COMMISSION ON NARCOTIC DRUGS DISCUSSES DEMAND REDUCTION STRATEGIES, NEED FOR DECLARATION ON REDUCING ILLICIT DEMAND FOR DRUGS
Press Release
SOC/NAR/734
COMMISSION ON NARCOTIC DRUGS DISCUSSES DEMAND REDUCTION STRATEGIES, NEED FOR DECLARATION ON REDUCING ILLICIT DEMAND FOR DRUGS
19960423 (Reproduced as received from UN Information Service.)VIENNA, 22 April -- Switzerland's controversial clinical trial involving the controlled distribution of heroin to addicts was challenged this afternoon, as the Commission on Narcotic Drugs considered primary and secondary prevention methods in demand reduction. Speakers also underscored the need for a declaration on the "guiding principles of reduction of illicit demand for drugs".
The representative of Switzerland explained that the trial under way was an attempt to promote the survival and rehabilitation of carefully selected ill people and was not an attempt to take a soft approach towards the legalization of drugs. Nevertheless, other speakers expressed strong disapproval of such trials.
The President of the International Narcotics Control Board (INCB), Oskar Schroeder, voiced concern over the impact that the project might have on other areas of drug policy. Citing a similar study that was conducted in Sweden, its representative said the trials there had done nothing to improve the lives of the addicts, nor did they reduce drug-related crimes. In addition, the harm caused by such a policy to the society could be very significant. The representative of the Russian Federation also did not support the use of narcotics in treating addicts, and compared such treatment as tantamount to saving an alcoholic from death by giving the person beer instead of vodka.
Many delegations agreed on the need to establish a working group that would draft a declaration on demand reduction. Such a group could also address the problem regarding definition of terms and a glossary in the discussion about primary and secondary prevention. ("Primary" prevention includes awareness-raising campaigns while "secondary" prevention aims at reducing drug abuse through forms of treatment and rehabilitation.) The representatives of Canada, the United States and Bolivia were among those expressing an interest in participating in the working group.
The South African delegate's call for the inclusion of tertiary prevention (for example, stopping or retarding the transmission of associated illnesses such as human immunodeficiency virus (HIV) and hepatitis) as a separate item in the discussion of prevention measures, was supported by several speakers.
Also taking part in the discussion were the representatives of Netherlands, Syria, Brazil, Poland, Australia, Cuba, Colombia, Hungary, Spain, Sri Lanka, China, Nigeria and Kazakhstan. Representatives of the World Health Organization (WHO) and the United Nations Educational, Scientific and Cultural Organization (UNESCO) also participated, as did representatives of two non-governmental organizations -- the World Organization of the Scout Movement, and the Association for the Advancement of Psychological Understanding of Human Nature.
In the course of the discussion, Cindy Fazey, Senior Adviser in the Technical Services Branch of the United Nations International Drug Control Programme (UNDCP), introduced two reports -- on the world drug abuse situation, and on the state of knowledge in primary and secondary prevention.
Demand Reduction
J.G.S.T.M. VAN HELLENBERG HUBAR (Netherlands) said demand reduction should encompass prevention, treatment and rehabilitation. The primary prevention programmes were aimed at deterring the public from using drugs, while the secondary programmes sought to prevent the problems caused by drug use. Among the target groups for reduction and prevention policies in Netherlands were a considerable number of privileged individuals of foreign extraction. There was a need for flexibility and to amend primary preventive strategies as new target groups emerged. He noted that the Netherlands had grown from a uniform ethnic composition into a multiracial society over the last 25 years, and that almost half of the addicts in the country were of foreign extraction.
The Netherlands was also concerned with secondary prevention. Those programmes which included needle-exchange schemes and methadone hand-outs were run by addiction care services for addicts and by the social services for children and young people. The Netherlands had, as a result, low overdose fatalities and morbidity rates. The many programmes in the country, ranging from informal, easy-access humanitarian facilities to institutional detoxification programmes, were currently being evaluated. His Government attached high priority to both primary and secondary prevention.
JAKOB LINDBERG (Sweden) said that gaining consensus on the content of a declaration on reduction demand would not be easy because there were different views on treatment and rehabilitation. Opinion also differed within Sweden itself, but that was not seen as negative. The declaration should be a forum where important principles could be spelled out. Its importance would depend on the extent to which it could inspire Member States. It should be developed in close cooperation with national Governments and with drug treatment professionals. He favoured the proposal to convene a working group to prepare the draft declaration, and his country was willing to take part.
