How can I buy cocaine online in Israel
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Metrics details. The leading formal drug policy in Israel is the traditional approach of abstinence, probation, and punitive measures based on three main pillars: Enforcement, Treatment and Rehabilitation, and Prevention. However, under the treatment pillar, Israel has adopted a number of harm reduction services, focused mostly on people who use heroin and people who inject drugs. More specialized services are designated mostly for people who use drugs, who frequent the largest open drug scene in Tel-Aviv. Even so, the harm reduction approach has remained controversial, stigmatized, and is considered a sub-category for total-abstinence treatment in Israel. This paper follows the evolution of harm reduction interventions in Israel among people who use drugs and sheds light on the lack of a comprehensive, well-planned, formal national harm reduction drug policy. Although it is a major challenge to translate worldwide evidence and research findings into action and social change, recommendations are offered to implement a comprehensive harm reduction drug policy led by a multidisciplinary group of policy-makers across all areas of drug policy. These focus on expanding and developing more services for Opioid Maintenance Therapy patients and people who inject drugs as well as a national effort to reduce high levels of stigma and discrimination against them, encompassing other common substances and focusing on populations such as adolescents and young adults that engage in other types of substance use such as cannabis, amphetamine-type stimulants, and hallucinogens. Among PWID, heroin is the most common injectable drug. However, there is an alarming spread of injectable new psychoactive substances NPS called Hagigat i. This approach is based on three main pillars: enforcement, treatment and rehabilitation, and prevention. More recently, prohibition-based drug policy has been challenged, debated, and questioned on multiple fronts for its harm, ineffectiveness, waste of resources, and, as a human rights violation, discrimination toward marginalized populations \[ 12 , 13 , 14 , 15 \]. As such, there is an imperative for an updated drug policy \[ 14 , 16 \]. In Israel, the attitude of the establishment and general public has begun to soften. On the declarative de jure legal level, the war on drugs policy continues. However, the de facto substantive reality is focused mostly on drug dealers and less on users. As a result, in April , Israel officially decriminalized adult use of cannabis. Heroin found its way onto the Israeli illegal drug market in around , followed by a rapid increase in the number of heroin addicts. At that time, PWUO were offered barbiturates or transferred to closed wards in mental hospitals with other mental patients \[ 17 \]. Since the mids, Israel underwent an awakening of sorts in its need for a drug policy, when the number of drug users and amount of drugs seized by police began to increase. With media pressure, an inter-ministerial committee was formed in to formulate a comprehensive drug policy \[ 17 , 19 \]. In May , the committee submitted its recommendations. During the s, drug use in Israel evolved from a marginal concern to a social problem demanding a comprehensive solution. In addition, during the s, the Israel Prison Service started providing treatment services for prisoners who used drugs, including MMT \[ 3 , 17 , 21 \]. During those years, different ministries and non-governmental organizations NGOs attempted to offer solutions to the drug problem, but there was a lack of coordination among the various agencies as well as a lack of funding. Recognizing the need for a comprehensive and balanced approach, an inter-ministerial committee was appointed. IADA, under the authority of the Office of the Prime Minister, was the central body promoting inter-ministerial and inter-institutional cooperation and activities as well as formulating all national policies, including those related to treatment and rehabilitation. MOH considers addiction mainly as a health problem and operates medical and harm reduction treatments, while MOLSA views addiction as a social psychological problem and operates cognitive behavioral abstinence treatments \[ 23 , 24 \]. IADA also initiated services and programs against drug abuse and for PWUD, encouraging and funding research on data-based policies \[ 21 , 25 , 26 \]. SCDAA supervised all authorities that deal with drug abuse \[ 27 \]. In parallel, the penalties imposed on drug offenses but not for users in the Dangerous Drugs Ordinance were increased. From the s, various programs for treatment and rehabilitations services in Israel were established, which offered a myriad of treatment solutions \[ 2 , 3 \]. Harm reduction as a drug policy can be defined as policies, programs, and practices that aim primarily to reduce the adverse health, social, and economic consequences of the use of legal and illegal