Intercambiando: ideas for
drug policy reform
No. 6 - June 2004
In this edition:
· Closing the Southern
Cone Project
· ICCDA
meeting
· Drug
law changes in Brazil & Russia
· Exclusive
interviews: Denise Doneda (Brazil),
Anya Sarang (Russia), and Paulo Pimento (Brazil)
· Hepatitis
C petition
· Avellaneda
Municipality shows interest in Intercambios’ work
· Study
on Injection Drug Use in Buenos Aires
· Harm
Reduction in Paraguay
· Research:
Drug Policy in Holland and the EU
EDITORIAL
Some neighboring countries have started
to register changes in perception of themes related to drug use. Brazil is on the path toward changing its
legislation to no longer criminalize possession for personal consumption of
drugs, and in parallel, it is strengthening the punishments for larger cases of
drug trafficking. This will come into
force if Law No. 7134, which was approved by the House, is also approved by the
Senate.
In Uruguay, an attempt to increase penalization has been
rejected. This country has requested
the OAS (Organization of American States) to apply harm reduction strategies,
as suggested by UNAIDS, the WHO, and the UNODC.
In Paraguay, the Ypujhe Municipality
has started to implement harm reduction strategies.
In Argentina, the government of Avellaneda is recognizing the work developed by
intercambios, specifically the distribution of
condoms and syringes in that area.
Overall,
faced with irrational war against drug users, these advances show the
importance and recognition of drug users’ right to health. The promise of, little by little, securing
them a better life is being recognized at various decision-making levels in our
region.
Furthermore,
a recent investigation on the impact of harm reduction strategies in Buenos
Aires, between 1998 and 2003 shows the importance of applying these
policies. The topics outlined here are
dealt with more in this edition of the newsletter. Here we demonstrate the advances made in our region. While some are quite visible, like the
debate in Uruguay, others have not fully come to pass, as the example of law
reform in Brazil or the meeting of the Committee for Addiction Prevention and
Drug Trafficking in the Chamber of the Argentine Congressional House of
Deputies to debate the effects of criminal penalization in our country.
While
our neighbors take strong, individual, small steps, our country still needs to
do a great deal of serious debate about the efficiency of current
legislation. Furthermore, we warn that,
despite progressive trends of our neighbors in the region among others
mentioned in earlier editions of this newsletter, our country maintains the
regressive debate within a security framework.
Thus, essential aspects of the problem are forgotten, like for example
the dimension of pleasure, preventive health, and individual liberty. The media has a significant role in
representing the risks related to drug use and in portraying the need for
debate, based on experiences like those described in this edition.
To
enrich the discussion, we present some aspects of our neighbors’ successes
within this edition.
You will find exclusive interviews with public officials from Brazil
(Denise Doneda) and Uruguay (Leonardo Costa).
What’s more, to deepen the debate, we will organize the 2nd
National Conference on Drug Policy at the Chamber of the Argentine
Congressional House of Deputies.
II National Conference on Drug Policy
September 8-9, 2004
To be held in
the auditorium of the Honorable National Congress
Prof. GERRY V. STIMSON PhD, Executive
Director of the International Harm Reduction Association. Director of the Centre on Drugs and Health
Behaviour, Imperial College, School of Medicine, London, Great Britan.
Dr. ALAIN LABROUSSE, Sociologist and founder
of the Centre for Geopolitical Drug Studies, France.
Dr. LEONARDO COSTA, President of the National Coalition of Drugs and Secretary to the
Presidency of Uruguay.
Congressman
PAULO PIMENTA, Brazilian Congress. Author of the project for modification of Brazilian
Drug Law 7134.
For more information or to sign up: conferencianacional@intercambios.org.ar or at www.intercambios.com.ar / Tel.(54) 11-4954-7272.
REGIONAL LATIN AMERICAN PANORAMA
The Southern Cone Project Closes
The Argentine Ministry of Health again hosted the meeting of the
Drug Abuse Prevention and HIV/AIDS Project of the Southern Cone. Thus, on March 17th, 2003, the
launch ceremony was held in the auditorium of Ministry of Health. On May 14th, 2004, a seminar was
held in the same auditorium in order to share experiences gained through
conducting the project. Those present
included: Dr. Giovanni Quaglia -regional representative of UNODC, Dr. Laurent
Zessler -coordinator of UNAIDS for the Southern Cone, representatives of the
Ministry of Health and Secretary of Drugs, other governmental officials,
researchers, field extension workers, and Chilean, Paraguayan, Uruguayan and
Argentine NGO’s.
