2015 saw a significant HIV outbreak among people who inject drugs in Glasgow, with 47 new diagnoses compared to a previous annual average of 10. New cases continue to occur. Initial investigations suggested a link between the outbreak and injecting in public places in the city centre, with the majority of cases interviewed reporting this risk factor.

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

“Taking away the chaos” The health needs of people who inject drugs in public places in Glasgow city centre

Opioid overdose represents a major cause of premature death and accounts for the majority of deaths among injection drug users (IDUs) world-wide. Opioid overdose deaths are preventable through timely administration of naloxone, a potent mu-opiate antagonist that rapidly reverses opiate-induced respiratory depression.

In 2014, the World Health Organization (WHO) launched guidelines on the community management of opioid overdose, recommending that ‘people likely to witness an opioid overdose should have access to naloxone and be instructed in its administration’.

The community-based provision of naloxone rescue kits to opioid users (‘take-home naloxone’, THN) was first proposed in the 1990s. THN programmes typically involve training opioid users and/or their family members or peers in overdose risk awareness, overdose emergency management and naloxone administration. During the past 15 years, THN programmes have been implemented in Europe, North America, Asia and Australia. However, the vast majority of evaluations have been pilot schemes with uncontrolled study designs.

The evaluation of THN programmes is challenging: randomized controlled trials (RCTs) are often considered the gold standard of scientific study of clinical impact, but conducting such trials in this context would often be unethical and fraught with methodological difficulties, given the infrequency and unpredictability of overdose.

Are take-home naloxone programmes effective? Systematic review utilizing application of the Bradford Hill criteria

HIV infection among people who inject drugs (PWID) in Kenya is at 18%, and has been attributed to risky injecting practices. The risk environment enabling these practices has not been explored. This paper reports findings from Access to Care, a qualitative study in Kenya. Using in-depth interviews with PWID, we explore how the introduction of needle and syringe programmes (NSP) has impacted on needle and syringe sharing. PWID report significant reductions in sharing injecting equipment following NSP, although sharing continues, linked to challenges in supply and amongst PWID living with HIV, linked to hopelessness for the future. We conclude that NSP should expand across Kenya, linked to efforts to overcome delivery challenges and efforts to support people living with HIV.

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

Implementing needle and syringe programmes in Kenya

Global evidence indicates that mandated treatment of drug dependence conflicts with drug users’ human rights and is not effective in treating addiction. 

 argue that drug treatment policies must be evidence based and meet international standards

During 2013 to 2015 the Russian Federation (Russia) amended its laws to enable courts to force people who use drugs to have treatment for addiction. The laws give courts the ability to mandate sentenced offenders with drug dependence to undergo dependence treatment in combination with non-custodial measures such as fines or coercive labour. Russian authorities have stated that the new laws were enacted as motivation for treatment. Our analysis globally examines the acceptability and efficacy of legislative approaches mandating treatment of drug dependence.

Increasing drug use in Russia led to parallel HIV epidemic

Drug use in Russia, consisting mostly of injectable heroin, increased after the break-up of the Soviet Union. There were over 540 000 drug users registered in Russia but the United Nations Office on Drugs and Crime estimated that were about 1.8 million opiate users in the country in 2014. The prevalence of injecting drug use (2.29%) among 15-64 year olds is almost 10 times the global prevalence estimate of 0.27%.

Click here to read the full article (restricted access).

Mandatory addiction treatment for people who use drugs: global health and human rights analysis

On 24 March 2016, STOPAIDS convened over 60 representatives from government, multilateral organizations, NGOs, academic institutions, private foundations and activists living in middle income countries from across the international development field to generate ideas and debate around how to engage with middle income countries. The symposium revealed the overall futility of the middle income country category, reminding participants that the issue at hand was not middle income countries (MICs) vs. lower income countries (LICs) vs. higher income countries (HICs), but rather how to reach the people most in need of development assistance, wherever they are. Four central themes were discussed throughout the day: indicators for assessing development, leaving no one behind, the role of civil society, and transitions away from aid.

Middle income countries: reclassified symposium outcome document

The emergence of NPS over the last decade poses an important challenge to drug policy (UNODC, 2013). While prevalence levels of NPS use remain low in the general European population, there are important concerns with more problematic forms of use and harms in particular risk groups across different health and social settings.

Important public health issues have arisen as a consequence of their use, although the real extent of these harms across Europe remains unknown. Initial responses to NPS in Europe have largely been regulatory, focusing on their supply using legislative tools (EMCDDA, 2015a) but, as the phenomenon evolves, it has increasingly become a priority to formulate and implement effective public health responses. Yet, while information on and our understanding of the availability and use of NPS have increased, there are still considerable knowledge gaps in current practices and even in the challenges and needs of European health professionals who are responding to the use of and harms caused by these novel substances.

