Nora Volkow, USA National Institute on Drug Abuse. There was consensus from a very diverse group of scientists. There is a recognition that there are people who have more risks of becoming addicted because of their genes. Transition from drug use to addiction occurs during adolescence. We also know that some drugs are more addictive than others. The status of the drug can also influence access. Social systems are also crucial to prevent experimentation towards drug abuse. We recognise that it is important to prevent substance use and addiction. This should be treated as a health issue, not a criminal justice one. Drug addiction is a disease of the brain. It is a chronic disease. Imprisonment does not equate with treatment and relapse after prison is very high. Evidence based prevention should be seen as the most effective way to tackle drug addiction. There is a gap there. There should be evidence-based prevention and treatment strategy. Addiction has a better outcome if you treat it early. There are also issues of co-morbidity. Ministers of health should strengthen and coordinate health responses to substance use disorders, including allocation of funds. Training of health care personnel is also important. Criminal sanctions are not beneficial to tackle drug use and reduce prevalence. Stigma and social isolation accelerates the brain changes. Prison has also poor health outcomes, including mortality and HIV transmission. We call on the CND to consider developing a global strategy on prevention and treatment in consultation with scientists in preparation for the UNGASS in 2016. Finally, we promote the creation of a council of the scientific community to advise the CND.
Michel Kazatchkine. Special envoy for HIV/AIDS in eastern Europe and Central Asia, UN. At least 60% of oeple who use drugs live with hep C and 1 in 6 live with HIV. tere remains a significant gap between what science has shown that works, and what is being implemented in practice. We welcome UNODC’s initative to organise this scientific consultation and allow us to present it today. Current evidence on prevention and treatment of hep C and HIV:
1. There is a clear relationship in the sharing of injecting equipment and the risk of aquiring HIV and hep C. Criminalisation of drug use and incarceration are key drivers of these epidemics among people who inject drugs
2. The evidence of harm reduction (NSP in combination with OST) avert HIV infections and there is comprehensive and compelling, indisputable evidence of this. These interventions decrease mortality, crime, public disorder and improve quality of life of people
3. Harm reduction is cost-effective. The cost per HIV averted saves 100-1000 USD.
4. The incarceration of PWUD increase their vulnerability to HIV and hep C. We must stop this for minor and non-violent offences. Harm reduction should also be included in prison.
5. Need to reform laws and policies that hinder HIV and hep C prevention. Laws that criminalise use result in stigma and undermine support for harm reduction. And laws that facilitate harm reduction are effective structural interventions to reduce HIV and hep C among PWUD.
6. Harm reduction services should be tailored to women.
7. There is insufficient awareness on hepatitis C. It is a rising cause of disease and premature death among PWUD. It is a “ticking bomb” as said by WHO. Hep C treatment should be integrated into harm reduction services.