The Vienna Declaration: Experts highlight negative impact of drug war on HIV, call for decriminalisation

The criminalisation of illicit drug users is fuelling the HIV epidemic and has resulted in
overwhelmingly negative health and social consequences. A full policy reorientation is needed.

The Vienna Declaration is a statement seeking to improve community health and safety by calling for the incorporation of scientific evidence into illicit drug policies. We are inviting scientists, health practitioners and the public to endorse this document in order to bring these issues to the attention of governments and international agencies, and to illustrate that drug policy reform is a matter of urgent international significance. We also welcome organizational endorsements.

This is the official declaration of the XVIII International AIDS Conference (AIDS 2010) to be held in Vienna, Austria from July 18th to 23rd. The declaration was drafted by a team of international experts and initiated by several of the world’s leading HIV and drug policy scientific bodies: the International AIDS Society, the International Centre for Science in Drug Policy (ICSDP), and the BC Centre for Excellence in HIV/AIDS

The Declaration is now gathering signatures before its official launch at the XVIII International AIDS Conference, Vienna 2010. There will be a media launch event at the conference on July 20th (see here for details and press release) and a discussion event around the Declaration featuring Evan Wood from the ICSDP and other invited guests, in the Global Village Human Rights, Harm Reducation and Drug Policy Networking Zone on Wednesday July 21st at 2.15-3.15pm. The Drug Policy Networking Zone is co-organised by Transform and the International Drug Policy Consortium.

The full text of the declaration is copied below

To visit the Vienna Declaration website and register your support click here. The site contains background information, press information and comments from some of the Declaration's supporters, inclusing Michel Kazachkine is the Executive Director of The Global Fund to Fight AIDS, TB, and Malaria.

Transform is pleased to have had a role in the production of the Declaration as a member of the writing committee, providing editorial input and feedback on early drafts.

THE VIENNA DECLARATION

The criminalisation of illicit drug users is fuelling the HIV epidemic and has resulted in
overwhelmingly negative health and social consequences. A full policy reorientation is needed.

In response to the health and social harms of illegal drugs, a large international drug prohibition regime has been developed under the umbrella of the United Nations.¹ Decades of research provide a comprehensive assessment of the impacts of the global “War on Drugs” and, as thousands of individuals gather in Vienna at the XVIII International AIDS Conference, the international scientific community calls for an acknowledgement of the limits and harms of drug prohibition, and for drug policy reform to remove barriers to effective HIV prevention, treatment and care.

The evidence that law enforcement has failed to prevent the availability of illegal drugs, in communities where there is demand, is now unambiguous.^{2, 3}Over the last several decades, national and international drug surveillance systems have demonstrated a general pattern of falling drug prices and increasing drug purity—despite massive investments in drug law enforcement.^3,4

Furthermore, there is no evidence that increasing the ferocity of law enforcement meaningfully reduces the prevalence of drug use.⁵ The data also clearly demonstrate that the number of countries in which people inject illegal drugs is growing, with women and children becoming increasingly affected.⁶ Outside of sub-Saharan Africa, injection drug use accounts for approximately one in three new cases of HIV.^{7, 8} In some areas where HIV is spreading most rapidly, such as Eastern Europe and Central Asia, HIV prevalence can be as high as 70% among people who inject drugs, and in some areas more than 80% of all HIV cases are among this group.⁸

In the context of overwhelming evidence that drug law enforcement has failed to achieve its stated objectives, it is important that its harmful consequences be acknowledged and addressed. These consequences include but are not limited to:

• HIV epidemics fuelled by the criminalisation of people who use illicit drugs and by prohibitions on the provision of sterile needles and opioid substitution treatment.^{9, 10}
• HIV outbreaks among incarcerated and institutionalised drug users as a result of punitive laws and policies and a lack of HIV prevention services in these settings.^11-13
• The undermining of public health systems when law enforcement drives drug users away from prevention and care services and into environments where the risk of infectious disease transmission (e.g., HIV, hepatitis C & B, and tuberculosis) and other harms is increased.^14-16
• A crisis in criminal justice systems as a result of record incarceration rates in a number of nations.^{17, 18} This has negatively affected the social functioning of entire communities. While racial disparities in incarceration rates for drug offences are evident in countries all over the world, the impact has been particularly severe in the US, where approximately one in nine African-American males in the age group 20 to 34 is incarcerated on any given day, primarily as a result of drug law enforcement.¹⁹
• Stigma towards people who use illicit drugs, which reinforces the political popularity of criminalising drug users and undermines HIV prevention and other health promotion efforts.^{20, 21}
• Severe human rights violations, including torture, forced labour, inhuman and degrading treatment, and execution of drug offenders in a number of countries.^{22, 23}
• A massive illicit market worth an estimated annual value of US$320 billion.⁴ These profits remain entirely outside the control of government. They fuel crime, violence and corruption in countless urban communities and have destabilised entire countries, such as Colombia, Mexico and Afghanistan.⁴
• Billions of tax dollars wasted on a “War on Drugs” approach to drug control that does not achieve its stated objectives and, instead, directly or indirectly contributes to the above harms.²⁴

