“Prohibition is a historical wrong…Stop the harm.”

“Prohibition is a historical wrong…The three UN drug Conventions were intended to protect the health and welfare of ‘humankind’ (it actually says ‘mankind’, but I say humankind), but the criminality of drug use does not achieve its stated objective…seizures and incarcerations provide stimulus to drug production…punitive policy must be replaced with regulatory measures, like for alcohol and tobacco…The War on Drugs has completely failed.”—Anand Grover, former UN Rapportuer on the Right to Health, Opening Ceremony, The 24th International Harm Reduction Conference 2015, Kuala Lumpur, 18-21 October 2015.I agreed with what Grover said. I believe he meant what he said. The experienced, well educated, and informed minds on matters relating to health needs, health rights, and human rights condemn prohibitionist drug law regimes in favour of harm reduction initiatives, especially peer-led ones. Those who’ve held prestigious posts with reputable agencies at international, regional, and provincial levels agree with the sentiment of Grover’s words and, still, 32 countries offer capital punishment as a potential criminal sentence and 10 countries have mandatory death penalties for drug-related offences; mass incarceration rates for drug offences are boasted around the world; the stigmatisation and discrimination of people who use drugs (PWUD) still permeate every pore of society, including the hearts and minds of many PWUD who have internalised the sense of contempt for what is essentially a matter of bodily autonomy.

For me, there seems to be two dominant moots when considering harm reduction measures: 1) should we practice harm reduction; and 2) what’s best harm reduction practice? Debating the former is a waste of FUCKING time (lost lifetimes; collateral damage of the War on Drugs)! Harm reduction is an effective approach to health promotion. Harm reduction needs to be better understood, even in the countries that formally accept it in policy and implement service providers accordingly, like in Australia. Harm Minimisation was introduced as Australia’s National Drug Strategy in 1985 (grassroots activism played a significant role in the process). Harm Minimisation is a drug policy model that incorporates supply reduction (policing the market), demand reduction (dissuasion campaigns and treatment), and harm reduction (impartial pragmatism).

Wikipedia defines ‘harm reduction (or harm minimisation)’ as…and that’s where you stop referring to Wiki for credible information on the practice and philosophy that is ‘harm reduction’. Harm reduction can exist separate of ‘harm minimisation’ or any other drug policy model. Wikipedia, I love you so often, but this is one of those times when you got lazy. After your first sentence which collapses the notable distinction between harm reduction and harm minimisation, you give a sufficiently vague and yet still boringly dry description of the harm reduction part of harm minimisation, before giving an equal amount of words to the ideas of moral fantics:

Critics of harm reduction typically believe that tolerating risky or illegal behaviour sends a message to the community that such behaviours are acceptable and that some of the actions proposed by proponents of harm reduction do not reduce harm over the long term.^[1][2]

The evidence is overwhelming: harm reduction reduces the risk and instance of drug related harm; it does not increase uptake, but it does acknowledge the life experiences of people who exist in reality. You’d like to think those footnotes ^[1][2] referenced some research that had produced an empirically-based cautionary tale on harm reduction, but instead it’s a link to a Birmingham Evening Post article entitled ANGER AS VICE GIRLS GET FREE CONDOMS. Yes, Wiki, for the sake of  ‘balance’ you decided to include the opinion of Edgbastion locals who formed a volunteer group called ‘Street Watch’ who watch ‘Safe’ a mobile outreach service as it delivers free sexual health supplies in Birmingham, Walsall, and Sandwell. I’m not joking about those names, follow the link and read it yourself. ‘Safe’ was a program run through St Patrick’s Health Centre and ‘Street Watch’ is the name the Helen Lovejoys of Edgbastion coined for themselves for when they do their important work of spitefully watching health outreach workers deliver an essential service that prevents the transmission of STIs and encourages community development (did you know, in addition to VICE! condoms, Safe also pushed tea and coffee). Did you also know, in addition to being Street Watch’s stomping ground, Edgbastion is home to England’s second largest cricket ground.[1]

Sometimes when I feel battered by the uphill battle faced by harm reduction peer advocates, I find comfort in John Oliver’s bite-sized, sensible rants on Last Week Tonight. He addressed the issue of media representations of ‘both sides’ of the climate change debate, the format of which commonly give even screen time to denialists as they do the person speaking on behalf of 97% of the scientific community who agree climate is real and humans are to blame. The same parody could be applied to the debate on whether harm reduction is an effective health promotion strategy or it risks the promotion of drug use; the evidence demonstrates harm reduction saves lives and benefits the community as a whole (eg. that sterile injecting equipment reduces the transmission rate of BBVs is as well established as the theory of gravity and there’s NEVER been a HIV infection due to a needle stick injury from discarded equipment in the community EVER), but moralising skeptics are still allowed a turn with a microphone or, worse, they hold political power and routinely make decisions that destroy lives.

IHRC 2015, parallel 16: Grassroots advocacy in harm reduction, slide from Brun Gonzalez, ‘Kiciking the door open with the first substance analysis programme in Mexico’.

Even more than the relief John Oliver provides, I find comfort in
hearing from and sharing experiences with my peers and allies at gatherings like the IHRC 2015. This is an opportunity to address moot point #2: what is best harm reduction practice? I appreciate hearing what people like Brun Gonalez of Espolo have to say on, for example, UV light for LSD testing, semi-cuantitative cocaine analysis, onsite thin layer chromatography (on no budget but you MacGyver a blade-less kitchen blender to get more accurate results), and I want to hear how you get such a grassroots activist initiative to be formally approved? Because these are positive role models for programs like HRV’s DanceWize; I want to share such information with my peers at home, even if that means getting creative in order to over come the barriers that limit Ozzy partygoers’ access to drug checking services.

Slide from IHRC 2015, major session 21: Users choice, ‘The advocacy capacity of Latin-American civil society in drug policy debate’.

The IHRC 2015 is a conference, but it’s also a gathering of people who identify as part of a movement where there’s a sense we’re about to reach critical mass in order to transform the current paradigm. In April 2016 the UN General Assembly Special Session on Drugs (UNGASS) reviews the three UN Conventions on drugs. They’ve been reviewed twice prior to Y2K. Most recently, in 1998, UNGASS promoted this goal:

A Drug Free World. We can do it!

I didn’t put the exclamation there to be a smart arse, UNGASS did.

IHRC 2015 Workshop, 20 Oct, 2-3.30pm, ‘Stop the Harm: campaigning for harm reduction and drug policy reform in advance of the 2016 UNGASS.

Because as excited and hopeful as these meetings of like minds make me; advocates and activists in the drug policy reform and the international harm reduction movements finding space to share ideas and knowledge; people say good speeches and they mean what they say; it can be a bit of a welcomed group counselling session. But there’s also a restlessness, an urgency, because so many heroes in this battle are already dead without a trace. There’s so many more who we can herald for their bravery, but they’re no longer alive to see any future reforms that respect health and human rights. In her presentation ‘Harm reduction & leadership: who wins and who loses when sex work and drug use are seen as inherently dangerous and damaging?’, Ryan Cole, from Australia’s Scarlet Alliance, paid tribute to her friend Pippa O’Sullivan or Grace Bellavue who had died 6 days earlier.

IHRC 2015, parallel 26: Far from the stereotype: Drugs, sex work, and stigma, Ryan Cole, ‘Harm reduction & leadership: who wins and who loses when sex work and drug use are seen as inherently dangerous and damaging’, 19 October.

The IHRC’s 2015 theme is  ‘Call for Leadership’, I’m interpreting it as a call for action. In the lead up to UNGASS 2016, where there’s potential to dramatically shift the dominant narratives of drugs on an international scale, there’s no room to accept token gestures of change. We must  Stop the Harm.

Stop the Harm was launched at IHRC 2015.

