 Welcome to the webinar on COVID-19 and drugs in the European neighborhood lessons learned from Ukraine and Georgia. Before we begin, I would like to underline that this webinar is special for the EMCD as it's the first one where we start to share experiences of our collaboration with countries outside Europe. This time, we will be looking at Ukraine and Georgia, two countries in the East European neighborhood policy area. The agency actually has a long lasting cooperation with both countries, which is based on the working arrangements. However, since 2019, this cooperation has been strengthened thanks to the EU for monitoring drugs project, which is launched by the funding of the European Union. More information about the project you can also find on our website. So what we will do in this webinar, we will see what has been the impact of the COVID-19 pandemic to people who use drugs and their daily practices in Georgia and Ukraine. And we will also see how this situation has evolved between March and September 2020. And then we will also discuss how these experiences resonate with observations elsewhere in Europe and what might be the long term impact on the drug related health services. It is my pleasure now to present the panel. Today we will hear from Dr. David Otiashvili. He is a director of the Addiction Research Center, Alternative Georgia, and also associate professor of healthcare at Ilija State University in Tbilisi. Dr. Otiashvili was the initiator of this study, which will be presented during the webinar, and he also represents the work of the Georgian Research Group. Dr. Tatiana Kiryazov, the Senior Research Scientist of the Ukrainian Institute of Public Health Policy, will present the work done in Ukraine. Our panelists of this class will today be Mr. Julien Moral Darlo, director of the French Monitoring Center for Drugs and Drug Addiction, and active member also of the EMCDA-RATOX Network. Ms. Ketevan Zaragesvili, she is a chairperson of National Drug Observatory at the Georgian Ministry of Justice, and this National Drug Observatory is our main institutional partner in Georgian. And last but not least is Ms. Katarina Terich, a specialist at the Viral Hepatitis and Opiate Dependency Department of the Public Health Center of the Ministry of Health of Ukraine. Ms. Terich is also the national coordinator of the Opiate Substitution Treatment Program in Ukraine. So, now, when all the panelists are introduced, I'm very happy to move to Kyiv, and it is my pleasure to give the floor to Dr. Tatiana Kiryazova to begin the presentation. Good afternoon. We're happy to present the results of our study, impact of the COVID-19 epidemic on drug markets, substance use patterns, and delivery of harm reduction and treatment services, which took place in Georgia and Ukraine in March-September 2020. On the second slide, you can see Georgia and Ukraine on the map of Europe, and the next slide shows research teams of both countries, Georgia and Ukraine. The next slide shows the COVID-19 pandemic and how anti-pandemic measures were rolling out in both countries. So, you see the similar epidemiological situation in both countries, and regarding response measures, in both countries, strict lockdown took place in March-May 2020, including public transportation closure, and then partial release took place starting in May, in the end of May, and then the introduction happened of restrictions in September. The background of drug use in both countries shows that in Georgia, estimated prevalence of people who inject drugs is 2.2%, and most popular opioids are heroin and buprenorphine. Stimulant use is also prevalent, and new psychiatric substances are on the rise. HIV prevalence being 2.3%. In Ukraine, the prevalence of people who inject drugs is less than in Georgia. Drug scene is dominated by opioids, and historically it was so-called Shirka, homemade opioid. More recently, it was substituted with illicit methadone on the drug scene, and stimulant use is about 40%, as reported by the study participants. New psychiatric substances are also on the rise, and HIV prevalence is 10 times higher than in Georgia. The methods of our study was prospective cohort study of people who use drugs. There were 50 participants in Georgia and 51 participants in Ukraine, and each two weeks cohort participants filled online questionnaire answering questions about past two weeks about their drug use, drug availability, and access to services during this period of time. You see, this is shown with green circles, and yellow circles shows monthly conducted in-depth interviews with four key informants in each country. They were physician at WIT site, physician at detox clinic, harm deduction provider, and drug user community representative. To learn more about the context of the study, we conducted in-depth interviews with cohort participants twice at two points, three months at six months point during the study. The next slide shows the results obtained in Ukraine. At the next slide, you see our cohort participant characteristics, and you see that of the all 51 participants, almost one third were women. The mean age of participants was 38 years old, and mean duration of injecting drug use was 19 years, and all of them had history of injecting drugs, and of all the participants, 44% were unemployed. Slide 9 shows psychoactive substance used during lifetime and within past 12 and 3 months reported by participants of our study. As you can see, there are substances which were rather popular before, but are not used by our cohort anymore, such as heroin, cocaine, or LSD. At the same time, some substances, such as homemade opioids or pervitin, were used widely before, but not during past three months, and the most widely used was elicit methadone. More than 70% of our cohort were currently using this substance. The main trends we saw in this study, which actually aimed to monitor the trends in