Committee on Public Health Ordinary meeting
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SANT European Parliament
Follow its sittingsAdam Jarubas
Who is in favor? Against abstention, adopted. Compromise amendment 4. Who is in favor? Against abstention, adopted.
Compromise five, who is in favor against abstention, adopted. Now we have a separate vote. We have a free amendment in one vote. 274, 275, 276. Who is in favor?
I would reject.
Adam Jarubas
Yeah. We should check it. Open the vote. I close the vote. Reject.
Yes. Compromise amendment 6. Who is in favor? Against. Abstention adopted.
Final vote as a roll-call vote. I open the vote. One moment. One moment. I open the vote.
I close the vote. Adapted. Congratulations to the rapporteur. Thank you for your work. Dear colleagues, our next point is the adoption of the draft opinion in the form of a letter of the EU youth strategy in 2019, 2027, for which CART is lead committee.
The CART committee invited SANT to provide an opinion on their implementation report, and the SANT coordinators decided to provide the opinion in the form of a letter from the chair. I want to thank the groups for their collaboration in achieving this balanced opinion, and in ensuring that the sound views on youth shall be reflected in the final report. Let us proceed to vote, which is a single vote by roll-call. I open the vote. I close the vote.
It is adopted. Thank you. Let's move to the next vote, which is the adoption of the opinion on the draft council decision on the conclusion of a broad package of agreements to consolidate, deepen, and expand the bilateral relations with the Swiss Confederation. The committee in the lead is efforts at the meeting of 24th September of last year. Some coordinators appointed the chair of the committee to provide an opinion to the nonlegislative, enactment under the consent procedure, which grants the European Parliament the power to either strictly accept or reject a proposal without making amendments.
This opinion calls on the Committee on Foreign Affairs to recommend approval of the draft Council decision on the conclusion of a broad package of agreements to consolidate, deepen, and expand the bilateral relations with the Swiss Confederation. Found within this extensive package, the draft agreement on health and the draft amending protocol on mutual recognition justify this support as they establish binding mechanisms that integrate Switzerland into the US cross border health crisis preparedness, and disease prevention agencies, and regulatory oversight of medical devices and pharmaceuticals. Given the significance of this policy area to our daily work, it is relevant that the views of our committee are reflected in parliament's position on this agreement. Let's now proceed to the vote, which is a single vote by roll call. I open the votes.
I close the vote. Adopted. Thank you so much to everyone. Okay. Let's move to the next point.
Exchange of views, within the serious excellence in health science, with doctor Pavel Bem on the missing public health dimension in drug policy reforms in candidate countries within the EU accession process. I invite the speaker to take his place on the podium.
Experts are not there yet.
Okay. They're.
Speaker 5
Having issues with the entrance, so they're on their way now. So if issues to enter, they're on their way.
So we need to wait a little bit, anyway.
Adam Jarubas
Okay, dear colleagues. Let's start. The next item on our agenda is an exchange of views in the series Excellence in Health Science. By developing this series of exchange of views, I wanted to put more focus on science and innovation in health. And for this purpose, we are inviting representatives of excellence in health science.
As you remember, we already had four exchanges of views in this series, and we are continuing today with the presentation of the missing public health dimension in drug policy reforms in candidate countries within the EU accession process. I welcome today doctor Pavel Bem, who is a Czech politician, medical doctor, a former member of the parliament of the Czech Republic, and the former mayor of Prague. Currently, doctor Bem is a national drug policy coordinator in the Czech Republic. He initiated and conducted progressive drug policy reform in his country. Doctor Bem is an expert on the UN expert panel that was established to review global drug policy.
Today, as a speaker, doctor Bremer presents the Eastern and Central European and Central Asian Commission on Drug Policy. I will give the floor to doctor Bremer for his introductory statement, and after to the members for q and a session. If you want to take the floor, please indicate us by raising hands. Doctor Baem, you have the floor for 8 minutes, please.
Pavel Bém
Thank you very much, Mr. Chairman. Good morning, distinguished members of the EU parliament, ladies and gentlemen. First of all, allow me to express my thanks for inviting us to share with you a few thoughts about current EU drug policy, the key challenges for candidate countries. There are lots of misconceptions, misunderstandings, and threatening myths about drugs, drug use, and its consequences. I want to start from emphasizing the clear scientific evidence.
