Transcript Presentation Pavel Bem - What is the LOCAL

Local Pass Conference
Innovative Local Approaches towards
New Trends in Psychoactive Substance Use
“Time to Rethink our Policy on Drugs Effective Drug Policy Responses: the Czech
Experience”
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, 9-10th cent.
“Unintended negative consequences”:
Overall cost is to high…
BUT…
We act only on the “surface” of the problem…
Positive Results:
Demand and 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
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Acceptance of failures
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Understanding of best practices
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The role of supranational authorities:
Active leadership
(Latin America + Europe…)
The need for paradigm change
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Prague: case study
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Czech experience
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Global Commission on Drug Policy
Prague Drug Policy Design
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Pragmatic approach
Realistic attitude
Data based design
Balanced policy and
measurable outcomes
Prague Drug Policy Design
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Balance between public health and safety
Economy driven drug policy
Evidence based interventions
Police does it’s job on drug supply side
Demand and harm reduction services
Measurable outcomes (HIV, HCV, morbidity)
Prague Drug Policy Design
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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
Prevalence of PDUs in Europe
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Estimates of the prevalence of problem drug use (cases per 1 000 population
aged 15–64 (cases per 1 000 population aged 15–64)
This Project is funded by the European Union and implemented by a EU MS Consortium
16.11.2011
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Where are the benefits?
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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
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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
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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
1. No size fits all
 Innovative and effective interventions at
the local level that have responded to local
developments in the drug situation have
triggered most of the advances in drug
treatment, prevention, harm reduction as
well as law enforcement.
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2. Realism is the “key”
 A drug-free world is an unrealistic idea. It is a
harmful concept if set as an ultimate goal, like
other utopias that has been set in history.
 It is beneficial and realistic to aim to diminish
the harms related to drug trafficking and use as
much as possible: through reducing the nonmedical consumption of drugs and thus the
total volume of related risks by means of
prevention & treatment.
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3. Human rights apply to ill
people in particular
 Drug addiction is a disease defined by the
World Health Organization.
 There is no scientific justification and no
ethical principle to support the
criminalization of a disease or citizens
being deprived of their human rights
because they are ill.
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4. Public health and public safety
concerns must not be seen as
contradictory
 Both public health and public safety efforts share
the same ultimate goal in the field of drugs: to
minimize the adverse consequences related to
drug trafficking and use as much as possible.
 The „balancing“ of the two is a simplistic
concept; mixing is probably closer to the real
world scenario.
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5. Evidence-based decisions only
 There is no doubt that the values of individual
nations and communities should be reflected.
 However, every such decision-making
process should be firmly rooted in the
evidence gathered by scientific, replicable
and controllable methods.
 Never ever should be based solely on beliefs,
ideologies and/or wishful thinking.
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6. Evaluation and monitoring
 The monitoring and evaluation of interventions is
widely recognised as a condition sine qua non for the
successful implementation of any intervention,
programme or policy.
 Only those drug policies that involve evaluation as an
inherent component can be constantly improved.
 Monitoring in its wider sense – both of the
implementation of drug policies and of the drug
situation per se – is a prerequisite for any evaluation.
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7. Constant mutual information flows
between local, national and international
levels through a common voice
 The assessment, evaluation and development of
national and international norms should be
increasingly seen and influenced from the local
perspective.
 Such a process may be fostered, for example, by the
creation of a global platform for networks of cities
that are dealing with drug policies and that already
exist in countries and/or regions.
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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
“Wishful thinking” is still prevailing among many
politicians, decision makers as well as media
www.globalcommissionondrugs.org
www.vlada.cz
www.cadap.eu
www.praguedeclaration.com
k
Thank you for your attention