Side event: Drug reform: From a punitive to a supportive approach – The Norwegian proposal

Minister Bent Høie, Norway: Our attitudes and understandings of drugs have changed over the last years. The policy area has evolved but within the same framework: prohibition and sanctions are effective and reasonable. I have to admit, I have been in favour of this paradigm. Gradually, this approach has been questioned and criticised by more and stronger voices. They have grown into a public movement demanding to put humans at the centre of drug policy. That care and support should be fundamental. These demands have come from many, not least from civil society and people who use or have used drugs. This has been representative of the drug policy understandings evolving. Replacing punishment by support and decriminalising drug use was an initiative prior to UNGASS 2016. It came from civil society. Giving fines to people suffering for drug use contributed to this. People struggling with mental and drug use disorders have a reduced life expectancy compared to the rest of the population (of 20 years!). It’s an incredibly serious inequality. The language we use, the proportionality of punishment, the discrimination and stigma; what we learnt and had to admit is that there are attitudes that make it more difficult to live with addiction. Many people with substance abuse problems have received no treatment. Many persons with substance abuse problems are excluded and not allowed to participate in public life. But attitudes are changing in society and healthcare. When we now have decided to stop punishing people who use drugs, we will turn our backs to that old attitude. People in healthcare and social care will be responsible for people who use drugs. Treated with respect not condemnation It will lower the threshold to ask for help and provide assistance. The purpose is not only to provide better opportunities to help people struggle with addiction; it will help prevent addiction and reach out to those who are on their way to addiction. Use and possession of drugs will continue to be illegal. It’s important to signal this to children meaning to buy drugs. When it comes to treatment, to attitudes, to language; today we don’t talk about abusers and misusers, but people who use drugs, people suffering from substance use disorders or people who used drugs. Those who dared raise their voices, have provided knowledge Several fighting stigma and shame on behalf of people struggling with addiction. They have changed the way we think and act. It has changed people and attitudes.  I’m pleased to have shared the thinking and intention behind our process. This is why in 2018 the government declared we needed to transit away from punishment into assistance, treatment and follow-up. We will conduct drug policy reform to ensure better services to people who use illicit drugs, transferring the responsibility of questions of personal use from justice to health service. A government mandated committee has concluded a report, thorough and interesting, “from punishment to support”, which will be the subject of a public hearing. On the basis of this, the government will submit a proposal to the parliament in Spring 2021.

Gilberto Gerra, UNODC: Ten years ago, we published “From coercion to cohesion”. Same message, different words. I worked 20 years in addiction treatment before the UN. The idea that punishment is wrong came to me in talking to patients. Patients had a long list of disadvantages (care, psychological, neglect, abuse, trauma). Is it a good idea to punish people in this condition? Is it ok to add prison to these disadvantages? It’s punishing them twice! They have been punished by life, and we would be punishing them again institutionally! Recovering from social deprivation and providing social support is the main goal of the reform. Punishment discourages people to access treatment. If you want to tackle substance use disorders and hepatitis/HIV, you need to take punishment out of the equation. The Conventions, in 1988, clearly says in art 3 that the possession for personal consumption needn’t be punished; there are alternatives. UNGASS2016 reiterates this position. It is important that what has been said by Portugal and Norway; the Conventions allow this and this is not legalisation. A small appeal: the reform of Norway includes good treatment opportunities. Harm reduction, demand reduction together in a continuum of care that is not in conflict. There is a third element that is important. Respect for dignity and human person. The motto of our programme with WHO, ten years ago, nothing less than what is provided for any other chronic disease. No stigma, no discrimination, full access to healthcare. My question is how can Norway help low-income countries advance in the same direction.

