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Websites
Asian Harm Reduction Network (AHRN)
The Asian Harm Reduction Network (AHRN) is the first project of its kind. A global information and support network, created to link and support the courageous people and programs working throughout Asia to stop HIV among injecting drug users. Hundreds of individuals and organizations participate in the network and AHRN is endorsed by UNAIDS, the World Health Organization (WHO) and many governments who see harm reduction and networking as key approaches in the fight against HIV/AIDS. Every four months, the AHRN Newsletter [PDF document] features in-country updates, conference reports and other articles on HIV and injecting drug use in Asia.
Canadian Centre on Substance Abuse (CCSA)
The Canadian Centre on Substance Abuse (CCSA) is Canada's national addictions agency. Its mission is to provide objective, evidence-based information and advice that will help reduce the health, social and economic harm associated with substance abuse and addictions.
Language: English and French
The Canadian Harm Reduction Network
The Canadian Harm Reduction Network is the meeting place for individuals and organizations across Canada dedicated to reducing the social, health and economic harms associated with drugs and drug policies.
Caribbean Harm Reduction Coalition (CHRC)
The organisation of the Caribbean Harm Reduction Coalition is a major accomplishment of the NGO drug treatment and rehabilitation sector in 2000. The Coalition is loose grouping of individuals and NGOs that share a common view that interventions that reduce drug related harm are valuable activities irrespective if they lead to abstinence.
Central and Eastern European Harm Reduction network
CEE-HRN is a network to support, develop and advocate for harm reduction approaches in the field of drugs, HIV, public health and social exclusion by following the principles of humanism, tolerance, partnership and respect for human rights and freedoms.
Canadian HIV/AIDS Legal Network
The Canadian HIV/AIDS Legal Network is based in Montréal, Canada. It is the only national, community-based, charitable organization in Canada working exclusively in the area of policy and legal issues raised by HIV/AIDS. Every four months the network publishes the HIV/AIDS Policy & Law Review, providing analysis and summaries of current developments in HIV/AIDS-related policy and law.
Centre for Harm Reduction - Australia
The Centre for Harm Reduction at the Burnet Institute in Melbourne, Australia, brings together people working throughout Asia, and globally, with expertise in the prevention of drug related harm: in particular the prevention of transmission of HIV/AIDS and Hepatitis C among and from injecting drug users. A major aim of the Centre for Harm Reduction is to encourage development of rational, evidence-based drug policies that eschew judgements about personal behaviour and have the reduction of harm as their primary aim. The Centre for Harm Reduction also has offices in Jakarta (Indonesia), Hanoi (Vietnam) and Yangon (Burma/Myanmar).
Drug Policy Alliance
The Drug Policy Alliance is working to broaden the public debate on drug policy and to promote realistic alternatives to the war on drugs based on science, compassion, public health and human rights. The Alliance was formerly known as The Lindesmith Center - Drug Policy Foundation. The guiding principle of the Alliance is harm reduction, an alternative approach to drug policy and treatment that focuses on minimizing the adverse effects of both drug use and drug prohibition.
EMCDDA - Harm Reduction
The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) in Lisbon has a special project on harm reduction which aims to improve the information basis on the level of implementation of evidence based harm reduction measures in the EU Member States and Norway by monitoring national strategies and responses, analysing available evidence and documenting evidence based projects to support the transfer of expertise across Europe. Data are gathered on the whole range of response policies and intervention practices that aim to reduce health-related harm, but a specific focus is on four areas: Prevention of overdoses, Prevention of infectious diseases, Low-threshold services, and Consumption rooms. In its Annual Report 2003 the EMCDDA provided an overview of Harm reduction responses in the EU and Norway. Drugs in focus is the title of a series of policy briefings from the EMCDDA, including special editions about various harm reduction interventions.
Human Rights Watch
HIV spreads with frightening efficiency due to sexual violence, lack of access to condoms, lack of harm reduction measures for drug users, and lack of information. Human rights violations only add to the stigmatization of persons at highest risk of infection and thus marginalize and drive underground those who need information, preventive services, and treatment most desperately. Human Rights Watch (HRW) maintains special web sections on 'HIV/AIDS' and on 'Drugs and Human Rights' and has produced a special series of reports on HIV/AIDS & injection drug users from a human rights perspective:
- Not Enough Graves: The War on Drugs, HIV/AIDS, and Violations of Human Rights in Thailand, July 2004
- Lessons Not Learned: Human Rights Abuses and HIV/AIDS in the Russian Federation, April 2004
- Injecting Reason: Human Rights and HIV Prevention for Injection Drug Users; California: A Case Study, September 2003
- Locked Doors: the Human Rights of People Living with HIV/AIDS in China, September 2003
- Ravaging the Vulnerable: Abuses Against Persons at High Risk of HIV in Bangladesh, August 2003
- Fanning the Flames: How Human Rights Abuses Are Fueling the AIDS Epidemic in Kazakhstan, June 2003
- Abusing the User: Police Misconduct, Harm Reduction and HIV/AIDS in Vancouver, May 2003
International Harm Reduction Association (IHRA)
The International Harm Reduction Association (IHRA) works with local, national, regional, and international organisations to assist in: encouraging discussion about the relationship between drug policy and public health outcomes; promoting dialogue with the criminal justice system; encouraging the adoption of evidence-based and cost-effective prevention and treatment strategies; encouraging effective efforts to reduce initiation into drug use and the progression to problematic use; and continuing education, training, and research. IHRA organises the annual International Conference on the Reduction of Drug Related Harm, the key forum for the dissemination of harm reduction ideas and practice. It is attended by over 1000 people from over 60 countries - bringing together harm reduction workers, researchers, policy makers, government members and officials, judiciary, law enforcement, criminal justice workers, UN staff, members of national and international NGOs, and members of drug user organisations. The International Journal of Drug Policy is the official journal of the IHRA.
International Harm Reduction Development Program (IHRD)
The International Harm Reduction Development Program (IHRD), a part of the Public Health Programs of the Open Society Institute (OSI), focuses on diminishing the individual and social harms associated with drug use-particularly the risk of HIV infection-through innovative measures based on the philosophy of harm reduction.
Latin American Harm Reduction Network (RELARD)
The Rede Latino-Americana de Redução de Danos (RELARD) based in Brazil is a Latin American-wide network devoted to promote Harm Reduction principles and practices in the whole region.
