 Good afternoon. I'm Peter Sharoschi and this is stories from the front line drug reporters live video series on How that action and activists who are telling us how this crisis affects people use drugs in their countries today? I have two guests with me from Norway I am not some from the association for human drug policy He's a community activist and a long time advocate for drug policy reform in Norway and Oistan Brun Ericsson a social worker who works at the overdose prevention program operated by the City of Oslo So thank you guys for for accepting our invitation. How are you? Thank you. How are you? Thanks for having me good So, can you just first? Tell me something about how How how how this crisis affects your lives in general now? Are you at home or you're still working on the street? me Yeah, let's start with you. Are you I? Think the work in overall is the same as before cobit 19 There are still open drug scenes in the two largest cities and we are doing the same work as we did some a little less and some a little more No, I knew Oistan Yeah, well, it's Kind of the same kind of different for me because I'm mostly by behind a desk these days So instead of being down at the office in the very far it's at all. I'm having a home office. So I'm basically doing a lot of my work from from my living room But of course we might get back on it later, but there are of course some issues Coming from the covid situation, of course Can you tell me about the drug scene and the harm reduction scene in general in Norway? So how was that before the crisis? What kind of services are available for drug users? Yeah, yeah, I can maybe start on that one. I guess we have Some open drug scenes, of course downtown in Oslo and also in other municipalities around the Contribute maybe the main main thing we should have in mind is that Norway has a pretty broad welfare system which Also include is helpful for also the users drug users, of course, but It's pretty Effective also also in in a situate crisis situation like like this and there are a lot of public Harm reduction facilities and outreach rich facilities governed by the by the municipalities and stuff like that. So that's But also NGOs as well Ariel how how this current epidemic affected the the lives of people who use drugs in Norway Well The closing down of the society the closing of the boards and everything has made some impact We see that there are some There are less cannabis in the market and And many people who get heroin who live more stable lives out in Outside the city center and so on they cannot get they have shortage of heroin or Amphetamine so they have to come into the city center to start to buy drugs from the open drug Scenes and that makes the situation much worse for them. Of course, it's more less stable and of course, it's a risky situation With the virus and so on Do you see any like shortages of drugs in the market or rising drug prices? Yeah, rising drug prices shortages over Some drugs some places at some times It's very unstable. So many people come into the open drug scenes because they can't get drugs where they used to get it and many people who use cannabis to Prevent using harder drugs a lot of heavy drug users are coming to opiate substitution treatment and And they can live stable good with with that and cannabis and now they don't find cannabis anymore I have to pay Very high prices for it. So they start to use other drugs now. So we can see that in behavior more addiction more bad mental health and so on Yeah, go ahead. Yeah, I would like to say just also that For me not being as much in the front line anymore. I think it's hard to say too much about it, but of course As part of my work with the Regional competent center on alcohol and drugs. I participate and collect data every week from from Municipalities in Norway's who reports in on questionnaires on changes issues and challenges related to the corona situation and drug scenes this was launched by the Department of Health in Norway so for a way to monitor the The covid situation in the open drug scenes in Norway and So far I have to say that the main findings from these weekly reports is that few drug users are At this point infected with the virus And also that the low threshold facilities both the public ones, but also the NGOs seems to have some Control of the situation at this point that is That doesn't mean that that things couldn't be be even better But the impression is that a great share of the helping system has been able to to some degree Think and act pragmatic on the challenges that has been caused by the by the epidemic But I mean it's it's a growing concern as well with the potential and as Aril said Concerns about the drug drought With with the borders being locked down and persists to be be locked down so this effect, I mean will will probably Effect the the whole drug scene the facilities users and the personnel As it will be harder to get the the the drugs you used to use and those such as and stuff like that so this might be Make it come more violence and distress and stuff like that will Eventually might also be a big health concern with overdoses and stuff like that. So it is a growing concern with especially the potential drug Yeah, Oslo was once it was dubbed like the Overdose capital of Europe and it had very high Rates of overdoses. What is the situation now? It's the same situation, but there are a few reports of less overdoses during the covid 19 crisis. So This might lead to something good and I think because many people fear coming shortages of heroin More people want to seek treatment and treatment is available. So I think A lot of people is taking more concern during this time and and and see that this is the time to actually Start to do something about their problems In Norway as far as I know you have you have two drug consumption rooms Are these facilities open or closed or are they available for people? Unfortunately, they