Wednesday, April 29, 2009

'Fear drives the global war on drugs': AIDS leader calls for legal regulation

Update: video of speech added (see below).

Transform has been arguing for many years that the harm reduction movement should be more open and vocal in their critique of the harms caused by prohibition and its enforcement, and more actively engage with the the debate around ending prohibition and replacing it with a system of legal regulation. Senior AIDS activists are now doing just that.

For as long as I can remember, opponents of harm reduction have declared that it is a 'Trojan Horse for legalisation'. We have always said that for supporters of a longer term vision for policy and law reform, there was no need to hide our light under a bushel. We can be confident that calls for an end to the war on drugs will be an inspiration and offer a lead to those who are afraid to tell the truth about drug policy. Harm reduction's not a Trojan Horse, its a horse!

In a blistering speech, full of righteous indignation, at the International Harm Reduction Conference in Bangkok, (23 April 2009), Craig McClure, Executive Director of the International AIDS Society called amongst other things for the control and regulation of drug production and supply, as part of a broader critique of policy and enforcement related harms. drugs. Here are some excerpts:

"My first observation is how all of us continue to talk about people who use drugs as “other”. We use terms like “drug abuser”, “drug user” and even “person who uses drugs” as if some of us do not use drugs. But which one of us does not use a drug that alters our mood, our consciousness of pain, our physical or emotional state? A joint, a dab of speed, a line of coke, a tab of ecstasy, a shot of heroin. Even the last three Presidents of the United States between them have admitted using some of these. A pint of beer, a glass of wine, a shot of whisky. A cigarette. A cup of coffee or tea. A pain relieving medication, an anti-depressant, a valium, a sleeping pill. We are all people who use drugs. Our refusal to acknowledge this is all about our fear that “we” might become, or be seen as, one of “them”.

"Fear drives the global war on drugs. Otherwise how could such clear evidence of the failure of the past ten years’ international drug policy be so blatantly denied? How could billions of dollars be wasted on a global anti-drugs programme that fuels violence, harms individuals, families and communities, strengthens organized crime and punishes sick people with prison sentences rather than providing them with the treatment, care and dignity that they need?"

"It doesn’t take a rocket scientist to show that criminalizing drugs and drug use leads to a dramatic increase in drug-related crime, and that controlling and regulating the production and distribution of all drugs would go a long way towards reducing that crime."

"Finally, let us continue to search for common ground with those who are not yet on what Michel Kazatchkine referred to earlier this week as “the right side of history”? Let us find the passion and compassion to talk to our so-called enemies, show them the way, and help them overcome their fear. Because as Nobel Laureate and human rights warrior Aung San Suu Kyi said: “Fear is not the natural state of civilized people.”

Video of the speech - click to view

This followed a stunning opening speech at the IHRA event from the head of the Global Fund for AIDS in which he called for the decriminalisation of personal use.

Below is the full text of Craig McClure's speech:

Sawa dee Kap. Good afternoon.

Distinguished, compassionate and determined fellow harm reduction advocates.

Let me first thank the organizers, and Professor Gerry Stimson in particular, for providing me the opportunity to make some reflections on the politics of harm reduction and the global response to HIV.

Five years ago this week I became the Executive Director of the International AIDS Society. It was just three months before the International AIDS Conference in Bangkok, and the IAS was about to relocate to Geneva and restructure its operations, staff and strategic vision. Needless to say, things were somewhat of a mess, and believe me, I was terrified, despite having worked in HIV for close to 15 years at the time.

On July 11, the conference opened in Bangkok, the first time the meeting had ever been held in South-East Asia. Close to 30,000 people had registered, and, as the Asian bird flu epidemic had only recently been contained, I sighed with relief that the conference was not cancelled. I’m sure Gerry can relate that feeling to this week’s conference! Though bird flu was under control, the war against drug users in Thailand was not. It was estimated that thousands had been killed as part of then-Prime Minister Thaksin Shinawatra’s attempts to rid the country of drugs. The dead were mostly individual drug users and small-time dealers, certainly not the powerful mafia that control the production and distribution of illegal drugs in Thailand. They remained of course untouched.

At the opening session, Prime Minister Thaksin, former-UN Secretary General Kofi Annan, and, who could forget, Miss Universe, made strong commitments to the fight against AIDS. Dignitaries and celebrities were falling over themselves to say how much they cared.

And then it was time for the substantive part of the opening session – a global overview of HIV epidemiology and the current response, and a passionate call for humanity and harm reduction by one of Thailand’s bravest and strongest HIV-positive drug user activists Paisan Suwannawong. Paisan, if you are in the room today, I pay tribute to you. Inexplicably, the dignitaries, led by Prime Minister Thaksin, ceremoniously filed out of the stadium before the substantive discussions began. Paisan was left on the stage with a dwindling audience that, having seen all the dignitaries leave, thought the opening was over, and emptied the hall.

Needless to say, there was an outcry. Behind the scenes over the following days were angry meetings between the IAS and community leaders, and difficult meetings between the IAS and Thai government representatives. I realized that the IAS had made a mistake in allowing Paisan’s talk to be scheduled at the end of the programme, even though we did not know that the Prime Minister would leave early. I learned that it was not considered appropriate for a Thai Prime Minister to listen to a drug user. I learned a lot of things that week.

In the end, Paisan was given the opportunity to speak again, this time at the Closing Session, but the damage was done.

One of the many things I learned from that experience, that has been compounded over the past five years in the work I have done related to drug use, harm reduction and HIV, is the enormous fear that underpins the world’s approach to drugs, drug use and people who use drugs.

At the end of this year I will be leaving the IAS, after six IAS conferences and some dramatic progress in the response to HIV. I’d like to offer three observations I have made related to the response to HIV as it relates to drug use and harm reduction.

All three are about fear.

