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Drug policies and grass root involvement in Europe;
historical context, current perspectives and future challenges
Finnish Harm Reduction SeminarHelsinki, November 2011
John-Peter CoolsTribes Institute, The Netherlands
Content
1. Drug use and policy,
2. International perspective
3. State of affairs in Europe
4. Challenges for the future
Substance use
• people use psychoactive substances since time immemorial used for medical, spiritual or recreational purposes
• examples: herbs, nuts, leaves, derivates of plants and synthetics
• Opium laws:classification in useful (e.g. medicaments, consumer goods) and illicit substances
Drug use in Europe; 60s, 70s
60s: ‘Swinging 60s’
• wide range of substances (cannabis, LSD etc)
• part of alternative youth culture
70s: ‘Me Decade’ + start economic crisis
• increased use of amphetamine, heroin• injecting
Drug use in Europe; 80s
Economic social crises
• ‘Heroin/amphetamine epidemics’
• among vulnerable populations: unemployed youth, migrants, people with mental health issues, youth trauma
• increased marginalisation of drug users
• introduction of HIV in IDU populations
Drug use in Europe; 90s
Post-Cold War optimism
• new generation of synthetic drugs (e.g XTC)
• part of youth (rave and nightlife) culture
• increased use of (crack) cocaine
• Central and Eastern Europe: ‘Heroin/amphetamine epidemics’
Drug use in Europe; 2000 onward
Globalisation and internet
• ‘stable’ rates of heroin and cocaine use
• increased rates of amphetamines
• wide range of synthetic drugs (e.g. Examine, GHB, Mephedrone) and ‘legal highs’
• internet crucial in supply and consumer info
Global markets
• changed geo-political climate• increased travel and migration• shift in drug supply & trafficking
routes
• uneven economic development
Global markets II
• new developing drug markets (heroin and ATS) in transitional and developing countries in Asia, Latin America and Africa
• rich & middle class: ‘Taste new liberties and modernity’
• poor: ‘Forget sorrow and hardships.’
Drug policy; traditional approach
Ideological inspired, a drug-free world:
1. Prevention, ‘Just say No’2. Treatment, ‘Just stop’
3. current drug users:• criminalised, marginalised• coercive treatment: years of
imprisonment or inpatient drug-free psychosocial treatment
Drug policy;modern approach
• Banning is not realistic• Abstinence not the only goal• Range of alternatives to be developed
• In line with other substances:
– tobacco: regulate advertising, taxation, environmental policies, filters, lower tar& nicotine, chewing gum, patches
– alcohol: restricted sales, taxation, bottle labeling minimum drinking age, drunk-driving laws, server training
The Netherlands
• The Netherlands starts different new approach shift in paradigm: public health next to public order
• driven by public debate & new insights
• started 1976
Harm reduction
“Harm Reduction refers to policies, programmes and practices that aim primarily to reduce the adverse health, social and economic consequences of the use of legal and illegal psychoactive drugs without necessarily reducing drug consumption. Harm reduction benefits people who use drugs, their families and the community.”
(Source: Harm Reduction International aka IHRA)
“Temporary acceptance of second best goals on short term.”(Source: A. Wodak)
Part of comprehensive policy
• Harm reduction is:– no ‘One-size fits all’; but offers different
strategies – no ‘End point”, but offers an entry point
to generic services and referral
• Harm reduction is a set of practical strategies to reduce negative consequences of drug use and drug policies
• It incorporates a spectrum of strategies varying from safer drug use to abstinence
“Habit is habit and not to be flung out of the window by any man, but coaxed downstairs a step at a time.”
Mark Twain, 1894
European countries, 80s
• Netherlands, UK and Switzerland adapt pragmatic approach
• strong grass roots influence• based on commitment, solidarity and
advocacy for fair and effective policies
• initially: bottom-up• later: top-down endorsed, strengthened
and mainstreamed by authorities
• strong opposition from other countries
European countries, 90s
• in 90s more countries (eg Germany, Spain, Portugal) shift towards health-centered approach
• decriminalise cannabis
• focus services at problem drug use
• develop full range of tailored health and social services
European response, 2000 -
• various networks of HR and public health projects commissioned by the European Commission
• European drug strategy 2000-2004; importance of balanced approach
• European drug strategy 2005-2009 mentions HR
• European Action plans focus on evidence-base, effectiveness, coverage and quality of health services
State of Affairs;HR in Europe• Harm Reduction integral part of most countries
drug and HIV responses:– Needle Exchange Programmes– Opiate Substitution Therapy– explicit Information and Education materials– community based outreach– drug consumption rooms– services in custodial settings (arrest houses and
prisons)– involvement of users – ....
• also in countries with traditional approach (e.g. Italy, Sweden)
• HR is supported by collected evidence by EMCDDA• EU increasingly speaking with one voice
‘Unintended consequences of drug policies’
• prohibition and law enforcement generate violence and corruption
• pressure on health (and other) harms for users, e.g.:
– effects of black market on quality of substances
– marginalised existence of users
Challenges ahead
1. limited coverage of HR in all countries
2. limited drug user involvement in services and policy development
3. eroding quality of HR services
4. swing towards issues on security, safety and public order
5. new political (and funding) agenda’s
1. Limited coverage of HR
• on country and local level
• in prison settings
• access to HIV/HepC treatment
• responses for stimulant users
• new generations of drugs and users
2. Under-developed user participation
• recent inventory: limited number of peer support groups. Also in ‘old HR countries’
• existing peer initiatives on local level, national level are under pressure
• international recognition (e.g. UN system) of importance of user involvement
3. Eroding of HR services
• mainstreaming and roll out of HR may lead to medicalisation and technocracy of service delivery
• leading to decreased quality of services
4. More Public order
• increased role of public order and nuisance control.
• coercive treatments, compulsory treatment
• enlarged range of law enforcement tools: CCTV cameras and general municipal ordinance (specific areas, crowds, alcohol/drug drug free zones)
5. New political agenda’s
• decreasing sense of urgency
• economic crises, severe pressure on funding
• new administrations:– ‘small government’, reduce ‘welfare
state’, deregulate & cut costs– push for Security and Safety agenda– in drug policy: ‘Recovery’
Conclusions
• drug use has become inevitable part of our societies and peoples lives
• European drug policies are relatively well developed:
– they promote comprehensive policies (no single solutions)
– they encompass Harm Reduction– but are based on the unrealistic and
counterproductive principles of illegality of drugs
Ways forward for Harm Reduction
• ‘Get organised’. National and international networks and parterships
• ‘Build your case’ on comprehensive system linking prevention, treatment and harm reduction
• invest in linkages with ‘recovery-agenda’
• invest in partnerships between academics, politicians, services and drug user communities
• need for MEANINGFUL involvement of community and user initiatives
Ways forward II
AND:
• need to address contradictory drug policies
• develop policies based on regulation instead of prohibition
Thank you for your attention!
John-Peter Kools
Expert on drug use, HIV and harm reduction
Research, training and publication
+31 61504839