the drug scene and substance use practices, we see that while the use of other drugs was fluctuating, but not significantly changed, we see that the use of elicit methadone was gradually decreased. From the start of the COVID-19 pandemic and the strict lockdown introduction, while the use of medical methadone was abruptly increasing in the first one and a half months, and then stayed rather high compared to the pre-COVID times. Thank you. And talking about elicit methadone here in this study, we mean the methadone, the synthetic opioid, which is produced in powder or crystals, produced in clandestine laboratories and distributed mostly through starches or dead drops. And when we talk about medical methadone, we don't mean in this study the methadone from pre-governmental programs. We mean the medication in the form of pills distributed through pharmacies, and people get access to this methadone using prescriptions got from the licensed private physicians. And this is important to keep in mind that until recently the legislation allowed these private licensed physicians to prescribe methadone and buprenorphine for the so-called detoxification purposes. But in practice, there was no medical supervision, no follow-up for the patients after the prescriptions was issued, and a substantial proportion of these medical methadone obtained by prescriptions from these private providers actually appeared on the black market. And you see that the sources of this methadone were mostly starches, elicit methadone starches, and elicit, I mean, medical methadone, these were pharmacies as the main source. And here you can see the perception of changes in excess, price, and quality of the drug of choice of our participants. And you see that in the beginning of the pandemic, they perceive excess as becoming harder. They thought that price became more expensive and quality became worse, but this time, during six months of our study, their perception more or less returned to the pre-COVID times. Thank you. And regarding injection risk behavior and harm reduction, you see on the left figure that almost half of the participants didn't use the harm reduction services at all, but those who did, they also perceived that the excess to harm reduction programs became worse in the beginning of the pandemic, but then again it returned to the pre-COVID times. And talking about sources of syringes in the past two weeks, I mean, mostly the people bought them in the pharmacy and some got from HR programs. Talking about trends and risk behaviors in the past two weeks, we also see that, keeping in mind that the number of our cohort was 51 person, you see that the trends, I mean, there is some changing variations or fluctuations, but they were not significant. Thank you. Regarding excess to harm reduction services, both key informants and participants, drug users submitted that in the initial phases of the lockdown, excess was reduced, but the programs managed to adapt quickly and react flexibly to the situation and resume service provision, mostly increasingly using new modalities like mobile vans, going through the series in all CDD districts and more widely using outreach services, and also providing sanitizers and face masks, which was very appreciated, especially in the beginning of the pandemic, thank you. And excess to opioid against treatment was described as almost stopped in the beginning of the pandemic admission of new patients. Actually, it was not only reduced, but in Cape City, it was completely unavailable. And you can see on the figure to the left that more than three quarters of our participants actually did not treat, did not receive treatment for substance use at all, but for those who were receiving OAT services, only several people dropped out. And in the beginning, as I said, the admissions was unavailable, and those people actually who wanted to start OAT treatment in the beginning of the pandemic, they switched to these private physicians to buy prescriptions and to buy medical methadone. But the public health center reacted quickly and issued guidance to allow you to take home doses for OAT patients in March. And as well before the pandemic, about 60% of OAT patients in Kiev were receiving take home doses of methadone and buprenorphine during the lockdown, the strict lockdown for two and a half months, almost 100% receiving take home doses and about 80% actually stayed on these doses after the lockdown was finished. Thank you. And to summarize our results, we can say that many people experienced, many people who use drugs experienced reduced access to their drug of choice during the initial stage of lockdown, especially but for the most, they reported that it was restored after their transportation opened. And we saw a significant decrease in use of illicit methadone because of access difficulties when the transportation was closed and public gatherings, restrictions were in place, and many people who previously used illicit methadone switched to medical methadone obtained by prescription from private physicians and bought from many of them were buying the methadone from the pharmacists for themselves, and many bought the pills, like resold by their peers or dealers, and this situation did not return to the previous levels, even after the strict lockdown finished, indicating a sustained change in the drug scene in Ukraine. At least this is what we saw during the six months of the beginning of the pandemic, and harm reduction and OET programs managed to adapt to the rapidly changing situation quickly, and after the less availability in the beginning of the pandemic there is provision without major interruption, and these are the main lessons learned from our study that should be taken into consideration should the strict lockdown be introduced or any other pandemic appear. And thank you very much for your attention, and I'm happy to give the floor to the doctor