 Hello, good afternoon, I'm Peter Sharoschi and I welcome you all at today's discussion in our stories from the front lines live video series on drug reporter. Today we will speak about the situation in a country that was hit really hard by the COVID-19 epidemic, with high rates of infections and death rates, and the tough lockdown regime. This country is Italy. I have two guests here with me today, who will explain how this epidemic affects the lives of people who use drugs and harm reduction services in that country. So let me introduce my guests. First we have Susanna Ronconi, who joined us from Rome. She works for Forum Droga, an organization promoting drug policy reform in Italy. She's also the board member of Itard, the Italian harm reduction network, and also my fellow member of the civil society forum on drugs. Hello Susanna. And my other guest is Pino de Pino, coordinator of harm reduction office in the city of Venice, and also the board member of Itard, the Italian harm reduction network. Buongiorno Pino. Buongiorno. So thank you very much for accepting our invitation. First I would like to ask you, like, how are you guys? How is your life in quarantine in Italy? Do you see the light in the end of the tunnel? I am at home arrest, and this is our fifth week, so it's a long time. But anyway, we resist. We try to be physically separated, but not separating from a social point of view. So we try to maintain our relationship, also even if in a virtual way. And I have to say that sometimes I'm working much harder than before, because of course we are trying to monitor the situation. And we are starting with some research on what is going on. So we are trying to, we are making also some campaign for the rights of the most vulnerable people, you know. So we are busy. What about you Pino? Yes, we are busy too, because most of the harm reduction services and harm reduction professionals in Italy are still working. When we go on the streets, people from all around Italy tells me that we, the street worker are as people who use drug, the only one by the streets on the streets. So this is how you're going. Can you tell us how this lockdown affects their lives? Yeah, sure. There are different situations all around Italy, because there are some cities in which the drug supply is not so easy as before, for example. And also the normal activities of people who use drug to get money are now impossible, if you think about, for example, in a touristic city like the one I live in or Rome or Florence, there are no tourists. So their economy, their income are very, very low. Okay, and we know that the quality of the truck of heroin, especially about, I'm talking especially about heroin is going down every day. Today is worse than yesterday and better than tomorrow, maybe. And that's I suppose is why the tillers are finishing their supplies. Susana, do you have a kind of overview of the whole country? So do you see like how different regions are managing this crisis? Yes, you mean from the point of view of harm reduction intervention? Yes. Yes, I only want to add something about the drug markets because we know that the prices are increasing a lot. So we have problem with quality of drugs and also with prices of drug. So the situation is critical, I think. In regard to harm reduction, you know that in Italy, we have a lot of differences between different regions. So the central north of the country is well covered also in this moment and as Pino says, the great part of the outreach intervention and routine are working now. Sometimes with different opening times and so on, but they do work. We have a lot of problems in the south of Italy because we have a good system only in Naples, but in the southern regions we have nothing at all. And I have to say that we didn't receive any clear guidelines from regions. And I think that our services work thanks to the responsibility of the workers. I have to say that. In the first two weeks of the pandemic, the first reaction was, well, let's close everything because people have no idea what was going on. And we have no guidelines, no non-information and so on. But this was the first moment. Then everything is working. Sometimes, for instance, the dropping centers are not open because of the risk of overcrowding inside. But in this case, the workers can distribute any way syringes, maloxone, so they can guarantee the most important intervention, I think. So I think in general, where harm reduction is stable, we are able to cope with this situation. And I think it's a good challenge for us because it's also a sort of self-evaluation of our system. I also hear some news that now Italian people get pissed off because of this quarantine. A lot of people now break the quarantine and they just want this ended and also that there are some social distress in some cities, that people are kind of revolting. Is that true or is it what you also experience or it's maybe exaggeration? I don't know what you mean, but in my opinion it's a little exaggeration. I live in Torino and I don't see anyone on the street, absolutely, until now. But you know, it's the fifth weeks. So I think that from now on it would be harder, I think. And then we have to say that the pandemic is not the same for everyone, you know. For instance, in my case, I have a house, I have a connection to internet, I have a lot of friends, I can read the book and study and so on. So I think that my life, okay, I can do it. But we have to think of more poor people and vulnerable people and in this case, yes, I'm afraid is too hard for them. And this is the problem. It's a classist pandemic, I think. So Pino, I suppose that because of the stop of flow of tourists, Venice is suffering a lot economically as well and probably our clients lived