International Narcotics Control Board 'Out Of Step' With HIV/AIDS Control Efforts, Opinion Piece Says
Main Category: HIV / AIDSAlso Included In: Alcohol / Addiction / Illegal Drugs
Article Date: 02 Jun 2008 - 10:00 PDT
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The International Narcotics Control Board "remains out of step" with the rest of the United Nations' efforts to fight the spread of HIV, especially among injection drug users, and its practices should be open for review, Joanne Csete of the Canadian HIV/AIDS Legal Network and Daniel Wolfe, deputy director of Open Society Institute's International Harm Reduction Development program, write in a Lancet opinion piece.
The control board is an independent body of 13 members who are elected by U.N. members and oversee the implementation of international drug control regulations, according to the authors. Although the board's annual reports "repeatedly note that injection drug use is driving severe HIV epidemics," the board has "failed to criticize" countries where methadone or buprenorphine are illegal or "express concern" about countries where the medications to treat drug addiction are "effectively unavailable," Csete and Wolfe write. They add that the board also has not "spoken out" against the "many instances where addiction treatment -- required under the U.N. conventions -- is incarceration by another name, including forced labor, prolonged institutionalization, and unproven and punitive procedures." The board also "does nothing to highlight" the lack of access in many countries to clean needles or the "many instances where police use needle exchanges to target" IDUs for arrest, Csete and Wolfe write. In addition, the board would "do well to highlight and promote" the countries -- such as China, Malaysia and Indonesia -- that have good HIV/AIDS practices and policies regarding IDUs, the authors add.
The board is a "relic" of a time when "criminal law and crackdowns" were enough to deal with the health challenges of illegal drug use, Csete and Wolfe write, noting that an "ideal way" for the United Nations to show that drug policies need to be amended in the "era of HIV" would be for U.N. Secretary-General Ban Ki-Moon to commission an independent evaluation of the board's work. In addition, the United Nations should make board deliberations -- which are "held in secret" -- open to member states and civil society, according to the authors. "Such measures would contribute to making 2008 a milestone of real global progress toward dealing with the health consequences of drug dependence," Csete and Wolfe conclude (Csete/Wolfe, Lancet, 5/31).
Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation.
© 2008 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
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Visitor Opinions In Chronological Order (1)
Unwarrented Attack On No Evidence
posted by Peter O'Loughlin on 3 Jun 2008 at 1:24 amThe view that methadone treatment is a form of harm reduction is false, insofar as it is not possible to reduce the total harms already caused by the use of heroin, injecting or otherwise.
The INSITE evaluations as reported in various research journals include considerable overstating of findings, under reporting or omission of negative findings, and in some cases the discussion can mislead readers. The reports show no impact on the key issues that would most warrant its existence: Spread of HIV or other blood borne disease, getting clients into treatment and off of drugs, reducing overdose deaths. The reported impact on public disorder that is discussed is questionable, and so limited in scope as to be misleading. “Straw horse” findings are reported that also can be misleading. These are findings that one would naturally expect but that lack any real meaning.
The most conclusive finding is not discussed to any extent in the reports. Data in all of the reports suggest that only a small percentage of IV drug users use INSITE for even a majority of their injections. Most drug users use it only some of the time or not at all. This illustrates a shortcoming of harm reduction measures recently been highlighted by Professor Neil McKeganey in the UK: An inability to control a free moving population of IV drug users sufficiently to control disease in the face of continued use of drugs.
Here in the UK where we have a plethora of needle exchange facilities and where the vast majority of injecting drug users in treatment are on methadone, both HIV and hepatitis C infections are still rising year on year. Further, the vast majority of those on methadone continue to misuse other addictive drugs, whilst not infrequently selling their methadone in order to fund such use.
When the last favourable INSITE report was published earlier this year the writer sent the following questions to the researchers.
How many of the reported 8,000users have actually gone into treatment?
What type of treatment?
How many are still in treatment, how many have become drug free as the result of the treatment?
One of the interesting statements in the report reads as follows:
"Between 6 weeks before and 12 weeks after Insite opened in 2003, there were reduced numbers of users injecting in public."
That appears to be a nebulous statement. If less people were publicly injecting prior to opening, surely there
should have been less after opening? What was the situation 6, 12 18 and 24 months later?
None of the above questions have been answered, nor even the courtesy of an acknowledgement received.
The rhetoric offered by Csete & Wolfe is standard propaganda by the pro drug lobby, whose overall objective is the legalising of all drugs, which far from so called harm reduction results in increased use, thus spreading the devastion a mental, physical and spiritual disease and disorders associated with the ongoing use addictive drugs.
Methadone does have a place in treatment protocols as a stepping stone towards abstinence focused recovery. The ongoing use of it for longer than two years, as is common in the UK, is simply swopping one addiction for another.
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