UNGASS Roundtable 1: Demand reduction and related measures

Demand reduction and related measures, including prevention and treatment, as well as health-related issues; an ensuring the availability of controlled substances for medical and scientific purposes, while preventing their diversion. (‘Drugs and health’)

Chair: in order to encourage an interactive discussion, this will be conducted without a list of speakers. All participants at round tables are asked not to read prewritten statements. Before opening the floor, I remind panelists to limit their interventions to 5 mins.

Czech Republic: the abolition of death penalty is highly driven by this avenue. We believe that miscarriages of justice might be compensated if victims stay alive – this cannot happen under the death penalty. We also recommend the depenalisation and decriminalisation of drug use. Our drug policy rests on 4 pillars, including harm reduction and law enforcement. Harm reduction is a pillar of the same importance as the others. We have results to show on verifiable data – we have the lowest number of fatal overdoses per capita in the world. We have a uniquely low level of hepatitis amongst injecting drug users. 85% of drug users are involved in harm reduction. The role of NGOs has been immensely positive and irreplaceable. We have done our best to have the harms related to drugs as minimal as possible. As a doctor I am OKwith it, as a minister I am OK with it. In 2013 my country legalised the medical use of cannabis. We believe we have fulfilled the requirements of the international drug conventions.

In a sense, Czech Republic should be considered a country that upholds a pragmatic approach to drug policy. We applaud collaborations between UN bodies on drug policies. We believe this would be a great help to have more economic and feasible drug policies.

Argentina: we have an observatory and scientific information on drug policy. We have not had a public policy on drugs. We need to work together on supply and demand. We have opened 16 care centres with preventive measures. We are beginning to work on community projects as strategy, and the vulnerable population is who we want to target. The municipal level is the most effective level to target this community, it is more effective than the provincial level. My country is large and areas differ greatly in culture. We are trying to protect human rights and work together with neighbouring countries. Our aim is for individuals to participate in public policies. We would like to have continuity in our public policy. We would like to enhance accessibility to services. We are trying to include all Argentinians. We need to enhance this space and have a better future for all.

Norway: Health is not limited to the absence of illness. We are far from handling the world drug problem. We stress the need to push a health orientated perspective. We need a broader recognition that the perspective of health and human rights. Within a balanced approach, harm reduction has an important role. It prevents the spread of diseases. Harm reduction is a set of tools but is not enough. Helping those burdened by drug addiction to achieve a better. Life and not live with adverse consequences . The SDGs are an important approach in tackling the world drug problem. We cannot tolerate that millions of people suffer from pain and can’t access treatments. These substances are important in scientific research. Access is a key area when addressing the world drug problem to close exisiting gaps and coordinate collaboration between UN bodies.

Tunisia: thank you. I would like to recall that Tunisia has ratified all 3 drug conventions. We are trying to treat and prevent drug abuse and allow access to controlled substances for medical and scientific purposes. We aim to meet every 3 months the to address files of drug users. We strive to have strategies in school to prevent harm from drug use. We applaud the inclusion of civil society in the drug policy discussions. We need to consider drug users as patients who need treatment. Our ministry covers all drug use needs for scientific and medical use to provide access and stop abuse of these substances. We are determined to ensure regional and national coordination to combat drug use.

Singapore: we see two approaches – harm reduction and demand reduction, in Singapore we use demand reduction in our fight against drugs, in the 1990s we arrested 6000 people for drug use, now only 3000. Recidivism rates have halved in 25 years. What works for us may not work for other countries. We have targeted preventive education and tough laws to prevent drug use. We have not seen the need to go down the route of harm reduction, we have very little HIV rates and death from overdose. In our opinion, you move to harm reduction if demand reduction has not worked. Our research has proven that using cannabis is addictive. Where countries have been successful in dealing with the demand side, do not need to move to harm reduction. Every country should have the right to choose appropriate policies. We are aiming for a drug-free Singapore, along with a drug-free ASEAN. I am impressed by the words of  Czech Republic and Norway. I hope we can come to a concensous on what is best for our countries.