Harm Reduction in Paraguay
The Ypejhú Municipality, Canindeyu-Paraguay, has given important
backing to harm reduction interventions, promoting the handing out of free
syringes and protecting the identity of the program’s beneficiaries. Article 6 of the Municipal Decree calls for
“distribution of disposable syringes in exchange for used syringes.”
This decree represents recognition of harm reduction policies, and
the involvement of public health institutions, private actors and the local
health department.
OAS approaches harm reduction?
The
Inter-American Commission for Control of Drug Abuse (ICCDA) is an agency of the
Organization of American States (OAS).
ICCDA’s objective’s include: to promote multilateral cooperation in the
area of drugs, to strengthen the capacity of member states to prevent and treat
drug abuse, combat production and traffic, promote specialized investigation
and training, and to provide technical assistance.
ICCDA
was created in 1986. Their 13th
regular session was held in Washington in May 2004. Throughout this agency’s 18 years of activity, they do not seem
to have considered alternatives beyond the war on drug.
We find
it significant to inform that during this meeting, in which Argentina
participated, delegates from Brazil and Uruguay proposed the promotion of harm
reduction strategies and community-based, drug-abuse treatment services.
Harm
reduction strategies, already suggested by UNAIDS, the WHO and the UNODC, were
recommended by our neighboring countries at this OAS forum. We believe that, in Latin America, we need
to take advantage of the successful experiences from around the world and those
developed in our region.
As you
will find later in this edition, the representative of Brazil raised the issue
of the necessity of reinforcing harm reduction policies.
Leonardo
Costa, head of Anti-drug Coalition and the Secretary
to the Presidency of Uruguay, made Uruguay’s presentation. According to Costa, “we present the harm
reduction concept to the OAS in order to look at the consumer, not the
drug. We show what we have been doing
in Uruguay and how this has changed the paradigms and discourse, so that we can
implement harm reduction in our region.”
BRAZIL
InterCambiando interviewed Denise Doneda, chief of the prevention unit of
the Brazilian Ministry of Health’s National Program of STDs and AIDS. Denise
participated in the ICCDA meeting.
What is the position of the ICCDA in relation to harm reduction
policies?
Since 2002, the ICCDA has included AIDS issues in its agenda. Harm reduction has been cited as an
option. Although it has been recognized
with several limitations, the recognition represents a great development in
this forum, which seeks consensus among countries with differing drug policies.
What is the position of the Brazilian government?
Brazil adopted harm reduction as a public health strategy to
control the AIDS epidemic since 1998.
Among the action taken was to finance and support civil society to help
the local government carry out the actions and to facilitate that drug users
and ex-users be recognized as citizens.
What was the Brazilian governments request at the last ICCAD
meeting?
Brazil presented a resolution about harm reduction that was
debated throughout the week to reach consensus, although some differences of
opinion could not be resolved.
Which?
For example, the defense of the right of users to organize
themselves in associations, the word “harm” instead of “risk”, the
understanding that harm reduction must always be connected to chemical
dependence treatment. In spite of all
this, many countries that do not have a tradition of harm reduction were open
to the topic and to the scientific and technical arguments.
Usually, secretaries of the drug departments of member states are
present at ICCDA meetings.
Why was it that a representative of the Ministry of Health made
Brazil’s presentation?
It is because access to health services in the area of AIDS, like
that of drugs, demands a multi-sectored response, articulated by various
government bodies. Drug issues have a
great deal to do with health department employees. Collaboration among the different divisions of the government
agencies can create a wider range of support to drug users.
Harm reduction work, AIDS prevention, the fight against stigma,
and preconceptions directed at drug users will only change when all the sectors
of society are determined to their recovery as citizens. I believe that at the international level,
this is the scenario we must achieve.
XV INTERNATIONAL HARM REDUCTION CONFERENCE
The International Harm Reduction Association (IHRA) realized its
15th International Conference in Melbourne, Australia, between April
20th and 24th. To
understand what happened at the conference, interCambiando interviewed Anya
Sarang, winner of the Rollestone Prize. Anya is coordinator of the Central and
Eastern European Harm Reduction Network.
She participated in this event in Australia, and is an expert on the
problems related with drug use in Central and Eastern Europe.
In your opinion, what was the most important topic discussed at
the conference realized in Melbourne?
For me, as representative of the Central and Eastern European
Region, one of the most important topics is to secure equal anti-retroviral
treatment for drug users living with HIV.
