Municipal elections in British Columbia Saturday saw Vancouver get another in a string of pro-drug reform mayors, while a marijuana reformer was returned to the mayor's office in Grand Forks in the

Swiss voters will go to the polls November 30 to decide whether to approve marijuana decriminalization and the government's ongoing "four pillars" drug strategy, which includes the prescription of

Since 1990, IHRA’s annual international harm reduction conferences (formerly known as the ‘International Conferences on the Reduction of Drug Related Harm’) have grown in importance and become t

The Harm Reduction Coalition (HRC) is a national advocacy and capacity-building organization that promotes the health and dignity of individuals and communities impacted by drug use.

[Courtesy of Harm Reduction Coalition]

7th National Harm Reduction Conference: Towards A National Policy, November 13-16 2008, Hilton Hotel - Miami Florida, www.harmreduction.org

Letter from Allan Clear

Dear Friends,

Every two years at this time I write an inspirational letter of greeting for this conference announcement. This year the letter writes itself. The Seventh National Harm Reduction Conference is taking place within 9 days of the national elections. There is reason for optimism. With some mobilization, the purveyors of eight long years of lies, corruption, hypocrisy, destruction, nepotism, greed, callousness, con-passion, and debt creation will be shuttled off into a deep, dark, disused uranium mine. We will have an end to the worst presidency in our history. The characters that have lurked, like Harry Potter's death-eating foes, in the White House will be no more (although we all know that people like Cheney exhibit a Voldemort-like quality of never quite going away).

A Democrat in the White House will not guarantee that a change is going to come in any significant fashion. But taking a harm reduction approach of "meeting politicians where they are" and embracing any positive change, what can we reasonably expect? An end to the morale-crushing, exodus-inducing politicization of institutions such as the CDC, NIDA and SAMSHA should be on the score sheet. An open dialog with the scientific community about harm reduction-based interventions, such as naloxone and syringe exchange, could be held without the straitjacket of censorship. Local authorities would actually be encouraged to start and expand syringe exchange. A new administration might work with Congress to increase funding for viral hepatitis, eliminate racialized sentencing disparities for crack cocaine, direct SAMSHA to launch a national overdose prevention strategy, and formulate goals to make drug treatment on demand ―including buprenorphine for those at the margins of the health care system―a reality. Global AIDS funding through PEPFAR would be expanded for countries with injection-related HIV epidemics and restrictions on abortion providers, abstinence requirements in HIV prevention, and anti-prostitution "pledges" would be eliminated. Communities and health officials could pursue establishing safe injection spaces and heroin prescription without having to look quite as rigorously over their shoulders for the goon squad to come beating down the doors. And the federal ban on the funding of syringe exchange will ultimately become a footnote in the history of failed governance. Maybe by the year 2013, the feds will actually provide some money for syringe access. We've done the groundwork and the evidence exists to support our efforts, but we will not have an easy path, no matter who is in Congress or the White House.

The Seventh National Harm Reduction Conference will have an eye firmly on the national scene. There is no reason why compassion, science and common sense cannot prevail, nor any reason why the United States could not adopt a harm reduction framework to address drug and alcohol problems. Join us in Miami and be part of the direction, planning and brainstorming.

See you there.

Allan Clear
Executive Director

[Courtesy of North American Opiate Medication Initiative (NAOMI)]

For Immediate Release: October 17, 2008
Contact: Julie Schneiderman at (604) 806-8380

Results show that North America’s first heroin therapy study keeps patients in treatment, improves their health and reduces illegal activity

VANCOUVER, BC, October 17, 2008 – Researchers from the North American Opiate Medication Initiative (NAOMI Study) today released final data on the primary outcomes from the three-year randomized controlled clinical trial.

“Our data show remarkable retention rates and significant improvements in illicit heroin use, illegal activity and health for participants receiving injection assisted therapy, as well as those assigned to optimized methadone maintenance,” says Dr. Martin Schechter, NAOMI’s Principal Investigator, Centre for Health Evaluation and Outcome Sciences and Professor and Director, University of British Columbia School of Population and Public Health. “Prior to NAOMI, all of the study participants had not benefited from repeated standard addiction treatments. Society had basically written them off as impossible to treat.”