David Oteashvili from Georgia. Thank you Tatiana, happy to be here and present results of our study and happy to see so many friends in the audience. In addition to the results of a similar study that just presented by Tatiana, we also did the monitoring of online major online drug market for Georgia, so I will also present results of online market monitoring, sample characteristics, we have 50 individual majority were men, a minimum age was 38 and slightly more than half were employed at baseline. This is drug use, lifetime and the past year drug use, no surprises here, cannabis, leading alcohol, methamphetamine harrowing, MDMA would be high, I have to say our sample we tried to make it pretty homogenous, so our seeds, we had eight seeds for recruitment representing different two populations of people who use drugs like so called club drug users, non-injection users, non-injection, different age groups, so our sample was sufficiently heterogeneous in this regard. Next slide please. This is a busy slide, obviously this is a trend in drug use over the six months of the study and it is difficult to identify any meaningful trend. However, a trend in reduction of use of cannabis, alcohol, medicinal, methadone and medicinal, I think were statistically significant. Overall participants used fewer varieties of different substances at the end of the study if compared with a baseline and trend was also statistically significant. All qualitative interviews suggest that there were difficulties in obtaining drugs, specifically in the beginning of pandemic but during the strict lockdown period. The exceptions were medicinal, methadone and buprenorphine which were diverted from OSP programs to node from March 13 all patients on OSP received take home dosing in Georgia. Many individuals who use drugs switched to alternative substances when preferred drugs were not available and particularly club drug users reduced consumption of drugs due to cause of events where they usually consume drugs. There were certain changes in markets, there were certain changes in markets and I will highlight them at the end in conclusions. Next please. There was a flash showing source of clean needle and there were observable increased risk behaviors specifically in March, May, buying drugs in perfumed syringes used or using previously used syringes or receiving used syringes from friends or partners. But importantly, these risky practices were abandoned as soon as access to sterile equipment was restored. In terms of access to harm reduction services, respondents reported that access to services was affected again specifically in March and May during the strict lockdown due to closure or closure of services or reduction in working hours or difficulties with transportation. These findings are in line with data from Georgian harm reduction network who is a major provider of services in the country on the right side. You see that there was a dramatic reduction in HIV testing rates during the lockdown. However, access and utilization of services recovered as I mentioned as soon as lockdown measures were gradually lifted. This was a short report about findings from cohort study. Now Matanga online market and on a map you see four places where this major online drug market offers to deliver drugs which are bought from Georgian segment of Matanga. This is a technology for Matanga scrapping with developed custom software scraper which downloaded data from the site every hour so that we had 24 files downloaded every day. A major assumption during the monitoring, we assume that if product disappeared from a listing or amount was reduced, we consider that the product was sold. These are major findings. Surprising to us, frankly saying, there were over the six months of monitoring from April, including September, there were about 1,300 listings offered by 124 vendors. There were more than 22,000 transactions on Matanga and we speak about Georgian segment of Matanga and overall value of sales exceeded 4.5 million USD dollars. We recorded 19 types of different substances sold on Matanga over this period and cannabis accounted for the largest share of transactions and almost half of sales values. This slide shows cumulative total revenues on the left and number of transactions over the monitored period, cannabis was leading, cocaine was surprised to us. I mean in both in terms of number of transactions and value was second, then metadone, ecstasy and many other substances you can see. Again, probably busy site on the left part, we see monthly trends in transactions leading with cannabis and then if we remove cannabis, we see that the month with the highest number of transactions was not anymore August, it was April and then May. To be noted here, we lost the website for three weeks in the end of June, so we don't have that because it was integrated to a new address which is probably usual practice for such kind of web pages so we don't have data for these three weeks. Next, please. This slide shows similar data but in relation to revenues generated from the sales in Georgian segment of Matanga, again August appears to be the month with highest value if cannabis removed, April now becomes the month with the highest value of sales. Next, and this probably the last slide about Matanga, this is a unit cost, means unit cost of different substances and trends in the change in unit cost. It's difficult to explain why unit prices for some drugs increase dramatically over the period of the study, for example for alpha PVP or metadone or metamphetamine and not increase for others, we don't have all the explanations for these trends. To conclude, availability of drugs during the lockdowns declined and many individuals who use drugs switched to alternative substances. There was visible trend in increased diversion of opioid agronomic medications and many individuals who use drugs engaged in risky behaviors like