psychoactive drugs — without necessarily reducing drug consumption \[ 28 \]. Harm reduction provides an alternative to the classic criminalization option \[ 29 \]. It has a human rights agenda in bringing effective treatment to traditionally marginalized groups. However, it is confronted by complex ethical dilemmas due to its non-judgmental approach toward users who may pose threats to themselves and their communities \[ 30 \]. Historically, harm reduction has been overwhelmingly associated with interventions aimed to reduce the health harms associated with the injection of opioids such as Opioid Maintenance Therapy OMT , Needle and Syringe Exchange Programs NSEP , and safer injecting facilities. Most interventions focus on the injection of opioids, although harm reduction applies to all types of substances and drug use \[ 31 \]. In fact, during the past three decades, harm reduction has emerged as a stable doctrine in health-related drug policy \[ 32 , 33 \]. Many governmental agencies and NGOs support the promotion of harm reduction policy \[ 4 , 31 \]. Western Europe is a leading supporter of harm reduction policy and practice that is now positioned as part of the mainstream policy response to drug use \[ 34 \]. Israel is influenced by the activity of many agencies in the field of harm reduction, mostly agencies in Western Europe \[ 2 , 3 \]. More recently, treatment professionals and policymakers mostly from IADA and MOH have expressed interest in harm reduction approaches \[ 2 , 3 , 9 , 35 \]. According to the Global State of Harm Reduction GSHR , no explicit supportive documentary reference to harm reduction in Israeli national policy existed until \[ 4 \]. However, according to the newest GSHR published at the end of , Israel has started to explicitly make supportive reference to harm reduction in national policy documents \[ 36 \]. Although OMT has existed in Israel since the mids, it is not considered a classic harm reduction strategy. However, on the declarative level, the main drug policy still supports total abstinence. Harm reduction interventions thus remain the last resort for PWUD. The harm reduction policy of Israel was never clearly planned, balanced or comprehensive. In fact, lately there is concern over the uncertain future of all policies related to treatment, including the harm reduction policy. MOPS is responsible for law enforcement and security, and so the future of comprehensive and balanced approaches to drug treatment policy is very much a matter of concern. The new authority will probably focus more on enforcement and prevention pillars at the expense of treatment and rehabilitation pillars. This may well affect the continuity of promoting coordination of government ministries and NGOs in formulating national policies related to treatment and rehabilitation and harm reduction. Opiate addiction was then considered a chronic condition, and, therefore, the main goal was not abstinence, but rather trying to stabilize PWUO and expose them to life without crime \[ 17 , 18 \]. In Israel, in the mids, a great deal of controversy emerged over the role of MMT. A reaction started to support drug-free treatment. As a result, during the late s, IADA recommended reducing MMT distribution to PWUO and expanded and supported the establishment of a variety of total abstinence treatment options such as therapeutic communities \[ 17 \]. Additionally, MMT treatment was changed from drug substitution only to an integrative treatment, including psycho-social support from multi-disciplinary professionals \[ 2 , 20 , 38 \]. During the s, in accordance with the drug-free policy, MMT was pushed to the margins of the therapeutic system, its professional status and budget neglected \[ 21 \]. In this period, the regulations prohibited privately run MMTs except for a single private clinic to continue and their operation was exclusively in the hands of MOH \[ 3 \]. Currently, there are no waiting lists for any of the MMTs in the country. Most research on Israeli PWUD who are MMT patients confirms the advantages associated with MMT: reduction of opiate abuse, decrease in death rate, and lowering the risk of other complications \[ 40 , 41 \]. Even so, the stigma attached to MMT is very common, even among addiction facility professionals in the social services departments \[ 42 \]. The NA concept of abstinence can be controversial as methadone is considered a psychoactive substance similar to street drugs. For most NA members, individuals who consume methadone are actively addicted and thus a threat to the NA member philosophy \[ 44 \]. As a result, most NA members refrain from contact with MMT patients, derogating them as simply lacking willpower. In , buprenorphine Subxone was included in the health-drug basket, the first substitute for addictions of its kind \[ 46 \]. MOH now claims that buprenorphine, as a partial agonist, is safer than the full agonist, methadone. Buprenorphine is suggested as an opioid replacement therapy during pregnancy, causing