Anna Conway presented at the NDARC Webinar Series on Thursday 22 July 2021.

This presentation drew on the experiences of people receiving and providing Opioid Agonist Treatment (OAT) during COVID-19.

The COVID-19 pandemic required Opioid Agonist Treatment (OAT) services to adapt quickly to ensure continuity of care. The CHOICE Study uses data collected from 70 in-depth interviews (40 people receiving OAT; 30 providers) to explore how OAT services in Australia responded to COVID-19 and the wider implications of the pandemic for people receiving OAT. Study findings will inform clinical practice and health policy, and highlight areas of future research for people who are dependent on opioids.

The impact of COVID-19 on people receiving Opioid Agonist Treatment (OAT) in Australia

Today, International Drug Users Remembrance Day, is one day among all the others when the people we have lost continue to pop up in our thoughts through little memories, good or bad. It’s a day to acknowledge and value all the lives needlessly lost worldwide.

I’m just one young drug user among millions, living in Halifax, Nova Scotia, Canada. Each passing year, I lose three or four friends and comrades due to the toxic drug supply and the policy conditions and prejudice that create it.

The first one over the past 12 months that really shocked me and hit me hard was Jesse Harvey, who died in September 2020. It seems like everything we find out these days is through our phones or social media. It takes on a surreal, sinister feeling when you scroll and see your favourite harm reduction journalist tweet: “I’m at a loss of words this morning #HarmReduction has lost yet another one of its quiet heroes”—and then you realize you knew him well.

Jesse was such a brave young advocate, creating and effecting change as co-founder of the Church of Safe Injection in Maine. He was one of the first non-Canadian advocates I spoke with in depth as my commitment to international advocacy grew. We actually talked about maybe setting up a Canadian chapter, but at that time most of my focus was on working to open up our local overdose prevention site. Jesse was passing out safe using supplies, naloxone and fentanyl testing strips even when doing so was illegal, because that’s who he was. He talked about his battles to register the Church as a nonprofit and win it religious exemption from US drug laws.

“We’re not saying it’s our religious belief to use heroin. No, not at all,” he told 

the year before his death. “We’re saying that it’s our sincerely held religious belief that people who use drugs don’t deserve to die when there are decades of solutions.”

What International Drug Users Remembrance Day means to me

Ruth Birgin coordinates the Women and Harm Reduction International Network according to which drug policy presents the single greatest threat to the health and well-being of women who use drugs

Can you introduce yourself and explain the work of the Women and Harm Reduction International Network (WHRIN)?

 Certainly. My name is Ruth Birgin and I work as WHRIN Coordinator. Women who use drugs along with members of the international harm reduction community recognized the need to establish a mechanism to focus on gender responsive harm reduction services, leading to the development of the Women and Harm Reduction International Network (WHRIN), formed in 2009 and led by women who use drugs. The goal of WHRIN is to improve the availability, quality, relevance and accessibility of health, social and legal services for women who use drugs.

Women who use drugs face specific problems as compared to men… Can you explain what they are?

 Without a doubt the challenges faced by women who use drugs are overwhelmingly linked with and exacerbated by prohibition rather than the substances themselves. When combined with the social and structural impacts of gender inequality it is little wonder that, for example, rates of HIV prevalence are higher among women who use drugs than their male counterparts. (I list more women-specific challenges in other questions)

Could you explain why and in what ways women who use drugs are stigmatized, and what messages would you like to convey in this regard?

Women who use drugs face compounded stigma where gender inequality and punitive drug policy converge to mete out unique punishments and risks. Women who use drugs are doubly demonised for challenging gender stereotypes of women as conventional, demure mothers/daughters/sisters etc., simply by using drugs, with criminalization and media sensationalism and misinformation further exacerbating gendered stigma and discrimination.

This places women who use drugs in a unique situation, restricting access to health services while elevating the risk of violence and BBV transmission. Our key messages include that drug use does not equate with bad parenting, it is part of the human condition and that the world is in dire need of humane drug policy where women who use drugs are no longer criminalised, pathologized or infantilised – but instead enjoy the same human rights as other people.

Support, don't punish women who use drugs!

Nat Gombos hesitated before participating in a new campaign encouraging young professionals to speak openly about their illicit recreational drug use.

“I still struggle with it, thinking through the potential ramifications” the 28-year-old says. “I ask myself if it’s smart. But nothing happens without people agitating for change. By not speaking up, I contribute to the wall of silence harming people.”

The solicitor from Sydney, who takes drugs such as MDMA, ketamine, cocaine and cannabis every few months, says this silence presents a false narrative of what drug-taking looks like.

