Wednesday 26 February 2014

Beneficii și riscuri așteptate ale camerelor de injectare



În mod obișnuit, înființarea camerelor de consum supravegheat într-un cartier este precedată de o lungă perioadă de discuții, în timpul cărora interesele divergente privind sănătatea publică și individuală, ordinea și siguranța publică, locuitorii și afacerile din zonă, organele de aplicare a legii și administrația locală, și, într-o oarecare măsură, grupuri de interese ale consumatorilor, sunt puse în balanță. In niciunul dintre orașele în care au fost înființate astfel de centre,  decizia nu a fost luată uşor sau repede (Hunt, 2006).

Dincolo de reacția comună a oponenților acestui tip de servicii conform căreia aceste camere de injectare ar "trimite un mesaj greșit", poliția și experții în sănătate din respectivele orașe au acceptat centrele ca o soluție pragmatică (Joseph Rowntree Foundation,  2006).

Beneficiile așteptate sunt scăderea  consumului de droguri de mare risc, a morbidității și mortalității în rândul populației-țintă, accesul îmbunătăţit la asistență medicală și socială, inclusiv la tratamentul dependenţei de droguri, precum și reducerea consumului de droguri și a gradului de tulburare a ordinii publice din vecinătate. Riscurile posibile sunt încurajarea consumului de droguri, apariția de noi consumatori, prin faptul că ofera consumului de droguri un cadru mult mai acceptabil și confortabil (Schatz, Nougier, 2012) .

Photo source: Plateforme Mondiale SCMR - Global Platform DCR

 Deoarece camerele de consum îi vizează pe cei care nu sunt pregătiţi pentru tratament, o funcție majoră a lor este de a oferi alte servicii pentru  supraviețuire, inclusiv asistență medicală primară, alimente, apă, haine și adăpost. Motivul care stă la baza acestei funcții este că persoanele care consumă droguri ar trebui să fie ajutate să supraviețuiască, în perioada în care aceștia nu pot sau nu doresc încetarea consumului de droguri, în speranța că vor fi capabili la un moment dat să întrerupă consumul ( Hunt, 2003).

Sunday 23 February 2014

Decriminalization of drug possession and use is a human right?



Definition         
Decriminalization is defined as “ the removal of sanctions under the criminal law, with optional use of administrative sanctions (e.g. provision of civil fines or court – ordered therapeutic responses)” – Hughes CE, Stevens A.
“A system that punishes offences by means other than prison. Fines for most traffic violations are an example. In relation to drugs, it is normally limited to possession (and sometimes growth) of small amounts (often around one ounce) and sometimes to sale of equally small amounts to adults. It is also often limited to marijuana among the illegal drugs.” (http://www.dpft.org/policy.htm)

Introduction
Drug use and trafficking worldwide is a dynamic phenomenon, strongly  influenced by a multitude of social and economic factors. Also, the drug phenomenon particularly complex, with implications in  all spheres: public health, citizen safety and national security.
We  can observe  how models for drug decriminalization were developed during the last 10 years in countries as: Argentina, Armenia,  Australia, Belgium, Brazil, Chile, Colombia, Czech Republic, Estonia, Germany, Italy, Mexico, The Netherlands, Paraguay, Peru, Poland, Portugal, Spain, Uruguay, United States of America: State of California. 
All over the world, different policies are adopted. To save the costs, some countries have reduced harsh penalties for drug offenses, others have been increased harm reduction services to go down the destructive impact of problematic drug use.
As an alternative method, a new policy option might be decriminalization of drug possession  and use and could be an answer to the present problems which Romania is confronting – employment decline, stigmatization and public health harm.
In this moment, Romania is facing a new epidemiological wave of HIV infections.   If in 2008 there were just three confirmed cases with HIV infection, in 2012 there were 237 new, confirmed cases (Ref:  National Institute of Infectious Diseases, “Prof.Dr.M.Bals”).
In September 2012, the Romanian Angel Appeal Foundation NGO in collaboration with the National Antidrug Agency and the Carusel Association performed a Behavior Surveillance Study among injecting drug users in Bucharest and Ilfov county, Romania. Out of 417 participants  controlled with rapid test in this study 52,5% were positive  to HIV, 85% with Hepatitis C virus, and 20 % with Hepatitis B virus  (National Anti-Drug Agency, Report for 2013).

