The goal in helping a loved one with a substance use problem is not to reduce their use. It is to stop drug use, said mr Sven-Olov Carlsson, international president WFAD, in his opening speech at 5th World Forum Against Drugs 12-13 March in Vienna.
Ladies and Gentlemen, Dear Friends,
Welcome to the 5th World Forum Against Drugs – this time to be held in Vienna.
Alcohol is the world’s third leading cause of ill health and premature death, with an impact greater than tobacco. Alcohol is well accepted as a major risk factor for non-communicable diseases (NCDs); there is a strong link between alcohol and several non-communicable diseases, particularly cancer, cardiovascular disease, liver disease, pancreatitis and diabetes. Alcohol is also associated with several infectious diseases like HIV/AIDS and pneumonia.
Resolutions from the UN General Assembly as well as WHO World Health Assembly support the notion of the importance of the general level of alcohol consumption for the health problems caused by alcohol. That there is a relationship between adult per capita consumption and excessive or heavy consumption of alcohol is well established by several, independent scientific evaluations.
In a review of the evidence for the effectiveness and cost-effectiveness of policies to reduce the harm caused by alcohol, published in The Lancet 2009, the authors (Anderson et al) state, “Ecologically there is a very close link between a country’s total alcohol per head consumption and its prevalence of alcohol-related harm and alcohol dependence, implying that when alcohol consumption increases, so does alcohol-related harm and the proportion of people with alcohol dependence and vice versa.
In Alcohol: No Ordinary Commodity (second edition 2010), the authors, Babor et. al, state that “there is a strong relationship between the total consumption of alcohol in a population and the prevalence of people who are heavy drinkers. However, when total consumption increases, it is not only the consumption of heavy drinkers that increase, the consumption tends to increase in all consumer groups.” Further, drawing on decades of research, the authors state:
The research establishes beyond doubt that public health measures of proven effectiveness are available to serve the public good by reducing the widespread costs and pain related to alcohol use.
To that end, it is appropriate to deploy responses that influence both the total amount of alcohol consumed by a population and the high-risk contexts and drinking behaviors that are so often associated with alcohol-related problems. To conceive of these intrinsically complementary approaches as contradictory alternatives would be a mistake.
It is clear, in my view, that in order for an alcohol policy to be effective, it must aim for reductions in per capita alcohol consumption. I believe that the same is true for an effective drug policy; it too must aim to reduce drug use.
Reducing consumption of alcohol is seen by the most enlightened leaders of the field of substance abuse to be smart and in the public interest whereas in drug policy, many of these same leaders view the goal of reducing illegal drug use to be unwise, reactionary, and moralistic.
The World Federation Against Drugs (WFAD) is not ambivalent on the goal of reducing drug use as the first priority of drug policy.
WFAD focuses on reducing both use of drugs and use of alcohol.
Unlike WFAD, many substance abuse policy experts do not view reducing nonmedical and illegal drug use as a primary goal of drug policy. That viewpoint is a huge problem.
Why does this double standard exist on the primary goal of drug policy compared to alcohol policy?
In both alcohol policy and drug policy, many experts view coercion to stop use as troubling. I am less troubled by using reasonable coercion in the interest of public health.
For example, we ask why substance abuse programs should not insist that alcoholics stop drinking and drug addicts stop drug use, in both treatment and in the criminal justice system?
Why shouldn’t this no-use standard be enforced for children for whom the use of both alcohol and drugs is illegal? Why not have parents and schools insist that children be drug-free?
I reject the view that the crucial drug policy choice in the world today is between effective policies to reduce drug use and effective policies that reduce drug-related “harm.”
I support both goals. I see them working together and not in conflict.
However, our support of many of the harm reduction ideas in drug policy is tempered by the fact that many of these policies encourage drug use, such as tolerating continued drug use while patients are in drug abuse treatment.
Under the label of “harm reduction,” some countries in Europe now permit “drug consumption rooms” where the use of illicit drugs by addicts is sanctioned.
The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) have estimated that 60 drug consumption rooms exist in 36 cities across Europe, though that number has increased since. Drug consumption rooms are not exclusive to specific drugs.
A report promoting drug consumption rooms in Germany explained that the 12 drug consumption rooms in the state of North Rhine-Westphalia included 97 spaces for individuals to use drugs with 31 dedicated to inhalation consumption.
I ask, “Would anyone refer family members or friends to a drug consumption room whether for injection or inhalation of drugs?”
To me, the answer is clearly “No.”
The goal in helping a loved one with a substance use problem is not to reduce their use. It is to stop drug use.
This is a goal for which some harm reduction strategies do not strive.
Recently, a similar harm reduction strategy has been applied to alcoholics, providing them with “wet houses” so they can drink all they want without going out into the community where they could cause or experience “harm.”
I reject harm reduction policies and programs that encourage continued use of alcohol and other drugs for people with substance use disorders.
A false choice being widely trumpeted today in drug policy is between treatment and jail.
In my view, there is no conflict in drug policy between supporting substance abuse treatment and supporting the role of the criminal justice system in both supply reduction and demand reduction.
Rather, I encourage better linkage between health and criminal justice.
I encourage making full use of the potentials of both treatment and the criminal justice system to achieve ambitious public health goals together that neither can achieve alone.
These shared goals for offender populations include reducing alcohol and drug use, reducing criminal recidivism, and reducing incarceration.
