For five years, a secret supervised drug injection site has operated in the US, allowing drug users to inject more than 10,000 times in a sterile, protected environment.

The illegal operation is modeled after similar, legal sites in Canada and Europe, which seek to provide drug users with a place to get clean supplies, connect with social services and avoid overdosing in a dangerous place.

A study of the underground site published in the New England Journal of Medicine online on Wednesday revealed how lives could be saved if the US were to sanction such facilities.

At the clandestine site, there were 33 opioid-involved overdoses, which were reversed with the medication naloxone, according to researchers at the not-for-profit RTI International and the University of California, San Diego.

“Not only were the 33 overdoses all saved, none of them required anyone calling 911 or being sent to a hospital,” said Alex Kral, an RTI International epidemiologist. “This is a big piece of this – we don’t need to overburden the emergency system with all these overdoses if people are inside, if they have trained people monitoring them.”

Secret US drug injection site shows how supervision could save lives

Drugreporter and INPUD presents the first episode of a 10 chapter long series documenting how people who use drugs around the world have organised and formed collectives and unions to protect and defend the health and human rights of their community. The first episode uncovers the history of the movement in the Netherlands, and how it inspired activists in Belgium and France.

Since January 1981, when the first drug user group ‘Junkie-bond’ was established in Rotterdam in the Netherlands, the drug user movement has grown exponentially: people who use drugs have continued to organise and form collectives and unions to protect and defend the health and human rights of their community. This struggle for autonomy, self-determination and empowerment of people who use drugs has been, and is, a global phenomenon.

The Rights Reporter Foundation (Drugreporter) and the International Network of People who use Drugs (INPUD) produced this documentary film series that aims to document how the movement of people who use drugs have formed around the world, how they maintain momentum and mobilise, and how they undertake their work and show resilience in a context of criminalisation, marginalisation and oppression.

Taking back what's ours! – Episode 1: The Netherlands, Belgium and France

By Hakimie Amrie Hisamudin for Free Malaysia Today

PETALING JAYA: An expert in epidemiology has called for a halt to the jailing of minor drug offenders, saying this would reduce overcrowding in prisons and be in the interest of containing the spread of Covid-19.

Dr Ehab Salah, who works for the United Nations Office on Drugs and Crime, said the existing prison environment was not conducive to measures to contain virus transmission.

Key preventive measures such as social distancing and the use of face masks were not applicable in the prison setting, he added.

Ehab alleged that prisoners were not receiving healthcare services of the same standard available to the public at large.

Prior to the Covid-18 pandemic, he said, the spread of tuberculosis, HIV and Hepatitis C in Malaysian prisons were always a health concern.

Malaysia: End jailing of minor drug offenders, says medical expert

Pride has become a time defined by love and acceptance for the LGBTQ+ community (LGBTQ+ stands for Lesbian, Gay, Bisexual, Transgender, Queer/Questioning and the + is for everyone else who identifies in the community). For better or for worse, it has become a month long event with sporting and cultural bodies as well as small businesses and large, international corporations showing the rainbow flag and expressing their support for the LGBTQ+ community. The community has reached new heights of acceptance where being seen to be supportive of LGBTQ+ people is deemed to be profitable. This rainbow-tinted image of the community’s position in society is one that hides many of the problems our community still faces.

Aside from our community facing regular homophobia, transphobia, and other forms of discrimination, we experience a range of other issues in a manner different to our cisgender and heterosexual peers. The link between the LGBTQ+ community and drug use is incredibly evident when spending any amount of time in LGBTQ+ spaces. This link is also there in non-LGBTQ+ spaces, just go to any pub on a Saturday night or even your local Garda station. Drug use is present in all sections of society and prohibition has failed to have any tangible impact on drug use and addiction.

