Transatlantic Conference Brussels November 12 2013 Time to

Transatlantic Conference Brussels, November 12, 2013 “Time to Rethink our Policy on Drugs Experiences from Europe and the Americas” Pavel Bem, MD. National Drug Commission, Czech Republic Global Commission on Drug Policy

„Opportunities and risks stay so close together…“

50 Years of World’s Experience of Combating Illicit Drugs International cooperation in supply reduction Crop eradication Policies based on balanced approach between repression and prevention Role of primary prevention/health education Treatment and rehabilitation Focus at urban policies

50 years of wishful thinking

Negative Results: Supply reduction failed Supply of illicit opioids has increased 400% in last 30 years 75% decrease of heroin black market price 900% increase in heroin purity US budget increase in war on drugs: 600% (United Nations Office on Drug and Crime, 2010) No effect on supply reduction side

Negative Results: ”Balanced” drug policies failed Drug policy “driven” HIV epidemics, mortality Policy “driven” HCV epidemics, morbidity Missing balance in total expenditures: “supply vs. demand” 80% vs. 20% Failure in assessment of evidence based approach 20% vs. 80% Failure of national as well as supranational organizations in effective response Unintended negative consequences

Mustang: Ghar, Ghiling Gompa, 9 -10 th cent. “Unintended negative consequences”: Overall cost is to high…

BUT… We act only on the “surface” of the problem…

Positive Results: Demand harm reduction works Reducing HIV prevalence among PDU’s Reducing HCV prevalence among PDU’s Reducing hidden population of PDU’s Reducing mortality among PDU’s Reducing morbidity among PDU’s Reducing not only public health risks, but overall social and economic costs

The need for paradigm change Acceptance of failures Understanding of best practices The role of supranational authorities: Active leadership (Latin America + Europe…)

The need for paradigm change Prague: case study Czech experience Global Commission on Drug Policy

Prague Drug Policy Design Pragmatic approach Realistic attitude Data based design Balanced policy and measurable outcomes

Prague Drug Policy Design Balance between public health and safety Economy driven drug policy Evidence based interventions Police does it’s job on drug supply side Demand harm reduction services Measurable outcomes (HIV, HCV, morbidity)

Prague Drug Policy Design Availability of needles and syringes Availability of services + outreach Methadone + Buprenorphine + … Non-punitive legal framework (possession is not legal offence)

HIV prevalence among IUDs in Europe

Drug Overdoses–EU Countries

Where are the benefits? Low proportion of hidden population (< 30%) Low mortality rate Low prevalence of HIV among PDU’s-IVDU Manageable morbidity rates Manageable dynamics Reduced public health risks Acceptable economic and social costs 14

BUT…

We behave in simplistic way with no respect to human diversity and human rights (Papua, 2003)

New Penal Code: 1998 Penalizing possession Czech Republic case study

PAD: Impact Analysis Project of the New Drug Legislation Complex Cost and Benefit Analysis (5 major studies and 20 sub studies): 1. Secondary analysis of school surveys 2. Prevalence study of problem drug use in the CR 3. Economic and social cost of illegal drug use in the CR 4. Qualitative study among illicit drug users 5. Cost and benefit analysis of the implementation of penalization of possession of illicit drugs for personal use

Research Methodology Combination of quantitative and qualitative methods Measuring the direct as well as indirect costs Interdisciplinary research team Supervised by Florida State University, School of Criminal Justice Granted by the National Drug Commission

Main Hypothesis 1. Availability of Illicit Drugs Will Decrease 2. Use of Illicit Drugs Will Decrease 3. Incidence of Illicit Drug Use Will Decrease 4. Negative Health Indicators Will Not Increase 5. Social Costs Related to Drug Abuse Will Not Increase After Introduction of a Penalty of Possession for Personal Use

Results All hypothesis were rejected in 3 years study No positive impact of the criminalization law at all Lead to Decriminalization Act 2008 Evidence based additional costs for public budgets

Recommendations Prague Declaration, 2009 1. No size fits all 2. Realism is the key 3. Human rights apply to ill people in particular 4. Public health and public safety concerns must not be seen as contradictory 5. Evidence based decision only 6. Evaluation and monitoring 7. Constant and improving mutual information flow

Drug Policies at Crossroad Conclusions: 1. War on drugs has failed: Need for “rebalancing action” in drug policies design

Drug Policies at Crossroad Conclusions: 2. Need for wider implementation of cost effective public health measures: Harm reduction services especially at areas of high risk

Drug Policies at Crossroad Conclusions: 3. Decriminalization of drug possession and drug consumption worldwide

Drug Policies at Crossroad Conclusions: 4. Reallocation of drug budget priorities

The need for paradigm change Growing awareness internationally (Global Commission on Drug Policy: former presidents, prime ministers, UN officials, intellectuals…) Vienna high level meeting: CND 2014 (EU Action Plan on Drugs 2013 -2016, action #5] UNGASS 2016