We Have Consensus Houston

One of the unreported key events in the mainstream media at the recently concluded 57th session of the Commission on Narcotic Drugs (CND) in Vienna was the coming together of scientists from all over the world with clear consensus statements on what science tells us today on drugs and harm reduction.

The statements were presented in short and clearly articulated presentations at the opening of the High Level segment of the CND meeting. Although one scientific representative from the Russian Federation disassociated herself with the final conclusions, the statements certainly reflect a strong consensus in the scientific community.

After several months of preparatory work, two groups of scientists met in Vienna prior to the High Level Meeting.

One group was chaired by Nora Volkow, director of the National Institute on Drug Abuse (NIDA) in the U.S. Her group focused on issues surrounding addiction and dependency and concluded unambiguously that people who use drugs cannot and should not be seen as criminals.

The second group was chaired by myself * and provided a state of the art update on harm reduction science, including the following key points:

• The evidence that Needle Syringe Programs (NSP) and Opioid Substitution Therapy (OST) are effective in reducing the sharing of injecting equipment and averting HIV infections is compelling. In combination with antiretroviral therapy (ART), they reduce HIV transmission, decrease mortality, reduce drug dependency, reduce crime and disorder and improve quality of life.

• Harm reduction is very cost effective.

• The incarceration of people who use drugs, criminalization of drug use, restrictive drug policies increase vulnerability to HIV and hepatitis C. We need to stop the incarceration of people who use drugs for minor non-violent drug offences. We need to reform laws and policies that hinder access to harm reduction and realign harm reduction and law enforcement to support prevention and treatment of HIV and Hepatitis C among people who inject drugs.

• Harm reduction for women should be tailored to meet their special needs including for reproductive health services.

• Hepatitis C is a rising cause of severe liver disease and premature death among people who inject drugs, and represents a growing public health, social and economic burden. Hepatitis C services need to be integrated into harm reduction services.

While both statements echoed loudly both in the confines of a UN meeting room and beyond Vienna, many delegates, despite having heard the evidence, and despite saying that they wished to see policies being based on evidence, did not even take the first step of mentioning harm reduction in the final resolution.

The outcome of the High Level Review?

Yet another CND document where harm reduction is denied even a solitary mention. Once again, a resolution adopted by the CND after endless discussions looking for a minimal common denominator, comes as a great disappointment.

I believe we should, however, praise the UNODC for introducing for the first time a scientific debate prior to the CND and for presenting the scientific consensus achieved at the very opening of the High Level segment.

That in itself, I believe, represents promising progress.

But the final outcome only emphasizes how broad the gaps remain both between what science has actually demonstrated works and what real life government policies look like on the ground; and between what science tells us we should do and what is in reality implemented in those countries most affected by the HIV and Hepatitis C epidemics driven by unsafe injecting drug use.

These gaps need to be a key focus of attention for the debate in the two years that separate us from the 2016 United Nations General Assembly Special Session (UNGASS) on Drugs. Those arguing for that meeting's preparatory debate to be held in New York rather than Europe may have an even stronger case in light of the Vienna outcome.

We pay a high cost for not adapting scientific evidence in the language of international resolutions and national policies. We are, in effect, prohibiting a much needed shift in direction in policies and in the allocation of resources where they can have a real impact for the people in need. As a result, millions of lives remain at stake.

* My gratitude goes to all my co-authors: David Wilson, Steffanie Strathdee, Tasnim Azim, Kate Dolan, Adeeba Kamarulzaman and Philip Bruggmann