U.N. Anti-Drug Efforts Contributing To Spread Of HIV, Advocates Say
Main Category: HIV / AIDSAlso Included In: Alcohol / Addiction / Illegal Drugs
Article Date: 12 Mar 2009 - 4:00 PDT
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Members of the United Nations this week are expected to sign a declaration to extend a "war on drugs," a policy that some critics argue is ineffective and contributes to the spread of HIV, Reuters reports. The U.N. Office on Drugs and Crime is drafting the declaration, which calls for a 10-year renewal on efforts to eradicate all narcotics by using law enforcement to target traffickers and producers and end drug use worldwide.
Some critics of the policy say the declaration's lack of focus on harm-reduction strategies, including needle-exchange programs for injection drug users, has increased the spread of HIV and other diseases. In addition, some drug policy advocates, social scientists and health experts say that the strategy has not been successful, with statistics indicating that drug production, trafficking and use have increased during the past 10 years. The cost of law enforcement also has increased, according to statistics. UNODC Director Antonio Maria Costa said, "The crime and corruption associated with the drug trade are providing strong evidence to a vocal minority of pro-drug lobbyists to argue that the cure is worse than the disease. This would be a historical mistake, one which United Nations member states are not willing to make." Reuters reports that the declaration is expected to be signed in Vienna, Austria, on Wednesday or Thursday (Baker, Reuters, 3/10).
A statement released on Wednesday by Human Rights Watch, the International AIDS Society and the International Harm Reduction Association called for member governments not to support the declaration because "critical elements" to prevent HIV were stripped from the final document. The statement said, "What is at issue is a series of measures known collectively as 'harm reduction services,' which have been endorsed by U.N. health and drug-control agencies," including the UNODC, UNAIDS and the World Health Organization. According to the statement, such measures include needle- and syringe-exchange programs and medication-assisted therapy, inside and outside prisons, which are "essential to address HIV among people who use drugs." According to the groups, a "wealth of evidence proves harm reduction is essential to HIV prevention for people who use drugs." Up to 30% of all HIV infections outside sub-Saharan Africa occur through unsafe injecting drug use, the groups said, adding that there is "clear evidence that harm-reduction interventions can halt or even reverse HIV epidemics among people who inject drugs" (HRW/IAS/IHRA release, 3/11).
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Visitor Opinions In Chronological Order (9)
The Facts V The Propaganda
posted by Peter O'Loughlin on 13 Mar 2009 at 6:23 amThe views expressed by the various pro drug lobbies are a distortion of the truth.
Notwithstanding research carried out by the National Treatment Agency (NTA) which clearly established that the majority of those who have developed dependence, wish to become drug free; here in the UK, the focus for the past 10 years has been on ‘harm reduction’, rather than seeking to engage users into abstinence focused recovery. The outcome of this disastrous and misguided policy has been an escalation in drug related deaths which are at their highest for 5 years, 325 of which are attributed to methadone, the flagship of the harm reductionists, together with a devastating increase in the spread of blood born disease among Injecting Drug Users (IDUs) The statistics provided by the Health Protection Agency for England and Wales are as follows:
• The level of HIV infection among Injecting Drug Users (IDUs) in England and Wales is higher now than at the start of the decade.
• In London where the prevalence of HIV in IDUs is higher than elsewhere in England and Wales, 1 in 20 IDUs is infected.
• In the remainder of England and Wales HIV among IDUs has increased from approximately 1 in 400 in 2002 to around 1 in 150 in 2006.
• The prevalence of Hepatitis C among IDUs has increased from 33 percent in 2000 to 42 per cent in 2006.
• Approximately 1 in 5 IDUs has Hepatitis B infection, which extrapolates as an increase approaching 200 per cent since 1997.
The escalating increase in blood born disease has occurred despite the plethora of needle exchange facilities throughout England and Wales, and the growth of supervised drug consumption rooms
It is self evident from the foregoing that here in the UK at least, it is not the lack of harm reduction measures which is contributing to avoidable deaths and the epidemic of blood born disease being wreaked on our society, but the use of toxic psycho active substances.
It is not so called prohibition which has failed, but the encouragement by way of the tacit permission, and in many instances, the not so tacit encouraging of continued use, inherent in the harm reduction ideology, which has failed users and society so abysmally.
The supporters of Harm Reduction, under their various guises have never allowed the truth to interfere with their propaganda, or indeed their more covert agenda, to legalise drug use; the main beneficiaries of which would be the pharmaceutical industry. Such a move would be to inflict further incalculable harm on society, since it would result in a growth of use and addiction, similar, if not more widespread, to that seen in the late 1800’s when most of the drugs which are controlled today, were in fact legal.
