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Thai AIDS Treatment Action Group Warns Of New “War on Drugs”
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In February 2008, Thailand appointed a new Interior Minister - Chalerm Yubamrung – who was quick to reinstate ‘war on drugs’ in the country, prompting concerns from across the international harm reduction and human rights communities. In response, the Thai AIDS Treatment Action Group (TTAG) has issued an international press release expressing their concerns at this development given the country’s history of past human rights violations committed in the name of drug control.
The previous Thai Government declared a ‘war on drugs’ in 2003 which, according to unpublished Human Rights Watch data, resulted in the deaths of 2,819 people in 2,559 murder cases between February and April in 2003. Of those killed, more than half had no relation to drug dealing or had no apparent reason for their deaths. According to TTAG, “no concrete action has been taken to redress these wrongs, or to prevent their occurrence in the future. The [new] Government’s rash drug war announcement has not been accompanied by appropriate mechanisms… to guard against history repeating itself”.
The TTAG are calling upon the Thai Government to hold public consultations as a matter of urgency (to discuss the impact of this approach and to develop policies and laws that “uphold human rights rather than undermine them”), renounce the drug war, and enable work with civil society organisations - including those that represent people who use drugs (such as TTAG).
In the words of the TTAG, “Harm Reduction Saves Lives! No More Thai Drug War!”
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 Click here to view the TTAG Press Release [PDF:147KB]
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IJDP: New Issue Out Now
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Guest editors Craig Fry, Kaveh Khoshnood, Robert Power and Mukta Sharma present the International Journal of Drug Policy, Volume 19, Issue 1 (February 2007) – which has a special focus on ‘Values and Ethics in Harm Reduction’. This issue represents one of the few times that a number of articles have been brought together on this topic. It aims to bring together thought-provoking commentaries, original research and policy analyses from Australia, North America and the UK which explore both theoretical and practical ethical issues in the present and for the future of harm reduction.
The issue includes three commentary pieces, including one in which Bernadette Pauly argues that a social justice ethical framework for harm reduction is desirable to also address homelessness and poverty. In another, Andrew Hathaway and Kirk Tousaw examine the various moral and scientific viewpoints with reference to Insite - Vancouver’s safe injection facility. Finally, R. Douglas Bruce and Rebecca Schleifer highlight the human rights imperative of prisoners’ access to medication-assisted drug treatment.
There are also a number of new research papers. First, Rosie Phillips and Humphrey Bourne report on a study of drug treatment workers’ personal values and the potential impacts on client outcomes. Then, Greg Scott reports on an ethnographic study which highlights the ethical problems associated with using respondent-driven sampling methods with injecting drug users. Finally, from a ‘moral philosophy’ perspective, Timothy Christie et al propose that the ‘virtue ethics’ approach offers a balanced alternative to deontology (which focuses on the rightness or wrongness of actions themselves) and consequential reasoning (an approach in which the consequences of a particular action form the basis for any valid moral judgment about that action) in the abstinence versus harm reduction debate.
In addition to these commentaries and research reports, Barbara Paterson and Ciro Panessa review the efficacy of harm reduction interventions for young people, and the ethical imperative to engage and involve this population. Adrian Carter and Wayne Hall then examine the ethics of informed consent in opioid maintenance treatment in an additional policy analysis paper. They propose guidelines to increase the autonomy and decision-making capacity for opioid dependent persons.
The issue also includes a number of other articles unrelated to the value and ethics theme. Rebecca Winter et al draw on 20 years of experience studying the hepatitis C epidemic in Australia to present a model for integrating enhanced testing and counselling of drug users. Carla Treloar et al report on an innovative video study of injecting practices, which suggests that hepatitis C education needs to be broadened to include other aspects of safer injecting. Corrine Munoz-Plaza et al then explores drug user perceptions and decision-making on hepatitis C treatment and the importance of peer communication.
As always, the latest issue of the International Journal of Drug Policy and the abstracts can be reviewed at www.sciencedirect.com/science/journal/09553959
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February 2008 Article of the Month
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Van Den Berg C, Smit C, Van Brussel G, Coutinho R, Prins M (2007) Full Participation in Harm Reduction Programmes is Associated with Decreased Risk for Human Immunodeficiency Virus and Hepatitis C Virus: Evidence from the Amsterdam Cohort Studies among Drug Users. Addiction, 102(9), 1454–1462.