Photo source: www.who.int

Benefits
Decriminalizing drug possession and use would be the most effective policy.
Many benefits, as: helping more people get substitution treatment, would reduce HIV, HVC, and HVB epidemic, reduce overdoses, informed youth, fewer people arrested, reduce the criminal justice costs are effective ways to limit drug related harms in Romania.
In the report “The War on Drugs and HIV/AIDS: How the Criminalization of Drug Use Fuels the Global Pandemic”, launched by Global Commission on Drug Policy in June 2012, it shows that in certain countries, HIV risk behavior increased because of criminalization fear. That incarceration mass led to higher HIV transmissions rates in prisons. Commission’s members called repeatedly for decriminalization of drug possession.
More than everything the decriminalization would mean a switch in authorities' point of view, that will see persons that can be helped rather than law offenders.
Also, the abuses on drug users from police forces would be stopped. A big part of them are scared or traumatized about their experiences with the police. Instead of having processes, higher costs for all of these actions, the system could be replaced  by administrative penalties as: warnings, fines, suspension of a driver’s license,education and so on.

Risks
1. In the beginning, the police may have a negative attitude. But here  it is a problem because many of them consider drugs as evil, especially those from older generations. This can be changed through some trainings with police forces.
2.Fear that  drug use will increase

Costs
1.Monthly cost of a detainee
According to a local newspaper, the monthly cost of a detainee is 2,397lei (about 550 euro), mostly are staff costs. Effects: negative employment consequences, higher costs for criminal justice system, the government is losing the money and the drug user needs a strong collaboration between the public health system and the law enforcement because this could be significantly for an individual’s experiences.
2. Harm Reduction services costs
"According to the report launched for the World Anti-Drug Day (23 June), HIV treatment cost per person is around 500 euro per month while the cost of distribution disposable syringes is 450 euro per year."(Estimating Costs of Drugs Policy in Romania " Report). From decriminalization of drug possession and use would benefit, not only drug users, but also the general population, this turning into a win-win situation. In addition, the state would benefit, because it is cheaper to invest in a health service, and to prevent diseases, than to treat then.
Photo source: www.observatordebacau.ro

Decriminalization of drug possession and use is a human right
Decriminalization of drug possession and use should be a human right in order to avoid stigmatization, discrimination, insecurity, social exclusion and not only according to:
Article 25 of the Universal Declaration of Human Rights, which provides for the right to “a standard of living adequate for the health and well-being of himself” including “medical care and necessary social services.”
Article 35 of the Charter of Fundamental Rights of European Union states: “Everyone has the right to access preventive health care and the right to benefit from medical treatment under the conditions established by national laws and practices.”
The Court of Argentina declared the following: ‘Criminalizing an individual [for drug use] is undeniably inhumane, subjecting the person to a criminal process that will stigmatize him for the rest of his life and subject him, in some cases, to prison time’.

Study cases:
1. The Portuguese Decriminalization Model
“Some countries particularly stand out. In 2001, Portuguese legislators enacted a comprehensive form of decriminalization of low-level possession and consumption of all illicit drugs and reclassified these activities as administrative violations. Alongside its decriminalization law, Portugal significantly expanded its treatment and harm reduction services, including access to sterile syringes as well as methadone maintenance therapy and other medication-assisted treatments. After 10 years, none of the fears of drug war proponents has come to pass. According to the United Nations Office on Drugs and Crime, “Portugal’s policy has reportedly not led to an increase in drug tourism. It also appears that a number of drug-related problems have decreased. “Experts agree that, on balance, “there “is ample evidence of a successful reform.” 
“The Portuguese evidence suggests that combining the removal of criminal penalties with the use of alternative therapeutic responses to dependent drug users offers several advantages. It can reduce the burden of drug law enforcement on the criminal justice system, while also reducing problematic drug use…[and] may offer a model for other nations that wish to provide less punitive, more integrated and effective responses to drug use.” British Journal of Criminology, 2010”
  
2. Czech Republic
“Following years of intense debate, the Czech Republic became one of the most recent countries to formally decriminalize possession of illegal drugs in 2010.Interestingly, the Czech Republic had decided to decriminalize drug possession after carrying out a cost-benefit analysis of its criminal laws that were adopted in 2000. After a two-year project that was concluded in 2002, research found that:
1. penalization of drug use had not affected the availability of illicit drugs;
2. there was an increase in the levels of drug use within the country;
3. the social costs of illicit drug use increased significantly.