The Person Who Uses Drugs as “Other”

My first observation is how all of us continue to talk about people who use drugs as “other”. We use terms like “drug abuser”, “drug user” and even “person who uses drugs” as if some of us do not use drugs. But which one of us does not use a drug that alters our mood, our consciousness of pain, our physical or emotional state? A joint, a dab of speed, a line of coke, a tab of ecstasy, a shot of heroin. Even the last three Presidents of the United States between them have admitted using some of these. A pint of beer, a glass of wine, a shot of whisky. A cigarette. A cup of coffee or tea. A pain relieving medication, an anti-depressant, a valium, a sleeping pill. We are all people who use drugs. Our refusal to acknowledge this is all about our fear that “we” might become, or be seen as, one of “them”.

Throughout history human beings have been people who use drugs. We will always be people who use drugs. As human beings we strive to develop the knowledge and technologies to control our environment and to manage our circumstances. The drug user, the person who uses drugs, is not the “other”. She or he is you and me.

It seems to me that what we really need to focus on is the difference between drug use and drug addiction or dependency. Global drug policy continues to focus efforts primarily on the substances alone. This is wrong.

Of course, the harms associated with some drugs are worse than others. Sometimes these are due to the degree of addictiveness of a particular drug. But most of the harms are due to the way that a particular drug is acquired (for example in a dark back alley versus from a pharmacy) the way in which it is used (as a pill, for example, versus smoking, snorting or injecting), and, even more importantly, the way in which society treats people who use drugs. The vast majority of the horrific harms associated with drug use – crime, HIV and other infections, violence, incarceration, death – are clearly fuelled by the drug policies our governments pursue. It doesn’t take a rocket scientist to show that criminalizing drugs and drug use leads to a dramatic increase in drug-related crime, and that controlling and regulating the production and distribution of all drugs would go a long way towards reducing that crime.

If we are all people who use drugs then the critical questions seem to me to be:

Why is it that some people who use drugs go on to have problematic drug use?;
How we can prevent that from happening?;

How we can help those that already have dependence problems? and

How can we change the social and economic conditions that drive many people into drug dependence?

The reasons for drug use per se seem at least fairly well-characterized. We use drugs out of curiosity, to feel good, to feel better, to do better, or to manage physical, emotional or psychological pain. One might add to dance better, to have sex better, to relax more, to switch off, to switch on or to escape from the misery of social and economic deprivation. As to why some people go on to become drug dependent, the answers are less clear. There is some evidence, though still weak, that genetic factors, including the effects of our environment on gene expression and function, may contribute to vulnerability. People with mental health problems are at greater risk for drug dependency. This is not surprising, considering the generally pathetic state of mental health services around the world that drive people to self-medicate, and the neglect of the poor and the marginalized. How and why some people become drug dependent and not others and how we can prevent drug dependency is an area that still requires much research. But no reason should be used to blame or belittle anyone who is drug-dependent.

So long as we continue to define the drug user as “other” and define the drug itself as the problem we will be trapped in our misguided and harm-inducing programmes and policies.

The Wilful Denial of Evidence and the Abuse of Medical Authority

My second observation relates to the wilful denial of evidence by policy makers throughout the world and the abuse of power by some members of the medical profession who support this denial. The most obvious example of wilful denial of evidence is of course the fact that methadone remains illegal in Russia, thereby preventing the introduction of substitution therapy for people dependent on opioid drugs. The International AIDS Society has made the issue of access to methadone in Russia and throughout Eastern Europe and Central Asia a policy priority. Across the region, over 3.7 million people inject drugs, with over two million people injecting in Russia alone, the highest per capita in the world, with four times the overall global prevalence of injecting drug use. Close to 70% of all HIV infections in Russia are linked to injecting drug use, versus 30% globally outside of sub-Saharan Africa.

We all know that there are decades and decades of research showing that opioid substitution therapy is the most effective intervention to reduce injecting and prevent HV infection among people dependent on opioids, particularly if delivered as part of a comprehensive package of harm reduction interventions, including education and counseling, needle and syringe exchange programmes, provision of condoms, HIV diagnosis and treatment and TB and STI diagnosis and treatment.

But in Russia methadone remains illegal, and the Russian government maintains that there is no evidence that it works to prevent HIV infection or reduce the harms associated with injecting opioids. This denial of evidence is so profound that the government even dares to boldly distort the facts in international fora, such as at the high level meeting of the Commission on Narcotic Drugs in Vienna last month.

This kind of blatant and wilful denial of the evidence can only be based on deep-seated fear. Remember, this is a society steeped in denial due to fear. For decades the horrors of Stalin’s regime were denied by not only the Russian government but ordinary Russian citizens, until long after the death of Stalin, and despite the disappearance of tens of millions of people.

But this kind of denial of the evidence is by no means limited to Russia. Even in my own home country of Canada, a supposed bastion of democracy and human rights, there is a concerted and organized state-supported campaign to deny evidence related to harm reduction. For a number of years now a number of studies in the Downtown Eastside of Vancouver have struggled against the odds to scientifically determine the impacts of a number of harm reduction interventions, including a supervised injection site and heroin maintenance therapy. These studies have been dogged by government interference since their inception, including unwarranted attempts to shut trials down, spending of public funds on harm reduction-denialist organizations to write negatively about the trials, misrepresentation of the evidence of the studies’ results, and interference in the peer review process.

Fear drives the global war on drugs. Otherwise how could such clear evidence of the failure of the past ten years’ international drug policy be so blatantly denied? How could billions of dollars be wasted on a global anti-drugs programme that fuels violence, harms individuals, families and communities, strengthens organized crime and punishes sick people with prison sentences rather than providing them with the treatment, care and dignity that they need?

