Foil for Injectors

posted: 28/09/2009

'Harm Reduction' is the name given to anything that reduces health risks. For years injecting drug users have been provided with clean needles and syringes and this has helped keep the number of people with HIV from injecting drug use in Manchester and the rest of NW England low. Just 2% of HIV infections in the region came through injecting drugs, 118 people. This is far less than in Scotland and many other countries in Europe.

Now there are moves to provide aluminium foil as an alternative - the foil is used for smoking heroin and this is safer than sharing and using needles and syringes.

Drug treatment experts say that inhaling heroin instead of injecting reduces a user's risk of contracting HIV and Hepatitis C. A drug user heats a blob of heroin on the foil and smokes the fumes - which is called "chasing the dragon".

drugs paraphernalia and police

The Advisory Council on the Misuse of Drugs (ACMD) is examining whether the law should be changed to allow Britain's 300,000 problem drug users to receive foil as a way of protecting their health. Since last year, the ACMD's 31 members, who advise the Home Office, have been considering whether section 9A of the Misuse of Drugs act, governing "paraphernalia" or equipment used in the consumption of illicit substances, should be amended to allow the UK's network of needle exchanges to supply foil. At present, it prohibits the supply of "articles to be used for the preparation or consumption of illicit drugs".

Foil ban criticised

Critics say the ban endangers users' health because most drug workers are too afraid of being prosecuted to risk giving out something that many see as a sensible harm-reduction measure. An estimated 100 of England's 1,300 needle exchanges already defy the law by providing foil. Some have even had tacit support in the form of "letters of comfort" from their local police force, such as Avon and Somerset, which emphasises that it does not see the pursuit of section 9A as a priority.

The ACMD's technical committee has held two private evidence-gathering sessions on the subject with with Jamie Bridge of the International Harm Reduction Association, which backs legalisation, and drugs treatment researchers Neil Hunt and Rachael Pizzey. It is due to hear on 29 October from veteran Dutch drugs worker John-Peter Kools, who has issued foil in the Netherlands. Both Holland and Spain issue foil through needle exchanges without any major problems.

The full ACMD is to debate the issue in November and is expected to suggest setting up a pilot study on the effects of foil provision. It hopes to advise ministers of its views soon – possibly before the end of the year – on whether the law should be changed. Bridge said: "Smoking drugs is by no means safe, but is a great deal safer than injecting drugs – which is particularly associated with overdose, blood-borne viruses, drug-related litter, greater dependency, abscesses and vein damage.

police edging closer to foil acceptance

"The law has unintentionally put us in a strange position whereby we can give someone clean needles to inject with, but we face arrest for giving them aluminium foil to smoke with. Providing foil in this way is such a common-sense approach – with huge potential benefits and little opposition or potential costs – that we hope the law will change soon." Significantly, the Association of Chief Police Officers, which represents the country's most senior officers, is neutral on whether the law should be amended. But it would support a change if the ACMD recommended such a move on public health grounds, sources told the Observer.

Harry Shapiro of Drugscope, which represents 800 drug projects, said: "It's important to do everything possible to discourage Britain's 300,000 problem drug users from injecting their drugs, and we should allow injecting heroin users to be provided with foil as part of a harm-reduction programme. As the law now stands users' health is being compromised and it would be better if section 9A was repealed."

But James Brokenshire, the Conservative shadow home affairs minister, said: "I'm cautious about these sort of moves, which progress harm reduction rather than focus on getting people drug-free. In recent years there has been insufficient focus on getting people off drugs and too much on just maintaining people on drugs through methadone and other measures.

"I would need to be swayed that there are clear and compelling public health arguments to make such a change [in the law]. I want to promote abstinence-based rehabilitation. There needs to be a greater emphasis in getting people off their drug habit rather than maintaining their addiction."

Paul Hayes, the chief executive of the NHS's National Treatment Agency, which funds drug treatment, said: "Any way of using heroin is dangerous and likely to lead to addiction. However, injecting the drug is far more dangerous than other means of ingestion, such as smoking. Currently, the provision of foil is not legal. The NTA cannot advise drug treatment services to follow a course of action which is illegal and could have adverse consequences for provider services."
 

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Legalise It - former Chief Constable Tom Lloyd writes about legalising all recreational drugs instead of continuing the failing 'war on drugs'

Obama - Drugs Harm Reduction

posted: 17/03/2009

The Obama administration signalled today that it was ready to repudiate the prohibition and "war on drugs" approach of previous presidents, and steer policy towards prevention and "harm reduction" strategies favoured by Europe.

David Johnson, an assistant secretary of state, said the new administration would embrace policies supporting federally funded needle exchanges. The aim, he said, was to establish a policy based on public health needs. "This will result in a policy that is broader and stronger than the one we had in the past," Johnson said on the sidelines of a UN drug strategy conference in Vienna.

