 We are at the first meeting of the European Harm Reduction Network in Marseille, France, where harm reduction activists, professionals and policy makers gathered to discuss the challenges and problems ahead of the harm reduction movement in Europe. I know the impact of harm reduction in my country. Drug users have a job, have a home, are in treatment. If they use, they do it in a safe environment of a consumption room. Last year, in 2010, in the entire country of the Netherlands, there was only one infected person with HIV reported, one new case of HIV among drug users in an entire country. Thirty years ago, that was 30% of all infected drug users. Same rates about overdoses that has dramatically gone down. So if we want to talk about evidence about harm reduction, that battle has been won. We don't need to talk about evidence. It has become European policy, although harm reduction has become mainstream, there are still huge challenges ahead and that's one of the issues that we're going to discuss over the next days. We witnessed the emergence of new populistic policies and serious budget cuts in all countries of Europe. This year we went to the European Parliament, there was a hearing on public health issues and we asked the members of the European Parliament what can they do to support harm reduction in the European level. And one member of parliament answered that, you know, now we are struggling for keeping together the European Union, so we really don't have this issue in the agenda. One of the major problems is to keep this issue on the agenda. Harm reduction works. I mean, it works everywhere and it works also in France. We have basically reduced the prevalence of HIV among people who inject from 40% to 11% today. I mean, the result has been really immediate. In terms of overdose related to heroin, the reduction has been by 80%. That is an absolutely amazing success in terms of public health. And also in terms of criminality, the drug related crime also has decreased by 80%. So all these are like the major successes of harm reduction in France and I'm happy to say that still today, the French harm reduction system is still largely publicly supported for the long term. We are very happy about what we got in the 90s. Right now, we're basically trying to save the system. A lot of NGOs are facing very severe problems because of the budget cuts. We still do not have safe consumption rooms, even though in some neighborhoods they will be really life saving for many people. We still do not have any needle exchange in French prison, even though we know from Switzerland, for instance, right next door, that it's really simple to implement. We have a French government that has some populist tendencies that actually like to blame some people for the problem of the social problem that we're facing today and drug users are really an easy target. The simple use of drugs in France can be very harshly punished. Use and detention of drugs in France can be punished from one to ten years in prison unlike fines ranking up in the thousands or even millions if you look at the law. And this law is actually applied. You have tens of thousands of people who are facing serious personal problems because they're just users. And just stopping that oppression of drug users because it costs a lot of money, it costs a lot of police time for harassing poor people basically. Just stopping that will actually save a lot of very needed governmental cash that could actually be used to develop social programs. I think we do have achieved quite a lot, although not sufficient, consisting of needle exchange programs all over the country. In 200 cities there are automates outside, publicly available, 24 hours, seven days. We do have some 80,000 drug users in substitution treatment. There is heroin assisted treatment available. We do have some 25 drug consumption rooms in 18 cities in Germany. In 2010, only 3.2% of all the diagnosed HIV cases were drug related. And this is quite the lowest figure we ever had in the last 20 years. And this is, I think, the most striking success. Another success is that drug users get older and older. Germany is quite heterogeneous and very diverse. And there are huge treatment gaps from north to south and from east to west. Most of the people in prisons will not have access to opioid substitution treatment. Only a tenth of those in the community, there are only 3 to 5% of those who are in need of this treatment, will receive it. There's only one out of 220 prisons who offer a needle exchange program and automate and other services like Naloxone on release to prevent overdosage after release are non-existent. The most important policy action would be a decriminalization, a drug policy reform, which is badly needed. At the moment, it's completely untouched the whole area, although we have got a quarter of a million drug-related offenses year by year and 100,000 of them only for the possession of small quantities for personal use of cannabis. Oslo has a very, very large amount of overdose deaths. One of actually the cities in Europe with most overdose deaths per capita. In Oslo, there is one consumption room and that's the only consumption room in Norway. It is a very important harm reduction measure, but the consumption room still has a very small capacity. It has opening hours that are quite rigid and it's not open for a very long time. We have a lot of harm reduction measures. We have both a lot of cafes where drug addicts can come and get food. We have a needle exchange. The substitution treatment has grown and before it used to be a very rigid system. There has been a softening up of the system, which is very, very good. Spain had half a tradition of hard production about 15 years ago. Barcelona had seven consumption rooms, more or less maybe 15 drop-in centers. We have a lot of themes of outreach work in the streets. Did these consumption rooms change the picture on the street? Like there are less drug users using on the street and going more to consumption rooms? Is it an effect like that? Yeah, of course. I think that these kind of resources are very, very effective. But now we need to work for the hepatitis. 