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News Harm reduction

mr peabody

Moderator: PM
Staff member
Aug 31, 2016
Frostbite Falls, MN

Huge court win for Philadelphia safe consumption site

by Christopher Moraff | Filter | Oct 3 2019

October 2 will live long in US harm reduction history. A federal judge ruled that Safehouse⁠—a nonprofit planning to open the first sanctioned safe consumption site on US soil in Philadelphia’s Kensington neighborhood⁠—would not be violating federal law.

“The ultimate goal of Safehouse’s proposed operation is to reduce drug use, not facilitate it,” wrote US District Judge Gerald Austin McHugh Jr. in his detailed 56-page opinion, “and accordingly 856(a) does not prohibit Safehouse’s proposed conduct.”

Bill McSwain, the US Attorney for the Eastern District of Pennsylvania, filed a motion in February seeking to prevent Safehouse from opening on the grounds that providing a safe space for drug users to inject is illegal under law 856(a)—the so-called “crack house statute” of the Controlled Substances Act.

US Attorney McSwain and his allies then argued in court against both the legality and the efficacy of safe consumption sites—which operate in 10 countries around the world and are shown by reams of evidence to reduce harms and save lives. A June survey showed 90 percent local support for an SCS in Kensington.

The Safehouse leadership was obviously delighted by the verdict, but also sounded caution. Ronda Goldfein, executive director of the AIDS Law Project of Pennsylvania and a member of the Safehouse leadership team, told Filter that the organization doesn’t plan on moving forward until it can clarify certain positions with Judge McHugh. Goldfein did not elaborate on where there may be ambiguities in the ruling.

The group has implied in past conversations that it could be ready to open within a week of any ruling in its favor, but it clearly has concerns that there are details yet to be resolved.

“We have tried to be respectful and methodical in our approach and nothing has changed. We didn’t just bust out there and open up, we have patiently laid out our case,” Goldfein said. “The lives of the people we serve are chaotic enough; we don’t want to add a federal drug charge on top of that.”

However, she also hinted that a second site, outside of Kensington, may already be in the planning stage.

While this victory is hugely significant, the legal battle will continue—an appeal and further litigation are expected. “This case is obviously far from over. We look forward to continuing to litigate it,” said McSwain in a statement after the verdict.

Some local leaders, including Councilor Maria D. Quiñones-Sánchez, whose district covers some of the most impacted areas of Kensington, also remain opposed to Safehouse. “Injection sites have been successfully opened in locations where government has taken responsibility to fund, run and own the programming,” said Sanchez. “We are not there yet.”

Grassroots activism paved the way

But we’re a lot closer. As the city prepares to make history by taking a progressive leap forward on drug policy, it would be remiss not to mention the unsung harm reduction heroes who put a plan in motion for an illicit SCS when the City of Philadelphia still opposed the idea.

It was just over two years ago that I first became aware of a small but determined effort by a group of mostly young activists to establish an SCS in Kensington.

This was during the waning days of “El Campamento”—a secluded encampment of homeless drug users that was closed down by Mayor Kenney’s office in August 2017 under pressure from local political leaders. The move was informed by a narrow view of the city’s devastating overdose crisis and a misinformed media that stoked widespread outrage over the camp.

They were a fiercely determined bunch that included medical students, harm reduction veterans, nurses and former members of the military.

During the frigid winter that followed—as four tent cities sprung up in Kensington, to house people displaced by the closure and to provide temporary shelter for others drawn there by the availability of drugs—I gained the trust of a few key players in the movement to create a new, safe space for people to inject.

I use the term “movement” loosely. They were a fiercely determined bunch that included medical students, harm reduction veterans, nurses and former members of the military. Their brainstorming led to some truly innovative ideas, as they scouted sites on abandoned rail beds and debated racial politics in drug subcultures during weekly meetings.

“You don’t need a physician on site,” one local organizer in the drug user community told me off the record. “It raises the cost considerably without any real added benefits.”

Part of this involved fears of the consequences for any friendly physician involved in an unsanctioned SCS. “Well, you can’t go anywhere near the site,” one member of the group told a doctor who was devoting his time and expertise to overdose prevention. “There already aren’t enough harm reduction-minded doctors. We need you out here.”

The election of reformer Larry Krasner as district attorney and the city’s January 2018 announcement that it "would take a hands-off approach to SCS," then saw these radical activists switch their focus to establishing a sanctioned venue.

Against what seemed like insurmountable odds in the summer of 2017, Judge McHugh has now ruled that no doctors should have to go to prison for the “crime” of saving a life.

The local harm reduction community spent the evening of October 2 celebrating the decision. Sterling Johnson, an organizer at ACT-UP Philadelphia, called the ruling “a major step forward that lays the legal groundwork for safe consumption and other public interventions supporting drug user health care rights.”

Yet Alex Kral a leading researcher on SCS at RTI International, was reluctant to declare victory too quickly.

“Having been at this for 12 years and having had so many victories nullified along the way, I’m still a bit wary of what comes next,” he told Filter. “The champagne isn’t popping yet.”

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mr peabody

Moderator: PM
Staff member
Aug 31, 2016
Frostbite Falls, MN

Nanette Castillo grieves next to the body of her son, Aldrin.

The struggle of death, hope and harm reduction in the American midwest*

by Zachary Siegel Filter | Oct 7 2019

For those of us who are suffering, how do we find joy and experience pleasure? How do we create a world in which less suffering is possible? What does it look like to build community in the face of such suffering, and how can we create communities that are safe for each and every person?

These are the questions that Sarah Ziegenhorn, the 30-year-old executive director of the Iowa Harm Reduction Coalition and a medical student at the University of Iowa, had in mind when she and her team organized the fourth annual Iowa Harm Reduction Summit. It took place October 3-5 in Iowa City in the name of Andy Beeler, who died in his home from an accidental heroin overdose in March. Beeler was a program coordinator at the Iowa Harm Reduction Coalition, beloved by the participants to whom he dedicated his life.

Far from an abstraction, the questions raised by Ziegenhorn were present throughout the weekend. Deaths involving synthetic opioids like illicit fentanyl tripled from 2011 to 2017, while those involving heroin quadrupled from 2012 to 2017, according to the Centers for Disease Control and Prevention. In 2017, stimulants like methamphetamine contributed to 28 percent of the 342 overdose deaths in Iowa, according to Iowa’s Department of Public Health. A mix of heroin, illicit fentanyl and meth is contributing to an upswing in morbidity and mortality across the plains of Iowa and the Midwest at large.

A much-anticipated Saturday night presidential candidate forum was postponed after Senator Bernie Sanders—who was slated to wax on health care, drug policy and criminal justice reform—had a heart attack. “Due to Senator Sanders’ illness, we are postponing tomorrow evening’s kick-off candidate forum,” Ziegenhorn wrote in an email to panelists and speakers from out of town. “Because many of you arranged travel plans to Iowa around this event, we are throwing a party instead.”

Grim statistics and the big heart of America’s leading socialist giving out did not diminish the spirited, vulnerable tone of the weekend. Hundreds of people showed up with all the urgency that Ziegenhorn’s questions express.

At many harm reduction conferences, people tend to fly in from the usual hubs: New York, Chicago, Los Angeles, Seattle and the Bay Area. While these harm reduction hotspots were well represented in Iowa, sharing decades of wisdom and up-and-coming programs, the substance of the Summit was distinctly Midwestern. Many Iowans directly impacted by chaotic drug use and inhumane policies drove hours to hear about how to expand services that save lives, and learn about innovative strategies to mitigate harms to people who use drugs and sex workers.

Drug user organizing in a red state

Topics ranged from “Eliminating Hepatitis C in Iowa: Building Financial Sustainability for Payers and Providers” to “Drug User Organizing.” In the latter meeting, led by activists Jess Tilley and Louise Vincent, nearly 40 people who identified themselves as drug users sat in a circle and engaged with the difficult task of how to organize in their communities and fight to be treated with dignity by medical, legal and other institutions.

Christopher Abert, former executive director of the Indiana Recovery Alliance and founder of Southwest Recovery Alliance, told Filter how inspiring this had felt. “So many people identified as using drugs,” he said. “I’ve never seen anything like that before.” Indeed, they were mostly strangers to one another, but Abert felt a unique vulnerability and openness.

Tilley, who smiles with her eyes and frequently calls herself “jaded,” shared with the group how safe she felt there, and then got down to the business of people who use drugs engaging in direct action against punitive drug laws. Tilley and Vincent used their Reframe the Blame campaign, which targets cruel and misplaced drug-induced homicide laws, as an example of how people can make their voices heard.

Having flown in from Chicago, where harm reduction groups like the Chicago Recovery Alliance have a 25-year history, I had a question on my mind beyond those Ziegenhorn raised.

In the rural Hawkeye State⁠—which President Trump carried by the largest margin of any Republican candidate since Ronald Reagan in 1980, and where conservatives maintain a trifecta of control over the House, Senate and Governor’s office⁠—are harm reduction services, like naloxone and syringe distribution, fentanyl test strips and support for sex workers, really being embraced?

The answer, I learned, is an unsatisfying yes and no. But groups like the Iowa Harm Reduction Coalition are moving the needle. Part of this involves building bridges with critical institutions at the University and the state’s criminal-legal system. Except for the police chief.

The Iowa Harm Reduction Summit was instituted four years ago as a series of talks and panels to teach medical students how to better care for people who use drugs in their community. Today, the coalition constitutes Iowa’s largest free naloxone distribution program and provider of opioid overdose prevention education, and the Summit attracted hundreds of people.

A generation of people from all kinds of backgrounds and professions has grown up in a world of unfathomable grief. Yet even if harm reduction concepts are not being embraced by conservative legislators in red states (nor even by liberal politicians in big cities), this generation is fighting to create a world where people don’t have to grow up losing so many loved ones.

Hundreds of attendees at this year’s Summit were among those who have suffered. They’re simply fighting so that they and their loved ones, year-by-year, can suffer a little less.

*From the article here :
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mr peabody

Moderator: PM
Staff member
Aug 31, 2016
Frostbite Falls, MN

Pressure mounts on NY Gov. Cuomo to authorize safe consumption sites

by Alexander Lekhtman | Filter | Oct 10 2019

New York safe consumption site (SCS) advocates have been fueled by last week’s landmark decision in Philadelphia, when Judge Gerald McHugh ruled that Safehouse, a nonprofit plans to open the nation’s first sanctioned SCS, would not be violating federal law.

On the day of that decision, New York harm reduction group VOCAL-NY released a statement calling on Governor Andrew Cuomo to take action to facilitate overdose prevention centers, as they’re also known, in the state.

“Today, US District Judge Gerald A. McHugh ruled in support of Safehouse, dispelling the legal myths and rhetoric the Trump administration weaponized against these evidence-based public health interventions,” said Jasmine Budnella, VOCAL’s drug policy coordinator. “With over 20,000 overdose deaths under Governor Cuomo’s tenure, his legacy will be marked by his choice to either stand with New Yorkers or stand in the way of their survival. Every day that we wait on his approval, the Governor has blood on his hands.”

New York City has already proposed a plan to open four SCS. It was endorsed by Mayor Bill de Blasio in May 2018. The facilities would be housed within existing syringe service centers. But for over a year the plan has been delayed because of Governor Cuomo’s failure to authorize it. The NYC Mayor’s office confirmed to Gothamist it cannot move forward until the program is authorized by the Governor. Cuomo’s Department of Health is conducting a mandatory review of the proposal.