Health responses to new psychoactive substances

A health study in schools of Colorado has shown that cannabis use did not increase despite legalisation.

"Marijuana Use Four out of five Colorado high school students have not used marijuana in the last 30 days, a rate that remains relatively unchanged since 2013. Colorado does not significantly differ from the national average in lifetime or current marijuana use"

Colorado: Stable cannabis use among young people

The 26th June is the International Day against Drug Abuse. It is a day that embodies laws and policies that have criminalised, subjugated, excluded, and violated the human rights of people who use drugs and the communities in which they live. It is a day that stands for an ideology that has done untold harms. And it is a day that perhaps well-reflects a difficult half-year in global drug policy.

Not least of all was the United Nations General Assembly Special Session on Drugs 2016, with the UNGASS outcome document failing to take into account the needs and human rights of people who use drugs. Indonesia has announced plans for a new round of executions for drug-related offences, while the Philippines' President-elect has made the horrific call for people who use and/or sell drugs to be killed extrajudicially, both by citizens and the police. Then there was the UK introducing a blanket ban on all psychoactive substances.

Though it seems that in many corners of the world things are moving backwards, though the exclusion of the voices of people who use drugs in the formation of law and policy has continued, though the violence, stigma, and discrimination to which people who use drugs are subject have been encouraged, though the criminalisation of people who use drugs in some regions has been ramped up, we must persevere.

On this day, the International Network of People who Use Drugs (INPUD) emphasises that people who use drugs are not the problem. We are a fundamental part of the solution, a solution to the so-called ‘world drugs problem’. The problem is not drugs themselves, nor the people who use them. The problem is driven by punitive prohibition; it is driven by criminalisation; it is driven by stigma, discrimination, social exclusion, and violence; it is driven by a systemic denial of human rights to people who use drugs and their communities. And things are beginning to move in the right direction. More countries than ever before are pushing in the direction of drug policy reform; momentum is building for positive change, for an end to prohibition.

Support and empowerment for and by people who use drugs

For almost 20 years, Harm Reduction International has been a leader in promoting the harm reduction approach to drug use and policy around the world. What started initially as a forum for organising the annual International Harm Reduction Conferences in the 1990s has grown in the past ten years to become one of the world’s leading independent sources of research and policy analysis on harm reduction and human rights issues, and on advocating for policy change alongside our regional and global partners.

The past year saw many important achievements for us at HRI. However, the clear highlight was the success of our 24th International Conference in Kuala Lumpur, staged in partnership with the Malaysian AIDS Council. For over two decades, the HRI conference has been the main international gathering of people and organisations working on harm reduction. In Kuala Lumpur, we were pleased to welcome over 900 delegates from more than 70 countries, demonstrating once again the truly global nature of our movement, and the vibrancy and dedication of the broad harm reduction community. We look forward to celebrating the milestone of our 25th conference in Montreal in 2017.

2015 was also the year in which our 10 by 20 campaign kicked into full gear. 10 by 20 is a coordinated advocacy platform to advance our broader work on increasing global funding for harm reduction, which is a key objective of our strategic plan. Created in consultation with our global and regional partners, it calls on governments to redirect 10% of the money currently spent on the ‘war on drugs’ into harm reduction services. The campaign was launched during the 2015 meeting of the UN Commission on Narcotic Drugs, and was a visible presence at every key global event during the year, including our conference. The campaign will continue to be a central theme of our collective advocacy as we head towards a UN General Assembly Special Session on drugs in April 2016.