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This research, published in a recent issue of Addiction, is from an open, large-scale, and prospective voluntary cohort study and seems to indicate that “full participation” in harm reduction programmes is associated with a reduction in the risk of HIV and hepatitis C (HCV) infection. The study sample was 714 “ever-injected” drug users at risk for HIV and/or HCV in Amsterdam, the Netherlands. The study explored five levels of harm reduction and, interestingly, no statistically significant effects were found for needle exchange programmes or methadone programmes alone. However, “full harm reduction” (defined as 60mg or more of daily methadone treatment in the past six months and either no injecting drug use in the past six months, or injecting drug use in the past six months and “always” utilisation of needle exchanges) was associated with significant reductions in risks – “not only on injecting but also on sexual risk behaviour”.
This paper supports the implementation of a broad range of harm reduction interventions in order to have the required impact on drug-related harms. This is important, as many countries and regions have had an over-reliance on individual interventions (such as needle exchange). A comprehensive package of harm reduction includes the exchange of a full range of paraphernalia (not just needles and syringes), the provision of (ideally peer-led) safer drug use advice and information, outreach services and advice, a range of opiate substitution treatment programmes, counselling, condom distribution, and overdose prevention education.
Although this research is based on self-reported behaviour, only two harm reduction interventions (albeit it the “two most important components” according to the authors – needle exchange and methadone) and a very restrictive definition of “full” participation (only using needles from a needle exchange in the last six months), the findings are very encouraging for the on-going advocacy efforts towards a conducive global environment for harm reduction. The authors conclude that their research “is most important for countries with recent and sometimes explosive outbreaks of HIV and/or HCV among [drug users], as in the former Soviet Union and Asia. To provide needles and syringes only or methadone only will not be sufficient to curb the rapid spread of these and other blood-borne infections… It is essential to offer a comprehensive programme in which both measures are combined”.
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Click here to view the full, Open Access Article courtesy of Blackwell Synergy
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IHRA Launch New Report on the INCB
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IHRA are pleased to announce the launch of a new report entitled “Unique in International Relations?: A Comparison of the International Narcotics Control Board and the UN Human Rights Treaty Bodies”. This is the third publication from the HR2 (Harm Reduction and Human Rights programme of work, and provides a critique of the International Narcotics Control Board (INCB), who have justified the secrecy of their work and their lack of engagement with civil society by claiming that they are “unique in international relations”.
However, far from being unique, the INCB is instead an early example of the ‘independent committee of experts’ model that has been adopted and developed within the UN human rights system, and regional human rights systems, over the past four decades. It is a common model that continues to be used today. Yet in contrast to these similar bodies, the INCB has failed to modernise its processes, and retains working practices inherited from defunct monitoring bodies.
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Click here to view the report [PDF:953KB]
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Click here to view a list of reports from the HR2 programme
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UNODC Release Paper on Harm Reduction
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In January 2008, the United Nations Office on Drugs and Crime (UNODC) released a discussion paper entitled ‘Reducing the Adverse Health and Social Consequences of Drug Abuse: A Comprehensive Approach’. The paper, written in consultation with the much maligned International Narcotics Control Board (INCB), describes how “prevention and treatment on one hand and reducing the adverse health and social consequences of drug use on the other” can be complimentary, rather than contradictory, to one another.
The paper attempts to demonstrate how the INCB and the International Drug Conventions – so often accused of hindering harm reduction initiatives - are actually supportive of a comprehensive harm reduction approach. This comprehensive approach – outlined on page five – explicitly includes “low threshold pharmacological interventions” (substitution treatment), “medication and emergency kits for management of overdoses” (Naloxone distribution), and “needle/syringe exchange programmes”. The report has been strategically timed at the start of a year-long process to review the United Nations’ international drug policy response.