Senegal, civil society representative. I would like to make an appeal to represent civil society in is field. We need to focus on field work. I will focus on how difficult it is to express the challenges we face in various places. We need scientific reliable data in drug policy. We would like to work on capacity building with children and youth and in educational circles. In order to prevent viruses spreading we need to work on this, also on reintegrating people into society. This should be priority in preventing drug abuse. Even the families of drug users are victims of stigma. We don’t take into account the human right connections – drug users should not be stigmatised, and should be seen as human. South-South cooperation should be developed, as well as North-south cooperation, to recognise the gap that is in this area. We would like to say that cannabis is one of the most consumed drugs in Africa and is related to mental health and displacement of families. This is a great priority in our countries.

UNAIDS. It is an honour for me to take the floor on drugs and health. I want to congratulate my colleague from UNODC, Yury Fedotov, and the team, for organising such a meeting. It is a defining moment and have to ask ourselves a few questions – will we continue with a war on drugs prioritising law enforcement and a criminal justice response or will we restore the balance to improve the health and wellbeing of human kind? After 40 years of repressive responses, it is time to transition towards a comprehensive health and human rights approach. It is time to write the wrongs of global drug policies. My big brother Kofi Annan has a say – drugs destroy many lives, but drug policies have destroyed many more.  In fact, the world is failing to protect the health and human rights of PWUD. Last week, UNAIDS launched the report Do No Harm. This report tries to collect the best examples of where we could change and create space for people to access services. We also saw places where we were not able to do that and where HIV infections increased. For those reasons, the world has missed the target set for 2015. We did not decrease HIV infections by 50% by 2015, we only achieved 10%. We must bring at the core of the debate the insufficient ham reduction programmes and policies that criminalise and marginalise people who inject drugs. We cannot continue to not be courageous and only resort to punishment. We must ensure that human rights are at the centre. The war on drugs is a war on people. People are being left behind because of prejudice, discrimination and bad laws. We must restore dignity to people who use drugs. It brings people who use drugs out of the shadows, a focus of the health and rights of all individuals. We must ensure we leave no one behind. We know that harm reduction works in terms of hep C among PWUD. It delivers wider health benefits and reduces the pressure on the healthcare system. Let us not ignore the evidence. If by 2020 we redirected a fraction of drug control funds towards harm reduction, we would be able to reach millions of people who use drugs with harm reduction services. Let us be pragmatic, use scientific evidence on what works. The UNGASS on the world drug problem and the June HLM on HIV are critical opportunities to treat PWUD with dignity and respect, provide them with equal access to health services, reduce the harms of drug use and continue to the end of the AIDS epidemic and the achievement of the SDGs.

INCB. I want to address this roundtable on access to essential medicines while avoiding their diversion. Countries should ensure availability, it is in the conventions. They express the primary interest of the international community in protecting the health and welfare of mankind.  The important of access is also highlighted in international human rights instruments and a series of resolutions by CND and WHO. 92% of people access morphine in 17% of countries. Most people are left with limited or no access. Widespread conditions of palliative care are not met. This is particularly pronounced in low and middle income countries where 4 out of 5 people requiring treatment do not receive one. INCB has highlighted this important aspect of the international drug control system and identified the reasons for this situation. A comparison of data reveals that the situation has changed. Access is determined by physical availability but also affordability. High costs are major impediments to access. Inadequate estimates that don’t reflect needs, burden of requirements and punishment for inadequate prescribing, lack of training and awareness, fear of addiction, cultural attitudes and fear of diversion are key issues. Training for healthcare professionals remains a priority. The INCB recommends firm action for member states:

  • Review and streamline legislation
  • Strengthen healthcare for improving access
  • Ensure that opioid analgesics are affordable and made available locally at affordable prices
  • Ensure that healthcare professionals can administer
  • Provide education and raise awareness, combat stigma
  • Improve the way states estimate needs and requirements and be more accurate in reporting to the board
  • Establish benchmarks for consumption

Countries need advice, training and resources – there is a role for the international community here. This was reflected in the outcome document and we hope this will be translated with action on the ground.

