In 2010, the 63rd World Health Assembly (WHA) adopted the first resolution on viral hepatitis (WHA63.18). A new resolution will be presented at the 67th WHA.

Globally, an estimated 185 million people have been infected with hepatitis C virus (HCV). Since 2010, more than a million people have died from HCV, although it is treatable and curable. Nine to twelve million people have been infected since 2010, although HCV is preventable. Most new infections occur among people who inject drugs (PWID), yet access to HCV prevention tools (such as sterile injection equipment) is woefully inadequate, reaching a tiny percentage of those who need it. This shocking public health failure allows the epidemic to continue spreading.

Only a tiny fraction of people who have been infected with HCV are aware of their status. Most live in low and middle-income countries (LMICs) and have no access to diagnostics, care, or treatment. Pegylated interferon (peginterferon, or PEG-IFN), the backbone of the current standard of care for HCV, is priced cruelly out of reach. Even in places where HCV treatment is available, injecting drug use is often used as a criteria for denying access: only 2-4 percent of people who inject drugs are currently receiving treatment.

We, people living with HCV, HIV/AIDS, people who use drugs and our advocates, urge United Nations Member
States to act strongly in order to tackle the hepatitis C epidemic; it is feasible!

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Defuse hepatitis C, the viral time bomb!

Ahead of World AIDS Day on 1 December, the 

 has released today a new toolkit offering countries the latest guidance on monitoring infectious diseases, such as HIV/AIDS and viral hepatitis (B,C), among people who inject drugs (PWID). The toolkit is designed to help health professionals improve their monitoring practice in order to reduce the burden of disease in this vulnerable group and improve the coverage and quality of services delivered.

Prepared closely with experts, country representatives and international and EU agencies, the toolkit updates earlier guidance, and presents new monitoring methods and indicators in a more flexible and user-friendly format.

EMCDDA toolkit - Drug-related infectious diseases 

In most European Union (EU)/European Economic Area (EEA) countries, between 2010 and 2012, reports of new human immunodeficiency virus (HIV) diagnoses among people who inject drugs have been stable or declining. HIV outbreaks in Greece and Romania, first reported in 2011, continue and economic conditions hinder provision of effective response coverage. When measured against some established thresholds, prevention coverage remains inadequate in at least one-third of EU/EEA countries. Urgent consideration to scale up prevention efforts is merited.

In response to sharp increases in human immunodeficiency virus (HIV) notifications reported among people who inject drugs (PWID) in Greece and Romania, a risk assessment of HIV transmission among PWID was carried out in the European Union/European Economic Area (EU/EEA), Croatia and Turkey, in 2011. The report, covering 31 countries, confirmed outbreaks among PWID in Greece and Romania and noted a potential for outbreaks elsewhere [1,2]. This update, based on a survey conducted in mid-2013, summarises developments in HIV transmission and injecting risks among PWID since 2010 and identifies areas where scale-up of evidence-based preventive measures is needed to avoid further outbreaks.

HIV among people who inject drugs: Is risk increasing in Europe?

In June 2013, the UN Office on Drugs and Crime released estimates on HIV, hepatitis C and injecting drug use within the annual World Drug Report (WDR). The 2013 report presents ‘new data’ that it claims reflects a global ‘decline’ in the number of people who inject drugs since the 2008 figures published by the Reference Group to the United Nations on HIV and Injecting Drug Use. In particular, this ‘updating’ of the 2008 data claims a ‘decline’ in the number of people who inject drugs living with HIV worldwide from 3 million to 1.6 million.

, the main independent NGO resource on the international response to HIV and injecting drug use, Harm Reduction International raised immediate concerns to UNODC about this data, in particular the use of language and graphics that attributes these considerable differences to actual changes in the HIV epidemic among people who inject drugs since 2008. As a result, UNODC released an online statement clarifying that, ‘lower estimates [in the WDR] do not represent a decrease in the epidemic, but an improved availability of more reliable data’. However, despite this online clarification the official WDR has not been similarly amended to ensure that the data is not misrepresented or misinterpreted.

Concerns regarding new estimates on HIV, hepatitis C and injecting drug use

Kenya – like most countries – has a long tradition of punitive drug policy responses that seek to eradicate drug use and trade. This is in keeping with the prohibitionist approach that has been dominant across the world for more than 100 years, despite overwhelming evidence that this approach contributes to high levels of HIV transmission among people who inject drugs, as well as many other harms.

In recent years, civil society organisations in Kenya have started to adopt programmes and practices that focus more on public health and human rights – supported mainly with funding from international donors and technical assistance from international non-governmental organisations. As part of this effort, the Kenyan Ministry of Health has recently introduced guidelines and strategies for targeted and evidence-based harm reduction interventions for people who use drugs (see Box 1), as part of its HIV response.

This briefing paper aims to review the recent developments in the response to HIV and illicit drug use in Kenya, and highlights some key recommendations to address the remaining challenges and issues.

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IDPC Briefing Paper – HIV, harm reduction and drug policy in Kenya

The number of women in prison for drug-related offenses has increased since the 1980s, rising sharply since the 1990s. This has occurred worldwide, and Latin America is no exception. Women increasingly enter drug-trafficking circuits as consumers, low-level dealers and local (including in prison), national and international transporters. In various countries around the world, the female penitentiary population has grown faster than the male, although women are still the minority.

