10/21/18 Doug McVay

Century of Lies
Doug McVay

This week on Century: Canada legalizes marijuana, plus a discussion about harm reduction at the international level.

Audio file



OCTOBER 21, 2018

DEAN BECKER: The failure of drug war is glaringly obvious to judges, cops, wardens, prosecutors, and millions more now calling for decriminalization, legalization, the end of prohibition. Let us investigate the Century Of Lies.

DOUG MCVAY: Hello, and welcome to Century of Lies. I'm your host Doug McVay, editor of DrugWarFacts.org.

Well this week, we’re going to look at harm reduction this week. But first:

Canada’s federal legalization of marijuana went into effect on Wednesday, October 17. The rules vary from province to province. If you plan to visit, you must check the provincial government website for a list of the rules. They are not all necessarily tourist friendly.

In Ontario, for example, people aged 19 and older can only purchase marijuana online through the official Ontario Cannabis Store website. Orders are then delivered to customers, who must present their IDs to verify age in order to accept delivery. There are no retail stores. The only way to legally purchase marijuana in Ontario, until April First, 2019, at the earliest, will be through their website. If you go to Ontario thinking that you will spend a fun weekend and go down to a shop and buy some cannabis, you are mistaken.

So again, check these provincial websites, check the rules. If you're going up to Canada to celebrate their new laws, make sure you know what the rules are before you go. There are restrictions on where you can use, restrictions on the amount you can get, and again most importantly restrictions on how you can buy.

The rules are convoluted, the prices are too darned high, and there are a number of people formerly in law enforcement and in government, who supported prohibition, who are now cashing in by joining Canadian marijuana companies. Ending marijuana prohibition is a great first step, and Canada still has a long way to go. Still, congratulations on taking that step.

You know, Canada is well ahead of the United States on drug policy issues. Harm reduction, for example. There are supervised consumption facilities and overdose prevention sites operating in several Canadian provinces, while here in the US, there are not yet any legally sanctioned supervised consumption sites in operation.

Not the smoothest segue but let’s turn to harm reduction, and we’re going to keep an international focus.

The Commission on Narcotic Drugs will hold a set of intersessional meetings from October 22 through 25 of this year. They also held a set of these intersessional meetings back in September. In that September meeting, harm reduction wasn’t really on the agenda, but it was definitely part of the conversation, so we’re going to hear some of that discussion now.

Alexis Goosdeel is the director of the European Union’s drug agency, the European Monitoring Centre on Drugs and Drug Addiction, the EMCDDA. He spoke at the CND’s September intersessionals, during their discussion on the theme of demand reduction. We’re going to start listening to the recording a few minutes before Goosdeel actually starts to speak, so that we can hear an interchange about harm reduction between the Uruguay delegate and Vinay Saldanha, who was representing UNAIDS.

DELEGATE FROM URUGUAY: The issue of harm reduction seems to be a taboo subject here at the CND. We've been talking about harm reduction up until 2015, ad nauseum, and that phrase, simple harm reduction, couldn't be included in the UNGASS statement as such.

Why? Because many countries here in this room, and here in the CND, are of the view that, when handling drug addicts or possible addicts, providing various forms of prevention in order to stop HIV contamination or the spread of any other disease, as a use of injecting drugs or non-injectable drug use, as Mister Gerra pointed out today, and we were very pleased to hear that reference made by the way, many were of the view that in some way this would promote drug use.

And that actually is a contradiction because if somebody is given a syringe, an injection, and then you're being told 'don't use drugs,' but you're giving them a syringe, it makes it sound as if you are in a certain way motivating or encouraging that person to use drugs. Now that standstill went on for a year and a half, it was a stalemate, and we still haven't come out of it, and we haven't resolved it.

We won't probably have resolved it by next year, for the upcoming meeting in 2019. So it would be a good idea to get this out on the table once and for all because we have many countries, and we've just heard also from Mister Saldanha, who are well aware that there is a very strong trend, in particular in European countries, where there has been a clear emphasis placed on harm reduction.

