Gerry Stimson

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Gerry Stimson is a British public health social scientist, emeritus professor at Imperial College London from 2004, and an honorary professor at the London School of Hygiene and Tropical Medicine from 2017. [1] [2] Stimson has over 220 scientific publications mainly on social and health aspects of illicit drug use, including HIV infection. He has sat on numerous editorial boards including AIDS, Addiction, and European Addiction Research, and with Tim Rhodes he was the co-editor-in-chief of the International Journal of Drug Policy from 2000 to 2016. [3] He is one of the global leaders for research on and later advocacy for harm reduction.

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Contribution to the social understanding of health behaviour

Stimson studied social science and social psychology at the London School of Economics in the 1960s, and did his research training at the Institute of Psychiatry in London, joining the Addiction Research Unit there when it was first established in 1967. He was among a cohort of new social scientists working in what was then called 'medical sociology' and later the 'sociology of health and illness' which established the significance of the social sciences for understanding health behaviour, and in particular the importance of the perspective of the patient. His 1975 work on doctor-patient interaction, Going to see the doctor, [4] influenced medical school courses on communicating with patients. He was a founder with Robert Dingwall of the journal Sociology of Health and Illness. He taught courses on the sociology of health and illness at Goldsmiths College London, where he was head of the Sociology Department from 1980 to 1983.

Research on drug use and drug policy

Whilst at the Addiction Research Unit he conducted research on the prescribing of heroin at London drug dependency clinics, which became a long term follow-up study of people dependent on heroin, blending quantitative and qualitative research and a historical analysis of drug policy. [5] The research provides insights into drug treatment and addiction from the personal view of people who were addicted to heroin.

Work on HIV prevention and harm reduction

From the mid-1980s he became increasingly involved in the application of social science to public health issues, linked to his research on drug use and the risks of HIV infection. In 1987 whilst at Goldsmiths' College he was commissioned by the UK government to undertake the evaluation of the experimental needle and syringe exchange programme in England and Scotland. [6] He established (in 1990) and directed (until 2004) The Centre for Research on Drugs and Health Behaviour at Imperial College London. [7] His work there developed multi-methods research on illicit drug use and alcohol. His team pioneered consumer engagement in research by including drug users on research advisory panels and as fieldworkers. His work at the Centre for Research on Drugs and Health Behaviour mapped social-behavioural aspects of injecting drug use, the epidemiology of HIV infection, and the impact of needle exchange schemes and methadone treatment for people who inject drugs. [8] He viewed the UK response to HIV among people who inject drugs as a public health success. [9] The introduction of drugs harm reduction led the UK to have one of the lowest rates of HIV infection among drug injectors in the world.

Stimson has been a critic of the UK Government's drug policy. [7] In the late 1990s he coined the expression 'policy based evidence making', alluding to the ways in which politicians often selectively choose facts which support their positions, and as a counterpoint to the optimism that many social scientists had at the time that good evidence leads to good policy (a position known as 'evidence based policy making'.

In 1997 he established the Department of Social Science and Medicine at Imperial College London within the then new Division of Primary Care and Population Health Sciences.

He was a member of the UK Advisory Council on the Misuse of Drugs (ACMD) from 1984 until 1999 and a member of the Advisory Council on the Misuse of Drugs Working Group on AIDS and Drug Misuse. [10] Soon after the HIV antibody test was introduced in 1985 high prevalence of HIV infection had been identified in some groups of heroin injectors in Scotland. The ACMD concluded that "The spread of HIV is a greater danger to individual and public health than drug misuse [...] We must therefore […] work with those who continue to misuse drugs to help them reduce the risk involved in doing so, and above all the risk of acquiring or spreading HIV." [11] The report is described as "a key step along the road to the development of harm reduction as a distinct area of professional practice". [12] Stimson, writing in 1990, described what was seen as a new paradigm for those working in the drugs field, that focussed on the prevention of drug harms rather than on drug use itself. [13] Harm reduction had a significant impact on UK drug policy over the next ten years including the expansion of needle exchange programmes and methadone treatment.