According to that which was discussed in the Conference, what are
the most important advances and what are the most urgent challenges facing the
Harm Reduction movement?
One of the greatest advances, and at the same time still a
challenge, is to consolidate strength to influence political actors in the
international forum. The conference is
one tool, but we need to work together.
For example, when there is a problem in Russia, we need support from
around the world. Last November, a
state committee for drug control was established and announced that harm
reduction programs were considered against the law. Here is an example of a case where a strong response is needed
from the whole world.
I believe that a central problem to the work of consensus building
by those working in harm reduction is the media’s lack of interest in our
work. We need to focus strengths and
resources to attract the media and public to themes related to harm reduction,
human rights, and drug policy.
At this conference you received the Rollestone Award, that since
1992 has been given annually to people making important contributions to harm
reduction. What does this achievement
mean to you?
Receiving this award surprised me, since I did not believe I
deserved it professionally and I resisted accepting it. I accepted the award on behalf of all the
people with whom I work and on behalf of the members of CEEHRN (Central and
Eastern European Harm Reduction Network).
How do you evaluate Russia’s changes in drug laws? (described
below)
These changes are very good and I am proud of my government for
making these important changes in criminal codes. Particularly in spite of great resistance exercised by strong
handed parties and those that see drug users as a disposable social group. From a harm reduction and HIV prevention
perspective, these are very positive changes that facilitate our efforts. One main impediment to our harm reduction
work at the local level was that drug users were afraid to walk the streets
giving out clean needles, since just the little bit of drugs left in the used
syringes was enough to incarcerate them for years. Now with new legislation, it is going to be more difficult for
the police to accuse drug users who help other users, helping them receive care
and help where they may not have gotten it otherwise.
Another important consequence is that thousands of people will be
freed from prisons, who had been incarcerated for several years for having
committed non-violent drug-related crimes.
Jails are a place were many people contract HIV or lose their health due
to the terrible conditions, overpopulation and absence of minimum health
norms. Today there are, according to
official statistics, more than 35,000 people living with HIV in Russian
prisons. Many of these people were
infected within the prison and others were released only to die of AIDS for
lack of medical attention.
If the prison situation is normalized, the number of people living
with HIV in prisons will decrease. But
it is also important that the civil services are prepared to receive a large
quantity of people who will be freed, who will need medical help and social
protection.
What lessons were learned in this process of consensus building?
I learned an important lesson:
a small group of people cannot do everything, but if your work involves
different interests and groups of people, you can reach success. It may seem like common sense, but the drug
policy reform process represented a clear example of this lesson to me. Another lesson I learned is that my
government can take sensible and reasonable decisions, despite pressure from
uninformed public opinion. This was a
very new and encouraging experience and to show our respect in support of this
decision, the Central and Eastern European Harm Reduction Network sent a card
to the prime minister and other members of the government.
Russia: Depenalization of possession
for personal consumption.
Russian citizens must no longer remain in prison for possession of
small quantities of illegal drugs. The
new legislation mandates
community service for possession of one dose of drugs. In the months since President Vladimir Putin
declared this resolution last December, lawyers and NGOs have been working to
determine what exactly a dose is.
Whoever is found holding these quantities cannot be detained, although
the case must be registered by authorities of the federal anti-drug
service. The quantities permitted by
the new legislation are 20 grams of marijuana, 5 grams of hashish or opium, 1.5
grams of cocaine, 1 gram of heroine or methamphetamine, and 0.003 grams of LSD. The previous legislation imprisoned anyone
found with 0.1 gram of marijuana.
Foreigners can be expelled from Russia or denied reentry under this new
law.
SHORTS
Legalization of Cannabis does not increase consumption.
The May edition of the prestigious journal "American Journal of Public
Health" presented a report on the criminalization of drug
consumption. The report compares
realities in Amsterdam and San Francisco, California to find out if
criminalization limited the use of cannabis and if legalization increased
use. Both cities have more than 700,000
inhabitants, are financial and entertainment centers, and have an urban,
cosmopolitan image, both politically liberal and culturally tolerant.
However, their legislation on Cannabis is completely
different: in Amsterdam, it is possible
to sell and buy marijuana in 288 "coffee shops" and consume it in
public, activities that are illegal in US cities.
