 Fel fawr, wrth gwrs, mynd i chi'n fforddwch. Rwy'r fawr bywyd yn ymrydio'r gweithiau bod ystafellrol yng Nghymru, a'r ffocosio ar Weston i Eurfe, a'r Gweithio ar gyfer 2016, bod gyrfa'r Gweithgweithiaeth eithaf, os yw mewn tekis, ar gyfer y Gweithgweith Gweithgweithgysig,所有 yr gweithgwyr weithio yng Nghymru, mae hynny'n cymryd y salafio ar gyfer gweithgweithgwyr a byddwch yn cyd-dweud y gwaith yw'r ffordd yn ymddangos. Mae'n ysgol yng Nghymru, mae'n cyd-dweud, ac mae'n gweithio acyddiolol yma, ychyddiolol Yn Ymddangos Llywodraeth, ac mae'n gweithio Llywodraeth Yn Ymddangos Llywodraeth, yn y ddweud i'r cyfrifio'r cyfrifio ar gyfer y cyfnodol. Mae'n cyfrifio cyfrifio'r cyfrifio'r cyfrifio ar y cyfrifio'r cyfrifio. Mae'n gweithio'r cyfrifio'r cyfrifio, I might have to go quite quickly, but if I'm going too fast, just give me a shout. First up, needle and syranged programmes. They are present in all countries in Western Europe for which we have data except Turkey, which falls into our category of Western Europe. Overall, in the world we've seen a decline in the number of countries over the last two years providing needle and syranged programmes driven in part by Latin America, where it's more to do with a lack of demand now, but also in places like the Philippines and Laos, where there's a lack of support for those programmes. The general trend in Western Europe is for an increase in the number of needles distributed, so in seven countries we've got concrete data to say that there have been increases in the number of needles distributed. Elsewhere there have been some decreases in that number, but it's mostly due in Western Europe at least, it's mostly due to a lack of demand in places such as Spain and the Netherlands due to changes in patterns of drug use. Syranged dispensing machines are operating in at least six countries in Western Europe, having been launched in Cyprus since 2016. The barriers to access needle and syranged programmes where they operate, regional variation is something that's going to come up a couple of times as a barrier in this presentation. Needle and syranged programmes tend to be centred, or at least concentrated in urban areas, provincial capitals, so people particularly in rural areas tend to get left out of that. There is a perception reported by civil society that these services are targeted towards people who inject opioids, which means that people not injecting opioids, whether they're injecting amphetamine-type stimulants or image and performance enhancing drugs tend to feel that these services aren't for them. The services are for opioid users and in particular for male opioid users, which is why women as well as LGBT communities often have similar perceptions and feel that these services don't necessarily address their specific needs. OST is available in every country in Western Europe. Heroin assisted therapy, which we consider to be a high standard of OST given that it produces greater adherence and lower likelihood of use of heroin bought on the street. It's available in six countries plus pilots in Luxembourg that's happening now and one upcoming in Norway from 2020. Barriers to access here. A requirement for abstinence is a big one. In Luxembourg, for example, people on OST are required to abstain from use of all illicit drugs. In Germany, regulations have softened a bit and the official target of OST is no longer abstinence from all illegal drugs, rather just heroin, which is not perfect but a step in the right direction. Services for migrants in particular where we have OST based on health insurance systems, migrants particularly undocumented migrants, anyone that doesn't have health insurance is left out of those women and people in rural areas again for the same reasons as NSP tend to face greater barriers to access. Of course, one of the key reasons that we talk about NSPs and OST is HIV and hepatitis. 5% of new HIV infections in the EU in 2016 were due to injecting drug use, though there has been an overall decline in the number of new infections among people who inject drugs. However, there have been outbreaks of HIV where services are lacking, so we heard yesterday that there was an outbreak in Athens, also Luxembourg and currently ongoing in Glasgow. As for hepatitis C, official restrictions on access to direct acting antivirals have slowly been lifted, they were previously based on the high cost of treatment and now only six countries are placing those restrictions based on either drug use or the stage of the disease. Only two countries are placing restrictions based on drug use, that's Cyprus and Malta, and just as an illustration, 92% of new infections in the UK are among people who inject drugs. But the real key here is that people who inject drugs still face stigma and discrimination when accessing these services. The policy may say that there are no restrictions based on drug use, but what we've heard from civil society is that there's a gap between what the policy document says and what happens on the ground, and in that gap, often there are health professionals who are either not used to dealing with people who inject drugs or are not inclined to treat people who inject drugs. In 2016 there were 9,138 drug-related deaths in the EU, Norway and Turkey, which I'd guess is, let's say, 25 times the capacity of this room. 84% of them involved opioids. Two-thirds occurred in just three countries, Germany, Turkey and the United Kingdom. In Scotland 2017 was the fourth consecutive year that drug-related deaths had been the highest on record, and there were 934 deaths. 