Harm reduction and human rights

In 2004 Stimson left academic work and became Executive Director of the International Harm Reduction Association (IHRA) (now Harm Reduction International) and developed a programme of work linking public health and human rights approaches to harm reduction. He helped draft the definition of harm reduction, and instigated the biennial report on the Global State of Harm Reduction. His team at IHRA identified human rights abuses of drug users, and established within the UN system that access to harm reduction resources was part of the state's obligations to promote the right to health. He worked with international organisations including the World Health Organization, the Joint United Nations Programme on HIV/AIDS (UNAIDS), and the Global Fund to Fight AIDS Tuberculosis and Malaria to persuade them to incorporate harm reduction into their policies and strategies. He was the inspiration for the biennial Global State of Harm Reduction report [14] which maps progress towards the adoption of drugs harm reduction. With others at IHRA he produced a definition and description of harm reduction which is now available in twelve languages.

He encouraged consumer engagement in public health and drug policy by helping establish drug user advocacy groups and national and regional harm reduction associations including the United Kingdom Harm Reduction Association, Action on Hepatitis C, the Middle-East and North Africa Harm Reduction Association, YouthRise and the International Network of People who Use Drugs.

Tobacco harm reduction

From 2010 Stimson applied his interest in harm reduction to the prevention of tobacco smoking-related diseases and is a proponent of the use of safer nicotine products as alternatives to smoking. [15] He is the co-founder, with Paddy Costall, of the Global Forum on Nicotine. He is an advocate of vaping and e-cigarettes and other safer nicotine products as a tobacco harm reduction strategy. [2] Stimson argues that although nicotine is addictive, it is "almost harmless to health", that it is the tobacco smoke that is harmful, and that e-cigarettes have "negligible risk to health". [16] From 2012-14 he was a member of the UK National Institute for Health and Care Excellence Guidelines Development Group on Tobacco Harm Reduction. [17] He is a director of Knowledge-Action-Change which is a private sector agency working in the field of public health and harm reduction and which states that its aim is to promote health through harm reduction. In 2018 KAC published No Fire, No Smoke: The Global State of Tobacco Harm Reduction [18] which maps the uptake of safer nicotine products and the regulatory responses to these products. A second edition published in 2020 - Burning Issues: the Global State of Tobacco Harm Reduction [19] - provides the first estimation of the number of users of e-cigarettes globally. The Burning Issues report is highly critical of the influence of US philanthropic funding on international tobacco control policy and the network of international agencies that oppose tobacco harm reduction. The influence of Michael Bloomberg on tobacco control and on the World Health Organization is further explored in Fighting the Last War: the WHO and International Tobacco Control [20] . The production of these reports was funded by a grant from the Foundation for a Smoke-Free World, which is solely funded by Philip Morris International. KAC runs the Tobacco Harm Reduction Scholarship Programme. These scholarships are funded by a grant from the Foundation for a Smoke-Free World. He is a director of KAC Communications which organises the Global Forum on Nicotine which is described as the only global event that welcomes all stakeholders involved with new and safer nicotine products.

Between 2016 and 2018 Stimson was involved in a case brought before the UK High Court and the European Court of Justice (ECJ) to challenge the ban on the sale of snus within the European Union (except Sweden). The case was brought by Swedish Match, and the New Nicotine Alliance (NNA) joined the case as an intervenor. Stimson was then chair of the NNA. The NNA's legal argument was that the evidence from Norway and Sweden indicated that snus protects against smoking and that smokers have a right under the Charter of Fundamental Rights of the European Union to have access to a safer alternative to smoking. The legal challenge was rejected by the ECJ in November 2018.

Related Research Articles

Recreational drug use Use of a drug with the primary intention to alter the state of consciousness

Recreational drug use is the use of a psychoactive drug to induce an altered state of consciousness either for pleasure or for some other casual purpose or pastime by modifying the perceptions, feelings, and emotions of the user. When a psychoactive drug enters the user's body, it induces an intoxicating effect. Generally, recreational drugs are divided into three categories: depressants ; stimulants ; and hallucinogens.

