SANANIM: Curbing Drug Use in the ČR

Founded in 1990, SANANIM is currently one of the largest non-governmental organizations in the Czech Republic. Providing drug prevention treatment and re-socialization services through a series of outreach programs and clinics, the organization’s mission statement is that they “wish to offer a helping hand to all who yearn for it”. Warm words, but how does this organization really fit into the community, and are the services they provide simply encouraging drug users to continue down their path of addiction? I met with Aleš Termer, deputy head of field staff operations, to find out more about his organization and its progress in the field of drug prevention and treatment in the Czech Republic.

SANANIM’s headquarters are located in a modest building close to the Karlovo Náměstí metro station. From this base, Aleš, along with 12 other members, works 5 days a week (from Monday to Friday) out in the community, meeting with the members of society who require care, assistance, and/or testing with regard to their drug habit. On Mondays and Thursdays, SANANIM’s staff can be found in Vrchlického Sady (the park in front of Hlavní Nádraži). The SANANIM “ambulance” service provides the opportunity for users to obtain clean syringes (reducing the user’s chances of contracting needle sharing viruses), on-the-spot testing for H.I.V, HVC (Hepatitis C), and syphilis, as well as offering motivation and counseling to guide the individual toward the goal of long-term abstinence. All individuals are given basic first aid, social and crisis counseling and in necessary cases, referrals to specialist care facilities.

The organization also offers a number of other vital services:

What changes has Termer seen in the city’s streets and with individuals seeking treatment? Aleš was very clear when giving his answer. The amount of people using drugs in the city has not drastically dropped or increased over his 8 years with SANANIM. In his opinion, the government’s change in legislation didn’t have any profound effect on the numbers of users being treated by the preventative organization. Termer, whose background lies in social work, said that the biggest change over his 8-year career has been the increase in users taking either Subutex or other substances containing Buprenorphine as a heroin substitute. Buprenorphine is an EU-approved semi-synthetic opioid prescribed for addiction treatment.

Aleš pointed out that Buprenorphine became a very popular substitution for heroin users around the late 90s/early 2000s for two main reasons. Firstly, it is seen as a safer option when compared to heroin. There is no lethal dose, so chances of overdose are very minimal. Secondly, the low cost. Users of Subutex need between 100-400 CZK per day to support their habit as opposed to heroin, which costs 2000-3000 CZK per day. But Aleš was keen to point out that the increase in popularity was more to do with low price and availability (buprenorphines can be easily purchased on the black market) rather than any legislative change by the government.

I was interested to find out more about SANANIM’s relationship with the police: does the organization have the support of the police force? “The Police remain in one boat; sometimes it’s really strange that they view us [SANANIM] as supporters of drug users and endorsers of the crimes committed by drug users. This simply isn’t true.” 

Termer was very proud of the work carried out by SANANIM workers, highlighting that the organization was actively saving the country money by providing services to those in need. “The assistance, tests and treatment we provide are truly advantageous to the country, both socially and financially. A clean syringe costs approximately 3 CZK; your average user would use 3 syringes in one day, amounting to a 9 CZK initial cost per individual. We operate under the strict rule that clients must surrender a certain number used syringes before acquiring the clean ones. So it’s much better to offer the clean syringe to the clients. Firstly, it reduces the number of dirty needles in circulation, and secondly, it reduces the chances of infection. The cost of post-infection care can be up to half a million crowns per person per year. I hope that the politicians recognize the value of our work.”

During the course of our interview, I noticed that Aleš would always refer to those taking advantage of SANANIM’s services as ‘clients’ rather than using the traditional ‘addict’ or ‘user’ labels that had been assigned to the same individuals in my previous interview with Břetislav Brejcha of National Drug Headquarters of Criminal Police and Investigation Service. I could sense a divide between the police and organizations such as SANANIMLooking forward to the future, Aleš hopes that this current disconnect will be reduced in order to improve the situation for all those troubled by this long standing social issue.