Archive for the ‘Harm reduction’ Tag

If the UN trust politicians, should we trust them?

Monday, December 2nd, 2013

Another international agency has formally documented its concerns about the UN’s data collection methods around international levels of drug use. In my article about Count The Costs’ Alternative World Drug Report, I mentioned that the UN’s report about drug use across the globe had been criticised for relying on government self-reporting – leaving opportunities for those in power to be less transparent than we might hope. Opaque, in fact.

This time, Harm Reduction International has released a formal challenge to the UN figures. This worldwide organisation claims that the data collected by the UN is incomparable to the 2008 data due to the difference in the methods of data collection, and that, again, government self-reporting is unreliable and unscientific. Given that over a third of the data set collected were done so by annual review questionnaires – completed by governments without any traceable references to how data was collected – analysis of the results is impossible given the lack of openness about how the figures were compiled.

Worryingly, it seems that some countries may be under-reporting their levels of drug use and HIV infection. Russia, for example, have reported that HIV rates amongst their injecting drug using population have almost halved in the last three years. Even considering why a country would want to do this feels quite sinister – but the potential impact on service provision for the drug users with the highest health needs within these countries is frightening.

Harm Reduction International have taken the decision to ignore the UN’s most recent global data, and instead continue to refer to the 2008 figures, where data collection methods were less subjective. They acknowledge that this data is out-dated but, until peer review of the data is possible, they feel the new data may misrepresent the actual international situation. They do, however, recommend that the data is considered on a country-to-country basis, as some countries have provided apparently sound figures.

I suppose this raises questions for me about the integrity of the United Nations and the standards of their publications, and the lack of power they apparently now have in extracting reliable data from politicians. This means that, instead of international agencies working together to tackle the global problems the drug trade produces, there are rifts between them – and confidence in the organisation central to finding some conclusions and solutions is weakened.

On a different note, I do also want to apologise here for my lack of consistency with my blogs recently, which I have otherwise been writing faithfully every week for the last year. I am pleased to say it is because I have some exciting new ventures afoot, which have been sapping me of my time and energy – but I am fully back on board now, pen poised, and will be bothering you with new posts yet again.

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The War on Drugs versus livers

Thursday, May 30th, 2013

Kofi Annan has been reading my blog again. Last week I again raised my concerns about the spread of Hepatitis C, and this week he and his Global Commission on Drugs Policy have concluded that current drugs policy has resulted in a Hep C pandemic. I’m impressed he managed to pull a paper together so quickly – but then he’s probably been a follower of mine for a while if his opinions on the futility on the War on Drugs are anything to go by.

He and his posse of world leaders have this week published a report stating that current drugs policy is “repressive” and “ineffective”. Claiming that, by treating drug use as a criminal justice issue instead of a health issue, governments are breaching human rights and putting their communities at unnecessary risk, their argument about the spread of Hep C is conclusive and damning.

The report claims that those countries with the harshest drug policies, including the USA, provide the biggest deterrent to accessing health services which would reduce the chance of contracting the virus. This has led the commission to conclude that “The war on drugs is a war on common sense”.

There are some positives though (and not just the Hep C type), with Scotland being hailed as a model of good practice. Having learned about blood-bourne virus (BBV) transmission the hard way with the HIV outbreak of the 80s, Scotland’s Hepatitis C Action Plan has succeeded in reducing the numbers of those infected, both by increasing preventative measures, such as hugely increasing access to clean injecting equipment to reduce new infections, and by improving access to treatment for those who already have the virus.

The biggest win, for me, is Scotland’s eight-fold increase in Hep C treatment in prisons. Working with the War on Drugs policies, rather than against them, this idea uses the revolving door of incarceration as an intervention opportunity. Whereas, in England, it’s still nigh on impossible to even get liver function tests done for someone in prison (to enable quicker prescribing of an opiate blocker to encourage no ongoing use on release – common bloody sense, but seemingly too much trouble for prison healthcare teams, whose responsibilities end the second the individual walks out of their door), Scotland are now offering full Hep C treatment in prisons.

This is refreshing – treatment services in England are notoriously out-dated and a nightmare to negotiate. I have taken clients to appointment after appointment at hospitals, only to be told that six months drug-free is not a long enough period of stability to ensure treatment success and reduce risk of reinfection (“because drug addiction is a relapsing condition” – thanks for the positivity, guys), or that reducing alcohol use from nine cans of Special Brew a day to two cans of Carling is still not enough of a reduction in consumption. There is no evidence-base to support their criteria – in fact some Hep C services go and dish out treatment on the streets to current drinkers and injectors – but the liver specialists in big hospitals do not particularly relish being forced into changing their treatment population. They’d much rather work with people with hereditary liver conditions, or even drinkers, than IV drug users, and they gate-keep their services accordingly.