Harm reduction Public health policies designed to lessen the negative consequences associated with human behavior

Harm reduction, or harm minimization, refers to a range of public health policies designed to lessen the negative social and/or physical consequences associated with various human behaviors, both legal and illegal. Harm reduction is used to decrease negative consequences of recreational drug use and sexual activity without requiring abstinence, recognizing that those unable or unwilling to stop can still make positive change to protect themselves and others.

Needle and syringe programmes Method of providing drug users with uninfected equipment

A needle and syringe programme (NSP), also known as needle exchange program (NEP), is a social service that allows injecting drug users (IDUs) to obtain clean and unused hypodermic needles and associated paraphernalia at little or no cost. It is based on the philosophy of harm reduction that attempts to reduce the risk factors for blood-borne diseases such as HIV/AIDS and hepatitis.

Vaporizer (inhalation device) Device to vaporize substances for inhalation

A vaporizer or vaporiser, colloquially known as a vape, is a device used to vaporize substances for inhalation. Plant substances can be used, commonly cannabis, tobacco, or other herbs or blends of essential oil. However, they can also be filled with a combination propylene glycol, glycerin, and drugs such as nicotine or tetrahydrocannabinol as a liquid solution.

National Institute on Drug Abuse

The National Institute on Drug Abuse (NIDA) is a United States federal government research institute whose mission is to "advance science on the causes and consequences of drug use and addiction and to apply that knowledge to improve individual and public health."

Drug injection Method of introducing a drug

Drug injection is a method of introducing a drug into the bloodstream via a hollow hypodermic needle, which is pierced through the skin into the body. Intravenous therapy, a form of drug injection, is universally practiced in modernized medical care. As of 2004, there were 13.2 million people worldwide who self-administered injection drugs outside of medical supervision, of which 22% are from developed countries.

Tobacco harm reduction (THR) is a public health strategy to lower the health risks to individuals and wider society associated with using tobacco products. It is an example of the concept of harm reduction, a strategy for dealing with the use of drugs. Tobacco smoking is widely acknowledged as a leading cause of illness and death, and reducing smoking is vital to public health.

Electronic cigarette Device that vaporizes a liquid nicotine solution for inhalation

An electronic cigarette is an electronic device that simulates tobacco smoking. It consists of an atomizer, a power source such as a battery, and a container such as a cartridge or tank. Instead of smoke, the user inhales vapor. As such, using an e-cigarette is often called "vaping". The atomizer is a heating element that atomizes a liquid solution called e-liquid. E-cigarettes are activated by taking a puff or pressing a button. Some look like traditional cigarettes, and most versions are reusable.

According to experts, the total number of individuals with HIV was estimated in 2016 to be between 0.85 and 1.5 million. As for 2016, the prevalence of HIV in adult people was between 0.8 and 1%, and according to the UN, Russia had one of the fastest growing HIV/AIDS epidemics in the world. Approximately 95,000 Russians were diagnosed with HIV in 2015, and approximately 75,000 in the first nine months of 2016. Stigma surrounding the disease, and government indifference have contributed to the crisis. As of 2016 the HIV/AIDS epidemic, despite successes with intravenous drug users, was poised to move into the general population of sexually active young people.

Illicit drug use in Australia is the recreational use of prohibited drugs in Australia. Illicit drugs include illegal drugs, pharmaceutical drugs when used for non-medical purposes, and other substances used inappropriately. According to government and community organisations, the use and abuse, and the illegality, of illicit drugs is a social, health and legal issue that creates an annual illegal market estimated to be worth A$6.7 billion.

Kamiar and Arash Alaei incident Iranian HIV/AIDS physicians

Dr. Kamiar Alaei and his brother Dr. Arash Alaei are two Iranian HIV/AIDS doctors who were detained in Tehran's Evin prison from June 2008 through Dec 2010 and August 2011, respectively. Prior to their arrest, they developed harm-reduction programs in Iran and developed the program Global Health in the Middle East and Central Asia, an HIV/AIDS training program for regional health experts.