The growth of drug use during that period was the direct result of concerted efforts by leading members of the medical profession in promoting drug use, many of whom were influenced by Sigmund Freud, who was so unethical in his dealings that he accepted separate commissions from two competeing, large pharmaceutical companies, both of whom are still in business today, to write papers extolling the benefits of that destructive substance, cocaine, not only as the ‘elixir of life’, but also as a cure for alcohol and morphine addiction. The rest as they say is history
One has to ask is it a coincidence that many of the bodies, who are pressing for an end to what they term as prohibition, receive ‘research grants’ from the pharmaceutical industry?
Methadone-related Deaths
posted by Drug epidemiologist on 15 Mar 2009 at 9:59 amThe figures from the ONS that Peter O'Loughlin uses for methadone-related deaths do not tell the full story. He is again being selective about his sources. Figures from the National Programme on Substance Abuse Deaths (as well as research undertaken in Scotland) consistently show over the past 5 or 6 years that in at least 60% of the cases where methadone was directly implicated in a death, that methadone had not been prescribed to the deceased individual.
This is an issue related as much to prescribing and dispensing practices as it is about harm reduction vs. abstinence. Surely, if you can't get people to become and remain abstinent, at least some attempt at harm reduction should be made. It is not simply one or the other as a policy option. Individuals need to be treated according to their needs and wants.
Prison Drug Advisor
posted by prison drug advisor on 16 Mar 2009 at 4:58 amYet another unhelpful false dischotomy article. Harm reduction and abstinence are two ends of the same spectrum of intervention required. Complex needs require multi-faceted solutions, not one solution at the expense of any other. Open your mind and try to help real people instead of helping to demonise part of the workforce.
Selective Indeed.
posted by Peter O'Loughlin on 16 Mar 2009 at 11:55 amDrug Epi who prefers the cloak of anonymity should be aware that 'people who live in glass houses should not throw stones'
The figures he/she accuses me of being 'selective' about come from the only trustworthy and coincidentally official source, the UK Statistics Authority. I make no apology for that, nor the fact that they relate to England and Wales and not Scotland.
The view that methadone related deaths in Scotland may be the result of diversionery abuse which could not occur without some cooperation from those in charge of the methadone programme, may well be the case.
Whether or not people can be motivated into drug free recovery is debatable, what is indisputable is that methadone is itself a highly addictive substance, and those who have been locked into it purely because it has been the only option available to them do not become free of heroin addiction, but simply go on to develop methadone addiction.
I would also suggest to this correspondent that he takes the time to study the weel researched evidence from the Royal College of Nursing, regarding the adverse effects of methadone on the quality of life of those coerced into using it.
I would also suggest to Epi that he/she visit the wired in recovery site and read the stories of those who despite their wishes to become drug free were told they had to stay on methadone, because the authorities 'knew best', as did the pharmaceutical companies, who are the main beneficiaries that particular drug.
I would also point out that from an ethical standpoint, that those in treatment should be mentally and physically capable of giving their consent to treatment, a rather important point that the pro drug lobby are inclined to dismiss.
Of course none of that will make the slightest difference to those who are ideologically, materially inclined to promote drug use.
Addition To Previous Response To Drug Epi.
posted by Peter O'Loughlin on 16 Mar 2009 at 1:15 pmThis is not, as the anonymous correspondent claims, an issue relating to prescribing and dispensing practices, nor is it as he also claims, an issue regarding harm reduction v abstinence; both suggestions are in my opinion 'red herrings' to divert attention from attempts by those with vested interests in legalising drug use to distort the truth which is the main thrust of my original response.
I mentioned Methadone related deaths since they are of relevance, but in this incidence only incidentally so.
Missing The Point Again
posted by Steve Rolles on 16 Mar 2009 at 3:53 pmPeter
To suggest that the recent upturn in drug deaths and HIV transmission is 'The outcome of this disastrous and misguided policy' - of harm reduction is extraordinarily misleading. It ignores the fact that the determinants of these mortality/HIV stats are many and varied. They may include, for example, changes in the underlying levels of drug use or indeed any number of social, economic and cultural shifts that are entirely unrelated to drug policy and service provision.
A more useful analysis therefore might be to compare countries that have deployed harm reduction with those that haven't, or regions within a country that have little or no harm reduction services with ones that have better provision; or a similar analysis could be done temporally seeing how changes in provision of certain interventions has affected rates of HIV/hepC and drug deaths through time. This has all been done of course, many times.
This might lead you to the conclusion that the UK, as the pioneer of harm reduction since the mid 1980s, in fact has historically had one of the lowest levels of HIV amongst injectors in the western world, unlike, for example, the Russian Federation that has no harm reduction and over a million HIV cases from needle sharing. One could also conclude that the more recent deterioration in some of the the UK's previously positive outcomes (in relative terms at least) might be because harm reduction has been de-prioritised in recent years in favour of CJS administered coerced treatment as part of a broader crime reduction agenda - and that the deterioration in outcomes were the result of too little harm reduction and not too much. No one has ever died in a supervised injecting center, and HIV transmission associated with prescribed heroin using the swiss clinic model is zero. There is no evidence that harm reduction encourages use - and the idea that we should maximise harms associated with drug use as a form of deterrent is unconscionable.
