 |
|
|
|
|
| |
October 2006 | | | |
| Busy month for IHRA
| It has been a busy month for the staff and Executive Committee of IHRA, taking part in several successful campaigns and events alongside the rest of the harm reduction community. For example, IHRA was involved in a campaign supporting the drug consumption facility in Canada (which faced closure in September 2006 but has been granted an extended license to continue its excellent work). The IHRA Executive Director also wrote to the French Government about their plans to reclassify Buprenorphine (which have since been rejected). Several IHRA representatives were also represented at events in Taiwan and England.
Insite in Vancouver, Canada is North America’s only supervised drug consumption facility and has been operating since 2003 under a special legal exemption on a pilot scheme basis (granted by the Liberal Government at the time). However, in September 2006, this license was up for renewal and the service faced an uncertain future, with the new Conservative Prime Minister (Stephen Harper) stating that he “will not use taxpayers' money to fund drug use”. The facility received a great amount of coverage through the 17th International Conference on the Reduction of Drug Related Harm (in Vancouver, May 2006), protests and discussions at the XVI International AIDS Conference (in Toronto, August 2006) and letters of support from numerous national and international organisations. In particular, Professor Gerry Stimson, the Executive Director of IHRA, wrote personally to the Minister of Health to urge that the facility be allowed to continue serving the Downtown Eastside Vancouver community. Professor Stimson is a member of the Joseph Rowntree Foundation’s “Independent Working Group On Drug Consumption Rooms”, who launched their report in May 2006 recommending that the facilities are piloted in the UK. A summary of this report was also sent to the Canadian Minister of Health. For now, Insite has an extended license to operate until the end of 2007, when a further decision will be made about its future.
In France, the Government had announced plans to reschedule Buprenorphine as a narcotic drug. Although the Government has always maintained a commitment to harm reduction, there were growing concerns around the misuse of prescribed buprenorphine (with a national survey showing that a quarter of prescribed buprenorphine was being diverted to the street market). Plans were made to tighten the controls on the drug in terms of who could prescribe it, dispense it and receive it but this raised international concerns that this valuable and proven treatment would become much less accessible for French drug users. IHRA was among the numerous harm reduction and human rights organisations that wrote to the French Government urging them to reconsider. Accordingly, a working group created by Xavier Bertrand (the French Minister of Health) has made the final decision not to reschedule the drug. This comes just months after the WHO Expert Committee of Drug Dependence decided against the international rescheduling of buprenorphine (as had been recommended by the International Narcotics Control Board) after an international campaign in which Professor Gerry Stimson (IHRA Executive Director) gave evidence at a WHO meeting in March 2006.
On September 9th and 10th 2006, the 8th Taipei International Conference on HIV / AIDS was held in Taiwan. Professor Gerry Stimson (IHRA Executive Director) presented on the global situation for harm reduction, Dr. Alex Wodak (IHRA Executive Committee member) presented on the barriers to harm reduction and Bill Nelles (former IHRA Executive Committee member) presented on Methadone Maintenance Treatments. Then, alongside Dr. Allan Clear (Harm Reduction Coalition, USA) and Professor Don Des Jarlais (Beth Israel Medical Centre, USA), they also took part in a roundtable discussion to provide recommendations and advice to the harm reduction movement in Taiwan, which had made remarkable strides in recent years. The event was featured in the national media. To read the Taipei Times article, please visit www.taipeitimes.com/News/taiwan/archives/2006/09/10/2003326951
| Finally, IHRA was also involved in the “Advancing Harm Reduction” event on the 7th September 2006 in London. The event was designed as a feedback session for those who were unable to attend the 17th International Conference on the Reduction of Drug Related Harm in Vancouver, Canada (May 2006). Professor Gerry Stimson presented in the opening session and spoke about the Vancouver event as a “travelling circus of harm reduction” touring the world to share information, advice, best practice and research in a neutral, interesting environment. For the full Rapporteur report from this one-day event, please visit www.conferenceconsortium.org and follow the “past events” link.
|  |
| IJDP: Volume 17 Issue 5
| The latest issue of the International Journal of Drug Policy (IHRA’s official journal) presents a diverse range of original research papers as well as the full Rapporteur report from the 17th International Conference on the Reduction of Drug Related Harm. This report has been written by Steffanie Strathdee and her colleagues from the conference’s official Rapporteur Team, which presented at the closing session of the event in Vancouver, Canada.
