Abstract: This document, from Forward Thinking on Drugs, details the theory and practice of harm reduction and evaluates its effectiveness. The first section of the document outlines what harm reduction is, including its main principles, and addresses key criticisms. The second section of the document outlines key harm reduction interventions, including: needle and syringe programmes; methadone and other replacement therapies; depenalisation; information, education and communication; safer injecting and other drug consumption rooms; and motivational interviewing. The paper outlines three key findings from the evidence. Firstly, harm reduction works, especially methadone and other replacement therapies, and needle and syringe programmes. The author argues that these should be considered for adoption in regions where they are currently unavailable. Secondly, harm reduction programmes show promise and require cautious, monitored, and locally adapted expansion. Finally, the author finds that harm reduction interventions are widely used yet under-researched, especially those which include information, education and communication programmes, and motivational interviewing approaches to conventional harm reduction targets such as HIV prevention. The author concludes that the best response is to develop better evidence in order to discard approaches that do not work and develop and disseminate those that do.

Abstract: This document is intended to provide general information about the EU accession process and EU drug policy for NGOs in Central and Eastern Europe (CEE) and the former Soviet Union (FSU) working the field of harm reduction. It is intended that after reading this document and referencing some of the sources cited, such NGOs will be more able to negotiate effectively with their governments and on an equal footing. That is, they will be able to understand the vocabulary of the accession process and the EU and apply the principles of EU drug policy to their own countries in order to craft arguments for satisfactory drug policies in their own countries. Familiarity with these concepts and arguments may also be useful when applying to foundations, international organizations and governments for funding. The first part of this document provides an overview of the EU accession process, highlighting areas of relevance to drug policy. The second part of this document outlines current EU drug policy, highlighting areas of relevance to countries of CEE and FSU.

Abstract: The Government of the Australian Capital Territory commissioned this review. Few papers have been published reporting evaluation of Prison Syringe Exchange Programs. Only some of this material has been published in English or has been previously translated into English. This review has been based on a comprehensive search of electronic databases, contact with experts in this field to identify any missed publications and the existing published literature and material which was translated specially for this review. Some of this review is based on the ‘grey literature’ of reports and other official documents. The first prison syringe exchange program in the world was established in Switzerland in 1992. A total of 19 prison syringe exchange programs were operating as of December 2000 (7 in Switzerland, 7 in Germany and 5 in Spain). A further three countries (Italy, Portugal and Greece) were also seriously considering the introduction of prison syringe exchange programs. Prison regulations have been modified to allow these facilities to operate under certain conditions. Most programs are in small prisons with fewer than 200 inmates. Programs operate in both male and female prisons. In some prisons, injecting equipment is provided by health professionals while in other prisons, automatic vending machines exchange sterile injecting equipment for used needles and syringes. Evaluation of pilot prison syringe exchange programs in Switzerland, Germany and Spain has been favourable in all cases. Drug use patterns reported at interview were stable or decreased over time (six prisons). Reported syringe sharing declined dramatically and was virtually non-existent at the conclusion of most pilot studies. No cases of inmates seroconverting for HIV, hepatitis B or hepatitis C have been reported in any prison with a prison syringe exchange program. No serious unintended negative consequences have been reported. There have been no reported instances of initiation of injecting. The use of needles or syringes as weapons has not been reported. One inmate (in Germany) is reported to have been injured by a discarded used needle. The number of needles and syringes distributed correlated with increased quantities of drugs detected in prisons and also when inmates receive payment. Staff attitudes were generally positive but response rates to these surveys varied. Attempts were made in all prisons to involve staff in planning. Staff from prisons where programs had been successfully established were involved in planning new programs in different prisons. In each country, negative attitudes of prisons staff to these programs reflected similar attitudes to harm reduction programs in the community. The rationale for establishing syringe exchange programs in prisons is even stronger than in communities. This rationale is accepted by an impressive number of prestigious bodies. Because of the rapid turnover of inmate populations, spread of blood borne viral infections among prisoners cannot be considered to remain for long within the confines of correctional facilities. There is increasing evidence that experience of incarceration is a strong predictor of HIV and hepatitis C infection. Overall, this review confirms that prison syringe exchange programs are feasible. Based on the data available and extrapolating from the vast literature on community-based programs, prison syringe exchange programs appear to be effective in reducing blood borne viral infections. At this stage, there is no evidence to suggest that these programs have serious unintended negative consequences.