As a result of this analysis of the impact of introducing penalties for drug possession, the Czech Republic formally decriminalized possession of illegal drugs in 2010.The delay in implementing decriminalization was the result of a full assessment of drug-use patterns by the Czech authorities to ensure that quantity thresholds were set at the appropriate levels. Even before the new legislation, Czech policy focused on public health approaches to drug use and this was reflected in the low rates of imprisonment for possession offences. Following passage of the legislation and a new directive issued by interim Prime Minister Jan Fischer in late 2009, police and prosecutors are now instructed to charge individuals possessing up to 15 grams of cannabis, 1 gram of cocaine, 1.5 grams of heroin, 4 ecstasy tablets, or 40 pieces of hallucinogenic mushrooms with an administrative offence – not a criminal charge. Such an offence brings with it potential fines of up to the equivalent of £550 processed through municipal administrative procedures, but no criminal record is created for the individual. In June 2011, the law changed to allow police officers to issue fines on the spot for drug use – similar to the process for minor traffic offences. While the broader effects of the Czech Republic’s legislative change cannot yet be determined, preliminary assessments show the fears of the new law’s critics that there would be an explosion of drug use in the country have not been realized. Jindřich Vobořil, the Czech government’s national anti-drug coordinator explained in 2011:
"There is not a more prevalent drug problem [since the new law came into effect]. We have always had high rates of marihuana use, and that has not changed. We also have problems with the use of harder drugs but that has not got much to do with this change".

Recommendations
As are presented the two study cases above, the Romanian Government should eliminate criminal penalties for personal drug use possession. Also an expansion of harm reduction services and treatment programs should accompany the new policy.
Drug users should have the right to work, access to education programs or healthcare services. Thereby, Romanian government will win through this situation, reducing criminal costs and more, but the employment might raise or at least, it will remain at the same level.
Is a successful and a viable option demonstrated around the world through decriminalization polices.
In order to start the procedures for decriminalization of drug possession and use, Article 4, law 143/2000 – „Growing, production, manufacture, experimentation, extraction, preparation, processing, purchase or holding drugs for one's own consumption, without legal right, shall be punishable by imprisonment from 2 to 5 years „ – has to be modified and small amounts of drugs for personal use, should be allowed.

Sunday 2 February 2014

Interview with Jamie Bridge on DCRs

DCRs Expert Interview Series; Name: Jamie Bridge - Senior Policy and Operations Manager
International Drug Policy Consortium (IDPC)


1. What is your opinion ondrug consumption rooms?

"Where there is a clear need (visible, problematic public drug use; high overdose rates; etc), they are invaluable public health interventions that can save lives. The evidence clearly shows that they are effective: http://idpc.net/publications/2012/06/idpc-briefing-paper-drug-consumption-rooms-evidence-and-practice



2. Do you think that drug consumption roomsare helpful for drug users? (Please detail…)

"Yes. Not every drug user needs to use a consumption room, but for those without accommodation or safe, clean places to use their drugs – these centers can provide invaluable support."



3. Please specify what problems could be solved by drug consumption rooms.

"So many things – but mainly overdose deaths and non-fatal overdoses; public injecting and discarded drug paraphernalia; crime and disorder; HIV and other BBV transmission; injecting injuries and poor injecting techniques. Where drug consumption rooms offer facilities for injecting, smoking and sniffing drugs – they can also help people to shift away from injecting and toward safer routes of drug administration: http://www.ncbi.nlm.nih.gov/pubmed/20167464



4. In which area of the city do you think should be located such a place?

"In any city that has high rates of overdose or public injecting. Any city should aim to do a proper analysis of need before setting up a service, including talking to the local drug users to ask if they would use such a service."



5. What perception would the community have on a drug consumption room in their area of living?

"If there is an acknowledged problem of public injecting, then residents may welcome any service that solves this problem. If not, it can be hard to open a service – due in part to ‘NIMBY’ syndrome (“Not In My Back Yard”). But services that work hard to engage local residents and explain their benefit to the community are generally well accepted (i.e. the service in Geneva does a lot of work in this area). It is crucial to get the media on side too."



6. Who should support the costs to open a drug consumption room?

"Like any other health service for vulnerable people, this should be covered by government (national or local)."



7. From your experience, what were the obstacles in developing such a service.

“NIMBY” syndrome as described before, funding, legal barriers around allowing drug use on a premises, media attention."

Photo source: Plateforme Mondiale SCMR - Global Platform DCR