Panama. Controlled drugs like morphine are essential for pain relief and palliative care. But these are not available in many areas or difficult to use due to legal regulatory or administrative impediments, such as misperceptions among doctors. The INCB estimates that 75% of people don’t have access to such drugs. Panama has maintained a strong position on the use of substances for medical purposes and pain management. A legislative assembly in March 2016 adopted a new regulation to ensure better access. Since 2010 we have a palliative care strategy. We also participated in resolution 67 of the WHO on strengthening palliative care. Panama has followed this and helped to improve our situation. We have technical criteria to tackle the world drug problem, looking at this through a public health perspective. We also believe that a multi-sectoral response is important. A plan of action should be set out to address to drugs for the majority of the world. The UN can provide guidelines to all to improve this situation under guidance from the WHO We hope regulations can be reviewed so that we can provide adequate training for professionals to prevent drug abuse or diversion. We must ensure comprehensive education among children and ensure active participation of other agencies in the country. We must include a universal public health package. This will help us provide patients with healthcare they need.

Korea. I am excited to speak today of our new programme on drugs. The use of narcotics for medical purposes has grown rapidly in Korea because of survival rates of cancer. The directory is one reason for the growing consumption of psychotropics. We established NIMS to monitor narcotics use at all times. It will help control abuse and misuse more effectively without compromising access and improve quality of life at the same time. We work with other stakeholders including medical institutions and pharmacies. We will be fully operating by the end of next year. The system tracks all the steps of drug supply from manufacturing to prescription and sale. The system will also minimise undesirable consequences such as abuse and dependency. i want to propose international society the development of proactive prevention systems. We are ready to share our experience and are convinced that this will prevent abuse and misuse of narcotics.

New Zealand. Our recently released drug strategy focuses first and foremost drugs issues based on health. It provides a framework for improving our interventions over time. It means ensuring access to ess meds while avoiding misuse ad diversion. We will make cannabis products more available for compassionate grounds, as well as expand treatment and harm reduction including OST and NSP. New Zealand has provided OST for 40 years and NSPs for 30 years. But we are also talking about the welfare of mankind and well-being seeking to minimise harm. We have a responsibility to ensure that the environment and social determinants of health are in place. We must connect our drug strategy with addressing poverty, access to housing and employment/education. We work with multiple agencies. We work with families and communities to develop policies that work for them. Drug related law enforcement should also remain fit for purpose. We commit to reviewing our health based responses. It will include drug classification assessments, and access to controlled drugs for medicinal purposes. Three words come to mind – compassion, innovation, proportion. If we use those, we will come a long way to ensure effective drug policy.

Dominican Republic. Despite reiterated efforts made by our states and the UN itself, a challenge remains – that of reducing demand for drugs. This remains very relevant today. This is an essential concern owing to the serious consequences that these have had for our populations. I also refer to the painful reality in addressing drug seizures and incarceration for drug offences. This drug issue cannot be addressed through a victims perspective. Drug use can be considered to be inoffensive, but there are various levels of economic development. Today it is urgent, as we face NPS, for example ATS at global level, we need to strengthen our common and shared responsibility to address and reduce this phenomenon and reach consensus. Each state has its own challenge and differing capacity levels. For this reason, each one must decide on the most appropriate response depending on the capacity and respecting the concept of non-interference. Any policy making drugs more easily accessible should be rejected because all drugs cause public health problems and have consequences for people, families and society at large. We believe in community initiatives and enthusiastically welcome references made by Argentina earlier when the panellist mentioned the involvement of local authorities as part of the response. So far, in the Dominican Republic we had a good response in involving authorities in reducing drug use, based on studies and our own experience. This constitutes an effective solution. We must pay attention to certain drugs that lead to addiction in major developed countries. We must tackle the consumption of synthetic drugs and respond to synthetic drug precursors. A key aspect for us is to respect human rights for all, including universal access to healthcare services. Lastly, we must underscore a policy where we invest more resources in evidence to combat poverty, underscore education. There was also a reference to the right of all people to access education and health services – this is essential in reducing demand.

Australia. Demand reduction includes prevention, treatment, after care and social reintegration, focusing on children, youth, ethnic groups. We recognise the challenges faced by young people and want to explore the ways social media can convey messages.  We focus on resilience and building strong communities, support for individuals and societies needing assistance, with support of civil society and government agencies. We have a step by step approach to treatment, we have more intensive treatment programmes. We also support diversion programmes of non-violent offenders into education and treatment services. Our diversion programmes were launched in 1999. We reinforce the importance of broad-ranging demand reduction strategies to bring together young people, affected communities, civil society and government agencies. We are proud of the role we have taken to ensure access to controlled medicines and commit to working with member states to improve the situation.

