 It's a five past one and we can start because of the new ideas from our director are never ending this time for the first time we are broadcasting from a drug, a real drug consumption rooms. I'm at the MCDDA, but my colleagues and the director himself are in a drug consumption room here in Lisbon. I don't take more of your time and I give immediately the floor to Alexis Luzdi, our director for opening this webinar today. Thank you, Alexis. Thank you, Marika. Good afternoon. Hello everybody. We are very happy, very proud to welcome you for this new webinar of the MCDDA. And as Marika said, this time, another innovation. We organized the webinar and it takes place starting from the place where things are happening here in Lisbon in Arge de Pignale, together with the colleagues of the DCR that was opened last year. It's a very important meeting for us, not only the webinar, but also today and tomorrow we have a European seminar with representatives from DCRs from many countries. We are going to explore the ways in which their work and the situation has changed in the recent years and also to explore together how can the MCDDA be more useful or even more useful to support their work. We have activities that we have projects, we have plans. One of them is to provide more structured support for the evaluation of DCRs. That is a very important challenge for the DCRs but also for decision makers who take the decision to open some such drug consumption rooms in their country. It's also extremely important for the MCDDA and useful because with the work of the DCRs, it's a unique opportunity to take the pearls of what is changing at the level of the consumption at local level. And, for instance, since the DCR opened here in Lisbon, last year, already one or two months after the opening, the colleagues were sharing with us the information that 50% of the clients were coming to consume crack cocaine, which is something that was a bit surprising given that it was not that obvious that there was such an important consumption of crack cocaine. While also in Athens, for instance, in the drug consumption room that has opened recently, there is also a section in the space in the DCR for the consumption of crystal meth, which is called the Shisha in Greece, which also it's a way to reflect to show that the reality, the conditions of work, the innovation at the level of DCRs have really changed a lot. There were very interesting changes over the last five to 10 years. What we know and the way the DCRs are operating today is partly the same at the same time, quite different from what it was 10 to 15 years ago. And also we have more than 100 DCRs that are operating or that soon we will operate on the territory of the European Union. And we at the EMCDDA, we receive at least once per month a request from a national or local parliament or authorities, municipality to share what do we know what is the best practice concerning DCRs. What are the indications for the opening of DCRs? What are the things? What are the counter indications? What are the questions or the key criteria people should pay attention when they have the project and starting, of course, from a diagnosis of the situation. So plenty of activities in which we are fully engaged. And as I said in the opening of the meeting this morning, the EMCDDA is there to serve, to serve practitioners, to serve decision makers, and ultimately to provide support to be useful for people who are using drugs, their families, their relatives, people who live with them. Very, very interesting focus, perspectives for further development, we are going to discuss today and tomorrow with the colleagues. And today for this webinar, the first that is on site, and I received already a few suggestions for the next on site visit. Maybe one day in the metadontist of Arej Dupignyal or in another country in another city. We have three persons that are going to share with us, well four persons who are going to share with us their experience. We have Hirona from Barcelona. We have Roberto Arej and Polo Caldera from Arej Dupignyal. Arej Dupignyal is where we are today. And as I said, they opened last year the Salad de Consumo Vigiado. And of course we have also Athanasios Theoharis from Ocanae in Greece. In Greece, Ocanae in the past opened the first experiment of drug consumption room that was called Odysia, that was not maintained, there were challenges, difficulties. Now there is a new initiative, a new program that was opened two or three months ago. I had the privilege to visit the center even before it's opening. And again, it's a very rich illustration with the three experiences and the colleagues that are with us today to see what are the differences. And in fact, for me, I think it illustrates that now more and more we need to look at the drug consumption rooms as key instruments, part of the portfolio of interventions for harm reduction. But this means that we need to be aware of what are the changes in the addictive behaviors and also the changes in the risk behaviors. Because that's on that basis that in Athens, if needed, people can consume Shisha or that in Lisbon people consume cocaine. Or if I remember my first visit to the drug consumption room in Copenhagen, that after a few months they were surprised also to see that 50% of people were coming to use cocaine. This was not foreseen, but it's not a problem because the question is, those programs are there to help reduce the risks. So we need to start from the reality and from the ideology. And that's the contribution that we tried to make. And I think, not only the speakers, but also Marika, with responsible for harm reduction at the MCDDA, and Alessandro Pirona with organizing together with the seminar with the DCS of the European Union in Lisbon. Thank you very much. Thank you very much, Alexis, always very inspiring introduction. I also have heard new ideas to follow up. And thank you also for having introduced Isiah Rindave, who joined relatively recently our unit, our agency, and she will take care of harm reduction. And today she will share this webinar. So I switch off my camera. I remind in the backstage to help if it is needed. Thank you Isiah, the floor is yours. Hi, Marika. And thank you, Alexis. So I'm honored to be chairing this first seminar, or this was webinar, sorry, on DCRs here on site in Ars du Pinial. And I hope that all these new ideas will in fact become true. I will not steal too much time from our distinguished speakers who have been already been introduced by our director and there's not much more to add than to say that I'm very happy that you are here. And I would like to pass directly to the first question and I will give the floor to each of the speakers as we have the availability. So the first question for you will be, what are DCRs? So the current reality you are living as some of you older DCRs or some of you relatively new DCRs in Europe, could you please share your insights and your experience? Let us start with Roberta Reis and Paolo. You can share your screen. Do you have problems? No, it's okay. Good afternoon to all. I'm Roberta Reis from Ars du Pinial. We are very happy to this event is here in our DCR. Thank you very much for this opportunity. And so I'll start to answer the first question and I think it's very important to us to reinforce that DCRs are protected places and use it for safer consumption of pre-obtaining substances, pre-obtaining drugs. What means that the clients must have the drug with him on a non-judgmental environment and then there's supervision of training and stuff. When you think about DCR, they can be fixed or they can be mobile and they are used located in areas where is an open drug scene. In our case, in our DCR, we are a fixed one and we are the first one in Portugal after 20 years. Okay, so to talk about the main goals of DCR, it's to prevent overdoses and intervening overdoses that