wanted to.

Now in Kyrgyzstan, the government started to understand that a progressive drug policy cannot be built without a community. However, it is very important for us that the community participation in the development of programs was not just for show. We want our opinion to be respected, considered and trusted. We need the possibility of professional growth.

About the professional growth

The project “Bridging the Gaps: Health and Rights for Key Populations” (BtG) started to help us a few years ago. Over the past two years, this project gave people from the community the possibility to take part in trainings on negotiation skills, legal monitoring by the community, analysis of regulatory legal acts.

These trainings helped us to develop some of our skills. Using this knowledge, people from our community started to develop their own organisations, participate in working groups with governmental representatives and implement advocacy programs.

About the new drug policy

Last year, our country started talking about changes in criminal and administrative codes. Governmental representatives finally understood that sending people who use drugs to prison instead of rehabilitation and harm reduction programs is ineffective and cruel.

During the analyses of new regulatory acts that HRNA conducted with the support of the BtG project and AFEW-Kyrgyzstan, we found some negative changes. For example, new amendments, which now started to work, increased the fine for carrying and possession of drugs twice. The new fine is unaffordable, which means that people will again be imprisoned. Now we are negotiating with international and state structures, with other NGOs and explaining to them why this novelty needs to be revised.

BtG also provided us with an opportunity to conduct focus groups among PWUDs. We found out that not all people are aware of the new laws. This creates extortion and corruption. Now we are constantly monitoring new cases of detention of drug users and support people who use drugs.

About the alternative to prisons

According to the new offense code of Kyrgyzstan, alternative punishment that is called probation is provided for people who use drugs and who have committed any kind of offense. Therefore, now a person has an opportunity to avoid prison.

The initiative itself is very good and we now have a lot of work for its successful implementation. We have already come to the agreement with several probation services and they are letting us know if a person who uses drugs came to them.

HRNA also plans to work with judges to explain that we should punish people only for offenses, not for using drugs. People in our country still have many stereotypes towards people who use drugs. These stereotypes can influence judges’ decisions about sending a drug user to prison or probation.

About the needs of the community

People who use drugs almost always remain alone. Parents turn away from them, doctors reject to help, friends betray them, mass media use offensive words, police suspect them in all crimes. Sometimes we become the only home and friend for each other. With our examples, we show that people who use drugs deserve love and respect.

To help our community to be strong and united, the BtG project is supporting our dialogue platform. Thanks to this, we can meet, discuss and stay united. I feel that the community is getting stronger and more confident with years passing by.

Together we build a liberal healthy future in Kyrgyzstan, where every person can get help and fulfill their potential.

AIDS 2018: Prison Corner and Harm Reduction Networking Zone Activities

More than 5 000 people, including famous actress Charlize Theron, visited the prison corner in Harm Reduction Networking Zone (HRNZ) located in the Global Village at the 22nd International AIDS Conference (AIDS 2018) in Amsterdam. During five days, visitors could stop by, have a delicious cup of coffee made by former prisoners and participate in a programme with interactive debates, interviews, and presentations. Prisoners are usually a forgotten group since very few organisations pay attention to this vulnerable group of people. Taking into consideration that in many countries the issue of HIV/AIDS in prison is very sensitive and that the implementation of programs in prisons can hibernate or even fail, a pragmatic step-by-step guide for prison authorities and civil sector actors is now being developed by European Monitoring Centre for Drugs and Drug Addiction and European Centre for Disease Prevention and Control.

The executive director of AFEW International Anke van Dam stressed on the necessity of working in prisons in Eastern Europe and Central Asia (EECA). Health protection in prisons is a serious public health issue. Even though international law recognises the right of everyone, including people deprived of their liberty, in practice, many prisoners receive healthcare of a lower standard to the one available outside of the prison, if they receive treatment at all. In Eastern Europe and Central Asia, the unbearable circumstances and lack of coherency within the penal systems of the regions exists. AFEW recognizes the importance of people living within prisons receiving the same healthcare and life opportunities during and after their stay in prison. Together with prison authorities, AFEW is in constantly implementing prison health projects that seek collaboration with organisations working in prison. To introduce the region where AFEW is actively represented, Anke van Dam gave a book Invisible Lives: HIV on the Fringes of Society to Monica Beg, Chief of HIV/AIDS Section and Global Coordinator for HIV/AIDS at United Nations. Stories from the representatives of key populations from Tajikistan and Ukraine are depicted in the book.

