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Buprenorphine: WHO recommends no change to current international scheduling
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Further to an international campaign, concern expressed by various governments, and expert evidence, the WHO Expert Committee of Drug Dependence has decided not to recommend the rescheduling of buprenorphine.
The International Narcotics Control Board has been pushing to move buprenorphine from the 1971 Convention on Psychotropic Drugs into the more stringent 1961 Single Convention. Many feared that such a move would result in national governments putting the drug under tighter control, making buprenorphine less available for the medical treatment of opioid dependence and as an analgesic.
Buprenorphine is on the WHO Essential Drugs List. It is important in the scaling up of substitution treatment, and often used in countries where legal restriction or medical prejudice restricts the availability of methadone. It is recognised as contributing to the prevention and treatment of HIV/AIDS.
Over 160 organizations in 40 countries had joined the campaign against rescheduling. Gerry Stimson, IHRA's Executive Director, gave expert evidence at the Geneva meeting of the ECDD (28 - 31 March 2006) of the potential impact of rescheduling on the global effort against HIV/AIDS.
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Professor Gerry Stimson – keynote speaker at alcohol conference in Scotland
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On February 22, 2006 the alcohol conference “Harm Reduction? The Way Forward” organised by Alcohol Focus Scotland conference took place in Glasgow. The aim of the conference was to explore what “harm reduction” means in the context of alcohol.
The participants also discussed and identified practical measures that can be used to combat alcohol-related harm.
Keynote speaker Prof. Gerry Stimson, Executive Director of the International Harm Reduction Association, explained that drinking and drunken behaviours are socially patterned and can therefore be changed to reduce harm. In his presentation, he suggested that policy should aim to maximise pleasure and minimise harm.
Please visit www.alcohol-focus-scotland.org.uk for the conference summary.
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Commission on Narcotic Drugs - more support for harm reduction
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The Commission on Narcotic Drugs (CND) is the central policy-making body within the United Nations system dealing with drug-related matters.
Key highlights of the 49th Session of the Commission on Narcotic Drugs - 13-17 March 2006 were (a) a resolution supporting drug users' access to HIV and hepatitis prevention, (b) numerous countries endorsed harm reduction in CND plenary session, and (c) a resolution supporting civil society participation in drug demand reduction and preparations for 10th anniversary of 1998 UNGASS.
Daniel Wolfe and Jonathon Cohen from the Open Society Institute International Harm Reduction Development Program provide the following report:
CND supports drug users' access to HIV and hepatitis prevention
The Commission on Narcotic Drugs approved a resolution. Responding to the Prevalence of HIV/AIDS and Other Blood-Borne Diseases among Drug Users, “that supports drug users' access to a variety of HIV and hepatitis prevention measures.” As in previous years, all mentions of access to sterile injection equipment were struck from the resolution. However, the resolution invited member states to take three important steps:
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- To facilitate access to "different types of prevention, treatment and care" for drug abuse, HIV/AIDS and hepatitis;
- To make efforts to promote access to health and social care for drug users and their families and to cooperate with non-governmental organizations; and
- To provide access to "measures that have been shown to be effective in reducing the risk of HIV, hepatitis and other blood borne diseases among injecting and other drug users," in conformity with national law and international drug conventions.
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The reference to "international drug conventions" in the resolution can be interpreted different ways. The United States made it clear that it views needle exchange programs as facilitating continued drug abuse and thus violating the conventions. Numerous other countries take the position that needle exchange is consistent with the conventions.
The resolution also referenced recent decisions of the Programme Coordinating Board (PCB) of the UNAIDS. This could be interpreted as an endorsement of the June 2005 global HIV prevention paper adopted at the PCB, which supported access to sterile injection equipment.
Countries endorse harm reduction in CND plenary session
In a CND plenary session on drug demand reduction, several countries and the European Union endorsed harm reduction as an important component of HIV prevention among injecting drug users, and endorsed the HIV prevention strategy adopted by UNAIDS.
