OT: AIDS Experts Urge Global Decriminalization of Drug Use

[mars]

Hi All

News from the AIDS 2010: XVIII International AIDS Conference in Vienna by Medscape Medical News


Vienna Declaration Urges Global Decriminalization of Drug Use

by Norra MacReady and Martha Kerr

July 27, 2010 (Vienna, Austria) — More than 13,000 clinicians, researchers, and public policy experts have signed a declaration calling for the global decriminalization of drug use and the implementation of evidence-based policies to halt the rampant spread of HIV infection among injecting drug users (IDUs).

Released here at AIDS 2010: XVIII International AIDS Conference, the document, known as the Vienna Declaration, states that in parts of Eastern Europe and Central Asia, where the spread of HIV is most rapid, infection "can be as high as 70% among people who inject drugs, and in some areas more than 80% of all HIV cases are among this group." Yet these countries have some of the most punitive antidrug laws in the world.

"The International AIDS Conference is a unique mix of advocacy, activism, and science that you don't see at other conferences," Evan Wood, MD, director of the Urban Health Research Initiative at the BC Centre for Excellence in HIV/AIDS in Vancouver, British Columbia, told Medscape Medical News. Dr. Wood was a coauthor of the Vienna Declaration.

The Vienna Declaration calls drug policy reform "a matter of urgent international significance" and states that the epidemic will continue to spread if more-effective policies are not adopted, said Stephen Rolles, MSc, senior policy analyst at the Transform Drug Policy Foundation, a think tank based in London, England.

"The conference...was shaped by the outpouring of support for the Vienna Declaration and the need for scientists to stand together to support illicit drug policies based on evidence instead of ideology," Dr. Wood observed.

In the 50 years since countries around the world have outlawed the manufacture and possession of certain types of drugs, "the situation in terms of any indicators you might choose — public health, human rights, criminal justice — has deteriorated," Mr. Rolles added.

"For a policy that specifically aims to create a drug-free world, to eradicate drug production, prevent drug supply, and eliminate drug use from the world, it's been a staggering failure. Every year since this policy was begun, we've moved further and further away from that goal," he continued.

"Using drugs in a certain way and in a certain environment criminalizes the lifestyle that tends to lead to the spread of HIV, and that's what the Vienna Declaration is focusing on," Mr. Rolles stated. "It's calling for a shift away from this get-tough criminal justice populism that has tended to define the debate, and move it towards a more pragmatic, evidence-based, public health, scientifically driven model."

The best evidence to date suggests that HIV-positive IDUs benefit most from a triple-pronged approach to treatment, consisting of opioid substitution therapy, needle and syringe programs, and antiretroviral therapy. These are the key elements of a harm-reduction approach, Mr. Rolles said, which acknowledges that some people may be unwilling or unable to abstain from use drugs and instead "focuses on reducing the harm associated with the use itself."

Outside of sub-Saharan Africa, IDUs account for about one third of HIV disease internationally. To stem the epidemic, countries and clinicians around the world must grant HIV-infected drug users access to adequate healthcare services without turning them into criminals, forced laborers, or pariahs.

Despite clear evidence that opioid substitution therapy works, it is not available in many of the countries in which the epidemic is worst. Worldwide, only 8 of every 100 IDUs have access to it.

"The science has really moved forward, but that there is either a lack of political will or worse when it comes to addiction," Dr. Wood added.

"Methadone is on the World Health Organizations List of Essential Medicines but is illegal in places like Russia, where other harm-reduction tools are also scarce. Not surprisingly, it is now estimated that more than 1 in 100 adult Russians is HIV infected," Dr. Wood pointed out.

"The health impacts of the war on drugs obviously go beyond HIV.... Incarceration is a huge problem, with 1 in 100 Americans now in prison, and obviously there is an intersection with HIV," Dr. Wood said. "One in 9 African-American males ages 25 - 35 is incarcerated in the United States on any given day, and obviously this is the population where HIV is spreading most rapidly in the United States.

"The Obama administration's lifting of the needle exchange ban federally and the announcement about allowing [the President's Emergency Plan for AIDS Relief] funding for needle exchange in advance of the meeting were obviously welcome," he added.