AFEW expresses a big gratitude to our prison corner partners: The Council of Europe Pompidou Group, Asian Harm Reduction Network, International Corrections & Prison Association, Health Through Walls and UNODC.

Ukrainian success with the monitoring instrument

During the session about engaging young people who use drugs in Ukraine in the HIV and human rights response, AFEW-Ukraine presented the developments achieved during ‘Bridging the Gaps: Health and Rights for Key Populations’ and PITCH projects, supported by the Ministry of Foreign Affairs of the Netherlands.

AFEW-Ukraine’s manager Irina Nerubayeva presented the instrument for monitoring violations of human rights of adolescents using drugs in Ukraine, that has been used for a year among the partners in four regions of Ukraine. ‘Bridging the Gaps’ project partner – social worker from Kharkiv NGO Blago Alina Khokhlova – told about challenges and results of using the instrument and emphasized the importance of her organisation in developing effective advocacy programs in the city. Youth activist Daria Kopyevskayskaya from Kropyvnitsky (NGO Return to Life) emphasized the role that young people play in delivering information to their peers about rights.

Legal expert Vita Musatenko presented the most typical cases that were identified in the process of monitoring and advised what social workers can do to provide adequate response and help to a young person. Evgenia Kuvshinova from NGO Convictus told about her work with young people who use drugs in Kyiv at the Street Power Club where young clients receive a range of services, including testing for HIV, sexually transmitted diseases, hepatitis. There they also engage in educational activities and are trained as leaders.

From harm reduction programmes to methadone therapy

The session on HIV prevention, treatment, and care in the countries of the former Soviet Union allowed to learn about challenges and achievements of prison programmes from various countries of the former Soviet Union and receive information from government officials and NGOs. The head of the Medical Department of Kyrgyz Penitentiary Service Nazgul Soltobekova told about the system of HIV prevention and treatment in Kyrgyz prisons. She also shared the country’s successful experience in providing comprehensive services for people who use drugs in penitentiary facilities – from harm reduction programmes to methadone substitution therapy.

Konstantine Turashvili from the medical department of the Ministry of Corrections of Georgia told about HIV programmes in Georgian prisons and the country’s successes in hepatitis elimination programmes. Both speakers emphasized the importance of cooperation with community-based organisations that provide effective counseling services for inmates and help to ensure continuity of care of those released from detention facilities. This topic was further followed by Natalia Rudokvas from Kazakh NGO “Answer” who shared the experience of her NGO’s work with HIV positive inmates. Ikrom Ibragimov from AFEW-Tajikistan shared his experience of cooperation with the penitentiary system and told how NGO can build the capacity of prison staff in HIV, TB, and other related issues.

Being an expert in prison health, AFEW will continue advocating for HIV, TB and hepatitis C prevention and treatment programs for prisoners in EECA. We are promoting essential elements like harm reduction, including needle and syringe programmes, and opioid substitution therapy. Transitional client management that prepares prisoners for release and ensures linkage to follow-up after release is a valuable variant of client management that meets many of (ex)prisoners’ needs.

‘Bridging the Gaps’ in Georgian Provinces

Gocha lives in a small town of Telavi

Author: Irma Kakhurashvili, Georgia

Gocha and Nikoloz are clients of ‘Bridging the Gaps: Health and Rights for Key Populations’ project in Georgia.

Art therapy works

Gocha lives in the hottest region of Georgia – Kakheti – in a small town of Telavi. He is a client of a Rehabilitation Centre in Gremi village. There he receives support to overcome his alcohol and substance use problems.