The risk of developing drug abuse problems was greater among the socially underprivileged, he continued. There must be a close interplay between demand reduction and supply reduction. That linkage would not be given enough attention if the emphasis was put on treatment and
- 3 - Press Release SOC/NAR/734 23 April 1996
rehabilitation.
ALI DARBULI (Syria) pointed out that the focus of demand reduction efforts was not limited only to consumers, and that educating drug consumers was facilitated through media technologies that reached millions of people. He said efforts should be made to strengthen the media's understanding of drug-related issues worldwide to further enhance national strategies in that area.
DOMINGOS BERNARDO GIALLUISI DA SILVA E SA (Brazil) stressed that the topic of demand reduction should become a permanent focus of the Commission, and urged delegates to find a consensus text on the subject. He called for extensive information programmes aimed at informing people of the dangers of drugs, in addition to the existing alcohol and tobacco programmes. Teachers should have access to ongoing training, and local schools could be used to educate other members of the community. Adults should also have access to prevention services in the workplace. There was nothing magic about solving the drug problem; it was a health and education problem, and a challenge for human development.
TADEUSZ CHRUSCIEL (Poland) offered to share with others information about his country's experience in the crop replacement of poppy straw. Drug abusers there were using the extract from poppy straw, which contains morphine and heroine in low quantities, as a domestic heroin. The strategy to counter this drug use involved introducing a low-morphine poppy which could not be used by addicts. He added that the experiment in Switzerland had much less value than if it were conducted using a randomized double blind.
TONY KINGDON (Australia) said he was disappointed by the confusion that arose in scheduling the demand reduction item for discussion in the Committee of the Whole and the plenary. As such, it was difficult to maintain coherent discussions. He reaffirmed support for a demand reduction declaration and the creation of a working group to prepare a draft text. Australia would be pleased to participate in that process.
BASILIA LAHENS ESPINOSA (Cuba) said that, in her country, medicines subject to international control were distributed only by the national health programme. There were rigorous controls. Every attempt was made to ensure that the consumption of controlled substances was done only by those who really needed them.
CARLOS BULA CAMACHO (Colombia) thanked Sweden, Australia and others for their studies on supply and demand. He told the Commission his country's national drug control plan included demand reduction.
- 4 - Press Release SOC/NAR/734 23 April 1996
KATALIN SZOMOR (Hungary) said that drug problems in occurred mainly among juveniles, with 25 per cent of 16-year-olds reported to have used drugs. Accordingly, the focus of prevention programmes was on juveniles, and several prevention programmes were run in the schools. That strategy had resulted in a decline in drug use. Experience had shown that good intentions and money were not enough, and that sophisticated research and analysis must support prevention programmes. She supported the drafting of a drug reduction declaration and suggested that demand reduction plans should form a part of the national drug control plans.
JUKKA SAILAS, representative of the World Health Organization (WHO), said that his agency's approach to drug abuse was based on health considerations. The definition of prevention contained in the document on state of knowledge in primary and secondary prevention reflected the WHO's position. However, the ensuing paragraphs which interpreted primary, secondary and tertiary prevention did not. The WHO's approach was based on a comprehensive approach to all psychoactive substances. Its message was to discourage the use of tobacco in any form. Prevention should be based on the promotion of healthy lifestyles.
Caution should be exercised when making a comparison between the efficacy of primary and secondary prevention as both were needed and could not replace each other, he continued. The WHO was currently involved in promoting a major initiative on primary prevention of substance abuse in different regions of the world. A key consideration was to encourage local communities, individuals and non-governmental organizations (NGO's) to initiate action in primary prevention. The WHO's aim was to offer information on how to assess substance abuse problems in communities, identify trends and develop appropriate interventions.
He suggested that specific internet sites could be created for the further development of the guiding principles of demand reduction and the approaches to primary and secondary prevention. A debate through the internet would offer flexibility and sufficient time to make suggestions, eventually leading to papers which would have been extensively discussed prior to their submission to the Commission. The secretariat could serve as the host for such sites but the task could also be assumed by his organization. He informed the Commission that the thirtieth WHO Expert Committee on Drug Dependence, to take place in October, would focus on the issue of treatment.
IHOR MALYNIWSKY (Canada) supported the development of a draft declaration on demand reduction, and proposed that a working group be established to prepare the text. Canada had contributed $60,000 towards the working group and had expressed interest in becoming a member.
