Sending an update from Prague, having been attending a Correllation event based around peer work and peer support. A great focus for an event, and one that promised to include a deeper look into what peer work is, what makes it successful, the obstacles, why its important etc, with the aim of boosting it and outreach work in Europe. The title was ‘Stimulating Inclusion, Participation and Meaningful Involvement’ (European Seminar on Peer and Outreach Work).
The Czech Drug Situation…(A quick glance)
Anyway, having a quick squiz at the drug situation in Czech Republic on the way over, I was interested to learn a bit more about the Czech peoples relationship with amphetamines, which are apparently the drug of choice over here. In fact, according to the EMCDDA’s 2010 report on drug use in Europe, the Czech Republic has the highest prevalence of amphetamine use in Europe at 3.2%, (Denmark comes a very close 2nd at 3.1% and then Estonia 2.5%…Ok ok, us Brits are in 4th place with 2.3%!!).
In any case, what is interesting is that its use has risen markedly since data started being collated in 2002. Most of it is methamphetamine in powder form, therefore it’s primarily injected in 90% of cases. Many eastern and central European countries have seen recent surges in problematic amphetamine use and have been caught unprepared in how they should deal with it, with treatment systems largely organised to deal with opiate users.
It was kinda interesting also to note the Czech relationship with speed
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going back to the 1950’s with a few pharmaceutical amphet based preparations proving the drugs of choice. Consumption greatly increased through the 60’s and 70’s until the ol’ meth labs appeared and took the place of the, now banned pharmy meds.
The 1980’s saw the expansion of meth users, mainly quite closed groups that grew up around meth dealers and production areas and by the end of the 80’s an estimated 25-30000 users were dependant on non alcohol drugs – principally pervitin (which is the name used for methamphetamine in Czech Republic and Eastern Europe).
Since 2000, pervitin use has grown beyond these small groups into the wider popluation and is now quite extensive in Slovakia as well. Just to round up, the EMCDDA report mentioned that the surge in pervitin use in Slovakia corrosponded with a drop in retention rates at methadone clinics from 77% in 1999 to 46% in 2003 (quite a drop). This seem to show that opiate users were using pervitin as well, and were either getting chucked off the methadone clinics or leaving themselves. A change in the philosophy of the clinics whereby meth clients were not excluded from clinics but were given a low-ish dose of methadone (a max of 40mg) and were not required to become abstinent. This appeared to stop the drop in retention rates which, in 2008 improved to about 58%. (Perhaps something for the conservatives abstinence evangelists to think about!)
Finally on the drugs front, just to throw in that methamphet is reported as the primary drug of choice by around 70% of those entering treatment and is also reported by opiate users as their secondary drug of choice – especially by those in methadone programmes. Searching for, no doubt, something to break the monotonous dullness of long term methadone use!
Back to the Seminar then!
We heard that the Czechs have around 10,000 problematic drug users in Prague, one of the lowest rates of HIV in Europe (although they have low rates of testing), approx 50% of opiate users are in treatment but they don’t have much involvement from drug users themselves in services, as peer workers etc (nothing new there then).
John Peter Kools, one of the conference organisers, urged us over the days ahead to find the similarities that bind peer workers and professionals, rather than the differences. He said he had seen the biggest changes happen when people have started to relate to others and searched for that common ground, finding that ‘win-win’ position. He assured us that it is an uphill battle and that wont change i soon; the political climate around Europe for small government (in other words – do it yourself!) is spreading fast and he mentioned specifically the situation in the UK where a new government policy document had just been written (The Coalitions new drug strategy) and the words harm reduction weren’t mentioned even once. Shocking, to be sure. He urged us to keep engaged because we could, indeed we have in some instances, lose precious hard won ground.
Rhythm and Pace.
Just a highlight from the first day, a speaker (actually from the UK) named Graeme Tiffany, who talked very eloquently about outreach work with young people about successful outreach being the matching up of the Romantic (of the era) and the scientific. He was very clear about such ‘hard to reach’ groups – are not at all that; in fact it is services that raise the threshold too high. So true! When you think about teenagers (and i was a drug using youngster!) – regulations are not of your language then – you need a service that keeps the bar low – that allows you to retain your identity, not one that trys to lift you out of your scene and strip you of what you feel is what protects you: your youth culture, your mates, your sense of belonging, all I think are felt so much stronger when your a teenager. He talked about the directives he gives when training youth workers now, after learning some fascinating work of an agency in Pamplona Spain that insisted its workers go out, and sit on the wall in the street (where the kids hang about) for 6 hours. It was called feeling the ‘rhythm and pace‘ of the community. That you need to stop and ‘feel’ the pace of things, the movement, you have to listen to the street. So often people sit in offices and very rarely go out and see and really feel the local street scene, or as is the case with outreach – rushing out of the office to hurry around the area doing ones ‘work’.
Then it is about ‘proximitie’ the french meaning – to be close enough to ‘hear the request’, hear what is being asked of you – not to think you know what someone needs and lumber in with ideas of what you think is important for them – you need to hear the request; when you have taken the time to tune into their space you will be asked and you will understand what they need from you. Then he talked of ‘accompagne‘ also in the french sense, which means unity and solidarity – to stand by and be with. It really was a wonderful ‘code’ by which to help outreach workers tune into their local youth scene.
A wonderful woman from Macedonia named Maria Tosheva from the Healthy Options Project in Skopje gave us some truly inspiring news about real peer involvement.
HOPs began as a user led initiative doing syringe exchange out on the streets of Skopje, despite harassment and suspicion from the local police and community. Hops has expanded enormously and become a service in its own right but it has retained its community members as being the most important part of the Hops team.
21 out of the 52 paid workers are drug users – a truly remarkable achievement we just done see replicated enough. Maria said that there is no real meaningful involvement of community members unless they are part of challenging the laws and creating the policies that affect them; changing the main obstacles that they face. She recommended that in order to support and foster this we have to invest in community groups, pay as equals, respect individual ambitions and preferences of those involved, and respect the need for members natural group development and structures; it is not always about the structures that you think will be most effective – you must listen and allow space for the natural development of user groups. Brilliant stuff – and what we KNOW to be true words spoken. Nice one Maria!
Ill end here and try and give an update on day 2, which had me a bit teary at one stage! I always write my blogs too long, hope you’ll forgive me readers. Until later,