The Rehabilitation Centre for drug users run by Tanadgoma is the first and only stationary rehabilitation centre in the country offering free services to its clients. Since it was founded, over 25 clients received help free of charge there. In the Centre, clients can get social, psychological and health services. The Centre applies twelve-step recovery programme. Besides, it offers art therapy classes and even runs a ceramic workshop. The instructors working in the Centre were trained in a Ukraine-based rehab.

As many of his friends, Gocha used to smoke “harmless weed” since he was a schoolboy. Soon enough, he found himself among people who were eager to use other drugs as well. At first, he was curious to experiment with substances, but during the heroin boom in Georgia – when it could be purchased even in the Kakheti villages – the situation changed. If Gocha was lacking money to buy drugs, he had enough to get some alcohol. Gocha’s family knew about his problems. His parents told him that he would find himself in a trouble, but it did not help. After the government introduced stricter rules for drug dealers and users, Gocha switched to the homemade drugs.

He first came to the Tanadgoma Rehabilitation Centre two years ago. Gocha took part in the twelve-step recovery programme, attended counselling sessions and art therapy classes. Currently, the man is in remission, but sometimes he comes back to the Centre seeking services. He says that sometimes he drinks alcohol. Georgia is the motherland of wine, so it is hard to quit alcohol.

“I do not know what would happen to me if not for this project. Now working with clay and ceramics is the biggest joy for me. There is a radio set in the workshop and I can work all night long, listening to music. I have a lot of creative insights and the process of work is very important for me. When I draw sketches, I think of nothing else. My negative thoughts go away,” he tells.

Gocha does not know if he will be able to quit drugs and alcohol for good. There are no guarantees, but at least now he understands how to reduce the harm he does to his health. Gocha finds his support in knowing that if he goes home and has a relapse again, he can always come back to the Centre or contact harm reduction programmes.

Sometimes small tours are organized for the clients of the Centre. This region of Georgia is famous for its historical sights and beautiful nature.

“Sounds of the river calm me down. There I can think about my life. I spent 11 years behind the bars and I have many regrets… Now there are a lot of pharmacy drugs in Georgia, many people need psychosocial support… I do not understand why the government does not want to implement rehabilitation and employment programmes instead of the repressive drug policies. It does not want to be responsible for such people as me. So far, the Centre is the only place where someone cares about my mental health,” says Gocha.

He has two dreams: to equip the Rehabilitation Centre with exercise equipment for its clients to stay fit so that they are able to start a family.

“I want my empty house in Telavi to be full of child laughter and hope. I want to live a normal life,” says Gocha.

Drug use changed my life

Nikoloz is a former police officer

Nikoloz is 45 years old. He is a former police officer. His professional career ended up when he was arrested for drug use and sentenced to seven years of imprisonment. Before that day, he had no problems.

“I was 18 when my friend and I tried drugs for the first time. Little by little, I got used to drugs. My brother also did drugs, but I was afraid to tell him. I felt uncomfortable to talk about it with my family. Then I studied law, started working in police and that is when I got really “hooked.” I had powerful relatives, so I felt safe, but after eight years of active drug use I was locked up,” remembers Nikoloz.

Seven years in prison were a dreadful, lost period of his life. Then it was easy to get drugs in closed settings and Nikoloz used this opportunity. However, one case of severe overdose, when he almost died, made him rethink this situation. After he got back home, all his social connections were lost.

“Then I thought that it was enough, I had to stop. Even now, I hate drugs with all my heart. I fight them and fight myself. Last year I had a relapse. Therefore, I had to enrol into a substitution therapy programme and receive treatment in a clinic,” confesses Nikoloz.

He feels sorry because drugs changed his life but says that if years ago he had access to harm reduction programmes, he would definitely enrol in them. Back then, he knew little about reducing the risks of drug use.