- 5 - Press Release SOC/NAR/734 23 April 1996
With regard to the state of knowledge in primary and secondary prevention, he suggested, in a later intervention, that any discussion on that topic should include tertiary prevention strategies because of their importance in the fight against the spread of diseases such as HIV and hepatitis strains. He suggested that the secretariat's paper on prevention would benefit from a glossary and definition of terms. The proposed working group, with expertise in demand reduction, could approach this problem of definitions and a glossary.
RECIA MCMAHON (United States) supported and expressed a willingness to participate in the formulation of the draft declaration on the guiding principles of demand reduction. One third of her Government's current drug control budget was focused on demand reduction, she said.
The United States focused on primary and secondary prevention. Despite the recent increase in the use of drugs, there had been considerable progress made during the past decade in reducing drug use. The widespread social tolerance of drug abuse in the 1970s had been replaced with disapproval. Although homicides had increased overall, those that were drug related had reduced by 25 per cent and there had been a decrease in violent crime. Research showed that citizens were keenly aware of the drug problem, and one in five citizens reported that substance abuse had created a problem for a family member or friend. Research also showed that drugs were a problem for all categories of Americans, not just the inner-city poor or minorities. Speaking later, she reiterated her support for a draft declaration and stressed the need for a glossary and definitions when discussing primary, secondary and tertiary reduction strategies.
ANDRI ISAKSSON, representative of the United Nations Educational, Scientific and Cultural Organization (UNESCO), said his agency had a natural vocation to emphasize the crucial role of demand reduction. Education was a long-term process and should run parallel with drug supply programmes. UNESCO's education sector served educators and the main priority was to promote access to education, to improve the quality of, and reinforce the international dimension of, education. Preventive and health education should be a part of every child's education and a fundamental right of every person.
The agency would continue to foster education against drug abuse. Experience had shown that comprehensive school education could influence behaviour and have a powerful and lasting impact. It was important to strive to limit the overlapping and duplication of efforts. His agency would aim towards actions in school preventive education. Schools had the opportunity to reach children worldwide and to have a constructive influence on the community at large. He pointed out that although international efforts to expand access to education had resulted in increased enrolment, only 40 per cent of children in the least developed countries had completed the fourth grade. While education was accessible to a large number of people, it
- 6 - Press Release SOC/NAR/734 23 April 1996
sometimes failed to reach the most vulnerable. Outreach programmes for street children should receive priority attention.
A variety of actions to prevent drug abuse among children existed worldwide. The major challenge was to get drug abuse policies integrated into established curricula and to promote coherent messages for societies at large. There must be harmony between overall personal development and cultural development.
ANATOLIY SHEVTCHENKO (Russian Federation) reported his country had not categorized drugs into soft and hard because long-term use of the so-called soft drugs, such as methadone, could cause poisoning. The long-term use of soft drugs damaged the physiology of the addict. First, there was a deterioration of the central nervous system, followed by deterioration of the digestive and reproductive systems. Those led to various illnesses and death.
The Russian Federation did not support the legalization of any drugs or the use of narcotics in treating addicts, he said, comparing the treatment of drug addicts with narcotics as tantamount to saving an alcoholic from death by giving the person beer instead of vodka.
FRANCISCO PEREZ PEREZ (Spain) said the exchange of information from different regions of the world was enriching. Regional cooperation was a positive approach to demand reduction. He was pleased with the continuation of forums on demand reduction and supported the Executive Director and his team in their preparatory work. The variety of approaches followed today illustrated how primary and secondary prevention could be used to achieve results in the treatment of drug abuse.
E.W. HARVEY (South Africa) proposed that, because the report on the state of knowledge in primary and secondary prevention made frequent reference to it, tertiary prevention should be treated as a separate item.
DIYANATH SAMARASINGHE (Sri Lanka) suggested that measuring the success or failure of demand reduction programmes required further development. Sensitive indicators for measuring success needed to be developed so that demand reduction programmes could conduct early self-evaluations.
The representative of the World Organization of the Scout Movement recalled that the Executive Director had expressly invited the Commission to consider how the UNDCP could develop a dialogue with NGOs to encourage their participation in drug abuse control programmes. He suggested that the Commission should recommend that Member States make use of the experience, expertise and the existing information exchange network of local, national and international NGOs in developing and implementing national and international programmes of action.
- 7 - Press Release SOC/NAR/734 23 April 1996
The Commission should urge Member States to invite NGOs to join governmental experts in the deliberations of national, regional and international expert working groups dealing with drug-related issues. The Commission should encourage Member States to closely involve NGOs in the process of drafting, monitoring, implementing and evaluating, and it should ensure that States provided resources for all NGOs active at the grass-roots level in the area of drug prevention education. The UNDCP should be instructed to assist in every way.
