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.
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.
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.
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.
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.
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.
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.
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.
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."
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.