Side event: Cooperation, involvement and inclusion: how to promote cooperation between peers and professionals in drug work

Side event organised by the governments of Finland, Norway, Sweden, and Denmark.

Ambassador Anu Laamanen, Finland’s Permanent Representative to UN organisations in Vienna: The Nordic countries have had a very deep cooperation for 60 years. We have been pioneers in cooperation. Civil servants meet every year to discuss drug policy. It is very good that in the CND the health and wellbeing of drug users gets more and more mention. Focusing on the rights of drug users has benefits – promoting services for them, and helping to reduce risks. But there are limits to our capabilities. We need to hear the experiences of the target group themselves. So we will hear how peers – former or current drug users – can work together to provide new insights.

Fredrik Wang Gierløff, Ministry of Health and Care Services, Norway: To actually implement user-centred care can be tough, although people often claim to be doing it. We need to move power and influence from the professionals to users and patients. We need to ask what results those most affected would like to see. But can we trust drug users to know what’s best for them? All of us need public services and healthcare at some point in our lives. Drug users are human beings deserving respect – that might seem obvious to us, but to some it is not. My government has made many changes to empower drug users – they can meet with government ministers, and we invited NGOs and users to a consultation about the UNGASS experience. Users are also often involved in providing help to the drug-using population. Users and their organisations are radical innovators in public policies – they know best why treatment does or doesn’t work in the real world. We do not dare exclude users as advisors and partners. The public and media image of drug users has changed significantly – from deviants to citizens. They are not defined by their user or criminal status.

Lina Pastorek, Sweden: Sweden also has a long history of including affected populations in public policy-making. We have to include people impacted by our decisions. We provide a platform where users can have influence and involvement. Sweden hosted an event in November on such participation. We may not always agree with the users with whom we meet, but their involvement helps shape our decisions. Ahead of UNGASS, we have involved lots of different organisations and users. We even want to include a user on the Swedish delegation to UNGASS.

Helena Virokannas, A-clinic Foundation, Finland: In Finland we have a great history of collaboration between peers. Peers are people who have personal experiences similar to drug users. They have inside information that can have positive impacts on the provision of treatment and services. They can bring credibility to this work – users prefer to speak to people who have shared similar experiences. Even an active drug user can be a peer, but they must be sober and functional when they work. Peer contributions are secondary to personal wellbeing – they must prioritise their own health. Peers seek those in need of help, listening and supporting them. They act as a bridge between professionals and clients. They provide clean equipment and health education. Peers seek and map out potential clients from their own networks. They can therefore provide them with information on how the street clinics work, and provide harm reduction. Peers and professionals go together to clients’ homes, to engage them and get them to use public services. In Finland, we also have a women-specific group called VeryNais. 750 clients, via 1,800 meetings, have been reached who were not previously in contact with services. Trust in the service system has increased. When users or former users become peers, their dignity returns, they gain an identity, and no longer see themselves as worthless or criminals. Their drug use also often decreases because they have something else to focus on and commit themselves to. Our main principle is that everyone can do something useful – even drug users. From professionals’ point of view, peers can be colleagues, clients, or both. Each peer is at a different stage of life and we must take that into account. They must not be over-worked and must feel appreciated and valued.

Sturla Haugsgjerd, The Association for Human Drug Policies, Norway: The majority of people who use drugs do not have a problem with their use. I am treated differently because I use drugs on a regular basis. Some countries have very draconian policies, and would imprison or even torture me. I can get hold of drugs very easily, no matter where I am. This is the reality of drug users in Oslo, Norway – my home city. Despite harassment and the threat of arrest, we still find drugs. I imagine a future when our energy spent on obtaining drugs could be put to much better use. The war on drugs has been a complete failure, and we have to engage as many affected people as possible to end it. Nothing about us without us. But you are nothing without us either – because we represent your children, your parents, your brothers, sisters, colleagues, politicians, UN officials maybe. But we are still treated as second-class citizens, through criminalisation and stigmatisation. In Mexico, where I am today, around 60,000 people have been killed in the war on drugs in the past 10 years. Fire cannot extinguish fire. Organised criminals have achieved what they wanted – corruption creeps into all corners of society. Violence and crime are the real danger – not drugs themselves. If we had explored options for regulating drugs earlier on, maybe the Mexicans would not be losing so many lives. Cartels don’t fear arms – they fear an intelligent and mature society. So let drug users like me be at the forefront of shaping society’s response to drugs. Let us keep our jobs, let us contribute our capabilities. In 1998 you told us: “A drug free world – we can do it!” We spent 20 years telling you we were wrong. Our slogan should be: “Drugs: we can do them and still be vital members of society.”

Elina Kotovirta, Ministry of Social Affairs and Health, Finland: We have an obligation to enable the kind of innovation that Sturla mentioned. Harm reduction saves money. Our experience with AIDS and needle exchanges in Finland showed us this. Of course, there are different realities and different drug situations, but it is important to have some common themes in our approaches. We need to help women who use drugs, for example, and provide them with sexual health services and support.

Fredrik Wang Gierløff, Ministry of Health and Care Services, Norway: I sympathise with Sturla’s position and efforts to change current approach but I think that the prospect of decriminalising drug use is some way off in the future. But you also show that active users, not just former users, have an important role to play in policy development.

Sturla Haugsgjerd, The Association for Human Drug Policies, Norway: Thank you, Fredrik. Your statement was also very progressive. I’m very keen on the idea of user participation, as you propose. I’d also like to compliment the speaker before me – she made some very important points. If active drug users are put to use in peer work, they really do have a greater sense of meaning and fulfilment, and can help them use drugs less frequently or more safely. There are many types of drug use, and we need to account for those differences better.

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