He said the Commission should instruct the UNDCP and the secretariat to provide observing NGOs with all necessary technical and possible financial resources at forthcoming sessions of the Commission and at other international conferences and forums to facilitate and encourage their participation. The secretariat had not supplied the non-governmental community with adequate space and had provided no technical equipment for this year's session.
OSKAR SCHROEDER, President of the International Narcotics Control Board (INCB), reported on the growing advocacy concerning the non-medical use of heroin and its controlled supply to drug addicts. He said that in 1994, the Government of Switzerland launched an extensive clinical trial involving the controlled distribution of heroin to heroin addicts. That trial would continue until 1997. The Board had expressed concern over the impact of that project on other areas of drug policy, particularly with respect to demand reduction.
The international drug control system had evolved gradually to restrict the use of narcotics and opiates. To allow use of those drugs for non-medical purposes would lead to widespread abuse, with serious public health consequences. However, the situation was such that in some highly developed countries, the will to restrict narcotic drugs to only medical and scientific use appeared to be rapidly weakening. The proliferation of radically liberal attitudes and legitimization of the non-medical use of drugs under the umbrella of harm minimization was not justifiable.
Clinical trials, or expansion of treatment schemes, did not occur in an ideological vacuum, he said. Those individuals and groups advocating legalization often misinterpreted such trials, with the aim of achieving a much wider and more general application. He reminded the Commission that as the policy-making body for international drug control, it had a responsibility to determine the policy on the controlled distribution of heroin to addicts.
GUSTAVO PEDRAZA (Bolivia) said he was alarmed at the increase of precursors throughout the world, and told the Commission that his country had implemented various drug prevention programmes. He supported the draft declaration and expressed an interest in participating in it.
- 8 - Press Release SOC/NAR/734 23 April 1996
CINDY FAZEY, Senior Adviser, Technical Services Branch of the UNDCP, introduced the reports on the world drug abuse situation and on the state of knowledge in primary and secondary prevention. She said that although the patterns of abuse might be changing in some areas, the extent of drug abuse was increasing. Cannabis was abused by more people and the intravenous use of heroin was spreading. Intravenous drug use was associated with the spread of the HIV infection. She called attention to the increasing spread of drug abuse in jails.
She described the difficulties in estimating the extent, patterns and trends of drug abuse, noting that some countries were reluctant to report an increase in abuse, while others only reported the abuse of certain drugs. The report defined and described varying approaches to primary and secondary prevention. The difficulties of evaluating programmes were explored and the different criteria that were used as indicators of success were noted. Some initiatives, such as school-based and alternative programmes, had yielded success.
In secondary prevention, the aim was to persuade the user against continuing the abuse and in treating the abuser. However, the working group on the subject would be looking at a glossary of terms. There was evidence that primary prevention could delay the onset of drug abuse and had the effect of making secondary prevention more successful. Nevertheless, the evaluation of programmes was expensive, sometimes more so than the programmes themselves, thus restricting the process of evaluation to those countries which could afford it.
Mr. LINDBERG (Sweden) said he was deeply concerned about experiments being conducted in some countries with respect to clinical trials of the non-medical use of heroin, and he supported the INCB's analysis. He recalled a trial conducted in Sweden that allowed morphine to be provided to drug addicts by their doctors. One argument for conducting such a trial was based on the assumption that, with legal access to drugs, the addicts' lives would improve. Another argument was that fewer crimes would be committed by drug addicts. The trial proved that neither of these arguments was true. He urged other countries to learn from Sweden's experiences and avoid making the same mistakes. While a reduction of harm to the individual might be demonstrated in certain circumstances, the harm caused by such a policy to the society as a whole could be very significant indeed.
Mr. KINGDON (Australia) said that the ultimate goal was for a society free of substance abuse. One could not ignore the evidence of secondary effects associated with such abuse. A failure to address the serious threats to a community with practical solutions would pose far greater harm than the drug abuse itself. The document on the state of knowledge was useful in
- 9 - Press Release SOC/NAR/734 23 April 1996
promoting better understanding of primary and secondary prevention. It was, however, too easy for those responsible to call for more education and prevention activities. While they were essential, it was critical that they be effective and represent value for money. The report was practical, realistic and applicable to a variety of circumstances and needs. Desired outcomes were influenced by a range of factors. Often one initiative was effective only if supported by other actions. He cautioned against raising unrealistic expectations.
