Monday, May 18, 2009

On progress on harm reduction programs in Malaysia

Needle syringe exchange programme injects hope
Sunday May 17, 2009

IN the fight to reduce the spread of diseases like HIV, Malaysia is one of many countries that have turned to harm reduction efforts, including the somewhat controversial needle and syringe exchange programme (NSEP).

The NSEP, which started out in three states as a pilot programme, looks set to be available in at least one site of each state in the peninsula by next year.

NSEP is a component of harm reduction efforts implemented by the Health Ministry. The other is methadone maintenance therapy (MMT).

Health Minister Datuk Seri Liow Tiong Lai says the programme will be expanded throughout the country via health clinics and partnership with related non-governmental organisations (NGOs) under the Malaysian AIDS Council (MAC).

There are seven health clinics which have NSEP and there are expected to be 12 by end of year.

The HIV epidemic in Malaysia is mainly driven by injecting drug users (IDUs). The Minister says 71.2% of reported HIV cases from 1986 to Dec 2008 were IDUs.

“The decision to implement the NSEP is to prevent the transmission of HIV infection among the IDUs,” Liow says, adding that distributing clean needles and syringes can help reduce the risky behaviour of needle-sharing.

The Cabinet has allocated RM100mil for a five-year period, beginning 2006, under the National Strategic Plan on HIV/AIDS.From this, RM43.1mil is being channelled to the NSEP.

As of December last year, 12, 230 IDUs were registered with the programme under NGOs. Another 253 are registered at health clinics. The target is to include 15,000 IDUs by next year.

Liow says Malaysians are wise and mature enough to understand the concept of NSEP and the ministry has outlined several steps to further curb the spread of HIV in its five-year strategic plan.

“NSEP will serve as a driving force towards a wide range of harm reduction-related activities such as information, education and communication on risk reduction, HIV testing and counselling, health screening, anti-retroviral treatment and psycho-social care and support,” he adds.

On the involvement of health clinics, Liow says IDUs are regarded like any other patients in need of treatment.

He says the stigma towards IDUs was obvious in the early days when NSEP was started in the clinics but this has changed..

“The acceptance of patients to the programme and IDUs is much better. We hope the stigma will be eliminated in the near future,” he says.

MAC president Prof Dr Adeeba Kamarulzaman notes that while Malaysia has come a long way in its harm reduction efforts, tmuch more needs to be done.

“The big challenge is to reach out to more people. A target of at least 60% of drug users must have access to these services,” she says.

Towards this, there must be more NSEP outlets, outreach workers for rural areas like Felda and fishing villages, and expansion of the MMT by including more general practitioners (GPs).

She says it is not ideal to have a health system where methadone is given free through government centres while patients pay if they go to GPs.

“We need to look at existing laws and policies which give rise to a lot of problems. Among the challenges the council faces include finding the right people for the job and law enforcement.

“While MMT is probably better understood among those who have seen its effects on people they know, the majority have yet to understand it.

“The NSEP, on the other hand, is still viewed negatively by society,” she says.

As an advocate of harm reduction, Prof Dr Adeeba wants to see greater coverage by both the NSEP and MMT.

However, she says they are only part of the picture. Other things need to be done such as re-integrating drug users into society and job placement, and anti-retroviral therapy for the HIV-infected.

“Most importantly, as a country, we need to seriously relook our drug policy,” she says.

“We need to really understand the problem and, more importantly, reexamine laws that treat drug users in the same vein as traffickers.

“Putting small-time drug users into ‘rehabilitation’ and/or prison is not going to solve any of these problems.” – By AUDREY EDWARDS

Thursday, May 14, 2009

End to War on Drugs?

Dear IDU Bloggers,

Appologies for the heavy US focus, of late, in the BLOG. But it's interesting times in drug policy in the US. The latest, below.


White House Czar Calls for End to 'War on Drugs'
Kerlikowske Says Analogy Is Counterproductive; Shift Aligns With Administration Preference for Treatment Over Incarceration


WASHINGTON -- The Obama administration's new drug czar says he wants to banish the idea that the U.S. is fighting "a war on drugs," a move that would underscore a shift favoring treatment over incarceration in trying to reduce illicit drug use.

In his first interview since being confirmed to head the White House Office of National Drug Control Policy, Gil Kerlikowske said Wednesday the bellicose analogy was a barrier to dealing with the nation's drug issues.

"Regardless of how you try to explain to people it's a 'war on drugs' or a 'war on a product,' people see a war as a war on them," he said. "We're not at war with people in this country."

