 Good morning, I'm Peter Sharusian. This is Drug Reporter Stories from the Frontlines live video series on harm reduction during the COVID era. Today we are discussing the situation in Greece. As usual, I have two guests with me, two professionals from two leading harm reduction organizations based in Athens, capital of Greece. I have Niki Voduri from Praxis and Tassos Smetopoulos from Steps. Good morning guys, how are you? Good morning, hello, we are fine, you? Thanks. Good morning. Today is a special day, June 26th, the UN calls this day an international day against drug abuse and illicit trafficking but the harm reduction community told that we need to reframe this day and activists transformed this day a few years ago into the support on punish global day of action. As I see Tassos, you have a t-shirt with the sign, you can show. So yeah, this is the sign and on this day, everywhere in the world, NGOs and activists and professionals are doing some activities to raise awareness on the need to change drug policies and make them more supportive rather than based on punishment. So before we start to discuss general situation in Greece, can you tell me if there are any activities or programs in Athens regarding support on punish action day? Day, you mean for this day? Yeah, yeah, today, yeah, on the support. Yes, there is an activity in Kipseli, in the main market of Kipseli, there is the platform of NGOs, there is a coalition of NGOs, Praxis and Steps are members of it and there's going to be discussion on the rights of drug users, what should be done? There will be representatives from the state, from other NGOs, from addictions, addiction therapy bodies, Tassos, am I forgetting something? It's today six o'clock, three o'clock time. Yes. Okay. Oh, that sounds good. So let's start to speak about how this COVID crisis affected people who use drugs in your city. So can you tell me how the crisis changed the lives of drug users? Now I suppose the lockdown is more or less over in most cities. But let's go back to when this crisis started and please tell me how it affected your clients and your work. Maybe you can start Nikki and then Tassos. Okay. What you must understand is that the main problem during COVID was concerning the drug users that were in the streets, homeless drug users. In Athens, there are quite a few people that don't have a place to stay. So as soon as the lockdown was implemented in Greece, everything was shut down. And there were cafeterias shut down, restaurants shut down. This was a indirect correlation with the drug users because suddenly they didn't have access, not even to bed and the whole house like before, but they didn't even have access to water, to a toilet, to food. So it was suddenly they were with nothing. In Athens, it's rare to have public toilets and water. So it's really difficult to have access to these things. And it was quite challenging for us because we had to find ways to provide even more basic things that we had to do before. So it was a really big problem and a big challenge. Tassos, do you have anything to add? More or less Niki described the situation, plus that the police was pushing people from corner to corner, not allowed them to find peace in spots. Actually I remember when we were with my colleague Istvan, we went to Athens to film about harm reduction. I remember that it's very visible on the streets of Athens that there is a strong police presence and like I've heard a lot of stories about police aggression against people who use drugs. So can you explain me or those people who don't know the situation in Greece, why is this so so much, you know, why the police is so aggressive in Greece and why there are so much emphasis on this kind of repressive law enforcement on the streets. So how did you get there in this state? My opinion, it's lack of education. The philosophy of punishment in Greece is for the drug users, I mean, it's the prevailing philosophy, not only for the police but quite often, and Tassos correct me if I wrong, in the general public. So because there is very scarce education concerning drug matters and also the police, the punishment is what is mostly what we deal with. There have been laws the last few years that seem to be shifting a little bit the things from, you know, from punishment to rehabilitation and support and stuff, but it's not enough in my opinion yet and also from the founding of a law to the implementation of the law and to what the police and people understand about this law, it's a long way. Tassos? You know, let's say at 60s in Greece, we used to say that the teachers, the priests and the police men are the real powers in Greece. This time, we lost the teachers. So we stayed with the priests and the police. So this is how they have it in their minds, that they have a power and they have to exercise their power and the easiest way to do this is to the most vulnerable people. So I think when we talk about Greece, we can't say that before this COVID crisis, it was everything normal because you already had a crisis, right? Since 2008 or it may be even before that the Greece was a country which was very hardly hit by this financial crisis and the austerity policies, politics and the budget cuts and lack of access to social and health care. So did it also make worse the police violence? Like was it even bad before this crisis or is it connected or linked to this crisis that the police became so aggressive? In