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Lire entre les lignes à la 56ième session de la Commission des stupéfiants

Je m’attendais pleinement à ce que la 56^ième session de la Commission des stupéfiants (CND) soit aussi déprimante que celles auxquelles j’ai assisté au cours des dernières années. Avec tant d’organisations travaillant pour changer les politiques sur les drogues au niveau mondial et pour recentrer l’attention sur les torts causés par les politiques globales sur les drogues au niveau des individus, des familles, des communautés et des pays, participer à la CND signifie bien souvent être confronté à la réalité de la lenteur, parfois extrême, à laquelle les changements se produisent dans ce forum international traitant des politiques sur les drogues.

Dès le début de la session, il est devenu évident qu’il y avait quelque chose de nouveau dans l’air. D’une part, le «buzz» habituel entourant le spécialiste américain en drogues n’était étrangement pas au rendez-vous; son budget de déplacement ayant subi de sérieuses coupures, Gil Kerlikowski est donc resté chez lui cette année. Pas si mal, compte tenu que son service de rédaction de discours aurait eu du mal à expliquer la situation récente au Colorado et à Washington, où les électeurs ont adopté des résolutions visant à mettre en oeuvre un régime juridique concernant l’utilisation personnelle du cannabis par des consommateurs adultes.

Eva Morales, Président de l’État plurinational de Bolivie, dans son allocution d’ouverture devant la Commission, a remercié les délégués d’avoir permis à la Bolivie de se joindre à nouveau aux conventions, ajoutant une réserve respectant la constitution bolivienne qui soutient l’utilisation de la feuille de coca dans le cadre du patrimoine culturel bolivien. Le Président Morales a ensuite demandé s’il y avait une certaine tension dans la salle, possiblement liée au fait que « la guerre contre les drogues a échoué de manière globale ? » Il a par la suite dénoncé les USA pour avoir essayé de forcer la Bolivie à limiter sa production de coca en faisant des menaces et en liant l’éradication du coca à la construction d’écoles durant les années 80. Les paroles de M. Morales étaient particulièrement percutantes, du fait qu’il a clairement fait remarquer que les efforts déployés pour contrôler le trafic de drogue sont étroitement liés aux autres objectifs géopolitiques de « maîtrise » et de « domination ». De telles déclarations audacieuses sont rares dans le forum public de la CND.

Les remarques préliminaires du Directeur de l’ONUDC, Yuri Fedetov, furent un intéressant mélange de l’ancien et du nouveau. Tout en affirmant qu’un certain progrès a été réalisé au niveau du problème global des drogues, Fedetov a reconnu que la politique internationale sur le contrôle des drogues ne peut être isolée des améliorations nécessaires au niveau des services liés au VIH, ni ignorer la discrimination et le manque de services fondés sur des données probantes pour les consommateurs de drogues. Pendant la session consacrée à la société civile en compagnie du Directeur, Fedetov était animé et semblait très ouvert à la franchise de la discussion durant cette session, pendant laquelle un certain nombre de questions centrées sur la réforme des politiques sur les drogues ont été abordées.

Le Ministre du revenu néo-zélandais, Peter Dunne, une véritable cure d’oxygène, a expliqué à la Commission la nouvelle législation innovatrice qui sera présentée devant le parlement de la Nouvelle Zélande cet automne, et qui portera sur les nombreuses substances psychoactives nouvelles apparaissant quasi quotidiennement, et dont les traités ne tiennent pas compte. En vertu de la législation proposée, la Psychoactive Substances Bill (Loi sur les substances psychoactives), toutes ces nouvelles substances seront interdites, à moins que le fabricant ne puisse prouver qu’elles ne présentent aucun risque plus que minimal. Plutôt que d’interdire immédiatement toute nouvelle substance, le gouvernement néo-zélandais prévoit transférer la responsabilité à l’industrie, pour que celle-ci garantisse la sûreté de ses produits. Si ces produits passent le test, ils seront incorporés à un calendrier règlementaire permettant la vente au détail de tels produits, sous réserve de certaines conditions. Lorsqu’on lui a demandé comment ce régime a été reçu par les autres délégations, le ministre Dunn a déclaré que la législation proposée a suscité beaucoup d’intérêt et que les autres pays surveillent attentivement les résultats.