“I had no strength or desire to quit drugs, but I would surely use them in a safer way, for example decreasing the frequency of injections. I would be able to control my life and health and would avoid overdose and hepatitis C. Drugs will always be there. Non-medical use of drugs is bad for everybody – the individual and the society – so protection of public health requires protection of drug users’ health. For that purpose, drug users should be integrated into the society and not isolated,” says Nikoloz.

In jail, Nikoloz got acquainted with people working for Tanadgoma, who offered different services to the inmates, in particular, psychological support, which was very important for him.

After Nikoloz was released, he went to a social bureau in Tbilisi. Tea Chakhrakia, working for Tanadgoma, helped him to re-issue his documents. Besides, people from Tanadgoma helped him to get a job with Akhali Gza NGO providing harm reduction services to people who use drugs. Since then, Nikoloz has been working as a social worker there. For him, his job is not only his responsibility, but also his real family, where he is loved and respected, and such love and respect are mutual.

Nikoloz is convinced that harm reduction services are more effective than incarceration. The best approach to resolve drug-related problems is to work with people who use drugs and not punish them.

“In our country, drug policy is based on some Utopian ideas because the government thinks that the drug use may be eradicated. In Georgia, criminal justice is the only method to solve the problems of injecting drug use. Drug use is treated as a criminal offence, though there is a strong evidence proving that repressive drug policies are ineffective and prevent access of people who use drugs to health services,” says Nikoloz.

Nikoloz is happy to share his experience with junior outreach workers. He works with clients, motivating them to get tested, helps them to prepare all the required documents, develops support plans, and tells people about safer drug use methods.

“I am really grateful to the project for the job that I have, which helps me feel that people need me. I received help one day, and now I can help others, sharing my experience with them. My clients are people who use drugs. Many of them use drugs only to overcome their withdrawal syndrome. They are the ones who really need support. I want them to understand what is waiting for them ahead,” he says.

Nikoloz says that with support of harm reduction experts many good things may be done for people who have already lost any hope. That is why it is important to implement the projects, which meet the specific needs of vulnerable populations.

“I am glad that in prison I met people who saw my potential and believed in me,” he says.

About the project

Bridging the Gaps: Health and Rights for Key Populations‘ is an international project implemented in 16 countries of the world to improve the health and protect the rights of vulnerable populations. In Georgia, the project was launched in September 2012. Its main goal is protecting human rights of drug users by changing social attitudes and government policies and improving the quality of services delivered and access to them.

In Georgia, the project is implemented by Bemoni Public Union and Tanadgoma Centre for Information and Counselling on Reproductive Health. Bemoni provides services in the social bureau based in Telavi (Kakheti), and Tanadgoma – in the social bureau based in Tbilisi. Besides, in 2015 Tanadgoma opened a Rehabilitation Centre for people who use drugs in the Gremi village, Kakheti.

In 2012-2017, over four thousand people who use drugs received 17,321 medical, psychological, social and legal services within the project.

Georgian Youth for Music and Harm Reduction

For the first time in the history of Georgian music festivals, a team of volunteers delivered harm reduction services 24 hours a day during 4GB festival

Author: Irma Kakhurashvili, Georgia

4GB is an annual electronic music festival which has been held in Georgia since 2011. The festival is dedicated to the memory of DJ Giorgi Bakanidze – one of the Georgian club music pioneers. This year, 4GB was held in an abandoned Cosmic Constructions Centre near the Saguramo village. Apart from the high-quality lineup, sound systems and headliners performing on stage, 4GB festival had another prominent feature – for the first time in the history of Georgian music festivals, a team of volunteers delivered harm reduction services 24 hours a day. Mandala – Harm Reduction youth project team members did their best to make sure that more than one hundred participants of the festival stay healthy. Thanks to this project, drug and alcohol intoxication, overdoses and other risky situations were brought to naught.

Information as weapons

Information about the new project first appeared in social networks. Several days before opening of the festival, organizers announced that due to the growing number of drug-related deaths (last month, seven young people died in Georgia – author’s note) they decided to protect their guests and music lovers with the help of Mandala – Harm Reduction.

With the financial support of Doctors of the World (France), 20 young volunteers, who received harm reduction training, were engaged in the project.