The data, which was collected from 251 participants at sites in Vancouver and Montreal, demonstrate that a combination of optimized methadone maintenance therapy (MMT) and heroin assisted treatment (HAT) can attract and retain the most difficult-to-reach and the hardest-to-treat individuals who have not been well served by the existing treatment system.

Key findings at the 12-month point of the treatment-phase of the study showed that HAT and MMT achieved high retention rates: 88 per cent and 54 per cent respectively. Illicit heroin use fell by almost 70 per cent.

The proportion of participants involved in illegal activity fell by almost half from just over 70 per cent to approximately 36 per cent. Similarly, the number of days of illegal activity and the amount spent on drugs both decreased by almost half. In fact, participants once spending on average $1,500 per month on drugs reported spending between $300-$500 per month by the end of the treatment phase. Marked improvements were also seen in participants’ medical status with scores improving by 27 per cent.

Of particular note amongst the findings, participants receiving hydromorphone (DilaudidTM) instead of heroin on a double-blind basis (neither they nor the researchers knew) did not distinguish this drug from heroin. Moreover, hydromorphone – an opiate licensed for the relief of pain - appeared to be equally effective as heroin, although the study was not designed to test this conclusively. According to the NAOMI Study Investigators, further research could help to confirm these observations, allowing hydromorphone assisted therapy to be made more widely available.

While a comprehensive health economics study is pending, researchers have already determined that the cost of continued treatment is much less than that of relapse.

“We now have evidence to show that heroin-assisted therapy is a safe and effective treatment for people with chronic heroin addiction who have not benefited from previous treatments. A combination of optimal therapies – as delivered in the NAOMI clinics - can attract those most severely addicted to heroin, keep them in treatment and more importantly, help to improve their social and medical conditions,” explains Schechter.

A summary report of the findings and background information on the study are available at: www.naomistudy.ca.

The battle over harm reduction in Vancouver just gets uglier all the time:

VANCOUVER -  The Pivot Legal Society has asked federal Auditor-General Sheila Fraser to examine whether the RCMP exceeded its law-enforcement mandate by commissioning studies into Vancouver's supervised injection site.

Pivot lawyer and spokesman Doug King on Wednesday revealed RCMP e-mails indicating the national police force commissioned reports researching Insite.

"The RCMP Act gave the RCMP a mandate to act as peace officers for the citizens of Canada. Using public funds entrusted to them to fund a cynical critique of health-based research clearly does not fall within this mandate," King said. [Vancouver Sun]

Indeed, police are responsible for enforcing the law, not shaping social policy. Law enforcement’s backhanded attempt at inserting itself into the academic debate over harm reduction is completely inappropriate and disturbing. Does anyone believe that police-sponsored research will ever reach conclusions other than the need for more police power?

RCMP now claims that it conducts research all the time, which may be true, but misses the point. Police research should focus on measuring the effectiveness of their own programs, not producing political ammunition against non-police programs that police don’t like.

Check out this interesting logic from the FDA:

WASHINGTON - A top government health official rejected the idea of an immediate ban on cough and cold medicines for young children, saying it might cause unintended harm.

Food and Drug Administration officials at a public hearing Thursday said they need to gather more data on whether over-the-counter remedies are safe and effective for children ages 2 to 6.

The FDA is also worried that a ban — as sought by leading pediatricians' groups — might only drive parents to give adult medicines to their youngsters. [MSNBC]

Well, that sounds like a logical concern. People tend to make safer choices when available and more dangerous ones when their options are restricted. Yet federal law still blocks funding for needle exchange and criminalizes people who use marijuana as an alternative to powerful opioid-based pharmaceuticals.

                                                                                                                                                                              {Thanks, Caryn]

Despite having nearly a million heroin addicts, with HIV spreading rapidly through that population, Russia's government has very tragically said no to methadone maintenance. According to a short video posted by the Hungarian Civil Liberties Union (HCLU), 80% of all new HIV cases in Russia are due to needle sharing by injection drug users.

Check out the video here:

Check out HCLU here.

Cato Unbound has a wonderful piece, Towards a Culture of Responsible Psychoactive Drug Use, by Earth and Fire Erowid, the founders of Erowid.org. The article provides a rational discussion of why people use psychoactive substances and what can be done to minimize the harms and maximize the benefits of such use. Over the next week, Cato will post responses from Jonathan Caulkins, Jacob Sullum, and Mark Kleiman.

