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Closed to reason: time for accountability for the International Narcotic Control Board Small, Dan; Drucker, Ernest May 8, 2007

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ralssBioMed CentHarm Reduction JournalOpen AcceCommentaryClosed to reason: time for accountability for the International Narcotic Control BoardDan Small*1,2,3 and Ernest Drucker4Address: 1PHS Community Services Society, Vancouver, Canada, 2Department of Anthropology and Sociology, University of British Columbia, Vancouver, Canada, 3Department of Medicine, University of British Columbia, Vancouver, Canada and 4Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USAEmail: Dan Small* - dansmall@interchange.ubc.ca; Ernest Drucker - emdrucker@earthlink.net* Corresponding author    AbstractFor more than two decades, the International Narcotic Control Board (INCB) has tried to stop harm reduction and itsHIV prevention programs. This posture is based on a fundamental misunderstanding of their responsibilities and of drugaddiction itself – i.e. as a public health and clinical care matter made criminal by decree. A recent focal point for theBoard's action has been rejecting the use of supervised injection facilities to reduce morbidity and mortality of druginjectors. They single out individual countries and attempt to bully them into rejecting such programs under the bannerof the United Nations (falsely) and in the name of international treaties. Their unrelenting and unjustified badgering ofsignatories to the international treaties that established the INCB is not only unjustified; it is an affront to one of the corepurposes of the Board itself: to ensure adequate medical supplies and safe use of controlled substances. The INCB's ill-conceived obsession with intravenousaddiction as a crime flies in the face of the medical view and policies of the WorldHealth Organization and the universally endorsed principles of the General Assembly of the United Nations.The latest target of the INCB is North America's only supervised injection facility, Insite, located in the inner city ofVancouver, Canada. Using the power of their office to meddle in matters of public health for individual nations is withoutmedical, scientific or legal justification. But, most importantly, it is a matter of lifeand death for these most marginalizedof citizens. The empirical evidence remains that a significant portion of the continued growth of the AIDS pandemic isdue to injecting drug use, and the INCB's intrusion will inevitably result in additional deaths due to preventable HIVinfections and drug overdoses.So we are very pleased to call to our readers' attention to a recent report produced by the Canadian HIV/AIDS LegalNetwork and the International Harm Reduction Development Program (IHRD) joined by former United Nations SpecialEnvoy for HIV/AIDS in Africa, the respected Canadian statesman Stephen Lewis. The full report, "Closed to Reason: TheInternational Narcotics Control Board and HIV/AIDS" is attached along [see Additional file 1] with a Russian translation ofthe key findings of the authors [see Additional files 2] as well as Russian and Chinese translations of this abstract [seeAdditional 3 and 4]. As the report makes very clear, the time to inject some accountability and reason into the INCB isnow.Howmany times must a man look upBefore he can see the skyYes and how many earsPublished: 8 May 2007Harm Reduction Journal 2007, 4:13 doi:10.1186/1477-7517-4-13Received: 10 April 2007Accepted: 8 May 2007This article is available from: http://www.harmreductionjournal.com/content/4/1/13© 2007 Small and Drucker; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Page 1 of 8(page number not for citation purposes)Must one man haveHarm Reduction Journal 2007, 4:13 http://www.harmreductionjournal.com/content/4/1/13Before he can hear people cry?Yes, and how many deathsWill it take till he knowsThat too many people have died?Bob DylanBackground: facing the epidemicIt has been over 25 years since physician Michael Gottliebidentified the first clinical cases of AIDS in the San Fran-cisco [1]. But AIDS continues to ravage the world. Morethan 25 million people nearly the population of Canadahave died of AIDS, 15 million children have beenorphaned by AIDS and 65 million people having beeninfected with the preventable HIV virus[2] AIDS is nowthe leading cause of death in the world for people aged 15to 49 years of age[3] A central feature of the last two dec-ades of the AIDS pandemic has been iintravenous druguse – which continues to be responsible for a massivewave of new HIV infections worldwide[4] Harm Reduc-tion programs, that provide sterile syringes, SupervisedInjection Facilities, and innovative overdose preventionprograms that help bring users to drug treatment and HIVscreening and treatment