La révision globale des politiques sur les drogues dans l’hémisphère occidental, ordonnée lors du dernier Sommet des Amériques en avril 2012 auprès de l’Organisation des États Américains, a également suscité un grand intérêt, maintenant que les attentes s’intensifient en vue de la conclusion prochaine de la révision au cours des mois à venir.

Dans l’ensemble, la CND a connu des moments intéressants cette année, si l’on peut lire entre les lignes et porter une oreille attentive aux bourdonnements qui régnaient en coulisse. Mon opinion est qu’il existe une reconnaissance implicite, sinon explicite, que le paysage politique en matière de drogues est en effet en pleine évolution, que de nouvelles approches sont maintenant considérées et que divers pays exigent désormais un débat plus large sur les politiques en matière de drogues. Il est crucial que de telles discussions soient accueillies comme étant une occasion importante lors des prochaines réunions de la Commission, afin d’assurer la pertinence continue de la CND.

March 27, 2013
Civil Society is Key to Global Drug Policy Reform

The CDPC is continuing its coverage of the week-long meetings of the Commission on Narcotic Drugs in Vienna this week.

The current UN drug control system is based on three international drug control treaties: the 1961 Single Convention on Narcotic Drugs, the 1971 UN Convention on Psychotropic Drugs and the 1988 Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances. This drug control systems requires member states to take measures to prevent the non-medical use of a wide range of drugs through restrictions on production and supply, and by suppressing demand.

Canada is a party to these treaties and subject to scrutiny by the International Narcotic Control Board. Historically, these drug control treaties and organizations were created by governments and stacked with law enforcement professionals with very little influence or participation by civil society groups.

The United Nations Office on Drugs and Crime (UNODC) operates as the secretariat for the UN and advises governments on effective law enforcement, treatment systems, methods of estimating drug use and publishes the annual World Drug Report. The UNODC is front and centre this week because of its responsibilities for the organization of the Commission’s meetings

On Wednesday, the head of the United Nations Office on Drugs and Crime, Yury Fedetov, met informally with NGO’s. Fedetov was faced with drug policy reform groups like the Transnational Institute in Holland, Transform Drug Policy Foundation, the International Drug Policy Consortium, and Law Enforcement Against Prohibition. I almost felt sorry for the guy and then I remembered that he still holds many of the cards when it comes world drug control. Fedetov faced many questions about the involvement of civil society in the deliberations of the Commission. Clearly there is a push for these groups to be involved in a more meaningful way – and there are examples at the UN where civil society groups play a much larger role, such as UNAIDS.

This week the CND Committee of the Whole is discussing a resolution entitled “Preparations for the high-level review of the implementation by Member States of the Political Declaration and Plan of Action on International Cooperation towards an Integrated and Balanced Strategy to Counter the World Drug Problem.” Yes, apparently the titles given to CND resolutions can be … long. Let’s just say the resolution has something to do with an upcoming review of the Commission’s activities.

This resolution also refers to the 2016 UN Special Session (UNGASS) on the “World Drug Problem”. This session is the first opportunity for a global discussion on drug policy since 1998. The last paragraph of the resolution would make the CND the primary preparatory body for UNGASS 2106. Some civil society groups are here in Vienna pressing delegations to open the preparatory process so that it will include civil society and other UN organizations with a stake in drug policy.

This is key to global drug policy reform. We want as fulsome and open a debate in 2016 as we can muster to ensure the numerous experiments in reform taking place around the globe can be openly considered.

March 14, 2013
Bolivia and Coca Chewing: Speaking Truth to Power

As I mentioned in my previous blog, representatives of the CDPC are here in Vienna at the annual week-long meetings of the UN Commission on Narcotic Drugs. The opening plenary on Monday March 11th included an extremely engaging speech from Evo Morales, President of Bolivia. While most speakers reiterated their support for international drug control efforts and continually emphasized the need for “international cooperation”, Morales pushed through the usual dull diplomatic language to speak some truth to power. He opened his speech by asking if there was tension in the room and he wondered if it was related to the knowledge that “the fight against drugs has failed globally?”

This isn’t something that’s said very often here in heart of international drug control policy-making.

Morales thanked the 169 countries who supported Bolivia’s re-accession to the 1961 Single Convention on Narcotic Drugs. After a first attempt to amend the Single Convention failed in 2011, Bolivia left the Convention with the intent to rejoin with a new reservation designed to align its international obligations with its constitution, which protects indigenous rights.

