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Advancing Harm Reduction: International Lessons for Local Practice

September 7, London, United Kingdom, "Advancing Harm Reduction: International Lessons for Local Practice -- Highlights from 17th International Conference on the Reduction of Drug Related Harm in Vancouver, May 2006." Registration 47 pounds (including VAT) including refreshments and lunch, for further information contact Michelle Vatin at 0207 272 6902 or [email protected].
Data: 
Thu, 09/07/2006 - 9:00am - 5:00pm
Localização: 
London
United Kingdom

Harm Reduction: Global Harm Reductionists Issue Urgent Declaration Calling for Action on Drug Use and HIV

Representatives of 19 international and regional harm reduction organizations meeting in Toronto this week have issued a declaration calling for immediate action to address the spread of HIV through injection drug use. Known as the Declaration of Unity, the statement demands that governments and international anti-drug organizations stop impeding the adoption of harm reduction measures proven to reduce the spread of disease, such as needle exchanges and safe injection sites.

The groups urged governments to:

  • provide adequate coverage and low threshold access, including in correctional settings, to sterile injection equipment, condoms, methadone and buprenorphine as essential components of comprehensive HIV prevention and care;
  • ensure that drug users and all marginalized populations have equitable access to quality HIV prevention, medical care, and highly active antiretroviral treatment, that concrete country-level and global targets be established, and that progress be monitored;
  • provide meaningful involvement of drug users at all levels of planning and policy, and financial support for their organizations; and
  • put an end to disenfranchisement and human rights violations of drug users including mass imprisonment, punitive and degrading drug treatment programs, and the widespread use of withdrawal as a form of coercion.

Noting that UNAIDS cannot effectively slow the spread of HIV when forces within the UN system are creating obstacles to effective harm reduction measures, the groups demanded that:

  • the United Nations Office on Drugs and Crime, as the UN agency tasked with leadership on HIV prevention among drug users, ensure that effective community protection against HIV is not ignored in the name of drug control and law enforcement;
  • the International Narcotics Control Board, as the body charged with responsibility for monitoring implementation of the drug treaties, publicly and unambiguously endorse and promote harm reduction as an approach consistent with those treaties and monitor global delivery of substitution treatment and HIV prevention measures for drug users;
  • the international community and all major UN bodies involved in drugs and HIV approach drug use as a health and social matter which also requires some law enforcement interventions rather than being primarily a matter of criminal justice.

The harm reductionists from around the globe were in Toronto for the International AIDS 2006 conference. "HIV is being spread increasingly -- in some parts of the world, chiefly-through the sharing of injecting equipment, said Dr. Diane Riley, who signed the declaration on behalf of the Canadian Foundation for Drug Policy and the Youth Network for Harm Reduction International. "Considerable evidence exists that harm reduction strategies such as needle exchange programs can effectively, safely and cheaply reduce the spread of HIV; yet very few such programs are in place. Governments are in effect spreading infection through their own drug control and enforcement policies which encourage use of non-sterile equipment, and marginalization and incarceration of users," Riley added in a press release announcing the declaration.

"The United States, the world's most important donor of international aid, restricts implementation of harm reduction strategies," Riley charged. "Political and social commitment, including commitment of the necessary resources, and an end to the US administration's embargo on harm reduction are needed now," Riley said. "If we fail to do this, further catastrophe is inevitable and the global economy will simply not be able to cope with the resultant burden."

Europe: British Public Supports More Rational Drug Policies, Survey Says

A survey of British attitudes toward drug policy has found that a majority of people are ready to decriminalize marijuana or make it an offense equivalent to a parking fine. But the poll also found that a solid majority draws a distinction between "soft" drugs like marijuana and "hard" drugs like cocaine and heroin. Most people do not want to see any lessening of restrictions on the use or sale of hard drugs.

The survey's release this week comes with Britain in the midst of a battle over redefining its largely drug war-style drug policies. Just two weeks ago, a parliamentary committee studying drug policy released a report calling Britain's drug classification scheme unscientific. Marijuana policy continues to bedevil the British, as does rising cocaine use and high levels of use of other drugs. The government is also discussing drug policy now because in two years it must evaluate its current 10-year strategy.

