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Op-Ed: Canada’s drug policy is in with the wrong crowd

By Michel Kazatchkine, Ottawa Citizen February 25, 2014

The world’s nations have begun talks ahead of the United Nations General Assembly Special Session on Drugs in 2016. This is a time of increasing high-level calls for drug policy reform and a sense that policies long dominated by prohibition and law enforcement in many parts of the world have failed miserably. Countries may be better served with a public health policy approach instead.

Canada has long been a world leader in implementing harm reduction policy when it comes to drug use at home.

So it was almost shocking to see it aligning itself to countries such as Russia and China in vocally opposing the inclusion of “harm reduction” in a new a new set of UN principles that will guide talks at the special session in 2016.

It is a disturbing decision, given the international acknowledgment of Canada’s progressive harm-reduction approach to HIV prevention that has successfully saved thousands of lives.

Many of these approaches, such as clean needle and syringe programs and the provision of opioid substitution therapy, are now recommended by the World Health Organization (WHO), the Joint United Nations Program on HIV/AIDS (UNAIDS), and the United Nations Office on Drugs and Crime (UNODC), and have become the gold standard for other countries to replicate.

The evidence from trials and from experience on the ground is comprehensive: harm reduction reduces the risk of acquiring HIV; it decreases mortality among people who inject drugs.

The evidence has long been in. Harm reduction interventions were the primary reason that an HIV/AIDS epidemic was avoided among the drug user community in the developed world at the onset of the disease in the 1980s.

Harm reduction interventions also increase the lifelong chances of quitting drugs, decrease delinquency and violence related to drugs, and help re-socialization in the workplace and with family.

How can Canada speak out at the UN against the very programs that has made it a world leader in the fight against HIV?

It is somewhat ironic that probably the most famous and studied harm-reduction program in the world is in Canada. Insite, Vancouver’s supervised injection site, is a facility where addicts can inject street drugs under the protective gaze of a nurse.

Since it opened 10 years ago, more than one million injections have taken place at Insite. Fatal overdose rates dropped 35 per cent in the neighbourhood, and thousands of people have been connected to detox and drug treatment options, housing and employment, and health services like HIV and hepatitis C treatment.

Throughout, not a single needle has been shared, meaning no one has contracted, or transmitted, HIV at Insite.

As a result of services like Insite, Vancouver has become the only jurisdiction in the world to demonstrate dramatic decreases in HIV among its injection drug-using populations.

However, Canada’s current federal government has done everything in its power to close the facility, and to prevent others from opening.

In 2007, Canada expunged the words “harm reduction” from its National Drugs Strategy, and in taking an anti-harm reduction stance at the United Nations last month, Canada has joined ranks with member states that equally oppose harm reduction, including Russia — the country with the world’s fastest-growing HIV epidemics among people who inject drugs.

While UNAIDS reports that annual HIV infections are dropping worldwide, Russia is seeing its rates climb: More than one million people, or about one in one hundred, are living with HIV. That figure was around 250,000 only a decade ago.

Sixty per cent of all new infections in Russia come from needles used and reused to inject drugs. This number grows by about 200 new cases every single day, meaning that Russia is spreading HIV five times faster than the global average.

As the UN Secretary-General’s Special Envoy for HIV/AIDS in Eastern Europe and Central Asia and as a scientist, I and my colleagues who work in the field have seen countless examples over the past three decades where harm reduction interventions, of the kind that exist in Canada, have successfully prevented an HIV epidemic among people who use drugs in so many countries.

On so many levels it is disappointing to see Canada — a country that was formerly a defender of harm reduction and human rights in the international system — turn its back on the very approaches to HIV prevention that it has helped pioneer, and that hold the potential to save millions of lives worldwide.

Michel Kazatchkine is the UN Secretary-General’s Special Envoy on HIV/AIDS in Eastern Europe and Central Asia.

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