Abstract: The Alternative World Drug Report, launched to coincide with the publication of the UN Office on Drugs and Crime’s 2012 World Drug Report, exposes the failure of governments and the UN to assess the extraordinary costs of pursuing a global war on drugs, and calls for UN member states to meaningfully count these costs and explore all the alternatives. After 50 years of the current enforcement-led international drug control system, the war on drugs is coming under unparalleled scrutiny. Its goal was to create a “drug-free world”. Instead, despite more than a trillion dollars spent fighting the war, according to the UNODC, illegal drugs are used by an estimated 270 million people and organised crime profits from a trade with an estimated turnover of over $330 billion a year – the world’s largest illegal commodity market. In its 2008 World Drug Report, the UNODC acknowledged that choosing an enforcement-based approach was having a range of negative “unintended consequences”, including: the creation of a vast criminal market, displacement of the illegal drugs trade to new areas, diversion of funding from health, and the stigmatisation of users. It is unacceptable that neither the UN or its member governments have meaningfully assessed these unintended consequences to establish whether they outweigh the intended consequences of the current global drug control system, and that they are not documented in the UNODC’s flagship annual World Drug Report. This groundbreaking Alternative World Drug Report fills this gap in government and UN evaluations by detailing the full range of negative impacts resulting from choosing an enforcement-led approach.

Abstract: This Review summarises the literature on the provision of sterile injecting equipment to people who inject drugs and other related issues. The proportion of the Australian population thought to inject drugs is about one percent or approximately 275,000 people. The first case of HIV infection in a drug injector without other risk factors in Australia was detected in 1985. In the following year, a Needle and Syringe Program started in Australia. At that time, hepatitis C infection was already well established among drug injectors with more than half being infected2. Staff at Needle and Syringe Programs provide much more than injecting equipment. They are often the first point of contact with health services for people who inject drugs, facilitating the entry of many drug users into drug treatment. Some Programs also provide primary medical care to this disadvantaged section of Australians whose health is usually very poor. Needle and Syringe Programs have reduced the transmission of HIV, hepatitis B and hepatitis C. The size of the reduction of HIV transmission due to Needle and Syringe Programs has been calculated to be at least 30 percent. Australia’s Needle and Syringe Programs were estimated to have prevented almost 3,000 cases of HIV infection in 1991 alone, a saving of $266 million. HIV epidemics have occurred recently in some cities in North America where Needle and Syringe Programs existed. Arbitrary restrictions on the number of needles and syringes provided from the Programs are thought to have been a critical weakness in their effectiveness in preventing transmission of blood borne viral infections. Research has shown that Needle and Syringe Programs do not increase injecting drug use or the number of discarded needles and syringes. Even though Needle and Syringe Programs enjoy a high level of support from the public in Australia and abroad, they also attract some criticism. Objections to Needle and Syringe Programs include: concern about specific locations, the inconsistency in providing some free injecting equipment to drug injectors but not to people with diabetes, concern that the Programs are responsible for all discarded injecting equipment in a local area and that the Programs condone drug use. Some members of the public are concerned that they may receive a needlestick injury from a discarded needle and syringe and then become infected with HIV or hepatitis. No cases of HIV, hepatitis B or hepatitis C infection resulting from a needlestick injury due to discarded injection equipment have been identified although researchers have investigated the outcomes of such injuries. There is abundant evidence from Australia and other countries of the public health benefits of Needle and Syringe Programs. The US Secretary for Health and Human Services, Donna Shalala, has announced that: “This nation is fighting two deadly epidemics – AIDS and drug abuse. They are robbing us of far too many of our citizens and weakening our future. A meticulous scientific review has now proven that needle exchange programs can reduce the transmission of HIV and save lives without losing ground in the battle against illegal drugs. It offers communities that decide to pursue needle exchange programs yet another weapon in the fight against AIDS (20 April 1998)” Countries that have implemented these Programs have averted HIV epidemics among injecting drug users, while countries that have not implemented these measures have often experienced uncontrolled epidemics. There is strong evidence that if HIV becomes endemic among injecting drug users, HIV can then spread to their sexual partners and children resulting in high mortality rates and large social and economic costs to the entire population.