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Twenty-nine-year-old British expat R. Simmons came to Berlin as an aspiring writer and university graduate before falling into a spiral of addiction that took him from U-Bahn platforms to a run-down Kreuzberg drug den. Now in rehab, he tells Exberliner his story. I came to Berlin in just after my final-year exams. I had no clear intentions to stay indefinitely, but nothing was pulling me back to London either. I was content just to explore somewhere new, to find my feet after three years as a student, and seek out some new adventures. I first scored on the platform of U-Bahnhof Rosenthaler Platz. I knew you could buy heroin there because a friend who looked a lot like Nick Cave in his Birthday Party degenerate glory, appropriately enough had described how an ever-changing gang of Lebanese teenagers stood there daily, waiting for customers. I lived around the corner, and perhaps this is what made me curious. It certainly grabbed my attention that something previously so peripheral to my life was now almost literally on my doorstep. At the same time, I was in a new city, and looking to create impressions and connections in an unfamiliar place. I had just fallen in love. How did heroin fit into all of that? I decided to find out. They were not difficult to spot. I approached them and we stared at one another for a long time. At Rosenthaler Platz it was just as my friend had told me. Two young and surprisingly frail teenagers dragged their feet along the edge of the platform. My girlfriend and I smoked it together off aluminium foil. I halfexpected something terrible to happen the moment I inhaled, police breaking down the door or an instant overdose, the way Catholics sometimes terrify themselves with thoughts of the Devil appearing to cart them off for unrepented sins. Instead, the effects were surprisingly mild. I felt tranquil and protected in a way that gave me a sense of confidence. It was subtle and sensual at the same time. We talked, cuddled, watched a film, and had sex. Lots and lots of sex. The desire and well-being changes to impotence and disconnection, but when we came to realise that, Berlin had become so ubiquitous with addiction that sometimes we despaired of ever being disentangled from it. We failed to stop or cut down even when our usage was became increasingly frequent. Weeks without using turned into days, and those days shortened until by the same time in , we were smoking daily. Suddenly, heroin was everywhere, as if by using I gained a sixth sense for its existence. I realised then that not every customer sold homeless magazines or begged and no longer cared to hide their swollen hands or pinhole pupils. We would meet, exchange greetings, then melt away with hurrying steps to wherever we went to get high. My girlfriend and I soon began drifting into the more experienced and established heroin scene in Kreuzberg. Most of the dealers there were Germans who worked from their flats instead of on the streets. We started to inject instead of smoke — first because it was cheaper, then because it associated us more intimately with the mythology of heroin use, and finally because we were too addicted to turn back. This, I thought, was the authentic Kreuzberg: look, this woman used to sell speed to Blixa Bargeld! And unlike the Lebanese gangs, who were all clean, the Kreuzberg dealers sold to support their habits and, as such, let you use around them. He was in his mid-twenties and existed in a cloud of heroin and cocaine, spending hours searching his arms, legs and neck for a vein before passing out in front of his Xbox. She was in her late forties, a kind of emaciated Courtney Love with brown teeth which she glued back herself after her dog knocked them out. Now she was his lover — they spoke of getting married, once Stefan granted her a divorce, that is. Together, the three of them held court. If you entered the toilet without knocking, you were almost certain to find Sputnik sitting on the toilet seat, trousers round his ankles, needle dug into his groin. He was in his early fifties, still boyish, with a voice that reminded me of the wolf in Little Red Riding Hood. After Jan went to prison and where, withdrawing, he suffered a total mental breakdown , Stefan took over completely, and my mid-twenties slipped away on his sofa watching day-time television or laughing at his jokes, hoping to appease him like some capricious idol. In that flat, summer turned into winter and the only way you could tell was by looking at the tops of the trees in the park over the road to check the colour of the leaves. His coffee table was a permanent mess of bloody needles, beer bottles and alcohol pads. The stairwell was almost never free of customers arriving as snivelling wrecks and leaving in a daze. Others, out of favour with Stefan, who lorded it over his customers as much as any pasha, hid themselves in the shadows to smoke, sniff or have a fix. He was generous with credit, especially if he sensed you had money on the way. To support my habit, I signed on, worked cash-in-hand jobs, sold my possessions or performed poetry in bars, restaurants, and the streets. Already, though, my veins were collapsing. From a relatively simple operation in the crook of my arm, it had become time-consuming and messy. But addiction is a series of broken pledges: I would never do this, sell that, hurt myself that way. So I turned to my feet and legs. Everything about being addicted at the beginning had morphed into its other, just as we had morphed into our addictions. Heroin does not change people, its demands crowd out and refuse to give space to anything else. And even when you want to stop, the fear of cold turkey drives you on, hour after hour, day after day. Over time, the heroin scene changed. The quality grew worse and it was harder to buy. With