have now laid the foundation forreducing the spread of AIDS in this population.While the INCB has, after 20 years of opposition andobstruction of harm reduction measures, now (grudg-ingly) recognized that needle exchange and substitutiontreatment are not in conflict with the international con-ventions under which the INCB established. But the INCBcontinues, in effect, to demonize needle distribution (andharm reduction measures in general) by portraying suchmeasures as being at perpetual risk of contradicting thesacred goal of demand reduction. Therefore, needle distri-bution programs; if they are to exist at all, must be purgedof any sign of "encouraging" drug use. It is telling that theINCB concludes its description of needle distribution withthe following proclamation:"The Board welcomes the United States Government'sunequivocal policy position against any form of legal-ization of the non-medical use of drugs". [5] (p. 10).By linking what they call "needle distribution schemes" todrug "legalization", the INCB constructs an ideologicalbarrier to HR programs. Rather than act as an aid in theestablishment of widespread needle distribution pro-grams, the INCB continues to undermine them. And if theINCB notes that " governments may, lawfully, implementtradiction typical of its pronouncements, that any "pro-phylactic measures should not promote and/or facilitatedrug abuse" [6] (p. 1). Implicit in this declaration is theassumption that somehow harm reduction measuresmight promote or facilitate drug abuse – for which thereis not a shred of justification, or of evidence. This positionprefigures (and explains) their attack on Supervised Injec-tion Facilities:""The Board has stated on a number of occasions,including its recent Annual Reports, that the operationof such facilities remains a source of grave concern.The Board reiterates that they violate the provisions ofthe international drug control conventions.""The Board reiterates that article 4 of the 1961 Con-vention obliges States to ensure that the production,manufacture, import, export, distribution of, trade in,use and possession of drugs is to be limited exclusivelyto medical and scientific purposes. Therefore, from alegal point of view, such facilities violate the interna-tional drug control conventions."So, then, the INCB appears to begrudgingly allow for nee-dle distribution programs, as long as injecting drug users,many of whom are the most marginalized of citizens,inject drugs furtively and outside of a healthcare settingdesigned to prevent overdoses and HIV infections.In British Columbia, needle distribution has historicallybeen similarly considered as closely connected to ademand reduction strategy. This meant a kind of "one forone" policy whereby needles were not be given unlessinjection drug users provided a needle in exchange. Thisstrategy was aimed, in part, at ensuring that people withactive addictions satisfactorily disposed of their needles.As well, there was a limit (e.g. six per day) placed on thenumber of needles that were allowed per injection drugusers. This limit was regardless of the persons injectingpractices or drug of choice (cocaine users would injectmany times per day versus heroin users who would injectless frequently for example). The placing of a limit on thenumber of syringes allowed embodied a kind of "demandPage 2 of 8(page number not for citation purposes)measures such as needle distribution programs to reducethe spread of HIV/AIDS" it then states, with inherent con-reduction" value inherent in the delivery of the service.This meant that when people required many needles forHarm Reduction Journal 2007, 4:13 http://www.harmreductionjournal.com/content/4/1/13drug use, they were limited at 6 per day regardless of theirneed. The needle exchange at that time was a centralizedrather than a decentralized. There are those that believethat this implicit "demand reduction" approach to needle"exchange" rather than "distribution" (unlimited syringeaccess) contributed, in part, to the explosion of HIV andHCV in the IDU population in the region.While the INCB overtly concludes that the NEP are tech-nically allowed this does not mean that the Board, in actu-ality, entirely supportive of this harm reduction measure.Their stance on Supervised Injection Facilities is indicativeof their "true colors" on this life saving matter. Thesekinds of mediocre stands when it comes to life saving pro-grams like NEP have drastic consequences, on the ground,for marginal IDU populations where local governmentsstruggle to address the AIDS pandemic. What they requireis support and leadership, not mixed messages from aninternational body invested with the prestige of the globalcommunity.When it comes to the pandemic of AIDS and InjectionDrug Use, what is required is clear leadership with respectto strategies that will save lives. The