Eurasian Harm Reduction Association (EHRA) is a non-for-profit public membership-based organisation, registered by the initiative of harm reduction activists and organisations from Central and Eastern Europe and Central Asia (CEECA) in 2017.

Eurasian Harm Reduction Association

The Eurasian Harm Reduction Association (EHRA) presents „Regional analysis of the provision of drug checking services in the Central and Eastern Europe and Central Asia region“.

Illicit drug use in the Central and Eastern Europe and Central Asia (CEECA) region continues to be a public health concern. The prevalence of opioids, new psychoactive substances (NPS) and amphetamine-type stimulants (ATS), including polydrug use (very often NPS combined with other traditional drugs), is observed not only among experienced drug users, but also among young people and other key populations. Injection is a common route of administration for opioids and NPS and the CEECA region has one of the highest prevalence of injecting drug use worldwide. Overdose remains highly underreported due to poor data collection and reporting mechanisms from the responsible agencies at local and national levels.

Repressive policies remain in place in relation to drug possession and supply which, in turn, affect the access and quality of harm reduction services and the implementation of novel interventions. The harm reduction philosophy is acknowledged by the vast majority of CEECA countries and recognised in national health and drug strategies. However, the harm reduction goals are mainly connected to HIV responses. The harm reduction infrastructure is mainly designed to cover the needs of people who use opioids and are not yet ready to cope with the problems of people who use NPS. Addressing the challenges of illicit drug use requires the implementation of effective and innovative strategies and interventions.

 are not only a harm reduction intervention but also a valuable monitoring mechanism that provides reliable data on the drug market, its changes and developments, supporting policymakers and public health experts to respond to newly emerging needs.

In the region, drug checking services are in the infantile phase, with small-scale interventions operating in several countries supported by the government or donor initiatives and private donations. They operate in a legal grey area, limited in terms of modes of operation, with staff not allowed to handle drugs and clients at risk of prosecution.

Overcoming barriers that impede the adoption, leverage and scaling-up of drug checking services requires a careful examination of the country’s political and social context. However, the evidence currently available suggests that drug checking services can be piloted and/or implemented in the CEECA region, taking into consideration some recommendations from countries where these programmes have been operating for many years.

Regional analysis of the provision of drug checking services in the CEECA region

This document was developed by Lana Durjava for the Eurasian Harm Reduction Association (EHRA) as part of the project “Sustainability of Services for Key Populations in Eastern Europe and Central Asia”. It presents a brief guide with recommendations for harm reduction service managers on how to launch a new – or improve an existing –online harm reduction service aimed at people who use drugs (PWUD). The guide entails step-by-step practical tips regarding web outreach programme design, implementation, and evaluation. The purpose of this guide is to provide managers of harm reduction services, as well as representatives of other organisations working with key populations, with all the essential information needed to start an online outreach programme compiled in one place and presented in the form of concise, evidence-based, easily implementable recommendations.

The recommendations included in this guide can be adapted in line with the needs and resources of individual organisations, local contexts, and characteristics of the target population. They can also be adapted for web outreach with other key populations, such as people living with HIV, sex workers, or men who have sex with men.

This guide aims to complement a number of existing resource materials on the topic of online outreach, such as EHRA’s “Digital Help: 

 on Digital Services for Key Population”, EHRA’s “Peer-to-Peer Counsellor 

 for Online Counselling”, and UNODC’s “

: Web Outreach for People Who Use Drugs”. The links to these materials, as well as other resources, are included in the Annex of this guide.

Recommendations for setting up online harm reduction services

The Eurasian Harm Reduction Association (EHRA) presents Matrix for analysing trends in human rights violations against people who use drugs. The purpose of this Matrix is to facilitate the analysis of documented human right violations by grouping violations into strategic blocks that are easy to use for the subsequent reporting to human rights treaty bodies and/or as part of follow-up advocacy at national level; and to equip human rights activists with knowledge/skills in how to prepare/ write reports for a human right body. The Matrix aligns the analysis with the environment in which human rights treaty bodies and national governments develop human rights practices, surrounded and mediated by community-led monitoring.