“We’re ready to go, but Cuomo has not let this move forward,” Mike Selick, a training and policy manager at the Harm Reduction Coalition, told Filter. “The Safehouse ruling shows there is no legal reason stopping us from doing this. The only reason we haven’t already started yet is because Cuomo is not letting his Department of Health approve it. We’ve already lost a lot of time; this pilot program would be finishing up at this time if it had been allowed to move forward initially.”

Selick said that existing harm reduction programs stand ready to rapidly convert into SCS if the city’s pilot is approved. “These centers already have staff and supplies and trust within their communities,” he said. “Some centers may need to construct or renovate a new space for this. There is money put aside for these operations⁠—but that can’t happen until the program gets green-lit by the state.”

VOCAL-NY has also put pressure on Mayor de Blasio to proceed with the pilot even without the Governor’s approval. “We are continuing to demand his full-throated support for overdose prevention centers,” Jeremy Saunders, VOCAL’s co-executive director, told Filter. “We should not even have to wait for the governor; our mayor should be bold and say he will take the steps Philadelphia is taking and we will do this.”

The number of overdose deaths in New York City decreased slightly last year (by 3 percent). But at 20.5 deaths per 100,000 residents, the rate is still nearly double the rate from 2012, and 1,444 lives were needlessly lost in 2018. The most common substance involved was fentanyl. SCS are proven to reduce mortality—in large part through having trained staff or volunteers ready to use naloxone.

The demands are coming not only from activists, but from state lawmakers in Cuomo’s own party.

After Judge McHugh’s decision last week, New York Senator and Health Committee Chair Gustavo Rivera (D-Bronx) said the state must lead the way on SCS. “With this ruling, we know that the federal government cannot prevent us from moving forward,” he said. “These centers are not about enabling people to use drugs. They are about treating drug abuse disorders as the public health issue they are.”

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mr peabody

Moderator: PM
Staff member
Aug 31, 2016
Frostbite Falls, MN

Why isn't the overdose crisis an election issue? Because it's complicated, expensive and controversial.

by Daphne Bramham | Vancouver Sun | Oct 16 2019

None of the federal leaders has strolled along Vancouver’s Hastings Street near Main at the epicentre of the crisis. None is likely to do so.

If more than 12,800 Canadians had died in the past three years due to flu or gunshot wounds, causing life expectancy estimates to drop for the first time in decades, it’s inconceivable that it wouldn’t be something that federal party leaders would be talking about.

Yet that is the number who have died in the epidemic of opioid overdose deaths from January 2016 to the end of March this year.

None of the federal leaders has strolled along Vancouver’s Hastings Street near Main at the epicentre of the crisis. None is likely to do so, and that is not only because NDP incumbent Jenny Kwan is generally believed to have a lock on the riding.

The opioid addiction/fentanyl overdose crisis has devastated a neighbourhood that already had more than its share of problems. The chaos and abject misery there are so vividly obvious that it is an indictment of both past and present social policies.

All of the parties’ addictions plans are short on details.

The Conservatives are mostly likely to appeal to the majority of Canadians with their focus on recovery. It echoes many of the recommendations in the B.C. Centre on Substance Use’s 2018 report, Strategies to Strengthen Recovery, including enhanced funding for education, acute care and a range of services to support recovery.

Recovery services have been neglected for decades as provinces have put most of their scarce money for addiction services into keeping addicts alive by providing free needles and supervised injection sites.

“Rather than just maintaining addictions and maintaining people in a lifetime of unimaginable hardship and terribly dangerous behaviour, breaking that cycle and focusing on recovery is our focus,” leader Andrew Scheer said at a meeting with The Vancouver Sun’s editorial board.

“We understand that recovery programs are the best way to get people off of addictive drugs and what we’re saying in this platform is that we want to start the groundwork to refocus some of the attention.”

His party’s promises: $36 million for recovery community centres, including high schools, that support both the people trying to overcome their addictions and their families, and $30 million for a national education program that focuses on the benefits of staying drug-free.

"These are only first steps," Scheer said, adding that "the goal is “to precisely avoid the prospect of people having to lose everything in their lives before they are able to start to get well again. This will take cooperation. It will take resources. It will take provincial government buy-in. But we believe that with this platform, we can start that.”

Scheer stopped short of committing to universal access to all recovery services under provincial health-care plans, even though the cost of residential care — the highest level of treatment — is well beyond the economic reach of most middle-income Canadians.

The Tory plan also addresses the dismaying fact that many inmates come out of prison addicted. It proposes full body scans of anyone entering prisons to keep illicit drugs out, noting that in 2018, correctional officers seized 376 grams of hashish, 80 grams of crystal methamphetamines, 72 grams of opioids, and 55 grams of crack cocaine.

It promises better rehabilitation services for inmates, although the cost of the prison programs is not included in the platform.

The Liberals disavowed part of their platform earlier in the campaign after the Conservatives began running Chinese-language ads and sent out a media release saying that the Liberals would legalize drugs.

The platform states they would establish a drug treatment court as a default option for first-time, non-violent offenders charged with simple possession.

In an email, party spokesman Guy Gallant insisted that "Liberals would neither decriminalize nor legalize illicit drugs."

"What's left is the promise of $700 million over the four years for more community-based services, more in-patient rehab beds, and scaling up the most effective programs such as extending hours for InSite and other safe consumption sites.”

New Democrats support decriminalization — not legalization — and would invest $400 million over four years on overdose prevention sites and better access to treatment. Only the Greens support providing a safe supply of drugs to addicts and would spend $500 million over five years to provide drug-testing equipment to community organizations, more naloxone kits to treat overdoses, and unspecified “medical support” to combat addictions.

If only this were a flu epidemic fixed with a vaccine or a problem solved by restricting guns. Canada’s addiction crisis is far more complicated. Even the idea that addiction is a health issue — as opposed to a moral failing — is controversial in some communities.

Addressing addictions requires untangling and dealing with the causes that often include trauma, chronic pain, mental health, homelessness and poverty.

As nascent as the parties’ platforms are, there is consensus that what is being done isn’t working.

And that should be enough for the new government to open a public conversation about what the next steps might be.

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mr peabody

Moderator: PM
Staff member
Aug 31, 2016
Frostbite Falls, MN
Safe injection rooms save lives – yet the UK government continues to oppose them

by Rick Lines | The Conversation | 24 Oct 2019

Urgent action is needed to stem the UK's overdose crisis, according to a group of cross party MPs, who have called upon the government to properly tackle the issue. Drug-related deaths rose to record numbers in 2018 in England and Wales. A total of 4,359 people died due to drug poisoning—over half of them related to opiate use.

MPs have urged for a number of important policy changes. These include the decriminalisation of drug possession for personal use and the the creation of supervised injecting facilities.

Supervised injecting facilities—sometimes known as overdose prevention centres or drug consumption rooms—are a critical tool in ending the overdose crisis. These are places where people are allowed to inject illegal drugs in hygienic conditions in the supportive presence of medical staff and peer workers.

They are primarily intended to provide services for vulnerable, poor or homeless people who would otherwise inject in public places—such as alleys or parks. Circumstances that significantly increase the risk of fatal overdose and transmission of blood borne infections via unsterile injecting equipment

According to the nongovernmental organisation, Harm Reduction International, which monitors global developments on programmes to reduce drug-related harms, there are almost 120 such facilities operating in 11 countries. This includes Canada, Australia, France and the Netherlands. And research by the European Monitoring Centre on Drugs and Drug Addiction found that supervised injecting sites help to reduce unsafe injecting and fatal overdoses.

Outdated logic

Yet despite the record of success of safe injecting facilities too many governments continue to oppose their implementation. Over the summer, Dublin City Council refused planning permission to open Ireland's first safe injecting room. This despite the Irish government changing the law two years earlier to clear legal barriers to their operation.

In Canada in 2011, the Conservative government of Stephen Harper went all the way to the Supreme Court to try to shut down the country's first safe injecting facility in Vancouver. Only to have the government lose in humiliating fashion in a unanimous decision. Yet despite the court ruling in favour of safe injecting facilities, some provinces continue to obstruct their implementation.

In the US earlier this month, health advocates won an important legal victory when a District Court judge blocked an attempt by the US Justice Department to prevent the nation's first legal supervised injecting facility from opening its doors in Philadelphia. The Justice Department sought to have the not-for-profit project, Safehouse, declared unlawful under a 1986 federal law intended to shut down "crack houses."

Lifesaving programmes

But not all efforts end in victory. In the UK in December 2016, the Advisory Committee on the Misuse of Drugs—the government's expert body – recommended implementing safe injecting facilities in response to massive increases in overdose deaths. But in July 2017, the government of Theresa May rejected this recommendation. And four months later the Lord Advocate in Scotland blocked plans by the City of Glasgow to open the UK's first safe injecting facility.

The Conservative government has even blocked the appointment of experts known to be supportive of these lifesaving programmes. In July 2019, it emerged that the CEO of the drugs charity Release, Niamh Eastwood, had her appointment to the the Advisory Committee on the Misuse of Drugs blocked by the Home Office. Her crime? Tweeting criticism of the government's rejection of the recommendation for safe injection facilities in 2017.

Earlier this month, a leading UK drug expert, Alex Stevens of the University of Kent, resigned his seat on the the Advisory Committee on the Misuse of Drugs citing "political vetting" of appointments by the Home Office. Stevens said "if suitably qualified experts are excluded from membership on the basis of stated disagreements with government policy, this will erode the quality of advice that the Advisory Committee on the Misuse of Drugs can give."

Human rights crisis

Since the 1970s, and the start of the "war on drugs", punishment, policing and prisons, rather than health, became the core approach of drug policy. Alongside this has been an escalation of human rights violations linked to drug control. Denial of life saving programmes, such as safe injecting facilities, is but one example.

As I highlight in my book, in recent years we have examples of courts stepping in to defend the rights of people who use drugs against the excesses of government drug warriors. And the publication earlier in 2019 of International Guidelines on Human Rights and Drug Policy marks a significant milestone in this slow process of reform.

Following the US court decision, a supporter of Safehouse described it as "a resounding defeat for Donald Trump and his minions' callous efforts to increase the suffering of people and communities struggling with addiction." With the UK experiencing the highest levels of drug-related deaths in history, how much more suffering and death will people who use drugs have to endure before the callous efforts of the UK government come to an end? Indeed, the quick and negative response of the government to the MPs call for health-centred drug reforms seems to suggest the overdose crisis will continue to escalate.



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mr peabody

Moderator: PM
Staff member
Aug 31, 2016
Frostbite Falls, MN

Narcan has been used to stop many from overdosing on opioids.

Carrying Narcan can carry heavy costs

by Christian Wade | Nov 11 2019

Insurance companies reject policies for those who carry anti-OD drug.

BOSTON — Access to the overdose-reversing drug naloxone can be had without a prescription in Massachusetts and a majority of states. A "standing order" allows nurses, drug counselors, family members or friends of people dealing with opioid addiction to carry and administer the life-saving medicine.

The expanded availability of naloxone, widely known by the brand name Narcan, has been credited with saving countless lives in recent years and blunting the deadly impact of a wave of addiction.

But lawmakers are now concerned that some who carry the drug, including physicians, may be rejected for disability, life or other long-term insurance policies.