my opinion, I really don't know if the financial crisis had to do with the police violence. In my opinion, the financial crisis in general, and I'm not speaking only about the police right now, was also an ethical crisis. Many things in the country were challenged, many ideas, many beliefs that we had up until now about life in general and rights and who is poor, who is the drug user. So the financial crisis was a really significant time but we also have to add to this seclusion also other things that happened in Greece during this time. For example, the HIV epidemic in Athens in 2012, in drug users, injection drug users and how they were treated at that time from the police and from the authorities. There were people that were arrested, they were accused of prostitution women, to be particular, they were accused, they were prosecuted that they were, how can I say, intentionally harming others. So I think that at this point we come through a series of things happening in Greece during the financial crisis concerning the police and the drug use and adding to this the cat-backs of harm reduction kits from public organizations like Okana and others. So it's a little bit complicated. You mentioned Okana and for those who don't know the system in Greece, Okana is a state agency as far as I understand and it provides lots of services for people who use drugs in Greece and it has a very central role in the systems. Do you think it's a good system? Okana is the only state agency, the only agency state or private, there's no private that has the right and the ability to provide substitution. Ok, so it's the only place where a drug user can have methadone or reprenorphine or any kind of substitution. So in my opinion, in these terms, no, to have just one, no. Tassos, do you agree? Yes, I just want to add that as someone that is coming from the community, because I used to be a person with problematic drug use for more or less 20 years, I can say that not many things really change since 80s in Greece. And I'm talking for the daily life of the people that are out there struggling to find their dose or struggling to have access to the services. It's having waiting lists, it's something that says that something is wrong, because many times if you lose the timing, I mean let's say finding someone on the streets in a street works if that saying that I'm tired, I want something for my life now. So if you cannot respond to this, what he wants at the moment, you lost it. And you don't know if there is another time that you are going to have the chance to serve the person or to support the person in order to find another way. What do you think what should be done to change the situation? What is needed? What kind of reform? First of all to decriminalize the law of the drug users. I mean in one hand we provide the kids for the safe use and in a gray zone. And in the other hand the state and the law says that these people are criminals. So the thing is that we have to change how they see all these people and what they are dealing with. Do you see any openness from the governments to change the drug laws increase? No. I mean it's and there are the examples let's say in Barcelona in 90s or in Portugal in more or less the same period. They realize that they have a problem, they sit down, they collaborate in order to find solutions and to deal with it. In Greece the last almost 40 years is just putting the problem under the carpet. So do you feel as NGOs that your voice is not heard by decision makers that there are no mechanisms to involve civil society? It's some years now and Niki correct me if I'm wrong but the civil society and organizations and NGOs are trying to asking strongly to be part of the policies and we have a strong denial from the state and also from the ones that they suppose to support these people such as Ocana, such as Keter. We've been included in discussions in workgroups in many kinds of things where ideas are exchanged and strategies are being discussed but in the basic policy making it's not us that have any words so but we are there at any time whenever the state has any difficulty, problem, trouble implementing anything the NGOs are the first to come and implement because it's easier for us to implement programs than the state so we are there at any time. I think that because we have a knowledge from the street we should be heard more except from academic and you know idea exchanging things. So when you had this COVID epidemic in Greece and you had to respond quite rapidly to this problem so did you see that maybe this could change your relationship with the decision makers that they were like dependent more on your knowledge and expertise and doing some new interventions on the streets, things like that. One positive thing that happened during the lockdown of COVID was the implementation of two shelters for homeless people from the municipality of Athens as the key stakeholder. One was for the homeless people and the other was for homeless drug users. So these kinds of shelters we have been asking and discussing for I really don't know how many years that they should be there in Athens for people to have a bed, a warm meal, access to toilet to water. So in terms of this, this was a positive step that happened. And if it was not for COVID and the lockdown and fear of people gathering together, I'm sure that it would be a lot more difficult than it was now. So emergency circumstances