Side Event: Reducing Health Risks of the Use of NPS in EECA Region – Organized by the Governments of Estonia and the Republic of Moldova, and the Eurasian Harm Reduction Association

Aljona Kurbatova (National Institute for Health Development, Estonia): […]

Dr. Z hannat Kosmukhamedova (UNODC): The UNODC published a technical guide, the ‘HIV Prevention Treatment, care and support for people who use stimulant drUNODCugs’ to increase awareness of the needs and issues faced by affected groups and to provide recommendations in responding to them. The global HIV infections have gone down in number but the decline is not fast enough, especially among key population groups. You can see statistics inside the handbook and it shows sexual partners of key populations are heavily affected. 47% of new infections globally come from key populations. The risks of acquiring HIV are much higher among sex workers, transgender people and men who have sex with men. We conducted two regional workshops for eastern European countries: Moldova and Ukraine. The estimation of the problem in these countries is lacking but we have a few figures that indicate the scale of the issue. The sexual way of transmission has increased why the parental way has declined. Prevalence of HIV, HBV and HCV are higher among those who use opiates. In Belarus, we saw a number of new HIV cases still going high, though the prevalence among people who inject has declined since 2015. Among key groups, people who use drugs were the most affected. We conducted a “Darknet study” in Belarus and identified the most popular drugs. The growth in sales was 500%.
HIV and Stimulants – policies and barriers: Policies are mostly absent or fragmented. Barriers are access to target group(s), stigma, lack of knowledge and understanding. What steps can we take? We assess needs, develop country-tailored technical guides on prevention and treatment, community outreach program. We work together with NGOS, key populations and the ministry of health.

David Subeliani (ENPWUD): From a drug user perspective, on synthetic cathinols. I come from Georgia, a particular group of drugs are drawing a lot of attention. The states in general are not ready to respond to NPS posed problems. There are so many new drugs on the market! We have a lot of anecdotal knowledge but I have done smaller scale descriptive study where we reach out to a few hundred people who use NPS to understand what is actually going on. There is a number of NPS that mimic the effects of Cannabis, these dominate the market mostly. Psychedelic NPS are also emerging as the access to traditional drugs is restricted. So, people reach for these alternatives before the legal system can respond to the new market dynamics. But then it can happen people develop relationships with the new drugs. A lot of cannabis-type NPS on the market: school-aged kids (14-17) use NPS EU average around 7%. Nowadays the main complaint is that kids are smoking weed, but when it’s gone, more harmful alternatives surface, so we have to assess which is more dangerous? If we squeeze out substances from markets, users will find ways to achieve similar effects with other means. I saw a fast change on the drug scenes in Easter European Member States – cities have moved on from traditional illegal drugs to whatever the market was able to provide. A very aggressive takeover on the market. It increased the risk of infections as the effects are wearing off maybe faster and users might need to administer more often.
Methadone treatment is not part of the formal protocol but is available here and there. The target population should be people who use drugs and their friends and family. There is a huge distrust against people who use drugs. I had my share of issues with my family as an openly user of drugs, so they have to be part of education.

Eliza Kurcevic (EHRA): We conducted a research with Swansea University about NPS use in Belarus and Moldova to collect data on use, needed services, etc. In Moldova, ca 40K PWID, 12K registered with dependence, 14% has HIV. Belarus 66K PWID 8K registered with dependence, 30% HIV prevalence. The most common used drugs are NPS – so why is NPS use growing so rapidly? People responses were mostly about costs, easy access, darknet expansion, repressive drug policies, free movement of goods and products in the EU (+regional relations). We’ve conducted focus groups and interviews with people with lived experiences and we found most users are poly-drug users, they have easy access even on social medias, they think NPS are very low cost, they usually smoke or inhale. Loads of young people are starting to use NPS and there is no age-appropriate support or harm reduction services for them. It is hard to determine NPS as the formulas change often, so users often have the intention to avoid drug testing to interfere with their substitution therapy. In Belarus, we found some specifics; the legal liability status starts at 14 (even for use of drugs), we also saw a rejuvenation of the key group, the price has decreased and informal networks span all online platforms for purchase. Key risks and consequences related to NPS use in both Moldova and Belarus: mental health support is the most needed response. In Belarus, people are resistant to call an ambulance on an overdose because they will be taken into prison – the ambulance arrives with police and the person who called the police will be indicated as a criminal for not intervening in the consumption. Our recommendations: periodic data collections from various stakeholders, research risks and consequences on NPSC consumption, adjust harm reduction programs and implement relevant interventions, adapt existing interventions and ensure effective work together with the affected populations, review repressive policies and redesign it based on evidence.

James Nicholls (Transform): Q&A

Audience: There is no drug checking in any of your countries so how do you know what the substance really is?

Eliza: In our research it was self-disclosure, responders based in on the information they got from their provider.

[…]

Audience: Did you see relevant differences for women? Have you interviewed only adults?

Eliza: Yes, we only collected data from adults but I hope we will be able to do it with adolescence in the future. Regarding women, not so many of them attended the focus groups – in the online formula, we have a good percentage of female respondents but we assume based on the cultural context, women were less keen on admitting their use.

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