International Journal of Drug Policy RSS feed: Current Issue. The International Journal of Drug Policy provides a forum for the dissemination of current research, reviews, debate, and critical analysis on drug use and drug policy in a global context. It seeks to publish material on the social, political, legal, and health contexts of psychoactive substance use, both licit and illicit. The journal is particularly concerned to explore the effects of drug policy and practice on drug-using behaviour and its health and social consequences. It is the policy of the journal to represent a wide range of material on drug-related matters from around the world. Electronic usage: An increasing number of readers access the journal online via ScienceDirect, one of the world's most advanced web delivery systems for scientific, technical and medical information. Average monthly article downloads for this journal: 9,932* * Figure is an average based on full text articles downloaded monthly via ScienceDirect between August 2008 and March 2009 http://www.ijdp.org/?rss=yesElsevier Inc.en © 2010 Published by Elsevier Inc. All rights reserved. International Journal of Drug Policy0955-3959212March 2010 © 2010 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.ijdp.org/article/PIIS0955395910000241/abstract?rss=yesEditorial Board10.1016/S0955-3959(10)00024-1International Journal of Drug Policy 21, 2 (2010)2010-03-01International Journal of Drug Policy2010-03-01212S0955-3959(10)X0002-0CO3CO3http://www.ijdp.org/article/PIIS0955395910000162/abstract?rss=yesThis special focus issue of the International Journal of Drug Policy coincides with IHRA's 21st International Conference in Liverpool held from 25–29 April 2010. Twenty-one years ago, in 1990, the first ever International Conference on the Reduction of Drug Related Harm was held in Liverpool and attracted 420 people. That first conference was the culmination of a concerted strategy in Liverpool to promote and develop harm reduction as a first line public health response to drug use (), and the links between people in Liverpool and others around the world who were starting to introduce harm reduction projects and policies. The conferences now attract between 1200 and 1500 people from over 80 countries. They have become the key forum for the dissemination of harm reduction ideas and practice, and have helped to put harm reduction on the map and to coordinate advances, innovations, evidence and advocacy in this field. The International Journal of Drug Policy also had its origins in the events of the late-1980s and also has its 21st birthday this year. The journal started life as the Mersey Drugs Journal in 1988 under the editorship of Alan Matthews and in 1990 became the International Journal of Drug Policy under the editorship of Alan Matthews and then Pat O’Hare.Harm reduction: Moving through the third decadeGerry V. Stimson, Pat O’Hare10.1016/j.drugpo.2010.02.002International Journal of Drug Policy 21, 2 (2010)2010-02-22International Journal of Drug Policy2010-02-22212S0955-3959(10)X0002-0EDITORIAL9193http://www.ijdp.org/article/PIIS0955395910000058/abstract?rss=yesAbstract: In the mid-1980s in Liverpool, and the area surrounding it (Merseyside and Cheshire), harm reduction was adopted on a large scale for the first time in the UK. The harm reduction model was based on a population approach to achieve the public health goal of reducing the harm to health associated with drug use. The particular concern at that time was the risk of HIV infection, but there was also the issue of the health of a group of young people who were under-served by health services. To achieve the goal, services were developed that would attract the majority of those at risk within the community, not simply the few who wished to stop using drugs, and which would enable contact with the target group to be maintained so as to bring about the necessary changes in behaviour required to maintain health and reduce risk. This Commentary describes some of the background to the development of the Mersey Model of Harm Reduction from the memories and perspectives of two people who promoted harm reduction within the health service and the region.Public Health and the origins of the Mersey Model of Harm ReductionJohn R. Ashton, Howard Seymour10.1016/j.drugpo.2010.01.004International Journal of Drug Policy 21, 2 (2010)2010-02-17International Journal of Drug Policy2010-02-17212S0955-3959(10)X0002-0COMMENTARIES9496http://www.ijdp.org/article/PIIS0955395909001364/abstract?rss=yesAbstract: HIV/AIDS was the defining issue for international harm reduction during its first twenty