HARM REDUCTION

Mainline's mission is to promote health and fulfil the human rights of people who use drugs without a primary focus on the reduction of drug use and with respect for the individual drug user's freedom of choice and human potential.

MAINLINE OPENS POPPI

Poppi: Drugs Museum Amsterdam

In March 2019, Mainline threw open the doors to Poppi: Drugs Museum Amsterdam.

Poppi's mission is threefold:

  1. provide objective information on drugs, addiction and drug policy
  2. generate income for projects that support the health of people who use drugs
  3. provide job opportunities for people who use or have used drugs

Poppi targets a broad audience, and informs visitors through art, entertainment and new technology.

The museum established itself in the public consciousness in 2019, thanks to extensive media coverage, the ongoing debate around drugs and the museum’s events. Poppi is developing at a rapid pace, so if you’d like to stay informed, follow us at:

  • www.poppi.amsterdam
  • Facebook: @poppi.amsterdam
  • Instagram: @poppi.amsterdam
  • Twitter: @poppiamsterdam/#poppimovement

A preview of the year ahead
Poppi plans to stage three long-running pop-up events in 2020. The first of these will be a photography exhibition titled 'Dutch Drugs Stories', to be held at the Vrijpaleis in Amsterdam. We look forward to seeing you at the opening on 26 June 2020.

Interested in supporting or investing in Poppi? Then please contact us at info@poppi.amsterdam.








359

Supporters

 

100%

Successful

 

30.230

euro

 





International

SOUTH AFRICA: NOTHING ABOUT US WITHOUT US!

South Africa has long been a driving force in the practice of involving people who use drugs in the design of harm reduction projects. And given that facilitating meaningful peer involvement remains a challenge for many pursuing projects of this nature, the country provides a useful template for the rest of the industry.

TB/HIV Care Association and OUT Wellbeing have a wonderful track record involving people who use drugs in the introduction and development of HIV prevention and harm reduction services in South Africa, guided in their efforts by their adherence to the principle of “Nothing About Us Without Us”.

In 2019, Mainline, in collaboration with its local partners the FDP and the Centres for Disease Control and Prevention, launched a study to determine how to improve the effectiveness of harm reduction programmes even further with the help of people who use drugs. The results will be published in 2020, and will include globally applicable recommendations.



LEARNING HUB IN VIETNAM

Crystal meth use is on the rise in Southeast Asia. In light of this trend, Mainline established a regional learning hub in Vietnam, in collaboration with SCDI and with support from the Open Society Foundations.

We laid the foundation for the hub in 2019 with a two-month training course in Hanoi. Harm reduction services aimed at stimulant use are still few and far between. It was therefore necessary to address a number or urgent questions. How do you go about setting up effective programmes? And what challenges are specific to stimulant use? The learning hub enabled Mainline and SCDI to assemble the relevant stakeholders in one place. We aim to expand the hub’s scope to other parts of Southeast Asia in 2020.

This video gives an idea of our work with the stakeholders. You can learn more about the learning hub here.

HARM REDUCTION BOOST IN PAKISTAN

In 2019, Mainline tasked itself with scaling up its harm reduction efforts in Pakistan. Research in Punjab revealed that HIV prevalence among people who inject drugs was running as high as 70%. In response to this alarming statistic, the Global Fund immediately allocated more funds to Pakistan, increasing the country’s HIV budget for 2021–2023 from USD 35 million to USD 71.5 million.

HIV prevalence among injecting drug users in Pakistan has been running at an average of 38% for the past few years. This is very high. At the same time, the resources to fight HIV are severely lacking.

Nai Zindagi, one of Mainline's local partners, are among the few organisations promoting harm reduction in Pakistan. And despite the Global Fund’s considerable investment in the country, getting support to all who need it remains a challenge.

As does locating those who smoke heroin as opposed to injecting it. Yet, when Mainline and Nai Zindagi surveyed non-injecting drug users in 2019, we found that HIV prevalence among this group was running at 4.1%, a much higher rate than exists in the general population (0.1%). This prompted the decision to open up Nai Zindagi's harm reduction services to non-injecting users as well. The goal over the next few years is to substantially increase the coverage of such services in Pakistan.



MAINLINE TRAINS LOCAL TRAINERS

Mainline offered its Training the Trainers programme (ToT) for the second year running in July 2019. The objective remains the same: develop the in-house training capacity of our local harm reduction partners.

