The World Health Organization (WHO) Department of Mental Health and Substance Abuse organized, for the first time, the global Forum on alcohol, drugs and addictive behaviours (FADAB) with the primary goal of enhancing public health actions in these areas by strengthening partnerships and collaboration among public health oriented organizations, networks and institutions in the era of Sustainable Development Goals 2030 (SDG 2030). International Drug Policy Consortium, Harm Reduction International and International Network of People Who Use Drugs issued a joint statement at the forum. The text of the statement is included herein:
Joint Intervention at the WHO Forum on Alcohol, Drugs and Addictive Behaviours
Thank you for the opportunity to address this forum.
I am speaking today on behalf of the International Drug Policy Consortium, Harm Reduction International, and the International Network of People who Use Drugs. I would like to thank WHO for facilitating the participation of civil society in this important discussion.
Firstly, we acknowledge and welcome the proactive role that WHO played in the 2016 UNGASS on the world drug problem. Dr Margaret Chan spoke at the UNGASS in New York and at this year’s Commission on Narcotic Drugs, speaking in favour of harm reduction and the public health approach.
In implementing the UNGASS outcomes, and in preparing for the high-level meeting on drugs scheduled for 2019 in Vienna, it is crucial that WHO and the in-coming Director-General, continue to remain strongly and visibly engaged, and champion harm reduction in the often fraught international drug policy debate.
There are an estimated 12 million people who inject drugs around the world. 14 percent of them are living with HIV, and 67% with hepatitis C. People who inject drugs are 24 times more likely to be living with HIV than people in the general population. And the situation is worsening: the 2011 Political Declaration on AIDS set a target to reduce HIV transmission among people who inject drugs by 50% by 2015. In reality, new HIV infections among this population increased by a third over this period.
This is a problem of political will. We know that harm reduction works, we also know that unsupportive legal and policy environments impede service access and results in the gross violations of the rights of people who use drugs.
Moving away from a criminal justice approach to drug use, and towards a public health approach instead, is essential. But this does not mean a sole focus on biomedical responses – the health outcomes experienced by people who use drugs are always shaped by social and structural factors. We must stop treating people who use drugs as criminals, but we must also stop assuming that they have a disease. This shift must happen in practice, and not just in rhetoric spoken by governments at UN fora.
WHO’s Consolidated Guidelines for Key Populations call for member states to ensure access to harm reduction services. But they also outline critical enablers to optimise service access and impact, which include removing criminal punishment for drug use. We call on WHO to loudly and consistently advocate for decriminalisation across national, regional and international discussions.
Despite the commitments made last year at the UNGASS on drugs and the High Level Meeting on HIV – the coverage of proven harm reduction services remains far too low around the world. Harm Reduction International’s 2016 report on Global State of Harm Reduction shows that no new countries have implemented needle and syringe programmes (NSP) since 2014, and only three have introduced opioid substitution therapy (OST).
These services need funding, which is why we call for governments to redirect the resources currently being spent on drug law enforcement. This does not require new money, just a better balance in public expenditure towards harm reduction. In fact, modelling data show that a redirection of just 7.5% could virtually end AIDS among people who inject drugs by 2030. We also need international donors to reconsider their withdrawal from middle-income countries where the majority of people who use drugs live, and where governments are too often unwilling to fill the gaps.
The Sustainable Development Goals hold the promise of a people-centred, transformative agenda centred on transparency, participation and inclusion. This is a unique opportunity to ensure that the health and social needs of people who use drugs are met, and that governments are held to account. Target 3.3 pledges to end AIDS and combat hepatitis, but we will not achieve this – nor Target 3.5 to strengthen drug treatment – if people who use drugs continue to be left behind. Crucially, the Goals are inter-related. Achieving public health targets requires progress on poverty reduction, gender equality, reducing inequalities, and so forth. We urge WHO to recognise the inherent dignity of people who use drugs – who suffer more than most from economic and political inequalities, social marginalisation and criminalisation.
It is also important to acknowledge the role that communities must play in achieving the SDGs. Examples of the central role of communities abound in public health – from the HIV response to Ebola to Yellow Fever. Communities are not just beneficiaries of services, but also vital contributors and they must be fully resourced and engaged. To quote our colleagues at the Stop AIDS Alliance and the Free Space Process, “Communities stay where donors leave and governments change, which leads to long-lasting change and results”.
Finally, I conclude by mentioning the crucial and unique role of the WHO within the international drug control system. The WHO’s Expert Committee on Drug Dependence is mandated by the 1961 and 1971 drug control conventions to undertake scientific reviews, and recommend the appropriate scheduling of substances to the Commission on Narcotic Drugs, taking into account both risks related to non-medical use and therapeutic usefulness. Scheduling decisions are central to ensuring access to controlled medicines, and the ECDD has taken a laudable stance in its evidence-based defence of therapeutic access to ketamine. The Outcome Document of the 2016 UNGASS gives due prominence to the issue of access to controlled drugs by assigning its own pillar or theme, thereby raising the profile of the ECDD, whose work in maintaining the principle of scientific review is critical and in increasing demand. The Committee needs to be strengthened, supported and funded by member states.
The classification of substances is not a matter of dry legislation, but impacts upon people’s lives. As such, the classification of substances should never be the result of arbitrary or politically driven actions. Drug control can only be truly fit for purpose once it is aligned with the imperatives and outcomes of public health and human rights; both of which are core values of the United Nations. We saw this in action in the recent deliberations on ketamine, and we eagerly await the results of the forthcoming pre-review of cannabis which is long overdue.
Thank you again for the opportunity to address you today, which is also the 5th annual Global Day of Action for the Support. Don’t Punish Campaign. This year there are actions in over 200 cities from every continent with thousands of people participating to call for an end to punitive and damaging drug policies.
We look forward to working alongside WHO and other UN agencies in striving towards putting health and human rights at the centre of this important debate.