fewer neonatal abstinence syndrome symptoms than methadone, with a lower level of dependence and tolerance. With longer duration of action and lower risk of fatal overdosing, PWUDs can be treated in their community and no longer require necessary daily clinic visits \[ 39 , 48 \]. Despite the relatively high price of the treatment in private clinics, most young PWUD prefer to receive BMT there due to limited medical supervision such as random urine tests and minimal or absent psycho-social support \[ 23 \]. With changes to the OST model, the OMT is the currently preferred model, one that includes medical and psycho-social interventions encompassing harm reduction interventions such as identification, prevention, and referral to treatment of infectious diseases. In MOH formal documents, it was reported that there are only 12 public units and 6 private clinics for OMT across the country. As noted, the terminology still considers the latter as inferior to the former. In the lates and beginning of the twenty-first century, an increase of HIV infections among drug users was noted, especially among new immigrants \[ 52 , 53 \]. New immigrants from the former Soviet Union FSU brought their heroin injecting patterns with them \[ 54 \]. PWID tend to be characterized by behavioral patterns including shared use of needles and paraphernalia and unprotected intercourse \[ 57 \]. Yizhar operates NSEP in five cities with a base of professionals, although it relies mainly on volunteers. These NSEP centers provide additional services such as paraphernalia, condoms, warm beverages, food, clothes and shower facilities \[ 53 , 58 \]. In addition, Yizhar volunteers wander the streets where the hard-to-reach user population gathers, especially at nights, in order to distribute syringes to them in the field. In , , syringes were distributed \[ 59 , 60 \]. HIV diagnoses among PWID declined in the absolute numbers of HIV cases, from 70 cases in to 42 in , and these lower numbers remained constant until \[ 53 \]. These outbreaks were associated with changes in injectable drugs — from heroin to the cheaper Hagigat that requires many more daily injections and does not require sterilizing cooking and boiling. Only pre-injection melting is needed due to the high solubility of the new compounds \[ 9 \]. NSEP in Israel is supported by governmental agencies and public health associations. However, NSEP suffers from lack of funding, and is based mainly on volunteer staff. Open drug scenes are defined as settings where public use and trade of drugs occurs \[ 64 \]. They exist in several cities in Israel, the largest of which is located in the old central bus station in Tel Aviv, which began to take shape in the mids. Most homeless PWID are found in this area \[ 7 , 8 , 65 \]. The PWID in the open drug scene who inject heroin, Hagigat , Ritalin, and other mixed substances are considered socially inferior and marginal \[ 7 , 8 \]. In this area, the authorities and NGOs established a few harm reduction interventions. These include the Levinsky Clinic, established in by the District Health Office of Tel Aviv as a treatment and harm reduction community clinic for sex workers and prevention of sexually transmitted diseases. The clinic offers voluntary medical care for the addict population that continues to gather in the area. In , the Yizhar NSEP program was established and the Tel Aviv unit was also located in the FSC, providing PWID with resources such as showers, clothes, condoms, snacks and hot drinks, or just a chat with professionals and volunteers at the center. Once a week, it functions as a harm reduction center for women only \[ 8 , 66 \]. In , an emergency apartment called Saleet was established for addicted women engaged in prostitution and living on the street. Policy makers have recently adopted two approaches among youth and young adult populations based on harm reduction. The second is the harm reduction approach for young-adult backpackers who use drugs. This includes providing tips for backpackers and information in case of emergencies such as acute psychosis due to substance abuse. It was established as a first response site for those negatively affected by drug use \[ 27 , 68 , 69 \]. These initiatives are intended to reduce drug abuse and provide assistance to young backpackers far from home. Protecting young adults from drug-related harm, such as young Israeli backpackers, highlights how much can be accomplished when policymakers and the public approach harm reduction as a net benefit to their own children and peers \[ 70 \]. In addition, new volunteer initiatives for young-adults were set up to provide safety information and consulting as well as safe zone at raves i. Their volunteers identify young people in crisis due to psychoactive substances at popular events like raves. They stay with the individual to provide psychological aid and support. In , the project team reported having treated about emergency cases \[ 71 \]. Recently, following the deaths of