You have not given us any context at all - instead making an inference from some cherry picked data. Rather than a rational and balanced review of the voluminous evidence base from the experience across the world over the past 20 years you have chosen to make petty unfounded accusations, falling back on conspiracy and name calling. You suggest harm reduction advocates are part of a 'pro drug lobby', apparently on the basis that you determine yourself to be 'anti-drug' and you disagree with them - a perfect example of a false binary. It is not only intellectually ridiculous and quite wrong, but it is offensive to the work of tens of thousands of service providers, police, scholars, and policy makers who are involved in harm reduction work on a daily basis - saving lives.
Not content with this you then add insult to injury with the suggestion that people who disagree with you must also be in the pay of the pharmaceutical industry. The bizarre insinuation via your exotic Freud reference is beyond me (even though I have been on the receiving end of this particular brickbat elsewhere) - I know of no leading voices or scholars in harm reduction who have ever cited Freud as an influence (a pub med search for Freud + harm reduction turns up zero hits) defended him or his work, or even mentioned him in passing, let alone advocated cocaine as a cure for alcohol or morphine addiction - the rest is demonstrably not history. Its utter nonsense.
So who else, apart from the 1000s of academics, service providers, and elected representatives from across the globe is part of the this Freudian inspired big-pharma conspiracy to legalise drugs and promote drugs, death and HIV? Well, for starters all of the following have clear public positions in favour of harm reduction:
the WHO
the UN General secretary
UNAIDS
the UNODC
the INCB
the UN High Commissioner for Human rights
the Global Fund to Fight AIDS, Tuberculosis and Malaria
the UN Human Rights Council
the UN Special Rapporteur on the Right to Health.
the UN Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment
the UN general assembly Declaration of Commitment on AIDS 2001 and Political Declaration on AIDS in 2006
oh, and the govenments of over 80 countries, The Red Cross, The BMA, NiCE, the RSA, the Home Affairs Select Committee, all three major UK political parties, Barack Obama, Rowan Williams etc etc. I could go on.
Response To Criticisms.
posted by Peter O'Loughlin on 17 Mar 2009 at 8:45 amResponse to Prison drug adviser,
It is regrettable that you see this as an attack on part of the work force, when in fact it is nothing of the sort, It is however an attack on those who want to legalise drugs and prefer to conceal their true intentions under the guise of harm reduction. Those, who deliberately distort what has been said in respect of reducing drug use, as an attack on harm reduction protocols the UN recognises has a place in the overall treatment strategy.
My personal criticism of harm reduction, is that it has been allowed to become the dominant protocol in favour of abstinent focused treatment for those who are unfortunate enough to have become addicted and in the process have lost the ability to control their use.
Response to Rolles.
I do not require you to tell me what you feel is a more useful analysis, nor am I particularly interested in what you have to say. I am stating the facts as they are in this country.
Addiction as defined by the criteria in ICD-10 or DSM-V where it is described as dependency is an irreversible, progressive and incurable condition, the inevitable outcome of which is abstinence. Whether the latter arises from death, or effective treatment, is of concern to me, as it is to those who value the sanctity of human life.
Harm reduction has, as the UN have acknowledged, a valuable role to play in the case of those who have not yet developed addiction, but meet the criteria for substance misuse disorder. Regrettably, the powers that be in the UK have allowed harm reduction to be hijacked by people who, for their own selfish reasons, exploit it to disguise their true intention which is to increase the use of toxic, psycho active substances throughout the world, regardless of the costs in terms of human suffering. Their complete disregard for the latter equips them to be willing to go to any lengths, to achieve their aim, including attempts to discredit those who challenge them.
One of the favourite clichés of the pro drug lobby is ‘freedom of choice’. A cliché designed to suppress the truth. What starts out as the drug(s) of choice can and does lead to drugs of addiction, then progresses to drugs of death, disease, and human degradation.
You Just Keep On Digging
posted by Steve Rolles on 18 Mar 2009 at 6:18 amGiven your smears of the harm reduction movement in the original piece I can only laugh at the irony of your comment about:
'attempts to discredit those who challenge them.'
Disagreeing with you, or highlighting the shortcomings in your analysis, is not an attempt to discredit you. Its an entirely appropriate part of quite normal, indeed healthy, debate. This is a 'discussion forum' after all. Critical engagement of different ideas, and dialogue between those with different views is how scientific discourse happens and how progress is achieved in all fields of science and policy making. Offensive and unfounded accusations of corruption and sinister agendas of those who differ with your stance is not.
Switch On The Light.
posted by Peter O'Loughlin on 19 Mar 2009 at 2:40 am"You Just Keep On Digging."
And that is what I'll continue doing.
Well done, you finally got something right.
You can describe the disclosure of indisputable and inconvenient facts in any way that you choose to suit your drug use promotion agenda, but it will not in any way alter the facts.
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