Kabul, the capital of Afghanistan, consists of 7 million populations from original Kabuli and from different provinces and returnees from neighbor’s countries. Kabul is known as heroin transient smuggling way, consist of more than 1000,000 people who use drug countrywide and more than 20,000 injecting drug users, there is increment of drug users.

Since April 2006, MdM has been running a model Harm Reduction (HR) program targeting Injecting Drug Users (IDUs) in Kabul within the Afghan National HIV/AIDS framework. This program was designed to introduce HR in the country. Two of the major services introduced were ART (AntiRetroviral Therapy) in April 2009 and methadone (used as Opioid Substitution Therapy) in February 2010, to mitigate and reduce HIV/AIDS and other blood borne viruses (BBV) among IDUs.

For many years detoxification was the only intervention available, some authorities were opposite for the Harm Reduction Program even, much still to MMT. As detoxification has 90% relapsed (WHO), HIV prevalence and other BBV are increased day by day, and that’s why MDM attempted to start a Pilot MMT program in Afghanistan-Kabul for People who use drug particularly for injectors. Finally after much more attempts and struggling against Ministry of Counter Narcotic and DRC, MDM succeed to start Methadone Maintenance Therapy Practically in Kabul February 2010.

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

Drug users and methadone maintenance therapy impact

A multiannual EU Drugs Strategy (the current one covers the period 2013-2020) sets out the priorities and objectives for the action on drugs of EU countries, the Commission and other EU Institutions and bodies.

The Council endorsed the EU Drugs Strategy (2013-2020) on 7 December 2012. The aim of this strategy is:

reduction in drug demand and drug supply 

within the EU, as well as a reduction as regards the health and social risks and harms caused by drugs.

The Strategy is centred around two pillars: drug demand reduction and drug supply reduction. These are complemented with three cross-cutting themes that represent the horizontal nature of the drugs problem:

information, research, monitoring and evaluation

Two successive EU Drugs Action Plans, covering the period 2013-2016 and 2017-2020 respectively, set out concrete actions to implement the EU Drugs Strategy: EU Action Plan on Drugs (2013-2016) and the EU Action Plan on Drugs (2017-2020).

The EU Drugs Strategy (2013-2020)

The report by Tony Kirby and Michelle Thornber-Dunwell (July 27, p 295)uncovers an emerging and troubling public health and community issue. The intersection of unprotected sex and use of street and party drugs is likely to amplify the transmission of HIV, hepatitis C virus (HCV), and sexually transmitted infections (STI) in men who have sex with men (MSM).

Early diagnosis and treatment is increasingly becoming, or will likely become, the dominant approach to control STIs, HIV, and viral hepatitis. With use of a similar approach for these related infections, it might become more feasible to implement coordinated control strategies that are effective. However, one of the large dangers for which we provide warning is risk disinhibition and primary prevention fatigue, which we are seeing as starting to counteract the benefits of improved access to diagnostic testing and effective treatment. In the longer term, research with vulnerable MSM is needed to better understand the range of relevant factors including how these men perceive risk and balance that against pleasure and the causes of the increased incidence of unprotected sex and substance use. The results of such research can be used to strengthen the health and wellbeing of communities of MSM around the world.

Click here to read the full publication (restricted access)

HIV, HCV, and drug use in men who have sex with men

As with many western countries, New Zealand’s drug laws are out of date and are causing more harm than was originally intended. The laws carry the shadow of a prohibitionist past, have failed to keep up with innovations in drug production and supply and do not relate well to modern understandings of harm reduction and health protection.

The challenge of Benzylpiperazine (BZP) ‘party pills’ in the late 1990s and early 2000s made deficiencies in New Zealand’s drug law abundantly clear. No framework for controlling BZP and other party pills could be found within existing laws and regulations. An endless cat and mouse game began between the Government and the ‘legal high’ industry, with new psychoactive substances (NPS) coming onto the market as quickly as existing substances could be banned.

This prompted the New Zealand Government to order a review by the New Zealand Law Commission of the Misuse of Drugs Act 1975 (MODA).

The recommendations from this review led to New Zealand’s ground-breaking and worldleading Psychoactive Substances Act 2013.

New Zealand’s small population and remote location make for a poor and risky market for international drug rings. Drugs like heroin and cocaine, which are present in other parts of the world, are relatively rare. The creation of NPS continues a long history of New Zealanders making the most of available resources to create
substitutes for drugs that are unavailable.

It is fitting then, that New Zealand has become the first country to pass legislation that seeks to regulate NPS to ensure they are low risk, rather than to control them through prohibition and punitive measures.

The Psychoactive Substances Act 2013 has been generally well-received by politicians, the ‘legal high’ industry and the public. It is also receiving considerable attention from like-minded jurisdictions around the world.

As we shall see, if is far from a perfect or final solution, but it bodes extremely well for future drug policy development and reform, both here and overseas.

