Jamie Bridge, IDPC: What impact is your country’s drug policy having? Drug Impact Assessments are not new. The UNODC compiled an Illicit Drug Index that was used in the 2005 World Drug Report but not since then. It might still be used behind the scenes but never reported on again, which is a shame because it could have been used to track changes over time. In the UK in same year, we experimented with the Drug Harm Index, and it looked at 19 different harms, selected because they have data. They only wanted to include harms for which there was reliable annual data they could use, eg. drug-related crime. This lasted for a few years but not in practice now. It is a useful index, and weighted the harms across 19 categories and assessed harm relative to the baseline. In Bulgaria, they did a retrospective review of drug policy impacts from 2009 to 2014, and was entirely the initiative of civil society.

The fact that the UNODC and UK assessments are not in practice anymore are indicative of it being a challenging task. There are issues around data, and it is means trying to reach a balance between simplicity and credibility. The product can be a set of data or different indicators, or it can be a set of composite indicators so that a country can get an overall score out of 100 for example. There is a guide on this that illustrates the compromise between reliability of data and providing easy-to-digest results, eg. the OECD Handbook on composite indicators (2008). It is an ongoing debate.

It is crucial that others are able to complete the data, that it is feasible for completion by country partners, as well as being valuable for country partners in their work. The assessment needs to use existing data and measures, acknowledging issues with availability, reliability and consistency. Also crucially is how to weight the different elements.

On next steps, IDPC has completed a literature review, even indexes that have existed for a number of years, when you dig into the numbers you can see there are a lot of challenges such as missing data. The framework for assessment will be drafted for review by country partners, and produce baseline data hopefully by 2018. For IDPC, this is important as a proof of concept. If we have success in the Baltic States we can roll it out in other countries. Eventually we may be able to produce a global state of drug policy, to match the global state of harm reduction produced by Harm Reduction International.

Tim from Australian Federal Police: what involvement has there been of law enforcement?

Dasha Ocheret, EHRN: we have just started this project and one of the challenges is involving the stakeholders including civil society and law enforcement.

Gerry Rodriguez, Australian Border Force: are you looking to have a single indicator to cover all the categories?

Jamie: we are still working this out, the challenge of going for one score is how to weigh health harms with criminal harms for example. That is a process, and if we do that we will have to involve law enforcement and other stakeholders. If civil society were to do that we might end up giving more weight to health harms, and it needs to be wide accepted and credible.

Gerry: the challenge is also that data may be more reliable in developed countries but not in others.

Jamie: yes that is why we are piloting this in 3 countries first, and we will be guided by the available data.

Dasha: Dadu will now speak on a community perspective on how to tell whether a drug policy is going in a good direction?

Dadu Ballard, ENPUD: today I will speak about drug policy in Eurasia, there are many countries with balanced drug policy but also countries where there is regression. One of those countries in Georgia and I want to tell you some real cases. This is how we want to be, to be able to carry 1 g of heroin in Kyrgyzstan for example, it should be possible to obey the law if you use drugs and should be allowed to carry daily supply of drugs, and we want police to help us not punish us, eg. police can accompany a person in need of access of harm reduction services to those services. In Georgia a problem is human rights, eg. police conducting urine drug testing. At night, police can ask for your urine and you don’t have a choice to go into a toilet, they will give you a diuretic pill so that you can urinate, it is a form of torture. This is written in our constitution, that police can do this, we want to change this law.

With our last President, he set a zero tolerance policy against drug users, and intensified the war on drugs. For consumption of ecstasy, the penalty is 6 months imprisonment and US$450 but normal salary is $200. The results of that policy is that heroin and cocaine were displaced by new home-made drugs (based on pharmaceuticals), massive incarceration of people who use drugs. After that, we now have more injective drug users than before. Now we have krokodil etc. Then we tried to protect ourselves. Everyone was fighting with us so we had to do it, started a campaign on 42nd article of the constitution so that we could refuse to submit to urine testing, but we could be detained for 12 hours and tortured by police, and forced to obey. Article 42 says that a suspect has a right not to testify against themselves, eg. submit to urine test. Police get bonus payments for each positive urine test. The impact on people who use drugs include abuse and torture, economic costs – one fine for drug use is on average their monthly wage, for the possession of 0.00009 desomorphine (= traces in a used syringe) the punishment is 8 years imprisonment. For possession of 2 LSD doeses – the fine is  equal to the price of 2 bedroom apartment and 3 years probation.

The results of zero tolerance approach also saw increased numbers of registered people who use drugs.