87% involved opioids. Also 59% involved benzodiazepine, so some maths tells us that there's some poly-drug use involved there playing a role. Two key responses to overdose. Firstly naloxone specifically for opioid overdose and also drug consumption rooms. So to start with naloxone, across Western Europe we see that it's widely available in Western Europe in medical settings, so in hospitals, emergency rooms. And then we can draw a distinction outside of medical settings between take-home naloxone and peer distribution of naloxone. So take-home naloxone would be something like the model that operates in Ireland and France, where naloxone is distributed to people with a prescription, either in drug services or by a GP. And we can contrast that. There are eight countries that operate such programs, including the three which I think is actually four I heard this morning that Denmark, Italy, Norway and the UK all have some level of programme, all have some level of programme of peer distribution of naloxone, ensuring rapid distribution of naloxone to target groups by not requiring prescriptions, or in the Italian model providing naloxone over the counter. Drug consumption rooms, also known as safe for injection facilities, overdose prevention sites. In Europe, drug consumption room seems to me to be the most appropriate vocabulary given that we're not just talking about injecting and we're not just talking about opioid overdose. These facilities serve people who inhale drugs and people who inject drugs other than opioids as well, particularly in places like the Netherlands where injecting opioids isn't really the most common means. There are 88 drug consumption rooms in Western Europe in eight countries, so that means one is the overall number has remained pretty stable, one new country joining that group, which is Belgium and Ireland and Portugal with plans for DCRs in the near future. The global figure will show a greater rise mostly due to opening new facilities in Canada and barriers to access, regional variation again. We can say that drug consumption rooms operate in Spain, but actually drug consumption rooms operate in Catalonia and the Basque country only. So there are still 17 of the autonomous communities of Spain, as an example, that don't operate drug consumption rooms similar in Switzerland and Germany. This tends to be more relevant to those places that have highly devolved administrations. The corollary to people on OST being not permitted to take illicit drugs is that people on OST are also excluded from drug consumption rooms. But really the biggest barrier to people using drug consumption rooms is that they don't exist in a lot of places and a key reason for that is political opposition. Probably a good example for this is Scotland where the city of Glasgow approved the drug consumption room, the Scottish Government approved the drug consumption room, the Scottish Parliament approved a drug consumption room, but the UK government in London and Westminster blocked that proposal. So even though they'd got through three levels of government, it was still thwarted by a veto actor at the last moment and you can see that in the US as well. So as I just mentioned, amphetamine-type stimulants and new psychoactive substances are relevant to drug consumption rooms in Western Europe and to needle and syringe programmes. But overall harm reduction for these substances lags behind that for opioids. This is the first time that we're covering this in the global state of harm reduction because we are seeing an emerging field of interventions. We have safer sniffing kits, safer smoking kits, social intervention, substitution, online interventions and drug-checking services, which is probably, well, I don't know, it's maybe one of the most significant ones at least. They operate in at least eight countries in Western Europe to which we can add several countries in Latin America, Australia, New Zealand, Canada, the US, Poland, Czech Republic. They're increasingly present. In Western Europe the concern tends to be with purity or that is high doses in pills. A gael example is from 2015 to 2016 the amount of MDMA in each tablet in Zurich increased by 27%. Generally these tend to be privately funded either through public donations, crowdfunding or by charging fees at the venues they go to. So that would be for on-site services, parties, festivals, that kind of place, fixed site services accessible by post or walk-in services, which in Zurich and Byrn have been found to access a slightly different group of amfetamin user people that tend to be in more vulnerable housing situations, for example. Finally, I think, harm reduction in prisons. We know that drug use is prevalent in European prisons and it's not just NPS, which are highly prevalent and much more than they used to be in cannabis. 13.3% of prisoners in Belgium report using heroin while incarcerated. Of course even apart from drug use being prevalent in prisons, the period while you're in prison and immediately upon release are very high risk for opioid overdose. OST broadly though is available in Western European prisons although often on a more limited basis than in the outside community. For example, we've heard of places in Portugal where you have to be transferred to a different facility which means you have to go sort of guarded and you have to be supervised while you go to receive OST. A 2016 European Court of Human Rights ruling found that the denial of OST while in prison violates Article 3 of the European Convention on Human Rights. So this is an obligation for every country in Western Europe. NSPs are only available in four countries in prisons, that is, in Spain, in all prisons, in one prison in Germany, one prison in Luxembourg and about 10% of prisons in Switzerland. So that's a real area where there is room for improvement. Only four countries providing the locks on release with any sort of regularity. Those are Denmark, France, Norway and the UK. In none of these is it. A blanket policy. Inside prisons, it's available to prisoners in Germany, Italy and Norway and available to prison authorities only in Italy, the Netherlands and Switzerland. Not Germany. No. The latest harm reduction, the global state of harm reduction, which contains all of this information on each of our nine regions in the world will be launched on December. So just a few weeks time. Thank you very much.