Language: Portuguese (parts in Spanish and English)
The Pompidou Group
The Council of Europe's involvement in the fight against drug misuse and drug trafficking is carried out through the work of a multidisciplinary co-operation group known as the Pompidou Group. The Group was set up in 1971 at the suggestion of the late French President Georges Pompidou and was incorporated into the Council of Europe in 1980. It provides a forum for European ministers, officials, specialists and other professionals to co-operate and exchange information. The Pompidou Group hosted the Dublin Ministerial Conference "New Challenges for Drug Policy in Europe", 16-17 October 2003.
UNAIDS
The Joint United Nations Programme on HIV/AIDS (UNAIDS) is the main advocate for global action on the epidemic. It leads, strengthens and supports an expanded response aimed at preventing transmission of HIV, providing care and support, reducing the vulnerability of individuals and communities to HIV/AIDS, and alleviating the impact of the epidemic. UNAIDS has special web sections on harm reduction and injecting drug use.
US Harm Reduction Coalition (HRC)
The Harm Reduction Coalition (HRC) in the United States is a nationwide network of service providers, drug users and those with a history of drug use, methadone and other drug substitution therapy consumers, health care workers and medical professionals, drug treatment specialists, activists and community organizers, policymakers, researchers, academics, and legal professionals committed to facilitating the creation of effective harm reduction services and policies in communities throughout the country.
World Health Organization (WHO) - Substance Abuse
This website contains information pertaining to psychoactive substance use and abuse, and also information about the World Health Organization's projects and activities in the areas of substance use and substance dependence. WHO is the only agency dealing with all psychoactive substances, regardless of their legal status. WHO's mandate in the area of psychoactive substance use includes:
- Prevention and reduction of the negative health and social consequences of psychoactive substance use;
- Reduction of the demand for non-medical use of psychoactive substances;
- Assessment of psychoactive substances so as to advise the United Nations with regard to their regulatory control. The WHO also has a section on Harm Reduction Approaches to Injecting Drug Use. The WHO "3 by 5" initiative is the global target to get three million people living with HIV/AIDS in developing and middle income countries on antiretroviral treatment (ART) by the end of 2005. It is a step towards the goal of providing universal access of HIV/AIDS prevention and treatment services for all who need them as a human right.
Documents
Governmental and Official Documents
Nederlandse Kamervragen over kritiek van UNODC op harm reductie 28 februari 2005.
Antwoord van de heer Bot, minister van Buitenlandse Zaken, mede namens de heer Hoogervorst, minister van Volksgezondheid, Welzijn en Sport, op vragen van de leden Koenders en Albayrak (PvdA) over de kritiek van het UNODC op de harm reduction benadering in drugsbeleid.
Parliamentary questions in The Netherlands (non-official translation) [PDF document] 28 February 2005.
Reply by Mr Bot, Minister of Foreign Affairs, also on behalf of Mr Hoogervorst, Minister of Health, Welfare and Sports, to questions from members of parliament Koenders en Albayrak (PvdA) about the UNODC critique on the harm reduction approach in drug policy.
UN Millenium Project. Combating AIDS in the Developing World [PDF document]
Task Force on HIV/AIDS, Malaria, TB, and Access to Essential Medicines, Working Group on HIV/AIDS, UN Millenium Project, 2005. The report includes a section on "Policy and treaty barriers to harm reduction among injecting drug users" (chapter 2), saying:
The conflicting imperatives of the fight against AIDS and the international war on drugs as currently conceived have led to an inconsistent response of the United Nations system. [..] The working group believes that the evidence overwhelmingly supports needle exchange and other harm-reduction approaches as the most effective way to prevent HIV infection among injecting drug users and urges both national governments and the UN system to remove obstacles to and rapidly increase access to these proven interventions. We propose a target of ensuring that 80 percent of injecting drug users have access to harm-reduction services by 2015. In addition, we recommend that:
# The international drug control conventions should be revised to explicitly support the full range of HIV prevention services for drug users, including needle exchange and substitution treatment. In the meantime, the UN, with the support of its drug control arms, should actively promote the expansion of harm-reduction programs as a necessary part of a comprehensive HIV prevention strategy.
# Methadone should be reclassified to a less restrictive category under the drug conventions. In addition, methadone and other substitution therapies should be included on the WHO essential drugs list along with other critical HIV/AIDS medications.
# At the national level, syringe and needle possession should be decriminalized and imprisonment for possession of small quantities of drugs should be ended.
WHO - Effectiveness of sterile needle and syringe programming in reducing HIV/AIDS among injecting drug users. (Evidence for action technical papers, 14 January 2005) [PDF document]
This publication by the World Health Organization aims to make the evidence for the effectiveness of needle syringe programmes (NSP) and other selected key interventions in preventing HIV transmission among injecting drug users accessible to a policy-making and programming audience. The studies reviewed in this report present a compelling case that NSPs substantially and cost effectively reduce the spread of HIV among IDUs and do so without evidence of exacerbating injecting drug use at either the individual or societal level. This suggests that authorities responsible for areas threatened by or experiencing an epidemic of HIV infection among IDUs should adopt measures urgently to increase the availability and utilization of sterile injecting equipment and expand implementation to scale as soon as possible.
Dublin Declaration on Partnership to fight HIV/AIDS in Europe and Central Asia
Declaration adopted at the Ministerial Conference "Breaking the Barriers - Partnership to fight HIV/AIDS in Europe and Central Asia", Dublin, Ireland, 23 to 24 February 2004. On of the action points agreed to was: "Scale up access for injecting drug users to prevention, drug dependence treatment and harm reduction services through promoting, enabling and strengthening the widespread introduction of prevention, drug dependence treatment and harm reduction programmes (e.g. needle and syringe programmes, bleach and condom distribution, voluntary HIV counselling and testing, substitution drug therapy, STI diagnosis and treatment) in line with national policies."
EMCDDA - Consumption rooms report
The European report on drug consumption rooms (Full report [PDF document, 757 KB]; Executive summary [MS Word document, 66.5 KB) describes what consumption rooms are and why and how they came about; whom they target, which specific objectives they have and how they function. It summarises available evidence on the expected benefits and risks of such facilities. Expected benefits are decreases among the target population in high risk drug use, morbidity and mortality, increased uptake of health and social care including drug treatment, and reductions in public drug use and neighbourhood nuisance.
