An interesting article below (from the blog "Talking Drugs") on increases in opium cultivation in India.
http://www.talkingdrugs.org/opium-cultivation-increasing-in-india
Opium cultivation increasing in India
An increase in illegal opium cultivation has brought new prosperity to parts of the Arunachal Pradesh region in eastern India. However this source of new wealth has also left a trail of addiction in its wake.
The Lohit valley in eastern Arunachal Pradesh on the border with China and Myanmar currently has about 10,000 hectares of opium fields. India is a big legal producer of opium, which is used to make such medicinal products such as Codeine and Morphine. However the opium fields in the valley are not licensed and it is roughly estimate that they produce around 100 tons of opium a year, some of it is consumed locally in the region while the rest is sold on the illegal market. India is said to be a major transit route for illicit heroin, opium, morphine base and hashish from Afghanistan, Pakistan, Myanmar and to a lesser extent Nepal. A lot of the drugs trafficked through India end up on the European market.
Myanmar which after Afghanistan is the second biggest illegal opium producer in the world accounts for 5 percent of global production. Although opium production has increased in the last two years, due to international pressure the 1990s saw the Myanmar military government carry out a major crackdown on illegal opium cultivation. This caused cultivation to shift across the border into India. Rising poverty in the region is seen as the reason that more people are choosing to grow the crop instead of legal alternatives that bring in less income.
The local government seems to have turned a blind eye not only on the increasing opium addiction but also on the lack of infrastructure and addiction treatment clinics in the area. Financial support packages that are designated to the region are often siphoned off by corrupt local government officials and have little effect on alleviating poverty.
Like most people in developing or third world countries who chose to cultivate drugs for the illegal market, the opium growers in eastern India seem to be doing it more out of economic necessity than a desire to be the next Pablo Escobar. If the governed improved the local infrastructure and looked for legal alternative crops, villagers would find opium cultivation less appealing.
The profits from opium cultivation has meant now in rural villages in the Lohit valley it is not uncommon to see expensive solar panels on the houses, as well as well dressed girls with polished nails. However in most villages in the valley at least a quarter of the adult population are addicted to opium. This has a toll on society far greater than the economic benefits brought by this lucrative crop.
Monday, August 31, 2009
Alcohol Harm Reduction?
Readers,
In the harm reduction movement, there's an effort to develop strategies to reduce the harms realted to alcohol. The WHO is active in this effort, and has released a draft strategy, viewable at the website below:
http://www.who.int/substance_abuse/activities/msbwden.pdf
Many PSI countries are considering how to get more involved in lifestyle diseases or health problems more common in developing economies - alcohol certainly falls in that category. There are many ways PSI could get involved. Here's one section from the report, below, showing some possible interventions:
Possible policies and interventions
(1) regulating the drinking context to minimize violence and disruptive behaviour
(2) serving alcohol in plastic containers or shatter-proof glass
(3) enforcing laws against serving to intoxication
(4) legal liability for consequences of harm resulting from intoxication caused by the serving of alcohol
(5) management policies relating to responsible serving of beverage on premises
(6) training staff in relevant sectors how better to manage intoxicated and aggressive drinkers
(7) reducing the alcoholic strength of different beverage categories
(8) social welfare care and support programmes
(9) providing necessary care or shelter for severely intoxicated people
(10) providing consumer information and labelling alcoholic beverages on the harm related to alcohol
(11) fortifying alcoholic beverages or food products with vitamins in order to prevent nutritional deficits among heavy drinkers
In the harm reduction movement, there's an effort to develop strategies to reduce the harms realted to alcohol. The WHO is active in this effort, and has released a draft strategy, viewable at the website below:
http://www.who.int/substance_abuse/activities/msbwden.pdf
Many PSI countries are considering how to get more involved in lifestyle diseases or health problems more common in developing economies - alcohol certainly falls in that category. There are many ways PSI could get involved. Here's one section from the report, below, showing some possible interventions:
Possible policies and interventions
(1) regulating the drinking context to minimize violence and disruptive behaviour
(2) serving alcohol in plastic containers or shatter-proof glass
(3) enforcing laws against serving to intoxication
(4) legal liability for consequences of harm resulting from intoxication caused by the serving of alcohol
(5) management policies relating to responsible serving of beverage on premises
(6) training staff in relevant sectors how better to manage intoxicated and aggressive drinkers
(7) reducing the alcoholic strength of different beverage categories
(8) social welfare care and support programmes
(9) providing necessary care or shelter for severely intoxicated people
(10) providing consumer information and labelling alcoholic beverages on the harm related to alcohol
(11) fortifying alcoholic beverages or food products with vitamins in order to prevent nutritional deficits among heavy drinkers
Sunday, August 30, 2009
Overdose Awareness Day - Aug 31st
Dear subscribers,
Today (Aug 31) is Overdose Awareness Day.
Please find below a link to a new website (put together by the Int'l Harm Reduction Association) bringing together some some critical documents (from research to advocacy) on overdose.
Opiod overdose continues to be one of the main causes of mortality among our drug user clients in virtually every country where we work with IDUs. Our flagship program on this issue is PSI Russia, implementing an Innovations Fund-funded project to reduce overdose deaths through outreach and distribution of Naloxone.
Rob
http://www.ihra.net/Overdose
Today (Aug 31) is Overdose Awareness Day.
Please find below a link to a new website (put together by the Int'l Harm Reduction Association) bringing together some some critical documents (from research to advocacy) on overdose.
Opiod overdose continues to be one of the main causes of mortality among our drug user clients in virtually every country where we work with IDUs. Our flagship program on this issue is PSI Russia, implementing an Innovations Fund-funded project to reduce overdose deaths through outreach and distribution of Naloxone.
Rob
http://www.ihra.net/Overdose
Drugs and west Africa
Please find below a link to a new UNODC report on drugs and crime in west Africa, with a special focus on the issue of the trafficking of cocaine and other drugs from S. America via west Africa to Europe.
The link also brings you to a superb photo essay on Guinea Bissau, now widely regarded as having become a 'narco-state.'
While the report is illuminating (just skim the exec summary), it mentions HIV only in passing and includes no recommendations for how to deal with growing rates of drug use among west Africans, due to their increasing exposure to these trafficked drugs. In that respect, the report is yet another disappointing publication from UNODC, the lead agency on IDU within the UN, but still ill-at-ease with this role, it seems.
We continue to look more to UNAIDS and WHO for leadership on strongly advocating for harm reduction for people already involved in drug use, in Africa and the rest of the world.
http://blogs.law.harvard.edu/drugsandconflict/2009/08/24/photoessay-the-fall-of-africas-first-narco-state/
The link also brings you to a superb photo essay on Guinea Bissau, now widely regarded as having become a 'narco-state.'
While the report is illuminating (just skim the exec summary), it mentions HIV only in passing and includes no recommendations for how to deal with growing rates of drug use among west Africans, due to their increasing exposure to these trafficked drugs. In that respect, the report is yet another disappointing publication from UNODC, the lead agency on IDU within the UN, but still ill-at-ease with this role, it seems.
We continue to look more to UNAIDS and WHO for leadership on strongly advocating for harm reduction for people already involved in drug use, in Africa and the rest of the world.
http://blogs.law.harvard.edu/drugsandconflict/2009/08/24/photoessay-the-fall-of-africas-first-narco-state/
Thursday, August 27, 2009
Editorial on drug reform
Alex Wodak, one of the most respected figures in the harm reduction movement, wrote an enlightening piece on drug reform, below, summarizing some of the major developments in drug reform, globally, in recent months. Worth reading.
