31st August: World Overdose Day

When you are using drugs intravenously, overdosing is a real reality. Drug user unions all over the world are constantly pumping out overdose prevention materials, workshops, etc. But more recently, some more fortunate country policies have led to NALOXONE being handed out to every user at risk. Naloxone is the stuff that the paramedics inject you with that brings you around from an opiate overdose often in less than 30 seconds. Except, even though in some countries contless lives have been saved by by passing the wait for the ambulance and just giving it direct to users to uuuse on each other should something go wrong, there are still too many dying of what is now so often preventable. Sadly, they haven’t got Naloxone in Nepal yet as this writer and INPUD member tells us. But thank god he was able to get some lifesaving advice, on this real overdose day.
Written by NK, Nepal.
 
 
The purple ribbon worn on 31st Auug, International Overdose Day

The purple ribbon worn on 31st Auug, International Overdose Day

It was the 30th August 2014, one day before the world overdose awareness day and I saw another overdose.
We three friends gathered in as usual place and decided to inject NOORPHINE, DIAZEPAM, EVIL, STAGUN , PHENARGUN.
 
So we got what we wanted and the whole plan was arranged by me. Recently i am on methadone treatment.  I love to inject all these drug formulas to get high, but on the 30th August in the afternoon i was a bit confused about injecting NORPHINE, even though this whole plan was organised by me.
 
So i decided to exclude NORPHINE from the above drug combination as some one told me not to inject NORPHINE. So i told my friends just to fill the syringe with all other drugs but to exclude NORPHINE for me and one of my friends.
 
Among three of us, two of us are on OST programe (methadone), and we both decided to do the same formula but in some corner in my mind i was confused, so i tried to phone many people to take some advice.
 
Mr Anjay K.C (an INPUD member and activist) was one person who suggested to us clearly not to inject.
 
As i love to inject all these formulas,I first phoned him once to confirm that how much (mls) should I inject for my safety and as he knows that I am on methadone treatment, so he clearly told me not to use all these drugs together for my safety.
 
A second  call was made by him to tell me about why i should not use all these drugs together while i am on methadone.  And the third phone call was made by him to know whether i had made a bad choice of injecting or not and I choose not to inject but one of  my friends did choose to inject and he is now in hospital. (On third phone call i was out getting a taxi for an emergency ride to hospital).
 
I am sitting now outside the hospital and thinking why we dont have access to NALOXONE in Nepal? If naloxone works to prevent overdose then it should be in Nepal.
 
It was thanks to Mr Anjay that my mother didn’t cry and my relatives didnt visit hospital saying different discriminating words.  I am sitting now outside the hospital and thinking why we dont have access to NALOXONE in Nepal. If naloxone works to prevent overdose then it should be in Nepal.
 
During the last 5 years i had seen a lot of friends of mine die due to overdose.  Well, I think its not a natural death – because we dont have access to Naloxone or something which could prevent the future people who inject drugs from overdose accidents..
 
Every phone call made to Mr Anjay Kc were on Handsfree so we  three could hear his suggestions on Injecting all the drugs above or not, and the second phone call he made played a vital role and i didnt inject. So i am alive to write this email. Well, i am seeing my friends mom’s emotions towards her son and even i can feel how his relatives are feeling now.
 
As his mother cant see this message, i really want to say Sorry to his mom and him for arranging all this  and i am praying god he will recover him soon,even it was his choice to inject.
 
When a overdose accident happens,we all face the same root causes of OVERDOSE and I know that this advice on 30th Aug given to me by Anjay will work while I am on methadone but when i am done with methadone the best way to prevent OVERDOSE is naloxone.
 
Please Anjay, dont think this is a lavish praise to mr Anjay KC, this is a illustrative example which could happen to anyone but there wont always be people like Anjay brother and i am lucky that on 30 august 2014 he was there to help me to prevent possible  death or  a hospital bed  
 
And most of people who use drugs in Nepal do hango and pango with all the possible risks, and this is happening. (The street name in Nepal for all above drugs are HANGO and PANGO). Well we are drug users and noone has be shocked to know that I am taking my choice of substances or injecting all above things sometimes or once in a week.and I am not afraid tell the fact, and its not  that everyone listened or will listen to Anjay brother or to others who knows its high risk behavior, but with easy access to Naloxone it is a better idea to prevent more overdose accidents in near future.
 
Thanks for a sobering message NK, on International Overdose Day 31st Aug. 
 
Your favourite ‘liked’ guest blog gets a cash prize every 3 months so dont forget to ‘like’ . 
 
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Life Goes On in Russia’s Crimea

Here are the final 2 blogs in the series of 4, from Igor Kuzmenko’s personal blogs of Crimea, in particular, life for those who once lived under Ukraine law and received Opiate Substitution Treatment (OST) such as methadone only to lose their new found stability after the region’s Referendum when the majority voted to go back to Russian governance. This effectively closed the doors for good on OST leaving over 800 people in shock and despair. So what is a person withdrawing from treatment supposed to do? What would you do if your access to methadone or buprenorphine was cut off almost overnight…? Igor gives us a frighteningly honest account of what happened to the OST community in Crimea..Here is part 3 and part 4.

 

RIP Crimean OST Program, 2006

Igor Kuzmenko

Igor Kuzmenko

Part 3

Meanwhile life in the Crimea went on. As spring approached, people continued to go to work, and students proceeded to attend their studies. Very few inhabitants of the Crimea understood that 806 people of the region’s  population, were literally on the way out.

 

Death From Abstinence

As I  wrote previously, the first patient in Simferopol died around the beginning of April. He was about 50, was seriously ill and couldn’t move at all. Everything was good with him before the March events; the doctor wrote a prescription for him so he could get liquid methadone and he continued to use Opiate Substitution Therapy without leaving the apartment. But after March 16, everything changed and the prescription form of OST was suspended in Crimea. It goes without saying that any coroner wouldn’t determine a cause of death as ‘death from abstinency’. But something tells me that if he continued to have the opportunity to receive methadone, he would be still alive.