EMCDDA - Role of Harm Reduction
Table with an overview of the official acceptance of harm reduction in national drug policy documents and current developments in the EU and Norway, from the EMCDDA Annual Report 2003.
EU Council Recommendation [PDF document]
Council Recommendation of 18 June 2003 on the prevention and reduction of health-related harm associated with drug dependence.
INCB - Flexibility of Treaty Provisions as Regards Harm Reduction Approaches [PDF document]
This revealing International Narcotics Control Board (INCB) document, dated 30 September 2002, was prepared by the Legal Affairs Section of UNODC on the request of the INCB to develop for its consideration a legal position on the flexibility of the treaty provisions as regards harm reduction approaches. For that purpose, four types of harm reduction programmes (substitution/maintenance treatment, drug-injection rooms, needle/syringe exchange and drug-quality control) are reviewed. In its closing comments, the document states: "It is evident that new threats like growing rates of intravenous HIV transmission of serious illness or of youth death from impure ecstasy at rave parties require that governments come up with new strategies to cope. It could even be argued that the drug control treaties, as they stand, have been rendered out of synch with reality, since at the time they came into force they could not have possibly foreseen these new threats."
INCB Report for 2003 - Measures to reduce harm [PDF document]
The International Narcotics Control Board (INCB) is responsible for reviewing whether measures taken in a country are in line with the three international drug control conventions. In that context, the Board has, over a period of many years, expressed its views on the compatibility of harm reduction measures with the conventions. In these paragraphs from its Report for 2003 the Board tried to further clarify the issue.
INCB - Interview with Dr. Philip O. Emafo, President of the International Narcotics Control Board in Update, UNODC Newsletter, Vienna December 2002.
The president of the INCB speaks out about legalization, harm reduction and the growing problem of synthetic drugs. "[T]o promote drug use illicitly through the giving out of needles [..] would, to me, amount to inciting people to abuse drugs, which would be contrary to the provisions of the conventions."
Leadership Statement - Injecting drug use and HIV/AIDS [PDF document] XV International AIDS Conference, Bangkok, 11-16 July 2004.
From the preamble: "There is overwhelming, high quality evidence of very effective, safe and cost effective harm reduction strategies to reduce the negative health and social consequences of drug injection. It is also clear that comprehensive harm reduction services including substitution maintenance therapy provide additional entry points for scaling up ARV therapy. Experience of numerous programs and projects in all regions of the world indicate that HIV/AIDS epidemics among injecting drug users can be prevented, stabilized and even reversed by timely and vigorous harm reduction strategies."
Pompidou Group - Public Health Policy in Evidence-Based Management of Drug Addiction.
Paper presented by Dr Martin Luzi Büechi (Bern, Switzerland) at the Pompidou Group Ministerial Conference, "New Challenges for Drug Policy in Europe", Dublin, 16-17 October 2003
Red Cross/Red Crescent. Spreading the Light of Science Guidelines on harm reduction related to injecting drug use. International Federation of Red Cross and Red Crescent Societies, 2003.
From the forword by Juan Manuel Suárez del Toro Rivero, President International Federation of Red Cross and Red Crescent Societies: "Forcing people who use drugs further underground and into situations where transmission of HIV/AIDS is more likely, and denying them access to life-saving treatment and prevention services is creating a public health disaster. This happens even though the evidence from scientific and medical research on best practices and cost benefit analyses is overwhelmingly in favour of harm reduction programming. This includes needle exchange, drug substitution treatment and condom distribution as part of the response to HIV/AIDS. The message is clear. It is time to be guided by the light of science, not by the darkness of ignorance and fear. If we are to put a stop to this trend, communities need to treat drug users in a more humane way, respecting them as people with rights and needs. The Red Cross and Red Crescent is well placed to advocate for the just treatment of drug-users and for harm reduction in general."
UNAIDS - Drug abuse and HIV/AIDS: lessons learned [PDF document]
Central and Eastern Europe and the Central Asian States. Joint publication of UNAIDS and UNODCCP (former name of UNODC), in the UNAIDS Best Practice Collection series.
Joint publication of UNAIDS and UNODC (under its former name UNODCCP), in the UNAIDS Best Practice Collection series. The term "harm reduction" is used in some of the case studies. According to a 'note of clarification', from the point of view of UNODC "the term is meant to cover activities aimed at reducing the health and social consequences of drug abuse, an integral part of the comprehensive approach to drug demand reduction", as recognised in the Declaration on the Guiding Principles of Drug Demand Reduction adopted by the 1998 UNGASS on drugs. "In the present document, the following three principles are referred to as "harm reduction principles": (a) Reaching out to injecting drug users; (b) Discouraging the sharing of contaminated injecting equipment by providing sterile injecting equipment and disinfectant materials; (c) Providing substitution treatment."
UNAIDS - Address by Catherine Hankins [PDF document] Opening Ceremony, 13th International Conference on Drug Related Harm, March 3, 2002, Ljubljana, Slovenia, by Catherine Hankins, Associate Director (designate), Strategic Information, UNAIDS. "The United Nations fully endorses the fundamental principles of harm reduction."
UN/CND - Preventing the transmission of HIV among drug abusers [PDF document] A position paper of the United Nations system. Endorsed on behalf of ACC by the High-Level Committee on Programme (HLCP) at its first regular session of 2001, Vienna, 26-27 February 2001.
Also endorsed as a conference room paper (E/CN.7/2002/CRP.5) at the 2002 meeting of the Commission on Narcotic Drugs (CND). "Several reviews of the effectiveness of syringe and needle exchange programmes have shown reductions in needle risk behaviours and HIV transmission and no evidence of increase into injecting drug use or other public health dangers in the communities served. [..] A comprehensive package of interventions for HIV prevention among drug abusers could include: AIDS education, life skills training, condom distribution, voluntary and confidential counselling and HIV testing, access to clean needles and syringes, bleach
materials, and referral to a variety of treatment options."
UNDP - Taking narcotics out of the conflict: the war on drugs [}DF document] Chapter 13 from: Colombia, Solutions to Escape the Conflict's Impasse, National Human Development Report 2003, United Nations Development Programme (UNDP).