The second edition convened a select group of ten participants from five countries for a week in Thailand, during which they got to grips with the fundamentals of training. How do you decide your goals? How do you identify training needs? The participants returned home with coursework, which was assessed periodically. Further coursework is set to follow in 2020, some of which will require the participants to provide training within their respective organisations. Upon satisfactory completion of all coursework, participants will be awarded a Basic Skills of Training Qualification, accredited by both Mainline and the International Drug Policy Consortium.


INDONESIAN HEALTHCARE PROVIDERS LEARN ABOUT CRYSTAL METH

Mainline, in collaboration with the Indonesian Ministry of Health, Atma Jaya University and our local partner Karisma, provided harm reduction training to 24 healthcare providers from 12 health centres across the country. The training focused on the mental health of people who smoke methamphetamine, and having knowledge of this nature integrated into the normal workings of the municipal health service constitutes a significant milestone for harm reduction in Indonesia. A track record of our efforts leading up to this achievement is available here.











8.663

PEOPLE WERE ABLE TO ACCESS HARM REDUCTION SERVICES THROUGH MAINLINE

 

4.694

PEOPLE RECEIVED PSYCHOSOCIAL SUPPORT

 

6

COUNTRIES: INDONESIA, KENYA, PAKISTAN, TANZANIA, SOUTH AFRICA AND VIETNAM

 





MAINLINE GOES TANZANIAN

Mainline was responsible for the only needle exchange programme to run anywhere in Tanzania in 2019. Mainline, in collaboration with Médecins du Monde (who originally founded the project), provides the necessary support for the local organization Mukikute to run a drop-in centre, a needle and syringe exchange programme and support services for women who use drugs.

Combating infectious diseases is a key priority for us and our partners in Tanzania, as are wound care and providing a refuge for people who use drugs.



The drop-in centre, in the capital city of Dar es Salaam, gives people who use drugs access to resting rooms, medication, laundry facilities, a doctor and a support group for discussing drug-related challenges.


Mukikute's fieldworkers fan out across town each day to locate those who cannot afford the trip to the drop-in centre. Each fieldworker is responsible for their own drugs hotspot, where they oversee a crew of peer educators, i.e. users who distribute clean needles and syringes and collect used ones. We plan to extend these efforts to other cities in Tanzania in 2021, provided we secure the necessary funding from the Global Fund. You can read more about this here.

KENYA HIT ITS 90-90-90 TARGETS IN 2019

Mainline’s Kenyan partner, MEWA, did themselves proud in 2019! Their harm reduction project in Mombasa succeeded in testing 98% of their clients and provided medication to 97% of their HIV-positive clients, resulting in an immeasurable viral load in 90% of clients.

Mainline also facilitated a knowledge-exchange visit between MEWA and our Tanzanian partner Mukikute with the aim of developing the former’s capacity to provide services to women who use drugs. Mukikute, in expanding its own services in this area, had faced similar questions to the ones MEWA was facing: how does one reach women who use drugs in East Africa? And how do you go about offering them relevant harm reduction services? Mukikute are now applying their answers to these questions in services launched at their Dar es Salaam centre in 2020.

Women who use drugs are given support in taking control of their lives.










98%

tested

for HIV

97%

received treatment

with anti-retrovirals

90%

of clients

had an immeassuarable viral load





BEST PRACTICE IN GEORGIAN PRISONS

Everyone deserves a second chance. But how do you rehabilitate ex-offenders once they’ve served their prison sentence? What are the most effective ways of helping people reintegrate into society? And what are the key considerations if the person in question uses drugs?

Mainline has been working closely with Tanadgoma in Georgia for the past two and a half years. Our collaboration has centred on exploring the possibilities for altering the approach adopted by Georgia’s prison service and creating more leeway for effective reintegration programmes. Our efforts have thus far resulted in a research project and a lobbying campaign, as well as a practical and user-friendly booklet with a selection of informative case studies from the Netherlands.

You can read more about this on our project page.








582

CARE WORKERS WERE TRAINED BY MAINLINE (AND ITS PARTNERS)


IN 6 COUNTRIES

461

POLICE AND LAW ENFORCEMENT OFFICERS RECEIVED OUR TRAINING


133

HUMAN RIGHTS VIOLATIONS WERE ACTED UPON 


A MATTER OF GREAT URGENCY





National

FIELDWORK IN 2019

As with every other year, 2019 found us pounding the streets all over the country, and providing our services at drug consumption facilities, drop-in centres, assisted living facilities for people with substance abuse issues, homeless shelters and red light districts.