Fear also drives the abuse of people who use drugs by doctors and others in the medical system. In particular, I’m referring to the continuing use of forced detention and isolation, electro-shock therapy, forced participation in medical experiments and other abuses of people who use drugs that many of us might refer to as “torture”. Doctors who administer these abuses under the guise of “drug treatment” are not just wilfully denying the evidence, they are violating human rights and the Hippocratic Oath. And make no mistake, as a membership association of health care professionals and researchers working in HIV, the International AIDS Society abhors and condemns these unethical and inhumane practices.

Fear drives the denial of evidence. I have seen it in the denialists who claim that HIV does not cause AIDS and the denial of the evidence that antiretrovirals work to control HIV.

Fear can induce denial of any evidence we throw at it.

The Need for Common Ground between the Harm Reduction and Anti-Drugs Movements

My third and final observation relates to the seemingly vast gulf of irreconcilable differences between those of us advocating for harm reduction approaches to drug use and those in the anti-drugs movement.

Recently I visited the INSITE supervised injecting site in the Downtown Eastside of Vancouver. It was late afternoon, a very busy time at the centre. There was actually a queue of people outside the door over 15 people deep, each waiting impatiently for his or her chance to inject in one of the supervised cubicles inside. I spoke with a few individuals. These were not happy people. They were skinny, undernourished, bruised and cut, in tattered clothing, scared, twitchy, and desperate. There was a hint, a glimmer, of hope in the eyes of one or two, but not much. The road ahead for these people looked bleak to me. God knows how it looked to them. Using the supervised injecting site was just one small but significant notch above sharing a needle and syringe in the alley up the road. Homeless and hungry, their lives pretty much devastated by the harms associated with drug use and the failure of the Canadian health and social systems. This is the reality of a supervised injecting site, an entry point to reduce harm amidst a sea of neglect.

To bridge the gap between the harm reduction and anti-drugs movement we harm reduction advocates must not be coy about the horrific problems that can be associated with drug use – their effects on the individual, the family, the community and humanity. Individuals in the anti-drugs movement are motivated too by their experience of the worst harms associated with drug use. Discussing these experiences openly and without prejudice could be the beginning of a common language we share. If we are not able to reach out to these groups and find common ground then our evidence will never overcome their fear.

Most importantly, our own fear that we might weaken the argument of our evidence that harm reduction works if we acknowledge and talk openly too much about the ugly side of drug dependency must also be overcome. If we let the chasm between us and the anti-drugs movement get too great then we will have to fight this battle far longer than necessary. We are not, after all, “pro-drug”, we are not “encouraging drug use”. We must reach out for dialogue consistently, with passion and compassion if we are to make further gains.


Next year, in July 2010, the International AIDS Conference will be held in Vienna, Austria. This will not be a repeat of the recent meeting in Vienna that has so angered us all. The conference will have a major focus on injecting drug use and human rights. There will be a special sub-focus on Eastern Europe and Central Asia, using Vienna in its historical role as a bridge between East and West. Let’s work together to ensure that Vienna in 2010 helps confront the fear that was rampant at the Commission on Narcotic Drugs in Vienna in 2009.

Fellow people who use drugs, let us all continue to dig deep within ourselves to face our own fears about the drugs we use, how we use them, how we can continue to be curious, to feel good, to feel better and to do better. Let us continue to consider how we can prevent or reduce any harm we might cause ourselves, our families, our communities and society. Let us stop HIV infection in people who use drugs and treat, care and support those that are living with HIV. Let us move towards a unified voice where public health and human rights are two sides of the same coin. Let us fight for a more just and equitable society for all people in all places.

Finally, let us continue to search for common ground with those who are not yet on what Michel Kazatchkine referred to earlier this week as “the right side of history”? Let us find the passion and compassion to talk to our so-called enemies, show them the way, and help them overcome their fear. Because as Nobel Laureate and human rights warrior Aung San Suu Kyi said:

“Fear is not the natural state of civilized people.”

Thank you.

Photos by Steve Rolles

Thursday, April 23, 2009

New consultation on drug sentencing guidelines

The Sentencing Advisory Panel (sap) has published a consultation paper relating to the sentencing of the most commonly committed drug offences - deadline for submissions is 15th July.

The panel recognises that, 'the courts approach to sentencing for supplying drugs has been driven by the desire to provide a deterrent effect. However, there is no evidence to show that lengthy sentences have the desired deterrent effect and research suggests that drug barons are more concerned about the loss of their assets than the threat of imprisonment.'

The deterrent effects of prohibition are poorly supported by the evidence. The response of Government to questioning on these claimed benefits has been to restate a ‘belief’ in such effects rather than to produce any evidence to support them. No research in this area has been commissioned or published by Government despite its centrality to the entire prohibitionist paradigm, and public commitments to do so. The limited research that has been done does not demonstrate any significant regional or national correlation between the intensity of enforcement and levels of use or misuse, suggesting any deterrence effect is marginal, especially for key populations responsible for causing most harms.

Reinforcing the view that criminalisation is not the best way to deal with drug use/misuse is a recent report published by the Cato Institute that reviews the impacts of drug decriminalisation in Portugal. The paper concludes that the change in laws has been overwhemlingly successful.

'The data indicates that decriminalization has had no adverse effect on drug usage rates in Portugal, which, in numerous categories, are now among the lowest in the EU, particularly when compared with states with stringent criminalization regimes. Although post-decriminalization usage rates have remained roughly the same or even decreased slightly when compared with other EU states, drug-related pathologies—such as sexually transmitted diseases and deaths due to drug usage—have decreased dramatically. Drug policy experts attribute those positive trends to the enhanced ability of the Portuguese government to offer treatment programs to its citizens—enhancements made possible, for numerous reasons, by decriminalization.'

The Cato report concludes that, 'Within this success lie self-evident lessons that should guide drug policy debates around the world.'

The sap consultation document looks at drug sentencing guidelines for the most serious offences and notes that they are harsher than sentences for rape or death by dangerous driving.
'Currently, Crown Courts impose higher sentences in the most serious cases of supplying drugs than they do for cases of rape of an adult, for the most serious cases of assault and for causing death by dangerous driving.'