also from tourists, indirectly at least. So how people are feeling now, like, are they getting distressed and desperate about the situation? I think, well, people who live on the streets, I think, is organizing the time and their economy in another way. Okay, but as you say, this city, the lack of people from abroad is a very big problem for them. Someone told me that two hours asking money in Venice can, they can gain until 20 or 40 euros in two hours. So now this money is, they are missing this money, okay. And also, I think that also because the market changed. And so now, as we had before the crisis, we had a good heroin sale by people from Sub-Saharan Africa who don't live in this town. So now they cannot reach the town. There is low quality heroin, more difficult to find it. But I'm talking about heroin, but yesterday I was reading that the tobacco sellers are saying that CBD, marijuana, doubled the sales in last month. So I think there is a very big problem about getting the drug you want to get, okay. That's a problem for people who are addicts. And but what I want to say is that our system, not only the harm reduction system, but also the treatment system. And I mean the access to substitutes of the opioids is changing anyway. So for example, in cities like mine, where it was very difficult to get methadone or it will have to wait a long time. One week before the first counseling and getting methadone. Now this time is getting very, very short because you and people who ask for treatment are increasing now. Sorry, I want to stress something about OST. Because from one side, I think that we have a good system about that because you know methadone in Italy is guaranteed by the national health system is free of charge. We have 600 administration centers, so it's a well organized part of our system. But anyway, we are learning something from this crisis. One thing is what the Pino was saying, and the other is that they are increasing the number of take home methadone. So in this period, many, many people can have methadone doses for two or three weeks or even more. And this is already included in the methadone protocol, but usually doctors adopt this model in a very restrictive way. While now they are opening, you know, and in this, this is very important both for people who can self-regulate and self-administrate their lives in a more free way. And this is important also for the administration center because they avoid overcrowding and they limited the number of clients going there. So I think this is one of the more optimistic side of the crisis because we are learning something that could work better also in ordinary moments. Yeah, that's a very interesting point what you raised both of you because last time we had a discussion with people from Prague and Bratislava and they also said that maybe this crisis will be also an opportunity, you know, to change some of the outdated rules which were not effective anymore. And maybe we can change some policies for good. What do you experience about, for example, about police and law enforcement, like do they still arrest people for using drugs or do they now tolerate this or what do you see about that? At the beginning of the crisis, there were some news from cities like big cities like Rome or Milan and people who live on the streets, not only people who use drugs and live on the streets were not arrested but there is something like a fee and where there is a fee for living on the streets. What I experienced is that now this is not happening. For example, in Venice we don't have nobody is being chaired for being on the streets during the crisis. And that's also another lesson we are learning. I think for people who live on the street and now city councils and city systems don't know where to put them to let them stay in case of their ill and so on. We are also learning that in this years I think the public in Italy was very angry with the people who live on the streets. And they ask more police, more punishments and so on. And this public and political announcements took us to a situation that now for example there are cities in which there is only one Skelter for people who live on the streets to sleep in. If we for example had two or three Skelters, now we should have a place for them to stay. So this is also another lesson we are learning that public services for people who live on the streets, for people who use drugs and this is also valid for OST. It's not only a human right for people but it could also be a protection for all the community. Imagine now if a group of ten people on the streets one gets the COVID. Now in two days the ten people will get it because of the no and they or if one of them is symptomatic because they told here, where do you put him? Where does he go or she goes? So do we have to let him go to the hospital? Well no and so on. And so the lack of Skelters in cities is one of the problems we are experiencing now. Okay, go ahead Susana if you want to add something. Only that thinking of Torino, the situation in Torino, homeless people are in a very hard situation because the first response was let's close the shelters. It was the first response by the municipality and it was absolute, of course. Now they are trying to organize a more effective system but for instance we realized that one problem is not only to have not shelter enough but also that sometimes we have two big shelters. I mean shelter where there are too many people crowded in a small room, in a small place. And they think that that is interesting and the lesson learned could be let's organize a more human situation where there are not so many people and where the dimension is more familiar. And it is interesting what Pino said that this is useful for the quality of life of