“Last month, several young people died of drugs, and we thought that in such circumstances our initiative will be very timely. We still remember the last-year GEM FEST, where 22-year-old Natia Tavartkiladze died of drug intoxication in Anaklia. Therefore, our goal was to give all people, especially young ones, objective information about health, drug use and personal safety,” says Temur Khatiashvili, Project Coordinator.

20 young volunteers, who received harm reduction training, were engaged in the project

According to Temur, the awareness-raising materials distributed at the festival were specially developed for young people – pocket-size brochures with the original design, which used simple language to describe a number of popular club drugs, their potential harms, and universal overdose prevention and safety rules. The brochure included a matrix showing the compatibility of different low- and high-risk drugs and a map of the festival territory marking the tent offering harm reduction services. In the friendly atmosphere of the tent, all interested people could receive consultations, get free condoms, drinking water and hematogen (nutrition bar that is often considered to be a medicinal product and is used to treat or prevent low blood levels of iron and vitamin B12 – editor’s note).

Project to be continued

The 4GB festival had a happy end. Participants of the Mandala – Harm Reduction project coordinated their efforts with the ambulance team, which they contacted over the radio in case of need.

The 4GB organizers welcomed Mandala – Harm Reduction as it clearly demonstrated that such project is important for thousands of people who are brought together by such large-scale music event. Participants of the festival were also positive about the project.

21-year-old Tamar Ninua thinks that today electronic music is the fastest growing youth culture in the world, and such projects are especially important for people who may use drugs, not being fully conscious of the consequences of their unsafe behaviours. In such cases, access to timely assistance is very important.

“Despite of the high health risk, people still use various substances. The festival is not an exception. The efforts of Mandala volunteers helped to mitigate the risks. Many young people lose self-control in the euphoria of the festival. The Mandala volunteers, who were easy to recognize as they were wearing kind of a uniform, were moving around in an organized way and were promptly responding to any cases who might need help,” says Tamar.

The project initiators are optimistic and say that in the nearest future the idea of festival-based harm reduction will be extended to cover all the music events in Georgia. They hope that they will receive support not only from different harm reduction charities but also from the mayors’ offices.

It is not that easy

In the nearest future the idea of festival-based harm reduction will be extended to cover all the music events in Georgia

“We will try to improve this project and will learn to overcome the barriers that we face. E.g., festival organizers said that we could by no means hand out syringes. They said that young people might see it as an incentive for using drugs. However, we insisted until the end that this service is necessary. Besides, they were against the distribution of naloxone but we were able to prove that having a highly effective medication to deal with overdoses is vital,” told Mariam Ubilava, project volunteer and coordinator.

According to Mariam, the project is aimed at preserving the health of each festival participant, at mitigating the negative consequences of substance use and achieving behaviour changes.

“We noticed one more problem. When some young people saw us, they were more eager to practice risky behaviours, hoping for our help. Thus, they reduced their own responsibility, shifting it on us. That is why we will have to think how to prevent it from happening in future and find a balance,” says Mariam.

Such projects as Mandala – Harm Reduction are widely implemented at various music events all over the world, such as Amsterdam Open Air, Lollapalooza Paris, Tomorrowland, etc.

GeNPUD is Allowed Official Registration

A landmark judgment allowing an official registration of Georgian Network of People Who Use Drugs for Human Drug Policy (GeNPUD) was delivered on March 26, 2018, by Tbilisi City Court Judge Tamar Chuniashvili.

The lawsuit was prepared on behalf of GeNPUD after the network was refused official state registration as stated in LEPL National Agency of Public Registry’s decision. The rejection of registration was based on the “name issue.” Public Registry references the law which says that the name of GeNPUD (any kind of drug users’ organizing assembly) seemed to be an attempt “to put the illegal activities in the legal framework” and is misleading the entire society. GeNPUD is disagreeing saying that this is the violation of the community’s fundamental rights guaranteed by the Constitution and the European Convention.