"If neither consumption nor production can be eliminated, the rational and realistic option would be to reduce as far as possible the harm done by one and the other. [..] On the supply side, reducing harm means more manual eradication and less aerial spraying, more profitable alternatives for the settler or peasant farmer, more emphasis on prevention and on strengthening the social tissue, more distinguishing between the big dealer and the small farmer."
UNGASS - Declaration on the Guiding Principles of Drug Demand Reduction General Assembly, 20th Special Session on drugs, A/RES/S-20/3, June 1998. Article 10: "Demand reduction programmes should cover all areas of prevention, from discouraging initial use to reducing the negative health and social consequences of drug abuse."
UNGASS - Declaration of Commitment on HIV/AIDS [PDF document] General Assembly, 26th Special Session on HIV/AIDS, A/RES/S-26/2, June 2001.
The declaration in its article 52 urges all Member States that "harm reduction efforts related to drug use," and "expanded access to essential commodities, including [... ] sterile injecting equipment" should be ensured by 2005.
UNODC - Report of the Executive Director (HIV/AIDS-2004) [PDF document] Strengthening strategies regarding the prevention of HIV/AIDS in the context of drug abuse, Commission on Narcotic Drugs, Forty-seventh session, Vienna,15-22 March 2004, E/CN.7/2004/3, 12 January 2004.
"Taking into account that drug use is a chronically relapsing condition, policies governing HIV/AIDS prevention must follow pragmatic approaches and therefore must address high-risk behaviour first before striving to achieve long-term goals such as total abstinence from drugs. [..] Thus, those injecting drug users who cannot stop injecting can be provided with clean needles and syringes, those who can stop injecting but who are not ready for abstinence-oriented treatment can be offered substitution treatment and a variety of treatment and rehabilitation options can be made available to those who have been able to stop using drugs. [..] A comprehensive package of measures also usually includes treatment instead of punishment for persons convicted of minor drug offences, since incarceration usually increases the risk of HIV transmission. The scientific evidence and the experience with such programmes strongly indicate that the above-described package is effective in reducing the risk of HIV transmission among injecting drug users and the risk of HIV diffusion from infected drug users to the general population."
UNODC - Opening speech Dr Sandro Calvani
Building synergies between public health and public security for the prevention of drug related harm, Opening speech at 14th International conference on reduction of drug-related harm, Chiangmai, Thailand, by Dr. Sandro Calvani, Representative UNDCP Regional Centre for East Asia and Pacific (currently Representative UNODC Bogota, Colombia). "The emergence of HIV in the mid 80s and its linkage to public transmission through injecting drug use has thoroughly shaken the government approaches to drug control. [..] UNODC is a pro-active partner of national and international programmes which address the harm caused by drug abuse. [..] Where the legal provisions of Member States allow for this, UNODC's projects support access to clean needles and syringes, and substitution treatment, services that could be subsumed under the broad category of "harm reduction services". Nonetheless, the terminology "harm reduction" is not officially used in UNODC in view of the lack of consensus among members of the organization's governing board, the CND, as to the correct definition, usage and meaning of the terminology".
UNODC - Letter from the Executive Director Antonio Costa [PDF document] Dated 11 November 2004, to Robert Charles, Assistent Secretary International Narcotics and law Enforcement Affairs (INL), US State Department.
"Under the guise of 'harm reduction', there are people working disingenuously to alter the world's opposition to drugs. [..] UNODC maintains a strong opposition to heroin maintenance, as well as drug injection and consumption rooms. [..] Another element of "harm reduction" is needle exchange (or even needle giveaways, as you mentioned). Here, the linkages between drug abuse, particularly by injecting drug users, and the HIV/AIDS pandemic fuel a well known controversy. We strongly agree with the INCB view that any such prophylactic measures to prevent the spread of HIV/AIDS should be undertaken only within the overall effort to reduce drug abuse. Yet, the controversy remains and this, of necessity, continues to place UNODC in a difficult position. Nevertheless, and again taking our guidance from the conventions, CND and INCB, we neither endorse needle exchange as a solution for drug abuse, nor support public statements advocating such practices."
UNODC Builds Responses to Control the HIV/AIDS Epidemic among Injecting Drug Users in South East Asia [PDF document] Internal document of the UNODC Regional Centre for East Asia and the Pacific.
"UNODC, as a cosponsor of the Joint United Nations Programme on HIV/AIDS (UNAIDS), is especially committed to breaking the linkage between the non medical use of drugs and the transmission of HIV. It is particular concerned with reducing the vulnerabilities of injecting drug use and alleviating the social and economic conditions that contribute to drug abuse. With historically strong connections to the drug control sector in East Asia, UNODC exercises its UN mandate and cosponsor status through a demand reduction approach by building regional and national capacities for effective responses to the emerging HIV epidemic. These responses include prevention, early intervention, treatment and rehabilitation, and the immediate alleviation of adverse consequences through harm reduction methodologies."
UNODC - Harm Reduction Approaches to Injecting Drug Use [PowerPoint}
As part of the advocacy material of the regional project on Reducing HIV/AIDS from Drug Abuse, UNODC Regional Centre for East Asia and Pacific (Bangkok) has created a web-based power point presentation on the principles of harm reduction with the purpose to clarify UNODC position and support for this approach to its national and international counterparts. "In the absence of harm reduction activities, HIV spreads to 40% or more among drug users communities within 1 to 2 years. [..] Hence, harm reduction carries significant HIV preventive potential for both injecting drug users and the general population."
UNODC - HIV/AIDS: Spread through Injecting Drug Use and in Prisons Needs to Be Addressed The Executive Director of the UN Office on Drugs and Crime (UNODC) Antonio Maria Costa addressed the Bangkok International AIDS conference (11-16 July 2004) in his capacity as Chair of the UNAIDS Committee of Co-sponsoring Organizations (CCO).
"The news is not all bad. During the past decade, we have also learned that the HIV/AIDS epidemic among injecting drug users can be stopped -and even reversed- if drug users are provided, at an early stage and on a large scale, with comprehensive services such as outreach, provision of clean injecting equipment and a variety of treatment modalities, including substitution treatment. It is, however, a sad fact that less than five per cent, and in many high-risk areas, less than one per cent of all drug users have access to prevention and care services. In too many countries, drug users are simply incarcerated. This is not a solution; in fact, it contributes to the rapid increase in the number of people living with HIV/AIDS."