Empowering vulnerable communities and pagan courtship rituals in Porto

Attending Club Health Lisbon 2015 provided me with the perfect opportunity to meet with members of CASO, Portugal’s drug user organisation (DUO). Much to my embarrassment, after arranging a meeting, which I assumed would take place in Portugal’s capital, Lisbon, I quickly learned that CASO and the incandescent activist spirit that gave momentum to the country’s decriminalisation reform at the turn of the millennium, was actually centered in Porto. I was able to reschedule the meeting, no problem. Getting to Porto was pretty straight forward (and flying there with Ryanair was like taking a poignant refresher course in the importance of self-assertion). However, I was arriving in Porto on 23 June; I was completely under-prepared for Festa de São João do Porto, but it was a case of serendipitous timing…I was privileged to witness the kind of passion that is required in order to reform draconian drug laws!

Where to start? There’s so much to write on Porto, CASO, and the non-governmental development organisation, Apdes, that empowered the drug user org into existence. ‘You had to have been there‘ is a bit too patronising and while I really do encourage you to see Porto, especially on the day the city celebrates a mix of sacred and profane traditions in the name of St John, I will limit this post so it’s an introduction to CASO, with reference to Apdes, and catalogue the DUO’s agenda ‘Wish List’.

First, I met with CASO Chairman, Sérgio Rodrigues. CASO is an acronym for Consumidores Associados Sobrevivem Organizados, which translates (roughly) to Consumers Associated Survive Organised. CASO was established in 2007 after Apdes facilitated a meeting between local drug users and Theo Van Dam (no relation to Jean Claude and more kick-ass). Theo is a key player in the global drug user activist movement which started in Holland in the mid-1970s; he spoke of the increased drug user rights activism efficacy that could be achieved if a DUO were established. When Theo visited Porto in 2007, Sérgio was a local peer educator performing outreach for one of Apdes’s harm reduction projects, GIRU (Group Intervention on the Rua or street).

Sérgio spoke highly of the encounter, which commanded my respect. Here’s my musings on what I’ve interpreted as Apdes and Theo’s ‘call to arms’: when your government (even relatively progressive ones) and international bodies of authority reinforce the idea that ‘you’re a bad person because you use drugs’ and those (the the majority of people) who are only affected to the extent that they have to publicly censor themselves every now-and-then, find it easier to just accept the status quo that’s been entrenched by moralistic, pro-abstinence fanatics.

It’s quite radical and liberating to be told that you should be proud of yourself and you deserve to have your health rights and human rights respected, and that peer education is real work that should earn pay. To be told that educated well-dressed people can be and frequently are, wrong or weak-willed and choose wait for the impetus of the populace, before showing any political courage. What I’m writing about is stigma and discrimination; a stealth and pervasive assassin. Even though CASO originated in 2007, which was 6 years after decriminalisation was enacted in Portugal, there was still an integral role for drug user activists to play and Apdes provide a fertile landscape for CASO to flourish.

When I met with Apdes’ Executive Director, José Queiroz, I assumed our conversation was going to concentrate on practical harm reduction measures (practiced and proposed) in Porto specifically and then discuss Portugal more broadly and largely, that’s what we did. What I wasn’t expecting was to have a warm and welcomed reminder of just how important it truly is to approach my work (and life) with a conceptual awareness of community development as a pragmatic, but also philosophical process. A lot of the time I want to approach issues guns blazing, because the injustice and the solution is so glaring obvious (for example, NSPs in prisons, and insert here xyz examples of other basic health interventions that will save individual lives and benefit the community as a whole!) And I’m often skeptical when someone says ‘we don’t want to rush into things, we have to do this properly’ it’s a tactic used to make them sound calm and reasonable, when really they’re buying time, waiting for the pendulum’s impetus to swing back the other way and allow bigotry to reign for another day (like what Abbott’s doing right now with gay marriage in Australia, shame…shame). But José wasn’t stressing the importance of unnecessarily risk adverse ‘bureaucratic process’, but Process; processes that empower an affected community/a key population, so that outcomes are positive, collaborative, and sustainable. Teach a [hu]man to fish, kind-of-style, but he managed to do so without sounding rhetorical.

From 2007, Apdes empowered the founding members of CASO in the form of funding and training and in 2011 CASO was formalised. Sérgio shared examples of the DUO’s subsequent key advocacy successes; including a petition signing which prevented the closure of CAT/ET Gaia, a treatment centre; and the staging of a two day protest over World AIDS day in December 2011 outside the Russian Consulate in Porto. CASO is in the midst of various campaign partnerships across Europe too. While CASO operates from within the Apdes office space, it’s members also meet each Tuesday morning at Biscuit cafe in Balatha Plac, the DUO independently navigates its own agenda, and both organisations consider CASO’s autonomous operation integral to their respective objectives.

CASO Chairman, Sérgio Rodrigues, with traditional hammer used in Porto’s Festa de São João.

Sérgio Rodrigues

CASO’s Agenda ‘Wish List’:

1) Consumption rooms i.e. safe smoking and injecting spaces. The decriminalisation reform included provisions for consumption rooms, but the dissonance between policy and practice has meant they haven’t been implemented in Portugal. José speculates this may be the combined result of the Mayors of Portugal’s two main cities lacking the political courage necessary to push on the issue against overt moralistic naysayers and NGOs lacking the self-confidence and knowledge of such services. Anti-stigma/discrimination education and consciousness-raising could do a lot to shape how consumption rooms are perceived by the public, because it is an evidence-based service that improves the health and quality of life for people who use drugs.

2) Naloxone is not available in Portugal, which really shocked me. This will happen and, most likely, within two years (just assert it with confidence, you’re backed by reason and common sense, she tells herself). Why hasn’t it been rolled out? There’s no significant politicised or moralistic opposition to the life-saving opiate-antagonist being introduced; it’s Dollar $ign$ pretty much, but prevention is better [cheaper] than a cure and easily avoidable overdoses are tragedies (See EMCCDA report on overdoses).

3) Needle & Syringe Programs (NSP) do not exist in Portuguese prisons. Like with consumption rooms, Portugal’s 2001 drug policy reform included a proviso for NSPs in prisons. But the implementation of NSPs in custodial settings has been used as leverage by prison unions protesting for higher pay rates for prison staff. It’s argued their role involves higher risk if the service exists. There is also opposition from non-injecting inmates. José commented that the ‘official’ and dominant argument that is proliferated is that ‘there is no drug use in prisons’ and to introduce NSPs would be tantamount to an admission. With the Vanguarda project, Apdes is allowed to perform harm reduction education though safer injecting etc. Education may be more palatable and still life-saving, but subject to impotence in the absence of practical tools (i.e. it’s safer to inject when you’re using sterile equipment)! José suggested a civil society NGO could be successful in gaining ground on this issue by conducting research on HCV incidences in prisons and using the findings to pressurise for reform.

4) Cannabis legalisation. This is an issue that has momentum independent of CASO or Apdes, but from a DUO perspective it is an engaging, non-gender specific issue that appeals to a broad age demographic (and I bet it’s nice to be in line with the mainstream on some points, no one wants to feel marginalised and ostracised while facing an uphill battle, just to stay alive or retain your autonomy).

5) Prescription heroin. At present this is not available in Portugal, but a mixed model approach to OST is better able to accommodate for the multi-faceted pharmacotherapy needs of people who use drugs; so this is something CASO advocates for.

6) Subutex (buprenorphine) is available, but not free like methadone.  Like prescription heroin, more pharmacotherapy options means the complex needs of peers are able to be better met. Apdes has conducted a study on the OST preferences of people who use drugs and a finding is, doctors don’t or only rarely ask consumers what they want. This highlights a potential role for peer educators to empower their peers with a better understanding of the range of pharmacotherapy options available to them. Further, harm reductionists could provide training for prescribers, so they felt more confident offering a diversified range of OST. At present the Portuguese government has a monopoly over methadone, which limits the incentive for expanding the OST options available.

7) Peer educators serve a highly valuable function and CASO wants this to be better recognised as a professional service. The tension between the respective and complimentary roles of peer educators and harm reductionists highlights the hierarchical nature of healthcare. Apdes has conducted research that concluded the integration of the peer education model is critical in order to ensure harm reduction outreach is as effective as possible. (See InPar).