Cuba. In Cuba, the world drug problem is set in several principles. Firstly political will. This has led us to address the issue. Next, prevention is crucial. Addressing the world drug problem is essentially based on a prevention policy focused on the culture of rejecting drugs, with a zero-tolerance policy. In my country drug use is prohibited. Our approach must be multilateral with every agency having its own function to control drugs. Fifth, legislative actions from an administrative perspective. This is a last resort to apply this against perpetrators who should be sanctioned accordingly. Sixth, international cooperation, which should be broad, deal with tax matters, customs issues. To tackle the drug problem, we must do this together or we will fail. Next, social reintegration to consider addicts as having an illness and deal with them from a health and social perspective. These pillars have led us to address the drug problem. Of the many sanctioned, only one was sanctioned owing to drug use – our policy has led us to success.

Canada. In Canada we have an issue with opioid prescription abuse. We saw a steep growth in overdose deaths in our country. Last week British Colombia declared a state of emergency because of increases in overdose deaths. Innovative evidence based policies are needed, through concerted efforts with all involved. We make strives in this discussion – a second supervised injection site was approved, naloxone was also approved, we released a study revealing a new option for heroin substitution treatment. Tomorrow, parliament will introduce good samaritan laws and we will continue this work to tackle the problem. We emphasize public health and harm reduction and commit to share our experience and goal of improving health outcomes.

Cyprus. We are fully aligned with the EU drug strategy. On drug prevention, we support groups providing programmes in areas of high risk. On treatment and reintegration, we provide treatment to specific sub-groups to migrants, women, etc. We increase treatment programmes such as in the criminal justice system. We passed last week relevant legislation to refer to treatment instead of punishment. We also provide harm reduction in the health system. We promote evidence based and effective measures. Harm reduction has been implemented in the EU and proved effective including NSPs, OST, naloxone provision. We are happy that the UNGASS outcome document mentions these measures in the context of a balanced approach in demand reduction. This saves lives and evidence should be our only guidance here.

Colombia. UNGASS is an opportunity to look back from what we did and failed to do and still have to do. In Colombia we have neglected demand reduction for years, exclusively focusing on supply. We have neglected the public health aspect for our citizens. In the past few years, drug consumption has increased 3 fold. We now have a true and genuine policy to control demand. A public health policy focused on the individual: prevention (multi-sectoral that can be evaluated, put in place for 5 years). Second, treatment accessible for all citizens with regulations on treatment centres. Third, pilot harm reduction projects including NSPs, OST. Fourth, we have removed administrative barriers to access to essential medicines. We have initiated a process for producing medical cannabis and we will soon initiate granting cannabis prescribing. Public health, human rights and welfare of mankind are critical, based on evidence. Otherwise we will repeat errors of the past. But we must also build state capacity in remote areas of the country. We strengthen leadership and are aware of our objectives. Gradually we are building up our capacity.

United States: Thank you. I am grateful for the opportunity to be here today. I have come here to share our view – that the world drug problem is a public health problem that requires a public health solution. 40 years ago, my country initiated a war on drugs that unintentionally became a war on people who use drugs. It ended up stigmatising and criminalising them instead of addressing the root cause of the problem. What we have learned is that addiction is not a moral failing, it is a chronic illness that must be treated with skill, urgency and compassion. People living with addiction need support and treatment. We have learned the importance of working with partners in law enforcement to balance public health strategies with smart public safety objectives – recognising that both are essential. But we have also learned that we cannot prosecute and incarcerate our way out of the drug problem. Instead we must invest in education, prevention and treatment that leads to recovery. Because last year’s world drug report recorded that 246 million people used an illicit drug in 2013. Illegal drugs are only part of the problem. An epidemic of prescription opioid overdose is destroying lives, in part because of the over-prescribing of these legal drugs and the lack of training and education. We must strengthen training in prescribing practices, help healthcare professionals understand the addictive nature of opioids and their role in the treatment of pain. We now have clear guidelines on this. According to the UN, there were more than 200,000 drug related deaths worldwide in 2014. Our shared mission must be to end this epidemic by using public health tools to reduce substance use and the related consequences. These tools must include medically assisted therapy, using methadone, naltrexone and buprenorphine, non-stigmatising counselling and NSPs, all of which have been proven as saving lives. I urge member states to recognise substance use as a public health problem and to scale up your public health response, adopt evidence-based interventions to prevent and treat addiction and support those in recovery so that all in need have access to the full range of public health services as necessary to rebuild their lives without discrimination or judgement. We have made great advances in behavioural sciences.

