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

HFHR, HRI, IDPC and EHRA submit this briefing to the UN Committee on Economic, Social and Cultural Rights (hereinafter, “the Committee”), in relation to the 7th periodic report of Poland. 

We welcome the fact that the Committee included under the Right to Physical and Mental Health (art. 12) of the List of Issues prepared ahead of the country review a request (no. 23) to: 

provide information on any follow-up measures taken, and their impact, with regard to the National Programme on Countering Drug Addiction 2016–2020. Please also provide information on any follow-up measures taken, and their impact, to increase access to opioid-substitution treatment for drug dependence. 

We note challenges in the field of harm reduction and opioid-substitution treatment as is now more commonly referred to as opioid agonist therapy (OAT) as well as the human rights consequences of drug policy in Poland. The content of this submission comes from the long-lasting monitoring of in-country situation but is also heavily influenced by information and insights provided by local organizations during the civil society consultations conducted jointly by the EHRA and the HFHR for Human Rights between June 2023 and January 2024 with the aim of supporting the upcoming CESCR’s General Comment on Drug Policy.

HFHR, HRI, IDPC and EHRA recommend that the Committee considers including the following in its concluding report to the Polish government:

ground drug policy in human rights, scientific evidence and reliable data 

decriminalize drug use and possession for personal use (which should include the removal of all sanctions, both criminal and administrative), and consider transformative change to the country’s punitive drug policy, as recommended by the OHCHR 

increase the coverage of, funding for, and diversify the range of harm reduction measures, including access to naloxone, both in the community and prison settings and ensure that such services are tailored to the specific needs of women, LGBTQI+, youth, migrants and other particularly vulnerable groups of people who use drugs 

ensure equal access to evidence-based prevention, harm reduction and treatment services on a non-discriminatory basis, taking into account the specific needs of particularly vulnerable groups 

actively combat stigma and discrimination against people who use drugs, including by developing a campaign in consultation with people who use drugs to counter stereotypes and raise awareness of the rights of people who use drugs.

Joint submission to the UN CESCR regarding opioid agonist therapy (OAT) and human rights in Poland

Over the last years an increasing number of governments in Central Eastern Europe & Central Asia (CEECA) are adopting new laws and practices that constrain civic space (restricting rights and liberties of civil society), thereby exerting additional pressures and burden on already criminalized populations (LGBTQI+, people living with HIV, people who use drugs, sex workers). Russia’s war against Ukraine has intensified the negative human rights trends of previous years, leading to increased insecurity. It caused disruption of access to treatment and basic medical and social services, increased vulnerabilities to HIV in Ukraine, and in countries affected by the refugee crisis, and throughout the region, where economic and social upheaval and changing patterns of migration are felt.

The confluence of geopolitical turmoil, rising authoritarianism and the resulting shrinking spaces for civil society, criminalization of key populations and donors’ narrow view and scope in addressing HIV brought us to this boiling point where, more than ever the robust and pragmatic approaches in addressing interconnected issues of HIV, public health, gender equality, civil and human rights are needed.

The purpose of the Communique is to acknowledge and coordinate efforts among communities, civil society, politicians, experts and professionals, and other national and international stakeholders to address the shrinking space for civil society and communities to act in the spheres related to public health (including HIV), sustainability and security in the CEECA region.

Secure the future: Civil society and human rights imperative for public health and HIV response in Central and Eastern Europe and Central Asia

The 67th session of the United Nations Commission on Narcotic Drugs (CND) took place from March 14-22, 2024, in Vienna, Austria. For the Eurasian Harm Reduction Association (EHRA), it was an opportunity to engage with delegates from the CEECA region countries, co-sponsor side events, participate and ask questions in the informal dialogues with WHO, UNAIDS and UNODC, and advocate for progressive drug policies centered around public health and human rights.

Webinar will be in English and Russian languages.

Harm reduction, the 'Vienna spirit', and the pro-reform coalition - Follow-up to #CND67

The BOOST project, a collaborative effort aimed at combating HIV/AIDS and viral hepatitis in Europe, supports EU and neighboring countries through community-based and led harm reduction initiatives. This response, vital due to the disproportionate impact of these diseases on people who use drugs (PWUD) and marginalized populations, is structured around four main pillars: Inform, Improve, Support, and Connect & Act, which focus on data collection, capacity building, best practice enhancement, and advocacy, respectively.