This paper analyzes the roles played by women in criminal networks in Latin America and the means by which they become involved, highlighting the ways in which gender relations and socio-economic factors shape the configuration of international drug trafficking networks and women’s participation. It also critically examines the main characteristics of the region’s penitentiary systems from a gender standpoint. Finally, it offers a series of conclusions and proposals aimed at promoting a review and reform of drug and penitentiary policies.

IDPC Briefing Paper - Women, drug offences and penitentiary systems in Latin America 

Methoxetamine (MXE), a ketamine analogue, is one of the new “legal highs” sold on the Internet. The aim of this qualitative study was to provide an initial understanding of what characterizes the experiences induced by MXE. Anonymously written reports (33 persons) on the effects of MXE were collected from public Internet forums and analyzed using the Empirical Phenomenological Psychological Method. The analysis generated 10 themes: (1) preparation, motivation and anticipation; (2) initial effects; (3) malfunction of cognitive processes stabilizing normal state; (4) inner personal processes and learning; (5) emotional processes; (6) altered sensory perception; (7) dissolution and transition; (8) spiritual and transcendental experiences; (9) effects and processes after the experience; (10) re-dosing and addiction. MXE induced a heavily altered state of consciousness. The effects were similar to those induced by classic hallucinogens (such as LSD, psilocybin) and the dissociative ketamine. MXE seemed to have quite a high abuse potential. Beside the positive effects described, negative effects like fear and anxiety were also reported. Acceptance was considered the best coping strategy. Dissolution of identity and body often culminated in spiritual and transcendental experiences. More research is needed on safety issues, how to minimize harm, and the motivation for using legal highs. 

Methoxetamine: A phenomenological study of experiences induced by a “Legal High” from the internet

This is a guide to regulating legal markets for the non-medical use of cannabis. It is for policy makers, drug policy reform advocates and affected communities all over the world, who are witnessing the question change from, 'Should we maintain cannabis prohibition?’ to ‘How will legal regulation work in practice?'

Just a few years ago, this book would have been largely theoretical. Now, however, the cannabis regulation debate has moved decisively into the political mainstream, and multiple cities, states and countries are considering, developing or implementing a range of regulated market models for the non-medical use of cannabis. So this book draws on evidence not only from decades of experience regulating alcohol, tobacco, and medicines, but also from Spain's non-profit 'cannabis social clubs', commercial cannabis enterprises in the US and the Netherlands, and Uruguay's government-controlled system of cannabis regulation.

This book will help guide all those interested in cannabis policy through the key practical challenges to developing and implementing an effective regulation approach aimed at achieving the safer, healthier world we all wish to see.

How to regulate cannabis: A practical guide

The BGIPU hosted a seminar in Westminster on Drug Policy Reform from 28 to 30 October. Around 50 members from 30 parliaments from Latin American, West African and Europe attended along with a range of expert speakers and observers.

This event followed on from the 128th IPU Assembly in Quito panel discussion on drug policy reform and the seminar encouraged an open and frank debate on global drugs policy reform among parliamentarians from countries that are especially affected by this issue from the drugs supply and demand side. A key focus was on the unique role parliamentarians, as legislators and opinion leaders, could play on drug policy reform issues.

Drug policy reform parliamentary seminar: Perspectives from Latin America, West Africa and Europe

The latest in the Global State of Harm Reduction series, when sex work and drug use overlap : Considerations for advocacy and practice examines the multiple and varied contexts within which drug use (including use of alcohol, hormones and image- and performance-enhancing drugs) and sex work overlap. It provides a snapshot of available evidence on the factors that contribute to vulnerability among people who sell sex and use drugs. Drawing on experience from the harm reduction and sex work communities, the report explores implications for practice, highlighting existing programmes that reach people who sell sex and use drugs around the world, and offering practical suggestions on how programmes can better serve this overlapping population.

When sex work and drug use overlap

This report was commissioned by the International Drug Policy Consortium (IDPC), with the support of Australian Aid, for the purpose of developing a better understanding of drug policy advocacy activity in 10 Asian countries: Cambodia, China, India, Indonesia, Lao PDR, Malaysia, Myanmar, the Philippines, Thailand, and Vietnam. It aims to achieve three goals:

Identify organisations engaged in harm reduction and drug policy advocacy

Identify gaps and challenges in harm reduction and drug policy advocacy that remain to be addressed

Develop recommendations for prioritising new activities in harm reduction and drug policy advocacy.

The report does not provide an exhaustive review of drug policy content, rather it focuses on the process of drug policy making and attempts to understand the relationships between key stakeholders, including both policy makers and policy advocates, engaged in policy processes at local and regional level.

The report combines data collected from published reports with key informant interviews to draw its conclusions.

Drug policy advocacy in Asia: Challenges, opportunities and prospects

In South East Asia, Thailand is lauded for its success in reversing an HIV epidemic in the 1990s, particularly amongst sex workers. Thailand is also known for its success in significantly reducing opium cultivation, and implementing effective alternative development programmes for opium farmers. However, other aspects of the government’s response to illicit drug markets in Thailand undermine these successes and have been characterised by the exclusion and marginalisation of people who use drugs, which has fuelled on-going epidemics of HIV and hepatitis C virus (HCV) among this population.

The Thai government’s response to drug use continues to be one of ‘zero-tolerance’, focused on eradicating drug consumption and production with the imposition of harsh punishment for drug-related crimes, ranging from compulsory detention to the death penalty. This response reflects the regional commitment to achieving a ‘drug-free ASEAN by 2015’.

Publications