Marijuana is currently a Class C drug -- the least serious drug category -- and possession offenders are typical ticketed, while marijuana sales remains a serious crime punishable by up to seven years in prison. Only 38% wanted both possession and sales to remain criminal offenses, while 30% wanted lesser criminal penalties for possession only, 13% wanted simple possession totally decriminalized, and another 15% wanted to see both sales and possession treated as not a crime. In other words, 58% of respondents favored marijuana policies more lenient than current policies.

Attitudes were much tougher toward "hard" drugs, with 73% of respondents favoring the status quo. Only 17% favored lesser criminal penalties for simple possession and only 6% favored entirely decriminalizing possession. The poll didn’t even ask whether anyone would favor legalizing the hard drug trade.

Respondents also broadly agreed that a new drug classification scheme, perhaps containing a Class D for drugs like alcohol, tobacco, and marijuana, would be a good thing by a margin of 56% to 30%. When it comes to comparing the harms of various drugs -- licit and illicit -- respondents ranked heroin as worst, followed closely by cocaine, solvents, ecstasy, and tobacco in descending order. Marijuana was rated as less harmful than any drugs except prescribed tranquilizers and coffee.

The British citizenry also displayed an awareness of the notion of harm reduction, with a whopping 89% agreeing that: "Whether we like it or not, there will always be people who use drugs and the aims should be to reduce the harm they cause themselves and others."

If this survey is any indicator, it looks like the British public is ready for some more rational drug policies. The question is: Is the British political class ready?

Harm Reduction: Boston About to Move to Supply Addicts with Heroin Antidote

Boston public health authorities will likely approve a trial program providing heroin users with naloxone (brand name Narcan) next week, the Boston Globe reported Wednesday. If the Boston Public Health Commission indeed approves the program, it will join cities such as Baltimore, Chicago, and New York where authorities have already approved its distribution to drug users.

https://stopthedrugwar.org/files/naloxone.jpg
In many locales, only paramedics or hospital emergency rooms administer the drug, which can stop a heroin overdose from turning into an overdose death. But with Boston facing a high number of heroin overdose deaths -- fatal overdoses increased 50% between 1999 and 2003 -- city health officials want to put the drug where it can do the most good most quickly: in the hands of drug users.

"The number one hope with this is to save lives," Public Health Commission executive director Joel Auerbach told the Globe. "Our paramedics have said it's a miracle drug. They've seen people who are comatose who are then revived and perfectly fine."

The trial run is expected to enroll 100 heroin users, who would have to undergo training and evaluation, as well as listen to encouragements to quit. But if they were not prepared to stop using, they would be instructed in how to administer Narcan. Then they would be given a prescription for two doses.

The proposed move comes just a week after the Office of National Drug Control Policy -- the drug czar's office -- rejected the idea as somehow encouraging drug use. "We don't want to send the message out that there is a safe way to use heroin," ONDCP spokesperson Jennifer DeVallance told the AP.

No Honor for Last Holdout State Against Needle Exchange

A few weeks we reported in Drug War Chronicle that New Jersey had become the only state in the nation not allowing needle exchange programs in some form or at least syringe purchase without a prescription -- the second to last state, Delaware, passed a needle exchange law last month. The Times of New Jersey opined on the matter this morning in an opinion piece titled, "The Last One Standing." The Times writes:
After 13 years of debate without action, New Jersey is now the only state without a needle-exchange program -- a title the state should be embarrassed to hold, especially since its accompanying titles include fifth highest rate of adult HIV/AIDS cases in the nation and double the national percentage of cases caused by injection.
Having observed the issue in New Jersey for most of those years -- I well remember the days when Diana McCague and New Brunswick's The Chai Project mounted their open challenge to New Jersey's needle exchange prohibition -- and being originally from New Jersey myself, I am glad to see a major paper speak up again. According to the editorial there are "only a few loud legislators who are fundamentally opposed" to two state senate bills that would legalize needle exchange and permit prescriptionless syringe sales. In my view, those "loud legislators" have committed a monstrous crime against humanity -- really -- and so did the attorney general who squelched the newer programs opened by city emergency order through the courts. Former governor Whitman was maybe the worst villain in this. Large numbers of New Jerseyans are contracting AIDS and Hepatitis C through needle sharing, are dying from those diseases and spreading them to others. The scientific evidence supporting needle exchange programs is absolutely overwhelming. Talk about moral confusion! There should be new Chai Projects, in all the cities around the state, law or now law. Then let the legislators catch up and the opponents fall behind into history's dustbin where they belong.
Localização: 
NJ
United States