If there are drugs, drug use in prisons, then there's also going to be HIV prevalence. That's principal. But it's not just about that. Harm reduction is a much broader subject than that, and it's not going to be simple to resolve. My question, Mister Saldanha, can you help us resolve this contradiction? Thank you.

VINAY SALDANHA: To the Honorable Delegate from Uruguay, thank you for your question, and if I could in one short response help you to resolve this question, I don't think I would have the job that I have today.

Having said that, as UNAIDS coordinates and unites all the UN agencies working on HIV, including UNODC, including WHO, one of the many areas of work we're involved with on an ongoing basis is looking at the evidence of the impact of harm reduction programs globally, regionally, and individual countries.

And one thing we have never seen, ever, anywhere in the world, is any evidence that a harm reduction program, when implemented, has triggered an increase in the use of drugs. If anything, it has produced the opposite, a very rapid and very positive improvement of the situation vis a vis HIV prevalence, hepatitis prevalence, and much safer overall trends related to the use of drugs, including a reduction in illicit or illegal forms of drug use, particularly when these harm reduction programs are combined with opiate substitution therapy programs.

So, if there are any member states, or work in cities or regions of member states, where there is evidence of the opposite, of course, the entire UN family, certainly the UNAIDS and our Secretariat, would be very interested in looking at that kind of evidence, but all the evidence that we've looked at suggests exactly the opposite.

And that's why, on behalf of UNAIDS, we can very confidently use the term "harm reduction," not only because it's an official policy that's endorsed by UNAIDS, WHO, and UNODC, and has been discussed many, many times at our board, the program coordinating board of UNAIDS, but also because time and time again the evidence has been shown it to be safe and effective. Thank you.

CND CHAIR: Thank you very much for this very good illustration. I think that Doctor Gerra would like to add something on top of this.

GILBERTO GERRA, MD: Only to support what the colleague has said now, because, if we do this kind of intervention that they called in my presentation a low-threshold outreach intervention to reduce the health and social consequences that is called under the umbrella harm reduction, we've got to incentivate the possibility of this patient to ask for, to knock to the door of the treatment system.

Because they start to say, these people are coming to see me in the night, when it is snowing. In Afghanistan, we have distributed blankest for harm reduction, because in winter it's snowing, and it's very cold, for example, in Afghanistan.

Or saving people from overdose. If you come every night to take care of me, without any condition, means that for you, I am of value. And they start to think that I am also valuable myself, and they gain some different perspective in life, not these things, starvation, in some place devoted to substance use, but to the door of the treatment system.

Good harm reduction interventions are able to increase the number of people asking for -- asking for a new perspective in life.

CND CHAIR: Thank you very much, to both of you. And now I would like to move to our next panelist, who is Mister Alexis Goosdeel. He's the director of the European Monitoring Centre for Drugs Addiction [sic: European Monitoring Centre on Drugs and Drug Addiction], EMCDDA. He has been nominated as panelist for WEOG [Western European and Others Group], and it's a great pleasure to have you here, Mister Goosdeel, and you have the floor -- the floor is yours.

ALEXIS GOOSDEEL: Thank you, Chair. Honorable delegates, excellencies, distinguished colleagues, and friends from other UN family organization. It's an honor and a privilege to share with you some highlights of the European experience and outcomes as far as evidence based drug policy is concerned. And my presentation will be around five points.

The first point is that the European public health approach has not come out of nowhere. It started around the apparition of a big heroin epidemic in the '80s that caused a lot of deaths from overdoses, and I think in all the main cities in Europe there were people dying from overdose almost every day.

This is where came, for instance, the Frankfurt Declaration in the early '90s. There were also the spread of the outbreak of HIV and AIDS related or associated to drug use, and last but not least, the apparition of the hepatitis C epidemic.