young people from the LGBT community related to drug use, the LGBT community embarked on a cooperative initiative with city health and welfare representatives to develop harm reduction interventions. Israel was an innovator in harm reduction services, such as MMT as an acceptable treatment form, in the mids. Even so, and despite some positive statements on harm reduction policy from national agencies such as MOH and IADA, there is still criticism and controversy regarding this policy. Although it is a major challenge to translate worldwide evidence and research findings into action and social change, and it is also challenging to translate the evidence into the local reality, Israel should adopt and implement a comprehensive harm reduction policy led by a multidisciplinary group of policy-maker representatives from all the relevant ministries. Rather, harm reduction approaches and principles should be integrated across all areas of drug policy. They should be applied to all services that work with people who use drugs, with the understanding, support, and collaboration of law enforcement agencies \[ 31 \]. HiAP systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts in order to improve population health and health equity. It can provide a framework for regulation and practical tools that combine health, social and equity goals with economic development, and manage conflicts of interest transparently \[ 72 \]. The lack of comprehensive drug policy in Israel is noted by some addiction professionals, who complain about insufficient resources to make the existing treatment system accessible to needy population groups. As the two major ministries still have different policy approaches to addiction: MOH — public heath approaches and harm reduction and MOLSA — total abstinence. However, the latter does not fit the needs of a wide part of the PWUD. Both ministries should thus coordinate their service planning and agree on a comprehensive treatment-harm reduction national policy. There is a need for less strict conditions for OMT patients then currently exist \[ 38 \]. Also, the aging of OMT patients raises the need to build rehabilitation services that are suitable for the needs of these patients, with an emphasis on occupational rehabilitation \[ 23 \]. Underfunded, it relies mainly on volunteers and lacks strong political support. More professionals such as nurses and medical supervision in treatment centers are also critical. In any case, in the absence of health personnel, the development of an organized network of volunteers, including expert volunteers who receive better training, can be helpful. Also, Israel should adopt more radical harm reduction interventions for PWID such as providing Naltrexone to prevent death by overdose, consumption rooms, and heroin-assisted treatment HAT \[ 8 \]. As noted, harm reduction services are still considered a last resort for PWUO after abstinence treatments. This is so, even though almost a third of PWUO receive OMT and data confirms the success of harm reduction services in Israel and other countries \[ 33 \]. Indeed, there is persistent misunderstanding and denial of the needs of PWID by the authorities and the Israeli public \[ 7 , 8 \]. Thus, there is a need for promoting increased public awareness of Substance Insecurity, defined as the uncertain availability of quality substances or their substitutes and ability to acquire them and safe injection equipment in socially acceptable or not ways \[ 8 \]. Even though and saw an increase in new HIV cases due to injection of Hagigat, an amphetamine-type stimulant ATS , in the open drug scene \[ 9 , 61 , 62 \], the harm reduction policy and services did not change with these circumstances, and ATS harm reduction strategies and services are not readily available. In fact, the drug market dynamic is continuously changing as new substances and new forms of consumption, along with related behaviors, are introduced into the drug-using community. Harm reduction services should be updated to stay current with new trends and adapt relevant responses and services. A national effort to reduce high levels of stigma and discrimination against OMT patients and PWID is an important and necessary undertaking. Harm reduction awareness should target professionals and public alike. Educational intervention, especially among social services department personnel, may benefit people who use opioids and improve the overall quality of treatment for opioid addiction in Israel \[ 42 \]. PWUO are aging and, therefore, need new facilities for older OMT patients such as home visits and home-delivery of medications — even as more young adults with higher socio-economic status are known to use cannabis, NPS, prescription drugs, and other illicit drugs \[ 16 , 73 \]. However, harm reduction approaches, which have some legitimacy in specific domains such as opioid addiction and among PWID, are generally not considered acceptable by the authorities and professionals for non-opioid and