faint and clarifiedpraise for NEP and rejection of SIFs by INCB is a barrier toimplementing critical population health initiatives. TheBoard's implicit and explicit resistance to harm reductionis especially influential in the minefield of moralitywithin which injection drug use and AIDS are situated.The politics of blame surrounding people living withactive addiction make the conditional support of theINCB especially unhelpful and even more damning.In times of sweeping death due to uncontrolled illness, anunsure healthcare intervention is better than no medicalintervention at all. Better yet, a healthcare interventionwith clear efficacy and evidence base, such as SIFs, eventhough culturally controversial, demand action ratherthan clarified and conditional support. Clarified supportsare the kind where a population healthcare interventionlike a SIS might be possible an "ideal world", when the"trees all grow to heaven" and the populace is blessedwith a month of Sundays with eternal sunshine. SIFs can-not wait for this month of Sundays. Their time is now andby opposing their establishment, the INCB is being a partof the problem rather than the solution for the AIDS pan-demic.Supervised injection facilities (SIF) are, to a large extent,an HIV prevention initiative that provides clean injectionequipment. Vancouver's SIF, Insite, supervises approxi-mately 20,000 injections every month. Every one of these20,000 occurrences is an injection that is not shared andwell as its allowance of injection itself under supervisedconditions, it has come under condemnatory fire from theInternational Narcotic Control Board. Of course, every-one, including both the operators and users of the facility,hopes for abstinence and restoration to full health, but fornow, the prevention of HIV, HCV and fatal overdoses is agood medical beginning. In medicine, a partial medicalintervention, with efficacious outcomes, is better than nointervention at all. Sometimes, rather than shooting forthe stars such as eradicating addiction altogether, we haveto satisfy ourselves with more earthly outcomes such aspreventing an HIV infection.Needle distribution is a hallmark component of an SIF.The efficacy of needle distribution is no longer open fordebate in the medical and scientific community. TheWorld Health Organization (WHO) has reviewed theavailable scientific and medical literature on harm reduc-tion programs and concluded that the evidence over-whelmingly indicates that providing such services forinjecting drug users significantly reduces HIV infections:"The studies reviewed in this report present a compel-ling case that NSPs substantially and cost effectivelyreduce the spread of HIV among IDUs and do so with-out evidence of exacerbating injecting drug use ateither the individual or societal level. This suggeststhat authorities responsible for areas threatened by orexperiencing an epidemic of HIV infection amongIDUs should adopt measures urgently to increase theavailability and utilization of sterile injecting equip-ment and expand implementation to scale as soon aspossible. conditions and other approaches bettersuited in other places and conditions. The importantpoint is to aim to reduce the circulation time of nee-dles and syringes."[7] (p. 30)In recognition of the need for efficacious and evidenced-based action with respect to the AIDS pandemic, theUnited Nations General Assembly unanimously adoptedan imperative Resolution to address the AIDS on 2 June2006. In this resolution, the United Nations GeneralAssembly unanimously publicly declared the importanceof harm reduction and needle distribution by reiteratingthat:"...prevention of HIV infection must be the mainstayof national, regional and international responses tothe pandemic, and therefore commit ourselves tointensifying efforts to ensure that a wide range of pre-vention programmes that take account of local cir-cumstances, ethics and cultural values is available inall countries, particularly the most affected countries,Page 3 of 8(page number not for citation purposes)makes use of a clean syringe. To a large extent, the SIF is aneedle distribution program and, for this key feature, asincluding information, education and communica-tion, in languages most understood by communitiesHarm Reduction Journal 2007, 4:13 http://www.harmreductionjournal.com/content/4/1/13and respectful of cultures, aimed at reducing risk-tak-ing behaviours and encouraging responsible sexualbehaviour, including abstinence and fidelity;expanded access to essential commodities, includingmale and female condoms and sterile injectingequipment; harm-reduction efforts related to druguse; expanded access to voluntary and confidentialcounselling and testing; safe blood supplies; and earlyand effective treatment of sexually transmitted infec-tions;" [emphasis added][2] (p. 4)And yet, despite