SURIA’s research is routinely underpinned by service user narratives and experiences of engaging with OST (primarily methadone), using a human rights perspective that traces the progressive realisation of rights instruments pertaining to the highest attainable level of healthcare (Article 12 of The Economic, Social and Cultural Rights among a number of other rights instruments). Our rationale for this approach stems from the fact that OST/MMT is a public health service and therefore clients should enjoy the same rights and treatment as others who are accessing modalities of treatment for other illnesses. However, our research continuously demonstrates that this is not the case and those using methadone often allude to institutional stigma, poor treatment practices and not being afforded any input in their own service provision, (Healy et al. 2022). This research is SURIA’s fifth research output, as we continuously attempt to highlight the plight of those engaging with methadone and other OST services in Ireland. We have repeatedly highlighted that these services are sub-standard, stigmatising and often harmful for those seeking refuge from problematic opiate use, (SURIA 2018, 2020).

Our research suggests that Irish OST (Opioid Substitution Treatment) and MMT (Methadone maintenance Treatment), as harm reduction modalities, often paradoxically produce harm in the lives of clients. Our work continuously highlights the lack of progress in client’s lives, poor reintegration, the over-extension of power into the lives of clients (including in matters that have little to do with drug use) and the poor quality of life for those who expected to be helped by methadone services, (SURIA 2020, 2018).

SURIA’s work is underpinned by four principals that have emerged continuously in our research. They include supervised urinalysis, the lack of care plans, choice of treatment and meaningful review, and the absence of an independent and robust avenue for complaint for clients who feel they are not being provided the highest attainable level of healthcare, as per the Economic, Social and Cultural Rights Agreement (1976) of which Ireland is a signatory. However, it must be noted that the State has not ratified the Optional Protocol, which arguably reduces the potential of this rights mechanism to propagate meaningful change.

The importance of this research lies in the timing of its publication, as Ireland enters a post lockdown landscape. COVID 19 enforced a plethora of changes to MMT practice in Ireland. Clinics and GPs were forced to allow clients to avail of more takeaways (doses that are taken home). Prior to COVID, the administration of takeaways was considered a privilege that was earned by providing urine samples that ‘marked’ the client as drug free. However, the provision of extra takeaways did not perpetuate chaotic drug use, as many key stakeholders predicted. Instead, even the EMCDDA alluded to the fact that for the vast majority of service users, extra takeaways did not lead to more opiate use. Instead, Alexis Goosdeel, the Director of the EMCDDA is on record as suggesting that COVID illustrated that service users could be granted more takeaways, more trust and that the paternalistic disposition that dominates much of MMT was in fact a misnomer. The International Network of People who Use Drugs (INPUD) echoed this sentiment, positing that COVID represented a chance to implement a “new normal” in how methadone (and other OST models) are prescribed and managed (Chang et al. 2020).

Ireland is currently in the process of a Citizen’s Assembly on Drug Use, as the State, with the help of key actors and stakeholders commence an in-depth examination of Irish drug policy. Therefore, one would assume that change is imminent, that years of advocacy and nuanced debate are potentially beginning to bear fruit. Unfortunately, this research suggests that not much has changed in how OST and MMT is practised in Ireland. The same four principals are still embedded in how service users are treated, the same four principals suggest that the human rights of this vulnerable populace are still being overlooked at best, blatantly ignored at worst. Service users are still experiencing the same levels of opprobrium as SURIA have been highlighting since our inaugural research in 2012.

The empirical evidence that informs this research is drawn from 229 service users, from three different areas in Ireland. As such, we believe that we have employed an effective, credible and cogent methodology, from which the Irish service user narrative can be captured and explored. This analysis of the data will be demarcated by the four principals that have emerged from all our research projects, 2012, 2017, 2018/19, 2020. The common themes that are repeated across all of these projects potentially suggest that little progress has been made in the provision of OST and MMT in Ireland. Lack of treatment choice, supervised urinalysis, no treatment plan and the lack of a robust and independent complaint mechanisms are shortcomings that our research has continuously identified. Within this barrage of failure, there are some signs of progress. However, the question of whether this enough is debatable. While progress is welcome, the perennial stigma and poor treatment that drug service users routinely endure is quite simply unacceptable.