Fighting drugs through purely repressive measures never worked, but regulation does. That is why policies must be based on scientific evidence, good practices should ensure human rights, and have a good balance between security and public health components. Moreover, some public health measures, such as, for example, opioid agonist treatment, have proven to decrease drug-related crime. The more people are involved in those treatments, the less need for illicit drugs. Repressive drug policies brought even more harm than drugs by itself.
Among many others, for example, those epidemics of HIV, hepatitis C, TB, corrupted bodies, disproportionate and not cost effective funding of law enforcement, as well as public health measures, increased drug crime and violence, increased drug trafficking and availability, increased incarcerations, overdoses, pure access to controlled substance needed for medical use. I suggest to have an open discussion on three topics. The first one is new EU drug strategy 2026, 2030. Then drug policy reforms in candidate countries, based on our policy analysis. And I would like to touch the reality of the war in Ukraine as far as mental health conditions and psychoactive substance use is concerned.
The emerging problem I see is that the European Commission's new 2026, 2030 EU drug strategy and action plan risks reversing decades of evidence-based health and human rights-focused drug policy. It's emphasize on law enforcement, border control, security reflects a punitive approach that has been repeatedly shown to fail. The previous EU strategy and action plan offered a more balanced approach across prevention, treatment, harm reduction, all these public health concerns, as well as international cooperation. New strategy, however, represents shift towards security and supply reduction priorities, with health and harm reduction chronically unprioritized. Harsh enforcement does not reduce drug use or disrupt markets.
Instead, it fuels violence, increases stigma, and pushes people away from essential services. The most vulnerable communities, youth, women, and migrants have faced the greatest harm. Currently, the Council of the EU has been working on an implementation framework for this strategy, and the implementation framework must correct the imbalance. We need to ensure that DG center leads on health-related pillars. European parliament can provide political support to ensure that the implementation framework addresses public health and human rights aspects of drug policy, but not only focused on law enforcement and security targets.
Europe has long been at the forefront of progressive drug policies. France, Portugal, Switzerland, Czechia, and some other countries offer striking examples of effective drug policies and measures which prevented HIV outbreaks, lowered overdose deaths, and reduced incarceration. While, let me respectfully draw your attention to the following. While DG Home has advanced a strong security and law enforcement focused agenda, drug demand reduction and harm reduction in the public health areas related to drug use remain comparatively underdeveloped and lack a dedicated action plan. In this context, DG Sante should be encouraged to take a more active role to ensure a balanced implementation framework for EU drug strategy, one that prioritizes health responses, harm reduction, civil society participation, and equal footing with the law enforcement and supply reduction measures.
The shift comes at a critical moment for global drug policy. In 2025, the UN initiated a process to review the international drug control framework for the first time since its inception, while the high commissioner for human rights has called on the international community to shift away from punitive approaches and explore responsible regulation of drugs. To sum up, I suggest following, reinforce the oversight role of the EU European Parliament. The European Parliament can play a central role in shaping policy towards and that protects public health, and reaffirms Europe's leadership in advance to advance global reforms. The EU drug strategies must move beyond these declarations, detailed implementation for a bank should cover all pillars, prevention, harm reduction, treatment, reintegration with clear timelines, measurable public health targets, dedicated funding, and accountability mechanisms.
When we look at the drug policy reforms in candidate countries and the EU accession process, we see that there is a missing public health dimension. EU accession is one of the strongest policy drivers for reforms in all candidate countries, including Ukraine, Moldova, Georgia, Serbia, Montenegro, North Macedonia, Albania, and Bosnia and Herzegovina. Based on our long term continuous work in accession countries, we see that the drug policies in these countries are characterized with repressive, punitive, and restrictive measures. Police and security measures prevail over public health and social support. There is low access to controlled medicine due to strict regulations.
There is a high incarceration rate. Approximately 10 percent of prison inmates are people who just possess or use psychoactive substances, drugs. They are not dealers or criminals. There is a high corruption in the law enforcement area. Thus, EU accession creates a critical window of opportunity, and this moment matters more than ever.
In the area of drug policy, accession should support alignment with the EU key in a way that reflects the union's broader commitments to public health, human rights, civil society participation, and balanced evidence-based policy. But there is an imbalance. And, to address this imbalance, we emphasize the necessity of first updating the EU accession negotiation framework in particular chapters twenty-four and twenty-eight to ensure stronger attention to health and human rights. Improving coordination between EU bodies responsible for accession negotiations, health policies, and drug policies, dismantling the punitive legal framework in accession countries, support candidate countries in replacing criminalization of people who possess or use drugs with health-centered approaches, including abolishing discriminatory drug user registries and ensuring drug policy reforms across accession negotiating clusters. Secure access to health services.
