Drug Policy and Stigmatization: Aspects of Public Health for a European…

…Convention on the Promotion of Public Health Policies to Combat Drugs
Statement by Dr Massimo Barra, President of the Italian Red Cross and Federation representative, at the trilateral conference of the Benelux Parliament, the Baltic Assembly and the Nordic Council, in Liege
From: “” Liege 18 May 2006

Mr. President, Ms. Chair, Mr. Rapporteur, Members of the Parliament, Ladies and Gentlemen, it is an honour for me to speak at this trilateral conference of the Benelux Parliament, the Baltic Assembly and the Nordic Council. I would like to address my particular thanks for allowing me to address such a prestigious audience on the important links between public health and drug use.

Today, I would like to share my experience as a medical doctor who has been working for more than 30 years with drug users. I will also mention how this work relates to the broader humanitarian mission of the Red Cross. Finally, I will bring a message of hope and confidence: a new way out the drug use tragedy is possible, a way beyond the old dogma. A new way that consists of bringing drug policy and public health ever closer. The draft European convention on the promotion of public health to combat drug use is a step in this new direction. I will in fact call on to all stakeholders, from policy and law makers – and there are many today representing 11 countries – to the people on the ground to face their duty to give drug users their right to health.

Personal conviction: fighting stigmatization, the first step towards recovery

Since founding one of the first drug user care centres in Italy thirty years ago, I have met more than 30,000 users. I have lost lots of illusions but gained some few solid convictions that I would like to share with you today. A first conviction is that drug use is a very complex, changing phenomenon hard to apprehend in a single formula. It covers many different realities: from use, abuse, dependence and mania. These four levels of drug use take different forms for each person. Generalisation on drug use is dangerous as it fails to grasp the complexity of the relation between drug and the individual. There is no magic treatment or simple answer. But a treatment that works is one that is adapted to the special circumstances of the individual. It is important that the policy framework addressing drug use also reflects this flexibility.

This is the complexity that, in my opinion, the so-called ‘prohibition’ – legalization debate fails to grasp. Trying to criminalize our way out drug addiction has always backfired. I have never understood how some people think that force is an effective way to beat a drug user’s addiction. How can force be the right treatment for somebody who is essentially a sick person? One can only look at the catastrophic effects of prison on drug users to know that repression makes drug users more vulnerable and dangerous. On the other hand, the so-called ‘legalisation’ approach, which proposes to lift criminal restrictions on addictive substances, therefore limiting the criminalization of users, does not solve the problem of how to control and progressively reduce use. Both approaches focus on substances, whilst drug use is essentially the problem of the complex relationship between an individual and a substance.

The bottom line is that we should privilege care and health over judgment about whether a substance is good or bad. Care and health-based interventions represent the first, most effective approach to drug use problems. Why? Because care makes a drug user less dangerous for himself and for the society. I know for a fact that a drug user on methadone is more lucid than one on valium, which is used when proper substitution treatments are not available. But care is also the most effective step to restore calm in troubled communities and strengthen, on the long-term, Law and Order. Care is a policy in the interest of all, not only of drug users. Another conviction is that life is a difficult endeavor for everybody, but some among us are weaker and need substances to cope with the hardship of life. They need the illusions that they are stronger.

Drug addiction is a disturbing but real fact of human nature. Current policy makes the weaker individual more vulnerable and more dangerous. I have learned as a practitioner that stigmatisation and lack of care for drug victims is unwise and destructive, not only for the users themselves but for the communities in which they live. Stigmatization is the first killer disease to drug user. The first aim of any drug policy should be to lower the danger that drugs represent both for the user but also for the community as a whole. Current practices clearly do not lower this danger. On the contrary, traditional drug responses makes drug users twice more dangerous to their own and to the society’s health through transmittable disease like HIV/AIDS as well as to the safety of their communities. Violence and intolerance, which often feed our drug policy, transform drug users in violent and intolerant individuals themselves. We cannot except anything else.

A policy primarily aimed at reducing human suffering does not only save the lives of drug users, it removes the element of violence and intolerance, which often kills more than diseases themselves. Caring for drug users – regardless of their conditions and the type of addictions – does not only benefit public health but also Law and Order. I know that the police in the city of Rome with whom my drug care centre Villa Maraini works on a regular basis will agree with me; like many other actors at the frontline of the drug problem. (Segue alla pagina successiva >>)