By responding to this concern and providing overdose prevention education and tools, harm reduction programs attract drug users to their other services, including HIV testing, counseling, and treatment. In a publication called Why Overdose Matters for HIV, Open Society Foundations and the Eurasian Harm Reduction Network identify several reasons why people who care about HIV should care about drug overdose.

A recent article in the journal AIDS, by Brown University’s Traci Green and colleagues, calls renewed attention to the overdose-HIV connection. According to research, people who use drugs have a 74% greater risk of overdose if they are HIV-positive compared to their counterparts who are not.

As the article notes, researchers are not sure why this is the case. Is it biological, due to such things as abnormal liver function or respiratory problems in people with HIV? Or is it behavioral? Could high-risk lifestyles and psychiatric co-morbidities explain both overdose events and HIV status among drug users? Or could it be structural: Do factors like incarceration, neighborhood poverty, and homelessness play a significant role?

The authors point out the many shared risk factors for HIV infection and opioid overdose. Clearly more research needs to be done to see which factors matter most, but, given the overlap, scaling up interventions and policies known to reduce risk for one could impact the other.

Green and her co-authors discuss three such interventions: highly active antiretroviral therapy (HAART), an HIV treatment regimen that may also be protective of overdose; medication-assisted addiction treatments like methadone and buprenorphine, which decrease both HIV risk and overdose risk among opioid drug users; and naloxone distribution, which can prevent overdose deaths and connect drug users to HIV prevention and treatment services.

Naloxone is a safe medication with one purpose—to reverse an overdose of heroin and other opioids. It has no potential for abuse and it has no effect on someone without opioids in his or her system. You can read previous blog posts to find out more about this lifesaver.

The Global Fund to Fight AIDS, Tuberculosis and Malaria and the President’s Emergency Fund for AIDS Relief (PEPFAR)—the world’s two biggest funders of HIV programming—have agreed to pay for overdose prevention programs, including innovative ones that distribute naloxone to drug users. This is a positive step but in most countries drug users are still waiting to see these words result in action.

Other international organizations focused on drug users and HIV, like UNAIDS, the World Health Organization, and the UN Office on Drugs and Crime, provide little guidance or assistance to governments when it comes to overdose, despite its toll on drug users, including those living with HIV.

Programs working with drug users should use Green’s paper as evidence when seeking support—from donors and local governments—for overdose prevention initiatives. And for UN agencies and others working to curb deaths among people living with HIV, this should be a wake-up call that advocating for overdose prevention and response is part of their job too.

Today marks Overdose Awareness Day, and drug overdose survivors and communities all over the world are holding vigils, rallies, and media campaigns to draw much-needed attention to harm reduction responses.

As Azadeh Momenghalibaf wrote last week, overdose deaths are preventable, yet they still take too large a toll. The media often reports on celebrity deaths, but most people are unaware just how staggering the numbers are when it comes to overdoses. For example, in the European Union, there is the equivalent of an overdose death every hour. In many other countries, we don’t have good statistics on the exact number of deaths, but people know their friends are dying.

A new campaign from the Eurasian Harm Reduction Network and the Harm Reduction Coalition called “I’m the Evidence. Naloxone Works” calls attention to naloxone, an antidote to opiate overdose and calls for laypeople—drug users, pain patients, and their families and friends—to have access to this life-saving medicine for emergencies. Scores of people have posted video testimonials on naloxone—how the medicine gave them a second chance or how they used it to save a friend’s life. An example from China is above, and you can see more on the Facebook page I'm the Evidence.

Many of the posts from the Facebook page are from the United States, but drug users in Thailand, Tajikistan, Russia, and elsewhere are saving lives with naloxone too. At a recent conference, Tuan from Vietnam told his own story:

In the past ten years, heroin injection has grown popular in Vietnam. As the number of heroin injectors increases, so does the number of overdose cases.

I was also a drug user, and I witnessed many painful overdose deaths with my own eyes. My best friend was an overdose victim. He died of an overdose, right in my arms. That was an unforgettable moment, and it helped me want to live and start over. I’ve stopped using drugs and I am currently the leader of a peer support group for drug users in Ho Chi Minh City.

According to an unofficial survey conducted in our city, from 2007 to 2009, there were about 100 overdose deaths. But, based on my experience and observation, the real number is much higher. In December 2009 alone, in our working area, there were 16 overdose cases, in which 14 people died. It’s a pity that we didn't know anything about naloxone back then. When overdoses happened, we could only try mouth-to-mouth or call the person's name, which usually didn't work. When I saw someone die of an overdose, it haunted me, and I always felt guilty that I couldn't do much.

Fortunately, last August, we got information about naloxone from a drug user in Hanoi. This person, who had attended an overdose training workshop at an international conference, had used an expired vial of naloxone to save another drug user who’d overdosed just two days after the conference. Five other drug user groups then received training and naloxone from a local organization.

Now we’ve provided information and skills on overdose prevention and response to hundreds of drug users. We formed an “overdose rescue team,” which consists of five core members who are also drug users, and distributed pamphlets on overdose with the contact information of the five members whom people can call if they see someone overdose.

