15th INTERNATIONAL CONFERENCE on the Reduction of Drug Related Harm ABSTRACTS Plenary speakers' abstracts have been listed first in alphabetical order by their surname. All other abstracts for oral or poster presentations are listed in numerical order by their abstract identification number. Abstracts for films shown in the Film Fest and those in the training sessions are listed separately There is also an alphabetical index of first authors beginning on page 248. PLENARY SPEAKERS’ ABSTRACTS David Bewley-Taylor been good for the health of injection drug users: the health of drug users is a HARM REDUCTION AND THE GLOBAL DRUG CONTROL REGIME: low policy priority, and drug prohibition stands as an inescapable impediment CONTEMPORARY PROBLEMS AND FUTURE PROSPECTS to harm reduction. Moreover, legal systems everywhere are failing in important ways, often incapable of delivering on their promises of fair and Faced with changing patterns of illicit drug use and the spread of HIV effective social control and sometimes merely acting as a tool for corruption. amongst injecting drug users (IDUs), increasing numbers of nations are In spite of these difficult conditions, people in the harm reduction quietly reviewing their stance on the international drug control system. This movement are making important progress by working with law as it is process has involved the implementation, or serious discussion, of harm actually put into practice by specific people in specific institutions in reduction policies that deviate from the predominantly prohibitive ethos of particular places. By seeing law as a set of local social practices, harm the global drug control regime. Through liberal interpretation of treaty reductionists are finding ways to change what actually happens to drug provisions several European states, and other countries such as Australia users. Learning about how people in law enforcement think about their and Canada, are currently exploiting the latitude that exists within the work, what resources and incentives they have, what tools they use, how extant international legal framework. their missions are defined and how they fit into larger networks of power This presentation suggests that such an approach is not without its allows harm reductionists to find levers for change and opportunities for problems, however. Liberal minded nations must endure condemnation collaboration. from parts of the UN drug control apparatus, particularly the International Harm reduction is still hampered by an ambivalence about the nature of Narcotics Control Board (INCB) and prohibition oriented members of the its broader social goals and commitments. Despite its day-to-day effects, Commission on Narcotic Drugs (CND); not least the regime’s most drug prohibition is not the fundamental cause of the IDU health crisis and enthusiastic and influential supporter, the United States of America. Their not the best target of harm reduction as a social movement. Drug use and rigid interpretation of the Conventions, and in the case of the USA various harm are influenced by illegality, but drug prohibition is just one mechanism forms of suasion, often does little to encourage policy experimentation and and drug-related harm just one manifestation of fundamental social inequality. evaluation that is in line the letter, if not the spirit of the regime. Moreover, Harm reduction has much to offer to and much to learn from the ongoing with efforts to implement harm reduction approaches to the multidimensional movement for health equity, in which law is one important field of struggle. issue of drug use at the national level comes the growing recognition that the flexibility of the international Conventions is not unlimited. It is likely Larry Campbell that the time is not too distant when further movement within states away from the prohibitive paradigm will only be possible through some sort of FOUR PILLARS – THE VANCOUVER EXPERIENCE change in or defection from the regime. Both options are fraught with The City of Vancouver experienced a rapid escalation of both heroin and difficulties. Yet, as the presentation argues, revisiting the Conventions is a cocaine use during the 1990’s. This resulted in the deaths of hundreds of worthwhile pursuit. A coalition of like-minded nations, assisted by civil people not only in Vancouver but throughout the Province of British society, may well be able to initiate a reassessment of the current system, Columbia. Specifically, the downtown core of Vancouver deteriorated to the including the place of harm reduction within it. point where open drug dealing, injecting and smoking were the norm rather than the exception. The rate of HIV infection increased dramatically as did Neal Blewett the incidence of Hepatitis A, B