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In Finland, 2006, a conference was organized in close co-operation with the Pompidou Group to 'promote constructive dialogue, provide information and share experiences between drug policy authorities in order to improve the effectiveness of their work'. A proposal to set up a European network in conjunction with the Pompidou Group in order to tackle drug problems was adopted resulting in the merger of EXASS Net. The inaugural meeting held in Helsinki, April, 2007 focused on drug related health problems. The second EXASS Net meeting in October, 2007, was held in Lancashire, England with representation from Croatia, Finland, Germany, Ireland, Netherlands, Romania, Ukraine, France and the Russian Federation, joined by colleagues from the Home Office in London. The meeting, hosted by Lancashire Drug and Alcohol Action Team (LDAAT) provided me with my first interaction whilst hosting a visit to HMYOI Lancaster Farms. The delegates enjoyed a presentation highlighting interventions, support and programmes available for both young people (15 years to 18 years) and young adults (18 years to 21 years) followed by a tour of the Substance Misuse Department. An opportunity was taken to have a constructive discussion with Thomas Kattau (Administrator of the Pompidou Group) which suggested the aims of both EXASS Net and the UK Drug Workers Forum had many commonalities. The third meeting was held in Frankfurt, Germany in May, 2008, and an invitation to attend was accepted. The UK Drug Workers Forum provides an arena to share experiences but to network and assess the methods of reducing the harm caused by substance misuse in Europe was seen as an excellent opportunity. The following report provides a vivid perspective of the third EXASS Net meeting:-1. Frankfurt faced an open drug scene in a city park and around the main railway station during the late 80s and early 90s that was of a dimension without precedent: at an average 700 and up to 1000 injecting drug users were present on this scene day and night. Zurich and Frankfurt were the most affected cities in Europe by the number of injecting drug users in open drug scenes.
2. An average of 60 drug injection related medical emergencies per day requiring ambulance/doctor assistance cost the City over € 6000 a day. Intensified repression and policing of the situation led to an on-going displacement of the scene which finally ended up in the gardens of the well to do districts of the City.
3. There were nearly 6000 registered drug users (being recorded by the law enforcement agencies) at the time with a dark field estimated 3 or four times as high. Throughout the period of intensified law enforcement, the number of registered drug users increased as did drug related crimes, in particular property offences. Annual drug-related deaths reached nearly 150 per year in this time.
4. On the political level, Frankfurt's bid for the seat of the European Central Bank (ECB), the presence of the open drug scene directly in front of all major banks, as well as the occurrence of the drug scene in gardens and green spaces of the up-market residential areas, are seen as key factors in bringing about a turn towards more innovative drugs policies. However, on the level of concerned stakeholders at frontline level (law enforcement, judiciary, social and health services etc.) it was probably the sheer dimension of the phenomenon that led to a concerted effort.
5. The 'Monday Round' of decision makers in key positions of the above mentioned stakeholder agencies, as well as the 'Friday Round' bringing together professionals working at front-line level were the informal institutions that created the cooperation in partnership and moved this forward over the past 15 years.
6. The four pillar concept: (1) prevention, (2) treatment, (3) securing survival + harm reduction, and (4) repression and law enforcement, developed by this inter-agency partnership of stakeholder agencies, is still in place today. The number of registered drug users has been reduced by over 30 % and drug related crime is equally down by significant numbers as statistics show. Drug-related medical emergencies are down from an average of 60 per day to approx. 12 per week. And above all, the number of drug-related deaths p.a. fell from 147 (1991) to 24 (2005).
7. A variety of low threshold services are established in various parts of town, dealing with different types of drug use and associated health and social problems. There is virtually no more visible open drug scene in Frankfurt. The passage from the railway station to the city centre has become safe again and the park in the banking district is clean and frequented by families and children again. Today's main concern of public nuisance in the park is fast bicycle riders.
8. A detailed timeline on the development of the local drugs policy and consolidation of the drug user support services in the City of Frankfurt has been prepared by Jürgen Weimer and is included in appendix 1.
Observations
9. The programmes and interventions developed under the four pillar approach 15 years ago are still functional today with little modifications. Changes in drug cultures, consumption patterns, like poly-drug use etc. were successfully addressed by the existing approach. Flexible responses are ensured through specific projects in which different front-line services and professionals regularly engage. Professionals and other drug workers delivering front-line services show a continued high level of motivation. These factors, together with the statistical indicators on drug use and crime, suggest that the approach and the applied low-threshold services have worked and are still working. This is further corroborated by the fact that the concept has not been dropped by any city government during the last 15 years despite various changes across the political spectrum.