sharing or obtaining a use of preloaded syringes. However, importantly, these risky practices were abandoned as soon as their access to sterile equipment and harm reduction services was restored. We believe that some individuals who use drugs might benefit during the period of lockdown due to reduced drug use under the lockdown, probably most applicable to so-called club drug users. We observed important very interesting service innovations like utilization of mobile and self-testing technologies, bending machines and take on closing, so service providers were able to show enough flexibility in adjusting to new situations. Drug markets, which was one of our prime interests, were able to function without any remarkable disruption during the lockdown. Adjustment strategies included new places for drug home delivery, increased role of remittalment and support, and in terms of results on a price and quality of drugs results were mixed and difficult to make any conclusions. That's it. Thank you for your attention. We'll be happy to respond to any questions. Thank you, David. Thank you, David and Tatiana for your introductory presentation. We did receive actually three questions, I would say. We received the question and we are keeping received the questions and I will now pose the two of them. The question comes on which antihistamine products are used and is there a addiction on pregabalin in your population? And maybe David and Tatiana could briefly respond that. Yeah, I can respond regarding the Ukrainian situation that our main antihistamine drug is dimetrol or diphenhydramine and it is used also in injection. It is actually added to the opioids to the syringe directly to prolong the action of the opioids. And especially during the pandemic when in the beginning the prices a little bit increased, the people were using this dimetrol and sent out more actively to prolong the action of the sometimes smaller doses they could buy of the opioids. And regarding pregabalin, pregabalin is available in Ukraine in the form of pregabalin and also Lyrica and Gabana and it is very popular but mostly as far as I know it is popular to use like in the morning to relieve the withdrawal system syndrome as far as I know. Thank you, Tatiana. Is there anything to add from part of David? No, I think the situation is pretty similar in Georgia. We have few other questions. One of them is what percentage of participants were attained over the duration of the study in each country. And also the participants would like to hear what were the rates of the COVID infection among people who use drugs compared to other people in the population if there are any data and if there are any overdose fatality. If you have anything to comment on? Yeah, can I? Okay, we don't have data on the prevalence of COVID among people who use drugs unfortunately. In our cohort study 27 participants were tested for COVID over the study period and none was confirmed. We had two participants lost for follow up, only two and overall the compliance was very good. We missed only 40 for zero sessions out of six. Tatiana, any comments from your side on this? As far as I know the retention was very high. I think one person died during the study and all other were retained and we don't have data on the COVID prevalence in our cohort or in any other population. Maybe Katarina from the Public Health Centre can add anything. Thank you. Thank you very much. And thank you also this nice introduction because now we would like to go a little bit to the discussion with our panelists. And I already introduced our three panelists from Ukraine, from Georgia and from France. And indeed I would like to start with Katarina and I would like to ask her to comment. How would you comment on this study from your experience and from your viewpoint? Good day to everyone. Many thanks to the presenters because the results of the study are very interesting and have a great importance not only among stakeholders but also as a governmental level too. As a national coordinator of opioid substitutional therapy in Ukraine, I would like to add some points on how COVID-19 influence the OST program. Firstly, I would like to say that the COVID-19 epidemic has shown that the government can be flexible and fast in its decision. And it can be able to quickly respond to factors that may affect the functioning of the OST program. And when on March 2020 the strict quarantine measures were set in Ukraine, the government made a decision to transfer OST patients on take-home medication dispensing for up to 10 days as was mentioned by previous speakers. And for example, in previous years approximately 53% of OST patients were on take-home medication dispensing and started from March 2020. This number of patients increased up to 80% and it still remains at the same level. Such decision was quite risky for the government but such practice really helped keep high patient retention in the program and also according to other reports there were no overdoses increasing upon OST patients on take-home dispensing. Thank you. Also, just a couple of things. Also, I would like to say that despite the strict quarantine, there was a good setting of new patients to the OST program. The previous year was the most effective year since setting new patients to the OST program and it was increased by almost 2,500 new patients despite the strict quarantine measures on the territory of Ukraine. Thank you if you have probably questions about OST program functioning, I am ready to answer. Thank you. Thank you, Katerina. And now I would like Ketevan to comment from the Georgian point of view. How do you, what are your comments on the results of this research and how does it speak with your experience? Thank you for this question and first of all, good afternoon everybody, to the speakers, to the organizers and the participants who are attending to this event. As of our understanding, it's