The purpose of this report is to review the current epidemiological situation viral hepatitis B and C in Eastern Europe and Central Asia (EECA) and the responses from Governments and civil society representatives to the epidemic. The report also reflects the main mechanisms used by representatives of NGOs dealing with access to treatment for viral hepatitis in the region and its improvement. This analysis is important due to the development of a large-scale global movement aimed to eliminating viral hepatitis and ensure that the interests of the EECA region are taken into account in the development of universal access to innovative, highly efficient therapy schemes, which are currently being implemented.

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

Hepatitis B and C in Eastern Europe and Central Asia: an epidemic and a response

More than a decade in the making, America’s opioid crisis has morphed from being driven by prescription drugs to one fuelled by heroin and, increasingly, fentanyl. Drawing on historical lessons of the era of National Alcohol Prohibition highlights the unintended, but predictable impact of supply-side interventions on the dynamics of illicit drug markets. Under the Iron Law of Prohibition, efforts to interrupt and suppress the illicit drug supply produce economic and logistical pressures favouring evermore compact substitutes. This iatrogenic progression towards increasingly potent illicit drugs can be curtailed only through evidence-based harm reduction and demand reduction policies that acknowledge the structural determinants of health.

Today’s fentanyl crisis: prohibition’s iron law, revisited

Each year, an estimated 28,500 Guatemalans experience advanced, chronic illnesses, such as cancer; heart, lung, or renal disease; and HIV/AIDS. Many thousands of them will suffer significant pain related to their illness.

This pain can generally be treated well with inexpensive medications and eased with palliative care: a health service that includes treatment of pain but focuses on improving the overall quality of life of people with life-limiting illnesses.

However, a Human Rights Watch analysis has found that Guatemala’s lack of effort to ensure access to palliative care, regulatory barriers, and needlessly restrictive and complex regulations on controlled substances condemn many patients with pain to needless suffering, with devastating consequences for them and their families.

Punishing the patient: ensuring access to pain treatment in Guatemala

The UK government’s 2017 Drug Strategy published in July 2017 continues where its 2010 predecessor left off.1

The overarching aim of both is to reduce all illicit drug use and increase the number of people recovering from drug dependence. The new strategy promises enhanced monitoring of the prevalence of substances controlled by the Misuse of Drugs Act 1971, but offers no real prospect of reducing the harms associated with their use.

Nowhere is this more evident than in the failure to introduce new measures to prevent drug related deaths, which have risen across all drug classes since 2010 to an all time high,2 now outstripping the number of traffic fatalities in the UK. Marked increases in deaths involving cocaine and 60 fatalities involving the synthetic opioid fentanyl highlight the need for the government to innovate and invest in drug interventions that work, while objectively reviewing drug regulation and treatment directives that may be costing lives.3

Click here for the full article (behind paywall)

A new drug strategy for the UK

As the world approaches the midway point between the 2014 launch of the 90–90–90 targets and their December 2020 deadline, UNAIDS has reviewed the progress made. This has been done with the support of national AIDS programmes, which report data annually to the United Nations and the guidance of national programme managers, researchers and other experts within the UNAIDS Scientific and Technical Advisory Committee (STAC) on 90–90–90. The latest epidemiological estimates and programme data from 168 countries in all regions reveal progress and gaps across the HIV testing and treatment cascade. Changes in HIV policy since 2014 were also reported by countries, as were the development and roll-out of innovations in technology and service delivery.

Consistent with the commitment to leave no one behind in Transforming our world: the 2030 agenda for sustainable development, UNAIDS and its partners reviewed and synthesized country data and studies that revealed the particular challenges and strategies for securing the full preventive and therapeutic benefits of antiretroviral therapy among children, young people, women, men and key populations at higher risk of HIV acquisition.

Ending AIDS: Progress towards the 90–90–90 targets

The Sustainable Development Goals Report 2017 reviews progress made towards the 17 Goals in the second year of implementation of the 2030 Agenda for Sustainable Development. The report is based on the latest available data. It highlights both gains and challenges as the international community moves towards full realization of the ambitions and principles espoused in the 2030 Agenda.

While considerable progress has been made over the past decade across all areas of development, the pace of progress observed in previous years is insufficient to fully meet the Sustainable Development Goals (SDGs) and targets by 2030. Time is therefore of the essence. Moreover, as the following pages show, progress has not always been equitable. Advancements have been uneven across regions, between the sexes, and among people of different ages, wealth and locales, including urban and rural dwellers. Faster and more inclusive progress is needed to accomplish the bold vision articulated in the 2030 Agenda.