both are closed and they are still closed and but this is up to The politicians are considering now if they shall open a tent or or find Other buildings so that they can open them again. This is so bad for the situation People are sitting outside the drug consumption rooms and injecting out in the streets And so that's not that's very awful But it has reached political attention and written a lot about it in the media And this situation it's a terrible situation But this has really opened many people's minds about drug policy and that we have to have more health measures and less Ideology and more knowledge about what to do. So there are more politicians now concerned about the drug given consumption rooms and there are members of parliament going out in the media and focusing on the negative effects of shortage of drugs in the market and also The health authorities is now considering if we also now should try Uh, I have a try out with giving out Substitution treatment also for those who's addicted to other drugs than heroin like Pensodiacepins and at least amphetamine Wow, that sounds interesting because it's like so few experiences we have from the world about about stimulants substitution When when are you going when the government Plan to you know open this program or is there any any any date for that? Yeah, the health directories shall have a note ready now I haven't seen it yet, but they are having a hearing internal hearing first and then they will give it out And this is primarily because we have great isolation units for drug users in Oslo and Bergen. I hope many more places This is where this is very important. There are very few or no COVID Infections among the drug you the problematic drug users in the open drug scenes and so but So this is a very vulnerable group But this is not a group that is dangerous to others But they have opened two isolation units with very good drug Competence and treatment competence and the morphine pills and methadone and buprenorphine And then so they have to be so that they want to stay there if they are testing positive They can Voluntarily go into these units and of course because of that they know a lot of people is addicted to amphetamines As addicted as people are addicted to heroin So they can't give them opiate substitution treatment So they should give them the drug that they are addicted to so therefore they have started to Consider having amphetamine substitution treatment And and then also they are thinking about all those vulnerable people with 20 years Lives than others. What about them? So they have to go down to the drug scene get money very fast Inject amphetamine out in the street or should they get amphetamine as medicine so that they can go home and take care just like everybody else Yeah, yeah, you know what it's like so interesting to see that this crisis is just opening up new opportunities Also, like not only closing but also Opening up things or is then you wanted to add something Yeah, it's just like to also say that it's really important in this situation to Have more thoughts in the mind mind at the same time because Even though the of course the covid situation is really really dramatic and really important to focus on We can't let it be so overwhelming that every other focus will just be pushed aside and and for overdose prevention you said talk about Oslo being one of the The the cities in europe with most overdoses. I think it's really important that we we still focus on on problems with with that and I know that the the municipalities has been pretty pragmatic in in meeting the The challenge is coming from the covid situation with as Adil said the isolation post and quarantine post in Oslo Which has demanded some rearrangement in personnel so that you have to shift some focus throughout this situation, of course, but Still as long as we are in this situation with the corona We The the overdoses and the overdose deaths won't be set on pause until we find the solution If anything it might be even worse. So I think it's just really important that we Keep on working with with the other things as well You are working on on distributing naloxone, right? So is that still working? So do you still distribute naloxone to people? Yeah, yeah, we do. I mean My job as a project coordinator is coordinating and and involving new municipalities and low threshold To make them able to to distribute naloxone to the user groups And at this point we are really eager and And and we see the importance of maintaining a high level of naloxone kit distribute distribution nasal spray as we have in Norway And these days we have tried to be pragmatic and and change the naloxone trainings a bit with Focus more on how to minimize risk of transmiss transmitting the disease And a bit less on on what is the usual data collection part of the project. I mean, it's It's a research project. So we we have routines on on collecting data, but When In this situation you you're not supposed to be too close to people at too too too long a time. So so we try to Push the barrier to to get the naloxone's out At least for at this point You have like protective measures such as masks and gloves. I I suppose at services You know, I'm not quite sure how that is At these times in in Norway. It hasn't been that much discussed. I guess but I mean the the shelters and the Didn't load the low threshold sites and facilities are Are mostly it's still open and and trying to To to do a good good thing out of the situation. So I'm not not quite sure about those measures There are a lot of discussions also about, you know, testing like over testing Whether we need to test People who live on the street or not. Do you have any Position on that or do you have any opinion about that? Well, um, the the in the city of Oslo, and I and also Trondheim now these days I started Along with NGOs sick repuried nurses on wheels at least in Oslo I started Covid testing in the drug