Crises and radical thinking on drug policy

Reform has always been a “two-steps forward, one-step back” undertaking.

It’s sad that drug policy reform must always be wrapped tragedy but alas – in the context of drugs – crisis has historically been the mother of invention.

It was in the face of thousands of overdoses and the highest HIV prevalence in Western Europe that Switzerland introduced effective heroin-prescription programmes, safe injection facilities, needle and syringe-exchange programmes and low-threshold methadone services.

Helped along by lawmakers who were not afraid to lead from the front, these policies resulted in making Switzerland’s HIV prevalence among people who use drugs one the lowest in Western Europe, at about 1.4 per cent.

In Portugal, the year the country witnessed 1,430 new HIV infections among people who use drugs (accounting 52 per cent of all new infections), the government introduced dramatic reforms, decriminalising all drugs and establishing model services for drug users.

Almost 10 years later, new HIV infections among people who use drugs dropped to 164 (15% of all new infections).

It was a similar HIV crisis in the UK in the mid-1980s that spurred the then-Conservative government to launch a number of harm reduction interventions that greatly reduced HIV among people who inject drugs.

Now, as Latin America faces its own supply-side crises with tens of thousands of drug-related killings, gross human rights abuses and overflowing prisons, governments are increasingly vocalising a desire to take bold action toward reform of failed prohibitionist policies. 

In 2009, the Latin American Commission on Drugs and Democracy – including the former presidents of Mexico, Colombia and Brazil, as well as leaders in journalism, politics, academia and literature – called for a paradigm shift in the approach to drugs. This was followed by a report by the Global Commission on Drug Policy that encouraged “experimentation by governments with models of legal regulation of drugs to undermine the power of organized crime and safeguard the health and security of their citizens.”

Subsequently, numerous Latin American governments have openly discussed forms of regulation, including government sale of marijuana or licencing private facilities.

However, drug policy reform has always been a “two-steps forward, one-step back” undertaking and while creativity is being sought in the Americas, Europe is losing some of its pioneering spirit.

Austerity, in some contexts, is a danger to gains made in HIV prevention, among people who use drugs. In Greece, the European Monitoring Centre on Drugs and Drug Addiction (EMCDDA) warned of an increase in the number of newly identified HIV cases among people who use drugs, from between 3 and 19 a year from 2001 to 2010, to 113 new HIV cases as of July 2011.

The Greek government has increased services for drug users to address the situation but the EMCDDA cautions, that “the level of activity is still insufficient to meet the demand within the injecting drug using population.”

In other cases, a nascent abstinence-agenda is trying to manufacture a bogus tension between treatment models – suggesting that providing life-saving services to drug users, like needle-and-syringe exchange programmes, is at odds with ensuring availability of abstinence-based treatment for those who want it.

Some other lawmakers may argue that services to drug users are poor investments in lean times, ignoring the fact that it is immensely cheaper to prevent blood-borne viruses and bacterial infections like HIV, than treat them.

This is the current global paradox in drug policy.

While a new approach may indeed be rolled out to reduce black market violence in Latin America and other parts of the world, a regression to old, expensive and failed ideas in Europe may revise costly and avoidable crises from the past. 

And, perhaps, inspire some fresh thinking once again.

Kasia Malinowska-Sempruch is the director of Open Society Foundations Global Drug Policy Program

A drug user injects heroin. Photograph: Getty Images

Kasia Malinowska-Sempruch is the director of Open Society Foundations Global Drug Policy Program.

Photo: Getty
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The big problem for the NHS? Local government cuts

Even a U-Turn on planned cuts to the service itself will still leave the NHS under heavy pressure. 

38Degrees has uncovered a series of grisly plans for the NHS over the coming years. Among the highlights: severe cuts to frontline services at the Midland Metropolitan Hospital, including but limited to the closure of its Accident and Emergency department. Elsewhere, one of three hospitals in Leicester, Leicestershire and Rutland are to be shuttered, while there will be cuts to acute services in Suffolk and North East Essex.

These cuts come despite an additional £8bn annual cash injection into the NHS, characterised as the bare minimum needed by Simon Stevens, the head of NHS England.

The cuts are outlined in draft sustainability and transformation plans (STP) that will be approved in October before kicking off a period of wider consultation.

The problem for the NHS is twofold: although its funding remains ringfenced, healthcare inflation means that in reality, the health service requires above-inflation increases to stand still. But the second, bigger problem aren’t cuts to the NHS but to the rest of government spending, particularly local government cuts.

That has seen more pressure on hospital beds as outpatients who require further non-emergency care have nowhere to go, increasing lifestyle problems as cash-strapped councils either close or increase prices at subsidised local authority gyms, build on green space to make the best out of Britain’s booming property market, and cut other corners to manage the growing backlog of devolved cuts.

All of which means even a bigger supply of cash for the NHS than the £8bn promised at the last election – even the bonanza pledged by Vote Leave in the referendum, in fact – will still find itself disappearing down the cracks left by cuts elsewhere. 

Stephen Bush is special correspondent at the New Statesman. He usually writes about politics.