where the reason why this happened, it happened quite quickly for the Greek times. So it happened quite quickly during the lockdown. We were asked in this project in a way for the homeless people as practices, we are still implementing there along with the municipality. We have social service and medical service there for the drug use, the drug user's shelter. We have been having a lot of meetings and, you know, being asked about our opinions and, but in the end it is implemented from the municipality O'Connor and another addictions agency or anybody who doesn't know, still, it's still more needed. As I saw in the pictures, it was even opened by the mayor of Athens, right? And so is he quite supportive to this? Yes, he was supportive of these projects and they were much needed in the city of Athens and there are more needed because they are, you know, they are spaces that have a number of places and I think it's not enough, in my opinion. Many other places, spaces should be opened and also what is what should be done, what we're saying years now that it should be done, there has to be also a place for the drug users to use drugs, you know, a drug consumption room. Now we have a place that some of the people can stay, not everybody, but we still have people having to use in the streets. So is the, you had a drug consumption room, right, operated by O'Connor, so is it still open? No, no, no, it's not open. It was a pilot program, it was shut down due to law things and complications and stuff and people working in the drug consumption room were nearly prosecuted because of the gaps of the law, you know, employees, I mean. And now we have the law and we don't have the drug consumption rooms. If I can add something more, because there is a little story behind the shelters, the lockdown in Greece was like 46 days, more or less. And at a point, there was a discussion that there is people left outside by themselves. And the government said that, oh, this is not our business. This is the municipality's business. So the reality was that the central government said that, oh, no, you guys, you have to deal with this. It's not us. So the municipality of Athens, it wasn't like that, oh, we want to do that. They had to do that because the central government said that this is not, it's out of our business. So the before the lockdown was finished, it was like more 10 or 12 days that they opened the shelter for the people that had problematic drug use. This is, in my opinion and our opinion, this is points how they are interested or how they care about this population. Tassas, you mentioned before that there are long waiting lists for opiate substitution program. Did that change now with this crisis that people can maybe get their methadone for a longer period, take home? How does it work now? This was happening also before, I mean, take home for a longer period. The waiting list from time to time is changing. But the main thing is that why? Why we have to have one specific way to have access to a medicine? Because methadone or Subotex or whatever, it's a tool. It's a tool and it's a medicine. And the right place for a medicine is the pharmacist. And then people can have easier access on what they need. So you can see, yes, yes. So you suggest that there shouldn't be any restrictions on accessing opiate substitution medicines. Just go to the pharmacy, buy it for prescription, right? Yeah. And do you have a discussion about this with the decision makers? What are the, what are the arguments against this? You know, there has to be somebody overseeing the therapy of somebody because it is a medicine. In my opinion, you know, it's not like an aspirin that you can go to the pharmacy and take as much as you want or think you need or whatever. So there has to be medical supervision because it's a medicine. But what I think in my opinion is, and I think that's also we agree, is that it shouldn't be so restricted in only one place with all the bureaucratic procedures and waiting lists for these two, for these to happen. For example, it could even be in, you know, in family doctors, family GPs that could be able to prescribe or municipal medical practices and or wherever. I mean, not just go to the pharmacy and take as much as I want, but not in this kind of, you know, way because it produces time delays. No wonder. Yeah. We had a similar video with Norwegian professionals last time and they said that now during this COVID crisis, they are now considering to introduce a stimulant substitution also for those people who are in shelters, homeless people. So now we can speak a bit about the drug market in Athens. So what drugs people use and inject in Athens? How is the drug market now? Did it change during the COVID crisis? Maybe the prices went up. Are there any significant changes? During the lockdown wasn't any access even to the drug market because in an empty city full of police, you know, it's a bit, people didn't have access to buy any drugs. That means that the risk was higher to buy things that wasn't drugs. Synthetic opioids, it's one thing. Synthetic or a kind of cocaine. Also, it's another thing. And the crystal meth, it's, I think, plus the pills, different kinds of pills that they used to take. And I think that the services that we have for harm reduction has to do only with the ones that they are injecting or using opioids. We have this phenomenon for the CISA, which is crystal meth. Over five years now, and