In a confidential and authoritative memorandum to the INCB, UNODC legal experts argue that most harm reduction measures are in fact acceptable under the conventions. According to the Legal Affairs Section "it could easily be argued that the Guiding Principles of Drug Demand Reduction provide a clear mandate for the institution of harm reduction policies that, respecting cultural and gender differences, provide for a more supportive environment for drug users."
Drug consumption rooms have been established in several countries, where confirmed drug users are allowed to consume their drugs in hygienic conditions and without fear of arrest. These facilities, which mostly operate in big cities, emerged because of serious health and public order problems associated with drug use, especially drug injecting in public places. In 2004, there were about 60 consumption rooms in 36 European cities and two pilot projects of medically supervised injecting centres in Australia and Canada.
The first drug consumption room for opiate-dependent persons in Germany was opened in Frankfort on the Main in December 1994. In March 2003 there were 19 drug consumption rooms in the Federal Republic of Germany: These institutions provide several hundred drug injecting places; they are used every day by several thousand addicts several times a day.
Besides the classic approaches (drug counselling centres, therapy for substance abuse) there exist reform and pilot projects to develop alternative ways of helping. These are intended for longtime drug users who have undergone several therapies unsuccessfully or could not be reached by existing resources. Amongst those alternative services is the treatment with substitution therapy as well as the establishment of drug consumption rooms.
State-controlled public injection rooms are not expressly referred to in any of the relevant international conventions. It is thus necessary to determine, by way of a preliminary factual enquiry, the exact characteristics of such institutions that fall within the ambit of one or more of the conventions. The rather superficial provisions concerning drug addicts stand in stark contrast to the stated primary aims of the conventions, which are formulated in the preambles as preventing and combatting abuse of narcotic drugs and psychotropic substances and the public health and social problems which such abuse engenders.
This paper examined whether use of crack cocaine has become a risk factor for HIV infection. Smoking of crack cocaine was found to be an independent risk factor for HIV seroconversion among injection drug users. This finding points to the urgent need for evidence-based public health initiatives targeted at people who smoke crack cocaine. Innovative interventions that have the potential to reduce HIV transmission in this population, including the distribution of safer crack kits and medically supervised inhalation rooms, need to be evaluated.
Eberhard Schatz, Katrin Schiffer, John Peter Kools
15 January 2011
This paper, written in collaboration with the Correlation Network, briefly describes the history and the basic elements of the Dutch drug dependence treatment policy, including recent trends in drug use and the current drug treatment system implemented in the four largest cities in the Netherlands. Building on more than 30 years’ experience, the Dutch approach focuses on an integrated treatment system, which provides comprehensive support and services to the most vulnerable groups, including homeless people, problematic drug users and chronic psychiatric patients. At the same time, a strong emphasis is given to public order and crime reduction.
The global war on drugs is driving the HIV pandemic among people who use drugs and their sexual partners. Throughout the world, research has consistently shown that repressive drug law enforcement practices force drug users away from public health services and into hidden environments where HIV risk becomes markedly elevated. Mass incarceration of nonviolent drug offenders also plays a major role in spreading the pandemic. Today, there are an estimated 33 million people worldwide living with HIV – and injection drug use accounts for one-third of new HIV infections outside of sub-Saharan Africa.
For the past 10 to 20 years, drug consumption rooms (DCRs) have become an integrated part of the drug treatment and harm reduction strategy in a variety of countries in Western Europe, North America and Australia. However, they have not yet been established in the majority of countries worldwide.
Lynne Leonard, Emily DeRubeis, Linda Pelude, Emily Medd, Nick Birkett, Joyce Seto
30 April 2007
Among injection drug users (IDUs) in Ottawa, the capital of Canada, prevalence rates of HIV (20.6 percent) and hepatitis C HCV (75.8 percent) are among the highest in Canada. Recent research evidence suggests the potential for HCV and HIV transmission through the multi-person use of crack-smoking implements. On the basis of this scientific evidence, in April 2005, Ottawa's needle exchange programme (NEP) commenced distributing glass stems, rubber mouthpieces, brass screens, chopsticks, lip balm and chewing gum to reduce the harms associated with smoking crack.