homeless people but it's useful also for the whole community. So you see we are learning a lot of things. I don't know if we will be able to change something after the crisis. This is a common question. But we are taking note of everything from this perspective and I think we must be able to give feedback to our municipalities about all that. I also wanted to ask you about one other vulnerable group, which is prisoners. So do you see what is the situation in prisons we saw some dramatic pictures of you know, I can say that prisoner now is the group in the worst situation in a very bad condition in Italy because also in prison of course the first answer to the crisis was to block everything. So they blocked the meeting with family parents and so on. They blocked volunteers so prisoners couldn't meet anyone inside the prison. They blocked the people who in their daily lives and so on. And they didn't give information and they didn't give any alternatives, for instance to different kind of meeting with the families, virtual meeting and so on. And of course the prisoner felt in a trap and feeling like that we had a lot of riots inside prison all over the country and we have now 60,000 of prisoners and this riot involved 15,000 of people. It was a really great number and unfortunately the outcome of this riot was 13 deaths, 13 prisoners died and we are still waiting for to know the cause of the death. We have organized a campaign that is named a campaign for truth and justice because it's not clear what happened. And now think are slowly changing, but only thanks to civil society and thanks to the ombudsman for prisoner rights. So the government make a decree telling that prisoner with minor crimes would have been released and some others will assess to alternative form of sentences and so on. But this process is very low because we think that it's necessary to release about 5,000 people to gain a more safer situation inside prison. And we know that only 4 or 500 people have been already released, you know, and we have already tanks of cases of a positive prisoner inside prison. So the idea is to have an epidemic bomb. And we are waiting for an explosion, you know, so this is, I think that is the worst situation about the pandemic now. We also hear news that it's very hard to access masks and gloves and all this protective equipment in Italy. What about you Pino like do you have access to these things and hand sanitizers and all this, all this stuff. Yeah, my colleagues, fortunately, yes. But I know that some colleagues around Italy did wait for one week before having API. And, and that that's why also as Susanna said before in the first week. The harm reduction services were stopped. No, because at the beginning, there was a debate between rights of people who use drug to access to our harm reduction services and the safety of people who work in harm reduction say services. As Susanna said that the responsibility of people engaged in this job made it possible to have API for everybody and still work now. I don't know if I answered your question but access masks and DPI in Italy is a huge problem. If you think that, for example, in Lombardia, I read a few days ago that in Lombardia, which is the region of Italy with the highest number of contagious people who work doctors and nurses who work in the hospitals didn't get the DPI as soon as possible. So that's, that's why we are buying and receiving the Italian government is buying and receiving masks, masks from abroad, from Saudi Arabia, from China and so on. It's like as we as a system, as a country, we weren't ready for such a crisis. Now we are buying everything at the last moments. In many cities now in Europe, HIV and hepatitis C testing completely stopped because there is a there is a concern that you know it's dangerous to deal with the saliva and blood samples of people. How is that in Italy? Do you do you still provide testing? I don't know. Sincerely, I don't know. Well, I'm, I'm, I don't have information about that, but what I know that in low threshold services, we use it to make a rapid test, you know, and now I think that nobody is doing that. So I think that this is one of the problems we have. Did you, did you discuss whether to test clients of harm reduction programs for Corona virus, like do you have tests maybe to test them if they have initial symptoms so you just send them to the hospital or how We have, we have not the possibility to make the test we have to to send them to the hospital. And we have not yet data about how many people who use drug is infected. I think we will need time to have this kind of data. Okay. Do you have any clients who are already infected or We had one now in our schedule when people come from for example from the shower, we take them the temperature. And now nobody has symptoms. Okay, but we cannot say they are not infected with the virus. Okay, but in Italy, the test is done to people who have symptoms or people who live with people with symptoms. So if you don't have any fever or any You don't get the test. You don't get the test done. Okay. So now we had one one clients not not so many only one in Venice. I was asking because for example in Denmark in Copenhagen they now starting a bus like a mobile service and they will test people on the street for Covid virus. So do you think that would be useful also in Italy, or you don't have any opinion about that. No, I think it would be very useful but I think it's impossible now for us. I think also because we we are very critical towards our Government, because we in general I, we are doing very few tests in our opinion, we have not an effective policy in this in this field, and it is a great debate in our country. And so I think that we have no no possibility to implement