3rd Informal Civil Society Hearing – Discussion: How do the UN drug conventions accommodate a health-based approach?

This session focused on how the UN drug conventions accommodate a health-based approach, and was chaired by Graciela Touze, Intercambios and rogers Kasirye, Uganda Youth Development Link.

Paul Rompani, Executive Director of Mentor International. My organisation works to prevent drug use and substance abuse in particular among young people. Prevention is one of the main components of drug control. We are concerned with the use and abuse of illicit drugs included in the conventions, but also alcohol and tobacco. Since the conventions were established, the types of prevention approaches evolved significantly. First they focused on the fact that drug use was morally wrong, through printed leaflets. The next phase aimed to provide unbiased information on drug use. But this was not sufficient. More recently, we included the need to address risk factors and enabling factors, taking into account social behaviours. These programmes aimed at promoting healthier habits. I encourage the adoption of the WHO definition of health – a state of complete physical and mental well-being. During the last 20 years, drug prevention has become scientifically based. Practitioners and policy makers have a better understanding of use and abuse. Studies and trials on prevention indicate that these have reduced risks and prevented anti-social behaviours among young people. We have also seen that we need to move away from universal prevention into selective prevention with different approaches for different needs. Research also indicates that there are also ineffective practices. There are scarcely any voice promoting the development of research on prevention practices. It is critical to support this in low- and middle-income countries to contribute to the knowledge base. Member states and NGOs should work together on the meaning of health and develop approaches within the framework of the conventions that are evidence-based and realistic.

Ann Fordham, Executive Director of the International Drug Policy Consortium. IDPC is a global network of NGOs that come together to promote policies that are based on human rights, health, development, social inclusion. We hope that there will be strong civil society representation towards the 2016 UNGASS. I want to agree with Paul that we should be talking about health in the broader sense. The Drug control system is premised on the protection of the health and welfare of mankind. And there are provisions in the conventions that provide for the development of health and social interventions. However, there are also clear limitations in the conventions since they promote a clear focus on criminal penalties and law enforcement. So what are the practical implications of this? Governments have relied on punishment and repression to deter involvement in the drug market with negative consequences and little impact on drug use. A study by WHO showed that levels of drug use in society were independent from harsh or less harsh penalties. But harsh penalties led to mass incarceration, the construction of drugs as a moral failing and a security threat (leading to compulsory detention, overdoses, HIV and Hep C transmission, escalating violence, problems in producer countries). If we are serious about health we must be serious about harm reduction. This includes ensuring harm reduction for people who use drugs – harm reduction is about to reducing harms among people who use drugs, such as needle and syringe programmes. But harm reduction can also be applied to the drug market as a whole. The sole focus on the eradication of the market is at odds with a health-based approach to drug control. There have been positive developments, for e.g. in the USA where alternatives to incarceration were introduced. There are also decriminalisation policies being implemented, such as in Portugal where the country has adopted a strong health focus. The important trend of cannabis regulation in two US states and Uruguay has been designed in the interest of protecting health. These developments do violate the conventions. But this highlights that the conventions that are 50 years old may not respond to today’s realities. We have been following the debate closely over the past few months and joint positions are difficult to achieve. There is a disconnect between issues on the ground and the policies at national and international level – with the inability for the CND to respond to these problems. We call on UNODC to start a serious debate on drug control.

Fay Watson, EU Civil Society Forum on Drugs.  I am talking on behalf of all 40 members of the CSF on drugs. We meet at least once per year to exchange views among various CS groups and the EU. I will talk about the evidence across Europe. The EU drug strategy is very comprehensive. CSOs at the CSF on drugs played a role in developing the demand-reduction side of the strategy. We have evidence about drug prevention across Europe. Unfortunately, an EMCDDA study showed that only 2 countries across Europe were implementing evidence-based and effective prevention programmes. There will be a conference in Iceland soon on these issues. A programme paid for by the EU found that prevention programmes were effective if they focused on developing life-skills, in particular among young people. In the field of risk and harm reduction, evidence shows that Opioid Substitution Treatment (OST) is effective in reducing HIV and hepatitis infection. There is research from Amsterdam on which treatment models can be effective for users and their families. Family motivational interventions are very effective to reduce uses of cannabis, but also to reduce the effects on families. Rehabilitation programmes instead of prison are also very effective and in practice in Europe. In terms of social integration, it is not something widely used in Europe and other regions, although it is very important in terms of standards of living, professional training, etc. At the CSF on drugs, we have a few organisations promoting the social reintegration of drug users. In terms of recovery, a combination of pharmaceutical and psychosocial interventions are best. All of these interventions can be developed within the framework of the conventions.