Devora Kestrel, WHO: This topic is at the centre of our work. We support a move away from a criminal justice approach to a social support approach. To ensure support for people who use drugs. There’s a legendary troll in Norwegian folklore, which hinders progress invisibly. In a tale the troll says: who are you? Troll responds: myself. It’s about staying true to oneself. Instead of facing the challenges, many chose to ignore or go around the challenges faced in drug policy by defending a restrictive and punitive approach; or by letting the guards down and moving towards the normalisation / full/partial legalisation for nonmedical drug use. Instead of beating around the bush, we need to go straight into the dilemmas that we face: a people centred approach, which doesn’t involve capitulating on primary prevention. This side event is about going straight to the heart of the drug policy discourse with a concrete example. Thank you for bringing us up to the task of this forum. While it is recognised that one size doesn’t fit all, drug policies are moving towards a more balanced and comprehensive approach that highlights public health and development, which is consistent with the original purpose of the Conventions: promoting the health and welfare of humankind. WHO welcomes this move. As part of the UN system, WHO’s role is protecting individuals from drug use harms and promote health interventions to reduce harm. WHO, is one of the 4 treaty bodies,  mandated to carry out scientific and medical assessments to determine whether they should be controlled. Our focus is not just preventing drug use, and drug use disorders, but also access to medical and scientific purposes and drug-related infections, such as HIV and HepC. Difficult issues, such as opioid crisis and difficult questions such as related to cannabis use and cannabinoids. SDG 5 underlines prevention and treatment for substance use. Important to keep in mind that the highest negative impact on public health by substances comes from alcohol and tobacco. Challenges requires bold and innovative approaches, independent of the legal status of these substances. WHO views drug control as means to protect the health and welfare of humankind as required by the Preamble of the conventions. We welcome the approach taken by Norway and we know that this is a work in progress, so we will follow then debate, outcome and evaluation of the results.

Cornelis de Joncheere, INCB: The Board is the independent and impartial body of the Treaty. The topic is pertinent to our work. Whether decriminalisation fits within the framework of the treaties. The Board has consistently stated that the Conventions seek to protect human health and safeguard people from criminal responses related to use. Norway’s proposal aims to change the attitude of authorities to people who use drugs. States have this discretion. It is fully consistent with the conventions to exempt criminal prosecution and react proportionally to minor instances of possession, from a health-based approach. In relation to Portugal, my predecessor expressed the potential positive results of within the drug control system, from a health non-punitive perspective, without legalisation. States have discretion on the types of measures related to drugs. But there is no derogation to the limitation of use to medical and scientific purposes. Possession for reasons contrary to the conventions should be punishable, but these do not need to be punishable criminally. Alternative measures are possible in instances of minor nature. Treatment, education, aftercare, rehabilitation, etc. Many countries are asking how to treat drug use as a public health concern. The principle of proportionality, which underpins the conventions, should shape this understanding; distinguishing possession from other offences. While Norway still fleshes out this approach, INCB (…). The Board remains at the service of all States wishing to apply humane, nonpunitive responses to minor offences.

