 Good morning. My name is Pita Sharoshi. I'm the editor of the Drug Reporter website and welcome you all who are watching us to the Drug Reporter's live video series, Stories from the Frontlines. In this series, we are talking to people from different European and other countries about what is happening with harm reduction after the COVID-19 epidemic started. Today, we will discuss the situation in southern European countries, Spain. I have two guests with me, one from the southern part of the country, one from the northern part of the country. One is Nuria Kazada from Energy Control from Barcelona. And also, I have here Pedro Kazada from the organization UNAD. So how are you guys? How is life now in Spain during quarantine? So we are confined as all the world and well, resisting this situation. Thanks for having me. It has been a great opportunity to take a shower. So thank you to have me. Pedro, how are you? Fine. Well, if I can say fine, you know, the situation is not very easy in Spain. I must say to begin with that I represent UNAD, which is in the whole state, not only in the south. And as you may know, the situation in Spain is really hard. We are one of the more affected countries in the European Union. And this means that we are the first in the global health for the COVID-19 crisis. Where are you now? Where are you now? Where are you based now? Are you from Madrid or from Andalusia? Yes, we are based in Madrid, my entity, but personally I live in Andalusia obviously. Yeah. Okay. So my first question is just to please tell me about your organizations and what kind of services you provided before the crisis? What is the focus of your organizations? Maybe we can start with Nuria from Energy Control. Okay. First of all, I want to say that I am the coordinator of Energy Control, which is a harm reduction project that works in nightlife settings. It's a project of the Spanish NGO Asociación Bienestar Desarrollo, ABT. And ABT offers support to vulnerable people such as people who use drugs and manage different programs and services in different areas, prevention, treatment, and social reinsertion. Energy Control is a part of the prevention area and it offers interventions in nightlife settings as well as drug checking services, among others. The drug checking service works on site at parties and festivals, but it also a stationary service present in four Spanish cities. And in addition, it also works by postal receiving samples from both from Spain and other countries. Regarding ABT manages several treatment centers and supervised consumption rooms in Barcelona and which offer the basic and typical services. Thank you very much. What about you and Unad Pedro? Unad is an Spanish network of more than 200 entities. We work with people who use drugs and families through all Spain. We serve to about more than 48,000 users We count on about 2800 professionals and plus 2800 volunteers that work together with these professionals. We can say this is one of the most important networks in the drugs field and we count on the main entities in all the countries. One of them is ABD, which is one of the most important entities in Unad. We work all through the complete country, South North and all the regional governments work together with us. What can you tell us about how this epidemic changed the lives of your clients and how did they how did it change the drug markets where you are? What about Barcelona? Well, that is the million dollar question. We don't yet have much information about how the COVID situation has impacted particulars drug habits and drug markets. Although we will have some hypotheses based on feedbacks from networks, users and mass media, for instance, about how the drug users are now buying drugs, but we need to have solid data. So at this moment we are running an online survey to collect information about the impact that COVID is having both on drug consumption patterns and another market variables such as availability, purity and prices. And this survey is being conducted with three European countries, Portugal with Cosmic Care Association, Italy with Projecto Neutrabel, and Spain with Energy Control. So the collected data will not only improve our knowledge at the national level, but will also allow us to make comparisons between these three countries. But if we focus on people with problematic drug use, especially heroin users, we know that they are having problems to obtain money because they lost their main funding resources and they are dealing with higher prices, lower purities and lower drug availability. Actually, in the last two weeks, we have been collecting samples from safe consumption rooms and also from Metineras, which is a project for women who take drugs. But because we cannot access our main laboratory, we are running tests in our offices using the thin-liar chromatography. And this technique allows us to detect the most common drugs and also data adulterants, although it doesn't allow us the quantification of compounds nor the identification of unusual substances. So at this stage, we cannot make solid comparisons with purity levels detected before COVID. In any case, the first results point to an increase in adulteration, as we expected. Okay. Pedro, anything to add to this? Well, I would I would assume more or less a situation in Spain since the government declared the state of Harlem in March the 14th. There were some decrease in technical documents afforded by the government in which they adopted some measures for for the limiting of mobility of individuals and the social and economic activity for all people. In none of these decrease, which is the situation for us, in none of these