 But after March 16, everything changed and the prescription form of OST was suspended in Crimea.

Bupe Not Methadone

Actually,  there were not so many people receiving OST on a prescription basis in the Crimea. And there were a few reasons for that. First,  the prescription form is possible only for those people who receive buprenorphine in Ukraine. There are cities where all clients of the buprenorphine program constantly receive it using a prescription. But everything is much more difficult when dealing with methadone.

ukrainian methadone Methadose and Metadol

Ukrainian methadone:
Metadict and Metadole -dispensed in the form of tablets , but rarely syrup

The medicine used in a Ukrainian methadone OST program – known as ‘Metadict’ and ‘Metadole’ – are both made in Germany or Canada. Both of them are in the form of tablets, not syrup. They come in blister packs of 10 tablets: 25 mg each, (total 250mg)  or in bottles of 500 mg. But it is impossible to get it using a prescription because according to the laws of Ukraine a single prescription dose of any narcotic substance mustn’t exceed 112 mg. The blister packs are not allowed to be cut up or tablets prescribed separately from the packaging. There were individual cases when patients could receive a liquid methadone on prescription, but only on a commercial basis and it is very expensive.

 

Methadone Not Bupe

In the Crimea, it is different. Slightly more than 50 people out of 806 patients received buprenorphine, the others got methadone. About 10 people out of those 50 had the opportunity to receive buprenorphine on prescription though not on a constant basis. They got it occasionally – because of a business trip, illness or going on a holiday.

Ukrainian Metadol

Ukrainian methadone; Metadol

There is also one more reason for prescriptions being shut down in the Crimea after “the referendum”. Doctors were afraid to write out prescriptions on both of these substances because they are actually illegal in Russia and so employees of drugstores in turn, were afraid to sell the medications and fill  these prescriptions.

 

May 20th – D Day

May 20 was the last day when people could use the OST program in the Crimea, so after that each of the 806 person’s who were prescribed had to make one’s own choices of what to do. There were only four options:

  1. String oneself up to stop using drugs forever
  2. Go to Russian local rehabilitation centers praised by numerous Russian “guests”;
  3. Continue using OST by moving to Ukraine;
  4. Go back to using “street” drugs.

According to my knowledge, no more than 20-30 people went to Russia for rehab. Many of them couldn’t undergo an entire “rehabilitation course” till the end and ran away. However, some stayed in rehab for the whole term. One OST client from Simferopol died in St. Petersburg during the rehabilitation process. He died of an overdose.

Slightly less than 60 people risked going to Ukraine. This option was, undoubtedly, the most realistic of all. For example, in many cases it was necessary to buy tickets at ones’ own expense to go to Russia, but in Ukraine both tickets, accommodation and food were paid for you.

 

Should I Stay or Should I Go?

Nevertheless, as you can see by the number of people who went to Ukraine, it didn’t become a mass phenomenon. Partly, this was due to mass media propaganda which colourfully described the various ‘atrocities’ of Ukrainians in relation to the inhabitants of the Crimea who risked leaving and facing the ‘mockeries’ of the Ukrainian border guards who were taking away passports on the border and other nonsense. The other reason that many of inhabitants of the Crimea never left for Ukraine, was they had neither friends, nor relatives there and simply couldn’t imagine where they were supposed to go.

Now many of the clients of OST who had gone to Ukraine, already found a job there, and all without exception found rented accommodation and received some financial support from the project MBF “Renaissance”.

 

“It turns out that more than 600 people started taking street drugs again.”

 

From those people with whom I was in contact no more than 10 people could finally stop taking drugs of any kind.

If you make simple arithmetic operation, it turns out the following:

806 (total number of clients in the Crimea OST program) minus 20 (number of those who undergone “rehabilitation” in Russia), minus 60 (left to Ukraine), minus 50 (suppose not 10, but 50 people stopped taking drugs) = 676.

About 30 already died out of that number of people. It turns out that more than 600 people started taking street drugs again. And many of them during many years of using the OST program found work, started a family and gave birth to children.  Now it’s all over.

 Igor Kuzmenko

Below is the final part of Igor Kuzmenko’s series on Crimea. Please feel free to add your thoughts and comments and let us know if you have a story to tell from your country.

 RIP Crimean OST Program, 2006

Igor Kuzmenko

Igor Kuzmenko

Part 4

How to reach those people who made decisions on the issues of Opiate Substitution Therapy (OST)  in the Crimea? Which words should be found to explain to them that situation where 800 drug users under constant medical and psychological control, employed and reintegrated, is much better than 800 people coming back to being criminalised in the drug trade? How could one explain what the blue sky is to the person born blind? How it is possible to explain to a mother, whose son quietly had been using OST for several years, stopped breaking the law, started a family and found a job, why he has died of an overdose during the rehabilitation? Who benefits from it?

“What we had been created for several years was destroyed in two and a half months.”

Probably, for those people who have nothing to do with OST and don’t have the slightest idea of what this therapy actually is, it is only a “change of the dealer” – earlier I bought drugs on the street and now I get them free of charge from the doctor. But actually OST is a difficult system in which the process of taking methadone or buprenorphine is only a small part of the whole process. OST is a complex of actions that allow the person to live a more or less productive life. Many elements of this scheme, such as the ART (Anti Retroviral Therapy*), anti-tubercular therapy, are strongly connected with OST. There is no point in pretending otherwise, many people started to use ART and to look after their health only after they visited the OST site.

Irina,one of the 806 OST patients to lose their prescriptions

Irina,one of the 806 OST clients in Crimea to lose their prescriptions

Stability and the Street

What we had been created for several years was destroyed in two and a half months.

So, more than 600 former people from the OST programs have taken part in the illicit drug scene again since May. What do our people use to medicate themselves with now?