70% of the drug users, injected drug users, are infected by the hepatitis C. We have a decreed law that frameworks the harm reduction intervention in Portugal. So that's a great achievement. With decriminalization, we start to look at users, not as a criminal person, but as a person with a disease. Some people from the Portuguese state and from the Portuguese government, they could look at harm reduction as a philosophy that believes, accepts and tries to work with the drug user, not as a sick person, but as a citizen. The state has instrumentalized NGOs from civil society to do a great hell of a job with a few amounts of money. For sure, between 3% and 5% of the Portuguese budget state to the drug field is only dedicated to harm reduction between 3% and 5%. And I'm being generous with the numbers. Even though harm reduction is officially recognized, it is not directly supported by the state, with one exception, which is the Ministry of Justice, the National Prison Administration, which introduced funding for syringe exchange programs and opiate substitution treatment in prisons. Most harm reduction services are based in Bucharest. Even though we have scaled up needle exchange programs and substitution treatment in Bucharest, the access is still low compared to the full population of drug users, especially opiate users. Well, I think the main success is that we are still existing, that there is some harm reduction, which is existing. And while we can't even speaking about the scaling up, because in the last years there were closed of the project, some of the project has been closed, and because of the budget cuts and the situation we have, we just don't know what will be the next year. People are going to prison and serving in the prison for very small dosages. The IRA made a global state of harm reduction report a few years ago and it mentioned Hungary as a good example, which has a very progressive harm reduction oriented drug strategy. And last year our new government just rejected this progressive drug strategy and now they are retrafting a new drug strategy based on zero tolerance approach. In Poland there is access to the opiate substitution treatment, but there is still very limited. There is big region, a geographical region of Poland where there is no any opiate substitution treatment. We have also needle exchange programs. There are in two, the biggest cities, Krakow and Warsaw. Last year we parliament approved new law, which opened the little window of opportunity because in cases where somebody possesses a small amount of the drug, prosecutors can abandon the idea to start prosecutions. So this is really small liberalization. 80 million swathes, so approximately 40 million of dollars, are spent for that very restrictive law. What have you achieved in terms of harm reduction in the past in Ireland? The HIV within IDUs is falling. Hepatitis C within the IDUs is obviously rising. And obviously services are being curtailed back. I would love to see drug consumption rooms in Ireland to actually roll out have a national hepatitis C strategy. Again, that's not there at the moment. National overdose prevention strategy as well. The UK is one of the birthplaces of harm reduction in Europe and the world, particularly with the initial projects in Liverpool that then spread across the rest of the United Kingdom. And through the 80s and 90s we had very successful harm reduction programmes and there was a very strong awareness that these programmes should be driven by public health and the need to prevent HIV and other blood-borne viruses. The way we have set up our drug services in the UK, I think, stifles innovation. It makes for a very bureaucratic response and this is not helpful when drug scenes are changing very, very fast. What do you think about the smaller coalition partners' idea to decriminalise drug use? I think it's very positive that we now have two political parties in the UK that are talking about drug law reform very openly, which is the Liberal Democrat Party, which is part of the government, but also the first Green MP from Brighton is now also talking about the need for drug law reform very seriously. And my hope is that actually the financial crisis may actually be the thing that says this is not about ideology, this is not about morality, this is about funding. And prohibitionist models are very, very expensive and lead to growing costs as you do more damage to the health of people who use drugs. So I hope that we actually may persuade people that of all times it's in the middle of a crisis that you go for the best value for money model, which is harm reduction.