The reservation, which legalizes coca for local use, applies only to Bolivian territory and the exportation of coca internationally remains prohibited. With the support of those 169 countries Bolivia re-entered the Convention with the reservation in place. Only 15 countries objected, including Canada.

Morales reminded his audience that traditional and indigenous use of coca leaf has important social and health benefits and that its inclusion in the 1961 Convention was an error. In its natural state it has many medicinal properties, and he suggested that international drug controls have hindered scientific research into these benefits. He was careful to emphasize that Bolivia does not support the trade in cocaine but he pointedly noted that efforts to control drug trafficking are intertwined with other geopolitical goals of “mastery” and “dominance”. He chastised the U.S. for trying force Bolivia to curb its coca farming with threats and by tying eradication of coca to the building of schools in the 1980s. In no uncertain terms, Morales drew a parallel between these policies and American efforts to control the region. No doubt, in a sedate and conservative institution like the CND, his words stung for some delegates.

His speech was a reminder that the edifice of international drug control has some serious cracks. Not only are other Latin American leaders speaking out on the need for debate about the way forward, but the recent legalization of cannabis in Colorado and Washington, a proposal by the Norwegian government to decriminalize heroin smoking (a way of using heroin considered to be more safe than injecting because the risk of overdose is less), and the now fairly long-standing decriminalization of drugs in Portugal, represents the efforts of jurisdictions to plot a new way forward guided more by the principles of justice and public health than by law enforcement. In fact, in eight U.S. states bills legalizing cannabis have been introduced in recent months.

It looks like the long-term efforts to broaden the scope of policy options for drug issues is beginning to reap rewards. Let’s hope the CND can catch up.

March 12, 2013
Repressive Drug Policy Still the Norm at CND

The Commission on Narcotic Drugs (CND) was established in 1946 as a commission of the UN Economic and Social Council (ECOSOC). UN commissions carry out specific responsibilities assigned to ECOSOC. The CND assists ECOSOC in supervising the application of international drug control conventions and agreements. It is the principal policy-making body within the UN system on drug control issues. It is also the governing body of the UN Office on Drugs and Crime Programme.

The CDPC is here in Vienna for the annual week-long meetings of the CND at the UN. And as you can see, it’s easy to slip into talking in acronyms when attending such an event. The casual use of these acronyms is only the tip of the iceberg when it comes to accessing the often turgid and mostly impenetrable operations of the CND. Unlike other UN commissions and programs, civil society plays a small but growing part in the deliberations of the CND. In fact, some countries still oppose the participation of civil society entirely. What this means is that the key policy-making body for global drug control is still partly insulated from the concerns of groups working on issues like human rights and the prevention of HIV and Hep C among people who use drugs. It’s also clear that words like “harm reduction” are flash points. Official country delegations and speakers avoid this term assiduously.

The opening plenary session on Monday morning signaled the tone of these meetings. Most speeches in this session reiterated support for the international drug control system but cracks were apparent, such as a rousing speech by the President of Bolivia, Evo Morales. A speech by Yuri Federtov, Executive Director of the UNODC, reflected some of these tensions. Federtov’s speech was a carefully constructed one. He embraced the key assumption of these UN groups and meetings: that drugs are at the centre of the world’s drug problems and he touted the role that the UNODC is playing in trying to control the availability of drugs.

An alternative diagnosis might suggest that drug laws based on the international treaties are responsible for many of the harms associated with drugs themselves. Criminalization of drug use fosters discrimination and discrimination drives people away from health and other services. Criminalization has failed to stem the tide of drug use around the world, but it has helped to create a lucrative underground economy without regulatory controls.

Despite lofty words to the contrary, drugs are more available than ever and ever more pure than they were 40 years ago. But, and this is an important but, Federtov acknowledged that international drug control policy cannot remain isolated from needed improvements in HIV services nor can it ignore discrimination and the lack of evidence-based services for people who use drugs. In fact, the Deputy Executive Director of the UNODC admitted that historically, drug control was handed over to law enforcement and the principle of public health has been forgotten until recently.

Despite these admissions, much more needs to done to change a system where repressive drug policies and laws still trump public health approaches in many places around the world with dire consequences for people who use drugs.

