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Public health experts are calling for reforms to drugs policies, as the United Nations General Assembly meets in New York from 19-21 April for a special session on drugs.
Many countries continue to focus on reducing supply and depend on law enforcement and the criminalisation of drug use. However research shows that public health approaches, such as 'harm reduction', can be more effective. This means providing services such as needle and syringe programmes or opiate substitution therapy.
Drug war declarations have serious negative consequences on human rights and public health, as they focus on prosecution rather than treatment. In Asia, the majority of prisoners are in jail for drug-related crimes, according to a 2015 report by Harm Reduction International (page 20).
In 2015, the United Nations Office on Drugs and Crime estimated that more than 12 million people worldwide inject drugs. This is a major factor in the spread of HIV in some parts of the world. According to the UNAIDS 2014 Gap report, around 13 per cent of people who inject drugs are living with HIV. Outside sub-Saharan Africa, 30 per cent of new HIV infections are caused by injecting drug use.
How harm reduction works
Murtaza Majeed is a co-ordinator at Youth RISE, an international network led by young people to promote harm reduction strategies. He defines harm reduction as a public health philosophy and intervention that seeks to reduce the harm associated with drug use and ineffective drug policies.
He says: “A basic tenet of harm reduction is that there has never been, and will never be, a drug free society. Harm reduction is to give basic health care for people who use drugs in order to prevent health and social damage caused by drug use. It promotes health and safety of people who use drugs until a reliable and effective treatment is available to achieve drug free life.”
Common approaches to harm reduction include the provision of clean needles for people who inject drugs and supervised consumption facilities. Some people argue that this promotes drug use and drains resources from treatment services. But the latest research by the World Health Organization (WHO) shows that needle and syringe programmes reduce HIV risk without increasing or promoting drug use.
Punishing drug users causes more harm
Current legislation, punitive law enforcement measures and punishment, as well as social stigma, cause more harm among young people who use drugs around the world.
Pramila Satyll, aged 22, from Kathmandu in Nepal is an injecting drug user. She says: “I started drugs in my early teens. My brothers and my cousins use drugs so I was already in that cycle. Just like anyone, I started with a small puff of weed. At 19, I was taking anything I could put my hands on that could make me high. I smoke, snort and inject drugs.
“I have been jailed twice for drug possession and I dropped out of school because I was in prison. It’s hard for me to stop drugs because I’m kind of hooked. Once I attempted quitting when one of the girls in my neighbourhood died due to a drug overdose. I was really scared it might happen to me, but after a couple days I went back to using drugs.”
Time for change
Majeed argues that prevention policies are not working. On the contrary, drug use has grown and the number of people using drugs has increased, causing more harm to people’s health and to society.
“The war on drugs has caused more damage and many lives have been lost,” he says. “Countries have become unstable, corrupt. Famers have lost their family and prisons are filled with people for just using drugs.
“The United Nations General Assembly Special Session is a great opportunity to bring changes in current failed approaches and ask all state members to demand a health and human rights based approach to drug use and drug dependency.”
He adds that access to highest attainable health is a human right and that people who use drugs are at daily risk of overdose, infections, HIV, hepatitis and other health problems.
Value for money
The UNAIDS GAP report shows that $160 billion is spent annually on drug law enforcement, yet only about $2.3 billion would be required to fund HIV prevention among people who inject drugs.
Majeed says: “It is proven that a dollar spent on harm reduction can save four dollars on drug treatment. Many countries are implementing a health based approach to drugs and the results are comparatively effective and better than the classic criminalised approach to drug use.”
Satyll’s experience shows that harm reduction does work. She says: “We do have non-governmental organisations that come and educate us and give us reading material on the risks of HIV and other blood borne diseases. They have opened up a drop-in-centres in the city and encourage us to visit these facilities. They also provide counselling regarding safer practices and distribute condoms and other HIV services.
“I have learnt a lot from these organisations. I’m better informed now and I use safer practices when I’m using drugs. I’m considering quitting and planning to go back to school.”
Majeed adds: “Harm reduction is a pragmatic approach to promote health and social life of people who are unable or unwilling to quit drugs. Research shows it reduces HIV infections and prevents its spread in society.”
Francis Chimenya lives in Malawi and is a member of Key Correspondents, a citizen journalism network reporting for action on HIV. The network is supported by the International HIV/AIDS Alliance.