Tuesday, June 30, 2009

1 in 25 Global Deaths linked to Alcohol

Some staggering figures on the global health burden related to alcohol, in the new Lancet study, below. (http://addiction-dirkh.blogspot.com/2009/06/1-in-25-global-deaths-linked-to-alcohol.html)

We (PSI) should be at least be considering how we might help reduce alcohol-related death and disability.

The report text is below.


Vodka kills more Russians than war, Lancet reports.

A team of researchers at the University of Toronto reported in Lancet that 3.8 % of global deaths could be attributed to alcohol. In Europe, the report stated, the rate of premature death from alcohol was 1 in 10 during 2004, the year studied. And in a related study, more than half of all premature deaths among adult males in Russia were attributable to booze.

The world health care burden, as spelled out by Dr. Jurgen Rehm and others at the University of Toronto, is staggering: “The costs associated with alcohol amount to more than 1% of the gross national product in high-income and middle-income countries, with the costs of social harm constituting a major proportion in addition to health costs.”

In a BBC News report,the study authors warned that the worldwide effect of alcohol-related disease was similar to that of smoking in prior decades. The report takes note of prior research indicating a health benefit from moderate drinking, stressing that any purported benefit is “far outweighed by the detrimental effects of alcohol on disease and injury.”

The Lancet study concludes that the overall mortality figures are “not surprising since global consumption is increasing, especially in the most populous countries of India and China.”

Professor Ian Gilmore of the Royal College of Physicians, quoted by the BBC, called the report “a global wake-up call,” and urged the adoption of “evidence-based measures” for reducing alcohol-related harm, such as price increases and advertising bans. “Many countries are investigating new ways to cut deaths and disease and reduce the burden on health services by using the price of alcohol to lower consumption,” Gilmore said. Pricing strategies have been used effectively in the past to lower cigarette consumption, researchers have noted.

In one of the Russian studies, Professor Richard Peto of the University of Oxford led a statistical analyses, concluding: “If current Russian death rates continue, then about 5% of all young women and 25% of all young men will die before age 55 years from the direct or indirect effects of drinking.” The Russian figures are also affected by the high rate of associated smoking in the former Soviet Union.

Peto added: “When Russian alcohol sales decreased by about a quarter, overall mortality of people of working age immediately decreased by nearly a quarter. This shows that when people who are at high risk of death from alcohol do change their habits, they immediately avoid most of the risk.”

Wednesday, June 24, 2009

World Drug Report 2009 released

The Report was launched in Washington, D.C., by UNODC Executive Director Antonio Maria Costa and the newly appointed Director of the United States Office of National Drug Control Policy, Gil Kerlikowske.

Download at:


Monday, June 22, 2009

switching injectors away from injecting

A program in Canada managed to reduce needle sharing & reduce injecting of crack cocain by promoting smoking of cocaine as an alternative - a classic application of harm reduction principles, to shift people away from the most harmful forms/types of drug use. Admittedly, this requires a progressive enabling environment, but we should all be thinking about how to actively reduce the riskiest forms of drug use in our countries.

For details, see the article below.



Sunday, June 21, 2009

Global State of Harm Reduction

The Global State of Harm Reduction e-tool is now live on the INTERNATIONAL HARM REDUCTION ASSOCIATION website.

If you want to know how many countries support harm reduction, have needle syringe programmes, have methadone or buprenorphine maintenance treatment or drug consumption rooms etc



Thursday, June 4, 2009

Helping drug users to stop smoking

Blog readers,

An audio and powerpoint presentation of a superb talk on helping drug users to stop smoking is (at the 2009 National Drug Treatment Conference) is at:


Smoking reduction/cessation, not just for drug users, is now quite effective, with drugs that are, however, unaffordable to most people in the developing world. This is, I think, a major potential growth area for PSI.


Wednesday, June 3, 2009

"Nice People Take Drugs" Campaign

A UK organization has launched a public campaign called "Nice People Take Drugs".

View the website and more info at:



Two hundred drug addicts in Montreal and Vancouver will be lining up for free heroin later this year at publicly funded clinics. And they can thank the federal Conservative government, despite its hard line against hard drugs.

The trial - which will offer the drug in pill and injectable forms as well - builds on a similar heroin experiment last year that found most participants committed far fewer crimes and their physical and mental health improved.

The three-year medical trial will put Canada on the leading edge of international addictions research "for a population that is in desperate need for alternate health options," said Michael Krausz, the lead investigator.

But the project is only proceeding with the blessing of, and $1-million in funding from, the Canadian Institutes of Health Research, an agency of Health Canada.

The federal Conservative government is currently fighting Vancouver's supervised-injection facility, Insite, in court. Prime Minister Stephen Harper has argued that taxpayer money should not fund drug use, but should be spent on prevention and treatment.

The heroin trial goes even further than Insite, not only providing a safe place to inject, but also the heroin itself.

The drug is legally purchased in Europe and brought to Canada under armed guard.

The trial is called SALOME, the Study to Assess Longer-term Opioid Medication Effectiveness, and it will build on a similar heroin experiment that wrapped up last summer. The North American Opiate Medication Initiative (NAOMI) was also funded by the Canadian Institutes of Health Research with the approval of Health Canada

The NAOMI trial was criticized by some addictions physicians but drew no comment from the federal government, which paid more than $8-million for the research.

