Polina Patsi is bracing for a summer of overdoses.
The 33-year-old outreach worker in Athens, Greece, told The Fix that the country’s austerity measures, which have eviscerated social welfare programs and curbed access to drug treatment, will lead to more deaths this season, as it has each year since the country’s economic crisis began in 2007. “It’s hot here, the addicts are dehydrated, and they pass out in the direct sun, which is dangerous,” Patsi said. “We end up calling the ambulance two or three times a month. But with the cutbacks, they don’t always make it in time. The safety nets are tearing apart.”
Greece’s financial crisis has led to an alarming surge in intravenous drug use, overdoses, prostitution and HIV infections, according to experts in the field as well as academics studying the problem. Prior to the crisis, Greece had a historically low prevalence of HIV. But last year, the number of new infections spiked 57% over 2010, according to the Hellenic Center for Disease Control and Prevention, spreading most rapidly among a growing population of dirty needle users, among whom the rate was 15 times higher than in 2010. Little wonder, since the country saw a 20% rise in heroin use in 2010—to an estimated 24,100 users from about 20,200 the previous year, according to a report last fall in the British medical journal The Lancet.
“Drug use in Greece was already on the rise before the crisis,” said Alexander Kentikelenis, a public health policy expert at Cambridge University and the lead author of the Lancet report. “What changed after the crisis were cuts to money for needle exchange programs, condom distribution and drug rehabilitation,” he told The Fix. “So you have more people injecting drugs at the same time that you have less money available to cater to the needs of this group, and that creates a dangerous situation.”
And it is likely to get worse. The new coalition governmen, which took office on June 20, has very few options in stemming the country’s death spiral of addiction and HIV, thanks to the brutal austerity measures imposed by creditors, who have already given Greece multibillion-dollar bailouts. Led by Prime Minister Antonis Samaris, the government is faced with trying to either renegotiate those crippling terms or further cut social programs and salaries for a population already “injured” and in need of “healing,” as Samaris has put it. Greece has been reluctant to pass major reforms, like reducing its pubic sector, improving tax collection and privatizing certain industries, in hopes of raising some $62 billion.
Wary of Greece’s chronic foot-dragging on these targets, its creditors, such as EU nations like Germany, are far from eager to accept a loosening of demands. But it could prove an omen for other EU countries threatened with economic collapse, and even the US. So far, the makings of an austerity-driven perfect storm of health emergencies in other EU crisis countries—Ireland, Portugal, Spain and even Italy—have not been borne out. In fact, the EU’s drug agency announced in its annual report last year that the use of at least one drug, cocaine, had fallen since the economic crisis hit, in part because of its affluent identity and high cost compared to other street drugs.
However, the head of the European Monitoring Center for Drugs and Drug Addiction, Wolfgang Götz, noted darkly, “Policymakers must not take their eyes off the ball. Conditions for future drug-related outbreaks [of HIV] may now again exist in some member states.” He warned that budget cuts could jeopardize successful prevention programs especially among drug injectors, who continue to pose “major health problems.”
Kentikelenis, who said he will monitor health issues in other EU countries as the data appears, predicts that the other shoe will drop across the rest of the crisis zone. “Studies show economic crises are associated with a rise in health problems,” he said. “People don’t have money to pay for private medical care at the same time that there is less money to take care of them publicly. So their illnesses go untreated and become more severe. That’s why social policies should be counter to economic cycles.”
Last February, Greek joblessness hit a record 27.1%, with nearly 1.1 million people out of work, mostly in Athens and other cities. Hardest hit are the young—the ones most likely to turn to drugs and prostitution. A record 54% of Greeks between the ages of 14 and 25 are out of work. With a national debt that is 142% of GDP [gross domestic product], Greece had to borrow $170 billion from the International Monetary Fund under crippling austerity measures, slashing government spending by 30%. “When you have a radical drop in GDP, you need labor-market programs to help these people re-renter the job market and not become the long-term ill and unemployed,” Kentikelenis said.
In Greece, budget cuts in 2009 and 2010 killed a third of the country’s outreach programs to counsel and treat prostitutes, addicts and the homeless. An October 2010 survey of 275 drug users in Athens found that 85% were not in a drug-rehabilitation program. Reveka Papadopoulou, the general director ofMedecins sans Frontieres’ Greek branch, said cases of HIV in the city center had gone up last year by 1,450%, according to The Guardian. The medical charity attributed the rise largely to the suspension of the capital’s needle exchanges.
For outreach workers like Polina Patsi who works for Kathea, the nation’s largest affiliation of drug outreach and rehab facilities, one of the biggest challenges is trying to encourage addicts to get treatment or enter rehab. She and her team of five do harm reduction in the center of Athens, where addicts and prostitutes congregate in groups of 60 or more, on Omonoia Square, across from the nation’s parliament. Her team counsels some 350 addicts and homeless people per month, handing out condoms and pamphlets on HIV prevention and directing addicts to a shrinking number of syringe swaps.
“When we try to motivate them, they say, ‘It’s not worth doing because when we get out, society is against us. With the financial crisis, we cannot find jobs, so why should we?’” Patsi said. “There’s a sense of despair.” Patsi and her team have seen their own pay cut by a third.
Junkie desperation, coupled with financial panic, has led to a doubling in new HIV infections in Greece. Traditionally, women, men and transgender people who do sex work, which is legal in Greece, sometimes supplemented their incomes through odd menial jobs at, say, sidewalk cafes or through money received—or stolen—from their family. But “under the crisis, there’s a lot less money available to them,” Kentikelenis said.
