Failed Drug Policies Call for a Paradigm Shift

Three questions to Ruth Dreifuss

Member of the Global Commission on Drug Policy and President of the Geneva Advisory Commission on Addictions

Drug legalization is a divisive issue. Some doubt the effectiveness of tougher penalties to deter both suppliers and consumers, while others argue the answer lies in more sanctions. Additionally, relocating crack users and opening low-risk consumption centers in cities exacerbates tensions between local residents and authorities. Drug policies are at the heart of such debates. Although there seems to be a consensus today that the prohibition model has failed, calls for a paradigm shift struggle to be heard. Ruth Dreifuss, member of the Global Commission on Drug Policy and President of the Geneva Advisory Commission on Addictions, sheds light on these controversies, outlining courses of action for a drug policy that is both effective and humane.

What is the objective of the Global Commission on Drug Policy?

In 1961, the United Nations adopted the Single Convention on Narcotic Drugs, a treaty aiming to combat drug use through coordinated international intervention. The ambition was to limit drug use to medical and scientific purposes, and to fight drug trafficking through international cooperation. Later in 1971, US President Richard Nixon declared the "war on drugs", mobilizing police and military forces. This marked the birth of an international drug control system that has clearly failed. The figures speak for themselves.

While the cost of repressive measures amounts to nearly €100 billion, prohibited psychoactive substances production as well as organized crime drug profits have continued to increase. The global turnover of illegal drug trafficking is estimated at €500 billion per year. This has serious consequences for public health, security and for the fundamental rights of people either in vulnerable situations or affected by drugs.

As a response to the failure of conventional drug control policies, and under the leadership of Brazilian President Fernando Henrique Cardoso, a group of former presidents, heads of government and senior officials of international organizations founded the Global Commission in 2011. Its objective is twofold: to stimulate an informed and evidence-based debate, and to promote a holistic approach towards drug policies. Both goals should be based on the respect of human rights and consider all the aspects including health, social, economic and security challenges posed by the production, trafficking and use of substances.

Since the Global Commission’s inauguration, the reflection and experiences gathered within it have defined 5 different pathways that should be guiding drug policies.

The first pathway is to put people’s health and safety first. In principle, it calls for the reduction of risks linked to substance usage through the development of substitution treatments and the implementation of prevention measures. In addition to abstinence-based treatment, treatments should be evidence-based, and they should combat the prejudices and stigma surrounding drug use and drug dependence.

Treatments should be evidence-based, and it should combat the prejudices and stigma surrounding drug use and drug dependence.

The second priority is to promote access to palliative care and pain treatment. Prohibition has impeded access to controlled psychoactive substances for medical purposes, depriving many patients of the care they need. This problem is particularly worrisome in low and middle-income countries. According to the WHO, only 14% of those in need of such drugs currently have access to them worldwide, leaving 5.5 billion people without access to the means to relieve their suffering.

The third priority advocates for the decriminalization of drug use and drug possession for personal use. The criminalization of substance use leads to increased stigmatization, and an intense criminal repression of users and small dealers. This then creates an overloaded criminal justice system and an explosion of incarceration rates. Here again, the figures are revealing. With about 105 people in prison per 100,000 inhabitants, France has one of the highest incarceration rates in Europe. The figure stands at 90 in Italy, 76 in Germany and 50 in Sweden and Finland. Moreover, according to the International Prison Observatory, France counted more than 7,500 "excess" prisoners in early 2021 - prisoners that exceed the capacity of its prison infrastructures. In France, as in the rest of the world, 20% of prisoners are involved in drug violations. Countries that gave up penalizing drug use made significant progress in the reduction of petty crime and prison overcrowding.

The fourth priority is to steer drug law enforcement policies towards organized crime elites. Instead of focusing on petty criminals and drug users, policies should target the right level in the fight against trafficking. In drug producing countries, many farmers and slum dwellers have no other alternative for economic survival than to collaborate with criminal organizations. In these contexts, governments need to focus on development programs instead of the use of military force. To this end, the Commission suggests the introduction of social measures for small-scale drug dealers, smugglers and consumers. This will also rely on community police forces being trusted by the population in neighborhoods that are particularly affected by drug dealing and consumption. Progress in international cooperation to fight corruption and money laundering is a prerequisite in fighting against the true leaders of criminal organizations. Currently, the extreme violence in Latin America and in some Asian countries is taking a heavy toll on populations caught in the crossfire. In these regions, the rise of criminal organizations is jeopardizing the proper functioning of States.