The Rapporteur team identified several themes that emerged from the conference proceedings including the maturation of the harm reduction movement, the importance of human rights for drug users, the need to improve harm reduction coverage and the role of policing and criminal justice partnerships. They end by quoting the keynote opening speech by UNAIDS official Dr. Prasada Rao (who stated that, internationally, what is lacking most is not money, but political will) and Conference Co-Chair Sue Currie (who closed the event by stressing that “the success of any conference can only be measured by what comes before and what comes after”).
|  Download the Vancouver Rapporteur Report [PDF: 83KB]
| This latest issue also focuses on the topic of peer involvement and intervention (Broadhead et al. report on the efficacy and costs of peer-driven HIV prevention in Russia, while Allman et al. discuss the role of peer-networks in the reduction of drug related harm), legal and illegal drug injecting environments in Canada (Côté et al. examining injecting behaviour in an illegal shooting gallery in Montreal, while Kerr et al. report from Vancouver’s legal drug consumption facility in terms of overdose incidence and predictors), adolescent drug use and services (McCrystal et al. examine pre-teen drug use patterns and behaviour in Belfast and Bell et al. describe consultations for designing a residential drugs service for Tasmanian adolescents), characteristics and risk practices of drug users who obtain their injecting equipment from pharmacies in Australia (Bryant & Treloar) and a further discussion of the ethics and regulation of substance misuse research (Cvetkovski & Fry).
| |
| World Health Organization Survey
| In September 2006, the World Health Organization (WHO) conducted a survey of academic and research institutions, Non-Governmental Organisations and industry representatives to express views and opinions on the problems related to alcohol consumption. IHRA was one of the hundreds of associations to submit as part of this survey. Also, the WHO have released long-awaited clinical protocols relating to Hepatitis.
The alcohol stakeholders survey was conducted to provide the WHO with more information about how alcohol related problems were perceived around the world. This is in response to a 2005 World Health Assembly resolution, which calls upon the WHO to draw up recommendations for effective alcohol harm reduction policies and interventions in time for the 2007 World Health Assembly. So far, the WHO has consulted key stakeholders through meetings with civil society groups, scientists and industry representatives and selected representatives (including IHRA) have also been invited to present their views to the WHO this month.
The survey asked groups to write up to 300 words on (1) the magnitude of health problems related to alcohol consumption, (2) effective interventions to reduce health problems related to alcohol consumption and (3) any additional comments. After consultations between the IHRA Executive Director, IHRA Executive Committee and IHRA Communications and Project Development Officer, the organisation’s response was as follows:
(1) As WHO is fully aware, there are numerous health problems associated with the consumption of alcohol, even though the majority of people consume alcohol in a responsible way. These can be broadly divided into chronic, longer-term health problems and acute, shorter-term harms and risks.
The long-term health problems related to alcohol consumption are many and they are generally the highest profile and costliest harms in terms of treatment, impact, morbidity and mortality. The treatment of these problems is a major burden for healthcare services and governments globally. The prevention of these harms is often targeted at the population-level (due to the associations between long-term health problems and per capita alcohol consumption), but certain sub-populations and patterns of drinking are at much higher risk of alcohol harm (such as binge-drinkers, young people, pregnant women, chronic drinkers, indigenous populations and the homeless). Prevention should be targeted to reflect this imbalance in risk.
The short-term health problems associated with alcohol consumption include accidents, falls, poisoning or overdose, violence and suicide. Generally, these receive less attention than long-term health problems (including in WHO literature) and are often not adequately measured. However, they are sufficiently costly (both in terms of lives and healthcare resources) to warrant significant prevention interventions. Prevention measures should be targeted at vulnerable sub-populations, drinking behaviours and drinking contexts. These short-term health problems are more responsive to changes in drinking behaviour and are therefore good indicators of change.
Importantly, however, the harms that alcohol can cause go beyond medical problems and include a variety of problems related to social nuisance and public order. Prevention measures and policies (national and international) must also consider the social, community, economic and criminal impacts.
(2) For many decades, supply and demand reduction measures (such as taxation increases and restrictions in availability and licensing) have been promoted as the most effective response to alcohol-related problems. This is based on evidence that increases in per capita alcohol consumption are generally accompanied by increasing alcohol-related problems and vice versa. However, such measures are politically, economically or ideologically beyond the reach of many societies and nations across the world (especially in the developing world). They also fail to take in the importance of non-commercial alcohol. Further, focussing only on supply and demand can have the negative impact that it absolves people at a local level from engaging in action to reduce alcohol-related harms. Hence the national and local repose to alcohol needs to be significantly broader.