such a such a service. And I am very sorry for that, but it is not. It's not possible. So what about the local governments like city and regional level governments do you have any good cooperation with your local governments. You know, you know. As, as Susanna said before in Italy, harm reduction situation is not the same in all the country and in the same region is not the same. The same in all the cities. So it depends on region and city policies before the crisis, you know, in cities where there was a good policy and harm reduction oriented policies is still go on. I think like Bologna for Italy, where some, there are a lot of they now offer the opportunity to people who live on the street to stay in the skeleton all the day long if they want just to protect them from the from the virus and protect people from the virus as well. But other cities where I think where there is a different policy is still going on and harm reduction is still hard to cooperate with other agencies. I think so. So if you could like sit down with your, I don't know minister or government for five minutes what what would be your questions what would be your demands to the to your government what is what what is what you really need from government. The first thing I think it would be to to say that the the lives of vulnerable the most vulnerable people do matter. And if they matter the the front line of the law threshold services is crucial. It's important. So the first question is, let's make a harm reduction services stable, covered from a financial point of view. And and stable all over the country, not only in some region. And this is the first, the first thing, I think, and we are working on that since many years. And I think that we will, we would make a good use of this crisis. Okay, this is my my opinion. I think that in Italy, there is a lack of multi agency approach to drug drug use phenomenon. And a lot of human issues, which are now treated like public order problems and law enforcement duty, you know, and that's why what I should ask to our government. Oh, and I asked what Susanna said, and also that we need a multi agency approach in this situation of crisis more than ever, because if I could sit with my local government or with my national government. There are a lot of things we know we people who work on the streets and all, of course, people you stroke now know about this problem and the needs of vulnerable people that should be parts of the strategy in a crisis. You know, we are now experiencing a pandemic about an influential more than an influential virus, but this is this virus is getting a lot of problems, you know, enormous use problems to our communities. And as I said before, if we took care about people of vulnerable people, we are caring about our communities, local communities. That's what I should said and we need a multi agency approach we need arm reduction to be guaranteed all in all the country, as Susanna said before in Italy, the north of Italy as the most services in Italy, but as south you go the more south you go, the less harm reduction services you find. No, for example, and also in my region, for example, Venice is the only city who still has another national services there are no harm reduction services all around the cities. No, and, and that's what we need. I think what why is it that in the south part of Italy you don't have harm reduction like is it lack of professionals there or there is no money to start programs or why is it. In general, the south of Italy is more weak with regard to the health, the public health system in general. And so it's not easy to guarantee the high level of services in general and it is also more difficult to make innovation, you know, is a sort of weak and rigid system. I think this is the problem. I want to stress another act because we are a big debate in Italy now just about the public health system, because in this in this crisis, not only in the drug field but in general, we realize that we have a strong public health system is so important. And our system is still an universalistic one. But it's. There are I think 20 we have 20 years of continuous financial cuts to the system and the stronger privatization process. So during this crisis we, we are discussing about that again, because we realize that only public health approach can cope with this kind of pandemic. And as I think in the future, we will have to cope many times, because we we haven't. I think we have understood that this kind of pandemic is not a isolated cases, but this is something that are related to many strategic fields, so climate and so on globalization and so on. So we, we have to think of our national and international system. So I think that we will put the drug issues inside a more general debate that deal with the need of support finance and innovate our public health system I think this is a political issues very very important. I'm very happy that you mentioned this. Yeah, go ahead Pino if you want to add something. And also our criminal criminal justice system I think will be another important debate to do after this crisis because Susanna remember before we have in Italy we have 60,000 people in jail. And most of them are in jail because of our drug law, you know, for the tension of marijuana or the tension of little quantities of any other drug. Yeah, our days are full are empty. We have more people, 11,000 people more than the capacity of our jail system in our jails. And so our criminal criminal justice system is another problem we have to put in the agenda after this one. If we have a lot of allies about the public health system, we should we as arm reduction networks and not only arm reduction networks or I think also about human rights network networks in Italy will