Harm Reduction International annual report 2015

内容提要 “我们重申承诺加大努力处理和应对世界毒品问题各方面的新兴和长期挑 战与威胁……为此我们建议采取以下措施：……酌情促进使用和分析……相 关、可靠、客观的数据，以改进全面、综合、平衡的国家禁毒战略、政策和 方案的实施工作，并鼓励……交流最佳做法和经验教训。” 大会世界毒品问题特别会议题为“我们对有效处理和应对世界毒品问题 的共同承诺”的成果文件 《2016 年世界毒品问题报告》是在大会世界毒品问题特别会议这一全球禁毒政策 具有里程碑意义的时刻之后发表的。第一章是阿片剂、可卡因、大麻、苯丙胺类 兴奋剂和新型精神活性物质的供应和需求及其对健康的影响全球概览。该章还审 查了使用多种毒品的科学证据、大麻的治疗需求以及世界一些地区大麻娱乐性使 用合法化以来的事态发展。第二章着重从可持续发展目标的角度阐述世界毒品问 题与可持续发展的所有方面之间的互动机制。 吸毒及其健康后果 据估计，2014 年，每 20 个成年人中就有 1 个，即 15 至 64 岁的人中有 2.5 亿人， 使用过至少一种毒品。这一数字大约相当于法国、德国、意大利和联合王国四国 人口之和，尽管人数众多，但过去四年中在全球人口中所占比例似乎并没有增加。 然而，逾 2,900 万吸毒者估计患有吸毒疾患，其中 1,200 万人是注射吸毒者，这 其中有 14.0%感染了艾滋病毒，吸毒的影响及其健康后果仍然是灾难性的。 2014 年估计有 207,400 例涉毒死亡，相当于每百万 15-64 岁人口中有 43.5%例死 亡，全世界涉毒死亡人数也保持了稳定，虽然这是不可接受的，也是可以预防的。 吸毒过量致死占涉毒死亡的大约三分之一至一半，在大多数情况下是吸食阿片类。 刚从监狱释放的这段时间，毒品导致死亡（主要是由于吸毒过量）的风险大幅度 增加，死亡率远远高于普通民众所有死亡原因所造成的死亡率。 在许多国家，监狱仍然是传染病的一个高风险环境，这是监狱保健的一个重大关 切。一些研究报告监狱中存在大量吸毒现象，包括使用阿片类药物和注射吸毒。 此外，狱中在押犯人的艾滋病毒、肝炎和肺结核病的流行率可能大大高于普通民 众。但是，尽管存在高风险环境和有效保健干预措施的科学证据，世界各地许多 监狱的预防和治疗服务仍存在重大差距。 注射吸毒者面临与不安全吸毒有关的一些最严重的健康危害，总体健康状况不佳 （包括高度非致命和致命的过量吸毒风险），并更有可能过早死亡。注射吸毒者 中有七分之一是艾滋病毒携带者，一半患有丙型肝炎。注射吸毒者是艾滋病毒和 肝炎的重要高危人群，撒哈拉以南非洲以外的艾滋病毒新感染病例几乎有三分之一发生在注射吸毒者中。此外，研究发现，注射兴奋剂者会从事更危险的性行为， 导致艾滋病毒感染的风险高于注射阿片类药物。 大麻仍是全球最常使用的毒品，2014 年估计有 1.83 亿人使用过这种毒品，而苯 丙胺仍然是第二常用的毒品。阿片剂和处方阿片类药物的使用相对较少，估计有 3,300 万使用者，但阿片类药物仍然是具有潜在危害和健康后果的主要毒品。在 以前海洛因的使用曾不断下降的一些市场（尤其是北美），海洛因的使用出现急 剧增加，表明海洛因仍然是引发公共卫生关切的主要毒品之一。

随时掌握与药物政策发展相关的最新信息。

世界 毒品 报告 2016

"Мы вновь заявляем о своей приверженности осуществлению более активных усилий по устранению новых и сохраняющихся вызовов и угроз в контексте всех аспектов мировой проблемы наркотиков и противодействию этим вызовам и угрозам ... и мы рекомендуем следующее: ... поощрять, в надлежащих случаях, использование и анализ актуальных, надежных и объективных данных ... с целью повышения эффективности осуществления всеобъемлющих, комплексных и сбалансированных национальных стратегий, политики и программ контроля над наркотиками ... и поощрять обмен передовым опытом и извлеченными уроками". Итоговый документ специальной сессии Генеральной Ассамблеи по мировой проблеме наркотиков под названием "Наша общая приверженность эффективному решению мировой проблемы наркотиков и борьбе с ней". Всемирный доклад о наркотиках 2016 года публикуется по завершении знаменательного события в истории глобальной политики в отношении наркотиков – специальной сессии Генеральной Ассамблеи по мировой проблеме наркотиков. В главе I представлен общий обзор ситуации с предложением опиатов, кокаина, каннабиса, стимуляторов амфетаминового ряда (САР) и новых психоактивных веществ (НПВ) и спросом на них, а также их воздействия на здоровье человека. В ней рассматриваются также научные данные о полинаркомании, обращаемости за лечением в связи с потреблением каннабиса и изменениях, произошедших после легализации потребления каннабиса в рекреационных целях в некоторых районах мира. Глава II сосредоточена на рассмотрении механизмов взаимодействия мировой проблемы наркотиков и всех аспектов устойчивого развития через призму целей в области устойчивого развития.