Although UNODC declares itself to be guided both by the prohibitionist drug control conventions and the UN’s human rights norms, at least insofar as its work on HIV prevention and “drug abuse” is concerned, the agency has in the past made little attempt to reconcile the inherent contradictions between the two. Ironically, the UN Special Rapporteur on Health’s 2007 report on Sweden, which criticised the country’s failure to provide harm reduction measures on human rights grounds, coincided with the release of a UNODC report applauding Sweden’s zero tolerance approach and promoting it as an example of successful prohibitionist (and anti-harm reduction) policies.
This new publication explicitly states the UNODC’s support for substitution treatment, overdose prevention and needle exchange (as well as other harm reduction interventions). While this is clearly a positive step, the report stops short of supporting safe injecting facilities despite the fact that they have been shown to have a significant impact on drug-related harm, and have been deemed legal under the international drug conventions by legal experts from the United Nations International Drug Control Programme (UNDCP). The UNODC report also reiterates that harm reduction measures must be in line with the international drug control conventions, but does not mention human rights (apart from a brief mention of the “right to be healthy”). Unfortunately, the document also suffers from the type of stigmatising language that so often emanates from the United Nations - referring to people who use drugs as “abusers”. Such language reinforces negative views of some of the most marginalised populations and can ultimately contribute to discriminatory practices.
Despite these shortcomings, IHRA welcomes this new and strategically-timed UNODC document, which stands as the strongest statement to date from the UNODC of its support for harm reduction.
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Click here to view the UNODC Discussion Paper [PDF:217KB]
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Death Penalty for Drug Offences: An Update
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In February 2008, a special issue of Drink and Drugs News – the leading magazine for substance misuse professionals in the UK - featured a cover story on the issue of the death penalty for drug offences. Entitled “Deadly Serious: Drugs and Capital Punishment in the 21st century”, the article features extensive commentary on the issue from Rick Lines, IHRA’s Senior Policy Advisor.
The article – written by David Gilliver – looks at how the fields of harm reduction and human rights are “coming together to try and tackle this 21st century barbarism”. It follows on from IHRA’s recent analysis of the death penalty for drug offences - “The Death Penalty for Drug Offences: A Violation of International Human Rights Law” – which was published by IHRA’s HR2 (Harm Reduction & Human Rights) Programme in December 2007.
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Click here to view the full IHRA report. [PDF:598KB]
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Click here to view the Drink and Drug News article [PDF:86KB]
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Drink & Drugs News (DDN) is a free, fortnightly UK-based magazine for substance misuse professionals and others dealing with drug and alcohol issues in the course of their work. For more information about DDN, please visit www.drinkanddrugs.net
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New Newsletter for US Needle & Syringe Exchange Programmes
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In January 2008, the Harm Reduction Coalition (HRC) in the USA released the inaugural ‘Syringe Exchange Program Technical Assistance Newsletter’. This new resource is from the HRC’s ‘Syringe Access Expansion Project’, which aims to provide technical assistance to syringe exchange programmes in the USA. For example, the first issue focuses on funding and provides advice on writing proposals and grant applications, as well as an insight in to the current funding landscape in the USA – where there has been a ban on the use of federal funding for needle exchange programmes since 1988.
Needle and syringe exchange programmes have existed in the USA since the 1980s, despite periods of well-documented hostility and opposition from a series of governments better known for the “war on drugs” approach than harm reduction. These programmes have often operated on short-term charity funds or fundraising, but they are being increasingly accepted as mainstream services in the USA – with challenges being made to the federal funding ban.
The HRC are committed to providing technical assistance and support through their projects and staff, and enquiries, suggestions or comments can be sent to askhrc@harmreduction.org. Although focused on the USA, these newsletters are a valuable resource for needle exchanges around the world. .
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Click here to view the HRC newsletter
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1st Asian Consultation on HIV and Drug Use Takes Place in Goa
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Response Beyond Borders - the first Asian Consultation on the prevention of HIV related to drug use – took place in January 2008 in Goa, India. The event was organised by the Asian Consortium on Drug use, HIV, AIDS and Poverty - a voluntary network of national and international organisations and service providers. The Consultation brought together over 400 delegates from South Asia, Southeast Asia, Central Asia and the Middle East – including a significant number of high-level ambassadors and politicians from several countries in the region, policy makers, practitioners, frontline workers and people who use drugs (who represented around half of the total attendees).