more than 100 people listening now to us and it's very promising and very pleasant to hear that. Thank you for having this kind of webinar and giving us the possibility to be the part of this event to speak on behalf of Georgia and the Ukrainian experience. How did the COVID impact the general drug policy? I also want to thank Tatiana and David for holding, having this kind of cohort study which is very important to not only for those people who are the beneficiaries or who might affect it from the study but also for the policymakers and for the people working on the drug policy in Georgia. As you know so far, we with the MCDDA, the National Drug Observatory in Georgia and the Ministry of Justice hold the similar transport study which was focused mostly on the similar and same topics, how did the COVID influence on the drug users, the services and the drug market. I just want to comment that the results that we received in March, April period was quite similar as David has presented and also Tatiana in the context of Ukraine regarding the accessibility to the OST programs, the take home doses which is quite similar that we have observed. The number of the people has drastically increased. There was some obstacles in the beginning about the accessibility on the harm reduction services but because of the good adaptation of the new reality, the harm reduction services and the network managed to adapt the new reality and they were the study providing the mobile services. Beyond that, there were some other findings that this transporter study has shown us and by the way this study is also accessible on the web page of the MCDDA and the Ministry of Justice both in Georgia and in English. We have also observed and I'm pretty sure that it's also to some extent included in the cohort study that operative Georgia and David and the whole team conducted using the injection using of the drugs was drastically decreased. On the second part, I believe we will have the chance to talk about how we're going to use this study because both of the countries, it's quite obvious and it's quite clear that we tend to develop the evidence based drug policy and this kind of studies, especially in the time of the pandemic is very important tool and the findings that the cohort study and the transporter study showed us will be the lessons learned for us that will be used for the further development of national policy. Thank you. Thank you, Catherine. And now we are going to Paris and let's hear from the our rate of focal points representatives from Julian. How this, how the results of the study resonant resonate with your experience in France. Well, thank you very much. It's an eye to everybody. Good day. It's a real pleasure to attend this webinar. We watch the first webinars and it's a real pleasure to to enlighten what he's done with the cooperative countries of the MCDDA and you for MD projects. It's a real pleasure for me as the head of the national French French national focal point member of the rate of as you mentioned and well, we we worked in France, especially during this lockdown period in the first part of the 2020. And we released different publication that you can find in the chat. I think two main publications. I think the first one, which is quite near the presentation we have but different in the in the methods we have a network called trend, which means emerging trends and new drugs that has celebrated the 20 years of activity last year and monitoring system of qualitative information during 80 for 80 in in France. And we made a special survey with our network during the spring of 2020 and released to built in of information and it's focused mainly and on problematic drug users so it's one of the key points I would trust just after a while. The second point is quite interesting because we've made a web survey. You all know that the MCDDA has launched a new web survey, a European web survey on drugs in March, and we will test a web survey for cannabis users because in this case, the main use is cannabis. So an opioid or cocaine is very, very less used in France than cannabis. So we made a special survey on that cannabis online 2020, you will find the result of this survey also online. What's very interesting from these two studies, I would find first similarity with France and I think what the MCDDA has shown are the rate of feedback during 2020. First of all, the fifth unit is the isolation, the problematic drug users as they're called, people who have a lot of social difficulties and the lockdown has caused an intensification of these difficulties about housing, about having some incomes like that. So it's one of the issues that you can find during your studies when you get some social problems and your drug users, you face more problems during a time of lockdowns. And one of the issues for that is that practitioner services has to adapt themselves very much. One main differences between Ukraine and Georgia and the French situation is that in France since the mid 90s, we have a very large access to OST. And I think if I'm correct, but I see will correct me that we are the country with the most coverage of OST for the drug users and people who inject drugs. So it's a situation that has limited the access to heroin for example nowadays. And one of the points is that just after the beginning of the lockdown, public services, public policies has changed because practitioners and the people on the field told them that we have to facilitate the access to OST. So there was some big change to the access of OST to facilitate the access of the drugs to the OST medicines during the lockdown and it was one of the main change. And the same thing for naloxone to prevent a period of overdoses. So it was to change very important in France at trying to avoid overdoses. That would be one, some similarities between Ukraine, Georgia and what we find in France and second