People who use drugs (PUDs) are dying a preventable death

Every year, today we commemorate a friend, partner or family member who had passed away as a result of overdose to raise awareness that the tragedy of overdose death is preventable. We, the Asian Network of People who Use Drugs (ANPUD) express our grave concerns upon the lack of commitment and unwillingness of Asian governments towards a more progressive implementation of harm reduction interventions for people who use drugs. We are angered by their inaction and lack of compassion towards our community.

Current approaches has led to an overdose epidemic

Overdose is one of the leading causes of death of people who use drugs. An estimated minimum of 190,000 – in most cases avoidable — premature deaths from drugs have occurred last year globally and the majority are attributable to the use of opioids. (1) Data on overdose remains extremely limited across Asia; however, it is estimated that there were between 13,600 and 100,700 deaths in 2013. (2)
Asian governments are infamously known for their extremely punitive drug laws and policies that focus on intensified law enforcement, imprisonment or compulsory center for drug users (CCDU) and unlawful killings. The current drug laws and policies fuel an overdose epidemic because:

Choosing to inject opioid puts users at elevated risk, especially for the first time injectors. (3) Intensified law enforcement facilitates change in the route of drug administration from oral/ingestion to injection, as it is easier, faster and less likely to be tracked by the authorities.

A reduction in tolerance, seen when opioid use is restarted after a period of abstinence, markedly increases the risk of an opioid overdose. (3) Imprisonment or detention of people who use drugs at CCDUs are merely factories for human rights violations. PUDs released from either prison or CCDU are more likely to restart drug use than those who receive the voluntary community based treatment.

Overdoses are more likely to happen due to impurity (contamination) or mixture of multiple drugs. War on drugs massively increases overdoses as it delegates the regulating power to the illegal drug market that does not care about the purity of the drugs. Johann Hari, a British Journalist has quoted Ethan Nadelmann, one of the leading drug reformer in the United States “People overdose because [under prohibition] they don’t know if the heroin is 1% or 40%. Just imagine if every time you picked up a bottle of wine, you didn’t know whether it was 8% alcohol or 80% alcohol [or] if every time you took an aspirin, you didn’t know if it was 5 mg or 500 mg.” (4)

The solution was there for the past 40 years

Naloxone is a safe, highly effective rescue medicine for opioid overdose. It has been listed in the core list of WHO’s Essential Medicines and has been endorsed by the WHO, UNODC and UNAIDS Technical Guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users. (5) Though inadequately only few countries like India, Thailand and China in South and Southeast Asia have included overdose prevention and management as part of their national harm reduction programme. (6)
In 2014, the WHO Community Management of Opioid Overdose Guideline recommended countries expand naloxone access and overdose management training to people likely to witness an overdose in their community, such as friends, family members, partners of people who use drugs, and social workers. (3) However, accessibility of naloxone has been limited only through hospitals in most of the countries, and it can be too late before it is administered to the person in need.

Based on the recommendations from WHO guideline and other resources, we urge Asian governments to:

Include naloxone in the national essential list of medicines and endorse all drug-related overdose prevention and management as part of the harm reduction programme.

Routinely monitor, document and report both fatal and non-fatal drug-related overdose cases.

Ensure friends, partner or family members and community outreach workers who are more likely to witness an opioid overdose have access to naloxone and are instructed in its administration to enable them to use it for the emergency management of suspected opioid overdose.

For a sustainable response we demand the governments in our region to swiftly end the war on drugs and work towards decriminalization and legalization of drugs.

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References

1. UNODC. World Drug Report 2017
2. UNODC. World Drug Report 2015
3. WHO. Community Management of Overdose 2014
4. Johann Hari. Chasing the Scream: The first and last days of the war on drugs 2015
5. WHO, UNODC, UNAIDS Technical Guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users –2012 revision
6. HRI. The Global State of Harm Reduction 2016

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