decrease or technical documents, there was some recommendations or some regulations mentioned regarding the special situation of the services for people who use drugs. So we were without a guide, without rules, without anything. In this situation, our entities decided to adopt their own services to the situation by themselves, with no help from the Spanish government, with no help from the regional government. So in a very, very difficult situation, the specific problem in this in this situation is that we are not receiving any specific economic measures, not even the specific ones for the situation of alarm, but even not the regular ones for 2020. And in some occasions, for some entities, they didn't receive even the economic measures for 2019. So the situation is really traumatic for for all these people. This is the reason why you now decided to to try to get some recommendation, some measures from the delegation of the government, the national plan for drugs. But we receive no answer, no answer at all. The reason why, according to these delegations, is that the responsibility for for our services are the regional government. But the regional government would not take decision on this since it is a special situation, the state of alarm. And then we decided to go with attitude Europe, which I think you, you know, the document we sent to the main institutions, European Commission, the European Parliament, the Council and even the NCTDDA to apply for some sort of help to apply for some sort of encourage to the to the Spanish government to take decision on on this. I don't know if to speak about the document or maybe later on if you if you prefer. Oh, yeah, I mean, you can you can just summarize it. What is it about? Okay, we basically applied for some sort of of aspects that we understood where should be addresses urgently. The first one was to to ensure the service provided with the protection that they need. I mean, the the professional should work with protective equipment and with diagnostic test to know about their health and to know that they are that to check that they are okay to to to be able to give these sort of services. Secondly, we applied to the institutions to encourage Spain to ensure effective drug services during the state of Holland. I mean, obviously, for outpatient, patient centers for residential drugs, service centers for harm reduction programs, obviously, and for center for homeless people that are using drugs, which according to our point of view, are the more vulnerable in all this situation. Okay, we understand the government should facilitate people to access to the service they need. And they would they should ensure that these programs face to face that has been cancelled because of the situation should be reactivated immediately after the end of the of the state of of Harlem without any affectations. So in a third way, we encourage the the government to ensure services for people deprived of their liberty. People in open regime, people serving alternative sentencing. I mean, people in active consumption are in rehabilitation processes. Okay, I think this very important for them, since they are not in prison, they are not receiving these services, and it could create a big problem. Okay, not only for them, but for the society. And finally, we think it is really important to create or to implement a state coordination, regardless the region where the people live. I mean, the people that use drugs and the people and their families. I think it would be a mistake to let the regional government to take individual decisions and not take into account that we live in our country, and we need the same services and the same way measures fall off of us. These are the main questions included in the document. That's a very important document and all these are very important points. So one of the most vulnerable groups of our society is homeless people and within homeless people, drug users who are homeless are maybe even more vulnerable. And I know that, for example, in Barcelona, you try to deal with this situation with those people who use drugs and homeless. Can you explain us about that, Muria? Well, this is a global problem we have to face and to deal around the world. Obviously, these populations have problems to stay at home because they don't have home to stay in. And they are usually rejected from the most shelters because they are drug users. So with the confinement rules derived from these times of COVID, we have the opportunity to set up a pioneer service imposed by the council city of Barcelona. It accommodates 70 homeless people, 40 men and 50 women with alcoholism and other addictions, and it covers basic needs, such accommodation, food, hygiene, as well as supervised consumption rooms, psychosocial support, and other activities. The building has three falls, one for men, one for women, and the third one is an isolated space for positive cases of COVID, in addition to the common spaces. This shelter works in coordination with several public treatment services and also services of the homeless assistance network. The space is a beautiful yacht hostel provided by Perra Torres Foundation and is managed by our organization ABT. Actually, we are very excited about it because it's a service that we have been expecting for at least eight years. And the shelter is working much better than we expect. The fact that we have achieved a balance between men and women means that the admissions have have not been abrupt because women come into contact more slowly than men. And I have to say that this shelter is a beautiful space and the equipment is really good, much appreciated by professionals as well as