there is nothing, nothing, nothing. There is a big zero about the harm reduction for these people. And maybe I'm not wrong. It's the population that uses crystal meth at this, at this moment is even higher than the ones that injecting opioids. Nikki, anything to add from your experience? No, I agree in general. We have our history of drug use as a country is mostly many different kinds of drugs together. Okay, multi-drug use. Usually people don't just take one drug. Of course they have their drug of preference, but mostly due to economic reasons or other reasons, they use many different categories of drugs. So that's just right, either pills and the kind of cocaine or real cocaine and opioids and everything like that. And I agree that we don't have any, I can say, plans about the CISA users right now except from certain NGOs that distribute these, you know, pipettes for safer drug use. At times there is nothing, you know, stable. Even that, Nikki, I think nobody's doing this. Maybe I'm wrong, but I think nobody's distributing pipes. Okay, I think we lost Nikki a bit, but I hope she will join us again. So, Tassos, do you also have new synthetic drugs, so new psychoactive drugs coming to Greece? Yes, and I think the multi-use has to do also with the bad quality of the drug. Of course the street drugs. So it's very cheap and in a very bad quality. And this is, I think it's one of the reasons that we have this multi-use of different kind of drugs. Okay, and so what about prison, what about the situation in the prisons? Do you have any services for people who use drugs inside of prisons? There is some, but still not enough to cover the need. Let's say there isn't any distribution for safe use in prisons, because, you know, it goes like, if we do that, it's like accepting that we have a drug use in prisons. So the prison... The system is a kind of refusing the existence of many things. So this goes like not allowed to them. And that was, I mentioned before that the first thing is that you have to accept that you have a problem. And then you have to sit down and talk and find the ways that you deal with it. So the prison system is in a state of denial, right? Yes, and it's a very close system. But still there is some NGOs that they are working and trying to make a difference. But it's not enough. So you mentioned that in the Greek society, policemen and priests are very important persons. So how is the church, what is the role of the church in this discussion or in this discourse? Do they have any? Yes, but you know, in this theory of this church way, I mean, has to do nothing. It's like giving something to you poor people. Has nothing to do with the existence and the soul of the persons. That it's persons like us. Welcome back Niki. Do you hear us? And now I think she's connecting to the audio. So we also, in Athens you also have lots of refugees and migrants. And what is the situation of drug use among these people? Is there any special problem or? There is no service for, I mean, there is just one service and to advise from Keter. To advise migrants and refugees. There is a lack of translators. And of course, if they don't have the papers, they have access to nothing. And I really want to say that last night, we went to the shelter with a guy that he's a migrant. He has papers with his leg is, I mean, we deal with him and went to the hospital and take care of his leg. And the guy asked that now it's the time for me to go to the center because I have also to deal with the, with my leg and staying outside. It's, it's a risk. And the answer, we argue with the argue in a way with the security guards like, oh no, is nobody here. After some time was somebody there. And the answer that we get was like, we don't have space, but maybe we have space for emergencies. So you have to come back tomorrow morning because our supervisor for emergencies are coming tomorrow. We don't know exact time, but coming tomorrow. Okay, now I think Nikki tries to rejoin with another computer. What about, what about this drug consumption room story, let's get back to that. Do you have any chance that it will be reopened? Do you have any discussions with the ministries? How to, because you said that now there is a load. Hi, Nikki, you here? Sorry, my internet completely collapsed suddenly. I'm sorry, I'm back. No problem. We were just, I was just asking Tassos and also you that let's get back to this story of the drug consumption room. So that you said that now there is a load. So the legal background is there. So what is the still, what, what, what is the barrier? Why, why they don't open it? Is it now lack of money or political will or why, why they don't open it? I don't know. Because in different kinds of discussions, what we hear is that there is a will. It is going to happen, but it doesn't. So, I don't know if it's lack of money, if it's, you know, hesitation, because the public is also not educated in the benefits of a drug consumption room. So many times there's the belief that if we have a drug consumption room in Athens, in the center of Athens, because we cannot have it in the woods, we have to have it where people are. So there are people living in the area that think that it's, you know, we're going to have more drug users and more crime and so it's, it's need, they need to be educated. So I don't know if it's hesitation concerning this. And, and actually just correct me if I'm wrong, but this room was pretty