Canada is no exception. As CDPC’s upcoming report on Canadian drug policy will reveal, a public health approach to drug use has not been fully realized. We still rely on a patchwork of policies and programs to support harm reduction and treatment, while law enforcement continues to receive escalating resources. This approach is expensive, lacks evidence of its effectiveness and continues to result in harms to people who use drugs including criminalization and marginalization.

March 11, 2013
Sometimes Violations of International Law Are Cause for Celebration

The United States is again in violation of international law. That is a strong statement and one that reminds us of the invasion of Iraq, Guantanamo bay, water-boarding, rendition, and the strong international legal arguments made about these situations.

But in this case the violation will be hailed by many as a positive step.

On 6 November various ballot initiatives were voted on in the US, from abolishing the death penalty to allowing assisted suicide, to legalising gay marriage. Three had the clearest potential to render the US in breach of international law if they succeeded. With the votes in Colorado and Washington which established a legally regulated framework for non-medical production and sale of marijuana, that breach has now occurred.

The laws in question are the 1961 UN Single Convention on Narcotic Drugs and the 1988 UN drug trafficking conventions (which has a longer, duller title). Alongside one other treaty (which deals with synthetics) these form the bedrock legal foundation of the global drug control regime. Most countries follow them very closely, including the US.

Some states have been pushing at the boundaries of these treaties for some time, however, on particular points of contention that have developed in the decades since the treaties were negotiated. Times have changed since 1961. Grey areas have been exploited, arcane scheduling systems utilised, and interpretations adopted that allow more room for manoeuvre.

But what sets these ballot initiatives apart is that there is no grey area to exploit, and it would take some legal gymnastics to interpret your way past that. This is straight up legalisation of recreational use, production, and sale, which is not permitted. It’s what the system was set up in large part to prohibit, with marijuana receiving particular attention alongside coca and opium. While most substances are listed in annexed schedules, these three are written into the very terms of the treaties (‘cannabis’ is the term used).

The US (alongside over 180 other states) is required, under a very robust and politically supported regime, to ‘limit exclusively to medical and scientific purposes the production, manufacture, export, import, distribution of, trade in, use and possession of drugs’.

There is more, of course, and there are various provisos and caveats on certain provisions, but this is a ‘general obligation’ of the regime around which all else revolves. In other words, the US is not just in breach of some marginal aspect of the system, now, but a fundamental requirement of it that goes to the heart of prohibition.

Millions of US citizens are now permitted to buy and sell marijuana for recreational purposes (regulations pending). These laws apply to a population far exceeding that of Sweden (where I am currently sitting) and way over twice the size of Ireland (where I’m from). This would be supported by neither government, which have signed contracts with the US in the form of these international agreements to the effect that none of them would allow it. The fact that this has happened at state and not federal level does not rectify the legal dilemma the US government now faces.

Many in the US and worldwide are celebrating the results in Colorado and Washington as the beginning of the end of the war on drugs – and appropriately through a democratic process. People have voted for the US to breach international law. That very few would have cared or knew about this is not relevant. This is the fact of it.

There are now four possible scenarios. The US Federal Government can fight it out, stepping all over state sovereignty. The US can withdraw from the treaties in question. The treaties themselves can be changed by international processes. Or the US can carry on in breach and turn a blind eye. I think the fourth is the most likely. Ironically, this leads inexorably to arguments for broader reform, but this is something the US overnment has ardently opposed, even signing a recent declaration with the Russians to that effect.

So the implications for international law and the place of the UN drugs conventions within it must be considered.

We would not celebrate an ongoing breach by the US of the Convention on the Elimination of Racial Discrimination or the International Covenant on Civil and Political Rights, to which it is also bound. Nor would we tolerate (though they happen regularly) violations of the Geneva Conventions, the Torture Convention, the Nuclear Non-Proliferation Treaty or environmental protocols. Indeed, there is a hierarchy in international law that is exposed by the Colorado and Washington votes.

But it is one within which the drug control regime has an unnaturally elevated position due to the widespread political consensus around prohibition, and fears that have been intentionally fuelled over the years. Drugs, in the UN conventions, are seen as a threat to mankind, and an ‘evil’ to be fought. Over time, respect for the UN drugs conventions has been equated with respect for the rule of law itself. ‘The three United Nations drug control conventions…set the international rule of law that all States have agreed to respect and implement’ said the President of the UN’s International Narcotics Control Board (INCB) in a recent speech. (The INCB is the body that monitors States’ implementation of the drugs conventions). He has confused the rule of law with specific laws.