The fifth and final priority promotes state regulation of psychoactive substances. Countries such as Uruguay, Canada and some US states recently initiated policies on cannabis regulation. Some European countries such as Malta, Luxembourg, Portugal, the Netherlands, Germany and Switzerland are also cautiously moving in this direction. It is obvious that regulatory experiments will have to be conducted and monitored closely, according to the risk levels of the substances concerned. This does not mean drug liberalization, quite the contrary.

Serious scientific evaluations must be carried out in order to document the consequences of tested models. It is essential that the results of scientific research guide the conduct of any public drug regulation policy. The population needs to be duly informed about any new policies.

Since the 1990s, Switzerland has been experimenting with a so-called 4-pillar model consisting of prevention, therapy, harm reduction and repression. How did this model come about?

In the 1980s, many Swiss cities experienced an "open drug scene" - referring to the consumption of narcotics in public spaces. These open drug scenes left a strong impression on public opinion. They also caused numerous health and safety problems, including poor hygiene, discarded syringes, and an increase in contamination and overdoses.

In order to eliminate these open drug scenes without driving drug users back underground and out of care, Swiss cities adopted various innovative therapies and harm reduction measures. These include substitution treatments (also based on the prescription of heroin), the supply of clean syringes for users, the creation of supervised consumption places or the analysis of substances bought on the black market. These measures complement other interventions for the population suffering from addiction, such as psychological, social, and health services.

To eliminate open drug scenes without driving drug users back underground and out of care, Swiss cities adopted various innovative therapies.

These policies were initially carried out by cities. In 2006, they were formalized by the adoption of the so-called 4 pillars policy at the federal level. In addition, the Federal Court set thresholds for drug use and possession, which led to a significant reduction in the number of penalizations. In addition, the country replaced criminal sanctions with administrative (not criminal) fines for the possession of cannabis for personal consumption.

As for the supervised low-risk consumption rooms, they have been placed in "strategic" locations close to the places of consumption or close to medical institutions. The feedback has been positive with fewer overdoses, HIV cases or hepatitis infections. Local residents report that they have been relieved of nuisances in their neighborhoods.

More recently, the Swiss Parliament adopted a modification of the law on narcotics allowing for pilot tests to regulate the market of recreational cannabis. The tests will be duly evaluated by interdisciplinary scientific teams. The aim of this work is to gain evidence for a possible generalization of regulated use of recreational cannabis.

In light of current debates in France concerning crack, cocaine or drug injection rooms, what are your recommendations?

To date, there is no product as a substitute for crack or cocaine. Nevertheless, promising experiments have been carried out in France for supervised drug consumption facilities, such as the Gaïa space, near the Gare du Nord train station in Paris. Unfortunately, the deployment of such facilities is delayed. These initiatives often face resistances from both decision-makers and residents.

It is important that local residents are closely involved throughout the process of setting up low-risk consumption rooms. This means that authorities need to conduct prior information campaigns, hold regular meetings with residents and listen closely to fears. For instance, this should entail setting up hotlines in order to report any problems or inconveniences.

Facilities for safe consumption need to be part of a broader and more complete response toward consumer populations. The development of a social offer and support for users are essential to ensure the effectiveness of these places. Portugal created an interesting model with the establishment of dissuasion commissions, which could potentially serve as an inspiration for France. These commissions are composed of legal advisors, psychiatrists and social workers. They can impose fines (about 10% of cases) or community services, as well as help in finding a job and housing. However, its role is also to refer addicts to treatment that they are willing and able to follow.

The State has a central role to play. It needs to convince all concerned parties and promote policies that approach addiction as a chronic disease requiring prevention, care and support. A chronic disease means that relapses are always possible, but so are remissions. The State should be transparent regarding positive and negative consequences of these measures. This should rely on data concerning the effectiveness of measures, such as the reduction of sanitary risks through the limitation of contaminations of drug users, overdoses or risks of psychiatric decompensation. Other factors to be considered include the improvement of hygienic conditions, the setting up of care and withdrawal paths, social reintegration and the reduction of nuisances for local residents.

Copyright: THOMAS COEX / AFP