The European Union, represented by Austria, called attention to the "alarming situation with regard to HIV/AIDS" among injecting drug users, and "especially welcomed" the recent adoption of a new UNAIDS strategy that endorsed needle and syringe programs as part of a comprehensive approach to HIV prevention.
Belgium added that it "strongly backs" the UNAIDS strategy and has succeeded in reducing HIV risk among drug users through "official needle exchange programs."
Ukraine acknowledged that a majority of people with HIV in the country were injecting drug users, and that it was "in full solidarity with the European Union" in addressing this problem.
Ukraine said it was piloting methadone substitution programs as part of its effort to enrol 8,000 drug users in substitution therapy.
Switzerland backed the UNAIDS prevention strategy and stated that its HIV prevention policy "devotes a significant place to risk reduction."
Norway endorsed the European Union statement and said it was undertaking an "enormous expansion" of drug treatment through "medication-assisted rehabilitation" with methadone, buprenorphine, and trial naltrexone.
Iran said it was experiencing an increase in injection-related HIV and hepatitis C due to trafficking of opium from neighbouring Afghanistan. It said it was addressing this epidemic through treatment for addiction and sexually transmitted diseases, methadone therapy including in prisons, and needle and syringe programs.
Brazil cited its "strenuous efforts" to contain HIV and other blood- borne diseases among injecting drug users, stating that "harm reduction has been shown by scientific evidence to be effective, contributing to the protection of human rights and the advancement of policies that promote public health and social inclusion."
Brazil estimated that 76% of injecting drug users in the country have access to harm reduction services, contributing to a 62% reduction in HIV cases among injecting drug users since 1994. It stated that harm reduction is "part of demand reduction" and "needs to be firmly on the policy agenda."
Denmark endorsed the European Union statement and focused the rest of its remarks on cannabis.
The United States and Russia, two countries that have steadfastly opposed harm reduction at the CND, did not address the plenary session on drug demand reduction.
Japan, also an opponent of harm reduction, stated that its demand reduction activities focused on "primary prevention" and raising awareness among young people about the dangers of drug use.
Civil society and UNGASS
An additional CND resolution supported civil society engagement in the preparations for the tenth anniversary of the 1998 UN General Assembly Special Session (UNGASS) on drugs. A third, which had called for the involvement of civil society, the World Health Organization, and UNAIDS in the evaluation of progress since that
1998 session, was amended to remove mention of WHO, UNAIDS, or civil society.
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Former IHRA President Alex Wodak meets President Bill Clinton
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President Clinton has often spoken publicly since leaving office of the great and growing dangers of the HIV epidemic. In Sydney, Australia, on 22 February he signed a Memorandum of Understanding on behalf of the Clinton Foundation with AusAID, the Australian government aid organisation, regarding forthcoming joint HIV/AIDS projects in Asia. The establishment of a new major Australian business community AIDS initiative in Asia was also announced at the same reception.
During the reception, Dr Alex Wodak, former President of the International Harm Reduction Association (1996-2004) told President Clinton (1992-2000), the 42nd President of the USA, that injecting drug users now accounted for one third of new HIV infections outside Africa but that effective prevention strategies were known but all too often blocked by an entrenched commitment to inflexible drug law enforcement approaches.
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IHRA launches alcohol harm reduction initiative
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Alcohol is a source of relaxation and pleasure in many societies, but is also associated with personal and public harms.
IHRA is committed to reducing harms from all psychoactive drugs, and is therefore launching this new initiative which aims to put alcohol harm reduction high on the agenda for harm reduction practitioners, national governments and international organizations. Prof Gerry Stimson, IHRA’s Executive Director says that ‘Alcohol is highly amenable to harm reduction interventions, the aim is to make drinking safer and at the same time reduce harms to the individual and the community – it’s a matter of finding ways to maximize the benefits and minimize the harms’.
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