Within the lawsuit and during the Court hearing among legal arguments versus the Public Registry, Strasbourg Court’s judgments solid arguments as well as factual circumstances that demonstrated the importance of the network activities in the process of human rights protection, harm reduction services’ effective delivery to the targeted groups, liberalization of the drug policy, formation of effective health system and in overall all for public benefit were presented.

GeNPUD believes that Tbilisi City Court’s judgment would be an important step in the protection of the communities’ rights and interests not only at the local level but at the international scene and it will become the new window of opportunities to fight for health and the fundamental rights of the community members. It is believed that this judgment will further strengthen the democratic values on the way of establishing the effective drug policy.

Source: Drug Policy Georgia

AFEW Grieves Over the Loss of Yury Sarankov

We, at AFEW network, are shocked by the sad news that our colleague Yury Sarankov passed away.

Yury worked in AFEW from the very beginning. Starting in Russia, when AFEW was not yet founded and activities were implemented under the flag of Medecins sans Frontiers (MSF), he specialized in developing and implementing harm reduction activities. Later, he moved to Kyiv to give harm reduction a boost in Ukraine. He was there when AFEW was established in 2000 and continued working on harm reduction. Yury was a rather introvert person and you would not always notice him, but when the subject of injecting drug use and especially harm reduction was discussed, and how, in the early days, the establishment of harm reduction was often blocked, he raised his voice. Yury became well-known as a harm reduction expert and as the editor of a harm reduction digest that he was spreading by the e-mail through the AFEW network.

In the last couple of years, Yury decided to stop his work with AFEW. However, he continued to work as a consultant on men who have sex with men (MSM) and LGBT issues. He kept the link with AFEW, and until his last days, he remained the member of AFEW-Ukraine fund. We have lost a strong advocate for HIV prevention, the rights of key populations affected by HIV, and also a very nice man and a very dear colleague. Our condolences go to his family, friends, and colleagues.

AFEW Presents Important Assessments about EECA

AFEW International, together with its network members from Eastern Europe and Central Asia (EECA) is getting ready for AFEW’s Regional autumn school to be held in Almaty, Kazakhstan from October 30 till November 3, 2017. The autumn school will provide the platform for learning, exchange, strategizing and planning for community members and NGO partners from 10 different countries. The regional autumn school is an annual event that takes place as a part of ‘Bridging the Gaps: Health and Rights for Key Populations’ regional approach of AFEW.

One of the highlights of the autumn school’s program will be the presentation of three important assessments that AFEW International recently finalized as a part of the ‘Bridging the Gaps’ program. The final results of all assessments will be available to the general public around December of 2017.

Harm reduction friendly rehabilitation

The assessment on harm reduction friendly rehabilitation in EECA is the study that describes the state of rehabilitation services in Ukraine, Russia, Georgia and Kyrgyzstan. It presents seven international approaches for rehabilitation programs and its activities. The participants of AFEW’s autumn school will discuss the recommendations of what approach is better to adopt for developing stronger work capacity.

Migrant people who use drugs

The assessment on migrant people who use drugs (PUD) is coming from the questionnaire that was disseminated in the EECA region. A survey amongst 600 people who use drugs in Tajikistan and Kyrgyzstan showed that 43% of the respondents have experienced periods of migration to another country in the EECA region, mostly to Russia. From the qualitative interviews with migrant PUD in Russia and Kazakhstan, it is possible to assume that people have very little access to health facilities, legal documents and often little options to return to their native country. The participants of the autumn school will discuss the full assessment and come up with interventions for the coming two years to build good practices and to advocate for the rights and lives of the community members.

Shrinking space for the civil society

The assessment on shrinking space for civil society is the in-depth assessment on the space for the civil society organizations with a special focus on harm reduction and drug policy in NGO’s and community networks. The withdrawing of international funding and shrinking space for the civil society form a real threat for the fight against the further spread of HIV in the region and the rights and lives of communities. During the autumn school, the coping mechanisms will be discussed and further steps will be designed to address the conclusions.