The assessment of each block of violations corresponds to state human rights obligations according to international human rights covenants and, where appropriate, specific human rights conventions. Each item in a block can become the subject matter of simultaneous assessments under different sections of international treaties.

Matrix for analysing trends in human rights violations against people who use drugs

: To understand the short- and long-term responses of drug services to a major flux of displaced people and the related challenges.

: COVID-19 has raised attention in Europe, and globally, on the importance of monitoring preparedness towards potential emergencies.

Europe was again put to test with the start of the war in Ukraine. The massive flux of displaced people challenged the health services in Ukraine, in its neighbouring countries as well as in the rest of Europe.

The EMCDDA published a preliminary Trendspotter study in July 2022 to investigate the overall situation (an update is planned for 2023).

In this webinar we would like to highlight both sides of the coin: the challenges of a country at war and the responses implemented by the receiving countries.

The participation of experts based in Ukraine is confirmed although we need to be prepared for possible a black-out during the webinar.

Mrs Olga Gvozdetska, Deputy Director General of the Public Health Center, Ukraine

Dr Kostiantyn Dumchev, Scientific Director at the Ukrainian Institute of Public Health Policy, Ukraine

Mrs Stela Bivol, WHO strategic advisor for TB, HIV, hepatitis and STIs, WHO Geneva

Mrs Ganna Dovbakh, Executive Director, Eurasian Harm Reduction Association (EHRA), Lithuania

Dr David Otiashvili MD PhD, Director, Addiction Research Center Alternative Georgia, Georgia

Mr Artur Malczewski, Polish Reitox Focal Point - National Center for Prevention of Addictions, Poland

: Jane Mounteney, Head of unit, Public health

: EMCDDA opening remarks, panellists’ questions, guided discussion, Q&A.

: The webinar is open to all upon registration, after which the person will receive a link to connect.

: 14 December, 12.00-13.30 Lisbon time 13.00-14.30 (CET)

https://us02web.zoom.us/webinar/register/WN_-2yEi4w0QiSPS5mLmDrIhQ

Displaced people and European Union preparedness and response — lessons from Ukraine

Harm Reduction International (HRI), UNAIDS, the Eurasian Harm Reduction Association (EHRA), the Global Fund Advocates Network (GFAN) and the Network of Asian People who Use Drugs (NAPUD) invite you to a 

webinar on the implications of the Global Fund replenishment on harm reduction on December 5th at 1:00-2:30pm GMT.

The webinar presents the opportunity to regroup and take stock of the replenishment outcome and what is means for harm reduction in NFM4; to share actions to support inclusion of harm reduction programming in country grants and to strategise around the challenges that remain. We will also hear from the Global Fund Secretariat on their new guidance for harm reduction programming. The over-reliance of harm reduction on the Global Fund will be highlighted and the importance of other donors and national governments increasing their investments to address the funding gap for harm reduction will be emphasised.

There will be translation into French, Spanish and Russian.

Global Fund post-replenishment debrief: Implications for harm reduction

By the International Network of People who use Drugs, the Eurasian Harm Reduction Association and Harm Reduction International

In advance of the Global Fund Seventh Replenishment Conference to be hosted by President Biden in New York on September 19, 2022, the International Network of People who use Drugs (INPUD), the Eurasian Harm Reduction Association (EHRA) and Harm Reduction International (HRI) developed key harm reduction messages from implementation of the new Global Fund Strategy and the NFM4 cycle.

