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…

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

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  Acceptance of failures  Understanding of best practices  The role of supranational authorities: Active leadership (Latin America + Europe…) l

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 and 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, 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. 4/23/2015 DC&D II Conference - PrgDecl 28

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 non- medical consumption of drugs and thus the total volume of related risks by means of prevention & treatment. 4/23/2015 DC&D II Conference - PrgDecl 29

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. 4/23/2015 DC&D II Conference - PrgDecl 30

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. 4/23/2015DC&D II Conference - PrgDecl 31

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. 4/23/2015DC&D II Conference - PrgDecl 32

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. 4/23/2015DC&D II Conference - PrgDecl 33

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. 4/23/2015DC&D II Conference - PrgDecl 34

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 , action #5]  UNGASS 2016

“ Wishful thinking” is still prevailing among many politicians, decision makers as well as media

k Thank you for your attention