one some differences. Thank you very much. Thank you, Julien. Thank you very much for your insights, what has been done by your agency as well and how does the experience of Georgia and Ukraine is comparable to what you saw in the scene in France. And we have a second question for all of our panelists and this time I would like to ask to Ketavan who actually already brought up the question, so what's the future, how these type of the studies will influence the drug related services and also in general responses to drugs in future. Thank you, Ilza, for this question. I think this is very important and shared question and topic for all the countries because all of us were quite heavily affected by the COVID and it has showed that something has to be changed. And these studies also confirmed that the new reality does exist and the responses that we had before it's quite outdated for the new reality. That was a good year for in terms of lessons learned and in terms of planning the new activities and the new responses to the drug related challenges. For instance, when we were discussing and we like to analyze the previous year meaning the 2020 during the heavy COVID period. We have one of the topic that was identified was the adoption of the new instructions and guidelines for the drug related services providers, how to react during the crisis periods like pandemic and the other global prices. We also this study that was presented by David and Tatiana once again confirmed that the services we should also be ready to provide the remote services to the beneficiaries because before that was not that actual there was not the necessity in that scale as we had before. Another thing that we think is necessary to think not only in the context of Georgia but global why they speak enhancement and again adaptation of the rehabilitation and psychological services for the drug users because these services should also include some component how to provide the services during the pandemic and during the lockdown period because this is another stress for the drug users. We have and how we should use those findings. Obviously, one of the best tools to translate those ideas in the future activities is the action plans and quite recently, the Ministry of Justice and the government of Georgia has already adopted the two year section plan for related to the drug policy in Georgia and those new ideas were transmitted as the future activities. This is very natural how we see the use in those findings and the challenges that we saw and analyzed during those findings from the cohort study and also the transporters study that we did with the Ministry of Justice. Thank you. Thank you, Ketevan, very much for those insights. It's great to hear that there are supposed to change already in Georgia. Now, what will change in France? What will change in France? I can't answer this question in less than three minutes. I will stick to the subject and the topic of the webinar today and I will be shorter than my first intervention because I think it will be interesting to hear the result and the opinion of the researchers on our comments. I would just say one of the main issues of the first lockdown and the new normal we face since last summer because for us, I think there was a lockdown in the spring of 2020 that was very unique, very strict in France, and then we're working with webinars, with telework and so on and so on. So one of the main lessons is to comfort the cooperation between all the practitioners, the public services, to help and to assist people who need the most of support. So as Ketevan just mentioned, we also have in France a lot of advances for the public measures on arm reduction in France and it's very important to have some good feedback of experiences from the first lockdown. So it's one of the most main challenge in France that we're working with feedback and lesson learned to improve arm reduction in our country. And I have a question for the researchers. I was wondering if these cohorts would be followed during the year 2021 because I think one of the main issues for all of us is to find the way to monitor this new normal. And I know that Alexi is very aware of that and we are all in the retox. How do we know to adapt our monitoring system to this new normal situation? And so I think it's very important to have a cohort and to follow this cohort for many months and years. So that would be my last comment. Thank you very much. Thank you, Julianne. I will leave your question to the researchers maybe after the last intervention for the end where we will give floor to them. And now I would like to ask Katarina in Kiev. So for you, for the Opiate Substitution Treatment Services in Ukraine, will the COVID experience change something in the service provision? Thank you. Of course, the COVID-19 epidemic changed a lot in the functional emergency program as I told before. But the results of this study that was presented is great importance to move forward because it provides an opportunity to make conclusions for the work that was done previously in the previous year and make the necessary adjustments for the future activities in the OSD program and all the governmental programs in Ukraine and not only Ukraine, I suppose. Thank you. Thank you, Katarina. And now going back to Davide and also Tatiana, there was a question in the questions and answers about the policing, about the seizures. Is there any comments from your side that Davide, I saw that you were already responding to that question in written? And then the second question then from Julianne, would you see the possibility to continue the observation of this cohort in both countries? And what are the needed, let's say, frameworks for that? Okay, to be short, we didn't notice or document any dramatic increase in seizures at that period, specifically even specifically of methamphetamine. So we really do not have any