While many countries around the globe can look to Portugal’s reformed drug policy model as a positive progression towards the promotion of the health rights and human rights of people who use drugs, echoing the philosophical reflections above, it is an ongoing process. Peer-led advocacy is, and always will be, essential in order to avoid regression and further refine the empowerment of this key population.

Porto’s Festa de São João.

DanceWize: harm reduction peer education down under (verbatim), as presented by Sass at Club Health Lisbon 2015

SLIDE 1 (depicted in the above photo)

DanceWize is a harm reduction peer education outreach program administered through Harm Reduction Victoria, which is an Australian state-wide drug user organisation. The peer-led charity was established in the late 1980s in response to the HIV/AIDS epidemic. In Australia each state and territory has a similar drug user organisation and the Australian IV League (or AIVL) is the peak national body. At present, Australia’s network of drug user organisations is funded by the Department of Health, but in the early years these were grass roots movements that followed in the tradition of the first Dutch drug user organisations which utilised civil disobedience actions in order to advocate for policy and treatment reforms and respect for the civil rights of people who use drugs, especially the most marginalised sub-demographic of people who inject drugs.

Slide 2

The Ozzy application of this civil disobedience tradition was evidenced by drug users disseminating sterile injecting equipment to their peers from 1986 onwards. That is, drug users were the first to respond after it was understood that HIV was a blood borne virus. Luckily the policy-lag for establishing needle and syringe programs was only a year and NSPs were formally rolled-out in Australia in 1987. The coupling of drug user civil disobedience and subsequent pragmatic policy meant Australia averted an HIV epidemic and the rate of HIV incidence among people who inject drugs down under has never exceeded 2%. Drug users caring about other people who use drugs; their peers, the community, and mobilising themselves; filled the gap of bureaucratic process, which too often allows drug-related harm to prevail. Flash forward to present day Australia, and let’s introduce DanceWize and consider some of the challenges the program encounters due to the practical reality of drug use trends and the inadequate policy responses or omissions of the Australian government.

Slide 3

What is now known as ‘DanceWize’ was independently established in 1995 by a dedicated group of ravers, as such, they called their initiative RaveSafe. RaveSafe negotiated free entry into Doofs and in return this crew would host a marquee as a chill space for people experiencing distress due to intoxication. It was also a space to information-share among peers. While it may be obvious, before continuing I should probably explain what I mean by ‘Doof’. SLIDE 4 (see below) Urban Dictionary attributes the origins of the term to Australian street slang referencing large outdoor raves that play electronic music, especially trance, in remote bush locations. If you’re intrigued, Urban Dictionary also defines the verb ‘Doofing’ and provides a scripted example of how Ozzy Doofers might use the term in a typical sentence. Now in the 90s and early noughties/00s RaveSafe performed its services at Doofs specifically and only. In 1999 RaveSafe came under the administration of Harm Reduction Victoria who was able to offer these ravers some limited but valuable resources. Coming under HRV’s administration meant RaveSafe was Department of Health funded too. The value of this program started to be recorded and reported with visit stats and annual reports and, in part, this formalising process helped refine the program’s model; a model that could be applied to a range of types of music events and festivals not just Doofs. In 2008 RaveSafe was rebranded as DanceWize.

Slide 4

Slide 5

Today DanceWize still attends multi-day outdoor Doofs, but also large commercial events, which may be indoor or outdoor, single or multi-day events, and city-based nightclub events. The DanceWize chill space is hosted by our team of volunteer Key Peer Educators (KPEs). KPEs are trained in senior first aid; mental health first aid; depressant overdose prevention and response (including naloxone training); trip sitter training for challenging psychedelic experiences based on techniques advocated by the Californian-based Multi-disciplinary Association of Psychedelic Studies (or MAPS) and anecdotally we´ve found these techniques quite effective for managing stimulant overdoses, including drug-induced psychosis too; basic pharmacology and legal drug classifications; Needle and syringe program training; blood borne virus and STI education training; paralegal training; responding to sexual assault training; and substance specific harm reduction education and information sharing sessions are a regular feature of DanceWize´s fortnightly team meetings. You might say the DanceWize team is multi-disciplinary as we have team members with backgrounds in medicine, social sciences, law, and education professionals, some team members are completing studies in complementary fields and their hours of volunteer work are recorded as a placement component for their studies, other team members are unemployed and have no formal qualifications, but most importantly all DanceWize KPEs are recruited from the dance scene and they are drug user peers by self-definition and are recognised as such by their peers. There is no hierarchy among KPEs and each team member has a wealth of personal experience that informs their work. When operating the DanceWize chill space a team leader is nominated for each shift, this is generally a more experienced KPE, but we operate on a horizontal structure and the team leader is simply the person who is most familiar with or has a flare for the paperwork that now goes along with running the DanceWize chill space.

The DanceWize chill space is still a place where people experiencing distress can receive care and support, but now, for the sake of duty of care, anonymous records are kept on people who come into DanceWize´s care and we describe these as ´Intense Interventions´. During Intense Interventions we use a coding system that has been approved by a Victorian emergency service, which serves as an appropriate response guide and indicates when a referral to medical services is advisable or essential. Further, the DanceWize chill space is still a place where information-exchanges occur among peers. These are recorded as Brief Interventions. During Brief Interventions Key Peer Educators may disseminate harm reduction educational resources from a range of alcohol and other drug service providers, including DanceWize´s own substance specific publications. SLIDE 6 (see below) The series of 13 resources is one of DanceWize’s greatest achievements in recent years. These resources are in a way collaborative publications developed over years which provide insight into what our peers want, need, and already know. DanceWize’s Brief Intervention records inform how we edit and refine our resources. In each double-sided A4 sheet we don’t waste words trying to discourage uptake or promote the cessation of use. If we did we’d lose our credibility and severe the unique and productive link we have with our community. What do we say?

Slide 6

We define the chemical compound, provide dosage tips, and encourage people to record their pattern of use according to a unit of measure that suits them best; we catalogue the short and long term physical, emotional, and psychological effects of the substance; its duration, and note the minimum amount of time needed between last use and driving a vehicle, we discuss the effect of poly drug combinations with particular emphasis on common combinations; we stress the importance of balanced nutrition; and we remind people to stay hydrated.

We take a holistic approach to health and wellbeing and Brief Interventions may also be in regard to requests for health and sexual health supplies like condoms and the ´hard-sell´ dental dams, ear plugs, dust masks, sun screen, space blankets, female sanitary products spare clothing, and DanceWizers regularly help festival goers repair footwear with gaffa tape and cable ties, we also offer NSP supplies for both injecting drug use, but more commonly peers request barrels for accurate GHB measurement. Two of the most common Brief Intervention topics our community approaches DanceWize for information on are in regards to Police Powers in matters such as Passive Alter Detection or sniffer dog operations and random roadside drug testing, and our peers want pill testing or drug checking services to be made available to them.

Both topics cut to heart of the compounding pressures on drug-related issues in Australia. The health of people who use drugs and the wellbeing of the community at large is consistently jeopardised by moral prudery and hysteria, the strangle hold of the populace vote, by knee-jerk panicked reactions that misunderstand the practice and philosophy of harm reduction and inaccurately reduce it to apathy at best and at its worst the promotion of drug use.

In 1985 Australia adopted the harm minimisation model as its National Drug Strategy. As you´re aware, Harm Minimisation is not a ‘zero tolerance’ approach to drug use, rather it is a three-faceted response consisting of supply reduction (that is, enforcement initiatives that aim to reduce the net market of illicit drugs), demand reduction (health interventions that aim to reduce the prevalence of drug use through targeted health promotion campaigns and alcohol and other drugs sector treatment), and harm reduction (health interventions that aim to reduce the prevalence of drug-related harm through targeted health promotion education messages and the provision of necessary health services like sexual health supplies and needle and syringe programs). Harm Minimisation is a practical approach to drug policy which acknowledges that drug use is a reality that can be found in every demographic of society; it accepts that some degree of drug use will always prevail; and that supply reduction efforts that target individual users, that are imbalanced against, or exist in the absence of demand and harm reduction efforts, actually increase the prevalence of drug-related harm.