the overwhelming evidence and consen-sus of professional judgment support the importance ofharm reduction (including needle distribution and thehealthcare centres from which clean injection equipmentis distributed, supervised injection facilities) anotherinternational organization, the International NarcoticControl Board (INCB), has been publicly attacking thesehealth programs. The INCB gains its authority from threetreaties, the Single Convention on Narcotic Drugs (1961),the Convention on Psychotropic Substances (1971) andthe United Nations Convention against Illicit Traffic inNarcotic Drugs and Psychotropic Substances (1988)[8]The INCB, generally speaking, is responsible for ensuringthat adequate supplies of narcotic drugs are available inthe world for medical and scientific use while, conversely,pointing to weak points in the controls of these same sub-stances that lead to the sale, use or manufacturing of illicitdrugs. The INCB monitors governments with respect totheir control of illicit drugs and makes recommendationsto assist each signatory to the aforementioned treaties tomaintain their nation's responsibility with respect to thedistribution of medically sanctioned drugs and the corre-sponding prevention of illicit drugs. The INCB is prima-rily concerned with the international and national flow ofdrugs, both illicit and licit.Unlucky number 13: the 13 member board of the INCB assail HIV preventionIncongruously, the INCB has become confused about HIVprevention programs and, as a result, developed a patternin recent years of speaking out against accepted medicaland public health strategies. The 13 person committeegoverning of the INCB, often mistakenly understood bythe public to be synonymous with the United Nations,seems to have decided that it is not accountable to scien-tific evidence, the opinion of most public health officials,nor to the mounting toll of AIDS due to syringe sharingamong injecting drug users. As a result, the INCB is begin-ning to play a central role in promoting unsafe injectionpractices (by ruling out syringe distribution as a health-care initiative), and, inadvertently, spreading regionalAIDS outbreaks.In marked contrast to the vast majority of the medical andscientific establishment, the INCB sees SIFs as neithermedical nor scientific and this is basis of their repeatedpublic grievances about purported infringements on inter-national drug control treaties. In so doing, the board iscontinuing to chase its imaginary tail with increasing fer-vor within an unaccountable and unscientific universe ofits own construction. This would be allowable if AIDSwere not such a serious matter.By showing aggression towards SIFs, the InternationalNarcotics Control Board is undermining HIV preventioninitiatives that save lives. The INCB began declaring thatSIFs are in breach of international treaties in 2001 and2002 when they stated:"Establishing drug injection rooms, where drug abus-ers can inject drugs that they have acquired from illicitsources, is contrary to the international drug controltreaties"(p. 70)[9].Since that time, the INCB has repetitively attempted toundermine Vancouver's SIF, Insite, the only such healthprogram in North America. In 2003, from their headquar-ters in Vienna, the INCB proclaimed that Insite violatesinternational law and attempted to urge the Canadiangovernment to comply with their wishes that the programbe closed[10] In 2004, the INCB singled out Australia'slone SIF as an affront to international drug control trea-ties[11] Similarly in 2005, the INCB chastised Norway forestablishing a SIF and stated that injection rooms "facili-tate" the use of drugs[12] Once again, the Board misun-derstood the deeply medical purpose of these healthcareinitiatives, that is, to avert wherever possible needlessdeaths due to drug addiction due to preventable over-doses and HIV and HCV infections. In 2006, the INCBturned its attention to Switzerland and highlighted theaddition of "inhalation" components of this country'smultifaceted consumption rooms as unlawful. Likewise,the board paid a visit to Germany, chastised this countryfor their harm reduction efforts in operating SIFs. Theythen lamented the existence of such medical initiativesSwitzerland, Canada, Luxembourg, the Netherlands, Nor-way, Spain and Australia[13] Finally, the group mountedits most recent attack in the press against Vancouver's thelife-saving injection facility in March of 2007 and vowedto pressure the Canadian government directly to have themedical program shut[14].In fact, the international treaty to which the INCBrepeated refer is the Single Convention on Narcotics of1961 (amended in 1972). The Preamble of the Conven-tion begins by highlighting that the signatories are prima-Page 4 of 8(page number not for citation purposes)rily concerned with the wellbeing of humanity and