Because of the potential and significant mental health impacts of the intense treatment, reported low mood is another classic reason for being deemed ‘not appropriate for treatment’. This seems to miss that point that, for someone whose existence is miserable, repetitive and cut-throat, and who may not have anywhere to live or food in their belly, low mood is kind of a must-have. So no drug or alcohol use, never feeling down, and a stable living environment – it makes you wonder who amongst us would actually qualify for Hep C treatment. (I would fail on all counts.)

But if this public health disaster isn’t bad enough, there is a hidden population who do not seek testing or treatment, because they perceive their injecting behaviour to be healthy. Steroid users are increasing in numbers, with little or no access to safer injecting information or blood-bourne virus prevention advice. I have heard many reports of one needle being passed around four or five men in a gym toilet, meaning a high risk for all of BBV infection and bacterial infection. And given that drug users generally spend their time working out and bulking up whilst in prison – and Hep C rates amongst IV drug users are estimated at 80% in the county I work in – it doesn’t bode well for the beefcakes, who may not know that the healthy-looking, fake-tanned meathead in front of them was once a pale, scrawny smackhead.

Whilst working in a busy city-centre needle exchange several years ago, one canny gym owner used to come and get boxes of needles to distribute to his customers. Most gym owners aren’t so conscientious – they will happily sell steroids to their members, but these come without injecting advice or equipment. One gym owner in the whole of one of the biggest cities in the country. That’s a whole lot of new livers required in twenty years’ time – for those whose hearts last that long.

Anyway, for the rest of you, some quick advice – don’t share toothbrushes or razors, and use a clean piece of paper or a straw each instead of sharing a grimy twenty pound note when you’re banging cocaine up your noses in pub toilets. Hep C can be transmitted by a single invisible drop of blood, and, unlike HIV, can live outside the body for up to four weeks. It’s a feisty little beast. And livers are quite handy.

Also here’s a shout-out to the big man, KA, and all his homeboys and girls. Good work on the report, guys, and let me know if you want me to join your little commission thing – and in the meantime, peace.

Frank – it’s Cockney rhyming slang

Thursday, February 7th, 2013

It’s ten whole years since the Government launched their new weapon against the war on drugs – Frank. I’m guessing the name was intended to be a pun bulging with bathos.

At the time the campaign went public, there was a real need for something practical and useful for young people. Drug use was at an all-time high, and ecstacy had become cheaper than alcohol. Schools didn’t have a clue how to deal with drug use, with responses ranging from ignoring it to calling the Police, parents knew they were out of their depth, and the links for young people between vulnerability and drug use grew fiercely stronger.

The problem with Frank was – it was absolutely shit. Fancy branding and expensive adverts could not hide the fact that on the end of the phone was not Frank, knowledgable big brother with his hand on your shoulder and a quirky sense of humour, but instead Bernard, a middle-aged divorcee with charisma issues who works in a call centre and hasn’t yet quite mastered the software providing him with his stilted answers. It was like having a conversation about sex with a nun on an iPhone. I could have got better drugs advice off my grandma. Thinking about it, Frank could easily have been the most common name amongst its employees.

Ten years on, there are claims that this service is somehow linked to the reduction in drug use nationally. Then there is the opposition that the service has not stopped anyone taking drugs. These positions both seem to miss the central purpose of the service, as I understand it – Frank was never intended to stop people taking drugs. It was developed during the heyday of harm reduction, and was created to provide information so people made more informed decisions about their drug use.

These misconceptions are either accidental and come from the assumption that ‘drugs are bad, kids’, or are purposefully missing the point to support whichever political argument you might favour. However they may also be symptomatic of what Drink and Drug News have called ‘stigma created by an abstinence-focused recovery wave’. Which side-lines drug users. Which means people don’t get the information or support they need. Which leads to health and social problems. Which is why the harm reduction movement started. (Can anyone else see a pattern emerging..?)

I have to agree with the critics – that this is an attempt by the Government to plug a hole that should be filled by comprehensive drugs education in schools (possibly why it has escaped budget cuts so far). But as long as the drug stats are falling, despite this not being the raison d’ĂȘtre for the service, the politicians can sit back and say they are ‘addressing’ the drugs problem.

However, considering that they had nearly four million contacts with young people last year, Frank certainly seem to be doing something right.

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