Regional Seminar “Reducing Harms of DrugUse in Middle East and Central Asia” conducted in Tehran, Iran (27-29 October).

The seminar was organized by the Drug Control Headquarters of Islamic Republic of Iran and UNODC-Iran. The aim of the seminar was to advance regional capacities in reducing harms of drug use through sharing information on best practices, identifying gaps in different components of programmes of interventions, and identifying measures to address the shortcomings. Participants of the seminar represented ministries of health, drug control agencies, ministries of justice and interior, and academia of countries covered by UNODC Offices for Middle East and Central Asia, total more than 60 people. Besides high level Iranian officials and research fellows who presented results of the implementation of a comprehensive drug policy in their country, Mr. Ch.J.S. Volkman, Chair , UNTG on HIV/AIDS in Iran, Roberto Arbitrio, Head, UNODC-Iran, Dr. Gilberto Gerra, Head of Health and Human Development Section, UNODC HQ, and four prominent international consultants (Prof A. Uchtenhagen, Switzerland, Dr. A. Wodak, Australia, Dr. G. Fischer, Austria, Dr. J-P. Grund, the Netherlands, Dr. Beatrice Stambul, France) contributed to the seminar by making presentations and/or chairing plenary sessions. The plenary sessions and consecutive group work covered the abstinence oriented treatment of drug dependence, opioid substitution treatment, needles and syringe distribution programmes, and harm reduction programmes in prison settings. At plenary sessions, almost all present countries made presentations of various aspects of drug dependence treatment and other interventions for mitigating medical-social consequences of drug use employed in their countries. It should be noted that only Iran out of all present countries could present substantive and consistent data on drug /HIV policy and demonstrate an impressive scale of coverage by OST and other interventions, as per WHO/UNODC/UNAIDS HIV prevention essential package. A visit to the Iranian National Centre on Addiction Studies was utmost useful and memorable as it clearly showed the role of science in shaping drug policy in Iran. Practical implementation of the policy was demonstrated at the Drop-in Centre opened in one of the “drug using district” of Tehran.

Azerbaijan Delegation has been represented by Rafik Ramazanov, Chief of Registration Department, MoJ and Telman Mammadhasanov, Chief of Department, MoJ.

In the end of Regional Seminar Recommendations have been adopted by participants, representing Middle East, West and Central Asia (see bellow)

“The Regional Seminar on Reducing Harms of Drug use in Middle East, West and Central Asia” took place 27-29 October 2008 in Shaghayegh Cultural Complex in Tehran. The seminar was hosted by the Iranian Drug Control Headquarters jointly with the United Nations Office on Drugs and Crime (UNODC) Country Office I.R. of Iran. The consultations arrived at following recommendations:

HIV is still spreading among and from Injecting Drug Users in this region and represents a very serious threat to the health of drug users and the general community. The harm reduction package has been found to be an effective, safe and cost effective way of controlling HIV infection in drug injector populations in the community and in prisons. But time is running out. Implementation to scale of Harm Reduction interventions is needed urgently.

Harm Reduction refers to policies and programmes aiming primarily to reduce the adverse health, social and economic costs of psychoactive drugs without necessarily reducing drug consumption. Harm Reduction is an integral element of drug policy. Advocacy among key persons such as policy makers and religious leaders plays a major role in integrating Harm Reduction policies in the current national drug policies of the region. Also communication initiatives with mass media may prove useful.

Countries in the region can establish a network/forum to exchange positive and negative experiences and good practices, implement and discuss common projects through technical and financial support of organisations. National, regional and international seminars, round tables, tele-video conferences, round emails, websites, newsletters and study tours are among the effective means of achieving progress. It was agreed that Islamic Republic of Iran serves as the secretariat of this network.

The necessity of capacity building especially training is considered to be high even so in universities and academic centres. Nonetheless the region already has a number of available resources to be utilised for training in terms of ongoing projects as well as institutions in operation:

• The Regional Harm Reduction Centre of ECO member countries in Tehran/Iran
• The Treatnet resource centres including the Iranian National Centre for Addiction Studies (INCAS)
• The National Research and Clinical Centre on Medical and Social Problem on Drug Abuse Kazakhstan
• The Regional Research Centre of Narcology & Psychopharmacology affiliated to St. Petersburg Pavlov State Medical University
• The Central Asian component of the UNODC Global project on effective responses to drug dependence treatment and for prevention of health consequences of drug abuse (J71)
• WHO Knowledge Hubs especially the Iranian National Centre for Addiction Studies (INCAS) and the Soins Infirmiers et Developpement Communautaire (SIDC) Association in Lebanon
• UNODC projects like Bridging the Gap, implemented by the Regional Office for Middle East and North Africa-XNAJ58, Advocacy and Regional Cooperation of Country Office Iran-I57,

and other UNODC Regional and National projects with components of capacity building (trainings), exchange of expertise, etc.

Countries in the region need to create a regional database containing information on national and international research/studies specifically on epidemiology, legislation, norms/standards, regulatory and mechanisms related to harm reduction implementation, monitoring and evaluation in general and in prisons. UNODC can be considered as the custodian.

Different drug treatment and comprehensive harm reduction approaches are currently running in the countries of the region, especially programmes of the Islamic Republic of Iran were considered at an advanced level in this regard. Further scaling up of all these varieties including psychosocial treatments, counselling and rehabilitation programmes are deemed necessary and urgent.

In addition to maximisation of the quality and quantity of treatment and comprehensive harm reduction services, accessibility needs to be increased. Stigma and discrimination are among serious barriers hindering proper scaling-up.

NGOs and peer groups are playing a significant role in comprehensive harm reduction activities and positive prevention in countries of the region. They should be further empowered and strengthened in carrying out their roles both inside community and in prisons.

There is a growing awareness of the critical contribution that injecting drug users in prisons make to the spread of HIV. The same HIV intervention strategies required in the community are also needed in prisons. Wherever possible the size of prison populations needs to be reduced to help control HIV spread.

Opioid Substitution Treatment and Needle and Syringe Programmes are still not available in many countries neither in community and nor in prison settings; proper training, utilising expertise from inside the region as well as other countries seems very useful. In some countries introduction of Opioid Substitution Treatment may require amendments in legislations and regulations. More cooperation and collaboration between countries in the region is needed to improve responses.

In establishing Opioid Substitution Treatment special consideration should be given to reducing the costs for drug users and ensuring that adequate government resources are provided.

Governments should play a more active role regarding with integration of treatment and comprehensive harm reduction services including Opioid Substitution Treatment and Needle and Syringe Programmes in Primary Health Care systems.