Editorial: Sometimes They Tell the Truth

David Borden, Executive Director

https://stopthedrugwar.org/files/borden12.jpg
David Borden
It's alternately refreshing or appalling to hear public officials who deal with drug policy occasionally tell the truth about it. This week reformers got to bring home some of both.

The refreshing truth-telling came from Great Britain, where a Parliamentary Committee harshly tore into the official drug classification scheme used in the Misuse of Drugs Act, and the agency that is responsible for maintaining it. Many of the rankings seemed to have resulted from "knee-jerk responses to media storms," the committee charged, with no consistency and "no solid evidence to back-up the view that classification had a deterrent effect." "The current classification system is riddled with anomalies and clearly not fit for its purpose," the chairman said. "From what we have seen, the Home Office and ACMD approach to classification seems to have been based on ad hockery and conservatism." (See two articles below in this issue to read all about it.)

Gotta like that! But now for one that I don't like -- not at all. In Philadelphia, one of the cities suffering under the crisis of fentanyl-laced heroin and the resulting wave of often fatal overdoses, the harm reduction program Prevention Point Philadelphia, partnering with a local physician, has begun to help distribute naloxone, a medication that if used soon enough during an overdose can save the victim's life.

Naloxone distribution is a type of program known as "harm reduction," the idea of which is that since we know some people are going to use drugs regardless of how we fight them, there are things that can be done to help them save their lives and the lives of others -- even before they stop using drugs, for that matter even if they never stop using drugs. Needle exchange programs are another example of harm reduction at work.

The drug czar's office reacted to the PPP venture with criticism. If heroin users have a chance of surviving an overdose, the reasoning went, it is "disinhibiting" to the objective of getting addicts to just stop using the stuff. "We don't want to send the message out that there is a safe way to use heroin," an ONDCP spokesperson said. But "dead addicts don't recover," as the common mantra in the harm reduction field goes.

While the drug czar's position is dead wrong about this -- deadly wrong, in fact -- the comment seems a fairly truthful explanation of the horrible way that many drug warriors think. It is a direct corollary of the spokesperson's comment that it is better to have people who could be saved instead die, in order to dissuade others from using drugs -- better to make sure that drugs kill -- so that everyone will be sure that drugs do kill. But the dead from overdoses are definitely (and permanently) dead, whereas those who, through the withholding of livesaving assistance to some, are thereby saved from death through their own choices, may or may not exist.

Those who oppose harm reduction are in effect supporting "harm intensification" instead -- a deliberate attempt through policy to increase the dangers of drugs -- at a cost of lives, and in my view of morality too.

But that is what prohibition is truly about, harm intensification on a global scale. Hence the need for legalization instead -- so morally defunct ideas like those expressed this week by the drug czar's office can be laid to rest and their ghastly consequences finally be made to cease.

Harm Reduction: Drug Czar's Office Opposes Letting Heroin Users Have Easy Access to Overdose Antidote

When heroin users around Philadelphia started overdosing on junk laced with fentanyl, a powerful synthetic opiate, a local harm reduction group began working with a sympathetic physician to provide addicts prescriptions to naloxone (brand name Narcan). The Office of National Drug Control Policy thinks that's a bad idea.