that, people became increasingly desperate. In Kreuzberg, people were being arrested. Moreover, the more time I spent in this world, the worse it seemed. Eventually, we fell out with Stefan. Later I discovered that while he had not been arrested, he had been beaten to within an inch of his life by assailants armed with a baseball bat, revenge for having left their friend outside his flat to die after suffering an overdose. I began to avoid Kreuzberg, tried several times to stop, but always ended up lapsing. By then, around , you had to travel all over the city to score. Once there, all you had to do was follow the line of customers pumping their arms and legs like cross-country skiers, faster and faster until they descended on the dealers in a pushing and shoving mass, fist-clenched money pushed under their noses, one counting the cash, the other dispensing the bags or summary justice to those who stepped out of line for which purpose he carried a police nightstick, right up until the day he whacked an undercover officer and was hauled to jail in Moabit. In , both my girlfriend and I decided to stop for good. It is not hard to say why, because the reasons for stopping had been there for a long time. Wealth, health, time, love not in that order! What is not so simple is why then and not sooner, or later. I felt the mythology I had built around Berlin and heroin could no longer exist. The stories and characters I used to hoard had become repetitive, or tragic, and I had other ways I wanted to spend my time. Having come here for adventure, I felt the need for some new ones rather than the same one again and again. Some never reached that point, and three of them were foreigners like me. One, a designer, overdosed the first time taking heroin in years. Josh, the musician, who had also become a close friend, committed suicide in London having struggled desperately to get clean in Berlin. Despite efforts to discourage her, she kept going. It was only a few weeks later I found out she had overdosed in a bathroom. Her boyfriend, who found her, could not revive her. Now in a treatment progamme, we pass the time of day. Some of my friends, who cannot believe I am clean, ask me where I buy from now. Others, when I tell them that I am in treatment, quickly edge away from me, as if frightened junkies, like misery, love company. Groups of junkies waiting to score give me a strange feeling of unease. Most of all, though, I am trying to remake my own Berlin away from the heroin scene that, for half of my twenties, seemed indivisible with the city itself. And I still avoid Kreuzberg. Sign up for our.

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These datasets underpin the analysis presented in the agency's work. Most data may be viewed interactively on screen and downloaded in Excel format. All countries. Topics A-Z. The content in this section is aimed at anyone involved in planning, implementing or making decisions about health and social responses. Best practice. We have developed a systemic approach that brings together the human networks, processes and scientific tools necessary for collecting, analysing and reporting on the many aspects of the European drugs phenomenon. Explore our wide range of publications, videos and infographics on the drugs problem and how Europe is responding to it. All publications. More events. More news. We are your source of drug-related expertise in Europe. We prepare and share independent, scientifically validated knowledge, alerts and recommendations. About the EUDA. This document is also available as a PDF. People who use drugs face the same risks as those of the general population and therefore need to be aware of the appropriate advice to reduce their risk of infection. They can be exposed to additional risks, however, that require developing assessment and mitigation strategies. These are linked to some of the behaviours associated with drug use and to the settings in which drug use take place, or where care is provided. Risks are increased by the high level of physical and psychological comorbidity found among some people who use drugs, the fact that drug problems are often more common in marginalised communities, and the stigmatisation that people who use drugs often experience. The current public health crisis raises serious additional concerns for the wellbeing of people who use drugs, ensuring service continuity for those with drug problems, and the protection of those offering care and support for this population. The purpose of this briefing is to highlight emerging risks linked to the COVID pandemic for people who use drugs and those providing services for them from a European perspective, and where necessary to encourage planning, review and adaption of frontline and specialist drug interventions. National and local level service reviews and updates will need to take place within the context of country-specific guidelines and rules for responding to the COVID outbreak, and the advice provided by ECDC and WHO. Top of page. Recreational drug use often takes place within settings in which individuals congregate together and drugs or drug equipment may be shared. More generally, the stigmatisation and marginalisation associated with some forms of drug use may not only increase risk but also create barriers for promoting risk reduction measures. Because of the high prevalence of chronic medical conditions among PWUD, many will be at particular risk for serious respiratory illness if they get infected with COVID Examples of this include:. The main life-threatening effects of any opioid, such as heroin, are to slow down and stop a person from breathing. Because COVID like any severe infection of the lung can cause breathing difficulties, there may be an increase in the risk of overdose among opioid users. The antidote naloxone blocks the effect and