International AIDS conference and the role of Drug Policy #‎IAS2015

Dr. Evan Wood speaks at ‪#‎IAS2015 conference in Vancouver, on How Drug Policy should respond to the HIV Epidemic. International AIDS conference 2015’s daily plenary sessions feature some of the world’s most distinguished HIV scientists, policy specialists and community leaders.

Tuesday July 21, 2015:

When Dr Wood led the writers of the Vienna declaration at the AIDS conference in 2010, I was a fresh research assistant in Dublin, Ireland. As a Slovakian, I followed preparations of the conference with great excitement. Bratislava, our capital, was only 30-mins drive from the conference. All my former colleagues went the www.ODYSEUS.org needle exchange attended the conference in Vienna.

 
Dr Evan Wood (photo credit:http://bc-cfe.tumblr.com/)

It has never crossed my mind that five years later, I’d be working alongside this giant brain and great leader, Dr Wood. This time, I got to see his talk at the conference in Vancouver, Canada.

 

What is the problem?

Drugs are not the problem, addiction is. A neuroscientist, Dr Carl Hart, thinks that more dangerous than drugs is ignorance about drugs. Most people who use drugs do so relatively without problems or addictions. Our understanding and definition of addiction evolved over time. Experts now think it’s a disease; some say a disease of the brain. In the past, addiction went from being considered as a moral failing, to medical condition, to psychosocial, bio-psycho-social, and to bio-psycho-social-spiritual disease. Reducing it back to the brain component seems to go against the flow of time and our evolution of knowledge.
“Addiction is a disease — a treatable disease — and it needs to be understood.”
– Dr. Nora Volkow
Dr Wood told us a story of the epidemic of HIV among people using drugs in Vancouver, BC. If you’ve lived in British Columbia, you’d seen a miraculous 90% reduction in new HIV cases over the years. It was well over a decade before HIV has emerged among people who used drugs. Historically, single room occupancy hotels served fishermen and loggers – seasonal workers. Poverty took over these hotels a century later. People went up into these buildings where the likelihood of interacting with police is less, but provision of clean needles or HIV tests is very problematic. In 2002, the only needle programme closed at 6PM each night.  The illegal Marijuana-growing industry in BC is closely linked to the Cocaine industry.  People who inject cocaine need to do so many times a day. Without an access to clean needles, this led to huge health problems. Almost 1 Fatal overdose per day happened during the HIV epidemic.

What is the solution?

 
Treat everyone. Access to care is a human right. Is it feasible? Treatment rates are low, but does everyone need the treatment? In U.S. only about 10 percent of people with addictions get treatment, out of an estimated 23.2 mi people affected.  Although treatment may not have the solution or capacity to help those millions of people, the progress in addiction science has led to new, effective medications. They can mean the difference between life and death for some people, especially those living with HIV.
The empowerment of the community in Vancouver, BC, really turned the tide of the HIV epidemic. They urged the city government to take action that came up with a 4-pillar approach to drug problem in Vancouver: 1. Peer-to-peer syringe provision – in 2010, there were over 30 places where you could get clean needles; people are moving away from injecting despite the availability of clean needles; 2. Safe-injecting rooms preclude the opportunity for needle-sharing. Dirty needles don’t end up on the society. None of the 2mi injections of drugs in the safe rooms has led to a fatal overdose; 3. Expansion of methadone treatment; it’s not just that methadone protects against HIV but there’s advantages in terms of antiretroviral therapy; 4. Treatment as prevention impact of the viral load in the community is the strongest drive for people becoming HIV positive. In the population of people who have been considered hard to treat, only about 3% are not on antiretrovirals.

What does it mean for early-career addiction scientists?

 
The mandate of addiction science is to find evidence to help people with addiction. We’ve studied drugs for decades and learned that their effects are predictable, mainly: the higher the dose, the higher the likelihood of toxic effects.  Moving on from studying the effects of drugs, we should study the effect of contexts where drugs are being used. How do these contexts change the effect of drugs on people? What’s the role of milieu in addiction?
“What is far more important – studying the brain or studying behavior?”
– Dr. Carl Hart

When the HIV epidemics happen, they do not occur by accident. They are the consequence of an un-orchestrated happenstance. They have their origins in harmful policies and circumstances, limitations and harms of criminal justice approaches. In this context, the importance of community empowerment and the value of integrating harm reduction, addiction- and HIV- treatment cannot be underestimated.