scenes downtown in Oslo. I think that's a good measure for monitoring the situation A lot of the people in the drug scenes are in risk The risk groups for for the corona. So I think that's a good good thing Um, Arir what what is happening with homeless people like are there are there good shelters for them? Is there no problem with overcrowding? You said that you have some good quarantine places so that means that These these places are quite okay with there is no overcrowding at these places There's no overcrowding because there's a very little virus if at all among People we have the bad drug Addiction or people living on the street, but of course the situation for people Living on the street is not good enough. I know Many shelters were closed down in the beginning and I read about a church that opened for I don't think with some 40 something people in one church And of course the hygiene situation is not good enough When 40 people sleep at one place with maybe one or two toilets or something like that. So Uh, there has been some suggestions also from Politicians many from Bergen in Oslo that homeless people should get to a hotel room each And I really hope they could because that would then we have their own bathroom And and the politician also said that We are we are expecting a heroin assisted treatment in Norway. It has just haven't been built up, but They are soon ready to start up and the politician in bergen from the city council in bergen He said that they Wanted that the homeless people should come into the hotel room and get opiate substitution treatment even heroin assisted treatment to their hotel rooms and I thought that was a very great great idea Actually, the the Norwegian government was quite Progressive in drug policy even before this crisis, but what you are saying to me now It sounds like maybe even this reform process can get accelerated by this crisis like new New things can be introduced which were not Proposed before is that the case? Yes, and as you say, we are in a drug policy reform time. We are being transferring the The responsibility from justice to health decriminalization, but We we really have this now because What do you call it state? Attorney office or something said to the police Wrote the letter to the police just in march saying that Crime that will lead to Small response Should not lead to any response at all. So use and possession of drugs is now Decriminalized in praxis So that's that's great. And of course when we are in the drug policy reform time We can think about health messengers and really what works, you know, like just say no And we we push out this just saying no thinking and come to a corona situation That leads media and politicians to understand better what to do and we open to help In more ways than we have done before because there's a little there's a lot of irrational What do you say irrational narrowing or helping drug users when the overall Politics is to punish them and now that we are starting to stop stopping punishing them It opens up opens up to see more ways of helping people with problematic drug use So that was an under undergoing criminal reform in norway Via this crisis stop this procedure or is it going according to the plans how it was planned before Yes, the policy Progress is going on just like before we are in a hearing we are sending in letters about this report You remember we were in vienna and health minister told about this in vienna and who and Many The special big organization supported this and this is getting known in norway today and people are sending in Their responses to this drug reform report from punishment to help I think I think there has been a pretty big shift over the last at least decade, but maybe five six years in the public debate Regarding regarding the criminalization. So I Think we'll get there pretty soon. I really hope so I just want to say about about the homeless people in the shelters. I don't have the The overview on everything on that matter in the whole of norway, but as for us, so I it seems like most of the shelters has the same capacity as as earlier and I know that the situation has forced the shelters and the personnel and residents there to think new both with Food-serving visitors hours and stuff like that, but They are mostly still open with somewhat the same capacity as before at least in in Oslo and the public ones So I just just want to say that Okay Any news about you know prisoners What is happening in the prisons? That's a big problem in many countries. I don't know what's the situation in In norway. How many drug users do we have in prison? So is that a problem? I should probably do something about this as we collaborate with some of the prisons with an alexand project, but I'm not really up to date on on that situation. I have to admit So I don't know if you have heard anything about that. Are you I know a lot of people are concerned about the situation for prison inmates, of course, there's a lot of inmates that have drug problems and there's There are less drug treatment inside the prisons and there are fear that they might get a lot of covid in In the prison, but I haven't heard of any measures to do anything about it. I wish they would People with short sentences and so should be released now if that's the best for them, of course You mentioned this stimulants Substitution program. Do you think that it would work the same way as as as it works with opiates or Or do you think there are there would be any any changes or any anything different with stimulant over Substitution or does it work in the same way as as with opiates? Uh in some ways it do work the same way So the craving for drugs is as a say strong as strong with amphetamines as to heroin But the risk of dying of overdose is not as high Uh, but of course and I know a lot of people now with amphetamine problems When they inject amphetamine for two like two weeks, they start they stop eating They