The panel chairman, Andrew Ashworth, said,
'our provisional view is that current sentencing levels sometimes go beyond the levels that are justified by the seriousness of individual offences. We have compared them with the starting points for other serious crimes such as rape and grievous bodily harm and we want to know what other people think about comparative levels of sentences.'

Another key issue that the panel is consulting on is the sentences given to drug couriers.
'The Panel also considers the sentencing of drug couriers who are very often na├»ve, vulnerable men and women from third world countries whose fates are totally disregarded by those at the top of drug supply chains. Under the current approach such couriers often serve long prison sentences while their role in criminal organisations is minor. The Panel suggests that they should be treated as “subordinates” in the supply chain. This would be likely to lead to lower sentences than those currently being imposed.'

Keith Vaz MP announced recently that the Home Affairs Select Committee would also be carrying out a 'major inquiry into drugs that will begin at the beginning of April. We will look not just at what the Government have done in this case and at classification, but at the way in which drugs enter this country and at whether the penalties are sufficient to deal with what has been an increase in the availability of cannabis and other drugs. It will be a long inquiry and will be concluded at the end of the year, and we are willing and eager to have evidence and views from all political parties.'

Whilst Transform welcomes any consultation that commits itself to reviewing the evidence regarding the enforcement of prohibition, the narrow parameters of the sentencing guidelines consultation do not allow it to go far enough, and the HASC inquiry will not be much better as it will be limited to reviewing the status quo rather than looking at alternatives to the prohibitionist framework. What is needed is an open and honest public consultation on the wide-ranging effects of criminalising drug users as part of a impact assessment on the costs of prohibition for society.

Wednesday, April 22, 2009

Minister for a Day

This is a piece I penned recently for a regular slot titled 'Minister for a Day' in Whitehall and Westminster World 21 April

Danny Kushlick
becomes Home Secretary for a day

7:00am Wake up, shaking myself into comprehending that yes, David Cameron has included me in his new government. My kids think it’s hilarious, having heard me sing: “Build a bonfire, build a bonfire; put the MPs on the top.” So shoot me, I’ve sold out. However, as young men we both experimented with cannabis, and he did call for a serious discussion of drug legalisation as a backbencher on the home affairs select committee back in 2002, so here we go. My brief is to kick into gear the process of getting the UK out of the drugs war. I’m looking forward to having fun.

For nigh-on 20 years I’ve campaigned against successive governments’ attempts to convince the Great British Public that the drug war keeps them and the wider world safe from the threat of ‘drugs’ (bar, of course, the legal ones: alcohol and tobacco). With the upcoming publication of a comprehensive impact assessment of global prohibition that I’ve commissioned, people will begin to see the flaws in that policy. Despite the evidence, my predecessor seemed more willing to discuss her husband’s viewing habits than legalisation and regulation of drugs.

I guess hiring me for a day to deliver this message is probably the easiest way to deal with the inevitable controversy. It’s got to be better than wasting some genuine ministerial talent, like David Davis.

8.00am First meeting of the day is with the permanent secretary and senior departmental colleagues. No love lost here, but a job’s a job. Like George Best in his heyday, Sir David Normington turns on a sixpence and says he has convened an interdepartmental meeting to announce the end of UK support for a prohibitionist drug policy.

I begin by letting the assembled group know that there will no longer be a need to mislead voters into supporting the very regime that creates the ‘drug menace’. Drug policy will now protect the public, rather than party political interests. No more will the UK support a policy that operates as a price-support mechanism for illegal drug traders, and turns plants into products worth more than their weight in gold. We will be taking £160bn a year away from the international criminals and at the same time drastically reducing crime (government figures suggest half of prison inmates have some kind of drug habit). No longer will drug policy punish the poor and disadvantaged the world over.

Concerns about half-empty prisons, redundancies amongst customs officers and organised criminals, and lack of material for draconian commentators such as Peter Hitchens, Melanie Phillips and Simon Heffer to froth over are raised and rebuffed. We’ll talk about resource reallocation later, I tell my officials.

The real concerns about increasing levels of drug use are discussed within Mr Cameron’s newly adopted framework of promoting overall wellbeing. It is now widely recognised that high levels of use and misuse are most closely associated with high levels of inequality and more general disparities in health. The Home Office will now be tasked with genuinely identifying and tackling low wellbeing as a cause of crime.

Oh, and we will also be releasing documentation, withheld under the misnamed Freedom of Information Act, that shows that UK governments have privately discussed the benefits of legalisation for at least 20 years.

Just as they stand up to leave, I tell them that the PM is minded to abolish prisons entirely. “Only joking,” I tell them – sadly.

10.00am The interdepartmental meeting. Chancellor Vince Cable begins by informing the group that we will no longer spend £4bn a year fighting a battle that creates £16bn worth of costs – and a living hell from Afghanistan to Colombia, and on the streets of every industrialised nation on earth. UK policy will now follow the sage analysis proffered (but then buried and ignored) by the PM’s strategy unit in their drugs report of 2003: that prohibition is the problem. Defence, intelligence and Foreign Office bods seem delighted that a significant source of insecurity will disappear from their in-trays. As we leave, two senior officials tell me sotto voce that they used to be warned away from discussing legalisation, lest it damage their careers.

12.00pm Time for a legally boozy lunch with Hillary Clinton (you didn’t seriously think that Cameron would go it alone, did you?). Time for the ‘special relationship’ to work for peace rather than war, methinks.

3.00pm As I walk back to my (very temporary) office, I am about to call key journalists but feel an infinitesimally brief pain in the side of my head. As the afternoon sunlight fades to grey, the last words I hear are my own: “And I thought I was on a roll. I was so looking forward to being president for a day. I could have ended world poverty… So shoot me…”

4.00pm The PM wrings his hands (eat your heart out, Tony Blair) as he issues a press statement confirming that a gunman of Colombian origin was shot while fleeing from a book depository overlooking Parliament Square. Meanwhile, rumours persist that Damian McBride and former drugs tsar Keith Hellawell had been emailing each other about the whereabouts of a grassy knoll.