So, this is to say, as Gilberto Gerra said before, that we have not developed, or we have not learned this more balanced approach, combined supply reduction interventions and public health, out of nowhere. We have payed the price, because thousands of people have died and certainly we should keep being inspired by this, in being prepared to avoid this repeat in the case of a new epidemic.

This is one of our benchmarks, therefore, for the work in the EU, is to look at what was the situation twenty-five or thirty years ago, and I will come back to this in my conclusion.

The second point I wanted to make is that something that was very quickly identified as a priority among the European member states, and this was stressed by President Mitterrand in '89, was the need and still is the need for monitoring for reliable data, and for scientific evidence guiding decisions.

As President Mitterrand said to his fellow heads of state in '89, basically, we lacked any serious and robust information helping to orient the decisions to be taken by decision makers at national and at European level.

So, the consensus that has grown up around this issue between the European Union member states is that we need data, strong data, and monitoring to understand the situation, to analyze the needs, to design the interventions, and to evaluate the research and where possible their impacts.

Therefore, this is how, in '89, was taken the decision to establish a European Monitoring Centre for Drugs and Drug Addiction, which I have the privilege to lead for the moment.

The third point is the agreement, the consensus on the need for a more multidisciplinary and more collaborative approach between the European member states, and I would say this is probably one of the strongest assets of the European Union efforts and policy on drugs. It is not a top to bottom approach. It is a collaborative approach between all the member states.

The EU strategy and action plans are adopted together by the member states, not imposed on them, and it is also submitted to an external evaluation by a third party.

The European Commission role is also extremely important to support and encourage, and coordinate, where necessary, the action between the member states. And what we have seen that has developed over the last twenty, twenty-five years, it's an exchange of knowledge and best practice between the representative of the EU member states, and this takes place on the monthly basis at the Council in Brussels.

What is very important to understand is that if you look at some of the press clippings of 25 years ago, there were only very strong public declarations from some politicians or decision makers from one country against another.

Today, we don't discuss ideologies at European level. All EU member states share experiences and questions and best practice, and then according to the better knowledge they have of the drug situation, thanks to the European monitoring system, then they can decide and take decisions that apply to a better knowledge of their situation.

So, and this is reflected, if I anticipate on some questions made to the previous speakers, by the fact that all member states have a national strategy that is articulated with the European strategy, and the European action plans. Many, if not most, of them are evaluating their strategies and action plans, and this is what also led to the common position of the European member states that was presented at the UNGASS by the Commissioner Mimica on behalf of EU member states.

And so, those achievements, those positions, they are not -- they are not the result of something very short term. It's the result of a long term investment from the member states.

My fourth point is the balanced approach, combining public health interventions and supply reduction, and I think what is one of the cornerstones, and this was highlighted by Commissioner Mimica in New York in 2016, is that the basis is the charter for fundamental rights that are addressing and applied or are applicable to everybody living in Europe, including persons who are using drugs.

This led also to experiences like decriminalization in Portugal, but more broadly to what's a convergence between the member states through the conclusion that provided that people who are, or were, only using drugs, it was counter productive to put them in jail and that alternatives should be offered, and they are different models or experiences in the member states.

Still, there is a strong consensus that a repressive approach and putting people in jail because of drug use only is not something that is a good investment, from the point of view of the member states.

What it also allowed us to do is to build, over the years, a common toolbox based on scientific evidence, including an important set of harm reduction interventions based of course, and it was highlighted by my colleague of UNAIDS, based on strong scientific evidence.

Of course, we in the EU consider that one size doesn't fit all. As I said, depending on the diagnosis of the needs and the situation in the member states, the tools, the parts of the toolbox, are used according to the needs and the political priorities. Still, the toolbox includes also the OSTs [Opioid Substitution Treatment], needle exchange programs, but also drug consumption rooms, and evidence available about naloxone.

DOUG MCVAY: That was Alexis Goosdeel, director of the European Monitoring Centre on Drugs and Drug Addiction, speaking to the Commission on Narcotic Drugs at the CND’s September intersessional meeting.