are on site. I can tell you that since we are open about one year, we have 18 overdoses happening here on this side, successfully reverted. It's important to provide sterile equipment in order to not spread infection disease and we educate the clients for safer consumption practices. When you think about operational models of DCR, it can be a specialized service with only consumption rooms, it can be a mobile service that can go around the city and at the places that are problematical areas, or it can be integrated service. In our case, in our DCR, we choose for the option of an integrated service. It makes sense for us because we are located in a historically problematic area with traffic and drug use, and with a significant number of homeless people, 21% of our population, who have other needs besides a consumption room. So, our service is composed by, to supervise its consumption room, I smoke at one and I inject it to one, a recession, it's where the clients goes when they come here for the first time. We have a coffee desk where we are able to offer little snacks and coffee and tea. We have psychosocial support, we have pet sizing service, because we understand that we have many clients that have animals and this can be a novice talk to come to a service. We have laundry and coats bank, we have bathroom, and nurse and medical consultations, and we have screening for infections disease, and we have a community team that goes around the neighborhood every day to collect all the drug paraphernalia that is in the neighborhood, so like you can see all these images. We can talk, we can see that in the first year, we have much more people that smoke than people who inject, so this is the kind of thing that make us think about the roots of Substance Administration, and the importance of have smoke at the room included in our service too. We are a multidisciplinary team with composites by psychologists, social workers, nurse, educators, physician and psychiatry. I can tell you a little bit of our history but Paul will tell you about more after, but in 2017 a diagnosis was conducted to understand the dimension of the problem and choose the exact area of the DCR. In the beginning, we fought with this diagnosis that we can enroll at the end of one year 300 people, but right now, after one year, we have more than 1,300 people enrolled in our service, and so this show us how this facility is so needed for this community. Thank you. Thank you very much. Can we give Athanas in the floor? Hello. I hope that you hear me thank you for inviting us and inviting the DCR of Athens in this beautiful meeting. It is of great honor for us to show our work. We are the newest I think one of the newest DCRs in Europe now. As Alexis said, there were some efforts in the past but there were other obstacles that didn't come out to work the DCR in a better function. So we came with a legal framework and we have our new DCR. Can we move to the slides? As you know, our organization is the biggest public service provider in Greece for the addiction treatment. And through our pillars, we have also the harm reduction where we put our DCR functioning. So can we move to the next slide please? The first DCR in Athens with concrete and specific requirements and legal framework opened almost one and a half month in April. Mr. Gustel came and showed we had a great support and this was the support of first of all Alexis Gustel and the president of the Hellenic democracy. The president of the government, the prime minister as well the ministry of health, the minister and the sub minister and the deputy minister. And of course we had the support of the mayor of Athens, the city where the DCR is seated. So we have 12 spaces for safe injecting and or inhaling use. We can hear you Athanasius. It's okay, go ahead. Okay, so we have 12 spaces for safe injecting and inhaling use. It is a need that as Alexis said, we have found out that there is an increasing trend in the field for inhaling use and especially of that crystal meth. As they called it in Greek in Greek field. So we have put inhaling using within the DCR. We have waiting room for the beneficiaries after they do the use. We have a fully equipped infirmary with all the primary healthcare and all the overdose treatment and I will put an asterisk. We finally have nasal naloxone for use in Greece. And our professionals can use it. We have also some place for counseling and psychological support. Following our holistic approach, we offer primary healthcare services. We offer the council support and we try to meet all the basic needs for personal hygiene and traditional clothing for most of the people who come in the DCR, which are homeless. And of course we try to connect them and to refer them to other services of our programs and of course treatment programs that we have. Can we go to the next slide to see how this thing happened. Finally, as I told you before, we had the formulation of the legal framework in April of 2020. And we had the law for the first time giving a specific and concrete operational framework for the DCRs for mobile and stable ones. Next, we went to June on 2021 and we submitted a proposal to the Ministry of Health in order to open a stable and mobile DCRs in Athens, where most of the problem is cited. In November of the same year, we had the authorization for the stable DCR and it was issued. And we had also the permission for the opening of the mobile DCRs in Athens. As I told you before, we have also in the same month in November, we had the expansion of the use of naloxone using nasal naloxone for professionals and street workers by Okina and other organizations. So we reached the point this April 2022 to open the first DCR in Athens, Greece and in South East Europe and to offer its services. Thank you very much Athanasius. The floor is US Noelia. Thank you, so first of all, I have to say thank you for the invitation and thank you to all the people who are joining the webinar. So I'm going to tell you a little bit about the work on DCRs of Barcelona. When the colleagues of the MCTDA ask to me what are the drug consumption rooms and what are the current reality, the first things that I have to say is that the drug consumption rooms have to be safe places for the people who are taking drugs. If we think about places for the people, these places have to be safe and they have to be in a comfortable way there. So which kind of services we have, we have two drug consumption rooms in Barcelona and in Casabaloart in the drug consumption rooms that I manage. We have a heat and coffee place and we have treatment programs. Barcelona have a specific model on drug addiction treatment and annotation that they want to share the treatment area and the hand reduction area. So all the people that come to the service can use the hand reduction area and the treatment area. Okay, we have to don't lose the approach, the comprehensive approach to drug use and addiction. And in the drug consumption rooms we have the role to detect new trends and to detect what's happening with the drug use. And all the time we have to think about strategic lines on drug intervention and new approaches and new tools and new, all the new things that we need to implement for the people who use drugs. So another thing that I think about when I have to think with the current reality from the drug consumption rooms in Europe and concretely in Barcelona. I need to think about the fight about the stigma that all the people that are taking drugs are suffering. We have a lot of programs but we don't have to forget the stigma that they are suffering and we have to work with the stigma and we have to work with the community. They have to be part of the community and the DCRs are part of the communities. So that's one point that we have to be working all the time with. So another thing that it's super important is the empowering of people who use