This Advocacy Strategy provides an overarching framework and sets priorities for regional harm reduction and community-led networks working for EU and neighboring countries. The objectives of the Strategy will serve as a basis for developing joint regional advocacy actions for comprehensive health and harm reduction services for people who use drugs.

The Strategy aims to enhance the quality, accessibility, and coverage of harm reduction services. It focuses on increasing political will and financial sustainability, promoting community-driven harm reduction, ensuring access to specific health services, and advocating for comprehensive health and social care. The strategy emerged from an inclusive consultation process, including extensive online dialogues, surveys, and strategic meetings, which identified key barriers to service access and outlined objectives for improving harm reduction efforts across the continent.

Through this collective approach, the BOOST project and its partners aim to address the critical health needs of people who use drugs, advocating for changes that support harm reduction, health rights, contribute to the priorities of the EU Drugs Strategy 2021-2025, and ultimately, the goal of eliminating HIV/AIDS and viral hepatitis as public health threats by 2030.

United for change: Advocacy strategy for comprehensive health and harm reduction services for people who use drugs in Europe

The CLM initiative led to policy changes in Ukraine, Georgia, Montenegro, and Moldova. For instance, in Ukraine, the research revealed gaps in psychological and social support within the OAT programme, prompting advocacy efforts to address these deficiencies. In Georgia, the findings influenced decisions on take-home dosing, while in Moldova, they sparked a formal investigation into programme outcomes. Additionally, the research led to increased access to buprenorphine in Moldova and improved staffing at a central clinic in Montenegro.

Furthermore, CLM enhanced the capabilities of community organisations by providing them with new research skills and in establishing partnerships with professional researchers. Getting approval from ethics committees added credibility to the community organisations, allowing them to engage with institutions and to strengthen their advocacy. This initiative also boosted the confidence of communities and helped them fine-tune their advocacy goals.

Overall, CLM not only generated crucial knowledge about OAT programmes but also transformed community organisations, enabling them to play a more influential role in advocating for positive changes in policy and practice.

Based on the findings, the following recommendations are proposed:

Quality of life and client satisfaction should be frequently and routinely monitored as part of the M&E approach to OAT programming.

Community-led monitoring should be leveraged for the monitoring and evaluation of OAT programmes as such enabling collaboration with communities allows are more informed understanding on how best to improve quality of life and client satisfaction.

Referral systems should be strengthened between OAT programmes and HIV, hepatitis C virus (HCV), and tuberculosis (TB) related prevention, testing, treatment and support programmes.

Psychosocial support provided at OAT sites should be enhanced.

OAT service hours should be adjusted to enable OAT participants to more easily pursue employment.

Individual approaches to take-home doses should be enabled.

Decriminalisation would reduce imprisonment of OAT clients and until decriminalisation is instituted, continuity of access to OAT programming should be guaranteed for people experiencing detention.

Quality of life and client satisfaction studies can be leveraged to counter efforts to cut costs, or to “optimise” spending, which would otherwise push for the elimination of psychosocial support as a service that is too costly.

Community-led monitoring of opioid agonist treatment

EHRA and team of researchers presented and discussed assessment findings of opportunities for optimal access to mental health care services for people who use drugs in the CEECA region. This exploratory study inquired as to how mental health care services are rendered to people who use psychoactive substances in the region of Central and Eastern Europe and Central Asia (CEECA) region.

Data for this study were collected during in-depth research of the situation in four selected countries of the region: Czechia, Estonia, Moldova and Poland. This was followed by an analysis of research publications/literature on mental health services and services available for selected target groups. In addition, semi-structured interviews were conducted with health service providers, harm reduction service staff and patients/clients. Reflections on the situation in the region were also utilised from a multidisciplinary expert group meeting, ‘On barriers, challenges and needs on accessing mental health care and support services for people who use drugs during COVID-19, people who use new psychoactive substances (NPS), as well as migrants and refugees’.

Although all four participating countries of the study have relatively developed structures of both mental health and treatment facilities for people who use psychoactive substances, all of them find significant obstacles when mental health services are needed for people who use psychoactive substances, as integration of these services has not yet become a reality. Similarly, although mental health care is expected to start at the primary level of healthcare, only in some countries are general practitioners ready to provide an initial assessment of the mental health status of a patient.

