This is our 21 st conference a chance to engage in some nostalgia and also to look to the next generation of harm reduction.

Transcription

1 OPENING SPEECH This is our 21 st conference a chance to engage in some nostalgia and also to look to the next generation of harm reduction. The first ever international conference on the reduction of drug related harms was held here in Liverpool in That conference brought together many people who were starting to introduce harm reduction projects and policies. This all started in the mid 1980s as a response to the newly discovered HIV epidemics among people who inject drugs. To the younger members in the audience - 25 years is a long time ago - before , the web, and mobile telephones. Harm reduction began in a modest way. In the Netherlands the Junkie-Bund a drug users union 1

2 started needle exchange in 1984 (actually in response to a hepatitis B epidemic). In Switzerland, the first needle exchange started in In the UK one of the first needle exchanges started near here in the Mersey Regional Drug Training and Information Centre in Maryland Street, By the end of 1986 and the beginning of 1987 programmes had started in many parts of Europe and in Australia. In 1988 a needle exchange programme started in New York. Parallel to this there was an expansion of methadone treatment and wider acceptance of methadone maintenance. Harm reduction started as public health strategy, informed by social justice. The new approach started a major transformation in dealing with drug problems. A new social movement energised around HIV/AIDS prevention. There were new ideas of working with drug users, in practical terms through outreach and peer education. But also a new ethos - that the fight HIV/AIDS needed a collective and collaborative response - bringing together the work of public health and drug agency workers with 2

3 drug users. That was an ideal that drove HIV/AIDS prevention as a social movement in the 1980s. The international harm reduction community should be proud of what has been achieved. Who could have imagined that, twenty five years later, harm reduction would have received such acceptance in the international community. Let us just take a moment to thank those early pioneers of harm reduction, many of whom are here today. [Applause] The comprehensive package of evidence based HIV prevention interventions that developed over the last two decades has been endorsed at the highest levels in the United Nations system. It is evidenced based. It works in a wide range of cultural, social and religious settings. On Wednesday we will release IHRA s report on the Global State of Harm Reduction. This shows that there are 93 countries worldwide that support harm reduction, eleven more than when we last reported in 2008 volume of the Global State of Harm Reduction. 3

4 Needle exchange exists in 82 countries and opioid substitution therapy in 70 countries. That s good, but not good enough. There are 76 countries and territories with drug injecting but with no needle and syringe exchanges. There are 88 countries where injecting occurs and where there is no opioid substitution treatment. And as you will hear from Bradley Mathers talk in the plenary tomorrow - globally only two sterile needles are available per injector per month for every 100 people who inject drugs only eight receive OST for every 100 people who inject drugs living with HIV only four receive anti-retroviral treatment Coverage is way behind anything that is likely to have a major impact on a global scale. [Pause] 4

5 I have talked a lot about harm reduction and HIV. That is inevitable because many harm reduction interventions came to global prominence around HIV prevention, and many harm reduction projects are funded through HIV/AIDS money. But harm reduction is not just about HIV. Harm reduction is relevant to all psychoactive drugs. Indeed harm reduction started much earlier than HIV, for example in the 1960s in the advice about how to minimise harm and maximise pleasure. Considerable thought and energy has gone into trying to reduce the impact of drug use in night time recreational settings - focussing on the drug use environment in which drugs are used. So for example, training club bouncers to be gentler people, ensuring there is ventilation and adequate water available for club goers, are all ways to reduce the potential negative impacts of drug use. Regarding alcohol, there is a long tradition of trying to reduce harms related to drinking, by making the drinking environment safer for drinkers, safer for drunks, and safer for people who are not drinking. 5

6 Drink driving legislation is a classic example of harm reduction. It separates out two risky activities, drinking and driving. It does not ban either of those activities, but tries to make sure they do not occur together. Furthermore, helping tobacco smokers to shift to non smokable nicotine products can dramatically reduce tobacco related harms. Unfortunately in the case of tobacco as with other drugs, laws often stand in the way of harm reduction interventions. Safer forms of nicotine are more highly regulated than smokable tobacco. Oral tobacco is banned altogether in the European Union except in Sweden. It is easier to obtain the more harmful tobacco products than the less harmful ones. Promoting harm reduction for legal drugs may lead us to some unusual allies. My personal view is that it is very difficult to promote harm reduction for alcohol and tobacco without engaging with producers and distributors of those drugs. So, harm reduction is relevant to all psychoactive drugs including alcohol and tobacco. And that point is made 6

7 clear in the IHRA position paper entitled what is harm reduction?. On Thursday we will release that in 10 languages. Harm reduction is based on the reality that many people throughout the world continue to use psychoactive drugs - indeed that many people like using drugs - including alcohol and tobacco despite even the strongest efforts to prevent the initiation of or continued use of drugs. The theme of the conference is harm reduction the next generation. That next generation includes all the young people who have not benefitted from harm reduction or who are excluded from information and services solely due to their age. The next generation includes how we can expand HIV related harm reduction into places where it is much needed, and how we can increase our demands on international agencies such as Global Fund to properly fund harm reduction. The next generation includes the challenges of how we can deliver harm reduction in resource constrained settings. 7

8 The next generation also includes what harm reduction will look like as we move through the third decade. Many obstacles stand in the way including ignorance by governments, antipathy to drug users, legal barriers, and the undervalued place of people who use drugs in society. The next generation is about how harm reduction gets to grips with the way we control and regulate all psychoactive substances. Massive investment in law enforcement has not paid off, and can itself be harm maximising. In the United Nations Drug Conventions, starting with the Single Convention on Narcotic Drugs in 1961, the threat of drugs to health and welfare was made clear. But despite lofty intentions, the policies that flowed from those international conventions did little to reduce drug use or tackle health problems. Huge investment has gone into trying to keep drugs from people, and to eradicate cannabis, coca and opium poppy, with little success. But the failure lies not only in unachieved international policy objectives. International and national drug policies 8

9 stand in the way of improving health and welfare and exacerbate problems. Academic rigour and strong ethical standards combine in harm reduction to produce a powerful antidote to the moralistic ideology that so often drives drug policies. What started in the margins as a public health mission has, over time, become an epicentre of reform. This is because harm reduction follows the evidence. But sometimes the evidence leads us to difficult places and asks of us very difficult questions. We must have the courage to continue to follow the evidence and to draw the necessary conclusions. Criminalising drugs and drug users causes considerable harms, serves as a barrier to public health objectives, and has no discernable purpose other than to punish. A reassessment of the international drug control system is way overdue. The negative consequences of international drug control are now well known. And they are severe. Drug control has contributed to the corruption of law enforcement and criminal justice, to violence, to security 9

10 destabilisation, food insecurity, human displacement and a wide range of human rights abuses inflicted on drug users. It has impeded the response to the HIV/AIDS pandemic. It is time for that to stop. Alternative policy options must be considered, and they must be considered now. But they will not. The political will is simply not there. It will be a very long and hard fight. One day, though, reason will win out. The next generation of harm reduction, I hope, will be one where harm reduction is increasingly seen as the very foundation of drug policies, national and international, rather than an afterthought. Thank you. 10