Unfortunately, evidence of the failure of drug prohibition to achieve its stated goals, as well as the severe negative consequences of these policies, is often denied by those with vested interests in maintaining the status quo.²⁵This has created confusion among the public and has cost countless lives. Governments and international organisations have ethical and legal obligations to respond to this crisis and must seek to enact alternative evidence-based strategies that can effectively reduce the harms of drugs without creating harms of their own. We, the undersigned, call on governments and international organisations, including the United Nations, to:

• Undertake a transparent review of the effectiveness of current drug policies.
• Implement and evaluate a science-based public health approach to address the individual and community harms stemming from illicit drug use.
• Decriminalise drug users, scale up evidence-based drug dependence treatment options and abolish ineffective compulsory drug treatment centres that violate the Universal Declaration of Human Rights.²⁶
• Unequivocally endorse and scale up funding for the implementation of the comprehensive package of HIV interventions spelled out in the WHO, UNODC and UNAIDS Target Setting Guide.²⁷
• Meaningfully involve members of the affected community in developing, monitoring and implementing services and policies that affect their lives.

We further call upon the UN Secretary-General, Ban Ki-moon, to urgently implement measures to ensure that the United Nations system—including the International Narcotics Control Board—speaks with one voice to support the decriminalisation of drug users and the implementation of evidence-based approaches to drug control.²⁸

Basing drug policies on scientific evidence will not eliminate drug use or the problems stemming from drug injecting. However, reorienting drug policies towards evidence-based approaches that respect, protect and fulfil human rights has the potential to reduce harms deriving from current policies and would allow for the redirection of the vast financial resources towards where they are needed most: implementing and evaluating evidence-based prevention, regulatory, treatment and harm reduction interventions.

REFERENCES
1. William B McAllister. Drug diplomacy in the twentieth century: an international history. Routledge, New York, 2000.
2. Reuter P. Ten years after the United Nations General Assembly Special Session (UNGASS): assessing drug problems, policies and reform proposals. Addiction 2009;104:510-7.
3. United States Office of National Drug Control Policy. The Price and Purity of Illicit Drugs: 1981 through the Second Quarter of 2003. Executive Office of the President; Washington, DC, 2004.
4. World Drug Report 2005. Vienna: United Nations Office on Drugs and Crime; 2005.
5. Degenhardt L, Chiu W-T, Sampson N, et al. Toward a global view of alcohol, tobacco, cannabis, and cocaine use: Findings from the WHO World Mental Health Surveys. PLOS Medicine 2008;5:1053-67.
6. Mathers BM, Degenhardt L, Phillips B, et al. Global epidemiology of injecting drug use and HIV among people who inject drugs: A systematic review. Lancet 2008;372:1733-45.
7. Wolfe D, Malinowska-Sempruch K. Illicit drug policies and the global HIV epidemic: Effects of UN and national government approaches. New York: Open Society Institute; 2004.
8. 2008 Report on the global AIDS epidemic. The Joint United Nations Programme on HIV/AIDS; Geneva, 2008.
9. Lurie P, Drucker E. An opportunity lost: HIV infections associated with lack of a national needle-exchange programme in the USA. Lancet 1997;349:604.
10. Rhodes T, Lowndes C, Judd A, et al. Explosive spread and high prevalence of HIV infection among injecting drug users in Togliatti City, Russia. AIDS 2002;16:F25.
11. Taylor A, Goldberg D, Emslie J, et al. Outbreak of HIV infection in a Scottish prison. British Medical Journal 1995;310:289.
12. Sarang A, Rhodes T, Platt L, et al. Drug injecting and syringe use in the HIV risk environment of Russian penitentiary institutions: qualitative study. Addiction 2006;101:1787.
13. Jurgens R, Ball A, Verster A. Interventions to reduce HIV transmission related to injecting drug use in prison. Lancet Infectious Disease 2009;9:57-66.
14. Davis C, Burris S, Metzger D, Becher J, Lynch K. Effects of an intensive street-level police intervention on syringe exchange program utilization: Philadelphia, Pennsylvania. American Journal of Public Health 2005;95:233.
15. Bluthenthal RN, Kral AH, Lorvick J, Watters JK. Impact of law enforcement on syringe exchange programs: A look at Oakland and San Francisco. Medical Anthropology 1997;18:61.
16. Rhodes T, Mikhailova L, Sarang A, et al. Situational factors influencing drug injecting, risk reduction and syringe exchange in Togliatti City, Russian Federation: a qualitative study of micro risk environment. Social Science & Medicine 2003;57:39.
17. Fellner J, Vinck P. Targeting blacks: Drug law enforcement and race in the United States. New York: Human Rights Watch; 2008.
18. Drucker E. Population impact under New York's Rockefeller drug laws: An analysis of life years lost. Journal of Urban Health 2002;79:434-44.
19. Warren J, Gelb A, Horowitz J, Riordan J. One in 100: Behind bars in America 2008. The Pew Center on the States Washington, DC: The Pew Charitable Trusts 2008.
20. Rhodes T, Singer M, Bourgois P, Friedman SR, Strathdee SA. The social structural production of HIV risk among injecting drug users. Social Science & Medicine 2005;61:1026.
21. Ahern J, Stuber J, Galea S. Stigma, discrimination and the health of illicit drug users. Drug and Alcohol Dependence 2007;88:188.
22. Elliott R, Csete J, Palepu A, Kerr T. Reason and rights in global drug control policy. Canadian Medical Association Journal 2005;172:655-6.
23. Edwards G, Babor T, Darke S, et al. Drug trafficking: time to abolish the death penalty. Addiction 2009;104:3.
24. The National Centre on Addiction and Substance Abuse at Columbia University (2001). Shoveling up: The impact of substance abuse on State budgets.