UNODC - Encouraging progress towards still distant goals [PDF document] Progress Report by the Executive Director as a contribution to the Mid-term (2003) Review of UNGASS. UNODC/ED/2, 8 April 2003.
"the concept "harm reduction" has become a battlefield for recrimination, perpetuating an increasingly unhelpful debate. [..] this debate can only be enriched if the ideology is taken out, and empirical evidence brought in. In terms of guidance, the International Narcotics Control Board (INCB) pronounces on whether particular harm reduction measures are consistent with the conventions."
US Health Department - Evidence-Based Findings on the Efficacy of Syringe Exchange Programs An Analysis from the Assistant Secretary for Health and Surgeon General of the Scientific Research Completed Since April 1998, Washington DC, Department of Health and Human Services, 17 March 2000.
US Assistant Secretary for Health and Surgeon General Dr David Satcher concludes in this report that, "After reviewing all of the research to date, the senior scientists of the Department and I have unanimously agreed that there is conclusive scientific evidence that syringe exchange programs, as part of a comprehensive HIV prevention strategy, are an effective public health intervention that reduces the transmission of HIV and does not encourage the use of illegal drugs."
The Warsaw Declaration A Framework for Effective Action on HIV/AIDS and Injecting Drug Use
Two decades after the AIDS epidemic was first recognized, the spread of HIV infection through injecting drug use is an increasingly serious public health problem in many countries and regions of the world. Abundant, high-quality evidence of effective, safe and cost-effective harm reduction strategies exists, yet in many countries, the implementation of such strategies is still "too little and too late." Continued failure to act can no longer be blamed on the absence of effective policies, programs, interventions or resources. Political and social commitment, including commitment of the necessary resources, is what will make the difference between success and failure. The Warsaw Declaration provides a framework for mounting an effective response to slow and eventually stop the HIV/AIDS epidemic among injecting drug users worldwide. The 2nd International Policy Dialogue on HIV/AIDS was held in Warsaw, Poland in November 2003, and was hosted by the Government of Poland with support from UNAIDS, Health Canada, the Open Society Institute, and the Canadian International Development Agency.
WHO/UNODC/UNAIDS position paper [PDF document] Substitution maintenance therapy in the management of opioid dependence and HIV/AIDS prevention.
The World Health Organization (WHO), the United Nations Office on Drugs and Crime (UNODC) and the Joint United Nations Programme on HIV/AIDS (UNAIDS), have developed a joint position on substitution maintenance therapy for opioid dependence. Based on a review of scientific evidence and oriented towards policymakers, the WHO/UNODC/UNAIDS position paper covers a wide range of issues, from the rationale for this treatment modality, to the specific considerations regarding its provision for people with HIV/AIDS.
WHO - The Practices and Context of Pharmacotherapy of Opioid Dependence in South-East Asia and Western Pacific Regions [PDF document]
This publication presents an overview of the practices and the context of pharmacotherapy of opioid dependence in selected countries of the South East Asia and Western Pacific regions of WHO. It describes the current situation with opioid use and its health consequences, the role of pharmacological treatment of opioid dependence in public health responses to opioid dependence and associated health consequences in the region, as well as priorities for development of treatment responses. The publication contains key informant reports from Australia, China, Hong Kong, Indonesia, Lao People's Democratic Republic, Malaysia, Myanmar, The Philippines, Thailand and Viet Nam.
WHO - The Practices and context of Pharmacotherapy of opioid dependence in Central and Eastern Europe [PDF document]
This publication presents an overview of the practices and the context of pharmacotherapy of opioid dependence in selected countries in Central and Eastern Europe and the Newly Independent States. Based on reports provided by professionals involved in the treatment of opioid dependence in these regions, this document describes the current situation with opioid use in Central and Eastern Europe and the Newly Independent States, the role of pharmacological treatment of opioid dependence in public health responses to opioid dependence and associated health consequences in the region, as well as priorities and recommendations for development of treatment services and responses. The publication contains key informant reports from Belarus, Bosnia and Herzegovina, Bulgaria, Croatia, Czech Republic, Estonia, Kyrgyzstan, Hungary, Latvia, Lithuania, Poland, Russian Federation, Slovakia and Ukraine.
NGO Documents
US Gag on Needle Exchange Harms UN AIDS Efforts. Before UN Narcotics Meeting, Groups in 56 Countries Assail US Tactics Press release by Human Rights Watch, Open Society Institute and The Canadian HIV/AIDS Legal Network, New York, 3 March 2005
US efforts to force the United Nations to withdraw support for needle exchange programs endanger global efforts to prevent the spread of HIV, a group of AIDS organizations, human rights groups, scientific researchers and policy analysts from 56 countries said today. The groups urged the United Nations to stand firm at a crucial international policy meeting on narcotic drugs to be held next week in Vienna. "If governments do not stand up to this bullying, millions will pay the price."
HIV/AIDS at the 48th UN Commission on Narcotic Drugs (CND) A Human Rights Watch Brief, February/March 2005 [PDF document]
The United States pressures the UN to oppose needle exchange, even though it is proven effective and endorsed by the World Health Organization. CND delegates should stand up for the health and human rights of drug users.
Harm Reduction or Harm Maintenance. Is There Such a Thing as Safe Drug Abuse? Human Rights Watch, 15 February 2005
Human Rights Watch respectfully submits this testimony to the Subcommittee on Criminal Justice, Drug Policy and Human Resources as it addresses harm reduction-based approaches to HIV prevention among injection drug users.
Protecting the Human Rights of Injecting Drug Users: The Impact of HIV and AIDS February 2005, Open Society Institute (OSI)
Compiling statements given at the 2004 session of the UN Commission on Human Rights, this IHRD-produced volume argues that unduly strict interpretation of UN drug control treaties undermines HIV prevention efforts by discouraging countries from implementing effective, realistic, and compassionate public health policies. The publication's contributors-including OSI president Aryeh Neier-demonstrate that international bodies and national governments must give greater consideration to the human rights-particularly access to HIV treatment-of injection drug users.
Thai NGO Letter to UNODC [PDF document] February 21, 2005.