years. This issue was marked by strong contrasts: rapid HIV transmission in some populations of injecting drug users, and close to elimination of HIV in other populations; a formidable research base for designing effective HIV programmes and persistent political problems in implementing evidence-based programmes on a public health scale. Elevated rates of HIV infection among ethnic minority drug users have occurred in many different countries. We do not yet have systematic knowledge of how to reduce stigmatization of AIDS or people who use drugs. Nevertheless, international harm reduction for people who use drugs has moved beyond HIV/AIDS to a variety of other health and social problems, while retaining firm bases in science and human rights.Learning from HIV epidemics among injecting drug usersDon C. Des Jarlais10.1016/j.drugpo.2009.11.001International Journal of Drug Policy 21, 2 (2010)2009-12-17International Journal of Drug Policy2009-12-17212S0955-3959(10)X0002-0COMMENTARIES9799http://www.ijdp.org/article/PIIS0955395909001686/abstract?rss=yesAbstract: Recent systematic reviews have provided a global picture of injecting drug use, HIV and the global response to HIV epidemics among people who inject drugs. They have also revealed significant gaps in our knowledge, in both the problem and the response. It is clear that the prevalence of injecting drug use, and of HIV among injecting populations, varies geographically, differing hugely both within and across countries. In many cases, however, data on the number of drug injectors, and of the proportion who are living with HIV, is often unavailable or inaccurate, and gaps exist in many low income countries. The response to injecting drug use and HIV also varies hugely; both the nature and the scale of the response show marked geographic variation. The lack of quality data acts as an impediment to accurate assessments of effective and targeted responses to HIV among people who inject drugs. It is encouraging that the comprehensive suite of interventions considered “essential” by UN agencies in the response to HIV among people that inject drugs is being introduced in more countries now than ever before. Nonetheless, there remains an urgent need for more and higher quality data to be collected, in order to sufficiently inform, improve and ultimately evaluate the response.Improving the data to strengthen the global response to HIV among people who inject drugsBradley Mathers, Catherine Cook, Louisa Degenhardt10.1016/j.drugpo.2009.12.007International Journal of Drug Policy 21, 2 (2010)2010-02-08International Journal of Drug Policy2010-02-08212S0955-3959(10)X0002-0COMMENTARIES100102http://www.ijdp.org/article/PIIS0955395910000034/abstract?rss=yesAbstract: Injecting drug use is a major driver of the HIV epidemic globally. Whilst robust evidence points to the effectiveness of harm reduction programmes to halt and reverse injecting drug use driven epidemics, uptake of these programmes in developing and transitional countries has been slow. In part, this slow uptake stems from inadequate financial resources for harm reduction; legal, socio-cultural and medical barriers leading to stigmatisation; and weak health systems unequipped to manage marginalized groups.The Global Fund to Fight AIDS, Tuberculosis and Malaria, established in 2002, has become the major multilateral source of external funding for harm reduction programmes in countries experiencing concentrated HIV epidemics driven by injecting drug use. Between 2004 to end of 2008, the Global Fund invested around US$180 million in harm reduction programmes in 42 countries. This funding has helped to initiate and scale up harm reduction programmes in settings where domestic funding was lacking.In addition to financing harm reduction programmes globally, the Global Fund has stimulated a strong dialogue between vulnerable groups and governments. Furthermore, the Global Fund has engaged in a dialogue with countries to encourage an evidence-based approach to policy-making that recognizes the immense value of harm reduction in HIV prevention and control.The Global Fund's leadership on harm reduction: 2002–2009Rifat Atun, Michel Kazatchkine10.1016/j.drugpo.2010.01.002International Journal of Drug Policy 21, 2 (2010)2010-02-22International Journal of Drug Policy2010-02-22212S0955-3959(10)X0002-0COMMENTARIES103106http://www.ijdp.org/article/PIIS095539590900156X/abstract?rss=yesAbstract: As countries in Asia strive to meet their universal access targets, harm-reduction programmes are yet to be scaled up to reach effective levels of coverage. Resource tracking and estimation