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Tag: Hot Topics

Russian Harm Reduction NGO Declared “Foreign Agent”

The Andrey Rylkov Foundation (ARF), the only NGO that provides sterile needles and syringes to injecting drug users in Moscow, has been declared a “foreign agent” by the Russian government. This means that the Russian government regards as presenting a threat to national security because they receive funding from international donors.

The ARF have released this press release:

Press Release

By The Andrey Rylkov Foundation For Health And Social Justice, Regarding It’s Inclusion Into The List of Organizations Carrying Out Functions Of A Foreign Agent

Citizens, keep alert – this press-release is issued by the organization carrying out functions of a foreign agent!

On June 29, 2016, The Ministry of Justice of the Russian Federation included our organization, the Andrey Rylkov Foundation for Health and Social Justice http://www.rylkov-fond.org in its list of “foreign agents” and has published an official announcement on its website. According to the announcement, the “fact that the organization has characteristics of an NGO carrying out functions of a foreign agent was established by the Main Department of the Ministry of Justice in the Russian Federation in Moscow during a regularly scheduled document check.”

Our organization works on issues related to public health: prevention of HIV, Tuberculosis, hepatitis C and drug overdoses. We also provide social support to people who suffer from drug dependence, helping them to stay healthy, referring them to medical and social services in Moscow, rehabilitation centers, and narcological hospitals. We make contact with people who use drugs through street based social work and we are the only organization in the city which has constant access to this group. This group is very vulnerable to health problems and their access to medical services throughout the city is restricted. Almost no one wants to work with them. People who are drug dependent often can’t receive the medical help they need whether it is treatment abscesses or TB\HIV. Most of participants of our project are denied access to the hospitals, refused help and left to suffer. Together with our participants and supporters we fight for the accessible medicine, effective treatment, improved health care and protection of rights. These were the actions that Ministry of Justice considered to be a political activity.

We work on the streets of Moscow every day. Last year we served 3854 men and 1096 women, carrying out over 300 consultations on HIV and hepatitis; providing consulting to 371 people on drug dependence (including consultation with a psychologist and referral to treatment); and many received consultations regarding overdose and abscesses. In only the last two years, through our work due to promote the use of naloxone, a medication for overdose deaths prevention we received confirmation that we had saved 417 lives! And these are just the ones that we know about. It is harder to count the number of HIV or hepatitis infections that we prevented.

Yes, we do carry out our work using foreign funding, donations from private foundations and crowdfunding. But this is not because we want to work this way. Over the last few years, we applied for President’s grants 4 times so that our work could be funded from Russian sources but our projects were never financed. For a long time already, HIV prevention is not funded from public funds. But we will try to continue to work as we have in the past, helping drug dependent people on the streets of Moscow, and trying to promote the drug policy based on humaneness, tolerance, public health, human rights and dignity.

Recently we received the administrative offence report from the Ministry of Justice clarifying exactly which of our activities were considered political. These include:

  • Participation in the “Support. Don’t Punish” campaign in 2015. This is a global advocacy campaign calling for better drug policies that priorities public health and human rights. We participate in this campaign for many years. In 2015, in addition to us, 160 other cities took part in it. Within this complain we hold one-person pickets in front of the office of the Federal Drug Control Service (which since been disbanded) demanding for the introduction of opioid substitution therapy (a cost-effective evidence based approach to deal with drug dependency) in Russia.
  • Publication on our website of an Open letter from the Eurasian Network of People Who Use Drugs (ENPUD) to the Prime Minister of the Russian Federation (RF) on the results of a special session of the Government Commission of the RF on the response to the HIV epidemic and public health.. The Ministry of Justice payed particular attention to those parts of the letter which called for the introduction of the opioid substitution therapy in Russia
  • Interview of the President of the Andrey Rylkov Foundation Anya Sarang given at TV Rain on 26.11.2013. In this interview Anya provided a negative feedback on the law introducing the forced treatment of the drug dependent people. In the opinion of the Ministry of Justice, the expression of the expert opinion on the “policy pursued be the public authorities” also is considered as a political activity.

In spite of the much higher risks we face now due to numerous traps hidden in the law of the foreign agents which could lead to significant administrative fines, at the moment, we are planning to continue our activities including those focused on prevention of HIV and other health related problems among people who use drugs. And we will appeal the decision of the Ministry of Justice. The legal support will be provided by the NGO Lawyers Club.

Best regards,

Andrey Rylkov Foundation

Follow us on Twitter @AndreyRylkov and in Facebook.

The Andrey Rylkov Foundation needs Your help more than ever – the only way to ease the isolation and stigmatisation of the organisation is support from the international community. Please go to the Global Giving website and make a donation today!

Naloxone And The Rising Cost of Saving a Life

Dan Bigg is the Director of the Chicago Recovery Alliance who have been giving out naloxone since the mid 1990s, in this short film he talks about the impact a rising cost of the drug is having on the number of people whose lives can be saved.