Mr. Zaved Mahmood, OHCHR: His Excellency Minister of Health of Norway Madam Ambassador Excellencies, colleagues from UN agencies and civil society,  Distinguished participants. On behalf of the Office of the High Commissioner for Human rights (OHCHR), I thank Norway and other organisers of this special event for extending invitation to OHCHR to speak at this side.  At the outset of my this presentation, on behalf of our office, I welcome Norway’s new proposal on the drug reform which recommends to move away from the punitive approach to supportive approach in addressing the drug problem. This approach is a positive step towards developing human rights and public health based drug policies and laws. The World Drug Report 2019 has once again shown that drugs have taken many lives, but poorly constructed policies have destroyed many more. Globally some 35 million people -up from an earlier estimate of 30.5 million published in 2016- suffer from drug use disorders and require treatment services. The death toll is also rising: 585,000 people died as a result of drug use in 2017. Data and experience clearly demonstrate that the so-called “war on drugs” and punitive approaches have failed and are not the solution to the drug problem. The harmful consequences of such punitive approaches are deep and far ranging: more violence, more human rights violations and abuses, and public health failure. In this context, the new Norwegian  proposal is not only an important and positive step for the protection of human rights in Norway, but surely, it could  be a good practice model for many others around the world in coming years and decades. Madam Chair, In 2018, thirty-one principals of UN agencies and entities adopted a UN System Common Position on drug related matters. The Common Position is based on joint commitments of States- as outlined in the Outcome Document of UNGASS 2026; and also framed taking note of obligations of States under international human rights law.  In the UN Common Position, heads of UN agencies and entities, including our High Commissioner for Human Rights, reiterated their strong commitment to supporting Member States in developing and implementing truly balanced, comprehensive, integrated, evidence-based, human rights-based, development-oriented, and sustainable responses to the world drug problem, in the framework of the 2030 Agenda for Sustainable Development. Through a public health and human rights lens, the Common Position provides several direction of actions, including: supporting the development and implementation of policies centred on people, health and human rights; shifting drug policies and interventions toward public health approaches; ensuring respect for human dignity and human rights for those who use drugs in all aspects of drug and social policies; and ensuring equal access to public services including housing, health care and education for individuals who use drugs. In the UN Common Position, the UN entities agreed that criminal justice responses, when appropriate, should promote alternatives to conviction and punishment through decriminalization of drug possession for personal use and promotion of the proportionality principle. The criminalization of personal drug use and possession impedes realization of the human right to health. Criminalization of possession and personal use of drugs often results in disproportionate sentencing in addition to hindering persons in need of treatment for drug use from receiving such treatment. Criminalization of drug use and minor drug offenses also aggravates the stigmatization of and discrimination against people who use drugs. For many years,  several UN entities, including WHO, UNAIDS, OHCHR  and as well human rights mechanisms, such as the UN Committee on Economic, Social and Cultural Rights  and the Special Rapporteur on the Right to Health;  have called for States to remove obstacles to achieving the right to health and to adopt a public health-based approach to addressing the world drug problem. Evidence indicate that decriminalization, in tandem with “the provision of a continuum of support, prevention and treatment measures, can result in a decrease in overall drug use and in the drug-induced mortality rate.” Three international drug control conventions afford flexibility to introduce non-criminal responses to the possession of drugs for personal use.  In her statement delivered at the International Harm Reduction Conference held in Port in the last year, the UN High Commissioner for Human Rights recommended States to review and repeal of punitive laws criminalising, or otherwise prohibiting, drug use or the possession of drugs for personal use. The new Norwegian proposal exactly proposes this. We welcome the report’s recommendation on decriminalization of possession and personal use of drug. After careful reading the summary of the recommendations of the Norwegian Proposal, from human rights perspective I can say that many aspects of the Proposal compliment the UN system common position and joint commitments of the UNGASS2016.  The UN human rights mechanisms could take the new Norwegian proposal to other parts of the world as a good practice model, including neighbouring countries of Norway where immediate actions and drug policy reform are much needed for the protection of human rights of people who use drugs. Dear Chairperson Since 2016, in the spirit of inter-agency cooperation, OHCHR partnered with UNDP, WHO, UNAIDS and the International Centre on Human Rights and Drug Policy of the University of Essex to develop the International Guidelines on Human Rights and Drug Policy. We appreciate the support of Norway for promoting and supporting the International Guidelines. In concluding, I note that the OHCHR believes that the International Guidelines on Human Rights and Drug Policy is the best tool at our disposal for the implementation of the human rights commitments of the UN Common Position on drug related matters, as well as the human rights commitments of the Outcome Document of UNGASS 2016 and the 2019 Ministerial Declaration on Drug related matters. We hope that at the next phase of the reform process, the Norwegian authorities and other stakeholders, including civil society organisations and the community, will further consider and use the International Guidelines on Human rights and Drug Policy for the formulation of the new laws as recommended in the new Norwegian proposal.