Sunday, April 19, 2009

Head of Global Fund to Fight Aids calls for decriminalisation of use

In an article in today's Observer Curb Aids and HIV by decriminalising drugs, say experts and in advance of his speech to the International Harm Reduction Conference in Bangkok, Michele Kazatchkine, Head of the Global Fund to fight AIDS, TB and Malaria states:

"I say drug use cannot be criminalised. I'm talking about criminalising trafficking but not users. From a scientific perspective, I cannot understand the repressive policy perspective."

and in a quote that echoes Transform's recent discussions about who governments are protecting with prohibition, Kazatchkine calls for a total rethink of drug policies:

"What I'm saying is that government's function is to protect their citizens."

Whilst endorsing Kazatchkine's call, Transform would ask that he question the benefit of criminalising traffickers, producers and suppliers? Three guesses as to where users get their drugs from? That's Mexico, Afghanistan, Colombia and West Africa. For too long harm reductionsists have failed to recognise the links between demand and supply when it comes to criminalisation. Is Kazatchkine unwittingly protecting the very people that he seeks to undermine? However, this is a good start.

But it's not the first time that this has happened. In March 2008 the Secretary general of the UN backed a report by Peter Piot of UNAIDS that said:

"I look to Asian Governments to amend outdated laws criminalizing the most vulnerable sections of society, and take all the measures needed to ensure they live in dignity,"

From the Observer coverage:

Curb Aids and HIV by decriminalising drugs, say experts

The use of illicit drugs must be decriminalised if efforts to halt the spread of Aids are to succeed, one of the world's leading independent authorities on the disease has warned.

In an unprecedented attack on global drugs policy, Michele Kazatchkine, head of the influential Global Fund to Fight Aids, Tuberculosis and Malaria, has told the Observer that, without a radical overhaul of laws that lead to hundreds of thousands of drug users being imprisoned or denied access to safe treatment, the millions of pounds spent on fighting HIV and Aids will be wasted.

Kazatchkine will use his keynote speech at the 20th International Harm Reduction Association conference tomorrow in Bangkok to expose the failures of policies which treat addiction as a crime. He will accuse governments of using what he calls "repressive" measures that deny addicts human rights rather than putting public health needs first.

He will argue that governments should fully commit to the widespread provision of harm reduction strategies aimed at intravenous drug users, such as free needle exchanges and providing substitutes to illicit drugs, such as methadone.

"A repressive way of dealing with drug users is a way of facilitating the spread of the [HIV/Aids] epidemic," Kazatchkine said. "If you know you will be arrested, you will not go for treatment. I say drug use cannot be criminalised. I'm talking about criminalising trafficking but not users. From a scientific perspective, I cannot understand the repressive policy perspective."

He condemns policymakers who argue that, because drug users frequently turn to crime to fund their habit, it justifies making it a criminal justice issue. Harm reduction both helps the addict and wider society and reduces the need to commit crime, he said.

"The one population where [Aids] mortality has been untouched - and in fact has worsened - has been IV [intravenous] drug users. It's amazing, because what we call harm reduction, such as exchanging needles, has been scientifically proven as the most effective.

"This is why I will most probably start my speech in Bangkok by mentioning the contrast between major progress achieved in decreasing mortality from Aids in the poorest countries of the world versus the total lack of progress for what is the main route of transmission in most parts of the world outside Africa."

Kazatchkine suggested that politicians feared that the public would label them soft on drugs. A doctor and respected Aids expert with 20 years in the field, he has in his two years at the helm of the Global Fund overseen some of the most dramatic improvements in treatment and prevention of HIV globally.

Since it was established in 2001, the fund has received $21bn in contributions from the world's wealthiest nations and used it to play a significant part in reducing rates of new HIV infections. It has also contributed to the distribution of much needed life-preserving anti-retroviral drugs to millions of people already diagnosed.

Alex Stevens, a senior research fellow specialising in drugs and criminalisation at the University of Kent, said tomorrow's speech would highlight many of the troubling consequences of criminal justice approaches to drugs policy.

"In many countries, serious human rights infringements are committed in the name of fighting drugs," he said. "These include the use of the death penalty for drug offences, compulsory treatment regimes that include methods (such as physical beatings) that are akin to torture, and, for example in the USA, depriving convicted drug law offenders of the right to vote."

Stevens said that, while the UK was ahead of many other countries on harm reduction, its tendency to criminalise drug users could undermine its efforts.

What is needed, Kazatchkine will argue tomorrow, is a total rethink of drugs policies. "What I'm saying is that government's function is to protect their citizens. This is why harm reduction should be supported by all governments everywhere."

Thursday, April 16, 2009

Transform organise major session at IHRA Bangkok conference: 'Can Harm Reduction End the Drug War'

Transform has organised a major session at the upcoming International Harm Reduction Conference in Bangkok next week, titled Can Harm Reduction End the Drug War, the session abstracts for which are copied below.

The broad principles of harm reduction have been widely adopted in much of the world but remain controversial for some political groupings in the prohibitionist camp. Some view harm reduction’s non-judgemental position and tolerance of continued use as tacitly condoning drug use, even encouraging or facilitating it, whilst for others the movement is portrayed as little more than a sinister ‘trojan horse for drug legalisation’. Yet for most working in the harm reduction field it is more simply a pragmatic set of principles and strategies aimed at, first and foremost, saving lives, and such debates are an irrelevance and distraction from the harsh day to day realities they have to deal with.

