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29th August 2008
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Overdose Awareness Day: Report from Eastern Europe and Central Asia
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The Eurasian Harm Reduction Network (EHRN) have launched a new report – timed to coincide with the International Overdose Awareness Day on 31st August – which reviews the situation regarding drug overdose epidemiology, services, knowledge and policies in Latvia, Kyrgyzstan, Russia, Romania and Tajikistan. The report was funded by the World Health Organization Regional Office for Europe.
Though overdose-related deaths are largely preventable, they remain one of the leading causes of death among people who inject drugs around the world. In Russia, for example, official statistics indicate that there were at least 7,500 overdose deaths in 2006. However, a range of effective harm reduction interventions exist to reduce overdose mortality – including the distribution of Naloxone (an overdose antidote that is listed by the World Health Organization as an ‘Essential Medicine’), awareness building and training amongst people who use drugs, the provision of opiate substitution treatments, and supervised injecting facilities.
August 31st each year marks Overdose Awareness Day and people from around the world are invited to remember those who have died or are suffering permanent injury from drug overdoses. The event – marked by silver ribbons – is also used around the world to call for better harm reduction policies and services. For the people who use drugs, this event can also show them that people do care.
This year, to accompany the report, EHRN have also released a press release, a short background document, and a reading list. The aim of these resources is to highlight the situation in Eastern Europe and Central Asia and make recommendations for action. According to EHRN Executive Director Raminta Stuikyte, “We can stop this with better access to education, drug treatment and medications like Naloxone. It’s about recognising people who use drugs as valued human beings, and working with them to help them protect themselves. In 2008, no one should be dying from a heroin overdose”.
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25th August 2008
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New Guide to Opioid Substitution Treatment in Custodial Settings
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In many parts of the world, opioid dependent people are over-represented in prisons. In Europe, Asia, and North America, they represent about one third of the prison population – and up to 80% in some countries in Central Asia. In sub-Saharan Africa, the problem is also rapidly emerging. As a result, access to opioid substitution therapy (OST) is an important harm reduction issue in prison systems around the world.
In order to address this, a new document has been published to support prison doctors, health care workers, prison administrators, NGOs and others to deliver or support substitution treatment for opioid dependent prisoners. The document – ‘Opioid Substitution Treatment in Custodial Settings: A Practical Guide’ – was written by Andrej Kastelic, Jörg Pont and Heino Stöver and is based on the expertise of scientists, medical doctors, psychiatrists and healthcare professionals working in the field. The guide also reflects the recommendations on prison health and harm reduction that have been produced by the World Health Organisation, UNAIDS and the UN Office on Drugs and Crime.
The Practical Guide is based on the principle that everybody in the prison system has a key part to play in ensuring the best treatment for prisoners, and also in ensuring that drug-related harm is reduced as much as possible. It is hoped that, through the recommendations in this Guide, healthier environments for prisoners with drug dependence will be created, health standards and practices will be improved, and prison staff will be trained and supported in their work.
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25th August 2008
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Harm Reduction Activities at the XVII International AIDS Conference
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Following on from the successes at the 2006 event in Toronto, the harm reduction community worked together to deliver a wide range of activities at the XVII International AIDS Conference in Mexico City in August 2008. Two key harm reduction advocates were integrally involved in the conference organisation – Pascal Tanguay from the Asian Harm Reduction Network (who sat on the Conference Coordination Committee and ensured support for harm reduction at the highest levels of conference organisation) and Marcus Day from the Caribbean Harm Reduction Coalition and the IHRA Executive Committee (who was a member of the Community Programme Committee and the Co-Chair of the Global Village Organising Committee). As a result of the work of these two key figures – and several other individuals and organisations – harm reduction had a highly visible focus and profile throughout the event.
In the ‘Global Village’ (the open access area of the conference for networking and civil society involvement), two dedicated ‘zones’ – one for ‘Harm Reduction’ and one for ‘Human Rights’ – were placed adjacent to one another in order to secure over 180 square meters of space in which a programme of workshops, presentations and panel discussions was delivered alongside skills sessions, film screenings and daily receptions. The space – coordinated by the Canadian HIV/AIDS Legal Network and funded by the Open Society Institute – offered space for relaxation and respite from the larger event (which attracted around 22,000 delegates). The zones were also used to coordinate the provision of opiate substitution treatments (OST) for people who use drugs – which was facilitated by Pascal Tanguay, Marcus Day, the International Network of People who Use Drugs (INPUD), and the International AIDS Society (IAS). This was the first time that OST were made available to delegates and it was a landmark as no OST services were previously available in Mexico.
