It‘ s time for a humanitarian drug policy
New principles towards drugs use
After more than 30 years of personal and professional involvement in the drugs field, especially in the care of 25,000 drug users I have met throughout my career, I can say that I have gained many doubts and also a few clear certainties.
My first certainty is that the drug phenomenon is dramatically complex, difficult to face and to explain. It is for this reason that governments throughout the world are facing difficulties in elaborating efficient strategies taking into consideration some important realities:
1. That the use and abuse of substances is old as the world itself and it is part of human nature that seeks a relief or escape from pain, death and imperfection.
2. That the use and abuse of substances have ethical and scientific implications, cultural, traditional and economic scenarios, from care to needs, to freedom, power, the law, desires, fears and pleasure. My second certainty is that caring for people is far more effective than punishment and inhumanity. I cannot bear this attitude that force is a cure for addicts. Where have people got this cruel idea from?
We face the choice to use our response to drug issues to build a caring society, or allow it to be exploited so that we end up at war with ourselves. It is a question of what kind of world we want to live in.
Finally, my third certainty is that knowing and taking care of all drug users is a part of any State’s and any Government’s interest and duty throughout the world. Creating anti-drug centres, centres for substitutive therapies, day and night reception centres, but also looking for drug users in the streets and public places where their daily tragedy transpires, is an excellent investment for Public Health but also for Law and Order.
While transforming the fight against drugs into a fight against drug addicts, these addicts are forced into clandestinely and social exclusion, their health is put at risk and social nuisance increases. Clearly, for drug users like for the society, repression and condemnation are not a wise decision.
The Venice conference is looking at questions related to licit and illicit substances. Scientific arguments will be given to validate or invalidate the distinction between those substances. One thing is sure; stigmatisation is what distinguishes an illicit drug user from a licit drug user. Regardless of the effects of substances and how effectively you can reduce those effects, the fact that victims of illicit drug use are criminalised as well as stigmatised by the society as a whole is a true failure of our time.
Fighting stigmatisation and public health crisis
The International Federation of the Red Cross is determined to be at the forefront of international health-based drug policy. In a landmark report published in 2003 on harm reductions related to injecting drug use, the Red Cross calls on the international community to be ‘guided by the light of science, not by the darkness of ignorance and fear’.
This report ensures that a wide range of prevention programmes, including access to sterile injecting equipment and harm reduction efforts related to drug use are implemented throughout the world. At the last international conference of the Red Cross and Red Crescent in November 2003, all 181 Governments, which have signed the Geneva Convention, National Red Cross and Red Crescent societies and the International Committee of the Red Cross agreed to do this major step.
Compassion and empowerment of the individual are now widespread social values in open societies across the world. However, sadly, when it comes to drug users, those values do not apply. Looking at the way drug policy envisages the individual, one could say that if all individuals are equal, some, drug users, are less equal than others. And this has not only dreadful effects for drugs users themselves but for public health and social stability.
With a two-measure world: the one of the free and healthy, and the one of the sick and stigmatised, entire nations have reached a public health crisis point. I think more particularly of countries from Asia, Russia and Eastern Europe where improper injection drugs use is driving HIV/AIDS epidemics out of hand to dangerous levels. 70% of HIV/AIDS infection in Ukraine are estimated to be the result of injecting drug use; 90% for Russia only.
In its 2002 report on HIV/AIDS, the IFRC presents HIV/AIDS epidemics not only as an health problem but also as an economic and security threat. Clearly, not caring for drugs users is contributing to a disaster that shakes the very basis of entire societies. With young users the first victims of this epidemic, lack of care has a considerable economic cost. From clean needle exchange, opiate substitutes to psycho-social counselling, harm reduction practices benefit public health, they help us build a more stable and inclusive society.
The scientific and medical knowledge is available, it is a matter of political and social mind sets. In order to change mind sets, the International Federation created in 1998 The European Red Cross Network on HIV/AIDS, ERNA, whose head office is based in Bratislava. ERNA promotes and transfers innovative health practices to fight HIV/AIDS. With now a total of 32 national societies involved in the network, a twofold increase from the initial number, ERNA is a testimony of the urgent need for care and reason in places where ignorance and fear have for too long shown their toll in human lives.
It is therefore urgent to restore the social and health dignity of drug users, by putting drug policy into a more human and scientific perspective, not an ideological one. A key to move away from ideology and polemic is to bring the whole drug policy community together on the ground. The drug users care centre, Villa Maraini, which I opened in Rome in 1976 is a telling example of what reason and pragmatism can achieve when applied on the ground.
Despite strong resistances from different sides of the Italian political and civil societies, and this is today still the case, we are collaborating closely with the Carabinieri and the Police of Rome, who, each time a drug user is arrested, calls Villa Maraini’s social workers and doctors to provide care. The Police have understood after many years that a humanitarian attitude towards drug users pays better than a force-based approach. They have become our allies.
My experience at Villa Maraini teaches one important lesson: care and science works, in the case of harm reductions, public health is dramatically improved; on the contrary discrimination and repression creates health and social situations out of control.
Time for a new rationale for drug policy
The work of the International Federation does not stop at harm reduction. Our core rationale is a humanitarian one, which embraces both public health and human right rationales. This broad humanitarian basis provides the Federation a unique convening power. In the case of drug policy and especially of drug users, we intend to use our humanitarian approach to conduct a twofold strategy: to fight the criminalisation of victims like drugs users as well to prevent the causes of this victimisation.
This is true for example in the context of prison. An increasing concern of the Red Cross Movement, my own work in Italy, and more recently the United Nations Office of Drugs and Crime, is prisons. Heavy handed law enforcement approaches that drive up prison numbers are a waste of money, and ultimately do harm. Prisons are one of the unsolved problems of our modern times: there is little difference between now and the middle age: modern prisons are not far from the prison of Castel Sant’Angelo depicted in the last act of La Tosca.
All over Eastern Europe, prisons are playing a major role in the spread of HIV/AIDS, not only amongst prisoners but also in the community these people return to. With my Red Cross Foundation Villa Maraini in Italy looking after intoxicated people in prison cells, I have a close experience over many years of how dangerous it is to mix drug addiction and the criminal justice system.
It is a lethal and irresponsible combination. For drugs users whose only fault is to buy and possess drugs for personal use, prison will be the learning ground on how to become criminals. The choice is clear. If you want to look after the public health, respect human rights, and promote humanitarian values, social inclusion and harmony, then a rational approach based on evidence is the way to go. In 2008 the United Nations will review its drug policy commitments made in 1998.
This will be the opportunity to make new choice and ground drug policy on new humanitarian principles for the benefit of drug users and society.
Massimo Barra