the users, and this allows us to work in good conditions and make everyone feel comfortable. What about like the other harm reduction services in the city, like drug consumption rooms and needle exchange programs, are they still open or are they available? Well, our response, we have to adapt the services to the new governmental regulations, in some cases by shooting down the programs, others by maintaining the services at a low level and developing new ones to respond and face the new needs that emerged by these exceptional situations such as the new shelter for homeless people who use drugs that we were talking about. Respecting the treatment centers are working but with a reduction in opening hours. The potential consoles were canceled as well as blued and urine tests. Group and family therapies are being done online and they are tending and crisis situations and offering non-essential care and health support. Method is dispensate as regularly but with little time reductions and specific prevention measures are being used. It's true, we run a methadone express program for withdrawal syndrome and it offers the possibility of accessing substitute treatment with methadone to mitigate the difficulties in obtaining money, accessing heroin and deal with the changes in the market such as higher adulteration, higher prices and lower supplies. The current situation has induced an increment in the demand of substitution services and this new and extraordinary circuit allows people access to prescription and dispensing within 24 hours. So it's really very, very fast. The supervised consumption rooms maintain their usual opening hours with the usual programs. The services in the services safe distance are being respect and showers and hygiene services are working now more even than ever. They are doing street controls in the street access controls in order to detect suspect cases of COVID and isolation and hospital referrals when needed. In spaces like the social cafeteria where the security distance is difficult to maintain are closed so the meals are, they are given the meals outside of the facility. We have to take in account that some social can teams are closed so our services are provided even more food than before COVID. Around 150 meals twice a day, breakfast in the morning and a hot meal in the afternoon and this is only possible because of the super of the nutritionists without borders and donations from the nostrum restaurants. So citizen collaboration has been key to ensuring food provision to population that is mostly homeless. I think regarding energy control we have shut down almost all the activities, interventions at the schools, interventions and parties, external training sessions and drug checking services. Our main lab allocated in Hospital Del Mar has been closed so we also have to stop the international drug checking service and we basically we are working at home and attending through mail or telephone. Okay thank you Arrecia. I'm really glad to see actually that there are many signs of social solidarity in Barcelona and the response to this crisis was relatively fast or rapid comparing to some other parts of Europe but we know that you know Barcelona is not the whole of Spain and there are other probably other situations in other parts of the country. Pedro can you tell us about what's happening in other parts of Spain? Well to give a general view of a view in general terms I can say that almost all programs are carrying on are going on with their problems, big problems. In fact the outpatient centers are giving their programs through telephone and online services. The problem is specifically with the face-to-face programs which are impossible right now even in this case some emergencies are being covered by these programs with a lot of problems. Residential drug services centers are working with more or less same activity as before with some obviously some problems regarding the providers and all these services they need from outside and regarding the centers for homeless I knew the program that Nuria showed us and I understand I find it is a really good initiative and some parts of Spain are trying to do the same services. In fact I know the case in Seville in Andalucía apart from the spaces that were stated for these homeless people who use drugs they have opened three new spaces, big spaces to cover the needs. They can sleep there, they can have their needs, their main needs and I think there are about 600 new users in these big spaces apart from about 70 users that are in hostels, in hostels which are covered part of the social security, part from the town hall services and the big part from private enterprises. So more or less we are trying to keep all the programs with a lot of problems because we don't receive any help from the national government, the state and the regional governments but I want to think that with a lot of energy, with a lot of work our entities are trying not to lose the programs and the users. I see in many parts of Europe that and you also mentioned it that one of your recommendation was that the government should provide protective equipment to people who work in the field but does it really happen? I mean you said that the national government doesn't help you but can service providers access to like masks and gloves and things like that? I can tell you that about a couple of days ago we began receiving some protection, some masks but it's been from the very beginning we have been working with them without protection, with the necessary protection and even now we don't have tests. I have heard that yesterday and the day before yesterday some of our entities received some