In addition, the Global Village also featured ‘Youth Pavilion’, for which the sub-committee was co-chaired by Caitlin Padgett from Youth RISE – the international youth network for harm reduction. This area featured workshops, skills building sessions and other youth-centered activities over five days. The key themes for the Pavilion were ‘Rights’, ‘Respect’, ‘Responsibilities’ and ‘Resources’.
Harm reduction also received a strong focus in the mainstream conference programme, including a tone-setting plenary presentation by Professor Adeeba bte Kamarulzaman – from the University of Malaysia and the IHRA Executive Committee – on the topic of substance use and harm reduction. Adeeba brought home the fact that people who use drugs do not live in isolation but as part of the community, and that their health problems are the health problems of the community. She reinforced the evidence-base supporting harm reduction and bemoaned the lack of universal implementation and the continued focus on the criminalisation of people who use drugs. In a separate session, Professor Gerry Stimson (the IHRA Executive Director) also presented on 'Harm Reduction: An Evidence-Based, Non-Judgmental, Effective Strategy for Health and Dignity'.
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There was also a dedicated session Wednesday 6th August entitled ‘The New Frontiers of Harm Reduction’. This session was coordinated by Marcus Day and chaired by Gerry Stimson, and aimed to demonstrate how harm reduction has moved beyond the traditional focus on opiate drugs, injecting drug use, needle and syringe exchange and OST. The presenters were IHRA’s Rick Lines, Caitlin Padgett, Olanrewaju Onigbogi from the sub-Saharan Africa Harm Reduction Network, Stijn Goossens from INPUD, and Graciela Touze from Intercambios.
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Finally, in order to make it easy for harm reduction advocates to follow all of the relevant activities and presentations, an online ‘Harm Reduction Roadmap’ was created by Roxanne Saucier and her colleagues at the Open Society Institute. The roadmap enabled those delegates interested in harm reduction to navigate the labyrinthine conference, and still has value for anybody wishing to navigate the conference archives and footage.
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25th August 2008
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IHRA Publish UN Special Rapporteur Speech from Harm Reduction 2008
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 IHRA’s HR2 (harm reduction and human rights) team have released a new report, ‘Human Rights, Health and Harm Reduction: States’ Amnesia and Parallel Universes’. This report is the transcript of the keynote speech delivered by Professor Paul Hunt (then UN Special Rapporteur on the Right to Health) at the opening of Harm Reduction 2008: IHRA’s 19th International Conference in Barcelona, Spain on May 11th 2008.
Professor Hunt’s address contains some of the strongest comments to date from a UN human rights monitor in support of harm reduction and against human rights abuses resulting from drug policies and practices. In it, he details some of the multiple human rights abuses experienced by people who use drugs, criticises the international policy environment for allowing such abuses to occur and describes the ‘bizarre’ situation in which numerous countries acknowledge their human rights obligations on one hand, yet suffer from what he calls ‘amnesia’ about these obligations when they participate in international fora such as the UN Commission on Narcotic Drugs.
Professor Hunt reinforces his expert view that harm reduction is an essential element of the right to health under international human rights law, and suggests that the overarching goal should be ‘a strong, accessible, integrated health system that is sensitive to the distinctive needs of all, including people who use drugs’. He asserts that drug policy must be carried out in conformity with human rights, and encourages advocates and activists to incorporate human rights mechanisms at the international level into their existing work.
IHRA hopes that this speech will be a useful reference tool use for future advocacy and research on harm reduction and human rights around the world.
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 Click here to view the report [PDF:519KB]
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21st August 2008
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August 2008 Article of the Month
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Kayser B & Smith ACT (2008) Globalisation of Anti-Doping: The Reverse Side of the Medal. British Medical Journal, 337:a584 – doi: 10.1136/bmj.a584 (Published 4 July 2008).