SURIA is a service user-led group that campaigns for rights-based MMT/OST. One of our principal objectives is to recognise service users as consumers as opposed to passive recipients of a public health service. As such, we advocate for a symmetrical partnership dynamic to inform doctor/client interaction. We are committed to reform within the MMT/OST sector that will enable service users to be seen as partners in their own recovery plan, as opposed to engaging with services that are frequently characterised by a highly imbalanced power dynamic in favour of the service provider, (Bennett 2011, Harris & McElrath 2012). Within this system, any form of recovery is unlikely, the quality of life remains poor and services become buttressed by “us and them” relationships.

This analysis will commence by comparing some of the findings of out last project, Nothing About Us Without Us (2020). In this way, our continued tracing of the progressive realisation of the right to health provides the backdrop to this analysis. The nuances and challenges that are routinely endured by Irish service users will be captured, highlighting that the potential of methadone and other substitute treatment models are inhibited by poor practices, a lack of training and a refusal to follow international best practice and literature. As part of this cycle of continuous analyses, this report will also discuss some of the new findings that have emanated from this round of research.

'Lives on hold': Fifth monitoring report by Service Users Rights in Action (SURIA)

Despite billions spent in drug control, European drug policies have failed to protect the health and safety of our communities.

Drug use is reaching historical records. New substances are entering the EU market every year. War-on-drugs policies have been unable to stop the growing power of organised crime. Evidence shows that prevention, treatment, and harm reduction are necessary to save lives and protect our communities, but services for people who use drugs lack resources and political support.

The 2024 European elections must bring a paradigm shift. This manifesto lays down a vision for a pragmatic, innovative, and human rights-centred European drug policy that will deliver healthier and safer communities. We invite all European civil society organizations, parties, and candidates to endorse the following calls to action.

Together, we will build a drug policy that prepares Europe for the future.

Open To Everyone, Initiated by Correlation – European Harm Reduction Network, the International Drug Policy Consortium (IDPC), NEWNet Enjoying Safer Nightlife.

The Principle of the Drug Policy Manifesto:

Ramp up investment in health and social care

Drug use in Europe is at record levels, and the growing presence of new psychoactive substances, including synthetic opioids, has raised the alarm. Law enforcement and drug control will not stop this new threat, just as they have failed in other regions of the world. To be prepared for the future, the EU institutions must prioritise support and funding for integrated health and care services that are proven to work. A focus on services that support, rather than punish, people who use drugs is necessary to save lives and keep communities safe.

EU drug policy must be rebalanced, ending the current prioritisation of law enforcement over health. The EU institutions must ramp up investment and support for selective and indicated prevention programmes, evidence-informed voluntary treatment, life-saving harm reduction (including HIV/AIDS and HCV prevention, opioid assisted treatment, take-home naloxone, drug checking services, and drug consumption rooms), and community-based and community-led services that can reach out to everyone in need.

It is time to abandon war-on-drugs policies that, despite costing billions, have failed to reduce the size of illegal drug markets, to curb the power of organised crime or to reduce violence. Policies and narratives that stigmatise and blame people who use drugs and marginalised communities must be replaced with interventions grounded in evidence, inclusion, and human rights.

To ensure an integrated, holistic, and intersectional approach to drugs, EU health bodies must have a pivotal role in shaping EU drug policy. Drug policy must be mainstreamed across social, health and economic policies, and not be left at the hands of law enforcement alone.

The EU institutions must mainstream an inclusive, human rights and gender-based approach to drugs, including an unequivocal support for the decriminalisation of people who use drugs as a measure to remove stigma and improve access to services.