drugs. They have to know which obligations have, they have to know which rights have, they have to know where they can do it, where they cannot do, how to wear something, how to manage her drugs, how to deal with the police, with the judges, with the health services, with the social services. They have to know how to manage all her life. So one of our objectives is empowering the people who use drugs to be able to do all these things. We have to keep in mind all the time, this, this, this farce, you know, this, the supper don't punish, we have to keep in mind all the time. These words, and we have to contribute to the visualization of the people that taking drugs, not only the services or not only the programs, you know, that these people have to be visibly excited to. If I have to think in the people, in the people who use drugs, and one of the basic things that we have to do are training all the people who use drugs and overdose prevention and attention. In Barcelona, we train all the people and we train all the professionals that works on the DC ours. We put it all of the in a program that have the name take home Naloxone, all of they have no to manage an overdose and all of they have Naloxone kids and to intervene this Naloxone. And we have to listen to the people as key actors, they are experts on her lives, they are experts on drugs, they are experts in all the new trends and all the new things related with drugs so we have to take it them in all the things that we are thinking to implement. They are information providers, and they have to be an active part of the DCR without the client or without the people, we cannot run. So, we have to keep in mind all of this block of things about people because if they are not in the center of the DCR, the DCS cannot give a good attention or a good problems. So, thank you for this first part. Thank you, Noelia. So, I hear loud and clearly from all panelists that there is not one definition that is more an integrative approach that is more about safe place and integrated approach into the community providing multiple services also training and prevention efforts programs. And in that sense, I think we can also see that the experiences have been very different for those that have just started over those that have been doing this work for a while and those that have been really long time doing this. And I will use this to pass to the next question and ask our panelists what they have in their experience found where the main facilitating factors or obstacles in implementing and also in running a DCR. Can we, we will start again with Roberta and Paolo. Can you share your screen please. No. Thank you very much for the invitation. Good afternoon to everybody. First of all, to answer this question, I suppose it's, we have to split in implementation and running a DCR. Talking about the implementation. I have some kind of technical problem here. Just a moment. Well, we will try again. Okay, now, when we talk about the implementation, I suppose the challenge is to know that our obstacles and turn the debt obstacles into facilitating factors. So, the first obstacle that I think in the, a lot of countries deal with it's the law, the fact of the law, there are an obstacle to the implementation of the DCR. Luckily, in Portugal, we have this fantastic law from 2001 that in the chapter 10 planned the opening and implementation of DCRs. The truth is that so that can go to the facilitating factors, but the truth is that it took 20 years to open the first DCR in Portugal. So, what happened? Of course we have the mobile DCR in 2019 here in Lisbon, but to a fixed DCR it took 20 years. So, it brings me to the second obstacle. It's the political will. In the 20 years ago, mostly the people that inject drugs, the consumption are decreasing and probably the decision makers thought that they are not necessary to have drug consumption rooms. And the political will to open one isn't there. In Portugal, with the crisis of 2008 and 2010, there are increasing of the consumption and the diagnosis that Roberto talked about before show us that it's a really needs to open the DCR. The political will change. The municipality of Lisbon, they do a lot of efforts to open these DCRs and then I suppose the political will go to the facilitating factor again. The third obstacle is the stigma and because when you talk about the problem of drug consumption, everybody agrees with the implementation of DCRs, but the problem is that nobody wants the DCR in my backyard. Well, can we manage that situation? I suppose in my humble opinion that we have to choose carefully the place that we put the DCR. And in our case here in Portugal, we have this sadly famous neighborhood, this Casal Ventoso, that in the 90s and in the 80s, it's the biggest supermarket of drugs in Europe. And what happened is when the municipality of Lisbon starts demolition of the neighborhood, they change the people to that new neighborhood that is in blue. Our DCR is in yellow. So we are right in the action zone. So we are near the traffic areas and the places that the people buy drugs. And that is a facilitating factor because we are not taking a problem to a neighbor that don't have drug problems. The problem is already here. And we are coming to try to help the, not to solve, but to the problem. We have to hear the local community. And here in Portugal, the local community, when we start the meetings with them, we listen to their needs and they have a lot of things. We are not against the DCR, but look, we need a bus. We need a system of water that is not good for 20 years. And we hear their needs and these guys have rights. So what the municipality of Lisbon in a clever way do is, okay, let's negotiate. We will give you that. And the reality is that we don't have problems with the local community now. So to the implementation, I suppose it's looking to your obstacles and turning to facilitating factors. Of course, it's easier to speak than to do it. But I suppose it's possible here in Portugal, it was possible. Now we're talking about the running the DCR is now open. Let's see what we have to do to running successful the DCR. Maintaining the contacts with local community. It's very important. Then work closely to decision makers. They have to know what our, what is the question that all every day we have here in the DCR. And most important is here, here the clients. What we have here is work closely to them. The Noelia said it's DCRs must be a safe place and exactly that. The DCRs must be a safe place and the people must have a sense of belonging to the DCR and to do that, they have to feel that their needs are here from the team. Of course, not everything that they ask us, it's possible to do, but we do a lot of things that they ask us and I suppose they have this sense of belonging to the DCR. And finally, the team. Sometimes it's a very hard to work here. And we have to listen to our team and to pay attention to them because it's a pleasure to work here, but sometimes it's quite difficult. Thank you very much, Paolo. Can we give the floor to Athanasius. So, the challenges that we had as we try to open the Athens DCR is to meet the needs of around a population of 800 to 1000 drug users in the center of the city and a little bit wider. And of course the community and all the stigma concept that follows the drug use. We talk about a high risk population and we had to reduce the concentration of this population and of course to reduce it all the transmitted diseases and prevent the outbreaks among drugs users because we have the paradigm, the example of 2012 in Athens, where we had a big outbreak of HIV. The treatment of overdoses, which is a very common phenomenon in the streets of Athens and in parks, as well as all the crime that might be connected or associated with the drug use and the meeting places of the drug users. As we told you in the beginning and in