Heroin-assisted treatment Alternative medical treatment

Heroin-assisted treatment (HAT), or diamorphine assisted treatment, refers to a type of Medication-Assisted Treatment (MAT) where semi-synthetic heroin is prescribed to opiate addicts who do not benefit from, or cannot tolerate, treatment with one of the established drugs used in opiate replacement therapy such as methadone or buprenorphine. For this group of patients, heroin-assisted treatment has proven superior in improving their social and health situation. It has also been shown to save money, as it significantly reduces costs incurred by trials, incarceration, health interventions and delinquency. It has also drastically reduced overdose deaths in the countries utilizing it, as patients take their dose in a controlled, professionally supervised setting, and Narcan (naloxone) is on hand in the case of an accidental overdose. Opiate related overdoses in the U.S. kill around 70,000 people per year.

DrugScience or Drug Science is a UK-based drugs advisory committee proposed and initially funded by hedge fund manager Toby Jackson. It is chaired by Professor David Nutt and was officially launched on 15 January 2010 with the help of the Centre for Crime and Justice Studies. The primary aim of the committee is to review and investigate the scientific evidence of drug harms without the political interference that could result from government affiliation.

Harm Reduction International, formerly known as International Harm Reduction Association, describes itself as a non-governmental organisation (NGO) in Special Consultative Status with the United Nations Economic and Social Council, and works within harm reduction model in the field of harm reduction. In 1990, the first International Harm Reduction conference was held in Liverpool, England. As Liverpool was one of the first cities in Britain to instigate harm reduction policies, including opening one of the first government-funded needle exchanges under the 'Mersey Harm Reduction Model', the first International Harm Reduction Conference attracted a diverse range of harm reduction proponents, including academics, community workers, medical professionals and drug user activists.

Low-threshold treatment programs are harm reduction-based health care centers targeted towards people who use substances. "Low-threshold" programs are programs that make minimal demands on the patient, offering services without attempting to control their intake of drugs, and providing counselling only if requested. Low-threshold programs may be contrasted with "high-threshold" programs, which require the user to accept a certain level of control and which demand that the patient accept counselling and cease all drug use as a precondition of support.

Responsible drug use maximizes the benefits and reduces the risk of negative impact psychoactive drugs cause on the lives of the user. For illegal psychoactive drugs that are not diverted prescription controlled substances, some critics believe that illegal recreational use is inherently irresponsible, due to the unpredictable and unmonitored strength and purity of the drugs and the risks of addiction, infection, and other side effects.

Martin T. Schechter is a Canadian epidemiologist recognized for contributions to HIV research, prevention and treatments, addiction research, and Indigenous health research. He is a professor and the former founding director of the School of Population and Public Health in the Faculty of Medicine at the University of British Columbia (UBC). Schechter received his Order of British Columbia in 1994 alongside BC's first Nobel Prize laureate Michael Smith and noted Indigenous artist Bill Reid.

The scientific community in United States and Europe are primarily concerned with the possible effect of electronic cigarette use on public health. There is concern among public health experts that e-cigarettes could renormalize smoking, weaken measures to control tobacco, and serve as a gateway for smoking among youth. The public health community is divided over whether to support e-cigarettes, because their safety and efficacy for quitting smoking is unclear. Many in the public health community acknowledge the potential for their quitting smoking and decreasing harm benefits, but there remains a concern over their long-term safety and potential for a new era of users to get addicted to nicotine and then tobacco. There is concern among tobacco control academics and advocates that prevalent universal vaping "will bring its own distinct but as yet unknown health risks in the same way tobacco smoking did, as a result of chronic exposure", among other things.