You're listening to Century of Lies. I'm your host, Doug McVay.

Now, let’s hear more about harm reduction. Olga Szubert from Harm Reduction International spoke to the CND delegates on Monday September 25, during that discussion on harm reduction. She was a civil society representative nominated to speak by the Civil Society Task Force.

OLGA SZUBERT: The 2016 UNGASS outcome document contains the strongest international endorsement of harm reduction in a drug policy document. Member states committed to initiatives and measures aimed at minimizing the adverse health and social consequences of drug use, which includes considering the introduction of medication assisted therapy, injecting equipment programs, antiretroviral treatment, and naloxone for the prevention of overdose related deaths.

While this language is a positive step, there remains a considerable gap between rhetoric and implementation of these life saving measures, and one of the primary barriers to implementation is inadequate funding for harm reduction.

Harm Reduction International tracks funding for harm reduction in low and middle income countries, and our latest research found that only 188 million dollars was allocated to harm reduction in 2016. This is just over one tenth of the one point five billion dollars that UNAIDS estimates is required annually in low and middle income countries by 2020 for an effective response to HIV among people who inject drugs.

The trends in harm reduction funding in low and middle income countries is of serious concern. There has been no increase in funding since 2007. Moreover, harm reduction funding represents just one percent of the estimated nineteen billion spent by donors and governments on the HIV response in 2016, and available funds for harm reduction equate to just four cents per day per person injecting drugs in low and middle income countries.

International donors continue to be the most important source of support, yet their funding for harm reduction has declined almost one quarter over ten years. Donor governments are withdrawing bilateral support that was once strong for harm reduction, and our research suggests that funding allocations from the Global Fund to Fight AIDS, TB, and Malaria, and which is the largest funder for harm reduction, were eighteen percent lower in 2016 than in 2011.

In the face of donor withdrawal, the responsibility is shifting to national governments, and there are some bright spots where low and middle income governments are working to protect people who use drugs for a scale-up in funding, and our research identified domestic investment of over one million in ten countries, including India, China, Vietnam, Iran, Georgia, Thailand, and Myanmar.

However, nearly all national governments, including those with higher rates of investment in harm reduction, continue to prioritize ineffective drug law enforcement, placing the health and rights of people who use drugs and their communities at risk.

In short, funding for harm reduction is in crisis, and even when funding is available, it is not often aligned with where there is a clear need. For example, upper middle income countries have the largest share of people who inject drugs but receive a fraction of harm reduction funding.

As a consequence of donor retreat, and the lack of domestic investment in harm reduction cannot be overstated, people who inject drugs are among the most vulnerable to contracting blood borne viruses. New HIV infections among this population increased by one third between 2011 and 2015, and HIV epidemics among people who inject drugs are common place in Asia and in eastern Europe.

Harm reduction is integral to the world's HIV response, and cannot be ignored. And the benefits of harm reduction go far beyond the HIV response, too. As several countries play witness to overdose crises, we should be reminded of the importance of adequate naloxone provision and medication assisted therapy, both of which are highlighted in the 2016 outcome document, yet remain scarce.

And this says nothing of the range of other evidence based health, social, and economic interventions for people who use drugs, which many countries continue to ignore to the detriment of improving public health.

So if the enormous shortfall for harm reduction funding in low and middle income countries is not addressed, the commitments made at the UNGASS will continue to ring hollow and several important global health targets, including the SDGs, will now be missed.

And the Commission on Narcotic Drugs recognizes this dire situation, and in Resolution 60/H, urged member states and donors to continue to provide bilateral and other funding to address the growing HIV epidemic among people who inject drugs.

HRI supports CND's call for funding, and also recommends that international donors increase harm reduction funding in line with epidemiological need, and do not withdraw or reduce funds without adequate transition plans in place.

National governments invest in their own harm reduction responses. They should track and critically evaluate their policy -- drug policy spending, and redirect resources from drug control to harm reduction.