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This analysis paper in the British Medical Journal (BMJ) critiques current international anti-doping policies in sport. These policies essentially represent costly, repressive zero-tolerance approaches for elite sport and, like similar prohibition-focussed approaches in society generally, they have very limited evidence supporting their effectiveness or success. In fact, the authors argue that this current stance in ‘elite sport’ is actually linked to increases in the illicit use of performance enhancing drugs in the general population, which has significant public health costs. The authors call for a “critical systematic examination of the impact of anti-doping policy” and the exploration of alternative policies – including harm reduction approaches.
Performance enhancement has always existed in sport but, fuelled by the World Anti-Doping Agency (WADA) – which was formed in 1999 – a global movement of repressive, punitive anti-doping policies has developed in recent years. The authors identify seven ‘postulates’ by which this current approach is flawed – including the disproportionate nature of the punishments, the weaknesses in existing drug testing technology, and the impingement on athlete’s privacy. It is also claimed that such policies are at odds with broader social values outside of sport – where “enhancement technologies like cosmetic surgery and eye surgery and use of substances like caffeine, fluoxetine, modafinil, sildenafil and anti-ageing drugs are an increasingly accepted social behaviour”.
Timed to coincide with the 2008 Olympics in China, this paper provides an interesting insight into a traditionally under-emphasised area of drug use and harm reduction.
The main points of the article have also been supported by a number of key scholars in the field – including Gerry Stimson (the IHRA Executive Director), Pat O’Hare (the IHRA Honorary President) and Nick Crofts (a member of the IHRA Executive Committee). To conclude their analysis, the authors point to harm reduction interventions such as anabolic steroid user clinics as part of an alternative policy which “might involve making legal the use of drugs associated with low harms and testing health rather than testing for drugs”. This issue is something that IHRA hopes to explore at Harm Reduction 2009 in Bangkok, Thailand.
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21st August 2008
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INPUD Asia-Pacific Deliver Statement to UN Secretary-General
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In August 2008, at the XVII International AIDS Conference in Mexico City, the following statement was presented by Prem Limbu to Ban Ki Moon (UN Secretary-General) on behalf of the Asia-Pacific branch of the International Network of People who Use Drugs (INPUD-AP):
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1. Allocation of resources must be proportionate to incidence of drug use, prevalence and vulnerability to HIV…
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There is a serious misallocation of resources. According to UNAIDS, less than 0.5% of the US$8.1 billion earmarked for the global AIDS response in 2006 was invested in harm reduction. Considering that 30% of new HIV cases are detected among injecting drug users outside Sub-Sahara Africa, there is a clear imbalance in resource allocation that must be urgently addressed in order to curb HIV transmission. In addition, overwhelming evidence indicates that harm reduction programmes are effective, safe and cost-effective and yet those programmes are underfunded, under-supported and often marginalised among the donor community. Ignoring people who use drugs and denying services will lead to negative consequences and Universal Access goals and the Millennium Development Goals are unlikely to be met.
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2. Removal of legal and policy barriers limiting access to quality treatment, prevention and care services…
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We understand that the UN Secretary General has already noted in his addresses this year a need for removal of policy barriers to effective prevention, treatment and care for people who use drugs and we are extremely grateful for this support. Yet more must be done. Policy harmonisation within national governments should a priority – too often drug control policies are in direct conflict with HIV policies and commitments made on HIV are not carried over and taken into consideration when drug control legislation and policies are developed. Law enforcement continues to be a major barrier to the implementation of services in almost all the countries.
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3. Greater Involvement of People who Use Drugs (GIPUD) at all levels and stages…
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Just like the GIPA [Greater Involvement of People living with HIV/AIDS] principles tell us, the global response to HIV and drugs must include people who use drugs and provide safe spaces for their meaningful involvement and participation. Yet drug users are generally left out of discussions and are not consulted on the development, implementation, monitoring and evaluation of programmes and policies that directly affect their lives and livelihoods. It is therefore essential that UN agencies and all stakeholders demonstrate leadership in terms inviting people who use drugs to have an active role in determining their own fate.
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4. The Asian situation…
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There are almost 5 million injecting drug users in Asia and government support for harm reduction and effective responses are rare and too small in scale to have a sustainable impact on HIV transmission. Without addressing the root causes of HIV transmission and drug use – poverty – the response will not achieve the objectives set consensually by stakeholders. In Nepal, opioid substitution therapy was introduced, phased out, and re-introduced again recently because of political difficulties. Drug use remains common and access to services is constrained by stigma, discrimination as well as disenabling policies and legislation.