Jamie Bridge, VNGOC: Thank you Madame Ambassador, distinguished speakers, excellencies, ladies and gentlemen. I really appreciate this opportunity to speak on behalf of the Vienna NGO Committee on Drugs – or VNGOC – at this special event. Our Committee comprises around 200 members from every corner of the world, and also covers a wide range of viewpoints – so to speak on all of their behalf is always a huge honour, but also a major challenge as you can imagine. With this in mind, I want to start by emphasising that there is no clear consensus among VNGOC members on the topic of decriminalisation, and it is important to recognise the various different shapes which this approach may take in different settings. However, even going back to civil society’s “Beyond 2008” consensus resolutions from more than a decade ago, you will find reference to the fact that all three drug conventions explicitly allow for alternatives to conviction or punishment, and an acknowledgement from civil society that this clause has been under-utilised by Member States to date. Crucially, however, there is a lot that we, as civil society, do agree on – and I want to focus my intervention today on two of these areas that particularly align with the possibilities and challenges that the Norwegian reforms present. Firstly, the VNGOC has long held the position that greater attention needs to be given to health and human rights. This means providing evidence-based prevention, treatment, rehabilitation, social reintegration, mental health, harm reduction and recovery services. It means working closely with people who use, or used, drugs to ensure that services meet their needs and are fit for purpose. Norway is a champion of this ideal – both domestically and internationally. So it is great to hear them speak of moving ‘from punishment to assistance, treatment and follow-up’ – to quote the government’s original platform on this issue in 2018. This is about more than decriminalisation alone. It is about reducing stigma, strengthening services and ensuring better access to support and medicines – which reflects the UNGASS Outcome Document in action, and something that should be of great interest to the CND. Secondly, and most predictably, civil society can of course agree that civil society should be meaningfully engaged in drug policies! Last year’s Ministerial Declaration once again committed the CND to work closely with civil society, while the UNGASS Outcome Document and the UN Common Position emphasise the important role we play in the formulation, implementation and evaluation of drug policies. It is my understanding that civil society has played a central role throughout the reform process in Norway, which is something to celebrate and be thankful for. Going back to the year of the UNGASS, several Norwegian NGOs collaborated on public petitions and open letters to Ministers, calling for a re-focus of national policies. The Expert Committee itself includes representatives from civil society and those with lived experience, and has liaised with NGOs across the country. I believe this is all going to be elaborated further by NGO colleagues from Norway: at a side event on best practices co-hosted by the EU’s Civil Society Forum on Drugs on Thursday at 2pm, and at another side event on using the media, at 8am on Wednesday. The ongoing public hearing will be a further opportunity for NGOs from all sectors and perspectives to have their voices, expertise and unique perspectives heard. This is such an important part of the process, and will help to ensure that the proposals and reforms in Norway have a positive impact on the real lives and wellbeing of people who use drugs across the country. As the VNGOC, we look forward to learning more about the reforms in Norway as these develop, and to supporting the ongoing civil society engagement in any way that we can. Thank you once again for the opportunity to speak today, and for your kind attention.

Alexis Goodeel, EMCDDA: Cannabis is the most used controlled substance in Europe. The idea is that higher penalties deter use. We studied the situation and found no direct link of causality. No clear impact of penalties on use. Recent research on what makes policy work suggest taking into account three levels: System (wording of the law, definition of legislation), Provider (criminal justice and health system), Client (experience and perceptions of the system). If we want policy that delivers more on results, the first condition is being clear about the objective of the policy (so we need evidence). Second, we need implementing guidelines related to each level. And we need to take into account feedback from the people targeted by the system (that the system seeks to help). Usually, there’s no specific data collection associated with many of the drug policy measures implemented. These elements are very important and I would support the Norwegian authorities in embarking in these challenges of foreseeing the background of the policy evaluation before starting. It’s close to our European balanced approach, between enforcement and public health and a part of the European Treaty of Lisbon. From a medical perspective: First, don’t do harm. Punishment  has nothing to do with a medical or public health approach. Especially for women and minority populations that face bigger barriers to access to health and other services

Member of the Norwegian Expert Committee, Norway: The report was written by a commission of 10 with 3 secretaries. Experts on health, law, medical system, social services. I am a prosecutor, not a health expert; but I know about criminalisation of people who use drugs. The Law Committees mandate was to prepare the government’s drug policy reform transferring the responsibility of responding to use and possession of drugs for personal use to health and care service. It doesn’t say “decriminalise”, but health services doesn’t deal with criminalisation; so it is implied. And there is an element of alternative response (to help). We accepted this as our mandate. So why are we going along these lines? The current legislation is similar to other countries. Explicit prohibition of dealing. Section 24: in the absence of a legal right it is prohibited to possess or use drugs. This prohibition won’t change. But it is also a criminal offence; and this is what we aim to change. In the Penal Code, there are also provisions related to drugs and they will remain intact as they refer to trafficking. The Committee seeks a model where use, acquisition and possession of a limited quantity of drugs will be illegal and trigger a response. But this response will not be criminal, rather mandatory attendance at a municipal counselling unit. The model includes all people who use drugs. Areas not affected to the proposal? Dealing that doesn’t have to do with personal use, no change in penal provisions on substance use and driving, no proposal to legalise. Not everyone needs treatment, but the counselling unit will offer information. If the person does not want treatment, the person can just leave without sanction; we didn’t want “Punishment lite”. This is a simple model; it is pretty simple to not punish people who use drugs.


