How to trigger an epidemic: A U-turn in Hungarian drug policy and its public health consequences.

RESEARCH OBJECTIVE: The paper aims to investigate and describe the developments of Hungarian drug policy in 1993-2018 with special emphasis on harm reduction and its local dimension as well as public health consequences of studied policies. It attempts to link the changes in drug harm reduction policies to broader political changes in the country. THE RESEARCH PROBLEM AND METHODS: Hungarian drug policy has been a subject to numerous significant changes over the last few decades. The phenomenon, while receiving attention from the point of view of addiction science, public health or sociology, is hardly addressed using public policy and political lenses. This paper aims to fill this gap, examining the problem using a single case study method and providing an in-depth insight into the issue through qualitative analysis of interviews with key-informants working in the field. THE PROCESS OF ARGUMENTATION: Hungarian drug policy developments are very strongly connected to government changes where periods of social-democratic governments have been favourable for pragmatic and more liberal approach, and periods of conservative governments have been characterized by legal restrictions, moral approach and hindering harm reduction services. As such, drug policy in the country has been neither consistent nor coherent over time. A strong U-turn took place after 2010 parliamentary and local government elections won by Fidesz party. Significant cuts in drug-related budget and hostile political environment on both state and local levels resulted in the closure of two biggest needle exchange programs located in Budapest, which combined were responsible for over 50% of distributed sterile syringes in the country. Strategies and methods of operation of local politicians contributing to these closures were clearly distinct, with a populist political style in one case, and opportunism and calculation in the other. Nevertheless, both contributed to a dramatic decrease in needle exchange availability. RESEARCH RESULTS: As a consequence of hostile policies of Budapest local governments, few hundred previous clients of needle exchange programmes do not maintain relationships with any services and their health status is unknown. On the other hand, the prevalence of risky practices like equipment sharing or multiple uses has increased. Over only a few years the prevalence of Hepatitis C among people who inject drugs doubled. CONCLUSIONS, INNOVATIONS, AND RECOMMENDATIONS: This paper addressed the political and policy-making aspects of drug harm reduction in Hungary, identifying two styles of dealing with unwanted services on the local level: populist and opportunist one. Combined with the longitudinal analysis of the field development, it can be thus seen that applying a moralistic approach to this policy field can put public health in jeopardy, especially in combination with local policies being implemented ad hoc and dictated rather by political interest than long-term policy goals.