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Conference report
Remembering the past, rebuilding the future: A summary of the 17th
International Conference on the Reduction of Drug Related Harm,
Vancouver, Canada, 30 April–4 April 2006
Steffanie A. Strathdee a,∗ , Robin A. Pollini a , Cari L. Miller b ,
Darlène E. Palmer c , Monica Malta d , Tasnim Azim e
a
University of California San Diego School of Medicine, San Diego, CA, USA
b
British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
c CACTUS Montréal, Projet PLAISIIRS, Montréal, Canada
d Oswaldo Cruz Foundation, Brazilian Ministry of Health, Rio de Janeiro, Brazil
e HIV/AIDS Programme, Laboratory Sciences Division, International Centre for Diarrhoeal Disease Research (ICDDR,B), Dhaka, Bangladesh
Received 16 July 2006
The Monday opening session of the 17th International tion coverage; (4) the role of policing in social control versus
Conference on the Reduction of Drug-Related Harm in Van- social justice; and (5) new partnerships.
couver, Canada followed a vibrant spectacle of dancing, The maturation of harm reduction as a movement was evi-
music and thanksgiving to the traditional owners of what denced by the way this conference was conducted as well as
is now known as the Province of British Columbia. In a the proceedings. People who use drugs were part of every
region where persons of aboriginal descent comprise a dispro- component of the conference, from the organizing commit-
portionate number of persons who experience drug-related tee to the plenary speakers and chairpersons, Film Fest and
harms, the plenary session entitled “Indigenous Peoples: Rapporteur Team. The conference theme, “Hear + Now: The
Remembering the Past, Rebuilding the Future” provided a Peer Conference” exemplified the ways in which conference
forum through which indigenous peoples encouraged con- participants are learning to change our language, metaphors
ference participants to reflect upon the ways in which colo- and models. Gone (mostly) are the days when conference par-
nization, inter-generational abuse and what Dr. Karina Wal- ticipants used the word “junkie” or “addict,” with the growing
ters referred to as ‘micro-aggressions’ create vulnerabilities understanding that all use is not abuse. Participants also heard
leading to drug-related harms (abstract Mo.1.2; abstract ref- different metaphors that described how various people have
erences refer to the Final Program, Harm Reduction, 2006). come to understand the concept and the necessity of harm
The personal, moving accounts from this session provided reduction. Vancouver Mayor Sam Sullivan, a pioneer of leg-
both a global and intimate context for the remainder of the islation for people with disabilities in Canada, spoke about
conference, which was attended by over 1300 delegates from how disability as a metaphor helped convert him from a
over 60 countries. harm reduction naysayer to a harm reduction advocate. These
Together, the six-member conference Rapporteur Team metaphors do not always fit perfectly, but they should be
identified several themes that emerged from the conference welcomed and respected as they help people understand that
proceedings: (1) the maturation of the harm reduction move- harm reduction can save lives. UN Envoy for AIDS in Africa,
ment; (2) drug use and human rights; (3) limited harm reduc- Stephen Lewis, echoed this theme by reminding people to
strive for consistent, non-contradictory messages (Mo.21).
