Harm reduction (or less commonly known as harm minimisation) refers to a range of public health policies designed to reduce the harmful consequences associated with recreational drug use and other high risk activities. Harm reduction is put forward as a useful perspective alongside the more conventional approaches of demand and supply reduction.^[1]

Many advocates argue that prohibitionist laws criminalise people for suffering from a disease and cause harm, for example by obliging drug addicts to obtain drugs of unknown purity from unreliable criminal sources at high prices, increasing the risk of overdose and death.^[2] Its critics are concerned that tolerating risky or illegal behaviour sends a message to the community that these behaviours are acceptable.^[3][4]

Drugs[link]

Heroin maintenance programmes[link]

Providing a medical prescription for pharmaceutical heroin (diamorphine) to heroin addicts has been seen in some countries as a way of solving the 'heroin problem' with potential benefits to the individual addict and to society. The treatment greatly improves the social and health situation of patients, while reducing costs incurred by delinquency, criminal trials, incarceration and health interventions.^[5][6]

In Switzerland, heroin assisted treatment is fully a part of the national health programme. There are several dozen centers throughout the country at which heroin-dependent people can receive heroin in a controlled environment. The Swiss heroin maintenance programme is generally regarded as a successful and valuable component of the country's overall approach to minimising the harms caused by drug use.^[7] In a 2008 national referendum a majority of 68% voted in favor of continuing the programme.^[8]

The Netherlands has studied medically supervised heroin maintenance.^[9] A German study of long-term heroin addicts demonstrated that diamorphine was significantly more effective than methadone in keeping patients in treatment and in improving their health and social situation.^[10] Many participants were able to find employment, some even started a family after years of homelessness and delinquency.^[11][12] Since then, treatment had continued in the cities that participated in the pilot study, until heroin maintenance was permanently included into the national health system in May 2009.^{[13][dated info]}

The British have had a system of heroin maintenance since the 1920s. Drug addiction was seen as an individual health problem in Britain; drug addiction to opiates was rare in the 1920s and mostly limited to middle class people who had easy access to opiates due to their profession, or people who had become addicted as a side effect of medical treatment. In the 1950s and 1960s a small number of doctors contributed, through legal prescribing of excessive quantities of addictive drugs, to the alarming increase of drug addicts in the U.K. This gave the method a bad reputation and the U.K. switched to a more restrictive drug law.^[14] However, in recent years the British are moving again toward heroin as a legitimate component of their National Health Service. This is because evidence is clear that methadone maintenance is not the answer for all opioid addicts and that heroin is a viable maintenance drug which has shown equal or better rates of success in terms of assisting long-term users establish stable, crime-free lives.^[15] A Norwegian government appointed committee gave an evaluation of internationally available research reports on maintenance treatment with heroin concluded, in 2011, that there are so many uncertainties and knowledge gaps about the effects of heroin treatment that they would not recommend the introduction of maintenance treatment with heroin in Norway.^[16]

The first, and only, North American heroin maintenance project is being run in Vancouver, B.C. and Montreal, Quebec. Currently, over 80 long-term heroin addicts who have not been helped by available treatment options are taking part in the North American Opiate Medication Initiative (NAOMI) trials. However, critics have alleged that the control group gets unsustainably low doses of methadone, making them prone to fail and thus rigging the results in favor of heroin maintenance.^[17]

Critics of heroin maintenance programmes object to the high costs of providing heroin to users. The British heroin study cost the British government £15,000 per participant per year, roughly equivalent to average heroin user's expense of £15,600 per year.^[18] Drug Free Australia^[19] contrast these ongoing maintenance costs with Sweden's investment in, and commitment to, a drug free society where a policy of compulsory rehabilitation of drug addicts is integral, which has yielded the lowest illicit drug use levels in the developed world,^[20] a model in which rehabilitated users present no further maintenance costs to their community, as well as reduced ongoing health care costs.^[19]

A substantial part of the money for buying heroin is obtained through criminal activities, such as robbery or drug dealing.^{[citation needed]} King's Health Partners notes that the cost of providing free heroin for a year is about one-third of the cost of placing the user in prison for a year, making it cost-effective even without perfect outcomes.^[21][22]

Needle exchange programmes[link]

A bin allowing for safe disposal of needles in a public toilet in Caernarfon, Wales.

The use of some illicit drugs can involve hypodermic needles. In some areas (notably in many parts of the US), these are available solely by prescription. Where availability is limited, users of heroin and other drugs frequently share the syringes and use them more than once. As a result infections such as HIV or hepatitis C can spread from user to users through the reuse of syringes contaminated with infected blood. The principles of harm reduction propose that syringes should be easily available or at least available through a needle and syringe programmes (NSP). Where syringes are provided in sufficient quantities, rates of HIV are much lower than in places where supply is restricted. In many countries users are supplied equipment free of charge, others require payment or an exchange of dirty needles for clean ones, hence the name.