25. Wood E, Montaner JS, Kerr T. Illicit drug addiction, infectious disease spread, and the need for an evidence-based response. Lancet Infectious Diseases 2008;8:142-3.

26. Klag S, O'Callaghan F, Creed P. The use of legal coercion in the treatment of substance abusers: An overview and critical analysis of thirty years of research. Substance Use & Misuse 2005;40:1777.
27. WHO, UNODC, UNAIDS 2009. Technical Guide for countries to set targets for universal access to HIV prevention, treatment and care for injection drug users.
28. Wood E, Kerr T. Could a United Nations organisation lead to a worsening of drug-related harms? Drug and Alcohol Review 2010;29:99-100.

IHRA conference plenary : 'The Next Generation of Drug Policy: Decriminalisation and Beyond'

Transform, in collaboration with the International Drug Policy Consortium organised the Tuesday plenary session at this year's International Harm Reduction conference in Liverpool, titled 'The Next Generation of Drug Policy: Decriminalisation and Beyond'. The Session was chaired by John Ashton, and the presentation abstracts are copied below (full program available here in pdf). Transform's contribution made the front cover of today's conference report (see below), with Alex Steven's presentation on Portuguese decriminalisation also covered on page 6. When the video of the session is available online we will add a link here.

Session Chair John Ashton, Director of Public Health for Cumbria

Shift of paradigm in drug-related public policies in the Argentine Republic and Latin American countries

• Presnted by Martín Acuña: High Court judge and Ministerial advisory board on Narcotics member, Argentina

Argentina, like all the other Latin American countries, has adhered to the 1961, 1971 and 1988 United Nations Conventions on drugs and the subsequent laws that have been passed reflect this by penalising possession of drugs for personal use and imposing heavy penalties for drug trafficking and even micro-traffic. This enforcement- focused approach to drug control has placed a heavy burden on the judicial system and the high incarceration rates for drug-related offences have led to prison overcrowding.

To address the negative consequences of prohibition, many countries in Latin America have enacted a series of laws to discriminalise the possession of small quantities of drugs for personal use: Brazil (2006), Chile (2005), Paraguay (1988), Uruguay (1998), Mexico (2009). Argentina’s and Colombia’s Supreme Courts have recently followed suit in the cases of “Arriola” and “Bastidas” 2009, respectively.

The Argentinian goverment’s decision, translated at an international level into the United Nations (51st session, March 2008), advocating a paradigm shift in drug policy towards greater emphasis on access to the health care and respect for the drug user’s dignity and basic human rights. At a national level the shift led to the establishment of the Scientific Advisory Committee on Drugs, aimed at developing drug-related programmes from a public health perspective, and pursuing reform of domestic and international drug control systems in line with the international conventions on human rights.

The committee’s calls for reform highlighted the need to ensure access to health care as the central focus of any drug policy, as well as critiquing the failure of the current drug policy on supply control and demand reduction indicators. This critique demonstrated in particular the futility of enforcement efforts which disproportionately focused on low-level users and small-scale dealers.

Decriminalisation: pushing the limits of drug control

• Presented by Genevieve Harris from Release/IDPC,
• Originally to be presented by Ann Fordham from IDPC, who was unable to attend because of the volcano flight disruption.