The EU Adopts Its Most Progressive Drug Action Plan Ever

Author: Peter Sarosi

Although it was without much fanfare that the European Commission, in July 2017, published the new Action Plan on Drugs (2017-2020), the drug policy community should celebrate it as a great achievement both for its progressive content and for the meaningful involvement of civil society in its preparation.

If there is a sign that the European Union is getting through difficult times, it’s the limited attention its new public policy initiatives receive. While the adoption of previous EU drug strategies and action plans has been well covered by the media, now, two years after the great migration crisis and one year after the Brexit vote, almost nobody noticed the adoption of the new EU Action Plan on Drugs. There was no press conference or press release. It seems drug policy is not a priority for decision makers these days – there are other topics occupying public attention. It’s a shame, because this is the most progressive drug policy document the EU has ever adopted. It is most needed, at a time when European drug markets have been undergoing cataclysmic changes, with the emergence of new drugs and new risks which require new responses and interventions.

The three-year Action Plan translates the goals of the seven-year EU Drug Strategy (2013-20)into concrete actions with clear responsibilities and performance indicators. This is the second action plan relating to the current drug strategy, the previous one (2013-16) having been evaluated by external evaluators, RAND and EY in 2016. The evaluation report, which also included civil society views, highlighted some very significant shortcomings of EU drug policies. It pointed out that among the five pillars of the EU drug strategy, demand and harm reduction significantly lags behind in terms of progress made in the period of the previous Action Plan. According to the evaluation, “there is room for improvement in implementation and access to risk and harm reduction measures across various Member States and… stakeholders from civil society expressed concerns about the extent and quality of these measures.“ Interviewed by the evaluators, these civil society representatives reported scaling down and closure of harm reduction programs, increasing rates of hepatitis C and HIV infections and high rates of overdose deaths among injecting drug users in some member states. Harm reduction should be expanded beyond injecting drug users, including drug checking and other safer nightlife initiatives. The report also emphasised that discussion about new cannabis policies, within and outside of the European Union, is missing at the European level.

The new Action Plan has been prepared with the involvement of the Commission’s expert group, the Civil Society Forum on Drugs. This diverse group of more than 40 NGOs represents various fields, perspectives and ideological approaches. As one of the Core Group members of the Forum, I had the pleasure of coordinating civil society responses to the evaluation of the old Action Plan and the preparation of the new. It has been the first time in the history of the European Union that civil society has been systematically and meaningfully involved in this process, with a significant impact on the final document.

These are a few highlights of the fields where civil society could have a significant impact:

HARM REDUCTION

Unlike the previous AP, this document lays great emphasis on scaling-up access to harm reduction programs – and not only the mainstream programs, such as opiate substitution and needle and syringe programs, but novel interventions such as naloxone distribution, drug consumption rooms, and drug checking are also mentioned. This is the first time that the EU has officially recognised these innovative programs. Another impact of the involvement of civil society can be seen in the list of performance indicators. These indicators were often vague in previous documents, but are much clearer now, for example by adopting indicators from the WHO’s technical guidelines, recommending the distribution of at least 200 sterile needles per injecting drug user per year. These indicators make governments more accountable.

GENDER, AGE AND OTHER FACTORS

The lack of gender- and age-specific services is a huge barrier to access to any kind of treatment or harm reduction programs in the EU. In many, mostly Western-European, member states, there is an increasingly ageing population of drug users who need other kinds of social and health support than those aimed at young people. Underage kids also need different services than adult people. Specific services for women and LGBTQ comunities are equally missing from many member states. Prisoners and asylum seekers often don’t have access to even the basic services which are widely available in the community. This AP addresses this problem and aims to close this gap. At least partly. There are still no specific interventions targeting LGBTQ people in the age of chemsex for example.

