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Abstract
Background
Across Europe, harm reduction services experienced significant disruptions during the COVID-19 pandemic. This study analyses the experiences of harm reduction service providers during the pandemic in 34 European cities, focusing on their main challenges, adaptations, and opportunities for change. A closer examination of Athens and Dublin offers an in-depth look into these experiences.
Methods
A mixed-methods approach is used, integrating qualitative and quantitative data. Two surveys conducted in 2020 and 2021 involved 34 European cities. In-depth and informal interviews with four local experts from Athens and Dublin complemented the analysis.
Results
Despite significant disruptions, many harm reduction services scaled up their operations and achieved favorable policy reforms that were met with resistance before the pandemic. In Athens, major gains were opening the first housing program, the first drug consumption room, and the liberalization of naloxone. In Dublin, new housing, lowered thresholds for methadone provision, benzodiazepine provision, and improved naloxone availability were key gains.
Conclusion
The pandemic triggered opportunities for policymakers to reframe matters of social equity in the field of drug policies, opening policy windows to further advance harm reduction. Based on these lessons, recommendations to improve social justice and equity for people who use drugs are provided.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Notes
1 C-EHRN is a European civil society network in the drug use and harm reduction field, with participants ranging from grassroots and community-based organisations through service providers, drug user organisations to research institutes. The network currently has 170 organisational members from most European countries.
2 Cities partaking in the survey in both years were: Amsterdam, Antwerp, Athens, Barcelona, Berlin, Bern, Bratislava, Bucharest, Budapest, Copenhagen, Dublin, Glasgow, Helsinki, Krakow, Kyiv, Ljubljana, London, Luxembourg, Milan, Nicosia, Novi Sad, Paris, Porto (Villa Nova de Gaia on the map), Prague, Rijeka, Rome, St Petersburg, Skopje, Stockholm, Tallinn, Tbilisi, Tirana and Vienna. Kristiansand was no longer an FP in 2021, and Malta started as an FP in 2021. Podgorica skipped the survey in 2020 and Vilnius in 2021.
3 The main services provided (offered by more than 50% of FPs) are outreach work; HCV and HIV prevention, testing, and treatment; drop-in centres; NSP; STI prevention; and legal support. Less than 15% of FPs provide housing or shelter, Heroin Assisted Treatment, or Drug Consumption Rooms.
4 DCRs and drug checking services, however, do not exist in most of the cities that took part in the survey.