Arthur Dean. I want to talk about alternatives to incarceration. In the USA, we have 2,000 judges that supervise people caught up in the criminal justice system for drugs offences. They are supervised in a treatment process, in a formal way through drug courts. For more information, please attend the side event on the issue next week. It is an effective way to help people and reintegrate them into society. My organisation supports our members with technical assistance, training, research dissemination and evidence, and advocacy work. We also work on tobacco. The 3 drug conventions support this work to implement effective, comprehensive and evidence-based interventions. Drug prevention is key to make this happen. We need law enforcement, education, treatment, and youth involvement in the community. All should come together to work in a comprehensive way to reduce the demand for substances in their community to achieve a drug-free community. We are doing similar work around the world, offering trainings in 24 countries where we promote the same practices and interventions. We must assess what the problems are, see what intervention is necessary, and implement it to ensure the best outcomes possible. We do not support legalisation as the best intervention to overcome this problem. We have found early research in Washington and Colorado on the damage related to legalisation. We will hold an event next week to discuss these challenges in those states. We do not arrest people for drug use any more in the USA.

Questions and answers

– I do not believe that drug control does not have an impact on levels of drug use.
Ann response: This study has been done by very prominent experts members of the World Health Organisation. the policy response can shape the drug market in a positive way. Responses based on harm reduction, ensuring that people can have access to health services. But criminalisation is problematic. So policies have a role to play, but not necessarily to reduce drug use prevalence.

– We need to acknowledge that a debate is happening. This has been difficult to do over the past months on the negotiation of the Joint Ministerial Statement.

– When we talk about drugs, we talk about demand and supply reduction. When we talk about health, we talk about demand, but not supply. This question is for Paul – external factors do influence prevention in the supply side. Do you work on this issue?
Paul response: We are concerned in my organisation with drug use among young people. Social acceptance does impact on levels of use. So the criminal justice system will have an effect on social acceptance. So any policy that makes drug use less acceptable, then we encourage it. However, we don’t fully understand the impact of a substance on a young person’s mind. We don’t work on supply side issues.

Opinion on Portugal decriminalisation?
Fay response: When Portugal decriminalised, they focused very much on referring people to health services. A study showed an increase in drug use among people 15-16 year-olds. But for Portugal, drug use is still an offence although it is administrative and no more criminal. It is not necessarily true that you could adapt Portugal’s example to another country. This is what we saw when we tried to apply a new alcohol policy into the UK – this actually had negative effects on UK alcohol use.

– Finland delegate: Yesterday we agreed on the focus of dealing with health effects in drug control. For you, what would be the number 1 issue that should be changed here in Vienna?
Fay: At the CSF on drugs, we have many different perspectives. From a personal perspective, I would like to see the role of social inequality to be more prominent. There is a lot of scope for research on this now.
Paul: From what I’ve heard today, much of the advances in tackling drug demand reduction can fall within the drug control conventions which are flexible enough. they are effective and efficient. In terms of international policy, we must look at interpretation of the conventions to make sure that what works is delivered on the ground
Ann: It is very difficult for IDPC as a network to offer one single policy change. I agree with Fay and Paul. But first and foremost, what we are really calling for is an honest and open debate. The fact that real discussions are going on outside of Vienna, means that Vienna does need to take note of the debate and that there are significant problems related to the current system. We do need to modernise the system. We also do need to focus much more on access to essential medicines. The system was set up to ensure that people would have adequate access to the relief of pain and suffering and the system has failed. There is flexibility within the conventions, but governments don’t utilise this flexibility to the best they can. But this does not mean that some reviews of some aspects of the conventions are not necessary.
Arthur: the multi-sector, community-based approach is critical. We must build on the community to address the issue of substance abuse. We must understand the strategies to prevent, and then tackle drug abuse if it does happen. I also do believe that there are good alternative strategies to incarceration and we must adapt and perfect them. Drug courts are one example of these.
Rogers: One issue that has not come up is where we place children in the system. Coming from Africa, people keep asking us about children. If we want to improve policies, we must also include the issue of children.

– WOLA and IDPC representative: My area of expertise is Latin America, but want to say that people who use drugs do continue to be arrested for drug use in the United States.

– ACLU representative: I am interested in hearing the data that backs up the harms that have taken place in the States of Washington and Colorado. I also support the fact that people do keep getting arrested for drug use, in particular for cannabis use. Data demonstrates that the average days that a person spends for marijuana use is 4 days in the USA. These are alarming rates. 

– Kevin Sabbet: If we look at the past 5 or 6 years, there has been an encouraging reduction in incarceration rates for drug use. Many people who come into the criminal justice system don’t come for drug use, but for offences around their use. RAND has just published a study on marijuana possession and the change of a person smoking cannabis per year was 1 in 12,000. The largest category of reduction in incarceration is the female African-American prison population. Policies have changed. 

Graciela Touze. The debate is very lively within civil society and this is healthy. We should not be afraid to initiate the debate. It is not necessary to agree on every point.

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