Despite the invaluable fiscal support DanceWize receives from the Department of Health, the current funding climate (where community programs must compete for tenders before then being expected to foster productive partnerships and jump through performance indicator hoops) and, speaking in personification, the identity crisis that is Australia’s National Drug Strategy (with harm minimisation being fatally misunderstood by those responsible for its supply reduction component), it is no surprise that drug user organisations like HRV, must continue to employ grass roots initiative and civil disobedience actions in order to promote the health rights and human rights of people who use drugs.

Slide 7

With reference to DanceWize´s recordings, let us first consider the impact of how police in Australia address personal drug use; and, secondly, the barriers that restrict pill testing or drug checking kits being available for Ozzy partygoers direct from a harm reduction program like DanceWize.

Passive Alert Detection or Sniffer Dog Operations are regularly conducted in or near music festivals or events in Aus. Some event promoters, more commonly those who organise large commercial festivals, want this police service as, arguably, their compliance mitigates their culpability in an event where serious drug-related harm occurs. In such cases the sniffer dogs are often positioned immediately after a festival’s entrance meaning attendees are funneled towards the sniffer dogs. Unlike other more progressive jurisdictions, there is no legal framework for drug amnesty bins in Australia and police are mandated to intervene upon the reasonable suspicion that someone is in possession of a controlled substance. Alternatively, sniffer dog operations are also set up on the roadside near a Doof and going to such parties is deemed reasonable suspicion warranting a vehicle search. My work vehicle was searched twice in one day while performing outreach despite me showing them my Department of Health NSP outreach worker registration card and I have no priors. If a sniffer dog identifies a festival attendee as being in possession of drugs they are searched, often strip searched, and if drugs are found on their person the most common outcome is a drug diversion issued at police discretion and they may be referred for a drug and alcohol intake assessment. A drug diversion means no charge, but a record is kept and it stands against the individual if their conduct attracts police attention again in the future.

A NSW Ombudsmen inquiry conducted in 2006 found sniffer dogs an ineffective deterrent strategy with a false positive detection rate of 75%, that is 3/4 people subject to police searches were NOT in possession of illicit drugs, and the unofficial false negative rate is everyone who is still able to get high at the party. However, Police in some Australian states report success rates as high as 85% because 85% of people searched disclosed that they had been in contact with illicit substances in the past. The most outrageous example I´m aware of was an individual who was searched, was not in possession, but disclosed they had been in contact with illicit substances 1 year prior! I argue that statistic demonstrates the persuasive power of police to obtain admissions statements rather than a job well done by dogs with an acute sense of smell. I wish I could write my own funding performance indicators with the same amount of discretion. There are documented cases of deaths where festival goers have panicked upon seeing sniffer dogs and consumed all the drugs in their possession at once. The most recent example was in Sydney in 2013.

Now remembering the goal for police under a harm minimisation model is to reduce supply, consider this outcome and you decide whether sniffer dog operations equal tax payer money well spent. In Melbourne this month a commercial event attracted a crowd of close to 9,000 people. The nature of the event’s set up, with only a single entrance, meant every attendee was funneled past sniffer dogs. 35 arrests were made. 2 people were charged with drug offences. On average these 35 people were each in possession of less than 1.6 grams of cannabis.

In Australia a disproportionate amount of funding is directed toward supply reduction efforts despite the more effective outcomes our demand and harm reduction sectors continue to produce. Dr Alex Wodak, President of Australia’s Drug Law Reform Foundation metaphorically described Australia’s Harm Minimisation model as being a three-legged stool with one very long leg. In 2015 the Australian government rolled-out the National Ice Taskforce in order to address what is callously referred to in the media as Australia’s Ice epidemic. I understand that of the Taskforce’s $45.5 million budget, $42 million has been dedicated to supply reduction efforts.

Slide 8

My introduction referenced the place for civil disobedience in health promotion and harm reduction peer education. Finally, I´d like to discuss pill testing or drug checking. Of the 1,957 Brief Interventions DanceWize performed in the last financial year, 587 were classified as cases where peers were seeking substance specific harm reduction information and strategies regarding MDMA or pills. DanceWize KPEs typically handle these queries by informing people that pills may or may not contain MDMA and may contain novel psychoactive substitutes and adulterants like PMMA, we encourage people to test their drugs even if only with reagent tests like Mecke and Mandelin, and inform people that such tests do not give an indication of dose.

In another almost 200 Brief Interventions peers approached DanceWize directly requesting drug checking services. On their face pill testing kits are legal in Australia, but DanceWize can´t promote such a service without attracting negative attention from authorities including our funder who is risk adverse and doesn´t see the harm reduction benefit of drug checking. So DanceWize team members have to act independent from the program in order to facilitate such a service and, due to these independent efforts of individuals, in the last 12 months in Victoria three different pills have been found to contain PMMA; other pills were found to contain 2CI, 2CB, and methylone; 2CE, MXE and another ketamine analogue were detected being sold as ketamine; several tabs the consumers thought was LSD were NBOMe; and this is not the exhaustive list. NPSs aren´t taking over by any means, but their presence is noteworthy.

The most significant drug trend I observe is that Australians like drugs. According to the 2014 Global Drug Survey 18% of Australians aged 14 years and older have used illicit drugs or misused pharmaceuticals in the last year. Australia´s drug market is well cultivated and many Ozzy partygoers are intrepid psychonauts, with substances such as DMT having a cult-like status in certain circles. Despite this she´ll be right, let´s get on it mentality, I´ve witnessed the impact unexpected reagent results have on peers who willingly discard the drugs they were so eager to consume. In the absence of regulation, drug checking is an essential harm reduction tool. It would be wonderful if DanceWize could proactively promote such a service or, better yet, partner with services that have the capacity to conduct more sophisticated tests.

SLIDE 9 (see below)

But in the meantime DanceWize will just continue doing what it´s always done: make ends meet and keep moving forward in order to advocate for the health rights and human rights of our peers.

Slide 9 (same as 1)

Ola Portugal! What does decriminalisation mean again?

In 2014 I had the pleasure of visiting several drug user activist and harm reduction organisations in the UK and continental Europe. My goals included networking and information sharing so I could return to Harm Reduction Victoria with a fresh perspective and developed initiative on how to approach my work regarding drug-related issues down under. It’s been almost a year and now I have the opportunity to pick up HarmReductionSass.wordpress.com in 2015 since I’m back in the northern hemisphere for the 9th International conference of nightlife, substance use, and related health issues which is being hosted in Portugal, Lisbon. Lisbon was chosen because of its acclaimed  nightlife and progressive drug policies.

Effective from 2001, Portugal adopted a decriminalised drug policy model. What does this mean? In short, the use and possession (of quantities determined to be equal to or less than a 10 day supply) of scheduled substances IS STILL ILLEGAL, but now it’s an administrative rather than criminal offence. In little more than a decade the Portugal example has empirically proven that removing the criminality previously applied to people who use drugs does not impact (or more specifically, did not increase) the rate of uptake, but it has dramatically reduced the incidence of drug-related harms (See Glenn Greenwald (2 April 2009). “Drug Decriminalization in Portugal: Lessons for Creating Fair and Successful Drug Policies”). At the end of the 20th century drug-related issues was the country’s number one concern and now such concerns are faint bleeps on their socio-political radar – so Portugal no longer pisses tax payer revenue into the supply reduction wind and personal drug use is no longer a criminal activity. In previous blog posts I’ve raised concerns about the posed risk that decriminalisation may pathologise all drug use. For anyone who respects bodily autonomy, people who use drugs should not be deemed criminals, but nor should automatically be classified as ‘patients’. Now in Portugal the legal intervention of people who use drugs ends with a referral to a dissuasion board of health professionals, often even if such individuals’ use does not present as problematic. Admittedly, this inconvenience pales in comparison to incarceration and the multi-faceted harms that flow from criminal conviction, but what other cautionary tales can be told about the decriminalisation model?