This news item was sourced from the Asian Harm Reduction Network (AHRN) website.
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18th August 2008
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New Directors Appointed at the 2008 IHRA AGM
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On 13th May 2008, at Harm Reduction 2008: IHRA’s 19th International Conference in Barcelona, Spain, IHRA held its 2008 Annual General Meeting (AGM) for IHRA Members to review the organisation report and finances, and to appoint new members for the IHRA Executive Committee. The AGM was chaired by Dr. Alex Wodak and was attended by a record number of people, as the credibility, profile and interest in the organisation continues to rise year upon year.
In the formal part of the meeting, as required by UK company law, the previous AGM minutes and finances were presented and approved. Professor Gerry Stimson – the IHRA Executive Director – then presented a report of IHRA’s activities over the last 12 months. Over this time, IHRA has continued to grow in terms of staff, skills and capacity, and has launched a series of reports – including the Global State of Harm Reduction 2008. Through funding from the UK Department for International Development, IHRA has also been able to support the development of a number of new harm reduction networks – including the International Network of People who Use Drugs (INPUD), Youth RISE (the international youth-led harm reduction network) and the Sub-Saharan African Harm Reduction Network (SAHRN). IHRA has also continued to work on its HR2 – Harm Reduction and Human Rights programme, and launched the Global Alcohol Harm Reduction Network (GAHR-Net).
Also at the meeting, an election was held to fill five vacancies on the IHRA Executive Committee – as Danny Kushlick, Suresh Kumar, Monica Gorgulho and Ernst Buning had completed their three-year terms of office (and Raquel Peyraube left in November 2007). After providing great service to IHRA over the years, Suresh Kumar, Monica Gorgulho and Ernst Buning decided to leave the Executive Committee, and we thank them for their hard work, support and major contribution to the development of IHRA.
There were eleven nominations for the five spaces and, as a result of the members ballot, the following individuals were elected onto the Executive Committee as Directors of IHRA:
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- John-Peter Kools, an independent consultant who has been working in harm reduction and HIV prevention since 1983, was involved in starting the first needle exchange service in the Netherlands, and co-founded the Dutch NGO ‘Mainline’.
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- Danny Kushlick, the founder and Director of the Transform Drug Policy Foundation – a UK charity campaigning for the legal regulation and control of illicit drugs – who originally joined the Executive Committee in 2005 and has been re-elected for a second three-year term.
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- Ananda Pun, who is currently the chair of both the International Network of People who Use Drugs (INPUD) and Recovering Nepal – a national network of drug users and drug service organisations in Nepal.
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- Dr. Emran Razaghi, the Director of the Iranian National Center for Addiction Studies (INCAS), and Associate Professor of Psychiatry at the Tehran University of Medical Sciences (TUMS).
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- Richard Utendale, the President of the Vancouver Area Network of Drug Users (VANDU), who is also a member of the Low Income Land Use And Housing Coalition (LILAHC) and facilitates needle exchange training for the Vancouver Coastal Health Authority in Canada.
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Click here to view the 2008 IHRA AGM minutes [PDF:36KB]
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14th August 2008
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International Journal of Drug Policy Focuses on Australian Heroin Drought
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Volume 19, Issue 4 (Pages 267 to 338) of the International Journal of Drug Policy (IJDP) - released in August 2008 – critically reflects on the probable causes, consequences and policy implications of the well documented Australian heroin shortage of 2001. In their respective commentaries, John Jiggens and Alex Wodak re-evaluate the likely roles that domestic law enforcement, international heroin production and drug markets played in the drought. These articles are then followed by responses from Kora DeBeck and Evan Wood (from the perspective of drug law enforcement theory), Will Small and colleagues (who consider changes in drug use that occurred in Canada at around the same time) and Louisa Degenhardt and Wayne Hall (two key academic experts on the 2001 drought).
