Harm Reduction and Drug Policy Reform in the U. S.

1. Harm Reduction and Drug Policy Reform in the U. S. Laura Thomas, MPH, MPP Drug Policy Alliance MIDARP's 8th Annual Drug Addiction Research Symposium June 14, 2013

2. Drug Policy Alliance • The Drug Policy Alliance envisions a just society in which the use and regulation of drugs are grounded in science, compassion, health and human rights, in which people are no longer punished for what they put into their own bodies but only for crimes committed against others, and in which the fears, prejudices and punitive prohibitions of today are no more. • Our mission is to advance those policies and attitudes that best reduce the harms of both drug use and drug prohibition, and to promote the sovereignty of individuals over their minds and bodies.

3. Drug policy reform victories • Greater public support for drug policy reform • Legislative and ballot victories • New voices in support • Increased positive media coverage • New movement internationally

4. And yet… • And yet we still arrest over 1.5 million people for drugs every year, almost half for marijuana. • We still incarcerate a larger proportion of our population than any other country, with African Americans bearing the heaviest burden of incarceration and its collateral consequences. • Two-thirds of people incarcerated for a drug offense in state prison that are black or Latino, although these groups use and sell drugs at similar rates as whites. • Congress refuses to fund sterile syringe access to prevent HIV and hepatitis C transmission, thanks to a federal ban reinstated by Congress in 2011

5. Accidental drug overdose kills more people than motor vehicle accidents

6. Drug war violence kills thousands • Number of people killed in Mexico's drug war since 2006:  70,000+

7. What does the future hold for drug policy reform in the U. S.? • We still rely primarily on our criminal justice system to respond to drug use, rather than seeing drug use as a health issue. • People who use drugs are heavily stigmatized, marginalized, and criminalized • Popular opinion is well ahead of elected officials • Agreement that we need to try something different • Health insurance system is about to change dramatically • Other countries stepping forward with new models: Portugal, New Zealand, Uruguay, Colombia

8. Harm reduction: the seat belt and bike helmet of drug use • Harm Reduction refers to policies, programs and practices that aim primarily to reduce the adverse health, social and economic consequences of the use of legal and illegal psychoactive drugs without necessarily reducing drug consumption. Harm reduction benefits people who use drugs, their families and the community. • The harm reduction approach to drugs is based on a strong commitment to public health and human rights. • Large evidence base for effectiveness

9. Harm reduction interventions • Sterile syringe access (needle exchange) for HIV and viral hepatitis prevention • 911 Good Samaritan laws for overdose prevention • Naloxone to reverse opiate overdoses • Opiate substitution therapy (methadone and bupenorphine) • Heroin assisted treatment • Supervised injection services

10. Supervised injection facilitiesDrug consumption rooms “legally protected places where drug users consume pre-obtained drugs in a safe, non-judgmental environment and may receive health care, counseling, and referrals to other health and social services, including drug treatment.” (City of Vancouver Four Pillars Drug Strategy)

11. Research findings from Insite • The SIF has resulted in reductions in public disorder related to injection drug use. It is associated with reductions in public drug use and publicly discarded syringes. • Use of the SIF has been associated with increased uptake of detoxification services and other addiction treatments. Drug users who use the facility are more likely to enter detox programs, especially if they have had contact with the on-site substance use counselor. In Vancouver, use of detox increased by over 30% after Insite opened. • The fatal overdose rate decreased by 35 percent in the immediate vicinity of Insite since it began operating in 2003, while the rest of the city experienced a much smaller reduction of 9 percent.

12. More findings • The SIF has attracted and retained a high risk population of IDU who are more likely to be homeless and to frequently inject heroin and cocaine. • Use of the SIF has been associated with reductions in HIV and HCV risk behavior (syringe sharing) and overall injectors used safer injections practices after attending Insite. • Many individuals at risk for HIV and HCV infection are receiving safer injection education at the SIF, and increases in safe micro-injecting practices have been observed • The establishment of the SIF has not not prompted initiation into injection drug use • Insite has not led to increases in drug-related crime

13. 2005 Lancet article “This study found that IDUs who use Insite to inject drugs are 70% less likely to share syringes than IDUs who do not use the facility. An important finding was that IDUs who use Insite were as likely as those who do not use Insite to share syringes before Insite opened. In other words, the reductions in syringe sharing observed among Insite users only occurred after Insite opened, suggesting that Insite may have been responsible for this important behavioural change.” Kerr T, Tyndall M, Li K, Montaner J, Wood E. Safer injection facility use and syringe sharing in injection drug users. Lancet, 2005; 366(9482): 316-318.

14. 2010 Addiction article on cost “Insite’s safe injection facility and syringe exchange program reduce substantially the incidence of HIV infection within Vancouver’s IDU community. The associated savings in averted HIV-related medical care costs are more than sufficient to offset Insite’s operating costs. Pinkerton S. Is Vancouver Canada’s supervised injection facility cost-saving? Addiction, 105, 1429–1436 S

15. So why do we not have supervised injection services in the U.S.? • Legal issues • Political concerns • Lack of a public health/harm reduction approach to drug use • What is the cost of a slow learning curve?

16. Portugal model • Health-based, social inclusion approach • Decriminalized possession for personal use • Increased treatment capacity • Dissuasion Commissions • Positive results: • Lower HIV rates • Fewer overdose deaths • Reduced drug use • Reduced crime

17. What more can we do to end the criminalization and stigmatization of people who use drugs, provide treatment for those who need it, and reframe our approach to one based in science, compassion, health, and human rights?

18. Contact information Laura Thomas, MPH, MPP Deputy State Director, California Drug Policy Alliance131 – 10th Street | San Francisco, CA 94103Voice: 415.241.9800 lthomas@drugpolicy.org www.drugpolicy.org