reverses the breathing difficulties caused by opioids and is used in both clinical and community settings as an overdose prevention measure. The characteristics of some of the settings frequented by people who use drugs may put them at an increased risk of exposure to COVID Prevalence of drug use and infectious disease is high in prisons. These are closed environments, where over-crowding, poor infrastructure and delayed diagnosis has been documented European Centre for Disease Prevention and Control and European Monitoring Centre for Drugs and Drug Addiction, In order to reduce the transmission of COVID, sharing drugs or drug equipment should be strongly discouraged and appropriate social distancing and hygiene measures promoted. Communication strategies need to be developed to appropriately target different behaviours and user groups including marginalised groups, such as the homeless, recreational drug users and cannabis users. PWUD should be encouraged to consider where it is possible to stop or reduce their consumption of drugs as a protective measure, and actions are needed to ensure professional support and help for those seeking access to services. As practiced by other health and social services, drug services, homeless shelters and prisons should disseminate clear messages on how to reduce the risk of infection and make appropriate materials available to both service users and their staff. These should include:. It will be crucial to guarantee the continuity of core health services to drug users. In this context, it is vital to ensure services are properly resourced, staff protection measures are in place and service planning is prioritised. The EMCDDA is compiling examples of advice being issued to people who use drugs and service providers by some national bodies and different associations, networks and NGOs. Homepage Quick links Quick links. GO Results hosted on duckduckgo. Main navigation Data Open related submenu Data. Latest data Prevalence of drug use Drug-induced deaths Infectious diseases Problem drug use Treatment demand Seizures of drugs Price, purity and potency. 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Last updated: 25 March Context — the coronavirus outbreak COVID in the EU People who use drugs face the same risks as those of the general population and therefore need to be aware of the appropriate advice to reduce their risk of infection. Underlying chronic medical conditions are associated with some forms of drug use and increase the risk of developing severe illnesses Because of the high prevalence of chronic medical conditions among PWUD, many will be at particular risk for serious respiratory illness if they get infected with COVID Examples of this include: The prevalence of chronic obstructive pulmonary diseases COPD and asthma are high among clients in drug treatment, and smoking of heroin or crack cocaine can be an aggravating factor Palmer et al. There is also a high incidence of cardiovascular diseases among patients injecting drugs and people using cocaine Thylstrup et al. Methamphetamine constricts the blood vessels, which can contribute to pulmonary damage, and there is evidence that opioid misuse can interfere with the immune system Sacerdote, The prevalence of HIV, viral hepatitis infections and liver cancers — leading to weakened immune systems — is high among people who inject drugs. Tobacco smoking and nicotine dependence are very common among some groups of PWUD and may increase their risks of experiencing more negative outcomes. The risk of drug overdose may be increased among PWUD who are infected with COVID The main life-threatening effects of any opioid, such as heroin, are to slow down and stop a person from breathing. Sharing drug-using equipment may increase the risk of infection While sharing injecting material increases the risk of infection with blood-borne viruses, such as HIV and viral hepatitis B and C, the sharing of inhalation, vaping, smoking or injecting equipment contaminated with COVID may increase the risk of infection and play a role in the spread of the virus. The virus causing COVID spreads mainly from person-to-person, between people who are in close contact with one another, and through respiratory droplets produced when an infected person coughs or sneezes. The virus can also survive for relatively long periods of time on some surfaces. Whereas harm reduction messages usually focus on risks associated with injecting, less attention is often paid to other routes of administration. The COVID outbreak may present additional risks that are currently not widely recognised, for example the sharing of cannabis joints, cigarettes, vaping or inhalation devices or drug paraphernalia. Crowded environments increase the risk of exposure to COVID The characteristics of some of the settings frequented by people who use drugs may put them at an increased risk of exposure to COVID Recreational drug use often takes place in groups or in crowded settings, thus increasing the risk of exposure to COVID This can, to some extent, be mitigated by social distancing, following established safety guidelines or other measures to reduce the use or access to high risk environments. Drug treatment centres, low-threshold services and social support services for people who use drugs may have areas were social distancing is difficult, such as waiting rooms or community facilities. As with other settings, introducing appropriate distancing and hygiene practices are critically important. PWUD experiencing homelessness often have no alternative but to spend time in public spaces and lack access to resources for personal hygiene. Self-isolation is very challenging for homeless people and access to health care is often very limited. Addressing the needs of PWUD who are homeless or in unstable housing will be important for responses in this area. Risks