testing to check the situation of the both the users and the professionals. We decided that it was more important to give these tests to the users to check the population to see if they are okay and afterwards and when some more tests will be coming we will try to do all the tests to all the professionals and users of these entities but it's been a lack of help, a big lack of help because I understand this is a really important thing to to have at least the protection to be able to serve to be able to keep the the problems to be able to help these people and even not to create a bigger problem. Yeah Nuria you have the same problems? Probably the main problem we were facing in the harm reduction centers in the first weeks were the acquisition of sanitary masks and other protection materials as well as the difficulty in testing professionals with clinical symptoms which translates into continuous sick leaks without confirmation of positive cases. Now we have enough masks for professionals and users but I have to say that it has been possible again thanks to the effort and contact of our networks there were not provided by the government so we improve step by step we are improving the situation but not for the government but I understand Barcelona and Catalonia is different in our drug policy that in other spaces of Spain and we have more harm reduction centers and more better drug policy I think. I do agree with what Nuria said absolutely and I must say that before the protective equipment and these masks will come from the government there are there were a million of private initiatives to try to create some sort of mask and some sort of protective equipment but I suppose the best thing to do right now is to to receive these protective equipment technical protective equipment from the government. Okay so if you would now sit down for five minutes with the Spanish government what would you what would be the most priority for you to ask from from the government? My top yeah well I would obviously encourage them to state some very very urgent measures regarding the services for for people who use drugs I would encourage them absolutely to to keep or to to keep equipment protective equipment for professionals and I would encourage them to try to keep all the services on and to warranty that these services even the one face-to-face as we can say will be reactivated as soon as this will end and I think this is the most important obviously to try to get a real state coordination for all things that keep us informed and that keep us all the necessary to be able to face this situation as the rest of the health crisis too. Yeah we are now speaking a lot also about this crisis as an opportunity you know that it's not only a crisis but we can also learn something from this from this crisis for the future so Nuria what do you think what can we learn what can we learn and what are the lessons learned from this crisis? There are a lot of lessons we can learn about this crisis not only in the drug policy or the drug area in the life in the life and in all the scenes I don't know we are very happy with the new shelter I think it's a it's a big pity that this opportunity this new resources appears with the disaster situations you know but they think the shelter it was created in this exceptional circumstance but it opens the door to hope for its permanent establishment so we expect that this new shelter maintains or we know we know that this shelter the future is not there's not occurring in the same space where it's now allocated because it's a temporary settlement but we hope it will continue in another space with human and good conditions because you know we are we are usually have the worst spaces for people who are stressed they they are not living in good conditions so for example in this in this new shelter people are at least 18 people are super happy with the equipment and the conditions they are living Pedro any lessons learned you would like to share with us well being realistic I think no one could expect this situation so it is difficult to to think about the future because I think we will always be shocked by these situations but maybe the main lesson I am I think we should learn is that we cannot live day by day we must think about the future we cannot be without protection without sanitary tools we cannot be working day by day with the only resources that we think we need in these days we need to think about the future we need to think about times about possible situations like this one and we should try to to have some second option in these in these cases I for example remember this the example of Finland I think it's Finland has been has been keeping some materials for these situations and protective equipment some masks and now they are suffering a bit less than the rest of the of the Europe for example I just want to I would like to add that this situation show us the beautiful things right like the human quality of a society is measured by the quality standards of living of its small most vulnerable members then I think Barcelona is showing right now a high level of human quality and an example for the rest of the world so I think it's a good opportunity to push this this this kind of resources yeah thank you that was a very good conclusion of our discussion and thank you so much for being available and joining this call and informing people about what's happening in Spain and for those who are watching us online on Facebook please follow us on social media we will inform you about the next videos in the stories from Frontline series and stay safe and stay informed thank you goodbye thank you thank you very much take care