Presented by Sharon Stancliff MD at the International Society of Addiction Medicine (ISAM) Congress in Dundee, 2015.

1. Global implementation of Harm
Reduction
1
Sharon Stancliff, MD
Harm Reduction Coalition
USA
harmreduction.org
stancliff@harmreduction.org

2. ISAM Policy
“Physicians in addiction medicine will together
formulate empirically-grounded policies for
addressing this illness on the national and
international level”
http://isamweb.org/about_isam/mission/

3. Focus: injection drug use
• Injection drug use has been reported in 158
countries
• Estimates of numbers of people who inject
drugs (PWID):8.9-22.4 million
• How many already are infected with HIV?
Between 0.9-4.8 million
• Opioid overdose is the leading cause of
preventable drug related mortality
Global State of Harm Reduction 2014;
World Drug Report, UNODC

4. Harm Reduction Principles
• Accepts, for better and or worse, that licit and illicit drug use is part
of our world and chooses to work to minimize its harmful effects
• Does not attempt to minimize or ignore the real and tragic harm
and danger associated with licit and illicit drug use.
• Encompasses a continuum of behaviors from heavy drug use to
total abstinence, and acknowledges that some ways of using drugs
are clearly safer than others.
• Establishes quality of individual and community life and well-
being–as the criteria for successful interventions and policies.
• Recognizes that the realities of poverty, class, racism, sex-based
discrimination and other social inequalities affect both people’s
vulnerability to and capacity for effectively dealing with drug-
related harm.
Harm Reduction Coalition
Harmreduction.org

5. Consolidated guidelines on HIV prevention, diagnosis,
treatment and care for key populations
World Health Organization 2014

6. Consolidated guidelines on HIV prevention, diagnosis,
treatment and care for key populations
World Health Organization 2014

7. Needle and Syringe Programs Globally
Global State of Harm Reduction 2014

8. Opioid maintenance treatment globally
Global State of Harm Reduction 2014

9. Prevention Works for NYS’s IDUs
As the annual number of syringes exchanged increases,
the number of new HIV infections among IDUs decreases

10. Newly Diagnosed HIV Cases by Transmission Risk
New York State, 2002-2012*
0
1000
2000
3000
4000
5000
6000
2002 2004 2006 2008 2010 2012
MSM Fem. Pres. Het. Heterosexual Unknown
IDU MSM/IDU Pediatric Blood Prod.
10
*December 2013 NYSDOH/AI/BHAE

11. Changes in reported cases of HIV in Ukraine
International HIV/AIDS Alliance in
Ukraine, 2012 report

13. Decriminalization- De jure
Written into law
• No offense: Uruguay
• Police discretion: Spain
• Administrative decision: Portugal, Czech Republic
• Criminal Justice Decision: Germany, Peru, Estonia
International Drug Policy Consortium

14. Decriminalization- De facto
• No sanction: Netherlands
• Police diversion: USA: Seattle
• Criminal justice diversion: USA in many states
International Drug Policy Consortium

16. International Drug Policy Consortium
5 Asks
1: Ensure an open and inclusive debate
2: Re-set the objectives of drug policies
3: Support policy experimentation and innovation
4: End the criminalization of the most affected
populations
5: Commit to the harm reduction approach

17. Funding levels
The global budget for drug law enforcement almost
certainly exceeds US$ 100 billion every year
It is estimated that 10% of this budget could fund
much of what is needed
International Drug Policy Consortium

18. Potential asks for addiction physicians
• Access to evidence based medications including but
not limited to methadone and buprenorphine in
general and in the criminal justice system
• Overdose prevention with treatment and naloxone
• Access to clean injection equipment
• Exploration of models of decriminalization
• Drug use in pregnancy as a medical issue
• Access to optimal pain management

19. Acknowledgement
• New York and Vienna Nongovernmental
Organizations Committees on Drugs
• International Drug Policy Consortium
http://idpc.net/