In this film Dan mentions the differing costs of the different forms and formulations of naloxone, including the Enzio Auto-Injector which currently costs over $750.

What are your opinions on the rising costs of this (and other) life saving medications. Is it just a case of needing more equipment suppliers to drive down the costs, via competition or is there some other way to ensure lives can continue to be saved?

Will The New NSP Guidance Change Services For People Who Use Steroids?

NICE have released their latest guidance for Needle and Syringe Programmes, in this latest version they have included strong guidance for the delivery of services to people who use Performance and Image Enhancing Drugs (PIEDs).

Including that services:

  • Are provided at times and in places that meet the needs of people who inject image and performance-enhancing drugs. (For example, offer services outside normal working hours, or provide outreach or detached services in gyms.)
  • Provide the equipment, information and advice needed to support these users
  • Are provided by trained staff
  • advice on alternatives (for example, nutrition and physical training can be used as an alternative to anabolic steroids)
  • information about, and referral to, sexual and mental health services

View full guidance

So, do YOU think this guidance is going to change the way services are delivered to PIED users? Will commissioners take notice?

Needles Are Not Enough

In the 1980s, the UK and many other countries started developing needle programmes in an attempt to limit the impact that HIV was having on the injecting community and by extension the general public. Needle programmes have also become early engagement tools to help people get into treatment

The range of equipment provided has gradually increased with (in the UK) minor law changes to allow distribution of citric, filters, spoons and water. 30 years later and these projects are still helping keep HIV levels low and now they’re helping minimise the risks of HepB and HepC.

But this intervention only works with injectors. Injectors are likely to have been using drugs for a number of years already, so surely supplying equipment to people smoking or snorting their drug of choice should be a logical next step in early engagement.

There have been studies into distribution of foil to heroin smokers (Pizzey and Hunt: Distributing foil from needle and syringe programmes (NSPs) to promote transitions from heroin injecting to chasing: An evaluation) These demonstrate that as well as being a good engagement tool the supply of foil can also act as a route transition away from injecting.

In 2008, I presented at the National Needle Exchange Forum meeting about a crack equipment project I’d started that had resulted in an increase in clients to the service, many of whom had never attended before. These new attendees engaged with the HepB vaccination programme and counselling . Both clients and staff said they’d become more confident in delivering and receiving support.

In 2010, the ACMD gave Theresa May a detailed report on foil provision and in November 2012, she wrote to them asking “what evidence [is there] that provision of foil would get people off drugs” (you can see her letter, and the ACMD reply).

Where the provision of smoking equipment has been embraced (like Holland for foil, or some states in the US for pipes) there have been more great successes in engaging with people before they move to injecting. But in the UK, we’re prevented from expanding in this way by Section 9a of the Misuse of Drugs Act, a law that was devised to prevent ‘head shops’ from selling drug paraphernalia. Head shops still sell drug kits, now they just put a sign on them saying ‘novelty use only’, but many drug services have become so risk averse that they are unlikely to give out this equipment, although there has never been a successful conviction under this law and the Crown Prosecution Service state that prosecution of “bona fide operators” of drug services is not in the public interest. (UPDATE: As of September 2014 foil is now legal in the UK, but with strong restrictions).

It’s clear that needle programmes can only do so much, we need pipe programmes and foil projects as well if we want to engage people earlier.

This topic was submitted by Nigel Brunsdon the Community Manager at HIT and owner of the Injecting Advice website. All opinions expressed in this topic are his own. Thanks to Jamie Bridge for assistance in writing this topic.

Overdose, Stigma and the Great Challenge

Last year on the 31st of August 2011, (International Overdose Awareness Day) I posted an image of Jimi Hendrix to Twitter with the following caption; ‘Imagine how much sweeter the world would sound with a little more harm reduction’. (While there are varying reports regarding the nature of Hendrix’s death the official finding was that he asphyxiated on his own vomit after consuming more alcohol than he was able to tolerate – effectively an overdose of alcohol). It was my way of acknowledging that when a fatal overdose occurs it is not just a death that occurs but the loss of an opportunity.

With a little more harm reduction, Jimi Hendrix may have well gone on to record many more revolutionary albums enriching our lives artistically and culturally, but just as important are the many non celebrities who have experienced overdose. They too have lost the myriad and unforeseeable opportunities that a longer future could have entailed. Really, everyone’s world would rock with a little more harm reduction. It is these thoughts I ponder as we approach International Overdose Awareness Day 2012.

I live in Australia, a nation with relatively well developed harm reduction programs. The Medically Supervised Injecting Centre in Sydney has now been operating for over a decade and has saved countless lives, not only intervening when people overdose but also providing a gateway to a myriad of health and treatment services to an all too often marginalised population of injecting drug users. In the Australian Capital Territory a pilot program  designed to widen the availability of naloxone to the peers and families of opiate users is under way with the aim of increasing the speed in which we can respond to opiate overdose. Australia’s well developed needle syringe programs are also playing their part, providing crucial harm reduction information to people who use drugs.

