'Drug policies should be first of all concerned with preserving public health'
Bangladesh's recent impetus on cracking down on drug abuse and trade has led to some divisive results—while there is no doubt that this is an issue that needs to be addressed, the approach taken by the authorities has been questioned. The country recently passed the Narcotics Control Bill 2018, which provides for the death penalty for possession of low quantities of certain drugs. This is in contradiction to the recommendations of The Global Commission on Drug Policy, which is a panel of world leaders and intellectuals, committed to studying how the war on drugs has led to "devastating consequences for individuals and societies around the world", and which advocates for a healthcare-based approach to drug policy, as opposed to criminalisation. Khalid Tinasti, Executive Secretary of the Global Commission on Drug Policy, talks to The Daily Star's Moyukh Mahtab about the healthcare-based approach to drug policy and examples of countries which have had success. Tinasti is also author of scientific papers and research reports on public policies and international drug control mechanisms.
The Global Commission on Drug Policy has consistently pointed out wars on drugs are not effective. What leads you to that conviction?
It is quite simple: for the last 20 years, there has been a steady increase in production, in trafficking and in use of different substances, contrary to the stated goals of current drug control.
Moreover, the unintended consequences of prohibition are numerous: From the illegal market of overwhelming dimensions to the fact that repression creates a balloon effect and displaces violence, production and substances.
But mostly, the failure is visible in how current drug policies are weakening the social fabric—exactly the opposite of what they are supposed to be doing. The enforcement of drug laws ends up being arbitrary and affects the most vulnerable, the poorest, and those who are easiest to apprehend. It's never wealthy people—who have the same patterns of use—who are arrested.
Yet the lure of cracking down hard persists globally. Drug abuse has been seen mostly as a crime rather than a health issue with social consequences. What would viewing drug policy from a health perspective entail?
It would entail that drug policies be first of all concerned with preserving public health. Prohibition as a paradigm was chosen at a time when public health was not as much a social debate, but personal hygiene was. The world is a much different place now: The early 90s, globalisation—and the free movement of people, goods and capital—and the HIV epidemic have changed how we design public health interventions. We now work on social determinants. But in drug policy, much focus is on the substances and not the core causes.
A core problem remains the relationship between people who use drugs and the state. A health approach depends on the decriminalisation of personal possession—without questioning the prohibition of sale of trade of illegal drugs. As long as people suffer discrimination and stigma in society, or fear interaction with the criminal justice system, they will hide or will not adhere to treatment. The idea of decriminalisation as a public health approach is to strengthen the social fabric by building up this kind of contact. This is key to not leaving anyone behind.
It could be argued that investments that such an approach would require are not justified—is a health focussed approach ultimately more expensive than wars on drugs?
Evidence shows harm reduction services and treatment cost less than repression and law enforcement. When you arrest someone, the individual becomes the responsibility of the state and that represents onerous costs. Bringing people into the health system if they need it is not more expensive. People will just be joining existing practices.
But to the question of "why invest in these people"—well, it is investing against all the harms that the current approach imposes on our societies. The best way to reduce drug use, the best prevention, is to be in touch with those who are most concerned by the issue.
What is the case against death penalty for involvement in the drug trade?
It was after the UN Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances in 1988, that many countries brought the death penalty into their laws. But there is no evidence to show that it acts as deterrence for trafficking. We see now many countries, such as Malaysia and Iran, changing these laws or thresholds of possession calling for the death penalty. The Human Rights Committee of the Human Rights Council has repeatedly said that drug offences are not part of the "most serious crimes" and should not have the death penalty applied to them. The case for the death penalty—that drugs cause death, and those who sell it must therefore die—is sadly simplistic and unrepresentative of reality. The ramifications of the international drug market are so complex that it is almost impossible to say that deaths by consumption are intentional.
What countries or policies have been effective, and how?
The first effective step is to put health first—by providing prevention, harm reduction services and treatment. The biggest successes we see are in Europe. Countries like France and Switzerland had introduced health and harm reduction services in the early 90s, and have now one of the lowest HIV transmission rates in the world among people who inject drugs, at less than one percent.
The second important approach is the decriminalisation of personal use and possession. What is the need to criminalise a person who does no harm to others? Evidence of the effectiveness of decriminalisation comes from Colombia, Portugal, or the Czech Republic (which considers drug use as a misdemeanour incurring a fine).
The other path is shifting the focus from low-level actors to those who control the illegal market. It is our point of view that low-level actors in the illegal market—including dealers or women couriers—need proportional sentences or alternatives to incarceration. How useful is it to send a woman who carries drugs in her body to jail because she is doing it out of an economic need—because she has no other option? These are people coming from the poorest communities. They usually don't even know what kind of punishment they could get if they are arrested and caught. We need to find ways to help low-level actors, not only for their human rights and dignity, but for our societies to heal, to bring them in instead of throwing them out.
Usually, problems are photosensitive. Put them to the light and they disappear. Prohibition keeps us in the dark. There's difficulty for research, for understanding the ramifications, of getting data, of understanding why people do it. The paradigm needs to change to move beyond the failure—and drug control is a failure as it is now.
To talk of one of the examples you mentioned, in Medellín, Colombia, it has been said that by addressing urban inequality and investing in these communities, the number of users seeking health services increased. Could investing in these communities, to give greater access to education and healthcare, to reduce inequality, lead to solving the roots of the problem?
That is key—ending the incarceration and allowing for other investments and approaches to those social and economic determinants of drug use. Vancouver and São Paulo (through the programme Braços Abiertos), for example, introduced housing as a harm reduction service to their homeless drug using communities.
Nevertheless, I would be a little cautious about linking the issues so simply because the data that we have on drug use does not show the bigger picture. For example, there are an estimated 250 million people who use drugs around the world. How do we know that? Only by what is reported, by those who have been touched by the system, either went to treatment or were arrested. We also need to review how we measure current policies. And as long as we are in the prohibition paradigm, because of the social and legal risks of coming forward, we cannot do that effectively or sufficiently.