parallel as the Portuguese case, we had the this lack of a political frame or legal framework. And so there was this kind of no framework and no law for opening a DCR. But the this government that it's now on has recognized the need to establish to establish a DCR has put that in the pre-election program. So it was a thing that they wanted to do it and when they came into power, they put the law and enforced this situation. So all this thing was to find this facility to help people to have the right to access the treatment and to be for everyone. This was the main challenge that we had to communicate either to the politicians or to the people in the community. In this, in all this concept we had also to face this COVID period, which was a challenge for us because it was it triggered Okana in order to expand its services and to operate DCR as well as other services like a hostel or day centers we opened lately and to help people all the homeless people drug users all the people that were in need for further and integrated into holistic services. Can we go to the next slide and say they are my personal experience is that we had very strong support from the government. As I told you, we had a very strong support from the local authorities, which is amazing for a mayor, the mayor of Athens, who was very supportive to us. And we will tell you in the next discussion that we had a very good cooperation throughout the COVID period and we made this shelter with the municipality of Athens. He recognized the problem and he he's very helpful to every action that we do in order to minimize the problem in the center of the capital of Greece, Athens. And of course we worked within the community in the region where the DCR functions and we can we went to the shops we went to people working by the DCR. We sometimes needed to buy things in order to support these their professional activity and in order to show that they are not different. We support them and we are in the same society in the same environment so we need to coexist. And the most exciting was that around 10 months were to have this from the decision to open the DCR which is I think very a few months from the cases that we hear in all over the Europe. The main message that we communicated was that the DCR are so important to meet the people's needs and to achieve the this opening of DCR advocacy and working should be together going. So the key is to make the government the community and the local authorities to be aware of the need of the need of DCR. So here you can see some photos from the from our Steki Sarada XC Steki 46 the word is Steki is the place where they are gathering. The name is from the drug users themselves and you can see the road is in one of our premises the inside place that they have the place that they can eat or make a drink or tea or coffee. And then there is the supervised drug use place or the area you see the places you see the material that we have we have all the equipment and we have also the scanning of the drug users when they want to have safer use. And of course we have all the equipped nursery the Naloxone and as you see the last on the right picture is the inhaling room that we have for CISA need where we found out through our outreach and the state work actions. And from last August we give the material for safer use for people who use CISA crystal meth in the field. We have bought pipes with several things to put for each user in order not to exchange between the users and to avoid all the transmission of diseases. So the first data we don't have so many that is because we are almost one and a half month functioning. As I told you we have opened in April and the first 15 days we had 55 visits and 18 supervised drug use cases cases during May we have 790 visits and 222 supervised drug use cases. It's enormous enormous numbers. We have reached the 240 supervised drug use cases, and it's increasing. And this is a point that I should put an asterisk saying that Alexis Gustel has right. We have noticed that the drug use is changing. And now, for example, we have much more use of inhaling drug use and CISA use where the seats are not always for heroin use. They are mostly for inhaling use. Okay, thank you very much. Thank you. So about the facilitators and obstacles to implement and run a DCR. I have to say that in Barcelona. Our first DCR was opened at 2001. Casval Guard, the DCR that I run was opened at 2004. And in 2022, we have 14 DCRs in Barcelona, only in Barcelona and fix it and mobile DCRs. One facilitator that's super important is that all the DCRs that are in the city, they are running by expert NGOs. And all the drug strategy on the city have a political concerns every four years. All the political parties is of Barcelona they have to meet and take a conscience on on drug policies on the city. So this is a good thing for the DCRs and for the drug treatment and drug reduction programs. And all the centers in Barcelona have to be integral drug care centers have to have to have drug reduction programs and treatment programs. So these are the main facilitators to implementing a DCR for us. So you can see on the on the past slide, the annual plan of drugs and some images about our mayor and the parliament where they where they take all these decisions and they they make a good dissemination on mass media all the time when they make this kind of decisions. The next slide please. So, and the obstacles. Barcelona have always have a big, not in my backyard effect. Since the opening of the first drug consumption room, we have a lot of or not my backyard effect. And now in 2022, we have as you can see on the left corner on the right corner story of the image. This is a platform for the closing of Casvalo art, our DCR. It was a Twitter profile of a group of neighbors that they live super near of the DCR and they, they have a good organization to share all this appointment, all this agrees and all the things that it's happening all the time on the street, related or not related with drugs and drug users but they put it all the responsibility there, and they have a high impact on the community and and you can see that on the in the center we have an image with a lot of policy. We have policy 10 hours per day in front of the DCR like a municipality strategy to to deal with the violence or with the reporting security of the neighbors so the municipality they put us 10 hours of of police and in front of the door. We have to deal with the police every day, the outreach team have an outreach team of 12 workers. I have to meet the police every week to to make engagement and to make a sense on the intervention in the, in the place that we are situate and in the mass media makes a lot of work to do to share all the things that happen around the DCI on the on the left corner and an article that say that the DCR of Trasane is that it's the place that we are looking and it was converting in a point of drug dealing and drug selling. So we have every day every month notices like this we we are in the point of view of mass media all the time neighbors, political parties that try to manage these things in her own benefit but they cannot do it because there's a fact, and they have to take this path these these are called but sometimes they try to manage them. The drug is sent out to for her benefit. And then we are concerned that since four years and we are in the middle of the community. Four years ago we are situated in a, in a specific and a little bit more far place five streets far, but we are alone there, we don't have neighbors there. And then in our, in our change of place for years ago, we start to to make a really convivance with neighbors. And that was one of the obstacles that that running this year have because we have to every day every week and deal with these things that one of that we have to be more, be more careful, we have to do all the things that