Almost all nations are currently members of the global drug prohibition regime. This operates via a UN-based treaty system comprising a suite of three international drug control conventions: the 1961 Single Convention on Narcotic Drugs (as amended by the 1972 Protocol), the 1971 Convention on Psychotropic Substances and the 1988 Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances. The bedrock of the regime is the Single Convention. This contains a general obligation for signatory nations, subject to the provisions of the convention, to limit exclusively to medical and scientific purposes the production, manufacture, export, import, distribution of, trade in, use and possession of drugs. Although the prohibitionist ethos of the regime is beyond doubt, the conventions nonetheless contain a certain degree of flexibility. This presentation explores the various legal mechanisms behind such “wiggle room” and outlines how a growing number of parties to the conventions have engaged in “soft defection” from the regime’s prohibitive expectancy; a process involving interpretative strategies that keep national policies within the confines of the letter, if not the spirit, of the international legal framework.

Despite such grey areas, latitude is by no means unlimited, however. Indeed, it will be shown how, in expanding domestic policy space, many states are now at the limits of what is legally permissible within the extant regime. The presentation will also show how, while the conventions permit a degree of policy flexibility in terms of possession for personal use, there is no such scope for production and supply. This is a particularly acute point of tension as more jurisdictions adopt tolerant approaches to dealing with the recreational use of cannabis.

National strategy on drugs in Portugal: innovation and evidence

• Presented by Alex Stevens, criminologist from Kent University
• Originally to be presented by Fatima Trigueiros from the Institute for Drugs and Drug Addiction, Portugal, who was unable to attend because of the volcano flight disruption.

In 1999, the Portuguese government approved the first national strategy on drugs, a historic turning point for drug policy. One of the measures proposed by the strategy was the decriminalisation of consumption and possession of all illicit drugs for personal use (defined as a quantity that must not exceed that needed for average individual consumption over ten days). In 2001, this was made law in Portugal. This new law meant that personal consumption and possession would no longer be considered a crime, but would constitute an administrative offence – therefore no longer carrying a penalty of imprisonment.

The main purpose of this law was to prevent and reduce drug use and to promote and protect the health and social well-being of people who use drugs and encourage them to enter treatment. Eight years later, all the available evidence and indicators suggest that the overall impact of this law has been positive – although a direct link between these results and decriminalisation cannot be assumed. Decriminalisation is one element of a comprehensive national strategy aimed at preventing drug use, facilitating access to counselling and treatment, and establishing effective measures to reduce the adverse health and social consequences of drug use.

There have been some problems and challenges in implementing the law and we intend to propose some adjustments to it in the near future, based on past experiences. The INCB orginally accused Portugal of disrespecting the UN conventions on drug control but – after two missions to Portugal – they now recognise some of the benefits of Portuguese law. The 2009 World Drug Report noted that “Portugal’s decriminalisation of drug usage in 2001 falls within the Convention parameter”.

The2009 Annual Report of the EMCDDA has also recognised that decriminalisation has not led to an increase in drug use or drug tourism in Portugal.

After the War on Drugs: Blueprint for Regulation

• Presented by Steve Rolles, Senior Policy Analyst for Transform

This presentation explores what an evidence-based drug policy, based on public health and harm reduction principles, might look like if freed from the constraints of existing absolutist prohibitions on drug production, availability and use specified by the UN drug conventions. In a post-drug-war world how might legal regulation and control of drug markets function? What would the appropriate models be for different drugs? How could they be developed and implemented?

It will be argued that legal regulation of drug markets – finding the optimum point between the extreme poles of absolute prohibition and unregulated legal commercial activity – is the rational continuation of a broader harm reduction approach; one that considers the origins of drug harms in macro policy environments, specifically the punitive enforcement approaches.

The menu of possible regulatory options for drug markets will be reviewed in summary, including potential legal controls over products, outlets, vendors, availability, premises and using environments, and purchasers, to consider how to control availability in ways that deliver the best outcomes both for users and wider society.

It will be proposed that different drugs, depending on product risk assessments and local environments, could be made available either through medical prescription models, a specialist pharmacist model, various forms of licensed sales or licensed premises, or unlicensed sales. More risky drugs would be less available, less risky drugs relatively more available, thus in the longer term progressively shepherding patterns of use towards safer drugs, preparations, behaviours and environments, in direct contrast to the harm maximising impacts of illicit drug markets. Implementation would be phased over a number of years and supported by rigorous monitoring and evaluation.

This presentation aims to broaden the harm reduction debate by providing a foundation for discussing legal drug regulation as a practical option for the next generation of drug policy development.