of resource needs and gaps is critical to inform the financing decisions of major donors of harm-reduction programmes in the region. This study aimed at estimating the financial resource needs and gaps for scaling-up harm reduction in the region, building on previous research conducted by the Independent Commission on AIDS in Asia. The overall resource need for achieving universal access in the target population in 2009 was US $0.5 billion, with NSP and OST accounting for nearly 70% of the overall regional resource need. A significant resource gap, approximately 90%, of the resource need in 2009, was identified for harm reduction in the region, representing less than 2% of the overall global resource need to address AIDS. Additional resources will be required to support the introduction and scaling-up of integrated, comprehensive harm-reduction programmes that provide a full range of services to reduce HIV transmission among people who inject drugs.How much will it cost? Estimation of resource needs and availability for HIV prevention, treatment and care for people who inject drugs in AsiaAnne Bergenstrom, Ross McLeod, Mukta Sharma, Fabio Mesquita, Jimmy Dorabjee, Rifat Atun, Gary Lewis, J.V.R. Prasada Rao10.1016/j.drugpo.2009.11.004International Journal of Drug Policy 21, 2 (2010)2010-02-10International Journal of Drug Policy2010-02-10212S0955-3959(10)X0002-0COMMENTARIES107109http://www.ijdp.org/article/PIIS0955395909001352/abstract?rss=yesThe development of the international drug users’ movement has been intrinsically linked to the growth and development of the international harm reduction movement but more particularly with the annual International Harm Reduction Association (IHRA) conferences. These conferences gave drug user activists a chance to meet in an environment where our lives were being talked about and our treatments decided and our views have, over the years, been given increasing consideration. The impetus for us to have a visible presence was extremely important. We had not had much success in making an impact on the drug and alcohol fields in our individual countries. It was the outbreak of HIV/AIDS that gave us our voice in the local situation and led to the birth of harm reduction initiatives, in particular, the provision of needle exchange. However, it was the drug and alcohol arena that had such a big and so often negative impact on the majority of drug users’ lives, particularly in the late eighties and early nineties. It has been said that it was learning activism in the HIV/AIDS movement that led to us bringing our newly found voices to the emerging harm reduction movement. It is true to say that except for the Dutch MDHG Belangenvereniging voor Druggebruikers (Interest Association for Drug Users) experience of setting up the world's first needle exchange in 1984, in response to an outbreak of Hepatitis B amongst people who inject drugs (), activist drug users were a rarity prior to HIV/AIDS. They were not seen as having any worthwhile experience or knowledge to give to the wider community. In this crucial respect, it was drug users themselves who kick-started the harm reduction movement. However, in the early years our voices were largely stifled by the increasing professionalisation of the field and the marginalisation of people who used drugs.Coexisting or conjoined: The growth of the international drug users’ movement through participation with International Harm Reduction Association ConferencesJude Byrne, Eliot Ross Albert10.1016/j.drugpo.2009.10.009International Journal of Drug Policy 21, 2 (2010)2009-11-30International Journal of Drug Policy2009-11-30212S0955-3959(10)X0002-0COMMENTARIES110111http://www.ijdp.org/article/PIIS0955395909001583/abstract?rss=yesAbstract: Globally, young people under 25 accounted for an estimated 45% of all new HIV infections in 2007. Across the Eastern Europe and Central Asia region as many as 25% of injecting drug users (IDUs) are younger than 20. The Eurasian Harm Reduction assessment of young peoples’ (under 25) drug use, risk behaviours and service availability and accessibility confirms, young people at risk of injecting, or those already experimenting with injecting drugs, find themselves isolated from health and prevention services, which increases the risks for health and social harms, while the approach towards young peoples’ use rely heavily on law enforcement. Denying young drug users’ access to life-saving drug treatment and other harm reduction services contributes to the risk environment surrounding their use and violates their right to health and well-being as identified in the