Lyrica. This beautiful and romantic word is actually the name for one of the biggest problems of the Crimean drug scene nowadays. Lyrica (active agent – Pregabalin). An antiepileptic and anticonvulsive medical product made by Pfizer Company. Many ex-OST patients are suffering from its over-use today. It has excellent medical qualities if you take it on prescription, but it causes terrible side effects and dependence for those people who try to combat withdrawal syndrome with its help. It is sold freely in any drugstore in the Crimea and costs not so much.

Only a total deficiency of any medical products in local drugstores is saving others from the serious consequences of pharmaceutical drug dependence in the Crimea.

“Now I hear from people who were full of vim and vigor, who had plans for the future just two months ago, that they want to die.”

Checks. “Checks” is how people name portions of raw opium from which it is possible to extract heroin, if you add acetic anhydride to it.

“Checks” existed in the Crimea as far back as I can remember. It is a good reliable way to quickly recover from withdrawal syndrome. You could get “checks” quite easily at any time. But after the OST programs were closed, hundreds of drug users suddenly entered the market (more than 200 people just in Simferopol! ) and devastated all the opium reserves in the Crimea. Moreover, new anti-narcotic structures represented by the Russian police (all police officers came to the Crimea from the Russian cities – Perm, Kazan, Moscow, there are not any local representatives in police) and by Federal Service on Control of the Drug trafficking (FDCS) – the nightmare of the Russian drug users. The increase in number of “checks” users led to a decrease in its supply and importing from Ukraine became a big problem.

By hearsay, so as not to suddenly miss an opportunity to increase profits, dealers began to add foreign substances to their product, it could be harmless substances or hard shit like home-made methadone. New police forces and new circumstances around buying drugs has led to the situation where purchasing “checks” poses a big problem now.

Heroin. I often hear from people in the Crimea that there is lot of cheap heroin here now. But I couldn’t find even one person who saw or tried that heroin. So I can draw a conclusion that there is not and there was not any heroin in the Crimea.

Krokodil. I assure you that if it wasn’t for a deficiency of medical products in drugstores, including codeine-containing ones, “krokodil” would now be problem No. 1 in the Crimea. But every cloud has a silver lining.  People just can’t find the substance that you should use to make this poison, and that’s why krokodil isn’t present in the Crimean drug scene.

“Well, this is how it goes.”

Well, this is how it goes.

Now I hear from people who were full of vim and vigor, who had plans for the future just two months ago that they want to die. Former patients aren’t able to go to work because they suffer from never-ending withdrawal syndrome. Their families suffer as much as they do.

I am an optimist.  My glass is always half full. But I can’t see anything optimistic in the future of those from the last OST programme in Crimea.

Well, who knows, maybe I’m mistaken.

Written by Igor Kuzmenko

*ART: Anti Retroviral Therapy is a medical treatment for HIV/AIDS

 

All 4 parts in the Crimean OST series has been written by Igor Kuzmenko and here’s a massive public thank you to him for his really honest and personal insights into what it has been like for our peers in the region, and answering many of our questions too, I’m sure. The blogs were translated from Russian into English by the very professional Daria Mighty, and we are indebted to her speed and accuracy, thank you Daria! (The Russian version is available at ENPUD)
If you want to find out more about the drug using community and its issues in the region of Eurasia, or you are living in that part of the world, check out INPUD’s sister organisation on their website ENPUD (The Eurasian Network of People who Use Drugs). You can become a member, read other blogs from Igor and others and find out the news and views on drug issues and politics.

Please write to us at blog@inpud.net if you have a drug related story from your country.

Posted in Eastern European Countries, Europe, law enforcement, Law reform, methadone, peer insights, Regional Information, Regional News & Info | Tagged , , , , , , | Leave a comment

Last Calls on Methadone…Russia’s in Charge

The recent events in Ukraine were watched by us all over the world. A president is deposed, and civil unrest spreads throughout the region. The Ukraine loses control of its western front in Crimea and by way of a rushed referendum supported by the people, has to hand the region back to Russia.  Military personal appear in the streets and laws change overnight. But what happens to the drug users? At INPUD, our members know very well that while the Ukraine recently started giving methadone and buprenorphine (mainly buprenorphine) to its users, Russia on the other hand, deems both drugs illegal and will not entertain OST (Opiate Substitution Therapy) for any reasons whatsoever. So, to the Crimean drug users who had once been lining up outside the methadone clinic, what was going to happen? Igor Kuzmenko was there and has written a series of blogs for us to give readers an insight into life after The Russian Referendum. 

Note: Igor Kuzmenko is an active member of INPUD’s sister organisation ENPUD, the Eurasian Network of People who Use Drugs / Click the link to find out about what is going on in the region (pages are translatable with Chrome) and if interested, if you can fill in their membership form.

RI.P. Crimean OST program, 2006 - 

By Igor Kuzmenko

Part 1 (of 4)   It just so happened that when that a life changing referendum was being held in March in the Crimea this year, the one which asked all Crimean citizens about whether our region should stay with the current government of Ukraine or return again to Russia, I was participating in the annual commission of Narcotic Drugs in Vienna.  This meant  I could only receive news from the Crimea via Skype or by phone. And the news was bad. For my own work as a social worker dispensing Opiate Substitution Treatment (OST),  it really was bad news; a sharp decrease in dosages was followed by panic among the patients and  low spirits of the medical personnel on the OST site. And then there was the strange armed people and large numbers of ‘unknown’ military equipment now appearing in the Crimea…

igorVienna1_ed

Igor Kuzmenko outside the Commission for Narcotic Drugs In Vienna this year. He would return to quite a different Crimea…

Almost nothing has changed in the Crimea on the surface. Except that instead of usual Ukrainian flags there are now Russian ones, and instead of traffic cops there are notorious “green little men” at the junctions. And at night you can sometimes hear the roar of military machines crossing the city.