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

Sustainable Development Goals report 2017

Concepts in the field related to drug problems, including but not limited to drug policy, addiction treatment harm reduction or such, are labelled and defined in variable ways by different professions and disciplines throughout the world. Occasionally attempts have been made to standardize usage of terms related to the matter and affect the general change by reducing misunderstanding that as a long term result has reducing of stigma and discrimination. Nevertheless major challenges remain.

The World Health Organization recommended that “Terminology in national drug control legislation and policies should be clear and unambiguous in order not to confuse the use of controlled medicines for medical and scientific purposes with misuse”.

People of different backgrounds have difficulties in understanding and using proper terms related to drugs. Many of the words used to describe addiction and addicts only add to stereotypes and stigma. The language should be changed to reflect today’s greater understanding. By choosing terminology that is not stigmatizing, we can begin to dismantle the negative stereotype associated with addiction.

Glossary of terms used in drug policy

People who use and inject drugs are among the groups at highest risk of exposure to HIV, but remain marginalized and out of reach of health and social services.

People who inject drugs need urgent access to harm reduction interventions, including needle–syringe programmes and opioid substitution therapy. There is irrefutable evidence that new HIV infections drop sharply when people who inject drugs have access to harm reduction and other public health programmes.

People who inject drugs, including people in prisons and other closed settings, need access to harm reduction services to prevent HIV infection, including needle–syringe programmes, opioid substitution therapy, antiretroviral therapy and nalaxone.

Evidence shows that harm reduction approaches such as needle-syringe programmes reduce the health, social and economic harms of drug use to individuals, communities and societies. They do not cause increases in drug use.

UNAIDS is calling for the global adoption of a peoplecentred, public health and human rights-based approach to drug use and for alternatives to the criminalization and incarceration of people who use drugs.

Harm reduction saves lives

This EMCDDA publication examines the case for distributing naloxone, an emergency medication, to people who inject opioids such as heroin and to others who might witness an opioid overdose.

Through its capacity to reverse opioid overdose, naloxone can save lives if administered in time. This comprehensive review looks at opioid overdose and how naloxone counteracts it, and discusses the circumstances of opioid overdose deaths and the use of naloxone in regular clinical practice. As well as documenting the historical development and spread of take-home naloxone programmes in Europe and beyond, the study looks at the practical side of their implementation, including the training of naloxone recipients in how to recognise and respond to an overdose.

Although take-home naloxone is supported by the World Health Organization, the report finds that barriers to its access exist in Europe and considers how the availability of the intervention may be expanded.

Preventing opioid overdose deaths with take-home naloxone

 examines some of the many ways in which international and domestic drug control laws engage human rights and create an environment of enhanced human rights risk. In this edition, the authors address specific human rights issues such as the right to the highest attainable standard of health (including health protection and promotion measures, as well as access to controlled substances as medicines) and indigenous rights, and how drug control laws affect the protection and fulfillment of these rights. Other authors explore drug control though the lens of cross-cutting human rights themes such as gender and the rights of the child. Together, the contributions illustrate how international guidelines on human rights and drug control could help close the human rights gap—and point the way to drug laws and policies that would respect, protect, and fulfill human rights rather than breach them or impede their full realization.

The case for International Guidelines on human rights and drug control

Drug overdose, driven largely by overdose related to the use of opioids, is now the leading cause of unintentional injury death in the United States. The ongoing opioid crisis lies at the intersection of two public health challenges: reducing the burden of suffering from pain and containing the rising toll of the harms that can arise from the use of opioid medications. Chronic pain and opioid use disorder both represent complex human conditions affecting millions of Americans and causing untold disability and loss of function. In the context of the growing opioid problem, the U.S. Food and Drug Administration (FDA) launched an Opioids Action Plan in early 2016. As part of this plan, the FDA asked the National Academies of Sciences, Engineering, and Medicine to convene a committee to update the state of the science on pain research, care, and education and to identify actions the FDA and others can take to respond to the opioid epidemic, with a particular focus on informing FDA’s development of a formal method for incorporating individual and societal considerations into its risk-benefit framework for opioid approval and monitoring.

Pain management and the opioid epidemic: Balancing societal and individual benefits and risks of prescription opioid use

Often called the Orange Book, this is guidance for clinicians treating people with drug problems.

This 2017 version offers new guidelines on:

new psychoactive substances and club drugs

misuse of prescribed and over-the-counter medicines

preventing drug-related deaths, including naloxone provision

The new guidelines also have a stronger emphasis on recovery and a holistic approach to the interventions that can support recovery.

Publications