Last minute change for UN drugs conference

The UN international drug strategy conference meets every ten years to agree the international drugs strategy. It has been deadlocked. Europe is leading calls for harm reduction measures, such as needle exchanges and methadone, to help manage injecting drug use and reduce the risk of HIV and hepatitis C tranmsission, while the USA has stuck with the former USA "war on drugs" rhetoric and outright hostility to the pragmatic harm reduction approach. Now the USA seems to be swinging towards European policy, at the last minute.

His words come days after his nomination of the Seattle police chief, Gil Kerlikowske, to the post of director of the Office of National Drug Control Policy, the nation's drug czar. Kerlikowske has built a reputation in Seattle for pursuing drug policies based on harm reduction. The state has an established needle exchange programme, has legalised marijuana for medicinal purposes and has made marijuana among the lowest priorities for law enforcement.

Congress calls for drugs policy change

In a further sign of a new approach in Washington, congressional committee hearings last week heard lawmakers argue for a shift in national drug policy, largely in response to the rising drug-related violence seeping into the US from Mexico.

Those hearings followed a report by the former presidents of Mexico, Colombia and Brazil, which dubbed the war on drugs a "complete failure". Ernesto Zedillo, César Gaviria and Henrique Cardoso, all conservative politicians, blamed the US emphasis on criminalisation for the continuing toll caused by drug trafficking, and called for an approach based on public health, including the legalisation of marijuana.

Change came the top

Johnson said the latest shift came as a result of a direct instruction from the new administration. "There was very much an official directive from Washington," he told Reuters. "There was no confusion whatsoever. The [switch on] needle exchange was the clear signal of that."

Ethan Nadelmann, the executive director of the Drugs Policy Alliance, which lobbies for alternatives to the war on drugs, welcomed the change.

Public health comes before politics

"These statements really indicate a significant shift," he said. "It's not just a repudiation of the Bush administration, it's a repudiation of the Clinton administration. This signals a new direction in US drug policy. This is about all the leading scientists and all the public health people pushing in the same direction and Obama saying he's putting science above politics."

In a statement last week announcing the nomination of the new drug czar, Obama said: "With escalating violence along our Southwest border and far too many suffering from addiction here at home, never has it been more important to have a national drug control strategy guided by sound principles of public safety and public health."

Kerlikowske faces bruising confirmation hearings in the Senate. After his name was floated for the position, it emerged his stepson has been arrested several times on drug-related charges. Kerlikowske alluded to this at the announcement of his nomination. "Our nation's drug problem is one of human suffering," he said, "and as a police officer, but also in my own family, I have experienced the effects that drugs can have on our youth, our families and our communities."
 

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UN Drugs - No Harm Reduction

posted: 11/03/2009

IAS, the International Aids Society and other international organisations, are insisting that countries must reject the new draft 10 year UN drug policy, because it does not include harm reduction - the supply of clean needles and syringes to prevent the spread of HIV and hepatitis. And it lacks key human rights protections.
 

Lacks critical HIV prevention points

The new UN Political Declaration on Drugs, designed to guide drug policy for the next 10 years, lacks critically important measures for treating and stemming the spread of HIV, Human Rights Watch, the International AIDS Society, and the International Harm Reduction Association said today.

The groups said that respect for human rights and HIV prevention should be at the heart of the policy, but that critical elements had been stripped from the final declaration. They called on member governments to refuse to support the declaration, which is being considered at the high-level segment of the Commission on Narcotic Drugs (CND) this week in Vienna .

Weak declaration "undermines fundamental health and human rights obligations"

"Government delegations could have used this process to take stock of what has failed in the last decade in drug-control efforts, and to craft a new international drug policy that reflects current realities and challenges," said Prof. Gerry Stimson, executive director of the International Harm Reduction Association. "Instead, they produced a declaration that is not only weak - it actually undermines fundamental health and human rights obligations."

Harm reduction services left out

What is at issue is a series of measures known collectively as "harm reduction services," which have been endorsed by UN health and drug-control agencies, including the UN Office on Drugs and Crime, UNAIDS and the World Health Organization. However the draft declaration excludes these. These measures include needle and syringe exchange and medication-assisted therapy (for example, with methadone), both inside and outside prisons, as essential to address HIV among people who use drugs. The groups noted that a wealth of evidence proves harm reduction is essential to HIV prevention for people who use drugs. The action was taken against the direct advice of UNAIDS, the Global Fund to fight AIDS, Tuberculosis and Malaria, and the UN special rapporteurs on health and on torture.

Harm reduction ommission is "unacceptable and unconscionable"

Up to 30 percent of all HIV infections outside of sub-Saharan Africa occur via unsafe injecting drug use. The groups said there is clear evidence that harm reduction interventions can halt or even reverse HIV epidemics among people who inject drugs.

"This political declaration fails public health," said Craig McClure, executive director of the International AIDS Society. "Coming less than 12 months after UN member states convened a high level meeting in New York to restate the international commitment to fight HIV, the denial of any reference in the declaration to life-saving harm reduction programs is unacceptable and unconscionable."