Rob
http://www.brisbanetimes.com.au/opinion/tide-turns-in-favour-of-drug-reform-20090826-ezph.html
Tide turns in favour of drug reform
Alex Wodak
August 27, 2009
One hundred years ago, the US convened the International Opium Conference. This meeting of 13 nations in Shanghai was the beginning of global drug prohibition.
Prohibition slowly became one of the most universally applied policies in the world. But a century on, international support for this blanket drug policy is slowly but inexorably unravelling.
In January, Barack Obama became the third US president in a row to admit to consumption of cannabis. Bill Clinton had admitted using cannabis but denied ever inhaling it. George Bush was taped saying in private he would never admit in public to having used cannabis. When Obama was asked whether he had inhaled cannabis, he said: ''Of course. That was the whole point.''
Obama has candidly discussed his drug use. ''Pot had helped, and booze; maybe a little blow [cocaine] when you could afford it.'' He has also admitted the ''war on drugs is an utter failure'' and called for more focus on a public health approach.
In February, a Latin American drug policy commission similarly concluded that the ''drug war is a failure''. It recommended breaking the ''taboo on open debate including about cannabis decriminalisation''. The same month, an American diplomat said the US supported needle-exchange programs to help reduce the transmission of HIV and other blood-borne diseases, and supported using medication to treat those addicted to opiates.
In March, the United Nations Commission on Narcotic Drugs met in Vienna as the culmination of a 10-year review of global drug policy. A ''political declaration'' was issued which, at the urging of the US, excluded the phrase ''harm reduction''. This omission caused a split in the fragile international consensus on drug policy and resulted in 26 countries, including Australia, demanding explicit support for harm reduction in a footnote.
In April, Michel Kazatchkine, of the Global Fund to Fight Aids, Tuberculosis and Malaria, argued in favour of decriminalising illicit drugs to allow efforts to halt the spread of HIV to succeed. The same month, a national Zogby poll in the US provided evidence of changing opinion on the legalisation of cannabis: 52 per cent supported cannabis becoming legal, taxed and regulated.
In May there was movement on several fronts. The Governor of California, Arnold Schwarzenegger, said: ''I think it's not time for [legalisation], but I think it's time for a debate.'' He was supported by a number of other American politicians, while Vicente Fox, a former Mexican president, said he was not yet convinced it was the solution but asked: ''Why not discuss it?'' The Colombian Vice-President, Francisco Santos Calderon, is already convinced. ''The only way you can really solve the problem [is] if you legalise it totally.''
Obama's drug czar, Gil Kerlikowske, the director of the Office of National Drug Control Policy, said he wanted to banish the idea of fighting a ''war on drugs'', while the United Nations Secretary-General, Ban Ki-moon, said criminal sanctions on same-sex sex, commercial sex and drug injections were barriers for HIV treatment services. ''Those behaviours should be decriminalised, and people addicted to drugs should receive health services for the treatment of their addiction,'' he said.
In Germany, the federal parliament voted 63 per cent in favour to allow heroin prescription treatment.
In July, the Economic and Social Council, a UN body more senior than the Commission on Narcotic Drugs, approved a resolution requiring national governments to provide ''services for injecting drug users in all settings, including prisons'' and harm reduction programs such as needle syringe programs and substitution treatment for heroin users. This month, Mexico removed criminal sanctions for possessing any illicit drug in small quantities while Argentina is making similar changes for cannabis.
Portugal, Spain and Italy had earlier dropped criminal sanctions for possessing small amounts of any illicit drug, while the Netherlands and Germany have achieved the same effect by changing policing policy.
It is now clear that support for a drug policy heavily reliant on law enforcement is dwindling in Western Europe, the US and South America, while support for harm reduction and drug law reform is growing. Sooner or later this debate will start again in Australia.
Alex Wodak is director of the Alcohol and Drug Service at St Vincent's Hospital.
Rob
http://www.brisbanetimes.com.au/opinion/tide-turns-in-favour-of-drug-reform-20090826-ezph.html
Tide turns in favour of drug reform
Alex Wodak
August 27, 2009
One hundred years ago, the US convened the International Opium Conference. This meeting of 13 nations in Shanghai was the beginning of global drug prohibition.
Prohibition slowly became one of the most universally applied policies in the world. But a century on, international support for this blanket drug policy is slowly but inexorably unravelling.
In January, Barack Obama became the third US president in a row to admit to consumption of cannabis. Bill Clinton had admitted using cannabis but denied ever inhaling it. George Bush was taped saying in private he would never admit in public to having used cannabis. When Obama was asked whether he had inhaled cannabis, he said: ''Of course. That was the whole point.''
Obama has candidly discussed his drug use. ''Pot had helped, and booze; maybe a little blow [cocaine] when you could afford it.'' He has also admitted the ''war on drugs is an utter failure'' and called for more focus on a public health approach.
In February, a Latin American drug policy commission similarly concluded that the ''drug war is a failure''. It recommended breaking the ''taboo on open debate including about cannabis decriminalisation''. The same month, an American diplomat said the US supported needle-exchange programs to help reduce the transmission of HIV and other blood-borne diseases, and supported using medication to treat those addicted to opiates.
In March, the United Nations Commission on Narcotic Drugs met in Vienna as the culmination of a 10-year review of global drug policy. A ''political declaration'' was issued which, at the urging of the US, excluded the phrase ''harm reduction''. This omission caused a split in the fragile international consensus on drug policy and resulted in 26 countries, including Australia, demanding explicit support for harm reduction in a footnote.
In April, Michel Kazatchkine, of the Global Fund to Fight Aids, Tuberculosis and Malaria, argued in favour of decriminalising illicit drugs to allow efforts to halt the spread of HIV to succeed. The same month, a national Zogby poll in the US provided evidence of changing opinion on the legalisation of cannabis: 52 per cent supported cannabis becoming legal, taxed and regulated.
In May there was movement on several fronts. The Governor of California, Arnold Schwarzenegger, said: ''I think it's not time for [legalisation], but I think it's time for a debate.'' He was supported by a number of other American politicians, while Vicente Fox, a former Mexican president, said he was not yet convinced it was the solution but asked: ''Why not discuss it?'' The Colombian Vice-President, Francisco Santos Calderon, is already convinced. ''The only way you can really solve the problem [is] if you legalise it totally.''
Obama's drug czar, Gil Kerlikowske, the director of the Office of National Drug Control Policy, said he wanted to banish the idea of fighting a ''war on drugs'', while the United Nations Secretary-General, Ban Ki-moon, said criminal sanctions on same-sex sex, commercial sex and drug injections were barriers for HIV treatment services. ''Those behaviours should be decriminalised, and people addicted to drugs should receive health services for the treatment of their addiction,'' he said.
In Germany, the federal parliament voted 63 per cent in favour to allow heroin prescription treatment.
In July, the Economic and Social Council, a UN body more senior than the Commission on Narcotic Drugs, approved a resolution requiring national governments to provide ''services for injecting drug users in all settings, including prisons'' and harm reduction programs such as needle syringe programs and substitution treatment for heroin users. This month, Mexico removed criminal sanctions for possessing any illicit drug in small quantities while Argentina is making similar changes for cannabis.
Portugal, Spain and Italy had earlier dropped criminal sanctions for possessing small amounts of any illicit drug, while the Netherlands and Germany have achieved the same effect by changing policing policy.
