WHO has released the following new document:
POLICY GUIDELINES FOR COLLABORATIVE TB AND HIV SERVICES FOR INJECTING AND OTHER DRUG USERS AN INTEGRATED APPROACH
Our IDU programs should be looking for ways to actively link our IDU clients with TB services. This document outlines best practices on how to do this, and more.
You can download it at: http://www.psi.org//HIV/tools/Collaborative%20TB%20HIV%20Services%20IDUs.pdf
Rob
Wednesday, December 3, 2008
What Global Fund Wants to See in Proposals
In the latest edition of the Global Fund Observer (available at www.aidspan.org), there is a short article outlining what GF wants to see in proposals. Especially for people in countries applying in Round 9, reading this will be 3 minutes well spent. (see below)
Rob
+ + + + + + + + + + + + + + + + + + +
1. NEWS: TRP Provides Important Guidance on What it Wants to See in Proposals
+ + + + + + + + + + + + + + + + + + +
The Fund’s Technical Review Panel (TRP) has provided some important guidance on what can lead it to recommend that a Global Fund proposal be funded or not funded. This guidance, which is much more explicit than the TRP has provided in the past, is buried deep in a report prepared for last month’s Global Fund Board meeting. The report, entitled, "Report of the Technical Review Panel and the Secretariat on Round 8 Proposals," is available under "TRP Report to the Board" at www.theglobalfund.org/en/board/meetings/eighteenth/documents.
In the report, the TRP listed a number of factors that it said constitute "the minimum fundamental prerequisites for a recommendation for funding."
Although the prerequisites listed below have not been adopted as formal Global Fund policy, they nevertheless constitute important guidance for applicants preparing proposals for Round 9 (and beyond) because they provide insight into the way the TRP evaluates proposals.
The prerequisites listed by the TRP (and we quote them exactly as written) are as follows:
A disease proposal that is based upon and responds directly to the current, documented, epidemiological situation;
A coherent strategy that flows in a consistent order throughout the proposal – with the implementation plans having the same objectives, program areas ('Service Delivery Areas'), and interventions/activities as are stated in the budget, the work plan, the 'Performance Framework';
A robust gap analysis, both programmatic and financial, that accounts for the full extent of existing resources (including those planned and/or reasonably anticipated based on past practice) and not merely signed arrangements;
Clear and realistic analysis of implementation and absorptive capacity constraints (whether disease specific or broader health systems) that relate directly to the in-country social, environmental and other contexts;
Logical strategies to address capacity constraints, whether through the existing funding application, or through other domestic or partner supported initiatives (which are also subject to performance assessments and adjustments);
Implementation arrangements that recognize and respond to the need to broaden service delivery channels to multiple sectors to achieve universal access to prevention, treatment, and care and support services for people most affected;
Demonstrated effort to address the more challenging drivers of, especially, the HIV epidemic in ways that will have a meaningful impact on preventing further infections;
A clear plan for how to monitor activities and evaluate the impact of interventions;
A budget that is sufficiently detailed to allow the costs of activities to be assessed;
A workplan that makes clear the timing and sequencing of activities and responsibilities for each activity;
and
Planned outcomes (included as indicators in the 'Performance Framework') that address and respond to current epidemiological data, and demonstrate that the incremental investment of additional Global Fund resources will improve disease specific and broader health outcomes for those most at risk.
The TRP said that by dealing effectively with all these prerequisites, an applicant will demonstrate to the TRP that it "has a clear need for the additional resources, and has planned its funding request in a way that will supplement and strengthen in-country responses to the three diseases."
Significantly, the TRP added that "addressing weaknesses in earlier 'Category 3' proposals is also an important, but not determining factor, as to whether a proposal is recommended for funding."
The TRP went on to provide a number of observations on Round 8 proposals. These are discussed in the next article.
Rob
+ + + + + + + + + + + + + + + + + + +
1. NEWS: TRP Provides Important Guidance on What it Wants to See in Proposals
+ + + + + + + + + + + + + + + + + + +
The Fund’s Technical Review Panel (TRP) has provided some important guidance on what can lead it to recommend that a Global Fund proposal be funded or not funded. This guidance, which is much more explicit than the TRP has provided in the past, is buried deep in a report prepared for last month’s Global Fund Board meeting. The report, entitled, "Report of the Technical Review Panel and the Secretariat on Round 8 Proposals," is available under "TRP Report to the Board" at www.theglobalfund.org/en/board/meetings/eighteenth/documents.
In the report, the TRP listed a number of factors that it said constitute "the minimum fundamental prerequisites for a recommendation for funding."
Although the prerequisites listed below have not been adopted as formal Global Fund policy, they nevertheless constitute important guidance for applicants preparing proposals for Round 9 (and beyond) because they provide insight into the way the TRP evaluates proposals.
The prerequisites listed by the TRP (and we quote them exactly as written) are as follows:
A disease proposal that is based upon and responds directly to the current, documented, epidemiological situation;
A coherent strategy that flows in a consistent order throughout the proposal – with the implementation plans having the same objectives, program areas ('Service Delivery Areas'), and interventions/activities as are stated in the budget, the work plan, the 'Performance Framework';
A robust gap analysis, both programmatic and financial, that accounts for the full extent of existing resources (including those planned and/or reasonably anticipated based on past practice) and not merely signed arrangements;
Clear and realistic analysis of implementation and absorptive capacity constraints (whether disease specific or broader health systems) that relate directly to the in-country social, environmental and other contexts;
Logical strategies to address capacity constraints, whether through the existing funding application, or through other domestic or partner supported initiatives (which are also subject to performance assessments and adjustments);
Implementation arrangements that recognize and respond to the need to broaden service delivery channels to multiple sectors to achieve universal access to prevention, treatment, and care and support services for people most affected;
Demonstrated effort to address the more challenging drivers of, especially, the HIV epidemic in ways that will have a meaningful impact on preventing further infections;
A clear plan for how to monitor activities and evaluate the impact of interventions;
A budget that is sufficiently detailed to allow the costs of activities to be assessed;
A workplan that makes clear the timing and sequencing of activities and responsibilities for each activity;
and
Planned outcomes (included as indicators in the 'Performance Framework') that address and respond to current epidemiological data, and demonstrate that the incremental investment of additional Global Fund resources will improve disease specific and broader health outcomes for those most at risk.
The TRP said that by dealing effectively with all these prerequisites, an applicant will demonstrate to the TRP that it "has a clear need for the additional resources, and has planned its funding request in a way that will supplement and strengthen in-country responses to the three diseases."
Significantly, the TRP added that "addressing weaknesses in earlier 'Category 3' proposals is also an important, but not determining factor, as to whether a proposal is recommended for funding."
The TRP went on to provide a number of observations on Round 8 proposals. These are discussed in the next article.
Tuesday, November 25, 2008
Confirmation that methadone in prison reduces infection risk
From Australia the first trial to randomly allocate prisoners seeking this treatment to methadone maintenance - important, because previous trials could not eliminate the possibility that outcomes were simply due to promising cases self-selecting for treatment. Making this option available led to substantial reductions in heroin use, injecting and syringe sharing. Print publication 2004 [Drug and Alcohol Findings, UK]
http://findings.org.uk/docs/nug_10_8.pdf
http://findings.org.uk/docs/nug_10_8.pdf
First randomised trial of needle exchange
First randomised trial of needle exchange
Alaskan needle exchanges passed an unusually stringent test of whether they improved on simply enabling injectors to buy equipment from pharmacies. Risky injecting was reduced without increasing (and if anything reducing) injecting frequency and cocaine use. Print publication 2004 [Drug and Alcohol Findings, UK]
http://findings.org.uk/docs/nug_10_7.pdf
Alaskan needle exchanges passed an unusually stringent test of whether they improved on simply enabling injectors to buy equipment from pharmacies. Risky injecting was reduced without increasing (and if anything reducing) injecting frequency and cocaine use. Print publication 2004 [Drug and Alcohol Findings, UK]
http://findings.org.uk/docs/nug_10_7.pdf
Friday, November 21, 2008
2009 Harm Reduction Conference - Update
Over the past few months, there has been a lot of hard work behind the scenes in planning for Harm Reduction 2009 – www.ihraconferences.net – and the Conference Director, Professor Gerry Stimson, has written an open letter to everyone interested in the event in order to update our colleagues on some of the significant developments.
http://www.ihra.net/Thailand/News#AnOpenLetterfromProfessorStimson,ConferenceDirector
http://www.ihra.net/Thailand/News#AnOpenLetterfromProfessorStimson,ConferenceDirector
Wednesday, October 15, 2008
Initiating IDU
A new paper on youth initiation of IDU is out. Details below.
We'll try to have the paper available on the PSI IDU site later this week.
Rob
AIDS and Behavior, Volume 12, Number 6 / November, 2008
Original Paper
Initiators: An Examination of Young Injecting Drug Users Who Initiate Others to Injecting
Joanne Bryant1 and Carla Treloar1
(1)
National Centre in HIV Social Research, University of New South Wales, Sydney, NSW, 2052, Australia
Received: 4 July 2007 Accepted: 3 December 2007 Published online: 21 December 2007
Abstract
Research about initiation to injecting drugs emphasises the role that relationships with others plays in the experience, suggesting investigations of initiation should include an examination of both initiates and initiators. This paper uses cross-sectional data collected from 324 young, early-career injecting drug users (IDU) to describe the socio-demographic characteristics, drug and injecting practices, and harm reduction knowledge and practices of people who report initiating others to injecting. Fifty-five participants (17%) reported giving someone else their first injection. They reported initiating a total of 128 other people within the first 5 years of their own injecting. Compared to non-initiators, initiators were more likely to pass on harm reduction information [odds ratios (OR): 2.36, 95% confidence intervals (CI): 1.26–4.40]. However, the quality of this information was unknown and initiators did not have more accurate knowledge of blood borne viruses (BBV) than non-initiators, and commonly obtained needles and syringes from sources where the sterility of the equipment could not be guaranteed.
We'll try to have the paper available on the PSI IDU site later this week.
Rob
AIDS and Behavior, Volume 12, Number 6 / November, 2008
Original Paper
Initiators: An Examination of Young Injecting Drug Users Who Initiate Others to Injecting
Joanne Bryant1 and Carla Treloar1
(1)
National Centre in HIV Social Research, University of New South Wales, Sydney, NSW, 2052, Australia
Received: 4 July 2007 Accepted: 3 December 2007 Published online: 21 December 2007
Abstract
Research about initiation to injecting drugs emphasises the role that relationships with others plays in the experience, suggesting investigations of initiation should include an examination of both initiates and initiators. This paper uses cross-sectional data collected from 324 young, early-career injecting drug users (IDU) to describe the socio-demographic characteristics, drug and injecting practices, and harm reduction knowledge and practices of people who report initiating others to injecting. Fifty-five participants (17%) reported giving someone else their first injection. They reported initiating a total of 128 other people within the first 5 years of their own injecting. Compared to non-initiators, initiators were more likely to pass on harm reduction information [odds ratios (OR): 2.36, 95% confidence intervals (CI): 1.26–4.40]. However, the quality of this information was unknown and initiators did not have more accurate knowledge of blood borne viruses (BBV) than non-initiators, and commonly obtained needles and syringes from sources where the sterility of the equipment could not be guaranteed.
Friday, October 10, 2008
New Tool from FHI
FHI has released "Treatment and Care for HIV-Positive Injecting Drug Users: Training Course." The training manual covers a wide variety of topics, including information about dependence, coinfection, psychosocial care and ART.
The manual is available online at http://www.fhi.org/training/en/HIVAIDS/IDUModules/index.htm.
Thanks
The manual is available online at http://www.fhi.org/training/en/HIVAIDS/IDUModules/index.htm.
Thanks
Monday, September 29, 2008
PSI Films at Int'l Harm Reduction Festival in 2009?
The call for submissions of films/video related to IDU has come out for the 2009 Int'l Harm Reduction Conference.
If your program has any film/video (long or short) that you think might be appropriate, please see the submission information below.
Deadeline for submission is Jan 15th.
Rob
Call for Submissions
The ‘International Drugs and Harm Reduction Film Fest’ has become an integral part of the annual IHRA conferences. Following the success of the fifth event in Barcelona in 2008, we are pleased to provide an even bigger stage in Bangkok, Thailand for film-makers to present their latest films, training videos, documentaries or fictional works.
The Sixth International Drugs and Harm Reduction Film Festival in Bangkok will run from April 19th to the 23rd 2009 as a parallel stream in the conference programme for ‘Harm Reduction 2009: IHRA’s 20th International Conference’. For more information about Harm Reduction 2009, please visit www.ihraconferences.net.
For more information about the film festival, please visit:
www.burnet.edu.au/home/cih/projects/film
Film Submissions
If you are interested in submitting a film, please complete the submission form on the following page and email it to filmfest@burnet.edu.au. Alternatively, please contact the film festival organisers at filmfest@burnet.edu.au for more information.
All submissions will be subject to review by a panel and are not guaranteed to be screened. All films must be:
• In English (or have English subtitles)
• On DVD or Video (DHS or PAL) formats
We are also interested to know if you will able to attend the conference to present your film, so please mark the appropriate box when filling out the submission form. Delegates will be required to register for the conference.
All films must be submitted with a hard copy and an electronic copy of the submission form by January 15th 2009.
In early 2009, the film festival team will determine which films are suitable for either Lounge Sessions (where films are screened and unaccompanied by a presenter) or Symposium Screenings, which offer the opportunity for someone who has been involved (directly or indirectly) in the making of a film (up to 30 minutes long) to introduce and discuss their work.
Presenters must also register for the conference – please visit www.ihraconferences.net for more information.
Submission Form
Film Title:
Director:
Producer:
Organisation:
Year of Production:
Length:
Format:
Language:
English Subtitles:
Will a presenter be attending the conference? Yes No Undecided
Name of person presenting the film:
Email address:
Postal address:
Telephone number:
Synopsis of the film:
(250 words maximum)
Please indicate your answers to the questions below by placing an ‘A’ (accept) or ‘D’ (decline) at the end of the question.
1. Do you agree to have your film used for educational purposes by the Centre for Harm Reduction outside of the conference film festival?
2. Do you agree to have your contact details provided to others interested in your film?
Please post films and submissions to:
Burnet Institute,
6th Drugs Film Fest c/o Peter Higgs
The Burnet Building,
85 Commercial Rd,
Melbourne, Victoria, 3004 Australia
Please ensure you include your film with your submission form
If your program has any film/video (long or short) that you think might be appropriate, please see the submission information below.
Deadeline for submission is Jan 15th.
Rob
Call for Submissions
The ‘International Drugs and Harm Reduction Film Fest’ has become an integral part of the annual IHRA conferences. Following the success of the fifth event in Barcelona in 2008, we are pleased to provide an even bigger stage in Bangkok, Thailand for film-makers to present their latest films, training videos, documentaries or fictional works.
The Sixth International Drugs and Harm Reduction Film Festival in Bangkok will run from April 19th to the 23rd 2009 as a parallel stream in the conference programme for ‘Harm Reduction 2009: IHRA’s 20th International Conference’. For more information about Harm Reduction 2009, please visit www.ihraconferences.net.
For more information about the film festival, please visit:
www.burnet.edu.au/home/cih/projects/film
Film Submissions
If you are interested in submitting a film, please complete the submission form on the following page and email it to filmfest@burnet.edu.au. Alternatively, please contact the film festival organisers at filmfest@burnet.edu.au for more information.
All submissions will be subject to review by a panel and are not guaranteed to be screened. All films must be:
• In English (or have English subtitles)
• On DVD or Video (DHS or PAL) formats
We are also interested to know if you will able to attend the conference to present your film, so please mark the appropriate box when filling out the submission form. Delegates will be required to register for the conference.
All films must be submitted with a hard copy and an electronic copy of the submission form by January 15th 2009.
In early 2009, the film festival team will determine which films are suitable for either Lounge Sessions (where films are screened and unaccompanied by a presenter) or Symposium Screenings, which offer the opportunity for someone who has been involved (directly or indirectly) in the making of a film (up to 30 minutes long) to introduce and discuss their work.
Presenters must also register for the conference – please visit www.ihraconferences.net for more information.
Submission Form
Film Title:
Director:
Producer:
Organisation:
Year of Production:
Length:
Format:
Language:
English Subtitles:
Will a presenter be attending the conference? Yes No Undecided
Name of person presenting the film:
Email address:
Postal address:
Telephone number:
Synopsis of the film:
(250 words maximum)
Please indicate your answers to the questions below by placing an ‘A’ (accept) or ‘D’ (decline) at the end of the question.
1. Do you agree to have your film used for educational purposes by the Centre for Harm Reduction outside of the conference film festival?
2. Do you agree to have your contact details provided to others interested in your film?
Please post films and submissions to:
Burnet Institute,
6th Drugs Film Fest c/o Peter Higgs
The Burnet Building,
85 Commercial Rd,
Melbourne, Victoria, 3004 Australia
Please ensure you include your film with your submission form
New research on Injecting Initiation
Important new paper on initiation of IDU (below). The paper itself will be in the IDU library on the PSI website (http://www.psi.org/hiv/IDU/index.html) soon.
Rob
Harocopos, A., et al. New injectors and the social context of injection initiation. Int J Drug Policy (2008), doi:10.1016/j.drugpo.2008.06.003
Research paper
New injectors and the social context of injection initiation
Abstract
Background
Preventing the onset of injecting drug use is an important public health objective yet there is little understanding of the process that leads to injection initiation. This paper draws extensively on narrative data to describe how injection initiation is influenced by social environment. We examine how watching other people inject can habitualise non-injectors to administering drugs with a needle and consider the process by which the stigma of injecting is replaced with curiosity.
Method
In-depth interviews (n = 54) were conducted as part of a 2-year longitudinal study examining the behaviours of new injecting drug users.
Results
Among our sample, injection initiation was the result of a dynamic process during which administering drugs with a needle became acceptable or even appealing. Most often, this occurred as a result of spending time with current injectors in a social context and the majority of this study's participants were given their first shot by a friend or sexual partner. Initiates could be tenacious in their efforts to acquire an injection trainer and findings suggest that once injecting had been introduced to a drug-using network, it was likely to spread throughout the group.
Conclusion
Injection initiation should be viewed as a communicable process. New injectors are unlikely to have experienced the negative effects of injecting and may facilitate the initiation of their drug-using friends. Prevention messages should therefore aim to find innovative ways of targeting beginning injectors and present a realistic appraisal of the long-term consequences of injecting. Interventionists should also work with current injectors to develop strategies to refuse requests from non-injectors for their help to initiate.
Keywords: Injecting drug use; Initiation; Social setting; Narratives
Rob
Harocopos, A., et al. New injectors and the social context of injection initiation. Int J Drug Policy (2008), doi:10.1016/j.drugpo.2008.06.003
Research paper
New injectors and the social context of injection initiation
Abstract
Background
Preventing the onset of injecting drug use is an important public health objective yet there is little understanding of the process that leads to injection initiation. This paper draws extensively on narrative data to describe how injection initiation is influenced by social environment. We examine how watching other people inject can habitualise non-injectors to administering drugs with a needle and consider the process by which the stigma of injecting is replaced with curiosity.