A new proposal by Sen. Joan Lovely, D-Salem, would prohibit insurers from cancelling or rejecting applicants, or charging them higher premiums, "based solely on a prescription to carry or possess the drug naloxone." Companies that violate the rules could be fined by state regulators for "unfair or deceptive acts" under the proposal.

Lovely, the Senate's assistant majority leader, said she's been made aware of physicians who've lost coverage because they carry naloxone, and she's concerned about a chilling effect on good Samaritans "who are trying to do the right thing."

"This medicine saves lives, and if people are thinking they're going to lose their life or disability insurance simply by filling a prescription for it, that's a serious problem," she said.

Lovely said she wants to prevent insurers from lumping people who carry naloxone to save others in with those suffering from addiction, who carry it because they are at risk of dying from an overdose. The latter, more risky group is far less likely to qualify for life insurance or other coverage.

Lovely said she recently underwent training to administer naloxone after seeing a man overdose in a supermarket. She now carries a Narcan rescue kit.

"Thankfully I haven't had to use it," she said. "But you never know if you'll need it, and we need to make sure more people have access to this medicine."

State agency responds

The issue has caught the attention of the state Division of Insurance, which issued a bulletin in February warning insurers not to deny coverage to applicants solely because they have prescriptions for naloxone or other opioid antagonists. Doing so, the agency said, would "defeat the commonwealth's important public health efforts."

While insurance underwriters are permitted to review applicants' medical histories, including prescriptions, the state agency noted that naloxone, similar to some HIV drugs, "may be intended to prevent, not treat an existing illness or disease" and must be treated differently.

"Carriers need to be aware that Massachusetts law permits the purchase of naloxone rescue kits by friends and family of people who use opioids, and persons without substance use disorder may have prescriptions for or purchase naloxone in order to assist others," Gary Anderson, the state's insurance commissioner, wrote in the advisory.

Last year, the American Council of Life Insurers issued a statement in response to the concerns saying that insurers support the efforts of good Samaritans and policies to make naloxone more accessible. At the same time, the group defended the practice of reviewing prescriptions as part of applications for coverage.

"The clearer the picture life insurers have of applicants’ medical situations, the more accessible and affordable coverage is for all," the statement read. "Indeed, a life insurer would not be doing its job of assessing the risks it assumes on behalf of current and future policyholders if it did not notice and evaluate such a prescription."

Lovely said the current rules aren't enough to prevent insurers from denying coverage to people based on naloxone prescriptions. She wants the protections baked into state law.

Her proposal would require insurers to review information "to determine if an applicant has obtained such a prescription for a reason not relevant to the applicant’s health." Naloxone counteracts the effects of heroin, fentanyl and other opioids.

A state program created by lawmakers several years ago purchases the life-saving medicine in bulk and then sells it to local police and fire departments at a reduced cost. The state has also eased pharmacy regulations to give the public more access to the drug.

Opioid-related deaths in Massachusetts fell about 4% from 2016 to 2018, according to state health officials, who attribute the decline, in part, to public access to naloxone. Still, nearly 2,000 people died from opioid-related overdoses in the state last year, most of them involving fentanyl.

The U.S. Surgeon General's Office has cited studies showing that expanding naloxone access has contributed to declines in opioid-related deaths.

Earlier this year, Sen. Ed Markey wrote to the National Association of Insurance Commissioners and other groups demanding answers from the industry.

"We must be doing all we can to make access to naloxone easier, not harder, for all Americans," wrote Markey, a Malden Democrat. "Knowing that carrying naloxone could result in the denial of an insurance policy application would undoubtedly dissuade individuals from obtaining it to help save the life of a loved one or even a stranger."

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mr peabody

Moderator: PM
Staff member
Aug 31, 2016
Frostbite Falls, MN

Syringe exchange programs have prevented thousands of new HIV cases in Philadelphia, Baltimore

Medical Xpress | Oct 29 2019

Syringe exchange programs established in Philadelphia and Baltimore prevented a total of 12,483 new cases of HIV over a ten-year period, according to a study published today. The averted HIV infections also saved both cities millions of dollars every year, according to the researchers.

"Small investments in syringe exchange programs yield large savings in treatment costs," said Monica S. Ruiz, Ph.D., MPH, an associate professor in the Department of Prevention and Community Health at the George Washington University Milken Institute School of Public Health (Milken Institute SPH) and the principal investigator on the project. "Syringe exchange programs represent a powerful way to stop the spread of HIV, especially in communities struggling to fight the opioid epidemic. "

The new study, published in the Journal of Acquired Immune Deficiency Syndromes, may help policymakers nationwide understand the benefits of providing funding for syringe exchange programs. Such programs distribute sterile injection equipment to injection drug users and thus discourage the practice of sharing needles, which can spread HIV, the virus that causes AIDS.

Ruiz and her colleagues looked at how policy changes allowing for implementation of legal syringe exchange programs in Philadelphia and Baltimore affected the number of new HIV cases over a decade. The researchers used a mathematical modeling technique to estimate how many cases of HIV had been averted after the programs had been set up.

The researchers found that policies to allow syringe exchange programs to operate averted 10,592 new cases of HIV in Philadelphia and 1,891 new cases of HIV in Baltimore over a ten-year period.

Syringe exchange programs help some of the most vulnerable people in urban, suburban and rural communities avoid HIV infection—a risk associated with injection drug use. Both Philadelphia and Baltimore have seen a spike of new HIV cases associated with drugs, including heroin and other opioids.

This study showed that the averted HIV cases also saved each city money because most people who inject drugs are covered by public health insurance. Philadelphia saved an estimated $243 million every year due to the drop in new HIV cases—cases averted by syringe exchange. In Baltimore, the savings amounted to $62 million annually.

Ruiz and her colleagues also factored in the lifetime cost of treating someone with HIV and the expense associated with setting up a syringe exchange program. They found that the one-year return on investment was nearly $183 million for Philadelphia. For Baltimore, that same return on investment was estimated at about $47 million.

Policymakers and public health officials considering a syringe exchange program to reduce the threat posed by the opioid epidemic and HIV should take a hard look at the scientific results in this study and others. A 2015 study by Ruiz showed a syringe exchange program in the District of Columbia prevented 120 new cases of HIV and saved D.C. an estimated $44 million in just a two-year period.

"Giving injection drug users access to clean syringes can not only help them avoid HIV but often helps them obtain other health services, including access to drug treatment programs," Ruiz said. "Such programs offer communities huge public health and societal benefits, including a reduction in new HIV cases and cost savings to publicly funded HIV care."

The study, "Using Interrupted Time Series Analysis to Measure the Impact of Legalized Syringe Exchange on HIV Diagnoses in Baltimore and Philadelphia," was published as part of a supplement to the Journal of Acquired Immune Deficiency Syndromes (JAIDS).

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mr peabody

Moderator: PM
Staff member
Aug 31, 2016
Frostbite Falls, MN

UK parliament committee endorses decriminalizing drugs

by Tom Angell | October 23, 2019

A UK House of Commons panel is calling on the government to decriminalize drugs and adopt other harm reduction approaches to address a growing overdose crisis.

“We recommend a radical change in UK drugs policy from a criminal justice to a health approach. A health focused and harm reduction approach would not only benefit those who are using drugs but reduce harm to and the costs for their wider communities,” reads a report issued on Wednesday by the Health and Social Care Committee. “Decriminalisation of possession for personal use saves money from the criminal justice system that is more effectively invested in prevention and treatment.”

“Every drug death is avoidable. However, the United Kingdom, and in particular Scotland, have amongst the highest drug death rates in Europe. The evidence we have heard leads us to conclude that UK drugs policy is failing.”

The panel said that decriminalization alone “will not be effective without investing in holistic harm reduction, support and treatment services for drug addiction.” To that end, it is also voicing support for syringe exchange programs, drug checking services, naloxone, safe consumption facilities and heroin assisted treatment—components that it says “can all play an important role in preventing deaths amongst drug users as well as protecting their communities by reducing the harm from discarded syringes and drug related crime.”

The committee also wants to move responsibility for drug policy from the Home office, which handles crime, to the Department of Health and Social Care. “We strongly recommend this move,” the report says.

When it comes to the proposal to remove criminal penalties for drug possession, the committee wrote about witnessing the success of that policy in Portugal, where it was enacted in 2001.

“On our visit to Portugal we saw a system marked by a positive attitude to service users which recognised the impact that chaotic lifestyles could have on engagement with support and treatment,” the report says. “There was a striking ethos of holistic, non-judgemental treatment and access to services focused on the needs of individuals rather than the convenience of the system.”

The lawmakers said that UK-based treatment professions share “a similar ethos, but their capacity to deliver is compromised by inadequate funding and the policy framework.”

The Portuguese model, they write, has “had an impact on stigma” and has led to a “dramatic drop in drug related deaths…without significant increases in drug use.”

“All those we met in Portugal involved in this policy area were very positive about their model,”
the lawmakers said. “On introduction, there had been significant opposition, but there is now political consensus and nobody would want to go back. Some of those we met were now of the view that the next step should be legalisation and regulation, to enable the generation of taxation revenue and quality control.”

“Efforts to improve the unacceptably high rates of drug-related deaths would be strengthened by explicitly reframing drug use as a health rather than a criminal justice issue.”

The panel’s report also recounts how members toured supervised drug consumption facilities in Germany, and recommends that they be “piloted in areas of high need” in the UK.

“Police representatives told us that these facilities should not be viewed simply as allowing people to take illicit drugs–they are about safety, stopping drug overdoses, and very importantly, providing access to a wraparound of other services to eventually stop that person’s drug use,” they wrote. “Harm reduction approaches such as [drug consumption rooms] reduce the wider harms to local communities as well as for those using drugs.”

A government spokesperson rejected the committee’s recommendation to remove criminal penalties for low-level drug offenses, saying that it “would not eliminate the crime committed by the illicit trade, nor would it address the harms associated with drug dependence and the misery that this can cause to families and communities.”

But Dr. Sarah Wollaston MP, chair of the Health and Social Care Committee, said that “a holistic approach centered on improving the health of and reducing the harm faced by drug users, as well as increasing the treatment available, must be a priority going forward.”

“This approach would not only benefit those who are dependent on drugs but benefit their wider communities,”
she said in a press release. “The Government should learn lessons from the international experience, including places like Portugal and Frankfurt. It should consult on the decriminalisation of drug possession for personal use from a criminal offence to a civil matter. Decriminalisation alone would not be sufficient. There needs to be a radical upgrade in treatment and holistic care for those who are dependent on drugs and this should begin without delay.”

James Nichols, CEO of the pro-reform Transform Drug Policy Foundation, praised the report but also suggested its recommendations didn’t go far enough in that they would leave the market unregulated by simply decriminalizing possession.

“We need to think about drugs as a health issue, not a criminal justice agenda. This isn’t simply a matter of thinking differently. It’s about creating an entirely new policy landscape. It means action, not just words,” he wrote in a blog post. “Decriminalisation is essential in moving drug policy away from the simplistic, ineffective and often prejudicial approach we have today. Ultimately, though, we need to bring the whole market under legal regulation in order to really get drugs under control and reduce the violence and exploitation that prohibition creates.”

The UK committee’s endorsement of decriminalization is just the latest sign that broad drug policy reforms beyond marijuana legalization are gaining traction around the globe.

This month, Scotland’s ruling party unanimously adopted a resolution endorsing “decriminalization of possession and consumption of controlled drugs so that health services are not prevented from giving treatment to those that need it.”