It is now clear that support for a drug policy heavily reliant on law enforcement is dwindling in Western Europe, the US and South America, while support for harm reduction and drug law reform is growing. Sooner or later this debate will start again in Australia.
Alex Wodak is director of the Alcohol and Drug Service at St Vincent's Hospital.
IDU issues from the 9th International Congress on AIDS in Asia and the Pacific
The link below will take you to the Int'l Drug Policy Consortium site.
Scroll down to the section "9th International Congress on AIDS in Asia and the Pacific" to see a short collection of links to stories from this year's ICAAP conference related to IDU. For those of us who couldn't be at ICAAP, this is a good summary of the main IDU-related issue that came up at the conference.
Cheers
Rob
http://us1.campaign-archive.com/?u=7988ee3f817fe418a60a5e9ec&id=4f04ce9b31&e=0daf2fdf1e
Scroll down to the section "9th International Congress on AIDS in Asia and the Pacific" to see a short collection of links to stories from this year's ICAAP conference related to IDU. For those of us who couldn't be at ICAAP, this is a good summary of the main IDU-related issue that came up at the conference.
Cheers
Rob
http://us1.campaign-archive.com/?u=7988ee3f817fe418a60a5e9ec&id=4f04ce9b31&e=0daf2fdf1e
Tuesday, August 25, 2009
Evidence supporting increased distribution on injecting equipment
The below abstract from a new article shows how NSP in Australia is reducing HIV but not being as effective at reducing HCV (Hep C).
HCV is much harder to control, but it is predicted that increasing needle distribution rates would have a positive impact on reducing HCV.
The article provides more evidence for why a "free" needle distribution policy (rather than one-for-one needle "exchange") is the right thing to do, from a public health perspective.
Rob
The Impact of Needle and Syringe Programs on HIV and HCV Transmissions in Injecting Drug Users in Australia: A Model-Based Analysis, Kwon, Jisoo A BSc; Iversen, Jenny; Maher, Lisa; Law, Matthew G; Wilson, David P, Journal of Acquired Immune Deficiency Syndromes: August 2009 - Volume 51 - Issue 4 - pp 462-469
Objectives: We aim to estimate how changes in sterile syringe distribution through needle-syringe programs (NSPs) may affect HIV and hepatitis C virus (HCV) incidence among injecting drug users (IDUs) in Australia.
Methods: We develop a novel mathematical model of HIV and HCV transmission among IDUs who share syringes. It is calibrated using biological and Australian epidemiological and behavioral data. Assuming NSP syringe distribution affects the number of times each syringe is used before disposal, we use the model to estimate the relationship between incidence and syringe distribution.
Results: HIV is effectively controlled through NSP distribution of sterile syringes {with the effective reproduction ratio below 1 [0.66 median, interquartile range (0.63-0.70)] under current syringe distribution}. In contrast, HCV incidence is expected to remain high and its control is not feasible in the foreseeable future. The proportion of injections that are shared and the number of times each syringe is used before disposal are the driving factors of HCV incidence. The frequency in which each syringe is used can potentially be influenced by changes in syringe distribution. We estimate that if syringe distribution or coverage doubled, then annual incidence is likely to reduce by 50%. However, if it was decreased to one third of the current level, then ∼3 times the incidence could be expected.
Conclusions: This research highlights the large benefits of NSPs, puts forward a quantitative relationship between incidence and syringe distribution, and indicates that increased coverage could result in significant reductions in viral transmissions among IDUs.
HCV is much harder to control, but it is predicted that increasing needle distribution rates would have a positive impact on reducing HCV.
The article provides more evidence for why a "free" needle distribution policy (rather than one-for-one needle "exchange") is the right thing to do, from a public health perspective.
Rob
The Impact of Needle and Syringe Programs on HIV and HCV Transmissions in Injecting Drug Users in Australia: A Model-Based Analysis, Kwon, Jisoo A BSc; Iversen, Jenny; Maher, Lisa; Law, Matthew G; Wilson, David P, Journal of Acquired Immune Deficiency Syndromes: August 2009 - Volume 51 - Issue 4 - pp 462-469
Objectives: We aim to estimate how changes in sterile syringe distribution through needle-syringe programs (NSPs) may affect HIV and hepatitis C virus (HCV) incidence among injecting drug users (IDUs) in Australia.
Methods: We develop a novel mathematical model of HIV and HCV transmission among IDUs who share syringes. It is calibrated using biological and Australian epidemiological and behavioral data. Assuming NSP syringe distribution affects the number of times each syringe is used before disposal, we use the model to estimate the relationship between incidence and syringe distribution.
Results: HIV is effectively controlled through NSP distribution of sterile syringes {with the effective reproduction ratio below 1 [0.66 median, interquartile range (0.63-0.70)] under current syringe distribution}. In contrast, HCV incidence is expected to remain high and its control is not feasible in the foreseeable future. The proportion of injections that are shared and the number of times each syringe is used before disposal are the driving factors of HCV incidence. The frequency in which each syringe is used can potentially be influenced by changes in syringe distribution. We estimate that if syringe distribution or coverage doubled, then annual incidence is likely to reduce by 50%. However, if it was decreased to one third of the current level, then ∼3 times the incidence could be expected.
Conclusions: This research highlights the large benefits of NSPs, puts forward a quantitative relationship between incidence and syringe distribution, and indicates that increased coverage could result in significant reductions in viral transmissions among IDUs.
Monday, August 24, 2009
Overdose Videos
In honor of the upcoming Overdose Awareness Day (Aug 31), there are some high quality videos on YouTube about overdose, for example:
http://www.youtube.com/watch?v=q5GsQjU606s
Cheers
Rob
http://www.youtube.com/watch?v=q5GsQjU606s
Cheers
Rob
Traces of cocaine found on up to 90% of dollar bills in American cities
Ed Pilkington
New York
guardian.co.uk
Monday 17 August 2009
It's an image much beloved of Hollywood directors: the head lowered over a mirror, a crisp greenback tightly rolled and inserted in a nostril, then applied at the other end to a line of white powder.
Researchers from the American Chemical Society in Washington have discovered that the practice of consuming cocaine through rolled up paper money is far more than just a cinematic cliché. They found that in big cities in the US, up to 90% of the notes tested positive for traces of the drug.
In Washington itself, the percentage of notes with cocaine residue reached 93%, a prevalence almost matched by other urban areas such as Boston, Detroit and Baltimore.
Though some of the contamination can be blamed on cocaine crystals being rubbed from one note onto others in bundles of currency, the researchers did find an apparent growth in the phenomenon. Similar tests conducted two years ago found that only 67% of US banknotes had cocaine traces.
The study put that growth down to a probably increase in cocaine consumption in America, where there are thought to be as many as 6 million regular users of the drug.
For the first time, the researchers compared the results with tests on banknotes from other parts of the world. After the US and Canada, Brazil recorded almost as high a frequency of cocaine residue, at 80% of its paper money.
China (20%) and Japan (16%) were notably lower on the scale.
Any film directors hoping to be authentic in their portrayal of cocaine snorting should note that the researchers found that in the US the bills of choice of cocaine consumers were $5, $10, $20 and $50. Both the modest dollar note, and the more elusive $100 note appear to be rarely deployed as an aid to nasal intoxication.
New York
guardian.co.uk
Monday 17 August 2009
It's an image much beloved of Hollywood directors: the head lowered over a mirror, a crisp greenback tightly rolled and inserted in a nostril, then applied at the other end to a line of white powder.
Researchers from the American Chemical Society in Washington have discovered that the practice of consuming cocaine through rolled up paper money is far more than just a cinematic cliché. They found that in big cities in the US, up to 90% of the notes tested positive for traces of the drug.