Method
In-depth interviews (n = 54) were conducted as part of a 2-year longitudinal study examining the behaviours of new injecting drug users.
Results
Among our sample, injection initiation was the result of a dynamic process during which administering drugs with a needle became acceptable or even appealing. Most often, this occurred as a result of spending time with current injectors in a social context and the majority of this study's participants were given their first shot by a friend or sexual partner. Initiates could be tenacious in their efforts to acquire an injection trainer and findings suggest that once injecting had been introduced to a drug-using network, it was likely to spread throughout the group.
Conclusion
Injection initiation should be viewed as a communicable process. New injectors are unlikely to have experienced the negative effects of injecting and may facilitate the initiation of their drug-using friends. Prevention messages should therefore aim to find innovative ways of targeting beginning injectors and present a realistic appraisal of the long-term consequences of injecting. Interventionists should also work with current injectors to develop strategies to refuse requests from non-injectors for their help to initiate.
Keywords: Injecting drug use; Initiation; Social setting; Narratives
Wednesday, September 24, 2008
IDU Resource Library now online
PSI/Washington's IDU Resource Library has now gone online! The articles are available at http://www.psi.org/hiv/IDU/index.html and sorted by topic. Just click on the topic and the resources will appear underneath.
If you have any questions- or any resources to add- please send them to IDU@psi.org.
Thanks
Shimon
If you have any questions- or any resources to add- please send them to IDU@psi.org.
Thanks
Shimon
1 in 5
According to a recent Lancet report, about 1 in 5 IDUs worldwide are living with HIV.
News story on this below. I'll try to get the report and circulate it around.
Rob
http://afp.google.com/article/ALeqM5jVF1jHGnraGyelaqFY8Z0RCRZ6XA
Nearly one in five intravenous drug users may have HIV: estimate
5 hours ago
PARIS (AFP) — Around 16 million people around the world inject illegal drugs, and nearly one in five of them may have the AIDS virus, according to an estimate published online Wednesday by The Lancet.
The global tally of intravenous drug users (IDUs) is put at 15.9 million, around three million of whom could have the human immunodeficiency virus (HIV), it says.
China has largest number of IDUs, with a mid-range estimate of 2.35 million people. The HIV infection rate among them is calculated at 12.3 percent.
The United States has the second highest total, with around 1.85 million IDUs and an estimated infection rate among them of between 15.6 percent.
The report also warned of high HIV numbers among IDUs in Ukraine and Russia, which could be 42 percent and 37 percent respectively.
The assessment is led by Bradley Mathers of the National Drug and Alcohol Research Centre at the University of New South Wales in Sydney, Australia.
It is based on official national figures and estimates published in peer-reviewed journals.
The review covers 148 countries, but admits that many blanks remain where the data are sketchy or absent and the range estimates are broad.
"Areas of particular concern are countries in Southeast Asia, Eastern Europe and Latin America, where the prevalence of HIV among some sub-populations of people who inject drugs has been reported to be over 40 percent," the paper says.
Injecting drug use is one of the major drivers for the global AIDS pandemic.
HIV is spread by infected IDUs who share syringes or turn to prostitution, which thus helps the virus to enter the main population.
AIDS campaigners say the problem has to be tackled by a panoply of methods, including programmes to exchange used needles for sterile ones and the use of methadone, an opiate substitute, to wean IDUs off heroin.
Hosted by Copyright © 2008 AFP. All rights reserved. More »
News story on this below. I'll try to get the report and circulate it around.
Rob
http://afp.google.com/article/ALeqM5jVF1jHGnraGyelaqFY8Z0RCRZ6XA
Nearly one in five intravenous drug users may have HIV: estimate
5 hours ago
PARIS (AFP) — Around 16 million people around the world inject illegal drugs, and nearly one in five of them may have the AIDS virus, according to an estimate published online Wednesday by The Lancet.
The global tally of intravenous drug users (IDUs) is put at 15.9 million, around three million of whom could have the human immunodeficiency virus (HIV), it says.
China has largest number of IDUs, with a mid-range estimate of 2.35 million people. The HIV infection rate among them is calculated at 12.3 percent.
The United States has the second highest total, with around 1.85 million IDUs and an estimated infection rate among them of between 15.6 percent.
The report also warned of high HIV numbers among IDUs in Ukraine and Russia, which could be 42 percent and 37 percent respectively.
The assessment is led by Bradley Mathers of the National Drug and Alcohol Research Centre at the University of New South Wales in Sydney, Australia.
It is based on official national figures and estimates published in peer-reviewed journals.
The review covers 148 countries, but admits that many blanks remain where the data are sketchy or absent and the range estimates are broad.
"Areas of particular concern are countries in Southeast Asia, Eastern Europe and Latin America, where the prevalence of HIV among some sub-populations of people who inject drugs has been reported to be over 40 percent," the paper says.
Injecting drug use is one of the major drivers for the global AIDS pandemic.
HIV is spread by infected IDUs who share syringes or turn to prostitution, which thus helps the virus to enter the main population.
AIDS campaigners say the problem has to be tackled by a panoply of methods, including programmes to exchange used needles for sterile ones and the use of methadone, an opiate substitute, to wean IDUs off heroin.
Hosted by Copyright © 2008 AFP. All rights reserved. More »
Monday, September 22, 2008
2008 Harm Reduction Conference - Presentations
The 19th International Harm Reduction Conference took place from 11th – 15th May 2008 in Barcelona, Spain. You can now dowload most of the presentations (including PSI's) from the following website:
http://www.ihra.net/Thailand/Barcelona2008
Enjoy!
Rob
http://www.ihra.net/Thailand/Barcelona2008
Enjoy!
Rob
Monday, September 1, 2008
Overdose Awareness Day
August 31 was Overdose Awareness Day.
Please see message below for an important new resource on this important IDU-related health issue.
Rob
Dear Colleagues,
Though overdose related death is preventable, it remains one of the leading causes of death among people who inject drugs. The Eurasian Harm Reduction Network (EHRN), to mark Overdose Awareness Day, August 31, has created a report highlighting the situation in our region and making recommendations for action. The report is available for download:
In English: http://www.harm-reduction.org/od/OD_EHRN_Report_en.pdf (PDF, 800 KB)
In Russian: http://www.harm-reduction.org/od/OD_EHRN_Report_rus.pdf (PDF, 1.2 MB)
Also please find attached a press release, backgrounder and a list of useful resources.Please feel free to distribute widely.
Your feedback is welcome as we want to seek ways to cooperate to better address this critical issue. We ask everybody to recognize the importance of this issue and take action!
Kind regards!
Katya
--
Jekaterina Navicke
Information Coordinator
Eurasian Harm Reduction Network
Siauliu St. 5/1 -21, Vinius, Lithuania LT-01133
Tel.: +370 5 269 1600, +370 652 00 523
Fax: +370 5 269 1601
katya@harm-reduction.org
www.harm-reduction.org
Please see message below for an important new resource on this important IDU-related health issue.
Rob
Dear Colleagues,
Though overdose related death is preventable, it remains one of the leading causes of death among people who inject drugs. The Eurasian Harm Reduction Network (EHRN), to mark Overdose Awareness Day, August 31, has created a report highlighting the situation in our region and making recommendations for action. The report is available for download:
In English: http://www.harm-reduction.org/od/OD_EHRN_Report_en.pdf (PDF, 800 KB)
In Russian: http://www.harm-reduction.org/od/OD_EHRN_Report_rus.pdf (PDF, 1.2 MB)
Also please find attached a press release, backgrounder and a list of useful resources.Please feel free to distribute widely.
Your feedback is welcome as we want to seek ways to cooperate to better address this critical issue. We ask everybody to recognize the importance of this issue and take action!
Kind regards!
Katya
--
Jekaterina Navicke
Information Coordinator
Eurasian Harm Reduction Network
Siauliu St. 5/1 -21, Vinius, Lithuania LT-01133
Tel.: +370 5 269 1600, +370 652 00 523
Fax: +370 5 269 1601
katya@harm-reduction.org
www.harm-reduction.org
Friday, August 15, 2008
IDU in the PSI BCC Catalogue
PSI HQ has sent out to each CR the PSI BCC Catalogue on CD-Rom.
This is just a quick piece of advice for IDU program managers to briefly look through the materials that PSI has produced on IDU around the world. Materials are from countries including Thailand, Vietnam, India, Central Asia, China, and others.
It can also be accessed online at http://misaccess.psi.org/bcc_catalog/web/search.html
Cheers
Rob
This is just a quick piece of advice for IDU program managers to briefly look through the materials that PSI has produced on IDU around the world. Materials are from countries including Thailand, Vietnam, India, Central Asia, China, and others.
It can also be accessed online at http://misaccess.psi.org/bcc_catalog/web/search.html
Cheers
Rob
Wednesday, August 13, 2008
On Needle Programs
Needle exchange: learning from when it DOESN'T work
Six case studies show how the complex balance of needle exchange services can be disrupted, leaving hepatitis C and HIV spreading rapidly. Common themes are resource starvation, local hostility, counterproductive restrictions, and a non-interventionist ethic. Print publication 2003 [Drug and Alcohol Findings, UK]
Cheers
Rob
Six case studies show how the complex balance of needle exchange services can be disrupted, leaving hepatitis C and HIV spreading rapidly. Common themes are resource starvation, local hostility, counterproductive restrictions, and a non-interventionist ethic. Print publication 2003 [Drug and Alcohol Findings, UK]
Cheers
Rob
Switching IDUs from injecting to "chasing" for HIV prevention
One of the new frontiers of harm reduction is "RTIs", or Route Transition Interventions - projects to help drug users switch to less risky forms of drug use, or to reduce initiation of risky forms of drug use.
PSI is on the forfront of this work with our efforts in C. Asia to reduce IDU initiation among youth.
Below is a fascinating intervention to encourage IDUs to move to "smoking" (AKA "Chasing the Dragon) heroin, a much less risky form of opiate administration.
Our harm reduction programs should be considering if this kind of work is appropriate for our different environments.
Rob
---------
Distributing foil from needle and syringe programmes (NSPs) to promote transitions from heroin injecting to chasing: an evaluation
The report presents evaluation results from an intervention using specially produced foil packs to promote a transition from heroin injecting to inhalation (chasing) with injecting drug users (IDUs) attending four needle and syringe programmes (NSPs) in south west England [Harm Reduction Journal]
http://www.harmreductionjournal.com/content/5/1/24
PSI is on the forfront of this work with our efforts in C. Asia to reduce IDU initiation among youth.
Below is a fascinating intervention to encourage IDUs to move to "smoking" (AKA "Chasing the Dragon) heroin, a much less risky form of opiate administration.
Our harm reduction programs should be considering if this kind of work is appropriate for our different environments.
Rob
---------
Distributing foil from needle and syringe programmes (NSPs) to promote transitions from heroin injecting to chasing: an evaluation
The report presents evaluation results from an intervention using specially produced foil packs to promote a transition from heroin injecting to inhalation (chasing) with injecting drug users (IDUs) attending four needle and syringe programmes (NSPs) in south west England [Harm Reduction Journal]
http://www.harmreductionjournal.com/content/5/1/24
Tuesday, August 12, 2008
WHO, TB, PSI, GF Round 9
For those of you working on IDU issues both on the HIV and TB sides, the WHO has produced a new manual on this important topic. see weblink below.
FYI, some people are beginning to speak of Global Fund Round 9 as a "TB Round" - i.e. a round where countries should think strategically about how to scale up TB work. If your country has a serious TB problem (see your DALY Map to check, if you're not sure), now would be the time to have a meeting with the national TB program, to see if there's a role for PSI.
Cheers
Rob
POLICY GUIDELINES FOR COLLABORATIVE TB AND HIV SERVICES FOR INJECTING AND
OTHER DRUG USERS AN INTEGRATED APPROACH
Web: http://www.who.int/tb/publications/2008/en/index.html
FYI, some people are beginning to speak of Global Fund Round 9 as a "TB Round" - i.e. a round where countries should think strategically about how to scale up TB work. If your country has a serious TB problem (see your DALY Map to check, if you're not sure), now would be the time to have a meeting with the national TB program, to see if there's a role for PSI.
Cheers
Rob
POLICY GUIDELINES FOR COLLABORATIVE TB AND HIV SERVICES FOR INJECTING AND
OTHER DRUG USERS AN INTEGRATED APPROACH
Web: http://www.who.int/tb/publications/2008/en/index.html
Friday, July 18, 2008
Overdose among Amercian youth
Interesting NYTimes editorial below, citing troubling stats on overdose in the US today.
Cheers
Rob
July 18, 2008
Editorial
More Kids Dying
Despite a decline in overall drug use, the rate at which young Americans between the ages of 15 and 24 have been dying from drug overdoses has jumped dramatically — more than doubling between 1999 and 2005. In the same period, according to the Centers for Disease Control and Prevention, “accidental poisoning deaths” in this age group, mostly drug overdoses, have jumped from 849 to 2,355.
Instead of rushing to save these young people, state governments are actually shortchanging them. Only a tiny fraction of the money that Washington sends to the states under the Substance Abuse and Prevention and Treatment Block Grant program is aimed at young drug abusers. This cannot go on.
Prescription painkillers like oxycodone and Vicodin are the most common drugs involved in fatal overdoses by young people. The problem need not be measured only in fatalities.
Other, more familiar kinds of drug abuse have increased as well: the percentage of high school seniors who smoke marijuana on a daily basis tripled from nearly 2 percent to 6 percent in the 1990s. The number drifted down to 5.1 percent last year, but that is still alarmingly high, and marijuana is more potent than ever.
Even so, fewer than 1 in 10 American adolescents who need drug treatment get it, according to the Substance Abuse and Mental Health Services Administration. This threatens their health and well being. Drug abuse is also much more difficult and expensive to solve if it is not addressed early.
Every year, Congress dispenses a block grant to the states for drug treatment and prevention — $1.75 billion in 2007. Yet it attaches too few strings. States are not required to spend the money on addiction treatments of proven effectiveness, leading to wasteful experimentation. And while there are set-asides for groups like pregnant women, there is no requirement that any of the money be spent on adolescents. The states are left to decide whether to treat the young, and how.
In 2006, less than 6 percent of the grant — $104.8 million — was spent on people below the age of 25. And adolescents 17 and below nationwide, arguably the most vulnerable group, received less than one-third of that.
That’s obviously not enough. If there is any doubt, just take another look at the rising numbers of kids dying from drug overdoses.
Cheers
Rob
July 18, 2008
Editorial
More Kids Dying
Despite a decline in overall drug use, the rate at which young Americans between the ages of 15 and 24 have been dying from drug overdoses has jumped dramatically — more than doubling between 1999 and 2005. In the same period, according to the Centers for Disease Control and Prevention, “accidental poisoning deaths” in this age group, mostly drug overdoses, have jumped from 849 to 2,355.
Instead of rushing to save these young people, state governments are actually shortchanging them. Only a tiny fraction of the money that Washington sends to the states under the Substance Abuse and Prevention and Treatment Block Grant program is aimed at young drug abusers. This cannot go on.
Prescription painkillers like oxycodone and Vicodin are the most common drugs involved in fatal overdoses by young people. The problem need not be measured only in fatalities.
Other, more familiar kinds of drug abuse have increased as well: the percentage of high school seniors who smoke marijuana on a daily basis tripled from nearly 2 percent to 6 percent in the 1990s. The number drifted down to 5.1 percent last year, but that is still alarmingly high, and marijuana is more potent than ever.
Even so, fewer than 1 in 10 American adolescents who need drug treatment get it, according to the Substance Abuse and Mental Health Services Administration. This threatens their health and well being. Drug abuse is also much more difficult and expensive to solve if it is not addressed early.
Every year, Congress dispenses a block grant to the states for drug treatment and prevention — $1.75 billion in 2007. Yet it attaches too few strings. States are not required to spend the money on addiction treatments of proven effectiveness, leading to wasteful experimentation. And while there are set-asides for groups like pregnant women, there is no requirement that any of the money be spent on adolescents. The states are left to decide whether to treat the young, and how.
In 2006, less than 6 percent of the grant — $104.8 million — was spent on people below the age of 25. And adolescents 17 and below nationwide, arguably the most vulnerable group, received less than one-third of that.
That’s obviously not enough. If there is any doubt, just take another look at the rising numbers of kids dying from drug overdoses.
Monday, July 7, 2008
Preventing HIV among IDUs - online book
Useful, free, download-able book, below.
Preventing HIV Infection among Injecting Drug Users in High Risk Countries: An Assessment of the Evidence
This free PDF was downloaded from:
http://www.nap.edu/catalog/11731.html
Preventing HIV Infection among Injecting Drug Users in High Risk Countries: An Assessment of the Evidence
This free PDF was downloaded from:
http://www.nap.edu/catalog/11731.html
Sunday, July 6, 2008
What's Killing America's Drug Users?
Interesting perspective piece in drug use in America today, below.
Rob
http://www.slate.com/id/2194716/
What's Killing America's Drug Users?
It all depends on how you look at the data.
By Jack Shafer
Posted Thursday, July 3, 2008, at 4:30 PM ET
--------------------------------------------------------------------------------
Last month, citing a new state of Florida study, the New York Times reported that the "rate of deaths caused by prescription drugs was three times the rate of deaths caused by all illicit drugs combined." The story's headline, "Legal Drugs Kill Far More Than Illegal, Florida Says," reinforced the image of prescription pharmaceuticals exterminating Florida's drug users by the thousands.
Nobody denies that many psychoactive drugs—prescription or otherwise—can be deadly. But a hard look at the Florida study (PDF) and its underlying data indicates that what's killing most users in the drug-saturated state—and, by extension, in the rest of the country—is not individual drugs. The deadliest of drug-taking behaviors is the consumption of multiple drugs, or, in the lingo of the drug-abuse industrial complex, "polydrug abuse."
The study, conducted by the Florida Department of Law Enforcement (FDLE) and the Florida Medical Examiners Commission, analyzed the cases of 8,620 people 1) who died in the state during 2007, 2) whose death led to a medical examiner's report, and 3) who had one or more major drugs (including alcohol) in their bodies at the time of death. The "vast majority" of cases involved more than one drug, according to the study.
"The state's medical examiners were asked to distinguish between the drugs being the 'cause' of death or merely 'present' in the body at the time of death," the study states. Because medical examiners often attribute cause of death to multiple drugs, a single death can result in two or three drugs earning "credit" for causing the death. The report provides this disclaimer about such double- and triple-counting: "Many of the deaths were found to have several drugs contributing to the death, thus the count of specific drugs listed is greater than the number of cases."
So when the Times reports that "benzodiazepine, mainly depressants like Valium [diazepam] and Xanax [alprazolam], led to 743 deaths," it's lifting numbers directly from the report. But most of those deaths were actually polydrug deaths.