Q&A

Mat Southwell, EuroNPUD: Could you discuss the input of people who use drugs?
Norway: People who use/d drugs have been a driving force in this reform. Sharing their experiences, helping shape ours, participating in the commission, collaborating to raise the profile of this debate in society; it’s the fundament of the reform. It wouldn’t have been possible without individuals with personal experience taking a step forward and giving people the possibility to get to know people that have been affected by existing policies. They’re here today!

Kaye Hall, Australia: Supply continues to be illegal. How do you manage a system whereby a user is supplying to facilitate their own disorder / use of substance. How’s that manage? Someone supplying large quantities to support their disorder, how does that figure in your system?
Norway: This is not decided yet. The suggestion is to continue to have a criminal responsibility for all trafficking.

Ancella Voets, Frontline AIDS: What about the gender aspect? Given that women are disproportionately affected.
Norway: It’s a general problem and something that’s part of the law; to give sufficient help to those who need it. When it comes to vulnerable groups, special attention should be given.

Andrea Nielsen: I thank my fellow countrymen for this work and the penal. It’s refreshing to see the international community supporting a rights-based and evidence-based approach.

Steve Rolles, Transform: Has there been any consideration of not imposing any sanctions at all? Is this compliant with the Treaties?
Norway: There were deliberations in the Committee about sanctions. Sanctions against the drug offence at such, or sanctions against attending the Council. The conclusion was not to propose sanctions. Same reasons to avoid punishment. There are responses but not punitive sanctions.

Norwegian civil society organisation: We are mostly focused on developing countries. I have not been involved in this discussion. I’ve been observing it. The problematic is that there is no room for discussion. The response is that either you take the proposal for the Committee or you are against it. Most people in Norway are in favour of many aspects of the report (moving from sanctions to health). Do we have to accept everything or is there room for discussions about the details? The devil is in the details.
Norway: I do not agree that there isn’t room for discussion. There’s been a lot of discussion. There is political support and agreement about the title. There will and there is discussion about the detail too. Most of the discussion relates to the concern about young people experiencing illegal drugs. Organisations, parents, are concerned that this reform will make it easier for people to experiment with illegal drugs. This is the first concern from people I meet all over the country. And the next one is about the “list”, the amount; some think it’s too high, some too low. The first one is the most complicated and concerns me the most. The second one, I’m not so afraid; a list like that is very easy to change. If we see it’s not working, we can change it. It’s very important, but we can change it. The important part is to make it clear to people that we’re not giving up on young people and prevention too. There will be a lot of discussion, especially because we’re now a minority government.
EMCDDA: I would highlight that in Portugal there is an experience that changed the policy and decriminalised the use of all substances, 20 years ago; it was one of the first countries and has evaluated it regularly. There is no negative impact on use of young people. It’s not just about decriminalisation; it’s about decriminalisation within a broader context where there is law enforcement, where what is prohibited is clear, and investment in prevention and treatment. On that basis, and the Minister said it, there is room for fine-tuning if quantities need to be adjusted, if messages need to be adjusted. There are administrative measures in Portugal too. It’s not legal or encouraged to use drugs.

Arild Knutsen, Foreningen for human narkotikapolitikk: I remember standing outside Parliament, protesting our exclusion. Now we’re included for a human rights and evidence based policies. It’s fantastic. On Thursday, we have a side event about involving civil society, working together with the government. And thank you for this, Bent.
Norway: Thank you. We have been discussing this for 20 years, Arild. You were right and I was wrong.

 

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