small, right? So it's just a lot of few people and I, when I also talked to some activists, they told me that the rules were quite restrictive or they felt that the rules were quite restrictive. So it was like kind of high threshold service. So would it, would it really help the situation or if it would be open? It would help the situation. Even with, let me say that this, the previous drug consumption room, it was introduced as a pilot program. Okay, so it was working as a pilot program. In my opinion, we have the experience from the previous drug consumption room to do it right this time. But honestly, in any way that we can take people from the streets that are using with all the dangers of using in the street and all the, the, how can I say, the, the abundance of their dignity and their, and their rights and, you know, using in plain sight, any way that we can do it, it can, it will be a plus. Okay. So in Greece, you have some organizations for people who use drugs. Can you also tell us a bit about those organizations and what role they played now during this COVID crisis? Was it important that you had the voice of the users? You're talking about the state organizations or the, of people that use drugs? The people who use drugs, organizations of people who use drugs. Okay, so they, we have organizations of people that use drugs, we have created a platform with these people and with NGOs that are in the field. And we, all of us together, we try to implement, to suggest new implementations, changes of strategy, and all these kinds of things. We as praxis, we employ people that are injection drug users, we have in our staff people that are working with us. So, and in my opinion, it's a very valuable, you know, experience to have and to work with these people in, in this field. So I think that more is needed, more, you know, to, to involve them more, because they're the ones that know, they're the ones that leave it. Yeah. Tassels, do you have anything to add to that? Because you said you also have lived experience. Yes. I think, you know, people that has, or had the experience, they have a knowledge. And this knowledge is, is, is something that the institutions or the, the governments or the NGOs need in order to, to understand more about the drug use and the addiction. Still, there is, you know, it's still, there is like praxis has some people, but still, we need more, more, more chances and for these people to, to, to use their knowledge because, you know, it's sometimes it's very hard to, to go back to the to go back and find a job from the beginning. But if you have an option to, to do something with your knowledge on the streets, it's a way out. And it's useful for everybody. So, I think that there is, there is more that we can do in this way. Now that when, when all the lockdown is, is eased, and we have, maybe we are still having in front of us another wave of the epidemic, we don't know, but right now it's a bit calmer period. It's interesting that those achievements that you had achieved in a sense like this shelter for drug users. Can they be maintained for the longer run. The bill this shelter kept open even after this epidemic is over. We hope it's a question. We hope, we hope that it's going to continue. We feel that it's necessary and, as I told you in the beginning, more need, more need to, to be implemented. For example, we have constant telephone calls or emails in praxis for people that are homeless and use drugs from different municipalities in Athens or in Greece. So, I think that this was a good, how can I say, pilot for more shelters to be implemented throughout in the center of Athens but throughout Attica and Greece eventually. What are the other hotspots of injecting or other problematic drug use in Greece outside of Athens. Right outside of Athens, there's, there are two, how can municipalities, Tassos, Zephyr, Menidii. Okay, there are, you know, mostly in the west of Athens, it's a suburb, two suburbs of Athens, if I can say, and mostly this is where the dealing is being done. But also, there is drug use. You can see buses full of people that use drugs coming and going to these places. So, the main, except from the center of Athens, the main other places there. In the, you know, outside Athens, I think that places of use and dealing are more concealed in small cities and towns. So, it's not very obvious like in Athens. A few years ago, you had an outbreak of HIV among injecting drug users. What is the situation now with HIV and hepatitis C? For injection drug users, you know? It was clearly reduced. Okay, there were actions implemented. This was a time that there was quite big cooperation of the state and the NGOs and the addictions agencies that everybody worked together. And it was a good cooperation at that time in order to increase the testing, increase the kits and the needles and all the harm reduction tools that we need. And, you know, refer the people who were testing positive as soon as possible to the infectious units and stuff. So, it was a good time. We managed to have it almost to zero, but at the last year or two because of the cat box and reduce of tools being distributed and many kinds of other reasons. Embirically, I can tell you that there are new diagnosis of HIV in people that use drugs. There is a danger, always there is a danger. What about the hepatitis C situation? Now we know that we have a cure for hep C, but do people access to this