This work is supported by a regional project by Eurasian Harm Reduction Network and European Network of People who Use Drugs, with the support of IDPC as lead of the international consortium, funded by the Robert Carr Fund for civil society networks.

Mart Kalvet, Estonia, EHRN: what is desomorphine, and what is it made of?

Dadu: you can go to pharmacy and buy what you want in Baku, Georgia.

Dasha: you can buy this on black market.

Anne, Norway: some of the punishments you describe is extreme. Also you said that when the injecting rooms closed down, the numbers of people who use drugs increased. I’m sure there were many factors, but can you explain connection between closing the injecting room to the increase of numbers of people who use drug.

Dadu: because cocaine is expensive, but if you can cook it yourself, you can produce more and share it with your friends.

Dasha: I think there was misunderstanding that there were injecting rooms in Georgia, there are not.

Mart Kalvet, Estonia, EHRN: it is not so harsh in Estonia, but same motivations can be seen in enforcement officials. We have take home naloxone now, but in trouble spots we see that if you carry naloxone outside your home and if police stop you they have reason to frisk you more thoroughly to look for drugs.

Dasha: these are unforeseen effects, where providing naloxone to members of community can expose them to more risks.

 Jamie: the lived experience of written policies can be different from their intended effects, and we hope to note this in our impact assessment. It cannot be said with absolute certainty that A led to B, but we hope the range of factors can show overall impact.

Dasha: we know there has been some positive interaction between policy and community. I will ask Zhanat to speak on this and the effects of involving police in the impact assessments.

Zhanat Kosmukhamedova, UNODC: UNODC has mandate for working with law enforcement it is good to have balanced approach and meet needs of people who use drugs. Here we are talking about lack of supportive legal and policy environment and law enforcement practices, and we are doing some work at country level to build strong, multi-sectoral partnership and collaboration to address this.

Why is partnership between law enforcement agency and CBO/CSO important? LE official intersect with key populations in situations that often challenge the boundaries of how police are meant to respond. LEA and CSOs are the ones working on the ground – they are the ones with access, the ones that can make a difference. Building bridges, enhancing capacities and creating health space for dialogue between LEA and CBO/CSO are key here. CBO/CSO are experts on providing services for users and not necessarily equipped to start working relationship with police. Our job is to help building bridge and enhance capacity.

How can we help law enforcement agencies to become HIV sensitive?:

• Reform laws – but must ensure reformed ‘laws on the books’ lead to reformed ‘law on the streets’
• HIV sensitive law enforcement practices and culture – training, sensitization, SOPs, orders, promotion goals, liaison and partnership with key communities
• Empower communities: strengthen their capacity and willingness to collaborate with police
• Advocacy for alternatives to criminalization and incarceration, including diversion away from arrest and incarceration.

It would be naïve to believe that training law enforcement officials will lead to changes. Capacity building across the entire policing service can lead to revision of internal policy, standard operation protocols for police working with key populations, occupational health and safety protocols for HIV prevention, treatment and care for law enforcement staff, a clear articulation of the role of police in the national HIV response, an integrated operation framework that highlights the collaboration of law enforcement officials with other stakeholders, and pilot schemes of local police referral services for people who use drugs.

The capacity building work we have done for police to support access to HIV harm reduction services, includes adaptation of UNODC training manual for inclusion in police academy curriculum (Belarus, Brazil, Kazakhstan, Thailand, Vietnam etc); support establishment of dialogue workshops between CSOs and police in 20+ high priority countries; support development of joint action plan between CSOs and police, etc.

To provide training for CSOs to improve cooperation and interaction with law enforcement officials, we have done some work with LEAHN and INPUD.

Mario, EU Action against Organised Crime: Our work covers central and south Asia. I think it is very useful to go beyond the usual indicators of arrest and seizures, and it is important to know the impact of policies. But how do you tell a country that their policy has failed? How can you ensure results of your research is objective?

Jamie: When we had our first discussion with country partners, they told us that being able to compare countries, particularly neighboring countries, could help their advocacy. There are cross-border advocacy groups and communications mechanisms, so this project will promote results and hopefully get media interest. The country partners believe it will help bring change to their country. So the project is not just about data collection it is about using that data.

Dasha: we are going to have a pilot in 3 countries but we want the international community to agree that this is important and to agree on methodology. We want to assess how countries are with their drug policies and promote best practices. We know we can’t move forward with drug policy unless we get agreement on measuring impact on drug policy in countries, otherwise our resources will be spent in a chaotic way. We will continue to approach civil society and other actors to see if we can have a formal discussion next year.