One of the highlights of the Consultation was that it provided a great opportunity for advocacy with policy makers from the region and facilitated a direct dialogue between the Parliamentarians and drug using communities. For example, the Opening Plenary featured a speech by Dr JVR Prasada Rao - Director of the Regional Support Team of the Joint United Nations programme on HIV/AIDS (UNAIDS) – in which he concluded, “We have over 20 years of experience… So let us just do it. Let’s get on and make Universal Access a reality”.
At the event, the Asia-Pacific branch of the International Network of People who Use Drugs (INPUD) formulated a ‘Goa Declaration’ as a follow-up to the previous Vancouver and Warsaw Declarations by INPUD. This document emphasised the need for the implementation and scaling-up of evidence-based harm reduction policies and programmes, and the greater engagement of people who use drugs in key policy forums and decisions.
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Click here to view the Goa Declaration
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The Dutch Ministry of Foreign Affairs also used the event to launch a major new resource entitled “Out of the Margin: Harm Reduction and HIV Prevention”. The booklet documents the Ministry’s experiences as a major international supporter and sponsor of harm reduction programmes. It sets out the components of an effective, evidence-based harm reduction programme – “a comprehensive and coherent package of interventions and services promoted through outreach and peer education and delivered in the framework of a rights-based approach”.
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Click here to view the Dutch Ministry’s Report
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IHRA was represented at the Consultation by three members of the Executive Committee - Professor Nick Crofts (the IHRA Vice-Chair, who delivered a plenary speech at the event on ‘Drug Policy Reform in Asia’), Professor Adeeba Kamarulzaman and Dr Suresh Kumar (who were both members of the event’s organising committee and also presented summaries from the three sub-regional workshops at the closing ceremony). It was agreed amongst the participants that it is now essential to continue the momentum from the Consultation and to develop regional dialogue. The 2nd Asian Consultation is to be held in 2009 in South-East Asia.
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Click here to view the Opening Plenary speech by Dr JVR Prasada Rao [PDF:31KB]
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Click here to visit the ‘Response Beyond Borders’ website
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Eurasian Harm Reduction Network: Steering Committee Elections
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In February 2008, the Eurasian Harm Reduction Network (EHRN) will start election procedures for candidates for the EHRN Steering Committee - EHRN’s governing body. The role of the Steering Committee is to facilitate the network’s mission by developing and implementing policy, strategy and operational principles of the organisation. The Committee is formed of elected representatives of EHRN sub-regions – led by a Steering Committee Coordinator. There are currently vacancies for members from Belarus and Moldova.
To apply for one of these positions, please contact the EHRN Secretariat and send a resume/CV, a letter explaining why you would like to be a part of this group, and formal consent to participate in the election process. The deadline for applications is March 10th 2008.
The results of the elections will be announced in April 2008. For further information, please visit www.harm-reduction.org or contact the EHRN Steering Committee Coordinator, Kaleria Lavrova.
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‘Findings’ Online Archive Growing
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The new web-based information service from the creators of ‘Drug and Alcohol Findings’ - http://findings.org.uk - is continuing to grow. The resource was launched in August 2007 to allow drug and alcohol agencies from around to freely access research and evidence of 'what works' in terms of drug and alcohol interventions, approaches and policies.
Since the website’s launch, the first six issues of ‘Drug and Alcohol Findings’ have been uploaded alongside a special series on opiate overdose prevention (Series 1). The latest issue to be uploaded (Issue 6 - first published in 2001) covers issues such as assessment and screening for alcohol problems, efforts to find employment for drug service clients, encouraging people to return to services for aftercare, and the effect of police ‘crackdowns’ on the demand for drug treatment.
This online collection will continue to develop over the coming months and will eventually feature all 15 issues of ‘Drug and Alcohol Findings’ and an ‘Effectiveness Bank’ of recent evaluation studies that have important implications for evidence-based practice. The website is managed by three prominent UK organisations - DrugScope, Alcohol Concern and the National Addiction Centre. The project is supported by the J. Paul Getty Jr. Charitable Trust and the Pilgrim Trust
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