ground explanation for such a rise in unit price of certain drugs. I thought I missed the question about police. If you can tell me, you will be happy to respond while I will respond about the cohort. Yes, of course, we asked all our cohort participants and asked for permission to contact them in the future if similar studies are implemented and we have this permission almost from all of them. We don't have yet any specific plans when and in which form this might be done. Davide, there was a question regarding the police seizures or policing in the neighborhoods. I cannot see any more as well. Yes, policing, increased policing was there. Yes, of course. And that was partly reason for some restructuring in drug supply, specifically when bought from Matanga and Central online market, you know, when drop offs are hidden somewhere and then buyer is receiving photo or coordinates of the place. So these places to hide the post moved often from the central parts of the city to suburbs to more quiet places where there was less police presence because police shifted its attention more towards central and busy parts of the city during lockdown and it was more safe to hide those drugs somewhere in a distant location. And if I may to add regarding Ukraine, of course, the police presence in the streets was like increased during the especially during the strict quarantine and so some people reported they were happy to wear masks. And that's why probably not only because of convenience or because medical methadone was cheaper than illicit methadone people also felt and deported in the qualitative interviews that less criminal was involved in buying with buying medical methadone because they could be stopped in the streets and still not be charged with anything. This is first, but we didn't hear about any like arrests or something like that. And regarding the overdoses also the system of registration of overdoses is not ideal in Ukraine and we almost don't have access to this data. However, according to the community drug user community representative, the number of overdoses significantly increased especially in May, June and July in Ukraine in different cities because our data is only regarding Kiev city. And he thinks that this was because of decreased access to the drugs of choice. So people had to experiment with using new drugs and sometimes buying drugs, they're stashes, you know that you don't know exactly what you are buying. So he explains in this way why the overdoses numbers was increased and the same actually reported the representative of OIT site. He also said that they had the information in their colleges that the number of overdoses is increased, but it's kind of great data. So this is not from the official sources. Thank you. Thank you, Tatiana. And so we have exhausted our questions also. I see a few questions coming in still from the participants. We have a question from Sam Friedman asking about the police corruption and demand for money from people who use drugs during these street events. I guess I don't know if anybody has anything to add on this topic if you collected any inside data from the peer review. Thank you, Sam. Hello. Good to see you. We don't have any specific data. We never know any events that attracted our attention or no information coming from any source about changes in police attitudes or practice or way, how they work and how they deal with drug users in general terms. I mean this issue has been, I guess, solved in case of Georgia and Georgia police and you don't see any more in Georgian streets, you know, such corruption or any other violations of drug users' rights or, I mean, exceptions exist, of course, but as a rule it's like civilized in this country. Thank you, David. So the questions are exhausted and, well, I give floor back to Marika for the final words. And thank you all for being together with us and presenting your experience. Thank you very much, Ilse and all the participants for excellent timekeeping. I would like to give the floor to our director who always gives some inspiring, conclusive remarks. Thank you. Thank you, everybody. Thank you also to the audience for the interesting questions arrived. Thank you very much, Marika. I think you are too nice with me. Well, first I would like to address special thanks to Tatiana, Katerina, Ketevan, Dato and also to Julien. If I think about the first contact we had with your countries, also in cooperation with Poland and Czech Republic, in particular our friend Thomas, who was involved in the first attempts of the EU to establish focal points and better evidence-based policy, I think you made a huge progress against all odds, against plenty of challenges and difficulties. I think what is very interesting from what you present is that finally some of the impacts that you have been observing following the beginning of the COVID pandemic, they are more or less belonging to the same categories of impact we are facing in the EU member states. The modalities may be different, but I stayed there. I think that what I would like to, I have a few questions for the future activities in the context of the project, but I would like to locate them into the context of what we can do together to prepare for the post-COVID-19 world and life, in particular in your country. So we are lucky enough that we have almost between one and half and two years until the end of this project. Certainly the project at the end would be very useful, probably differently useful than what we imagined when we were planning it. I think there are very interesting developments. I see some of the questions that at least that would be interesting for us to understand a bit better. I think first of all, one of the things that are a priority, I would say absolute priority for us, is to manage to document the innovation and change in the interventions, whether it is for prevention, for treatment or harm