we do. Super careful and thinking about the community all the time and, and trying that the, that the drug users be part of, of this, these careful steps that we are taking since 18 years. Thank you, Noelia. I think it's very interesting that all of you pointed somehow towards that the barriers or the challenges can be turned into opportunities and that you all had some strategies to turn them into opportunities and in fact, pretty successfully in many cases. And I will use this also to ask you now very briefly to give me an idea of what do you think is the future of TCRs in Europe. We will start with Robert and Paolo sharing the screen. This is our team. So, I forgot in the, to show it to show them. The future. In my own opinion, I think, in the places in the neighborhoods that like Casal Ventos like this neighborhood, a lot of traffic, and a lot of people buying and using drugs. The model that we have here, it's already the, it's yet the right model. But we have to go in to the places that that aren't so big, but they have people injecting and consuming drugs. So, I suppose, not so expensive projects. But it must have safe places to people to, to consume. And that probably not with the stuff like nursing and doctors and this, this kind of expensive team, but like peers and educators, all around the city, all around the city when we're consumption, of course. And perhaps this is the future. And we are talking about that situation the other day, and perhaps in the places that are the people goes to drink or to go to the night to consume some cocaine, some methamphetamines, probably some mobile events nearby to consume in the safe way. So I suppose it's one of the ideas for the future. So I would like to to enforce the idea that it's very important, like I said before, it's very important to meet the needs of people who use drugs. And I think it's very important to be aware of the changing of routes of substance administration. And, like I said before, in our experience, we have, we have the majority of our population is smoked and smoke crack, crack cocaine. So I think it's very important to be aware of this change in the route and try to create facilities that support this kind of needs. And I think we have to think about this for the future. Thank you. I give the floor to, no, are you talking? No, give the floor to Athanasius. So, our thoughts on the next steps is to that we need more DCRs in the, at least in major cities of Greece, one of that cities, Thessaloniki, and especially is very easy to use mobile ones, because we can put into action in different places and to meet much more needs of people. In Athens, we have also concluded and we are in a phase of, let's say, final materialization of this project, the five mobile DCRs that we are going to work with the municipality of Athens and the support of the mayor of Athens, which will work 24 seven. And they might start working by the end of this year. So this is news that we will have very in the next month. Also, the drug checking is another issue that is concerning us as well in the DCRs. And we are trying to find out ways how to see the trends and all the new drugs that are coming within the field. And especially through the all this situation with the Ukraine war and all these changes that are happening worldwide. And my point is the need for monitoring all these work that we do. The work needs to be evaluated and evaluated through an evidence base thought which will support us, will support, sorry, will support our work to the stakeholders to communicate all the productivity of these programs. This is very crucial because when we go and we discuss with them, the first thing that they ask, okay, what's the good thing and what's the bad thing, but they don't, they don't see very often the good things and the all the development that might come better with the opening or the functioning of DCR. Of course, we would like to have this kind of communication through the all the DCRs in Europe, and a digital platform would be very helpful in order to connect all our DCR network across Europe and to share all this data, either real time or in specific period times, all the best practices and all the challenges that we face every day, every time, which will make us even better and we will try to find out other ways of thinking, sometimes in order to solve problems. And as I told you before, there is a real need to monitor all the new substances that emerging now in Europe. And since all these routes are changing, we have to see it as well. So I think all the network and this is the thing that all this technical meeting that we have these days and this webinar comes out to bring to us and to help us is all this network and this communication of the messages and the problems that we have and how we can face them. That's why we thank EMCGDA and all of you, the organizers, and we are here to discuss. Thank you very much, Noelia. Yeah. So when I have to think about the future of DCRs. I think that's that's super important to having in to keep in mind the political strategies. And as I say, you know, have the key point that all the political parts have to be in a corner, but all the political strategies have to be in the same way. Always, because if it doesn't go in the same way, it cannot run. It's, it's, it can be so much difficult for us. We have to keep in mind the dynamic reality and the new trends on drug use. We have to think all the time in this dynamic reality and in three in three months, you can change everything in in two years and a half. And the profile that P Woods that I see in the drug consumption room, changing. We have now the 13% of the consumption on the DCR and based on methamphetamine. We have only two people taking methamphetamine in 2015, I think, and in 2022 we have 247 people taking methamphetamine. So in a short time, it can change everything can change. So, and we have to keep in mind the community resistances and mass media, and how to deal with it all the time. And we have to work and we have to keep in mind all the time, the stigma, we have to, we have to create strategies to fight and to face the stigma, all the time. So how can we do this, we have to, to question it all the roles, the role that is your role that he would roll the politicians role the institution role the community role we have to ask ourselves, all the time, which is my role. All the time, all the time, all the time, all the time I need to question myself every time I need to question my service every time I need to question my politicians every time every day. It's it's super important on don't lose this. role approach, and then my proposals, because we have to think about solutions and proposals. It's that we need to update the harm reduction model and harm reduction facilities to the new trends to the new needs to the new. And we have to think all the time in how to open this year's 24 seven. And it has been around since seven in the morning at 10 on the night, and only close the Christmas day and the New Year's Day, they all all the other days we are open. And it's not enough, because we close at 10 but until 10 to seven in the morning the people still taking drugs and still taking drugs in the night in unsafe places in hostile places in risky places. So we have to think about that we cannot offer attention only for no only for an hour's and and when I close you have to stop to take drugs now they're going to keep taking drugs so we have to think about that. And we have to think about how make a good and successfully community engagement. It's super complicated that we have to we have to think about that all the time, and how to make social and health system engagement. Our clients the people have a lot of needs and have a lot of complicated situations, and they, they faced a lot of risk is and a lot of complicated situations every day and we need to to search solutions and we