6 Nov, 12 | by BMJ Group
Past drug strategies have called for a careful evaluation of “best practices”—something the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) does admirably well. But when it comes to reducing HIV, hepatitis C, overdose, and improving access to treatment, we already know what works and the problem isn’t finding the answers, but rather getting member states to heed the lessons of their neighbours.
One challenge is that the lessons of these successful drug policies reflect that a departure from harsh law enforcement is required—and that’s not something governments are typically keen to do. It’s now an established fact that punitive drug laws don’t work. Countries that enforce punitive models see prison populations and health epidemics mount, those with health based approaches show far better results.
Portugal, for example, decriminalised all drugs and established model services for drug users in 2000. Before these reforms were introduced the country witnessed 1,430 new HIV infections among people who use drugs in 2000 (accounting for 52% of all new infections). After 10 years that number dropped to 116 in 2010.
The EMCDDA writes, “A downward trend can be observed also in the prevalence of HIV, hepatitis C, and hepatitis B among clients of drug treatment settings.”
Switzerland, though not a member of the EU, grappled with thousands of overdoses and the highest HIV prevalence in Western Europe when it introduced effective heroin prescription programmes, safe injection facilities, needle and syringe exchange programmes, and low threshold methadone services. These policies resulted in making Switzerland’s HIV prevalence among people who use drugs one of the lowest in Western Europe, at about 1.4%.
Similarly positive results have been seen the Czech Republic.
In times of austerity such approaches may sound costly and there is a risk that countries that are in need of finding savings, will roll back on some of their tremendous gains. Moreover, vulnerable populations, like people who use drugs, are easy targets for populist rhetoric championing criminalisation over treatment and care.
Even countries that boast more successful models, like the Czech Republic and Portugal, are under pressure to find savings. However, as governments look for savings, they would be well advised to consider the numbers and the success of their own experiences.
Health services, reinforced by a supportive legal environment, save money in the long term.
Romania makes for an interesting case study. According to the Romanian Harm Reduction Network, the cost of needle and syringe exchange is less than €500 per client, per year. However, that cost dwarfs the expense of treatment and care on HIV and other blood borne viruses and bacterial infections. In fact, according to the Romanian Ministry of Health, HIV treatment and care cost almost €6,000 per person per year. Thus, runaway levels of HIV infection among people who use drugs will cost far more in the long run than prevention.
Such outbreaks are not hypothetical. They are occurring right now in several countries, including Romania.
There were only three to five new HIV cases reported annually among people who use drugs, from 2007 to 2009, but in 2011 there were 129 new cases, according to Matei Bals from the Romanian National Institute for Infectious Diseases.
And it shows no signs of slowing down. By mid 2012, 98 new HIV cases were reported, accounting for 31% of the total new HIV cases registered by the National Institute for Infectious Diseases.
This increase coincided with a reduction in services. One of only four needle and syringe programmes in the country was closed in 2011 and another site was expected to be shut down in 2012.
The EMCDDA recently wrote, “The low level of provision of opioid substitution treatment and the recent decrease in the number of syringes provided through needle and syringe programmes, as well as a recent rise in the combined use of opioids and amphetamine type stimulants resulting in increased injecting frequency, could all have contributed to increased HIV transmission.”
All of this will come with tremendous financial costs to say nothing of the human costs, service providers warn.
Valentin Simionov, the executive director of the Romanian Harm Reduction Network said, “We are grappling with a terrible situation in Romania. Romanian NGOs have proven their capacity to develop successful HIV prevention services among people who use drugs with support from international donors. No government is immune to tragic spikes in HIV if services are cut and harsh realities are denied. When governments ignore the need to continue vital services it not only costs money but also lives.”
Europe remains the pioneer of some of the best health based approaches to drugs in the world and the future EU Drugs Strategy will doubtless allow member states the room to adopt these practices should they choose to.
However, the bigger question remains—why aren’t they choosing to?
Kasia Malinowska-Sempruch, is the director of the Open Society Foundations Global Drug Policy Programme.