non-injecting drug use, especially as an approach for adolescents and young adults engaging in other types of substances use. Of course, most substance users are young adults who favor cannabis \[ 1 \]. Indeed, recent changes in the legal status of cannabis in Israel from probation to decriminalization are potentially transformative. However, they do not alter the fact that except for the enforcement pillar no clear comprehensive enforcement, treatment, prevention, and harm reduction drug policy plan for cannabis exists. One harm reduction intervention recommendation is to provide appropriate information about safer methods of drug use. Medical cannabis patients and young adult recreational users share information and tips on how to avoid harmful cannabis use in informal groups and online cannabis chat forums. However, this should not be mistaken for an official and formal harm reduction plan. Additionally, more harm reduction measures should be taken for youth and young-adult populations. New treatment projects for people who use ATS and hallucinogenic substances at mass gatherings such as raves \[ 71 \] should be formalized with supervision by the authorities and policy makers, as is typical with existing comprehensive alcohol consumption strategy \[ 67 \] and for backpackers \[ 68 , 69 \]. In fact, these examples highlight how much can be accomplished when policymakers and the public approach harm reduction as a net benefit to their own children and peers \[ 70 \]. Nevertheless, there is still more to be done to arrive at a comprehensive harm reduction policy to reduce high risk health behaviors in young adults and other populations. In conclusion, a gap exists between comprehensive harm reduction policies as outlined in international documents and research findings and as they are actually implemented in Israel by governmental agencies. A multisector response is required to ameliorate the harms associated with drug addiction in the country. Psychoactive drug use among the adult population in Israel- national epidemiological survey. Jerusalem: Israel Anti-Drug Authority; In Hebrew. Google Scholar. Israel-Drug situation and policy. Pompidou Group of the Council of Europe, IADA-web, Harm Reduction International. Chemtob D. In Hebrew-Abstract in English. S09—3: Injecting drug use, sex work and differential harm reduction approaches for women: Ethnographic study in Israel's largest open drug scene. Heroin Addiction and Related Clinical Problems, 20, Bonny-Noach H, Ronel N. J Drug Issues. Article Google Scholar. Mell H. Heroin Addiction and Related Clinical Problems. Single convention on narcotic drugs. Collins J. Int J Drug Policy. Public health and international drug policy. Gray J. Why our drug laws have failed: a judicial indictment of war on drugs. Temple University Press Social consequences of the war on drugs: the legacy of failed policy. Criminal Justice Policy Review. Wakeman SE. Reiter M. Treatment of drug victims in Israel. Green, Ed. Drugs-facts, questions and problems. Ministry of Defense, Israel Department for the treatment of substance abuse, Israel Ministry of Health: Responsibility and services. Caspi J. Dangerous drugs: policy, control, enforcement and trial. Haifa: Tamar. Front Clin Med. Methadone and agonists treatment. Hovav Ed. Tel-Aviv: Tcherikover. Ben-Yehuda N. Moral panics: sociological perspective. In: D. Green Ed. Ministry of Defense, Israel Inbar A. The medical treatment of drug addiction in Israel-a report submitted to the special committee on drug and alcohol abuse. Knesset, Research and Information Center. Structured difficulties in the treatment of drug addicts in Israel. In: Hovav, M. Jerusalem: Carmel. Gal S. Israel Anti-Drug Authority: Responsibility and services. Isralowitz, M. Greenwood Publishing Group. Lewental E. Treatment of health services for drug victims. Bonny-Noach H. The evolution of Israeli public policy for drug-using backpackers. Isr J Health Policy Res. Harm Reduction International-web. Einstein S. Harm and risk reduction: history, theories, issues, and implications. Substance Use Misuse. Examining the ethical boundaries of harm reduction: from addictions to general psychiatry. Isr J Psychiatry Relat Sci. PubMed Google Scholar. Drug policy guide, 3 rd Edition. Jourdan M. Technical Guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users. Rhodes Eds. Harm reduction: evidence, impacts and challenges. Natan G. Treatment of addicts for hard drugs and alcohol in Israel. Research and Information Center: Knesset; Global State of Harm Reduction Buprenorphine for opiate dependence: clinic based therapy in Israel. High methadone dose significantly reduces cocaine use in methadone maintenance treatment MMT patients. J Addict Dis. Similarities and changes between and year survival and retention rates of patients in a large medical-affiliated methadone maintenance treatment MMT center. Drug Alcohol Depend. Knowledge and stigma regarding methadone maintenance treatment among personnel of methadone maintenance