The authors (Craig Reinarman, Peter Cohen and Hendrien Kaal)
interviewed more than 5,000 people in both cities and selected those who had
consumed drugs at least 25 times, representing 12% of the Dutch group (535 volunteers) and 39% of the US group (349). Despite the differences
in cannabis regulation, the profile of users was
similar: they had started to use drugs
at 16, at 19 began to use regularly, and two years later reached their highest
consumption.
In San Francisco, just as in Amsterdam, the majority of those interviewed (80%)
warned new users of the advantages of moderation. According to the report, effectiveness of penalization is
doubtful. “If the measures taken
against drug use influenced users’ consumption, we would not have found such
great similarities where legislation was so different.” This research concludes that legislative
measures do not influence consumption, but rather the norms put forth by the
user.
The Avellaneda Deliberating Council Declares Intercambios’ Actions of Municipal Interest.
The government of the City of Avellaneda issued a decree
declaring, “the municipality is interested in the AIDS prevention program
developed by Intercambios in Avellaneda City which works with intravenous drug users and
distributes syringes and condoms.”
This decree represents formal recognition of the work we have been
doing since 1998. We share this honor
with all those who have been part of this program, and in particular with the
outreach workers who spend time on the streets of Avellaneda, giving out
syringes and condoms, advice and experiences, gathering complaints and
succeeding in doing prevention work meets the the needs of the local
population.
Hepatitis C doesn’t wait.
On December 1, 2003, a petition was given to the Ministry of
Health signed by people living with HIV/AIDS.
The petition showed that the quality of life of the petitioners has
improved since the introduction of free antiretroviral treatment, guaranteed by
the National AIDS Law. Hepatitis C
coinfection makes their situation worse and makes treatment more difficult.
Upon updating the mandatory health plan, full treatment for
Hepatitis C was determined to be mandatory for people with employment-based and
pre-paid health insurance policies. The
government has not yet responded to the question of full treatment access for
those without any type of insurance coverage.
In Argentina, there are 800,000 people affected by this chronic
infection, whose quality of life worsens day by day.
CHANGES IN INJECTION
DRUG USE IN THE BUENOS AIRES METROPOLITAN AREA
During the second
phase of the Regional AIDS Project associated with drug use in the Southern
Cone, a study was carried out in the Buenos Aires Metropolitan Area that looked
at changes in injection drug use practice between 1998 and 2003. The study investigated changes in practice
and risk of 140 current IDUs and worked with 35 injection drug using
couples. Further, the study looked at
the characteristics of interventions geared toward injection drug use and at
the opinions of 27 workers from the fields of health, community work and
prisons. The goal of this study was to
propose appropriate forms of interventions based on the identified
changes. The majority of IDUs injected
cocaine. 51.4% of the sample of IDUs
had been in contact with Harm Reduction Programs (HRP) and 48.6% had no contact
with HRPs.
87% of IDUs
interviewed had friends or relatives who had died due to AIDS-related causes.
One important
finding of the study was that the IDUs who had prior contact with HRPs had
begun using safer practices when using drugs and had now share less injection materials,
as shown in the table below.
With respect to
change in injection drug use between 1998 and 2003, the investigation’s main
findings were:
*Frequency of use
has decreased and the same syringe is used fewer times than five years ago.
*Injection use has
become a more individual practice
*While there has
not been significant change in safer sex practice among IDU who are in contact
with HRPs and those who are not, there has been an evident change
showing a decrease in sharing of injection material, which is significantly
associated with links to HRPs.
REGIONAL LATIN AMERICAN PANORAMA
BRAZIL
As we stated in our 5th newsletter, PT Congressman, Paulo Pimenta,
was one who pushed for change in Brazilian drug law. These changes were approved by one house of the Congress and,
according to Paulo, the Senate may also approve this law.
Congressman Pimenta
will be one of the speakers at the Second National Conference on Drug Policy.
1) How did you
garner support for the change in drug law that has been approved by part of the
Congress?
The Brazilian law
on illicit drugs is from 1976. It is
quite outdated and insufficient in response to the questions surrounding drugs
that we face in reality. In 1992, there
had been an attempt to update the laws that did not meet success. Our project extended the debate, created a
distinction between legal treatment of drug-users and drug-dependents, and
illegal trafficking. We start
considering improper use of illegal drugs as a public health concern,
establishing more efficient juridical mechanisms to fight the trade of illegal
drugs.
2) What are the
necessary steps in validating this law?
The project has
already been approved by the one house of the Congress and lacks Senate
approval, which should happen in the coming days, now that everything is
underway.
3) Does this law
exclude prison sentences for those caught on charges of possession for personal
use?