The first time we received a call, another member and I were close to that area, so we went right away. When we arrived, the victim was hardly breathing. When we injected the naloxone, we were really worried, but the person slowly woke up after just five minutes. We were all very surprised and happy, and all our doubts about naloxone were swept away.

Our group has since reversed other overdoses. Being able to save lives is very meaningful to us, especially in one case when the victim had just turned 18. The effects have gone beyond our expectations. Even the police—they were there when we saved the second person. The policeman told us if anything bad happened to the overdose victim, we would be held responsible. But the person was revived. So later, we were contacted directly by the district police for the next overdose case.

The residents where we work have seen us in a different light, knowing the good things that we are doing. Especially when the people who’ve saved others used to be considered bad people in the community. Now all the compliments, or just pats on the shoulder from other people, are a great motivation for us. The drug users who were revived are now peer educators, paying it forward by helping out other drug users. Our groups feels that this is the most meaningful thing that we have ever done in our lives.

Sharing this story with you, I want to pass on something that a drug user said when he was revived: "Maybe I won't be able to quit using drugs after this, but now I know that there's someone who cares about me, and that will be my motivation to live."

On Overdose Awareness Day, join the call for wider access to naloxone by posting your testimony to I’m the Evidence. The stories will be forwarded to the World Health Organization, to encourage them to do more to respond to overdose. You can also join the Drug Policy Alliance’s Twitter campaign by tweeting about overdose with the hashtag #OD11, or do a keyword search for #OD11 to read all the tweets.

Check out Drug Policy Alliance’s Overdose Awareness Day site for more ways to get involved.

Over the past decade, governments have increasingly turned to arbitrary detention, cruelty, and even torture in order to combat drug abuse. This so-called rehabilitation rarely resembles the evidence-based drug treatment people deserve— a supportive experience, entered into voluntarily and with full consent to the treatment plan.

Two new publications issued by the Campaign to Stop Torture in Health Care, a coalition led by the Open Society Foundations, document the abuses that people detained in the name of drug treatment regularly suffer. The first, Treated With Cruelty: Abuses in the Name of Drug Rehabilitation, is a compilation of personal testimonies of detainees in Russia, China, Cambodia, and Mexico.

Consider how one detainee describes what treatment in a government-run “rehabilitation center” in China looks like. Forced to work more than 12 hours in order to meet an exhausting work quota, his “treatment” sounds more like a forced labor camp. If he didn’t meet his daily production quota of copper-threaded magnets, he could expect a severe beating at day’s end.

“Treatment” in Chinese centers typically lasts two to six years.

In Cambodia, Jin tells his story of being picked up by police while he was sitting on the side of a street, talking to a friend. Though he wasn’t given a trial or a sentence, he was charged as a drug user and locked in a room with some 50 other men and boys, ages 12 through 50. He was denied medication to help him through agonizing withdrawal. Instead, he was beaten and forced to work.

Outside of Asia—where governments mainly run these detention facilities— other countries instead have private establishments that are equally abusive. In these places, government officials normally turn a blind eye to these centers, usually run by vigilantes, failing to regulate or even investigate them after allegations of abuse.

Russia’s City Without Drugs Foundation is famous for its brutal treatment of people who use drugs. People are often kidnapped, held against their will, and then forced to sign consent forms, a practice that has caused the government to investigate it in the past. In October 2010, the head of a regional branch was sentenced to more than three years in prison for torturing people in the rehabilitation center, but his sentence was later recalled and he was merely placed on probation.

The foundation’s centers, located in several Russian cities, remain open and receive broad public support. What’s more, new legislation in the Russian Duma calls for drug users to be forced into treatment.

In Mexico, Adriana tells the story of her brother, Francisco. Her family sent him away to a center that promised to help with his crack use. He relapsed after three months, but told his sister “Please, don’t put me [back] there, you’ll regret it for the rest of your life.” Five days after he was readmitted to the center, he was dead, the result of beatings and abuse by center management.

It is hard to read these accounts and not consider them acts of torture, or at least cruel, inhuman and degrading treatment. These terms, however, have explicit definitions under international law.  In our second book, Treatment or Torture? Applying International Human Rights Standards to Drug Rehabilitation Centers, the authors make the case that such experiences do, in fact, meet the required legal definition. This analysis will be invaluable to anyone bringing cases of torture in drug detention to international, regional, or domestic bodies charged with preventing or prosecuting torture.

It is clear that abusive drug treatment centers should be shut down immediately. Instead, we need better access to community-based, voluntary drug treatment services that have been proven to work, such as methadone and buprenorphine treatment programs.

Yet while we should push for real treatment, we shouldn’t wait for it either. Many people are detained in these centers without clinical assessment, because of one positive urine test, or because the government wants to “clean the streets” of homeless and poor people. Detaining people in holding pens and labor camps isn’t a worthwhile way to address either poverty or addiction.

This June 26, let’s celebrate both international days by joining the call for governments to close abusive drug treatment centers and redirect our efforts to address the root causes of drug addiction and abuse.