"It's been disappointing," said Martin Schechter, who led NAOMI and is also working on SALOME. Dr. Schechter said European health authorities are very interested in the work, but Canadian authorities will not acknowledge it.

"There's a lot invested in NAOMI. We did everything we could to translate the information for decision-makers to make them understand what it meant," he said.

Dr. Krausz, a leading addictions researcher, has conducted another heroin trial in Germany, the largest such randomized clinical trial in Europe.

The Canadian research aims to determine if medically prescribed heroin is a safe and effective treatment and if users will accept the drug in pill form instead of injecting it.. It will also measure whether a licenced narcotic, Hydromorphone, can be used instead of heroin.

His team is now recruiting about 200 severe heroin addicts who have failed to respond to existing treatments and they expect to have the clinics in Vancouver and Montreal open by this fall.

Last week, Dr. Krausz's medical team sat down with Vancouver philanthropists asking for additional support for the clinics that will distribute both heroin and a legal narcotic substitute to hard-core addicts. Organizers say one business leader immediately offered a cheque for $100,000.

Trish Walsh, executive director of the InnerChange Foundation, who arranged last week's fundraiser with top Vancouver business and community leaders, said the 30 people who gathered in a corporate boardroom understood that the city cannot ignore its drug-addicted population.

"We have been sleepwalking right through the middle of this crisis."

Health Minister Leona Aglukkaq did not return calls, but her press secretary, Josee Bellemare, offered an e-mailed statement on the minister's behalf: "Our government recognizes that injection drug users need assistance. That's why we are investing in prevention and treatment, to help people recover from their drug addictions."

Overdose increase in Australia

1 June 2009, journalist Simon Palan

Heroin market back to the bad old days

Overdoses ... quality is said to have 'gone through the roof'. (File photo) (AAP : Julian Smith)

Link to story: http://www.abc.net.au/news/stories/2009/06/01/2586395.htm?section=australia

Audio: Doctors and users say heroin overdose cases are on the rise (PM) The so-called heroin drought looks like being well and truly over, as paramedics and emergency department doctors say they are treating rapidly increasing numbers of heroin overdose victims.

They say the drug has been making a comeback over the last six months. But despite the increase in overdose cases, the debate over prohibition has not gone away and there are some who say heroin should actually be legalised.

When heroin use was peaking a decade ago, Dr Gordian Fulde at Sydney's St Vincents hospital was treating at least one heroin overdose victim every day. Now, he says those days have returned. "We have an increase of people coming into the emergency department having overdosed on heroin. We also have an increase of people who admit to taking heroin - so heroin's coming back," he said.

Quality 'through the roof'

Thirty-nine-year-old Gordon has been a daily user for almost 20 years and he says there has been an increase in quantity and quality. "The quality's gone through the roof lately. It was probably about 30 per cent, 40 per cent - now it's jumped up to about 60, 70 per cent," he said. "It's the purity of it that's making people drop because they think they can handle it. "If you've got a small habit, like if you're only using one 50, two 50s a day, when the purity goes through the roof like that, you're not expecting it and people don't tell you."

Gordon says he has been lucky and has never overdosed. But he says he knows people who have. "I was speaking to a mate earlier who'd just come from the hospital who dropped today, so yeah I know a fair few people actually," he said. "In the last three or four days, actually."

Legalisation debate

In the late 1990s there was a reduction in the availability of heroin because the war in Afghanistan disrupted supplies. A big crackdown by Australian police also tightened the market here. Now it seems heroin is flooding back and some long-time observers are ambivalent about the consequences.

The pastor at Sydney's Wayside Chapel, Graham Long, helps counsel heroin users every day. "I actually think the word heroin spikes off a raw nerve in the public's mind but I don't see why that is the case actually," he said. "In fact I put it to you that alcohol's a much bigger problem. Alcohol's a nasty drug. Just because it's socially acceptable it's kind of the elephant in the room. "But the truth is, if you get any crowd and add alcohol, people want to hurt each other, and that doesn't happen with heroin or most of the other drugs. So, as drugs go, it's a nasty thing, it's quite a social problem."

Pastor Long says he thinks heroin should be legalised. "I don't quite understand why we want to fund a criminal path - why we want to hand to a criminal path a market has got me beat. I just don't understand," he said.

Soft drug?

Heroin user Gordon agrees, saying other illicit drugs are more damaging. "You don't see people going loopy on gear [heroin]," he said. "The worst that can happen to you on gear is you go to sleep, sort of thing. But with the ice, people go silly. With the amphetamines, people go silly. "I definitely think heroin would be one of the softer drugs."

But that is not so, according to Dr Fulde, who says heroin is a killer. "Crystal meth, the amphetamines, the cocaine per se don't in the first instance kill you, they just wind you up, you go mad, you do all sorts of things, but you don't stop breathing - it's not a death thing," he said. "You might die because you run in front of a train or do something stupid, and because you're totally out of it. "But heroin on its own, it's a killer. It stops you breathing and I would love heroin not to be around at all."