LGBTQ+ spaces are overwhelmingly places that are traditionally associated with alcohol consumption and illicit drug use. Gay bars and clubs were the original safe havens for our community and remain a place where LGBTQ+ people can come together and embrace their identity without having to fear the judgmental gaze of wider society. These spaces have changed and developed over time to what we see today in many city centres around the world. As time has gone on new spaces have been forged, notably with the more recent rise of Chemsex within the MSM (Gay, Bisexual and Other Men Who Have Sex With Men) community specifically.

Drug use and the LGBTQ+ community - Taking pride in harm reduction

Two years ago, the International AIDS Society (IAS) chose the United States of America (U.S.) as the site for the 2020 International AIDS Conference (AIDS2020). Community advocates argued that the U.S. was an inappropriate choice given legal travel restrictions on sex workers, people who use drugs, and Muslims, which would have made it very difficult for members of these communities to enter the country. The Trump regime’s racist immigration, detention and family separation policies, state-sanctioned violence against Black and Brown people, and the country’s worsening human rights conditions for LGBT people, added to advocates’ grave concerns.

The IAS’ decision created a dilemma for many in the global HIV movement and revealed a willingness by mainstream HIV actors to tolerate the discrimination of immigrants, people of color, Muslims, people who use drugs, sex workers, and transgender people in the conference’s host country. The IAS’ decision also resurfaced questions about the community-relevance of large, multi-million-dollar conferences in the face of shrinking global HIV investments. Moreover, persistent barriers to HIV prevention, care, and treatment services like the costs of medicines and diagnostics as well as criminalization, stigma, discrimination, and violence, compel community advocates to ask:

How can IAS better and more meaningfully 

directly benefit people living with and most affected by HIV 

(gay and bisexual men, people who use drugs, sex workers, and transgender women)?

improve its community-relevance and usefulness to the global HIV movement

How can future conferences model and evaluate participatory and dynamic approaches to sharing knowledge and deliberating new research findings with 

community advocates valued as equal partners and acknowledged as experts?

How can the conference be better leveraged to develop and advance 

interlocking HIV research, program, and policy agendas?

Advocates demand structural changes to all future International AIDS Conferences

At least 122 children, including a one-year-old, have been killed during President Rodrigo Duterte’s “war on drugs” in the Philippines, according to a report that concluded some children have been deliberately shot at and targeted as proxies.

The study, by the World Organisation Against Torture, adds to growing calls for the UN human rights council to establish an independent investigation into abuses committed under Duterte. Rights groups estimate that tens of thousands of people may have died as a result of unlawful killings during anti-drug operations launched after his election in 2016.

The report, which examines child deaths between July 2016 and December 2019, reports that police were responsible for just over half of the killings documented. Others involved unknown individuals, often wearing masks or hoods, some of whom allegedly had links to the police.

‘War on drugs’ blamed for deaths of at least 122 children in Philippines

The number of people using illegal drugs globally has risen by 30% over the past decade to 269 million while 35.6 million people have drug use disorders, according to the latest World Drug Report from the United Nations Office on Drugs and Crime (UNODC).

The report, published on 25 June, also warns that the covid-19 pandemic could worsen the situation because the resulting restrictions on borders and other areas are causing shortages of drugs locally, leading to increased prices and reduced purity.

UNODC’s report gives a global overview of the supply and demand of opiates, cocaine, cannabis, amphetamine type stimulants, and new psychoactive substances, and their impact on health.

Cannabis was the most used substance worldwide in 2018, with an estimated 192 million people using it, the report said. It noted that while frequent use of cannabis had increased in all countries that had legalised it, it remained the main drug that brought people into contact with the criminal justice system.

Opioids, however, remained the most harmful drug. Over the past decade, the total number of deaths from opioid use disorders rose by 71% to more than 110 000 in 2017.

Drug misuse rose 30% in past decade and covid-19 could worsen situation, UN report warns

The war on drugs has wreaked havoc on millions of people across the world for half a century, but remains uncontested by all but a few. It has become an established part of the world order, even when its devastating impacts – not to mention its lack of success – are all too obvious.