A 2010 review found insufficient evidence that NSP prevents transmission of the hepatitis C virus, tentative evidence that it prevents transmission of HIV and sufficient evidence that it reduces self-reported injecting risk behaviour.^[23] It has been shown in the many evaluations of needle-exchange programmes that in areas where clean syringes are more available, illegal drug use is no higher than in other areas. Needle exchange programmes have reduced HIV incidence by 33% in New Haven and 70% in New York City.^[24]

Targeted and low-threshold primary health care outlet[link]

NSP and Opioid Substitution Therapy (OST) outlets in some settings offer basic primary health care. These are known as 'targeted primary health care outlet'- as these outlets primarily target people who inject drugs and/or 'low-threshold health care outlet'- as these reduce common barriers clients often face when they try to access health care from the conventional health care outlets.^[25][26] For accessing sterile injecting eqipment clients frequently visit NSP outlets, and for receiving pharmacotherapy (e.g. methadone, buprenorphine)they visit OST clinics; these frequent visits are used opportunistically to offer much needed health care.^[27][28] These targeted outlets have the potential to mitigate clients' perceived barriers to access to healthcare delivered in traditional settings. The provision of accessible, acceptable and opportunistic services which are responsive to the needs of this population is valuable, facilitating a reduced reliance on inappropriate and cost-ineffective emergency department care.^[29][30]

Safe injection sites[link]

Injection kit obtained from a needle-exchange programme.

Safe injection sites (SIS), or Drug consumption rooms (DCR), are legally sanctioned, medically supervised facilities designed to address public nuisance associated with drug use and provide a hygienic and stress-free environment for drug consumers.

The facilities provide sterile injection equipment, information about drugs and basic health care, treatment referrals, and access to medical staff. Some offer counseling, hygienic and other services of use to itinerant and impoverished individuals. Most programmes prohibit the sale or purchase of illegal drugs. Many require identification cards. Some restrict access to local residents and apply other admission criteria, such as they have to be injection drug users, but generally in Europe they don't exclude addicts who consume by other means.

The Netherlands had the first staffed injection room, although they did not operate under explicit legal support until 1996. Instead, the first center where it was legal to inject drug was in Berne, Switzerland, opened 1986. In 1994, Germany opened its first site. Although, as in the Netherlands they operated in a "gray area", supported by the local authorities and with consent from the police until the Bundestag provided a legal exemption in 2000.^[31]

In Europe, Luxembourg, Spain and Norway have opened facilities after year 2000.^[32] As did the two existing facilities outside Europe, with Sydney's Medically Supervised Injecting Center (MSIC) established in May 2001 as a trial and Vancouver's Insite, opened in September 2003.^[33][34][35] In 2010, after a nine-year trial, the Sydney site was confirmed as a permanent public health facility.^[36][37] As of late 2009 there were a total of 92 professionally supervised injection facilities in 61 cities.^[32]

The European Monitoring Centre for Drugs and Drug Addiction's latest systematic review from April 2010 did not find any evidence to support concerns that DCR might "encourage drug use, delay treatment entry or aggravate problems of local drug markets."^[32] Jürgen Rehm and Benedikt Fischer explained that while evidence show that DCR are successful, that "interpretation is limited by the weak designs applied in many evaluations, often represented by the lack of adequate control groups." Concluding that this "leaves the door open for alternative interpretations of data produced and subsequent ideological debate."^[38]

The EMCDDA review noted that research into the effects of the facilities "faces methodological challenges in taking account of the effects of broader local policy or ecological changes", still they concluded "that the facilities reach their target population and provide immediate improvements through better hygiene and safety conditions for injectors." Further that the facilitates "does not increase levels of drug use or risky patterns of consumption, nor does it result in higher rates of local drug acquisition crime." While its usage is "associated with self-reported reductions in injecting risk behaviour such as syringe sharing, and in public drug use" and "with increased uptake of detoxification and treatment services."^[32] However, "a lack of studies, as well as methodological problems such as isolating the effect from other interventions or low coverage of the risk population, evidence regarding DCRs — while encouraging — is insufficient for drawing conclusions with regard to their effectiveness in reducing HIV or hepatitis C virus (HCV) incidence." Concluding with that "there is suggestive evidence from modelling studies that they may contribute to reducing drug-related deaths at a city level where coverage is adequate, the review-level evidence of this effect is still insufficient."^[32]

Critics of this intervention, such as drug prevention advocacy organisations, Drug Free Australia and Real Women of Canada^[37][39][40] point to the most rigorous evaluations,^[41] those of Sydney and Vancouver. Two of the centers, in Sydney, Australia and Vancouver, Canada cost $2.7 million^[42] and $3 million per annum to operate respectively,^[43] yet Canadian mathematical modeling, where there was caution about validity, indicated just one life saved from fatal overdose per annum for Vancouver,^[44][45] while the Drug Free Australia analysis demonstrates the Sydney facility statistically takes more than a year to save one life.^[46] The Expert Advisory Committee of the Canadian Government studied claims by journal studies for reduced HIV transmission by Insite but “were not convinced that these assumptions were entirely valid."^[44] The Sydney facility showed no improvement in public injecting and discarded needles beyond improvements caused by a coinciding heroin drought,^[47] while the Vancouver facility had an observable impact.^[44] Drug dealing and loitering around the facilities were evident in the Sydney evaluation,^[48] but not evident for the Vancouver facility.^[44]

Cannabis[link]

Specific harms associated with cannabis include increased accident-rate while driving under intoxication, dependence, psychosis, detrimental psychosocial outcomes for adolescent users and respiratory disease.^[49] Strategies recommended by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) to deal with those include roadside drug-testing to deter intoxicated driving and education about patterns of use that increases the risk for dependence, mental health and respiratory problems.^[49]