Convention on the Rights of the Child. Governments, health care providers and harm reduction services should work together to create an environment in which young people can access needed services, including non-judgmental and low-threshold approaches offered by harm reduction programs.Young people and drugs: Next generation of harm reductionSimona Merkinaite, Jean Paul Grund, Allen Frimpong10.1016/j.drugpo.2009.11.006International Journal of Drug Policy 21, 2 (2010)2009-12-28International Journal of Drug Policy2009-12-28212S0955-3959(10)X0002-0COMMENTARIES112114http://www.ijdp.org/article/PIIS0955395909001558/abstract?rss=yesAbstract: Although drugs are haram and therefore prohibited in Islam, illicit drug use is widespread in many Islamic countries throughout the world. In the last several years increased prevalence of this problem has been observed in many of these countries which has in turn led to increasing injecting drug use driven HIV/AIDS epidemic across the Islamic world. Whilst some countries have recently responded to the threat through the implementation of harm reduction programmes, many others have been slow to respond. In Islam, The Quran and the Prophetic traditions or the Sunnah are the central sources of references for the laws and principles that guide the Muslims’ way of life and by which policies and guidelines for responses including that of contemporary social and health problems can be derived. The preservation and protection of the dignity of man, and steering mankind away from harm and destruction are central to the teachings of Islam. When viewed through the Islamic principles of the preservation and protection of the faith, life, intellect, progeny and wealth, harm reduction programmes are permissible and in fact provide a practical solution to a problem that could result in far greater damage to the society at large if left unaddressed.Islam and harm reductionA. Kamarulzaman, S.M. Saifuddeen10.1016/j.drugpo.2009.11.003International Journal of Drug Policy 21, 2 (2010)2009-12-14International Journal of Drug Policy2009-12-14212S0955-3959(10)X0002-0COMMENTARIES115118http://www.ijdp.org/article/PIIS0955395910000071/abstract?rss=yesAbstract: Afghanistan has suffered decades of war, occupation and unrest. It is also the world's greatest producer of opium and drug production and trafficking account for a third of the total Afghan economy. Currently alongside the “War on Terrorism”, the control and eradication of opium production and related trafficking is a main concern of the international community. However, this focus on supply reduction has meant scant attention has been paid to increasing drug use problems within the country; it is estimated there are up to 25,000 opium users and 20,000 heroin users in Kabul city. Drug use is often a response to war, poverty and under-development, however, street opium and heroin manufactured in the country are widely available, affordable and of high purity. This paper documents the efforts of non-governmental organisations to promote and develop harm reduction and treatment services for problem drug users in Afghanistan in this difficult context.Implementing harm reduction for heroin users in Afghanistan, the worldwide opium supplierOlivier Maguet, Murtaza Majeed10.1016/j.drugpo.2010.01.006International Journal of Drug Policy 21, 2 (2010)2010-02-22International Journal of Drug Policy2010-02-22212S0955-3959(10)X0002-0COMMENTARIES119121http://www.ijdp.org/article/PIIS0955395909001303/abstract?rss=yesAbstract: The link between injection drug use and HIV has been extensively described. Despite worldwide prevention efforts, injection drug use continues to be a risk factor for HIV transmission and both HIV and injection drug use continues to spread across the globe. Although methadone has demonstrated multiple health benefits including the reduction in injection drug use and HIV acquisition, the utilisation of methadone in many areas of the world remains one of secondary, rather than primary, HIV prevention. As a result, many who finally begin methadone enter treatment having accumulated medical and mental health problems as a result of delayed treatment. Rapid access to treatment and a more aggressive policy that realizes that methadone can help reduce opioid drug use is necessary if methadone is effectively going to act as primary HIV prevention. To delay access to methadone only increases the probability that the individual will acquire an infectious disease that is more costly to the individual in terms of morbidity and mortality and more costly to society as a whole.Methadone as HIV prevention: High