The new EU Drugs Agency must create indicators that monitor the effectiveness and impact of current drug policy approaches such as crime prevention and demand and harm reduction, including on stigma, access to services, and human rights, and conduct more policy-oriented research. EU bodies mandated to uphold human rights, EU values and the rule of law must also be involved.

Ensure civil society and community participation

A safer and more effective drug policy requires the involvement of civil society organizations that work every day with communities, can reach out to vulnerable populations, and are best informed of new trends in drug markets. EU drug policy must reflect the principle ‘nothing about us without us’, involving first and foremost affected communities and people who use drugs.

Mechanisms for civil society participation in EU drug policy, including the Civil Society Forum on Drugs in the EU, should be appropriately funded, supported, and meaningfully consulted by the European Commission, the EU Drugs Agency, and all relevant EU institutions. They should include representatives of affected communities, including people who use drugs, young people, women, and those disproportionately affected by criminalisation, stigma, and discrimination.

Explore innovative approaches, including responsible regulation

A pragmatic drug policy requires exploring innovative approaches to drug markets, including the responsible regulation of drugs such as cannabis, as a key measure to protect the health and human rights of communities, and reduce the power of organized crime. The EU should facilitate these innovations, and monitor their impact on health, safety, and human rights.

European policy makers must ensure that European laws and policies facilitate the adoption of innovative approaches to drug markets, including responsible regulation. The EU Drugs Agency should monitor the impact of drug policies and regulation, to allow for evidence-informed policy making. This will support mutual learning, increase uptake of best practices, contribute to pragmatic solutions, and prepare Europe for the future.

Alliance Nationale des Communauté pour la Santé (ANCS)

Asociace poskytovatelů adiktologických služeb, z.s.

Correlation European Harm Reduction Network (C-EHRN)

Episteme - Investigació i Intervenció Social

International Drug Policy Consortium (IDPC)

RefletsduReel (RdR) - Asud auto-support usagers de drogues

For a drug policy that makes Europe safer, healthier, and more just - Drug policy manifesto for the 2024 European Parliament elections

Tides are turning against those who instigated the war on drugs under the previous administration. Despite President Marcos’ pronouncement that he will “not lift a finger” to assist the International Criminal Court in its probe on former president Rodrigo Duterte’s crimes against humanity, recent events have pointed to growing apprehension in the Duterte camp. The ongoing rift between the Dutertes and Marcoses further creates a fragile situation that will keep the drug war instigators constantly on their toes.

Undoubtedly, the arrest of Duterte and his ilk would be a big step toward justice for the drug war victims and their aggrieved families. But beyond Duterte’s arrest, there are critical issues fundamental to moving past the war on drugs. First, we must have a thorough accounting of the harm caused by this war; second, a progressive drug policy alternative must be laid out, and finally, we need to change the narrative toward a more humane approach to substance abuse.

Any effort for reform must start with a clear and honest assessment of what happened previously. The death toll is a common way to start. The number of deaths alone is enough to trigger outrage, although as the corpses piled up, the staggering numbers slowly lost their shock value. Near the end of Duterte’s term, only the organization Dahas continues to keep tabs on the death toll. Sadder still is the fact that the killings are just a sliver of the harm done. Children have to bear the trauma of seeing their fathers shot. Distrust prevails in barangays where neighbors and local officials listed “drug suspects” in their own community. Professional groups who were expected to push for an evidence-informed health policy fell silent, with some subscribing to the hegemony on substance use.

Philippine drug war won’t end with Duterte in jail

At Release, we have received an unprecedented number of requests for support from people who use drugs and professionals alike who are scared about the recent changes in the drug supply. We also fear what this may mean for people who use drugs across the United Kingdom, and we are looking to the international community for help.

The UK’s drug supply is getting increasingly dangerous: this comes from the rapid appearance of a group of synthetic opioids called nitazenes across drug supplies. Rapid drug checking analysis 

 across heroin, benzodiazepine, and even cannabis supplies, and are already linked to several deaths across the country.