In Washington itself, the percentage of notes with cocaine residue reached 93%, a prevalence almost matched by other urban areas such as Boston, Detroit and Baltimore.
Though some of the contamination can be blamed on cocaine crystals being rubbed from one note onto others in bundles of currency, the researchers did find an apparent growth in the phenomenon. Similar tests conducted two years ago found that only 67% of US banknotes had cocaine traces.
The study put that growth down to a probably increase in cocaine consumption in America, where there are thought to be as many as 6 million regular users of the drug.
For the first time, the researchers compared the results with tests on banknotes from other parts of the world. After the US and Canada, Brazil recorded almost as high a frequency of cocaine residue, at 80% of its paper money.
China (20%) and Japan (16%) were notably lower on the scale.
Any film directors hoping to be authentic in their portrayal of cocaine snorting should note that the researchers found that in the US the bills of choice of cocaine consumers were $5, $10, $20 and $50. Both the modest dollar note, and the more elusive $100 note appear to be rarely deployed as an aid to nasal intoxication.
Hep C treatment access
Please see brief report from ICAAP on the issue of Hep C (HCV) treatment access, a critical issue for our drug user clients in most of the countries where we work.
In many of our countries, upwards of 50% of our clients have Hep C, with little access to treatment. Wherever possible, we should be advocating for getting treatment for our clients.
Story below.
Rob
http://www.talkingdrugs.org/people-affected-with-hepatitus-c-are-dying-because-they-cant-afford-treatment
The 9th International Conference on AIDS in Asia and the Pacific (ICAAP) that took place on the 9th – 13th of August this year was interrupted by a small group of campaigners demanding access to drugs that treat HIV patients who also have been affected by Hepatitis C. The campaigners were from a broad coalition of Asia Pacific regional networks concerned with HIV/Aids and drug use. Seven Sisters, one of the main networks that participated brings together seven smaller networks that each provide a representative to form a committee that campaigns on behalf of drug users and people infected with HIV.
It is estimated that one-third of individuals with HIV also are infected with Hepatitis C and it has become an increasing cause of death amongst HIV sufferers. Drugs exist that have had success treating the virus however campaigners argue that the drugs are too expensive and people are dying because they cannot afford the medication, which can cost up to 1500 USD a month.
Protesters anger was aimed at the pharmaceutical giant Roche which they blame for keeping the prices high and they chanted “shame on you Roche, shame on you!”
Hepatitis C is an infection that affects the liver and can lead to liver fibrosis or cirrhosis, if sufferers do not receive treatment means that they will eventually need a liver transplant or die. Most individuals coinfected with HIV and Hepatitis are injecting drug users (IDU’s). However according to the WHO many countries still discriminate against injecting drug users and they are excluded from treatment.
Nanao Haobam a former IDU and now an HIV/AIDS activist in Bangkok who works with the Asia Pacific Network of People living with HIV (APN+) gave an insight to his own tragic personal situation "Almost every month my friends are dying and just in the last two months, five of them have lost their battle with Hepatitis C. Now, my doctor wants me to start on the treatment but it will cost me 1500 USD per month. Where do I get that money?"
The HIV treatment activist movement played a huge role in lowering the price of antiretroviral drugs by putting pressure on governments, bi-laterals and pharmaceutical giants. These efforts resulted in a dramatic fall in the cost of antiretroviral treatment to only a dollar a day. This is an inspirational example to the IDU community who want to reduce the price of these drugs in order to prevent people dying who otherwise could be saved.
Anne Bergenstrom from the UN Task Force on Harm Reduction in Asia Pacific has presented statistics on how IDU’s are being increasingly neglected by harm reduction policies and that they receive only two percent of the budget allocated to Aids policy in the region. Drug users in Asia and Pacific regions on average face greater discrimination than in Europe and would benefit from policies that allow drug users to obtain needed medications and treatments. Dean Lewis a member of the Asian Network for People who Use Drugs (ANPUD) told recent forum on Injecting Drug Users that "Such a policy is still unavailable in many Asian and Pacific countries."
Annie Maiden from the Australian Injecting and Illicit Drug Users League (AIVL) supported Mr. Lewis’s point stating that even in Australia the policies in place to protect the rights of drug users are not adequate. According to the WHO there are about 13 million estimated IDUs in the world out of which 43% of them belong to the Asia Pacific region. In some Asian countries 50-70% of HIV infections are due to injecting drug use.
An accomplishment would be the removal of the patent from the drug that treats Hepatitis C, known as Pegasys. This would allow low-cost generic versions on to the market allowing more infected individuals access to the drug.
In many of our countries, upwards of 50% of our clients have Hep C, with little access to treatment. Wherever possible, we should be advocating for getting treatment for our clients.
Story below.
Rob
http://www.talkingdrugs.org/people-affected-with-hepatitus-c-are-dying-because-they-cant-afford-treatment
The 9th International Conference on AIDS in Asia and the Pacific (ICAAP) that took place on the 9th – 13th of August this year was interrupted by a small group of campaigners demanding access to drugs that treat HIV patients who also have been affected by Hepatitis C. The campaigners were from a broad coalition of Asia Pacific regional networks concerned with HIV/Aids and drug use. Seven Sisters, one of the main networks that participated brings together seven smaller networks that each provide a representative to form a committee that campaigns on behalf of drug users and people infected with HIV.
It is estimated that one-third of individuals with HIV also are infected with Hepatitis C and it has become an increasing cause of death amongst HIV sufferers. Drugs exist that have had success treating the virus however campaigners argue that the drugs are too expensive and people are dying because they cannot afford the medication, which can cost up to 1500 USD a month.
Protesters anger was aimed at the pharmaceutical giant Roche which they blame for keeping the prices high and they chanted “shame on you Roche, shame on you!”
Hepatitis C is an infection that affects the liver and can lead to liver fibrosis or cirrhosis, if sufferers do not receive treatment means that they will eventually need a liver transplant or die. Most individuals coinfected with HIV and Hepatitis are injecting drug users (IDU’s). However according to the WHO many countries still discriminate against injecting drug users and they are excluded from treatment.
Nanao Haobam a former IDU and now an HIV/AIDS activist in Bangkok who works with the Asia Pacific Network of People living with HIV (APN+) gave an insight to his own tragic personal situation "Almost every month my friends are dying and just in the last two months, five of them have lost their battle with Hepatitis C. Now, my doctor wants me to start on the treatment but it will cost me 1500 USD per month. Where do I get that money?"
The HIV treatment activist movement played a huge role in lowering the price of antiretroviral drugs by putting pressure on governments, bi-laterals and pharmaceutical giants. These efforts resulted in a dramatic fall in the cost of antiretroviral treatment to only a dollar a day. This is an inspirational example to the IDU community who want to reduce the price of these drugs in order to prevent people dying who otherwise could be saved.
Anne Bergenstrom from the UN Task Force on Harm Reduction in Asia Pacific has presented statistics on how IDU’s are being increasingly neglected by harm reduction policies and that they receive only two percent of the budget allocated to Aids policy in the region. Drug users in Asia and Pacific regions on average face greater discrimination than in Europe and would benefit from policies that allow drug users to obtain needed medications and treatments. Dean Lewis a member of the Asian Network for People who Use Drugs (ANPUD) told recent forum on Injecting Drug Users that "Such a policy is still unavailable in many Asian and Pacific countries."