For instance, the report recorded 556 deaths caused by alprazolam and another drug (or other drugs) but just six deaths in which alprazolam was the only drug present and caused the fatality. Likewise, diazepam in combination with another drug (or other drugs) caused 171 deaths. By itself, it caused just three.
The pattern repeats for other popular pharmaceuticals used illicitly. Oxycodone (OxyContin): 664 deaths in combination, 41 alone. Hydrocodone (Vicodin): 251 deaths in combination, 13 alone. Propoxyphene (Darvon): 76 deaths in combination, nine alone.
The Times article also neglects to acknowledge that many of the deaths attributed to prescription drugs in the study were ruled suicides. Pages 34 and 35 of the study report that 19 percent of the alprazolam deaths and 21 percent of the diazepam deaths were suicides. For these individuals, the drugs were no more dangerous than the walkway along the Golden Gate Bridge. They chose to make the drugs deadly.
None of this is to endorse the recreational use of prescription drugs as safe. The obvious conclusion, though, is one that Florida authorities and the New York Times avoid—namely, that pharmaceuticals that are extraordinarily safe when taken under a doctor's direction can become wildly hazardous when combined with other drugs. Drug users should never mix their drugs!
What prevents the state of Florida and the Times from noting the obvious? Perhaps both worry they'll be accused of encouraging illicit drug use and would rather watch drug users die.
******
What's the "safest" nonpharmaceutical? The Florida study attributed not one death to cannabinoids—you know, marijuana and hashish. What's unsafe? Cocaine was ruled as the sole cause of death in 185 cases and killed another 658 individuals in combination with other drugs. Heroin caused 14 deaths on its own and 79 in combination. Obviously these two drugs, like prescription pharmaceuticals, tend to become more dangerous as one assembles them into cocktails. Speaking of dangerous drug cocktails, allow me to direct your attention to the new Super Furry Animals song "Baby Ate My Eightball." [Addendum, 6: 55 p.m.: An astute reader points out that an eightball is not a cocktail. I was thinking of a speedball as I hummed the SFA song. My apologies.] Send drug cocktail lyrics to slate.pressbox@gmail.com. (E-mail may be quoted by name in "The Fray," Slate's readers' forum, in a future article, or elsewhere unless the writer stipulates otherwise. Permanent disclosure: Slate is owned by the Washington Post Co.)
Track my errors: This hand-built RSS feed will ring every time Slate runs a "Press Box" correction. For e-mail notification of errors in this specific column, type the word alprazolam in the subject head of an e-mail message and send it to slate.pressbox@gmail.com.
--------------------------------------------------------------------------------
sidebar
Return to article
--------------------------------------------------------------------------------
The Florida study collected and examined information on these drugs:
Ethyl alcohol, amphetamines, methamphetamines, MDMA (Ecstasy), MDA, MDEA, alprazolam, diazepam, flunitrazepam (Rohypnol), other benzodiazepines, cannabinoids, carisoprodol/meprobamate, cocaine, gamma-hydroxybutyric acid (GHB), inhalants, ketamine, fentanyl, heroin, hydrocodone, hydromorphone, meperidine, methadone, morphine, oxycodone, phencyclidine (PCP), propoxyphene, and tramadol.
Jack Shafer is Slate's editor at large.
Article URL: http://www.slate.com/id/2194716/
Copyright 2008 Washingtonpost.Newsweek Interactive Co. LLC
Rob
http://www.slate.com/id/2194716/
What's Killing America's Drug Users?
It all depends on how you look at the data.
By Jack Shafer
Posted Thursday, July 3, 2008, at 4:30 PM ET
--------------------------------------------------------------------------------
Last month, citing a new state of Florida study, the New York Times reported that the "rate of deaths caused by prescription drugs was three times the rate of deaths caused by all illicit drugs combined." The story's headline, "Legal Drugs Kill Far More Than Illegal, Florida Says," reinforced the image of prescription pharmaceuticals exterminating Florida's drug users by the thousands.
Nobody denies that many psychoactive drugs—prescription or otherwise—can be deadly. But a hard look at the Florida study (PDF) and its underlying data indicates that what's killing most users in the drug-saturated state—and, by extension, in the rest of the country—is not individual drugs. The deadliest of drug-taking behaviors is the consumption of multiple drugs, or, in the lingo of the drug-abuse industrial complex, "polydrug abuse."
The study, conducted by the Florida Department of Law Enforcement (FDLE) and the Florida Medical Examiners Commission, analyzed the cases of 8,620 people 1) who died in the state during 2007, 2) whose death led to a medical examiner's report, and 3) who had one or more major drugs (including alcohol) in their bodies at the time of death. The "vast majority" of cases involved more than one drug, according to the study.
"The state's medical examiners were asked to distinguish between the drugs being the 'cause' of death or merely 'present' in the body at the time of death," the study states. Because medical examiners often attribute cause of death to multiple drugs, a single death can result in two or three drugs earning "credit" for causing the death. The report provides this disclaimer about such double- and triple-counting: "Many of the deaths were found to have several drugs contributing to the death, thus the count of specific drugs listed is greater than the number of cases."
So when the Times reports that "benzodiazepine, mainly depressants like Valium [diazepam] and Xanax [alprazolam], led to 743 deaths," it's lifting numbers directly from the report. But most of those deaths were actually polydrug deaths.
For instance, the report recorded 556 deaths caused by alprazolam and another drug (or other drugs) but just six deaths in which alprazolam was the only drug present and caused the fatality. Likewise, diazepam in combination with another drug (or other drugs) caused 171 deaths. By itself, it caused just three.
The pattern repeats for other popular pharmaceuticals used illicitly. Oxycodone (OxyContin): 664 deaths in combination, 41 alone. Hydrocodone (Vicodin): 251 deaths in combination, 13 alone. Propoxyphene (Darvon): 76 deaths in combination, nine alone.
The Times article also neglects to acknowledge that many of the deaths attributed to prescription drugs in the study were ruled suicides. Pages 34 and 35 of the study report that 19 percent of the alprazolam deaths and 21 percent of the diazepam deaths were suicides. For these individuals, the drugs were no more dangerous than the walkway along the Golden Gate Bridge. They chose to make the drugs deadly.
None of this is to endorse the recreational use of prescription drugs as safe. The obvious conclusion, though, is one that Florida authorities and the New York Times avoid—namely, that pharmaceuticals that are extraordinarily safe when taken under a doctor's direction can become wildly hazardous when combined with other drugs. Drug users should never mix their drugs!
What prevents the state of Florida and the Times from noting the obvious? Perhaps both worry they'll be accused of encouraging illicit drug use and would rather watch drug users die.
******
What's the "safest" nonpharmaceutical? The Florida study attributed not one death to cannabinoids—you know, marijuana and hashish. What's unsafe? Cocaine was ruled as the sole cause of death in 185 cases and killed another 658 individuals in combination with other drugs. Heroin caused 14 deaths on its own and 79 in combination. Obviously these two drugs, like prescription pharmaceuticals, tend to become more dangerous as one assembles them into cocktails. Speaking of dangerous drug cocktails, allow me to direct your attention to the new Super Furry Animals song "Baby Ate My Eightball." [Addendum, 6: 55 p.m.: An astute reader points out that an eightball is not a cocktail. I was thinking of a speedball as I hummed the SFA song. My apologies.] Send drug cocktail lyrics to slate.pressbox@gmail.com. (E-mail may be quoted by name in "The Fray," Slate's readers' forum, in a future article, or elsewhere unless the writer stipulates otherwise. Permanent disclosure: Slate is owned by the Washington Post Co.)
Track my errors: This hand-built RSS feed will ring every time Slate runs a "Press Box" correction. For e-mail notification of errors in this specific column, type the word alprazolam in the subject head of an e-mail message and send it to slate.pressbox@gmail.com.
--------------------------------------------------------------------------------
sidebar
Return to article
--------------------------------------------------------------------------------
The Florida study collected and examined information on these drugs:
Ethyl alcohol, amphetamines, methamphetamines, MDMA (Ecstasy), MDA, MDEA, alprazolam, diazepam, flunitrazepam (Rohypnol), other benzodiazepines, cannabinoids, carisoprodol/meprobamate, cocaine, gamma-hydroxybutyric acid (GHB), inhalants, ketamine, fentanyl, heroin, hydrocodone, hydromorphone, meperidine, methadone, morphine, oxycodone, phencyclidine (PCP), propoxyphene, and tramadol.
Jack Shafer is Slate's editor at large.
Article URL: http://www.slate.com/id/2194716/
Copyright 2008 Washingtonpost.Newsweek Interactive Co. LLC
Sunday, June 15, 2008
Life of a Heroin Addict
I haven't actually viewed this film (Life of a Heroin Addict) viewable from the site below, but probably worth checking out.
Details below.
Rob
---
Introducing...Wired In films
Using the views and experiences of people whose lives have been affected by addiction, Wired In has produced a catalogue of film material which we will be showing through this Blog.
http://wiredinfilms.blogspot.com/
Details below.
Rob
---
Introducing...Wired In films
Using the views and experiences of people whose lives have been affected by addiction, Wired In has produced a catalogue of film material which we will be showing through this Blog.
http://wiredinfilms.blogspot.com/
Friday, June 6, 2008
IDU Assessment in Asia
Please find a link below to a short but useful new report called:
BASELINE ASSESSMENT OF THE CURRENT STATUS OF RESOURCES, POLICIES AND SERVICES FOR INJECTING DRUG USE AND HIV/AIDS IN SOUTH AND SOUTH EAST ASIA.
http://www.unodc.un.or.th/drugsandhiv/documents/Report%20of%20the%20UN%20Regional%20Task%20Force%20Baseline%20Assessment%20Final%20Report.doc
BASELINE ASSESSMENT OF THE CURRENT STATUS OF RESOURCES, POLICIES AND SERVICES FOR INJECTING DRUG USE AND HIV/AIDS IN SOUTH AND SOUTH EAST ASIA.
http://www.unodc.un.or.th/drugsandhiv/documents/Report%20of%20the%20UN%20Regional%20Task%20Force%20Baseline%20Assessment%20Final%20Report.doc
Thursday, May 29, 2008
A brief overview of "Yaba" (Methamphetamines)
United Nations Office on Drugs and Crime
Yaba, the 'crazy medicine' of East Asia
19 May 2008 - Yaba, or 'crazy medicine' in Thai, is a tablet form of methamphetamine, and a very powerful stimulant. Introduced to East Asia during World War II to enhance soldiers' performance, methamphetamine has become increasingly popular in East Asia, particularly among young people. Yaba is now the main form of methamphetamine abused in Thailand, Laos and Cambodia as well as Viet Nam and Myanmar, where it is typically manufactured.
Mixed with caffeine and usually 30 per cent methamphetamine, the drug is a central nervous system stimulant. Although it comes in a pill form, yaba is usually crushed and smoked. Users get an intense 'burst' of energy, followed by increased activity, decreased appetite and a general sense of well-being. Once the effects wear off, the user 'crashes' and experiences prolonged periods of sleep and depression.
Like other forms of methamphetamine, long-term abuse of yaba can produce strong dependence. Users develop tolerance and require increasing amounts of the drug to feel the same effects. Excessive doses can result in convulsions, seizures and death from respiratory failure, stroke or heart failure. The drug can trigger aggressive and violent behaviour, and psychiatric disorders have also been associated with its use.
Traditionally used by occupational workers such as truck drivers, the use of yaba in East Asia shifted into youth culture about 10 years ago. Starting in Thailand and spreading into Laos, Cambodia and Viet Nam, yaba consumers in the region are now estimated in the millions. Recently, the drug has been spreading toward the Indian subcontinent; in 2007, a record 1,200,000 yaba tablets were confiscated in Bangladesh where there is a potentially very large market.
The development and spread of yaba in the region has been opportunistic. As UNODC expert Jeremy Douglas explains, "it is a drug that is cheap to manufacture and cheap to purchase. You introduce it somewhere and develop a market fairly quickly because it is cheap and highly addictive." With one tablet costing as little as US$ 1 in Cambodia to US$ 5 in Bangkok, the drug is very easy to produce if in possession of the necessary precursor materials. "You can have labs producing 10,000 tablets per hour hidden anywhere", he adds.
Unlike geographically confined, crop-based drugs, such as opium in Afghanistan, synthetic drugs like yaba can be produced anywhere in the world where there are weaknesses in law enforcement and in precursor chemical regulations. The portable and clandestine nature of production also makes it difficult to monitor and assess the situation systematically. "At the moment the information base is quite fractured", says Douglas. "In some parts of the world, we know it is there - we just don't know the extent to which it is."
To help address the issue, UNODC is launching the Global Synthetics Monitoring: Analysis, Reporting and Trends (SMART) Programme. Set up in hotspots and key priority regions of the world, SMART teams will assess data and information, thus enabling countries to strategically plan prevention and law enforcement responses.
Yaba, the 'crazy medicine' of East Asia
19 May 2008 - Yaba, or 'crazy medicine' in Thai, is a tablet form of methamphetamine, and a very powerful stimulant. Introduced to East Asia during World War II to enhance soldiers' performance, methamphetamine has become increasingly popular in East Asia, particularly among young people. Yaba is now the main form of methamphetamine abused in Thailand, Laos and Cambodia as well as Viet Nam and Myanmar, where it is typically manufactured.
Mixed with caffeine and usually 30 per cent methamphetamine, the drug is a central nervous system stimulant. Although it comes in a pill form, yaba is usually crushed and smoked. Users get an intense 'burst' of energy, followed by increased activity, decreased appetite and a general sense of well-being. Once the effects wear off, the user 'crashes' and experiences prolonged periods of sleep and depression.
Like other forms of methamphetamine, long-term abuse of yaba can produce strong dependence. Users develop tolerance and require increasing amounts of the drug to feel the same effects. Excessive doses can result in convulsions, seizures and death from respiratory failure, stroke or heart failure. The drug can trigger aggressive and violent behaviour, and psychiatric disorders have also been associated with its use.
Traditionally used by occupational workers such as truck drivers, the use of yaba in East Asia shifted into youth culture about 10 years ago. Starting in Thailand and spreading into Laos, Cambodia and Viet Nam, yaba consumers in the region are now estimated in the millions. Recently, the drug has been spreading toward the Indian subcontinent; in 2007, a record 1,200,000 yaba tablets were confiscated in Bangladesh where there is a potentially very large market.
The development and spread of yaba in the region has been opportunistic. As UNODC expert Jeremy Douglas explains, "it is a drug that is cheap to manufacture and cheap to purchase. You introduce it somewhere and develop a market fairly quickly because it is cheap and highly addictive." With one tablet costing as little as US$ 1 in Cambodia to US$ 5 in Bangkok, the drug is very easy to produce if in possession of the necessary precursor materials. "You can have labs producing 10,000 tablets per hour hidden anywhere", he adds.
Unlike geographically confined, crop-based drugs, such as opium in Afghanistan, synthetic drugs like yaba can be produced anywhere in the world where there are weaknesses in law enforcement and in precursor chemical regulations. The portable and clandestine nature of production also makes it difficult to monitor and assess the situation systematically. "At the moment the information base is quite fractured", says Douglas. "In some parts of the world, we know it is there - we just don't know the extent to which it is."
To help address the issue, UNODC is launching the Global Synthetics Monitoring: Analysis, Reporting and Trends (SMART) Programme. Set up in hotspots and key priority regions of the world, SMART teams will assess data and information, thus enabling countries to strategically plan prevention and law enforcement responses.
Sunday, May 4, 2008
Drug users preventing overdose deaths
A new Yale Univ. study provides more evidence to support providing drug users with a cheap, safe product (naloxone) that helps them prevent deaths of their peers from overdose.
Story below.
Rob
Drug Addicts Can Learn How to Save Lives, Yale Researchers Find
New Haven, Conn. — Drug users can be taught to identify and quickly respond to overdoses of heroin or other opioids as effectively as medical experts, a Yale University study suggests.
The study supports efforts of some drug counselors, physicians and public health experts who have started community-based programs to train addicts and supply them with the opioid antagonist drug naloxone in order to respond to potentially fatal drug overdoses.
Naxolone, a medication lacking in abuse potential and routinely used by emergency medical personnel to treat heroin and other opioid overdoses, can be administered by a simple muscular injection. The drug temporarily combats effects of an overdose until medical help can arrive. Critics of such a harm-reduction strategy, however, have questioned whether drug users have the ability to recognize an overdose and can properly administer the drug. This study, recently published in the early online edition of the journal Addiction, suggests this concern is unwarranted.
“You have to keep people alive long enough to get access to drug treatment for their addiction,’’ said Traci Craig Green, a doctoral candidate in the Yale School of Public Health and lead author of the research “You can’t treat a dead person.”
Ten individuals who were regular users of heroin or other opioid drugs such as oxycodone or hydromorphone were enrolled in the study at each of six sites across the United States. They were divided into two groups, one with members who had previously received training in overdose response and one with members who had not. Individuals were interviewed to determine if they could recognize signs of opioid overdose and when it was appropriate to administer naloxone. Their responses were then compared to those given by a group of medical experts.
The training, conducted well before the interviews were done, included recognizing differences between overdoses caused by opioids and those caused by other substances such as cocaine, for which use of the drug naloxone is not indicated.
“The study shows opioid users with training can spot an opioid overdose, are less likely to miss true opioid overdoses, and can determine whether naloxone should be administered and when it should not be administered," Green said.
The study was funded by the National Institute of Mental Health. Other authors included Robert Heimer and Lauretta E. Grau from the school of public health.
FOR IMMEDIATE RELEASE: May 1, 2008
--------------------------------------------------------------------------------
About OPA | Contact Us
Copyright © 2007, Yale University
Story below.
Rob
Drug Addicts Can Learn How to Save Lives, Yale Researchers Find
New Haven, Conn. — Drug users can be taught to identify and quickly respond to overdoses of heroin or other opioids as effectively as medical experts, a Yale University study suggests.
The study supports efforts of some drug counselors, physicians and public health experts who have started community-based programs to train addicts and supply them with the opioid antagonist drug naloxone in order to respond to potentially fatal drug overdoses.
Naxolone, a medication lacking in abuse potential and routinely used by emergency medical personnel to treat heroin and other opioid overdoses, can be administered by a simple muscular injection. The drug temporarily combats effects of an overdose until medical help can arrive. Critics of such a harm-reduction strategy, however, have questioned whether drug users have the ability to recognize an overdose and can properly administer the drug. This study, recently published in the early online edition of the journal Addiction, suggests this concern is unwarranted.
“You have to keep people alive long enough to get access to drug treatment for their addiction,’’ said Traci Craig Green, a doctoral candidate in the Yale School of Public Health and lead author of the research “You can’t treat a dead person.”