Gombos is participating in a campaign by registered charity Unharm called 

 One of the major tactics Unharm is employing to achieve their “legal and safe” drug use goal is mimicking the strategy of gay equality law reform movements: by persuading people to “come out” about their use – especially those who dispel stereotypes. Unharm’s ultimate goal is to decriminalise all drug use in Australia by 2030.

This has been done to varying degrees by other countries: Canada and 18 US states have legalised cannabis use and supply, and Portugal decriminalised all illicit drug use in 2001 and it has been regarded as a success, with fewer drug-related deaths and less drug-related crime. Germany, Spain, Switzerland, Chile, Peru, Uruguay and the US state of Oregon have also all decriminalised drug use in one way or another.

Coming out about illicit drug use: ‘The hush-hush attitude has to end’

Overdose deaths soared to a record 93,000 last year amid the COVID-19 pandemic, the United States government reported on Wednesday.

That estimate far eclipses the high of about 72,000 drug overdose deaths reached the previous year and amounts to a 29 percent increase.

“This is a staggering loss of human life,” Brandon Marshall, a Brown University public health researcher who tracks overdose trends, told the Associated Press.

The nation was already struggling with its worst overdose epidemic but clearly “COVID has greatly exacerbated the crisis,” he added.

Lockdowns and other pandemic restrictions isolated those with drug addictions and made treatment harder to get, experts have said.

‘Staggering loss’: Overdose deaths spike in US during pandemic

Since 2009, the Andrey Rylkov Foundation has been on the streets of Moscow, offering clean syringes so people can inject addictive drugs without the added risk of HIV. The Russian government isn’t a fan of this type of initiative, known as harm reduction — even though it’s recommended by the World Health Organization. Moscow prefers to take a harder line on drug use and prevent HIV by pushing traditional moral values.

That approach isn’t working. Initially fueled by injection drug use, lately the epidemic has been spreading beyond drug users to the general population, affecting well more than one in 100 Russians. (Diagnoses dropped in 2020, but according to the federal HIV monitoring center, that’s likely because testing decreased during the pandemic.) Pre-COVID, cases were on the rise in Russia.

So the Andrey Rylkov Foundation’s work isn’t just about distributing needles and the opiate overdose treatment Naloxone. They’re campaigning against Russia’s war on drugs — a mission that’s gotten much more difficult since they were forced to register under Russia’s “foreign agent” rules in 2016, which requires political organizations that receive assistance from abroad to jump through a bunch of extra hoops.

The new AIDS epidemic: Pushing past Putin

IDPC’s Drug decriminalisation [e]Course is a free-to-access online learning course that is open to anyone interested in this important topic.

When done properly, the decriminalisation of drug use and personal possession can have significant benefits for the health, wellbeing and rights of people who use drugs - yet this approach can sometimes be difficult to advocate for as it runs counter to decades of public and political messaging from a global ‘war on drugs’. To support and equip partners from around the world, the Drug Decriminalisation [e]Course was created in 2021 by IDPC in partnership with Mainline, Health[e]Foundation and Frontline AIDS includes seven modules:

Introduction, definitions and support for decriminalisation

Thresholds and defining drug possession for personal use

Designing decriminalisation: sanctions and intrusiveness

The ‘gold standard’ for decriminalisation 

It has been designed so that participants can take just one module, or all seven, and in any order they prefer. The [e]Course host, Marie Nougier, provides guidance throughout the modules – each of which should take between 1 and 2 hours to complete, including videos and activities – and participants receive a certificate at the end of each Module.

Click here to register and access the free course!

Introducing the Drug Decriminalisation [e]Course

The publication of the second phase of Dame Carol Black’s Independent Review of Drugs will, hopefully, mark a sea-change in approaches to treatment in this country. The report pulls no punches in describing the extent to which funding has been slashed in recent years, and it makes a call for an additional £550 million to be allocated to treatment over the next five years - bringing spending back to 2012 levels. Though even if the UK Government does agree to this additional funding - and we sincerely hope they do - it is worth comparing with the Scottish Government’s commitment to an additional £250 million over the same time period, for a much smaller population.

The report also calls for an overhaul of quality oversight, commissioning models and workforce development. All of which are urgently needed. The drug (and alcohol) treatment sector has been shamefully neglected in recent years, contributing to the appalling increases in drug-related deaths that we have witnessed over the same period. Carol Black is clearly committed to addressing the problems in the sector, and to improving the lives and prospects of those who need support for drug-related problems.

