As UNGASS 2016 draws to a close, what have we learned about drugs in the Global North?
The prevailing drug control strategy inspired half a century ago by the resource-rich Global North not only does not reduce drug use but also has dire consequences in the drug producing nations. Should that approach be reoriented on a global scale away from prohibition and abstinence to evidence-based treatment, harm reduction, and regulation it could be more easily managed.
While previous posts looked at the consequences of the war on drugs among the economically and socially most vulnerable, in this one I would like to discuss how solidifying and expanding a human rights based approach benefits citizens of the Global North. In Western Europe and North America there are a number of tested strategies for addressing problematic drug use at the national and local levels.
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In the late 1980s Switzerland became the locus of several large public drug-using areas. The Platzspitz Park in Zurich was one of the most popular in Europe – at its peak, up to 1,000 drug users visited the park per day and a number of them made it their home. In 1990, some 22 per cent of persons reached by health services in Platzspitz were HIV-positive. In 1992, the Zurich authorities abruptly closed the Platzspitz to drug users – which consequently, forced it out to other parts of the city.
In 1994 the Federal Council endorsed a new drug policy based on the idea of “four pillars” – namely: prevention of drug use; therapy for drug dependence, including heroin assisted treatment; harm reduction, including injection facilities; and law enforcement. This policy reorientation from public order to public health was followed with proper resource allocation.
Concerns over high rates of HIV infection have been cited as the prime driver behind Switzerland’s new drug policy. Zurich’s Research Institute for Public Health and Addiction reports that 10 years later, the number of injecting drug users with HIV was reduced by over 50 per cent.
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Confronted with widespread concern over intravenous drug use and growing levels of HIV infection, Portugal also broke with the war on drugs paradigm and decriminalised all personal possession of drugs in 2001. In Portugal, dissuasion commissions – panels of experts sitting outside the criminal justice system – consider cases of drug possession by evaluating the personal circumstances of the individual and, if needed, referring them to appropriate services, which may include treatment, or result in a fine or community service. Portugal compliments decriminalisation with a nationwide network of support services that include evidence-based treatment, harm reduction, and social services. These measures have resulted in improved health outcomes for drug users, including a significant reduction in the number of new diagnoses of HIV and reduced the burden on the criminal justice system – the proportion of drug-related offenders in the prison system fell from 44 per cent in 1999 to 21 per cent in 2008.
The Global Commission on Drug Policy points to Portugal as evidence that decriminalisation does not result in significant increases in drug use or dependence. In fact, the removal of criminal penalties, combined with the use of alternative therapeutic responses, has reduced the overall level of problematic drug use.
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In the United States, where prohibitionist policies have been in place at the federal level, a number of municipalities have come up with innovative approaches in response to drug-related problems. Seattle was the first city to introduce a Law Enforcement Assisted Diversion (LEAD) program allowing police to redirect low-level drug offenders away from prosecution into community-based treatment and support services, such as job training and housing. LEAD programs establish a unique collaboration between law enforcement, mental health and drug treatment providers, housing providers, the business community, elected officials, and community leaders. A rigorous evaluation found that LEAD programs reduce the number of people arrested, prosecuted, and incarcerated and that its participants were up to 60 per cent less likely to reoffend. At least eight other U.S. cities are running or are in the process of launching a LEAD-like program.
Much earlier, and in reaction to increasing HIV infections among drug users in New York, a response came at the level of the state. In 1992, 52 per cent of new AIDS cases in New York State were linked to injecting drugs; in 2012, after 20 years of a state implemented prevention program, that figure dropped to three per cent. Between 1992 and 2013, more than 171,500 people enrolled in a needle and syringe exchange program and many were referred to other healthcare services, including drug treatment. Each prevented infection was estimated to have saved the state US$38,000.
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In considering alternatives to prohibition we cannot assume that the policy innovations implemented in the Global North will be suitable for other countries. Where resources are scarce these solutions may not be feasible. Bolivia offers an excellent example of how a national strategy was devised that addresses their national and local concerns in a manner that is realistic and serves the interests of their citizens. Bolivia’s community control system has decreased violence, increased citizen engagement, limited corruption, stabilised and diversified local economies, and reduced coca cultivation. .
I write this as the 2016 UN General Assembly Special Session on the world drug problem (UNGASS) is coming to a close in New York. We end UNGASS with a document that has evolved from its unrealistic 1998 aspirations, “Drug Free World, we can do it” to one that calls for a “world free of drug abuse.” That’s modest progress. The countries of the resource-rich Global North that have managed over two decades to implement life saving interventions for their citizens are now publically speaking in support of harm reduction, approaches based on human rights, and against the death penalty for citizens around the world. Unfortunately, their voices are not yet forceful enough to fully redirect the drug policy “tanker” away from its devotion to the failed policies of the last half century that have led to so much violence, illness, and misery among the most vulnerable people in the world.
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