Responding to overdose however is not just about providing a safe physical environment, it’s not just about providing the right medications in a timely manner and it’s not just about getting technique right. While all of these things are vitally important, a crucial ingredient in addressing overdose is overcoming stigmatising attitudes towards people who use drugs. Stigma kills. It drives people who use drugs to the fringes of our community. Stigma has the power to separate people from much needed supports, marginalising them from health services and even their families. People use in secret or fail to let others know when something goes wrong due to fear of the judgement and condemnation.

I’ve known many, many people who have used drugs throughout my life. Some have been mad, some have been sad and some have been bad, but if I looked hard enough I could always find something positive about them. With the vast majority I haven’t had to look very hard at all. The reality is that people who use drugs are mothers and fathers, policemen and poets, sons and daughters – in short they are just people like you and me.

While I’ve known many people who use drugs, I’ve also met many people over the years who have held very strong negative opinions about people who use drugs. Possibly the most callous opinion I have heard uttered was the idea that we should ‘put buckets of the shit out in the street and let them all kill themselves.’ Many in our communities have dehumanised people who use drugs and fail to recognise the loss that lives cut short by overdose entails.

This loss may be best encapsulated not in my words but by the words of Kat Daley who recently published a stunningly honest account of her own experience of the overdose of a loved one.

There are so many assumptions that come with drug related deaths. People assume an overdose is a heroin overdose. And that heroin overdoses happen in laneways somewhere. They assume the person was a ‘junkie’ and had probably caused their loved ones much angst and heartache, having stolen from them and abused them and all of those other things that drug addicts do.”

“Sometimes all of that is true. But a lot of the time it’s not. Either way, it doesn’t matter. Losing a child who stole from you is still losing a child. Only a parent who has been through this can understand that losing your child means losing part of you. The day I lost my brother part of my mother went with him.

The great challenge in addressing overdose is not which programs we can put into place. The harm reduction sector has demonstrated time and again that through a combination of effective advocacy and the systematic collection and analysis of evidence, we can implement effective harm reduction programs (even highly contentious ones like drug consumption rooms) that prevent or reduce the likelihood of overdose. The greater challenge is how to address stigma in our communities. How can we convince the wider community that people who use drugs are human beings not that much different from anyone else? How can we convince our communities that reducing drug related deaths provides opportunities so broad and so large that the potential loss is unimaginable? Saving even one life from overdose may result in the greatest rock and roll album ever made or it might result in tender moments shared between a parent and a child that otherwise might not have been.

Matt Gleeson is an Educator, Blogger and Harm Reduction Advocate. He is currently employed by UnitingCare ReGen and in his spare time writes the blog, Stonetree Harm Reduction. All opinions expressed are his own.

Russell Brand on Newsnight

Last week, Newsnight hosted a discussion on drug policy, starring that well-known expert on drugs, Russell Brand. The BBC have decided that Russell Brand can make a documentary film in which he will tell us what we should be doing about drugs, or rather what we should be doing to people who use drugs.

He was interviewed by a star-struck Stephanie Flanders, a (normally excellent) economics expert, who let him spout his views unchallenged, although she did ask him how he was qualified to offer a blueprint for the future. His answer was that he used to take drugs, which itself went unchallenged. For the only time in my life, I yearned for Jeremy Paxman. (For a discussion on whether that qualifies him to tell us all what we should be doing, read this excellent article by Yasmin Alibhai-Brown in the Independent, in which she argues, successfully in my view, that experience is not the same as expertise.)

My Way, The Only Way

For Brand, the government is doing the wrong thing in giving people methadone, and the only way is abstinence-based recovery. He believes that we shouldn’t give people methadone because it is a drug, and they shouldn’t be taking drugs. I take three drugs a day and they deal with a medical condition that I have. Presumably Russell Brand thinks I shouldn’t be taking them because they are drugs. However, if he believes that drug “addiction” is a disease, should that not lead him to believe that the correct medication, or drug, one of which is methadone, should be prescribed?

His “empirical understanding” leads him to believe that drug users are people of “deep sadness and malady” who have a disease or disorder and who spend their lives doing silly and irrational things over which they have no control because they are using drugs. They are not themselves.

While not wanting to make light of the problems which can face some people who use drugs, legal and illegal, I have always believed that people take drugs, not the other way round. Most of the heroin users I have known have spent most of their lives doing very rational and well thought out things in order to have the money to buy their drugs.

This really is the cult of celebrity gone mad. While I believe that everyone has the right to express their point to view, for the BBC to give Brand such a platform could have serious implications for policy, which is supposed to be for the many, not the few, and will further contribute to the marginalization and stigmatization of people who choose not to be abstinent.

This Hot Topic is by HIT’s Director Pat O’Hare who has been involved in the development and promotion of drug services since the 1980s, Pat is also on the board of Harm Reduction International (HRI) and the Middle East & North Africa Harm Reduction Association (MENAHRA).