Prioritize equitable access to harm reduction, opioid agonist therapy, HIV, hepatitis C prevention, treatment, overdose prevention, and vaccination, both with member states and in accession countries as a nonnegotiable human rights obligation. We believe that EU parliament has a crucial responsibility to foster pragmatic, innovative, and human rights-centered policies that deliver healthier, safer communities across Europe. Finally, I would like to spend two minutes on the reality of war context in Ukraine. That represents the unprecedented context of not only security threats, but also public health and mental health ones. The war exposure is linked to trauma, displacement, injuries, increased mental health problems, increased use of licit as well as illicit psychoactive substances as a coping mechanism to primary disorder, collapse or strain of health care systems.
The WHO estimates that 1 out of 4 Ukrainians are at risk of mental illness. Up to 18 million people are affected. A national estimate shows that more than 70 percent of the Ukrainian population are using antidepressants. That is a message for us. Mental health impact on civilian and veterans is enormous.
Sharp rise in psychiatric hospitalization since the beginning of the war. War-related trauma cases increasing steadily. Conditions representing PTSD, depression, and anxiety disorders. Among veterans, almost 70 percent of them report psychological problems that need some support. What do we see as far as drugs and substance use trends are concerned in Ukraine?
We see a growing link between combat stress and substance use. Amongst soldiers, we see that one-third of them report amphetamine use. Use of opioids and synthetic drugs and synthetic cannabinoids is increasing. The major drivers of this reality are untreated PTSD, post traumatic stress disorder, pain management, easy availability of substances, and certainly substance use, which is seen as a coping mechanism. In conclusion, we have identified the following gaps and challenges.
There's a limited community-based care. The system is highly centralized based on the old way Russian psychiatric model, high stigma around mental illness, staff shortages due to the war, over 20 percent of people are displaced, attack on health care infrastructure, restrictive and punitive legislation that prevents innovation, for example, innovation for mental health or trauma like psychedelic assisted therapy, long term risk, reintegration challenges for veterans, and social instability in treated untreated trauma which persists. What are the needs and recommendations? Strengthened mental health systems, invest in community-based mental health services in Ukraine, integrate addiction and trauma care, increased access to medicines including innovations, and I mentioned all of this, psychedelic-assisted psychotherapy, support for harm reduction programs available for soldiers and for veterans, veterans rehab rehabilitation and reintegration services, and certainly necessity to reduce stigma through public campaigns. In conclusion, Ukraine faces a dual crisis, a mental health emergency on one side, rising substance use linked to war trauma on the other one.
Without intervention, long-term societal and economical costs will escalate. The EU has a strategic role, according to my opinion, in stabilization, recovery, and long-term resistance. Resilience. Sorry. Investing in mental health and addiction care in Ukraine is not only a humanitarian challenge, but it's a strategic investment in Europe's long term stability and security.
Thank you very much for your attention.
Adam Jarubas
Thank you, Doctor Ben, for your presentation. Dear colleagues, now I open the floor for questions by coordinators and other MAP colleagues. We're starting with Vitanis and Ruchitis, please.
Vytenis Povilas Andriukaitis
Thank you so much, Doctor Ben Del Pavel. I couldn't take any more. But if I may, I will raise, you know, questions related to new drug policy strategy because now you see at global level, once again, a shift from Trump administrations push very much once again shift to the war on drugs. And I see that today in the commission proposal, you see more focus on security and law enforcement, but less on possibilities to introduce evidence-based harm reduction, you know, in your policy, which were approved at United Nations level. What do you see such link linkage between some new wave of right wing understanding about war on drugs, denying evidence-based harm reduction policies in this very sensitive area.
And second one, if we will lose, you know, public health dimension in strategy, what would be consequences in long term?
Danke.
Gerald Hauser
Thank you very much, chair. I would like to reply to the previous speaker. It's not a question of left or right policies. If I don't think you should try to force it into some kind of framework. I don't think it really is suitable for that.
Rather, it's simply the question about consumption of drugs and fighting that. And if we have a report on Ukraine, then it's clear that war always leads to huge human suffering and problems. That's normal. We don't need a report on it. But I have one concrete question about Ukraine.
More than 10 times in the European Parliament, we've heard about peace negotiations to solve the conflict in Ukraine. We've been voting on that. And let me explain to you, please, why? When the majority in the EP is always against peace negotiations, a peaceful solution to the situation in Ukraine, that's really a fatal post posture for the European parliament. It's completely incomprehensible that the European parliament is against peace negotiations and keeps voting against them, and I think that's a horrible signal to be sending.