Harm reduction investment from international donors and governments in low and middle-income (LMI) countries totalled US$131 million in 2019 - just 5% of the US$2.7 billion UNAIDS estimates is required annually by 2025 for an effective HIV response among people who inject drugs. The Global Fund is the largest donor for harm reduction, providing at least 60% of all international donor support. The outcome of the replenishment will have significant consequences for harm reduction. The protection and scale-up of harm reduction programmes in low- and middle-income countries requires a fully funded Global Fund. An underfunded Global Fund will result in service closures, a reversal of gains made in HIV prevention among people who use drugs and ultimately, lives lost.

They urge the Global Fund and the wider donor community to be proactive in protecting harm reduction within all replenishment scenarios, in implementation of the Global Fund Strategy 2023-2028 and during the NFM4 cycle. The recommendations centre on the following five areas:

Harm reduction funding must be protected from any replenishment shortfall

Catalytic investments for harm reduction and key populations must continue regardless of replenishment outcome

Funding for community-led responses must be prioritised within NFM4, both for harm reduction and pandemic preparedness and responses

Funding for efforts to increase domestic investment in harm reduction, and broader key population programming must be increased

Funding for harm reduction in crisis must be protected and prioritised

Key harm reduction messages for the replenishment conference, implementation of new Global Fund Strategy and NFM4

Civil society organisations sent an open letter to the EU Commission to criticise the new call for drug policy grant proposals that almost only focuses on law enforcement and excludes harm reduction.

Since the Drug Unit of the EU Commission was relocated to the Internal Security Department, civil society has been concerned about the continuous shifting of its approach towards a more repressive, law-and-order direction from a balanced, integrated model of drug policies.

The new call for proposals launched by the Commission is another step in this direction. Unlike the previous EC JUST drug policy grant calls, this funding mechanism almost only focuses on supply reduction. From its four objectives, three focuses on improving supply reduction, it has only one objective on drug prevention – while harm reduction is completely missing.

Correlation – European Harm Reduction Network (C-EHRN), an umbrella of European harm reduction organisations (Rights Reporter Foundation, the organisation operating this website, is a Steering Committee member) sent an open letter to Ilva Johanson, Commissioner of Home Affairs, and Fiona Sipala, the head of the Drug Unit of the EC, to address this issue.

“We write to you on behalf of Correlation – European Harm Reduction Network (CEHRN), representing 158 civil society organisations (CSO) working in the area of harm reduction drug policy in Europe. C-EHRN is part of Foundation De Regenboog Groep and, as such, is also represented in the EU Civil Society Forum on Drugs.

Together with the undersigned networks, we would like to express our concern and disappointment with the current call of the Internal Security Grant concerning better law enforcement in the area of illicit drug trafficking. We believe this call does not reflect the principles of an evidence-based, integrated, balanced and multidisciplinary approach to the drugs phenomenon and is not in line with the Drug Strategy of the European Union. The call has a narrow focus on law enforcement interventions, with no objectives to improve complex public health and social services, including harm reduction.

For several years, the members and organisations we work with have benefited from the EC JUST Drug Policy grants launched by the European Commission. These grants demonstrated the balanced, evidence-based and multidisciplinary approach to drug policies in accordance with the core principles of the European Union. They provided an excellent opportunity for civil society organisations working in the field of drugs to cooperate internationally and exchange knowledge and good practices.
When the Drugs Unit was moved from the Justice Department to the Internal Security Department, civil society organisations were promised that this would not affect the balanced and multidisciplinary approach to drug policies of the EU Commission.
However, the apparent shift towards law enforcement and crime prevention proves different – with social and public health aspects slipping off the agenda.

The Internal Security call lays only limited emphasis on drug demand reduction and none at all on harm reduction. At the same time, no other EU Programme took over this responsibility, leaving drug demand and harm reduction behind, without any opportunity for EU funding and support.

This is an extremely concerning development. EU funding has become increasingly important in recent years because of the emerging funding crisis for harm reduction, especially in the Eastern part of the European Union. Since the 2008 economic crisis, funding for harm reduction has constantly been declining in most Member States.