In Canada, the House of Commons Standing Committee on Health issued a report in June recommending the government “work with provinces, territories, municipalities and Indigenous communities and law enforcement agencies to decriminalize the simple possession of small quantities of illicit substances.”

In the U.S., presidential candidates such as Pete Buttigieg and Tulsi Gabbard have voiced support for drug decriminalization during the course of their campaigns for the Democratic nomination, and businessman Andrew Yang and former Rep. Beto O’Rourke (D-TX) spoke in favor of removing criminal penalties for at least opioids during a debate this month.

Denver and Oakland have enacted policies this year focused on psychedelics decriminalization.

A poll released this month found that a majority of Americans—55 percent—support decriminalizing drugs.

Last week, a top Mexican lawmaker proposed going further by legalizing the production and sales of drugs in order to undercut the violent, cartel-controlled underground market.


Another UK parliament committee is calling for drug decriminalization

by Kyle Jaeger | Nov 5 2019

Another UK House of Commons panel is endorsing the decriminalization of drug possession for personal use, in addition to supporting the establishment of safe consumption sites to prevent overdose deaths.

The Scottish Affairs Committee said on Monday that after consulting with health professionals, government bodies and academics—as well as touring countries such as Portugal that have pursued far-reaching drug policy reforms—panel members determined that the UK government should address drug use as a public health, rather than criminal justice, issue.

A report the committee released recommends decriminalizing low-level drug possession, providing for safe injection sites and pursuing “evidence-based policymaking” as a means to curtailing overdose deaths and helping people suffering from addition to get into treatment.

“Throughout our inquiry we heard tragic accounts of the pain and suffering that problem drug use is causing in Scotland,” MP Pete Wishart, chair of the panel, said in a press release. “If this number of people were being killed by any other illness, the Government would declare it as a public health issue and act accordingly.”

“The evidence is clear—the criminal justice approach does not work,”
he said. “Decriminalisation is a pragmatic solution to problem drug use; reducing stigma around drug use and addiction, and encouraging people to seek treatment.”

This is the second House of Commons committee to embrace decriminalization in as many weeks. A separate panel, the Health and Social Care Committee, said last month that drugs should not be a criminal justice matter and voiced support for decriminalization, safe consumption sites and expanded access to the anti-overdose medication naloxone.

The Scottish Affairs Committee cited that policy stance in its report, stating that it “reflects the weight of evidence in support of this approach.”

On safe injection sites, the panel said the facilities “are proven to reduce the number of drug-related deaths, and can act as a gateway to further treatment which can address the root causes of substance use” and that they “could play a vital role in addressing Scotland’s drug crisis.”

“For too long successive UK Governments have ignored the evidence on how drug policy could be improved,”
Wishart said. “The Government must now start listening to the expert advice they are given, starting with our Committee’s Report, to reduce problematic drug use in Scotland and prevent the tragic loss of life.”

Decriminalization is gaining mainstream appeal internationally. Scotland’s ruling party, which is the third largest in the UK Parliament, also came out in support of the policy change last month.

And in Canada, the House of Commons Standing Committee on Health released a report this summer urging the government to “work with provinces, territories, municipalities and Indigenous communities and law enforcement agencies to decriminalize the simple possession of small quantities of illicit substances.”

A number of Democratic presidential candidates in the U.S. are backing decriminalization as well, with South Bend, Indiana Mayor Pete Buttigieg and Rep. Tulsi Gabbard (D-HI) stating that they’re in favor of removing criminal penalties for possession of all illicit drugs. Businessman Andrew Yang and former Rep. Beto O’Rourke (D-TX) discussed decriminalizing opioids during a debate in October.

Psychedelics decriminalization is also picking up steam stateside, with Denver and Oakland becoming the first cities in the U.S. to make possession and cultivation of the substances the lowest law enforcement priority. The movement is spreading throughout the country, with advocates increasingly pursuing decriminalization throughout the country.

While Congress might be slow to act on the policy reform, a poll released last month showed that a majority of Americans—55 percent—support decriminalizing drugs.

Going beyond decriminalization of possession, a top Mexican lawmaker proposed legalizing the production and sale of drugs to mitigate cartel-related violence.

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Naloxone to be handed out on the streets in England

by Jamie Grierson | The Guardian | 3 Nov 2019

A life-saving drug that reverses the effect of an overdose of an opioid, such as heroin, is to be handed out on the street to people in England under a pilot scheme to tackle the record numbers of drug-related deaths.

The main life-threatening effect of an opioid overdose is to slow down or stop breathing – the drug naloxone blocks this effect and reverses breathing difficulties.

The majority of people who access naloxone do so through drug treatment or harm reduction services but studies show people outside of structured drug treatment are most likely to die of a drug-related cause.

Addaction, the drug and alcohol charity which provides drug treatment services, is to launch a pilot on Monday in Redcar and Cleveland, in the north-east of England, to hand out naloxone to users of opioids on the streets.

In August, the Office for National Statistics (ONS) reported that 4,359 deaths from drug poisoning were recorded in England and Wales in 2018, the highest figure since records began in 1993, and the steepest one-year increase. More than half of the deaths, or 2,208, involved an opiate such as heroin. Around two-thirds of the deaths reported, or 2,917, were from drug misuse.

Gary Besterfield, service manager of Addaction Redcar and Cleveland, said: “Every drug related death is a tragedy and every death is avoidable. Too many families in Redcar and Cleveland have lost loved ones. It’s time to take action."

“The opportunity to carry and use naloxone shouldn’t be restricted to people who are engaging in drug treatment. This is about being proactive, engaging people where they feel comfortable and saving lives.”

Under the pilot, a team of peers – people with lived experience of drug issues – will take naloxone out on the streets, approaching people who use opioids. The team will give out the drug and train people in how to use it.

The pilot will run for 12 weeks and is supported by Cleveland police. Addaction plans to roll out the scheme in all its services across the UK – the first national treatment charity to do so.

George Charlton, an independent trainer and consultant, who has teamed up with Addaction to launch the project, said: “Peer-to-peer naloxone is about more than not restricting naloxone to bricks and mortar. It’s about empowering people with a history of drug abuse to help their friends and show they have a positive role to play in society. When we use naloxone people get to see their kids grow up, they get to take care of the people they love. The only thing it enables is breathing.”

The official figures on drug-related deaths revealed that the north-east registered the highest number, with 96.3 deaths per million people, compared with 39.4 in London, where the rate was lowest. The figures for Wales, the north-west and Yorkshire and the Humber were also high.

Drug treatment experts, including the Royal College of Psychiatrists, reacted angrily to the data, accusing the government of putting people’s lives at risk by cutting the funding of vital treatments services.

Studies have shown that councils have responded to central government cuts by slashing spending on drug treatment services by about 27% since 2015–16, and by more than 50% in some areas.

Scotland is grappling with a similar crisis with the drug-related death toll increasing by 27% over the past year to reach a record high of 1,187, according to data released in July, putting the country on a par with the US in per capita terms.

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Lake Geneva, Switzerland

Switzerland couldn’t stop drug users. So it started supporting them.

by Taylor Knopf | Vancouver Courier | Jan 21 2019

The Swiss people took drastic measures to reduce the number of people dying from opioid overdose. Their approach is effective - and unorthodox. This is the first in a series of articles describing how Europeans have tackled their overdose issues.

ZURICH and GENEVA, Switzerland — Today, Platzspitz Park serves as a peaceful respite for those meandering along the Limmat River and past the Swiss National Museum. But it’s best known by the nickname “Needle Park.”

That’s because in the 1980s the park was hijacked by thousands of heroin users and dealers. The space, despite being in the heart of downtown Zurich, became one of the most famous examples of Switzerland’s “open drug” scenes.

Local police were tired of trying to control and disperse large groups of users, so Needle Park became one of the spots law enforcement left alone.

Rates of HIV infection soared from the sharing of needles. And the number of drug overdose deaths climbed.

People were injecting and dying outside one of the most beautiful hotels in Zurich. The same thing happened near political buildings in Bern, the nation’s capital, said Rita Annoni Manghi, director of the opioid substitution and heroin-assisted treatment programs at Hôpitaux Universitaires Genève.

Platzspitz Park, nicknamed “Needle Park,” sits next to a river by the National Swiss Museum in downtown Zurich.
It’s a clean, peaceful space now, but in the 1980s was filled with heroin users and dealers.

"It was the equivalent of people dying on the White House lawn,"
she said.

“So you are obliged to see the problem,” she said. “And Switzerland is not so modern, but it’s very pragmatic. And Swiss politics is very pragmatic.”

The rise in HIV infections, drug overdose deaths and the public nature of the drug problem led the Swiss to make major changes in how they approached illegal drugs and treated people who use drugs.

And in 1994, Switzerland went on to pass one of the most progressive and controversial drug policies in the world, which included the dispensing of heroin.

“Switzerland is no one’s idea of a leftist country,” Joanne Csete wrote in her paper “From the Mountaintops: What the World Can Learn from Drug Policy Change in Switzerland.”

“Its famous tradition of protecting bank secrets, its having granted women the right to vote only in the 1970s, and its referendum-based rejections of minarets on mosques and decriminalization of cannabis illustrate its quirky conservatism,”
Csete wrote.

But the Swiss are pragmatic. Instead of endlessly fighting drugs, they took a new approach and began supporting drug users through new treatment options.

The majority of Swiss citizens supported the measures, despite some pushback inside and outside the country.

The nation cut its drug overdose deaths significantly. HIV and Hepatitis C infection rates dropped. And crime rates also dropped.

The Four Pillars

To address the Swiss drug problem, elected officials, community members, law enforcement and medical experts all worked together to create the “four pillars” drug policy.

Those four pillars of the Swiss law are harm reduction, treatment, prevention and repression (or law enforcement).

“The goal was not to fight drugs anymore. It’s completely ridiculous to fight drugs,” said Jean-Félix Savary, secretary general of the Romand Group of Addiction Studies in Geneva. “We came to this conclusion and decided to change.”

Rita Annoni Manghi, medical director of the opioid substitution and heroin-assisted treatment programs
at Hôpitaux Universitaires Genève (left) sits a heroin injection spot inside the facility with Christel Ding
(right), a nurse who supervises the program.

“It was a big revolution. We don’t try to ask people not to take drugs, but take care of problems generated by the situations around people being addicted to drugs. The policies became as much about public order as public health,"
Savary said.

There was some resistance among some Swiss civil groups. Their push ultimately forced a national referendum in 1997 challenging the four pillars policy. But 70 percent of Swiss citizens voted in favor of the law. The four pillars have withstood other challenges as well, as the majority of Swiss voters continue to support it.

The multi-pronged approach included some controversial measures — such as legalized drug consumption rooms and heroin-assisted treatment facilities — but ultimately, the statistics show it has been successful.

Over the past two decades, the number of opioid-related deaths in Switzerland has decreased by 64 percent.

The number of new HIV infections also dropped significantly. In 1986, more than 3,000 people tested positive for HIV in Switzerland. In 2017, there were fewer than 500 new positive tests in a country of 8.4 million.

Switzerland began mandatory Hepatitis C reporting in 1988. The number of reported cases peaked between 1999 and 2002, declining since then.

Harm reduction

Harm reduction strategies aim to lessen the damage caused to a person by their use of drugs. Needles exchange programs fall under this category, as do legalized drug consumption rooms.