In 2008, Harm Reduction International released the Global State of Harm Reduction, a report that mapped responses to drug-related HIV and hepatitis C epidemics around the world for the first time.(1) The data gathered for the report provided a critical baseline against which progress could be measured in terms of the international, regional and national recognition of harm reduction in policy and practice. Since then, the biennial report has become a key publication for researchers, policymakers, civil society organisations and advocates, mapping harm reduction policy adoption and programme implementation globally.
French officials across the political spectrum have expressed support for "shooting galleries", where addicts could use drugs under medical supervision. Such centres exist in several other European countries. The debate over "shooting galleries" started in the headquarters of an anti-addiction association located in the Belleville neighbourhood of Paris. In May 2009, the association, called ASUD (Self-support and Risk Reduction among Drug Users) opened a centre in which addicts could use drugs under medical supervision.
A legal, city-funded center where intravenous drug users can get needles and shoot up without consequence is on the agenda in San Francisco. The idea comes from the city's Hepatitis C Task Force, created by then-Mayor Gavin Newsom in 2009 in response to growing concern over the 12,000 San Francisco residents infected by the disease, most of whom have no idea of their status. Opening the nation's first legal injection drug center garnered unanimous support by the task force.
The number of drug-overdose deaths on Vancouver’s notorious downtown Eastside fell sharply after the opening of a safe injection site, new research shows. The study, published online Monday in the medical journal The Lancet, shows that fatal overdoses dropped 35 per cent in the vicinity of Insite in the two years after it opened. By comparison, OD deaths dropped only 9 per cent in the rest of Vancouver in that same period.
InSite does not operate under the assumption that addiction is incurable. We believe in recovery; in fact, the biggest difference between our approach to recovery and the opinion expressed by Barbara Kay in her recent column (Rehab still the best solution for addiction) is that we believe it should be possible even for addicts who are not ready to get clean. InSite’s purpose is to help prevent addicts from dying, either from an overdose or from a disease, before they get a chance to recover.
Insite’s operators have twice applied for a federal health exemption to allow crack cocaine smokers to use the room – the request was rejected in 2006, ignored in 2009. Proponents say the room would allow health officials to reach a fast-growing segment of drug users, a group prone to viruses because of dirty crack pipes. Critics say scientific evidence for the benefits of supervised inhalation rooms is scant.
When the Supreme Court of Canada convenes to consider Vancouver’s supervised injection site, it will hear detailed arguments that hinge on the fine print of the Canadian Constitution. But besides being a landmark showdown between federal and provincial powers, the hearing also sets the stage for a ruling expected to affect not only the daily lives of injection drug users on Vancouver’s Downtown Eastside but drug policy across the country and potentially farther afield.
Vancouver’s supervised drug-injection clinic, Insite, saves lives and prevents human misery. Providing addicts with a safe, sterile place to inject heroin and other drugs is a pragmatic and effective way to curb the spread of infectious disease, including HIV/AIDs and hepatitis B and C, and to reduce substance abuse and overdoses. Yet the federal government persists in opposing it, viewing Insite not as a critical component of British Columbia’s health-based approach to treating addiction, but as a stark violation of criminal law.
Divided by politics but united by drug policy, five former Vancouver mayors have issued a last-minute plea to Ottawa to drop its appeal of earlier court decisions approving Insite, the city’s supervised drug injection site. “Since opening in 2003, Insite has proven – beyond a doubt – its worth to our community,” the five ex-mayors say in an open letter issued to the federal Conservative government. Open letter supporting Insite from Vancouver mayors.
For all the thunderous warnings about Stephen Harper’s hidden agenda, there has been remarkably little talk in this election about one of the few real examples of Conservative social conservatism – namely, the party’s stunningly steadfast opposition to the Insite supervised injection facility in Vancouver’s Downtown Eastside.