Wednesday, July 28, 2010

Why Overdose Matters for HIV

For most drug users and people who work with them, overdose is an urgent issue. Many AIDS, harm reduction, and other drug service organizations have created programs to educate people who use drugs about overdose prevention and response techniques; to distribute naloxone—a safe and highly effective opioid overdose antidote that is included in the World Health Organization’s Model List of Essential Medicines; and to document the extent of overdose and the success of responses. But funding has been limited.

Recently, the Global Fund to Fight AIDS, Tuberculosis and Malaria and PEPFAR both issued guidance that they will support these kinds of overdose prevention activities. Service providers should ensure that overdose services are available to their drug-using clients directly or through local referral networks.

This document, prepared by overdose experts Matt Curtis and Nab Dasgupta for OSI and EHRN, presents evidence and arguments that organizations can make to AIDS funders to show that overdose prevention and response matter for HIV programming.

The document is available in English and Russian at this link:

For your reference:
The Global Fund’s harm reduction information note for Round 10:
PEPFAR’s IDU Guidance:

Lowering the Threshold: Models of Accessible Methadone and Buprenorphine Treatment

Deemed “essential medicines” by the World Health Organization, methadone and buprenorphine treatment help reduce drug injection and drug-related crime and improve public order, family satisfaction, return to employment, and adherence to HIV treatment.

Unfortunately, even when methadone or buprenorphine are available, treatment fails to reach many of those who could benefit. One reason for this is the many requirements—including admission restrictions, limited hours of operation, waiting lists, and cumbersome prescription and storage requirements—that make it difficult for patients to enter treatment programs.

Lowering the Threshold: Models of Accessible Methadone and Buprenorphine Treatment documents low-threshold methadone and buprenorphine programs—that is, programs that seek, in the spirit of harm reduction, to meet patients “where they’re at” and minimize bureaucratic requirements.

Lowering the Threshold includes the following topics:
• Methadone on Demand: The Hong Kong Model
• Treatment by Prescription in France
• Slovenia: High Coverage, Low HIV Prevalence
• Widespread and Uncontroversial: Methadone and Buprenorphine in Croatia
• Methadone by Bus in Amsterdam
• Vancouver: Integrated Low-threshold Models of Care

Lowering the Threshold is available in Russian and English at this link:

Thursday, July 22, 2010

Lancet series on people who use drugs

HIV in people who use drugs
Launched in Vienna, Austria, July 20, 2010

Executive summary
Almost three decades after the discovery of HIV, this Series highlights the threat of a largely unpublicised and growing HIV epidemic: in people who use drugs. While large gains have been made in fighting the epidemic in the general population, socially marginalised populations such as people who use drugs, who often enter prison systems, continue to suffer great stigma and lack of access to treatments that can save both their own lives and prevent HIV transmission to others. “Complacency about the HIV /AIDS epidemic now would be a terrible mistake,” says Lancet Editor Dr Richard Horton.

The Series tackles the myths surrounding HIV and people who use drugs, and subjects as diverse as women and drugs to the effect of amphetamines, alcohol, and human rights on the epidemic. The issues surrounding antiretroviral HIV treatment, opioid substitution therapy, and needle and syringe programmes are covered in depth, as are the social issues around decriminalisation of drug users and reducing intimidation, stigmatisation, and imprisonment of drug users.

Follow this link to view articles.


Thursday, July 15, 2010

Those important 2 Weeks After Release...

An interesting article is out showing a much higher risk of death among drug users in the the first 2 weeks after release from prison.

This is precisely the kind of evidence that enables us to zero in on the right times and places (the "Place" P) to deliver components of our Marketing Mix.

Abstract pasted below.


Meta-analysis of drug-related deaths soon after release from prison

Elizabeth L. C. Merrall

Aims The transition from prison back into the community is particularly hazardous for drug-using offenders whose tolerance for heroin has been reduced by imprisonment. Studies have indicated an increased risk of drug-related death soon after release from prison, particularly in the first 2 weeks. For precise, up-to-date understanding of these risks, a meta-analysis was conducted on the risk of drug-related death in weeks 1 + 2 and 3 + 4 compared with later 2-week periods in the first 12 weeks after release from prison.

Methods English-language studies were identified that followed up adult prisoners for mortality from time of index release for at least 12 weeks. Six studies from six prison systems met the inclusion criteria and relevant data were extracted independently.
Results These studies contributed a total of 69 093 person-years and 1033 deaths in the first 12 weeks after release, of which 612 were drug-related. A three- to eightfold increased risk of drug-related death was found when comparing weeks 1 + 2 with weeks 3–12, with notable heterogeneity between countries: United Kingdom, 7.5 (95% CI: 5.7–9.9); Australia, 4.0 (95% CI: 3.4–4.8); Washington State, USA, 8.4 (95% CI: 5.0–14.2) and New Mexico State, USA, 3.1 (95% CI: 1.3–7.1). Comparing weeks 3 + 4 with weeks 5–12, the pooled relative risk was: 1.7 (95% CI: 1.3–2.2).

Conclusions These findings confirm that there is an increased risk of drug-related death during the first 2 weeks after release from prison and that the risk remains elevated up to at least the fourth week.

Tuesday, July 13, 2010

Harm Reduction at the 2010 AIDS Conference

For those of you going to the Int'l AIDS Conference in Vienna, please take a look at this useful summary of some of the main conference presentations and events related to Harm Reduction, available at the link here.


Monday, July 5, 2010

Vienna Declaration

As many of you know, the 18th International AIDS Conference will begin in Vienna, Austria in less than two weeks. The Vienna Declaration is "a statement seeking to improve community health and safety by calling for the incorporation of scientific evidence into illicit drug policies." This is the official declaration of the conference and we encourage you to read and sign-on. Learn more at:

Take Home Naloxone

An interesting study came out in the journal "Drugs: Education, Prevention and Policy". Entitled, "Responsible management and use of a personal take-home naloxone supply: A pilot project", Scottish researchers reported on the success of a program designed to train people who use drugs to administer naloxone and to provide a take home supply of the drug. The study found that after six months, 89% of study participants reported that they still had their naloxone at home, ready for use. Two individuals reported using the naloxone during an overdose.

The study results shows that people who use drugs can be trained to administer naloxone and to keep a stock of naloxone in their home. This contributes to a growing evidence-base that proves naloxone can and should be provided for home administration. This is where the majority of overdoses occur, and by putting naloxone in the hands of the people that need it most, we save lives.

PSI is working to build access to naloxone in Russia. If you're interested in introducing naloxone programs in your platform, contact Rob or Petra for more information.

Saturday, July 3, 2010

Harm Reduction Certificate from York University

As your harm reduction program expands, it may be wise to consider building the capacity of your team members in a more formal way. York University offers a Certificate in Harm Reduction, described below.



The Certificate in Harm Reduction consists of 117-hours of instruction designed to introduce service providers, administrators and policy makers to the principles, concepts and practices of harm reduction, to provide an opportunity to critically examine examples of harm reduction work; and to become familiar with strategies for mobilizing support for and developing harm reduction programs in communities, families and institutions.

Participants who complete all evaluative components will receive a Certificate in Harm Reduction from York University.