“If, at the beginning buprenorphine was reduced by 2 mg a week, at the end of April and in May it was being reduced by 2 mg every other day. It was a very painful process.”

The OST site changed externally even less – the same people, the same fuss. But it was only externally. The fear started to grow. The doctors and nurses were afraid because legally, if the Crimea belongs to Russia and obeys Russian laws and they continue with methadone distribution on the site, they could be arrested for “distribution of drugs in especially large amounts performed in collusion by a group of people”. And you should agree, that’s no laughing matter.

OST clients were terrified because changes to prescriptions are always frightening. Their families were terrified too, because years of quiet living came to an end after the termination of OST.

Dosages decreased more and more. If, at the beginning buprenorphine was reduced by 2 mg a week, at the end of April and in May it was being reduced by 2 mg every other day. It was a very painful process. Of course, many patients tried to compensate for a lack drugs by using a large amount of barbiturates and those who could, also used street drugs. Thus the condition of patients constantly worsened: barbiturates helped to numb unpleasant feelings a little but not the pain, which was enfeebling you at the same time. I still remember people wandering about the site yard like ghosts, patients who had grown old in just a few days.

OST Patients walking away having consumed their last dose of methadone...

OST Patients walking away having consumed their last dose of methadone…

How OST Died

I want everyone to have a clear idea of how exactly OST died in the Crimea. There weren’t any documents issued by local authorities or from the Ukrainian or Russian side which could forbid, limit or in any other way have an effect on the situation with substitution therapy on the Crimean sites.

The reasons for the decrease in dosages were a limited quantity of pharmaceuticals in the Crimean warehouses and an impossibility to import methadone and buprenorphine from Ukraine to the Crimea.

It was difficult to import enough methadone and buprenorphine for a month into the Crimea even before the referendum because there wasn’t calm in Ukraine due to the Maiden* and, after March 16, all these difficulties were multiplied by the issues of state affiliation. We just weren’t allowed to import a new consignment of medicine. OST wasn’t banned in the Crimea, it was strangled.

“OST wasn’t banned in the Crimea, it was strangled”

OST wasn’t banned in the Crimea, it was strangled. Whose fault is this? It is difficult to tell. It seems to me that happiness of the patients wasn’t important for both sides. A patient on pills is a medical issue, and a suffering patient is political issue. We live in politically charged times and in my opinion, a political outcome was favorable to both parties: beneficial for Russia because methadone is not legal there, and Ukraine got its’ chance to once again confirm the inhumane actions of Russia.

In Simferopol there were rumours of drug users being severely beaten by ‘groups of sporty looking people’. However, Igor says; “There was the death of a patient in Simferopol that was for real during that period. He just didn’t have any energy left to live with a daily decreasing dose…”

In the meantime there were a lot of rumors spreading around. Rumors of absolutely fanatical methods of counter-drug operations by FDCS,  (The Federal Drug Control Service of the Russian Federation) such as shooting out the wheels of suspected cars. Rumors about groups of young sporty looking people who had recently appeared in Simferopol to attack drug addicts and beat them almost to death in places where it is possible to buy drugs. Rumors about  a shipload of heroin delivered to the Crimea from Russia. But there wasn’t any real confirmation of these rumors either.

But there was the death of a patient in Simferopol that was for real during that period. He just didn’t have any energy left to live with daily decreasing dose…. The fear of the future was for real too. And at the same time, there were high hopes. At that time very few people believed that OST, which everyone had gotten used to and without which nobody could imagine one’s life, would be banned and services closed all of the sudden.

The hope helps us to live.

Igor Kuzmenko

* Maiden: The name of the city Square in Kiev. It has been the site of many important protests including The Orange Revolution but for many months in 2014 it became the place where Euro-centric activists protested, camping out and fighting back against authorities. After bloody battles, people power reigned and the Ukrainian president fled into Russia. The protest gained the name The EuroMaiden Revolution.

RI.P. Crimean OST program, 2006

Part 2         Igor Kuzmenko

Around April, during the period of intensive decreases in methadone and buprenorphine doses, one of the patients approached me in the OST site in Simferopol. He was an adult man, slightly over 50 years old. He had multiple diagnoses, including  active form of tuberculosis (before the referendum he was admitted to the tuberculosis dispensary where he could get methadone, but after the referendum this opportunity didn’t exist anymore and he had to go the remaining OST site to get his methadone among healthy patients). He also suffered from Hepatitis C and HIV. He is an artist and looks like a true artist – he wears a raincoat and a long scarf. It was notable that he was extremely worried. Nervously taking a puff, he said:

“Igor, if sometimes you need my help, you can count on me. I have only one wish right now – to douse myself in gasoline and set myself on fire. If only it could do any good!”

Many of us didn’t want to sit back and do nothing. We organized a group. We didn’t set a task to change the political reality, obviously we were unable to do it, and we simply wanted to draw as much attention as possible to the stopping of the importation of OST medicine to the Crimea. So three of us paid a visit to the Ministry of Health of Ukraine, in Kiev.

The Opiate Substituion Programme In Simferopol closes its doors for the forseeable future...

The Opiate Substitution Programme In Simferopol closes its doors for the forseeable future…

Besides us, inhabitants of the Crimea, there was a large number of local activists and representatives of The Alliance Ukraine (an HIV/AIDS organisation) participating in a protest action. Unfortunately, we couldn’t meet the minister, but some officials from the civil service on HIV issues found a little bit of time for us.

“…It became absolutely clear to me that there will be no importation of OST medicines to the Crimea at all.”

I must admit that after this meeting in the Ministry of Health, it became absolutely clear to me that there will be no importation of OST medicines to the Crimea at all. Nobody was interested in that..