mainpurpose of the convention is to relieve suffering:Harm Reduction Journal 2007, 4:13 http://www.harmreductionjournal.com/content/4/1/13"The Parties, concerned with the health and welfare ofmankind, recognizing that the medical use of narcoticdrugs continues to be indispensable for the relief ofpain and suffering and that adequate provision mustbe made to ensure the availability of narcotic drugs forsuch purposes" (p. 1)[15].The ensuing section trumpets about the importance ofbeing committed to fighting the forces of evil, languagethat was indicative of the spirit of the time half a centuryago when the agreement was drafted, before highlightingthe importance of the drugs in the context of medical andscientific use. In fact, it is precisely for scientific or medicalpurposes that SIFs are eligible for exemption under Sec-tion 56 of the Controlled Drug and Substances Act (CDSA)of Canada.AIDS is a public problem for all of humanity. Similar towhen a situation or area is designated as a national disas-ter, the categorization of an epidemic brings public atten-tion as well as national resources. When a diseaseoutbreak is categorized as an epidemic, it also goesthrough a social transformation to become a public prob-lem. Not all social problems are declared public problems[16]. For example, homelessness might be considered apublic problem in some areas but not in others. When aproblem becomes a public problem then the governmentofficially has to take on responsibility to address it. Mentalillness, poverty and drunken driving have not in the pastbeen considered public problems, whereas today they areexpected to be focus of government attention and theresponsibility of officials and publicly funded agencies.Drug addiction, as a leading cause of HIV infection, is apublic problem.Certain words are highly significant, like the word pan-demic, and they are moored in significant places in thesocial space and only certain people are consecrated withthe social privilege to employ them [17]. Just as only aphysician can pronounce someone dead, only certainmedical professionals are consecrated with the authorityto declare an epidemic (such as, in today's context, theChief Medical Health Officer, the Health Minister, theHealth Board). Similarly, these same socially designatedbodies can socially bury or put out of sight problems thatrequire action. The United Nations is such a body; it can,through an act of social magic, raise a problem to thenational stage or, through inaction, relegate the sameproblem to the shadows.Only certain societal bodies or individuals such as teach-ers, priests, doctors or legislators are delegated with theauthority to carry out key responsibilities [17]. For exam-Similarly, at the College of Physicians and Surgeons, onlythe President can deliver a reprimand to a physician guiltyof professional violation. It would socially awkwardindeed if a passerby were to spontaneously break a bottleof champagne on the side of a boat at a christening cere-mony or if a public member of the College of PhysiciansCouncil proceeded to take the lead in reprimanding aphysician. In certain social settings, only the designatedrepresentative has been invested with social authority toperform significant tasks. In the case of the pandemic ofAIDS, the socially designated institutions responsible forfighting HIV are many including the United Nations, theWorld Health Organization, each sovereign country and,perhaps, all of us.Key societal institutions, such as the INCB, have the socialauthority to consecrate certain states of affairs:"To institute, in this case, is to consecrate, that is, tosanction and sanctify a particular state of things, anestablished order, in exactly the same way that a consti-tution does in the legal and political sense of the term.An investiture (of a knight, Deputy, President of theRepublic, etc.) consists of sanctioning and sanctifyinga difference (pre-existent or not) by making it knownand recognized; it consists of making it exist as a socialdifference, known and recognized by the agentinvested and everyone else" [17: 119].The institution achieves a kind of social wizardry byanointing the credentials of key individuals, such as ChiefMedical Health Officers, Surgeon Generals or Chief Coro-ners, who have the official qualifications to declare publicproblems such as epidemics that demand widespreadattention and resources.With respect to the historical analysis of epidemics, it isoften the case that what was not studied is as revealing aswhat is studied [18]. With respect to AIDS, there waslengthy period of time in the United States during whichthe actual acronym was never mentioned publicly or inany official correspondence of the President. AIDS was,officially, culturally erased. As a result, national resourcescould not be dedicated to addressing an important issuethat, for all intents and purposes, did not exist overtly.The time for reasonSo we are very pleased to call to our readers attention to arecent report produced by the Canadian HIV/AIDS LegalNetwork and the International Harm Reduction DevelopmentProgram (IHRD), joined by former United Nations SpecialEnvoy for HIV/AIDS in Africa, Stephen Lewis, who held apress conference to release "Closed to Reason: The Interna-Page 5 of 8(page number not for citation purposes)ple, the christening of a yacht can only be completed by adesignated person can perform the task of christening.tional Narcotics Control Board and HIV/AIDS."