Construction of electronic cigarettes

An electronic cigarette is a handheld battery-powered vaporizer that simulates smoking, but without tobacco combustion. E-cigarette components include a mouthpiece, a cartridge, a heating element/atomizer, a microprocessor, a battery, and some of them have an LED light on the end. An atomizer consists of a small heating element, or coil, that vaporizes e-liquid and a wicking material that draws liquid onto the coil. When the user inhales a flow sensor activates the heating element that atomizes the liquid solution; most devices are manually activated by a push-button. The e-liquid reaches a temperature of roughly 100–250 °C (212–482 °F) within a chamber to create an aerosolized vapor. The user inhales an aerosol, which is commonly but inaccurately called vapor, rather than cigarette smoke. Vaping is different from smoking, but there are some similarities, including the hand-to-mouth action of smoking and a vapor that looks like cigarette smoke. The aerosol provides a flavor and feel similar to tobacco smoking. A traditional cigarette is smooth and light but an e-cigarette is rigid, cold and slightly heavier. There is a learning curve to use e-cigarettes properly. E-cigarettes are cigarette-shaped, and there are many other variations. E-cigarettes that resemble pens or USB memory sticks are also sold that may be used unobtrusively.

Discrimination against drug addicts is a form of discrimination against people who suffer from a drug addiction.

References

  1. ↑ "Gerry Stimson - Nicotine Science and Policy". nicotinepolicy.net. Retrieved 1 August 2017.
  2. 1 2 Nathalie Dunand. "Gerry Stimson: "Vaping is a consumer led market solution to a health problem"". Vaping Post. Retrieved 20 May 2017.
  3. ↑ "Contact". International Journal of Drug Policy. Retrieved 20 May 2017.
  4. ↑ Stimson, Gerry (1975). Going to see the Doctor: The Consultation Process in General Practice. London: Routledge and Kegan Paul.
  5. ↑ Stimson, Gerry (1982). Heroin Addiction: Treatment and Control in Britain. London: Tavistock.
  6. ↑ Stimson, Gerry V (1988). "Syringe-exchange schemes for drug users in England and Scotland". British Medical Journal. 296 (6638): 1717–19. doi:10.1136/bmj.296.6638.1717. PMC   2546097 . PMID   3135891.
  7. 1 2 "Imperial College London - Gerry Stimson attacks government policy on drugs and crime". Imperial.ac.uk. Retrieved 20 May 2017.
  8. ↑ Stimson, Gerry (2017). "My time with the International Journal of Drug Policy". International Journal of Drug Policy. 39: 143–5. doi:10.1016/j.drugpo.2016.12.001. PMID   28024803.
  9. ↑ Stimson, G V (1995). "AIDS and injecting drug use in the United Kingdom, 1988-1993: the policy response and the prevention of the epidemic". Social Science and Medicine. 41, 5 (5): 699–716. doi:10.1016/0277-9536(94)00435-V. PMID   7502102.
  10. ↑ AIDS and Drug Misuse Part 1. London: HMSO. 1988.
  11. ↑ AIDS and Drug Misuse Part 1. London: HMSO. 1988. p. 75.
  12. ↑ McKeganey, Neil (2006). "The lure and loss of harm reduction in UK drug policy and practice". Addiction Research and Theory. 14, 6 (6): 557–588. doi:10.1080/16066350601002369. S2CID   55323614.
  13. ↑ Stimson, G.V. (1990). "AIDS and HIV: the challenge for British drug policy". British Journal of Addiction. 85 (3): 329–339. doi:10.1111/j.1360-0443.1990.tb00645.x. PMID   2334820.
  14. ↑ Global State of Harm Reduction. Harm Reduction International. 2016.
  15. ↑ Stimson, Gerry (7 November 2020). "The Birth of Harm Reduction Informs the World's Need for Safer Nicotine" . Retrieved 7 November 2020.
  16. ↑ BMJ (3 October 2013). "Gerry Stimson: A life or death moment for tobacco policy – The BMJ". Blogs.bmj.com. Retrieved 20 May 2017.
  17. ↑ Smoking: harm reduction PH45. London: National Institute of Health and Care Excellence. 2013.
  18. ↑ Shapiro, Harry (2018). No Fire, No Smoke: The Global State of Tobacco Harm Reduction. London: Knowledge-Action-Change.
  19. ↑ Shapiro, Harry (2020). "Burning Issues: The Global State of Tobacco Harm Reduction". Global State of Tobacco Harm Reduction.
  20. ↑ "Fighting the Last War: the WHO and International Tobacco Control". Global State of Tobacco Harm Reduction. Retrieved 20 March 2022.
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