The fact that cannabis possession carries prison sentences in most developed countries—although rarely imposed—is also pointed out as a problem by EMCDDA, as the consequences of a conviction for otherwise law abiding users arguably is more harmful than any harm from the drug itself. For example by adversely affecting professional or travel opportunities and straining personal relationships.^[49] Some people like Ethan Nadelmann of the Drug Policy Alliance^[who?] have suggested that organised marijuana legalization would encourage safe use and reveal the factual adverse effects from exposure to this herbs individual chemicals.^{[citation needed]}

The way the laws concerning cannabis are enforced is also very selective, even discriminatory. Statistics show that the socially disadvantaged, immigrants and ethnic minorities have significantly higher arrest rates.^[49] Drug decriminalisation, such as allowing the possession of small amounts of cannabis and possibly its cultivation for personal use, would alleviate these harms.^[49] Where decriminalisation has been implemented, such as in several states in Australia and United States, as well as in Portugal and the Netherlands no, or only very small adverse effects have been shown on population cannabis usage rate.^[49] The lack of evidence of increased use indicates that such a policy shift does not have adverse effects on cannabis-related harm while, at the same time, decreasing enforcement costs.^[49]

In the last few years certain strains of cannabis with higher concentrations of THC and drug tourism have challenged the former policy in the Netherlands and led to a more restrictive approach; for example, a ban on selling cannabis to tourists in coffeeshops suggested to start late 2011.^[50] Sale and possession of cannabis is still illegal in Portugal^[51] and possession of cannabis is a federal crime in the United states.

Alcohol[link]

Traditionally, homeless shelters ban alcohol. In 1997, as the result of an inquest into the deaths of two homeless alcoholics two years earlier, Toronto's Seaton House became the first homeless shelter in Canada to operate a "wet shelter" on a "managed alcohol" principle in which clients are served a glass of wine once an hour unless staff determine that they are too inebriated to continue. Previously, homeless alcoholics opted to stay on the streets often seeking alcohol from unsafe sources such as mouthwash, rubbing alcohol or industrial products which, in turn, resulted in frequent use of emergency medical facilities. The programme has been duplicated in other Canadian cities and a study of Ottawa's "wet shelter" found that emergency room visit and police encounters by clients were cut by half.^[52] The study, published in the Canadian Medical Association Journal in 2006 found that serving chronic street alcoholics controlled doses of alcohol also reduced their overall alcohol consumption. Researchers found that programme participants cut their alcohol use from an average of 46 drinks a day when they entered the programme to an average of 8 drinks and that their visits to emergency rooms drop to an average of eight a month from 13.5 while encounters with the police fall to an average of 8.8 from 18.1.^[53]

Downtown Emergency Service Center(DESC), in Seattle Washington, operates several Housing First, harm reduction model, programmes. University of Washington researchers, partnering with DESC, found that providing housing and support services for homeless alcoholics costs tax-payers less than leaving them on the street, where tax-payer money goes towards police and emergency health care. Results of the study funded by the Substance Abuse Policy Research Program (SAPRP) of the Robert Wood Johnson Foundation^[54] appeared in the Journal of the American Medical Association April, 2009.^[55] This first US controlled assessment of the effectiveness of Housing First specifically targeting chronically homeless alcoholics showed that the programme saved tax-payers more than $4 million over the first year of operation. During the first six-months, even after considering the cost of administering the housing, 95 residents in a Housing First programme in downtown Seattle, the study reported an average cost-savings of 53 percent—nearly US $2,500 per month per person in health and social services, compared to the per month costs of a wait-list control group of 39 homeless people. Further, despite the fact residents are not required to be abstinent or in treatment for alcohol use, stable housing also results in reduced drinking among homeless alcoholics.

Alcohol-related programmes[link]

A high amount of media coverage exists informing users of the dangers of driving drunk. Most alcohol users are now aware of these dangers and safe ride techniques like 'designated drivers' and free taxicab programmes are reducing the number of drunk-driving accidents. Many cities have free-ride-home programmes during holidays involving high alcohol abuse, and some bars and clubs will provide a visibly drunk patron with a free cab ride.

In New South Wales groups of licensees have formed local liquor accords and collectively developed, implemented and promoted a range of harm minimisation programmes including the aforementioned 'designated driver' and 'late night patron transport' schemes. Many of the transport schemes are free of charge to patrons, to encourage them to avoid drink-driving and at the same time reduce the impact of noisy patrons loitering around late night venues.

Moderation Management is a programme which helps drinkers to cut back on their consumption of alcohol by encouraging safe drinking behaviour.

The HAMS Harm Reduction Network is a programme which encourages any positive change with regard to the use of alcohol or other mood altering substances. HAMS encourages goals of safer drinking, reduced drinking, moderate drinking, or abstinence. The choice of the goal is up to the individual.

Harm reduction in alcohol dependency could be instituted by use of naltrexone, in a treatment developed by Professor Sinclair. The aim is to take naltrexone daily before having alcohol and reduce the endorphin reward caused (it is an opiate antagonist) leading to more moderate intake and the possibility of replacing alcohol with healthy endorphin-releasing activities on non-drinking days. Research suggests 60-80% of people completing 3 months of treatment reduce their intake to <24 units a week by the end.