Annie Maiden from the Australian Injecting and Illicit Drug Users League (AIVL) supported Mr. Lewis’s point stating that even in Australia the policies in place to protect the rights of drug users are not adequate. According to the WHO there are about 13 million estimated IDUs in the world out of which 43% of them belong to the Asia Pacific region. In some Asian countries 50-70% of HIV infections are due to injecting drug use.
An accomplishment would be the removal of the patent from the drug that treats Hepatitis C, known as Pegasys. This would allow low-cost generic versions on to the market allowing more infected individuals access to the drug.
More UN endorsement for Harm Reduction
See below article which describes how another UN body (ECOSOC) has endorsed harm reduction.
While this is good news, the story highlights the sad reality that the UN still does not speak with one voice on this issue. Even though all the main UN health bodies (i.e. WHO, UNAIDS) fully endorse harm reduction, as have the most recent General Secretaries, some UN bodies (i.e. UNODC and the notorious Commission on Narcotic Drugs), still prevaricate on the issue. UNODC is the lead agency on IDU within the UN, but its director still often speaks of NSP programs with only moderate support.
In our IDU countries, we look primarily to WHO and UNAIDS to support our harm reduction programs. It's important to keep UNODC colleagues well informed, but we usually don't rely on them for strong, vocal support for harm reduction. We hope UNODC will continue to be more and more comfortable supporting harm reduction in the future.
Details below.
Rob
18th August 2009
UN Economic and Social Council Endorses Harm Reduction
http://www.ihra.net/News#UNEconomicandSocialCouncilEndorsesHarmReduction
In July 2009, the United Nation’s Economic and Social Council (ECOSOC) adopted a resolution related to the work of the Joint United Nations Programme on AIDS (UNAIDS). The resolution was agreed at an ECOSOC meeting in Geneva focusing on the social determinants of health. It contains an explicit supportive reference to harm reduction – the first official mention of harm reduction by this senior UN body.
The resolution “[r]ecognizes the need for UNAIDS to significantly expand and strengthen its work... to support increased capacity and resources for the provision of a comprehensive package of services for injecting drug users including harm reduction programmes”. The resolution was supported by 31 Member States (and was not opposed during the meeting), and follows on from another recent endorsement of harm reduction by the UNAIDS Programme Coordinating Board. This resolution is further evidence of the expanding acceptance and credibility of harm reduction approaches at the international level.
ECOSOC was one of the original UN bodies established under the United Nations Charter in 1945. It co-ordinates the work of a number of specialised UN agencies, programmes and commissions – including UNAIDS. The ECOSOC meetings serve as the central forum for discussing a broad range of issues such as standards of living, employment, economic and social progress, and health problems. Crucially, however, ECOSOC is also the ‘parent’ body of the central drug policy forum in the UN – the Commission on Narcotic Drugs. Unlike ECOSOC, CND which has yet to make an official, explicit endorsement of harm reduction, due in no small part to an over-reliance on consensus which has allowed a minority of Member States (including Japan, Russia and the USA) to actively oppose harm reduction during discussions and in the wording of resolutions. It will be interesting to see whether the ambiguous and incongruous position of CND changes now that harm reduction has been formally endorsed by ECOSOC as well as the UN General Assembly (the chief organ of the United Nations comprising all 192 Member States), and the Office of the High Commissioner for Human Rights.
While this is good news, the story highlights the sad reality that the UN still does not speak with one voice on this issue. Even though all the main UN health bodies (i.e. WHO, UNAIDS) fully endorse harm reduction, as have the most recent General Secretaries, some UN bodies (i.e. UNODC and the notorious Commission on Narcotic Drugs), still prevaricate on the issue. UNODC is the lead agency on IDU within the UN, but its director still often speaks of NSP programs with only moderate support.
In our IDU countries, we look primarily to WHO and UNAIDS to support our harm reduction programs. It's important to keep UNODC colleagues well informed, but we usually don't rely on them for strong, vocal support for harm reduction. We hope UNODC will continue to be more and more comfortable supporting harm reduction in the future.
Details below.
Rob
18th August 2009
UN Economic and Social Council Endorses Harm Reduction
http://www.ihra.net/News#UNEconomicandSocialCouncilEndorsesHarmReduction
In July 2009, the United Nation’s Economic and Social Council (ECOSOC) adopted a resolution related to the work of the Joint United Nations Programme on AIDS (UNAIDS). The resolution was agreed at an ECOSOC meeting in Geneva focusing on the social determinants of health. It contains an explicit supportive reference to harm reduction – the first official mention of harm reduction by this senior UN body.
The resolution “[r]ecognizes the need for UNAIDS to significantly expand and strengthen its work... to support increased capacity and resources for the provision of a comprehensive package of services for injecting drug users including harm reduction programmes”. The resolution was supported by 31 Member States (and was not opposed during the meeting), and follows on from another recent endorsement of harm reduction by the UNAIDS Programme Coordinating Board. This resolution is further evidence of the expanding acceptance and credibility of harm reduction approaches at the international level.
ECOSOC was one of the original UN bodies established under the United Nations Charter in 1945. It co-ordinates the work of a number of specialised UN agencies, programmes and commissions – including UNAIDS. The ECOSOC meetings serve as the central forum for discussing a broad range of issues such as standards of living, employment, economic and social progress, and health problems. Crucially, however, ECOSOC is also the ‘parent’ body of the central drug policy forum in the UN – the Commission on Narcotic Drugs. Unlike ECOSOC, CND which has yet to make an official, explicit endorsement of harm reduction, due in no small part to an over-reliance on consensus which has allowed a minority of Member States (including Japan, Russia and the USA) to actively oppose harm reduction during discussions and in the wording of resolutions. It will be interesting to see whether the ambiguous and incongruous position of CND changes now that harm reduction has been formally endorsed by ECOSOC as well as the UN General Assembly (the chief organ of the United Nations comprising all 192 Member States), and the Office of the High Commissioner for Human Rights.
Using heroin to treat addiction
The story below presents results from a new study showing the efficacy of using controlled prescription of heroin to reduce health and social harms among drug users, which proved to be more effective than prescribing methadone.
Rob
New York Times, 19 August 2009, journalist Benedict Carey
Study Backs Heroin to Treat Addiction
Top of Form
For years, European countries like Switzerland and the Netherlands have allowed doctors to provide some addicts with prescription heroin as an alternative to buying drugs on the street. The treatment is safe and keeps addicts out of trouble, studies have found, but it is controversial — not only because the drug is illegal but also because policy makers worry that treating with heroin may exacerbate the habit.
The study, appearing in the current issue of the New England Journal of Medicine, may put some of those concerns to rest.
“It showed that heroin works better than methadone in this population of users, and patients will be more willing to take it,” said Dr. Joshua Boverman, a psychiatrist at Oregon Health and Science University in Portland. Perhaps the biggest weakness of methadone treatment, Dr. Boverman said, is that “many patients don’t want to take it; they just don’t like it.”
In the study, researchers in Canada enrolled 226 addicts with longstanding habits who had failed to improve using other methods, including methadone maintenance therapy. Doctors consider methadone, a chemical cousin to heroin that prevents withdrawal but does not induce the same high, to be the best treatment for narcotic addiction. A newer drug, buprenorphine, is also effective.
The Canadian researchers randomly assigned about half of the addicts to receive methadone and the other half to receive daily injections of diacetylmorphine, the active ingredient in heroin. After a year, 88 percent of those receiving the heroin compound were still in the study, and two-thirds of them had significantly curtailed their illicit activities, including the use of street drugs. In the methadone group, 54 percent were still in the study and 48 percent had curbed illicit activities.