Whilst there is substantial support for moves towards legally regulated supply for some or all drugs within the movement – most obviously regards a medical model for prescribing of opiates - an anti-prohibtion / pro law-reform position does not yet feature specifically in the definitions or lists of harm reduction principles. Part of the reason for this is that it is far from the consensus view (particularly regards the wider debate around non-medical use), but there are also frequently aired practical concerns that vital harm reduction work might be jeopardised in some areas where it is most needed if more contentious elements of the drug law reform debate become too prominent. There is also an element of institutionalisation with the harm reduction movement – a reluctance to ‘bite the hand that feeds’ as it were and jeopardise funding (often from the state) through vocal dissent, a phenomenon that has similarly ensured a troubling degree of silence on drug law reform from the treatment sector (for more discussion see 'In pusuit of truth', by Danny Kushlick here - p.12).

Thus in contrast the claims of ‘Trojan-horse’ conspiracists, the drug law reform movement has in fact struggled to activate the wider harm reduction field, whose concerns are often far more immediate than the longer term goals of system wide legal reform. That said, a significant difference between the harm reduction movement and many of its most vocal opponents remains; it is at least genuinely open to honest intellectual engagement with the prohibition / regulation debate, which is now a regular fixture in harm reduction journals and conferences.

“Harm reduction approaches also seek to identify and advocate for changes in laws, regulations and policies that increase harms, or which hinder the introduction of harm reduction interventions.”
The International Harm Reduction Association
Acknowledging the spectrum of views around what ‘harm reduction’ means, the important thing in the context of this discussion is to highlight the underlying principles of the paradigm, without necessarily endorsing everything done under its banner. From Transform's perspective Harm Reduction as currently described is somewhat limited in scope – a defensive position against the harms largely created by prohibition. It needs to evolve not only to more fully engage with the harms created by prohibition, as opposed to drug use harms, but also to evolve into a more creative and positive position that looks at wellbeing maximisation, not just mitigating harm.

Session abstract:

Can Harm Reduction End the Drug War?

For many in the drugs field, the harms caused by drugs are conflated by harms caused by the war on drugs – which makes harm reduction vastly more complex than it needs to be. This Major Session will explore the relationship between advocacy for harm reduction and advocacy to end the global war on drugs and replace it with an effective system of regulation and control.

The presentations will analyse which harms are created by the war on drugs and which are created by the use of drugs. The session will explore the extent to which harm reduction can reduce harms caused by the war on drugs and how the two movements can best work together. This session sets out to offer delegates the opportunity to explore issues that are rarely discussed in the harm reduction field – partly because of political pressures and partly due to the pressing need to save lives. It will be relevant to anyone in the harm reduction field whose work is influenced both by the behaviour of drug users and by the negative consequences of the war on drugs.

Session Chair:

Ethan Nadlemann; Drug Policy Alliance

Time and location:

Thursday 23rd April, 11.30am , Queens Park Room2, Queens Park Hotel, Bangkok

Session presentation abstracts:

Differentiating between drug-related harms and policy-related harms

Steve Rolles Transform Drug Policy Foundation

There is a growing understanding and acceptance within the drugs field that a significant proportion of what are broadly termed 'drug related harms' stem directly from the policy of prohibition and the illicit markets it has inadvertently fostered. Attempts to disentangle the harms caused by drug use per se, and those created or exacerbated by policy, specifically the enforcement of punitive prohibitions, have been comparatively under-explored and specifically have not been a prominent feature in the harm reduction discourse. This short presentation, as part of the proposed major session, will develop this theme by considering analysis from Transform Drug Policy Foundation and the 'Taxonomy of Drug Harms' by Reteur and McCoun (in 'Drug War Heresies' 2001). The broad analysis will then be illustrated by comparing harms associated with illicit use of 'street' heroin with supervised legal use of prescribed heroin. 'Prohibition harms' will be demonstrated to include:

  • Dirty/shared needles (Hep C / HIV risk)
  • unknown strength/purity (poisonings, infection, overdose risks)
  • Drug litter
  • Fueling large volumes of low level acquisitive property crime and street prostitution (low income dependent users fund raising to support a habit)
  • Organised crime from local street dealing (including drug-gang violence and turf wars) to international criminal networks (links to conflict and terrorism)
  • Destabiliation of producer countries (corruption and violence in Afghanistan)

A case will be made for the definition of harm reduction to be broadened to include the harms (or as the UNODC describes them 'unintended consequences') related to enforcement, for the harm reduction movement to more pro actively engage in the debate around the policy implications of this analysis; including changes to enforcement practice and alternatives to prohibition, and in the longer term, decriminalisation of use and legally regulated drug production and supply.

The Limits of Harm Reduction within the context of Prohibition

Donald MacPherson, Drug Policy Co-ordinator City of Vancouver

This presentation will consider the limits of harm reduction initiatives as a response to problematic substance use within the context of the criminalization of drugs and drug use. Harm reduction efforts take place in the margins between illegal underground drug economies, cultures of drug use and officially sanctioned efforts to deliver health care interventions and/or punishment to drug users and sellers. Current approaches to the use and sale of illegal drugs do not acknowledge how the criminalization of drug use limits the impact of health and/or criminal justice responses. International agreements that criminalize drug use have prevented communities from developing a full range of harm reduction interventions. These agreements have also prevented countries from developing alternative responses to illegal drug use and sales. The City of Vancouver has developed a strategy to prevent and reduce harm from substances that includes a call for dialogue on alternative regulatory mechanisms for currently illegal substances with a goal of maximizing prevention and reduction of harm. Regulation and control of currently illegal substances combined with social and economic development efforts can provide an alternative response to problematic drug use. This presentation will consider the significant limitations of harm reduction initiatives within a context of the continued criminalization of psychoactive substances in society.