In many cities, paramedics carry Narcan with them, but by the time they arrive on the scene, it can be too late, explained Casey Cook, executive director of Prevention Point Philadelphia, the group that runs the city's needle exchange program. "If people have to rely on paramedics, more often than not, the overdose is going to be fatal, just because of the amount of time for people to get there," she told the Associated Press in an interview last Friday.

But the drug czar's office is worried that providing addicts with the means to survive an overdose would prove "disinhibiting," much the same way social conservatives argue that providing teenagers with condoms to prevent pregnancy and disease "disinhibits" them from remaining abstinent. ONDCP doesn't want to appear to condone drug use. "We don't want to send the message out that there is a safe way to use heroin," said Jennifer DeVallance, an ONDCP spokesperson told the AP.

There were some 16,000 drug-related deaths reported in 2002, the vast majority of them involving either heroin or prescription opiates, and at least 400 people have died in the wave of fentanyl-related heroin ODs in the past few months. Better they should die than people think heroin is safe, huh?

In Memoriam: Methadone Pioneer Vincent P. Dole

(This memorial piece for a great pioneer in addiction treatment was written and distributed by his friend and colleague, Dr. Robert Newman.)

Dr. Vincent Dole (an internist) and his late wife, Marie Nyswander, MD (a psychiatrist), began their collaborative research with methadone with a handful of long-term heroin-dependent individuals in 1964. They did so in the face of overt threats of harsh criminal and civil action by federal narcotics agents. Their courageous, pioneering work demonstrated that methadone maintenance is a medical treatment of unparalleled effectiveness -- a superlative description that is as applicable today as it was four decades ago. As a result, well over three-quarters of a million people throughout the world are able to lead healthy, productive, self-fulfilling lives - over 200,000 in the United States, an estimated 530,000 in Western Europe, and many tens of thousands more in Eastern Europe, Middle East, Central Asia, Far East, Australia and New Zealand.

After the remarkable transformation they observed in their first few patients, Dr. Dole and Dr. Nyswander went on to provide direct supervision of the first methadone maintenance treatment program at Beth Israel Medical Center in New York. In so doing they demonstrated that it was possible to replicate on a large scale the therapeutic success they achieved in the small, controlled, research environment of the Rockefeller Institute (now Rockefeller University). Dr. Dole was also responsible in the early 1970s for convincing the New York City Department of Corrections (at the time headed by Commissioner Ben Malcolm) that detoxification of heroin-dependent inmates in the city's main detention facility at Rikers Island was imperative to save lives and lessen suffering (there had been a wave of suicides at the time that had been attributed to severe opiate withdrawal). The detoxification program continues to this day, and has become a model for enlightened corrections officials in other countries.

Dr. Dole and Dr. Nyswander's contributions, however, transcend the life-saving clinical impact on patients and the enormous associated benefits to the community as a whole. They had prescience to hypothesize, years before the discovery of the morphine-like endorphine system in the human body, that addiction is a metabolic disorder, a disease, and one that can and must be treated like any other chronic illness. What was at the time brilliant insight on their part is today almost universally accepted by scientists and clinicians alike, and remains the foundation upon which all rational policies and practices in the field rest.

In his mid-80s Dr. Dole traveled to Hamburg to be present at the naming ceremony of the Marie Nyswander Street; in less than ten years Germany moved from methadone being illegal to having over 60,000 patients in treatment! His efforts during recent years were devoted to fighting the stigma that, tragically, remains so widespread against the illness of addiction, the patients and the treatment.

Prosecutor Says Dangerous Heroin Now in Cape May County (New Jersey)

Localização: 
United States
Publication/Source: 
Press of Atlantic City
URL: 
http://www.pressofatlanticcity.com/news/local/capemay/story/6583660p-6430459c.html

Mayor Seeks Drug Maintenance for Drug Addicts

Localização: 
United States
Publication/Source: 
Vancouver Sun
URL: 
http://www.canada.com/vancouversun/news/story.html?id=bf184ac0-01c2-4251-8c46-24cbb64be30f

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