Tobacco[link]

Tobacco harm reduction describes actions taken to lower the health risks associated with using tobacco, especially combustible forms, without abstaining completely from tobacco and nicotine. These measures include:

• Smoking safer cigarettes
• Switching to Swedish or American smokeless tobacco products
• Switching to non-tobacco nicotine delivery systems

It is widely acknowledged that discontinuation of all tobacco products confers the greatest lowering of risk. However, there is a considerable population of inveterate smokers who are unable or unwilling to achieve abstinence. Harm reduction may be of substantial benefit to these individuals.

Sex[link]

Safer sex programmes[link]

Many schools now provide safer sex education to teen and pre-teen students, some of whom engage in sexual activity. Given the premise that some adolescents are going to have sex, a harm-reductionist approach supports a sexual education which emphasizes the use of protective devices like condoms and dental dams to protect against unwanted pregnancy and the transmission of STIs. This runs contrary to the ideology of abstinence-only sex education, which holds that educating children about sex can encourage them to engage in it.

These programmes have been found to decrease risky sexual behaviour and prevent sexually transmitted diseases.^[56] They also reduce rates of unwanted pregnancies.^[57] Abstinence only programmes, however, do not appear to affect HIV risks in developed countries with no evidence available for other areas.^[58]

Legalized prostitution[link]

Since 1999 some countries have legalized prostitution, such as Germany (2002) and New Zealand (2003). Those who support the prohibition of the sex trade also say that legalized prostitution does nothing to improve the situation of the prostitutes and leads only to an increase in criminal activities and human trafficking. For example, Netherlands, a country which has legal and regulated prostitution, has severe problems with human trafficking (it is listed by UNODC as a top destination for victims of human trafficking^[59]), and, in response to these problems has decided in 2009, to close 320 prostitution "windows",^[60] after having closed numerous other prostitution business during the past years. The mayor of Amsterdam, Job Cohen said about legal prostitution in his city: "We've realized this is no longer about small-scale entrepreneurs, but that big crime organisations are involved here in trafficking women, drugs, killings and other criminal activities".^[61] Ever since the 90's there has been a steady increase in the number of trafficking victims, with each year seeing a higher number of victims than the previous year: in 1994 (when brothels were illegal) there were 168 recorded trafficking victims;^[62] by 2004 there were 405^[63] (brothels were legalized in 2000); by 2008 there were 826;^[64] and by 2010 there were 993.^[65]

Sex work and HIV[link]

Despite the depth of knowledge of HIV/AIDS, rapid transmission has occurred globally in sex workers.^[24] The relationship between these two variables greatly increases the risk of transmission among these populations, and also to anyone associated with them, such as their sexual partners, their children, and eventually the population at large.^[24]

Many street-level harm-reduction strategies have succeeded in reducing HIV transmission in injecting drug users and sex-workers.^[66] HIV education, HIV testing, condom use, and safer-sex negotiation greatly decreases the risk to the disease.^[66] Peer education as a harm reduction strategy has especially reduced the risk of HIV infection, such as in Chad, where this method was the most cost-effective per infection prevented.^[66]

Decriminalisation[link]

The threat of criminal repercussions drives sex-workers and injecting drug users to the margins of society, often resulting in high-risk behaviour, increasing the rate of overdose, infectious disease transmission, and violence.^{[67][not in citation given]} Decriminalisation as a harm-reduction strategy gives the ability to treat drug abuse solely as a public health issue rather than a criminal activity. This enables other harm-reduction strategies to be employed, which results in a lower incidence of HIV infection.^[66]

Self harm[link]

This unreferenced section requires citations to ensure verifiability.

Harm reduction programmes work with people who are at risk of self harm (e.g. cutting, burning, etc.) Such programmes aim at education and the provision of medical services for wounds and other negative consequences. The hope is that the harmful behaviour will be moderated and the people helped to keep safe as they learn new methods of coping.

Psychiatric medications[link]

With the growing concern about psychiatric medication adverse effects and long-term dependency, peer-run mental health groups Freedom Center and The Icarus Project published the Harm Reduction Guide to Coming Off Psychiatric Drugs. The self-help guide provides patients with information to help assess risks and benefits, and to prepare to come off, reduce, or continue medications when their physicians are unfamiliar with or unable to provide this guidance. The guide is in circulation among mental health consumer groups and has been translated into Spanish and German.^[68]

Criticism[link]

Critics, such as Drug Free America Foundation and other members of network International Task Force on Strategic Drug Policy, state that a risk posed by harm reduction is by creating the perception that certain behaviours can be partaken of safely, such as illicit drug use, that it may lead to an increase in that behaviour by people who would otherwise be deterred. There is no empirical evidence or peer-reviewed literature to support these arguments, and much to refute them.^{[citation needed]} Little anecdotal evidence supports them beyond the arguments and claims put forth by anti-harm reduction groups themselves.^{[citation needed]}

We oppose so-called 'harm reduction' strategies as endpoints that promote the false notion that there are safe or responsible ways to use drugs. That is, strategies in which the primary goal is to enable drug users to maintain addictive, destructive, and compulsive behavior by misleading users about some drug risks while ignoring others.