Zambia. I thank you for giving me the floor to share some of the efforts of Zambia in addressing the drug use and abuse problem. The most common drug of abuse in Zambia is cannabis, either taken alone or in combination with alcohol, tobacco, cocaine and heroin. Other drugs of abuse are cocaine, heroin and prescribed drugs. Recently we have recorded an increase in demand of heroin arising from the usage combined with cannabis. I am happy to report that Zambia is developing a demand reduction programme through education on the dangers of illicit drugs through counselling, treatment and rehabilitation. To provide prevention among youth, we have included this in school curricula. We have also developed supplementary guidelines. We have initiated a youth development programme, as well as programmes among businesses. We are building a joint programme between the government and UNICEF on prevention. On treatment, rehab and social reintegration, drug dependent persons are treated as patients in various hospitals. Furthermore, the court system collaborates with the police on referrals to public institutions. We also ensure access to substances for medical and scientific purposes. Mechanisms have been established to ensure this while preventing their diversion. We must enhance international cooperation and exchange of information in this regard. I reaffirm Zambia’s commitment to promote the health, welfare and well-being of communities and stand ready to join concerned partners and working groups to work towards eliminating this scourge.

Mexico: Thank you. I wish to refer to the second part of this roundtable on the availability of controlled substances. Palliative care is a concept that gained momentum more than 15 years ago when the international community used it to refer to statements who lived and died in pain. In Latin America we faced incentives to find drugs to relieve pain and these developed. We carry out activities in my country to control drugs in line with international regulations, but this has led to a problem with the supply of drugs for patients. I refer to terminal illnesses but also those that people of all ages face which causes them to suffer pain that can impede their personal and labour development. A study by the WHO and civil society showed how drug laws impeded pharmaceutical distribution of these drugs a few years ago. Mexico has tried to implement laws so that these barriers can be brought down and to encourage doctors to prescribe pain-relieving medication. Additionally, we aim for strict and complete control of illicit substances in Mexico in the spirit of the INCB and the international obligation to tackle the world drug problem and to be committed to health progress. I would like to add that we have to pay further attention to how we treat patients and what medication we make available to them. The main aim is not to restrict illicit substances but to improve the health for everyone. Pain is terrible on a human level and we have to take this into consideration when discussing health.

Italy: In line with the principle of common responsibility, we remain committed to fighting the drug problem and try to do this through bilateral cooperation through several ways. Italy supports the sharing of best practices and the support of UN agencies in doing this. We need to constantly monitor organised crime in all its forms and shapes. Mr Chair, transnational and criminal networks seize advantages of any loopholes, which is why we need to constantly monitor and update our regulations. The use of internet for example is a way that new methods are being used for black markets. It is high time to ensure complete timely cooperation. Together with the 1988 convention, the Palermo convention can play a crucial role in this regard especially with regards to money laundering and the link between the trafficking of people. International cooperation against organised crime could be improved by a successful implementation of the Palermo conventions.

UNODC: UNGASS 2016 offers welcome evidence that member states are increasingly focusing on health-related aspects of the drug problem. We know that drug use disorders are preventable and treatable. The needed interventions can be supported by the work of the UNODC and other partners and more needs to be done to access these services. A chief objective of the conventions is to increase access to medical substances, and this needs to be reflected and anchored in the budgets in all countries. We look forward to more and closer collaboration with all member countries. With the development of SDGs, we are looking to decrease the size of the drug problem by 1930 and to increase the availability of HIV medication and many other therapies and substances. This can occur with the help of the WHO, UNAIDS, and many harm reduction methods. It is critical that policies respect the human rights and dignity of everyone including people who use drugs. Providing access to treatment as an alternative to the criminal sanctions which have caused harm, stigma, poverty and health issues is effective and cost-effective. We should also remember that women access treatment even less than men, and therefore we need to improve the availability, affordability and acceptability of these treatments. We will continue to support strives to reduce this gap and make treatment available. The UNODC supports countries in their efforts in making treatment available to all including those that are incarcerated. We look forward to working together with member states, UN agencies, civil society and the scientific community to help people and save lives.