Well, without the provision of pharmaceutical or commercial regulations, substances must still be sourced from a black market, which poses significant health risks because quality and dose are about as arbitrary as though the jurisdiction still had a prohibitionist model. Alas, Caveat Emptor (buyer beware)! There are no coffee shops or head shops in Portugal. If you’re being approached frequently with offers for weed, coke, MDMA at prices that keep dropping the more you keep walking, don’t assume you have a talent for bartering, it’s highly likely you’re being offered icing sugar (if you’re lucky) or grass held together with glue. And that is why you may stumble upon a discarded (approximately 5-8 gram) bag of what looks like cannabis in the middle of Av. de Liberdade.

Austerity in Athens.

Exarchia Square

Before being able to comment on the state of AOD services or the efficacy of drug user activism in Greece (and more specifically my focus is on the capital, Athens), the financial climate and responsive austerity measures have to be noted. And before doing that I have to put out a disclaimer that the situation is so complex and shrouded by the very corruption that contributed to Greece’s desperate economic circumstance, I’m afraid that my summary here is brief and generalised. However, my intention is simply to raise awareness of the systemic discrimination perpetuated by austerity programs, the excruciating treatment of people who use drugs in Greece, and to praise the efforts of the Greek Drug and Substitute Users Union and affiliated associations/NGOs.

So here’s my brief and generalised summary of Greece’s economic situation: following the Wall Street crash in August 2007, Greece and other countries received international funding and then struggled to make the repayments. In order to avoid defaulting on the repayments (the consequences of which could include Greece’s currency being reverted back to the drachma), in June 2011 the Greek government implemented a harsh austerity package. People who use drugs especially have been negatively impacted by austerity programs, as AOD services have experienced significant funding cuts.

I met with Efi Kokkini, chairwoman of the Drug and Substitute Users Union,  in the centre of Athens at Exarchia Square to discuss their association’s goals and gain some insight into the specific AOD service cuts caused by Greece’s radical austerity measures. Exarchia Square and surrounding areas is where you’ll see, smell, and taste Athens’ street drug scene. Nearby is (or, sadly since the beginning of September 2014, was) Athens’ first consumption space run by OKANA.

OKANA coordinates a range of AOD services, it was established in 1995, and reports to the Ministry of Health and Social Solidarity (see http://www.okana.gr/2012-04-03-07-49-40/item/253-about-us). They gained approval to operate a six month trial of the consumption space; this time frame ended at the beginning of September and, due to the disdain of local police and the Major of Athens, the consumption space was closed. This is but one example of the Greek government failing to provide adequate health services for people who use drugs.

The now closed OKANA-run consumption space.

Following the Global Financial Crisis (GFC), a reduction in the already limited accessibility to NSPs contributed to a dramatic spike in the transmission rate of HIV infection among people who inject drugs in Greece. There is reason to suggest that some NGOs who receive funding in order to operate NSPs do not perform the service (or at least not to the extent that that they claim to be doing), fabricate their statistics, and there is not the resources to effectively evaluate and audit such NGO activity. Further, limited access to HIV treatment compounds the issue; hospitals simply to not have the budget to provide treatment for those in need. IDUs and people with a HIV positive status who are homeless experience additional systemic discrimination because they are explicitly denied access to temporary or long-term accommodation shelters (even though this key population is over represented when it comes to experiencing homelessness). Phillip Dragoumis, affiliated with the Syriza political party, has proposed to make an inclusive shelter, but a practical time frame for its implementation is yet to be developed. Then there’s the situation with opiate substitution therapy (OST): there’s 8,500 people engaged in OST and 2,500 are on the wait list; the expected wait time before being inducted into an OST program reached 8 years after the GFC, and since 2012 it’s been reduced to the still entirely unacceptable length of 4 years. At present, 1 in 3 people who get offered a place on an OST program after their long wait are either dead or in prison and Greece’s incarcerated population is denied the opportunity to receive OST (on 2 September 2014 OST became available via a pilot in Agios Stefanos Prison in Patras only, see: http://studiolonline.weebly.com/). Since 2011 suboxone is the only OST option available to newly inducted participants (the Agios Stefanos prison pilot OST program strangely is an exception), but those previously stablised on eg. methadone are permitted to continue with such therapy (but those on methadone who lapse may only be re-inducted onto suboxone). Former president of Greece’s OST program and psychiatrist, Meni Malliori, was recently dismissed and it’s suspected that this is at least in part due to her support for harm reduction measures as opposed to strictly pro-abstinence services (I understand that an unfair dismissal claim is being pursued).

What options are available for people who use drugs in Greece? Well, there’s prison? A significant percentage of the prisoners detained in the infamous Korydallos Prison are incarcerated for drug charges including possession for personal use. OST and NSPs are desperately required in prisons around the world generally, but the situation is Korydallos is especially dire. Overcrowding and general dilapidation are but two of  Korydallos’ trademark features, and the prison’s medical facilities are so under-resourced it’s attracted the attention of Amnesty International and other human rights advocacy bodies (see:  http://en.wikipedia.org/wiki/Korydallos_Prison). One doctor visits the prison once a week, but it’s estimated that 200 inmates need emergency health services and the rate of HIV infection is predicted to be incredibly high (there is no systematic testing, nor treatment, for HIV so the actual percentage of positive inmates is unknown). There are reports that prisoners are only relocated once they’re on death’s doorstep and such action has more to do with avoiding bad press if an inmate were to die within the facility than the provision of health care and human rights. And if you avoid being charged and convicted, as an alternative to prison, you may find yourself in Amygdaleza, a detention centre that may have been designed for undocumented migrants and asylum seekers, but it’s inclusive enough to also accept people who use drugs. (Amygdaleza is essentially Greece’s version of Australia’s Manus Island or Nauru, see: http://www.youtube.com/watch?v=NgonnC2xrFU).

There is some positive action taking place though in Greece. In 2010 the Drug and Substitute Users Union was founded in order to advocate for the rights of people who use drugs, promote harm reduction policies, and reform the strict application of prohibition that exists in the Hellenic Republic. What I found quite remarkable about this organisation’s origins is that it was founded independent of any awareness that there are other drug user activist organisations around the world with growing memberships; the need for such advocacy developed organically in Greece because the needs of this marginalised population are so pressing. I was moved when I heard the story of how the Greek Drug and Substitute Users Union learned of the broader international network of user orgs, and glad to hear their inclusion in this network provides some reassurance that progress is possible and that people who use drugs are people too!

Collaborations in Copenhagen

In my last post, Bruger Foreninger: a recovery model, I chose to focus more on the philosophical influence my stay with the Copenhagen-based drug user union had on me, but now I’d like to catalogue the range of services I visited because there’s a whole lot of good shit going on in Denmark (albeit, they’ve got their challenges too).

Bruger Foreninger.

Founded in 1993, the drug user union emerged after about six months’ of weekly meetings among peers who were frustrated with the limited rights and services available to people who use drugs. Their goal was to create a supportive network, and an alternative to under-performing abstinence programs, in order for people who use drugs to be empowered to better their circumstances and be part of a community.

Near Forum station, above a children’s library, you’ll find Bruger Foreninger’s doors open from 10am. I was warmly welcomed, offered coffee and a light breakfast, before having the opportunity to help make Smoking Kits. Inspired by the Vancouver-based AOD service Portland Hotel Society’s crack pipe vending machine initiative (http://en.wikipedia.org/wiki/Portland_Hotel_Society), the kits contain: the very same glass pipes as those available in Canada, 2 x tips, a 5 pack of gauzes, and a baggie of baking soda (the baking soda is provided as an alternative cutting agent to ammonia, which can cause blindness).  Members can make 100 of these kits for a packet of cigarettes, and the kits are distributed to the nearby consumption spaces at Sundhedsrummet and MÆNDENSHJEM (http://maendeneshjem.dk/sundhedsrummet).

