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Global drug policy fuels hepatitis C epidemic, report warns
  The Hidden Global Hepatitis C Epidemic - New Report - Access Needed - (05/30/13)
War on drugs 'driving hepatitis C pandemic' - (05/30/13)
The Lancet, 1 June 2013
Fiona Clark
The latest report by the Global Commission on Drug Policy says that the war on drugs has caused a largely hidden hepatitis C epidemic in people who inject drugs. Fiona Clark reports.
Hepatitis C hasn't been at the top of the health agenda for a while, eclipsed by HIV/AIDS and tuberculosis as more pressing threats to global health, but the Global Commission for Drug Policy is set to change that.
It claims the war on drugs has failed and is fuelling a hepatitis C epidemic among people who use intravenous drugs. "Hepatitis C has to be one of the most grossly miscalculated diseases by governments on the planet", says Commissioner Michel Kazatchkine, who is also the UN Secretary General's Special Envoy on HIV/AIDS in Eastern Europe and Central Asia.
He says "barely a handful" of countries have shown substantial declines in new infection rates among people who inject drugs, and lays the blame directly on so-called zero tolerance laws that see drugs users who do no harm to others incarcerated in prisons where infection risks are high.
The Commission's new report-The Negative Impact of the War on Drugs on Public Health: The Hidden Hepatitis C Epidemic-released this week calls for personal drug use to be decriminalised to stop the spread of the disease, which kills one in four of those infected.
That's "a considerable number" of preventable deaths, says Kazatchkine. WHO says 150 million people have the hepatitis C virus (HCV). The Commission, which includes the former General Secretary of the UN, Kofi Annan, and the former Human Rights Commissioner, Louise Arbour, says 10 million people of the 16 million who inject drugs have hepatitis C.
The report, released ahead of the Harm Reduction International Conference 2013 in Lithuania (June 9-12), states the countries with the worst HCV infection rates are those with the strictest drug policies. Kazatchkine estimates that there are 1·6 million infected drug users in China, 1·7 million in Russia, and 1·5 million in the USA.
This is the third time the Commission has called for decriminalisation of drug use, but is anyone listening? Elena Vovc, WHO's Russia coordinator for HIV, STDs and Viral Hepatitis Programmes says she doubts Russia will enact such a change soon. "If we're very positive, in 5 years maybe", she says.
In the USA, Chris Beyrer, director of Johns Hopkins Center for Public Health and Human Rights, MA, says he's seeing some positive signs for change in the USA-the home of zero tolerance-and abroad. First, Colorado's vote for the decriminalisation of marijuana use shows that the public "wants to stop putting teenagers in jail for possession", he says. Then Latin and South America want an end to the drug cartel violence engulfing the region. And third, Portugal, which decriminalised personal drug use over a decade ago, is showing some evidence of reductions in HCV infection rates and overall drug use. "It hasn't been the social disaster people thought it might be", says Beyrer.
But for many countries decriminalisation is a long way off as they're still grappling with the concept of harm minimisation. "Harm reduction with its package of measures for an effective complex approach is not fully accepted in eastern Europe", says Vovc. "Some countries have accepted it, some have partially accepted it, and some are still trying to understand its benefits."
Russia, however, "doesn't have national harm reduction programme and it's not convinced about syringe and needle exchanges despite evidence of its effectiveness worldwide. China, on the other hand, has opted for a methadone programme, but needle exchange is not officially sanctioned. Russia has opted for neither", she says.
Kazatchkine goes further: "I see very little if no progress in Asia where they want a drug-free world by 2015, and parts of Eastern Europe where over 60% of people who inject drugs have HCV. There is no debate open and no willingness to open the debate."
But he adds that it is cost effective to adopt harm prevention and decriminalise personal drug use as treating the virus costs less (US$16 000-31 700) than treating one of its possible outcomes: liver cancer ($44 200). Then, says Beyrer, there's the cost of incarceration which is putting a strain on state budgets and leading people to rethink the sentencing system. "Many US states, including California, have been doing early release programmes for non-violent drug offences since it is so costly to incarcerate people."
Kazatchkine says it's time countries that can't afford broad access to treatment tackled the problem by invoking public health emergency measures to break patent agreements and make or import generic versions of effective drugs against hepatitis C. "I see no evidence that it's not a public health emergency", he says. "So the report should be taken as a wake-up call, not just on decriminalisation, but also on the awareness of hepatitis C and its treatment."

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