The BC Centre for Excellence in HIV/AIDS (BC-CfE) firmly supports a move towards a more people-centred and evidence-based approach to drug policy, as pledged by the Honourable Health Minister Jane Philpott in her statement at the UN General Assembly Special Session (UNGASS) on drug policy last week.
The global War on Drugs has for years forced people who use drugs -- and often their loved ones -- into the shadows. This creates barriers to accessing health care and addiction treatment, making it harder for public health services, care providers and support groups to do their important job of connecting with those hardest to reach.
Treatment as Prevention (TasP), pioneered by the BC-CfE and implemented in British Columbia with support of the provincial government, has shown that bringing HIV services to those in need where they are at saves lives, prevents new infections and contributes to health care sustainability.
People who use safe injection sites are 30 per cent more likely to enter detox programs and 70 per cent less likely to share needles.
The roll-out of harm reduction, coupled with expanded HIV testing and treatment in B.C., has led to a 90 per cent decrease in AIDS cases and HIV mortality among HIV-infected IDUs in the province, and a 65 per cent decrease in the number of new HIV cases within this demographic, from 1994.
Since the opening of Insite in 2003, still North America's first and only supervised injection facility, there have been no overdose deaths at the site. The number of fatal overdoses in the surrounding neighbourhood has decreased markedly, according to our BC-CfE research.
Our research has also found people who use safe injection sites are 30 per cent more likely to enter detox programs and 70 per cent less likely to share needles. The rest of the world is taking note as places like Ithaca, N.Y., and rural parts of Indiana are now considering implementing life-saving supervised injection facilities.
Our data clearly shows when pushed into alleys and hidden spaces, drug users might engage in unsafe behaviour to acquire or use drugs. Sharing needles can lead to the spread of some of the most costly health burdens of our time, including HIV and other blood-borne diseases such as infection with the hepatitis C virus (HCV). It is in this context we applaud Health Minister Philpott's visionary pledge at the Special Session on Drug Policy at the last UNGASS.
When pushed into alleys and hidden spaces, drug users might engage in unsafe behaviour to acquire or use drugs.
On Thursday, April 21, our B.C. Ministry of Health announced $5 million in funding for the BC-CfE to lead the monitoring and evaluation of hepatitis C treatment in B.C., with a special emphasis on core transmitters, including injection drug users, MSM and HIV co-infected individuals.
Similarly, as we have shown in HIV, the individual and public health impact of highly effective HCV treatment will only be optimized if individuals can be proactively linked to testing, support, treatment and ongoing wrap-around programs. These programs must prioritize harm reduction strategies, as well as access to addiction medicine services.
Our Canadian government has taken a bold new step with the endorsement of a drug policy supported and validated by years of peer-reviewed, evidence-based science. We applaud this effort and look forward to working together with all Canadian partners to support, monitor, evaluate and refine the implementation of these life-saving programs.
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More and more of the substance needs to be taken in order to achieve the same effect (called tolerance) and/or withdrawal symptoms emerge when the substance is stopped. Some drugs (such as opioids) can cause tremendous physiologic dependence, while others (such as marijuana) may cause relatively little.
While this is not currently one of the criteria used to diagnose substance dependence or abuse, it is likely one of the fundamental characteristics of all addictive behaviors. When someone has become addicted to a substance or behavior, it attains a level of emotional significance that keeps it in their thoughts almost constantly.
Using more or for a longer period of time than intended is one of the hallmarks of addiction. Interestingly, this behavior is not necessarily tied to enjoyment of the activity. For example, many cocaine users report continued use of the drug for hours or days past the point when it has stopped producing pleasure.
This is the truly pernicious aspect of addiction. Virtually every addict eventually experiences enough pain and suffering as a result of the addiction that he or she wants to stop. Unfortunately, by the time most individuals get to this point, the addiction has progressed so far that stopping without help is exceptionally difficult.
Obtaining, using and recovering from addictive substances requires more and more time as an addiction progresses. This is also true of behavioral addictions, such as pathological gambling. The substance or behavior becomes the focus of the addict's life, consuming more and more attention and time.
As an addiction progresses, the areas of our lives that are usually of greatest importance to us -- such as relationships, work or recreation -- are often sacrificed. One of the tragedies of addiction is that the substance or behavior often attains greater importance in the mind of the addict than his or her friends and family.
The sacrifices individuals make in service of an addiction often baffle those who have not experienced an addiction themselves. At the beginning, these consequences may be insubstantial, but as the neurological changes become more profound, even one's most deeply held values can become subordinate to the drive to continue using the substance or engaging in the behavior.
While addictions can be devastating disorders if left untreated, there are now many types of effective treatment, including group and individual therapy, medications and community-based, 12-step programs like Alcoholics Anonymous or Narcotics Anonymous. To learn more information about addiction and its treatment, visit www.edrugrehab.com or the National Institute on Drug Abuse.
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