This is likely to increase the number of fatal overdoses, particularly because people that are consuming presumed non-opioids are unlikely to carry naloxone with them, and would not have the means to reverse any overdoses should they occur.

Drug services are failing to reach many people who use drugs in the UK, particularly racialised communities, as well as people impacted by patriarchy.

Drug services are failing to reach many people who use drugs in the UK, particularly 

, as well as people impacted by patriarchy. This is particularly true for people already marginalised by criminalisation. In the UK, many small-scale harm reduction efforts have been swallowed up by large drug treatment companies, losing funding in competitive tenders against these companies This, in turn, has left marginalised communities without peer-to-peer drugs’ support or resources. In many parts of the country, even accessing needle and syringe programmes anonymously has become impossible. In the midst of a toxic drug supply crisis, this means that communities of oppressed people will continue to experience mass death.

All this happens within the already-lethal environment for British people who use drugs: the country already tops the leagues as the European nation with the 

 a day from opioid overdoses. Poor people in this country are 

, this figure increases to people in the poorest areas being 18 times more likely to die a drug-related death.

Despite consistent warnings on changing drug concerns and the need for emergency action, policymakers remain steadfast in their refusal to explore alternatives to a prohibitionist approach to drugs. Both the Labour and Conservative parties believe that the best approach to control drug harms is to seize record amounts of substances at the border and continue to incarcerate those who use drugs. Labour has committed to 

 if they come into power. We already know that policing is a barrier to people engaging with services, and there is evidence to show that 

increased policing increases the likelihood of experiencing an overdose.

 Doubling-down on more of the same punitive and carceral policies that created this lethal environment in the first place will only lead to more death.

We know that policing is a barrier to people engaging with services, and there is evidence to show that increased policing increases the likelihood of experiencing an overdose.

With most of drug-related public funding going into treatment services which fail to deliver true harm reduction, those of us in real community with people who use drugs need to resort to grassroots forms of community care in order to keep ourselves and each other alive.

Release currently and historically advocates for changing drug laws towards more compassionate solutions based on social and racial justice, rather than punishment. As a response to the nitazenes crisis, we have also decided to fundraise to open 

We have become tired of constantly trying to raise attention around drug-related harms and decided that we needed to take more direct action.

We have reached a point where we need to change our advocacy tactics and build a grassroots movement and our own systems of care. Along the way, we hope to build a better model of harm reduction practices which can be implemented across the country.

A community living room space for anyone, with access to tea, coffee, and phone chargers 

Signposting to relevant health and social services where it is desired

Merchandise for sale to contribute to ongoing operating costs

A welcoming space to simply have a friendly conversation 

Eventually, the space aims to be a meeting place for harm reductionists across the capital to gather, share best practice, and strategize on expanding the movement.

 this week to raise the funds needed to open and run the space.

We hope that friends within our harm reduction community and those embedded in other social justice struggles will support us in delivering this space. While the conditions which have brought about this plan are dire, this is also a great opportunity to breathe life into the British harm reduction movement that has been co-opted and defanged by public health authorities and abstinence ideology.

Release will begin construction immediately, expanding the room’s functions and breadth of services as they can.

We’re tired of waiting for change – we’re going to start making it happen.

The room is the beginning of a year of actions and community mobilisation. We’re tired of waiting for change – we’re going to start making it happen.

The link to the fundraising campaign can be found here: 

https://www.justgiving.com/campaign/harmreduxhub

In the face of more drug deaths in Britain, we must build a community of resistance

This study delves into the demographics, behaviors, and social dynamics of members of Cannabis Social Clubs (CSCs) in Barcelona from 2017 to 2020. Analyzing data from 2007 members across five CSCs, it reveals that most members are young men, with an average age of 36.1 years, and shows gender differences in cannabis procurement patterns. The study also highlights the longer membership duration among women, older adults, and medical users, despite their lower cannabis use compared to young, recreational male members.