Can Harm Reduction Win the War on Drugs? A Thai User’s Perspective

Paisan Suwannawong, Thai AIDS Treatment Action Group (TTAG)

Thailand drug policy consists of drug eradication, suppression and prevention approaches, with the heaviest financial and human resource investment on law enforcement and military techniques to achieve a “drug-free” country. Harm reduction is not included in its approach. In 2003, Thai drug policy reached its nadir when 2,500 people were extra-judicially executed and tens of thousands of other people allegedly associated with drugs experienced numerous other human rights violations in the name of drug control.

My community of both HIV-positive and HIV-negative people with a history of drug use is virtually the only group in Thailand to have publicly advocated against abuses committed by government sectors toward drug users. Thai drug users have introduced community-driven harm reduction interventions since the 1990s in spite of the ongoing repressive legal and policy environment: prior, during and following the infamous 2003 crackdown.

My presentation will depict the peer-led harm reduction interventions that we implement regardless of what stage of suppression the government wages, and how the drug war specifically effect the efficacy of our work. Our interventions are severely compromised by the lack of government support for this important rights-based public health approach. Until harm reduction policy becomes a reality in Thailand, drug users are placed at higher risk of HIV, viral hepatitis, TB and other severe diseases due to overemphasis on criminalization and resultant high rates of detention and incarceration.

The lack of support for evidence-based harm reduction approaches, plus the failure of relevant government ministries to recognize the various harms experienced by people who use drugs, combined with a criminalizing and stigmatizing environment condemns drug users and harm reduction workers to ultimately fail to make a significant impact due to the increased risk, extreme duress under which we work, lack of funding and political support, etc. Drug wars must be stopped.

The Bigger Political Picture: International Discourse on Harm Reduction and the Drug War

Sanho Tree. Institute for Policy Studies

Politicians and drug warriors often say that we know where the drugs are coming from, so why don't we stop them at the source before they can reach our kids? This is easier said than done. After decades of trying this simplistic strategy, more drugs than ever are reaching consumers. Despite spraying more than 3 million acres under Plan Colombia, coca cultivation has actually increased in that country and has been pushed into other countries in the region as well. In Afghanistan, attempts to curb opium poppy cultivation have been spectacularly unsuccessful. In both countries, hard line eradication policies have left peasant farmers with few economic alternatives and have helped drive some of them into the arms of insurgents.

There is simply too much ungoverned territory in the world and a relatively inexhaustible supply of impoverished farmers willing to take the risk of cultivating illicit crops. Attempts to eradicate these crops have been short-sighted -- trying to produce quick results (no matter how unsustainable) to meet the targets established by political officials -- while the economic development projects to compliment the eradication programs have been woefully under funded. In short, these supply side control measures have been about as effective as shovelling water.

The collateral damage associated with the drug war impacts the poor and people of color in ways unheard of to most harm reductionists. These lives are not squandered by necessity, but by political choice and accompanying neglect. Just as we advocate harm reduction policies for drug users on the demand side, there is a need for harm reduction in source country crop control on the supply side. This presentation will examine why these supply side policies have failed as well as the political dynamics driving this failed paradigm.

Wednesday, April 15, 2009

Mexican Drug War: Year of the Dead

Below is a video of a recent talk about the Mexican drug war at the Conference on World Affairs at the University of Colorado given by Sanho Tree, a drug policy analyst from the Washington based Institute for Policy Studies (and occasional Transform blogger). Incisive and informative analysis of the appalling unfolding crisis in Mexico.

"When you have these types of turf battles, its very counter-intuitive, but in terms of violence reduction, as long as we have high demand in places like the United States and as long as we have the war on drugs, drug prohibition, then the state getting in between a turf battle is possibly one of the worst thing you can do, which is a very difficult reality for politicians to face because they want to do something. Daniel Webster once said - 'the strong notion that something must be done is the parent of many a bad measure...especially if it happens in an election year."

See also this news piece from abc in the US, showing how collateral damage from the drug war is coming home to roost. Turf war related kidnappings are now commonplace in Phoenix, Arizona:

Phoenix - Kidnapping Capital of the U.S.A.

Tuesday, April 14, 2009

New York City Bar Association: 'A Wiser Course; Ending Drug Prohibition'

From a statement issued this week by the New York Bar Association


In 1994, the New York City Bar Association’s Committee on Drugs and the Law concluded that the societal costs of drug prohibition are too high to justify it as a policy and called for a national dialogue on alternatives. Fifteen years later, that dialogue has not occurred, we are no closer to a drug-free society, and the problems associated with the illegal drug trade are worse than ever.

The starting point for a critical inquiry into U.S. drug control policy is the Controlled Substances Act of 1970. The legal profession, in partnership with medical professionals and other stakeholders, should study the CSA and propose improvements to it where necessary.

A Call for Dialogue Fifteen Years Ago

On June 10, 1994, the Committee on Drugs and the Law (the “Committee”) of the New York City Bar Association released a report (the “Report”) entitled “A Wiser Course: Ending Drug Prohibition.”

It is available at

The Report argued in detail, inter alia, that drug prohibition strains the judicial system with no apparent diminution in drug trade or drug use, fills prisons at great expense to the taxpayers, disproportionately punishes racial minorities, corrupts police and erodes constitutional rights, subsidizes organized crime, drafts poor children into the drug trade, causes violence by engendering competition over the lucrative illegal drug market, fails to decrease demand for drugs, facilitates the spread of disease and impairs the health of drug users, and diverts resources from prevention and treatment to law enforcement.

In short, the Report argued that U.S. drug control policy is the cause of, rather than the solution for, many social problems associated with drugs, and it identified several alternatives to prohibition proposed by members of the federal judiciary (including repeal of all federal laws banning drug sales and possession in favor of state-level drug control, a policy of reduced arrests, and sale of drugs through state stores) without advocating any specific policy. (The Report also stated that any post-Prohibition regime should leave state and local governments able to apply penal sanctions when drug use results in harm to others, e.g. causing injury while using a motor vehicle under the influence of drugs and to address quality of life issues related to drugs. Report at 81-82.)