need to search engagement with the social and health system. We have to to work in group all the time so I think that these are the main topics to think about if we have to think about the future of this year's. So, thank you. Thank you, Noelia. Thank you to all the invited panelists I thank you very much for this insight in the different realities with at the end seem very similar and easy to bring to a common point. You talked all about integration, considering community and health services and other services you talk all about evaluation you have all raised the point of communication among us. I think that's a very nice insight in the reality of drug consumption rooms in in Europe and I would like to give now the floor to more recovery to help us a bit with the question and answers that we have in the chat. Yes. Thank you very much. There is a huge debate in the chat but this is visible to everybody so very interesting we will save the chat for for future reading. I grouped some of the questions. One is about it was easier to highlight the need for drugs and some from rooms when they address opioid use and the environment was full of dirty syringes etc etc. The question is now that the consumption rooms have changed, opening to other type of substances is still clear their function, especially to decision makers. I think, if you agree, we can launch the question and see who is willing to provide an answer. I have many more. So, in the Portuguese reality, I think that the beginning that decreasing of consumption of people that inject drugs, it's really make a point to not opening the DCRs. But I suppose that kind of idea is changing and what we saw is it took 20 years but the DCR is now open and I suppose everybody is happy with our results our achievement because we have like Roberto said, perhaps 300 people in one year we have 1300 in one year so the problem is bigger than everybody thought and I suppose the decision makers in Portugal are have the, they know that the reality is changed. So, I suppose they know that the needs of the DCR it's different from the 20 years ago, and I suppose here in Portugal, the people know that. Anybody else would like to add something or because we have many other interesting questions. Any other comments on this? I'd like only to add that I understand the question because in the beginning the main objective of the DCRs are for people who inject drugs and right now it's a little bit different but the problem is still there. So, we still have people that smokes in an unsafe condition, in not clean places, not safe places with many other difficult circumstances. So, I think it's too important to have this kind of place because some of them are very disorganized, some of them don't have any kind of condition of hygiene, the only meal that they have is here with us in this place. So, I think it's very important not only for the consumption room but for the integrated service that we offer to. So, I think we have to have this mindset. Thank you very much. There is a testimony from the Netherlands where there are consumption rooms but the colleague says the negotiation with the local community to have them accepted is a continuous process, it's not something that you do once forever, especially when you open new drug consumption rooms. And then there are a couple of questions on the relations with the other services, for example with the treatment services, if there are exchanges of people passing through, for example, drug consumption rooms and then going to treatment and vice versa, people in treatment and then go, I don't know who would like to answer this. So, I answer, we as Okana, the organization against drugs in Greece, we have all the treatment from the direct access to the OST treatment. So, we have lots of cases that come by and use the DCR and they are supported in order to have this referral to a treatment program. The treatment program is not always an OST, it might be also with no medicine program, but lots of them go to a treatment program with the OST. Some of them also come back and they go to the field again and they have this drug use again and they have this recurring behavior. But there is also this networking through the services of our organization, for example, who they follow the person, the beneficiary and they follow him whenever, wherever its need is. So, we can help him to be supported for the safe use, we support them for the safe use, we support them for hygiene and social issues and then we go to therapeutic issues and continue with therapy and OST treatment. Thank you, I don't know if anybody else wants to add something or I go ahead because I would like to ask you all the questions we won't be able. If nobody interrupts me, I go ahead. One of the questions is about, you mentioned already in your interventions, but if you can summarize with one statement, how drug consumption rooms contribute to reducing stigma? Whoa, how we can contribute to reduce the stigma. So that's a big question. We have some strategies in my drug consumption room focused on the participation of the drug users on the community activities. So we try to make popular dinners, we try to make activities with the neighbors, we try to make social photographers to sit on the community and we try to, now, for example, now I'm making a plan to make a dynamization of the community around this year. And then I want to involve one drug user who is, I don't know what's the name in English, but who are involved in the maintenance of public spaces when they, when he are working. And, and I want to involve this person in the, in the strategic plan about the, on the neighborhood. So we try to make that they are present in the positions and visibilize it on the community. But it's not an easy work, because they have a lot of stigma. Thank you very much. While we speak, other questions. Yes, yes, yes, go ahead. Say something about it. And before the implementation of the our DCR, our clients told us that in the, in the street in the neighborhood, they, the people from the community. Sometimes they don't treat him right. They take garbage on him. So, and with the implementation of the DCR and the consultants inside the DCR, they tell us now the people at the neighborhood treat us better. So it's, it's, it's an, I think it's an important thing that the important thing to our clients. I think it's very, very good. There are very, there are two questions that I will put together, because one is about what to do in rural areas. So where they use this disperse and you don't have probably strong support to having one. There is in mention a big central European town saying that use is still visible in the street. So how you manage these two extreme situations would like to address this difficult question. Composed question. I think we in Greece we have the opportunity that we lately developed three mobile units in the rural area, which are outreach, mostly outreach units, meaning that they are doing harm reduction actions. We go to Patras to Tripoli sent to retina to Crete, a big island that we have, and we have also another unit in Thessaloniki. So we try to go and have this kind of harm reduction work in order to help these people to find out the safer use and to be educated how they should make their use and how they should be supported by our organization and the opportunity to have this opportunity of entering a therapeutic program. This is a new entry so we have very good effect since now, lots of people are coming and asking for our help, and this has a very positive effect to society because society there in small towns comes and realize the immediate action that we have for example in Thessaloniki, as Mr. Gustel has seen by itself, we have this kind of problem and we try to make some cooperation among people and organizations that are working the field in order to solve all this kind of problem and solve the