reduction interventions, that all professionals, all people from the field who have been participating in the different surveys, web surveys, the webinars, that there is a need to keep some of those innovations for the future of the drug policies in the countries. I imagine it's the same for you. But ultimately, we are there also to help you to document this and to inform whenever it's needed, the decision makers, either at your level, but also at the EU member states level, you know that we want to use, as we did already in the past, to add the EU institutions to build on the data and the evidence, the analysis we provide together, to also help them to perceive what are your needs for support from the EU, as there are different corporate programs and funding supporting the cooperation between the EU and your country, to help you to bring out to build the case about what are the needs. And when I speak about needs, of course, I don't speak only in terms of security and fight against organized crime, but also priorities in the area of public health. What I think is one of the questions that we have all in common, and we don't have the answer, I think it's one of the key questions I would like to see how we can continue to work with you on that, is to try to see what is the likely market changes that will last, that may remain, and what may be the potential impact on drug use. And to tell you, one of the priority questions around those topics for us, also in the context of our work on the European drug market, is to understand, for instance, how the increased availability for some substances like cocaine in the EU, how can we feel the impact in terms of use and the potential public health impact, because there is always a time lag between the increase in the availability of some substances or the changes in patterns or the changes in the use of substances, and then I would say for some of those substances, the most severe health consequences may come much later if people just start or initiate its use last year or for the moment. So it's really important that we can help you and you can help us to understand and also to use these to raise the awareness of decision makers, both at the UN National level. And one of the questions, and I want of course to thank and to congratulate Julien and his team for the publication on the drug market in Georgia. For me, one of the questions that is not the topic for today, but that's a topic that I have in mind for you and us for the coming 18 months or for the 18 years, what is the likely impact on drug use in your country of what is happening maybe outside the capital cities? Because it is about the coverage of OSTs or whatever the name we give to those programs in your country, but both countries have some difficulties in some regions, in the country, in some border regions. What is the likely impact not only on drug trafficking and trafficking routes, but also on the modalities and risk behaviors in your country? I think that's something for which I would say any new initiative that we can take as we already started to do with this very interesting study that you presented that we could launch and implement in the coming 18 months would be very important because again, it's one of the things we contribute to break for 25 years now since the MCDDA and the Retox Focal Points Network have been established is to break this idea that they are the kind of bad producing countries. Then they are even almost so bad or equally bad transit countries and then they are poor victim using countries. Now we are all equally consumers, producers, trafficking countries. The EU is one of the biggest producers for some substances in the world and exporting worldwide. So how can we try to give some hints? Because basically one of the problems we are facing is the level of priority of drugs for policymaking globally or nationally or even at European level. And there is this still old idea that every time we speak about drugs, people keep the idea of the junkies acting heroin 30 years ago in Europe. The image is much more complex. How can we put flesh on the skeleton? How can we explain better what's happening? What's the likely impact? And what are the things we could try to help you in order to prevent more foreseeable negative impact? And then finally, I'm very excited to see and to listen to Gato and the result of the study on the dark night because there is some time the idea that this kind of study is for very advanced countries, very rich, because in the others they don't use internet or they don't have internet or there are no websites, nobody is using. And maybe there was some truth in that two, three years ago. But clearly the pandemic and the follow-up and the post-pandemic are changing the world much faster than we expected. And especially for those who are under 30 or even 25 years old, which is none of us. So we need to learn and you have the tools, you have the capacity. And maybe, and that's my final word, I think most probably we should see together and how can we also serve together on this acceleration of digital transformation to help you to bridge the gap. I don't know Tatiana for a long time, I just met her today for the first time. But I know Gato and the colleagues from Georgia for more than 10 years. And I know you feel friendly that it takes long to make change. It takes long to get better treatment. It takes long to have better service or more evidence-based policy. Today I think we somewhere we have a chance to accelerate a bit. How can we use those tools? And how can we at EMCDDA be more useful for you for that? Well, that's the question. And I'm looking forward for next webinar or for another meeting online or in the real life, even. We are still interested to meet you one day in the real life too. That will be the question we want to continue to exchange and explore with you in the future. Thank you very much.