of disruption in access to drug services, clean drug-using equipment and vital medications Continuity of care for PWUD using drug services may be a challenge in the face of staff shortages, service disruption and closure, self-isolation and restrictions placed on free movement. In this context, contingency and continuity planning are essential. Drug services — especially small, locally funded and NGO-run services operating alongside the formal structures of the public health systems — may be particularly vulnerable and lack access to the additional resources needed to ensure continuity of care. There is a risk of reduced access to opioid substitution therapy and other essential medications as well as clean drug use equipment, especially if community pharmacies are required to reduce their opening hours and services and stop supervising methadone. Access to medication is likely to be particularly challenging for those self-isolating, under lock down or in quarantine. Restrictions on movement in some localities due to COVID may also lead to the disruption of drug markets and a reduced supply of illicit drugs. This could have a range of repercussions especially for dependent drug users and could potentially result in an increased demand for drug services. Top of page Ensuring effective drug services during the pandemic — important considerations Implementing prevention measures against transmission of COVID in settings used by PWUD In order to reduce the transmission of COVID, sharing drugs or drug equipment should be strongly discouraged and appropriate social distancing and hygiene measures promoted. These should include: Personal protective measures: promoting proper hand hygiene and risk reduction practices such as, coughing and sneezing in your elbow. Ensure bathrooms are stocked with soap and drying materials for hand washing. Environmental measures: frequently clean used surfaces, minimise sharing objects, ensure proper ventilation. Current practice in communicating to PWUD on the risks of sharing drugs and drug equipment needs to be reviewed to ensure it is appropriate to the demands of reducing COVID exposure risks in the light of possible transmission modes droplets, surfaces. Current practices in providing clean injecting and other drug use equipment for example smoking and inhalation equipment to limit sharing among drug users need to be reviewed and adapted, if necessary, to ensure they remain fit for purpose. Scaling up the level of provision of equipment for clients in self-isolation is likely to be necessary. Social distancing measures need to be promoted and introduced for PWUD and those working with this group. These include avoiding close contact handshakes and kissing , standing an appropriate distance away from each other, and limiting the number of people that can use the services at the same time. Particular attention should be paid to supporting and providing the necessary means to clients of drug services, users of homeless shelters and prisoners to allow them to protect themselves and others from infection. These are likely to include provision of masks to those showing respiratory symptoms cough, fever , establishing an isolation area, and appropriate referral and notification procedures in line with evolving national guidelines. ECDC has published a technical report on infection prevention and control for COVID in health care settings, including long-term care facilities General guidelines and information for specific groups such as patients with chronic diseases and with immunocompromising conditions is available on the ECDC website. Guaranteeing continuity of care during the pandemic It will be crucial to guarantee the continuity of core health services to drug users. Ensuring service continuity: Drug treatment services and low-threshold harm reduction services for PWUD are essential health services, which will need to stay in operation under restricted conditions. Ensuring the ongoing provision of drug treatment services, including opioid substitution medications and other essential medicines to clients, will therefore be a paramount consideration. Contingency plans will be needed for potential medication and equipment shortages. Services will need to plan for the likelihood of staff absences by developing flexible attendance and sick-leave policies, identifying critical job functions and positions, and planning for alternative coverage by cross-training staff members. Services may need to plan for temporary alternatives in the event of any necessary closure of fixed sites e. Based on national guidelines, there may be a need to suspend, reduce, or implement alternatives to face-to-face, individual and group appointments during the pandemic. The availability and accessibility of service provision for PWUD who are homeless will be an important consideration, as this may be a group with limited resources to self-protect and self-isolate. Providing the necessary protective equipment for staff and introducing protocols for reducing the risks of transmission to both staff and patients, including the use of physical barriers to protect staff who interact with clients with unknown infection status. Minimising the number of staff members who have face-to-face interactions, and introducing appropriate risk management policies and procedures for clients with respiratory symptoms. Reviewing working practices for staff and volunteers at high risk of severe COVID those who are older or have underlying health conditions , including introducing remote working arrangements where possible. Establishing regular virtual meetings to allow a rapid response to issues arising in the local situation and the rapidly changing measures taken by local and national governments. Palmer, F. Sacerdote, P. Schwartz, B. Thylstrup, B.

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