In the afternoon Bruger Foreninger president, Jørgen Kjær, gave me a tour of their facilities; there’s a lecture room where audiences, including police and students, regularly attend harm reduction workshops and anti-stigma and discrimination presentations; a library, that boosts an impressive collection of position papers from around the world; a museum, where drug paraphernalia is displayed in a Wunderkammer (cabinet of wonder); a gym; a workshop; a sewing room; a safe smoking space; NSP; a kitchen, where communal food is readily available; bathroom facilities; laundry facilities; a room of bicycles for their member-activists’ use; and administrative office space.

Bruger Foreninger’s Wunderkammer-style museum.

Sundhedsrummet.

3 kilometres from the Bruger Foreninger complex is Copenhagen’s first of three safe consumption spaces, which opened in October 2012. Sundhedsrummet is a private organisation, but the staff’s salaries and NSP equipment are Municipality and regionally funded. Open 7 days a week from 11.30am-7.30pm, approximately 40-80 people use the space daily; on shift there’s always 1 nurse and a paramedic or 2 nurses, and a social pedagog; health resources and NSP equipment are available in the foyer; there are rooms for health checks, and on Monday and Thursday evenings appointments with volunteers doctors are available; the actual consumption space has capacity for nine people at a time; and the on-duty social pedagog monitors the space, anonymously recording the time and substance people inject (their database holds the pseudonyms of approximately 2000 clients, 80-90% are injecting cocaine).

One of the 9 boothes in Sundhedsrummet’s consumption space.

Instruction’s displayed in Sundhedsrummet detailing how to use the baking soda supplied in Bruger Foreninger’s smoking kits.

 Fixelancen.

The mobile consumption space is parked in front of Sundhedsrummet from 12.30-5pm, and it captures any overflow from the indoor consumption space.

Gadejuristen (street lawyers…on bikes).

Also often stationed in front of Sundhedsrummet is the Gadejurisden outreach lawyers who specialise in drug law. Founded by Nanna W. Gotfredsen, former secretary of Bruger Foreninger, the service has contact with approximately 6000 people and handles 1300 cases (mostly welfare law) annually.

As well as legal advice the Dagejuristen lawyer’s also offer basics like coffee.

MÆNDENSHJEM

A block away from Sundhedsrummet is a Men’s residence attached to another safe consumption space. There are separate rooms for injecting and smoking.

Brugernes (the users) Akademi.

Founded by Anja Plesner Bloch, the Akademi is an ally of Bruger Foreninger and advocates for the human rights of people who use drugs. Previously, Anja has entered abstinence-focused treatment facilities 23 times before realising such services were too detached from the practical realties people who use drugs face to actually be productive. The Brugernes Akademi shares an office with Gadejuristen.

Nanna W. Gotfredsen supports’s Release’s “Nice People Take Drugs” slogan on her office door.

My closing remarks on Copenhagen.

With so much activity aimed to serve the needs of people who use drugs, one may assume that there’s little need for reform in Denmark. The country implemented prescription Herion programs in 2012, and my impression is there’s a general political willingness to listen to drug user activists when developing policies that impact the life experiences of the community. But there’s always room for improvement. Yes, there’s prescription Heroin available in addition to substitution therapy, but why has there never been more than 74 people accessing such a program when there’s more than 100 places available? Well, one factor is that those on the list have to visit the dispenser twice daily, which dissuades people from participating in the program. On a global scale, Denmark may set a high standard in terms of AOD services, but people who use drugs are one of the most discriminated against demographics in the world. I was inspired by the advocacy efforts I witnessed in Copenhagen, but by no means does such progress mean it’s time to become complacent (especially since my next stop is Athens where austerity programs have plagued the health and human rights of the whole Greek population).

Bruger Foreningen: a recovery model.

Wiki reference: A recovery approach to substance dependence emphasises and supports a person’s potential for recovery. Recovery is generally seen in this approach as a personal journey rather than a set outcome, and one that may involve developing hope, a secure base and sense of self, supportive relationships, empowerment, social inclusion,  coping skills, and meaning. Other names for the concept are recovery model or recovery-oriented practice.

The concept of ‘recovery’ within in the context of the Alcohol and Other Drugs sector is often collapsed and a set outcome, namely abstinence, is prescribed on ‘patients’/’clients’/’consumers’/’persons with lived experience’s’ behalf. Often that nasty C-word comes out, and people talk about being ‘clean’ when really what they want is to be healthy and well irrespective of whether or not they use drugs. That’s the reality that a lot of people don’t want to accept or have never been reassured is possible: drug use and a healthy lifestyle do not have to be mutually exclusive, but it becomes increasingly challenging for people who use drugs to maintain a healthy lifestyle when they’re socially excluded, have lost their sense of self, and lack a network of supportive relationships. There are herdles for people seeking such balance, like the criminal justice system, the health system, and stigmatisation by the general public. For example, someone may struggle to find employment because of a drug charge for personal possession; or, after following a 12 step program someone may cease being dependant on a particular substance, but now they’re told they cannot use any other psychoactive substance ever again because they’re ‘sick’ and they always will be. Practically, such instruction makes someone who formerly used heroin a ‘failure’ if they subsequentally choose to participate in rituals like a celebratory toast or Eucharist even if they’ve never been alcohol dependant. Psychologically, this ‘all or nothing’ approach to recovery is disempowering. How can a 12 step program be a personal journey? If abstinence is the only goal for all, who will recognise when people make positive personalised lifestyle amendments, like starting to practice safer injecting practices, modifing one’s diet to meet their nutritional needs, or stabilising on substitution therapy with the goal of maintaining that dose for life? Well, drug user activists and harm reductionist celebrate these achievements of their peers even if normative sociey still has a Nancy Reagan-just say no-hangover. (FYI: you may know that as well as being staunchly opposed to drug use, Ronald and Nancy Reagan opposed women’s reproductive autonomy rights too. Then, once Ron was diagnosed with Alzimers, they founded the Ronald and Nancy Reagan Research Institute; as his health deteriorated Nancy increasingly advocated for embrionic stem cell research. That is, for Nancy fertilised embryos were the beginnings of human life with moral status until they were subjects of scientific research that may save her husband’s life. My only point is you need empathy, an open mind and willingness to listen, and/or lived experience before you’re qualified to make decisions that seriously impact the lives and human rights of others).

That was a long introduction, and thank you for your patience, but these are the ponderings inspired by my time in Copenhagen, Demark, staying at the Bruger Foreningen, a drug user activist association founded in 1993 by a group of peers. I arrived early in the morning last Thursday, I received a warm welcome and a thorough tour of the organisation’s vast complex from key long-standing member-activists, including President Jørgen Kjær; on my second day I visited Sunhedsrummet (a monitored consumption space), Maendenes Hjem (a men’s residence connected to another consumption space, with designated spaces for injecting and smoking), Fixelancen Stofindtagelsesrum (the mobile consumption space), I met Anja Plesner Bloch who founded the Bruger Akademi (Drug User Academy, see: http://brugerforeningen.dk/2014/06/support-dont-punish-begivenhed-hos-gadejuristen-i-kobenhavn-den-26-6-kl-15-00/?lang=en) and shares an office with Gade Juristen (founded by Nanna W. Gotfredsen, these street lawyers perform outreach on fixie bikes at sites chosen in order to support people who use drugs, http://www.gadejuristen.dk/). But I’m not going to detail in this post the specific services provided by such organisations, individual stories that moved me, the policy reforms and challenges ahead (I will though I promise, that’s for another day), instead here I’d like to summarise what I interpreted as the essence of Bruger Foreninger: the lifestyle its’ members practice and promote.

At the end of my first day at the Bruger Foreninger, before retiring to my sleeping quarters in the association’s library, I was invited to join the activists (that’s the preferential term given to their volunteers) and any members present (it’s membership is approximately 700, all of whom are welcome to appreciate the association’s services at their own accord, and in a day about 30-50 members would actually visit) for dinner. Everyone sat together and ate together; I got my 5+ fruit and vege and then some, and suppliments were offered as additional condiments (Omega, Magnesium, and a muli-vitamin). Following dinner I hung with one of the Bruger Foreninger’s founding members, Annalise Grønkjær, and she shared some her life experiences with me in such a way that I felt even more confident than ever before in two points: 1) peer-based models are essential in the AOD sector; and 2) abstinence-focused programs cause more harm than good. With reference to the varying degrees that some members engage with Bruger Foreninger and its’ services compared to others she said, “as long as someone is doing their best that’s enough”.