In recent years, the emphasis has changed slightly towards measures that attempt to modify hazardous drinking contexts, behaviours and patterns (often alongside measures that attempt to reduce per capita consumption). This “harm reduction” approach involves targeting interventions at specific groups within the general population (such as binge drinkers or pregnant women) or targeted at certain drinking contexts (high risk drinking venues) or high-risk behaviours. There is a growing body of evidence in support of interventions at the local, city level.
Local alcohol harm reduction measures must include all local stakeholders and be cross-sectoral in order to foster enthusiasm and a proactive culture. It is then essential to quickly assess the local situation – who drinks, where, when, why and at what cost? The alcohol field needs to develop capacity to undertake local “rapid assessments” that can provide the evidence of need for a comprehensive package of interventions, such as server training, designated driver schemes, safer (shatterproof) glasses in bars, safer better designed drinking environments and the enforcement of existing licensing laws.
(3) Like many commodities, alcohol can be enjoyed and misused, benefiting as well as harming those who consume it. When attempting to reduce the health problems associated with alcohol consumption, it is essential to gain a full understanding of the patterns, environments and contexts of drinking. The harms of alcohol do not apply to entire populations in equal measure – there are groups at higher risks than others. Essentially, however, these harms are preventable. Long-term objectives are to change the culture of drinking: but in the short term there are practical measures that can be implemented to reduce the impact on individuals and communities.
Harm reduction is not a new concept in the alcohol field. The notion of ‘making the world a safe place for drunks’ in the 1960s was based on the recognition that, despite valiant attempts to eradicate public drunkenness, there would always be some individuals who would end up intoxicated in public. Prudence dictated the need to reduce the harm these individuals caused to themselves and their communities. Harm reduction approaches to alcohol complement supply and demand reduction measures. Harm reduction acts to provide more pragmatic, targeted and locally defined approaches to the extensive problems that alcohol can cause.
The submitted opinions and views will be gathered in a forthcoming WHO report on the health problems related to alcohol consumption. In 2007, the WHO will be asked to present to the World Health Assembly on the subject of evidence-based strategies and interventions to reduce alcohol-related harm.
Additionally, the WHO have also released the following long-awaited clinical protocols, which are now available from www.euro.who.int/aids/treatment/20060801_1
| - Management of Hepatitis C and HIV co-infection
- Management of Hepatitis B and HIV co-infection
- Prevention of Hepatitis A, B and C and other hepatotoxic factors in people living with HIV/AIDS
|
| |
| IJDP call for papers – Values and Ethics in Harm Reduction
| The International Journal of Drug Policy is the leading forum for the dissemination of current research, reviews, debate, and critical analysis on drug use and drug policy in a global context. Plans are underway for a special issue in 2007 on “Values and Ethics in Harm Reduction”, to be guest edited by Kaveh Khoshnood, Robert Power, Mukta Sharma and Craig Fry. This is a call for papers and any other relevant contributions.
The guest editors wish to encourage any contributions related to this theme but would be particularly interested in papers on values, ethics and rights in harm reduction, harm reduction and human rights frameworks, ethical issues in drug user involvement, consultation and participation, ethical issues associated with harm reduction activities in developing countries, informed consent in harm reduction research and interventions and the regulation of harm reduction research. They are also interested in reflections from the field of harm reduction regarding applied responses to ethical dilemmas in practice and service delivery, policy making, research, law enforcement, prevention etc.
The following types of contribution are invited: scientific review papers (max 7,000 words), research papers (4,000 – 6,000 words), short research reports (2,000 – 3,000 words), policy and/or historical analyses (3,000 – 5,000 words), commentary and/or viewpoint articles (2,500 – 4,000 words), editorials (1,000 - 2,500 words) and short reports or research notes/case studies (750 – 1,500 words).
Initially, the guest editors are asking for expressions of interest (one page including title, authors, affiliations and a brief abstract) by Tuesday 31st October 2006 (with the final deadline for contributions set as 28th February 2007). These will then be peer-reviewed ready for publication in 2007. Expressions of interest should be emailed to Kaveh Khoshnood at kaveh.khoshnood@yale.edu (with “Harm Reduction Ethics” in the subject-heading field).
For subscriptions to the International Journal of Drug Policy, go to: www.journals.elsevierhealth.com/periodicals/drupol/home Alternatively, for details about concessions and IHRA membership packages that include a subscription to the journal, please visit the membership page for more information.
| |
|
|
|
|
|
|
|