Mr. Kerlikowske's comments are a signal that the Obama administration is set to follow a more moderate -- and likely more controversial -- stance on the nation's drug problems. Prior administrations talked about pushing treatment and reducing demand while continuing to focus primarily on a tough criminal-justice approach.

The Obama administration is likely to deal with drugs as a matter of public health rather than criminal justice alone, with treatment's role growing relative to incarceration, Mr. Kerlikowske said.

Already, the administration has called for an end to the disparity in how crimes involving crack cocaine and powder cocaine are dealt with. Critics of the law say it unfairly targeted African-American communities, where crack is more prevalent.

The administration also said federal authorities would no longer raid medical-marijuana dispensaries in the 13 states where voters have made medical marijuana legal. Agents had previously done so under federal law, which doesn't provide for any exceptions to its marijuana prohibition.

During the presidential campaign, President Barack Obama also talked about ending the federal ban on funding for needle-exchange programs, which are used to stem the spread of HIV among intravenous-drug users.

The drug czar doesn't have the power to enforce any of these changes himself, but Mr. Kerlikowske plans to work with Congress and other agencies to alter current policies. He said he hasn't yet focused on U.S. policy toward fighting drug-related crime in other countries.

Mr. Kerlikowske was most recently the police chief in Seattle, a city known for experimenting with drug programs. In 2003, voters there passed an initiative making the enforcement of simple marijuana violations a low priority. The city has long had a needle-exchange program and hosts Hempfest, which draws tens of thousands of hemp and marijuana advocates.

Seattle currently is considering setting up a project that would divert drug defendants to treatment programs.

Mr. Kerlikowske said he opposed the city's 2003 initiative on police priorities. His officers, however, say drug enforcement -- especially for pot crimes -- took a back seat, according to Sgt. Richard O'Neill, president of the Seattle Police Officers Guild. One result was an open-air drug market in the downtown business district, Mr. O'Neill said.

"The average rank-and-file officer is saying, 'He can't control two blocks of Seattle, how is he going to control the nation?' " Mr. O'Neill said.

Sen. Tom Coburn, the lone senator to vote against Mr. Kerlikowske, was concerned about the permissive attitude toward marijuana enforcement, a spokesman for the conservative Oklahoma Republican said.
[drug war]

Others said they are pleased by the way Seattle police balanced the available options. "I think he believes there is a place for using the criminal sanctions to address the drug-abuse problem, but he's more open to giving a hard look to solutions that look at the demand side of the equation," said Alison Holcomb, drug-policy director with the Washington state American Civil Liberties Union.

Mr. Kerlikowske said the issue was one of limited police resources, adding that he doesn't support efforts to legalize drugs. He also said he supports needle-exchange programs, calling them "part of a complete public-health model for dealing with addiction."

Mr. Kerlikowske's career began in St. Petersburg, Fla. He recalled one incident as a Florida undercover officer during the 1970s that spurred his thinking that arrests alone wouldn't fix matters.

"While we were sitting there, the guy we're buying from is smoking pot and his toddler comes over and he blows smoke in the toddler's face," Mr. Kerlikowske said. "You go home at night, and you think of your own kids and your own family and you realize" the depth of the problem.

Since then, he has run four police departments, as well as the Justice Department's Office of Community Policing during the Clinton administration.

Ethan Nadelmann of the Drug Policy Alliance, a group that supports legalization of medical marijuana, said he is "cautiously optimistic" about Mr. Kerlikowske. "The analogy we have is this is like turning around an ocean liner," he said. "What's important is the damn thing is beginning to turn."

James Pasco, executive director of the Fraternal Order of Police, the nation's largest law-enforcement labor organization, said that while he holds Mr. Kerlikowske in high regard, police officers are wary.

"While I don't necessarily disagree with Gil's focus on treatment and demand reduction, I don't want to see it at the expense of law enforcement. People need to understand that when they violate the law there are consequences."

Write to Gary Fields at

Monday, May 11, 2009

Harm Reduction Conference Reports

A team of Key Correspondents (KC) attended the 20th International Harm Reduction Conference (IHRA) in Bangkok, Thailand, 20-23 April 2009.

For the days of 27 April – 11 May 2009, the SEA-AIDS eForum Resource Team (eFRT) has posted the conference reports written by the KC Team. This posting reviews the KC articles posted between 4-11 May 2009.

Find an overview of the first installment of articles from IHRA (posted 27 April – 1 May 2009) here:

From Nixon to Obama: what hope for a better drug policy?