No Discontent Allowed

Meanwhile in Simferopol in the Crimea, our people tried to make a protest action near the headquarters of the Crimean government. And there we ran into surprise: all of us had gotten used to our liberal Ukrainian system regarding protest actions and meetings. It was rather simple to inform the city authorities of the time and place of a meeting in Ukraine. But as it became clear, in Russia, (and now in Crimea)  it is impossible for more than two people to gather together to show any discontent. Therefore we had to drop any idea of setting a protest action in the center of Simferopol.

sevestapol1_ed

Almost nothing changed in Crimea on the surface…(pic: Sevestapol)

Parental support is also very effective in context of raising the profile of OST, not least for the reason that parents are not drug-dependent and the stigmatizing that is usual in such cases, doesn’t apply to them. Unfortunately however, we also failed to attract a lot of parents to our movement.

I have to admit that the OST patient community couldn’t find complete consensus either. Some of us considered the proximity of Russia as being a benefit, others rejoiced at the sudden opportunity to quit methadone, and someone didn’t care at all. Some patients even participated in the referendum and the self-defense groups (groups which promoted pro-Russian forces in the Crimea). Nevertheless the majority of us wanted the same: at the maximum – the resumption of Opiate Substitution Treatment, and at the minimum – importation of a monthly stock of methadone and buprenorphine.

I am very grateful to the medical personnel of OST sites in the Crimea. Not their chiefs but the ordinary physicians and nurses. All of them are courageous people. Just think of it: according to Russian laws every day they went to work to give out methadone to the patients, they were making criminal acts. Acts that can be characterized as “distribution of drugs in especially large amounts performed in collusion by a group of people“. It was a very courageous especially as all of them without exception knew perfectly well how it could turn out for them.

And there were some things and some people to be afraid of. Both the administration and numerous “guests” put unbearable pressure on them. But I will tell you about that and many other things next time…

Stay tuned for part 3 and 4 in Igor Kuzmenko’s personal story of his community after Crimea becomes Russian again…

Posted in Eastern European Countries, Europe, law enforcement, methadone, peer insights, Regional Information, UNODC | Tagged , , , , , , , , | 5 Comments

New Publication for Women Injectors

WOMENwhoInject_HIV_specficNeedsPOLICY_BRIEF2014 poppy4Here is a link to an excellent newly released briefing jointly published by INPUD, UNODC’s HIV team, and UN Women looking at the particular challenges facing women who use drugs, and making concrete recommendations for service providers on the realisation of gender equality and human rights in harm reduction programming. Written by WHRIN founder and INPUD /INWUD member Ruth Birgin

Excerpt: To date, inadequate attention has been given to rectifying gender inequalities in harm reduction programming. Strategies and policies are urgently needed to address this gap as a first step towards improving the safety, health and well-being of women who inject drugs. Additional approaches should also be developed and implemented to provide comprehensive health, social and legal services that reach them and their sexual and drug-using partners. To be effective, such approaches should be based on evidence and human rights standards.

These steps are necessary not only for women who inject drugs, but also more broadly for communities and societies. Failure to adequately respond to the needs of this invisible and highly vulnerable population has harmful consequences for the health of the individuals themselves as well as for public health overall.

 The document is called:

Women who Inject Drugs and HIV; Addressing Specific Needs

WOMENwhoInject_HIV_specficNeedsPOLICY_BRIEF2014

 

Posted in HIV/AIDS, INPUD, INWUD, peer insights, Women | Leave a comment

Voices From The Global Movement Of People Who Use Drugs

For anybody there who has wondered just what drug user activism is….watch this

For any parent who thinks because their child uses drugs or is on a treatment prescription, that their life is effectively over…watch this

For any drug user who believes they are worth it, that their community is unique, and that their friends are worth saving, watch this – and if you dont -then you must watch this.

For all those people who never thought drug users could or would amount to anything – you owe us to watch this.

Have a look at some of the people, in some of the places around the world who have come together to talk about drug user activism, their incredible achievements, the massive obstacles they constantly tackle, bravely, beautifully and often with very little but their deeply felt belief that by saving each other, we are saving ourselves from the damage the war on drugs inflicts on our communities every day.

Australia’s National Drug User Organisation AIVL, (do NOT miss their excellent website) who are a truly supreme example of some world class user activism come good, have put together this really brilliant film, its only 14minutes long, not much time out of your life to see some positive images of people who use drugs; there are many more like this out there, if we would only choose to look again, not judge, not stereotype, not lap up the media cliches, but take a different approach and stop to see just what these amazingly dedicated people are doing for their communities.

Published on 29 Jul 2014; The Film ‘We Are Drug Users – Voices From The Global Movement Of People Who use Drugs’ was launched at “Through the Eye of the Needle – A Celebration of Drug User Activism” event at the 2014 International AIDS Conference in Melbourne.

NOTE: After over two decades of extremely hard work and excellent peer education and community involvement, AIVL and affiliated user organisations around Australia have overseen one of the lowest rates of HIV infection among the injecting community in the world, and have been a model of best practice throughout this time. Yet the current Australian Prime Minister Tony Abbott, a fundementalist christian no less, is actively working against this incredible network wanting to dismantle over 2 decades of seemingly insurmountable progress and innovation in the field of community, government and global user activism. SHAME ON YOU TONY ABBOTT, SHAME ON YOU!

INPUD stands beside AIVL in solidarity and against bigotry, ignorance, and small minded politicians all over the world and we wish them every success in their fight to survive the conservative christian tide currently swamping Australia.

Film Title: We Are Drug Users – Voices From The Global Movement Of People Who use Drugs’

Subscribe to AIVLS own TV Station, click this link

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Activists Hold a ‘Die In’ to Protest Hep C Drug Prices

Activists Hold Die-In to Protest High Price of Gilead’s Hepatitis C Drug

“HCV drugs are priced out of reach and out of control.”
—Michel Sidibé, UNAIDS

Photo by Alissa Sadler

Activists held placards and brought Greg Alton, the Executive Vice-President of Corporate and Medical Affairs of global pharmaceutical company Gilead, a cows liver on a platter, decrying the impossible pricing of the new HCV drug £1000 per pill, Solvaldi (sofosbuvir).

