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Tony and crew visiting the OKANA services in Athens. Tony Duffin

Opinion The Greek model of responding to drug use is worth keeping an eye on

Tony Duffin of Ana Liffey project and his long-time friends, Dr Brian Melaugh and Dr Austin O’Carroll visited Athens to see how drug use is handled there.

AT 4AM ON Friday 10 February, the cab arrived to take us to Dublin airport for our city break to Athens. Austin, Brian and I had booked this four-day trip before Christmas; and we were looking forward to experiencing Greek hospitality, culture and food.

We planned to visit the Acropolis and museums, eat in local restaurants, visit a hammam and go on one more excursion.

The three of us have experience working with people who use drugs (particularly people who have complex and multiple needs); and, in the build-up to the trip, we decided to see if we could arrange a visit to the recently opened Drug Consumption Room in Athens.

A different approach

Our contact was the President of the Organisation Against Drugs (OKANA), Athanasios Τheocharis whom I had met in November last year. OKANA is a country-wide service provider for people who use drugs. Following the recent expansion of its services, they now have 1,040 employees.

Established under legislation, OKANA has been in operation since 1995 designing and delivering responses to Greece’s burgeoning drug issue – which now includes a fixed site Drug Consumption Room in Athens.

We landed at lunchtime on Friday, dropped our bags at our accommodation and headed off to meet the team at OKANA in the homeless day centre/night shelter at 4 pm. The service is in a deprived neighbourhood of Athens – there are many dilapidated buildings and derelict sites there. There is also a number of open drug markets; people sleeping rough; and people who sell sex – predominantly women.

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Local residents, workers, and visitors have all witnessed scenes of open drug use, drug dealing, sex work, and all the associated issues for many years. This is why some of OKANA’s newest services have been established in this area.

Health-led approach

The OKANA team members greeted us enthusiastically outside the building and brought us in. The homeless day and night shelter is impressive with a range of health, social and accommodation services on site. It opened in July of last year and by December the day centre had 1,980 visits, and the accommodation had 910 intakes.

Meeting the people who use this service; it was clear to us that the client group had a diverse range of complex needs. Many who were sat in the day room were older. They were quietly watching TV, drinking coffee, some waiting patiently to see the doctor – who was on their way to see them.

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Having been shown around the day and night shelter, Athanasios walked us down the road to the Drug Consumption Room. People access this service by being assessed by a doctor and they must meet the entry criteria. Such processes differ from country to country – in such Drug Consumption Rooms in some locations the staff can assess whether the person meets the criteria.

Once assessed as appropriate for the service, and registered as a new client, they may enter with the drugs they have brought with them and proceed to the injecting area or inhalation room.

Unlike the planned pilot Supervised Injecting Facility in Dublin, the Athens Drug Consumption Room has an inhalation room where people smoke drugs. Drugs like Sisha. Pronounced ‘sis-ha’; this is methamphetamine cut with adulterants and is cheap to buy at €5 per gram. Athanasios explained that predominantly Sisha is smoked in Athens; whilst in Thessaloniki, Greece’s second-largest city, injecting Sisha is more common. OKANA is planning to open a Drug Consumption Room in Thessaloniki.

Needs at home

In Ireland, there would now be an argument for such an inhalation room as a response to the rise in smoking crack cocaine. As it stands, the planned pilot supervised injecting centre in Dublin will not have this facility.

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Another significant difference between the planned service in Dublin and the Athens service is that under Greek legislation, groin and neck injecting are not allowed in the Drug Consumption Room. The team try to help people find a different vein as an alternative option. They even have a specific machine that uses ultrasound technology to help the nurse inform the user where their best vein is. This is helpful for people who have very few veins left due to prolonged injecting. However, if they can’t find an alternative vein to inject themselves in – then they must leave to inject themselves in the groin or neck. Placing them at significant risk of harm on the streets.

In Ireland, the Supervised Injecting Facility will not be restricted by legislation in this way. Such matters are clinical issues.