And I don't understand it. Do you perhaps have an explanation?
Aurelijus Veryga
Aurelius Varega, please.
Thank you, mister chair, and thanks for your speech, doctor. So I have three questions. The first is related to Ukraine, but not only Ukraine. Because every war conflict and every conflict creates, let's say, environment for substance abuse, both legal and illegal. And Ukraine will not be an exception.
People with trauma, with PTSD coming back home, being traumatized, they will look for some solutions. And how would you see the balance between mental health support, treating PTSD because there are techniques to help them versus this so-called harm reduction for those who are abusing something, because after every war we have either opioids abuse, alcohol abuse, or whatever. So how we would see the balance between those two things? Second question is about legalization wave that I see is somehow moving through the world, which in my perspective creates an effect of normalization. And how would you see this effect going?
Because what young people believe, they believe if politicians agree, legalize something, they evaluate effects. That's the general approach of the young people. And the third thing is the third question is about new substances that appear every single day being new and newly invented. And wouldn't you see that the so called harm reductions for those old school opioids, it's becoming a little bit outdated. And every single day, we don't even know which substance we will deal with tomorrow.
So how would you see the primary prevention as a main, let's say, object for dealing with the substance abuse prevention? Thank you.
Stine Bosse
Thank you very much. My mother grew up during the war in London, and I'm very familiar with what happens in that case. You, I mean, PTSD, she suffered from that. In those days, we didn't know what it was called because it was just, you know, bad nerves or whatever, but it was clearly PTSD. So we lost her when she was 54.
She couldn't cope anymore, and she took her own life. These situations actually reach out to generations. And everything we can learn, understand, and prevent from what is happening in Ukraine, of course, we should. To Mister Hauser, I mean, this is about asking Russia to stop. Is there a war?
Is there aggression? Could we have stopped Hitler? Well, it was only the way that we discussed it. Right? So this is my plea to how we should deal with this.
We need, of course, to do regarding these areas of defense. We need, of course, to take exactly the same understanding when we talk about what are the learnings from what's happening in Ukraine to support, to help, but also to understand much better. That's what's happening in defense, to understand how warfare is nowadays, the same exactly we should do here, to have a much deeper understanding because I'm very sorry, ladies and gentlemen, this could be us. And we have to get on board the fact that we need to understand what's going on there, to also protect and prevent for our citizens. Thank you.
Tilly Metz
Thank you very much for your presentation, doctor Baem. I must say your presentation was music to my ears this morning. I was very happy about what I heard there. And I think it's very important, would it be in Ukraine or other war zones, to make really support low threshold and really accessible. I have concrete questions.
We ask for the countries, candidate countries, to have a balanced approach to shift away really from coercitive sanctions and also to shift away from stigma reduction. But on the other hand, how do you see the EU single voice in this context? Do you perceive the EU as a single voice regarding these topics? A second question that I have is civil society and also the concerned population or communities. How can we really directly support them and also make them participate in the support?
So participation and support to civil society and also to concerned communities, that's another question. And then you mentioned also another topic close to my heart is psychedelic therapies, especially to avoid addictions and to avoid suicide, etcetera. How can we guarantee quick access to them, especially in Ukraine, without, yeah, bypassing also the safeguards and the protected context that needs to be there in order to apply safely psychedelic therapies. Thank you very much.
Adam Jarubas
Thank you, Thillie. Is there anyone who wants to take the floor? If not, Doctor Baum, could you comment? Question posed by maps, please.
Pavel Bém
Responding to Mister Andrea Kukaridis. Witness, it's a great question. The drug policy reality as far as the effectiveness of policies are concerned is showing the clear data. The data first say the war on drugs is based on the visual thinking, and I would be happy if this visual thinking could be transferred into reality and being effective, for example. But this is not.
We see such an enormous amount of unintended negative consequences, killing people, just generating public violence, supporting mafia and organized crime. The looking at the retail market benefits of the organized crime with illicit psychoactive substances. This is, according to the UN estimates, 350 billion US dollars per year. So it's an enormous power. The thing is that looking at the effectiveness or effective drug policies, we see that the regulatory frameworks with our experience based on listed substances like tobacco, for example, alcohol regulation.