However, the report is disappointing in other respects. Unlike the Phase 1 review, which laid out in forensic detail the scale and impact of drug markets, this review is light on the evidence it brings to bear. It notes that key, evidence-based approaches such as Housing First are vital to holistic treatment approaches, but while calling for expansion of this model the body of the report, Housing First doesn’t make it into the actual recommendations.

England - Black review: Strong on treatment, but avoids law reform

he governor of Rhode Island on Wednesday signed a bill to establish a safe consumption site (SCS) pilot program where people could test and use currently illicit drugs in a medically supervised environment. It’s the first state in the country to legalize the harm reduction centers.

The legislation was approved by the House of Representatives last month, when lawmakers also accepted a Senate companion version. Last week, the Senate, which had passed an earlier version of the bill in February, approved changes and gave final approval, sending the proposal to Gov. Dan McKee (D).

The governor didn’t issue a statement on the legislation, but his office noted in a press release that he signed it along with more than 20 other bills.

Under the new law, individual municipalities will still need to authorize the facilities to operate in their jurisdictions during the two-year pilot program.

Rhode Island makes history by legalizing safe consumption sites

MEXICO CITY - Mexico's Supreme Court voted that laws prohibiting the use of recreational marijuana were unconstitutional on Monday. The vote came after the Mexican Senate and Congress have repeatedly failed to finalize a Supreme Court-mandated cannabis legalization bill that has now missed three separate deadlines.

But while certain laws prohibiting recreational marijuana have now been erased, weed is hardly legal in Mexico.

Lisa Sánchez, a prominent Mexican drug policy activist and director of the civil association Mexico United Against Crime, called the supreme court decision “very technical” but said: "If I had to translate it simply, the court recognized that the use of cannabis is protected by human rights."

The court ruling ordered the Mexican government to issue permits for personal marijuana use and the cultivation of small amounts of cannabis plants for any citizen 18 or older who applies. These kinds of permits have existed since 2015 but only for those who filed a court injunction.

However, the majority of cannabis restrictions still remain after the vote.

The Supreme Court is forcing Mexico to legalize weed, sort of

In 2020, a group of Nepali and international civil society and community organisations provided a comprehensive review of the human rights situation of people who use drugs in Nepal, on the occasion of Nepal’s 3rd Universal Periodic Review at the Human Rights Council.

The following statement was delivered by Bishnu Fueal Sharma, CEO of Recovering Nepal on the occasion of the adoption of the recommendations derived the Universal Periodic Review of Nepal by the Human Rights Council, during the 47th session of the Council held in June-July 2021.

Human rights and people who use drugs in Nepal: Statement at the 47th Session of the Human Rights Council

It is 50 years since the June 18, 1971 address by US President Richard Nixon that publicised the US administration’s war on drugs. Nixon declared that drug abuse was “America’s public enemy number one”. Despite Nixon mentioning “rehabilitation, research, and education” in his speech, the war on drugs has been an offensive, with military interventions, soaring arrest rates, and aggressive sentencing. The USA has borne a huge cost, both financially and socially, with those most marginalised and vulnerable shouldering the largest burden. Five decades in, and despite multiple administration changes, no sign of victory can be seen. Drug use flourishes, with 13·0% (35·8 million) of Americans aged 12 years or older in 2019 reporting they had used an illicit drug in the preceding month, as revealed by the National Survey on Drug Use and Health. The same year saw 70 630 deaths due to drug overdose, with 49860 involving opioids (of which 14139 were due to prescription opioids).

Although HIV was unknown at the time of Nixon’s speech, the fate of the war on drugs and the HIV epidemic are intertwined. 186500 of the 1·2 million people with HIV in the USA are believed to have acquired the virus through injection drug use. Despite the USA seeing an overall fall in HIV diagnoses over the past 5 years, infections due to injection drug use are on the rise. If the ambitious target of ending HIV in the USA by 2030 is to be reached the needs of injection drug users will be a key part of the strategy.

The effects of the war on drugs are not confined to the USA, and injection drug users face stigma and criminal­ isation worldwide. Globally, around one in eight people who inject drugs are living with HIV, and injection drug users are 29 times more likely than non­users to acquire HIV. In 2019, as shown in the new UNAIDS report Global Commitments, Local Action, 10% of new infections worldwide were in those who inject drugs. Many of these infections could have been prevented if the war on drugs had not contributed to an environment hostile (both politically and socially) to injection drug users. Some regions are hit harder than others: in eastern and central Asia 48% of new HIV infections are linked to injection drug use.

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