International donors, including donors governments, should, or must, invest in multilateral funding mechanisms such as the Global Fund, but also the Joint Programme, and should ensure that the UNODC HIV Section is sufficiently funded.

And lastly but most important, international donors should ensure financial support for overdose prevention, including naloxone and opioid substitution therapy. Thank you again, Madame Chair, for the opportunity to speak.

CND CHAIR: Thank you very much to you. And, I would like to thank, well, first of all, see whether there will be any comments from the floor. Ms. Szubert, I see China.

DELEGATE FROM CHINA: Thank you, Madame Chair. I've seen your data you talk about from 2007. The harm reduction measures, the contribution reduction is twenty percent on an annual basis. So if the situation is so favorable, why is it there are so many people who are no longer providing funding? Are these people stupid? Thank you.

OLGA SZUBERT: I'm sorry, I didn't get the question.

DELEGATE FROM CHINA: I'll [inaudible] in English. I saw from your presentation that the donor funding for harm reduction has fallen 24 percent since 2007. My question is, if the harm reduction measures are so good, why people withdraw money from it? Why will they take -- and you know, not donate more? Is that, are they foolish? Thank you.

OLGA SZUBERT: Well, I can't comment on the fact if they are foolish or not. But I can comment on the fact that donors are withdrawing bilateral funding. They're basically changing the way that -- how they are funding harm reduction.

So, donors are not funding other governments in the same way as, like, they have basically redirected the funding to multilateral donors. So they are using the Global Fund, or they are using more other multilateral agencies to fund harm reduction.

Whereas it doesn't mean that multilateral donors are funding harm reduction but this is how moneys are being channeled right now. So not bilaterally, but multilaterally.

DELEGATE FROM CHINA: Well, I just want to make sure -- figure out, are these measures so good? Or --

OLGA SZUBERT: I'm sorry?

DELEGATE FROM CHINA: Or, is -- I just want to make sure, to confirm, are these harm reduction measures so good, or is, you know, it's -- you know, universally accepted, or just a proposal from several, you know, countries or maybe organizations. Thank you.

OLGA SZUBERT: Well, I believe that harm reduction is universally accepted. Harm reduction measures are mentioned in the UNGASS outcome document. Harm reduction is being mentioned in the political declaration on HIV and AIDS, and ninety countries out of 158 countries endorse harm reduction in their national policy.

So yes, a majority of countries are accepting harm reduction.

DELEGATE FROM CHINA: Sorry, I don't think the UNGASS document adopted this word 'harm reduction.'

OLGA SZUBERT: No, the UNGASS outcome document didn't adopt harm reduction, but it mentions harm reduction interventions.

DOUG MCVAY: That was Olga Szubert with Harm Reduction International, speaking to delegates of the Commission on Narcotic Drugs on September 25. The CND has another set of intersessional meetings coming up October 22 through 25, and then another one in November. You can find a schedule of CND meetings at the UN Office on Drugs and Crime website, UNODC.org.

Those CND meetings are only webcast live. They do not keep any video or audio archive. I don’t have the travel budget to get to Vienna to be there in person over those days, so instead, with the help of very strong coffee and a stable wifi connection, I’ll stay up and record as much as I can, and I’ll bring you the good bits.

Well for now, that's it. I want to thank you for joining us. You have been listening to Century of Lies. We're a production of the Drug Truth Network for the Pacifica Foundation Radio Network, on the web at DrugTruth.net. I’m your host Doug McVay, editor of DrugWarFacts.org.

The executive producer of the Drug Truth Network is Dean Becker. Drug Truth Network programs are available by podcast, the URLs to subscribe are on the network home page at DrugTruth.net.

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We'll be back in a week with thirty more minutes of news and information about drug policy reform and the failed war on drugs. For now, for the Drug Truth Network, this is Doug McVay saying so long. So long!

For the Drug Truth Network, this is Doug McVay asking you to examine our policy of drug prohibition: the century of lies. Drug Truth Network programs archived at the James A. Baker III Institute for Public Policy.