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IDPC Briefing Paper - New Zealand’s psychoactive substances legislation

Evidence documents successful hepatitis C virus (HCV) treatment outcomes for people who inject drugs (PWID) and interest in HCV treatment among this population. Maximising HCV treatment for PWID can be an effective HCV preventative measure. Yet HCV treatment among PWID remains suboptimal. This review seeks to map social factors mediating HCV treatment access.

Combination intervention approaches need to encompass social interventions in relation to housing, stigma reduction and systemic changes in policy and health care delivery. Future research needs to better delineate social factors affecting treatment access.

Hepatitis C treatment access and uptake for people who inject drugs: A review mapping the role of social factors

This 32-page report, entitled “Time to Listen”, describes U.S. policy as “on auto-pilot”, largely due to the powerful bureaucratic interests in the Pentagon and the Drug Enforcement Administration and their regional counterparts that have built up over decades.

“The counter-drug bureaucracies in the United States are remarkably resistant to change, unwilling to rethink and reassess strategies and goals,” said Lisa Haugaard, director of the Latin America Working Group Education Fund (LAWGEF) which released the report along with WOLA and the Centre for International Policy (CIP).

The report also noted that new security technologies, including drones, whose use by the U.S. and other countries is growing quickly throughout the region, and cyber-spying of the kind that prompted this week’s abrupt cancellation by Brazilian President Dilma Rousseff of her state visit here next month, pose major challenges to the security environment and civil liberties in the region.

Total U.S. aid to Latin America hit its highest level in more than two decades in 2010 – nearly 4.5 billion dollars – due to the costs of the “Merida Initiative”, a multi-year programme for fighting drug-trafficking in Mexico and Central America, and a major inflow of assistance to help Haiti recover from that year’s devastating earthquake.

But aid fell sharply in 2011 – to just 2.5 billion dollars – and is expected to decline to just 2.2 billion dollars in fiscal 2014, which begins Oct. 1.

Military and security assistance also reached its height in 2010, at 1.6 billion dollars, but has since declined to around 900 million dollars, largely as a result of the phase-out of Plan Colombia and the Merida Initiative. Central America is the only sub-region in which aid, including non-security assistance, is increasing significantly.

Time to listen: Trends in U.S. security assistance to Latin America and the Caribbean

In early September 2013, the Association of South East Asian Nations (ASEAN) held a meeting in Brunei Darussalam for ministers with responsibility for drug control issues to discuss the mid-term review of the strategy for a drug-free ASEAN by 2015. As Chairman of the meeting, the Brunei Minister of Energy at the Prime Minister’s Office, said in his statement: 

“We have reaffirmed our determination to resolve and work closely together to realise the vision of a Drug-Free ASEAN 2015 and beyond, realising that combating the drug menace is no longer just the individual responsibility of each ASEAN state, but the collective responsibility of all.”

In emphasising the collective responsibility of ASEAN member states, the Chairman’s remarks reflect the recognition that illicit drug markets do not respect borders – perhaps a heightening concern as border controls are set to become more liberalised in the establishment of the ASEAN Economic Community in 2015. Incidentally, ASEAN’s current drug strategy ends in 2015 and to inform the development of a post-2015 strategy, Ministers announced that the final review of member states’ implementation of the current drug strategy would begin in 2014. Ministers expect that the final review will provide a clear picture of ASEAN’s achievements and gaps in implementing the drug strategy.

In an advocacy note released in 2012, IDPC referred to the regional trends in drug use and supply, which show the futility of focusing drug control efforts on eradicating drug markets. IDPC recommended that ASEAN develop a drug strategy capable of managing the complexity of causes and consequences relating to drug markets, in order to achieve the desired improvements in human security, health and development. These recommendations are consistent with those of expert bodies such as the Global Commission on HIV and the Law (established by the United Nations Development Programme) and the Global Commission on Drug Policy (body of eminent figures promoting informed, science-based discussion about humane and effective ways to reduce the harm caused by drugs).

This briefing aims to provide recommendations for ASEAN member states as they consider approaches to conducting the final review of the ASEAN drug strategy ending in 2015.

The advocacy note is available below in English, Burmese, Cambodian, Vietnamese and Lao.

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IDPC Advocacy Note - A drug-free ASEAN by 2015: Harmless rhetoric or a dangerous mantra?

Kratom (or Ketum) is a psychoactive plant preparation used in Southeast Asia. It is derived from the plant Mitragyna speciosa Korth. Kratom as well as its main alkaloid, mitragynine, currently spreads around the world. Thus, addiction potential and adverse health consequences are becoming an important issue for health authorities. Here we reviewed the available evidence and identified future research needs. It was found that mitragynine and M. speciosa preparations are systematically consumed with rather well defined instrumentalization goals, e.g. to enhance tolerance for hard work or as a substitute in the self-treatment of opiate addiction.

There is also evidence from experimental animal models supporting analgesic, muscle relaxant, anti-inflammatory as well as strong anorectic effects. In humans, regular consumption may escalate, lead to tolerance and may yield aversive withdrawal effects. Mitragynine and its derivatives actions in the central nervous system involve μ-opioid receptors, neuronal Ca2+ channels and descending monoaminergic projections. Altogether, available data currently suggest both, a therapeutic as well as an abuse potential.

