Sector News

  1. National Day of Action on the Overdose Crisis

    On February 21, 2017, a first national Day of Action will be held across Canada to demand different levels of government take meaningful and concrete action to address the opioid overdose epidemic devastating communities across the country. The demands include an end to the war on drugs, the removal of barriers to health care including immediate improved access to naloxone and opiate substitution therapy, and the implementation of policies that are informed by real life experiences of people who use drugs. Actions are taking place in Vancouver, Victoria, Edmonton, Ottawa, Toronto, Montreal, Halifax and other communities across Canada.

    Local organizations are seeking endorsements for their lists of demands. To sign on to the demands, or to find out more information about the actions taking place closer to you, visit https://www.facebook.com/events/371308773235925/?active_tab=about or contact admin@capud.ca.

  2. Injecting Risk Behaviours after Hepatitis C Virus Treatment in Australia

    Background

    Hepatitis C virus (HCV) infection prevalence is high among people who inject drugs (PWID) and is a major cause of morbidity and mortality among this population. Due to concerns that HCV treatment may increase injecting risk behaviours among people who inject drugs (PWID) the authors compared recent (past month) injecting risk behaviours between PWID who received and did not receive HCV treatment.

    Findings

    • Of the 124 Australian participants with a history of injection drug use, 69% were male with 68% treated for HCV infection.
    • HCV treatment was not associated with an increase in recent injection drug use (adjusted odds ratio (aOR) 1.06, 95% CI 0.93, 1.21). This is consistent with previous study findings.
    • HCV treatment was not associated with recent used needle and syringe borrowing (aOR 0.99, 95% CI 0.89, 1.08).
    • Treatment was associated with a decrease in recent ancillary injecting equipment sharing (aOR 0.85, 95% CI 0.74, 0.99). This is important given that sharing of equipment contributes to HCV transmission.
    • Although a small sample, the 24 participants who remained in follow-up (24 weeks) showed a significant decrease in injecting equipment sharing during follow-up. This is at least interesting to note because the side effects of interferon-based therapy mimic opioid withdrawal, which is a concern for some physicians (they worry that treatment might lead to relapse or an increase in drug use).

    Conclusion

    Hepatitis C virus assessment and treatment for people who inject drugs should be enhanced due to its effectiveness as it does not lead to increases in injection risk behaviours and has already been shown to be safe and effective for PWID populations.

    Alavi, M.,  Spelman, T.,  & Matthews, G.V. (2015). Injecting risk behaviours following treatment for hepatitis C virus infection among people who inject drugs: The Australian Trial in Acute Hepatitis C. International Journal of Drug Policy. Vol. 26. Issue 10, pp. 976-983.

  3. Cost-effectiveness of Harm Reduction Strategies

    Background

    Health care providers and governments across the globe are faced with an urgent task to improve health outcomes for PWID, specifically reducing increasing rates of HIV and HCV transmission.

    Approach

    The authors assess needle exchange programs (NSPs), opioid substitution therapy (ORT), and antiretroviral therapy (ART) in isolation and then in combination.

    Findings

    Effectiveness and Cost-effectiveness of needle syringe programs (NSPs)

    • NSPs are generally the least expensive at $23 -$71 (US) per person each year. This variation is cost depends on region of the world and the delivery system (e.g. pharmacies, mobile outreach).

    Effectiveness and Cost effectiveness of opioid substitution therapy (OST)

    • OST is a structural intervention with other societal benefits. Although it is more expensive than NSP, the largest benefits relate to a reduction in the number and severity of relapses due to opiate use, as well as, lower rates of criminal activity and incarceration for drug related crimes. OSTs are particularly more cost effective when these factors are included in economic analyses.

    Effectiveness and Cost effectiveness of antiretroviral therapy ART

    • Several studies have shown that ART is cost-effective for both keeping people alive and for the prevention benefits it offers.
    • A Russian study found that ART would cost approximately $1501 (US) per QALY gained when targeted to PWID. This is considered good value for money.
    • ART costs are expected to decline by 2020

    Effectiveness and Cost effectiveness of combination strategies

    • Comprehensive strategies appear to be a better approach because generally no single harm reduction strategy is sufficient.
    • Research shows that needle syringe programs (NSPs), opioid substitution programs, and antiretroviral therapy (ART) together have shown to be effective to reduce drug dependency, reduce injection equipment sharing, improve quality of life, and avoid HIV infections.
    • Overall, the unit cost of harm reduction interventions is low, but it can vary based on type of provider, delivery model, and region.

    Conclusion

    Harm reduction interventions are good value for the money invested and improve health outcomes for PWID, as well as, the broader population. Currently, coverage of harm reduction programs is too low across almost all global regions. Although scaling up is costly, it is worthwhile not only for the societal benefits, but also for the significant returns on investment for governments.

    Wilson, D.P., Donald, B., Shattock, A.J., Wilson, D., and Fraser-Hunt, N. (2015). The cost-effectiveness of harm reduction. International Journal of Drug Policy. Vol. 26, pp. S5-S11.