Several essential services operated by CSOs have been closed down or curtailed due to budget cuts and the retreat of international donors.

On top of the funding crisis, CSOs experience a shrinking space for civil society in several Member States, where governments are increasingly hostile to those organisations that receive international funding or work with marginalised groups of society. With decreasing national and local funds, direct funding from the European Commission was often the only funding opportunity to improve advocacy and innovation in the harm reduction field for many organisations. This opportunity is now lost.

DG Home is the department within the EC responsible for developing and implementing a balanced, integrated and evidence-based EU Drug Policy. Such a balanced approach requires that funding mechanisms are available for all drug policy areas and not only for law enforcement and crime prevention programmes.

We, therefore, call upon the European Commission and DG Home to reinstall the funding mechanism for drug demand and harm reduction to ensure a balanced and evidence-based drug policy also in the future.

We look forward to your response and hope for your continued support for civil society in the area of drug policy and harm reduction.”

Drug Policy Network South East Europe [DPNSEE]

EU HIV/AIDS, Viral Hepatitis and Tuberculosis Civil Society Forum

Eurasian Harm Reduction Association [EHRA]

European Network of People Who Use Drugs [EuroNPUD]

Federation des Acteurs en Education en Promotion de la Sante de Guyane [AGRRR] International Drug Policy Consortium [IDPC]

International Network of People Who Use Drugs [INPUD]

Youth Organizations for Drug Actions [YODA]

Civil society demands balanced EU funding for drug policies

By Eliza Kurcevič, Iga Jeziorska, Irena Molnar, Istvan Gabor Takacs, Katarzyna Smukowska, Peter Sarosi, Roksana Karczewska and the LET ME project

Existing drug education at the European level is not fully corresponding to the needs of young people who use drugs. At schools, drug education only focuses on preventive approaches, while in non-formal settings (including youth organisations and other after-school activities), the drug topic is almost never discussed because of a lack, or low level, of competency of youth workers in this area. Youth organisations are an undiscovered niche which may become a place for safe and open discussions about drugs with young people. Youth organisations are playing a crucial role in reaching out to young people and, more importantly, in promoting inclusiveness which is very important when talking about young people who use/might be using drugs. Inclusiveness should not only mean the inclusion of particular groups of people, but it should also mean the inclusion and implementation of different methods of work while speaking with young people about different topics, including drugs. Youth organisations might apply prevention strategies, but the harm reduction approach should not be left behind, especially if youth organisations are working with young people who are using drugs.

Most importantly, the voices of young people who use drugs should not be left behind — a safe space should be created where youth can raise their voice and openly speak and discuss issues related to drug use, as well as being able to be involved in drug education themselves. Communication with young people about drugs might be understood differently by different stakeholders. The most common understanding includes the provision of information about drugs, the preparation of preventive actions/activities, or education about drugs. All three ways have different aims and approaches, but the subject remains the same — communication about drugs with youth.

Manual on how to communicate with young people about drugs

United Nations Secretary-General
President of the United Nations Human Rights Council
United Nations High Commissioner for Human Rights

President of the European Commission
European Commissioner for Crisis Management
High Representative of the Union for Foreign Affairs and Security Policy
European Commissioner for Health and Food Safety

Organisation for Security and Co-operation in Europe

International Federation of Red Cross and Red Crescent Societies

We, the undersigned organisations, call on the United Nations, the European Union, the Organisation for Security and Co-operation in Europe and the International Federation of Red Cross and Red Crescent Societies to jointly support and set up, as a matter of urgency, an uninterrupted supply chain of humanitarian assistance to the affected populations within the country, and to establish safe humanitarian corridors to evacuate civilians from Ukraine.