Frantic for cash, and facing a shrinking client base, prostitutes—and addicts who might not have previously turned tricks—are taking greater risks during sex with johns who will pay more for unprotected sex. Prostitutes are also more likely to have unprotected sex “when withdrawal symptoms from drugs are particularly acute,” Kentikeleni said. “They are much more willing to compromise and do it.”
Greece’s universal healthcare system entitles its citizens, and those with social insurance, to visit general practitioners for free and hospitals for as low as 5 euros (or about $6.40). But thanks to 40% cuts in hospital budgets, which have led to shortages in both staff and supplies, people often opt not to bother. For those who have the money, there have been reports of bribes to jump the line in these overstretched hospitals. As a result, a large number of people in Kentikeleni’s study said that they were less likely to seek medical help.
Most Athens drug users are uninsured. But under Greece’s socialized medical model, doctors and nurses at clinics and hospitals often took it as an ethical duty to treat their STDs, according to Patsi. But with their state funding cut by a third or more, medical professionals no longer have the resources to care for these indigents. “They don’t want to give beds to people who can’t pay for it, especially drug addicts,” Patsi said. “They don’t want all the baggage and problems that come with it.”
So desperate are some addicts for the basic necessities of life, let alone treatment, that they are deliberately getting infected with HIV to obtain access to benefits of $890 per month and faster admission to drug substitution programs, according to a Greek Documentation and Monitoring Center for Drugs report. These programs offer access to synthetic opioids, and can have waiting lists of three years or more.
In a harsh crackdown leading up to the general election in May, the police, at the behest of the healthy ministry, began arresting prostitutes and force-testing them for HIV under the pretense of stemming the spread of the virus. They then broadcast their names and faces in print and online as part of a “warning campaign” to clients. More than 1,000 men called the state-run Center for Disease Control and Prevention (CDCP) daily after the first picture appeared in newspapers and on billboards. The minister of health also called for the criminalization of unprotected sex at the nation’s many brothels. Human rights and AIDS advocacy groups blasted the government for breaking the prostitutes’ medical confidentiality and putting them at risk of retaliatory violence. A federal court finally forced it to remove the photos.
Last summer, addicts in the city center, faced with the climbing costs of heroin and benzodiazepines, suddenly switched to a drug they had never tried before: crystal meth. They call it Shisha, the same name the Turks use for the tobacco they smoke in Hookahs. Patsi said Eastern Europeans had introduced the drug to the streets. At five euros per fix, it cost half the price of heroin. “People were dying because they were shooting it and not smoking it, like they shoot heroin,” Patsi said. When the price went up, she added, they stopped using it. They also “got scared,” she said, when people started OD’ing.
So far, Patsi has not seen an increase in the street-addict population. Though government statistics show teenagers using drugs at a younger age (14, down from 17 a few years ago), they tend to stay in the home. “Greek society and family try to hold onto their members,” she said. “They do not kick them out and kids tend not to leave. But if we see a bigger economic crisis, if people start to massively lose jobs, we might see them on the street, using drugs.”
Open drug use has become rampant among street people, however. It’s not uncommon to walk through Omonoia Square and see people shooting up heroin within view of parliament. “They used to sneak around and do it in side streets,” Patsi said. “People walking by don’t even care anymore. They don’t notice because they are preoccupied with their own problems. Athenians are tolerating these things. It’s part of the general misery.”
These dire straits may worsen under the new government led by a pro-austerity party. In his Lancet report, Kentikelenis warned that “in an effort to finance debts, ordinary people are paying the ultimate price: losing access to care and preventive services, facing higher risks of HIV and [other STDs] and, in the worst cases, losing their lives.”
Youths driven into prostitution by rampant unemployment and addicts choosing to get HIV in order to access drug treatment would seem, at the very least, to be signs of a nation whose priorities are gravely out of balance. That Spain, the EU’s fourth-largest economy with youth unemployment that is already above 50%, faces the possible imposition of extreme austerity measures suggests that the health crises in Greece may be merely the canary in the coalmine.
On June 21, a day after Greece’s new government took control, a group of Euro-zone finance ministers laid out its new tough-love policy: it said the country absolutely has to show progress on its long-delayed reforms before its creditors would consider any change to the bailout terms. Even then, the ministers suggested, there would be only limited leeway offered. Its creditors have said that Greece’s promised public-sector job cuts, which the newly appointed cabinet had refused to push through, are a cornerstone to reduce costs and meet deficit targets, if Greece wants more financing. So far Greece has laid off only a few hundred public workers. It needs to cut as many as 30,000.
The new government finds itself in a no-win situation: in order to get more bailout money it needs to increase austerity, cutting back social welfare and health programs. But if it does that, the Greek people will almost certainly riot in the streets and the government will fall in a month or two. That, in turn, will cause further economic uncertainty in the financial markets across the EU, ricocheting to the vulnerable economies across Southern Europe.
In this way, the high-risk games of Wall Street threaten to destabilize entire EU nations and devastate the younger generation, with completely unforeseeable, but not encouraging, political consequences. The public health consequences of slashing safety nets, on the other hand, are already in full view on the streets of Athens, and could be replicated in Spain, Italy and even in the U.S., should Mitt Romney be elected president in November and then implement the Republican Party’s austerity package known as the Ryan Plan.
This is the first part of a two-part investigation of how debt-driven austerity measures effect the lives of people with addictions.
Kevin Gray is a New York-based journalist. He writes about business, crime, politics and celebrity. He has reported from the Congo, Libya, Lebanon, Colombia, China and throughout the U.S. His work has appeared in The New York Times Magazine, New York, Details, People, Men’s Journal and the Washington Post.