Ten individuals who were regular users of heroin or other opioid drugs such as oxycodone or hydromorphone were enrolled in the study at each of six sites across the United States. They were divided into two groups, one with members who had previously received training in overdose response and one with members who had not. Individuals were interviewed to determine if they could recognize signs of opioid overdose and when it was appropriate to administer naloxone. Their responses were then compared to those given by a group of medical experts.
The training, conducted well before the interviews were done, included recognizing differences between overdoses caused by opioids and those caused by other substances such as cocaine, for which use of the drug naloxone is not indicated.
“The study shows opioid users with training can spot an opioid overdose, are less likely to miss true opioid overdoses, and can determine whether naloxone should be administered and when it should not be administered," Green said.
The study was funded by the National Institute of Mental Health. Other authors included Robert Heimer and Lauretta E. Grau from the school of public health.
FOR IMMEDIATE RELEASE: May 1, 2008
--------------------------------------------------------------------------------
About OPA | Contact Us
Copyright © 2007, Yale University
Sunday, April 27, 2008
DALYs for DC
Interesting story below about the expansion of needle exchange in DC, set for the summer.
Looks like DC is in for some significant DALYs gained through needle distribution!
Cheers
Rob
http://www.washingtonpost.com/wp-dyn/content/article/2008/04/24/AR2008042403383.html
More Money for Needle Exchanges
With Congressional Ban Lifted, City to Provide Funding
By Susan Levine
Washington Post Staff Writer
Friday, April 25, 2008; Page B04
Needle-exchange efforts in the District will expand significantly by summer as $494,000 in city funding -- the first local appropriation allowed in a decade -- begins flowing to four organizations on the front line of the fight against HIV/AIDS.
Last summer, Congress lifted a ban prohibiting the city from spending its tax dollars to provide drug addicts with clean needles, an approach that jurisdictions across the country have taken to stop the disease's transmission through shared, potentially contaminated syringes. No other city or state faced the same restriction, which dated to 1998.
More than half the money will go to PreventionWorks!, the sole group involved in such work during the ban, often despite tenuous private funding. It now will expand outreach to include more comprehensive disease screening of the people served through its mobile van.
Shannon Hader, director of the city's HIV/AIDS Administration, said yesterday that the other nonprofit groups that were awarded grants bring "three very different" approaches to the initiative.
Those recipients are Helping Individual Prostitutes Survive (HIPS), whose focus is men and women engaged in sex work in the District; Bread for the City, which assists the poor and homeless with a range of programs; and the Family Medical and Counseling Service, a more traditional health care provider in Ward 8.
Each will build on the work it does with intravenous drug users, Hader said. The grants are expected to double next year and be continued through 2010.
The District's rates of HIV and AIDS infection are among the worst in the country, with intravenous drug users accounting for a sizable portion of new cases annually.
Looks like DC is in for some significant DALYs gained through needle distribution!
Cheers
Rob
http://www.washingtonpost.com/wp-dyn/content/article/2008/04/24/AR2008042403383.html
More Money for Needle Exchanges
With Congressional Ban Lifted, City to Provide Funding
By Susan Levine
Washington Post Staff Writer
Friday, April 25, 2008; Page B04
Needle-exchange efforts in the District will expand significantly by summer as $494,000 in city funding -- the first local appropriation allowed in a decade -- begins flowing to four organizations on the front line of the fight against HIV/AIDS.
Last summer, Congress lifted a ban prohibiting the city from spending its tax dollars to provide drug addicts with clean needles, an approach that jurisdictions across the country have taken to stop the disease's transmission through shared, potentially contaminated syringes. No other city or state faced the same restriction, which dated to 1998.
More than half the money will go to PreventionWorks!, the sole group involved in such work during the ban, often despite tenuous private funding. It now will expand outreach to include more comprehensive disease screening of the people served through its mobile van.
Shannon Hader, director of the city's HIV/AIDS Administration, said yesterday that the other nonprofit groups that were awarded grants bring "three very different" approaches to the initiative.
Those recipients are Helping Individual Prostitutes Survive (HIPS), whose focus is men and women engaged in sex work in the District; Bread for the City, which assists the poor and homeless with a range of programs; and the Family Medical and Counseling Service, a more traditional health care provider in Ward 8.
Each will build on the work it does with intravenous drug users, Hader said. The grants are expected to double next year and be continued through 2010.
The District's rates of HIV and AIDS infection are among the worst in the country, with intravenous drug users accounting for a sizable portion of new cases annually.
Sunday, April 20, 2008
Safer Injecting Guide
FYI, a new guidebook on safer injecting for IDUs can be found at the below URL:
http://www.mqi.ie/docs/mqi_safer_injecting_guide_web.pdf
Rob
http://www.mqi.ie/docs/mqi_safer_injecting_guide_web.pdf
Rob
Heroin Blocking - Some new evidence
FYI
www.theage.com.au
Review of heroin-blocking implant urged
April 17, 2008 - 11:56PM
Use of a controversial stomach implant designed to block the effects of heroin must be urgently reined in, according to drug specialists who say addicts are being harmed.
A new report found that naltrexone implants commonly cause severe adverse reactions, including extreme dehydration and acute renal failure in those who are fitted with them.
Nine Sydney specialists writing in the Medical Journal of Australia have called for an urgent review of use of the product, which blocks the effects of heroin and stops cravings for about six months.
It has not been registered or rigorously tested in Australia but about 1,500 addicts have obtained it through the Therapeutic Goods Administration's Special Access Scheme for people with a life-threatening need.
Controversy has surrounded the use of the implants for several years, with advocates arguing they offer addicts the best chance of overcoming their addiction and opponents branding them dangerous and ineffective.
One study published last March linked the implant to five deaths.
A new study published has found that of 12 implant patients who were admitted to two Sydney hospitals last year, eight hospitalisations were implant-related.
Six were suffering severe dehydration, one had acute renal failure and another had an abscess at the implant site.
"These cases challenge the notion that a naltrexone implant is a safe procedure," said study leader Nicholas Lintzeris, a senior addiction specialist at the Sydney South West Area Health Service.
He called for the widespread and unregulated use of implants to be restricted until they have been properly tested for safety and effectiveness.
Professor Robert Ali, director of the Drug Alcohol Services Council in Adelaide, agreed the product should not be so widely available.
"The disturbing suggestions of mortality and morbidity from unregistered naltrexone implants makes a strong case for an independent review to determine whether this treatment is sufficiently safe for such widespread use," Prof Ali said.
However, another specialist, University of Western Australia Professor of Addiction Gary Hulse, said a trial he had undertaken had found the implant to be just as safe and effective as the oral form of the drug.
He defended its use and said many of the criticisms levelled at naltrexone occurred because people's withdrawals from heroin were not being managed properly.
© 2008 AAP
www.theage.com.au
Review of heroin-blocking implant urged
April 17, 2008 - 11:56PM
Use of a controversial stomach implant designed to block the effects of heroin must be urgently reined in, according to drug specialists who say addicts are being harmed.
A new report found that naltrexone implants commonly cause severe adverse reactions, including extreme dehydration and acute renal failure in those who are fitted with them.
Nine Sydney specialists writing in the Medical Journal of Australia have called for an urgent review of use of the product, which blocks the effects of heroin and stops cravings for about six months.
It has not been registered or rigorously tested in Australia but about 1,500 addicts have obtained it through the Therapeutic Goods Administration's Special Access Scheme for people with a life-threatening need.
Controversy has surrounded the use of the implants for several years, with advocates arguing they offer addicts the best chance of overcoming their addiction and opponents branding them dangerous and ineffective.
One study published last March linked the implant to five deaths.
A new study published has found that of 12 implant patients who were admitted to two Sydney hospitals last year, eight hospitalisations were implant-related.
Six were suffering severe dehydration, one had acute renal failure and another had an abscess at the implant site.
"These cases challenge the notion that a naltrexone implant is a safe procedure," said study leader Nicholas Lintzeris, a senior addiction specialist at the Sydney South West Area Health Service.
He called for the widespread and unregulated use of implants to be restricted until they have been properly tested for safety and effectiveness.
Professor Robert Ali, director of the Drug Alcohol Services Council in Adelaide, agreed the product should not be so widely available.
"The disturbing suggestions of mortality and morbidity from unregistered naltrexone implants makes a strong case for an independent review to determine whether this treatment is sufficiently safe for such widespread use," Prof Ali said.
However, another specialist, University of Western Australia Professor of Addiction Gary Hulse, said a trial he had undertaken had found the implant to be just as safe and effective as the oral form of the drug.
He defended its use and said many of the criticisms levelled at naltrexone occurred because people's withdrawals from heroin were not being managed properly.
© 2008 AAP
Friday, April 11, 2008
Harm Reduction Developments 2008 - New report from Soros Foundation
Soros Foundation has published a new report: Harm Reduction Developments 2008.
The report provides a snapshot of key developments in HIV prevention, policy, and treatment for injecting drug users in countries with injection-driven HIV epidemics.
Please find a link to the report, and a summary of its contents, below.
Cheers
Rob
http://www.soros.org/initiatives/health/focus/ihrd
Harm Reduction Developments 2008
Countries with Injection-Driven HIV Epidemics
March 2008
In 2007, injecting drug users (IDUs) comprised the largest share of total HIV cases in at least 20 nations in Asia and the former Soviet Union. The percentage of cases attributed to injecting drug use is over 70 percent in some countries in Eastern Europe and Central Asia, the region where HIV grew fastest in 2006.
In many of these countries, harm reduction has made important inroads—all countries in Eastern Europe and the former Soviet Union except Turkmenistan had needle exchange programs in 2007. In most, they remain too small to contain the HIV epidemic. Reports that new HIV cases among drug users have stabilized often reflect trends in testing rather than the impact of prevention. In Asia, home to more than half the world’s population, even low percentage rates of HIV cases translate into huge numbers of people infected, with profound economic and social implications. China, Indonesia, Malaysia, and Vietnam all have injection-driven HIV epidemics, and have all shown a willingness to adopt some of the measures necessary to halt the spread of HIV among IDUs and their sexual partners. The challenge for many of the hardest-hit countries, however, lies in turning commitments into practice, without sacrificing protection of human rights.
This OSI report provides a snapshot of some key developments in HIV prevention, policy, and treatment for IDUs in developing and transitional countries with injection-driven epidemics, and includes overviews on such issues as community mobilization, methadone and buprenorphine treatment availability, harm reduction in prisons, and HIV treatment for IDUs.
The report provides a snapshot of key developments in HIV prevention, policy, and treatment for injecting drug users in countries with injection-driven HIV epidemics.
Please find a link to the report, and a summary of its contents, below.
Cheers
Rob
http://www.soros.org/initiatives/health/focus/ihrd
Harm Reduction Developments 2008
Countries with Injection-Driven HIV Epidemics
March 2008
In 2007, injecting drug users (IDUs) comprised the largest share of total HIV cases in at least 20 nations in Asia and the former Soviet Union. The percentage of cases attributed to injecting drug use is over 70 percent in some countries in Eastern Europe and Central Asia, the region where HIV grew fastest in 2006.
In many of these countries, harm reduction has made important inroads—all countries in Eastern Europe and the former Soviet Union except Turkmenistan had needle exchange programs in 2007. In most, they remain too small to contain the HIV epidemic. Reports that new HIV cases among drug users have stabilized often reflect trends in testing rather than the impact of prevention. In Asia, home to more than half the world’s population, even low percentage rates of HIV cases translate into huge numbers of people infected, with profound economic and social implications. China, Indonesia, Malaysia, and Vietnam all have injection-driven HIV epidemics, and have all shown a willingness to adopt some of the measures necessary to halt the spread of HIV among IDUs and their sexual partners. The challenge for many of the hardest-hit countries, however, lies in turning commitments into practice, without sacrificing protection of human rights.
This OSI report provides a snapshot of some key developments in HIV prevention, policy, and treatment for IDUs in developing and transitional countries with injection-driven epidemics, and includes overviews on such issues as community mobilization, methadone and buprenorphine treatment availability, harm reduction in prisons, and HIV treatment for IDUs.
Wednesday, April 9, 2008
Drug use and HIV in Africa
In October 2007, the "sub-Saharan Africa Harm Reduction Network" (SAHRN) was formed to address the growing problem of drug use and HIV (and other harms) in Africa. The meeting notes are available at the following site:
http://www.ihra.net/uploads/downloads/NewsItems/SAHRNInaugralMeeting.pdf
PSI does not currently run interventions in Africa to directly address the issues of drug use and its associated harms, such as HIV, HEP C, overdose, etc. But HIV rates are on the rise among IDUs in many African countries. If this is an issue in your country, and you'd like to add IDU to your target groups, please don't hesitate to contact me or Mariah (mpreston@psi.org) for assistance.
Rob
http://www.ihra.net/uploads/downloads/NewsItems/SAHRNInaugralMeeting.pdf
PSI does not currently run interventions in Africa to directly address the issues of drug use and its associated harms, such as HIV, HEP C, overdose, etc. But HIV rates are on the rise among IDUs in many African countries. If this is an issue in your country, and you'd like to add IDU to your target groups, please don't hesitate to contact me or Mariah (mpreston@psi.org) for assistance.
Rob
Thursday, April 3, 2008
New War on Drugs in Thailand
Tuesday, 1 April 2008
New Thai anti-drug policy to be announced tomorrow
A new anti-drug policy will be announced in Thailand tomorrow which many fear will mark a reinstatement 2003's brutal war on drugs.
In February 2003, the Thai government, under then Prime Minister Thaksin Shinawatra, launched a violent and murderous ‘war on drugs’ aimed at the ‘suppression’ of drug trafficking and the ‘prevention’ of drug use. In the first three months of the campaign there were 2,275 extrajudicial killings,[i] a figure that reached well over 2,500 by the end of the ‘war’. In 2007, it was found that more than half of those killed had no connection whatsoever to drugs.[ii] Added to the thousands who lost their lives, thousands more were forced into coercive drug treatment. HIV prevention efforts were also seriously compromised with fear of arrest and mistreatment driving people who inject drugs underground and away from essential harm reduction services.[iii]
In 2005, the UN Human Rights Committee raised serious concerns about the “extraordinarily large number of killings” that took place during the ‘war’ and recommended that thorough and independent investigations be undertaken.[iv] The then UN Special Rapporteur on Extrajudicial, Summary or Arbitrary Executions, Asma Jahangir, sent an urgent communication to the Thai government in 2003.[v] In its response, Thailand said that every unnatural death would be thoroughly investigated in accordance with the law.[vi] To date, none of the perpetrators have been brought to justice.
In recent weeks, the government of Thailand has publicly stated its intention to again pursue its war on drugs. On 20 February, according to Human Rights Watch representatives in Thailand, Interior Minister, Chalerm Yubamrung, told parliament that
“… For drug dealers if they do not want to die, they had better quit staying on that road... drugs suppression in my time as Interior Minister will follow the approach of [former Prime Minister] Thaksin. If that will lead to 3,000-4,000 deaths of those who break the law, then so be it. That has to be done ... For those of you from the opposition party, I will say you care more about human rights than drug problems in Thailand”.
At the 51st session of the UN Commission on Narcotic Drugs, held in Vienna in March 2008, Thai government representatives assured fellow government delegations, UN representatives and NGOs that human rights would be respected in any anti-drug campaign. However, at the same session Thailand was among those attempting to block a resolution recognising the Universal Declaration of Human Rights and calling for all drug control to be in full conflormity with human rights.
According to the Bangkok Post, a new anti-drug campaign will be launched on April 2nd. Given the events of 2003 and the impunity for perpetrators since then, there is growing concern in Thailand and internationally at the Thai government’s plans. Human Rights Watch has already noted with concern the murders of alleged drug traffickers across Thailand since the announcement of the Interior Minister — two in Chiang Mai, one in Kalasin, and one in Krabi.
Drug law enforcement must accord with international human rights law, as stated repeatedly by the General Assembly and this year by the International Narcotics Control Board. A reinstatement of the brutal war on drugs would be a considerable retrograde step in Thailand’s progress on human rights, including its accession to the UN Convention Against Torture in October 2007.
On Human Rights Day 2007, to commemorate the 60th anniversary of the Universal Declaration of Human Rights, Thailand reaffirmed at the Human Rights Council its “unwavering commitment to the cause of human rights”.[vii] There can be no exceptions to this commitment.
The Thai government must comply with its human rights obligations before many thousands more are killed. It must announce publicly that it will not proceed with a second war on drugs.
Any new 'anti-drug campaign' must consist of integrated and comprehensive drug strategies, including harm reduction services, that comply fully with all human rights and fundamental freedoms.
A new 'war on drugs' cannot be tolerated. The international community and national and international NGOs will be watching closely.
2008 report on the possible revival of the 'war on drugs'
Report on the 2003 'war on drugs' (In English but some Thai statements are not translated)
Report on the 2007 investigation into the 2003 killings: Part 1 - Part 2
[i] See ‘Not Enough Graves: The War on Drugs, HIV/AIDS, and Violations of Human Rights’ A Human Rights Watch Report, Vol 16 No 8 (C), June 2004, p.9 (Not Enough Graves)
[ii] ‘Most of those killed in war on drug not involved in drug (sic),’ The Nation, November 27, 2007 (online at http://nationmultimedia.com/breakingnews/read.php?newsid=30057578). In August 2007, the military-installed government of General Surayud Chalanont appointed a special committee to investigate the extrajudicial killings during the 2003 war on drugs. The committee’s report – which has never been made public – said that of 2,819 people killed between February and April 2003, more than 1400 were unrelated to drug dealing or had no apparent reason for their killings. Human Rights Watch, ‘Thailand: Prosecute Anti-Drugs Police Identified in Abuses,’ February 7, 2008 (online at http://hrw.org/english/docs/2008/02/07/thaila17993.htm); ‘Southeast Asia: Most Killed in Thailand's 2003 Drug War Not Involved With Drugs, Panel Finds’, Drug War Chronicle, Issue 512, March 2007, http://stopthedrugwar.org/chronicle/512/thailand_drug_killings_half_not_involved_panel_finds (Date of last access: 5 March 2008).
[iii] ‘Not Enough Graves’, pp.36-40
[iv] Concluding Observations of the Human Rights Committee: Thailand, UN Doc. No. CCPR/CO/84/THA, 8 July 2005, paras 10 & 11
[v] Report of the Special Rapporteur on extrajudicial, summary and arbitrary executions: Summary of cases transmitted to governments and replies received UN Doc. No. E/CN.4/2004/7/Add.1, 24 March 2004, paras 557-558
[vi] ibid., para 558
[vii] Webcast available at http://www.un.org/webcast/humanrightsday/archive.html (Date of last access: 5 March 2008)
Posted by HR2 at 13:17
New Thai anti-drug policy to be announced tomorrow
A new anti-drug policy will be announced in Thailand tomorrow which many fear will mark a reinstatement 2003's brutal war on drugs.