I read the piece last night in its entirety and don’t recall finding a single word I disagree with. What struck me is how far removed modern drug education is from even discussing these commonsense principles. Do this information sound dangerous to you?

Fundamentals of Responsible Psychoactive Use

* Investigate the health risks and dangers of the specific psychoactive and of the class of drugs to which it belongs.
* Learn about interactions with other recreational drugs, medications, supplements, and activities.
* Review individual health concerns, predispositions, and family health history.
* Choose a source or product carefully to help ensure correct identification and purity
(avoid materials with an unknown source or of unknown quality).
* Know whether the drug is likely to reduce the ability to drive, operate equipment, or pay attention to necessary tasks.
* Take oneself "off duty" from responsibilities that might be interfered with (job, child care, etc.), and arrange for someone else to be “on duty” for such responsibilities.
* Anticipate reasonably foreseeable risks to oneself and others and employ safeguards to minimize those risks.
* Choose an appropriate occasion and location for use.
* Select and measure dosages carefully.
* Begin with a low dose until individual reactions are known and thereafter use the minimum dose necessary to achieve the desired effects: lower doses are safer doses.
* Reflect on and adjust use to minimize physical and mental health problems.
* Note changes in health over time that may be related to use.
* Modify use if it interferes with work or personal goals.
* Check in with peers and family and accept feedback about one’s use.
* Track reactions to specific drugs and dosages in order to avoid repeating mistakes.
* Seek treatment if needed.
* Decide not to use when the time isn’t right, the material is suspect, or the situation is otherwise problematic.

Anyone who has a problem with any of this should contemplate the consequences of allowing young people to learn these lessons the hard way. The fact that these ideas might be considered controversial should serve to remind us how badly our society has demolished its own ability to discuss drug use with people who use drugs.

Phillip S. Smith, Writer/Editor

Eight months after Congress voted to end a decade-long ban on the use of federal funds for needle exchange programs (NEPs) in the District of Columbia, money is starting to flow to the programs in

Australia's 2007 National Drug Strategy Household Survey, in which more than 23,000 people ov

The latest outrage in Canada's heated harm reduction debate came at the hands of Health Minister Tony Clement who went off the rails by questioning the ethics of doctors who practice harm reduction:

MONTREAL — The association representing Canada's doctors rapped Health Minister Tony Clement on Monday after he questioned the ethics of physicians who support the use of supervised injection sites for drug addicts.
…

"Is it ethical for health-care professionals to support the administration of drugs that are of unknown substance, or purity or potency, drugs that cannot otherwise be legally prescribed?" Clement said.

He said that in any other medical setting, supervised overdoses would be considered "highly unprofessional." [Canadian Press]

Canada's doctors beg to differ:

The Canadian Medical Association's president responded to Clement by saying 79 per cent of members agree that safe-injection sites and harm-reduction programs work.

Dr. Brian Day said sites that allow addicts to inject their own narcotics under the supervision of medical staff have been successful in curbing illegal drug use and slowing the spread of disease.

"We specifically take issue with the minister using that phrase," Day told reporters after Clement's speech.

"The minister was off base in calling into question the ethics of physicians involved in harm reduction.

"It's clear that this was being used as a political issue."

Doctors are not politicians. They work to save lives and they are the experts on how to do that. If they all agree that existing programs are working, and some politician disagrees, then he is just wrong and he should shut up.

The drug war debate is ugly and that's not gonna change anytime soon. But one thing we can do without is politicians feigning moral superiority over the doctors who are saving lives every day. That's what this is about. Harm reduction shouldn't be a political issue and if you succeed in politicizing it for the wrong reasons, people will die.

You Can Make a Difference

Dear friends,

Several months ago my colleague Naomi Long and I had an op-ed in The Washington Post calling for a repeal of the federal prohibition that blocks states from using their share of HIV/AIDS prevention money on syringe exchange programs. We had a hard-hitting conclusion: “As many as 300,000 Americans could contract HIV/AIDS or hepatitis C over the next decade because of a lack of access to sterile syringes. This essentially makes the national syringe ban a death sentence for drug users, their partners and children.”

Take action now to support a bill in Congress that would repeal the ban.

Last year my colleague Jasmine Tyler lost her father to HIV/AIDS that he contracted from injection drug use and it really hit our D.C. office hard. She had this to share: “From the time he found out he was HIV-positive until the day he died in April of 2007, he suffered greatly and so did our family.  Every day I know that the hell he lived through could have been avoided if only he had had access to sterile needles all the time.  It’s too late to bring him back, but every other life that can be saved should be.”