“...introducing human rights of drug users will not be an easy task for many advocates and activists particularly in Asia. How does one raise the issue of human rights for drug users in countries where the notion is often seen as a western propaganda?” – Palani Narayanan

Read it here:

Integrating services for HIV, TB and Drug Users – Prakash Tyagi

Read it here:

The missing link: poverty, deprivation and drug harm

“The dominant theme at this conference is the need for a rights-based approach to harm reduction. Policy makers would be wise to also consider sufficient interventions to reverse the social and economic factors amplifying drug-related harm, otherwise the effectiveness of harm reduction will be severely jeopardised in communities with populations who are relatively deprived.” – Ian Hodgson

Read it here:

The war on fruit juices: Making legal aid an integral part of harm reduction services

“By printing pocket sized cards for drug users with information about human rights, and local drug legislation, the project aims to inform drug users about the best ways to challenge illegal police activity... Messages on the cards include: Can a police officer search for drugs in my vagina or rectum? Are the police allowed to strip search me in the streets? Am I entitled to make a phone call if I am taken into custody?” - Palani Narayanan on the ‘Street Lawyers Project’ in Copenhagen, Denmark

Read it here:

Bring Law Enforcement and Harm Reducation Together: transforming theory into reality

“There is a need to understand this issue [drug use] more holistically. Police and law enforcement are a part of society and reflect public feelings.” – Prakash Tyagi

Read it here:

Ethics, rights and drug use: why is it so hard?

“Examples of the systematic abuse of many drug users confirm that legislation in many countries is based less on individual rights and more on command and control.” – Prakash Tyagi

Read it here:

Human rights violations again drug users in Asia: Case study examples – Palani Narayanan

Read it here:

Sunday, May 10, 2009

Obama Budget Bans Federal Funding For Needle Exchange, Breaking Campaign Pledge

Just FYI, see below.

Obama Budget Bans Federal Funding For Needle Exchange, Breaking Campaign Pledge

05/ 8/09 11:23 AM

President Obama's budget released Thursday takes a step backward from a controversial political position he had taken during the presidential campaign.

Obama, during the primary campaign, pledged his support of needle exchange programs to slow the spread of HIV/AIDS. When he took over the White House, the administration website affirmed: "The President also supports lifting the federal ban on needle exchange, which could dramatically reduce rates of infection among drug users."

Yet Obama's budget includes language that bans spending federal money on needle-exchange programs.

White House spokesman Ben LaBolt said the administration isn't yet ready to lift the ban - but Obama still supports needle exchange.

"We have not removed the ban in our budget proposal because we want to work with Congress and the American public to build support for this change," he said. "We are committed to doing this as part of a National HIV/AIDS strategy and are confident that we can build support for these scientifically-based programs."

He added, "In recent years, Washington has used the budget process to litigate divisive issues and score political points. This practice, which both sides have engaged in, has limited our ability to tackle our major economic challenges. President Obama decided not to play politics as usual with this budget and while he remains committed to supporting the program he wants to address that through the normal legislative process."

The White House website no longer features the president's support of the program, however. See the before and after here.

"It's hard to imagine how removing mention of support for a proven lifesaving program from the White House website is part of a grand strategy to 'build support' for syringe exchange," said Tom Angell, a spokesman for the group Law Enforcement Against Prohibition.

Obama's budget also includes a provision known as the "Barr Amendment," which prevents the District of Columbia from implementing a medical marijuana law that voters passed in an overwhelming referendum. Obama has pledged not to use Department of Justice resources to raid medical marijuana clinics in states where it is legal.

UPDATE: The Center for Global Health Policy writes in, noting that Obama also underfunded the Global Fund to Fight AIDS, TB and Malaria, which funds a wide variety of prevention efforts, including needle exchange in Eastern Europe, where drug addiction and HIV/AIDS rates are both soaring:

Another major disappointment for global health advocates is the Obama proposal for the Global Fund to Fight AIDS, TB and Malaria. Countries rely on the Fund, in particular, for funding for tuberculosis programs, and so far the Fund has also provided over $600 million for health system strengthening. The Global Fund requested $2.7 billion from the US for 2010, but the Administration is proposing only $900 million, the same level as 2009. Unless Congress goes above the Administration's proposal, the US will miss a major opportunity to use the Fund to leverage more donations from Spain, Germany, and other countries, and AIDS, TB and malaria programs will be stalled.
Ryan Grim is the author of the forthcoming book This Is Your Country On Drugs: The Secret History of Getting High in America