In February 2003, the Thai government, under then Prime Minister Thaksin Shinawatra, launched a violent and murderous ‘war on drugs’ aimed at the ‘suppression’ of drug trafficking and the ‘prevention’ of drug use. In the first three months of the campaign there were 2,275 extrajudicial killings,[i] a figure that reached well over 2,500 by the end of the ‘war’. In 2007, it was found that more than half of those killed had no connection whatsoever to drugs.[ii] Added to the thousands who lost their lives, thousands more were forced into coercive drug treatment. HIV prevention efforts were also seriously compromised with fear of arrest and mistreatment driving people who inject drugs underground and away from essential harm reduction services.[iii]
In 2005, the UN Human Rights Committee raised serious concerns about the “extraordinarily large number of killings” that took place during the ‘war’ and recommended that thorough and independent investigations be undertaken.[iv] The then UN Special Rapporteur on Extrajudicial, Summary or Arbitrary Executions, Asma Jahangir, sent an urgent communication to the Thai government in 2003.[v] In its response, Thailand said that every unnatural death would be thoroughly investigated in accordance with the law.[vi] To date, none of the perpetrators have been brought to justice.
In recent weeks, the government of Thailand has publicly stated its intention to again pursue its war on drugs. On 20 February, according to Human Rights Watch representatives in Thailand, Interior Minister, Chalerm Yubamrung, told parliament that
“… For drug dealers if they do not want to die, they had better quit staying on that road... drugs suppression in my time as Interior Minister will follow the approach of [former Prime Minister] Thaksin. If that will lead to 3,000-4,000 deaths of those who break the law, then so be it. That has to be done ... For those of you from the opposition party, I will say you care more about human rights than drug problems in Thailand”.
At the 51st session of the UN Commission on Narcotic Drugs, held in Vienna in March 2008, Thai government representatives assured fellow government delegations, UN representatives and NGOs that human rights would be respected in any anti-drug campaign. However, at the same session Thailand was among those attempting to block a resolution recognising the Universal Declaration of Human Rights and calling for all drug control to be in full conflormity with human rights.
According to the Bangkok Post, a new anti-drug campaign will be launched on April 2nd. Given the events of 2003 and the impunity for perpetrators since then, there is growing concern in Thailand and internationally at the Thai government’s plans. Human Rights Watch has already noted with concern the murders of alleged drug traffickers across Thailand since the announcement of the Interior Minister — two in Chiang Mai, one in Kalasin, and one in Krabi.
Drug law enforcement must accord with international human rights law, as stated repeatedly by the General Assembly and this year by the International Narcotics Control Board. A reinstatement of the brutal war on drugs would be a considerable retrograde step in Thailand’s progress on human rights, including its accession to the UN Convention Against Torture in October 2007.
On Human Rights Day 2007, to commemorate the 60th anniversary of the Universal Declaration of Human Rights, Thailand reaffirmed at the Human Rights Council its “unwavering commitment to the cause of human rights”.[vii] There can be no exceptions to this commitment.
The Thai government must comply with its human rights obligations before many thousands more are killed. It must announce publicly that it will not proceed with a second war on drugs.
Any new 'anti-drug campaign' must consist of integrated and comprehensive drug strategies, including harm reduction services, that comply fully with all human rights and fundamental freedoms.
A new 'war on drugs' cannot be tolerated. The international community and national and international NGOs will be watching closely.
2008 report on the possible revival of the 'war on drugs'
Report on the 2003 'war on drugs' (In English but some Thai statements are not translated)
Report on the 2007 investigation into the 2003 killings: Part 1 - Part 2
[i] See ‘Not Enough Graves: The War on Drugs, HIV/AIDS, and Violations of Human Rights’ A Human Rights Watch Report, Vol 16 No 8 (C), June 2004, p.9 (Not Enough Graves)
[ii] ‘Most of those killed in war on drug not involved in drug (sic),’ The Nation, November 27, 2007 (online at http://nationmultimedia.com/breakingnews/read.php?newsid=30057578). In August 2007, the military-installed government of General Surayud Chalanont appointed a special committee to investigate the extrajudicial killings during the 2003 war on drugs. The committee’s report – which has never been made public – said that of 2,819 people killed between February and April 2003, more than 1400 were unrelated to drug dealing or had no apparent reason for their killings. Human Rights Watch, ‘Thailand: Prosecute Anti-Drugs Police Identified in Abuses,’ February 7, 2008 (online at http://hrw.org/english/docs/2008/02/07/thaila17993.htm); ‘Southeast Asia: Most Killed in Thailand's 2003 Drug War Not Involved With Drugs, Panel Finds’, Drug War Chronicle, Issue 512, March 2007, http://stopthedrugwar.org/chronicle/512/thailand_drug_killings_half_not_involved_panel_finds (Date of last access: 5 March 2008).
[iii] ‘Not Enough Graves’, pp.36-40
[iv] Concluding Observations of the Human Rights Committee: Thailand, UN Doc. No. CCPR/CO/84/THA, 8 July 2005, paras 10 & 11
[v] Report of the Special Rapporteur on extrajudicial, summary and arbitrary executions: Summary of cases transmitted to governments and replies received UN Doc. No. E/CN.4/2004/7/Add.1, 24 March 2004, paras 557-558
[vi] ibid., para 558
[vii] Webcast available at http://www.un.org/webcast/humanrightsday/archive.html (Date of last access: 5 March 2008)
Posted by HR2 at 13:17
Tuesday, April 1, 2008
UN Secretary General calls for decriminalisation of injecting drug users
Monday, March 31, 2008
UN Secretary General calls for decriminalisation of injecting drug users
UN Secretary-General supports calls for Asian governments to amend outdated laws criminalising injecting drug users and other stigmatized groups.
At the launch of a major new report on HIV in Asia (March 26), UN Secretary-General Ban Ki-Moon called for increased health and human rights protections for people living with HIV, sex workers, men who have sex with men, and young people who inject drugs.
"Legislation can also stand in the way [of] scaling up towards universal access -- in cases where vulnerable groups are criminalized for their lifestyles" said Ban Ki-Moon, adding in his statement on the launch of the report; "As you have heard, I fully support the recommendations of the Commission."
UNAIDS Executive Director Dr Peter Piot (left), with United Nations Secretary-General Mr. Ban Ki-Moon, during the presentation of the new report “Redefining AIDS in Asia – Crafting an effective response” on 26 March in New York.
The 258 page report by the Independent Commission on AIDS in Asia (established by UNAIDS) is entitled Redefining AIDS in Asia: Crafting an Effective Response. Commenting on the report at the UN launch press conference on March 26th UNAIDS director Peter Piot said : "I look to Asian Governments to amend outdated laws criminalizing the most vulnerable sections of society, and take all the measures needed to ensure they live in dignity,"
Professor C. Rangarajan (right), Chair of the Commission on AIDS in Asia, presented the report of the Commission to the United Nations Secretary-General Ban Ki-Moon, 26 March 2008.
The report urges governments to provide a comprehensive package of harm reduction, including needle exchange programs and opiate substitution treatment, and says governments should abandon counterproductive "war on drugs" programmes. One of its key recommendations is to:
Avoid programmes that accentuate AIDS-related stigma
It is important to recognize that not all interventions aimed at most-at-risk groups are effective, and to note which have been proven to be ineffective, or even counter-productive. In their enthusiasm to initiate large-scale prevention programmes, Governments are seen to adopt certain programmes which accentuate stigma and violate the human rights of most-at-risk groups. These include ‘crack-downs’ on red-light areas and arrest of sex workers, large-scale arrests of young drug users under the ‘war on drugs’ programmes, mandatory testing in healthcare settings without the consent of the person concerned and releasing confidential information on people who are HIV positive through the media.
These initiatives can be counterproductive and can keep large numbers of at-risk groups and people living with HIV from accessing even the limited services being provided by the countries.
Full report (1.6 megs)
http://data.unaids.org/pub/Report/2008/20080326_report_commission_aids_en.pdf
UN Secretary General calls for decriminalisation of injecting drug users
UN Secretary-General supports calls for Asian governments to amend outdated laws criminalising injecting drug users and other stigmatized groups.
At the launch of a major new report on HIV in Asia (March 26), UN Secretary-General Ban Ki-Moon called for increased health and human rights protections for people living with HIV, sex workers, men who have sex with men, and young people who inject drugs.
"Legislation can also stand in the way [of] scaling up towards universal access -- in cases where vulnerable groups are criminalized for their lifestyles" said Ban Ki-Moon, adding in his statement on the launch of the report; "As you have heard, I fully support the recommendations of the Commission."
UNAIDS Executive Director Dr Peter Piot (left), with United Nations Secretary-General Mr. Ban Ki-Moon, during the presentation of the new report “Redefining AIDS in Asia – Crafting an effective response” on 26 March in New York.
The 258 page report by the Independent Commission on AIDS in Asia (established by UNAIDS) is entitled Redefining AIDS in Asia: Crafting an Effective Response. Commenting on the report at the UN launch press conference on March 26th UNAIDS director Peter Piot said : "I look to Asian Governments to amend outdated laws criminalizing the most vulnerable sections of society, and take all the measures needed to ensure they live in dignity,"
Professor C. Rangarajan (right), Chair of the Commission on AIDS in Asia, presented the report of the Commission to the United Nations Secretary-General Ban Ki-Moon, 26 March 2008.
The report urges governments to provide a comprehensive package of harm reduction, including needle exchange programs and opiate substitution treatment, and says governments should abandon counterproductive "war on drugs" programmes. One of its key recommendations is to:
Avoid programmes that accentuate AIDS-related stigma
It is important to recognize that not all interventions aimed at most-at-risk groups are effective, and to note which have been proven to be ineffective, or even counter-productive. In their enthusiasm to initiate large-scale prevention programmes, Governments are seen to adopt certain programmes which accentuate stigma and violate the human rights of most-at-risk groups. These include ‘crack-downs’ on red-light areas and arrest of sex workers, large-scale arrests of young drug users under the ‘war on drugs’ programmes, mandatory testing in healthcare settings without the consent of the person concerned and releasing confidential information on people who are HIV positive through the media.
These initiatives can be counterproductive and can keep large numbers of at-risk groups and people living with HIV from accessing even the limited services being provided by the countries.
Full report (1.6 megs)
http://data.unaids.org/pub/Report/2008/20080326_report_commission_aids_en.pdf
Friday, March 28, 2008
International Harm Reduction Association Website
One of the most useful resources for up-to-date information about Harm Reduction is the International Harm Reduction Association (IHRA) website, at: http://www.ihra.net
Frequently, information I share with you on this BLOG comes from that site.
For those of you who prefer not to rely on me to vet info that makes it to you, you can sign up to receive your own regular updates from IHRA by visiting the site.
Hope this helps.
Rob
Frequently, information I share with you on this BLOG comes from that site.
For those of you who prefer not to rely on me to vet info that makes it to you, you can sign up to receive your own regular updates from IHRA by visiting the site.
Hope this helps.
Rob
Monday, March 24, 2008
More evidence that needle distribution reduces transmission of blood borne viruses
Please find below an abstract from a paper offering more evidence of the efficacy of needle distribution to reduce the spread of HIV and other blood-borne viruses.
Rob
J Urban Health. 2008 Mar 14 [Epub ahead of print]
Greater Drug Injecting Risk for HIV, HBV, and HCV Infection in a City Where Syringe Exchange and Pharmacy Syringe Distribution are Illegal.
Neaigus A, Zhao M, Gyarmathy VA, Cisek L, Friedman SR, Baxter RC.
Institute for International Research on Youth at Risk, National Development and Research Institutes, 71 West 23rd Street, 8th Floor, New York, NY, 10010, USA, neaigus@ndri.org.
ABSTRACT
Comparing drug-injecting risk between cities that differ in the legality of sterile syringe distribution for injection drug use provides a natural experiment to assess the efficacy of legalizing sterile syringe distribution as a structural intervention to prevent human immunodeficiency virus (HIV) and other parenterally transmitted infections among injection drug users (IDUs).
This study compares the parenteral risk for HIV and hepatitis B (HBV) and C (HCV) infection among IDUs in Newark, NJ, USA, where syringe distribution programs were illegal during the period when data were collected, and New York City (NYC) where they were legal. IDUs were non-treatment recruited, 2004-2006, sero-tested, and interviewed about syringe sources and injecting risk behaviors (prior 30 days). In multivariate logistic regression, adjusted odds ratios (AOR) and 95% confidence intervals (95% CI) for city differences are estimated controlling for potential city confounders.
IDUs in Newark (n = 214) vs. NYC (n = 312) were more likely to test sero-positive for HIV (26% vs. 5%; AOR = 3.2; 95% CI = 1.6, 6.1), antibody to the HBV core antigen (70% vs. 27%; AOR = 4.4; 95% CI = 2.8, 6.9), and antibody to HCV (82% vs. 53%; AOR = 3.0; 95% CI = 1.8, 4.9), were less likely to obtain syringes from syringe exchange programs or pharmacies (AOR = 0.004; 95% CI = 0.001, 0.01), and were more likely to obtain syringes from street sellers (AOR = 74.0; 95% CI = 29.9, 183.2), to inject with another IDU's used syringe (AOR = 2.3; 95% CI = 1.1, 5.0), to reuse syringes (AOR = 2.99; 95% CI = 1.63, 5.50), and to not always inject once only with a new, sterile syringe that had been sealed in a wrapper (AOR = 5.4; 95% CI = 2.9, 10.3).
In localities where sterile syringe distribution is illegal, IDUs are more likely to obtain syringes from unsafe sources and to engage in injecting risk behaviors. Legalizing and rapidly implementing sterile syringe distribution programs are critical for reducing parenterally transmitted HIV, HBV, and HCV among IDUs.
Rob
J Urban Health. 2008 Mar 14 [Epub ahead of print]
Greater Drug Injecting Risk for HIV, HBV, and HCV Infection in a City Where Syringe Exchange and Pharmacy Syringe Distribution are Illegal.
Neaigus A, Zhao M, Gyarmathy VA, Cisek L, Friedman SR, Baxter RC.
Institute for International Research on Youth at Risk, National Development and Research Institutes, 71 West 23rd Street, 8th Floor, New York, NY, 10010, USA, neaigus@ndri.org.
ABSTRACT
Comparing drug-injecting risk between cities that differ in the legality of sterile syringe distribution for injection drug use provides a natural experiment to assess the efficacy of legalizing sterile syringe distribution as a structural intervention to prevent human immunodeficiency virus (HIV) and other parenterally transmitted infections among injection drug users (IDUs).
This study compares the parenteral risk for HIV and hepatitis B (HBV) and C (HCV) infection among IDUs in Newark, NJ, USA, where syringe distribution programs were illegal during the period when data were collected, and New York City (NYC) where they were legal. IDUs were non-treatment recruited, 2004-2006, sero-tested, and interviewed about syringe sources and injecting risk behaviors (prior 30 days). In multivariate logistic regression, adjusted odds ratios (AOR) and 95% confidence intervals (95% CI) for city differences are estimated controlling for potential city confounders.
IDUs in Newark (n = 214) vs. NYC (n = 312) were more likely to test sero-positive for HIV (26% vs. 5%; AOR = 3.2; 95% CI = 1.6, 6.1), antibody to the HBV core antigen (70% vs. 27%; AOR = 4.4; 95% CI = 2.8, 6.9), and antibody to HCV (82% vs. 53%; AOR = 3.0; 95% CI = 1.8, 4.9), were less likely to obtain syringes from syringe exchange programs or pharmacies (AOR = 0.004; 95% CI = 0.001, 0.01), and were more likely to obtain syringes from street sellers (AOR = 74.0; 95% CI = 29.9, 183.2), to inject with another IDU's used syringe (AOR = 2.3; 95% CI = 1.1, 5.0), to reuse syringes (AOR = 2.99; 95% CI = 1.63, 5.50), and to not always inject once only with a new, sterile syringe that had been sealed in a wrapper (AOR = 5.4; 95% CI = 2.9, 10.3).
In localities where sterile syringe distribution is illegal, IDUs are more likely to obtain syringes from unsafe sources and to engage in injecting risk behaviors. Legalizing and rapidly implementing sterile syringe distribution programs are critical for reducing parenterally transmitted HIV, HBV, and HCV among IDUs.
Tuesday, March 18, 2008
How to Manage a Needle and Syringe Program
Please find below a weblink to a very useful resource, published by WHO and written by IDU expert Dave Burrows (and others), on how to establish and manage a Needle and Syringe Program serving IDUs.
Rob
Guide to Starting and Managing Needle and Syringe Programmes by Dave Burrows, Nick Walsh, James Boothroyd et al. World Health Organization, Department of HIV/AIDS, 2007 64 pp. 812 kB
http://www.who.int/hiv/idu/OMSEA_NSP_Guide_100807.pdf
The transmission of HIV among injecting drug users and related populations of sex workers, youth and other vulnerable people is greatly adding to the burden of disease in countries worldwide. This guide is designed to assist in expanding the response to HIV among injecting drug users globally. The end of this guide provides a list of useful web sites, publications and networks, followed by annexes and notes.
Rob
Guide to Starting and Managing Needle and Syringe Programmes by Dave Burrows, Nick Walsh, James Boothroyd et al. World Health Organization, Department of HIV/AIDS, 2007 64 pp. 812 kB
http://www.who.int/hiv/idu/OMSEA_NSP_Guide_100807.pdf
The transmission of HIV among injecting drug users and related populations of sex workers, youth and other vulnerable people is greatly adding to the burden of disease in countries worldwide. This guide is designed to assist in expanding the response to HIV among injecting drug users globally. The end of this guide provides a list of useful web sites, publications and networks, followed by annexes and notes.
Friday, March 14, 2008
Using pharmacies to deliver products to IDUs
Please find below an article explaining how California is about to mobilize pharmacies to deliver urgently-needed HIV prevention products like sterile syringes to IDUs.
PSI is already using this model in Kyrgyzstan. It has proven to be an extremely effective way of reaching young IDUs, who are embarresed to go to traditional Needle Exchange Points (NEPs).
Rob
Harm Reduction Through a Pharmacy Near You
Wednesday, March 12, 2008
DPA Southern California recently brought together more than 60 pharmacists and healthcare professionals to learn about how harm reduction principles and over-the-counter sales of syringes at pharmacies can reduce the spread of HIV, hepatitis C and other blood-borne diseases. With an estimated 84,000 people in Los Angeles County still sharing drug injection equipment, the need for this event was evident and urgent.
The conference, the 2008 Los Angeles Pharmacists’ Summit on Viral Diseases and Their Prevention, was organized by DPA’s Southern California Harm Reduction Coordinator Meghan Ralston, co-sponsored and hosted by the University of Southern California (USC) School of Pharmacy, and supported through a grant from the California Endowment.
Sales of syringes to adults without a prescription have been legal throughout the county since last year via a program called the Disease Prevention Demonstration Project. The Pharmacists’ Summit was designed to educate pharmacists and generate interest in the program, with the goal of encouraging enrollment.