Key findings include the average daily cannabis use of 0.44 grams, with men procuring more than women, and members visiting CSCs approximately once a week. The average membership duration was around 1 year and 10 months, with longer memberships observed among men, older members, and residents living near the CSCs. Importantly, the study underscores the role of CSCs as social spaces beyond mere cannabis procurement, noting that they foster community building and harm reduction.

The study concludes that CSCs in Barcelona serve as more than just cannabis supply points; they are crucial for community care and socializing. Despite the unstable legal status of CSCs in Spain, which poses challenges for their operation, the research highlights their potential in harm reduction and community well-being. This comprehensive analysis contributes significantly to understanding the CSC model, especially in terms of its social dimension.

Who is in, for how long and what for. Exploring the social dimension of cannabis social clubs in Barcelona, 2017-2020

In order to raise public awareness of effective overdose-death prevention methods, activists set up an unofficial drug consumption room in the middle of Helsinki.

A tent was set up in the centre of Helsinki, where those who inject drugs could come and use them safely, with the support of health professionals offering help, advice, hygienic equipment, and food. The facility aimed to prevent drug overdoses and infections related to the sharing of injecting equipment.

At around 4:50 p.m. on Wednesday, the police arrived and asked the activists to disassemble the tent. The tent was disassembled shortly after.

According to the organisers, the police argued that there was a reasonable suspicion that people committed crimes in the tent. However, according to the organisers, no one has visited the tent to use drugs, so there is no reason for the police to suspect.

According to Juha-Pekka Pääskysaari, one of the organisers of the event, this was an act of civil disobedience, borne out of the frustration of professionals and activists that the establishment of drug consumption rooms in Finland has progressed so slowly.

Pääskysaari, like other volunteers, said he was not representing any organisation. The action was organised by individual citizens protesting repressive drug policies.

“Simply put, this is civil disobedience,” said Pääskysaari. “By setting up this room, we want to highlight how people with substance abuse are treated in society. How can there be one group of people in this society whose illness is treated as a crime?”

Police demolished 'illegal' drug consumption room in Helsinki

The Cabinet has approved a new Citizens' Assembly on drug use at its meeting in Dublin.

In a statement, the Government said the assembly will be asked to consider the legislative, policy and operational changes the State could make to significantly reduce the harmful impacts of ilegal drugs on individuals, families, communities and wider society.

Chief Whip and Minister of State with responsibility for Public Health, Well Being and the National Drugs Strategy, Hildegarde Naughton, said: "Drug use affects all members of society, whether directly or through families and communities, and it imposes significant health and financial costs. Involving citizens in decision-making on drugs policy is therefore appropriate.

"I want to ensure that the voice of young people is heard at the Citizens' Assembly, as they can be particularly impacted by drug use. To this end, I have initiated a consultation with young people through Comhairle na nÓg and youth drug projects in disadvantaged areas, which will be presented to the Citizens' Assembly for its consideration".

Minister Naughton said she would bring forward a motion to the Dáil and Seanad next week to formally establish the assembly.

It is expected to begin its work in April and conclude the process by the end of this year.

Ireland: Cabinet approves new Citizens' Assembly on drug use

Supervised consumption services (SCS) are an effective intervention to reduce the harms associated with drug prohibition and a toxic drug supply. SCS increase access to health care, promote safer consumption, and prevent overdoses and other health complications. An SCS may support multiple forms of drug consumption, including consumption by injection, inhalation (smoking), oral, and intranasal (snorting). For people who inject drugs, SCS reduce the risk of HIV and hepatitis C, soft tissue infections, venous injuries, sepsis, and overdose-related deaths.

However, a significant number of clients who inject drugs—between 14% to 49%, according to Canadian studies—require more than a safe, hygienic space and access to care and services: they also require assistance with injection. This resource answers some frequently asked questions about legal liability to help SCS providers in Ontario make informed decisions about their practices related to assisted injection.

Participation and accountability