Ukraine: EU Member States will need to prepare for possible increases in drug service demand

Since the Russian invasion of Ukraine on 24 February 2022, neighbouring EU countries have ensured a rapid humanitarian response, providing urgent support to meet the health and social needs of those fleeing the country. In a new briefing out today, the EMCDDA looks at how these countries are responding to the needs of displaced persons who use drugs (PWUD) and how they can be better prepared for the future.

It is estimated that around 8 million people have already fled the war in Ukraine, of which an unprecedented 5 million have crossed the borders into the EU. Of those fleeing the country, approximately 90 % are women, children and elderly citizens. The study found that, with reported numbers of displaced people from Ukraine growing, ‘EU Member States will need to be prepared for increased drug-related needs among this population’. This is likely to be the case particularly if population dynamics change, resulting in more displaced men.

The report — Responsiveness and preparedness in addressing drug-related needs of displaced Ukrainians in EU countries bordering Ukraine — focuses primarily on drug-related interventions for people with high-risk patterns of use, including opioid agonist treatment (OAT) and harm-reduction services, as well as interventions to prevent and treat drug-related infectious diseases. The purpose of the study was to: audit the initial service response to the needs of displaced PWUD from Ukraine in neighbouring EU countries; and identify factors that may help EU countries be better prepared for possible future needs in this area.

The briefing is the latest in a series of EMCDDA ‘trendspotter’ studies aimed at examining emerging drug-related trends. These studies use a methodology designed to rapidly collect and triangulate data from a variety of sources to allow for timely assessments of topics of concern. The analysis is based on a survey of 24 national drug monitoring centres (Reitox focal points), an open-source literature review, focus groups, expert meetings and a mathematical modelling exercise. 

National health systems in countries bordering Ukraine have had to rapidly adapt and respond to the health-related needs of an unprecedented large influx of civilians within a short period of time. These health systems, including drug services, were already suffering from the impact of the two-year-long and ongoing COVID-19 pandemic. One of the first steps taken was to ensure continued access to OAT and HIV medicines for those in need, especially those who were already receiving these treatments in Ukraine. Awareness-raising on available drug services was also prioritised (e.g. via posters, websites, apps).

The study found that, thus far, relatively low numbers of displaced individuals have sought continuation of OAT services in bordering countries. This is likely to reflect the fact that in Ukraine, PWUD and those receiving OAT are predominantly male, while those displaced are disproportionately female. Nevertheless, although the number of those seeking OAT in neighbouring countries is low and provision manageable, any increase in demand could cause capacity problems for already stretched services.

The number of displaced PWUD from Ukraine who are accessing infectious disease services in bordering countries was also found to be low and below the expected level. Given that HIV and viral hepatitis have for some years represented a serious public health challenge in Ukraine, the report underlines the need for antiretroviral therapy (ART), direct-acting antiviral (DAA) treatment continuity and testing.

In addition to assessing the demand for assistance, the report also looks at challenges in providing care and the actions needed to improve preparedness. Among the potential barriers to care identified for this group were: linguistic and cultural barriers; limited OAT medication quotas and supplies in some bordering countries; and ensuring continuity of care for those in temporary situations or in transit.

The study underlines the need for Member States to devise contingency plans for possible future increases in service demand generated by more displaced PWUD from Ukraine. Services need to be appropriate for women who use drugs as well as for clients who have had traumatic experiences. Measures are also needed to ensure that services have appropriate financial, linguistic and translation capacities.

Highlighting the need for integrated approaches, the report states: ‘… for both existing and future displaced people, more complex health needs may become apparent over time due to the trauma experienced by many of those fleeing the war. It is likely that, in some key locations, dedicated and culturally appropriate treatment, support and harm-reduction services will be needed’.