Scotland, Civil Society Representative: Thank you, I am a member of the UKIP parliament of the Scottish National Parliament. This event gives us an opportunity to discuss issues and improve responses. My own country experiences an epidemic of injection-related diseases in the 1980s and responses related the needle exchange programmes very quickly improved the situation. Harm reduction measures however require more support and budget allowance by all countries. Only 7% of what is required is currently spent on harm reduction measures. A tiny shift in funding could end the spread of AIDS in people who inject drugs by 2030. I urge member states here today to recognize the benefits of harm reduction measures in public and in incarcerated settings and to legally commit to providing these. We need to shift resources away from punitive measures and ensure equitable access to treatment instead. We cannot be serious about human rights and ending AIDS if we do not focus on harm reduction. Thank you very much.

Philippines: Thank you. The drug demand reduction initiatives are often focused on law enforcement. The Philippines have experienced the same dilemma in terms of balancing the fight against illegal drugs operations and focusing on health. The Philippines has its own accreditation system to ensure the quality of doctors and medical staff. We try to provide treatment interventions at the grassroots level. The civil society and governments have been facing issues related to drugs together and we look forward to establishing more alliances to face this problem together by sharing best practices. We extend our best wishes for a meaningful and productive meeting.

Trinidad and Tobago: Good afternoon. My name is Wendy Ann. We recognize that the UNGASS is a good opportunity for us to come together to fight the evil that is the global drug problem. Member states are encouraged to provide access to controlled substances for its own people, however, the two main international bodies, the UN and the WHO, seem to contradict each other. Trinidad and Tobago struggle with the attempt to achieve the dual objective of the INCB. Challenges include controlling the production of crops used for medical substances which can be easily diverged. Our governments has articulated that we need a scientific approach to develop effective demand and supply gaps. We try to focus particularly on vulnerable groups such as children and youth and to increase their availability for treatment. It is the society that ultimately bears the costs of lack of treatment and access to medicines, increased crime rates, the burden of actual drugs. We recognize that this is the shared responsibility of all of us to find solutions to these problem that improve the health and social wellbeing of the people. We need to protect the human rights of all individuals together.

European Union: The EU is happy to see that the GA is united today and willing to adapt their policies according to the needs of today’s world. We are glad to see that the UNGASS outcome documents clearly states a number of harm reduction and treatment therapies. We welcome that it welcomes member states to consider their own responsibility on taking action. Harm reduction measures are effective and even cost-effective. They do improve the health of people and save lives, and there are studies to show this. Drug policies must be based on facts. Member states have no excuse not to apply risk and harm reduction measures. The EU would like to strongly recommend to make harm reduction measures available in those places where they aren’t yet.

Indonesia: Thank you. I am the director of the narcotics control centre of Indonesia. We share the view that that treatment is an important factor in reaching sustainable development. We work with civil society organisations and community based centres to make this possible for more people. There are recommendations that…demand reduction strategies should be integrated comprehensively with the three conventions. These conventions must remain the cornerstone of all drug policy. The successful implementation of demand reduction programs requires care and must be made more widely spread. Thank you.

World Health Organisation: Thank you, I am the Assistant Director General of the WHO. The WHO welcomes calls to strengthen the health-focused approach to drug policy to promote health and welfare for mankind. This is intertwined with issues such as poverty and child welfare. Public health policies should empower people to access help and this is one of the key areas of our cooperation with UNODC and other partners. Special efforts should be undertaken by the international community to make treatments available. WHO also welcomes the commitment to improve access to controlled substances as explained in the outcome document. This is particularly important with regards to those documents listed on the WHO list of essential medicines. As countries develop and move towards universal healthcare, they must remove barriers to access. It is our duty to ensure that people requiring controlled medicines can access those that have proven effective. WHO remains convinced that the conventions can be transferred to mean development and progress for mankind.

Civil Society Representative: My name is Julius Kraemer and we work in prevention in Europe. I want to share with you some results from the young people consultation. We reach out to youth organisation from every region of the world and one of the conclusions is that young people want a public health focused approach to drug policy. They bring up people related to physical, mental and public health. The support initiatives that increase funding for civil society. Young people raise issues regarding the access to treatment for users and that they often face discrimination. 90% of youth organisations we work with say that drug policies cause damage to individuals and society at large. Young people reflect mostly much of what has been said here today but I just wanted to highlight their opinions. Thank you.