“The County’s best and most recent estimate is that there are around 1,600 people in the county who are HIV positive because they shared syringes and were exposed to the virus. With an additional estimated 1,700 people here currently living with AIDS because of sharing syringes, and over 80,000 still sharing their equipment, it was clear that we needed to do even more to drive home the point that pharmacy sale of syringes needs to happen now, at every pharmacy in the county,” said Ralston.
Physician Laveeza Bhatti, HIV researcher Dr. Stan Louie, pharmacist and Clean Needles Now board president Terry Hair, and Ralston presented information at the half-day event on Sunday, February 24. The USC School of Pharmacy was delighted with attendees’ interest in the subject matter, and pleased that so many people turned out for the event on a rainy Sunday morning. Due to the strong success of the summit, DPA has been invited to work with USC again to create a similar event in the future.
“Syringe exchanges do great work and are essential in disease prevention, but unfortunately their hours and locations are really limited in L.A.,” said Ralston. “The Disease Prevention Demonstration Project will go a long way to helping to get sterile syringes to the people who need them. So far it’s been a huge success, with about 270 pharmacies now authorized to participate--but L.A. is huge and we still have a long way to go. The summit definitely brought us one step closer to our goal.”
PSI is already using this model in Kyrgyzstan. It has proven to be an extremely effective way of reaching young IDUs, who are embarresed to go to traditional Needle Exchange Points (NEPs).
Rob
Harm Reduction Through a Pharmacy Near You
Wednesday, March 12, 2008
DPA Southern California recently brought together more than 60 pharmacists and healthcare professionals to learn about how harm reduction principles and over-the-counter sales of syringes at pharmacies can reduce the spread of HIV, hepatitis C and other blood-borne diseases. With an estimated 84,000 people in Los Angeles County still sharing drug injection equipment, the need for this event was evident and urgent.
The conference, the 2008 Los Angeles Pharmacists’ Summit on Viral Diseases and Their Prevention, was organized by DPA’s Southern California Harm Reduction Coordinator Meghan Ralston, co-sponsored and hosted by the University of Southern California (USC) School of Pharmacy, and supported through a grant from the California Endowment.
Sales of syringes to adults without a prescription have been legal throughout the county since last year via a program called the Disease Prevention Demonstration Project. The Pharmacists’ Summit was designed to educate pharmacists and generate interest in the program, with the goal of encouraging enrollment.
“The County’s best and most recent estimate is that there are around 1,600 people in the county who are HIV positive because they shared syringes and were exposed to the virus. With an additional estimated 1,700 people here currently living with AIDS because of sharing syringes, and over 80,000 still sharing their equipment, it was clear that we needed to do even more to drive home the point that pharmacy sale of syringes needs to happen now, at every pharmacy in the county,” said Ralston.
Physician Laveeza Bhatti, HIV researcher Dr. Stan Louie, pharmacist and Clean Needles Now board president Terry Hair, and Ralston presented information at the half-day event on Sunday, February 24. The USC School of Pharmacy was delighted with attendees’ interest in the subject matter, and pleased that so many people turned out for the event on a rainy Sunday morning. Due to the strong success of the summit, DPA has been invited to work with USC again to create a similar event in the future.
“Syringe exchanges do great work and are essential in disease prevention, but unfortunately their hours and locations are really limited in L.A.,” said Ralston. “The Disease Prevention Demonstration Project will go a long way to helping to get sterile syringes to the people who need them. So far it’s been a huge success, with about 270 pharmacies now authorized to participate--but L.A. is huge and we still have a long way to go. The summit definitely brought us one step closer to our goal.”
Friday, March 7, 2008
Evidence of impact on smoking cessation
Following on last week's BLOG about smoking, I attach below a link to an intervention from "Behavior Works" the former PSI US Programs based in Portland, Oregon. This intervention has some initial data linking their program with reduced rates of smoking.
http://www.bwpdx.org/programs/smoking-cessation/
Thanks to David Olson for forwarding this to me.
http://www.bwpdx.org/programs/smoking-cessation/
Thanks to David Olson for forwarding this to me.
Sunday, March 2, 2008
What about smoking?
Today's BLOG is not directly IDU-related, but is related to the topic of drug-related disease.
In most PSI countries, smoking-related illnesses account for a substantial portion of overall death and disability. And in many PSI countries, unfortunately, the problem is only getting worse.
To date, PSI has yet to delve into this field. The WHO has released a report on the "global tobacco epidemic." The link is below. I always thought that there is something PSI could be doing on this issue. The potential DALYs to be gained are enormous. It is not yet clear what that might be. I share this question with you for our common consideration.
Rob
http://www.who.int/tobacco/mpower/mpower_report_full_2008.pdf
In most PSI countries, smoking-related illnesses account for a substantial portion of overall death and disability. And in many PSI countries, unfortunately, the problem is only getting worse.
To date, PSI has yet to delve into this field. The WHO has released a report on the "global tobacco epidemic." The link is below. I always thought that there is something PSI could be doing on this issue. The potential DALYs to be gained are enormous. It is not yet clear what that might be. I share this question with you for our common consideration.
Rob
http://www.who.int/tobacco/mpower/mpower_report_full_2008.pdf
Wednesday, February 27, 2008
3% to 80%
See below a recent speech by a high-level UNAIDS official on IDU and HIV in Asia. Very worth reading. It gives a stark picture of the low rates of coverage of this high priority target group.
I'd like to draw your attention to the conclusion he draws:
"... So our main challenge in the next two years is to increase access from 3% to 80% for all injecting drug users in need of these prevention and treatment services."
Only a small proportion of all IDUs currently have access to urgently needed HIV prevention products and services. Product and service delivery is PSI's forte. PSI should/will have an important role to play in the rapid scale up needed for IDUs in Asia, and beyond.
Rob
Speech delivered by Mr JVR Prasada Rao, Director, Regional Support Team, UNAIDS Regional Support Team, Asia Pacific at the opening ceremony of the 1st Asian Consultation on the Prevention of HIV Related to Drug Use
28 January 2008
It gives me pleasure to address this Consultation for two particular reasons: firstly because it is the first Asia Pacific Consultation on the specific issue of reducing harm related to injecting drug use, including preventing HIV transmission. It is also special as an initiative entirely undertaken by civil society groups and communities and not by formal organizations in the Government or the UN system. I see in this room a dedicated group of individuals who share a common goal of making HIV prevention, treatment and care for drug users a reality. Congratulations to all the sponsoring agencies and individuals.Today, we have the means needed to make a real difference tackling HIV related to injecting drug use. We have high level commitment to address the epidemic; we have the science, meaning we know what works and we have the resources to scale up interventions.Injecting drug use as a catalyst of HIV epidemics and transmission of hepatitis among IDU in AsiaIn the past, HIV responses in the Asia-Pacific region were guided by global strategies on prevention, treatment and care. The global strategies were based on early experiences in high prevalence regions which witnessed extremely high growth rates within a matter of a few years. Only later was there recognition that the risk factors and the underlying social determinants of the epidemic in this region are totally different to those in other parts of the world.Injecting drug use has acted as a catalyst for HIV epidemics at the onset of the pandemic in many Asian countries. Sharing of injecting equipment is a very efficient way to transmit HIV from one person to the next. Once HIV enters the IDU network, it spreads very rapidly and a drug-use related HIV epidemic kicks off in a country. This is what happened in China, Indonesia, Vietnam and the north east of India, to mention a few of the countries thus affected. Soon after that happens, we start finding HIV among sex workers and sexual partners of drug users, as we saw in Manipur, And within five years of the initial epidemic among people injecting drugs, it had spread to children.Already, globally, three million injecting drug users are living with HIV. In our region, prevalence of anywhere between 20% and 85% has been reported among injecting drug users in several of the countries, including China, India, Thailand, Myanmar, Nepal, and Vietnam. And countries, such as the Philippines, which reported no injecting drug use related to HIV transmission before 2005, have since detected HIV among this population.The good news is that we have the science and we know what we have to do. The first golden rule in preventing a fast spreading HIV epidemic in any country is early intervention to halt transmission. Countries that report injecting drug use need to start prevention before HIV is reported among injecting drug users. I cannot stress this fact enough. Countries that waited and hoped that information, education and communication programmes for the general population would show results did not see them. In these countries, HIV prevalence among injecting drug users sky-rocketed up to 90%. On the other hand, countries, such as Bangladesh, that acted early and implemented focused interventions aimed at preventing transmission among people who inject drugs, have been rewarded with prevalence of around five percent or below, a level comparable level to Australia, Europe and the US.Universal Access and barriers to access among drug usersOn the basis of past experience we also have more detailed blueprint for responses to work with. Last year, UNAIDS and its cosponsors endorsed a practical guideline on prevention interventions. It recommends giving priority to interventions reaching people who inject drugs in all countries that report injecting drug use and it provides practical guidance on the core package of interventions for prevention of HIV related to drug use. By a comprehensive package we mean a full range of treatment options and relevant services. These include substitution treatment, needle and syringe programmes, peer education and outreach, voluntary HIV testing and counseling, prevention of sexually transmitted infections, primary health care and anti retroviral therapy.On top of this, we have a more supportive political environment. In the political declaration made at the high level meeting of the UN General Assembly in June 2006, countries committed to developing targets for Universal Access, while recognizing that the targets have to be cognizant of the realities at country level. Supporting countries to meet these targets has become a major focus of the international efforts, led by UNAIDS and its cosponsors.Ladies & gentlemen, with these guidelines and the political commitment we have a strong platform to take action. You might even think we're on course to solve the problem. But let me now give you a brief snapshot of what's actually going on. It's not a comforting picture.Take the latest data on coverage and access to the essential services by people who inject drugs. It shows that only a tiny proportion of injecting drug users in need of harm reduction programs (3% in South-East Asia and 8% (1 country only, China) in East Asia, actually have access to these services.Only a few countries provide access to substitution treatment, and where it is available, it is mostly at a pilot stage, for example in Indonesia, Nepal, Malaysia, and Myanmar. Only one country, China, has demonstrated a significant scale up effort.Even though it has been quite some time ago that WHO included both Methadone and Buprenorphine to the WHO List of Essential Drugs, yet, as of today, Methadone is legally available in only five countries in Asia (China, Hong Kong, Indonesia, Lao PDR, Myanmar) and Buprenorphine is available in only three: (India, Pakistan and Nepal). Moreover in five countries, namely Bangladesh, Bhutan, Cambodia, Japan and Singapore, both Methadone and Buprenorphine are still illegal.The priority now is to see that all countries which report injecting drug use make methadone legal, include it in the list of essential drugs and expand access to drug substitution treatment sites on the ground.However, a comprehensive HIV response also means that drug users have access to needle and syringe exchange and distribution programmes. Scientific evidence shows that easy and consistent access to sterile injecting equipment cuts transmission of HIV and hepatitis. Countries that took the initiative to implement needle and syringe programmes before a drug use related HIV epidemic took off have succeeded to date in averting a generalized epidemic, saving lives and a huge burden of cost.Yet, only 10 countries in Asia and the Pacific have at least one dedicated needle and syringe exchange programme and only two countries (Malaysia and China) have both NSP and substitution treatment programs in place.Countries that report injecting drug use need to significantly scale up the number of needle and syringe program sites if they are to attain the goal of Universal Access.Another issue of concern is equity, or should I say, the lack of equity, in access to HIV treatment by people who inject drugs. Of all injecting drug users receiving treatment globally, an astonishing 90% live in just one country, Brazil (WHO, 2007).Too often people who use drugs are denied the services that they need and have a right to. We hear that drug users are being told by physicians that "as long as you use drugs you cannot have ART". Similarly, we have heard that drug users on methadone treatment have been denied access to ART.I find this situation unacceptable. ,Denial of treatment is a denial of basic human rights. But let us be clear, it is also bad practice. Current or past drug use cannot be used as a criteria for deciding who can and cannot access treatment.To curb and reverse the spread of AIDS, treatment needs to be provided based on clinical criteria, not on moral grounds. Second; health care services need to be comprehensive, with good referral mechanisms between general medical care, drug dependence treatment, harm reduction services, HIV testing and counseling and psycho-social support.Delivery of anti retroviral therapy for IDUs through public healthcare services alone will not work. We need to expand access to anti retroviral treatment through community based organizations and experience shows us that the more we can involve people who use drugs in the design and delivery of treatment and care programmes, the more successful those programmes will be. Treatment services also need to reach HIV positive persons in closed settings, such as prisons and drug rehabilitation centres. Lessons learned from prison in Bali, Indonesia, show that it is feasible to make available comprehensive treatment and care services in a closed setting.Ladies & gentlemen, in 2010 we will take stock of the progress made towards achieving Universal Access. So our main challenge in the next two years is to increase access from 3% to 80% for all injecting drug users in need of these prevention and treatment services. This is a tall order, but unless we have the vision from the beginning, we will not go very far. To be successful, everyone needs to work together to scale up harm reduction programs and make universal access for drug users a reality at country level.Stigma and discrimination, involvement of drug usersBut let us consider some of the obstacles we must tackle to get there. One of the main barriers for access to prevention, treatment and care services by people who inject drugs continues to be the stigma and discrimination associated both with HIV and injecting drug use. The prejudice encountered by people living with HIV is well documented. But people who use drugs also report stigma and discrimination, and being an HIV-positive drug user brings with it a "double-stigma" that makes it all the more difficult to access relevant services.We also know that in several countries drug users and positive people's networks are still not allowed to organize themselves and that drug users and their networks are excluded from decisions that affect them. This needs to change. The stigma and discrimination associated with drug use and HIV need to go, communities and governments need to embrace the reality of what works in curbing the epidemic.By treating drug users and their representatives as equals, by including them in consultative processes and the decision-making and policy-making bodies that shape the HIV, drug, and other relevant policies, we are more likely to succeed. We also need to support direct involvement of drug users in provision of services, such as outreach, substitution treatment, needle and syringe programmes, delivery of anti retro viral treatment, and prevention of overdose due to drug use. After all, who understands the health and social needs of drug users better than the drug user?Legislation and policies; management of national programsBut the one, overarching bottleneck I hear of whenever I meet and work with colleagues who are dedicated to increasing access to the programmes reducing drug related harm, is how current legislation and policies hamper implementation. There is an urgent need to harmonize drug policies with HIV policies. Criminalization of drug users hampers access to treatment and prevention services.In most countries, the HIV program is managed by the Ministry of Health while the national narcotics control bodies have been left out of the response and as a result often lack understanding and ownership of the national HIV programs. Ministries responsible for controlling narcotic drugs should come forward to participate in these programmes and work closely with the national AIDS programs. China is a good example of such collaboration.ConclusionDespite such challenges, we now have a clear roadmap with which to address this crucial but neglected area of the region's epidemic. The Asia AIDS Commission, recognizing the vital importance of tackling the IDU-related spread of HIV, has given priority to a review of this dimension of the Asian epidemic. Its findings and recommendations will be coming out very soon. I strongly believe that if all of us, the Governments, the parliamentarians, the UN agencies, civil society and drug user organizations implement these recommendations as a matter of urgency we can not only change the current ground reality but alter the course of the epidemic in Asia.Call for ActionLadies & Gentlemen, Colleagues,Let us use this consultation as a platform from which to call on all those who are involved in the response to HIV to move for concerted action on the following agenda:? To review and revise laws that criminalize drug use? To tackle the stigma associated with drug use and HIV? To ensure comprehensive coverage of IDUs with prevention, treatment and care interventions? To involve networks of drug users and community based organizations in delivery of prevention, treatment, care and support services? To maximize financial and technical resources for prevention, treatment and care programs for injecting drug users? And finally to promote and facilitate organizations of people who use drugs.We have over 20 years of experience at hand, we have the evidence, we have the resources, we have the commitment. So let us just do it , lets get on and make Universal Access a reality.
I'd like to draw your attention to the conclusion he draws:
"... So our main challenge in the next two years is to increase access from 3% to 80% for all injecting drug users in need of these prevention and treatment services."
Only a small proportion of all IDUs currently have access to urgently needed HIV prevention products and services. Product and service delivery is PSI's forte. PSI should/will have an important role to play in the rapid scale up needed for IDUs in Asia, and beyond.