The Athens Drug Consumption Room opened its doors in April of last year. The service was established to run Monday to Friday 8 am to 4 pm each day. In the period April to December 2022 there were 6,411 visits from people who injected themselves at the Drug Consumption Room. In 10 months there were 17,000 visits for all the services e.g. food, bath, Drug Consumption Room, etc. A quarter of these visits were by women.

Importantly, the Drug Consumption Rooms is further proof that these services save lives; with the first 10 months of operation seeing the team intervene with and reverse 90 overdoses.

Significantly, at the request of the local community, the Drug Consumption Room will, in April, extend its hours to seven days a week from 8 am to 10 pm every day. A major expansion of 42 hours per week. This is not unheard of in other jurisdictions – a similar situation occurred at the Paris Supervised Injecting Facility – when local businesses requested the facility stay open longer.

Daily rounds

At about 5.30 pm, Athanasios gathered the team and we all piled into cars to reach out to people who use street drugs. The first area was an alleyway a few minutes’ drive from the Drug Consumption Room; there we found people who predominantly used heroin. Many were bedded down and obviously sleeping rough (it was bitterly cold that evening). The staff engaged with the people there – giving out chocolate and Harm Reduction packs (needles, syringes, citric, water, etc.).

There was quite a lot of drug-related litter – like used and uncapped needles still attached to syringe barrels. Nothing we hadn’t seen elsewhere; but, it was interesting to see that these were not cleared up by the outreach workers; nor was it reported to the municipal waste management department. Athanasios explained that the whole area of clearing drug-related litter was being looked at; and that a piece of research on testing the contents of used syringes was in the pipeline.

The second place we visited was another few minutes’ drive away where men who predominantly smoked Sisha were gathered in the street. Again, the team engaged with the people there – this time handing out chocolate and glass pipes with plastic changeable tips.

People here were more hyperactive; which was understandable, as Sisha is a powerful stimulant.

The final destination we visited with the outreach workers was in the university quarter of the city. It was a further drive away from the Drug Consumption Room and the other two areas. We pulled up to a main busy transport hub – next to a busy train station and bus stops. The first thing we saw as we stepped out of the vehicle were two men crouched down; one man was injecting the other in the neck.

Down the side of the station is a dark alleyway. Within minutes word spread that OKANA were there and very quickly people emerged from the darkness. Before long there was a queue of people for chocolate and harm reduction packs. This area is a more affluent part of the city, but the number of people engaging with OKANA was surprising – about 40 in total.

Our time with OKANA came to an end. We thanked them all for their hospitality and extended an invitation to visit us in Dublin. Afterwards, we all agreed that the services were impressive; that the pace at which they had been established in recent years was remarkable; and that the continued pace of expansion of innovative services must be a challenge. What really had us reeling is that no less than five mobile Drug Consumption Rooms are due to be rolled out across Athens in April of this year and there will be more innovations besides.

Athanasios explained that the next drug policy debate in Greece will focus on the decriminalisation of drugs for personal use. You would have to wonder if they will debate, decide and implement at the same breakneck speed. Time will tell. These developments, and future ones, demand our attention.

The Greek model of responding to drug use is definitely worth keeping an eye on.

Meanwhile, in Ireland, we too have had well-documented successes in the past number of years helping a similar cohort of people who use drugs. However, there are a couple of areas we have faltered on – like the implementation of the Misuse of Drugs (Supervised Injecting Facilities) Act 2017. Hopefully, we can soon emulate the successes of OKANA in this regard – we all know Supervised Injecting Facilities in Ireland are needed.
Brian, Austin and I enjoyed the rest of our stay in Athens; but we won’t forget the staff and clients of OKANA – they have left their mark on us.

Tony Duffin is the CEO of Ana Liffey Drug Project. Dr Brian Melaugh is a lecturer in the Department of Applied Social Studies Maynooth University. Dr Austin O’Carroll is a GP specialising in Addiction and Homelessness. They have been friends for the best part of 20 years.

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