—"Statement on so-called 'Harm Reduction' polices" made at a conference in Brussels, Belgium by signatories of the drug prohibitionist network International Task Force on Strategic Drug Policy^[69]

However, in Switzerland the incidence of heroin abuse has declined sharply since the introduction of heroin assisted treatment. As a study published in The Lancet concluded:

The harm reduction policy of Switzerland and its emphasis on the medicalisation of the heroin problem seems to have contributed to the image of heroin as unattractive for young people."

— Nordt, Carlos, and Rudolf Stohler, "Incidence of Heroin Use in Zurich, Switzerland: A Treatment Case Register Analysis,"^[70]

Critics furthermore reject harm reduction measures for allegedly trying to establish certain forms of drug use as acceptable in society:

Harm reduction has come to represent a philosophy in which illicit substance use is seen as largely unpreventable, and increasingly, as a feasible and acceptable lifestyle as long as use is not 'problematic'. At its root of this philosophy lay an acceptance of drug use into the mainstream of society. We reject this philosophy as fatalistic and faulty at its core. The idea that we can safely use drugs is a dangerous one. ... It is in fact an unsafe choice that brings great harm to individuals, families, and communities across. And it sends the wrong message to the most valuable yet vulnerable group of Canadians – our children and youth.

—Drug Prevention Network of Canada^[71]

Even though the world is against drug abuse, some organizations and local governments actively advocate the legalization of drugs and promote policies such as 'harm reduction' that accept drug use and do not help drug users to become free from drug abuse. This undermines the international efforts to limit the supply of and demand for drugs. 'Harm reduction' is too often another word for drug legalization or other inappropriate relaxation efforts, a policy approach that violates the UN Conventions.

There can be no other goal than a drug-free world. [...]

We support the INCB statement that 'harm reduction' programmes are not substitutes for demand reduction programmes and should not be carried out at the expense of other important activities to reduce the demand for illicit drugs, such as drug prevention activities.

— Declaration of World Forum Against Drugs, Stockholm, 2008, a conference with participation from 82 countries ^[72]

Pope Benedict XVI has strongly criticised harm reduction policies with regards to HIV/AIDS, saying that "it is a tragedy that cannot be overcome by money alone, that cannot be overcome through the distribution of condoms, which even aggravates the problems".^[73] This position has been widely criticised for misrepresenting and oversimplifying the role of condoms in preventing infections.^[74][75]

See also[link]

• Brief intervention
• Demand reduction
• Recovery housing
• Supply reduction
• Illicit drug use in Australia

References[link]

External links[link]

• Harm reduction: evidence, impacts and challenges. Lisbon: EMCDDA. April 2010. ISBN 978-92-9168-419-9. http://www.emcdda.europa.eu/publications/monographs/harm-reduction. 
• Harm reduction at the Open Directory Project
• TNI on Harm Reduction
• International Harm Reduction Association
• Tobacco Harm Reduction

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Ethan Nadelmann
Ethan Nadelmann at the World Economic Forum on Latin America in 2012
Born	(1957-03-13) March 13, 1957 (age 55) New York City, New York, U.S.
Nationality	American
Alma mater	Harvard University (Ph.D.) London School of Economics (M.Sc) Harvard Law School (J.D.) Harvard University (B.A.) McGill University (transferred to Harvard)
Occupation	Executive Director, Drug Policy Alliance
Website
Ethan Nadelmann

Ethan Nadelmann (born March 13, 1957 in New York City) is the founder and executive director of the Drug Policy Alliance, a New York City-based non-profit organization working to end the War on Drugs. Described by Rolling Stone as, "the point man for drug-policy-reform efforts," Ethan Nadelmann is known as a high profile critic and commentator on U.S. and international drug control policies.

Biography[link]

Nadelmann was raised in a Jewish family in New York City; his father was a rabbi.^[1] He earned B.A., J.D., and Ph.D. degrees from Harvard University and a master’s degree in international relations from the London School of Economics. He taught politics and public affairs at Princeton University from 1987 to 1994. While he was at Princeton, he lectured and wrote extensively on drug policy, attracting considerable attention with his articles in such periodicals as Science,^[2][3] Foreign Affairs,^[4] American Heritage^[5] and National Review.^[6][7][8] He also formed the Princeton Working Group on the Future of Drug Use and Alternatives to Drug Prohibition.

Nadelmann founded the Lindesmith Center in 1994, a drug policy institute created with the philanthropic support of George Soros. Six years later the Center merged with the Drug Policy Foundation founded by Kevin Zeese and Arnold Trebach. The merger became the Drug Policy Alliance, an advocacy group for drug policies "grounded in science, compassion, health and human rights."^[9] As the Executive Director of the Drug Policy Alliance, Nadelmann takes a public health - rather than a criminal justice - approach to the War on Drugs advocating for the application of harm reduction principles.

After Barack Obama won the presidential election, Matt Elrod, the director of the drug policy reform group DrugSense, filed an internet petition for Ethan Nadelmann as the new Drug Czar. Although any hopes in getting Nadelmann appointed were downplayed, "this petition will at least encourage President-elect Obama to think twice about his choice of drug czar."^[10] Drug Policy Alliance never lobbied for Nadelmann, however once media reports alleged that James Ramstad (R-MN) would be appointed to the post the organization urged people to oppose the appointment due to his opposition to medical marijuana and needle exchange among other things.^[11] Seattle's police chief Gil Kerlikowske became the next head of the White House Office of National Drug Control Policy (ONDCP).^[12] An appointment that DPA is cautiously optimistic about.^[13]

Advocacy[link]

Nadelmann has also been a strong advocate of less restrictive cannabis laws in the United States including legalizing the use of cannabis for medical purposes, regulating recreational usage, and imposing civil rather than criminal penalties for those who are caught using or possessing small amounts of cannabis. ^[14]

Quotes[link]

This section is a candidate to be copied to Wikiquote using the Transwiki process.

