Making a fundamental shift in drug policy and harm reduction

Harm reduction refers to public health policies designed as a practical response for people who are unable or unwilling to stop using drugs. Its immediate aim is to limit the transmission of bloodborne infectious diseases, particularly HIV and hepatitis B and C. Photo by: Trinn Suwannapha / World Bank / CC BY-NC-ND

In 1998, the United Nations General Assembly convened a special session under the slogan, “A drug-free world — we can do it!” with the goal of prohibiting the use, production, possession and trafficking of all illegal drugs by 2008.

Eight years past that target date, UNGA held another special session on drugs, which civil society had hoped would be an opportunity not only for their voices to be heard but an opportunity for real drug policy reform.

But the latest special session was disappointing for many working in the field of harm reduction, public health and human rights. The adopted declaration doesn’t call for an end to criminalization, incarceration and capital punishment for drug-related offenses.

Still, advocates say the declaration won’t stop the momentum that’s been building against the “war on drugs.” In many parts of the world, governments and civil society are working together to pursue progressive approaches such as drug decriminalization, regulation and the provision of treatment programs for drug abusers.

Shifting money and focus

According to a recent report by U.K.-based NGO Harm Reduction International, “The Case for a Harm Reduction Decade: Progress, Potential and Paradigm Shifts,” new HIV infections among people who inject drugs could be virtually eliminated by 2030 if a small percentage of global drug control spending is redirected toward harm reduction programs.

Redirecting 7.5 percent of the money spent on the war on drugs could reduce HIV-related deaths by 94 percent, the report found.

HIV prevalence among PWID is estimated to be 28 times higher than the rest of the adult population, according to the U.N. And while $100 billion is spent annually on global drug enforcement, only $160 million is invested in harm reduction annually, the organization said.

Maria Phelan, deputy director of HRI, told Devex there were two major barriers to the scaling up of harm reduction programs: political will and funding.

“One hundred percent the lack of political will is the main crux of the problem which is driven by the fact drug use remains criminalized,” she said.

“Governments just aren’t willing to prioritize drug users and aren’t willing to fund services. If we carry on at the same pace, it will be 2026 before every country that reports drug abuse has one harm reduction program in place.”

Pushing forward

In order to encourage government action, Phelan called for a fundamental shift in the way drug policy was measured: Rather than measure it on the amount of drugs seized or number of drug users or dealers imprisoned, it could be measured on the public health benefits, such as a reduction in HIV and hepatitis C rates and a reduction in overdose mortality rates.

“We can also measure success in terms of the quality of services provided and the ability of people to access equitable, gender sensitive, nondiscriminatory and free services,” she said. “It’s not just about reducing HIV; it’s how we get there in a way that upholds someone’s rights.”  

In addition, countries such as Portugal and the Czech Republic provide crucial examples for how to modify prohibitionist approaches, experts say. Both countries decriminalized minor drug offences and scaled up HIV prevention services that enabled the control of an unsafe injecting HIV epidemic.

Phelan said in countries where donor support for programs is at risk, a plan for a sustainable transition must be in place.

“Donors must leave responsibly and work with governments and civil society to ensure the programs that are saving lives don’t close abruptly,” she said.

“This really needs to be coming from national and grassroots levels. Governments need to be supporting civil society to advocate for harm reduction programs.”

Calling to account

Governments around the world offering harm reduction programs need to be held accountable, said Daniel Wolfe, director of the international harm reduction development program at Open Society Foundations.

In many countries in Latin America, he said, drug treatment is offered, but patients were often subjected to beatings and physical and emotional abuse. In many Asian countries, rehabilitation was often just seen as another name for imprisonment or punishment.

“Some 70 countries have included harm reduction in their strategies, but too few have devoted the resources to scaling it up,” he said.

“The most substantial and impactful changes are going to come not from international declarations, but from national and municipal changes, which is where decriminalization, health and respect for the rights of people who use drugs are actually advanced.”

Phelan agreed, adding that civil society played a critical role in the delivery of services such as needle exchange.

“The reality is that the majority of [drug] services and advocacy for human rights have expanded because of civil society. They have really driven the movement,” she said.

Overcoming challenges

NGOs working in harm reduction face myriad challenges in their day-to-day work. Aside from working with minimal resources and often in clandestine conditions — and against government policy — many face problems with the wider society.

Willy Demaere, technical director at the Asia Harm Reduction Network in Myanmar, told Devex that his organization sees resistance to their work, even though harm reduction is officially integrated into the country’s strategy on HIV.

“The biggest challenges in the past few years have been crackdowns, including physical abuse, by faith-based groups that are continuing up until this day. A lack of knowledge about addiction and faith-based thinking, like the ‘war on drugs,’ are major issues.”

The network provides comprehensive prevention and care services for PWID, including drop centers that distribute condoms and needles, primary health care including HIV and TB care and drug treatment including methadone. AHRN relies on international donor funding largely from the Global Fund and 3MDG, a donor consortium in Myanmar.

However, Demaere said he was concerned about funding programs in the future.

“As everywhere else, there are not enough resources and it’s doubtful they will become adequate in the future. This means there are not enough services and not enough geographical coverage.”

For now, though, the war on drugs maintains momentum, as more countries continue to decriminalize drugs and civil society groups around the world continue to work tirelessly to provide treatment and care to those most in need.

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About the author

  • Sophie Cousins

    Sophie Cousins a Devex Contributor based in South Asia. She is a health journalist focused on women and girls. She was previously based between Lebanon and Iraq, focusing on refugee health and conflict. She writes for international medical journals, including The Lancet, and for international news websites such as the Guardian.