MELBOURNE, AUSTRALIA, July 24, 2014 – Treatment activists at the 20th International AIDS Conference held a die-in to protest the exorbitant pricing of Sovaldi (sofosbuvir), Gilead’s new hepatitis C virus (HCV) drug.

As Gregg Alton, Gilead’s Executive Vice President of Corporate and Medical Affairs, spoke, activists brought him a liver on a silver platter while chanting “Pills Cost Money, Greed Costs Lives,” “Shame, Shame, Shame,” and “Pharma Greed Kills.” Their signs said, “Wanted: Crimes Against Access,” “Hep C Criminal,” and “Gilead Kills” as the O’Jay’s “For the Love of Money” blared in the background.

Worldwide, at least 150 million people have chronic HCV. Although curable, it kills 500,000 people each year. Hepatitis C is prevalent among people who inject drugs, and widespread in low- and middle-income countries (LMICs).

A few months of treatment with new oral drugs (including Sovaldi) can cure HCV. But Gilead charges US$84,000–168,000 for Sovaldi in the United States; prices across Europe are similar. Sovaldi is unavailable and unaffordable in LMICs, and access in high-income countries is limited.

Sovaldi must be used with other hepatitis C drugs, making treatment even more expensive. But these HCV drugs can be mass-produced generically for just a few hundred dollars for an entire course of treatment, according to researchers from the University of Liverpool.[1]

Alton defends Sovaldi’s price, claiming that treatment with Sovaldi is cheaper than a liver transplant. But most people with hepatitis C virus have not even been diagnosed, and have no hope for a transplant.

“Extortionate pricing will kill people, no matter what the illness —HIV, hepatitis, or cancer,” said Edo Agustian, an Indonesian activist coinfected with HIV and HCV.

Contact (in Melbourne):
Karyn Kaplan, Treatment Action Group (TAG)
E-mail: karyn.kaplan@treatmentactiongroup.org/Mobile: +1.646.316.8979

Niklas Luhmann, Médecins du Monde, France
E-mail: niklas.luhmann@medecinsdumonde.net/Mobile: : +33-7-86975185

Myths and Facts about Gilead’s

Sofosbuvir Pricing

 

MYTH: “The drug has to be priced this high for Gilead to recoup its investment.”

FACT: Gilead has already sold at least US$3 billion of sofosbuvir; sales will soon exceed its investment.

MYTH: “Gilead’s price is ‘cost effective,’ because it is cheaper than a liver transplant.”

FACT: Almost 500,000 people die each year from hepatitis C; most people living with hepatitis C around the world will never even have the hope of a liver transplant. A cure should not be held hostage by high prices. Medicines should be priced so that people who need them can have access—not priced based on a comparison with other interventions.

MYTH: “Gilead has already done so much to increase access to sofosbuvir for the world’s poor—it has dropped the price as low as it can go.”

FACT: Sofosbuvir is priced at US$1,000 per day in the United States. Gilead could make its investment back through volume of sales while making the drug affordable. Health economists estimate that sofosbuvir could be produced generically for less than US$1 per day—a model that includes reasonable profit margin for generic drug makers.

MYTH: “Sofosbuvir will be available everywhere.”

FACT: Gilead is making licensing agreements that limit access and keep prices too high for most of the world.

MYTH: “Governments can pay for sofosbuvir.”

FACT: Even in high-income countries, Gilead’s price is completely unaffordable. Reports show that paying for sofosbuvir will bankrupt health care and education budgets.

 

[1] Hill, A, et al. Minimum target prices for production of treatment and associated diagnostics for hepatitis C in developing countries (Poster LBPE12). International AIDS Conference; 2014 July 20–25; Melbourne, Australia.

 

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21st July 2014 – International Remembrance Day

NO MORE DEATHS IN THE NAME OF PROHIBITION 

INPUD Statement for Remembrance Day 2014

Click here for the entire document in PDF Form.

RemembranceDay2014 poster for free use.

The INPUD Statement for International Remembrance Day 2014 now has Russian/русский  and French/français translations and links (see below).

 

 

 

“I would like to meet with Theresa May, Norman Baker [a UK home office minister] and Yvette Cooper [the UK shadow home secretary] to start a sensible dialogue for change, from prohibition to strict and responsible regulation of recreational drugs.”
Anne-Marie Cockburn – mother of Martha Fernback

Anne-Marie Cockburn’s fifteen year old daughter, Martha, died in the UK in June this year after taking particularly pure ecstasy. Instead of calling for a ratcheting up of failed drug war policies, she called instead for “‘sensible’ political debate on legalising recreational drugs”. Like so many others, she realized that the single greatest cause of so called ‘drug related harm’ is prohibition and the criminalization of people who use illegal drugs.

International Remembrance Day was founded in Germany seventeen years ago by parents who had suffered a similar loss, when their son, an injecting drug user died of an accidental overdose. In response they launched a call for humane drug policies, for comprehensive access to harm reduction programs (including heroin prescription), and saw their son’s death not as an isolated incident but as a direct result of the systemic stigma, repression, and criminalization to which people who use drugs are subject. Ever since, drug user organisations and their supporters in cities across the world will be holding events to remember lost friends and loved ones, to honour their memory and to call for an end to the systemic war that is being waged upon our community.

On this International Remembrance Day, the International Network of People who Use Drugs, underlines the pointless deaths caused by the war on drugs and underlines the immense damage that it does to our communities and families. On this day we mourn and remember our lost friends, and recommit ourselves to ensuring that fundamental change comes.