But times are changing. The recent surge of the Black Lives Matter movement has motivated masses of people to challenge long-standing racism, demanding fundamental changes to law enforcement and other institutions. At the same time, governments are taking unprecedented measures to respond to COVID-19, suddenly making the impossible possible, leading many to consider what we want the new normal to be.

All over the world, Frontline AIDS partners work closely with people who use drugs. Every day we witness the devastating impact of the war on drugs. Here are four reasons why it’s time to speak up against it.

Four reasons to end the silence on the war on drugs

This article covers interviews with three activists from Ukraine, Russia and Norway and shares their insights concerning the effects of COVID-19 on people who use drugs and the responses from the community and governmental levels.

In most countries, some health services ceased and most became harder to access. Anton Basenko is a staff member of Alliance for Public Health and board member of the International Network of People who Use Drugs. He offered insights into the situation in Ukraine, where, though harm reduction services were still available, the hours and services offered changed. PWUD had to find out where to go and when to get materials or meet with a case or outreach worker. Increased complication of accessing services is one factor fueling a decrease in health seeking behavior among PWUD seen across Europe.

Basenko, a parent himself, shared that adapting to COVID-19 measures and accessing necessary harm reduction services posed even more challenges for parents, who had the double burden of managing their own and their children’s care.

At first, during Ukraine’s lockdown, those experiencing homelessness were stuck without options when people flocked to centers for shelter and food, which had even more limited capacity than usual.

In Russia, most state health services became unavailable, and harm reduction services, delivered by NGOs, also faced extreme difficulties. Maxim Malyshev, social work coordinator at the Andrey Rlykov foundation, spoke about the difficulties of administering harm reduction during COVID-19.

Though harm reduction services were scarce before the pandemic, the Andrey Rylkov foundation was able to reach 4,000 people annually, a reach which has been severely limited.

In Norway, it was extremely difficult for PWUD when businesses and services that they relied on closed down in early April. Many PWUD in Oslo rely on low-cost food and housing offers, but these options stopped. Both of Norway’s drug consumption rooms closed down during COVID-19, leading people to consume in more risky conditions and to dispose of materials publicly.

“It was really heavy for people,” shared Janne Andresen, activist and employee of the Organization for Humane Drug Policy (Foreningen for human narkotikapolitikk).

When Easter came, a generally difficult time for PWUD in Norway because it is a long holiday, the low-cost offers for food and temporary accommodation opened again. The salvation army started to give out soup and food to people. Additionally, health-checking services reopened as did the availability of treatment for sicknesses and abscesses.

“Things got so bad that things started to open again. Because the government saw what they were doing to people,” shared Andresen.

In all three contexts, loss of income was a primary driver of COVID-19 related hardship. Many people who had legitimate income sources had to resort to crime or go without. In Oslo, many PWUD sell a magazine that employs almost 2,000 individuals. When it closed down, it was a shock to the community, leaving many without any income.

Financial hardship also led, in some cases, to those who had ceased drug use to start again, or to riskier use. On top of that, people’s usual social safety nets were compromised. In Russia, those who were parts of groups such as Alcoholics Anonymous or other groups stopped seeing their community. In isolation, drug use becomes riskier because if there is a health-related event such as an overdose, there may not be someone there to help.

For some, the epidemic fueled desperation. Andresen shares that in Oslo, the street drug environment was dangerous for some time, as rates of criminality increased, such as fighting, stabbing, or selling fake substances.

In Norway, there was a temporary expansion in availability for opioid substitution therapy, which Andresen and her husband benefitted from. After consulting with their primary care physician, they were prescribed morphine, which allowed them to avoid the street drug scene.

The availability of OST during this time mattered for individuals and for the community.

“It’s smarter to give people substitution medicine than not, because then they can stay inside…You can do like normal people do,” shared Andresen.

“Then there’s a few more that don’t spread the disease.”