• The "war on drugs" and its prohibitionist, punitive strategy have failed to solve America's drug problem. In fact, they bear much of the blame for drug-related crime, epidemic use of crack cocaine and the spread of AIDS through dirty syringes. Washington must begin developing policy that seeks first to reduce the harm drugs do users and society. Officials need only look at successful innovations in Europe and Australia like needle exchange, addiction treatment and supervised maintenance, and decriminalization. Public health rather than politics should be paramount.^[15]
• We won't win until the average parent believes drug reform protects kids better than the war on drugs.^[16]
• Who are we? We are people who love drugs...we need to find a way to live with it in peace. But we are also people who hate drugs. We have suffered from overdoses and addiction. But we know that drugs are here to stay, and prohibition and the criminal justice system is not the way to deal with it. And we are people who don't care about drugs. People who care about the Constitution, who care about 2.2 million Americans behind bars, who care about fundamental rights and freedoms.^[17]
• "The best answer is to move slowly but firmly to dismantle the edifice of enforcement. Start with the possession and sale of cannabis and amphetamines, and experiment with different strategies. /.../ Removing the ban on possession would make it easier to regulate drug quality, to treat the health effects of overuse, and to punish drug-users only if they commit crimes against people or property." ^[18]
• If they're going to have a drug czar it's more likely to be somebody with a health background than what we have in the U.S. which is somebody who's a former police chief, a military general or a professional moralist. - About Europe ^[19]

Bibliography[link]

• Nadelmann, Ethan (1993). Cops Across Borders: The Internationalization of U.S. Criminal Law Enforcement. Pennsylvania State University Press. ISBN 0-271-01095-9. 
• Nadelmann, Ethan; Andreas, Peter (2006). Policing the Globe: Criminalization and Crime Control in International Relations. Oxford University Press. ISBN 0-19-508948-0. 

References[link]

External links[link]

Wikiquote has a collection of quotations related to: Ethan Nadelmann

• Brief bio of Nadelman at Drug Policy Alliance website
• Article on his 2001 talk to the San Francisco Medical Society
• Ethan Nadelmann, Ph.D A Guide to the Drug-Legalization Movement

This article is about the mental health advocate, writer, and counselor. For other uses, see Will Hall (disambiguation)

This article is an autobiography, or has been extensively edited by the subject or an institution related to the subject. Please help edit it to conform to Wikipedia's neutral point of view, in line with the discussion on the talk page. (April 2009)

Will Hall (born 1966), is a mental health advocate, writer, and counselor. Diagnosed with schizophrenia, he is recognized internationally as a leading organizer with the psychiatric survivors movement. In 2001 he co-founded the Freedom Center and in 2005 became a co-coordinator of The Icarus Project. He has consulted with Mental Disability Rights International, the Family Outreach and Response Program, and the Federal Office on Violence Against Women. Hall hosts the FM radio program Madness Radio, syndicated on the Pacifica Network, and in 2009 co-founded Portland Hearing Voices. He lives in Portland Oregon, where he studies Process Oriented Psychology and has a counseling practice.

Career[link]

After graduating from the Community Studies program at the University of California Santa Cruz in 1986, Hall worked for the Santa Cruz Sun newspaper as a staff reporter and for the Resource Center for Nonviolence's Brazil program. In 1988 he became a Co-Director of the Earth Island Institute's Environmental Project on Central America, and traveled to El Salvador and Nicaragua during the civil wars in those countries.

In 1990 Hall began to suffer a deterioration of his mental and emotional health, and was involuntarily committed to San Francisco General Hospital in 1992. He spent a year in the public mental health system, including restraints, solitary confinement, and more than 2 months in locked wards at Langley Porter Psychiatric Institute. He was diagnosed with schizoaffective disorder schizophrenia.

After leaving the traditional mental health system in 1993 Hall stopped taking psychiatric medications and began to reestablish his wellbeing using holistic health, spiritual training, and social supports. In 1996 he worked in the planning department of the advertising agency Wieden+Kennedy, and in 1997 became at student at the California Institute of Integral Studies. After another crisis in 1999, he left school and spent six months at the alternative residential facility Burch House in New Hampshire. In 2000 Hall moved to Northampton, Massachusetts, where he worked for five years at Broadside Bookshop.

In 2001 he began speaking publicly about his mental health experiences, and with Oryx Cohen co-founded and did peer counseling at the Freedom Center, a support, advocacy, and activism community run by people with psychiatric diagnoses. In 2004 he joined the co-coordinator collective of The Icarus Project and is author of the Harm Reduction Guide to Coming Off Psychiatric Drugs. He is Director of Portland Hearing Voices in Portland Oregon, and has worked as a consultant for Mental Disability Rights International and done talks and trainings in 7 countries. Will is also a therapist in private practice based on Process Oriented Psychology.