10. Approaches that push or force drug users into services and treatment had not worked in Frankfurt. It appears to be a key strength that the post 1992 approach seeks to facilitate an infrastructure of services and interventions that allow drug users to manage themselves. This infrastructure provides various entry ways into stabilisation, maintenance, treatment and eventually abstinence. It allows the drug user to be channelled into a passageway of life situation improvement based on his readiness to do so. The system also provides for the most problematic groups of chaotic drug users who have multiple therapy failures and suffer from HIV/AIDS, hepatitis etc., by providing a heroin medication programme.
11. A high degree of discipline among drug users was observed when visiting different projects and low threshold services around town. Most professionals working with drug users attributed that to the fact that (1) rules are clear and simple, (2) not too many rules, (3) sanctions are not unreasonable, (4) in the event of failure there is a path to return. Above all, drug workers concluded that it was the concept voluntary participation and the fact that the services offered a true improvement for the life situation of the drug users led to an overall more disciplined behaviour. Drug users feel that the services offer them something they need and want; consequently they are willing to accept the conditions, even if it is sometimes hard for them to comply with them.
12. Participants noted that there were no real user involvement or participation structures in the planning of drug policy strategies, delivery of services or management of institutions delivering the services. For the stakeholders participating in the Frankfurt partnership this has so far not been an issue. Some practitioners met during visits had expressed reservations about involving ex-drug users in services since the proximity to substances and the drug scene were seen as putting them at a too high risk to relapse.
13. For the short term future the Drugs Department of the City of Frankfurt looks to a further consolidation of available services for drug users. One of the priorities is to increase the availability of heroin treatment following the successful trial phase. In the medium term different types of services will require further adaptation to evolving consumption patterns and drug scenes/cultures. Several practitioners expressed concern about the growing number of refugees with drug use related problems. This target group is often difficult to reach with the existing capacities and competences of staff. In addition a high level of reluctance to accept formal help, including emergency interventions, is observed among this target group. Based on a deeply rooted general fear of official organisations help offered is frequently initially rejected.
14. An increase of different ethnic target groups, due to the expansion of the Schengen space and a generally greater mobility within Europe and neighbouring regions, will require more qualified personnel with inter-cultural and language competences. There is a difficulty in hiring students and professionals from immigrant backgrounds. The wish to work more in social fields, as well as possibly different personal perspectives on drugs problems make it hard to recruit professionals from this background. Consequently practitioners expressed the need for more professional exchanges between countries and direct working contacts between frontline professionals in Europe.
15. While the present approach appears to be sufficiently flexible to meet and adapt to emerging changes, the general recruitment of staff to work in this field is becoming more challenging. Among areas of employment in the social field the drugs services find it increasingly difficult to recruit young professionals. 20 years ago prevailing youth cultures stipulated altruism and support of the vulnerable; at the same time drugs policies were based on the belief that you can help all drug users to live a drug free life. With the emergence of HIV/AIDS, new substances (eg.synthetic drugs), poly-drug use and a better understanding of addictions the focus of modern drugs policies has now shifted towards an emphasis on managing the situation rather than pursuing the utopia of drug free societies by eradicating the drug problem once and forever. This coupled with an overall culture that has moved more towards self-fulfilment and individualism might offer a starting point to explain that working on the frontline of drug-related problems is less attractive then it might have been previously.
16. The Pompidou Group and the EXASS Net would obviously be well placed to look into further possibilities to facilitate a more international exchange of experience and support methods for professionals to assist each other. Study visits and work exchange programmes were among the specific requests articulated by many professionals that were met during the visits. There was a general feeling that while there was a lot happening on different levels to support European integration, the needs of professionals working in the drugs field concerning the consequences of European integration and globalisation -in particular the consequences of increased mobility and migration- do not appear to be sufficiently recognised and met so far.
Frankfurts experience of dealing with their problematic drug use appear to provide positive results, 147 drug related deaths in 1991, 24 in 2005. availability of heroin treatment, allowing drug users to manage themselves, drug clinics etc etc.
Representatives from EXASS Net have been invited to our National Conference in York when we will all be able to deliberate how Europe are meeting the challenges arising from problematic substance misuse. I believe we have a lot to learn, what do you think?
Mick FowlerClick here to download this report in pdf format