While our country spends billions of dollars on efforts to prevent the spread of HIV/AIDS, hepatitis C and other infectious diseases, the U.S. prohibits the use of prevention funds to support syringe exchange programs. This robs cities, states and private organizations of the right to do what’s best for the people, and costs taxpayers a lot of money. It’s far cheaper to distribute syringes and prevent the spread of HIV/AIDS and hepatitis than it is to treat people who contract those infectious diseases after it's too late.

Last year, District of Columbia Congressional Delegate Eleanor Holmes Norton and New York Congressman Jose Serrano successfully repealed a federal ban that prohibited D.C. from spending its own budget money on syringe exchange programs. This week Rep. Serrano introduced a bill that would repeal the national syringe funding ban. If enacted, it could save hundreds of thousands of lives and millions in taxpayer dollars. Please urge your representative to support this urgent, life-saving bill.

Take action now.

Want to do more? Set up a meeting with your representative when he or she is in your district during Congress's August recess. Learn how.

Sincerely,

Bill Piper
Director of National Affairs
Drug Policy Alliance

More Information

--According to the Centers for Disease Control and Prevention (CDC), of the 415,193 people reported to be living with AIDS in the United States at the end of 2004, about 30 percent of cases are related to injection drug use, either directly (sharing contaminated syringes) or indirectly (having sex with someone who used a contaminated syringe or being born to a mother who used a contaminated syringe).

--Each year, approximately 12,000 Americans contract HIV/AIDS directly or indirectly from the sharing of dirty syringes. About 17,000 people contract hepatitis C.
 
--The Centers for Disease Control and Prevention (CDC), American Medical Association, National Academy of Sciences, American Public Health Association, and numerous other scientific bodies have found that syringe exchange programs are highly effective at preventing the spread of HIV/AIDS and other infectious diseases. Moreover, seven federal reports have found that increasing access to sterile syringes saves lives without increasing drug use.

--Increasing the availability of sterile syringes through exchange programs, pharmacies and other outlets reduces unsafe injection practices such as syringe sharing, curtails transmission of HIV/AIDS and hepatitis, increases safe disposal of used syringes, and helps injection drug users obtain drug education and treatment.

--The lifetime cost of treating just one person who contracts HIV/AIDS can be as high as $600,000. This cost is often borne by taxpayers. In contrast, syringe exchange programs can prevent thousands of new HIV/AIDS cases at very little cost. Funding syringe exchange programs saves both lives and taxpayer money.

--A federal appropriations rider in the annual Labor, Health and Human Services, Education, and Related Agencies spending bill prohibits states from spending their share of federal prevention money on syringe exchange programs. H.R. 6680 would repeal that provision.

A study released this week charted a startling increase in deaths from "fatal medical errors," particularly those associated with people mixing street drugs and alcohol with prescription medication

Rep. Jose Serrano (D-NY) and 25 cosponsors filed a bill Wednesday that would remove all restrictions on the use of federal funds for needle exchange programs (NEPs).

Faced with an intractable and growing opiate addiction problem, in recent years Iran has increasingly embraced the principles of harm reduction.

Good morning,

I am reaching out this morning to my broad network of friends, family, and colleagues and asking that you consider signing onto the attached petition to the Government of Iran on behalf of Drs. Kamiar Alaei and Arash Alaei, physician brothers who have been working on HIV and drug use in Iran for many years. They have been detained without any charges by Iranian security forces since late June. We are concerned that their detainment may be related to their harm reduction work and leadership. The petition calls on the government of Iran to either charge or immediately release them.

Please consider signing PHR's petition and let me know if you would like me to keep you informed of progress in the case. The petition is online at http://actnow-phr.org/campaign/iran_free_the_docs.

Thank you.

Paola

Paola Barahona, MPH
Global Health Policy Associate
Physicians for Human Rights
1156 15th Street NW, Suite 1001
Washington, DC 20005
(202) 728-5335 (ext.300)
pbarahona@phrusa.org
www.HealthActionAIDS.org
www.physiciansforhumanrights.org
20 years of advancing health, dignity and justice

Spurred by a favorable court ruling in May allowing Vancouver's safe injection site,