Anna’s words resonated with points Jørgen made to me earlier in the day when explaining why activists perform services for their peers, to the effect: we want to be responsible for ourselves and show people that we can be responsible. Recover-as-abstinence is contentious because the focus is solely on the behaviour of the enaged individual, and the success of their recovery is based on an objective (external) measure: are you using or not. But individuals make up communities and any recovery they engage with needs to be integrated as such. Also, abstinence is not synonymous with wellness, one’s lifestyle shouldn’t be defined by what one does not do. Sometimes all that is required for an individual’s ‘recovery’ is for those around them to accept them exactly as they are.

The entrance to the Bruger Foreninger complex is a drop in centre where members can hang out, get coffee and food, use the internet, as well as having a range of other health services and social opportunities available to them.

 

A Berlin Fix

 

During the International AIDS Conference 2014 in Melbourne I was glad to meet Dirk Schäffer of the Berlin-based drug user organisation JES Bundesverband (http://www.jes-bundesverband.de/home.html), who recommended that if I made it to Berlin on my travels I should check out Germany’s only mobile consumption space.

Fix Punkt (meaning ‘fixed point’) is a government-funded non-profit service that performs a range of community outreach services in Berlin. Monday through Saturday from 2-6pm FixPunkt operates in the taxi rank by Wilmerdorfer train station. While Fix Punkt performs a range of outreach services in various parts of the city, the Wilmerdorf location is the only site where they provide a needle and syringe program (NSP) in conjunction with a consumption space. This set up consists of two vehicles: from a camper van marked ‘Fix Punkt’ two social workers ensure the provision of harm reduction education and disseminate a broad range of NSP equipment, including sterile water (FYI: while providing sterile water has been proven essential in order to prevent the transmission of hepitatis C especially, the Australian government does not fund this item as part of its’ NSP); parked immediately behind the camper is an unbranded van where two medicial professionals are stationed in order to provide free health services, and in this space clients may smoke or inject their drugs in a safe and sterile environment. In July this year 60 people per day used their Wilmersdorf space, and in August so far the average is 45 visits daily.

The social worker I interviewed explained that while the services they provide are government funded and the police understand that it is legal for people to use the consumption space, officers do visit (but not enter) in an attempt to intercept drug deals. Naturally, this can be intimidating for Fix Punkt’s visitors and it makes me beg the question again: why do enforcement-led supply reduction efforts seem to get priority over harm reduction efforts? 

Considering this question solely from a humanitarian perspective, the argument in favour of harm reduction is convincing to any reasonable and compassionate person: 1) many people use drugs; 2) their are potential harms that accompany drug use, especially in a prohibitionist context, such as the transmission of blood borne viruses, vein damage, overdose, social disconnection due to stigmatisation, limited employment opportunities due to stigmatisation, and criminal conviction (and the stigmatisation that follows being labelled a criminal); 3) while drug law reform away from a prohibition model would dramatically reduce the social harms that people who use drugs experience because of stigmatisation, numerous studies around the world have proven the potential health risks of drug use are dramatically reduced when people have access to harm reduction services like NSPs, consumtion spaces, and credible education. Why then would you operate supply reduction efforts (policing, that is) in direct conflict to life-saving and quality of life-enhancing harm reduction efforts? Well the reasonable and compassionate person would assume supply reduction must save even more lives indirectly by reducing the availability of these harmful said drugs? The brief and blunt response to that assumption is: No it fucking doesn’t! (Admittedly, I could have been more brief, but this is something to get angry about). For more than a decade the UN has estimated the illegal drug trade is a market worth over $300 billion dollars, and growing—so, yeah, there’s still some illicit substances out there just waiting to be confiscated by the authorities. In addition to failing to reduce the supply of illicit substances, supply reduction causes real harm: people are killed in narco-trafficking warfare, and people die because they’re denied or are fearful about engaging essential health services.

Considering my earlier question (why do enforcement-led supply reduction efforts seem to get priority over harm reduction efforts) from a purely fiscal perspective though, even a reasonable amoral capitalist has to concede that harm reduction trumps supply reduction. Not only is harm reduction cost-effect (ie. the benefit of the expenditure is demonstrable eg. Australia implement NSPs nationwide in 1987 and the rate of HIV injection among people who inject drugs has never been more than 2%), but these initiatives also save the health system subsequent expenses that would occur in the absence of harm reduction. Further, alternative drug law models have the potential to generate revenue through taxation. Globally, harm reduction is underfunded respective to supply reduction and the sector is experiencing a funding crisis that compromises such organisations from being able to continue (let alone expand) to provide people who use drugs with services that have overwhelming and consistently been proven effective from both a social and financial perspective. WTF!?! Why, asks both the reasonable compassionate person and the reasonable amoral capitalist? This question is complicated and requires sophisticated reasoning in order to be unpacked, something that could be done if there was a general willingness to at least have this debate and share concerns and collaborate in order to find solutions. But, apparently, there’s little political capital in harm reductionand politicians do like to be popular?

 

 

Hard Drugs in Holland

Most coffee shops have more discarded weed crumbs on the table surfaces than student flats have in the communal chop bowl.

What I’ve noticed about the coffee shops in Holland is they make pretty shit coffee. Turns out you don’t have to worry about burning the milk, over extracting the coffee, or selling a brew of instant for 2 euros, if you also provide people with weed. In fact, some coffee shops are a testament to the reality that you can disregard customer service and basic sanitation too, so long as you still sell weed.  With the same breath, some coffee shops have extensive menus, awesome everything, and encourage people to practice harm reduction, but the full spectrum of coffee shop experiences is out there in Amsterdam. (FYI: “Coffee shops”, as opposed to cafes, in the Netherlands sell cannabis for personal consumption, up to 5 grams daily).

In general, I’ve observed there’s a unique clash of standards in the Netherlands and I’d like to note a couple of examples with reference to both the coffee shops I frequented and my experiences at Low Lands festival, Biddinghuizen, 15-17 August (43kms East of Amsterdam).

So I love going to outdoor music festivals, I love the chaos and sense of community (aka. Rainbow Serpent Festival, Victoria). Working for DanceWize in Melbourne I get to work and play at such festivals, and I see the full range of experiences people have, including the distress people may experience because they’ve taken drugs (and not slept, and not eaten, and not had water, and at some point they decided to take their clothes off – the clothes and their campsite are now lost, and it can be 40+ degrees etc). Now I loved Low Lands, it was three days of awesome music in a beautiful place and it still had that friendly community atmosphere, but where were the dance floor die-hards? Where was messy Monday? Where was  this guy…(see right)

 

 

 

Die Antwood at Low Lands 2014

Lose your Beauty, lose your Clarity, lose your Reality.

 

 

 

 

I interviewed a paramedic from the Low Lands festival’s medical provider and he explained that they don’t have any specialist alcohol or other drugs services present, but the medical team will support anyone experiencing distress due to intoxication. However, at times, I felt like we were having a parallel conversation because the kinds of drug-related presentations the medics anticipated, if any, (and based on their experiences at past festivals) would be due to, quote, “Heroin and Cocaine” and would most likely require further medical treatment offsite anyway. The concept of trip sitting (check out this MAPS video: https://www.youtube.com/watch?v=1aBjoARwlOY), or supporting people with drug-related issues that were compromising something other than their physical health, was difficult for me to communicate, but as I understood it no such services existed at Low Lands. Sure, everyone at this Dutch-doof was drinking, half the people were on MDMA (at least), and I’m sure there were bits and pieces of a range of other substances being used too. But the impression I got was, frankly, if someone’s going to be tripping balls in Holland they should: first,  invent a time machine, travel back in time, and take a smaller dose so as to embrace controlled levels of fun, which is customary in these parts; second, if a time machine is unavailable, deal with the situation in private; and third, because you are most likely a foreigner, stick to the touristy parts of Amsterdam because there’s a 50/50 chance you’ll find plenty of new friends just like you to share the experience with. Now let’s consider harm reduction in the touristy parts of Amsterdam.