We also kept in touch with users and industry professionals by phone by online communication. We discussed new developments in drug use, care gaps and needs, and provided people with information on safe use and staying healthy, among other things. Above all, we made conscious efforts to remain present at all times during our interactions with anyone, and to engage in open and judgement-free conversations without hidden motives. It is our customary approach, and it has served us well with people who use drugs and industry professionals for three decades.

This year, we were particularly struck by the growing problem of homelessness. The country is experiencing a severe shortage of temporary shelter for the homeless, and we know from experience that homelessness typically results in more drug use. Thus, to alleviate the distress of those sleeping rough in the winter months, we assisted the Sheltersuit Foundation in handing out dozens of their water- and windproof Sheltersuits. We also picked up lots of worrying signs of drug use among recent migrants, especially those of Eastern European origin (Russians, Poles and Romanians).


Our outreach workers joined the Salvation Army’s mobile soup kitchen on some of its outings in 2019, which allowed us to reach yet more rough sleepers.

Fieldwork in numbers

352

Fieldwork activities

1.239

Contacts

DIGGING FOR ANSWERS

Our fieldwork activities allow us to spot things that demand further investigation, and 2019 saw us take a closer look at the effects of no-smoking and GHB policies in drug treatment facilities and problematic opioid use.

How practical are no-smoking policies?

Drug treatment facilities have increasingly been introducing a no-smoking policy, and we were curious to see what effect this was having on the accessibility of these places. So we spoke to users and personnel at a variety of centres and organisations within the care sector. Our research revealed a general understanding of the reasons for implementing this policy, but also mixed results concerning its enforcement. For instance, we found that penalties (such as suspension or dismissal) for smoking were simply demotivating. In addition, no-smoking policies in detox centres were often counterproductive, as it put some people off seeking treatment and caused others to halt their treatment prematurely. Consequently, some of the facilities had had to relax their rules.


Photo of Hendrik, from the Twaalfde Huis day centre in Groningen. Almost all of the centre’s visitors smoke, and many have problems with their lungs. Those who show up for a full week receive a bonus of a pack of rolling tobacco. The centre tried to enforce a no-smoking policy, but that just kept people away. Hendrik: “I enjoy smoking, so why should I quit?”

GHB policy in drug treatment centres

GHB use is on the rise in social care facilities, day care centres and drug consumption facilities. We were eager to know how such places were responding to this, and so conducted a national survey of 10 of them. All reported problems concerning the erratic and elusive nature of usage and users. Moreover, the personnel at these centres often had limited knowledge of GHB. They were also extremely nervous about what might happen if clients were permitted to use GHB on the premises, as they’d been primed by health professionals to expect “difficult behaviour” and possible overdoses. One of the centres was in the process of drawing up guidelines for handling GHB use. And while some were considering permitting their clients to use GHB in the designated drug consumption rooms, none had put this into practice at the time of writing.

In-depth interviews about opioid use

An estimated one million people in the Netherlands are prescribed synthetic opioids each year. And this is without counting those who buy their opioids on the black market. So, Mainline set out to gain a better understanding of the problematic use of these drugs (which include things like oxycodone), and conducted in-depth interviews with nine users. We discovered that synthetic opioid use cuts across all socioeconomic lines. In addition, cutting back once you start taking them is apparently quite an ordeal. Furthermore, dependence is often rooted in ignorance. As a result, users stressed that what they need is sound and comprehensive information.

CHEMSEX IN 2019

Industry professionals are finally paying chemsex the attention it deserves. We provided lots of training on the subject in 2019, and fielded lots of questions from the media. We also developed new projects around the subject, in addition to our existing online and offline fieldwork.

Fieldworkers Leon Knoops and Sjef Pelsser toured the country talking to people about chemsex, and found that ignorance around the issue remains widespread among gay men. “Chems on Tour” saw them in Rotterdam, Tilburg, Groningen and Nijmegen, where they spoke to a total of 130 men about drugs, HIV and PrEP, and other related matters. Sharing the stage with Sjef and Leon, wherever they went, were local partners (such as the GGD and COC), providing information and answering questions alongside our team. The tour was supported by Gilead Sciences.