There are some things that are wrong in themselves (malum in se) and things that are wrong because they are prohibited (malum prohibitum). But when it comes to drug laws, fighting something that is prohibited has resulted in widespread acts that are wrong in themselves and that breach basic legal principles – the rule of law.

The racially discriminatory nature of drug laws is common knowledge. Some governments rely on the international regime to justify executions of people convicted of drug offences (in violation of international law, in fact). Police violence, mass incarceration, denial of due process are routine in States’ pursuit of the general obligation the US now breaches.

The international legal arguments about the Colorado and Washington results will certainly arise. They must, though it will likely be in the rather closed and stale environment of UN drugs diplomacy. When that happens it must emerge is that these ballots are a victory for the rule of law even as they bring the US into conflict with the drugs conventions. Fundamental legal principles of proportionality, fairness and justice, not to mention democracy, have won out over arbitrary and unreasonable controls on human behaviour.

Ending the war on drugs, moreover, will be a victory for international human rights law. It will be a victory for international law itself – for environmental law, anti-corruption agreements, international security, for the achievement of international development agreements and improved health – all of which have been damaged by decades of prohibition. Colorado and Washington have taken us one step closer. For that we should all celebrate.

– Damon Barrett

Damon Barrett is Deputy Director of Harm Reduction International, co-founder of the International Centre on Human Rights and Drug Policy, and an Editor-in-Chief of the journal Human Rights and Drugs. This blog post was first published on Damon’s Huffington Post blog and the Transform website.

March 6, 2013
Is This The Future of Drug Law?

This week the New Zealand government will publish its Psychoactive Drugs Bill. Under the new regulations proposed in the bill, “legal highs” would have to undergo an approval process before being brought to market. The New Zealand Ministry of Health would then issue licenses relating to the importation, manufacture, and sale of psychoactive substances covered by the bill. This process would place the burden on the synthetic drug industry, which would have to prove its products are safe before being made available to the consumer.

From the BBC:

“The new law is a response to the problem of “legal highs”, but is being seized upon by reformers because it crosses a Rubicon – designing a legislative framework built upon regulation rather than prohibition.”

Therein lies the significance of this bill – it is a response to a drug-related issue that uses regulation rather than prohibition as the method of control. Instead of simply issuing criminal bans on emerging drugs, a method that has proven a failure time and time again, New Zealand is choosing to shift the focus to protecting public health.

Rather than allowing these substances to be controlled by the criminal element, they will instead exist within a regulated market. Beyond health considerations, a variety of restrictions will apply to the drugs, such as hefty fines and jail time for any manufacturer caught selling their products to minors.

This bill presents a timely and thoughtful solution to a rapidly emerging problem. In 2012, the European Monitoring Centre for Drugs and Drugs Addiction reported that a new “legal high” goes on sale every week.

Thus far, The Canadian government’s response to the phenomenon of “legal highs” has been a traditional approach of banning a substance when the media brings it to the public’s attention, as was the case with the great MDPV (aka Bath Salts) scare of 2012.

Last September, after the federal government proposed that MDPV be included in Schedule I of the Controlled Drugs and Substances act, we issued a submission to Health Canada recommending that banning the substance would have unintended negative effects and that the government should regulate, rather than criminalize its use.

The CDPC is optimistic about New Zealand’s Psychoactive Drug Bill as it is line with a greater paradigm shift occurring in many countries around the world. Leaving the control of drugs and drug quality in the hands of criminals protects no one and creates a litany of disastrous side effects. We look forward to seeing the bill implemented in the near future.

If you would like to learn more about how we are building a better drug policy for Canada, please sign up to our mailing list and we will keep you up to date on news and upcoming campaigns.

March 1, 2013
Canada’s War on Pot Just Got Weirder

Prohibition took another strange turn this week when it was reported that RCMP officers in Alberta have started to strap on snowboards and patrol the Lake Louise and Nakiska ski resorts in an effort to deter “substance abuse”.

From the CBC:

The officers, who are in uniform and carrying weapons, are focusing their attention on substance abuse on the chairlifts and gondolas.