Потребление наркотиков и его последствия для здоровья человека По оценкам, в 2014 году хотя бы какой-нибудь наркотик принимал каждый двадцатый взрослый – в совокупности четверть миллиарда человек в возрасте от 15 до 64 лет, что почти эквивалентно численности населения Германии, Италии, Соединенного Королевства и Франции, вместе взятых. Несмотря на значительность этого показателя, за последние четыре года он, похоже, не увеличился относительно численности мирового населения. Тем не менее потребление наркотиков по-прежнему оказывает разрушительное воздействие на здоровье людей: по оценкам, более 29 млн. человек, употребляющих наркотики, страдают в результате этого различными расстройствами, в это число входят 12 млн. человек, употребляющих наркотики путем инъекций (ЛНИ), из которых 14 процентов живут с ВИЧ. С учетом того, что в 2014 году от наркотиков, по оценкам, погибли 207 400 человек, уровень смертности от наркотиков составил 43,5 смерти на миллион человек в возрасте 15-64 лет. Этот показатель также почти не изменился, хотя следует отметить, что он остается недопустимо высоким и таких смертей можно было бы избежать. Приблизительно от одной трети до половины всех смертей, связанных с наркотиками, вызваны передозировкой и в большинстве случаев являются следствием приема опиоидов.

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ВСЕМИРНЫЙ ДОКЛАД О НАРКОТИКАХ 2016

“We reiterate our commitment to strengthen our efforts in addressing and countering emerging and persistent challenges and threats of all aspects of the world drug problem … and we recommend the following: … promote, as appropriate, the use and analysis of relevant, reliable and objective data … to improve the implementation of comprehensive, integrated and balanced national drug control strategies, policies and programmes … and encourage the sharing of best practices and lessons learned.”

Outcome document of the special session of the General Assembly on the world drug problem, entitled “Our joint commitment to effectively addressing and countering the world drug problem”

The World Drug Report 2016 is published in the wake of the landmark moment in global drug policy, the special session of the General Assembly on the world drug problem. Chapter I provides a global overview of the supply of and demand for opiates, cocaine, cannabis, amphetamine-type stimulants (ATS) and new psychoactive substances (NPS), as well as their impact on health. It also reviews the scientific evidence on polydrug use, treatment demand for cannabis and developments since the legalization of cannabis for recreational use in some parts of the world. Chapter II focuses on the mechanisms of the interaction between the world drug problem and all aspects of sustainable development through the lens of the Sustainable Development Goals.

It is estimated that 1 in 20 adults, or a quarter of a billion people between the ages of 15 and 64 years, used at least one drug in 2014. Roughly the equivalent of the combined populations of France, Germany, Italy and the United Kingdom, though a substantial amount, it is one that does not seem to have grown over the past four years in proportion to the global population. Nevertheless, as over 29 million people who use drugs are estimated to suffer from drug use disorders, and of those, 12 million are people who inject drugs (PWID), of whom 14.0 per cent are living with HIV, the impact of drug use in terms of its consequences on health continues to be devastating.

With an estimated 207,400 drug-related deaths in 2014, corresponding to 43.5 deaths per million people aged 15-64, the number of drug-related deaths worldwide has also remained stable, although unacceptable and preventable. Overdose deaths contribute to between roughly a third and a half of all drug-related deaths, which are attributable in most cases to opioids. The time period shortly after release from prison is associated with a substantially increased risk of death from drug-related causes (primarily as a result of drug overdoses), with a mortality rate much higher than from all causes among the general population.

In many countries, prisons remain a high-risk environment for infectious diseases, which is a significant concern for prison health. A number of studies report high levels of drug use in prison, including the use of opiates and injecting drug use. In addition, the prevalence of HIV, hepatitis and tuberculosis among persons held in prison can be substantially higher than among the general population. However, despite the high-risk environment and scientific evidence for effective health interventions, there are significant gaps in prevention and treatment services in many prisons around the world.

PWID experience some of the most severe health-related harms associated with unsafe drug use, overall poor health outcomes, including a high risk of non-fatal and fatal overdoses, and a greater chance of premature death. One in seven PWID is living with HIV, and one in two with hepatitis C. PWID are a key at-risk population for HIV and hepatitis, with almost a third of new HIV infections outside sub-Saharan Africa occurring among PWID. Moreover, studies have found people who inject stimulants to engage in more risky sexual behaviours, resulting in a higher risk of HIV infection than for those injecting opiates.

Cannabis remains the most commonly used drug at the global level, with an estimated 183 million people having used the drug in 2014, while amphetamines remain the second most commonly used drug. With an estimated 33 million users, the use of opiates and prescription opioids is less common, but opioids remain major drugs of potential harm and health consequences. The fact that a sharp increase in heroin use has been documented in some markets (particularly North America) where it was previously declining, shows that heroin remains one of the major drugs of public health concern.

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