UK based NGO Harm Reduction International (HRI) warns that if the roll back of funding harm reduction services such as needle and syringe programmes and methadone provision in the European Union remained unchecked, renewed spikes in HIV and Hepatitis C (HCV) infections amongst people who use drugs were inevitable.
The report Harm Reduction investment in the European Union - current spending, challenges and successes was released ahead of the 25th Harm Reduction International Conference (HR17) taking place in Montréal, Canada. Some 1000 scientists, doctors, public health bureaucrats and drug user activists from around the world will attend the event.
The report finds that the funding crisis for harm reduction in the European Union is principally being fuelled by a combination of factors: the retreat of international donors, austerity and poor political support for harm reduction. The crisis is being most felt in Romania, Hungary, Bulgaria and Greece. Of particular concern is the closure of grants from the Global Fund To Fight AIDS, Tuberculosis and Malaria (The Global Fund) in some eastern EU states which are now ineligible for funding due to their income country status. While governments have picked up the cost of some services previously covered by the Global Fund, harm reduction services have been left unfunded, leading to service closures.
In Hungary, harm reduction funding and services have been steadily reducing since 2010 and simultaneously, HCV prevalence among people who inject new psychoactive substances has doubled between 2011 and 2014. The closure of the country´s two leading needle exchange centres in 2014, servicing the majority of injectors in the country is sure to have worsened this situation and researchers warn of likely HIV 'outbreaks' among people who inject drugs.
In Romania and Greece, which both experienced HIV 'outbreaks' among people who inject drugs in 2011, experts warn that further outbreaks are likely unless urgent action is taken to increase harm reduction services.
The report undertook extensive surveys with national civil society representatives in the 18 EU states on the issue of harm reduction funding sustainability, finding that only in eight of the 18 EU states was funding considered secure.
"Europe is the birthplace of harm reduction so it is both ironic and tragic that a region that so proudly prevented HIV infection amongst the drug using community in the early 1980s now finds so many of its members facing a similar crisis amongst the same community," said Catherine Cook, Head of Research at HRI. "Some urgent action is needed if we are to defuse what is a public health powder keg situation within the EU."
The report makes three tiers of key recommendations including:
- National governments should undertake cost-effectiveness studies into drug policy spending and redirect funds from drug enforcement to harm reduction;
- The European Commission should create a time-bound emergency fund to keep services in operation in countries no longer eligible for Global Fund grants;
- The Commission should also lead the development of a new HIV Strategy and Action Plan with a strong emphasis on ensuring the sustainability of harm reduction services. The next EU Action Plan on Drugs, to cover the period 2017-2020, should support these efforts;
- The Global Fund should also ensure that there is a mechanism in place to directly fund NGOs in upper-middle income countries that fit the eligibility criteria, where government investment in programmes is not forthcoming
The HRI7 conference, convened by Harm Reduction International and partnered this edition with the Association des Intervenants en Dépendance du Québec (AIDQ), was first held in Liverpool, United Kingdom 27 years ago and is returning to North America for the first time since it was held in Vancouver in 2006.
The Canadian Federal Minister of Health Jane Philpott and Quebec Minister for Rehabilitation, Youth Protection, Public Health and Healthy Living Lucie Charlebois will both speak at the conference opening ceremony. The HR17 conference will take place against the backdrop of pending cannabis legalisation and regulation by the Canadian Federal government, and harm reduction returned as a pillar in Canada's Drug and Substances Strategy.
Canada and the United States are both experiencing public health emergencies around the prescription opioid Fentanyl, the painkiller which killed the artist Prince last year. The drug is 100 times stronger than morphine and a dose the size of a grain of salt can kill. Fentanyl's potency means large numbers of doses can be smuggled in small packages. The drug is commonly laced with heroin, cocaine and crystal meth.
In British Columbia some 922 people died of apparent illicit drug overdoses in 2016, an 80 per cent increase on 2015. About 60 percent of the deaths were linked to fentanyl, according to the British Columbia Coroners Service. There are also recent media reports indicating that Fentanyl has now made its way to the United Kingdom.
The HR17 conference will feature a major focus on the growing importance of drug checking and a highlight will be the inaugural results of the first ever Fentanyl testing study conducted at the Insite Supervised Injection Room in Vancouver.
There will also be considerable focus on the growing need for Supervised Injection Sites in light of the increasing overdose epidemic. Three Supervised Consumption Sites have been approved in Montréal, with 13 other sites across Canada under consideration. Canada currently has two Supervised Consumption Sites in operation - Insite and the Dr Peter Centre, both located in Vancouver, British Colombia.
"We´re delighted to that HR17 is being held in Montréal as Canada begins to adopt a more forward-looking approach to drugs," said Lisa Massicotte, Director General of AIDQ.
"There`s never been a better time to share with our colleagues internationally the progress being made in Canada."