Also in this issue, Chris Bonell and Adam Fletcher present an editorial which clearly sets out the advantages of whole population interventions rather than targeted interventions to address determinants of problem drug use among young people. There are also a number of original research articles, including:
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- An examination of the sexual health risks taken by people who use ‘dance drugs’ in the UK (Mitcheson et al)
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- An examination of the epidemiology of GHB and ketamine use from an Australian Household Survey (Degenhardt and Dunn)
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- A study of the changing epidemiology of HIV infections in Taiwan (Yang et al)
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- A qualitative study highlighting injecting drug users’ experiences of policing in US-Mexico border cities (Miller et al)
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- An examination of the effects of police conduct in Vancouver, Canada in terms of the confiscation of drugs and syringes (Werb et al); and
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- An exploration of practices and perceptions of ‘safer’ crack use in Canada (Malchy et al)
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The IJDP is the official journal of the IHRA and provides a forum for the dissemination of current research, reviews, debate, and critical analysis on drug use and drug policy in a global context. A free, annual subscription to the International Journal of Drug Policy is available for all 'Premium' and 'Institutional' IHRA members.
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13th August 2008
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UNAIDS Launch 2008 Report on the Global AIDS Epidemic
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The Joint United Nations Programme on HIV/AIDS (UNAIDS) has launched the ‘2008 Report on the Global AIDS Epidemic’, in time for the XVII International AIDS Conference in Mexico City. The most comprehensive of all the UNAIDS epidemic updates so far, it draws upon data from 147 national reports monitoring country progress towards the 2001 Declaration of Commitment on HIV/AIDS. Civil society organisations also played a key role in the creation of this document by producing ‘shadow reports’ detailing their national or regional situation, as well as collaborating with governments to gather data and produce national progress reports.
Overall, the UNAIDS report outlines the ‘uneven’ progress made so far towards the 2010 target of universal access to HIV prevention, treatment, care and support around the world. Despite unprecedented increases in financial commitments in recent years, the global HIV response in low- and middle-income countries requires far greater investments if universal access and the Millennium Development Goals are to be reached. In a section entitled ‘Preventing New HIV Infections: the Key to Reversing the Epidemic’, the need to maintain a “strong focus” on HIV prevention and to “tailor national responses to documented needs” is emphasised. It is stated that, in order to reduce the numbers of new HIV infections (2.7 million in 2007), funding must be provided “rationally” – ensuring adequate support for programmes which target populations that are most at risk (such as people who inject drugs). This point was also emphasised by Dr Peter Piot – the United Nations Under Secretary-General – speaking at the opening of the AIDS Conference. He stated that “It is high time every country in the world resolutely embraced the full spectrum of harm reduction among injecting drug users. Not doing so will only perpetuate the spread of HIV”.
Data within the report (along with the national progress reports) highlight the low priority that is currently given to HIV prevention, treatment, care and support for people who inject drugs – including harm reduction – in national HIV responses. Only 15 out of 147 countries provided information on HIV prevention programming for key populations and, across these fifteen countries, an average of only 46% of people who inject drugs were reached by HIV prevention programmes in 2007. Civil society in 40% of the countries highlighted that certain national laws, regulations or policies acted as obstacles to effective HIV service provision for people who inject drugs, and 84% of countries have no laws which prohibit discrimination against people who inject drugs. This was highlighted at the AIDS Conference in an address from Ban Ki-Moon (the United Nations in Secretary-General), who claimed that this directly impacting on HIV service access – “Not only is it unethical not to protect these groups: it makes no sense from a health perspective. It hurts all of us”.
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4th August 2008
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UK Report Concludes That Punitive Policies Have Little Impact
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A new report published by the UK Drug Policy Commission (UKDPC) has found that that illicit drug markets in the UK are extremely resilient to the policies and practices that are designed to suppress them, and that drug seizures have little street-level impact. Despite the huge amounts of money and resources spent each year on law enforcement activities around the world, there is remarkably little evidence of their effectiveness in disrupting drug markets and reducing the availability of illicit drugs.
Instead, the UKDPC report – entitled ‘Tackling Drug Markets and Distribution Networks in the UK: A review of the recent literature’ – claims that focusing on the reduction of ‘collateral damage’ (such as human trafficking, gang violence and corruption) is likely to have more of an impact than existing approaches. The evidence also supports a local partnership approach, in which law enforcement resources could be better engaged to deter open street-level markets or to guide people who use drugs towards treatment and support. The authors also claim that policy makers need to recognise and minimise the unintended adverse consequences of crackdowns, zero tolerance approaches and heavy-handed law enforcement – which are also highlighted in an IHRA document collection on ‘Policing and Harm Reduction’. The UKDPC is also currently working on a project to further consider how law enforcement resources can be practically re-focussed to address drug-related harms.