will have to build a lot of alliances about this. But now we have an argument more. Thank you and I'm very happy that you mentioned this social dimensions of this crisis because we had a discussion with the correlation European harm reduction network, and we came to the same conclusions that now we have to move beyond the traditional harm reduction advocacy to, you know, address the structural causes of the current crisis and the crisis is before, and we were also discussing new ideas to prevent a bigger humanitarian crisis and one such idea is the basic income. I also wanted to ask you about that, like what, what do you think about this idea to introduce an unconditional basic income during the crisis which the Spain Spanish government I think is now considering. Is there any discussion about this in Italy or what do you what is your personal opinion about this. I agree and there is also here in Italy a campaign for a quarantine income, but in general in Italy we have to improve our welfare system from this perspective because we have a very limited income. To be honest, only for very poor people and for a small part of very poor people. So I think that a basic income is another thing, I think, and we some municipality now have introduced some support to the income of a family during the crisis. But it is an emergency measure, you know, it is better than nothing. But I think that we have to rethink of our global welfare system in this perspective and I think that we are already discussing about that but our government is not very open I think now. Okay. You know, in Italy was, if Italy was the first country hit by this pandemic in Europe and in many cities we are looking at you as kind of our future you know like what will we do in like two or three or four weeks. So now we are we can imagine that we are doing some kind of time travel so we can ask you from the future what do you recommend us who are maybe before those problems you already faced so do you have any like tips or recommendations to other people working in harm reduction in other cities in Europe. I think. Okay. Okay, I think this crisis is good lesson to make our system more flexible. For example, as Susanna said before, we are experiencing that now some scalters are changing their timetable, their hours, no, for example, here, show service is three days a week instead three days a week as before four hours per day and not two hours per day as before so this is the first lesson we have to as people as to be protected, we have to increase our offers. Some other Italian harm reduction projects are changing and completely changing their mission. I think, especially health reach for a project in party settings. Okay, there is no party, no, no, no rave, no party. They are now changing their mission and they are, for example, in Rome, they are thinking about going on the streets and do harm reduction work and to deliver methadone on on the streets or syringes programs. So other one other thing we are experiencing is that we can also use with some with some clients, we can also use online counseling tools. Okay. And so that's what I think I think that as we work on the streets, or we work in contact with the always phenomenon that is changing every month, we can be flexible as well. And something about the situation in general in Italy. And I have to say that locking down has been useful, even it's hard to support to support, but it has been useful and now after five weeks. And how our infection line is decreasing. And we are with now started to see some results. So I think it has been, I think the right choice, but I think that our government make a campaign based on the citizens' respect of the rules and not based enough on the citizens empowerment, responsibility, and so on. In a certain sense, there has been a two millimeter approach to the also to the locking down. And it's a mistake, I think, because it's harder to think that we can govern such a situation in a low and other perspective or in a repressive perspective. But this is a general, a general problem, you know, because if you don't take care of the social relationship, normally, it's difficult to, to have a good cohesion and social relationship during the crisis. So I think it's a very general discourse, I realize, but it's important. For instance, some of us are making the proposal to making of irregular migrants regular in this crisis. I think that Portugal has already done it. And we are discussing now, and it would be obvious, because if you are not included, you cannot be responsible to. And you and the government cannot ask the people who are not included to be responsible. So, of course, it's clear for us, but it's not clear, clear for our politicians. But this is another big level, sorry, of discussion in the future. I think it is also lesson learned from this crisis. We have to take care of inclusion and of social cohesion. This is important. And I think that harm reduction as a sum has a role to play in this direction too. Thank you very much. I think that was really good conclusion of our discussion today. Thank you very much for taking time and being with us today and thank you for those who are watching us online on Facebook. This was the stories from the front lines drug reporters live video session. And please join us next time. Please follow us on Facebook and Twitter. Our plan is that the next country we will discuss will be South Africa, where there are some also some interesting developments. And we will update you on social media. And don't forget, stay safe and stay informed. Thank you. And I wanted to thank you and press reporter foundation because to make a good information and good communication is very important in this moment. Thank you. Thank you very much. Thank you.