Daniel Wolfe, MPH, from the International Harm Reduction Program of the Open Society Institute in New York City, noted at the conference that 5 countries in particular — China, Vietnam, Russia, Ukraine, and Malaysia — claim 47% of all HIV-infected IDUs in low- and middle-income nations. In Russia, IDUs account for 83% of all HIV cases, and in Malaysia, they account for 70%. Yet only about 25% of the patients most in need are receiving antiretroviral therapy, and less than 2% have access to opioid substitution therapy.

Draconian policies against drugs and drug users often are motivated by the idea that adoption of harm-reduction policies is tantamount to approving of, or at least tolerating, drug use, said Mr. Rolles, who was not involved in the Lancet symposium.

"In some circles there's a saying that 'harm reduction equals harm facilitation.' Often this can be traced back to a moralistic, almost quasi-religious view of drugs as inherently evil that has not been closely scrutinized until recently," Mr. Rolles said. "And anyone who challenges this policy was seen as being on the side of evil, or at least on the side of [using] drugs."

The problem with prohibitionist policies is that they ignore the overwhelming evidence that the war on drugs has failed, Mr. Rolles added. As the Vienna Declaration states, "the international scientific community calls for an acknowledgement of the limits and harms of drug prohibition, and for drug policy reform to remove barriers to effective HIV prevention, treatment and care."

"There was a strong sentiment [at the conference] that WHO and UNAIDS have been largely marginalized within the UN system with respect to the problems of drug addiction and a hope that the declaration will help to change this," Dr. Wood said.

He continued, "My colleague and president of the International AIDS Society, Julio Montaner [professor of medicine and chair in AIDS Research at the University of British Columbia] announced that the declaration and all the endorsements would be delivered to Ban Ki-moon [secretary-general of the United Nations], although we are keep the timeline open on this because the declaration process is going to culminate when the meeting is in Washington, DC, at AIDS 2012.

"Certainly, the focus on drug addiction and drug policy was welcome by those working in this area, given how it has not received much attention in the past," said Dr. Wood. "However, the problems in Africa and elsewhere are obviously huge issues, [and] so certainly must be acknowledged. It was interesting how the different groups (eg, gay men, sex workers, those with HIV, drug users, etc) united under the banner of the need for a human rights approach [to HIV], and hopefully this will strengthen the overall effort to address the epidemic."

The Vienna Declaration can be viewed on its own Web site.

http://www.viennadeclaration.com/

AIDS 2010: XVIII International AIDS Conference: Symposium TUSY07. Presented July 20, 2010.

Mars

[Amigo]

The so-called, "War on Drugs" has been a complete fiasco since its inception. It's interesting how our country managed to see the light of reason when it came to the repeal of prohibition, but remains hide-bound in its approach to other drug addictions.

We continue to shovel money into a bottomless hole with absolutely no appreciable positive results. I can only continue to hope that some day we will take a more enlightened approach, but seriously doubt I will live to see it.

[breakfast]

I am all for decriminalization of drugs but I am not so sure that it's going to be the answer to the AIDS epidemic. I would think it might almost make it worse. Many IDUs will still share needles, even if safe clean needles are legal to purchase over the counter. When one is an addict, their thought process typically does not make their safety and health a high priority, you know?

[Slinky]

Prohibition gave organized crime a strong foothold in this country. Our own government is responsible for helping to get the drug trade going in this country by providing our military w/"uppers", etc. to keep them fighting under difficult conditions and has thru multiple wars even before Korea. Even as recent as today our military has been known to provider "uppers" to keep the pilots flying. Talk about a bunch of two-faced hypocrites and politicians.

Maybe the politicians just need to do a cost analysis to see whether legalizing drugs or keeping them illegal lines their pockets the most.

[Goofproof]

Maybe we would be better off having the government buy the drugs, package them with new syringes, and resell them to the population. They could even do Reefers, make then self lighting and sell them buy the carton. The profits could be added to Social Security, so the few hundred of us that still have jobs could have health care when we get old.