In 2019, we expanded the support offered by our drop-in meetings with one-to-one sessions and extended opening times. Sjef and Leon also attended the European Chemsex Forum in Paris, where they participated in a joint presentation on the success of the Amsterdam Chemsex Conference (ACC), a joint initiative by eighteen Amsterdam-based organizations to share intelligence and interventions.


New material

Practical information remains vital. This year, we published an English language edition of Chems & Sex, our harm reduction magazine for men who engage in chemsex. It’s available for purchase in our online store. We also developed a short film about Chemsex titled “Friday Fever”, in collaboration with other members of the ACC, and premiered it at the European Chemsex Forum. You can see “Friday Fever” here.








38.340

NUMBER OF SEXNTINA.NL VISITORS

The Dutch and English-language information site on crystal meth for men who have sex with men that Mainline developed in collaboration with Soa AIDS Netherlands.

22.590

MORE UNIQUE VISITORS THAN IN 2018

Visitor numbers rose by more than 200 per cent in the year following the launch. Men from all over the world (and from Europe in particular) are flocking to sexntina.

6.349

REPEAT VISITORS

A significant number of visitors are visiting more than once. This is thanks to useful functions such as live chat, which allows visitors to receive answers to questions in real time.





“ERRATIC BEHAVIOUR” IN SOCIAL CARE FACILITIES

Social care facilities for the homeless and for people who use drugs are increasingly having to deal with residents with serious problems — known colloquially as people exhibiting “erratic behaviour”. To address this, Mainline and Volksbond Streetcornerwork began a new project in 2019 with support from ZonMw. The aim is to provide tools and guidelines that will help personnel at these facilities to handle such situations, and the initiative has thus far yielded a training course, a manual and an action research project.


Erratic Behaviour Training

In-depth interviews with personnel and mental health specialists revealed that these encounters often escalate from a situation of mutual misunderstanding. This insight provided the basis for developing a training course that highlights the various factors that can contribute to “misunderstanding”. The course, “Erratic Behaviour”, gives participants a better understanding of what someone exhibiting such behaviour might be experiencing, and offers guidelines for winning the individual’s trust in order to deescalate the situation.

A useful manual for participants

Participants leave the course with a practical manual to help them manage potentially explosive situations at work. The manual, titled Understanding Misunderstood Behaviour, is a reference book about the causes of erratic behaviour. It contains lots of basic information about stress factors, psychological problems, drug use and coping mechanisms. More importantly, it provides a wealth of easily applicable tips, all of which is laid out in a user-friendly and visually appealing manner. Understanding Misunderstood Behaviour is available (in Dutch only) through our online store.

Action Research

Alongside the development of the training course ran an action research project by one of our fieldworkers, Annet Vogelaar. This participatory research effort sought to develop additional activities within the confines of the training course for the purpose of improving mutual understanding between clients and personnel. Thus the course is continuously developed and improved. The research concludes in 2020.

TRAINING IN 2019

Whatever we encounter during fieldwork feeds directly into our training courses for industry professionals. And the main focus of much of this training is on winning and maintaining the trust of people who use drugs. This is vital, as without trust, you cannot assist anyone. Our training is designed to replicate the real-world encounters that these professionals have with their clients, and the sessions are interactive, pragmatic and fun. A lot goes into this work, and this is often reflected in the high levels of satisfaction that participants report afterwards.

Would you like a first-hand experience of our highly participatory training sessions? Then head over to our training page to find out how to sign up.

In 2019, Mainline ran training courses all over the country for industry professionals and fieldworkers in social care facilities, drop-in centres, drug treatment and healthcare facilities, and the hospitality industry. We gave basic training on drugs, addiction and forging relationships with clients, and specialised courses on overdose prevention, chemsex and GHB, among other subjects. We also developed a course on handling “erratic behaviour” for personnel in social care facilities.

Always useful to have a professional actor facilitator about the house. Ferry Barendrecht plays Sinterklaas for residents of an assisted living facility on the Jan Rebelstraat in Amsterdam.

4 EDITIONS OF MAINLINE MAGAZINE

Mainline magazine has been rolling off the press now for almost thirty years. The most recent of these saw us add four editions to the Netherlands’ eclectic archive on drug use.

The magazine is distributed nationwide via drug consumption rooms, social care facilities, sheltered accommodation units and drug rehabilitation centres. It is aimed exclusively at people who use drugs, but is also read by a wide audience of industry professionals. Thirty years after the first edition hit the streets, Mainline continues to be the perfect ice breaker for our outreach workers when trying to connect with people who use drugs.

