Dr. Chris Ford is a primary care physician living in the United Kingdom (UK) working with people who use drugs. She is the founding member of the relatively new International Doctors for Healthy Drug Policies (IDHDP), a global network of physicians providing care to drug users with the aim of increasing the participation of medical doctors in drug policy reform. Science Speaks sat down with Dr. Ford to discuss the goals of the IDHDP, what drug policies are most harmful, and where the need for drug policy reform is most urgent.
Tell me about what prompted this group to come together?
I’ve been going to the International Harm Reduction conference for about 12 years, and in the last few years it became increasingly obvious what a gap there was between drug policy and policymakers and people who treat people with drug problems. Not many doctors go to this conference, but at the April 2009 conference in Bangkok, there was a Chinese drug policymaker at a session speaking about the ways it might be possible to treat more people with the same resources. It was obvious he had no real idea about the practice of drug treatment, so couldn’t alter his policy to accommodate this. After that meeting I made a call in a magazine put out by the Harm Reduction conference calling all doctors to discuss this gap and ways we might help bridge this gap. There were only about 16 doctors at this conference and 12 came to the meeting – what I like to call the dirty dozen.
At that time we decided we would talk about how to improve our own practice, with sharing of guidance and good practice and encourage our colleagues to embrace harm reduction and discuss ways we could bridge the gap between drug policymakers and practice. We needed also to step up to become more involved with drug policy reform and encourage our colleagues to do the same – because a lot of them also don’t see this link.
From the first meeting we started an email list and asked other doctors to join, and with some help we put in a bid to the Open Society Institute to see if we could get some administrative funding.
How many of you are there at present? What does the membership look like?
We’re just up to about 150 doctors, but we now have members from 43 countries around the world – there is a great little map on our website that shows all of the countries where our members work. Today we just got a new member from the Czech Republic – but we have members all over in Asia, in North and South America, in the Eastern bloc – it’s great actually – Canada, Yemen, Vietnam, Pakistan, all over. We’re working to expand our inclusion to more infectious diseases physicians, particularly HIV physicians as the link between injecting drugs and HIV is obvious but there is also a gap there.
What objectives to you have – what goals do you hope to accomplish?
We want to be a unified, medical voice of doctors involved in harm reduction who to inform good practice and treatment guidelines but most importantly support drug policy reform. For example we support members and comment on policy in Afghanistan where there is a big heroin problem but it has been impossible to get a continuous supply of opiate substitution therapy to treat people and harm reduction and drug treatment programs are limited.
We are also working at challenging practices that we feel are against good health and we want to make sure policy decisions are based on scientific evidence and are effective in reducing drug-related harm. For instance, we’re doing some work around compulsory drug detention centers, which are used in several countries to detain people who may have used or be suspected of using drugs. We try to inform policymakers that these facilities are not only bad for the health of the patient, but they actually increase their risk of acquiring HIV and hepatitis and other blood borne viruses. They are packed in these facilities, they are not offered harm reduction, so increasing the risk of spread nor are they offered medical treatment if they are infected with HIV. It’s basically a prison rather than a treatment facility.
How do you define a “healthy drug policy?”
I feel that here in the UK we have some of the best drug policies. Every time I go around the world I think, “If I were a person struggling with drug addiction or a doctor who worked in drug treatment, I would want to live in the UK.” Sadly there still is some stigma and prejudice, but it is so much better than many other countries and we have good easy access to treatment if needed.
My idea of a healthy drug policy is one where people with drug problems are treated as with any other medical condition, such as diabetes. You should be treated with respect and given access to the most effective, evidence-based treatment that has adequate resources, whilst never forgetting to complement with good prevention policies.
Are there any countries with particularly problematic policies that you are targeting to influence their drug policies? Any headway made in that regard?
There are many but there are also signs of change. Russia provides poor, not evidence based treatment, mainly consisting of detoxification. So what happens is people go round the system many time or end up in prison. But a delegation of Russian health professionals has been in the UK this week to look at our system, which makes me feel slightly encouraging. They were fascinated by the UK Family Medicine system and we had an extraordinary discussion about the causes of dependency. For me if people are open there is hope. But that doesn’t take away from the fact that about 37 percent of injecting drug users in Russia are HIV positive – whereas in this country [the UK] it is about 1.5 percent. This low infection rate is the result of good drug policy, needle exchanges and widespread OST. HIV among people who inject drugs is a preventable if you supply clean injecting equipment and provide treatment, but this doesn’t happen in many Eastern Bloc countries.
Another example is the use of drug detention centers. The ministry of health in Vietnam was here talking about how they have worked diligently to improve the health of everyone in that country. They have begun small methadone programs but they also have drug detention centers not run by the health system. They call them treatment and rehabilitation centers, but they have no due process, they have no legal rights, and they aren’t offered health care. We hope with international pressure by many organizations, including IDHDP, this will be closed and it can’t come soon enough.
Are you all doing anything to create awareness of these issues at the International AIDS Conference next year in Washington, DC?
Yes, definitely. In April at the International Harm Reduction Conference in Beirut we had 11 countries presenting how drug treatment was effected in their country’s drug policy. The 2010 International AIDS Conference in Vienna was really the first world AIDS conference to have a drugs presence. We hope that this presence will be increased next year in Washington. We hope to have a similar seminar to Beirut, but this time ask “How is your HIV rate in people who inject drugs affected by your country’s drug policy?” We need to show these linkages. Hope to see some of you there.
If you are a doctor then join us, if not pass on to your colleagues as well as participating in our open forums.