and C. ABSTRACT UNAVAILABLE AT TIME OF PRINTING A collation was formed and produced a plan called the Four Pillars. This plan led to a coordinated effort to deal with the drug problem as a medical crisis rather than a criminal event. This resulted in the first Supervised Scott Burris Injecting Site in North America. While still in its infancy, the Four Pillars CHALLENGING PARTNERSHIPS: LAW, HARM REDUCTION AND PUBLIC Strategy has resulted in enforcement (police) and harm reduction HEALTH (Supervised Injecting Site) coming together in a concerted effort to address Law matters to the health of drug users and therefore to the harm the drug issue. More important is the fact that municipal, provincial and reduction movement. Partnership with law enforcement and other federal governments all worked together to ensure that the plan went government agencies is a necessity but also a challenge. The law has not forward and that harm reduction is an integral part of this situation. 49 15th INTERNATIONAL CONFERENCE on the Reduction of Drug Related Harm Astrid Forschner add to already existing IDU-fuelled HIV/AIDS epidemics in Myanmar, THE INTERNATIONAL DRUG USERS MOVEMENT PERSPECTIVE ON HARM Malaysia, Vietnam and parts of India and China. Despite these increases REDUCTION governments have been slow to respond. Most are concerned about the criminal aspects rather than the public health implications of drug use. Harm reduction as an international movement has had a powerful impact Many such as Thailand are still focussed on prevention of sexually on the lives of drug users in many countries. It has been the impetus for transmitted infections while others such as Malaysia have cited legal and needle and syringe programs, substitution treatments, drug user political barriers to harm reduction programmes, deferring to zero-tolerance organisations and a variety of other initiatives. drug policies. The lack of understanding that national epidemics can This presentation, which includes the perspectives of the drug users in change character is one of the barriers to realistic and effective prevention the many countries that make up the international drug users movement, programmes. Stereotypes about drug users means that women are often will explore and discuss: excluded from programmes. This paper examines the reasons for the • A brief historical analysis of the growth of harm reduction and reluctance of many Asian countries to tackle IDU prevention head-on and consumer involvement and empowerment; offers some suggestions as to what needs to be done. • Past and present policy and legislative frameworks that help and hinder the implementation of sound harm reduction initiatives; and Tony McCartney • The work of the international drug users movement and its pivotal role in the development and implementation of credible harm reduction ABSTRACT UNAVAILABLE AT TIME OF PRINTING initiatives. In concluding the presentation will share with delegates the views of Robert Newman the drug users’ movement regarding the future growth and sustainability of PHARMACOTHERAPY OF OPIOID DEPENDENCE: WHAT’S NEW IN harm reduction as a policy that can have real and lasting to benefit of INFORMATION AND ACTION? people who use/inject illicit drugs. For pharmacotherapy of opioid dependence, the last 40 years have been the best of times and the worst of times. From the 22 heroin addicts in the Ivan Glukhov original 1964 study of Dole and Nyswander, the number receiving ABSTRACT UNAVAILABLE AT TIME OF PRINTING medication-based treatment is now over a half-million world-wide. The discovery that the endocrine system produces powerful endogenous Karyn Kaplan opioids has lent credibility to their then-heretical hypothesis that "addiction HOW DRUG USERS GOT A GLOBAL FUND GRANT - THE EXAMPLE OF is a metabolic disease". Those who treat opioid dependence now have a THAILAND number of options in addition to methadone: agonists (LAAM, codeine and morphine preparations, and – increasingly – heroin); antagonists (naloxone, Issue: Approximately 50 percent of Thailand’s injecting drug users are HIV- naltrexone); mixed agonist-antagonists (cyclazocine, buprenorphine); and positive. Despite mention by the Thai National AIDS Strategic Plan of the non-opioid agents (clonidine, ibugaine). The greatest experience by far has need for targeted prevention activities, no effective plan has been been with methadone; its efficacy for maintenance and detoxification has implemented. Until recently, government policy excluded HIV-positive IDU been demonstrated in disparate geographic and socio-economic settings, from accessing antiretroviral treatment. The Prime Minister’s violent war on with patients using a variety of opiates by different routes of drugs led to the extrajudicial killing of