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 Click here to view IHRA’s ’50 Best Document Collection on Policing and Harm Reduction (Illicit Drugs)’
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The report provides an interesting critique of existing drug policies, and the implications are relevant around the world wherever crime-focussed, punitive approaches and ‘wars on drugs’ are the favoured approach. For example, this issue is particularly relevant to South-East Asia and Thailand – the host region and country for Harm Reduction 2009: IHRA’s 20th International Conference – and will be included in the conference programme.
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1st August 2008
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Delegate Feedback from Harm Reduction 2008
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 Harm Reduction 2008: IHRA’s 19th International Conference took place in May 2008 in Barcelona, Spain and was attended by over 1,200 delegates from around 80 different countries. On the closing day of the conference, 150 feedback forms were collected (representing one in eight delegates) in order to help IHRA to identify the strengths and weaknesses of the event and to further improve Harm Reduction 2009 in Bangkok, Thailand.
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Conference Strengths
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The vast majority of delegates who completed feedback forms enjoyed their conference experience, and identified a lot of strengths for the conference. These included the conference programme, the organisation and conference staff, the printed materials, the conference website and the provision of simultaneous translation into Spanish, French and Russian. On the feedback forms, the vast majority of delegates either ‘Agreed’ or ‘Strongly Agreed’ that:
• “the session topics were well chosen and relevant” (71%)
• “the speakers were knowledgeable and informative” (85%)
• “the sessions and topics were useful for my work” (70%)
• “[They] made new contacts with harm reduction colleagues” (74%)
• “[They] gained new knowledge about harm reduction” (67%)
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Successful Sessions
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On the feedback forms, delegates were asked to list the ‘most valuable’ sessions which they attended, and a number of particularly popular sessions stood out – including those on human rights, sex workers, drug consumption rooms, harm reduction in Spain and drug user activism. Other common highlights were the keynote speeches from Professor Paul Hunt (the UN Special Rapporteur on the Right to the Health) and Antonio Maria Costa (the Executive Director of the United Nations Office on Drugs and Crime), and the International Drugs and Harm Reduction Film Festival.
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Room for Improvement
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As with any international conference on this scale, the feedback forms also highlighted some areas in which IHRA could improve the conference in time for Bangkok in April 2009. These included the lack of time in the sessions for discussion and questions, the conference entertainment that is provided, and the internet facilities. All of these will be addressed for Harm Reduction 2009. Another common weakness identified by delegates was the conference catering, but (as is often the case) the venue in Barcelona had an exclusive contract with a catering firm, meaning that the conference organisers were unable to chose which company to provide the lunches and refreshments. One final comment on many feedback forms was the lack of engagement and visible involvement at the conference by people who use drugs. IHRA and others provided scholarships for a significant number of drug user activists to attend the event, but many of these activists chose to engage in a series of side-meetings to debate and discuss the future of the International Network of People who Use Drug rather than mainstream conference sessions.
IHRA and the Conference Consortium would like to thank all of the delegates who completed feedback forms, or provided their feedback in other ways. All of the comments and recommendations from delegates have been recorded and taken on board, and IHRA will do our up-most to address these in Thailand in April 2009.
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1st August 2008
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New Harm Reduction Training Course Announced in Asia
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The Asian Harm Reduction Network (AHRN) has announced a new short course on ‘Health and Social Care for People Using Drugs’. As governments across the Asia region increasingly incorporate harm reduction into their HIV and drug use policies and programmes, there is an increasing need to build capacity amongst those who deliver these services. As such, this six-day event is aimed at all staff working with injecting drug users – including programme managers, medical professionals, law enforcement personnel and frontline workers.
The course is scheduled for the 25th September to the 1st October 2008 in Chiang Mai, Thailand. The programme includes issues such as defining what ‘harm reduction’ means, improving service delivery, opiate substitution treatments, poverty alleviation and reintegration, and service user involvement. The overall aim is to enable services and projects across the region to effectively respond to the realities of drug use and HIV by learning more about harm reduction.
The registration fee for the course is €631 (which covers tuition, reading materials, refreshments and lunches), and the deadline for registration is 1st September 2008. There are a limited number of scholarships available. To register your interest in this important regional event, or for more information (including language requirements, registration forms, accommodation packages, payment methods and visa requirements), please contact AHRN.
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Click here to view the AHRN course flyer [PDF:410KB]
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