Crime should come to a stop as with low cost drugs and welfare w/food stamps, there would be no need to get out of our free government housing. As the prisons are emptied they can be shut down as most of the inmates were convicted on drug charges, and that would no longer be a crime. We might need a higher fence at the border, as the Land of the Free, would be as free as it can get! Jim

[roster]

Decriminalization of the manufacturing, selling and using of drugs needs to happen soon.

But you guys should first work on decriminalizing the selling of CPAP equipment: viewtopic.php?f=1&t=54210&st=0&sk=t&sd=a

[mars]

.
.

Mr. Rolles stated. "It's calling for a shift away from this get-tough criminal justice populism that has tended to define the debate, and move it towards a more pragmatic, evidence-based, public health, scientifically driven model."

.
.
............and when I was searching for an evidence-based website looking at the "Drug War", I found this remarkable site, which has great information, videos, and insight into the problem -

http://www.leap.cc/cms/index.php

cheers

Mars

[Wulfman]

If "murder" was decriminalized, it would help decrease the world population problem, too.
It's only "legal" if done by a government in the name of "war".
"Mother Nature" apparently can't keep up, even though there are many hundreds of thousands dying in natural and human-caused disasters each year.
We could follow some other countries' examples and just take the drug pushers out and shoot them.

There's already a "cure" for AIDS/HIV/STDs........Quit doing what you've been doing that's spreading it.

In my last job, I got to SEE the results of illegal drug use by juveniles. Making them "legal" won't keep their brains from being fried or their teeth from rotting out or keep them from committing crimes.

I'm a "baby boomer" who has never tried marijuana or any other illegal drugs......and I have very strong feelings about them. In fact, aspirin is about the strongest thing I've ever used.


Den

[So Well]

@Wulfman

If "murder" was decriminalized, it would help decrease the world population problem, too.
about them.

The murderer violates the inalienable rights of the individual murdered. The simple act of using drugs does not violate the rights of other individuals. Comparing a murderer and a simple drug user is not a valid comparison.

There's already a "cure" for AIDS/HIV/STDs........Quit doing what you've been doing that's spreading it.

Agreed. Always be prepared to suffer the consequences of your actions.

In my last job, I got to SEE the results of illegal drug use by juveniles. Making them "legal" won't keep their brains from being fried or their teeth from rotting out or keep them from committing crimes.

Glad to see you concede the point that making the use of drugs illegal is ineffective. I have seen up close the problems caused by the use of drugs. I am convinced that many of the problems would go away if drugs were legalized.

BTW, I would keep the use by or sell to "minors" illegal. There is some age below which the individual does not have the maturity to make good judgments about his own life. Discussion of penalties needs to be held, but the penalties should certainly not be as severe as the ones we have now.

I'm a "baby boomer" who has never tried marijuana or any other illegal drugs......and I have very strong feelings about them. In fact, aspirin is about the strongest thing I've ever used.

I have been numerous times in meetings with people who are in favor of legalizing drugs. Often the question is asked, "If drugs are legalized, who in this room will start using them?" With rare exceptions, the answers are always none of us. The rare exception is someone who has a painful chronic condition and would like to experiment with marijuana for pain relief. Some MS sufferers claim to get significant relief.

We know some very good things will happen if drugs are legalized and their manufacture and distribution are appropriately regulated. The drug war will end. The drug criminals will have to find something else to do. Drug prices will plummet. Drug users will commit fewer property crimes to get money for drugs. Police and imprisonment costs will plummet. Violet crime will plummet. Tax revenue from the sale of drugs will be established. Certainly the use of marijuana does not tend to make the users violent. The same is true of cocaine and heroin. So violent crime would likely decrease.

We don't know what the bad unintended consequences will be. Maybe drug use will increase. Maybe drug abuse will decline. There is some evidence that alcohol abuse was greater during the prohibition that before or after.

All in all, there are strong indications that drug use will be less of a problem if treated as a health and social issue instead of a criminal issue.

I, like you, am very careful about what I put in my body. I would like to see that we as a society repudiated drugs and turned entirely away from them. That is quite different from criminalizing them.

[Wulfman]

@Wulfman

If "murder" was decriminalized, it would help decrease the world population problem, too.
about them.

