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November/December 2006 | | | | | |
| Alcohol and the City Project Takes Shape
| In October 2006, IHRA hosted an “Expert Meeting” in Copenhagen, Denmark to discuss alcohol related problems in the city and how these could be reduced through pragmatic and realistic harm reduction interventions. The meeting was part of IHRA’s “Alcohol and the City” project - a multi-city project aimed at demonstrating how practical and realistic alcohol harm reduction interventions can be managed at a city level. The meeting aimed to bring together all of the key stakeholders in Copenhagen (such as the police, researchers, practitioners, politicians, campaigners, youth workers, the alcohol industry, and medical staff), and agree a “wish list” of harm reduction interventions and actions that could be instigated in the city.
Cities are crucial to effective alcohol harm reduction. They are where alcohol consumption is often concentrated (with both positive and negative consequences), and are where most of the agencies which can influence alcohol-related behaviours and harms actually operate. The positive aspects of alcohol use include socialising, pleasure and entertainment, but the well-documented negative aspects include crime, social nuisance and health problems. Therefore, as cities without alcohol are difficult to imagine in Western society, the challenge is to create a local drinking environment in which the benefits of alcohol are maximised, and the harms minimised.
The Alcohol and the City project was created to investigate whether or not city-wide alcohol harm-reduction strategies were feasible. Who should be consulted about such a strategy? How would a strategy operate? Who would manage it? Most importantly, however, the key question of the project was whether or not a strategy of this kind could have a positive impact on the local drinking environment.
In Copenhagen, IHRA organised an initial stakeholder consultation in May 2006, where it was agreed to conduct some “rapid assessment” research in the city in order to gain a fuller picture of alcohol patterns, contexts and problems in the Danish capital. The Expert Meeting in October 2006 was a follow-up to this research. IHRA gathered the key stakeholders together for this meeting to listen to presentations about alcohol harm reduction, discuss the situation in Copenhagen, and devise a wish list of possible interventions that were relevant to the city. The eventual list for Copenhagen included server training schemes (to help prevent bars serving to underage or intoxicated patrons), and study-visits to Scotland to share information and best practice.
The project is supported by a donation from Diageo, as part of their ongoing commitment to the responsible use of their products. More information will be made available when the IHRA website is re-launched in the coming months. In the meantime, please feel free to contact IHRA for more information on the Alcohol and the City project, to get involved in the project in the target cities above, or to express an interest in the project on behalf of your city.
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| Click on above images to view larger.
| IAS 2007 – 22nd – 25th July 2007
| The 4th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2007) will be held in Sydney, Australia from 22-25 July 2007. It will feature reports on the latest developments in the area of basic, clinical and prevention science, with particular emphasis on the Asia-Pacific region. As a defining feature of the conference, IAS 2007 will examine how scientific advances can, in very practical ways, inform the global response to HIV/AIDS.
IAS 2007 will be hosted by the International AIDS Society (IAS) and the Australasian Society for HIV Medicine (ASHM), and it promises to be the largest HIV conference ever to be held in Australia. The theme for the conference is “Bringing together the world of HIV science to address the challenges of research, prevention and treatment”. Scientists, researchers, policymakers and other professionals working in the field of HIV/AIDS are all expected to be in Sydney for this influential conference.
Registration opened on 1st December 2006 (register before 1st February 2007 to avoid a late surcharge). Please visit www.ias2007.org for further information on registration types and fees, or to submit an abstract (the deadline for which is 7th March 2007).
The conference team would also like to hear from you if you are interested in exhibiting at the event to showcase your organisation, or if you would like to register as a volunteer for front of house duties, exhibition coordination, speaker liaison, logistical support, or media support. To contact the IAS 2007 conference team, please email conferenceinfo@ashm.org.au or call +61 2 8204 0770.
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| Meeting Held on Access to Controlled Medications
| In September 2006, the World Health Organisation (WHO) convened a two-day global consultation meeting in Geneva, Switzerland to discuss access to controlled medications, especially opiate-based medicines. Across the world, millions of people are being denied access to effective pain management and substitution treatments, due to the international conventions controlling opiates. The WHO’s “Access to Controlled Medications Programme” aims to correct this situation, and IHRA was represented at the meetings by the vice chair Mukta Sharma.