I first visited Amsterdam in 2009, and returning after five years I was expecting a completely different vibe with the reforms in recent years that prohibit non-residents from purchasing cannabis. But the closest coffee shop to Amsterdam central (Coffeeshop Central) is only 260 metres away, and everyday it has a queue full of people with wheelie suitcases out the door. That’s just one of the Netherlands’ 478 licensed coffee shops. Just in case being able to rock up in Amsterdam and possess weed within a three minute walk isn’t enough for you, rest assured at almost any hour you may also purchase a novelty T-shirt that advertises the fact that you are stoned! So using my acute observation skills, so far I’ve shared with you the fact that drug tourism, primarily for Marijuana and hash, is still a draw card for Amsterdam. (More info: http://www.forbes.com/sites/ceciliarodriguez/2013/09/24/weed-ghettos-for-tourists-anger-netherlands-neighbors/).

For me, one thing that has changed between 2009 and now is I’ve been working in the alcohol and other drugs sector and this time round I was able to observe Amsterdam under a harm reduction lens. I noticed that some cafes hired out Volcanoes and other vaporisers, so people could remove the harms that accompany smoking; some cafes offer at no charge tobacco-free organic chop mix and organic papers, to reduce the harms that accompany smoking and in order to encourage people to manage their dose by having spliffs; some places offer free water, excellent ventilation, and actually enforce the no tobacco rule. Then, some places have special licences that allow people to drink alcohol and smoke weed. (As an aside, I observed a disproportionately high number of Irish establishments were set up like this – the Irish represent the whole world over don’t they)! As I criticised in my introduction, some other places were unclean, and light on the harm reduction advice. I mean consider the label on the Space Cake in the photograph below, essentially it says that dosage is hard to manage, the onset of effects can take an hour, you may experience negative effects, but don’t panic. I’d give that a 5.5/10 for harm reduction; I mean it’s something, but it’s hardly comprehensive. I really think more and more and more harm reduction education resources could be available in coffee shops, but then I also think the some about alcohol and bars? But, while in Amsterdam I didn’t actually notice really anyone experiencing distress due to their intoxication, maybe there’s some sights that will shock and gross some people out, and ‘so it is’? Which seems to be the generally chilled out response of most people in the Netherlands.

Coffee shops have posters like this “Stop Hard Drugs” one I sneakily photographed.

One point I’d like to end on and I think it’s an important one is I started noticing locals talk in terms of “hard drugs” and “soft drugs”, these are technical terms in the Netherlands and they refer to the Opium Act’s two schedules. Soft drugs means marijuana and hash products, and hard drugs is everything else. (See: http://www.government.nl/issues/drugs/difference-between-hard-and-soft-drugs). For all the praise I could give the Dutch, the labels tolerant and non-judgemental are two compliments I believe are handed to them too often simply because the Dutch are more tolerant and less judgemental than say the USA, Australia etc. People who use drugs are still stigmatised in the Netherlands. Like in Australia, where we drink alcohol until our liver hardens or die prematurely in some accident and judge anyone who uses other illegal substances as a druggie loser, in the Netherlands they drink alcohol and consume THC responsibly, accept that foreigners may do so too to a less responsible degree and judge anyone who uses other illegal ‘Hard Drugs’ as either a druggie loser or, often patronisingly, as unwell and in need of support.

 

 

 

 

Release: UK centre of Drugs and Drugs Law

Late last week I was welcomed to visit Release’s office in the very charming Ferguson House on City Road, London. Why has it taken me so long to write the post for that visit you ask? I’ve been off the grid for a few days, doof doof Dutch-style is my answer (I have a few comments relevant to this blog’s objectives to make on that adventure too, but I’ll need another day or two.

I’ve been made aware of Release in recent years due to the organisation’s “Nice People Take Drugs” campaign, as I work for DanceWize and we proudly display this slogan at the entrance of our outreach chill out space at music festivals  (this is where DanceWize provides care for intoxicated festival attendees experiencing distress, as well as disseminating harm reduction educational and health resources). However, on my recent visit I was very grateful that Release’s Executive Director, Niamh Eastwood kindly took the time to detail the charity’s full range of services, which I’ve noted below. Then, after being showered with “Nice People Take Drugs” promo paraphernalia (thank you), and meeting some of Release’s incredible staff, I was allowed to shadow one of the outreach lawyers during their appointments at North Westminster Drug and Alcohol Service’s legal surgery.

Niamh Eastwood at Release.

The North Westminster Drug and Alcohol Service is flanked by sunflowers.

Outreach. 

Five lawyers visit ten treatment centres around London in order to provide legal advice to client’s already engaged in each of the centres’ alcohol and other drugs services. This team of outreach lawyers provide advice to approximately 1,500 clients annually. Presentations are mainly in regards to social welfare law, debt, and benefits; less than 10% are actions against police and complaints. Release’s has received feedback from clients that they find it easier too access legal advice via a health service they’re already engaged with, and the experience (and fear) of stigmatisation is reduced in such a context.

Inbound legal advice line and ask@release.

In addition to their outreach role, Release’s lawyers respond to 400 calls and emails per month regarding drug law. It may be worth noting that, like with all of Release’s harm reduction initiatives (check out http://www.release.org.uk/drugs-law/drugs-a-to-z and /drugs-health-advice), the call service is not funded. Predominantly, the call and email service provides advice on possession and small scale cultivation matters, such as information on criminal procedures. Less frequently, callers and emailers query other cultivation and dealing chargers, but such cases are most likely eligible for aid and are referred to private firms known for their drug law expertise.

London’s equivalent to HRV’s PAMS.

Release’s drugs team receive calls from client who’ve been excluded from treatment; the staff can advocate on clients’ behalf, like HRV’s Pharmacotherapy Advocacy and Support service. Sometimes a situation provides Release with the opportunity to run a strategic test case. For example, at present they’re representing a client’s negligence claim against a treatment provider that abruptly discontinued the client’s Opiate Substitution Therapy. (However, since the layered services provided by Release were so efficient and the client only waited less than 72 hours before being in receipt of a new script, it will be challenging to demonstrate the client experienced the requisite level of emotional distress necessary for the negligence claim to be decided in the claimant’s favour).

Expert Testimony.

Members of Release’s drug team often provide expert testimony on drug law matters such as, the potential large-scale quantities of drugs that people may legitimately have in their possession for personal use only.

Y-Stop.

The Y-Stop campaign is Release’s collaboration with StopWatch (http://www.stop-watch.org/about-us/) and Fully Focused (http://www.fullyfocusedproductions.com/) that responds to the issues raised by random police stop searches. In the UK these searches can be conducted without reasonable cause, and data suggests that young people and anyone from a non-anglo background are more likely to be subjected to a stop search (FYI: 1.1 million people were stop searched in 2013; black people are stop searched by the police at more than 7 times the rate of white people; in the UK before the point of arrest, police can conduct a strip search as part of a stop search).

Over eight months Release consulted 100 young people, their insight helped shape the Y-Stop program’s design. Overwhelming, people said that it was difficult to challenge a stop search there in the moment, so the program follows a behavioural and harm reduction model: accept a stop search is happening, be calm, practical, and exercise your right to complain after the fact. Y-Stop facilitates the complaints’ process for those who experience a stop search, and they’re currently developing a website where people register their experience with Release’s who will collate data on police behaviour trends and unofficially complain on their behalf.

DanceWize is conscious of the issues raised by Passive Alert Detection (PAD) operations, or sniffer dogs, as well as stop searches too, and our educational resources on such topics are some of our most popular. Maybe we could consider implementing a program similar to Y-Stop in Victoria?

Policy.

Release develops reactive and proactive policy campaigns. Check out http://www.release.org.uk/campaigns and http://www.release.org.uk/publications.

DanceWize volunteers in front of the chill out space (and the “Nice People Take Drugs” sign).