What do our outreach workers talk to them about? About recognizable problems, about safe ways to use drugs, and about health. We began the year with the Pills Special. Benzos, smart drugs and opioids are readily available, and people who use drugs often go around with several of these in their back pockets. However, interactions between the different pills have been known to produce a variety of effects. The Pills Special delved into this, and took a close look at the online pill market, among other things.

There are lots of ways for people to improve their health and life without quitting drugs completely, so the second issue explored the theme of “Thriving without quitting”. It included portraits of three people who were doing just that, as well as tips for repairing tooth damage from substance abuse, for mending broken family relationships and for addressing nutritional deficiencies.

The Smoking Special delved into the most common source of addition: nicotine. According to most addiction specialists, nicotine is even more addictive than cocaine. Our Great Detachable Smoking Guide (in the form of a tip sheet) provided a list of all available smokable drugs and methods of consumption, with safety tips.
The Dark Days rolled off the press in December. People who use drugs often have a harder time of it during the holiday season, which often drives them to take even more. Thus, the issue featured a former user, Manfred, recounting his preventative admission to a drug treatment facility over Christmas. It also included a fold-out poster with practical tips on avoiding blackouts during the New Year celebrations.

Interested in a specific issue or an annual subscription? Then hurry over to our online store for the latest editions.

SOABOA SPECIAL

SOA

Besides our main magazine, we also publish an SOA BOA Special, a bi-annual mini-magazine about sex, drugs and infectious diseases. The first issue of 2019 was aimed at men who have sex with men (often unsafe sex) and take drugs while doing so. The second issue went into the differences between hepatitis A, B and C, which not many understand. Every issue published thus far is available in our online store.

BOA

The incidence of HIV and hepatitis often runs high among “old-timers”, who typically favour heroin or crack cocaine. Thus, the second issue also addressed the stigma surrounding the use of these drugs. Bart, one such “old-timer”, gave a candid interview reflecting on his sex life following infection. And our dear and recently deceased friend Pam revealed why she never experienced regret or shame regarding her drug use or hepatitis C infection.

MAINLINE SPEAKS CANDIDLY ABOUT STEROIDS

Performance and Image Enhancing Drugs (PIEDs) are drugs that people take to improve their physical appearance and/or enhance their strength and sporting performance. They include anabolic steroids, growth hormones and weight-loss drugs.

Mainline developed a great deal of expertise in this area through its efforts in 2019. These efforts included the organisation of a well-attended seminar on the issue with several international experts. You can read a report on the event here (Dutch landing page). Mainline also took part in a European project on the issue in 2018 and 2019, and evaluated the suitability of Finland’s e-learning intervention tool for application in the Netherlands.

Our crowning achievement to date is that Mainline’s website is now a treasure trove of information for people who take performance-enhancing drugs (Dutch landing page). If you have further questions about PIEDs that we do not address on the website, please don’t hesitate to contact us.

CHANGING OF THE GUARD

Farewell

We bade farewell to two absolutely fantastic board members in 2019: our treasurer Laetitia de Leede and chairman Victor Everhardt. Both had given Mainline the benefit of their expertise with boundless enthusiasm for years. They will be sorely missed, and we extend our warm thanks to them once again.

Welcome

Luckily, we were also in a position to welcome two very special people to our board: financial jack-of-all-trades Jantien Manders became our new treasurer and Monique Middelhoff is now enriching the team with her years of experience in international harm reduction and HIV prevention.

The election of our new chairperson is set for 2020. Who’s it likely to be this time? We’ll let the suspense build awhile longer.

SUSTAINABLE MAINLINE

Mainline is doing its bit to protect the planet. Want to know how? Have a read of our blog post on the subject, in which we touch on everything from working with cold hands because we’re trying to use as little heat as possible to compensating for our CO2 emissions.

Everyone at the Amsterdam office began dressing more warmly in 2019 to compensate for the limits we placed on room temperature settings.

As an employer, Mainline takes its responsibility for the health and well-being of its people seriously. To this end, 2019 saw us grant a total of 5,000 euros to staff members from our personal sustainability budget. You can find out more about what we’re doing to meet our corporate responsibilities by visiting our website. And if you feel we’re still falling short in our efforts and would like to lodge a complaint, you’ll be pleased to know that we also streamlined our complaints procedure in 2019.

Finance

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