Prescribed opiate drugs are essential for, among other things, effective pain management and control for terminally ill patients. Throughout the world, many people are not being provided adequate pain control, and are being denied the quality of a pain-free life. Similarly, many drug users around the world are being denied access to proven medical treatments to help them overcome or manage their addictions. This is because these medicines are associated with onerous regulation requirements, are classed as narcotics in various international conventions and are too expensive for many governments.
For example, the UN Single Convention places onerous restrictions on opiate medications in terms of the required record keeping. As a result, many governments have decided not to supply these medicines because they cannot afford to develop the necessary regulatory mechanisms for storage, transportation, prescription etc (in addition to the costs of the drugs themselves). Also, in many countries, these medicines are classed as “narcotics” as a result of being in the UN Single Convention. For example, in Russia, it is currently illegal to prescribe, possess or even advocate for methadone (an evidence-based medical treatment for opiate addiction).
The global coverage of methadone and buprenorphine treatments remains low, especially outside of the European Union. In 2005, there was only one African country with a national programme providing these medicines to drug users. The “Access to Controlled Medications Programme” is an important WHO initiative which should contribute to the expansion of substitution treatments in countries where it is currently unavailable or poorly accessible. In the past two or three years, the WHO has paid more attention to controlled substances. For example, methadone and buprenorphine are now listed in the WHO Model List of Essential Medicines, advocating for their global availability in adequate doses, at affordable prices, and in accessible settings.
At the consultation meeting, it was agreed that the programme should include all controlled medications on the WHO Model List of Essential Medicines, pay specific attention to the discrimination encountered by patients, and acknowledge the substitution treatments also provide a valuable platform for access to treatments for HIV, tuberculosis and other diseases frequently prevalent among drug users. A framework for action was also agreed, which includes ensuring cooperation and joint partnerships between agencies (including law enforcement authorities), identifying and tackling the existing barriers to the supply of opiate medicines (such as price, regulatory restrictions, and inadequate resources), advocacy and education of the general public, and demonstration projects to show how these medicines can be supplied, managed and controlled.
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| Update from the 18th International Conference on The Reduction of Drug Related Harm
| The closing date to submit abstracts for this conference has now passed, but there are still some key deadlines approaching. Only those who register and pay before January 15th 2007 will receive the “early bird” discounts, and the deadline for submitting entries for the 4th Drugs and Harm Reduction Film Festival is also fast approaching. The conference itself is the main meeting point for all those interested in harm reduction and has been tagged “Harm Reduction: Coming of Age”.
If you register and pay before 15th January 2007, you will be given an “Early Bird” registration fee discount of €100. To register for the conference, visit the official conference website If you have any questions about registration (such as support with obtaining a visa to enter Poland), please contact conference@harmreduction2007.org
| As well as being the “Early Bird” registration deadline, the 15th January 2007 is also the deadline for submissions for the Drugs and Harm Reduction Film Festival, which will be incorporated into the main conference programme for the fourth year running. For the fourth year in a row, Simon Baldwin and Gary Reid (from the Burnet Institute in Australia) aim to collect and present unique perspectives on harm reduction from around the world. The film festival is integrated into the conference programme and more information on the previous three festivals can be found at www.chr.asn.au/resources/filmfest.
|  Download the 4th Drugs and Harm Reduction Film Festival submission form [PDF: 34KB]
| Visitors to the official conference website will have noticed the numerous new additions to the site, including detailed descriptions of the main conference groups and committees, and a new section called “What Harm Reduction Means to Me” where key figures from the harm reduction movement offer their views. The website will continue to be updated over the coming weeks, as the programme will be finalised at an Executive Programme Committee “marathon meeting” in Warsaw in December. Around 1,000 abstracts were submitted online, and these are being peer-reviewed to ensure that the best are accepted for presentation at the conference. We would like to thank all of the authors and reviewers for their hard work.
The ICRDRH events attract over 1,000 people from over 60 countries around the world, and represent a perfect opportunity for an organisation to promote its work and products. To enquire about sponsorship and exhibition opportunities in Warsaw, please visit www.weaveconsulting.com
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| 3rd International Conference on Alcohol and Harm Reduction
| This international event took place on the 22nd – 25th October 2006, in the Arabella Sheraton Hotel in the centre of Cape Town. It was organised by Quest for Quality (Q4Q) and the University of Limpopo. IHRA was a co-organiser. About 200 people from over 30 countries attended the conference, including practitioners, policy-makers, researchers and alcohol industry representatives, and a large number of people from all over Africa. There were keynote speeches, presentations, workshops, debates and round-table discussions on a wide range of alcohol harm reduction topics.