[19] Thefull report is attached. [20]Harm Reduction Journal 2007, 4:13 http://www.harmreductionjournal.com/content/4/1/13The new report details the ways in which the INCB,funded and staffed by the UN, has "blocked effective HIVprevention among drug users."[19] The document focuseson errors of fact and omissions in INCB publications andstatements, the ways in which the Board has ignoredexpert legal counsel and scientific evidence, and the needfor greater accountability and transparency at the INCB.The reports recommendations are clear and compelling."To improve accountability, address the HIV epidemic,and meet its mandate to assess compliance with the UNdrug conventions, the INCB must change:• The INCB should regularly assess the supply andadequacy of treatment for chemical dependence. Itshould provide technical assistance to help countriesaccurately estimate the need for opiate substitutiontreatment, support governments that are striving toscale up such treatment, and encourage governmentsthat have yet to provide these life-saving therapies tofind safe and effective ways to do so.• The INCB should cite scientific evidence for itsobservations about drug use and health, and legalgrounds for its interpretation of law. It should providesources of information for its annual reports, andopportunities for UN member states and civil societygroups to offer corrections or additional information.• The INCB should provide greater opportunity forexchange with UN member states, UN agencies withrelevant mandates, civil society, and HIV/AIDSexperts. INCB country missions should include greateropportunities for engagement with these groups.• The World Health Organization, the UN Economicand Social Council (ECOSOC) and UN member statesshould ensure that INCB members include personswith expertise in HIV/AIDS policy and internationallaw.• The INCB should articulate, and ECOSOC shouldevaluate, public guidelines to clarify when INCB mem-bers are speaking for the Board, and how misstate-ments of fact can be corrected.• The UN Secretary-General should commission anindependent evaluation of the INCB, including a sci-entific evaluation of the Board's statements on health,and an examination of Board members' independenceand expertise, with particular attention to HIV, inter-national law and human rights"(pp. 3–4)[20].ConclusionIf the INCB were to be successful in just one of their fool-hardy attempts to bully governments into closing a singleSIF as a needle distribution centre, then this organizationwould, quite simply, have blood on its hands. Which ofthese 13 people, self-righteously sitting on the INCB,would be willing to face the consequences of their havingsacrificed medicine and science on the alter of a 46 yearold treaty about which even their legal interpretation isuncertain? Or, which of them, if any, would willing to facethe father or mother of the addict who died of a drug over-dose in an alleyway? Would they proudly talk of their suc-cessful mission from their comfortable office in Vienna toan injection room that they had, through their lobbyingefforts, successfully closed down?The Preamble of the Charter of the United Nations asenshrined since 1945, states the peoples of the UN arecommitted to work towards:"... conditions under which justice and respect for theobligations arising from treaties and other sources ofinternational law can be maintained, and to promotesocial progress and better standards of life in largerfreedom, and for these ends, to practice tolerance andlive together in peace with one another as good neigh-bours, and to unite our strength to maintain interna-tional peace and security, and to ensure, by theacceptance of principles and the institution of meth-ods, that armed force shall not be used, save in thecommon interest, and to employ internationalmachinery for the promotion of the economic andsocial advancement of all peoples..."