Side event: Collaboration between governments and civil society for new drug policies that prioritize health and communities

Organisers: International HIV/AIDS Alliance (IHAA), Harm Reduction International, International Drug Policy Consortium

Bangyuan Wang, IHAA: Welcome Mr. Victor Okioma, Chief Executive Officer, NACADA, Kenya and Ms. Roli Bobe-George, Director, National Drug Law Enforcement Agency, Nigeria who are serving as chairpersons today. Our line-up of speakers have changed a bit, with Yan Soe not being able to join us as he couldn’t get a visa on time, and Pan Zheng, Vice-Minister for Justice, China joining us as an additional speaker.

Victor: This is a good opportunity for dialogue. I welcome Colonel Zaw Lin Tun of the CCDAC in Myanmar as our first speaker

Colonel Zaw Lin Tun: Our traditional drug control priorities focussed on opium eradication and heroin use, but have now shifted to synthetic drugs as well. We developed a drug control policy that included several steps of consultation with various stakeholders including parliamentarians, civil society organisations, police and other government agencies.

Our principles of drug policy includes building safe and healthy communities by minimizing drug related health, social and economic harm, a comprehensive approach to the issues of both illegal and legal drugs based upon long-term development, etc. The priority policy areas include supply reduction, alternative development, treatment and harm reduction, international cooperation, research and analysis for a strong evidence base, and human rights as a cross-cutting issue.

The drug policy was adopted in February 2018. On supply reduction and alternative development, the drug policy focuses on effective laws, money-laundering and corruption,  and creation of opportunities for sustainable livelihoods, and development of infrastructure and human resources. On demand reduction and harm reduction, the focus is on prevention of use, quality of treatment services, rehabilitation and social integration, reduction of health and social consequences of drug use. On research and analysis, the focus is on gaining a clear understanding of drug-related problems.

Please see link to the Colonel’s presentation for further details.

Mr Okioma: we can see a clear balance in Myanmar’s drug policy response, covering harm reduction and alternative development.

Ms Roli: harm reduction is not a component that we can exclude, in order to address needs of vulnerable groups such as people who inject drugs.

Mr Pan Zheng, Ministry of Justice, China: I will present on drug abuse prevention and our drug policy. Since 2015, we adhere to people-oriented, care and assistance to drug rehabilitation the concept, to promote community drug rehabilitation project as a focus while mobilising all kinds of social resources. Our priority focus areas are:

  1. Improve the legal system of rehabilitation and detoxification
    1. China enacted 2008 drug law, and issued regulations in 2011 to strengthen implementation and establish direction of Chinese drug rehab work. Since 2015, China formulated the obtain employment of personnel of support employment, social security, drug addicts, community rehab.
  2. Construction of carrier to promote community rehabilitation of drug addiction
    1. The government put forward, through 5 years of effort, in national community level, built completely special workplaces, specialized personnel management community drug rehabilitation services, through fully mobilize resources from all sectors of society, providing drug treatment for drug rehab personnel, psychological counselling, social teaching aid, employment support services, try your best to help drug addicts to get rid of drug addiction.
  3. Strengthen policy support and guide social organizations to participate in rehab, prevention and treatment of HIV among drug addicts and mitigation of drug abuse injuries
    1. Actively promote community rehab and issued relevant normative opinions
    2. In 2015, China established social org to participate in
    3. Established methadone clinics as an important measure to detoxify and prevent HIV, and death associated with use of drugs. At present, China has established 771 methadone MMT clinics.

Please see link to presentation for further details.

Bangyuan: MMT is available to a lot of people in China, including through take-away methadone, which the International HIV/AIDS Alliance is supporting in Yunnan province. I also want to congratulate Myanmar on adopting their new drug policy.

Ms. Roli: civil society are a valuable partner for government so I now introduce the speakers from civil society.

Emily Rowe, HRI: Although harm reduction programs are being implemented globally, in many places these are small-scale and/or NGO-driven. Harm reduction is evidence-based and cost-effective. Evidence suggests policing and punishment have had little or no impact on number of people using drugs nor prevented millions of drug related deaths. Researchers and advocates continue to encourage shift in spending away from investment in punitive approaches to financing programs that inevitably prevent new HIV infections, save lives and prove to be more sustainable. As part of this research, we asked CSOs to colour-code (red, amber and green) their findings in regard to harm reduction coverage, transparency of data, government investment and sustainability of funding. The Philippines is most dire in terms of harm reduction coverage.

Overall it is difficult to access data on harm reduction funding, eg. stakeholders in Cambodia were not forthcoming with data, and this is serious concern. Even NGOs cannot explain how money is allocated and spent, but this is not unique to Asia. If we move onto government investment it is red for Indonesia, Cambodia, Thailand and the Philippines, but amber for Vietnam.