Volume Methadone Sites to decrease HIV incidence rates in resource limited settingsR. Douglas Bruce10.1016/j.drugpo.2009.10.004International Journal of Drug Policy 21, 2 (2010)2009-11-20International Journal of Drug Policy2009-11-20212S0955-3959(10)X0002-0COMMENTARIES122124http://www.ijdp.org/article/PIIS0955395910000125/abstract?rss=yesAbstract: Multiple factors are implicated in the diffusion of injecting drug use (IDU), including individual and demographic characteristics, drug markets, economics, social networks and political and cultural environments. However, studies show that individual transitions away from injecting are possible, and that a recent diffusion of non-injecting routes of administration (NIROA) has occurred in several countries. Injecting is more risk-laden than other routes of drug administration, yet relatively little attention has been paid to reducing or preventing injecting drug use by promoting NIROA. This commentary reviews the case for, and examples of, ‘route transition interventions’ which seek to do this. These include: prescribing oral substitutes; providing non-injecting equipment; providing safer smoking facilities; and training individuals to prevent transitions to injecting, promote NIROA, or prevent the initiation of new injectors. These initiatives have the potential—as yet largely unrealised—to offer public health gains and empower people to control and manage their drug use. Further research is needed to secure commitments at all levels to support this approach.Route transition interventions: Potential public health gains from reducing or preventing injectingJamie Bridge10.1016/j.drugpo.2010.01.011International Journal of Drug Policy 21, 2 (2010)2010-02-18International Journal of Drug Policy2010-02-18212S0955-3959(10)X0002-0COMMENTARIES125128http://www.ijdp.org/article/PIIS0955395909001340/abstract?rss=yesAbstract: Tobacco harm reduction is a controversial policy due to the experience with filtered and ‘light’ cigarettes and concerns that the tobacco industry will use reduced harm products to undermine tobacco control strategies. The most promising harm reduction products are high dose pharmaceutical nicotine preparations and low nitrosamine smokeless tobacco, such as Swedish snus. However, despite widespread availability, existing pharmaceutical nicotine preparations have not been taken up by smokers as an alternative to smoking. In Sweden, increased snus use was associated with decreased cigarette smoking and mortality from tobacco-related disease. We suggest a graduated series of policies to explore of the public health costs and benefits of encouraging smokers to switch to these less harmful nicotine products.Harm reduction policies for tobacco usersCoral Gartner, Wayne Hall10.1016/j.drugpo.2009.10.008International Journal of Drug Policy 21, 2 (2010)2009-11-30International Journal of Drug Policy2009-11-30212S0955-3959(10)X0002-0COMMENTARIES129130http://www.ijdp.org/article/PIIS0955395910000022/abstract?rss=yesAbstract: Despite a plethora of health-related problems, access to primary healthcare is often limited for drug users (DUs). Many seek care at emergency departments and tertiary hospitals because of late presentation of illness. The costs to both DUs and the health system are such that harm reduction based healthcare centres (HRHCs) have been established in various settings and utilising a variety of models. These provide a range of medical and sometimes social services, in one, integrated, low-threshold facility, including (or closely linked with) programs such as needle syringe provision. In some countries these HRHCs are becoming an alternative healthcare system for DUs. However, the need to provide such services on a broad, public health scale, in a sustainable, cost-effective manner, raises the question as to whether such programmes should be mainstreamed. This commentary provides insights on advantages and disadvantages to mainstreaming HRHCs, and approaches and barriers to achieving this. Two approaches suggest themselves: (i) providing harm reduction services through the regular healthcare system, or (ii) more closely integrating HRHCs with mainstream services. Funding and stigma are major barriers to mainstreaming. Diverse national policies towards DUs, healthcare systems and contexts, necessitate different approaches. Because of the various barriers to mainstreaming, any steps towards mainstreaming should be taken whilst maintaining the option of continuing the current targeted harm reduction services.Harm reduction healthcare: From an alternative to the mainstream platform?M. Mofizul Islam, Carolyn