HUMAN RIGHTS

To integrate international human rights standards into drug policies has been a civil society demand for a long time. Last year’s UN report on the human rights impact of drug policies was a big success for civil society advocacy. Now our demands have also been met by the EU – this AP aims to create and implement tailored human rights guidelines and impact assessment tools for policy makers. This gives civil society an incredibly important opportunity to address system-wide incoherence when it comes to repressive law enforcement, criminally underfunded services and the human rights of people who use drugs.

CIVIL SOCIETY INVOLVEMENT

Although in most member states civil society plays a key role in implementing drug policies by providing services, there is a great diversity in how the same organisations are involved in policy formulation and evaluation. Only a few member states have formal mechanisms for civil society involvement. Objective 9 of the new AP requires not only the involvement of the Civil Society Forum on Drugs in the formulation, implementation, monitoring and evaluation of drug policies at the European level, but also the involvement of civil society in policy making at a national level. The AP also mentions that civil society should be involved in the preparations for the upcoming UN high level meeting on drugs, to be held in Vienna in 2019.  The CSF has created a working group to facilitate this process. What is still missing from the AP, despite our recommendations, is a reference to the need to involve people who use drugs in decision-making. Shame.

TACKLING PSYCHIATRIC DISORDERS 

Members of the Forum from several member states reported a gap in tackling psychiatric co-morbidites, also known as dual diagnosis, among people with drug dependence. The number of people suffering from this problem is increasing, but member states are not creating specific treatment resources to meet needs. We therefore welcome the Commission’s inclusion, under action 2.6, of the promotion of comprehensive community care, creating specialised resources to ensure continuity in treatment for these users.

QUALITY STANDARDS

The CSF has a thematic working group on quality standards, which produced a paper highlighting the challenges and gaps in implementing these services. It recommended the introduction of clear indicators to measure the implementation of quality standards for demand reduction. Action 3.10 require member states to involve civil society in the implementation of these quality standards. Although the AP does not mention it, the CSF is in the opinion that standards should be implemented and monitored with the meaningful involvement of service clients.

ALTERNATIVES TO COERCIVE SANCTIONS

While civil society almost unanimously supports it, there is unfortunately no consensus among member states about the decriminalisation of drug use. However, the AP requires member states to apply alternatives to coercive sanctions. The CSF recommends to member states that alternatives to coercive sanctions should include, where appropriate, a Restorative Justice approach, recognised to reduce reoffending and increase the satisfaction of victims. Moreover, alternatives to prison should be correctly evaluated in order to avoid a “net-widening” effect – that is, punishing more actions and persons than before. These measures should be gender-specific, and should ensure that prison is used as a last resort and punitive measures are not used for the simple use or possession of drugs per se. We therefore welcome the inclusion of “increasing monitoring and evaluations” as indicators within action 5.22.

EVALUATING ALTERNATIVE POLICIES

The external evaluators of the previous Action Plan on Drugs pointed out that “the omission of a discussion on recent trends in cannabis policy was noted by a wide range of stakeholders and represented one of the most frequent items raised when exploring whether there are any issues not covered by the Strategy.” We recommended that the Commission provide a comprehensive analysis of developments relating to cannabis policy models (eg. cannabis social clubs in Spain) and their impacts, as we originally requested. The final text of the AP is not as progressive as we had hoped: it only asks the EMCDDA to provide an update about cannabis laws in the EU. Upcoming EU presidencies need to create platforms and organise forums to enable civil society, the scientific community, and decision-makers to discuss alternative policies and their impact.

Is this document a breakthrough in European drug policy reform? No. I believe we can expect the real breakthroughs to happen at national and local level. But it is clearly a step in the right direction. What is really concerning is the lack of political commitment and adequate funding to implement the action plan. The weakness of EU action plans is that the Commission itself has no significant drug policy budget; it is therefore up to the member states to provide funding for most interventions. And several member states are far from committed to scaling-up services – not even committed to continue funding existing services. What we have seen in recent years is programs being curtailed or shut down, especially in the Eastern part of the EU. It is our role to remind EU institutions and member states that broken promises do not only undermine trust in democratic institutions, but also endanger the health and well-being of future generations.

Source: Drug Reporter