Offering drug users clean needles and other supplies reduces their use of dirty needles, therefore reducing the spread of HIV and Hepatitis C infections.

Drug consumption rooms go one step further by providing users with a safe place to use under medical supervision, which reduces the chance of an overdose.

Swiss drug experts said the public also benefits: passersby no longer see people injecting in the streets or come in contact with many used syringes.

Harm reduction staff workers make a point not to judge people who come through their doors. And many build relationships with frequent visitors. Resources are available to drug users at these facilities as well to connect them to anything they might need, from a place to sleep, eat, do laundry, or find addiction treatment.

The Swiss are also very deliberate when it comes to placing their drug consumption rooms.

For example, in Geneva, a lot of people gathered and injected near the main train station. So now, around the corner, a drug consumption room is housed in a modern green building that stands out among the backdrop of the traditional Swiss architecture.

The drug consumption room in Geneva is around the corner from the train station and was placed there
because so many users gathered together and injected heroin. Now they use inside, with clean supplies
and medical staff.

Lowering barriers to treatment

“The goal in this field is to get as many users as possible into treatment,” said Thilo Beck, addiction psychiatrist and medical director of the heroin-assisted treatment program in Zurich.

He said that 75 percent of active users in Switzerland are in treatment on a given day, and about 95 percent have been in treatment at some point.

This is medication-assisted treatment, using methadone or buprenorphine. It also includes slow-release morphine or heroin, which aren’t used to treat people with substance use disorder in the United States.

“Treatment is available and accessible,” Beck said. “I think that’s how it should be in every country.”

There are circumstances in Switzerland that make treatment so accessible. First, the country has universal health care, so everyone has health insurance.

The four pillars law also expanded opioid substitution therapy (or medication-assisted treatment) and lowered the threshold for entry. "Someone can walk into a clinic for the first time and start treatment 20 minutes later," Beck said.

"Before the 1990s, this type of treatment was viewed as the first step toward abstinence. People were supposed to stay on the treatment for six months to stabilize them, then taper off and stop," Beck said.

“But this was not happening. Some people might do that, but the majority will not,” he said. “What we learned is you have to be pragmatic and take the problems as they are and think of the most feasible solution. “It doesn’t help to think of goals that are not achievable.”

People in drug treatment programs no longer need to visit a treatment center every day to receive methadone, buprenorphine or morphine. Stable patients receive take-home doses. Physicians can also write prescriptions for these same treatments. And there’s no expectation of abstinence from street drugs and no mandatory drug-screening tests.

“By offering opioid substitution therapy almost unconditionally to virtually anyone willing to change their consumption from heroin to another product, the health care system became a viable competitor among those supplying people addicted to opioids in Switzerland,” wrote Christian Schneider, a drug analyst who works at the Swiss Federal Office of Police.

Switzerland’s low-threshold opioid substitution program allows stable patients to receive take-home doses
of methadone, buprenorphine or morphine. Here, a worker at a substitution program in Geneva prepares a
week of doses for a patient.

The treatments are safer than street drugs because the consumer knows exactly what’s in it. Switzerland doesn’t have the same fentanyl problem as the United States, but there are other unwanted substances in their street drugs. Drug check sites help with this problem. These are places a user can take their drug to be checked, and it’s given back to them with a list of what is inside it.

And because a person in treatment is spending less time and money finding and buying drugs, they can focus on other things in their life, such as housing, work or family.

“Prescribed in a way tailored to fit the needs of consumers, opioid substitution therapy not only offered a much safer and much cheaper substitute but also ensured availability and access to products in a way that street dealers could never match,” Schneider concluded.

Law enforcement

The role of law enforcement changed under the four pillars approach. As more and more users went into treatment, the demand for opioids on the black market fell, as did the purity of the products.

The purity of heroin taken by Swiss police over the last decade or so is poor, averaging between 15 and 20 percent purity. The purity and price were much higher before the four pillars law.

The police are focusing less on the users and more on big time dealers.

“You have to help the consumer and fight the criminal,” Manghi said. “And the consumer may deal a little, but they are not organized enough to do high-level crime.”

Savary, a Swiss drug and harm reduction expert, explained that getting law enforcement support was essential to gaining public support for the four pillars law. From what Savary has seen, one supportive police officer has more influence than 100 medical experts.

The Swiss are prosecuting fewer opioid-related crimes. In 1993, the country had about 20,000 cases a year. Today, the Swiss average about 5,000 opioid-related cases annually.

"Prior to the four pillars law, house break-ins were common in Switzerland," Savary said. After the law was adopted, there was a huge drop in burglaries.

“We reduced theft by 98 percent. We never had a security figure like this,” he said, referring to crime statistics. “With health measures, you can have a very big security impact… You can do both. It’s cheap and effective. It sounds like a miracle, but you can do it.”

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The pilot project began in July with eight patients. who each get a fentanyl patch
applied to the skin, then changed every two days by a nurse.

Vancouver pilots new fentanyl-patch program to combat opioid crisis

by Andrea Woo | The Globe and Mail | Nov 12 2019

A Vancouver physician is prescribing fentanyl to patients with opioid-use disorder in the latest effort by the medical community to curb overdose deaths caused by a toxic supply of illicit drugs.

The pilot project began in July with eight patients who sought treatment for illicit-drug use but have not benefited from existing oral or injectable substitution therapies such as methadone, buprenorphine (Suboxone) or hydromorphone.

Each patient gets a fentanyl patch – commonly used to treat chronic pain for conditions such as cancer – that is applied to the skin and changed every two days by a nurse. To address misuse, the patches are signed and dated, and a transparent film is applied to prevent tampering. It is believed to be the first formal program of its kind.

The British Columbia Centre on Substance Use (BCCSU) said the program is still being evaluated. However, no adverse effects have been reported to date, and some improvement has been noted, according to a commentary on the pilot published on Monday in the journal Substance Abuse Treatment, Prevention and Policy.

“Some people are feeling great,” said BCCSU education physician lead Christy Sutherland, who runs the program. "They report that they’re using [illicit drugs] less, that they’re feeling hopeful about this new treatment option, but it’s still quite early.”

llicit fentanyl use in B.C. was once largely limited to smoking patches diverted from hospitals or pharmacies, or unknowingly ingesting it with other opioids such as heroin or oxycodone. But the drug came to replace most illicit opioids in B.C.

At the Harm Reduction International Conference in Portugal this spring, Jane Buxton, epidemiologist and harm-reduction lead at the BC Centre for Disease Control, noted that intentional fentanyl use in B.C. tripled over 3.5 years.

Illicit fentanyl is much stronger than heroin, meaning conventional treatments might be inadequate. A separate 2018 study in Vancouver found illicit fentanyl in 52 per cent of participants on substitution therapy, demonstrating the limitations of existing options.

Geoff Bardwell, a postdoctoral research fellow with the BCCSU and the faculty of medicine at the University of B.C., who co-authored the commentary, said illicit fentanyl has necessitated new strategies to attract and retain high-risk individuals in treatment.

“All of the research around methadone and Suboxone, about their efficacy, have only been done in the era before fentanyl,” Dr. Bardwell said. “We know that these treatment options aren’t working for everyone, so we need to turn to the medical community to come up with new models.”

Substitution therapy – also called opioid-agonist treatment – involves providing patients with medication to prevent withdrawal symptoms and reduce cravings. It can reduce the risk of harm associated with illicit-opioid use – such as involvement in crime, sex work, unsafe drug consumption and blood-borne illnesses – and can help people live more stable lives.

B.C. declared a public-health emergency due to overdoses in April, 2016. In the three years since, according to the centre for disease control, the number of people on methadone in B.C. increased by almost 10 per cent, or 1,342 people; buprenorphine (Suboxone), by almost 142 per cent, or 3,417 people.

Newer treatments include slow-release oral morphine, which 1,581 people are now on; injectable hydromorphone (108 people); and injectable, pharmaceutical-grade heroin (122 people).

The BCCSU’s guidelines for the clinical management of opioid-use disorder note that such treatments have been shown to be superior to simply stopping “cold turkey” in terms of retention in treatment, sustained abstinence from illicit-opioid use and reduced risk of disease and death.

But rather than call for the substitution therapy with fentanyl to be scaled up, Dr. Sutherland is urging government to regulate a legal and safer supply of drugs so physicians are not left to manage problems related to drug prohibition.

“The government has to decriminalize and create a legal, regulated market for drugs in Canada because [while] it’s nice to give medicine to people and to do primary care and come up with these solutions, they’re never going to address the root issue, because the root issue is caused by criminal justice,” she said.

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At-home naloxone kits have reversed over 50K opioid overdoses in B.C.*

by Sean Boynton | Global News | Nov 8 2019

The B.C. Centre for Disease Control says 50,000 overdose deaths have been prevented thanks to naloxone kits handed out to residents, businesses and public places.

As of Oct. 15, more than 50,000 take-home naloxone kits have reportedly been used to save a life from a fatal opioid overdose throughout B.C., according to the Provincial Health Services Authority (PHSA).

Those kits are among 175,022 distributed for free by the BC Centre for Disease Control (BCCDC) to drug users and people in the community likely to witness an overdose since 2012.

”Every free naloxone kit distributed in B.C. is a statement that we are committed as neighbours, as a community, as a province, to saving lives,” Judy Darcy, Minister of Mental Health and Addictions, said in a statement Friday.

“We know that people need to be alive to find their own unique pathway to healing and hope and this announcement tells people using drugs loud and clear that we want them to live.”

The BCCDC’s Take Home Naloxone program has seen a dramatic spike in kit handouts since 2016, when B.C. declared a public health emergency in response to a rise in drug overdoses.

According to the BC Coroners Service, 993 people died of illicit drug overdoses in 2016. In 2017, that number jumped by nearly 50 per cent to 1,487. In 2018, overdoses claimed 1,489 lives in B.C.

Since 2016, the BCCDC program handed out 169,949 naloxone kits. Only 5,073 were distributed between 2012 and the end of 2015.

The kits are available at 1,678 active distribution sites, including more than 700 community pharmacies across the province. The BCCDC says it ships between 17,000 and 19,000 kits to those sites every month.

A full list of where naloxone kits are distributed can be found here.

“I’m proud of our partners and community members for their dedication and working quickly and creatively to get this life-saving medication into the hands of people who need it,” said Dr. Jane Buxton, the BCCDC’s harm reduction lead.

The latest overdose numbers from the BC Coroners Service found 79 suspected illicit drug toxicity deaths in August 2019. That’s a 37 per cent decrease from the 125 deaths in August of 2018, but a 13 per cent increase from the 70 deaths in July of 2019.

The August numbers average out to 2.5 deaths a day, down from the roughly three deaths per day the province has seen for a majority of 2019.

For the first eight months of 2019, there were 690 deaths — a 33 per cent decrease from 1,037 deaths in the first eight months of 2018.

Buxton also called for a safe drug supply to further curb overdoses, a suggestion that has been gaining momentum in B.C.

Vancouver Mayor Kennedy Stewart, Vancouver Coastal Health’s chief medical health officer Dr. Patricia Daly and Provincial Health Officer Dr. Bonnie Henry have all called for a safe drug supply.

Prime Minister Justin Trudeau has said his government will not consider that step.

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Pioneering Glasgow clinic offers addicts pharmaceutical grade heroin

by Libby Brooks | The Guardian | 26 Nov 2019

Safe, supervised injecting room will help combat drug deaths and HIV infection.