Against the idyllic backdrop of Table Mountain and Cape Town, the conference providing in-depth (and, at times, tough talking) analysis and discussion of how harm reduction principles can be applied to alcohol related harms, The conference’s aim was to introduce, evaluate, debate and create realistic and concrete solutions to alcohol problems.
In his opening speech, the Conference President, Ernst Buning, stressed the role of the Harm Reduction movement in putting alcohol higher on the public agenda. Keynote speeches included an introductory overview of the field by Professor Gerry Stimson (IHRA Executive Director), an analysis of targeted interventions by Marjana Martinic (International Center for Alcohol Policies), and showcased examples of best practice in terms of industry involvement (Chan Makan from ARA in South Africa), server training (Jack Law from Alcohol Focus Scotland), and student drinking (Florence Kerr-Correa from Sao Paulo State University in Brazil).
The round-table discussions on the Monday (23rd) and Wednesday (25th) highlighted the issues of alcohol and young people, and how to turn policy and rhetoric into practice. On the Tuesday (24th), a “Special Session Focus on Africa” concentrated specifically on the situation in Africa, with presentations from South Africa, Zimbabwe, Egypt and Kenya.
Each afternoon featured smaller working groups, where between 20 and 60 people gathered to discuss specific issues on alcohol (such as young people, public-private partnerships, sexual behaviour and gender issues, translating research into practice, and drink-driving). The outcomes from these working groups were presented on the final day.
In addition to these sessions, there was also room for a lively debate on effective partnerships, a “Hear Your Peers” (HYPE) session (where delegates were filmed talking about their thoughts and experiences), a formal conference dinner, and lots and lots of networking with likeminded people from all over the world.
The 4th International Conference on Alcohol and Harm Reduction will be in 2008, possible in Asia. More details, including the slides from the keynote speeches and video material from the HYPE session, can be found at
| www.alcoholconference.org The IHRA website and e-newsletters will keep you briefed about further developments in the area of alcohol and harm reduction.
The high level of attendance from African delegates reflects the growing interest in the continent for harm reduction in general. IHRA is committed to developing harm reduction in Africa and identifying key partners from the region in order to develop a harm reduction network and knowledge hubs. If you are interested in this up-and-coming project, please contact IHRA.
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| Article of the Month- November/December 2006
| One of the main criticisms levied at the harm reduction approach to illicit drugs is that it condones and encourages drug use. However, this claim has been rejected in the latest research to emerge from Switzerland, where harm reduction interventions have formed a central part of drug policies for over 20 years. Analysis of drug treatment data there reveals that the incidence of heroin use has dropped significantly in the recent years.
Nordt C & Stohler R (2006) Incidence of heroin use in Zurich, Switzerland: A treatment case register analysis. Lancet, 367, 1830-1834.
The authors obtained information from the case register of substitution treatments in Zurich (over 7,000 records) and analysed the data to estimate the incidence of heroin use. They concluded that the number of new heroin users in Zurich had fallen from 850 in 1990 to only 150 in 2002 (a fall of 82%). The overall population of heroin users was also falling, albeit at a lower rate of around 4% a year (as many people who left substitution treatments re-entered them within the next 10 years – leading to a lower cessation rate).
Switzerland has often been criticised for its liberal drugs policies and is one of the strongest advocate nations for the harm reduction approach (such as needle exchanges and substitution treatment programmes) and the medicalisation of opiate addiction. These criticisms were often founded on the moral assumption that such approaches were condoning or normalising drug use, and that this would increase the numbers of drug users. However, the authors claim that heroin has become less attractive to potential new users (becoming a “loser drug”) as a result of the harm reduction / medicalisation approach.
This paper provides valuable evidence in favour of harm reduction approaches and, in particular, substitution treatment interventions. Far from condoning and encouraging drug use, this medical treatment for addiction management can actually alter the perceptions of opiate drugs and reduce the initiation of new users. Similar research is required outside of Zurich and Switzerland to build the harm reduction evidence-base.
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