[15]Treaties, then, are for the advancement of peoples. Trea-ties are not to be used to exclude marginalized persons,like injecting drug addicts, from receiving access to basiclife saving medical care such as injection facilities andsyringe distribution programs. International law is forpromoting inclusivity, of everyone, even those with themost comprised social tenure, in the global community.Three years after the establishment of the UN, in 1948, theGeneral Assembly of the United Nations approved theUniversal Declaration of Human Rights. Article 25, underthe Declaration, states that every person:"has the right to a standard of living adequate for thehealth and well-being of himself and of his family,including food, clothing, housing and medical careand necessary social services, and the right to securityin the event of unemployment, sickness, disability,widowhood, old age or other lack of livelihood in cir-Page 6 of 8(page number not for citation purposes)cumstances beyond his control" (p. 5)[15].Harm Reduction Journal 2007, 4:13 http://www.harmreductionjournal.com/content/4/1/13Every human being, including people living with intrave-nous drug addictions, has the basic human right to theirhealth and medical care and security of their person. Forsome people, that inalienable right to health might comethrough the provision of a clean syringe in an injectionfacility.While the increasing implementation of SIF medical initi-atives throughout the globe appear to be increasing thetravel budget for the INCB and the resultant tourist oppor-tunities of its 13 members as they embark on their "mis-sions", it does not appear to be effective in anyway withrespect to increasing their knowledge of populationhealth or epidemiological approaches to healthcare. Itappears that the International Narcotics Control Board isunwavering in its steadfast determination to drink its ownideological bathwater in spite of the widespread availabil-ity of knowledge available from the wellspring of medi-cine and science. It is clearly time to retire theInternational Narcotics Control Board in its current con-figuration as a cloistered and unaccountable body that isimpenetrable to evidence based science and medicine.According to the INCB annual report, the Board reports tothe Economic and Social Council of the United Nations.The Economic and Social Council, in turn, has a "report-ing, cooperating and advising relationship" with the Gen-eral Assembly of the United Nations[13].Every injecting drug addict was once someone's son ordaughter. They do not deserve to die from AIDS or drugoverdose due to a cloak of ignorance about basic medicalevidence that has, for too long, shrouded the Interna-tional Narcotic Control Board. It is the responsibility ofthe United Nations to protect their health and well-being.It is our opinion that the make-up of the governing bodyof the INCB needs to be dissolved forthwith in its presentcapacity as a matter of great public urgency in order toreconstitute the board in order to ensure that its make-upis comprised of HIV, medical and legal experts withrespect to intravenous drug addiction as a health issue.According to the founding documentation associatedwith the INCB, the Single Convention on Narcotic Drugsof 1961, the expenses of the Board are ultimately author-ized by the United Nations General Assembly[15] In lightof this financial reporting relationship, we suggest that theGeneral Assembly of the UN, at the next possiblemoment, bring to an end any expenditure by the INCBthat undermine, investigate (as in flight travel to visit andbadger) or publicly criticize accepted HIV prevention pro-grams including SIFs. What's more, we call on the UnitedNations to immediately put in place the legal means torepeal the 1961 Single Convention on Narcotic Drugs innot a crime as a "harm reduction measure" to prevent sub-sequent generations of INCB members from being simi-larly confused as the present participants on the governingcommittee.The time for accountability for the INCB is now. We arecalling on the general assembly of the United Nations, thesignatory nations to the treaties that created the mandatefor the INCB, to take steps to contain the damage done bystopping the deleterious work of the INCB before moreinjecting drug users needlessly die of AIDS and drug over-doses because of the ill-conceived and obstinately coun-terproductive efforts of this agency. We cannot allow thispublic body to continue to function in a way so discon-nected from the medical and scientific evidence aboutdrug use and AIDS. In the face of the almost universal con-demnation of the INCB by the legal community, theINCB's continued arrogance and intransigence sullies thereputation of the United Nations and violates the human-itarian spirit in which this board and all UN agencies werecreated. The goals of INCB in this matter should be con-gruent with those of the United Nations and WorldHealth Organization: to promote rather than hinder pub-lic health and, in so doing, save lives – not to bring aboutunnecessary deaths due to preventable HIV infections andAIDS.Additional materialAdditional file 1Closed to Reason: The International Narcotics Control Board and