A. Day, Katherine M. Conigrave10.1016/j.drugpo.2010.01.001International Journal of Drug Policy 21, 2 (2010)2010-01-21International Journal of Drug Policy2010-01-21212S0955-3959(10)X0002-0COMMENTARIES131133http://www.ijdp.org/article/PIIS0955395909001650/abstract?rss=yesAbstract: The response to the HIV epidemics among people who inject drugs in Asia began to emerge in the early to mid 1990s, with the rather hesitant implementation of small-scale needle syringe programmes and community care initiatives aiming to support those who were already living with the virus. Since then Asia has seen a significant scaling up of harm reduction, despite very limited resources and difficult policy and legislative environments. One of the major reasons this has happened, is the utilisation of programme based approaches and the firm entrenchment of harm reduction thinking within national HIV/AIDS programmes and strategic plans—in most cases aided by multilateral and bilateral donors. Several models of scale up have been noted in Asia. The transition away from project based approaches, while on the whole positive, can also have a negative impact if the involvement of civil society and a client focussed approach is not protected. Also there are implications for which models of capacity building can be systematised for ongoing scale up. Most crucially, the tensions between drug policy, human rights and public health policies need to be resolved if harm reduction services are to be made available to the millions in Asia who are still unable to access these services.Moving from a project to programmatic response: Scaling up harm reduction in AsiaAnindya Chatterjee, Mukta Sharma10.1016/j.drugpo.2009.12.004International Journal of Drug Policy 21, 2 (2010)2010-01-15International Journal of Drug Policy2010-01-15212S0955-3959(10)X0002-0COMMENTARIES134136http://www.ijdp.org/article/PIIS0955395909001571/abstract?rss=yesAbstract: An affinity between the evidence and arguments for drug normalization and the policy and programme directions favoured by harm reduction is often assumed but seldom critically examined. This commentary looks at parallels and contradictions emerging with respect to different cultures, social settings, types of problems and responses where the match is less than perfect. Mounting evidence of normalization has also led to backlash in some countries and the mobilization of forces reaffirming prohibition. We call for further research on normalization that focuses on substance use, risks, harms, and social context across a broader spectrum of the population, and in a variety of cultures. By emphasizing the most serious harms experienced by persons in the smallest segments of drug using populations, harm reduction often has neglected broader research and policy suggestions that might be implemented to benefit controlled, recreational drug users. Future policy development with respect to normalization will require more research and more serious discussion of its implications for informing the transition toward a global public health approach to substance use.Normalization and harm reduction: Research avenues and policy agendasPatricia G. Erickson, Andrew D. Hathaway10.1016/j.drugpo.2009.11.005International Journal of Drug Policy 21, 2 (2010)2009-12-18International Journal of Drug Policy2009-12-18212S0955-3959(10)X0002-0COMMENTARIES137139http://www.ijdp.org/article/PIIS095539591000006X/abstract?rss=yesAbstract: This commentary addresses some of the challenges posed by the broader normative, legal and policy framework of the United Nations for the international drug control system. The ‘purposes and principles’ of the United Nations are presented and set against the threat based rhetoric of the drug control system and the negative consequences of that system. Some of the challenges posed by human rights law and norms to the international drug control system are also described, and the need for an impact assessment of the current system alongside alternative policy options is highlighted as a necessary consequence of these analyses.Security, development and human rights: Normative, legal and policy challenges for the international drug control systemDamon Barrett10.1016/j.drugpo.2010.01.005International Journal of Drug Policy 21, 2 (2010)2010-02-01International Journal of Drug Policy2010-02-01212S0955-3959(10)X0002-0COMMENTARIES140144http://www.ijdp.org/article/PIIS0955395910000253/abstract?rss=yesIHRA Announcement10.1016/S0955-3959(10)00025-3International Journal of Drug Policy 21, 2 (2010)2010-03-01International Journal of Drug Policy2010-03-01212S0955-3959(10)X0002-0II