At first glance, it looks like any other ambulance. Anyone who wants to enter, but must follow a few rules.
You can only use your own drugs, only with the help of equipment provided by the staff. Another condition is the safe disposal of used material and a strict ban on the sale and purchase of addictive substances in and around the ambulance.
“It is supposed to provide space for hygienic and safe application of drugs. The goal is to reduce the number of overdoses and risky behavior,” says addictologist Viktor Mravčík about the application ambulance.
The client must also sign an informed consent. In it, he confirms, among other things, that he is over 18 years old and has experience with injecting drug use.
Then it’s down to business. “We ask the client what to put on, to which part of the body, what syringes he uses. And then he gets such a package – a needle, clean water, filters, alcohol disinfectants, plasters and the like,” lists Lenka Dospivová, who works with drug addicts. He shows all the equipment in a paper bowl that each visitor receives.
After taking the drug, the client may remain in place for some time. “He can get into a bit of a mess. We map how he feels, whether he has the expected condition or not,” explains Dospivová. A paramedic is also available at all times.
Since the start of the project, 17 people have injected themselves with addictive substances in the ambulance, two of them repeatedly. Another 30 used health or counseling services.
“We are still in the beginning, we expect more clients. We are currently focusing on getting the service up and running and clients and the public getting used to it,” explains employee Žofie Buchalová, adding that the project started working at the end of September.
According to her, in the beginning, people also overcome mistrust of workers. “They are often ashamed of their addiction, the app is a very intimate thing for them. We try to deepen trust and advise them on how to reduce the risks of use to their body,” he adds.
The company Podané ruce is behind the project. Among other things, it responds to problems associated with the use of drugs in public, i.e. mainly the occurrence of used syringes and the spread of infectious diseases.
“We have enough scientific evidence to show that the so-called application rooms help improve the health and social situation of clients, but also have a positive effect on the level of the community and the entire society,” says Jindřich Vobořil, director of Podaných roku. More than 90 of them operate worldwide, the first was established in the 1980s in Switzerland.
In the Czech Republic, approximately 45,000 people take drugs at risk. Of these, 35,000 people are primarily users of meth. The rest use opioids such as heroin.
In the application ambulance, they most often work with the second-named group. “We are also noticing the occurrence of fentanyl patches more and more often,” observes Buchalová.
“That’s a big problem,” agrees Dospivová. “It’s easy to overdose on fentanyl because it’s much more effective than heroin. But users often don’t know how to work with it.”
Drugs in public are particularly difficult in big cities. “According to estimates, there are a quarter to a third of all injecting drug users in Prague,” Mravčík comments on the figures.
In Brno, an estimated 2,200 people regularly and mostly inject methamphetamine or opioids. Of these, approximately 1,900 are meth users and 400 are opioid users as their primary drug.
There are typically more problematic areas in each city. For example, in Brno, the occurrence of the most risky, i.e. injection, drug use is mainly near the historic center of the city, in socially excluded locations in the area of Bratislavská, Cejl, Francouzská streets and the surrounding area.
The application ambulance is currently operating in the Brno-sever district. Since the beginning of the year, they have collected almost three thousand syringes with needles there. “There are localities and public spaces where people don’t feel safe and where they don’t even want to go,” sums up the alarming situation in his district, Mayor Martin Maleček.
“One can recognize it at that place – syringes are usually found on the ground. There are a lot of social services for the Roma community, for women who work in the sex business and the like,” adds Buchalová.
Despite this description of the environment, he claims that he does not feel in danger while working. “Most of the time, clients are friendly towards us, they are grateful that someone treats them on the same level,” he thinks.
The number of syringes found in public spaces is increasing year by year. The summary data of all finds of the Handed in Brno show a significant increase – from 1,061 pieces in 2016 to 4,086 pieces in 2022. Last year, police officers and workers from other organizations disposed of 9,820 pieces of found material.
The danger has also increased in connection with the substances that drug addicts use – in the past, they were of higher quality, so fewer applications were needed to achieve the desired state. “For example, one used to take heroin once or twice a day. Maybe ten times now. And the more times he injects, the riskier it is for him and for those around him,” explains Dospivová, adding that outreach programs increase the safety of addicts and the public.
“We Fell Asleep”
According to Mravčík, the Czech Republic is often cited as an example of a country where drug policy is rational and progressive.
Nevertheless, according to him, we also have many gaps. “We lost a lot of sleep in the implementation of some modern harm reduction interventions. Application rooms are one example for all – for the last 30 years we have been talking about the fact that they would be necessary, especially in large metropolises, yet it has not yet been possible in Prague, but in Brno it is only recently,” criticizes Mravčík.
Harm reduction refers to approaches to reducing or minimizing drug harm in people who currently use drugs and are not motivated to stop using them.
Harm Reduction seeks to minimize, limit or mitigate the risk of life- and health-threatening infections that are spread by sharing injection equipment during intravenous drug administration and unprotected sexual intercourse, such as AIDS and hepatitis B and C, the risk of other physical complications, long-term exposure to high doses, overdose, social debacle and loss of human dignity.
Source: National Drug and Addiction Monitoring Center
According to him, the problem is also the unavailability of low-threshold risk reduction programs – for example, there are only two contact centers in the entire metropolis (read more about drug problems in Prague here).