Overall there is very little government investment in NSP, and more for OST but in Philippines none in either NSP or OST. Sustainability of funding for harm reduction services in precarious, partly due to transitioning status in Cambodia and Indonesia in regard to the Global Fund. The situation is critical in the Philippines due to the drug law which does not permit harm reduction services, combined with inaccurate information about people who use drugs. In Vietnam, there is government allocation for harm reduction but uncertain due to shifting government priorities. HRI is advocating with government to redirect 10% of law enforcement funding into harm reduction, as part of the 10 by 20 campaign. Just a tiny shift in allocation can end injecting-related HIV infections by 2030. Our study indicates that there is an evident need for data on harm reduction spend to be made more transparent.

Please see link to presentation for further details.

Ms. Roli: it’s very difficult to change laws but we can always change practice because there are things we can incorporate along the way. I can also encourage pilot studies.

Haryati Jonet, Malaysian AIDS Council: First I would like to express my gratitude to the Malaysian delegation for coming to this event, and thank you to IDPC, International HIV/AIDS Alliance and HRI for adding Malaysia to this side event. I will share about some steps in drug policy making involving civil society. We have punitive approaches such as compulsory detention where we see people who use drugs in the same vicious cycle. Our home affairs minister Dato Rajak wants to see how he can help drug users, and so we have been involved in 4 weeks of back to back consultations involving civil servants, police officers, NADA officers, rehabilitation officers, and a few civil society representatives to be in the ‘think lab’ to think together, to agree and to disagree on what is the best approach for the community.

I am a drug user, and I have been in the system and some of my friends still haven’t found the right way to be better. We have had controversial debates on quantity thresholds for possession. The possibility of being incarcerated is very high if you are in possession and in the think lab we came up with ideas on some of the provisions in the drug law that could be amended. The timeline for amending the drug law is 2020 – 2022. The road is long as we have to engage with stakeholders including the cabinet. With that, they have in mind a more holistic approach to drug use, from diversion to treatment and voluntary approaches, so that people who have problems with their drug use can have the chance to choose whether they wish to go to counselling or treatment. I hope something will happen, I know the timeline is long but with the right evidence of harm reduction programmes in Malaysia which has drastically lowered the HIV prevalence of people who inject drugs from above 20% to now below 10%. We can see from that that harm reduction is cost effective and saves lives. With that, the government can take a look at the HRI’s 10 by 20 campaign.

Ms Roli: Thank you, it is good to see collaboration between civil society and government. Hope that the legal amendments will come along. Nigeria is working on the law and changing practice, we don’t criminalise drug users and above all dignity for drug users because we should not stigmatise any.

Rajiv Kafle, Asian Network of People who Use Drugs (ANPUD): I am a member of ANPUD, and I am a drug user, I use in the morning and at night. You should give more space for people who use drugs to be heard in forums like this. I actually decided not to be with this group of people after UNGASS as they don’t want to listen to evidence and to science. I don’t know how many of you use, or use alcohol. You might have taken someone who uses methamphetamine and put them away. But people don’t listen. I just tried to speak to the general from Pakistan just before this event, and he sounded like my mom who thinks that drugs is always someone else’s problem. Due to little time, I will just say you need to involve people who use drugs when discussing these things, to people who use methamphetamine when you are talking about it. It is completely different to heroin, it is a completely different high and very individual so not one solutions fits all. I might be able to control my methamphetamine habit but not my heroin habit that is why I decided not to use it but to use cocaine and methamphetamine because I can manage it.

People think we are bad, to the extent that they kill us, in the region I work in. People come here and try to solve the world drug problem but they can’t do it without us—listen to us, and we will charge for that because we have experience in this. We are capable of doing many good things, I take care of 22 orphans in Nepal, which even people who don’t use drugs don’t do. Give us more space, at the country level and here. I don’t know if I want to come back here because people don’t listen.

Mr Victor: This is the challenge, of developing policies, people who use drugs should be at the centre. Perhaps this is what we have needed to hear. Some have listened, and worked with people who use drugs, and we can learn from them.

Bangyuan: I’m sorry for putting you as the last speaker Rajiv, but we will continue to work with partners including IDPC to provide a platform for you.

Ms. Roli: This is a learning curve, we sometimes take a moralistic approach but forums like this help us to dialogue and give voice to everybody, and improve our approach. Bottomline we must protect lives, health, dignity and human rights for all.

Youth advocacy NGO representative: this side event was promoted as being about health and community but I see presentations which focus on law enforcement, and I encourage people in the room to present more perspectives from health.

Bangyuan: I agree but it is important to engage law enforcement and we encourage you to do the same.

Nick Crofts: can I mention the Law Enforcement and HIV Network (LEAHN) which supports police officers and we have several contact points in Asia and Africa. If you know of any police supportive of working with communities, please put them in touch with LEAHN or me.

Col. Zaw Lin Tun: We are not law enforcement, we are the policymaking body. In our consultations on drug policies we do engage people who use drugs, and understand this is all of our problem.

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