HIV/AIDS. Report by J. Csete and D. Wolfe of the Canadian HIV/AIDS Legal Network; International Harm Reduction Development Program (IHRD); Open Society Institute (OSI); 2007:1–32.Click here for file[http://www.biomedcentral.com/content/supplementary/1477-7517-4-13-S1.pdf]Additional file 2Closed to Reason: The International Narcotics Control Board and HIV/AIDS Key Findings. Russian translation of key findings of the above report.Click here for file[http://www.biomedcentral.com/content/supplementary/1477-7517-4-13-S2.pdf]Additional file 3"Closed to Reason": Time for Accountability for the International Narcotic Control Board. Russian translation of abstract of the above edi-torial.Click here for file[http://www.biomedcentral.com/content/supplementary/1477-7517-4-13-S3.pdf]Page 7 of 8(page number not for citation purposes)order to replace it with an updated language that reflectsthe fact that serious drug addiction is a medical issue andPublish with BioMed Central   and  every scientist can read your work free of charge"BioMed Central will be the most significant development for disseminating the results of biomedical research in our lifetime."Sir Paul Nurse, Cancer Research UKYour research papers will be:available free of charge to the entire biomedical communitypeer reviewed and published immediately upon acceptancecited in PubMed and archived on PubMed Central Harm Reduction Journal 2007, 4:13 http://www.harmreductionjournal.com/content/4/1/13References1. Gottlieb MS: Pneumocytis Pneumonia--Los Angelos.  Morbidityand Mortality Weekly Report 1981, 30(21):1-3.2. UnitedNations: Resolution Adopted by the General Assembly:Political Declaration on HIV/AIDS.  2006:1-8.3. UNAIDS, UNICEF, USAID: Children on the Bring 2004: A JointReport of New Orphan Estimates and a Framework forAction.  New York , The Joint United Nations Programme on HIV/AIDS (UNAIDS) United Nations Children's Fund (UNICEF) UnitedStates Agency for International Development (USAID); 2004:1-46. 4. UNAIDS, WHO: 2006 AIDS Epidemic Update.   Joint UnitedNations Programme on HIV/AIDS (UNAIDS) and World HealthOrganization (WHO); 2006:96. 5. INCB: International Narcotics Control Board Annual Report1995.  1995.6. INCB: INCB Cautions on "Harm Reduction" Measures inDrug Control.  Vienna , International Narcotic Control Board;2004. 7. WHO: Effectiveness of Sterile Needle and Syringe Program-ming in Reducing HIV/AIDS Among Injecting Drug Users.  InEvidence for Action Technical Papers Geneva, Switzerland , WorldHealth Organization; 2004:1-61. 8. INCB: International Narcotic Control Board: Mandate andFunctions.  .9. INCB: Report of the International Narcotics Control Boardfor 2002.  Vienna, Austria , International Narcotics Control Board;2002. 10. INCB: Report of the International Narcotics Control Boardfor 2003.  Vienna, Austria , International Narcotics Control Board;2003. 11. INCB: Report of the International Narcotics Control Boardfor 2004.  Vienna, Austria , International Narcotics Control Board;2004:1-110. 12. INCB: Report of the International Narcotics Control Boardfor 2005.  Vienna, Austria , International Narcotics Control Board;2005. 13. INCB: Report of the International Narcotics Control Boardfor 2006.  Vienna, Austria , International Narcotics Control Board;2006. 14. Edwards S, Hansen D: Safe Injection Site Breaks Treaties, UNAgency Says: Federal Health Minister  Will Be Urged to ShutDown Initiatives.  In Vancouver Sun Vancouver ; 2007:1-3. 15. Single Convention on Narcotic Drugs, 1961.  1961.16. Gusfield JR: The Culture of Public Problems: Drinking-Drivingand the Symbolic Order.  Chicago , University of Chicago Press;1981. 17. Bourdieu P: Language and Symbolic Power.  Cambridge, Massa-chussetts , Harvard University Press; 1995. 18. Farmer P: Social Inequalities and Emerging Infectious Dis-eases.  Emerging Infectious Diseases 1996, 2(4):.19. CHALN CHIVAIDSLN, OSI OSI: New Report Finds Interna-tional Narcotics Control Board Blocks Effective HIV Preven-tion Among Drug Users: NGOs and Stephen Lewis Call onINCB to Increase Accountability and Transparency.   [http://www.soros.org/initiatives/health/focus/ihrd/news/incb_20070227].20. Csete J, Wolfe D: Closed to Reason: The International Narcot-ics Control Board and HIV/AIDS.   Canadian HIV/AIDS LegalNetwork International Harm Reduction Development Program(IHRD) Open Society Institute (OSI); 2007:1-32. Additional file 4"Closed to Reason": Time for accountability for the International Narcotic Control Board. Chinese translation of abstract of the above editorial.Click here for file[http://www.biomedcentral.com/content/supplementary/1477-7517-4-13-S4.pdf]yours — you keep the copyrightSubmit your manuscript here:http://www.biomedcentral.com/info/publishing_adv.aspBioMedcentralPage 8 of 8(page number not for citation purposes)

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