Politics and harm reduction: Four Visegrád countries’ syringe access stories

By Iga Kender-Jeziorska

Drug policy varies greatly among European countries, despite common foundations in UN treaties or EU strategies. In this article I’ll review syringe service programs (SSPs) in four East-Central European countries—the Czech Republic, Slovakia, Poland and Hungary, collectively known as the Visegrád Group—to show how politics impact harm reduction.

The Overview

The Civil Society Forum on Drugs, an expert group of the European Commission, published a report a year ago on the implementation of services for people who use drugs (PWUD). The report reveals discrepancies in the accessibility and quality of 12 examined interventions, with the greatest contrast for SSPs found among the Visegrád Group.

Asked to rate accessibility of SSPs in their country, surveyed Czech professionals in the field gave a high score: 8.9 out of 10. Poland returned a medium score of 4.7. Professionals in Slovakia (3.5) and Hungary (just 1.8) gave low scores for SSP access.

Analysis of annual reports of SSPs shows that they are available in 65 percent of Czech cities, 21 percent of Hungarian cities, 15 percent of Slovak cities and only 7 percent of cities in Poland.

According to European Monitoring Center for Drugs and Drug Addiction data and information acquired directly from the services, 2017 numbers for sterile syringes distributed per PWUD were: 199 in the Czech Republic, 184 in Slovakia, 65 in Hungary and only 35 in Poland.

Where do these dramatic differences come from?

My experiences in drug policy and harm reduction research in the region suggest that the internal functioning of SSPs is similar. They hire similarly educated personnel, adhere to similar values and principles and have congruent procedures.

But criminal law around drugs varies greatly. In the Czech Republic, possession of small amounts constitutes an administrative offence, subject to a small fine. In Hungary, even drug consumption is punishable by up to two years in prison.

So it seems plausible to seek reasons for access discrepancies outside the services themselves.

This article was originally published by Filter, an online magazine covering drug use, drug policy and human rights through a harm reduction lens. Follow Filter on Facebook or Twitter, or sign up for its newsletter. This article is based on the findings of Iga Kender-Jeziorska’s study—”Needle exchange programmes in Visegrad countries: a comparative case study of structural factors in effective service delivery”—published in Harm Reduction Journal in September 2019. Harm Reduction Journal is an open-access, peer-reviewed publisher of research into drugs and many intersecting areas. Filter is proud to partner with Harm Reduction Journal to help bridge the gap between research and public understanding.