“It’s going to deter people from bringing narcotics or have that second look of doing something on the ski hill because they know there is going to be a police presence,” said RCMP Cpl. Jeff Campbell, the detachment commander in Lake Louise. (…)

Two officers will be on patrol Fridays, Saturdays and Sundays as well as holidays including March break and Easter weekend. RCMP hope to expand the program once they have more officers certified.”

While the RCMP ski patrol is a volunteer program, it is still very much official police business and carries the full weight of the law. The program has been in effect since December with the primary focus being to deter skiers and snowboarders from using “narcotics”, but has thus far resulted in just one minor cannabis seizure.

Officials from Lake Louise have gone on record welcoming the RCMP presence, but have also made a point of clarifying that crime isn’t an issue at the resort, which raises a number of questions as to why such a program even exists.

With 65% of Canadians in favour of either legalizing or decriminalizing cannabis, should the RCMP really be expanding their efforts to clamp down on casual use?

The RCMP is touting the ski patrols as a “pro-active policing initiative” but given that neither ski hill (nor any ski hill for that matter) has any real need for a police presence, is it an appropriate and responsible use of police resources?

This program, which explicitly promotes the additional enforcement of a highly unpopular law, is emblematic of a much larger problem: the growing disconnect between the RCMP and the Canadian public.

An Ipsos-Reid poll from late December on public confidence in the RCMP found that support for the mounties has decreased sharply over the past five years.

In January, Vic Toews, Minister of Public Safety, held a summit with law enforcement officials from across the country to discuss the economics of policing. The purpose of the summit was to examine policing costs, which reached a whopping $12.6 billion in 2011, and to discuss ways to make policing in Canada more efficient and cost-effective.

As the cost of policing becomes increasingly unsustainable and confidence in the RCMP heads downhill, chasing after pot-smoking snowboarders seems like a rather absurd waste of police resources.

So how could Canada lower its policing costs and repair public confidence in the RCMP?

One of the simplest solutions to these two critical problems would be to regulate and tax cannabis.

This would free up police resources currently being wasted on the suppression of a substance that the majority of Canadians think should not be illegal, while at the same time restoring faith in police officers by removing the burden of such an unpopular law.

If you’d like to learn more about how the CDPC is working to change cannabis law in Canada, please sign up for our email alerts and we’ll keep you up to date.

February 14, 2013
Training Drug Users and Bystanders to Treat Overdose Saves Lives

Drug overdose is a growing public health crisis that now kills more adults per year in the United States than motor vehicle accidents. In cars, seatbelts and airbags save lives. When it comes to opioid overdose a safe and non-abusable medicine called naloxone can restore breathing and avert death. Pragmatic doctors and health officials want anyone who uses opioids like heroin—and anyone likely to be around during an overdose—to have access to this life-saving drug, and know how to use it.

In Massachusetts, researchers led by Dr. Alexander Walley at the Boston University Medical Center set out to discover the results of a state-supported overdose education and naloxone distribution program on deaths from overdose. We sat down with Dr. Walley to discuss the findings.

What did your research find?

This study demonstrates that overdose education and naloxone distribution is an effective public health intervention to address the growing overdose epidemic. We found that communities that received overdose education and naloxone reported significantly fewer deaths than communities that received no training. We also observed that the higher the cumulative rate of program implementation, the greater the reduction in death rates. In other words, the more people at risk or in contact with people at risk for overdose who were given naloxone, and trained to prevent, recognize and respond to an overdose, the lower the overdose death rates.

Why are overdose education and naloxone delivery programs like these so important?

Since the beginning of the Massachusetts overdose education and naloxone delivery programs, there have been more than 1,700 overdose rescues using naloxone. While we do not know how many of these people may have died if they had not received naloxone, it is likely that many of them would have. These rescues have inspired many us to maintain hope that all overdose deaths can be prevented.

People who have recently stopped using opioids—whether because of jail time or treatment—are at increased risk of overdose, and we’ve heard inspiring stories of overdose reversals in these cases. While opioid addiction is a treatable disease, it is a chronic disease where relapse is unfortunately part of the natural history. Preventing overdose allows people to continue their progress towards recovery, and may enable them to seek out other lifesaving services.

What barriers stand in the way of implementing programs like this in other parts of the United States?

