Side Event: Beyond 2019: African Civil Society Common Position on Drugs

Organised by the Slum Child Foundation, the UNODC Civil Society Team, and the Vienna NGO Committee on Drugs

Mirella Dummar-Frahi (UNODC Civil Society Team): I have the privilege to moderate this session. We have been working in close cooperation with the Vienna NGO Committee on Drugs for many years. It’s great to have a joint event. I give the floor to the director for the division for policy affairs – Jean-Luc Lemahieu. He has been heading this division since 2013 and supporting the work with civil society.

Jean-Luc Lemahieu (UNODC Civil Society Team): Allow me to thank the Slum Child Foundation, African Union, and the Vienna Committee. It’s a pleasure to be here and sit next to George Ochieng Odalo, founder of the Slum Child Foundation. We were luck enough to engage with them for many years and are delighted to see the impact they’re making, not only in the slums in Kenya, but in taking this initiative on. We would also like to thank the African Union to allow space for the civil society to discuss and develop the common position.

The links between drugs and crime are very clear. Transnational organised crime is like a virus, festering on law immunity governance. Like any disease, it further lowers that immunity system of governance. Of course the impact is so much more devastating if your immunity system is already very low. As an example, in Kabul we had the Kabul Bank Embezzlement scandal – $1.3 billion disappeared. At the same time, HSBC in London was fined 1 billion Euros. In London there was greater resilience. In Kabul, that cost the country 5% of its GDP – which was needed to provide employment and develop youth.

We have enormous potential of youth to come forward. But we do know that if we look at the groups showing deviant behaviours – that’s also the young people. How do we avoid these challenges?

We are extremely happy to have African NGOs playing an active role, and will need to see even more of you. We want to thank as well the role of African NGOs in implementing the declaration of 2019 and the African plan of action in controlling crime prevention. Both very important to guide us forward.

Cisse Mariama Mohamed (African Union): The CSO community is 100% part of our plan. In the development of drug control, we need CSO partnerships. They have been helpful in advancing drug policies and are also key in drug education, prevention and treatment – in all member states – and in harm reduction. I’m informed that the army of youngest who turn the corner are growing on our continent – how can we support them? How can we mobilise them – not only for drug education, but health and prevention – not to mention how crucial they will be in passing on skills like ICT and agriculture.

Let me turn to our new AU Plan of Action on Drug Control and Crime Prevention 2019-2023. CSO involvement will be critical in all the nine pillars of the plan of action. CSO features strongly in implementation matters.

Pillar 1, with its objective to prevent drug use, enhance treatment and reduce harm, and implement and alternative to punishment for drug use – this will require strong CSO support. The same goes for cross-cutting pillars focused on human rights and vulnerable groups like women and children. Not to mention the critical role of CSOs in data-gathering. I fully support the African Civil Society Common Position as it will help us achieve our outcomes as identified under the pillars.

George Ochieng Odalo (Slum Child Foundation): One thing I believe is that it’s not where you’re coming from; it’s about the vision you have for the world. I’m grateful to the UN and the AU – I have now seen how far you can go. The most important thing, first of all, is to thank the UN for the support offered to us, the AU for accepting to be part of this and being able to accommodate civil society. In this room, we need to understand that it is not about us – it is about that slum child in Nigeria, or Nairobi; it is about those who have no access to treatment; about those children who have no hope and end up taking drugs. We are talking about these young people who do not have access to the UN. We are privileged to be here, but how about the civil society working in poor areas of Africa – this document is basically talking about them.

We have a lot of challenges we’re facing every day, including poverty, technical assistance, capacity building. The common position is an answer to all this; we will be able to move another step higher and keep things at the right level. Allow me to assure the AU and the UN, and other CSOs, that we will walk the talk – we will ensure the common position is well-implemented. We will work closely with states parties that have agreed to work with us.

For some of you in the room, look at the common position. It’s always important to know what we have committed to. I’m happy that we are basing our foundation on evidence-based interventions. It should factor in every single person on the continent. We are looking forward to be the best in the world and we hope Europe and other continents will follow what we’re doing.

Charity Monareng: Let me reiterate our gratitude to the AU and UNODC. The beauty of the common position is it acknowledges the efforts that African states as made – given it was seen that African countries were just transit routes and not a place of drug use.

The African Plan of action has mentioned harm reduction (for the first time) and alternatives to punishment. In South Africa, drug use has been criminalised for the longest time – with the majority of the prison population young men under 30. This is alarming considering unemployment rates. In discussing decriminalisation and legalisation, we are willing to come up with African solutions for African problems.

