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.

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What Donald Trump could learn from Ronald Reagan

Reagan’s candidacy was built on more than his celebrity. Trump not only lacks experience as an elected official, he isn’t part of any organised political movement.

“No one remembers who came in second.” That wisdom, frequently dispensed by the US presidential candidate Donald Trump, came back to haunt him this week. Trump’s loss in the Iowa Republican caucuses to the Texas senator Ted Cruz, barely beating Senator Marco Rubio of Florida for second place, was the first crack in a campaign that has defied all expectations.

It has been a campaign built on Trump’s celebrity. Over the past eight months, his broad name recognition, larger-than-life personality and media savvy have produced a theatrical candidacy that has transfixed even those he repels. The question now is whether that celebrity will be enough – whether a man so obsessed with being “Number One” can bounce back from defeat.

Iowa isn’t everything, after all. It didn’t back the eventual Republican nominee in 2008 or 2012. Nor, for that matter, in 1980, when another “celebrity” candidate was in the mix. That was the year Iowa picked George H W Bush over Ronald Reagan – the former actor whom seasoned journalists dismissed as much for his right-wing views as for his “B-movie” repertoire. But Reagan regrouped, romped to victory in the New Hampshire primary and rode a wave of popular support all the way to the White House.

Trump might hope to replicate that success and has made a point of pushing the Reagan analogy more generally. Yet it is a comparison that exposes Trump’s weaknesses and his strengths.

Both men were once Democrats who came later in life to the Republican Party, projecting toughness, certainty and unabashed patriotism. Trump has even adopted Reagan’s 1980 campaign promise to “make America great again”. Like Reagan, he has shown he can appeal to evangelicals despite question marks over his religious conviction and divorces. In his ability to deflect criticism, too, Trump has shown himself as adept as Reagan – if by defiance rather than by charm – and redefined what it means to be “Teflon” in the age of Twitter.

That defiance, however, points to a huge difference in tone between Reagan’s candidacy and Trump’s. Reagan’s vision was a positive, optimistic one, even as he castigated “big government” and the perceived decline of US power. Reagan’s America was meant to be “a city upon a hill” offering a shining example of liberty to the world – in rhetoric at least. Trump’s vision is of an America closed off from the world. His rhetoric invokes fear as often as it does freedom.

On a personal level, Reagan avoided the vituperative attacks that have been the hallmark of Trump’s campaign, even as he took on the then“establishment” of the Republican Party – a moderate, urban, east coast elite. In his first run for the nomination, in 1976, Reagan even challenged an incumbent Republican president, Gerald Ford, and came close to defeating him. But he mounted the challenge on policy grounds, advocating the so-called “Eleventh Commandment”: “Thou shalt not speak ill of any fellow Republican.” Trump, as the TV debates between the Republican presidential candidates made clear, does not subscribe to the same precept.

More importantly, Reagan in 1976 and 1980 was the leader of a resurgent conservative movement, with deep wells of political experience. He had been president of the Screen Actors Guild in the late 1940s, waging a campaign to root out communist infiltrators. He had gone on to work for General Electric in the 1950s as a TV pitchman and after-dinner speaker, honing a business message that resonated beyond the “rubber chicken circuit”.

In 1964 he grabbed headlines with a televised speech on behalf of the Republican presidential candidate, Barry Goldwater – a bright spot in Goldwater’s otherwise ignominious campaign. Two years later he was elected governor of California – serving for eight years as chief executive of the nation’s most populous state. He built a conservative record on welfare reform, law and order, and business regulation that he pushed on to the federal agenda when he ran for president.

All this is to say that Reagan’s candidacy was built on more than his celebrity. By contrast, Trump not only lacks experience as an elected official, he isn’t part of any organised political movement – which enhanced his “outsider” status, perhaps, but not his ground game. So far, he has run on opportunism, tapping in to popular frustration, channelled through a media megaphone.

In Iowa, this wasn’t enough. To win the nomination he will have to do much more to build his organisation. He will be hoping that in the primaries to come, voters do remember who came in second. 

This article first appeared in the 05 February 2015 issue of the New Statesman, Putin's war