Human Rights failings

The political declaration also fails human rights. In country after country around the world, abusive law enforcement practices conducted under the banner of the 'war on drugs' result in extensive, and often horrific, human rights violations. In addition, overly restrictive interpretations of the international drug-control treaties at national level result in the denial of access to essential pain medications to tens of millions of people worldwide.

Both of these issues were raised by the UN special rapporteur on health and the UN special rapporteur on torture, who wrote to the CND to urge explicit support for human rights within the political declaration. All member states of the UN have ratified at least one of the core UN human rights treaties, and the UN General Assembly has consistently stated that drug enforcement must be carried out in a manner consistent with respect for human rights.

"Given the widespread human rights abuses around the world directly resulting from drug enforcement, human rights must be placed at the heart of UN drug policy," said Joseph Amon, director of Human Rights Watch's health and human rights division. "But the political declaration makes scant reference to the legal obligations of member states under international human rights treaties, nor does it insist on respect for human rights in drug policy."

Failure to be followed by Failure?

The past 10 years international drugs policy was under the banner of "a drug-free world." It's been a conspicuous failure. Continuing to exclude harm reduction from international drugs policy is not likely to reverse the failings of the past ten years. 

The international community should recognize that the current approach to international drug policy has failed, the organisations said. Concrete steps should be taken to set forth a drug policy framework incorporating evidence-based measures to address drug-related harm and the human rights obligations of states, and of the UN as an international organization, at its heart.

This means supporting harm reduction measures. It means acknowledging that punitive drug policies don't work, and have taken a serious toll on the lives and health of millions of people. It also means acknowledging that we need a new way forward.

The groups called on member states not to lend their names to a political declaration that does not sufficiently prioritise the centrality of harm reduction and human rights within the global response to drugs, and join the call from other civil society organizations for further efforts across the UN system to find a more effective, coherent, and relevant response to drugs.

The January 2009 overview document by the International Harm Reduction Association and Human Rights Watch, International Support for Harm Reduction.
 

More on Human Rights Watch's work on drug policy.
 

Needle Exchanges Give Good Value

posted: 20/02/2009

Providing free needles and syringes to people who inject heroin and cocaine is a cost-effective use of NHS money, the government's medicines watchdog said today. Free needles and syringes help prevent the transmission of HIV and hepatitis.

The National Institute for Health and Clinical Excellence (Nice) issued its first guidance on how harm reduction services for injecting drug users should be run throughout England, suggesting combining non-judgmental needle exchange schemes with treatment to help users come off drugs.

1 in 4 share injecting drug kit

Professor Mike Kelly, director of the institute's public health division, said there are about 200,000 injecting drug users in Britain. He estimated about 25% of users share needles, putting themselves at a greatly increased risk of being infected with Hepatitis C or HIV.

NW England focus

In NW England there are just over 100 people diagnosed with HIV who were infected through sharing drug injection kit. The actual number is probably closer to 140 because many people have not yet been diagnosed with HIV. Whatever the actual number is, only 2 in 100 people with HIV in NW England got HIV through sharing drug kit. Most people become infected with HIV through sex without condoms.

Around 40% of injecting drug users have hepatitis C and then the risk of death is 10 times higher than among the population at large. Having both HIV and hepatitis C is common.

Kelly said: "The cost to the NHS of caring for someone who injects drugs is around £35,000 over their lifetime. From a societal perspective, the average [lifetime] cost rises to an estimated £480,000 when you take into account the high cost of crime including criminal justice costs."

Needle exchanges help people consider treatment 

If needle exchange schemes are run well, they can provide an effective conduit for doctors, nurses and pharmacists to gain direct contact with hard-to-reach groups – the first step towards encouraging them to seek treatment.

Providing injecting drug users with extra years of healthy life was cost-effective for taxpayers, said Nice.

Guidance supports HIV and hepatitis C prevention

Kelly added: "Keeping in check the epidemic of Hepatitis and maintaining HIV at its relatively low levels is an important aim that this guidance will serve."

Needle and syringe exchange schemes have been provided throughout England for more than 20 years. They provide injecting drug users with sterile equipment, needle disposal bins and advice on safer injecting practices. Primary care trusts (PCTs) have had discretion on how to run services to meet local needs.

Guidance for NHS

The Nice guidelines include advice on how PCTs should tailor the service to encourage injectors to seek treatment by offering more accessible opening times and locations.

Dr Mathew Hickman, chair of the Hepatitis C prevention working group at the Advisory Council for the Misuse of Drugs, said: "Needle and syringe programmes are a critical component of public health action to prevent Hepatitis C infections among injecting drug users.

"Evidence suggests that a combination of interventions is most effective. This means that staff need to use the opportunity they have with injectors actively to promote and refer people into treatment, such as opiate substitution programmes."

Dr David Sloan, vice-chair of the Public Health Interventions Advisory Committee, said: "Although HIV rates remain relatively low among injecting drug users in the UK, bad practice, such as the sharing of needles among multiple users, makes these individuals extremely vulnerable to any future outbreak."
 

The NICE guidance is now available for people using drugs, carers and the wider public. This includes professional guidance for healthcare staff, and the background papers and evidence for the new guidelines.

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