treatment in Greece? Right now, more people than at first have access, but the reality is that still people don't have access. Because there's the social security number problem. If you don't have a social security number, it's very difficult to have access to testing the viral load. It's really difficult for people to do. Also, we have to have services that support them in order to go and cooperate and be every time that they are needed to go to the hospital and to the doctor. So it's difficult, it's better than before, but it's quite difficult still. And also, the biggest problem are the drug users that are asylum seekers in Greece or don't have any legal documentation, because they actually don't have access. We don't have only Greek drug users. And I think I have to add something that sometimes, where we're talking about people that are homeless or they are spending most of their time on the streets, it's not their priority to have the therapy. So I think it's really needed that the therapy has to go on the streets and find the people. For example, what I can tell you that we have managed to do since 2012 after agreements and discussions with infectious units in hospitals of Athens. We have managed to have the antiviral medication of quite a few homeless people that are drug users in the day center of the homeless that for the homeless that we have that practice has. And because people come there to have a bath to wash their clothes to drink coffee or have a snack. We also have a primary health care practice so we give them their medication in the morning in the evening so it's easier for them to take them because they will come either way. Asus is very right when he says that when you don't have access to a house or a toilet, it's not a priority to treat your HIV or even your addiction. It's not a priority because what's left, if I don't have a house, if I don't have money, if I don't have access to toilet and water, what's the point in stop using drugs? What's the point? So I think he's right, I agree, I totally agree. If we start to speak about this like systematic factors behind drug problems such as poverty and social exclusion and homelessness in this regard, where is the Greek society now is heading to? Is there now an increasing problem like this homelessness, unemployment or is the problem has been diminishing in the previous time? And what do you expect? Are you optimist or pessimist about the prospects? Our point of view is that we are expecting a financial crisis following the pandemic crisis for many, many, many reasons. I think that we are going to see this coming in the next probably beginning of September. A crisis, a financial crisis? Yes, because it's expected, especially in Greece that it's mostly, our financials are mostly based in tourism and all these kinds of things. It's actually going to be a problem. We believe that it's going to be a problem and it will increase. But we still don't know what is going to happen if there is another lockdown, if there is a second wave that it's as large as the previous, even though Greece didn't have or we don't know if we actually had so many cases of COVID. But it seems that we deal quite mildly, but we don't know actually. So I mean everywhere we have a lot of questions we can't answer right now as we are approaching the end of our discussion. So do you have any concluding remarks on maybe some lessons learned from this COVID crisis, which you can use in the future, not to make the same mistakes, what you made in the past, so are there any lessons learned you want to share with us? One lesson learned is that we knew it. It's not a new lesson. I hope others learned it. It's really needed for people to have a place to stay. It's protective not only for these people but also for the general public, for everyone. It's no use for people being homeless. Injecting drugs is not a reason for somebody not to have a house. It's not a punishment. It's really harsh punishment for anybody too, not to have access to so basic goods and human rights actually. So we hope what started in COVID is going to continue and be actually a strategy. Our, I don't know if it's a lesson that learned but I have this feeling that the lockdown period was, I mean, okay, all these people left alone in the city center, but where the restrictions stopped, now they are the threat of the pandemic. I mean, the rest of the society that came out after 40, 50 days start pointing all these people that now these people that they left alone in the city center are a threat. We faced it having also to our team bullying us from neighborhoods that, oh why you are here and so I think maybe that period of the lockdown was a small oasis. If you know what I mean, because we wasn't, the society wasn't there pointing these people and when the lockdown was finished, we came back again pointing the enemy and the threat of the society. Well, it didn't teach us solidarity either way, the lockdown. Yeah. Definitely we need more solidarity and this is the message of today, the day action, global day of action, support don't punish. So Nikki and Tassos thank you so much for being with us. Thank you. Thank you for having us. And also thank you for those who were watching us online on Facebook. Please stay with us on Facebook and Twitter follow us and you will find out information about the next episode of stories from from the front lines. Stay informed and stay safe. Goodbye. Thank you.