Tuesday, June 29, 2010

"Methadone Man" and "Buprenorphine Babe"

A new multimedia campaign has been launched to support the roll out of Methadone and buprenorphine to help drug users stop injection, reduce HIV risk, and stay on AIDS treatment.

These essential medicines are available to less than 10% of the people worldwide who need them most.

The campaign features "Methadone Man" and "Buprenorphine Babe" in an innovative cartoon-style action story.

The materials are interesting and highly creative. Be careful about using them in your country, as I suspect that the campaign style might not appeal to people who are still not fully supportative of Methadone and buprenorphine. Two campaign websites linked up, below.



Friday, June 25, 2010

UNODC releases World Drug Report 2010

The UNODC launched the World Drug Report 2010 today. Taking part in the launch were UNODC Executive Director Antonio Maria Costa, Viktor Ivanov, Director of the Federal Drugs Control Service of the Russian Federation, and Gil Kerlikowske, Director of the White House Office of National Drug Control Policy.

The Report shows that drug use is shifting towards new drugs and new markets. Drug crop cultivation is declining in Afghanistan (for opium) and the Andean countries (coca), and drug use has stabilized in the developed world. However, there are signs of an increase in drug use in developing countries and growing abuse of amphetamine-type stimulants and prescription drugs around the world.

Click here to read a summary and to link to the report.


Harm Reduction Posters Online

Link to the below site for a set of quite good harm reduction posters, posted on line:



Monday, June 21, 2010

Safe Injecting Rooms

Australians are debating whether or not to expand the use of safe injecting rooms, which have been shown to reduce risk behaviors, deaths from overdose, and even street-based crime in many of the 76 sites around the world where they now exist.

Below is an opinion piece by renowned drug expert Robert Power, laying out the case for injecting rooms.

Most safe injecting rooms are in the developed world, leaving IDUs we serve in the developing world (once again) under-served and out in the cold, quite literally. In the future, PSI countries working with IDUs should consider whether or not to add injecting rooms to their marketing mix. Obviously, this would require a good enabling environment from the government. But the evidence base around this kind of intervention is getting quite strong. Something to think about, for the future.


Injecting rooms benefit all, not just drug users
June 22, 2010

The evidence is in, and Victorians must decide how best to use it.

LOTTE believes Sydney's supervised injecting room saved her life. "I've overdosed before, when I was living rough … was lucky, my mate called the ambos and they brought me round." She'd injected in a hurry, in a car, concerned that police were close by. The heroin was too strong and she passed out.

Now she attends the Sydney facility, where she can take her drugs in a secure environment, with medically trained staff close by. "They give us clean needles and teach us safe ways to inject. They talk to us like people, not junkies, tell us where we can get help for other stuff. If I hadn't gone there, I'd be dead on the streets, I know I would." She talks about trying to get off heroin, but hasn't made it yet. "I know when I'm ready they'll help me out."

A decade has passed since supervised injecting places were last seriously considered (and then rejected) as an option for Victoria. But the debate - and, more significantly, the evidence - has moved on from the days of the Bracks government. It is now timely for a considered and dispassionate review of this harm reduction option. Supervised injecting rooms have been around for 20 years, providing clean and safe places for drug users to inject. Of the 76 around the world, mainly in Europe, Scandinavia and North America, there's just one in Australia, in Sydney's Kings Cross.

The evidence points to three main conclusions: the facilities reap benefits for individual and public health; they render improvements in public amenity and community well-being; and they need to be part of a broader harm reduction response.

The facilities attract the most marginalised and stigmatised drug users: the homeless, sex workers, former prisoners, frequent injectors, and poly-drug users. Of Sydney's clients, three-quarters had never previously been in contact with a drug agency, and these are the ones most likely to be engaged in high-risk activities, such as needle sharing. For them, life on the street is unhygienic and often dangerous, leaving them vulnerable and liable to injecting drugs in dirty, rushed conditions, where overdoses, needle sharing and injuries linked to poor injecting techniques are everyday realities.