“The main finding is that, for this group that is generally written off, both methadone and prescription heroin can provide real benefits,” said the senior author, Martin T. Schechter, a professor in the School of Population and Public Health at the University of British Columbia.
Those taking the heroin injections did suffer more side effects; there were 10 overdoses and six seizures. But Dr. Schechter said there was no evidence of abuse. The average dosage the subjects took was 450 milligrams, well below the 1,000-milligram maximum level.
About 663,000 Americans are regular users of heroin, according to government estimates. The researchers said 15 percent to 25 percent of them were heavy users and could benefit from prescription heroin. That is, if they ever were to get the chance. Heroin is an illegal, Schedule 1 substance, meaning it has a high potential for abuse and serves no legitimate medical purpose. That designation is unlikely to change soon, researchers suspect.
In an editorial with the article, Virginia Berridge of the London School of Hygiene and Tropical Medicine concluded, “The rise and fall of methods of treatment in this controversial area owe their rationale to evidence, but they also often owe more to the politics of the situation.”
Link to story: http://www.nytimes.com/2009/08/20/health/research/20heroin.html?_r=1&ref=health
Rob
New York Times, 19 August 2009, journalist Benedict Carey
Study Backs Heroin to Treat Addiction
Top of Form
For years, European countries like Switzerland and the Netherlands have allowed doctors to provide some addicts with prescription heroin as an alternative to buying drugs on the street. The treatment is safe and keeps addicts out of trouble, studies have found, but it is controversial — not only because the drug is illegal but also because policy makers worry that treating with heroin may exacerbate the habit.
The study, appearing in the current issue of the New England Journal of Medicine, may put some of those concerns to rest.
“It showed that heroin works better than methadone in this population of users, and patients will be more willing to take it,” said Dr. Joshua Boverman, a psychiatrist at Oregon Health and Science University in Portland. Perhaps the biggest weakness of methadone treatment, Dr. Boverman said, is that “many patients don’t want to take it; they just don’t like it.”
In the study, researchers in Canada enrolled 226 addicts with longstanding habits who had failed to improve using other methods, including methadone maintenance therapy. Doctors consider methadone, a chemical cousin to heroin that prevents withdrawal but does not induce the same high, to be the best treatment for narcotic addiction. A newer drug, buprenorphine, is also effective.
The Canadian researchers randomly assigned about half of the addicts to receive methadone and the other half to receive daily injections of diacetylmorphine, the active ingredient in heroin. After a year, 88 percent of those receiving the heroin compound were still in the study, and two-thirds of them had significantly curtailed their illicit activities, including the use of street drugs. In the methadone group, 54 percent were still in the study and 48 percent had curbed illicit activities.
“The main finding is that, for this group that is generally written off, both methadone and prescription heroin can provide real benefits,” said the senior author, Martin T. Schechter, a professor in the School of Population and Public Health at the University of British Columbia.
Those taking the heroin injections did suffer more side effects; there were 10 overdoses and six seizures. But Dr. Schechter said there was no evidence of abuse. The average dosage the subjects took was 450 milligrams, well below the 1,000-milligram maximum level.
About 663,000 Americans are regular users of heroin, according to government estimates. The researchers said 15 percent to 25 percent of them were heavy users and could benefit from prescription heroin. That is, if they ever were to get the chance. Heroin is an illegal, Schedule 1 substance, meaning it has a high potential for abuse and serves no legitimate medical purpose. That designation is unlikely to change soon, researchers suspect.
In an editorial with the article, Virginia Berridge of the London School of Hygiene and Tropical Medicine concluded, “The rise and fall of methods of treatment in this controversial area owe their rationale to evidence, but they also often owe more to the politics of the situation.”
Link to story: http://www.nytimes.com/2009/08/20/health/research/20heroin.html?_r=1&ref=health
Mexico legalizes drug possession
See story from NYT below.
From a public health perspective, what's most encouraging about this is the stipulation that: "Anyone caught with drug amounts under the personal-use limit will be encouraged to seek treatment..."
Rob
August 21, 2009
Mexico Legalizes Drug Possession
By THE ASSOCIATED PRESS
MEXICO CITY (AP) — Mexico enacted a controversial law on Thursday decriminalizing possession of small amounts of marijuana, cocaine, heroin and other drugs while encouraging government-financed treatment for drug dependency free of charge.
The law sets out maximum “personal use” amounts for drugs, also including LSD and methamphetamine. People detained with those quantities will no longer face criminal prosecution; the law goes into effect on Friday.
Anyone caught with drug amounts under the personal-use limit will be encouraged to seek treatment, and for those caught a third time treatment is mandatory — although no penalties for noncompliance are specified.
Mexican authorities said the change only recognized the longstanding practice here of not prosecuting people caught with small amounts of drugs.
The maximum amount of marijuana considered to be for “personal use” under the new law is 5 grams — the equivalent of about four marijuana cigarettes. Other limits are half a gram of cocaine, 50 milligrams of heroin, 40 milligrams for methamphetamine and 0.015 milligrams of LSD.
President Felipe Calderón waited months before approving the law.
http://www.nytimes.com/2009/08/21/world/americas/21mexico.html?_r=1&scp=1&sq=mexican%20drug%20legislation&st=cse
From a public health perspective, what's most encouraging about this is the stipulation that: "Anyone caught with drug amounts under the personal-use limit will be encouraged to seek treatment..."
Rob
August 21, 2009
Mexico Legalizes Drug Possession
By THE ASSOCIATED PRESS
MEXICO CITY (AP) — Mexico enacted a controversial law on Thursday decriminalizing possession of small amounts of marijuana, cocaine, heroin and other drugs while encouraging government-financed treatment for drug dependency free of charge.
The law sets out maximum “personal use” amounts for drugs, also including LSD and methamphetamine. People detained with those quantities will no longer face criminal prosecution; the law goes into effect on Friday.
Anyone caught with drug amounts under the personal-use limit will be encouraged to seek treatment, and for those caught a third time treatment is mandatory — although no penalties for noncompliance are specified.
Mexican authorities said the change only recognized the longstanding practice here of not prosecuting people caught with small amounts of drugs.
The maximum amount of marijuana considered to be for “personal use” under the new law is 5 grams — the equivalent of about four marijuana cigarettes. Other limits are half a gram of cocaine, 50 milligrams of heroin, 40 milligrams for methamphetamine and 0.015 milligrams of LSD.
President Felipe Calderón waited months before approving the law.
http://www.nytimes.com/2009/08/21/world/americas/21mexico.html?_r=1&scp=1&sq=mexican%20drug%20legislation&st=cse
Thursday, August 20, 2009
Exchange Supplies
A few weeks ago, Rob posted a link to the Harm Reduction Works website to draw everyone's attention to some of the great materials available. If you haven't taken a look at them, I highly suggest it. Again, the website is http://www.harmreductionworks.org.uk/.
Harm Reduction Works is the product of Exchange Supplies and the National Treatment Agency. Check out some of the work of Exchange Supplies at http://www.exchangesupplies.org/. They are an innovative organization of drug workers that seek to improve injecting supplies, education tools, etc. to better serve people who use drugs. Their injection supplies include small changes - i.e. different colored plungers to reduce the risk of sharing - that make a big difference. Their campaigns on this site and on Harm Reduction Works are innovative and exciting - definitely worth a few minutes to check out their work.