United Kingdom: I am from the Department of Health in the UK. Very little attention has been given to providing access to controlled medicines. Most of us would not want this to be the case for ourselves so we should not accept it to be the case for others. The UK is going to continue its efforts to increase access for the poorest in this role. We also need to decrease damage caused when people to decide to take illicit substances. We remain fully committed to reducing HIV and other blood-born diseases. The target to reduce HIV by 2015 has not been met, but we do have the necessary tools at hand. We call on all member states to improve access to interventions. We look forward to addressing these issues. It is important that people are given every opportunity to recover from their dependence with the help of professionals. To achieve lasting recovery support must move beyond medical help towards stability, safe housing, employment, etc. The UK welcomes efforts by the international community and look forward to working together with others.

Singapore: I’m a psychiatrist and a researcher based in Singapore. My team and I have carried out research on the risks of cannabis. We found that cannabis is first of all, addictive. Long-term use was also found to be linked to anatomical change in the brain and brain volume, especially THC. Cannabis exposure is found to be linked to almost irreversible brain damage and sometimes serious mental health problems. There is some evidence to suggest that medical cannabis can help people deal with medical issues, but the writers of these papers have also cautioned towards care when using cannabis medicinally due to lack of knowledge on long-term effects. These findings have been around for decades and do not come from Singapore. I hope some of these findings will be useful to some of you.

Chile: Thank you. We have decriminalized the consumption, this has therefore always been a public health issue in my country. We try not to limit consumption but to protect the health of the population. We do not want to limit the human rights of the people in my country. Public health is a social right and we prioritize young people and children. We know there is a high social cost if we do not face this issue that affects society. In order to address inequity, we need to remember this is a health but also a poverty issue. This is very clear from prevention, treatment, reintegration evidence. We wish to endorse a health-focused approach and to hold a roundtable such as this one.

Brazil: I’m a medical doctor in the ministry of health of Brazil. We wish to highlight our commitment to offering medicines and treatment required for all health issues. Unfortunately, things like hepatitis treatment is not affordable for all people in this world, and governments must do their best to change this. Cocaine and methamphetamines are often neglected as if they were less important or dangerous than opiates. We will present some findings on this at a side event on Thursday. Thank you.

China: Thank you. China believes that demand reduction is an important link in tackling the drug problem and is one of the main pillars next to prevention and education, treatment and dependent rehabilitation. China has been engaged in these pillars. Families and communities have also launched various movements to furthering these causes. People voluntarily register themselves to receive treatment. We provide treatment and help by providing employment for former users. Three principles: reducing the demand should depend on the three UN conventions. Only for medical and scientific uses can substances be legal. If during the treatment, the purpose is not to stop the use but to engage in harm reduction, this is in essence a legalisation as users are free to use drugs freely. We believe that countries vary a lot including due to culture and society, and the effective use should be decided on by the countries according the national realities. There is no one size fits all program, and we do not want to see certain countries or regions to impose their views on others. We think that all measures should be balanced, such as increasing the accessibility of controlled substances whilst avoiding the abuse of such substances.

Spain: Our aim is to work out national strategies and coordinate these into a comprehensive plan to address the drug problem. The plan is not a governmental plan alone but one carried out with the joined help of civil society. We endorse the statements made by the EU and we wish to underscore a few matters that we believe are essential. With regards to demand reduction, no one can question that no one is an addict by choice. Based on this premise, we have the duty to help reinsert people into society. Spain’s experience in addressing this disease and related illnesses has been that substances are addictive and that we need useful diagnosis. The matter is complex. We have recently found that parents that are tolerant on alcohol use of their children are twice as likely to have children with drug problems. This shows that there are several substances with addictive qualities that are linked to each other. I want to add that recently we had a memorandum to train medical professionals in dealing with these issues. This is one possible step towards improving these issues. Regulating markets is not a feasible step towards solving this issue. Thank you.

Slovenia: Thank you, I am secretary of the ministry of health. The most important aspect I will discuss today is that substitution treatment has made an important contribution to an early recognition progress and dealing with illnesses linked to injecting drugs. HIV infections in Slovenia are very low. Most patients in Slovenia are prescribed with methadone and this has been successful. Slovenia believes in providing treatment programs and monitoring these so as to provide clear guidelines for future methods.

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