Evidence from across the globe shows that supervised injecting rooms can ameliorate these problems. Sydney's has attracted more than 12,000 vulnerable clients in nine years and supervised more than half a million injections: injections that took place off the streets, away from the public, with safe disposal of injecting material.

A Burnet Institute study found that two-thirds of injectors in Melbourne last injected in a public place, mainly in cars, streets, parks and in the stairwells of public buildings. This is not only inappropriate for the injector, but also bad for the local population, raising concerns about discarded needles and general security and safety.

Overdose is a huge risk to drug users on the street, as Lotte's experience shows. The Sydney facility has dealt with 3500 cases of overdose, with no fatalities. Indeed, no overdose fatalities have been recorded at any supervised injecting room anywhere in the world. Aside from the personal and familial tragedies averted, there are cost savings from thousands less overdose cases for ambulances and emergency rooms.

If we factor in the primary healthcare these facilities offer, alongside problems deflected through teaching injecting techniques, then the cost benefits and returns on investment increase.

Some European facilities have "contact cafes" where drug users can relax with staff and peers, receiving health promotion, counselling and much-needed trust building. A fifth of Sydney's clients were referred to health and social services, including drug treatment.

What of concerns over a "honey-pot" effect? The Sydney and Vancouver evaluations showed that drug dealing, drug acquisition crime and rates of new drug injectors have not increased in their environs. Indeed, many reported reduced crime and the closure of illegal "shooting galleries" in the surrounding areas. This improves local communities, with less visible signs of drug use, notably public injecting and discarded needles.

So where to for Melbourne and Victoria? First and foremost we need to be guided by the evidence. We must accept that some Victorians will continue to use illicit drugs and a smaller proportion will inject. Some may wish to stop using drugs, and these facilities, through their own staff efforts and referral networks, can help.

Harm reduction is based on a hierarchy of needs that equally well supports efforts towards abstinence alongside other public health goals. But for those who stumble and fall, we need to offer comprehensive harm reduction services to keep them healthy and protect society from drug-related harm.

For supervised injecting rooms to function effectively, there needs to be community and political support, engagement and collaboration with healthcare services and other agencies. The rooms need to be in places where drug users congregate and may be integrated into existing services, such as needle-exchange programs, or even as mobile units.

And supervised injecting rooms must be adequately funded, but not at the expense of other vital harm reduction services. In short, the evidence is there. It's now over to Victorians to decide how to use it.

Professor Robert Power is principal for disease prevention at the Burnet Institute.

Monday, June 14, 2010

Global Fund calls for Round 10 applications to include harm reduction

For the first time, the Global Fund has released an Information Note explicitly calling for countries to look for opportunities to launch and scale up harm reduction programs for IDUs through the GF rounds-based applications. (R10 applications are due on August 20th, 2010.)

Click here to read the document.

PSI countries thinking about applying for R10 funding for HIV and/or TB work with IDUs, can get support from the HIV Department to write the proposal. Contact Rob (robgray@laopdr.com) or Petra (pstankard@psi.org)


Monday, June 7, 2010

Interesting new article on the effectiveness of harm reduction, below.


The effectiveness of harm reduction in preventing HIV among injecting drug users

Alex Wodak and Lisa Maher

New South Wales Public Health Bulletin , Volume 21 Number 4 2010 pp. 69-73



There is now compelling evidence that harm reduction approaches to HIV prevention among injecting drug users are effective, safe and cost-effective. The evidence of effectiveness is strongest for needle and syringe programs and opioid substitution treatment. There is no convincing evidence that needle and syringe programs increase injecting drug use. The low prevalence (,1%) of HIV among injecting drug users reflects the early adoption and rapid expansion of harm reduction in Australia. Countries that have provided extensive needle and syringe programs and opioid substitution treatment appear to have averted an epidemic, stabilised or substantially reduced the prevalence of HIV among injecting drug users. However, despite decades of vigorous advocacy and scientific evidence, the global coverage of needle and syringe programs and opioid substitution treatment falls well short of the levels required to achieve international HIV control.