problem as well of housing, which is also a problem that concerns these people, in our population. So the effort is more combined with many, many, many small actions, little actions in harm reduction in housing, in social care, in social support, as well as primary health care support, which is very crucial to our work. And in cities, let's say, it's a little bit different because we have to solve this stigma problem and the case of Athens, I would like to tell you that we put the politicians into the game. For example, we had MPs coming to do street working. We had ministers street working. We had the president of the Hellenic Republic coming to the DCR, which is very, it's enormous to have the first citizen of the country to support this kind of action. So people started using these words and you could go around through the corridors in the ministries and hearing words like CISA or like drugs or like harm reduction or like other issues that are concerning us and things that you couldn't before 10 years, 10 years ago, you couldn't imagine that you would hear this kind of wording or discussions. So this turned into changing all these concepts and all this culture that we have. We need a lot of work to do, but okay, it's a point that we have started. Thank you very much. And I take an opportunity to ask our director the last question. There are, there are many still and I suspect we will need another webinar probably this time with the experiences from the northern countries this time we have seen the southern and then we will see another area. There are a couple of questions on the international documents and the drug consumption rooms, specifically, for example, the Ungas outcome document if drug consumption rooms are given the sufficient visibility that they deserve. Alexis, if you don't mind, I would ask you to see if you wish to answer and then and then to give your conclusions. Thank you, Marika. Well, of course, I mind, because if not, I would not have supported the organization of the webinar. So of course, I mind a lot. And I care. So there was a part already a good answer from Danilo Ballotta, making reference to a document that is available and that we can make available to all of you together with the link to the video after this webinar. The other things I want also to cheer our colleague and friend Verder Zipp, who's the former chair of the International Narcotic Control Board, because the INCB has at least sent a written letter declaration, declaring that drug consumption rooms and decriminalization were not in contravention with the UN conventions. Provide the data takes place without a more comprehensive program and strategy on drugs by the by the UN member states. So basically, it's not like officially adopted by all member states of the UN document still. It's the INCB, not only its chair. And what is interesting is that it has not been always fully supported but at the same time it has not been really challenged by the successors of Verner. So, Verner, I think we all you, we all owe you a lot to you and the INCB of that time for that statement, but that's extremely important. And I would say that sometimes we had the opportunity to share this document to highlight to explain and also to reduce the anxiety of some decision makers who were believing that maybe it would be like legalizing any kind of drugs or things like that. So, so it's not the final miraculous solution but that's that's certainly key document. And for the comment first, I would like to thank all of you, including all the people who have followed this webinar. Actually, yes, I think, Marika, you're right, we need to continue. We probably will need a few other webinars, not only one. I will not try to summarize everything but still a few comments and a few answers. The first is what was highlighted in many cases in all the presentations but in from all the work we do on DCRs for so many years it's the key role of the mayors and the city level. So in the meeting today, in this one we, we are privileged to have two representatives from the even younger, sorry, there is even more new DCR than yours. It is the Brussels one. We have also representative from the edge. And those are two cities where the mayor has played a key role because those are officially established but at the same time they are still officially illegal. So to the fears of some colleagues, the edge is such a avant-garde this city for many things it's in the edge that we open in Belgium, more than 30 years ago the first needle exchange program for instance. The drug consumption room is just the building nearby the police of the city. And as people are used in the police is well aware of the importance of harm reduction interventions, basically they don't take the opportunity to, to chase the drug users, the bad guys, and, and drug users feel comfortable, comfortable and they trust the system because it's not the first time that this kind of intervention. The role of the mayor and the team and everybody involved. And I think it's the same for Barcelona and all the other cities. And Lisbon, of course, including not only the old but the new mayor, the new president and the camera municipal, I think it's they play a very important role. They also take an important political risk, not only in Belgium. So, so this is why the, as a partner shows was saying the, the evaluation is important. And to answer to this first comment from a partner shows. I want to say that one of the things we are discussing today and tomorrow and we work on it at MCDD for a while already, is that we are working together to build tools to support DCRs to build their evaluation scheme. And that's extremely important that we as the European Agency we can provide the support, because there are plenty of people promoting evaluation, but it's not whatever evaluation. It has to be an evaluation that is applied to the reality of the DCRs, and that allows to highlight what works what doesn't work. Without sometimes proposing objectives that are completely unrealistic or that I'm not within the reach of the DCR. So that's one of the things we started already working on that. And one of the new initiatives we have launched already last year is also that we want to develop tools and support to evaluation, not only in the English language and culture. But for the moment, there is a small project ongoing with the French speaking DCRs with the help of member of scientific committee that is Marie-Jofre Roustille. And we hope to develop further also for other languages from other experiences in the future. One point that was also highlighted and basically I was reading an article in Le Monde day before yesterday. It's the problem of stigma, the problem of not in my backyard, but which also relates to the need for strong community work. And I think there certainly there is no magic solution, but this is an area where we are CMCDD, we can play a role also to raise the awareness of national decision makers, because basically the problem of the communities is not only about drug services. It's more a general problem of fragmented communities. And some of you have been participating in the other webinars, especially the first ones we organized on COVID. You highlighted very well that like also colleagues from professional associations like UNAF in Spain, you say what has been allowing us to be useful was the fact that there are also social services and services. And we need, as many of you have said, we need to also engage with the institutions, but certainly community work is something that is not really new. We started talking about this in Europe 30 years ago. And I remember some of the first to start talking about this was Espoir Goudour in Paris. And the funny thing is that it's not the French who have brought the idea. It's the Latinos and the Africans who were living in Paris and in Espoir Goudour who brought the experience