Our core is for African states to partner with CSOs, and using the SDGs to address the drug problem. If we’re not looking at a large population of people in our continent, we won’t be able to reach our targets.

Ebstesam Ahmed: One of the objective model drug law is to focus on enabling and facilitating adequate availability for medical and scientific purposes. Not only focusing on policies, but ensure these are implemented – medicines are available to patients.

  • Pain and symptom control are necessary for quality palliative care delivery in African countries
  • In 2012 and 2013 respective there were an estimated 850,000 new cancer cases and 1.1 million HIV/Aids-related deaths in Africa
  • It is projected that by 2030 the incidence of cancer will increase to 1.28 million
  • Palliative care has been shown to decrease the suffering and morbidity from these incurable diseases
  • Rising cancer and HIV/AIDS burden

Availability of pain medication: 7.2 million die with HIV or cancer with moderate to severe pain, 2.3 million of these had untreated pain. 74% of these deaths are in low and middle income countries. 36% of the world’s untreated deaths in pain were in Sub-Saharan Africa.

Human Rights Watch has done a lot of work on access to pain management. They have spoken about it threatens fundamental rights, and the provision of essential medicines is part of the minimum core obligations under the right to health.

The 2017 Lancet Commissions Report on Alleviating the access abyss in palliative care and pain relief – they estimated that 25.5 million currently died with health-related suffering. Over 80% live in low-income and middle-income countries where access is severely lacking.

The WHO also considers morphine and essential medicines for the treatment of pain – but if you live in a low income country, you basically have no morphine access. As a pharmacist I can tell you that it costs almost nothing – 3 cents per dose – but it never reaches millions of people who never have access to it.  We need this. This is the result of a deliberate, short-sighted policies that result in millions of people suffering.

Barriers to access: insufficient knowledge and training on efficacy and safety profiles – inappropriate use or no use. Practitioners are not well-trained and are not sure how to treat pain, so there is a lot of fear of opioids -including misuse and diversion, and labelling individuals. There is also inaccurate quantification of need in the supply chain. Culture norms also, as well as a lack of policy in regulations – in many countries prescriptions have to be written on a specific form with a specific stamp, etc. All of these are barriers.

2013 paper on Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in Africa. Showed that availability for some was almost never in some countries. This is a big challenge – these countries do not have access to basic opioids – like morphine.

World Health Assembly Resolution A67.19: encourages all member states to recognise palliative care as improving the quality of life, and to review policies and legislation for controlled medicines to ensure access.

One of the successful African models: Uganda has come up with a solution that goes back to the basics. The government took it upon themselves to make their own morphine, distributing it for their own patients. They import the powder, the mix and package it and deliver it to the patient’s home. This is now being done in Rwanda and Kenya – we hope that we can replicate this in other countries. There is no risk of diversion or misuse.

Mirella Dummar Frahi: Any questions to our panelists?

Q1 A quick comment on the presentation on access to medicines – Resolution L4 is being debated in the COW right now. Next year, we’re also looking to have a resolution on access to improved medicines in Africa.

Q2 After the opioid crisis in the US, we have to be careful. We have to be aware of the context we operate in also. There must be a middle road approach, such that when you are advocating for access to medicines, you take into consideration minimum or not enough skilled manpower to monitor and regulate the supply chain.

Ebstesam Ahmed: The opioid crisis is not a prescription crisis right now. It’s a carfentanyl and heroin crisis. It’s an education matter – education all professionals. What’s happening right now with opioid-phobia is not a good idea, it’s all about finding the right balance.

Q3 A general comment on Science will be adopted by the ICESCR Committee next week – this includes reference to opioids as an essential medicine for pain. We also need to talk about the amount of poppy being burned in Afghanistan. 

Q4 Many times in Africa, it is presented as one-size-fits-all solutions. People tend to prescribe situations that don’t fit. I see low prevalence in African situations, but the one-size-fits-all brings problems – we want to keep prevalence as low as we can so that young people are not targeted. We need a country-specific approach. 

Q5 We also need to start thinking about harm reduction and de-colonising the debate on drug policy. We need to be talking about safe injecting sites as well. 

Charity Monareng: We need to find African solutions, because there is a drug problem in Africa in general. It’s a human, not a western approach and we need to prioritise the rights of people.

Cisse Mariama Mohamed: The revised plan of action of AU has just been adopted in mid-February by the AU summit and it will be available very soon.

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