WANG QIANRONG (China) said he supported the INCB President's stand on the legalization of drugs. He opposed the legalization of limited use of heroin because that might lead to even greater use and a worsening of the situation. In the fight against illicit drugs, every nation should try to implement the relevant United Nations resolutions and adopt competent treatment measures for addicts so as to realize the final goal of the Commission -- to reduce demand.
Mr. GIALLUISI DA SILVA E SA (Brazil) said it was important to have a glossary on prevention and that social reintegration be included under tertiary prevention.
ROBERT FISCHER (Switzerland) said the Swiss project was under scientific and extremely strict medical care. It was an attempt to promote the survival and rehabilitation of carefully selected ill people. It was not an attempt to take a soft approach towards the legalization of drugs.
The Swiss would be asked to choose an approach to ensure a drug-free youth population. One approach was geared towards abstinence and repression, the other was legalization. Neither had any chance of being accepted because they were both too extreme. History had shown that repression was not the only valid tool to achieve progress. The Swiss Federation favoured a proactive approach through education, therapy, survival therapy for heavily addicted people and the repression of organized crime. Three-fourths of Switzerland's efforts were in favour of mankind, the other fourth was to combat crime.
MUSA BAMAIYI (Nigeria) said he was concerned that some countries had called for legalization of certain drugs. "We were supposed to address this globally and it becomes difficult if we do not have a set standard to apply", he said. Nigeria did not encourage the legalization of any type of drug, and the Commission should evaluate this critically before making a decision.
KAIDAROV RUSTEM (Kazakhstan) supported the INCB and Swedish positions concerning the non-legalization of drugs and reported that his Government prohibited the use of narcotic drugs by individuals and in the treatment of addicts.
- 10 - Press Release SOC/NAR/734 23 April 1996
Mr. LINDBERG (Sweden) said the secretariat had prepared several good papers but his delegation had difficulties with the report on the state of knowledge in primary and secondary prevention. There was need for an integrated policy to create effective prevention programmes. The definitions in the report were unusual and not in accordance with accepted terminology or with the definitions of the WHO. To define secondary prevention as all forms of treatment would create confusion. There was also confusion with references to research, and the efficiency of primary prevention was called into question. That was not a correct way to summarize results in the field. It was further stated in the report that treatment might be more cost-effective than demand or supply reduction. However, treatment could reduce demand only among those who were already addicted. The report should be rewritten before being more widely distributed.
Mr. DARBULI (Syria) said the Swiss heroin experiment posed a danger within the field of treatment. He questioned the national regulations governing the experiment and asked where the heroin had been sourced. He called for a long pause before any decision to include heroin in treatment was taken.
The representative of the Association for the Advancement of Psychological Understanding of Human Nature said that his was an international NGO with headquarters in Switzerland. He did not intend to criticize Swiss authorities but sought to ensure a more balanced understanding. The Swiss heroin projects were part of "harm reduction", a theory which maintained that society must learn to accept all levels of addictive and psychoactive drug consumption by adults and adolescents. The "responsible use" of those drugs must be taught in order to reduce harm. That would eventually lead to drug legalization.
According to the official Swiss evaluation, he continued, it was not clear whether the nearly cost-free distribution of heroin would ever lead to abstinence although that was the declared primary goal of the trial. Reportedly, a dangerous competition had been initiated by the projects which now offered a more comfortable alternative to the abstinence-oriented projects. The extensive media coverage on the trials, for the liberalization of drugs and for other harm-reduction methods, had damaged therapy projects and prevention efforts. Even though the projects would stop at the end of 1996, the addicts would continue to receive free heroin until the end of 1998. Meanwhile, the legal situation could be adapted to allow for the regular prescription of heroin to all addicts. It was unclear how those addicts would be dealt with in 1999.
Success should be measured by the number of addicts capable of abstaining from drugs. It was doubtful if the Swiss projects were responsible for the reduction in criminality as claimed. The improvements referred to in the Swiss evaluation were based on interviews with drug addicts. No reliable
- 11 - Press Release SOC/NAR/734 23 April 1996
data was available. Moreover, the approach was not necessarily welcomed by the entire Swiss population. His organization was present at the Commission today to ensure that the views and fears of the so-called silent majority were not forgotten by the international community.
While harm reduction might be seen for certain individuals, there might be great harm to society as whole. The influence and effect of the trials, the extent and character of the drug scene, the extent of drug-related delinquency, the extent of AIDS prevalence in the defined target groups and the effect on society as a whole were questions that would not be examined.
* *** *