Homeless addicts in Glasgow will be provided with pharmaceutical grade heroin to inject themselves with, in a pioneering scheme intended to combat soaring drug deaths and HIV infection rates across the city.

But medical staff expressed their frustration, as they launched the purpose-built enhanced drug treatment facility on Tuesday, that calls for a safe drug consumption room, which they believe could help hundreds more vulnerable addicts, had been blocked by the Home Office.

Glasgow’s Health and Social Care Partnership’s £1.2m facility is based in the city centre, alongside existing homelessness health services. The pilot project is licensed by the Home Office and the first of its kind in Scotland, but the second in the UK after a similar initiative began in Middlesbrough in October. Individuals referred to it will be given a prescription of diamorphine tailored to their requirements, which they must inject on the premises and under strict supervision.

Patients will take their pre-filled syringe from the dispensary counter to a small booth, furnished with a stainless steel counter, a padded chair and a sharps disposal box, which is screened for privacy but has a mirrored back wall to allow nurses to view their progress.

They will spend around 20 minutes in the booth, and then a further 20 minutes in a nearby seating area where they will be monitored in case of overdose. The facility will hold two injecting sessions each day, morning and afternoon, as well providing oral methadone for night-time use.

While the focus of Tuesday’s launch was inevitably on the radical provision of heroin by NHS Scotland, the facility’s specialist staff were keen to emphasise the intensive nature of the scheme. The frequency of visits – twice daily, seven days a week - means that ongoing relationships are forged with nurses who can then introduce patients to on-site support, including mental and physical health checks and treatment, in particular for those diagnosed with HIV, welfare rights and housing advice. This holistic approach aims to stabilise and reduce drug use.

The facility includes the newest equipment, such as a portable vein finder to reduce wound sites and vascular damage that is common with chronic injecting. Staff also hope that safer behaviour – such a using clean needles and correct injecting technique – will filter out on to the street where Greater Glasgow and Clyde health board saw the highest number of deaths in Scotland last year, at 394.

Dr Saket Priyadarshi, associate medical director and senior medical officer, Glasgow Alcohol and Drug Recovery Services described the facility as “much-needed”.

Findings from international trials suggest that the supervised use of medicinal heroin can be an effective alternative treatment for the small minority of entrenched opioid users who fail to respond to mainstream substitution therapy using methadone or buprenorphine.

“It is only appropriate that, as in other branches of medicine, we can offer addictions patients the next line in treatment,” Priyadarshi said.

But he expressed his “frustration” that plans for a drug consumption room, where addicts can use their own drugs in safer conditions, had stalled, despite support from both Glasgow city council and the Scottish government. Such a facility would require the UK government to either amend the Misuse of Drugs Act or delegate further powers to Holyrood.

“We have new cases of HIV every year and our drug-related death rate is rising too, and the people who are experiencing the most significant harms are those who would benefit from a drug consumption room,” Priyadarshi said.

While the new facility plans to accommodate up to 20 patients by the end of the first year, Priyadarshi argued that a drug consumption room – which specialists describe as “an enhanced needle exchange” – could help many more.

“We have a vulnerable injecting population of 500 to 600 in the city and a drug consumption room is very confident of engaging a high percentage of them. There is a strong evidence base and cross-party consensus now.”

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mr peabody

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Overdose crisis death toll would be more than double without harm reduction, study says

by Rafferty Baker | CBC News | Jun 05, 2019

The overdose crisis has killed an astonishing number of people across Canada, and British Columbia has been hit especially hard. A new study published Wednesday in the journal, Addiction, found that without harm reduction efforts, the death toll would have been more than twice as horrific.

Researchers looked at nearly two years of data, beginning when the public health emergency was declared in B.C. in April 2016 and ending in December 2017.

According to the study led by the B.C. Centre for Disease Control (BCCDC), there were 2,177 people killed by overdose in the province in that time.

But more than 3,000 deaths were prevented.

"It was one of these things that — you almost had to go back and check the numbers to make sure they were correct — that they actually were that high," said Mike Irvine, a post-doctoral fellow at BCCDC who works with the Ministry of Mental Health and Addictions and the Mathematics Institute at the University of British Columbia.

Irvine said the impact of widely distributed take-home naloxone kits was the most significant, in terms of lives saved.

"In 2017, there were 60,000 kits that had been distributed, so this is paying tribute, really, to how much that program had ramped up and rolled out across the whole province," he said.

In contrast, from 2012 to 2015, about 5,000 naloxone kits were distributed.

'Safe supply' program will distribute free opioids to entrenched users

In the period from April 2016 to December 2017, the study found there were:

- 1,580 deaths averted due to access to take-home naloxone kits.

- 230 deaths averted by overdose prevention and supervised injection sites (with 23 sites operating by the end of 2017).

- 590 deaths prevented by opioid agonist treatment or opioid replacement treatment (with 22,191 people receiving treatment in 2017, including methadone, Suboxone and hydromorphone)

According to Irvine, the three health interventions combined resulted in more overdose deaths prevented than they would have if each were carried out alone.

He said the team's research found that as the prevalence of fentanyl analogues like carfentanil began to increase in late 2016 and 2017, so too did harm reduction services.

"We know that this [crisis] is being driven by a toxic, highly variable street drug supply," said Irvine. "There's a huge number of deaths that were averted, in part because of the sheer volume and the scope of these services, but also the fact that the street drugs had become so toxic within that period."

Irvine said the study's findings are a reminder that health officials' response to the overdose crisis in the province is effective, but also that the deadly crisis is still a major challenge.

"Deaths are still very, very high, and there is so much more to be done," he said.

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Parents of teens, here's what you really need to know about MDMA

by Jarryd Bartle, Nicole Lee and Paula Ross | The Conversation | Dec 3 2019

We all want to reduce drug-related harm and ensure young people don't take unnecessary risks. But decades of research shows fear isn't an effective way to do this.

This week, Newscorp Australia released The Ripple Effect, a series of articles and accompanying videos about party drugs, aimed at parents of young people.

Rather than drawing on the science about reducing harm, the series overstates the nation's drug problem and the likelihood of problems from taking MDMA (ecstasy). And it's likely to scare the wits out of parents of teens.

So, what do parents really need to know about party drugs?

Most young people don't use drugs

Illicit drug use among teens is low and has been in decline for nearly a decade.

Although Australians overall have a relatively high rate of MDMA use compared to similar countries, only a small proportion of teenagers and young adults have used MDMA in the last year. Among high school students, the overwhelming majority have never tried MDMA.

Normalising the idea that drug use isn't that common is a key prevention strategy in drug education. If young people think "everyone" is using drugs, they are more likely to want to do it too.

Scare tactics don't work

As the Ripple Effect notes, NSW Health decided to drop a "shock campaign" on MDMA. The evidence shows scare tactics don't help reduce young people's drug use.

Fatal overdoses are relatively rare. Most people who use party drugs have no adverse consequences. So when young people see messages suggesting all drug use is dangerous, they know it's not true and may switch off, ignoring effective harm reduction messages.

Describing drugs as "deadly" or "dangerous" can actually make them more appealing, encouraging some people to seek out more of the potent product.

A far more effective approach is to normalize not using alcohol or other drugs.

Two examples of effective approaches were the Above The Influence and Be Under Your Own Influence media campaigns by the US Office of National Drug Control Policy. These campaigns promoted not using drugs as a way to support the goals of autonomy and achievement.

Prohibition doesn't work either

The idea we can eliminate drugs from society by telling young people to "just say no" is, at best, misguided. Campaigns with a prohibition approach are not effective.

These interventions fail for many reasons. They don't teach teens the interpersonal skills needed to refuse drugs; they don't address internal motivation to experiment or take risks; and they don't take into account the "forbidden fruit" effect in which restricted or banned activities become more desirable.

Young people who use drugs say the threat of police and drug dogs does not deter them from taking drugs. The NSW Coroner recently noted that some police practices at festivals, such as strip searches and sniffer dogs, can result in young people making more dangerous decisions about drug use, such as taking multiple doses at once.

Harm reduction is effective

The reality is that a small percentage of people will experiment with drugs and some will continue to use them. Harm reduction accepts that reality and seeks to keep those who choose to use drugs as safe as possible. Most people who use drugs do so only occasionally and for a short time in their lives.

While all drug use carries risks, most drug-related problems, including fatal overdoses, are preventable. This is because drug-related harms are heavily dependent on a range of factors such as temperature, knowledge of what you are taking, and how you take a drug.

How events such as music festivals are regulated impacts the kinds of harms that arise. Freely available water, medical staff who understand drug use, peer support and education can greatly reduce risks.

We recently conducted a review of drug-checking facilities internationally and found compelling evidence these services can reduce risky behavior and reduce the chance of finding adulterants in illicit drugs. Many MDMA related deaths can be traced to people not knowing the contents or dosage of the pill they have taken.

Data from a dance festival pill testing initiative in Portugal found 74% of participants would not use the tested drug after receiving unanticipated results; they said they were concerned about the "unknown" nature of the adulterants or potential harms of known adulterants.

In countries where pill testing is well-established, tested samples more closely match what people think they are buying, compared to countries not using these services.

Talk early, openly and often to young people about drugs

Remember, few young people use recreational drugs. And if they do, their drug use is most likely to be occasional. More than half the people who use MDMA use only once or twice a year.

Preventing drug use and reducing harms can start at an early age, even before school. Early and age-appropriate education about medicines, tobacco, alcohol and illicit drugs means a young person already has well-formed attitudes before the influence of their peers kicks in.

Children are strongly influenced by their parents' attitudes when it comes to alcohol and other drug use. For example, exposure to parents' drinking or drug use can increase risk of teens drinking and using drugs; an inattentive approach to monitoring children's activities is associated with teen alcohol and other drug use; and openness to discussing drugs is associated with lower rates of substance use.

Young people with parents who keep an open and honest dialog about drugs are more likely to discuss difficult issues with them.

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Congressman calls on airlines to carry NARCAN*

by Tim Barber | WJLA | Dec 5 2019

Ahead of the busy holiday travel season, one U.S. congressman is pushing for the life-saving drug to be carried on airplanes.

Last summer some airlines agreed to carry naloxone after a Delta passenger died from an opioid overdose.

Nearly 5 million Americans are expected to fly this holiday season.

Rep. David Trone (D-Maryland) wants all of them to have access to naloxone, which can reverse the effects of an opioid overdose.

“Top, top travel time of the season and a lot of them don’t travel that often and sometimes they are anxious, they are nervous and sometime drug use can clearly spike,” said Trone.

For Representative Trone the issue is personal, his nephew Ian was just 24-years-old.

“He died two and a half years ago right around this time of the year of a fentanyl overdose,” says Trone.

After a passenger overdosed on a delta flight last summer, some airlines agreed to put naloxone on their planes.

Spirit, Allegiant, Southwest and Jet Blue did not.

So, the congressman just sent them a letter urging them to reconsider.

“I don’t think the word has gotten up to the top of the chain,” Trone said.

Southwest Airlines provided ABC7 the following statement:

"Thank you for reaching out to us. Southwest puts no priority higher than the safety of our Customers and Employees, and we operate with comprehensive medical kits that meet all of the current regulations. We follow guidance outlined in Appendix A of the Federal Aviation Administration 14 CFR Part 121 to determine which medical supplies travel onboard our aircraft, and NARCAN (naloxone) is not currently on the list of required provisions."