In a letter to the UNODC regional representative the Thai Drug Users' Network and the Thai AIDS Treatment Action Group express their deep concern about the apparent shift in the agency's priorities related to the prevention of HIV/AIDS among drug users. "We are writing to elaborate our particular concerns about UNODC's apparent suspension of a regional project and task force in East Asia and the Pacific on drug use and HIV vulnerability."
CAMH and Harm Reduction: A Background Paper [PDF document] A Background Paper on the meaning and application of harm reduction for substance use issues
By the special ad hoc committee on harm reduction, Centre for Addiction and Mental Health (CAMH) in Canada, May 2002. This paper gives a workable explication of harm reduction to guide CAMH's diverse activities in preventing and responding to addiction problems. The purpose is to define the concept of harm reduction and set out its principles or core elements as they relate to CAMH's mandate and activities.
Drugs, AIDS, and Harm Reduction. How to Slow the HIV Epidemic in Eastern Europe and the Former Soviet Union Open Society Institute (OSI), 2001.
As many as four million people in Eastern Europe and the former Soviet Union are injecting drug users at great risk of becoming infected with HIV from shared injection equipment. We know that traditional, authoritarian methods of drug control do not stem the tide of drug use or the social and health harms associated with it. By contrast, harm reduction methods work.
Drug control, human rights, and harm reduction in the age of AIDS [PDF document}
HIV/AIDS Policy & Law Review, Volume 9, Number 3, December 2004, Canadian HIV/AIDS Legal Network, by Richard Elliott.
"Growing evidence indicates the dominant prohibitionist approach to illicit drugs is ineffective - and even counterproductive, blocking or undermining measures shown to reduce harms to drug users and to communities affected by open drug scenes. The growing debate over global drug control policy could shift us collectively away from the current, failed prescriptions to a more rational, pragmatic, and health-promoting framework of harm reduction."
Evidence for Harm Reduction [PDF document]
Open Society Institute (OSI), November 2004. "Evidence for Harm Reduction" describes in detail the scientific evidence supporting the effectiveness of harm reduction efforts.
From Concern to Action: Harm Reduction as the Key to HIV Prevention and Treatment Efforts in Eastern Europe and the Former Soviet Union Open Society Institute (OSI), Kasia Malinowska-Sempruch, July 9, 2002.
Transcript of the speech delivered by Kasia Malinowska-Sempruch, director of OSI's International Harm Reduction Development Program, on July 9, 2002 at the 14th International AIDS Conference in Barcelona, Spain.
Harm Reduction: Concepts and Practice A Policy Discussion Paper by the Canadian Centre on Substance Abuse (CCSA), National Working Group on Policy, 1996.
Harm Reduction: Position Statement [PDF document]
This position statement on the meaning and application of harm reduction for substance use issues by the Canadian Centre for Addiction and Mental Health (CAMH), May 2002, asserts that harm reduction can reduce the stigma associated with substance use and provides a pragmatic approach to managing addiction. It recommends that directing resources at empirically proven successful interventions will result in better individual outcomes and greater systemic accountability.
Harm Reduction: Questions and Answers [PDF document] Open Society Institute (OSI), November 2004.
Using scientific evidence, "Harm Reduction: Questions and Answers" briefly explains why harm reduction programs effectively reduce the individual and societal damage caused by drug use.
Illicit Drug Policies and the Global HIV Epidemic Effects of UN and National Government Approaches [PDF document] Open Society Institute (OSI), March 2004, by Daniel Wolfe and Kasia Malinowska-Sempruch.
More than two decades of HIV have taught the world some clear lessons on how to successfully contain the virus. Effective HIV prevention includes not only the provision of tools such as condoms to help block HIV transmission, but also recognition of the ways in which HIV risk is shaped by and reduced through the engagement of multiple sectors of society. The HIV epidemic also offers more bitter lessons about the consequences of failure to support HIV prevention. While HIV transmission through contaminated injection equipment is well documented, less attention has been paid to the ways that illicit drug policy and related issues, such as patterns of arrest of drug users or government stance toward provision of sterile injection equipment, shape global trends in HIV infection. This report examines the intersection of global and national drug policy and HIV trends, with particular attention to those countries where the use of contaminated injection equipment is the primary mode of HIV transmission. Specifically, it highlights the two competing frameworks most commonly used to conceptualize drugs, drug users, and appropriate policy responses at the international and national levels: one regarding criminal enforcement as central, and the other relying on the best practices of public health.
Implementation of harm reduction measures in Eastern Europe and Central Asia: Lessons learned [MS Word document], Anya Sarang et al, Central and Eastern European Harm Reduction Network, October 2004.
The first needle exchange and substitution treatment programs started to work in Poland, Slovenia and Czech Republic in the late 80's, early 90's. In 1995-1996 the region witnessed its first HIV outbreaks among injecting drug users (IDUs) in several countries of the former Soviet Union: in Ukraine, Republic of Belarus, and the Russian Federation. It became clear that the epidemic among drug users will be skyrocketing and without targeted harm reduction activities it would be impossible to stop it.
Unintended Consequences: Drug Policies Fuel the HIV Epidemic in Russia and Ukraine [PDF document] Open Society Institute (OSI), April 2003.
This report from the International Harm Reduction Development Program (IHRD), argues that strict UN drug control treaties directly undermine HIV prevention efforts by discouraging countries from implementing effective, realistic, and compassionate public health measures. The report was presented prior to the opening of a major UN Commission on Narcotic Drugs (CND) conference in Vienna. It calls for participants to amend UN drug policies and national drug and HIV laws to protect public health and human rights. Unintended Consequences focuses primarily on Russia and Ukraine, countries with two of the world's fastest-growing HIV epidemics. According to the report, over the past several years both nations have introduced harsh antidrug measures at the expense of HIV prevention programs in an attempt to comply with outdated UN drug conventions. Such strategies ignore the health consequences of widespread injection drug use, the main route of HIV infection in Russia, Ukraine, and other countries in Central and Eastern Europe and the former Soviet Union.
Research Documents
Evaluation of the Supervised Injection Site - Year One Summary Canada [PDF document}, September 2004
North America s first government sanctioned Supervised Injection Facility (SIF) was opened in Vancouver, Canada, on September 22, 2003. Vancouver Coastal Health (VCH) believes its Supervised Injection Site, Insite, is savings lives following the release of the one-year research report from the team responsible for evaluating the site for a three-year clinical trial. According to the evaluation report, Insite is achieving high client volumes, referring clients to health services they might not have otherwise accessed, and providing overdose interventions to clients. The report is the first of a four-part evaluation conducted for VCH by researchers at the BC Centre for Excellence in HIV/AIDS in Vancouver.
