Side event: Drug policy: Saving public costs

Eliza Kurcevic, Eurasian Harm Reduction Association. What costs more? Criminalisation (prisons) or social and health services (different treatment programmes, prevention, employment benefits, social security services, etc.)? You can use the link here to vote. Here is a map here which measures the costs of criminalisation in Eastern Europe and Central Asia (EECA). This assessment was made by civil society partners in 29 countries in the region. We included civil society and community partners, how much it costs to keep people in prison, and how much it would be to offer OST, unemployment benefits and NSPs. You can see that the numbers are in two colours: in pink you see how much it costs to keep people in prisons, and then in black how much social and health services cost. In some countries, criminalisation costs 3, 5 and even 10 times than health and social services. And this does not include the costs of investigation and the whole criminal justice proceedings. We are only counting the costs of incarceration. There are huge differences between the two sets of costs. In Bulgaria, the costs of imprisonment are 10 times higher. Do not forget that if we let people out of prison, we need integration services into society, which also cost money – and this has to be factored in the criminalisation costs.

Where would we spent the money if we did not put people in prisons? We counted that if we didn’t put the person in prison, we could help two people living outside of prisons with NSPs, OST and unemployment benefits, to reduce marginalisation. More information on our assessment can be found on the EHRA website, with a drug calculator that enables you to see the punishments for different offences in different countries of the region. Here I presented the negative side of things, but Inga will present how we can invest this money for the future, with the example of Lithuania.

Inga Juozapaviciene, Lithuania. How long does it take to bring some results when you change drug policy? Here again I encourage you to vote. The title of my presentation is ‘Back to the future’. This title reflects what happened in our country. We are open and honest to talk to you about this situation. In 2016, we intended to modernise our administrative law, and removed the responsibility for the possession of small quantities of drugs. This would have been a good thing, but we actually criminalised the consumption of small quantities of drugs. The new legal system entered into force in 2017. This wasn’t a review of criminal policy itself, but the situation brought us back. We now need to move on. 1,385 is the number of young people criminalised for drug possession in one year because of the new law. This is twice more than in the previous year, 2016.

So the answer to the main question is this – drug policy changes can bring a result in one year. On the other hand, the answer is also no – if you talk about real drug policy change, it takes time and we have to work hard to reach some results. Still, we have a modern car. We just need fuel to run it and move on. We have a pilot project in our capital where police officers and criminal justice officials are working together to refer people to health services. Now we have 100 people in one year in treatment, and 105 getting employment. We prototyped our future and have new long term strategies in Lithuania to decriminalise, but also to review deeply our criminal policy. This happened thanks to the good cooperation with the NGO sector. At the end of last year, the Parliament adopted a new law. It was hard, but we succeeded because we believed in this review. Our strategy contributes to zero overdose deaths, 2x less HIV infections, equal services in prisons. Am I an optimist? Yes I am. I am now turning to our colleague in Estonia and ask what good practice you could propose for Lithuania? And could peer consultants from PWUD community be effective as an alternative to imprisonment?

Aljona Kurbatova, Estonia. The answer is clear: yes. We made choices in drug policies decades ago and are known as a small country with a drug problem we are desperately trying to solve. I acknowledge my good partners, the Police and Border Guard, the Estonian Network of People Who Use Drugs, and others. They have a unique experience and competence on what we are working on.

Drug use in Estonia has been decriminalised for a decade. It is still illegal, people are processed and are financially fined or put in administrative detention. So we still have issues of punishment for people who use drugs and society in general. So we started thinking with the police on what could be done. We looked around and saw Portugal as one of the best models, but as a small country we didn’t have the resources to build a model like that. So we started to look further and discovered Law Enforcement Assisted Diversion (LEAD) in Seattle. This is now being mainstreamed across the USA. It has very good results, and what’s different about it is that it is a community-based approach that emerged as a harm reduction approach, focusing on case management. It provides help to people not specifically in treatment and health settings, but also a social approach. I will walk you through the programme.