The study team believes that the assessment findings and recommendations can be used as background for improving harm reduction programmes, and specific health and social care programmes for people who use psychoactive substances (including Ukrainian refugees) to achieve optimal access to mental health care. It could be used to overcome systematic barriers created by mental healthcare authorities and for improving cooperation between agencies providing – or those who could potentially provide – mental health care support to people who use psychoactive substances.

During the launch of the report lead researcher Dr. Tatiana Andreeva, PHD presented 

key regional findings of the assessment, barriers, and recommendations common for all EECA region

. Country researchers presented situation 

. Discussion of opportunities and possible next steps for integration of mental health and HIV response and harm reduction.

With this research, we hope to start systematic advocacy to integrate harm reduction and systems of provision of mental health support. We need to change the systems and approaches to stop “football by people”, sending people in pain between institutions and organizations supposed to help.

Linking Dots: Assessment of opportunities for optimal access to mental health care services for people who use drugs in the CEECA region

We are happy to present key findings of the report 

“Linking Dots: Assessment of opportunities for optimal access to Mental Health Care services for people using drugs in the CEECA region. Regional overview based on country cases of Czechia, Estonia, Moldova, Poland.”

 English and Russian with simultaneous translation

Presenting key regional findings of the assessment, barriers, and recommendations (20 min)

Short overview of country cases (Czechia, Estonia, Moldova, Poland)

Discussion of opportunities and possible next steps for integration of mental health and HIV response and harm reduction.

 for this meeting to receive the direct link on event.

Mental health care for people who use drugs in EECA: Discussing findings of the assessment

The objective of this webinar is to discuss the provision of high-quality harm reduction services tailored to the specific needs of young people who use drugs.

The need for youth-specific harm reduction strategies is urgent, given the unique set of legal and ethical challenges posed by punitive drug policies in EECA countries. This webinar aims to shed light on these issues and pave the way for innovative harm reduction services that meet the unique needs of young people who use drugs.

Presentations by “Mandala” from Georgia and “Drogart” from Slovenia (40 minutes)

Closing Remarks and Next Steps (10 minutes)

Monday 9th October, 11.00 (EEST/Vilnius time) - 

Simultaneous Russian-English translation will be provided.

If your organization has experience in working with youth and would like to share your insights as a presenter, please don't hesitate to contact igor@harmreductioneurasia.org. Your input would be invaluable in enriching the discourse and contributing to EHRA’s ongoing efforts to enhance the quality of harm reduction services.

Your active participation is crucial for the mobilization of harm reduction advocates and the communities we serve. Together, we can ensure the sustainability and efficiency of harm reduction services and advocate for non-punitive drug policies based on public health approaches and human rights.

Quality harm reduction services for youth: Sharing good practices and innovations

 Press Center of Ukrinform (Hall 2) - Kyiv, str. Bohdan Khmelnytskyi, 8/16. 

On July 31, 2023, the Ministry of Health published 

a draft order of the Cabinet of Ministers of Ukraine

 "On the approval of the State strategy of drug policy for the period until 2030 and the approval of the operational plan for its implementation for 2023-2025". The participants of the event will focus on the first results and further steps of the public discussion of the draft state strategy on drugs until 2030.

 - Chief specialist of the department for the prevention of non-infectious diseases and circulation of narcotic drugs of the Ministry of Health of Ukraine.

- Head of the Viral Hepatitis and Opioid Dependence Department of the Public Health Center.

 - Executive director of the Eurasian Harm Reduction Association (EHRA), deputy head of the Vienna NGO Committee (Vienna NGO Committee - VNGOC)

 - Lawyer, public association DRUGPOLICY.UA

 - Professor of the Institute of Physiology named after Bogomolets National Academy of Sciences of Ukraine, NGO "Higher Medical School", "MIST"

- Executive director of the International Drug Policy Consortium (IDPC), member and ex-chair of the UN Strategic Advisory Group on Drug Use, HIV, Health Care and Human Rights

 - Secretary of the Drug Policy Commission of Eastern and Central Europe and Central Asia (ECECACD)

Eurasian Harm Reduction Association

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