The 1994 Report closed with the Committee’s recommendation for “a public dialog regarding new approaches to drug policy, including legalization and regulation.” (Report at 83). Since the Report was issued, there has been a dramatic increase in the influence of drug policy reform advocacy organizations working around the United States on issues such as needle exchange, repeal of mandatory minimums, re-entry of drug law offenders into society, substance abuse treatment, and access to marijuana for medical purposes, but there has been no engaged, systematic evaluation of the rationale of United States drug control policy outside the reform community.

Today the Committee makes a renewed call for a serious discussion of U.S. drug policy through a focus on the medical paradigm and the Controlled Substances Act."

Event announcement:

On April 29th, the Committee is presenting a forum titled "Pleasure, Pain, Physicians and Police: The Law of Controlled Substances and the Practice of Medicine." Experts in law, medicine and history will discuss the CSA and its relationship to science, medical practice and the Commerce Clause.

  • Marcus Reidenberg, MD, FACP, Professor of Pharmacology, Medicine, and Public Health, Head, Division of Clinical Pharmacology, Weill Cornell Medical College;
  • Joseph Spillane, PhD, Associate Professor and Chair of the Department of History, University of Florida;
  • Buford Terrell, JD, LLM, Professor of Law (ret.), South Texas College of Law.
When: Wednesday, April 29, 2009, 6:30 p.m.
Where: New York City Bar, 42 West 44th St., New York NY 10036

About the Association

The New York City Bar Association (, since its founding in 1870, has been dedicated to maintaining the high ethical standards of the profession, promoting reform of the law and providing service to the profession and the public. The Association continues to work for political, legal and social reform while implementing innovative means to help the disadvantaged. Protecting the public's welfare remains one of the Association's highest priorities.

See also:

King County Bar Association Drug Policy Project and the report: Effective Drug Control:Toward A New Legal Framework' (2005)

Tuesday, April 07, 2009

Transform publishes comparative cost-effectiveness study of prohibition / regulation

Transform's latest report is published today:

A Comparison of the Cost-effectiveness of the Prohibition and Regulation of Drugs

media coverage listing below


‘The benefits of… [legalisation/regulation] – such as taxation, quality control and a reduction in the pressures on the criminal justice system – are far outweighed by the costs and for this reason, it is one that this Government will not pursue either domestically or internationally.”

Home Office Briefing, 2008

  • Despite the billions spent each year on proactive and reactive drug law enforcement, the punitive prohibitionist approach has consistently delivered the opposite of its stated goals. The Government’s own data clearly demonstrates drug supply and availability increasing; use of drugs that cause the most harm increasing; health harms increasing; massive levels of crime created at all scales leading to a crisis in the criminal justice system; and illicit drug profits enriching criminals, fuelling conflict and destabilising producer and transit countries from Mexico to Afghanistan. This is an expensive policy that, in the words of the UN Office on Drugs and Crime, has also created a raft of negative ‘unintended consequences’.

  • The UK Government specifically claims the benefits of any move away from prohibition towards legal regulation of drug markets would be outweighed by the costs. No such cost-benefit analysis, or even a proper Impact Assessment of existing enforcement policy and legislation has ever been carried out here or anywhere else in the world. Yet there are clear Government guidelines that an Impact Assessment should be triggered by amongst other things, a policy going out to public consultation or when ‘unintended consequences’ are identified, both of which have happened with drug policy in recent years.

  • Alternative approaches - involving established regulatory models of controlling drug production, supply and use - have not been considered or costed. The limited cost effectiveness analysis of current policy that has been undertaken has frequently been suppressed. In terms of scrutinizing major public policy and spending initiatives, current drug policy is unique in this regard.

  • The generalisations being used to defend continuation of an expensive and systematically failing policy of drugs prohibition, and close down a mature and rational exploration of alternative approaches, are demonstrably based on un-evidenced assumptions.

  • This paper is an attempt to begin to redress these failings by comparing the costs and benefits of the current policy of drug prohibition, with those of a proposed model for the legal regulation of drugs in the UK. We also identify areas of further research, and steps to ensure future drugs policy is genuinely based on evidence of what works.

  • This initial analysis demonstrates that a move to legally regulated drug supply would deliver substantial benefits to the Treasury and wider community, even in the highly unlikely event of a substantial increase in use.

Media Coverage:

BBC radio 4: The Today Programme:

New Statesman: Limping Along on the Left the cost of drug wars: £16 billion

Hungarian news portal:no translation available

not all the print coverage was positive / straight reportage:

South Wales Evening Post:
legalising drugs would lead to chaos

Daily Mail: Peter Hitchens: Eliot Ness couldn't stop booze, but he would win today's war on drugs ("Another parcel of garbage from the pro-drug lobby")

Other broadcast interviews included :

  • BBC Five Live drive-time
  • BBC radio Wales
  • BBC radio London
  • Talk Sport radio
  • LBC radio
  • Liverpool city talk radio
  • SFM (South Africa national radio station)
  • South Africa Broadcasting corporation TV news
  • BBC news channel
  • Channel five - The Wright Stuff (discussion of report not featuring Transform staff)

Wednesday, April 01, 2009

Shoveling Water: War on drugs, War on people

Please take a few minutes to watch this excellent short film produced by Witness for Peace, that considers the human and environmental costs of the disastrous ongoing efforts to eradicate coca production in Colombia using aerial fumigation. The film features occasional Transform blogger Sanho Tree, a drug policy analyst from the Washington based Institute for Policy Studies.

The film producers provide the following description;

"Journey to the heart of coca country where United States tax dollars have financed the aerial fumigation of 2.6 million acres of land in Colombia – the world's second most biodiverse country.

See cropdusters target coca plants, the main ingredient of cocaine, with concentrated herbicide as part of the U.S. war on drugs.

Listen to people on the ground, hear about the impacts, and learn new ideas about how to solve this deadly problem."