The murderer violates the inalienable rights of the individual murdered. The simple act of using drugs does not violate the rights of other individuals. Comparing a murderer and a simple drug user is not a valid comparison.

With the direction this country's heading, the individuals will have no "inalienable" rights......very soon.
It depends on if the drug user is the one who kills the individual whose home he broke into to steal money for drugs he's trying to buy......illegally or legally. If the drug users are too strung out on drugs, they probably aren't able to hold a job to have any money to buy those drugs (legal or illegal). So, they're still going to resort to crime to steal the money to buy them.

In my last job, I got to SEE the results of illegal drug use by juveniles. Making them "legal" won't keep their brains from being fried or their teeth from rotting out or keep them from committing crimes.

Glad to see you concede the point that making the use of drugs illegal is ineffective. I have seen up close the problems caused by the use of drugs. I am convinced that many of the problems would go away if drugs were legalized.

BTW, I would keep the use by or sell to "minors" illegal. There is some age below which the individual does not have the maturity to make good judgments about his own life. Discussion of penalties needs to be held, but the penalties should certainly not be as severe as the ones we have now.

From my viewpoint, I'm convinced that it will have no effect on many of the problems that exist.
Having a minimum age limit has had virtually NO effect on smoking, drinking or other things that have those restrictions.

I'm a "baby boomer" who has never tried marijuana or any other illegal drugs......and I have very strong feelings about them. In fact, aspirin is about the strongest thing I've ever used.

I have been numerous times in meetings with people who are in favor of legalizing drugs. Often the question is asked, "If drugs are legalized, who in this room will start using them?" With rare exceptions, the answers are always none of us. The rare exception is someone who has a painful chronic condition and would like to experiment with marijuana for pain relief. Some MS sufferers claim to get significant relief.

We know some very good things will happen if drugs are legalized and their manufacture and distribution are appropriately regulated. The drug war will end. The drug criminals will have to find something else to do. Drug prices will plummet. Drug users will commit fewer property crimes to get money for drugs. Police and imprisonment costs will plummet. Violet crime will plummet. Tax revenue from the sale of drugs will be established. Certainly the use of marijuana does not tend to make the users violent. The same is true of cocaine and heroin. So violent crime would likely decrease.

We don't know what the bad unintended consequences will be. Maybe drug use will increase. Maybe drug abuse will decline. There is some evidence that alcohol abuse was greater during the prohibition that before or after.

All in all, there are strong indications that drug use will be less of a problem if treated as a health and social issue instead of a criminal issue.

I, like you, am very careful about what I put in my body. I would like to see that we as a society repudiated drugs and turned entirely away from them. That is quite different from criminalizing them.

Somehow, I can't visualize the "drug war" ending.
The "legal" and "illegal" drugs would need to be enumerated and classified.
Which "drugs" would be be made legal or which ones would remain illegal?
How long ago was it that "Ecstasy" and "Crack" were unheard of? The chemists will be hard at work to come up with new creations.

http://www.sixwise.com/newsletters/05/0 ... ffects.htm

Many drugs are stolen from people who use them legally now.......prescription drugs.
Ever heard of "huffing"? I'm sure you have. That's inhaling chemicals from aerosol spray cans like paint and other toxic substances (usually in a paper bag).........that kills brain cells, too.
Street drugs are supposedly dirt cheap now. If they make them legal, it's still going to take money to buy them. That takes us back to the drug users source of money.
We already have a health care crisis......and drug use (illegal and prescribed) is already part of those problems.
It's already a social issue, too.

As with everything else that's coming down the chute, this would be another government-run program. Personally, I have absolutely NO confidence in any government-run programs. And, this would be another one that would be ripe with corruption.

Sorry, I'm not buying any of the arguments about legalizing "drugs".


Den

[who]

I hope my coffee is still legal tomorrow morning.

Another interesting thread, mars. Thanks.

[Amigo]

...
Sorry, I'm not buying any of the arguments about legalizing "drugs".


Den

Right...heaven forbid that we should try another approach when the untold billions we've poured down this rat hole are working so well.

[JockLitt]

Far out man