In 2000 Hall wrote about the pirate radio movement for GovWorks.com, and in 2002 joined activist Ed Russell to initiate a volunteer run, low-power Pacifica affiliate FM community radio station in Florence, Massachusetts, Valley Free Radio. He is host of Madness Radio an interview format radio show begun on VFR and now syndicated on the Pacifica Network, including KBOO in Oregon.

See also[link]

• Hearing Voices Movement
• Psychiatric survivors movement

References[link]

• "Listening to Madness", May 18 2009 Newsweek magazine
• "Mad Medicine," June 25, 2009 Portland Mercury newspaper
• "Freedom To Sit: Welcoming People With Psychiatric Disabilities At Meditation Retreats," June, 2007 Turning Wheel Buddhist Magazine
• "Mad Men and Women Embrace Their Mental Health Issues" November 2009, KATU TV Portland Oregon
• "(Low) Power To The People: How Pirate Radio Became Legal and Why Northampton Might Benefit," May 2001, Valley Advocate

External links[link]

• Freedom Center
• Madness Radio
• The Icarus Project
• Valley Free Radio
• Portland Hearing Voices
• Will Hall's website

Stephen Lewis
Stephen Lewis at a public speaking engagement on April 25, 2001
Leader of Ontario NDP
In office 1970–1978
Preceded by	Donald C. MacDonald
Succeeded by	Michael Cassidy
Constituency	Ontario
Member of Provincial Parliament
In office 1963–1978
Preceded by	New district
Succeeded by	Richard Johnston
Constituency	Scarborough West
Canadian Ambassador to the United Nations
In office 1984–1988
Preceded by	Gérard Pelletier
Succeeded by	Yves Fortier
Constituency	United Nations
Personal details
Born	Stephen Henry Lewis (1937-11-11) November 11, 1937 (age 74) Ottawa, Ontario
Political party	New Democratic Party
Spouse(s)	Michele Landsberg
Children	Avram David(Avi), Ilana Naomi, Jennie Leah
Residence	Toronto, Ontario
Occupation	Politician
Religion	Judaism

Stephen Henry Lewis, CC (born November 11, 1937) is a Canadian politician, broadcaster and diplomat. He was the leader of the social democratic Ontario New Democratic Party for most of the 1970s. During many of the those years as leader, his father David Lewis was simultaneously the leader of the Federal New Democratic Party. After politics, he became a broadcaster on both CBC Radio and Toronto's CityTV. In the mid-1980s, he was appointed as Canada's United Nations ambassador, by Progressive Conservative Prime Minister, Brian Mulroney. He quit in 1988 and worked at various United Nations agencies during the 1990s. In the 2000s, he served a term as the United Nations' special envoy for HIV/AIDS in Africa. He is currently Distinguished Visiting Professor at Ryerson University in Toronto.^[1] In 2003, he gained investiture into the Order of Canada.

Early life and education[link]

Stephen Lewis was born in Ottawa, Ontario, on November 11, 1937, to Sophie Lewis (née Carson) and David Lewis.^[2] His parents gave him the Hebrew name "Sholem", a Yiddish derivation of the Hebrew word shalom, which means peace, because he was born on Armistice Day.^[3] From the time he was born, and through his early childhood, his father was the National Secretary of the Co-operative Commonwealth Federation (CCF), the predecessor party to the NDP.^[4] When his family moved to Toronto in 1950, he attended secondary school first at Toronto's Oakwood Collegiate, and then his final three years of high school at Harbord Collegiate Institute.^[5] In 1956, he entered the University of Toronto (UofT) where he became a member of the Hart House debating committee, and on 14 November 1957, debated Senator and future American President, John F. Kennedy on the question, "Has the United States failed in its responsibilities as a world leader?"^[6][7] The Senator narrowly beat the Hart House team 204-194.^[8] Lewis's performance was considered the highlight of the event, while Kennedy's was flat according to many members in the audience like John Brewin.^[6] He spent his third year of university at the University of British Columbia (UBC) before spending his final undergraduate year back at UofT where he failed to write his final examinations.^[9] He went to law school twice in the early 1960s, dropping out of both UofT and UBC's programs.^[9]

Political career[link]

He left his studies in the 1960s and took up a clerical position with the Socialist International, where he received an invitation to a conference in Ghana. He attended, and instead of returning to Canada, spent more than a year working, traveling, and teaching in various places in Africa. He recalled in his 2005 Massey Lectures that the relatively brief sojourn would be a key influence on his life, especially after the turn of the new millennium.

He came back to Canada at the instigation of Tommy Douglas, and in 1963, at the age of 26, he was elected to the Legislative Assembly of Ontario. Following the engineered 1970 resignation of Donald C. MacDonald,^[10] Lewis was elected leader of the Ontario New Democratic Party. His initial experience at the helm in the 1971 provincial election was a disappointment, with the party slipping from 20 seats to 19.