Allegiant Air provided ABC7 the following statement:

"While we don’t carry Naloxone on our flights at this time, we are closely following the FAA’s process as it considers adding it to commercial airline medical kits. The safety and security of our passengers is our highest priority. Our in-flight medical kits contain the most common items needed during a flight. That includes antihistamines, acetaminophen, injectable epinephrine, nitroglycerin tablets and atropine, among other medications. Our crews are trained to use the medical kits only under the direct order of MedLink, our in-flight medical consultant. Allegiant flies short nonstop routes of four hours or less in the contiguous U.S., so in the unlikely event of a severe inflight medical emergency, we would be able to land quickly to ensure proper treatment is administered by medical professionals."

The Federal Aviation Administration told ABC7:

"Each airline has its own protocol for dealing with medical emergencies, including a possible drug overdose. At this time, Narcan is not one of the mandatory drugs included in the Emergency Medical Kit each airline must carry, but many airlines have customized their kits with additional medications, and some may contain Narcan."

The FAA says it does not track the number of in-flight overdoses.

*From the article here:

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mr peabody

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From zero tolerance to open dialogue: How harm reduction is shifting the conversation on drug use

by Jonathan Ore | CBC Radio | Dec 06 2019

Enid Grant got the kind of phone call many parents dread. Her teenage son was "freaking out" after trying psychedelic mushrooms with friends.

She was scared for her son's safety, but relieved he reached out to her for help.

"I couldn't prevent that from happening, but I could be there when it happened," said Grant, senior director of children's mental health at Skylark, a Toronto-based charity.

"I could make sure that we talked about it afterwards."

Grant's kids have since grown up to be "wonderful, caring adults." She credits harm reduction strategies — making it easier for them to talk about oft-taboo topics — with getting through the challenging years of their adolescence.

Harm reduction focuses not on abstinence, but minimizing harm and potential danger. The number of such initiatives in Canada has grown in recent years, including some high-profile safe injection sites in B.C. to help curb the deadly opioid crisis in that province.

But it hasn't come without pushback.

"We have been, you know, living in a society where abstinence or zero-tolerance policies have been the ones that have, I think, politically felt the most comfortable," said Sally Jenkins, an assistant professor at the University of British Columbia School of Nursing.

"And so we don't have a lot of information for parents about how to do this differently."

Teens respond to harm reduction over abstinence: study

A recent study led by Jenkins interviewing 83 teens in B.C., found that many responded more positively to harm reduction approaches than a don't-do-drugs edict.

Abstinence-based approaches didn't reflect the lived experiences of many youth, who either have already tried drugs, or encountered it among their peers or even their own family circles, she explained.

In one community they surveyed, she added, many teens told her the zero-tolerance rule was "assumed" without a discussion of any sort.

"Kids just knew it wasn't accepted. End of story," she said.

"They didn't engage in discussions about it. And it was a missed opportunity, and it led to family fragmentation and kids just feeling like they didn't have somebody to go to."

'Harm reduction is just drug education'

Dr. Brian Goldman shared his own story about harm reduction in November, when he revealed on Twitter that he bought a pack of cigarettes for his teenage son, who has fetal alcohol spectrum disorder.

Many tweets in response were supportive, but others questioned his approach.

"I have no right to question Dr. Goldman and his wife's choice for their son, nor does anyone else. I hope with all my heart that it restores and maintains their family relationship," wrote Matthew Stanbrook, deputy editor of the Canadian Medical Association Journal.

"But I'm concerned that others may take this example out of context and think that the right approach in general to a youth experimenting with tobacco or other substances is to enable it under supervision."

Nick Jakubiak, a peer harm reduction worker at Skylark, adamantly refutes the notion.

"I don't think harm reduction is ever enabling drug use. Harm reduction is just drug education," he said.

"I believe it's giving people the right tools so that they can make their own informed decisions."

He credits his open dialogue with his parents for helping him through his early struggles with drugs.

"Prior to using cannabis, I had, like, a whole conversation with my mom. How do you use it safely? [I told her,] this is where I'm going to be. This is who I'm going to be with. And it was really amazing," he said, adding he uses an app to track his cannabis use.

Jenkins says dispelling the stigma around harm reduction could mean the difference between life and death in the long run.

"I work with too many parents who have lost a child to substance use, and that's the point where they kind of shift in perspective around, you know, the role of harm reduction," she said.

"And I don't think we ought to be waiting for that."

Helping parents 'tune in' to harm reduction

In the "Tuning In" workshop at Skylark, parents learn how to steer clear from leading discussions about drugs with worst-case-scenarios typically intended to scare kids straight.

"As a parent, you have to decide: do I want to lead with my fears and what I worry about, or do I want to lead with our relationship and maintain that relationship?" Grant said.

"Because truthfully, if one of your kids is in trouble, do you want them to come to you, or to go to one of their friends who may not be able to help them?"

The workshop also grapples with the difficult notion that parents cannot protect their kids from undue influence at all times — and part of harm reduction is being available if things go wrong.

"As much as they can provide all of the wonderful things that parents can do for their kids, once their kids are adolescents and walk out that door, they're going to be faced with choices," Grant said.

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mr peabody

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Why India is tobacco harm reduction’s most important frontier

by Samrat Chowdhery | Filter | Sep 25 2018

Tobacco is India’s Trojan horse. It was brought to our shores five centuries ago on Portuguese ships. Indians readily took it in as a trade good, then farmed it in abundance for its assumed medicinal properties. They developed a multitude of ways to consume it, until it unleashed death and destruction on a scale the nation had never experienced before.

This country is now home to an estimated 12 percent of the world’s billion cigarette smokers. Yet even this vast group is only the tip of the iceberg. India has a larger population who smoke local variants of tobacco. These include: bidis, cigarette-like rolls of unprocessed tobacco wrapped in a tendu or temburni leaf; hookah; chilam, a traditional clay pipe; and other forms. Many more people chew tobacco, in forms known as khaini, zarda and gutkha, which avoid some major consequences of smoking, like lung cancer, but still carry significant risks.

Altogether, 29 percent of Indians—about 270 million people, not far off the population of the United States—use tobacco in some form. This figure comprises 42 percent of men and 14 percent of women, making Indians the second largest tobacco-consuming population in the world after China—and given our projected population growth, we could before long take an unwanted lead over our neighbor. We currently bear an enormous health burden of over a million tobacco-related deaths annually, with $22 billion in economic loss.

This massive human tragedy will worsen if we don’t act. But worse still than inaction, the government of India—just recently, more than ever—appears determined to behave in ways that prevent reduction of smoking-related harms.

The first problem is simply a lack of urgency from the Indian state. Although a number of WHO-recommended tobacco control measures have been implemented, and they have led to an absolute reduction in tobacco prevalence of 6 percent over a seven-year period between 2010 and 2017 (according to Global Adult Tobacco Surveys 1 and 2), this is hardly enough. If this fall is not substantially accelerated, it will take almost a century to eliminate tobacco use, in which time many millions more lives will be lost.

India had the lowest quit rates among the countries surveyed in GATS-2 (followed by Indonesia) and though there is an overall decline in use, the disease demography shows tobacco is becoming a bigger killer. Ischemic heart disease and chronic obstructive lung disease, both attributable to tobacco, ranked in positions one and two among causes of death in India in 2016, having ranked sixth and eighth respectively in the 1990s.

At present there are three main lines of state-sanctioned interventions: encouraging cold-turkey quit attempts, cessation services and counseling, and nicotine replacement therapy (NRT). These are not enough. Nationwide quit lines and media outreach have done little to change the 95 percent failure rate of willpower-led cessation. Tobacco cessation clinics remain woefully inadequate, with just 19 functional at present. The effectiveness of NRTs is also limited, hovering near 7 percent.

That favorite measure of policymakers, raising taxes, also has limitations in a country like India with a wide spectrum of popular tobacco products. For instance, raising costs of cigarettes above a certain level forces smokers to shift to cheaper, more harmful variants, thus causing more harm than good. High taxes do little to limit uptake either, when the average cost of loose cigarettes—in practice sold everywhere, although a few states have issued futile bans—is extremely low.

In this environment of non-existent and low-performing interventions, it is important to consider measures that are showing potential elsewhere. Key among them is tobacco harm reduction (THR). This pathway requires only the moderate effort of sensible regulation, with the market and users’ desire for a healthier life doing the rest.

We practice harm reduction all the time in our everyday lives, from switching to safer food habits to driving more eco-friendly cars, and this evidence-based concept is becoming increasingly prevalent in addiction treatment for other drugs.

Electronic Nicotine Delivery Systems (ENDS), such as e-cigarettes, which eliminate the tar produced by combustion of tobacco leaves, have been found to be around 95 percent safer than smoking. Swedish snus, a non-combustible form of tobacco that is placed behind the lip, has been shown by long-term epidemiological studies to also be a greatly risk-reduced alternative.

However, instead of heralding the public health opportunity THR provides, the influential tobacco control community, in India as in much of the world, has put up stiff resistance to its use. This community includes institutions such as the Indian Medical Association, the National Tobacco Control Programme, and the Public Health Foundation of India. There is a high human cost to this “moral” opposition when tobacco use—above all, smoking—is the world’s leading preventable cause of death.

This hardened and evidently anti-people position is a blowback from decades spent fighting the tobacco industry, which undoubtedly has tried all manners of dirty tricks to sell its products, leading to heightened suspicion towards any measure other than total abstinence from nicotine.

However, as with most industries, technology has changed the landscape, which requires a pragmatic recalibration of strategies and an imaginative recognition of opportunities that did not exist before.

In India this opposition has been especially bullheaded. Snus is effectively banned; when companies applied for licenses to produce it, permission was denied because snus is bizarrely classified as a food product, and use of tobacco in any food product is illegal under existing laws.

Then, just last month, the central government issued an advisory to states proposing an outright ban on ENDS. Among the reasons cited were the “harmful” effects of nicotine and fears of teen use. This appears to have be taken out of the old anti-tobacco playbook, but without adjusting for risk-appropriateness and the concept of harm reduction—perhaps because it requires coming to terms with the fact that mitigating harm is a lot more achievable and, therefore beneficial in practice, than being focused on completely eliminating use. Many working in drug addiction treatment (in international contexts, if not so much in the US) jumped this moral hoop long ago, but people in tobacco control, which impacts far more lives in India, unfortunately have not.

There are yet more hurdles. The tobacco industry claims to provide sustenance for 50 million households in India, which includes widespread farming of the cash crop. Add the government’s approximate 30 percent stake in the country’s largest tobacco company, ITC, along with its high dependence on tobacco taxes, and action becomes even more difficult.

It is worth highlighting that ITC’s stock price shot up on the news of the central advisory against ENDS, as investors felt reassured by state action to keep competing alternatives out of the market. (Although ITC has one ENDS product, Eon, its shortcomings and lack of popularity mean the company has no significant foothold in this space.)

Little forward movement on promoting lower-risk alternatives to curb tobacco use is possible until the state can be separated from tobacco commerce. This is a problem which the WHO Framework Convention on Tobacco Control (FCTC) has highlighted—Article 5.3 states, “Parties shall act to protect these policies from commercial and other vested interests of the tobacco industry in accordance with national law”—but not strictly enforced. The most glaring infractions are by the governments of Asian countries with some of the world’s highest rates of tobacco use, and the most urgent need for lower-risk alternatives.