As conference participants reflect upon the challenges,
∗ Corresponding author. Tel.: +1 858 822 6468; fax: +1 858 534 4642. successes and failures each year at this annual meeting, there
E-mail addresses: sstrathdee@[Link] (S.A. Strathdee),
rpollini@[Link] (R.A. Pollini), cmiller@[Link] (C.L. Miller),
is also a need to ask who is still not ‘at the table.’ Many con-
tiburonne@[Link] (D.E. Palmer), ference participants cited a need to include law enforcement,
momalta@[Link] (M. Malta), tasnim@[Link] (T. Azim). economists, policymakers and youth. In doing so, participants
0955-3959/$ – see front matter
doi:10.1016/[Link].2006.07.003
Please cite this article as: Steffanie A. Strathdee et al., Remembering the past, rebuilding the future: A summary of the 17th International
Conference on the Reduction of Drug Related Harm, Vancouver, Canada, 30 April–4 April 2006, International Journal of Drug Policy
(2006), doi:10.1016/[Link].2006.07.003
DRUPOL-603; No. of Pages 3
2 S.A. Strathdee et al. / International Journal of Drug Policy xxx (2006) xxx–xxx
will need to focus on mentoring a new generation of harm federal government’s proposal to establish mandatory mini-
reduction practitioners, researchers and advocates to promote mum sentencing for drug possession which, if implemented,
harm reduction as the conference participants continue to would be detrimental to the progress made within the harm
mature in age (but not in spirit!). Although they represented reduction movement over the past two decades. Despite Van-
a small number of the conference attendees, in the closing ple- couver’s advances in promoting harm reduction, the rest of
nary session, young people made a significant contribution. the country needs to rise above what Diane Riley referred
Many in the audience were moved to tears by poignant stories to as a “decade of dithering” (Mo.16.1). On the other hand,
from Kyrgystan (Dima Usenko, Th.03.1), China (Yul Yin, during the meeting Rebeca Ramos told how the President of
Th.03.2), Brazil (Lucas Neiva-Silva, Th.03.3) and Canada Mexico, Vicente Fox, was on the verge of signing a landmark
(Caitlin Padgett, Th.03.4) that focused on the need to create bill that would permit residents to possess small amounts of
programmes and safe spaces designed by and for youth in heroin, cocaine, ecstasy or amphetamines (Tu.01.3). This bill
various cultural contexts. At the close of this session, Diane quickly died as a result of U.S pressure, a testimony to Amer-
Riley announced the start of the Youth International Harm ica’s relentless interference in international drug policy. But
Reduction Association, which will have a role in making sure not everyone backs down. Pedro Chequer told of Brazil’s
that voices of youth are heard. decision to return $39 million of PEPFAR aid instead of
A second important theme, highlighted in numerous ses- capitulating to U.S. demands to compromise its proven pro-
sions and plenary addresses, focused on human rights for grammes that reduce harms among sex workers. According
people who use drugs—an issue which has proven to be an to Chequer, “Brazil has taken this decision in order to pre-
ongoing challenge recognized in conferences gone by. Con- serve its autonomy on issues related to HIV/AIDS as well as
ference participants were reminded that drug treatment and ethical and human rights principles” (Tu.21.3).
medical care are a right for all people who use drugs. Drug Issues relating to law enforcement also took center stage
use should never be a contraindication for medical treat- and reflected the ongoing tension between police as agents
ments such as therapies for treating HIV or HCV infections of social change versus social control. Several presentations
(Kimberly Page-Shafer, Mo.22.2; Shruti Mehta, We.03.2). To from the USA, Mexico, Canada, Poland, and the United King-
deny or make illegal drug treatments that have been proven dom described how punitive policing strategies directly and
effective constitutes a violation of human rights. Methadone indirectly affect the health of people who use drugs and their
maintenance is still illegal in Russia and unavailable in many access to harm reduction services (Jonna Weck, Tu.05.1;
countries where opiate addiction and lack of treatment pose Tim McSweeney, Tu.05.2; Deborah Small, Tu.05.4; Rebeca
major public health consequences (Paisan Suwannawong, Ramos, Tu.01.3). Fostering collaborative efforts between
Mo.02.2). On the other end of the spectrum, Iran has estab- human rights organizations and people who use drugs to
lished methadone maintenance in prisons—the first Islamic document law enforcement policies and police abuses that
country to do so (Nissaramanesh, Trace, & Roberts, 2005). negatively affect drug user health and advocate for eradica-
Switzerland has integrated heroin maintenance into its pri- tion of such policies and abuses is among the highest (and
mary health care system, representing a standard we all hope most challenging) harm reduction priorities. There were only
to achieve some day (Robert Haemmig, Tu.08.2). In the words a few examples of positive experiences with law enforcement.
of Dr. Robert Haemmig: “The time has come for us to give One such example was that of a police officer from New Mex-
back autonomy to our clients. They themselves can choose ico who once was an avid opponent of harm reduction but now
methadone or heroin maintenance as part of their primary is an advocate who speaks to other officers about how NEPs
care.” can make the streets safer. In Vancouver, police have openly
As described in the conference programme book and in supported the safe injection site and even escorted people
an excellent satellite session, coverage of harm reduction to the programme who were injecting in public places. One
programmes still remains uneven and is lowest in the coun- Vancouver police officer spoke of his orientation to the street
tries with the greatest burden of HIV and other blood-borne scene by an older officer, who told him that “the only differ-
pathogens. According to the UN Reference Group on HIV ence between you and that guy over there is that he sticks a
Prevention and Care Among IDUs, only 28% of countries spike in his arm and you don’t.” We can only hope to collect
report having at least one needle exchange programme, which more of these positive experiences in an effort to convince law
is similar number to that reported nearly a decade ago, and enforcement officials that harm reduction, rather than supply
many are small in scope (Strathdee et al., 1998). Conference reduction, will create safer communities for us all.