Harm reduction, Human Rights and the W.H.O. Expert Committee on Drug Dependence [PDF document]
Chapter by Robin Room, in: Harm Reduction: A New Direction for Drug Policies and Programs. P. Erickson, D. Riley, Y. Cheung and P. O'Hare, eds., Toronto: University of Toronto Press, 1997.
HIV/AIDS and Drug Misuse in Russia. Harm Reduction Programes and the Russian Legal System Published by International Family Health, September 2003.
Professor William Butler examines how Russian law hinders the development of Harm Reduction programmes to tackle HIV/AIDS in the Russian Federation. Although there are currently around 70 harm reduction programmes in Russia, none of these receive official support due to the belief that Russian law actually prohibits these programmes. The paper outlines the complexities of the laws governing HIV and drug misuse, as well as establishing the various legal difficulties these initiatives involve. A number of possible policy options currently available under Russian law are outlined. These options would address the current legal complexities and allow for harm reduction programmes to be an integral part of Russia's response to its HIV/AIDS epidemic.
Illicit drugs convention reform and the United Nations agencies [PDF document] Compiled by Andrew Wilson for the Network of European Foundations (NEF), September 2002.
This background paper provides a summary of the positions (stated or implicit), interests and potential contributions of various UN agencies regarding reform of the three main international conventions on illicit drugs. The paper specifically considers these agencies in relation to six issues: exchange and distribution of needles and syringes, heroin prescription, methadone maintenance, prison programming, crop eradication/alternative development, rescheduling of cannabis under the conventions.
"Opinion on the legality of health promotion measures in light of the United Nations drug conventions regime" [PDF document] Paper prepared for the Lisbon International Symposium on Global Drug Policy, 23-25 October 2003, Lisbon.
The British Institute of International and Comparative Law (BIICL) has been commissioned to undertake an independent review by the Senlis Council of the flexibility of the United Nations (UN) drug conventions regime as regards approaches aimed at promoting the public and private health of a society and its individuals. It is contended that there is a strong case for arguing that drug-injection rooms, needle-exchange programmes, substitution treatment and heroin treatment are permissible within the existing drug control regime.
Overview of Harm Reduction Programs and Policies Around the World: Rationale, Key Features and Examples of Best Practice [MS Word document]
This document was prepared as a Conference Paper for the 2nd International Policy Dialogue on HIV/AIDS in Warsaw, 2003, by Dr. Diane Riley and gives an overview of strategies for reducing drug-related harms, including HIV infection, along with examples of best practices in policies and programs from around the world. The limits of and barriers to harm reduction are also explored. Among the harm reduction approaches Dr. Riley explores are strategies to reduce the prevalence and frequency of injection as the preferred route of drug administration and to prevent epidemics among injection drug users (IDUs) through substitution treatment (including but not limited to methadone); community programs (needle exchange, equipment cleaning, education and outreach); law enforcement; and tolerance areas (including facilities where users can obtain clean injection equipment, condoms, advice and medical attention).
Prescribing heroin: what is the evidence? [PDF document]
Until recently, the UK was the only country in the world that allowed doctors to prescribe heroin for the treatment of opiate dependence. The Government wants heroin prescribing to increase and to be made available to all those who have a clinical need for it. This report, by Gerry Stimson and Nicky Metrebian from the Centre for Research on Drugs and Health Behaviour at Imperial College, looks at the reasons for international interest in prescribing heroin. It critically examines the research, clinical, political and practical challenges to expanding heroin prescribing in the UK. Joseph Rowntree Foundation, September 2003.
Rapid spread of HIV among injecting drug users in north-eastern states of India S. Sarkar, N. Das and S. Panda (a.o.), in: UNODC - Bulletin on Narcotics - 1993 Issue 1 - 006.
The rapid spread of HIV among the intravenous drug users in Manipur is a clear example of the inevitable spread of the HIV epidemic if high-risk behaviour is prevalent. Faced with other pressing public health issues, poor countries such as India, Myanmar and Thailand failed to give due priority to HIV before the epidemic struck them. The harm reduction approach as a strategy is possibly the only powerful and cost-effective tool in such a situation, but it has received scant regard in campaigns launched by the states or by pressure groups within the population. Of immense importance to such a programme, and a precondition for its initiation, is the creation of the necessary political will.
Reducing drug-related harm: Australia leads the way [PDF document]
Article in the Medical Journal of Australia (Volume 181, Number 5, 6 September 2004) by Alison Ritter, Alex Wodak and Nick Crofts describing the key issues issues discussed at the 15th International Conference on the Reduction of Drug Related Harm in Melbourne from 20 to 24 April 2004.
Review of the evidence-base for harm reduction approaches to drug use, Neil Hunt, Forward Thinking on Drugs Research Paper, March 14, 2003.
'Harm reduction' is a term that is used to refer both to a set of general principles used to underpin policies concerning the way that societies respond to drug problems and, simultaneously, to some specific types of intervention, such as needle and syringe programmes and methadone treatment, which are often seen as being synonymous with 'harm reduction'. This overview addresses both understandings of harm reduction and summarises its key principles before going on to consider the strength and nature of the evidence of the effectiveness of various forms of 'harm reduction' intervention. In doing so, some consideration is also given to criticisms of harm reduction that are occasionally encountered.
Use of Narcotic Drugs in Public Injection Rooms under Public International Law [PDF document] Legal Opinion prepared by the Swiss Institute of Comparative Law to examine the legality of drug consumption rooms in the context of the three international drug conventions. AVIS 99-121c, 7 January 2000.
Drug Consumption Rooms
A DrugScope Briefing Paper for the Beckley Foundation Drug Policy Programme, by Axel Klein, Marcus Roberts and Mike Trace. The defining characteristic of Drug Consumption Rooms (DCRs) is that they are legally sanctioned environments where people can take illegal drugs. Their purpose is to reduce drug-related harms. The underlying assumption is that if problem drug users are provided with safe private environments within which to administer drugs there will be a reduction in unsafe public drug use. While the benefits of DCRs should not be exaggerated - and they raise issues of ethical and legal principle that cannot be resolved easily - evidence is emerging that these facilities can make a positive contribution to reducing drug-related harms where they have the support of local services and communities.