For as long as the Indian state’s interests don’t align with those of the Indian people, it falls on the latter to advocate for reason and workable solutions to our tobacco epidemic. Even those of us who work in this field often feel incredulous that the biggest obstacle to public health remains those who have been tasked to protect it.

Amid these major challenges, the GATS-2 survey estimates that India already has about 260,000 ENDS users. Imagine how many they could become in more favorable conditions—and the corresponding preservation of life and health.

Encouragingly, while the motivation to quit, particularly for low-income groups, is low, there is nonetheless widespread public awareness of the harm caused by tobacco use. India is also a large producer of medicinal nicotine used in e-liquids, which can help in keeping costs down. Experience elsewhere show that adoption of ENDS is highest in lower-income populations because of their cost-effectiveness.

There is thus every reason to believe tobacco harm reduction can become a huge success story in India—if only better, pro-people policies will allow these lifesaving products to become widely available and affordable.

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mr peabody

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Decriminalisation must be considered in curbing UK drug deaths, treatment providers say*

by Andy Gregory | The Independent | 1 Dec 2019

The future government has been urged to consider every available measure to curb the current drug death “crisis”, including decriminalisation, in an unprecedented plea from the UK’s major drug treatment providers.

They implored the next government to be “brave and radical in the changes they make to current drug laws," they described as “not fit for the modern world.”

An independent commission must be established to revamp “incredibly outdated” policy, with no options off the table, said the UK’s largest drug treatment provider, Change Grow Live.

Ahead of the general election, the charity urged all political parties to commit to setting up this commission and implementing whatever it recommends, and to pledge centralised, ring-fenced funding for drug and alcohol treatment until at least 2025.

The call was also backed by Addaction, Turning Point and Humankind. Together the four organisations provided support for the vast majority of the 268,251 adults receiving drug and alcohol treatment in England this past year.

The plea for every political party to prioritise the crisis and pledge tangible, evidence-based change ahead of the general election comes in response to record levels of drug-related deaths, with 4,539 fatalities in England and Wales in 2018, and 1,187 in Scotland – the highest rate anywhere in Europe.

“What is most concerning and completely unacceptable is that these tragedies can be avoided: with the right policies, approach and support,” Change Grow Live’s CEO, Mark Moody, told The Independent.

Referencing the Misuse of Drugs Act, he said: “There are very few policies written in 1971 that are fit for the modern world – and drug legislation is one of those things.”

While the charity is “not suggesting a lift and shift of policies that have worked in other places, and doesn’t believe in 'silver bullets,' " Mr Moody said "decriminalisation, and other evidence-based policies, need to be evaluated in a British context, with nothing off the table.”

But while he sees “no criminal justice or health benefits” to criminalising individuals for possessing small amounts of substances for personal use, Mr Moody suggested criminalisation can further stigmatise drug users – which he described as “a big part of the problem in the country.”

“We should be talking about our fellow citizens as human beings who have a problem rather than demonising them,”
he said.

“When you characterise people in this caricature way, it does get in the way of sensibly thinking about how to do something, which is a problem for the whole of society, not just the person affected by it.”

In October, MPs on the health and social care committee urged ministers to consider decriminalisation to tackle what they described as a “public health crisis”.

But the Conservative Party has maintained a determined commitment to drug prohibition, ignoring pleas for safer drug consumption facilities and courting controversy after ministers’ alleged “political vetting” of the Advisory Council for the Misuse of Drugs fuelled questions over its independence.

Asked whether he feared certain parties may be less likely than others to implement the recommendations of an independent commission, Mr Moody said he believes “any politician who really has the interests of the country, morally, health-wise, and fiscally, realises the importance of re-evaluating drug policy."

The number of drug deaths has nearly doubled since 2012, when the government removed central, ring-fenced budgets for drug and alcohol treatment and transferred responsibility for public health to local authorities. It also placed an emphasis on achieving outright abstinence, which some experts say has negatively impacted lifesaving harm reduction efforts.

With embattled councils forced to slash spending on addiction services during a decade of austerity, Mr Moody said the move to localism “has led to a level of variability that can only lead to a postcode lottery, with hugely disparate facilities available for people to get help.”

He said: “If we’re talking about it being a health issue, like diabetes or cancer – I don’t think we should favour a postcode lottery for substance misuse any more than we would for those things.”

Turning Point’s managing director for substance misuse and public health, Jay Stewart, said: “The current lack of investment doesn’t make any sense in terms of the cost to society and the NHS."

“The human suffering that we see on the streets of every city and in rural areas really is the tip of the iceberg, while Brexit consumes all our political attention."

“Meanwhile deaths, untold suffering of children and communities and the waste of lives continues. At the same time it’s costing the taxpayer more money. A dose of common sense and immediate action is needed.”

As well as the return of ringfenced funding for treatment services until at least 2025, the charities called for targeted investment into piloting new approaches to tackling drug deaths, particularly in areas where substance misuse is disproportionately prevalent.

Such measures include piloting the near-universal provision of naloxone, a “proven lifesaver” that reverses the effects of opioids, and increased heroin-assisted treatment schemes – which see particularly entrenched heroin users given regular doses of the drug in medical-grade form.

Humankind’s CEO Paul Townsley said “thousands of lives” could be saved by investment in frontline services and harm reduction interventions, and welcomed the call to consider decriminalisation.

He said: “I believe we should focus on the evidence of what works, and be brave and radical in the changes we make.”

Robin Pollard, a policy researcher at Addaction, said: “Trying to arrest our way out of the issue has been a monumental failure and the next government must follow the evidence, treating people with compassion and dignity, not punishment ... It’s time to put people’s wellbeing and safety first.”

Responding to the treatment sector’s plea, a Labour spokesperson pointed to their manifesto pledge to “establish a royal commission to develop a public health approach to substance misuse, focusing on harm reduction over criminalisation.”

While the Conservative Party did not respond to request for comment, their manifesto promises to “tackle drug-related crime, and at the same time take a new approach to treatment so we can reduce drug deaths and break the cycle of crime linked to addiction.”

The Liberal Democrats have pledged to legalise cannabis and treat possession for personal use as a civil rather than criminal offence.

The Green Party promises to end the war on drugs, which it describes as a “resounding failure”, repeal the Misuse of Drugs Act, and pardon all those previously convicted for possession and small-scale supply.

Sian Berry, co-leader of the Green Party of England and Wales, told The Independent: “I absolutely support the calls for an independent commission on drugs."

“Prohibition has totally failed. The broken drug laws have destroyed communities and ruined lives. It’s time for politicians to put aside the dogma and work together with experts to develop evidence-based drug policies that focus on harm reduction and actually work."

“I would call on all politicians and candidates to support this initiative.”

*From the article here:

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mr peabody

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TripApp - the latest mobile innovation to make drug use safer

by Alexander Lekhtman | Filter | Dec 31 2019

Imagine going on a night out with friends, planning to share some “ecstasy” pills you bought locally. What if you first wanted to know the quality and purity of your drugs, but didn’t have the means to check? And what if you wanted to find local harm reduction organizations, information and services that could help keep your drug use safer?

The developers behind TripApp sought to provide some answers.

The free app—which launched this month and is so far available in Spain, Italy and Germany—shares real-time data from the Trans-European Drug Information Project (TEDI), an international illicit drug checking network. It also collects data from consumers who check their own drugs with reagent kits or test strips. It constantly updates its data in order to alert consumers when adulterated or high-risk drug batches are detected in their location.

“We realized that in discussions about drug use, there’s a lot of talk about monitoring and controlling people who use drugs, but when do we ever consider talking to them?” Florian Scheibein, deputy director of Help Not Harm and one of the app’s founders, told Filter. “People who use drugs and their communities are often excluded from having data about the quality of their drugs, that’s normally collected by governments and academic institutions. We instead wanted the people to be the primary beneficiaries of this data.”

Speed of information is key. “In the traditional drug alert systems it often took months between samples being collected by the police, then tested, results sent to the Ministry of Health or other relevant government agency, and then disseminated to the general public and partners in other countries,” said Jan Stola, executive director of Youth Organisations for Drug Action and another of the app’s founders. “TripApp does that in a few hours.”

People who download the app will also be connected with over 1,200 harm reduction providers in 15 countries, including syringe programs, HIV and STI testing, and safe consumption spaces. About 9,000 people in the European Union die of overdose each year, according to the European Monitoring Center on Drugs and Drug Abuse.

The TripApp team plans to roll it out in more countries. It is currently available for free from Google, but not yet from Apple. Part of the challenge of expanding to other countries is that reliable information and mapping of local harm reduction providers is required; this is time-consuming to collect, even with the assistance of harm reduction organizations and government agencies.

As it expands, TripApp’s developers also want to improve the self-reported drug checking system. Scheibein explained that in order for this feature to be useful, people testing their own drugs need to write their reports as objectively as possible. The reports need to be translatable to users speaking 15 different languages. And crucially, user-submitted reports are not permitted to encourage or facilitate sales of drugs.

Although TripApp is not yet available in the US, I asked Yarelix Estrada, a harm reduction expert and researcher in New York City*, for her thoughts about its value.

“This application could be really effective for people in the nightlife and party scenes,” she told Filter. “There is no easy or centralized way for drug checking organizations to aggregate and distribute their data. There’s so much good drug checking work being done, and so many urgent and unique needs that different drug-using communities have, that could be connected together.”

Estrada noted that self-reported drug tests may be susceptible to human error, if people incorrectly test their own drugs. People should also be aware that reagent testing kits only test for the presence of drugs, she added, not the amount or purity. And of course marginalized people who lack access to smartphones or internet can’t be reached in this way.

Other harm reduction Apps

While TripApp is the most comprehensive mobile application of its kind to date, it is not the first. The KnowDrugs app, launched in 2016, aggregates MDMA or “ecstasy” drug checking and testing information provided by local harm reduction organizations. It is "used by people from almost every country in the world,” according to its website, and is available from Apple and Google. Unlike TripApp, it does not source user-provided data.

Meanwhile, the similarly-named but functionally-different TripSit app provides people with comprehensive information about different drugs—such as typical dosage amounts, psychoactive effects and risks, and interactions between drugs. The app, which is available from Google, is updated regularly with scientific and academic data, but does not provide any localized drug checking information.

Other fascinating harm reduction apps include Remote Egg Timer (no longer available) and Second Chance (under development). Remote Egg Timer allowed people to set a timer that would automatically text an emergency contact for help if they didn’t press a stop button—presumably if they were unresponsive following overdose.

Second Chance converts a smartphone into a short-range sonar system that detects overdose based on changes in heartbeat or pulse. If the user doesn’t respond the app sends an emergency message to family members or first responders.

And the simplest, but most human, app of this kind is Harmredux, which is almost like an “Uber” for supervised drug consumption. Developed by a substance use counselor from Evanston, Illinois, Harmredux allows people to contact harm reduction volunteers by phone or text. They can arrange to meet with the person using drugs, monitor them for overdose or other negative side effects, and intervene if necessary with naloxone or by calling 911. The app is available from both Apple and Google.

The usefulness of any of these apps, Estrada cautioned, additionally depends on a critical factor: digital privacy. “If the technology is not using location services and collecting users’ personal data, that’s very important,” she said. “People using drugs are already marginalized and possibly breaking the law, so app developers interested in this issue have to make sure they’re doing this work just to help them—and not to take their information.”

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