Rob
Speech delivered by Mr JVR Prasada Rao, Director, Regional Support Team, UNAIDS Regional Support Team, Asia Pacific at the opening ceremony of the 1st Asian Consultation on the Prevention of HIV Related to Drug Use
28 January 2008
It gives me pleasure to address this Consultation for two particular reasons: firstly because it is the first Asia Pacific Consultation on the specific issue of reducing harm related to injecting drug use, including preventing HIV transmission. It is also special as an initiative entirely undertaken by civil society groups and communities and not by formal organizations in the Government or the UN system. I see in this room a dedicated group of individuals who share a common goal of making HIV prevention, treatment and care for drug users a reality. Congratulations to all the sponsoring agencies and individuals.Today, we have the means needed to make a real difference tackling HIV related to injecting drug use. We have high level commitment to address the epidemic; we have the science, meaning we know what works and we have the resources to scale up interventions.Injecting drug use as a catalyst of HIV epidemics and transmission of hepatitis among IDU in AsiaIn the past, HIV responses in the Asia-Pacific region were guided by global strategies on prevention, treatment and care. The global strategies were based on early experiences in high prevalence regions which witnessed extremely high growth rates within a matter of a few years. Only later was there recognition that the risk factors and the underlying social determinants of the epidemic in this region are totally different to those in other parts of the world.Injecting drug use has acted as a catalyst for HIV epidemics at the onset of the pandemic in many Asian countries. Sharing of injecting equipment is a very efficient way to transmit HIV from one person to the next. Once HIV enters the IDU network, it spreads very rapidly and a drug-use related HIV epidemic kicks off in a country. This is what happened in China, Indonesia, Vietnam and the north east of India, to mention a few of the countries thus affected. Soon after that happens, we start finding HIV among sex workers and sexual partners of drug users, as we saw in Manipur, And within five years of the initial epidemic among people injecting drugs, it had spread to children.Already, globally, three million injecting drug users are living with HIV. In our region, prevalence of anywhere between 20% and 85% has been reported among injecting drug users in several of the countries, including China, India, Thailand, Myanmar, Nepal, and Vietnam. And countries, such as the Philippines, which reported no injecting drug use related to HIV transmission before 2005, have since detected HIV among this population.The good news is that we have the science and we know what we have to do. The first golden rule in preventing a fast spreading HIV epidemic in any country is early intervention to halt transmission. Countries that report injecting drug use need to start prevention before HIV is reported among injecting drug users. I cannot stress this fact enough. Countries that waited and hoped that information, education and communication programmes for the general population would show results did not see them. In these countries, HIV prevalence among injecting drug users sky-rocketed up to 90%. On the other hand, countries, such as Bangladesh, that acted early and implemented focused interventions aimed at preventing transmission among people who inject drugs, have been rewarded with prevalence of around five percent or below, a level comparable level to Australia, Europe and the US.Universal Access and barriers to access among drug usersOn the basis of past experience we also have more detailed blueprint for responses to work with. Last year, UNAIDS and its cosponsors endorsed a practical guideline on prevention interventions. It recommends giving priority to interventions reaching people who inject drugs in all countries that report injecting drug use and it provides practical guidance on the core package of interventions for prevention of HIV related to drug use. By a comprehensive package we mean a full range of treatment options and relevant services. These include substitution treatment, needle and syringe programmes, peer education and outreach, voluntary HIV testing and counseling, prevention of sexually transmitted infections, primary health care and anti retroviral therapy.On top of this, we have a more supportive political environment. In the political declaration made at the high level meeting of the UN General Assembly in June 2006, countries committed to developing targets for Universal Access, while recognizing that the targets have to be cognizant of the realities at country level. Supporting countries to meet these targets has become a major focus of the international efforts, led by UNAIDS and its cosponsors.Ladies & gentlemen, with these guidelines and the political commitment we have a strong platform to take action. You might even think we're on course to solve the problem. But let me now give you a brief snapshot of what's actually going on. It's not a comforting picture.Take the latest data on coverage and access to the essential services by people who inject drugs. It shows that only a tiny proportion of injecting drug users in need of harm reduction programs (3% in South-East Asia and 8% (1 country only, China) in East Asia, actually have access to these services.Only a few countries provide access to substitution treatment, and where it is available, it is mostly at a pilot stage, for example in Indonesia, Nepal, Malaysia, and Myanmar. Only one country, China, has demonstrated a significant scale up effort.Even though it has been quite some time ago that WHO included both Methadone and Buprenorphine to the WHO List of Essential Drugs, yet, as of today, Methadone is legally available in only five countries in Asia (China, Hong Kong, Indonesia, Lao PDR, Myanmar) and Buprenorphine is available in only three: (India, Pakistan and Nepal). Moreover in five countries, namely Bangladesh, Bhutan, Cambodia, Japan and Singapore, both Methadone and Buprenorphine are still illegal.The priority now is to see that all countries which report injecting drug use make methadone legal, include it in the list of essential drugs and expand access to drug substitution treatment sites on the ground.However, a comprehensive HIV response also means that drug users have access to needle and syringe exchange and distribution programmes. Scientific evidence shows that easy and consistent access to sterile injecting equipment cuts transmission of HIV and hepatitis. Countries that took the initiative to implement needle and syringe programmes before a drug use related HIV epidemic took off have succeeded to date in averting a generalized epidemic, saving lives and a huge burden of cost.Yet, only 10 countries in Asia and the Pacific have at least one dedicated needle and syringe exchange programme and only two countries (Malaysia and China) have both NSP and substitution treatment programs in place.Countries that report injecting drug use need to significantly scale up the number of needle and syringe program sites if they are to attain the goal of Universal Access.Another issue of concern is equity, or should I say, the lack of equity, in access to HIV treatment by people who inject drugs. Of all injecting drug users receiving treatment globally, an astonishing 90% live in just one country, Brazil (WHO, 2007).Too often people who use drugs are denied the services that they need and have a right to. We hear that drug users are being told by physicians that "as long as you use drugs you cannot have ART". Similarly, we have heard that drug users on methadone treatment have been denied access to ART.I find this situation unacceptable. ,Denial of treatment is a denial of basic human rights. But let us be clear, it is also bad practice. Current or past drug use cannot be used as a criteria for deciding who can and cannot access treatment.To curb and reverse the spread of AIDS, treatment needs to be provided based on clinical criteria, not on moral grounds. Second; health care services need to be comprehensive, with good referral mechanisms between general medical care, drug dependence treatment, harm reduction services, HIV testing and counseling and psycho-social support.Delivery of anti retroviral therapy for IDUs through public healthcare services alone will not work. We need to expand access to anti retroviral treatment through community based organizations and experience shows us that the more we can involve people who use drugs in the design and delivery of treatment and care programmes, the more successful those programmes will be. Treatment services also need to reach HIV positive persons in closed settings, such as prisons and drug rehabilitation centres. Lessons learned from prison in Bali, Indonesia, show that it is feasible to make available comprehensive treatment and care services in a closed setting.Ladies & gentlemen, in 2010 we will take stock of the progress made towards achieving Universal Access. So our main challenge in the next two years is to increase access from 3% to 80% for all injecting drug users in need of these prevention and treatment services. This is a tall order, but unless we have the vision from the beginning, we will not go very far. To be successful, everyone needs to work together to scale up harm reduction programs and make universal access for drug users a reality at country level.Stigma and discrimination, involvement of drug usersBut let us consider some of the obstacles we must tackle to get there. One of the main barriers for access to prevention, treatment and care services by people who inject drugs continues to be the stigma and discrimination associated both with HIV and injecting drug use. The prejudice encountered by people living with HIV is well documented. But people who use drugs also report stigma and discrimination, and being an HIV-positive drug user brings with it a "double-stigma" that makes it all the more difficult to access relevant services.We also know that in several countries drug users and positive people's networks are still not allowed to organize themselves and that drug users and their networks are excluded from decisions that affect them. This needs to change. The stigma and discrimination associated with drug use and HIV need to go, communities and governments need to embrace the reality of what works in curbing the epidemic.By treating drug users and their representatives as equals, by including them in consultative processes and the decision-making and policy-making bodies that shape the HIV, drug, and other relevant policies, we are more likely to succeed. We also need to support direct involvement of drug users in provision of services, such as outreach, substitution treatment, needle and syringe programmes, delivery of anti retro viral treatment, and prevention of overdose due to drug use. After all, who understands the health and social needs of drug users better than the drug user?Legislation and policies; management of national programsBut the one, overarching bottleneck I hear of whenever I meet and work with colleagues who are dedicated to increasing access to the programmes reducing drug related harm, is how current legislation and policies hamper implementation. There is an urgent need to harmonize drug policies with HIV policies. Criminalization of drug users hampers access to treatment and prevention services.In most countries, the HIV program is managed by the Ministry of Health while the national narcotics control bodies have been left out of the response and as a result often lack understanding and ownership of the national HIV programs. Ministries responsible for controlling narcotic drugs should come forward to participate in these programmes and work closely with the national AIDS programs. China is a good example of such collaboration.ConclusionDespite such challenges, we now have a clear roadmap with which to address this crucial but neglected area of the region's epidemic. The Asia AIDS Commission, recognizing the vital importance of tackling the IDU-related spread of HIV, has given priority to a review of this dimension of the Asian epidemic. Its findings and recommendations will be coming out very soon. I strongly believe that if all of us, the Governments, the parliamentarians, the UN agencies, civil society and drug user organizations implement these recommendations as a matter of urgency we can not only change the current ground reality but alter the course of the epidemic in Asia.Call for ActionLadies & Gentlemen, Colleagues,Let us use this consultation as a platform from which to call on all those who are involved in the response to HIV to move for concerted action on the following agenda:? To review and revise laws that criminalize drug use? To tackle the stigma associated with drug use and HIV? To ensure comprehensive coverage of IDUs with prevention, treatment and care interventions? To involve networks of drug users and community based organizations in delivery of prevention, treatment, care and support services? To maximize financial and technical resources for prevention, treatment and care programs for injecting drug users? And finally to promote and facilitate organizations of people who use drugs.We have over 20 years of experience at hand, we have the evidence, we have the resources, we have the commitment. So let us just do it , lets get on and make Universal Access a reality.
Monday, February 18, 2008
How many needles?
If you run a needle and syringe distribution project for IDUs, you've likely struggled with the question 'How many needles and syringes should I give to clients each day.'
This is always an important issue for harm reduction programs. There are no simple answers.
Supply and demand factors need to be weighed. For example, on the supply side, your project may not have unlimited access to commodities. And giving out large numbers of free needles may simply result in those commodities being sold to pharmacies.
On the demand side, if your IDU clients are injecting cocaine, they may inject up to 10 times a day or more and thus need more needles, while heroin injectors (due to the longer half-life of opiates) typically inject much less frequently and so need fewer needles.
These are complex issues, but there is a growing evidence base on this issue which teaches us the following 2 general lessons:
Please don't hesitate to contact me (robgray@laopdr.com) or Mariah (mpreston@psi.org) for more guidance on this issue.
Rob
Needle exchange coverage key to reducing infection risk
Findings’ in-depth review1 of needle exchange and hepatitis C highlighted the importance of coverage – the extent to which exchanges approach the ideal of making a sterile set of equipment available for every injection. Two reports2 3 from researchers in California have confirmed that liberal exchange policies improve coverage which in turn reduces visitors’ risks of contracting or spreading blood-borne diseases.Both derive from a study of 24 of the 25 exchanges operating in the state in 2001. Each service’s policies and activity levels were explored in interviews with their directors, while 1577 injectors recruited between 2001 and 2003 as they were leaving the exchanges were asked about their use of the service and their infection risk behaviours.The number of syringes each injector had available to them over the past month was estimated on the basis of their visits during that time and how many syringes for their own use4 they picked up last time. This was divided by the number of times they injected during the month to construct an index of the adequacy of their supplies. On average exchange visitors (who mainly injected heroin and stimulants) needed nearly 90 syringes/needles in the past month to be able to use a fresh set each time.The first report2 showed that the less restrictive was the distribution policy of their exchange, the greater were the chances of reaching this level. Most restrictive was strict one-for-one exchange of new syringes for old with a cap on the quantity issued per visit. Compared to these services, exchanges which simply provided as much as was needed were five times more likely to achieve adequate coverage. Not far behind were services which implemented uncapped one-for-one exchange supplemented by a few extra sets. Further behind were those which did this but capped quantities, then came the strict one-for-one exchanges, bottomed out by the two which also capped quantities.An analysis which statistically evened out caseload differences confirmed that uncapped needs-based distribution was associated with the highest proportion of visitors (61%) receiving adequate supplies and the lowest receiving less than half their needs (19%). Corresponding figures for the next best option (uncapped one-for-one plus extras) were 50% and 34%. Bottom was capped, strict one-for-one exchange, which left most visitors with less than half their needs met. In exchanges which fell short of needs-based distribution, giving extras on top of one-for-one or not imposing caps made significant improvements to coverage. Visitors who received adequate supplies were significantly more likely to supply sterile syringes to other injectors who did not visit the exchange.A second report3 linked coverage to the proportion of injectors who in the past month had risked spreading infection by injecting with a syringe already used by someone else, or by letting someone else inject with their used syringe. On both measures, the more adequately the individual’s needs had been met by the exchange, the less likely they were to have incurred these risks. For example, when less than half their needs had been met, 38% had re-used after someone else. This proportion progressively reduced as coverage improved to just 9% of injectors who had received at least 50% more than they needed.Adequate coverage was also associated with fewer injectors re-using their own equipment (which heightens the risk of damage at the injecting site) and fewer sharing implements used to heat drug solutions. On all these variables there were some statistically significant differences between coverage levels. More adequately supplied injectors were also more likely to always safely dispose of used syringes by returning them to the exchange, though this fell short of statistical significance once other factors had been taken in to account.These results were relatively clear cut, possibly because so few injectors made up for shortfalls by purchasing syringes from pharmacies, which at the time could be supplied only on prescription.Another important finding was that injectors in treatment were twice as likely to be adequately supplied as those who were not. As in other studies,1 5 this probably reflects a synergistic impact, with exchanges facilitating treatment entry and treatment stabilising lives and reducing injection frequency, making it easier for exchanges to meet patients’ remaining needs.The implications of these findings can already be found in guidelines endorsed by the National Needle Exchange Forum for England and Wales.7 These advise allowing injectors "to take all the injecting equipment they need for themselves and the people they inject with" without capping supplies or routinely tying distribution to returns.There is some way to go to meet this standard. In 2004/5 a survey found that exchanges in England rarely operated a strict one-for-one policy, but also that amounts returned were commonly taken in to account in deciding how much to supply.8 A minority had fixed quantity caps. More common was a variable cap, often depending partly on returns. Around 30-40% had no upper limit. The result was wide variation in how much each exchange gave to the average client. Overall this was one syringe every two days, meaning that many customers must have been under-supplied. At the same time in Scotland (where there are legal caps on the quantity which can be supplied at a single visit) the picture was similar, though there the average distributed per client was less.9 Policies on how much to distribute per visit are not the sole reason for shortfalls; opening hours and other accessibility issues also play a role.The featured study concerned itself with only one element of coverage – adequacy of supply of exchange users – not with the extent to which all injectors in the area were adequately supplied.6 In 2000/1 exchanges in Brighton and Liverpool supplied enough equipment for just over 1 in 4 injections in their areas and in London 1 in 5,10 if anything less than a national estimate for England in 1997.11Thanks for their comments on this entry in draft to Ricky Bluthenthal of the RAND Corporation. Commentators bear no responsibility for the text including the interpretations and any remaining errors.1 Ashton M. Hepatitis C and needle exchange: part 4 • the active ingredients. Drug and Alcohol Findings: 2004, 11, p. 25–30.2 FEATURED STUDY Bluthenthal R.N. et al. Examination of the association between syringe exchange program (SEP) dispensation policy and SEP client-level syringe coverage among injection drug users. Addiction: 2007, 102(4), p. 638–646.3 FEATURED STUDY Bluthenthal R.N. et al. Higher syringe coverage is associated with lower odds of HIV risk and does not increase unsafe syringe disposal among syringe exchange program clients. Drug and Alcohol Dependence: 2007, 89, p. 214–222.4 As opposed to those they intended to pass on to someone else.5 Van Den Berg C. et al. Full participation in harm reduction programmes is associated with decreased risk for human immunodeficiency virus and hepatitis C virus: evidence from the Amsterdam Cohort Studies among drug users. Addiction: 2007, 102, p. 1454–1462.6 Burrows D. Rethinking coverage of needle exchange programs. Substance Use & Misuse: 2006, 41(6–7), p. 1045–1048.7 UK Harm Reduction Alliance, National Needle Exchange Forum, Exchange Supplies. Reducing Injecting Related Harm: consensus statement on best practice. London: UKHRA, 2006.8 Abdulrahim D. et al. The NTA’s 2005 survey of needle exchanges in England. National Treatment Agency for Substance Misuse, 2007.9 Griesbach D. et al. Needle exchange provision in Scotland: a report of the National Needle Exchange Survey. Scottish Executive, 2006.This reports (p.24) that 3,553,911 syringes were distributed to 31,955 (14,229 + 17,726) clients which equates to about 1 every 3 days, but many services were unable to estimate the number of clients, suggesting that this is an over-estimate.10 Hickman M. et al. Injecting drug use in Brighton, Liverpool, and London: best estimates of prevalence and coverage of public health indicators. Journal of Epidemiology and Community Health: 2004, 58, p. 766–771.11 Parsons J. et al. Over a decade of syringe exchange: results from 1997 UK survey. Addiction: 2002, 97, p. 845–850.LINKS Hepatitis C and needle exchange: parts one, two, three and four Nuggets 10.7 5.8 Comment on this entry Back to contents list at top of page
This is always an important issue for harm reduction programs. There are no simple answers.
Supply and demand factors need to be weighed. For example, on the supply side, your project may not have unlimited access to commodities. And giving out large numbers of free needles may simply result in those commodities being sold to pharmacies.
On the demand side, if your IDU clients are injecting cocaine, they may inject up to 10 times a day or more and thus need more needles, while heroin injectors (due to the longer half-life of opiates) typically inject much less frequently and so need fewer needles.
These are complex issues, but there is a growing evidence base on this issue which teaches us the following 2 general lessons:
- Programs should simply try to fill their clients' real daily need for needles and syringes
- Imposing low limits on the number of needles and syringes that IDUs can take (i.e. one-for-one needle "exchange") tends to result in more sharing of used needles, and hence more transmission of HIV and other blood-borne viruses
Please don't hesitate to contact me (robgray@laopdr.com) or Mariah (mpreston@psi.org) for more guidance on this issue.