I’ll start first by listing features of the program in Massachusetts that contributed to its success and would support broader implementation: one is the use of a nasal delivery device for naloxone, allowing naloxone to be administered through the nose, instead of by injection. The other is a standing order issued by the health department that permits non-medical personnel to deliver overdose education and distribute naloxone. Without this order, a doctor would need to be present each time naloxone is given out. To date, there are still large parts of the country with no access to a lifesaving naloxone distribution program; though this program locator tool can help you find out if there is one near you.

The two main barriers to the expansion of these initiatives are that insurance companies do not cover the nasal delivery device that allows naloxone to be administered through the nose, and prescribers (doctors, nurse practitioners and physicians’ assistants) are not yet adequately educated on prescribing naloxone. We’ve created a website, prescribetoprevent.org, to help facilitate naloxone prescribing.

What message would you send to officials in countries like Russia and China where the death toll from drug overdoses continues to climb?

Preventing needless deaths from opioid overdose is a bridge issue – it’s a cause that people from different perspectives on treatment and harm reduction can agree and work together on. It can be a starting point from which we can work together in addressing the harms associated with drug use.

What happens now?

We keep implementing and evaluating this program and ones like it. In Massachusetts, overdose education and naloxone have been delivered to heroin users, prescription opioid users, patients in emergency departments, and the people who are most likely to respond to an overdose including: people who are incarcerated, family members, social service providers, police officers, and firefighters. It is important to determine how these programs should be tailored to different populations to maximize their reach, effectiveness and sustainability. That’s what we’re working on now.

This blog post was originally published on the Open Society Foundations website.

February 7, 2013
SALOME Participants Need An Exit Strategy

The SALOME study (Study to Assess Longer-term Opioid Medication Effectiveness), is a clinical trial being conducted in Vancouver, BC. The study compares the effectiveness of six months of injectable diacetylmorphine (heroin) with six months of injectable hydromorphone (Dilaudid, a licensed medication) and the effects of switching from injectable to oral heroin or Dilaudid.

SALOME began active recruitment in December, 2011. Participants will be in the study for one year, followed by a 1-month transition period where they will be encouraged to, once again, take part in conventional treatments such as methadone maintenance, drug-free treatments, and detox programs (treatments that have proven to be ineffective for these participants).

SALOME is a follow-up to the NAOMI study, which tested whether heroin-assisted treatment or methadone is more effective in improving the health of chronic and long-time opiate users. The repeated failure of treatment efforts for participants is in fact part of the criteria for selection of participants in SALOME, as was the case in NAOMI.

Many of the first participants will be exiting the clinical trial now and over the next two months (February and March).

Both studies provide an immense value not only to our scientific understanding of heroin dependence, but also to those individuals who have participated in the research. But as with NAOMI, the current study protocol of SALOME puts research participants at an increased risk by failing to have an adequate “exit strategy” in place for when research is complete.

Each of the research participants has previously failed on methadone maintenance treatment and other conventional treatments before entering the study, yet if the study shows that they are benefiting from diacetylmorphine when the research is concluded, they will not be allowed to be maintained on the drug that is benefitting them. Instead, they will be returned to methadone or other conventional treatment options.

This practice, as demonstrated in international research and through the accounts of participants in the NAOMI study, produces real harms to members of our community, and we cannot tolerate it being repeated during the SALOME study.

Canada remains the only country conducting a prescription diacetylmorphine (heroin) trial that has failed to provide diacetylmorphine to the research participants at the end of the trial.

We feel that research testing new methods of treatment for the harms of addiction is valuable, but must be conducted in ways that effectively address the continuing treatment and support for the individual participants in the research if the intervention proves successful.

By not putting in place an adequate exit strategy, the study is putting marginalized and vulnerable people at risk.

We request that Providence Health Care take immediate steps to provide ongoing diacetylmorphine treatment for participants concluding the SALOME study by applying for and supporting Special Access to diacetylmorphine, and begin planning for a pilot program for providing this treatment to the community at large.

How you can help:

On behalf of the NAOMI Patients Association (NPA), a community letter directed to Providence Health Care in support of heroin assisted therapy is circulating. The letter is available here.

For more information please contact Susan Boyd, on behalf of NAOMI Patients Association at naomipatientsassociation@hotmail.com

To learn more about the NPA click here.

February 4, 2013