Continuing neglect of people who inject drugs
Authors: Keith Sabin
Journal: The Lancet Infectious Diseases (2016)

In the wake of the United Nations General Assembly Special Session on the World Drug Problem, which did not explicitly mention harm reduction in its outcome document,1United NationsResolution adopted by the General Assembly on 19 April 2016. S-30/1. Our joint commitment to effectively addressing and countering the world drug problem.https://documents-dds-ny.un.org/doc/UNDOC/GEN/N16/110/24/pdf/N1611024.pdf?OpenElementGoogle Scholar Louisa Degenhardt and colleagues highlight one aspect of the human cost of the global response for people who inject drugs in the public health context.2Degenhardt L Charlson F Stanaway J et al.Estimating the burden of disease attributable to injecting drug use as a risk factor for HIV, hepatitis C, and hepatitis B: findings from the Global Burden of Disease Study 2013.Lancet Infect Dis. 2016; (published online Sept 20.)http://dx.doi.org/10.1016/S1473-3099(16)30325-5Summary Full Text Full Text PDF PubMed Scopus (179) Google Scholar The rise in disease burden of HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) attributed to injecting drug use between 1990 and 2013 is reflective of the lack of success in supply and demand reduction approaches, combined with the struggle for legitimacy faced by harm reduction programmes and the fact that they remain unavailable in more than half of countries worldwide.3Harm Reduction InternationalGlobal State of Harm Reduction 2014. Harm Reduction International, London2014Google Scholar The four-times increase in disability-adjusted life-years, mainly due to increased mortality, results from a two-decade-long inability to mount an effective global public health response to injecting drug use and comorbid viral infections. Most mortality from these infections is due to transmission events that occurred 10–30 years previously. Mortality up to and including 2000 was largely unimpeded by treatment because of insufficient treatment access in much of the world. However, if there is increased treatment availability for HIV, HBV, and HCV infections among people who inject drugs, mortality would begin to slow as has been seen in the past 5 years with the major scale-up of antiretroviral treatment for all people living with HIV.4UNAIDS 2016Global AIDS update 2016. Joint United Nations Programme on HIV/AIDS, Geneva2016Google Scholar However, needle and syringe programmes (which started in the 1970s) and medically assisted treatment with synthetic opioids (which started in the 1940s) have existed for decades before the current antiretroviral treatment era, but are still not widely available. The current reliance of the global response on attempts to reduce supply and demand flies in the face of history. In the 19th century, the British waged war on China in defence of British and other merchants' ability to sell opium in China without restriction.5Perdue PC The first opium war: the Anglo-Chinese war of 1839–1842.http://ocw.mit.edu/ans7870/21f/21f.027/opium_wars_01/ow1_essay01.htmlGoogle Scholar Today's merchants of opium and other narcotics, who are mostly non-state actors, continue to fight to sell their products. And just as with the Opium Wars, the merchants are not losing. Opium production continues largely unabated and new trade routes, possibly pushed by attempts to delay, disrupt, or destroy existing supply routes, spread into areas previously untouched by heroin, such as Kisumu in Kenya.6UNODCWorld drug report 2016. United Nations Office on Drugs and Crime, Vienna2016Crossref Google Scholar, 7Syvertsen JL Ohaga S Agot K et al.An ethnographic exploration of drug markets in Kisumu, Kenya.Int J Drug Policy. 2016; 30: 82-90Summary Full Text Full Text PDF PubMed Scopus (18) Google Scholar Global numbers of people who inject drugs, as estimated by United Nations Office on Drugs and Crime, WHO, and UNAIDS, have plateaued in recent years but data are not available from many countries with some evidence of heroin use.5Perdue PC The first opium war: the Anglo-Chinese war of 1839–1842.http://ocw.mit.edu/ans7870/21f/21f.027/opium_wars_01/ow1_essay01.htmlGoogle Scholar It is therefore crucial that efforts be refocused on evidence-based prevention and treatment programmes. Degenhardt and colleagues' calculations of the population attributable fraction of injecting drug use for HIV, HBV, and HCV support the idea that a comprehensive approach to prevention, including needle and syringe programmes and medically assisted treatment, could achieve much to reduce virus transmission.8UNAIDSDo no harm: health, human rights and people who use drugs. Joint United Nations Programme on HIV/AIDS, Geneva2016Google Scholar In particular, the burden from hepatitis C could be substantially reduced by effective prevention programmes. The indifference of too many authorities to the plight of people who inject drugs ignores the burden injecting drug use places on families and communities, as well as on the individuals themselves. The recent government-sanctioned killing of nearly 2000 people involved in drugs in the Philippines is just the latest and perhaps most vicious manifestation of violations of the human rights of drug users.9Guerra K Nearly 2,000 have died in Duterte's ‘war on drugs' in the Philippines. One is a 5-year-old girl.The Washington Post. Aug 26, 2016; (accessed Aug 29, 2016).https://www.washingtonpost.com/news/worldviews/wp/2016/08/26/nearly-2000-have-died-in-dutertes-war-on-drugs-in-the-philippines-one-is-a-5-year-old-girl/Google Scholar The global community should consider Degenhardt and colleagues' findings and seek new, more effective approaches to the world drug problem. I declare no competing interests. The views presented are those of the author and not necessarily his institution. Estimating the burden of disease attributable to injecting drug use as a risk factor for HIV, hepatitis C, and hepatitis B: findings from the Global Burden of Disease Study 2013IDU is a major contributor to the global burden of disease. Effective interventions to prevent and treat these important causes of health burden need to be scaled up. Full-Text PDF Open Access