Yes, the law does
not decriminalize drug use for personal consumption, but it does not impose
prison sentences. In otherwords, use
will not call for imprisonment.
4) Does the law
propose alternative treatments?
The law does
propose alternatives to imprisonment, like for example community service,
limits to liberties, and that mandatory therapeutic treatments will be removed
from the justice realm.
Treatment should be directed to the public health system and the decision to
receive treatment is the decision of the user.
The need for treatment should not be defined by a judge but by a health
specialist.
5) What lessons
have you learned from the process of getting this law approved?
The first lesson is
that society cannot be hypocritical about this subject. The idea of prisons as therapy, served to
postpone the problem of many youths, who in truth need government support. Second, that the law is a compromise
between that which we wish to see and that which could be viable. It is necessary to understand that a single
system of drug politics demands participation of various actors.
6) What is the government’s position on
depenalization of substance possession for personal use?
The government
worked together with us on the elaboration of 73 articles that systematize all
the Brazilian legislation, so that it is no longer Anti-Drug Law, but becomes
Drug Policy.
The Ministries of Education, Sports, Justice, Health and Human Rights, together
with the National Anti-Drug Secretary (that should change its name and work
focus) will now be involved in this new phase of Brazilian politics on the
topic.
“Uruguay has
advanced legislation, and I believe the region is going toward depenalization”
Dr. Leonardo Costa.
Dr. Leonardo Costa
is President of the National Coalition of Drugs and Secretary to the Presidency
of Uruguay. He represented Uruguay in
the last ICCDA meeting (see previous article in this issue) and participated in
a recent public debate developing in his country on penalization of drug
possession for personal use. Costa has
been invited as a special guest to the Second National Conference on Drug
Policy.
To begin to get to
know one of the protagonists of the meeting that will be held on September 8-9
in the hall of the National Congress, we share this exclusive interCambiando interview:
How do you define
Uruguayan legislation on drugs?
Our legislation
permits for treatment of users, instead of criminalizing them. Our law does not send them to prison, nor to
the hospital. Consumption is not always
cause for health intervention, since use can be occasional. Most of all, we feel that use does not call
for police or penal intervention.
And to what end would you make
changes to improve the situation?
One reality is of
the small drug trafficker and we are working on this problem. In terms of individual consumers, what we
need to do is improve health services.
Does Uruguayan law
impose treatment?
In most countries,
possession for consumption demands obligatory treatment. Uruguayan law is more reasonable, in that
it does not impose treatment; usually treatments are not adequate and in some
cases there is a marked drive for profits steering treatment, which does not
seem to me to be the best path.
That is to say,
they combine an advanced law with flexible application?
Yes, I believe it
is an advanced legislation. This belief
is based on experiences in Europe and Australia and is based on data showing
efficiency of our own experiences. And the
application of the law also… when judges understand that the accused person had
drugs for personal consumption, they free them, because they understand that
prison is not the solution.
When did this law
come into effect and how effective has it been?
The law originated
in 1974 and in 1996 changed to strengthen the fight against drug
trafficking. Without a doubt, the
greatest result has been from not sending these people to jail. Jail only worsens the problem. In our countries, jail sentences do not
help, but worsen the situation and obligatory treatment is also not a solution.
What are the plans
for the future?
Now the
government’s plan is to use pharmacies as places of prevention for HIV with
drug users. We have started, with
success. Some pharmacists would not
sell syringes when they believed that they would be used for drug consumption,
and this resulted in users sharing the few syringes they had. This increased risk of infection. Fortunately, these tendencies have been
reversed.
What is the future
perspective in terms of drug policy in Latin America?
I believe that the
perspective, at the global level, will come from harm reduction, which at first
was perceived to be the same as legalization.
Harm reduction is based on the fact that there are harms…but is centered
on the individual and his or her substance.
Alcohol control in the USA is harm reduction. The US system establishes
fines for those who consume and drive, includes educational programs and
supervised sale. This is harm
reduction. I believe in the long run,
we will see the homogenization of control of legal and illegal drugs.
AGENDA
•
International AIDS Conference: Bangkok 2004, June 11-16. Bangkok, Thailand / www.aids2004.org/
• 2nd
International Conference on Alcohol and Harm Reduction. Warsaw, Poland. August 25-28, 2004. / www.alcoholconference.org
• Working under Fire: Drug Users, Health and
Justice 2004. 5th US Harm Reduction
Conference. - November 11-14, New
Orleans, USA / http://harmreduction.org/conf2004/