Click here to read the full publication (Restricted access)

From Kratom to mitragynine and its derivatives: Physiological and behavioural effects related to use, abuse, and addiction

About a third of the global HIV infections outside sub-Saharan Africa are related to injecting drug use (IDU), and this accounts for a growing proportion of persons living with HIV. This paper is a response to the need to monitor the state of the HIV epidemic as it relates to IDU and the availability of HIV treatment and harm reduction services in 21 high epidemic countries.

In order to be able to monitor the impact of HIV treatment and harm reduction services for PWID on the epidemic, epidemiological data on IDU and harm reduction service provision to PWID needs to be regularly collected using standardised indicators.

Availability of HIV prevention and treatment services for people who inject drugs: Findings from 21 countries

Experience from the last decade in Colombia and Mexico suggests that violence increases when governments achieve their objective of beheading and fragmenting drug trafficking organizations (DTOs). In this paper I provide a theoretical framework to understand this behavior. Drawing elements from industrial organization, I model DTOs as firms that collude by not attacking each other in order to increase their profits. DTOs always collude when they interact repeatedly; thus, previous analyses focusing on a static Nash equilibrium miss an important part of the dynamics between DTOs. I show that a peaceful equilibrium arises if there are only a few DTOs that care enough about the future.

Policies resulting either in a larger number of DTOs or in more impatient leaders increase violence between DTOs without reducing supply. On the other hand, policies that reduce the productivity of DTOs, without directly attacking their leaders and fragmenting them, are more desirable since they can curb supply, although this comes at the cost of increased violence if the elasticity of demand is below a certain threshold. I calculate this threshold, which is a refinement of the value suggested by Becker et al. (2006) for consumer markets.

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Should drug policy be aimed at cartel leaders? Breaking down a peaceful equilibrium

More or less ten years ago, a small group of professionals from APDES were confronted with a new arena of action: the streets, the “open scenes” where the drug users spent most of their time… Despite the experts naming these life scenarios “open scenes”, the communities living there were considered as “hidden populations”. And why was that?

Because they were rarely in contact with the health and social structures, never having an opportunity to see a doctor or to have a chat with a social worker. These were people never touched by the long arm of the social-sanitary system.

Unknown and abandoned to their fate, these were people wandering from street to street. So these professionals
were challenged with a new set of obstacles, experiences and ways of approach which were completely new. For the first time in their lives, these “open” settings exposed them to a new way of engaging with the communities, quite distant from the secure base of their desk at the office.

This book gives an answer to many of the questions that might be asked about what an outreach worker actually does, what attitudes he/she should acquire, and it gives a broad overview of the different activities, knowledge, skills and attitudes the professional outreach worker in harm reduction should know of and be aware of. A lot of work lies behind this extensive overview: it is not only about doing outreach, but also describes the importance of being able to form relationships with service users, and with other service providers, in order to support service users and to create opportunities for change.

People will find this E-Book useful when training new outreach workers, and it will help to create debate and reflection for the more experienced workers, thus becoming even better at doing their work.

Professional profile of the outreach worker in harm reduction

Among the radical options that are often proposed for a drug policy reform is the creation of a system of licensed cannabis supply subject to taxation and regulation of supply and demand sides of the market. In this study, we consider a hypothetical reform of this kind and identify a long list of possible sources of net social cost and benefit that could result. We attempt to quantify them, using the concept of net external benefit as an evaluation criterion. Net external benefit is the total value in cash-equivalent terms of the costs and benefits that cannabis use imposes on society outside the user him/herself, and it therefore excludes the potential net benefits (‘enjoyment’) accruing to cannabis users in a reformed market.

Our evaluation is consequently conservative in that it contains an inherent bias in favour of the prohibitionist status quo. In our view, it is impossible with available UK evidence to produce a credible estimate of net consumption benefits. Despite the bias this entails, it gives a far more reliable picture of the policy question than the many widely-cited estimates of the “social cost of drug use”, which include internal costs (potential harms to drug users) but ignore completely the internal benefits which are the reason that recreational drugs are used in the first place.

The estimates underpinning our evaluation should not be seen as predictions of what would happen if such a policy were to be introduced in some future period, since they relate to the market situation as it existed in England and Wales in 2009/10, and they abstract from any transitional adjustments (and any accompanying transitional cost). We have not attempted to extend the evaluation to cover Scotland or Northern Ireland, since most of the data resources available to us cover England and Wales only.

In constructing the estimates, we consider a wide range of evidence and the difficulties involved in drawing conclusions from that evidence. We provide simple, largely subjective, quantitative indications of the degree of uncertainty involved in our estimates, some of which should be regarded as illustrative calculations rather than formal estimates. Our aim is not to produce a definitive cost-benefit analysis of a licensed and regulated cannabis market – which we believe to be impossible in the present state of knowledge – but to set out clearly the range of considerations that need to be considered in forming a view about this policy, and to indicate which aspects of the evaluation are likely to be critical to the outcome of a full cost-benefit analysis.

Publications