Policy and harm reduction: What about the people?

Dr Ian Hodgson, CNS Correspondent
Speaking during the opening ceremony of the 25th Harm Reduction International Conference (#HR17), Montreal, Canada's Minister of Health, Jane Philpott, stated that, “Addiction is not a crime, or a moral failing, and not a bad choice, but a health problem.”

For the 1000 or so delegates listening this was nothing new. But this conference takes place against a global backdrop of diminishing harm reduction services, reduced funding, increasingly punitive legislation and brewing stigma against people who use drugs, and emergent crises such as the rapid escalation of drug-related deaths from overdose.

Globally, harm reduction is under immense pressure. According to the Global State of Harm Reduction Report, released in 2016 by Harm Reduction International, there is a quantifiable gap between international commitments made over the last two years and levels of financial leadership shown by governments and agencies. Since 2014 no new country has implemented needle and syringe programmes - the first time since the report’s inception in 2008. Of 158 countries where injecting drug use has been reported, 68 still have no such programmes in place. The report asserts that, Civil Society is “relied upon to deliver services, gather data, advocate for funding, and fight for the rights of people who use drugs.”

In Canada the current administration, under Prime Minister Justin Trudeau, is proposing a range of policies and legislation to tackle some of this country’s harm reduction challenges. Proposals include changing the status of Naloxone to be available without prescription and in multiple formats, granting approvals for four supervised ‘consumption sites’, and tabling legislation to support the process for similar sites. The government has also introduced a bill - C-37 - to streamline the process for applying for, and obtaining, approvals for supervised consumption sites. This is radical but necessary, and Canada is at least responding to the crisis.

Globally, however, the picture is less positive. In the Philippines, for example, more than 7,000 people have died since July 2016 in President Duterte’s ‘war on drugs’, surely a move towards drug prohibition. In February 2017 US President Trump presided over the creation of new treatment mandates leavened with the notion of recovery, or even abstinence, both approaches viewed extremely critically by harm reduction advocates. People using drugs in Hungary have faced significant de-funding of needle and syringe exchange programmes since 2011, and in 2015 the second of the two largest programmes - which together provided 55% of the service - was closed down. According to Peter Sorisi, Executive director of the Rights Reporter Foundation speaking here in Montreal, “Harm reduction is not isolated from the larger political environment.” Hungary’s ‘Action Plan for Drugs’, released in 2015, makes no mention of needle and syringe programmes, and the country is seeing increasing incidence of hepatitis C amongst injecting drug users.

As the Minister of Health stated at the conference, “The topic of drug policy remains politically and emotionally charged and open to controversy.” Some of this emotion manifested in a demonstration during her speech by the #TheyTalkWeDie campaign. Around 100 delegates, wielding banners, turned their backs as Philpott spoke, venting frustration at general political intransigence whilst people using drugs are dying. Stories shared so far during the conference certainly confirm that, as politicians spend time honing drug policy the impact of ineffective, or even non-existent, harm reduction for people who use drugs is catastrophic.

This annual International Harm Reduction Conference is a meeting of minds, offering a key opportunity for advocates to meet, share research findings, and learn of new and innovative harm reduction initiatives that are humane and grounded in human rights. Most importantly, it offers a safe, communal space in a hostile world. Towards the end of the conference’s opening ceremony, Minneapolis-based harm reduction activist Lee Hertel drove this point home. “We are loving, kind people, and we care about each other.”

People who use drugs are just that. People.

Dr Ian Hodgson, CNS (Citizen News Service)
23 May 2017