Drug Policy and the HIV Pandemic in Russia and Ukraine
A DrugScope Briefing Paper for the Beckley Foundation Drug Policy Programme, by Axel Klein, Marcus Roberts and Mike Trace. Over the past three years Russia and Ukraine have experienced one of the fastest growing HIV pandemics in Europe. In contrast to other parts of the world, the main driver behind the rate of infection is injecting drug use. Recent government policies have placed a heavy emphasis on reducing availability and on harsh punishments for drug users. This approach has not succeeded in significantly reducing the level of drug use. It has pushed the drug scene underground and increased risky behaviours among vulnerable groups. In the absence of measures to reduce infections and reverse the rate of transmission, the long-term impact of HIV/AIDS on population growth and economic development is likely to be grave.
Press Coverage
Wim Bossema Schone naalden voor spuiters
Het debat in: de Verenigde Naties Volkskrant, 19 March 2005
US Ideologues Put Millions at Risk International Herald Tribune, 5 March 2005, by Aryeh Neier
Global fanfare accompanies every International AIDS Conference, but an obscure United Nations meeting next week in Vienna may prove more critical to the course of the global HIV epidemic.
UNODC is caught between the rock of American intransigence on drug policy and the hard facts that
show needle exchange and other harm-reduction strategies to be effective. What is needed at this year's Commission on Narcotic Drugs is unanimous commitment to deploying the tools, including needle exchange, known to reduce HIV among drug users, not the American policy of scuttling prevention methods proven to save lives.
An Overdose of Morality. American Strong-arm Tactics Threaten to Scupper Successful UN Harm Reduction Drug Programmes The Guardian, 3 March 2005, by Mike Trace and Ruth Runciman
"The international community meets next week in Vienna to review progress in reducing global drug problems. The issue of how to tackle drug-related HIV infection is scheduled to be a major theme. The exchanges will take place with almost no media or parliamentary scrutiny, but the positions agreed will affect the lives of millions of people, and the scale and course of the HIV pandemic in years to come. If the outcome is a retrenchment from the progress made in recent years by UN agencies, this would represent a victory of moralism and financial muscle over evidence and tolerance."
Foreign AIDS, America's Overseas Social Engineering Reason Online, 2 March 2005, by Kerry Howley
"A Republican effort to stamp out needle-exchange programs abroad incensed editorial boards at the Washington Post and New York Times last weekend, and both pages slammed the latest Congressionally-mandated gag rule to hit the United Nations. That conservatives are trying to stamp out harm reduction abroad is no small story, but both pages missed the fact that this is only the latest installment in a long story of strings-attached giving that has been changing U.S. foreign aid policy for years."
Reason and Rights in Global Drug Control Policy Commentary, Canadian Medical Association Journal, 1 March 2005 [Volume 172, Issue 5]
"Developments in the coming weeks will indicate whether the World Health Organization and the member states of the United Nations can rise to the challenge of mitigating the negative health impacts of global drug control treaties or whether timidity in the face of ideological bullying will prevail. [..] Canada has implemented a wide range of harm-reduction measures domestically (partly in response to HIV/AIDS), and the declared central objective of our national drug strategy is harm reduction. Canada should therefore play the role of strong global advocate for harm reduction, including at the UN Commission on Narcotic Drugs. This debate needs rational voices informed by public health evidence and a firm commitment to the human rights of all people, including those who are drug dependent." The Journal also devoted its editorial to HIV, harm reduction and human rights.
Deadly Ignorance Editorial, Washington Post, 27 February 2005
According to a Washington Post editorial on February 27, the Bush administration is undermining the global battle against AIDS. "Not only is it refusing to spend federal dollars on needle exchange, but the administration also is waging a campaign to persuade the United Nations to toe its misguided line. The U.N. Office on Drugs and Crime, which is heavily reliant on U.S. funding, has been made to expunge references to needle exchange from its literature, and the administration is expected to continue its pressure on the United Nations at a meeting that starts March 7. The State Department's new leadership needs to end this bullying flat-earthism. It won't help President Bush's current effort to relaunch his image among allies. And it's almost certain to kill people."
Ideology and AIDS New York Times, 26 February 2005
In an editorial on February 26, the NYT condemns current US pressure on UNODC as "a triumph of ideology over science, logic and compassion." The US "should call off their budding witch hunt" against needle exchange and refrain from further attacks at the upcoming meeting of the UN Commission on Narcotic Drugs (CND) early March. The Bush administration should support needle exchange programs and if "it cannot bring itself to do so, it should at least allow the rest of the world to get on with saving millions of lives."
Losing Tolerance with Zero Tolerance Editorial, The Lancet, 19 February 2005
"The USA is currently pressing the International Commission on Narcotic Drugs to abandon its support for needle-exchange programmes and harm-reduction strategies to prevent HIV. [..] Prohibition policies have torn apart and destabilised drug-producing countries, and zero-tolerance approaches to drug use have often created more harm to the user than the drug use they were intended to prevent. [..] There must be a collective responsibility to ensure that the citizens of developing nations do not pay the price for a high demand for drugs in developed countries through drug-control policies that destroy livelihoods and their health, while having little impact on drug use."
US Cash Threat to Aids War The Observer, 6 February 2005, by Martin Bright
The United Nations agency responsible for the global fight against drugs has been forced to abandon its campaign to reduce Aids infection by giving clean needles to heroin addicts after threats by America to end its funding, The Observer can reveal.
Condemned to Death. Thanks to the US-Led Drug War, AIDS is Exploding among Injection Drug Users The Nation, 14 April 2004, by Daniel Wolfe [PDF document]
By any measure, the US-led global war on drugs has been spectacularly unsuccessful. It is also increasingly deadly, as OSI Consultant Daniel Wolfe points out in an article in The Nation. Bullied by the U.S. government and its allies in key United Nations agencies, nations around the world have implemented repressive antidrug policies that result in violent deaths for many drug users and a surge in HIV infections among others. Such developments are antithetical to basic human rights and public health standards, yet are tolerated or even condoned by key policymakers worried about U.S. criticism or aid withdrawal.
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