Harm Reduction Works is the product of Exchange Supplies and the National Treatment Agency. Check out some of the work of Exchange Supplies at http://www.exchangesupplies.org/. They are an innovative organization of drug workers that seek to improve injecting supplies, education tools, etc. to better serve people who use drugs. Their injection supplies include small changes - i.e. different colored plungers to reduce the risk of sharing - that make a big difference. Their campaigns on this site and on Harm Reduction Works are innovative and exciting - definitely worth a few minutes to check out their work.
Wednesday, August 12, 2009
2010 Int'l Harm Reduction Conference - Liverpool, England
The abstract submission system for ‘Harm Reduction 2010’ - next year's Int'l Harm Reduction Conference in Liverpool, England - is now open and will close on November 1st 2009.
All delegates who wish to present at the conference – either orally or with a poster – are encouraged to make submissions about innovative harm reduction services, new or ground-breaking research, effective or successful advocacy campaigns, or key policy discussions or debates.
In addition, the Executive Programme Committee is particularly keen to receive abstract submissions related to the conference theme – ‘Harm Reduction: The Next Generation’, and have produced a ‘Guide for Developing and Submitting an Abstract’ to further assist delegates.
For more information about the conference, please go to:
http://www.ihra.net/Liverpool/Home
Cheers
Rob
All delegates who wish to present at the conference – either orally or with a poster – are encouraged to make submissions about innovative harm reduction services, new or ground-breaking research, effective or successful advocacy campaigns, or key policy discussions or debates.
In addition, the Executive Programme Committee is particularly keen to receive abstract submissions related to the conference theme – ‘Harm Reduction: The Next Generation’, and have produced a ‘Guide for Developing and Submitting an Abstract’ to further assist delegates.
For more information about the conference, please go to:
http://www.ihra.net/Liverpool/Home
Cheers
Rob
Friday, August 7, 2009
Harm Reduction Works
The website below, from a UK organization called Harm Reduction Works, provides links to a long list of superb materials (including short videos and other highly creative items) on various topics related to harm reduction.
http://www.harmreductionworks.org.uk/ordering.html
Check it out; you won't be disappointed.
Cheers
Rob
http://www.harmreductionworks.org.uk/ordering.html
Check it out; you won't be disappointed.
Cheers
Rob
Wednesday, August 5, 2009
Helping America's Least Wanted
See below an opinion piece published in the Washington Post arguing in favor of needle and syringe programs, notable mainly because it was written by a conservative commentator closely alligned with George Bush.
NSP is not a conservative or liberal issue. Iran (both the government and highest religious authorities) support NSP. So does the Chinese Communist Party. So too the governments of Malaysia, Uzbekistan, and Indonesia. Israel and Afghanistan are aligned on this issue. Every government of western Europe explicitly supports needle and syringe programs.
As of March 2009, harm reduction policies or programmes have been adopted in more than half of the 158 countries and territories where injecting drug use is reported.
For a complete list of the countries that support harm reduction, go to: http://www.ihra.net/Assets/1556/1/HarmReductionPoliciesandPractiveWorldwide5.pdf
Rob
Helping America's Least Wanted
By Michael Gerson
Wednesday, August 5, 2009
The RV arrived at a corner near D.C.'s Marvin Gaye Park, also known to locals as "Needle Park." A steady procession of addicts came to the door, mounted a few steps and sat down. One by one, they dropped used needles into a container and received new needles in return, along with alcohol wipes and the small, bottle-cap-like "cookers" in which heroin is heated.
Reggie Jackson, Teefari Mallory and Hazel Smith -- staff members at PreventionWorks, Washington's largest needle-exchange program -- are at the park twice a week, offering clean needles to prevent disease transmission, condoms, drug treatment referrals, HIV/AIDS testing and a few kind words. "You still play the guitar?" "You'll have a swollen hand if you keep going there." "Love you, baby."
It is the eyes and arms of addicts that draw your attention. Eyes that are glassy, or unnaturally bright, or tired beyond exhaustion. Arms that are ulcerated sticks or purpled parchment; with repeated use, needles become blunt and tear the skin. Some addicts adopt a defensive politeness -- "yes, sir" -- and quickly leave. Others want to talk -- "I love plants, and I love kids" -- trying to provide hints of their humanity. They are America's least wanted.
They are also at the center of a controversy. Needle-exchange programs have always been politically controversial, with opponents arguing that they send a mixed moral message about drug use. The House of Representatives recently passed an amendment banning exchanges in the District within 1,000 feet of places where children gather -- which, if approved by the Senate, would effectively put programs like PreventionWorks out of business. Staffers joke that they could work only in graveyards and the middle of the Potomac.
This restriction might make sense if needle-exchange programs increased the number of addicts. But they don't. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, has comprehensively reviewed the scientific studies on needle exchange. "It does not," he says, "result in an increase in drug abuse, and it does decrease the incidence of HIV. . . . The idea that kids are going to walk out of school and start using drugs because clean needles are available is ridiculous."
My experience in Washington was consistent with Fauci's view. Addicts who came for needles were generally in their 40s and 50s. The availability of clean needles no more caused their addiction than the provision of clean shot glasses would cause alcoholism.
The main purpose of needle exchange, according to Jackson, the supervisor of the mobile unit, is to keep people alive until they can get clean -- a process that can take years, if it happens at all. Needle-sharing is the third-leading cause of HIV infection in our nation's capital. It is also a major contributor to the spread of hepatitis C, the main cause of liver transplants in the United States. Jackson is well acquainted with these facts because, while an addict, he contracted both diseases. "If they had a truck like this in the '60s, '70s and '80s," he told me, "maybe I wouldn't have gotten infected."
The staff members of PreventionWorks build long-term relationships with people no one else knows by name. Because of this, they have a good feel for when addicts are ready for treatment. While I was in the RV, Jackson signed up two addicts for detox. Mallory used her own car to drive one addict, with whom she had been working for eight years, to treatment. "He's ready, ready to go," she said, fighting tears.
Critics claim that needle-exchange programs create a moral hazard by legitimizing drug abuse. But it does not legitimate drug abuse to help people with the clinical disease of addiction avoid other deadly diseases until they are ready for help. Sacrificing the lives of addicts to send an "unmixed" moral message actually sends a troubling moral message: that the unwanted have no worth.
As each addict leaves the RV, Smith -- who was an addict on the street herself four years ago -- tells them, "I love you." When I asked her why, she said: "If someone years ago had told me they loved me, it might not have been so long."
Street addicts are connected to the rest of us by only a few invisible strands -- people such as Smith, Jackson and Mallory -- and those strands should not be severed.
mgerson@globalengage.org
NSP is not a conservative or liberal issue. Iran (both the government and highest religious authorities) support NSP. So does the Chinese Communist Party. So too the governments of Malaysia, Uzbekistan, and Indonesia. Israel and Afghanistan are aligned on this issue. Every government of western Europe explicitly supports needle and syringe programs.
As of March 2009, harm reduction policies or programmes have been adopted in more than half of the 158 countries and territories where injecting drug use is reported.
For a complete list of the countries that support harm reduction, go to: http://www.ihra.net/Assets/1556/1/HarmReductionPoliciesandPractiveWorldwide5.pdf
Rob
Helping America's Least Wanted
By Michael Gerson
Wednesday, August 5, 2009
The RV arrived at a corner near D.C.'s Marvin Gaye Park, also known to locals as "Needle Park." A steady procession of addicts came to the door, mounted a few steps and sat down. One by one, they dropped used needles into a container and received new needles in return, along with alcohol wipes and the small, bottle-cap-like "cookers" in which heroin is heated.