from those countries where community work involving the community was working or was existing sometimes also for mental health. We had some developments 20, 25, 30 years ago. Suddenly the fashion has disappeared. I don't know why, but certainly there is a paradox today. If you look at Paris with the situation of crack use, there is a huge political problem, which apparently on the top of that is not very new. There is a pressure from the citizen towards the authorities to do something and the authorities, they try to react very quickly. But to take the decision to open a DCR or any kind, even I read in the Lamont yesterday that even to open drug services, people are opposing that for the moment in some cities. So this means there is a contradiction we need a quick solution or quick support from the minister. And when the minister say yes let's open for this year's all the social process the consultation, the consultation the involvement of the community you cannot do that in two weeks, or in two months. So we have there is a pressure for results and for interventions, but not in my backyard, and without having always the time to take the time to consult to inform to raise awareness. So, so that's something to which at European level, we, we could also propose an offer support. I will finish on that in a few minutes. The importance of the involvement in the association of people who are using drugs there were comments in the in the chat. And of course we fully support that. And also, including people who are using drugs and more broadly the civil society. I think what what is interesting and we see this idea, there's some evolution in the last years. I think we, we need to have a kind to build together a kind of versatile model, because basically fixed or static consumption room cannot be the right answer for everything. And to combine together with other services and with mobile services is something that maybe five years ago nobody would have been really thinking about this. But, but maybe this is something that can be used also in in with the aim of reaching at least some consensus with people, because maybe those who are against the idea to have even a treatment center in the street. There's a bus that stops for half an hour and then is going to another place can be a first step in trying to raise awareness, showing that it will not create a very challenging situation also people need to be reminded that in most of the places where this has been established it is because there was a problem on site, there were public noisances there was an open scene. And I think this is still a good argument to avoid to create a new DCR. Yes, but 30 kilometers from the center far from the center of the city because people will not go. Then another important point is the mental health, not only of people and the clients of the DCS but the staff. I remember a discussion we had in the men's gym, I hope I pronounced well the DCR in Copenhagen, where we were discussing that for the nurses that stay in the room and see people who are injecting all the day and sometimes with very difficult behaviors. If you do that eight hours a day, I don't know how long you can just be resilient so as as Paula was saying we need to find a way to provide some support some supervision. And also, something we discussed with Athanasios and many other colleagues the recent months is there are many programs including those fantastic innovative programs in Greece, that are just being running with resources provided by some you other programs that will end up in the next months in one year, and the sustainability of those programs. Again, that's, that's a great challenge. And we need to see together how we can together raise the awareness of decision makers is good to have a pilot with the staff being co financed by some external donors. At some stage we need to make sure that if it works if it is really addressing the needs, we need to make sure that there is a stable financing, it can be involved it can be involving the municipality and the national or the regional level. But certainly, there is a danger for some of those programs that they may be very successful and very useful. Still, they may have to stop. To finish, I would like to mention to come back to the to the two points made by Athanasios and one by Noether. Athanasios mentioned the need for monitoring and for evaluation I answered already about evaluation. The platform, this is what we announced last year that the MCDDA is is a start at the development, the extension, the expansion of a digital platform for communicating with the organizations involved in bill checking, but also in the in the use of syringes. And there is, there was already last year a clear offer made to expand this digital platform to the DCR. What we are going to discuss today and tomorrow is how concretely we can use the budget and the platform, what are the specifications and how together with the DCR we can build and also make sure that not only is not the MCDDA offering something is together we build and together we can use and where we need also to offer all the guarantees for people who are participating and communicating through the platform that all the highest possible security is guaranteed. And then Noella was saying that we need to actualize the harm reduction model and the harm reduction facilities. Noella, I cannot agree more with you than on that because that's one of the things we discussed at the European harm reduction conference last November in Prague. I think time has come to reinvent harm reduction. And to reinvent we need to build on the scientific evidence and on the data that we can also receive from the DCR or the bill checking showing that drug and drug use today is much more than just heroin injection. And therefore, we need to update the understanding we have the problem, and we need to be again more creative, because I think the key is, and that's my last word and the conclusion at least for for this webinar that I propose you. I think we need to come back to the understanding of the risk behaviors. So it's not only harm reduction in English, harm is perceived from those non native English speakers sometimes as a bit. Limitative in French we speak about risk reduction, which means not only the consequences of use but everything around. And I think there are risks associated to other users that may need to be or could be addressed with the help of the DCRs. And I think that's very great to see so many changes and so much flexibility in the models of DCRs that we see all over Europe. So again, we are there together with you at your site. We are a partner for co production for reinventing in the future harm reduction to make sure that also all decision makers understand that harm reduction today and especially tomorrow. It cannot be only, for instance, neither exchange or method on substitution. We need continuity, but we need also creativity and co production, and that's what we managed to do fantastically with your help today, and we continue for those two days with the conference of the DCR program so from our side, and I'll be out for all colleagues. Thank you very much. Thanks to you Alexis and talking about platforms. There is an entire debate in the chat and many other interesting questions in the questions and answer that we are saving and keeping for further discussion. Meanwhile, I switched on the camera of Alessandro Pirona so that you also see him with the organizer of this meeting, and I would like to thank everybody really, including the drug consumption rooms who has hosted this broadcasting and Alexis for his many ideas who prevents from getting bored with our work. And thank you everybody I will launch a small poll to know your ideas. No worries, the speakers can go and I keep the system open a little bit more to avoid excluding people abruptly, but you can go if you wish. Thank you very much.