stop sleeping they can get psychosis. They are having a bad time And and therefore they use heroin every now and then and they very easily get Overdose because they are not tolerant to heroin They just use it now and then and those people they are putting getting put into the opiate substitution treatment So they are given a new addiction that they didn't have before heroin opiate addiction So and there are many more people injecting amphetamines than people who are injecting heroin And where you get opiate substitution treatment, you see that there's a less A very smaller heroin market But when the heroin market gets smaller the amphetamine market takes over So I think the overall situation I think this is the best thing you can do For problematic drug users to provide amphetamine central stimulants as A substitution medication and of course when you get After some time, it's much easier to stop using the medication Opiate substitution treatment. You are as addicted as you were to heroin when you were In the open drug scenes, but with amphetamine medication You get rid of the addiction by the medication So I think this will be the best thing we can do in the drug treatment service How do you see this Let's say how do you see the end of this crisis? Like, you know, there is a lot of debate whether the world will go back to normal soon or Will this crisis last for a longer time? Are you optimistic? Are you pessimistic? How do you see the light in the end of the tunnel? I guess, I think it's really Weird that there aren't been any more positive tested Covid on the use of group So far that there aren't more infected people I don't really get why that is but I mean that of course is a good thing In Norway now we have had a pretty Full lockdown as many other countries, but now we are Opening the society more So I'm I'm a bit worried and concerned about how that will affect The drug use group as well because There will probably be more Infected people in society and they will probably have some We'll have a role for the drug users as well. So and and it will probably last for a long time But who am I? I'm just a criminologist. So I don't know about this these kind of things Yeah I think we There's a good reason to be positive. We've been through the worst now. We know more and we have Changed our way over acting to others. There's a Larger distance. We are better in hygiene And we are thinking in other ways so working together and and I've really seen that the The government the health authorities the competent centers the scientists the drug treatment workers Those in low thresholds and the drug user organizations. We are really working very good together now We are seeing what's important and opening up to more ways of working and I've seen like The soul saver army has started to hand out the drug user equipment. They've never done that before So and there's so many people doing so fantastic work to protect the vulnerable people And drug users and people with drug problems They are the most vulnerable group because if you have a chronic disease or you're either very old Well, then you can lose a few years of your life If you get COVID-19 that the people with problem the problematic drug users They can lose very many lives that could be prevented and they could have a decent and long and good life So I think everyone sees that this is very important to work with this and the health minister bent her year last week He gave Approximately five million euro to the municipalities to work to give even more health to those with problematic drug drug problems Also to say I totally agree with Arjalan. We see a lot of good collaborations coming from the From the situation people need to think pragmatic and be fast in the decisions And I think we see a lot of good things coming coming from that and as an example Just need to to mention that that There has been this decentralization of syringe distribution in in Oslo So that the people who lives out in the districts don't necessarily need to go downtown to the city center to get their equipment and Now there are 15 out of 15 districts in Oslo of distributing user equipment and and that has come to happen Just over the last couple of weeks. So there are a lot of good things happening So that's true The harm reduction system is just growing Moving throughout the country and very much In and Oslo and around Oslo more and more people are coming into the harm reduction family Okay, so you sound quite optimistic that in the end of this crisis There will be more solidarity and better services for for people who are in need Is there any other message important message you want to Send to to people who work in the field or policymakers or anything else? Look to norway. We are now drug policy reform But there's there's also problems and that's the cannabis users and also those who get it as medication They are not being heard yet and they really should That's that's all this awful situation people with the mental health with the pain Diseases and they have to use bad drugs because they can't get cannabis as a medicine Yeah and use the situation like i'm i'm i'm happy about the the The directory of health who in norway who initiated the coronan drugs questionnaire as i talked about earlier in order to monitor the situation and That that's You get information fast. So when there are any shifts or anything dramatic happening We will hopefully see it fast and i think that's a really good measure And also keep more thoughts in the mind Keep working working our dose prevention and stuff like that Okay, thank you very much and thank you for accepting our invitation and we that you were here with us And also I thank for those who are watching us on facebook live Please keep following us on on facebook and twitter So we can let you know about the next episode of the front line Stories from the front line series And don't remember stay safe and stay informed. Goodbye