Reggie Jackson, Teefari Mallory and Hazel Smith -- staff members at PreventionWorks, Washington's largest needle-exchange program -- are at the park twice a week, offering clean needles to prevent disease transmission, condoms, drug treatment referrals, HIV/AIDS testing and a few kind words. "You still play the guitar?" "You'll have a swollen hand if you keep going there." "Love you, baby."
It is the eyes and arms of addicts that draw your attention. Eyes that are glassy, or unnaturally bright, or tired beyond exhaustion. Arms that are ulcerated sticks or purpled parchment; with repeated use, needles become blunt and tear the skin. Some addicts adopt a defensive politeness -- "yes, sir" -- and quickly leave. Others want to talk -- "I love plants, and I love kids" -- trying to provide hints of their humanity. They are America's least wanted.
They are also at the center of a controversy. Needle-exchange programs have always been politically controversial, with opponents arguing that they send a mixed moral message about drug use. The House of Representatives recently passed an amendment banning exchanges in the District within 1,000 feet of places where children gather -- which, if approved by the Senate, would effectively put programs like PreventionWorks out of business. Staffers joke that they could work only in graveyards and the middle of the Potomac.
This restriction might make sense if needle-exchange programs increased the number of addicts. But they don't. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, has comprehensively reviewed the scientific studies on needle exchange. "It does not," he says, "result in an increase in drug abuse, and it does decrease the incidence of HIV. . . . The idea that kids are going to walk out of school and start using drugs because clean needles are available is ridiculous."
My experience in Washington was consistent with Fauci's view. Addicts who came for needles were generally in their 40s and 50s. The availability of clean needles no more caused their addiction than the provision of clean shot glasses would cause alcoholism.
The main purpose of needle exchange, according to Jackson, the supervisor of the mobile unit, is to keep people alive until they can get clean -- a process that can take years, if it happens at all. Needle-sharing is the third-leading cause of HIV infection in our nation's capital. It is also a major contributor to the spread of hepatitis C, the main cause of liver transplants in the United States. Jackson is well acquainted with these facts because, while an addict, he contracted both diseases. "If they had a truck like this in the '60s, '70s and '80s," he told me, "maybe I wouldn't have gotten infected."
The staff members of PreventionWorks build long-term relationships with people no one else knows by name. Because of this, they have a good feel for when addicts are ready for treatment. While I was in the RV, Jackson signed up two addicts for detox. Mallory used her own car to drive one addict, with whom she had been working for eight years, to treatment. "He's ready, ready to go," she said, fighting tears.
Critics claim that needle-exchange programs create a moral hazard by legitimizing drug abuse. But it does not legitimate drug abuse to help people with the clinical disease of addiction avoid other deadly diseases until they are ready for help. Sacrificing the lives of addicts to send an "unmixed" moral message actually sends a troubling moral message: that the unwanted have no worth.
As each addict leaves the RV, Smith -- who was an addict on the street herself four years ago -- tells them, "I love you." When I asked her why, she said: "If someone years ago had told me they loved me, it might not have been so long."
Street addicts are connected to the rest of us by only a few invisible strands -- people such as Smith, Jackson and Mallory -- and those strands should not be severed.
mgerson@globalengage.org
Effectiveness of NSP to reduce HIV / HEP
The below article provides some fresh evidence linking NSP with reduced HIV transmission, from Australia. The authors also estimate that "if syringe distribution or coverage doubled, then annual incidence is likely to reduce by 50%." More evidence that getting needles into the drug user networks in generous quanitities reduces HIV.
Having these sources, published in the most respected journals in our field, provides us with strong evidence to help in our advocacy efforts to launch and scale up harm reduction services for IDUs.
The full article is not yet available pulically for free - just this abstract.
Rob
JAIDS Journal of Acquired Immune Deficiency Syndromes:
August 2009 - Volume 51 - Issue 4 - pp 462-469
doi: 10.1097/QAI.0b013e3181a2539a
The Impact of Needle and Syringe Programs on HIV and HCV Transmissions in Injecting Drug Users in Australia: A Model-Based Analysis
Kwon, Jisoo A BSc; Iversen, Jenny; Maher, Lisa; Law, Matthew G; Wilson, David P
Abstract
Objectives: We aim to estimate how changes in sterile syringe distribution through needle-syringe programs (NSPs) may affect HIV and hepatitis C virus (HCV) incidence among injecting drug users (IDUs) in Australia.
Methods: We develop a novel mathematical model of HIV and HCV transmission among IDUs who share syringes. It is calibrated using biological and Australian epidemiological and behavioral data. Assuming NSP syringe distribution affects the number of times each syringe is used before disposal, we use the model to estimate the relationship between incidence and syringe distribution.
Results: HIV is effectively controlled through NSP distribution of sterile syringes {with the effective reproduction ratio below 1 [0.66 median, interquartile range (0.63-0.70)] under current syringe distribution}. In contrast, HCV incidence is expected to remain high and its control is not feasible in the foreseeable future. The proportion of injections that are shared and the number of times each syringe is used before disposal are the driving factors of HCV incidence. The frequency in which each syringe is used can potentially be influenced by changes in syringe distribution. We estimate that if syringe distribution or coverage doubled, then annual incidence is likely to reduce by 50%. However, if it was decreased to one third of the current level, then ∼3 times the incidence could be expected.
Conclusions: This research highlights the large benefits of NSPs, puts forward a quantitative relationship between incidence and syringe distribution, and indicates that increased coverage could result in significant reductions in viral transmissions among IDUs.
Having these sources, published in the most respected journals in our field, provides us with strong evidence to help in our advocacy efforts to launch and scale up harm reduction services for IDUs.
The full article is not yet available pulically for free - just this abstract.
Rob
JAIDS Journal of Acquired Immune Deficiency Syndromes:
August 2009 - Volume 51 - Issue 4 - pp 462-469
doi: 10.1097/QAI.0b013e3181a2539a
The Impact of Needle and Syringe Programs on HIV and HCV Transmissions in Injecting Drug Users in Australia: A Model-Based Analysis
Kwon, Jisoo A BSc; Iversen, Jenny; Maher, Lisa; Law, Matthew G; Wilson, David P
Abstract
Objectives: We aim to estimate how changes in sterile syringe distribution through needle-syringe programs (NSPs) may affect HIV and hepatitis C virus (HCV) incidence among injecting drug users (IDUs) in Australia.
Methods: We develop a novel mathematical model of HIV and HCV transmission among IDUs who share syringes. It is calibrated using biological and Australian epidemiological and behavioral data. Assuming NSP syringe distribution affects the number of times each syringe is used before disposal, we use the model to estimate the relationship between incidence and syringe distribution.
Results: HIV is effectively controlled through NSP distribution of sterile syringes {with the effective reproduction ratio below 1 [0.66 median, interquartile range (0.63-0.70)] under current syringe distribution}. In contrast, HCV incidence is expected to remain high and its control is not feasible in the foreseeable future. The proportion of injections that are shared and the number of times each syringe is used before disposal are the driving factors of HCV incidence. The frequency in which each syringe is used can potentially be influenced by changes in syringe distribution. We estimate that if syringe distribution or coverage doubled, then annual incidence is likely to reduce by 50%. However, if it was decreased to one third of the current level, then ∼3 times the incidence could be expected.
Conclusions: This research highlights the large benefits of NSPs, puts forward a quantitative relationship between incidence and syringe distribution, and indicates that increased coverage could result in significant reductions in viral transmissions among IDUs.
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