However, Andresen stresses that the availability of OST during COVID-19 depended on one’s doctor’s willingness to prescribe. While they are fortunate to have an understanding and compassionate doctor, not all people who use drugs in Oslo or Norway could expect the same. Additionally, it can be difficult for people to get to the doctor for the chance of being prescribed OST. At the time that we spoke, the temporary prescription of morphine was ending.

During the COVID-19 lockdown, availability of take home OST in Ukraine expanded from about 50% to around 90% coverage. There were also new entrants to opioid substitution therapy because the economic hardships posed by COVID-19 which made it more difficult for people to purchase drugs.

However, the take-home dosages were only for 10 days in most places, so it was still necessary for OST patients to travel in order to collect their medication. When public transportation was made available to only essential passengers, like medical staff, this presented a huge difficulty for many PWUD. Ukranian cities tend to be sprawling and difficult to traverse, requiring individuals to reveal up to 40 kilometers to reach their OST site. Without access to public transport, reaching necessary services can become impossible for those who could not rely on personal vehicles or pay for taxis.

In response to this, after advocacy from PWUD organizations, OST patients in some localities were granted permits to access public transport, though the reach was limited.

For antiretroviral therapy for HIV-positive individuals, the service adapted to deliver the medicine by post or through couriers. Needles and syringes also began to be distributed in more meaningful quantities, so that people did not need to visit as often to collect these supplies. Hopefully, expanded access to take-home OST will also stay in place as will ARV by mail.

According to The European Monitoring Center for Drugs and Drug Addiction, some drug treatment experts across Europe believe there is potential that expanded access to OST during COVID-19 following relaxed regulations may be integrated into new national approaches after the pandemic subsides.

Malyshev shares that the Andrey Rylkov Foundation organization expanded their virtual presence during COVID-19. They have a large Telegram chat, which members turned to for social support and sharing resources during COVID-19.

The epidemic made some hard-to-reach populations a bit more accessible, such as younger recreational drug users and those who organize raves or own clubs. As Telegram became the primary way to reach their community, they were able to establish more contact with this group on the anonymous platform. The organization also provided psychological support online.

In general, Malyshev feels that the social ties among drug-related communities have become stronger, and that self-organization is evident in the way that harm reduction materials spread through these networks.

Similarly, in Ukraine, harm reduction NGOs introduced online consultations and The National Hotline on Drug Dependence and OST saw higher call volumes. Basenko believes that some of the services that NGOs began to provide during COVID-19 will remain, such as increased use of hotlines.
At the Organization for Humane Drug Policy, they began making bigger packages of supplies than usual. This meant more syringes and larger harm reduction kits, for example. Other organizations also began to give out supplies in Oslo, such as a bus that delivers syringes around the city.

Increased risk with buying drugs and policing

In the context of lockdown, every person’s movement is more visible. For those whose actions are criminalized and stigmatized, risk is always higher. In Russia, Malyshev shares, police used their increased power under COVID-19 to put pressure on drug users, who struggled to safely pick up drugs after purchasing them online. Similarly in Ukraine, there were instances of police using the power to enforce social distancing to target groups of PWUD who were gathered to access a service such as picking up clean syringes.

Basenko shares that the lockdown turned the streets into, “a white paper. Every step is very visible and can be controlled by policemen.”

Basenko added that people who use drugs also fear the gaze of other judgmental citizens and risk being beaten up when going to pick up drugs. As lockdowns are eased, and there are more people on the streets, this situation is getting slightly better.

In Norway, in contrast, Andresen shared that while police are present in the streets and also in the neighborhood where most drug purchasing and use takes place, their primary concern is making sure that PWUD respects social distancing guidelines to prevent the spread of COVID-19.

Andresen shared that, in her experience, COVID-19 led more people to realize the difficulties that people who use drugs face, though the attention was temporary. There was an upsurge in people buying the magazine that many people who use drugs in Oslo sell, out of a sense of compassion, but that also ended.

“I was on TV..and radio…People got to see how it really was. But you know, that lasts for 2 or 3 days, and then it’s forgotten again. Then you’re just another person on the street that’s “struggling,” as they so nicely say it.”