The programme we elaborated with the police and civil society partners needed to be flexible and simple. We needed a programme that didn’t lead to new work for the police. We established a support service provided with NGOs working on harm reduction. The police officer catching a person using drugs has the choice to offer the programme. If the person using drugs agrees, he is referred to a support person. The rest of the work is done by the support team. There is a risk assessment, which is simple. They agree together what are the priorities and how the problem should be solve. We don’t force people to stop using drugs. We want to make sure they just don’t cause public nuisance. We focus on peers as support persons. 11 persons are peers and have first-hand experience, then we have 1 social worker and 1 psychologist. People with similar experiences can be empowering, and this is important for the police too to see people they come across as possible role models. What is important is that peers can be valuable and an invaluable work force, but they also need support. The high level of empathy makes them vulnerable. We help them establish a system of support. We offer them team supervision and personal supervision.

People are given a chance, they are more receptive to participate in the programme, there is a relationship of trust established between people who use drugs, peers and the police. The community-based approach is increasing, and there is a flow of requests from the prosecutor’s office to expand the programme to other regions. I am happy to quote the chief of north police of Estonia: ‘There are thousands of people who inject drugs in Estonia that have been socially marginalised due to their addiction. In many cases these people are stuck, they are unable to get help and don’t see any way out of their situation. They need someone to listen to their worries, someone who helps them make the first steps towards finding a solution and to improve their lives’.

With the programme, we are able to help and support people with the most complicated cases. They can truly change their life. Now I will pass the floor to Inga, who will discuss Norway’s perspective from civil society of how they can help with the process.

Ina Roll Spinning, Association for Safer Drug Policies. I want to discuss Norway’s drug policy revolution and how civil society has contributed to the change inspired by the Portuguese model. A few years ago, I met a young man who was using heroin. I tried to convince him to seek treatment, and he said: you tell me heroin is killing me, but it’s the only thing keeping me alive. He began to tell me about his traumatic life, and I realised that people who are chasing around whom we have failed to protect from abuse and other trauma. We were not able to protect them when they were depressed, suffered from panic attacks, etc. We have made their lives worse and made their recovery more difficult. In 2014, the police wanted to eliminate the drug scene in Norway. People were denied access as a crime prevention measure to specific areas of the city. Those who violated this rule had to pay a fine, or were incarcerated if they couldn’t do so. Disenfranchisement and prison cannot solve this issue, and people knew it. But they thought this sent a strong signal for youth.

This is Kristoffer, 18 when he was caught for cannabis use. His driver’s licence was taken from him. He committed suicide because of his experience of criminalisation. This is an extreme case, but criminalisation adds to those who are already burdened.

Norway has a two-faced approach. On the one hand, they have a strong focus on treatment and harm reduction. On the other hand, we still insisted on treating people who use drugs as criminals. In 2015, the Parliament believed that repression was necessary to keep prevalence of use low. In the end, something happened. Organisations fighting for decriminalisation got together and joined forces, signing letters and opinion pieces on decriminalisation and the Portuguese model. Doctors, lawyers, psychologists joined the fight. We thought it would take years for changes to happen. But in 2016, the MoH of Norway had a change of heart and convinced the Conservative party and others to move towards decriminalisation. We now have an expert committee where civil society is represented, several meetings were arranged across Norway. We also decided to get new medications including with heroin, and to open drug consumption rooms. I hope that other countries can learn from our experience as every human matters. It’s time to give peace a chance.

Question from the floor. You compared the costs of prisons compared to health and social services. In Norway we would compare prisons and specialised health services. This would be twice the price. But it is still cost-efficient, because the money we put into treatment yields results.

EU Action against Drugs and Organised Crime. The project started 100% on supply reduction, but we decided to have a balanced policy, and have now 50-50% investments and I am thankful for the participation of nordic countries. My question is to Estonia: I want to employ you in one of our activities. We finally employed one Lithuanian colleague. My question is: you mention a team of 13 people. How many cases can be handled at the same time?

Estonia. When we piloted the programme, we had around 100 cases but we are expanding. This is a growing number so we will need more peers. Over 20 cases per peer is already too much because the load is too heavy for time and emotional burden.

Question from the floor. I have three questions: we want to copy your project. Are the peer consultants volunteers or paid? Do you do the referral only for those people detained for drug use or also possession of small amounts? What do they do if the police stops the same person several times who didn’t use the services? Is there any penalty?

Estonia. We are fine-tuning. It is a paid position, it is not voluntary work. Another thing is that it’s a referral and people can also come voluntarily. If it’s a repeat offence, the police again refers them to us. It is police discretion but it is not a one-time referral. We do this as long as it takes.

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