A radical left wing group nicknamed The Waffle had gained prominence, with one of its leaders, James Laxer winning one-third of the vote when he ran to be leader of the federal NDP in 1971. Lewis felt that The Waffle was threatening the credibility and stability of the party and supported a movement against the group in June 1972 on the basis that it was a party within a party.^[11]

Lewis led a strong campaign during the 1975 election with his oratory and passion bringing new supporters to the party. The NDP highlighted issues such as rent control and workplace safety. Each day, Lewis told the story of a different Ontarian in trouble, making a case that this was because of the lack of adequate legislation. Polls showed the NDP surging and the incumbent Ontario Progressive Conservative Party in freefall and in the course of the campaign Premier William Davis was forced to commit his party to bringing in rent control and other progressive reforms in order to retain power. When the ballots were counted the Tories were reduced to a minority government. Lewis' NDP had doubled its seats from 19 to 38, surpassing the Ontario Liberal Party to become the Official Opposition. To some it appeared that it was only a matter of time before the NDP would form the government.

The next election, in 1977, proved to be a disappointment. The growth of support for the NDP stalled, and while the Tories were kept to a minority, the NDP failed to make any gains. The party was reduced to 33 seats and lost its status as Official Opposition to the Liberals. In 1978, a frustrated Lewis stepped down as party leader and as a Member of Provincial Parliament.

Diplomatic and academic career[link]

Stephen Lewis, speaking at the University of Alberta, January 30, 2006

After working for several years as a labour mediator, columnist and broadcaster, in 1984 Lewis was appointed Canadian Ambassador to the United Nations by Governor General Jeanne Sauvé, on the advice of Prime Minister Brian Mulroney. Lewis served at the post until 1988. In the 1980s, he became a familiar voice appearing with Dalton Camp and Eric Kierans as part of a weekly political panel on Peter Gzowski's CBC Radio show, Morningside.

From 1995 to 1999, Lewis was Deputy Director of UNICEF. From 2001 until 2006, he worked as United Nations Special Envoy for HIV/AIDS in Africa. In his role as Special Envoy, he worked to draw attention to the HIV/AIDS crisis and to convince leaders and the public that they have a responsibility to respond. He has been widely praised for his effectiveness in this role. In 2005 he adapted his Massey Lectures in a book titled "Race Against Time", where he describes the disjuncture between what the international community promises and their actions in responding to the pandemic in Africa.

In May 2006, Lewis joined the Faculty of Social Sciences at McMaster University as a Scholar-in-Residence.^[12] Also in 2006, he was elected a Senior Fellow of Massey College in the University of Toronto. In 2009, Lewis strongly criticized Pope Benedict XVI's assertion that condom use only makes the AIDS crisis worse.^[13]

Foundation[link]

Lewis heads the Stephen Lewis Foundation, a charitable organization that helps people affected and infected by HIV/AIDS in Africa. As a preventative HIV/AIDS strategy, Lewis has made a somewhat controversial call for male circumcision when African boys receive the first of two UN administered Measles vaccination shots, so that their recovery progress can be monitored at the time of the second vaccination.^[14] Many studies have been conducted into the role circumcision can play in reducing the spread of HIV.

In October 2009, to raise money for the foundation, Lewis helped with a campaign to dare Canadians to do something for Africa called A Dare to Remember.^[15] The campaign, paired Lewis with musician k-os, Federal NDP leader Jack Layton, Olympic gold medalist Duff Gibson and many other Canadians performing various dares for the event.^[15] He faced his own personal fears as part of the campaign, and sang live on CBC's The Hour with the band the Arkells.

Personal[link]

Stephen Lewis is the son of former federal NDP leader David Lewis. He is married to journalist Michele Landsberg. Their son is broadcaster Avi Lewis, who married journalist and author Naomi Klein. Their daughters are Ilana Naomi Landsberg-Lewis and Jenny Leah Lewis; Ilana is the partner of musician and activist Lorraine Segato,^[16] and serves as executive director of the Stephen Lewis Foundation.

Lewis has at least three siblings. Two of them were active and high-ranking officials within the Ontario NDP during the 1980s and 1990s: Michael Lewis was the secretary, and Janet Solberg was the president. Another sister is Nina Lewis-Libeskind, the wife and partner of world-renowned architect Daniel Libeskind.^[17] Their grandfather Moishe Lewis was an activist in the Jewish Bund in Russia and the Jewish Labour Committee in Montreal.

Honours[link]

For his humanitarian work in Africa and the United Nations, the Governor General of Canada appointed Lewis a Companion of the Order of Canada on October 10, 2002.^[18] His investiture into the order was held on October 23, 2003.^[18] He delivered the annual Massey Lecture in 2005, and it was published in book-form under the title Race Against Time: Searching for Hope in AIDS-Ravaged Africa. The book consists of five lectures that depict the HIV/AIDS pandemic in Africa, critically examining the international community's passivity as a contributing factor.

In 2006, two new secondary schools in the Toronto area were named after Lewis: one in Mississauga, Ontario, Stephen Lewis Secondary School and one in York Region. The Mississauga school has a special focus on educating students on issues relating to social justice and global citizenship to enhance the Ontario Curriculum.

In 2007, Lewis received the World Citizenship Award, from the World Association of Girl Guides and Girl Scouts, as well as the Health and Human Rights Leadership Award from Doctors of the World-USA. Lewis was also invested as a Knight Commander of the Most Dignified Order of Moshoeshoe by King Letsie III of Lesotho.^[19][20]

In 2010, Forbes magazine, in conjunction with their 2010 list of World's Most Powerful People asked the feminist playwright Eve Ensler to identify Worlds' Most Powerful Feminists. She named Stephen Lewis as one of her top seven.^[21]

References and notes[link]