Transatlantic Conference

Brussels, November 12, 2013“Time to Rethink our Policy on Drugs -

Experiences from Europe and the Americas”Pavel Bem, MD.

National Drug Commission, Czech RepublicGlobal 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 responseUnintended 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…)

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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

16.11.2011 Seite 11This Project is funded by the European Union and implemented by a EU MS Consortium

Prevalence of PDUs in Europe Estimates of the prevalence of problem drug use (cases per 1 000 population

aged 15–64 (cases per 1 000 population aged 15–64)

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

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BUT…

We behave in simplistic way with no respect to human diversity and human rights (Papua, 2003)

New Penal Code: 1998Penalizing possession

Czech Republic case study

PAD: Impact Analysis Project of the New Drug

LegislationComplex Cost and Benefit Analysis (5 major studies and 20 sub studies):

1. Secondary analysis of school surveys2. Prevalence study of problem drug use in the CR3. Economic and social cost of illegal drug use in the CR4. Qualitative study among illicit drug users5. 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, 20091.No size fits all2.Realism is the key3.Human rights apply to ill

people in particular4.Public health and public

safety concerns must not be seen as contradictory5.Evidence based decision only6.Evaluation and monitoring7.Constant and improving mutual

information flow

Drug Policies at Crossroad

Conclusions:1. War on drugs has failed:

Need for “rebalancing action” in drug policies design

Drug Policies at CrossroadConclusions:

2. Need for wider implementation of cost effective public health measures:Harm reduction services especially at areas of high risk

Drug Policies at CrossroadConclusions:

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 2013-2016, action #5]

UNGASS 2016

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

www.globalcommissionondrugs.orgwww.vlada.cz

www.cadap.eu www.praguedeclaration.com

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Thank you for your attention