the case of Athens, Greece

Fotini Leobilla has dedicated her life to preventing drug overdose in Athens, Greece. In the early 1980’s she started using opioids and continued to use them until her husband died from an overdose in 1998. Through her recovery, she continues to recognize the shame that prevents people from seeking treatment. She is “haunted by the countless overdose victims” whom she has met along the way.

Athens is one of many cities around the world that is working to fight the opioid crisis. Worldwide, roughly one third of the almost 600 000 annual deaths from drug use are caused by overdose, in most cases by opioid overdose.

In addition to expanding access to treatment for substance use disorder, in March 2023, Greece through Ministry of Health and OKANA with strong support from the Prime Minister Mitsotakis, took action to expand access to a medication that can reverse opioid overdose within seconds by prioritizing policies that allow the use of naloxone.

The City of Athens, has been a catalyst for this, joining the Partnership for Healthy Cities that helps support this initiative and added its weight to an alliance of local agencies that is determined to improve emergency response and treatment for people who use drugs. The Mayor of Athens, Kostas Bakoyannis, and the Ministry of Health along with stakeholders in the field are leading the campaign to create a new national law that would make naloxone more accessible, including the friends and loved ones of people that use drugs.

As a result, Naloxone is now available in Greece to most health-care workers, but Fotini wants to expand access further so that everyone who uses drugs or could witness an opioid overdose can have the medication ready.

The strategy of the City of Athens builds on decades of investment in harm reduction services provided through OKANA and the Organization Against Addictions (KETHEA) that have developed an extensive system of support for people living with substance use disorder.

Globally, only one in five people who live with substance use disorder receive treatment, highlighting the significant barriers to accessing care.

But in Greece, President of OKANA, Athanasios Theocharis, has helped pave the way toward a long-term and comprehensive therapeutic approach that is accessible to anyone struggling with opioid dependence.

This inclusive therapy encompasses the restoration of both physical and mental health, as well as the re-integration of individuals into society. Among their services OKANA provides 64 facilities with opioid substitution therapy treatment centers,75 prevention centers and a drug consumption room.

Presently, naloxone is administered by OKANA’s health professionals and street workers in the field, and this is saving lives. To date, 373 experts have been trained and 131 overdose cases have been successfully reversed with naloxone to save lives.

Bakoyannis made naloxone a central part of the city’s strategy to prevent deaths from opioid overdose by adding medication to the toolkit and empowering more communities (family, friends, and street work teams) that are trained to approach people and build trusting relationships.

This approach aligns with WHO Guidelines on Community Management of Opioid Overdose, which recommends that people likely to witness an opioid overdose should have access to naloxone and be instructed in its administration to help prevent opioid overdose.

“Medicines like naloxone and methadone are deemed essential by WHO to prevent and respond to drug overdoses and to treat drug use disorders,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General, at the launch of the recent Global Coalition to Address Synthetic Drug Threats in Washington, D.C. United States.

The City of Athens was recognized for this initiative in March by the World Health Organization, Bloomberg Philanthropies and Vital Strategies at the Inaugural Partnership for Healthy Cities Summit in London.

Mayor Bakoyannis cited cooperation and coordination as key elements for this initiative: “Gone are the days when each of us did our own thing, guided by our own good intentions. We must unite our voice with every agency, scientist, and family in order to change the legislative framework governing naloxone. Too many Athenians do not have access due to bureaucratic procedures. The failure of this model is obvious, it has reinforced a stigma rather than raising awareness.”

George Kalamitsis, President of the Hellenic Liver Patient Association-Prometheus which is part of the city’s coalition said, “There is no true stereotype for people living with opioid addiction, such as the impoverished users often represented in the media. In truth, the victims are our family members, our spouses, our fellow students, and colleagues.”

Fotini Leobilla knows all too well the importance of making naloxone more accessible. She recalls using opioids with someone who overdosed, but the fear of her own legal consequences nearly led her to leave the friend behind. Instead, she called emergency services so they could assist. Emergency services were able to locate the victim, provide naloxone, and immediately reverse the overdose.

Fotini draws upon her personal experience to explain why she continues to advocate for new resources and support structures. “It is with an urgency born from my own experiences that I advocate for this life-saving antidote to be embraced and made widely accessible. Naloxone is not just a medication; it is a beacon of hope, a second chance, and an opportunity to reclaim lives otherwise lost to the shadows of addiction.”


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