proceedings showed that “North/South” differences persist The conference ended with highlights of some successes
between and even within countries. Canada was a case in that represent steps in the right direction. Intensive lobbying
point as a tale of two potential futures. On one hand, we wit- from IHRA and other international agencies led to the listing
nessed the establishment and efficacy of a safe injection site, of methadone as an essential drug by the World Health Orga-
as described by Dr. Jo-Anne Stoltz (Mo.09.2), and a heroin nization. In Cambodia, Vietnam and Brazil, peer-based harm
maintenance trial described by Dr. Martin Schechter during reduction initiatives have been accepted and endorsed by
Sunday evening’s opening ceremony. Meanwhile, the Cana- health officials (Serey Phal Kien, Mo.01.3; Luiz Guanabara,
dian press highlighted an ongoing debate about the Canadian Mo.13.2; Tuan We Nguyen,.070P). Safe injection sites have
Please cite this article as: Steffanie A. Strathdee et al., Remembering the past, rebuilding the future: A summary of the 17th International
Conference on the Reduction of Drug Related Harm, Vancouver, Canada, 30 April–4 April 2006, International Journal of Drug Policy
(2006), doi:10.1016/[Link].2006.07.003
DRUPOL-603; No. of Pages 3
S.A. Strathdee et al. / International Journal of Drug Policy xxx (2006) xxx–xxx 3
now been implemented in eight countries, which is a testi- transmitted through unsafe injection drug use practices. What
mony to the power of collaboration and consistent messaging. is lacking most, therefore, is not money, it is political will. In
Data from Vancouver, Norway and Australia show that safe the words of Conference Co-Chair Sue Currie, “the success of
injection sites have been associated with reductions in needle any conference can only be measured by what comes before
sharing, public injecting and increased referrals to drug treat- and what comes after.” So it is time to roll up our sleeves
ment (Allison Salmon, Mo.09.1; Jo-Anne Stoltz, Mo.09.2; and get back to work. We will next take stock at the 18th
Richard Pearshouse, Mo.09.3; Anluag Lia, M0.09.4). Not International Conference on the Reduction of Drug Related
a single overdose death has occurred at Vancouver’s safe Harm in Warsaw, Poland in May 2007 (see [Link] for
injection site. There is now sufficient data to support safe details).
injection facilities as an integral part of any harm reduc-
tion programme, which should encourage other countries to
develop their own programmes. The Canadian HIV/AIDS References
Legal Network has published an outstanding document called
“Nothing About Us Without Us” that epitomizes how harm Harm Reduction (2006) Final Program. 17th International conference on the
reduction should happen—from the ground up, with peo- reduction of drug related harm. Vancouver, Canada (April 30–May 4).
Nissaramanesh, B, Trace, M, Roberts, M. (2005). The rise of harm
ple who use drugs involved in every part of the process (see reduction in the Islamic Republic of Iran. The Beckley Foundation
[Link]). Drug Policy Programme, Surrey, UK. Accessed May 24 at [Link]
In the opening ceremony, UNAIDS official Dr. Prasada [Link]/reports/BeckleyFoundation BriefingPaper
Rao, Director of the UNAIDS regional support team for Asia [Link].
and the Pacific, pointed out that an estimated US$ 11 billion Strathdee, S. A., van Ameijden, E., Mesquita, F., Wodak, A., Rana, S., &
Vlahov, D. (1998). Can HIV epidemics among injection drug users be
is needed to stop the global HIV pandemic but only US$ 200 prevented? AIDS, 12(suppl. A), S71–S79.
million is needed to curtail the proportion of HIV infections
Please cite this article as: Steffanie A. Strathdee et al., Remembering the past, rebuilding the future: A summary of the 17th International
Conference on the Reduction of Drug Related Harm, Vancouver, Canada, 30 April–4 April 2006, International Journal of Drug Policy
(2006), doi:10.1016/[Link].2006.07.003