COVID-19 highlights the difficulties that people who use drugs face to maintain their health, safety and dignity. COVID-19 made existing vulnerabilities even clearer, highlighting the ills of criminalization and insufficient service provision. The ways that NGOs and, in limited cases, governments have reacted in order to respond to these increased difficulties provides learning opportunities that should be taken forward even after COVID-19. The importance of accessible OST, ART and safe materials cannot be overstated. Innovation also includes the integration of online service provision and telemedicine, though face-to-face services will always remain important. Street drug users tend to be hard for harm reduction services to reach, and in an era where much service provision goes online, they can be left behind.

Surviving the COVID-19 Era: Stories of People Who Use Drugs from Russia, Ukraine and Norway

It’s 10 in the morning in Abidjan, Côte d’Ivoire.

Like every morning, Arouna Bakari (not his real name), mask on his face, washes his hands before entering a “smoking room”, as people who use drugs call the open drug-taking places in Abidjan. He checks that the hand washing sink installed in front of the smoking room is working properly. He can now start his work and distribute prevention equipment against COVID-19 to the people who gather there.

Mr Bakari works for Parole Autour de la Sante (PAS), a community-led organization made up of people who use drugs and former people who use drugs, their relatives and social scientists. It operates the first “therapeutic community”, a mixed residential programme for people who use drugs, in western Africa.

Created in Côte d’Ivoire in 2016, PAS promotes the health of people who use drugs through harm reduction and services for HIV, tuberculosis, sexually transmitted infections and hepatitis. Since October 2019, thanks to funding from OSIWA (the Open Society for West Africa), PAS has strengthened its activities, with a focus on the respect of the human rights of people who use drugs—still a highly stigmatized and discriminated against community—and their access to health services. This is why Mr Bakari, in addition to his work in the smoking rooms, also trains health workers, journalists and the security forces.

There have been harm reduction programmes in Côte d’Ivoire for some years now. Community organizations have been set up and work with the national AIDS programme, the national institutions in charge of drug policy and the international nongovernmental organization Médecins du Monde.

Harm reduction continues for people who use drugs during COVID-19 in Côte d’Ivoire

This free, open access, training resource is a part of our social mission to develop and improve the harm reduction response to drug use.

In addition to our unique overdose recognition and naloxone administration course that allows people to buy naloxone online, we now have certificated training with a foundation course in level 1 needle and syringe programme delivery.

Written for staff delivering needle and syringe equipment distribution services in pharmacies and other services.

In the coming weeks and months courses will be added to take practitioners to level 3 needle and syringe programme delivery, giving advanced safer injecting advice.

All our training is (and always will be) free, and available to all.

Our mission is to maximize our impact on the reduction of drug related harm by improving injecting equipment and providing free access to accurate detailed harm reduction information online, so we have shared all the materials on this site under the terms of a Creative Commons 'Attribution-NonCommercial-ShareAlike 4.0 International license.

UK: Free online naloxone training course

“We are being led by the science” is the new mantra from Ministers seeking to justify their actions. This line of defence earns hollow laughs from the drug user movement, as we have been collectively burned. We have experienced politically motivated decisions leading to disinvestment from drug and alcohol services and undermining the coverage and quality of our harm reduction and drug treatment services.

In the early days of the HIV response, the UK could truly claim to have been driven by the science. The Advisory Council on the Misuse of Drugs (ACMD) was charged with evaluating the evidence and producing three highly influential HIV and Drug Misuse reports, which promoted harm reduction practice with linked specialist funds that invested in innovation and creativity.

New Labour took us on a journey of defining drug policy and practice not on the basis of the science but on the basis of what their focus groups told them the public would accept. This led to OST being justified as a crime reduction not a public health measure. Community mobilisation was redefined first as service user involvement (you only have value as the clients of our services) and then recovery (you only have value if you stop being drug users). This was an insult to the many drug user activists and groups who had played a pivotal role overcoming HIV through the 80s and 90s.

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