There is a new paradigm of programs that deliver on these goals. This new paradigm is based on the zero tolerance standard that is enforced by random monitoring for any use of alcohol or other drugs linked to swift, certain, but not draconian, consequences.
This new paradigm that does not tolerate continued substance use has shown dramatic benefits to both public health and public safety.
So, to summarize World Federation Against Drugs supports the following principles to serve as a platform for the drug policy debate:
- Drug policies should prevent initiation of drug use.
- Drug policies must respect human rights (for users and non-users alike) as well as the principle of proportionality.
- Drug policies should strike a balance of efforts to reduce the use of drugs and the supply of drugs.
- Drug policies should protect children from drug use.
- Drug policies should ensure access to medical help, treatment and recovery services.
- Drug policies should ensure access to controlled drugs for legitimate scientific and medical purposes.
- Drug policies should ensure that medical and judicial responses are coordinated with the goal of reducing drug use and drug-related consequences.
* * *
The best strategy for the future of drug policy is to find improved, cost-effective policies that are compatible with modern values that reduce drug use and also reduce the harms produced by this use – policies that link treatment to the criminal justice system and policies that discourage both alcohol and drug use.
I think the balanced approach in alcohol policy supported by many public health experts is a good model for the drug field – both reducing per capita consumption and promoting “harm reduction” when the “harm reduction” does not conflict with the goal of reducing consumption.
I encourage everyone interested in substance use policy to evaluate their approaches to both alcohol policy and drug policy and ensure that their goals support the public health, beginning with an overarching goal of reducing use both in individuals and in the society as a whole.
There are at least three false premises for legalization
- The first false premise is that The Criminalization of Drugs Does Fuel the HIV/AIDS Epidemic. It does not.
The prohibition of illegal drug use does not encourage the spread of HIV/AIDS. Rather it reduces illegal drug use among HIV/AIDS patients, as well as the non-infected population thereby reducing the population vulnerable to HIV/AIDS infection by contaminated needles.
Illegal drug use exacerbates weaknesses of the immune system, making individuals with AIDS more susceptible to infection and death. Marijuana use causes impaired immunity and opens the door for the virus that causes Kaposi’s Sarcoma, life-threatening for individuals with HIV/AIDS. Marijuana also contains bacteria and fungi that put users at risk for infection.
Illegal drug use among AIDS patients is life threatening because these drugs lessen the effectiveness of anti-retroviral (ARV) medications.
Nonmedical drug use is associated with increased risky sexual behaviors, which promote transmission of HIV/AIDS in a way that needle exchange cannot prevent.
• The second false premise is that the Criminal Justice System and the Public Health System are Conflicting Approaches to Drug Policy. They are not.
The Criminal Justice System and the Public Health System Are Complementary and Not Conflicting Approaches to Drug Policy.
Prevention and treatment are programs that promote public safety and public health. “Harm reduction” tolerates, and thus perpetuates, nonmedical drug use.
“Harm reduction” seeks to reduce the “harm” caused by nonmedical drug use without stopping the use itself.
Defining the roles of the criminal justice system in reducing illegal drug use as unreasonable or inhumane and defining illegal drug use as a “human right” are as sensible as defining drunk driving as a protected human right and its enforcement as an inhumane waste of resources.
Substance abuse prevention and treatment work to stop nonmedical drug use. Making nonmedical drug use as a crime is an important public health strategy that reduces many of the “harms” produced by illegal drug use.
To promote public health and public safety and to support a balanced restrictive drug policy that uses the criminal justice system, and the illegal status of nonmedical drug use, to reinforce both prevention and treatment. The current globally-endorsed balanced drug abuse prevention policy can be improved.
The challenge of future drug policy is to find ways to encourage the legal and justice systems to work better together with prevention and treatment to achieve goals that neither can do alone.
Treatment systems can work together with the criminal justice system by incorporating new, effective and evidence-based strategies to reduce illegal drug use among criminal offenders. These approaches also reduce the commission of new crimes and associated incarceration.
• The third false premise is that Major Costs of illegal Drug Use are generated by the criminal justice system itself. It is not.
The greatest costs of illegal drug use are not generated by criminal justice system but by the nonmedical drug use itself.
The costs include not only sickness and death but also reduced productivity and the high healthcare costs generated by illegal drug use.
The future of an improved drug policy is not to legalize intoxicating, abusable drugs, including marijuana.
It is in the development of a balanced, restrictive drug policy that prevents drug use, and that intervenes with drug users to provide them with a path to life-long recovery.
Instead of legalizing drugs, an enlightened drug policy can harness the criminal justice system to thwart drug markets, facilitate entry into treatment and restrict incarceration to egregious offenders.
The criminal law against illegal drug use is a major public health strategy to reduce drug abuse and the many health, safety and productivity losses imposed by drug abuse.
These are the elements of a successful drug policy. This drug policy makes clear that drug use is unacceptable.
With this I declare the 5th World Forum Against Drugs for opened.
Thank you for your attention!
… Against Drugs. Första konferensen hölls i 2008 i Stockholm. Därpå tre till i Stockholm ( 2010, 2012 och i maj 2014 tillsammans med ECAD:s borgmästarkonferens). Det femte hölls 12-13 mars i Wien, i samband med FN:s 59:e CND-möte, inför Ungass.
• World Federation Against Drugs , WFAD, som ordnare konferenserna har nära 170 medlemsorganisationer från alla kontinenter.