Under Heroin-Assisted treatment (HAT), pharmacological heroin is administered under strict controls in a clinical setting to those who have failed in other treatments like methadone. Every published evaluation of HAT has shown extremely positive outcomes: major reductions in illicit drug use, crime, disease and overdose; and improvements in health, wellbeing, social reintegration and treatment retention. More than a half dozen countries in Europe and Canada have implemented heroin-assisted treatment (HAT) programs.

Keep up-to-date with drug policy developments by subscribing to the IDPC Monthly Alert.

Heroin-Assisted Treatment 

With less than 5 percent of the world’s population but nearly 25 percent of its incarcerated population, the United States imprisons more people than any other nation in the world – largely due to the war on drugs. Misguided drug laws and draconian sentencing requirements have produced profoundly unequal outcomes for communities of color. Although rates of drug use and selling are comparable across racial and ethnic lines, blacks and Latinos are far more likely to be criminalized for drug law violations than whites. The drug war drives mass incarceration and racial disparities in U.S. judicial systems.

The drug war, mass incarceration and race

One solution to reducing the number of people swept into the criminal justice system for drug law violations is to enact various forms of decriminalization of drug use and possession. Decriminalization is the removal of criminal penalties for drug law violations (usually possession for personal use). Roughly two dozen countries, and dozens of U.S. cities and states, have taken steps toward decriminalization. By decriminalizing possession and investing in treatment and harm reduction services, we can reduce the harms of drug misuse while improving public safety and health.

Approaches to decriminalizing drug use and possession

Supervised injection facilities (SIFs) are controlled health care settings where people can more safely inject drugs under clinical supervision and receive health care, counseling and referrals to health and social services, including drug treatment. There is overwhelming evidence that SIFs are effective in reducing new HIV infections, overdose deaths and public nuisance – and that they do not increase drug use or criminal activity. There are currently 92 such facilities operating in 62 cities around the world – but none in the U.S.

SIFs can play a vital role as part of a larger public health approach to drug policy. SIFs are intended to complement – not replace – existing prevention, harm reduction and treatment interventions.

 Supervised injection facilities

Undoubtedly, the most prominent development we can see in global drug policy today is that more and more players, including countries, are admitting the need to move away from law-enforcement-dominated approaches in drug policy towards approaches that are based on public health instead.

Most notably, in recent years in Latin America there has been an intensifying debate about the failure of prohibition, and most recently even sitting presidents started loudly criticizing the ‘war on drugs’, saying that the Conventions should be more flexible to allow for experimentation with innovative approaches, especially where drug production and trafficking have caused a prolonged political and humanitarian crisis.

But what are these conventions that have bound the hands of politicians of decision-makers so much in Latin America and elsewhere?

Recent trends in drug policy reform and UNGASS 2016

There is an extensive body of literature documenting the stigma associated with alcohol and other drug problems. No physical or psychiatric condition is more associated with social disapproval and discrimination than substance dependence. For people who use drugs, or are recovering from problematic drug use, stigma can be a barrier to a wide range of opportunities and rights. For people who use drugs, or are recovering from problematic drug use, stigma can be a barrier to a wide range of opportunities and rights.

Stigma and people who use drugs

The global war on drugs is severely jeopardizing the fight against AIDS. Criminalizing drug use drives the HIV pandemic not just among people who use drugs – but also among their families and communities.

Criminalization creates barriers to treatment and encourages unsafe injecting practices. Evidence consistently shows that repressive drug law enforcement practices are strongly associated with higher HIV rates. Fear of arrest drives many people who inject drugs into environments where HIV risks are greatly elevated, and away from HIV testing, prevention and other public health services. Criminalization also erects multiple barriers to both HIV and drug treatment. Research clearly demonstrates that people who use drugs tend to have lower rates of antiretroviral therapy utilization and higher rates of death due to HIV/AIDS.

The drug war: Fueling the HIV/AIDS pandemic

While men are more likely to be targeted by drug law enforcement, many of the drug war’s victims are women. Largely as a result of draconian drug laws, women are one of the fast growing segments of the U.S. prison population. Most women behind bars are mothers, many of them sole caregivers. Women, and particularly women of color, are disproportionately affected by drug law enforcement, by social stigma, by laws that punish those unable or unwilling to inform on others, by regulations that bar people with a drug conviction from obtaining public assistance, and by a drug treatment system designed for men.

Women, prison, and the drug war

After first attempting to prohibit various synthetic drugs, New Zealand realized that simply banning these substances was unrealistic and ineffective. In July 2013, the country’s Parliament enacted an historic new law that will regulate and control – rather than criminalize – so-called “bath salts” and other new synthetic drugs.

New Zealand's groundbreaking regulatory model for new synthetic drugs

report on Scotland’s First Harm Reduction Café 

held in Glasgow in November last year. The event was a great success and we received a lot of positive feedback on the night and subsequently.

To mark the event and capture some of the atmosphere, learning and other outputs from the café, we have produced a report which will hopefully inspire and assist others to organise such an event. Along with partners at Turning Point Scotland and Crew we thank those who attended and contributed for all their efforts.

This report intends to support anyone wanting to host a harm reduction cafe in their local area.

1st Scottish Harm reduction cafe report

The economical crisis has a huge impact on the public health situation in most of the European countries. Severe budget cuts and austerity measures aimed at NGO’s and low threshold services strongly affect the social and health situation of marginalised and vulnerable groups.

This newsletter is devoted to this urgent issue and presents examples and reports from Correlation partners in South and South East Europe. Greece, for example, is in the middle of a public health disaster. To meet budget-deficit reduction targets set by the European Central Bank, European Commission, and International Monetary Fund (the so-called troika), Greece’s public health budget has been cut by more than 40%. As Greece’s health minister observed, “these aren’t cuts with a scalpel, but with a butchers knife.

The spending was reduced to 6% of GDP, a figure lower than the UK, at 8%, and Germany, at 9%.As a result, HIV infections have jumped by more than 200% since 2010, mainly affecting intravenous drug users, as needle-exchange programme budgets were cut in half.

Policy paper: Who is paying the price for austerity?

The UN Special Rapporteur on Torture has joined the growing list of health experts and human rights bodies urging a move long advocated by the Legal Network: the implementation of prison-based needle and syringe programs (PNSPs). In fact, we were among the invited experts at a meeting convened by the Special Rapporteur last year, to examine how to strengthen the UN's existing Standard Minimum Rules for the treatment of prisoners and people in other places of detention.

Informed by that meeting, the Special Rapporteur's latest report (see "Latest reports") to the UN General Assembly highlights the particular vulnerability to abuse in detention of people living with HIV, people who use drugs, women, sex workers, and LGBT people. It reaffirms that health care in prisons should be equivalent to that in the community, going so far as to state that the new UN rules on prisons should oblige states:

"to ensure that all harm-reduction measures, including ... needle and syringe exchange programmes and evidence-based substance abuse treatment, are available to people who use drugs at all stages of their detention."

The Special Rapporteur also reiterated (from a previous report) concerns about the practice in some settings of withholding methadone or other drug dependence treatment as an interrogation technique.

This latest report represents a significant step forward in the international recognition of the rights of prisoners and people who use drugs. Nevertheless, the Canadian government continues to resist scientifically proven harm reduction services, even working to undermine them at the international level. Such recalcitrance only underscores the necessity of our ongoing court case seeking the implementation of needle and syringe programs in federal prisons, as well as the need for us to keep our engagement internationally as UN member states begin a review of global drug policy over the next two years.

Publications from IDPC Members