On 24 February 2022, the Russian Federation launched a large-scale invasion of Ukraine, targeting several large cities including Kyiv, Kharkiv, Kherson, Meriupol and Zhitomir, and bombing neighbourhoods within those areas, inevitably resulting in countless civilian deaths. The escalating war actions are causing tremendous humanitarian crises affecting millions of people. Those staying in cities and villages in Ukraine are in urgent need of warm shelter, food, water, basic medicine and other essential supplies. Additionally, more than 100,000 people have been internally displaced since the invasion began, and the number of displaced people will continue to grow. At the moment, meeting the essential needs of internally displaced people is extremely difficult in Ukraine due to martial law, curfews and threats to the lives of volunteers.

UNHCR estimates that due to the war, up to five million people will flee Ukraine. As of 3 March 2022, one million refugees were estimated to have fled Ukraine to neighbouring countries —including Moldova, Poland, Romania, Hungary, and Slovakia. As the situation worsens, an estimated four million people may flee Ukraine in the coming weeks and months. We highly appreciate the efforts thus far of governments, international institutions and millions of citizens in European countries — especially those in Moldova, Poland, Slovakia, Czechia, Hungary and Lithuania — in organising comprehensive support for all refugees from Ukraine.

What is now urgently needed is the provision of basic, essential health supplies and medication for people in Ukraine, including those internally displaced, by means of revised importation rules and distribution networks. People who belong to vulnerable and discriminated groups — such as people who use drugs, people in prison, gay and other men who have sex with other men, sex workers and trans people — must not be overlooked in these efforts. Notably, Ukraine has the second largest population of people living with HIV, people with tuberculosis and drug-resistant tuberculosis and opioid dependency in Eastern Europe and Central Asia, and the country has developed successful and progressive harm reduction and treatment programmes, supported by the global community. To sustain those achievements and preserve human life, we ask you to ensure essential provisions including opioid agonist therapy, ARV therapy, and tuberculosis diagnostics and treatments.

Ukraine urgently needs humanitarian corridors supported by intergovernmental and multilateral organisations. On 1 March, the UN General Assembly adopted with overwhelming support (including by the European Union) a resolution demanding “all parties to allow safe and unfettered passage to destinations outside of Ukraine and to facilitate the rapid, safe and unhindered access to humanitarian assistance for those in need in Ukraine, to protect civilians, including humanitarian personnel (...) and to respect human rights.”

Following negotiations between the two sides on 3 March, Ukraine and Russia have agreed tentatively to create humanitarian corridors7 in the worst-affected areas of Ukraine, where civilians are most at risk from the war. But in reality, there is no clarity on how these passages could be implemented.

In line with this, we call on your organisations to:

Urgently establish safe, open and uninterrupted corridors for humanitarian workers and supplies, including essential food and medicine, to reach people in need throughout Ukraine (particularly in cities in eastern, southern and central Ukraine currently under attack).

Create a coordinated and agile system for assessing needs and tracking available services and supplies’ shortages and organising coordinated international response to address it.

Urgently support the establishment of inter-agency safe corridors for the evacuation of all people wishing to leave Ukraine, regardless of nationality, to neighbouring countries.

Organise transport of lifesaving cargo both for internally displaced people in Ukraine and refugees outside the country.

Engage in a sustained and coordinated manner with local and national authorities of neighbouring countries, and of expected destination countries, to ensure:
+ Continued safe entry and passage of people fleeing Ukraine (without the need for visas or other burdensome administrative requirements).
+ Distribution of food, COVID-19 personal protective equipment and medicine, including antiretroviral therapy (ARV) and/or opioid agonist treatment, without discrimination.
+ Safe and uninterrupted circulation of essential food and medicines — including utilisation of the simplified control procedures for the export, transportation and provision of medicinal products containing controlled substances, as recommended by the International Narcotics Control Board (INCB).

Help to ensure the parties to the conflict take the necessary measures to account for protected people, including prisoners of war and detainees.

Apply all efforts to negotiate this issue with both Russian and Ukrainian authorities through all possible channels, to ensure safe and effective humanitarian corridors are established as quickly as possible.