According to the report issued by the Global Commission on HIV and the Law in 2012 “[i]ntentionally or not, “wars on drugs” are wars on people who use drugs, and these people face police harassment, violence and incarceration; discrimination in health care, housing, employment and schooling; and political disenfranchisement”. There can be no doubt that fifty years since the passage of the UN Single Convention on Narcotic Drugs, and forty years since US President Richard Nixon declared his “war on drugs” that the single greatest burden of this war, fought in the name of morality, and supposedly, in the name of health, that this approach to addressing illicit drug use is an unmitigated disaster by every conceivable standard.

The Global Commission on HIV and the Law concluded by calling for countries to take “decisive action, in partnership with the UN, to review and reform relevant international laws and bodies […] including the UN international drug control conventions […] and the International Narcotics Control Board”. In spite of this far ranging, damning recommendation that skewers global prohibition as an absolute catastrophe for the rights, health, and citizenship of some of the world’s most marginalized people, why are we still seeing an absolute failure to act?

There can be no doubt that global prohibition, and the criminalisation that it entails, is the principal driver of human rights violations suffered by people who are criminalised and stigmatised for their drug use. There can be no doubt that criminalisation is the single most efficient producer of HIV and hepatitis C transmission amongst people who inject drugs, and lies behind our systemic exclusion from access to health care services.

The conclusion that “criminalization of drug use, restrictive drug policies and aggressive law enforcement practices are key drivers of HIV and hepatitis C epidemics among people who inject drugs” reached by the Consensus Statement “Science addressing drugs and HIV: State of the Art” presented at the High Level Segment of the Commission on Narcotic Drugs in March of this year is borne out by all evidence. You cannot end HIV, HCV, or mass incarceration without ending the war on people who use drugs.

Why then, in spite of this abundance of evidence is the world locked into a system in which human rights violations, stigma, discrimination, isolation, HIV and hepatitis C are the norm for people who use drugs?

REMEMBER FRIENDS AND LOVED ONES LOST TO PROHIBITION.
DEMAND AN END TO DRUG WAR DEATHS.
SHOW SOLIDARITY WITH PEOPLE WHO USE DRUGS AND THEIR COMMUNITIES

The INPUD Statement for International Remembrance Day 2014 now has Russian/русский  and French/français translations and links (see below).

There is also a Facebook post which can easily be shared if you would like to do so:https://www.facebook.com/notes/inpud/inpud-statement-for-international-remembrance-day-21st-july-2014/702127876491356

Download the statement and poster:
English: www.inpud.net/INPUD_Statement_for_International_Remembrance_Day_21.7.14.pdf andwww.inpud.net/RemembranceDay2014_poster.pdf
русский: www.inpud.net/INPUD_pyc_Statement_for_International_Remembrance_Day_21.7.14.pdf
Français: www.inpud.net/INPUD_Declaration_pour_la_Journee_international_de_commemoration_21Juillet2014.pdf and www.inpud.net/JOURNEE_EN_MEMOIRE_2014.pdf

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To those who lost their lives in the Malaysian Airlines crash

Sunflower Field

Remembering those who died and our friends and colleagues enroute to the World AIDS Conference

INPUD sends its deepest condolences to all of those lost in the Malaysian Airlines flight shot down over Ukraine, yet another tragic consequence of Russia’s war on the country. That so many on the plane were en route to the International Aids conference makes the tragedy even more acute to us. Amongst the dead were Martine de Schutter, manager of the Bridging the Gaps – health and rights for key populations programme of which INPUD and the other global key population networks are a part. We send love and condolences to the family, loved ones, colleagues, and friends of all those lost in this appalling act of violence.

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Eliminating drug using women from the ultimate elimination statement!

Many of you have heard of places like Project Prevention in the USA, where women who use drugs are paid around $300 in cash to be sterilized, (far lesser amounts for choosing ordinary contraception) and we also know of women using drug’s being encouraged, cajoled, harassed, threatened and bullied into having abortions simply because of their drug use  – which can even be instigated or supported by various government agencies in some jurisdictions and institutions around the globe. The USA, Australia and Sweden are just a few of the more shiny but shameful  examples…..

Strong Women

A great picture from a feminist blog with some great imagery and text. Click for more info

So it was great to see this statement has been released below, BUT on reading through, it identifies population groups most affected, but then fails to mention women who use drugs?  How very disappointing! Please see below -
Regards,
Ruth Birgin from WHRIN (Women’s Harm Reduction International Network) – The address for the listserve and how to become a member of both WHRIN and INWUD (International Network of Women who Use Drugs will be appearing very shortly, so please check back)
NOTE: Thanks so much for this Ruth, in fact Project Prevention and its’ sister groups are so abhorrent and such is the extended, even open use and abuse of this tactic against women who use drugs, that to not find anything about this group within this document was nothing short of incredibly disappointing. Especially as it proclaims to be a concise inter agency document of some repute; alliances with OHCHR, UN Women, UNAIDS, UNDP, UNFPA, UNICEF and WHO all worked on this publication. Grounded in ‘scientific evidence and drawing on lessons learnt from historical and contemporary practices’, this document is clearly carefully ‘anchored in international human rights norms and standards.’
So make no mistake, this is much needed piece of kit. It is in itself a new tool, a hammer blow that comes crashing down on any of the enforced sterilization ‘grey areas’ that exist in so many misogynistic and controlling, societies and communities and clearly states where the global face stands on these issues. As I said, much needed ammunition. The document also highlights much needed guiding principles for the prevention and elimination of coercive sterilization and also provides us with “recommendations for legal, policy and service-delivery actions”.
Yet, despite all this good stuff, it remains somewhat disappointing underneath because, while openly acknowledging disabled persons/women and girls, women living with HIV, ethnic and minority girls and women and transgender and intersex persons as the examples of persons most affected by such abhorrent practices of coerced/coercive sterilization, they left out us…
A glaring omission many would say as across the world women who use drugs are coerced, bullied, cajoled, abused, hit and harassed into not only sterilization, but enforced abortions, adoptions, fostering, and pre and post natal discrimination so intense that some women won’t even go to hospital to deliver their babies for fear of what may happen. (Project Prevention is  a project that is globally supported and growing and funded by hundreds of thousands of American dollars).
Just two days ago in full view of the media,  a Tennessee woman is the first to be charged under yet another harmful state law that specifically makes it a crime to take drugs while pregnant, calling it “assault.” The American Civil Liberties Union of Tennessee is actively seeking to challenge the law, which they describe as raising “serious constitutional concerns regarding equal treatment under the law.”