Even though the differences across the EU are enormous, the data are here. The good regulation protects public health. So the same is true for illicit substances. When we look at the political evolution in all EU countries, we see the movement, once to the left, once to the right, and certainly the right wing political parties are very much focused on law enforcement and prohibition, but it's not as it has been, for example, 20 or 30 years ago. So even in Europe, I am very optimistic.
I see a good shift towards the future. However, looking at the existing countries, the public health component is simply missing. I would love to have a good answer to Mr. Hauser. I do not. And I would just pray for the end of the war as all of us here.
So sorry. I do not have a good answer. Coming to the other question, PTSD and accessible care in Ukraine. We came back from Ukraine two months ago or two and a half months ago, and the current data are really threatening. Seventy percent of the civil population are using antidepressants.
The other aspect is that every family is just somehow affected by the war, losing sons and having injuries and displacements, etc. What is the balance on one side, PTSD versus on the other side, harm, harm reduction? I think we have to do both or, they have to do both, and we should support them to do both. Because looking at PTSD, we know that the traditional treatment, including psychotherapy and pharmacotherapy, does not work in approximately 50 percent of PTSD suffering people. So, therefore, we have to search also for innovative interventions.
And I was very much touched by my madam boss's story. I would love to turn the clock back, allowing your mother to have a psychedelic, a psychedelic assisted psychotherapy, because it might save her life. So, we have to simply experiment, with the trouble with this word experiment in case of Ukraine is that the estimate of the affected population is 18 million. How can we treat 18 million people? It's impossible.
And how can they treat eighteen million people in the condition which I have mentioned some of the components of the reality, displacement, lack of the professional workers, etcetera, and lack of experience. In this context, the harm reduction interventions are very cheap and very easy to deliver in place. So the answer is we have to do both. Legalization wave and normalization of drug-using behavior. Well, I am involved in drug policy implementation and design in The Czechia for almost 40 years.
And I have to say that, I don't like the words, legalization. Because, based on the scientific evidence and on rationality of our thinking, we just simply want to minimize the consequences intended or unintended, but negative. So, I think the right way to go forward is regulation, and the regulation must be very carefully implemented. And definitely, there is no single golden ballot for each country in Europe or in the EU. We have to take seriously into account the cultural consequences and the reality and the emergence of the new psychoactive substances changing the traditional way how we respond to the drug problems.
So I'm also scared of those who are supporting the full-size legalization. Careful regulation is the way forward, according to my experience. Normalization, old school opioids versus the new psychoactive substances on the market. So not only the question of new psychoactive substances like synthetic or semi-synthetic cannabinoids and opioids, and it doesn't just kill people. Fentanyl crisis in US, but we also see some fentanyl epidemics emerging in some European countries.
So it's not the question of only the United States' experience, tragic experience. In The United States in 02/1617, for the first time in the history after the end of the world war, the life expectancy due to the fentanyl crisis started to decline. Unbearable. So not only new synthetic and semi-synthetic drugs, but also the new ways of distribution in the shadow, darkness, online sales, online deliveries. So it's a great challenge, and it's also a great challenge for primary prevention, as you mentioned, because we don't want to see the normalization of using all these psychoactive substances as to happen.
Finally, coming back to madame Boss, I think you mentioned a very important thing of this transgeneric reality that the trauma does not disappear with the first generation, does not disappear with the second generation, does not disappear with the third generation. So it's just the repeating pattern and, the treatment, the effective treatment of the trauma, including all these innovative interventions, is definitely the key, the way forward. And finally, missus Metz, low threshold and accessibility of care and stigma. I'm happy that it's also a very tasty food for my brain. What do you have reflected?
If there is a single voice in the EU, no. There is not a single voice and, hardly achievable, a goal. Involvement in civil society and quick access to psychedelics, this is exactly what I would love to see, not only in Ukraine, but also in all our countries in the European Union. Thank you very much.
Adam Jarubas
Thank you so much, Doctor Wen. Thank you for your inspiring presentation, your work.
Adam Jarubas
valuable contribution to our discussion. It's a great challenge creating an effective anti drug system, not only in candidate countries, but everywhere. You remember we had a meeting with specialists, experts from Ukraine relating to mental health systems. So definite, certainly, they deserve our support from the European Union level. Thank you, doctor. Okay.
Bell, your dear colleagues, I closed this morning meeting. We will meet again this afternoon at three, and I invite coordinators to stay for the coordinators meeting.
Speaker 21
So the coordinators start at 10:15 only, and not everyone is present. So you might make a pause until 10:15?
Adam Jarubas
Yes. We will start at 10:15 with coordinators meeting. Let's have a short break for a coffee.
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