Rob
Needle exchange coverage key to reducing infection risk
Findings’ in-depth review1 of needle exchange and hepatitis C highlighted the importance of coverage – the extent to which exchanges approach the ideal of making a sterile set of equipment available for every injection. Two reports2 3 from researchers in California have confirmed that liberal exchange policies improve coverage which in turn reduces visitors’ risks of contracting or spreading blood-borne diseases.Both derive from a study of 24 of the 25 exchanges operating in the state in 2001. Each service’s policies and activity levels were explored in interviews with their directors, while 1577 injectors recruited between 2001 and 2003 as they were leaving the exchanges were asked about their use of the service and their infection risk behaviours.The number of syringes each injector had available to them over the past month was estimated on the basis of their visits during that time and how many syringes for their own use4 they picked up last time. This was divided by the number of times they injected during the month to construct an index of the adequacy of their supplies. On average exchange visitors (who mainly injected heroin and stimulants) needed nearly 90 syringes/needles in the past month to be able to use a fresh set each time.The first report2 showed that the less restrictive was the distribution policy of their exchange, the greater were the chances of reaching this level. Most restrictive was strict one-for-one exchange of new syringes for old with a cap on the quantity issued per visit. Compared to these services, exchanges which simply provided as much as was needed were five times more likely to achieve adequate coverage. Not far behind were services which implemented uncapped one-for-one exchange supplemented by a few extra sets. Further behind were those which did this but capped quantities, then came the strict one-for-one exchanges, bottomed out by the two which also capped quantities.An analysis which statistically evened out caseload differences confirmed that uncapped needs-based distribution was associated with the highest proportion of visitors (61%) receiving adequate supplies and the lowest receiving less than half their needs (19%). Corresponding figures for the next best option (uncapped one-for-one plus extras) were 50% and 34%. Bottom was capped, strict one-for-one exchange, which left most visitors with less than half their needs met. In exchanges which fell short of needs-based distribution, giving extras on top of one-for-one or not imposing caps made significant improvements to coverage. Visitors who received adequate supplies were significantly more likely to supply sterile syringes to other injectors who did not visit the exchange.A second report3 linked coverage to the proportion of injectors who in the past month had risked spreading infection by injecting with a syringe already used by someone else, or by letting someone else inject with their used syringe. On both measures, the more adequately the individual’s needs had been met by the exchange, the less likely they were to have incurred these risks. For example, when less than half their needs had been met, 38% had re-used after someone else. This proportion progressively reduced as coverage improved to just 9% of injectors who had received at least 50% more than they needed.Adequate coverage was also associated with fewer injectors re-using their own equipment (which heightens the risk of damage at the injecting site) and fewer sharing implements used to heat drug solutions. On all these variables there were some statistically significant differences between coverage levels. More adequately supplied injectors were also more likely to always safely dispose of used syringes by returning them to the exchange, though this fell short of statistical significance once other factors had been taken in to account.These results were relatively clear cut, possibly because so few injectors made up for shortfalls by purchasing syringes from pharmacies, which at the time could be supplied only on prescription.Another important finding was that injectors in treatment were twice as likely to be adequately supplied as those who were not. As in other studies,1 5 this probably reflects a synergistic impact, with exchanges facilitating treatment entry and treatment stabilising lives and reducing injection frequency, making it easier for exchanges to meet patients’ remaining needs.The implications of these findings can already be found in guidelines endorsed by the National Needle Exchange Forum for England and Wales.7 These advise allowing injectors "to take all the injecting equipment they need for themselves and the people they inject with" without capping supplies or routinely tying distribution to returns.There is some way to go to meet this standard. In 2004/5 a survey found that exchanges in England rarely operated a strict one-for-one policy, but also that amounts returned were commonly taken in to account in deciding how much to supply.8 A minority had fixed quantity caps. More common was a variable cap, often depending partly on returns. Around 30-40% had no upper limit. The result was wide variation in how much each exchange gave to the average client. Overall this was one syringe every two days, meaning that many customers must have been under-supplied. At the same time in Scotland (where there are legal caps on the quantity which can be supplied at a single visit) the picture was similar, though there the average distributed per client was less.9 Policies on how much to distribute per visit are not the sole reason for shortfalls; opening hours and other accessibility issues also play a role.The featured study concerned itself with only one element of coverage – adequacy of supply of exchange users – not with the extent to which all injectors in the area were adequately supplied.6 In 2000/1 exchanges in Brighton and Liverpool supplied enough equipment for just over 1 in 4 injections in their areas and in London 1 in 5,10 if anything less than a national estimate for England in 1997.11Thanks for their comments on this entry in draft to Ricky Bluthenthal of the RAND Corporation. Commentators bear no responsibility for the text including the interpretations and any remaining errors.1 Ashton M. Hepatitis C and needle exchange: part 4 • the active ingredients. Drug and Alcohol Findings: 2004, 11, p. 25–30.2 FEATURED STUDY Bluthenthal R.N. et al. Examination of the association between syringe exchange program (SEP) dispensation policy and SEP client-level syringe coverage among injection drug users. Addiction: 2007, 102(4), p. 638–646.3 FEATURED STUDY Bluthenthal R.N. et al. Higher syringe coverage is associated with lower odds of HIV risk and does not increase unsafe syringe disposal among syringe exchange program clients. Drug and Alcohol Dependence: 2007, 89, p. 214–222.4 As opposed to those they intended to pass on to someone else.5 Van Den Berg C. et al. Full participation in harm reduction programmes is associated with decreased risk for human immunodeficiency virus and hepatitis C virus: evidence from the Amsterdam Cohort Studies among drug users. Addiction: 2007, 102, p. 1454–1462.6 Burrows D. Rethinking coverage of needle exchange programs. Substance Use & Misuse: 2006, 41(6–7), p. 1045–1048.7 UK Harm Reduction Alliance, National Needle Exchange Forum, Exchange Supplies. Reducing Injecting Related Harm: consensus statement on best practice. London: UKHRA, 2006.8 Abdulrahim D. et al. The NTA’s 2005 survey of needle exchanges in England. National Treatment Agency for Substance Misuse, 2007.9 Griesbach D. et al. Needle exchange provision in Scotland: a report of the National Needle Exchange Survey. Scottish Executive, 2006.This reports (p.24) that 3,553,911 syringes were distributed to 31,955 (14,229 + 17,726) clients which equates to about 1 every 3 days, but many services were unable to estimate the number of clients, suggesting that this is an over-estimate.10 Hickman M. et al. Injecting drug use in Brighton, Liverpool, and London: best estimates of prevalence and coverage of public health indicators. Journal of Epidemiology and Community Health: 2004, 58, p. 766–771.11 Parsons J. et al. Over a decade of syringe exchange: results from 1997 UK survey. Addiction: 2002, 97, p. 845–850.LINKS Hepatitis C and needle exchange: parts one, two, three and four Nuggets 10.7 5.8 Comment on this entry Back to contents list at top of page
Sunday, February 17, 2008
How many needles?
If you run a needle and syringe distribution project for IDUs, you've likely struggled with the question 'How many needles and syringes should I give to clients each day.'
This is always an important issue for harm reduction programs. There are no simple answers. Supply and demand factors need to be weighed. For example, on the supply side, your project may not have unlimited access to commodities. And giving out large numbers of free needles may simply result in those commodities being sold to pharmacies. On the demand side, if your IDU clients are injecting cocaine, they may inject up to 10 times a day or more and thus need more needles, while heroin injectors (due to the longer half-life of opiates) typically inject much less frequently and so need fewer needles.
These are complex issues, but there is a growing evidence base on this issue which teaches us the following 2 general lessons:
Needle exchange coverage key to reducing infection risk
Findings’ in-depth review1 of needle exchange and hepatitis C highlighted the importance of coverage – the extent to which exchanges approach the ideal of making a sterile set of equipment available for every injection. Two reports2 3 from researchers in California have confirmed that liberal exchange policies improve coverage which in turn reduces visitors’ risks of contracting or spreading blood-borne diseases.
Both derive from a study of 24 of the 25 exchanges operating in the state in 2001. Each service’s policies and activity levels were explored in interviews with their directors, while 1577 injectors recruited between 2001 and 2003 as they were leaving the exchanges were asked about their use of the service and their infection risk behaviours.
The number of syringes each injector had available to them over the past month was estimated on the basis of their visits during that time and how many syringes for their own use4 they picked up last time. This was divided by the number of times they injected during the month to construct an index of the adequacy of their supplies. On average exchange visitors (who mainly injected heroin and stimulants) needed nearly 90 syringes/needles in the past month to be able to use a fresh set each time.
The first report2 showed that the less restrictive was the distribution policy of their exchange, the greater were the chances of reaching this level. Most restrictive was strict one-for-one exchange of new syringes for old with a cap on the quantity issued per visit. Compared to these services, exchanges which simply provided as much as was needed were five times more likely to achieve adequate coverage. Not far behind were services which implemented uncapped one-for-one exchange supplemented by a few extra sets. Further behind were those which did this but capped quantities, then came the strict one-for-one exchanges, bottomed out by the two which also capped quantities.
An analysis which statistically evened out caseload differences confirmed that uncapped needs-based distribution was associated with the highest proportion of visitors (61%) receiving adequate supplies and the lowest receiving less than half their needs (19%). Corresponding figures for the next best option (uncapped one-for-one plus extras) were 50% and 34%. Bottom was capped, strict one-for-one exchange, which left most visitors with less than half their needs met. In exchanges which fell short of needs-based distribution, giving extras on top of one-for-one or not imposing caps made significant improvements to coverage. Visitors who received adequate supplies were significantly more likely to supply sterile syringes to other injectors who did not visit the exchange.
A second report3 linked coverage to the proportion of injectors who in the past month had risked spreading infection by injecting with a syringe already used by someone else, or by letting someone else inject with their used syringe. On both measures, the more adequately the individual’s needs had been met by the exchange, the less likely they were to have incurred these risks. For example, when less than half their needs had been met, 38% had re-used after someone else. This proportion progressively reduced as coverage improved to just 9% of injectors who had received at least 50% more than they needed.
Adequate coverage was also associated with fewer injectors re-using their own equipment (which heightens the risk of damage at the injecting site) and fewer sharing implements used to heat drug solutions. On all these variables there were some statistically significant differences between coverage levels. More adequately supplied injectors were also more likely to always safely dispose of used syringes by returning them to the exchange, though this fell short of statistical significance once other factors had been taken in to account.
These results were relatively clear cut, possibly because so few injectors made up for shortfalls by purchasing syringes from pharmacies, which at the time could be supplied only on prescription.
Another important finding was that injectors in treatment were twice as likely to be adequately supplied as those who were not. As in other studies,1 5 this probably reflects a synergistic impact, with exchanges facilitating treatment entry and treatment stabilising lives and reducing injection frequency, making it easier for exchanges to meet patients’ remaining needs.
The implications of these findings can already be found in guidelines endorsed by the National Needle Exchange Forum for England and Wales.7 These advise allowing injectors "to take all the injecting equipment they need for themselves and the people they inject with" without capping supplies or routinely tying distribution to returns.
There is some way to go to meet this standard. In 2004/5 a survey found that exchanges in England rarely operated a strict one-for-one policy, but also that amounts returned were commonly taken in to account in deciding how much to supply.8 A minority had fixed quantity caps. More common was a variable cap, often depending partly on returns. Around 30-40% had no upper limit. The result was wide variation in how much each exchange gave to the average client. Overall this was one syringe every two days, meaning that many customers must have been under-supplied. At the same time in Scotland (where there are legal caps on the quantity which can be supplied at a single visit) the picture was similar, though there the average distributed per client was less.9 Policies on how much to distribute per visit are not the sole reason for shortfalls; opening hours and other accessibility issues also play a role.
The featured study concerned itself with only one element of coverage – adequacy of supply of exchange users – not with the extent to which all injectors in the area were adequately supplied.6 In 2000/1 exchanges in Brighton and Liverpool supplied enough equipment for just over 1 in 4 injections in their areas and in London 1 in 5,10 if anything less than a national estimate for England in 1997.11
Thanks for their comments on this entry in draft to Ricky Bluthenthal of the RAND Corporation. Commentators bear no responsibility for the text including the interpretations and any remaining errors.
1 Ashton M. Hepatitis C and needle exchange: part 4 • the active ingredients. Drug and Alcohol Findings: 2004, 11, p. 25–30.
2 FEATURED STUDY Bluthenthal R.N. et al. Examination of the association between syringe exchange program (SEP) dispensation policy and SEP client-level syringe coverage among injection drug users. Addiction: 2007, 102(4), p. 638–646.
3 FEATURED STUDY Bluthenthal R.N. et al. Higher syringe coverage is associated with lower odds of HIV risk and does not increase unsafe syringe disposal among syringe exchange program clients. Drug and Alcohol Dependence: 2007, 89, p. 214–222.
4 As opposed to those they intended to pass on to someone else.
5 Van Den Berg C. et al. Full participation in harm reduction programmes is associated with decreased risk for human immunodeficiency virus and hepatitis C virus: evidence from the Amsterdam Cohort Studies among drug users. Addiction: 2007, 102, p. 1454–1462.
6 Burrows D. Rethinking coverage of needle exchange programs. Substance Use & Misuse: 2006, 41(6–7), p. 1045–1048.
7 UK Harm Reduction Alliance, National Needle Exchange Forum, Exchange Supplies. Reducing Injecting Related Harm: consensus statement on best practice. London: UKHRA, 2006.
8 Abdulrahim D. et al. The NTA’s 2005 survey of needle exchanges in England. National Treatment Agency for Substance Misuse, 2007.
9 Griesbach D. et al. Needle exchange provision in Scotland: a report of the National Needle Exchange Survey. Scottish Executive, 2006.This reports (p.24) that 3,553,911 syringes were distributed to 31,955 (14,229 + 17,726) clients which equates to about 1 every 3 days, but many services were unable to estimate the number of clients, suggesting that this is an over-estimate.
10 Hickman M. et al. Injecting drug use in Brighton, Liverpool, and London: best estimates of prevalence and coverage of public health indicators. Journal of Epidemiology and Community Health: 2004, 58, p. 766–771.
11 Parsons J. et al. Over a decade of syringe exchange: results from 1997 UK survey. Addiction: 2002, 97, p. 845–850.
LINKS Hepatitis C and needle exchange: parts one, two, three and four Nuggets 10.7 5.8 Comment on this entry Back to contents list at top of page
This is always an important issue for harm reduction programs. There are no simple answers. Supply and demand factors need to be weighed. For example, on the supply side, your project may not have unlimited access to commodities. And giving out large numbers of free needles may simply result in those commodities being sold to pharmacies. On the demand side, if your IDU clients are injecting cocaine, they may inject up to 10 times a day or more and thus need more needles, while heroin injectors (due to the longer half-life of opiates) typically inject much less frequently and so need fewer needles.
These are complex issues, but there is a growing evidence base on this issue which teaches us the following 2 general lessons:
- Programs should simply try to fill their clients' real daily need for needles and syringes
- Imposing low limits on the number of needles and syringes that IDUs can take (i.e. one-for-one needle "exchange") tends to result in more sharing of used needles, and hence more transmission of HIV and other blood-borne viruses
The study below confirms these general lessons.
Please don't hesitate to contact me (robgray@laopdr.com) or Mariah (mpreston@psi.org) for more guidance on this issue.
Rob
Needle exchange coverage key to reducing infection risk
Findings’ in-depth review1 of needle exchange and hepatitis C highlighted the importance of coverage – the extent to which exchanges approach the ideal of making a sterile set of equipment available for every injection. Two reports2 3 from researchers in California have confirmed that liberal exchange policies improve coverage which in turn reduces visitors’ risks of contracting or spreading blood-borne diseases.
Both derive from a study of 24 of the 25 exchanges operating in the state in 2001. Each service’s policies and activity levels were explored in interviews with their directors, while 1577 injectors recruited between 2001 and 2003 as they were leaving the exchanges were asked about their use of the service and their infection risk behaviours.
The number of syringes each injector had available to them over the past month was estimated on the basis of their visits during that time and how many syringes for their own use4 they picked up last time. This was divided by the number of times they injected during the month to construct an index of the adequacy of their supplies. On average exchange visitors (who mainly injected heroin and stimulants) needed nearly 90 syringes/needles in the past month to be able to use a fresh set each time.
The first report2 showed that the less restrictive was the distribution policy of their exchange, the greater were the chances of reaching this level. Most restrictive was strict one-for-one exchange of new syringes for old with a cap on the quantity issued per visit. Compared to these services, exchanges which simply provided as much as was needed were five times more likely to achieve adequate coverage. Not far behind were services which implemented uncapped one-for-one exchange supplemented by a few extra sets. Further behind were those which did this but capped quantities, then came the strict one-for-one exchanges, bottomed out by the two which also capped quantities.
An analysis which statistically evened out caseload differences confirmed that uncapped needs-based distribution was associated with the highest proportion of visitors (61%) receiving adequate supplies and the lowest receiving less than half their needs (19%). Corresponding figures for the next best option (uncapped one-for-one plus extras) were 50% and 34%. Bottom was capped, strict one-for-one exchange, which left most visitors with less than half their needs met. In exchanges which fell short of needs-based distribution, giving extras on top of one-for-one or not imposing caps made significant improvements to coverage. Visitors who received adequate supplies were significantly more likely to supply sterile syringes to other injectors who did not visit the exchange.
A second report3 linked coverage to the proportion of injectors who in the past month had risked spreading infection by injecting with a syringe already used by someone else, or by letting someone else inject with their used syringe. On both measures, the more adequately the individual’s needs had been met by the exchange, the less likely they were to have incurred these risks. For example, when less than half their needs had been met, 38% had re-used after someone else. This proportion progressively reduced as coverage improved to just 9% of injectors who had received at least 50% more than they needed.
Adequate coverage was also associated with fewer injectors re-using their own equipment (which heightens the risk of damage at the injecting site) and fewer sharing implements used to heat drug solutions. On all these variables there were some statistically significant differences between coverage levels. More adequately supplied injectors were also more likely to always safely dispose of used syringes by returning them to the exchange, though this fell short of statistical significance once other factors had been taken in to account.
These results were relatively clear cut, possibly because so few injectors made up for shortfalls by purchasing syringes from pharmacies, which at the time could be supplied only on prescription.
Another important finding was that injectors in treatment were twice as likely to be adequately supplied as those who were not. As in other studies,1 5 this probably reflects a synergistic impact, with exchanges facilitating treatment entry and treatment stabilising lives and reducing injection frequency, making it easier for exchanges to meet patients’ remaining needs.
The implications of these findings can already be found in guidelines endorsed by the National Needle Exchange Forum for England and Wales.7 These advise allowing injectors "to take all the injecting equipment they need for themselves and the people they inject with" without capping supplies or routinely tying distribution to returns.
There is some way to go to meet this standard. In 2004/5 a survey found that exchanges in England rarely operated a strict one-for-one policy, but also that amounts returned were commonly taken in to account in deciding how much to supply.8 A minority had fixed quantity caps. More common was a variable cap, often depending partly on returns. Around 30-40% had no upper limit. The result was wide variation in how much each exchange gave to the average client. Overall this was one syringe every two days, meaning that many customers must have been under-supplied. At the same time in Scotland (where there are legal caps on the quantity which can be supplied at a single visit) the picture was similar, though there the average distributed per client was less.9 Policies on how much to distribute per visit are not the sole reason for shortfalls; opening hours and other accessibility issues also play a role.
The featured study concerned itself with only one element of coverage – adequacy of supply of exchange users – not with the extent to which all injectors in the area were adequately supplied.6 In 2000/1 exchanges in Brighton and Liverpool supplied enough equipment for just over 1 in 4 injections in their areas and in London 1 in 5,10 if anything less than a national estimate for England in 1997.11
Thanks for their comments on this entry in draft to Ricky Bluthenthal of the RAND Corporation. Commentators bear no responsibility for the text including the interpretations and any remaining errors.
1 Ashton M. Hepatitis C and needle exchange: part 4 • the active ingredients. Drug and Alcohol Findings: 2004, 11, p. 25–30.
2 FEATURED STUDY Bluthenthal R.N. et al. Examination of the association between syringe exchange program (SEP) dispensation policy and SEP client-level syringe coverage among injection drug users. Addiction: 2007, 102(4), p. 638–646.
3 FEATURED STUDY Bluthenthal R.N. et al. Higher syringe coverage is associated with lower odds of HIV risk and does not increase unsafe syringe disposal among syringe exchange program clients. Drug and Alcohol Dependence: 2007, 89, p. 214–222.
4 As opposed to those they intended to pass on to someone else.
5 Van Den Berg C. et al. Full participation in harm reduction programmes is associated with decreased risk for human immunodeficiency virus and hepatitis C virus: evidence from the Amsterdam Cohort Studies among drug users. Addiction: 2007, 102, p. 1454–1462.
6 Burrows D. Rethinking coverage of needle exchange programs. Substance Use & Misuse: 2006, 41(6–7), p. 1045–1048.
7 UK Harm Reduction Alliance, National Needle Exchange Forum, Exchange Supplies. Reducing Injecting Related Harm: consensus statement on best practice. London: UKHRA, 2006.
8 Abdulrahim D. et al. The NTA’s 2005 survey of needle exchanges in England. National Treatment Agency for Substance Misuse, 2007.
9 Griesbach D. et al. Needle exchange provision in Scotland: a report of the National Needle Exchange Survey. Scottish Executive, 2006.This reports (p.24) that 3,553,911 syringes were distributed to 31,955 (14,229 + 17,726) clients which equates to about 1 every 3 days, but many services were unable to estimate the number of clients, suggesting that this is an over-estimate.
10 Hickman M. et al. Injecting drug use in Brighton, Liverpool, and London: best estimates of prevalence and coverage of public health indicators. Journal of Epidemiology and Community Health: 2004, 58, p. 766–771.
11 Parsons J. et al. Over a decade of syringe exchange: results from 1997 UK survey. Addiction: 2002, 97, p. 845–850.
LINKS Hepatitis C and needle exchange: parts one, two, three and four Nuggets 10.7 5.8 Comment on this entry Back to contents list at top of page
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