Germany has entered its fourth wave of the COVID-19 pandemic, with daily infection figures reaching record highs. Drug-related deaths rose by 13% in 2020.

The knock-on effects of the pandemic to health and public services mean that the lives of drug users, and the work of those who want to help them, has become more difficult than ever before. 

Now, the country's largest needle exchange and recovery center is being forced to close. The situation is dire.

"The beginning of the pandemic was horrible," says Urs Köthner, head of the Freiraum Hamburg organization, which operates a large recovery center and a needle exchange truck. The organization has been operating since 1993 funded by the Department of Health, but it relies heavily on donations to provide hot meals during opening hours and individual case assistance that is not financed by official funds.

Freiraum Hamburg has had to drastically reduce services and the number of people it serves due to social distancing regulations and resulting space limitations, and for the greater part of the last 18 months, government help was almost nonexistent.

"There was a great deal of generosity at first, and we got a lot of donations," Köthner recalls. The government, however, "moved much too slowly — they had made no long-term plans, so neither could we." He says a lack of planning drastically impacted the organization's ability to respond to people's urgent medical needs. "We had, and still have to, operate week to week. And it took a very long time for the government to send us basic supplies, like masks, and when we got them, they were of such poor quality, they were unusable."

At the same time, economic and social restrictions during COVID have meant that part-time jobs — which many people with additional issues rely on to survive — have at times been either illegal or next to impossible, such as selling newspapers and sex work.  Köthner added that beyond his own facilities, many other "rehabilitation centers also closed or drastically reduced the number of free places."

Pandemic weakens social assistance net

According to a government studycarried out by researchers at the University of Frankfurt, the circumstances are similarly desperate across the country. 

The study revealed that recovery center personnel found it extremely challenging to accomplish their work — counseling in particular — under these circumstances. They highlighted the stress of having to carry out a task that requires closeness and empathy while wearing a mask and keeping a 1.5-meter distance from the patient. Throughout the pandemic, recovery center personnel were faced with shrinking budgets that forced many to quit or reduce their hours of operation just when patients needed them the most.

People struggling with the double burden of homelessness and addiction told the researchers that they had experienced an increase in evictions and fines from police, just as they faced reduced availability of social contacts and the medical services that are often crucial to recovery.

Köthner's experience also aligned with the study's finding that the co-consumption of alcohol and prescription drugs with "hard" drugs had increased, while the supply chain of those hard drugs — unlike many consumer goods — had surprisingly gone uninterrupted. 

Both Köthner and Heike Krause, a spokesperson for the Notdienst Berlin recovery center, highlight problems in the system that have been exacerbated by the pandemic.

For Krause, the issue of real estate — a market increasingly volatile and expensive — has led to an existential crisis for Notdienst Berlin's Kreuzberg center. This location is set to close at the end of the year after the Catholic charity Malteser declined to extend their lease, citing a need to renovate the building, she said.

"The problem is Berlin's real estate market and gentrification. Foreign investment firms are allowed to buy up everything," she says, adding that "we have no options left to us, except maybe somewhere at the very edge of the city that is nearly impossible for many of our clients to reach."

Since 1984 the Notdienst has been catering to drug users or those at risk of addiction and their children also through emergency service which is reachable via the Notdienst English language website.

Decriminalization and more awareness needed

Both Krause and Köthner call for the decriminalization of all drugs and a change in the public perception that addiction is a willful vice.

"We need systemic change… A heroin addict should not be in jail just for being an addict," says Köthner from Freiraum Hamburg. Krause agrees, expressing frustration with the fact that many, especially politicians,equate decriminalization with legalization.

In Berlin, Krause says "during the pandemic, the clubs were closed so there were fewer cases of abuse of party drugs, like MDMA…but people drank more alcohol and there was an increase in the use of other types of drugs, like benzodiazepines." She sees it as a particular folly to denounce those who use hard drugs in a place like Berlin, where "the majority takes drugs; it just depends on which are stigmatized and which aren't, like alcohol."

All over Germany, institutions like these see hundreds of patients for thousands of visits a year, saving lives through needle exchanges, medical checks, and providing safe places to take drugs and to sleep. Yet the extreme financial insecurity they face, made worse by the pandemic, is threatening to further devastate their ability to help those in need.

Krause said that her organization had also received very limited help from officials. "We have received some phone calls," though not until after a protest to try and save their recovery center, she says, "but no concrete help as of yet."

"What we need from the government is some financial security," is the complaint from Urs Köthner. "We  always have to search for ways to secure our funding, and that's not okay."

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