treatment and non-methadone maintenance treatment addiction facilities in Israel. Can a step program work in methadone maintenance treatment? Treatment of buprenorphine among opiate addicts. Addictions, violence and sex crimes — treatment in view of the law. Improved quality of life, clinical, and psychosocial outcomes among heroin-dependent patients on ambulatory buprenorphine maintenance. Network of outpatient treatment facilities- Isralowitz R E. Toward an understanding of Russian-speaking heroin addicts and drug treatment services in Israel. J Soc Work Prac Addictions, 1 2 , 33— IADA, Annual report. Jerusalem: IADA. Country progress report Israel. Wodak A, Cooney A. Do needle syringe programs reduce HIV infection among injecting drug users: a comprehensive review of the international evidence. Open drug scenes: A cross-national comparison of concepts and urban strategies. European Addiction Research. In: H. Mell, M. Golan Eds. Addiction, violence and sexual offense- mandatory treatment. Ezra SB. S 'a thousand-mile journey begins with one step' - a 'first step' for drug and alcohol addicts. Harel-Fisch Y. The evolution of an integrated and coherent policy on drugs and alcohol in Israel In: R. Muscat, B. Pike Ed. Reflections on the concept of coherency for a policy on psychoactive substances and beyond. Pompidou Group. Rescuing Israeli travelers: effects of substance abuse, mental health, geographic region of rescue, gender and age of rescuees. J Travel Med. Bonny-Noach H, Mell H. A drug treatment program for young Israeli \[2\] military veterans. Textbook of Addiction Treatment: International Perspectives. Pollack, H. Israel J Health Policy Res, 7 1 , Health in all policies: Helsinki statement. Framework for country action. Download references. This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The author declares that she has no financial interest or derives benefit arising from direct applications of her research. You can also search for this author in PubMed Google Scholar. Since , she has been a researcher and lecturer in the Department of Criminology at Ariel University. Correspondence to Hagit Bonny-Noach. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Reprints and permissions. Bonny-Noach, H. Harm reduction drug policy in Israel: what has been accomplished and what still needs to be done?. Isr J Health Policy Res 8 , 75 Download citation. Received : 13 October Accepted : 16 September Published : 16 October Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search all BMC articles Search. Harm reduction drug policy in Israel: what has been accomplished and what still needs to be done? Download PDF. Download ePub. Integrative article Open access Published: 16 October Harm reduction drug policy in Israel: what has been accomplished and what still needs to be done? Abstract The leading formal drug policy in Israel is the traditional approach of abstinence, probation, and punitive measures based on three main pillars: Enforcement, Treatment and Rehabilitation, and Prevention. Conclusions Although it is a major challenge to translate worldwide evidence and research findings into action and social change, recommendations are offered to implement a comprehensive harm reduction drug policy led by a multidisciplinary group of policy-makers across all areas of drug policy. Lack of comprehensive harm reduction drug policy Harm reduction as a drug policy can be defined as policies, programs, and practices that aim primarily to reduce the adverse health, social, and economic consequences of the use of legal and illegal psychoactive drugs — without necessarily reducing drug consumption \[ 28 \]. Harm reduction among youth and young-adult populations Policy makers have recently adopted two approaches among youth and young adult populations based on harm reduction. Conclusions: what more needs to be done? Availability of data and materials The data used in this paper is based on official documents, protocols, and reports available in IADA and MOH archives. Article Google Scholar Mell H. Article Google Scholar Gray J. Article Google Scholar Reiter M. Internal document. Acknowledgements Not applicable. Funding This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Ethics declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Competing interests The author declares that she has no competing interests. About this article. Cite this article Bonny-Noach, H. Copy to clipboard. 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How can I buy cocaine online in Israel
Harm reduction drug policy in Israel: what has been accomplished and what still needs to be done?
How can I buy cocaine online in Israel
How can I buy cocaine online in Israel
Harm reduction drug policy in Israel: what has been accomplished and what still needs to be done?
How can I buy cocaine online in Israel
How can I buy cocaine online in Israel
How can I buy cocaine online in Israel
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How can I buy cocaine online in Israel