Another law busting women who use drugs for having children. Coercive, enforced? Harmful discrimination? Judicial management of a woman’s right over her own body and that of being able to keep her child?

All this and more must signal work ahead for women’s rights and the urgent need to find entry points for changing our systems – work for us and many of us all to do.  This is why dear readers, when such a document as this global, respectable inter-agency one on enforced sterilization omits women who use drugs, it sets us back a few hard years unnecessarily. A few paragraphs acknowledging the reproductive reality for women who use drugs, on the streets, in rehabs, in boot-camps, in prisons, in misogynistic communities, and a few clear statements underlining our right to reproductive freedom, could be an even more unique and useful tool for us.
Because while we are essentially criminalized as illicit drug users, and then ignored or forgotten about (?) in important documents such as this one on such a crucial life subject as enforced sterilization, we will always be confronted with a smirk and a kind of ‘get out clause’ that governments and institutions can use to ignore or slip away from our attempts to challenge them on our own varied episodes of enforced sterilization, etc.
Thank you for spotting this Ruth from WHRIN. Contact them for further discussion on their forum and/or become a member. 
The document……

UN organizations call for an end to forced, coercive and involuntary sterilization

(Note: Yay UN! But…You forgot something essential dintcha?…..Erin)

Date: 18 June 2014
The World Health Organization (WHO), along with OHCHR, UNAIDS, UNDP, UNFPA, UNICEF and UN Women, have issued a statement on Eliminating forced, coercive and otherwise involuntary sterilization”. It reaffirms that sterilization as a method of contraception and family planning should be available, accessible to all, of good quality and free from discrimination, coercion and violence.
Sterilization is one of the most widely used forms of contraception in the world and, when performed according to appropriate standards, is an important option for individuals and couples to control their fertility. However, in some countries, people belonging to certain population groups, including people living with HIV, persons with disabilities, indigenous people’s and ethnic minorities, and transgender and intersex persons, continue to be sterilized without their full, free and informed consent. While both men and women are subject to such practices, women and girls continue to be disproportionately impacted.
The inter-agency statement highlights guiding principles for the prevention and elimination of coercive sterilization, and provides recommendations for legal, policy and service-delivery actions to ensure that the provision of procedures resulting in sterilization is based on the full, free and informed decision-making of the person concerned.
The document itself can be found here: Click here
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Now I did say I’d report back on our excursion into Iboga Nights…

Iboga Nights trailer from John Archer on Vimeo.

Last night, DG and I (see blog below for part one) cruised down to Russell Square in the centre of London, to see his own newly released documentary appear at London’s annual ‘Open City Docs Fest’. Now as I mentioned before, this is no ordinary documentary, by just any ordinary documentary film maker. David eats, sleeps and lives his films and this one was no different.

Iboga Nights, a film that is essentially a sequel to  a previous production filmed some ten years back for the BBC. His first foray into the sometimes bizarre but always intriguing world of ibogaine left him and his many thousands of fans and followers wanting more. It left David with many thousands of pleading, questioning and interrogating correspondence from people across the globe, needing answers to the many questions his film opened up.

Lasts night’s event was an intimate viewing of a film that gripped the attending audience. A Q and A session after the film gave people an opportunity to ask David about the three year project and the characters who took part in the film. Mostly however, people wanted to know what everyone wants to know about Ibogaine; its efficacy as a detoxification agent.

However, it was really interesting to witness most people in the audience being stunned into silence. Such was the effect of the highly contentious subject material and the many parts of the film that were not just highly gripping but were often very hard to watch, it left one feeling they had been on a journey to somewhere they didn’t know existed.

I will review the film after this blog entry but for now, as I have David sitting here in my garden, feeling slightly smug after just discovering his film had been shortlisted for best film out of 900 entries.

Not bad for an old junkie who suffered sidelining in the industry due to his former drug habit.

Over to you David….

” Three years of solid work and research went into the making of this film. I believe that working as a one man band as camera man and director lends a certain to Iboga Nights. I get deeply involved with the characters in the film and I hope this comes across to the viewer. Despite the fact that my voice guides or narrates the film, I feel it never overwhelms the true voice of those taking part in the film. This was essential because the film follows the subjects through one of the most intently personal and often extremely harrowing experiences of their lives. These fascinating individuals who gave me their time and let me into their lives, allowing me to film their most private moments, is what lent a real gravitas to the confusing ibogaine debate.”

David will write his own blog here to talk about how he went about making such a film including crowd-funding through social media in order to finance the film.

Thanks to the very talented David Graham Scott and a special thanks too, to those incredible and courageous drug users who, through their stories and lives laid bare, allow us all a deeper insight into Iboga.

AND GUESS WHAT???!!!! The winner of the Best UK Film Award category in the OPEN CITY DOCS FEST was Iboga Nights, directed by David Graham Scott. Giving the award, the jury said,
“With its spare yet telling portraits of people with desperate addictions, this compelling film brings the audience close to a very important issue.” The jury was also impressed by the strong personal mission of this fearlessly honest filmmaker. YAY David!!!!!

Erin and David.

David’s Vimeo page (where you can see part one to David’s Iboga film)

And a special article written by VICE magazine, interviewing David for more information

Posted in Injection Drug Use, peer insights, peer involvement, Research, Uncategorized | Tagged , , , , , , , | Leave a comment