According to UNODC harm reduction is fully compatible with the recent UN drug control system
"’Harm reduction’ is often made an unnecessarily controversial issue as if there was a contradiction between prevention and treatment on one hand and reducing the adverse health and social consequences of drug use on the other. This is a false dichotomy. They are complementary" – claims a recently published discussion paper on harm reduction produced by the United Nation’s Office on Drugs and Crime (UNODC). In theory there is no doubt that this is a well-formed statement: harm reduction and abstinence-oriented interventions are not contradictory but complementary. The only problem is that it’s far from reality in our world, where in many countries drug users have no access to harm reduction services or they are still arrested or harrased by police for using these services, or what is even worse, only for being a drug user. All these barriers are the direct consequences of the international drug control system and the three UN drug conventions which serve as a reference point for governments prohibiting or withholding support from harm reduction. The controversy is not about the theoretical reconciliation of abstinence-based treatment programs and harm reduction services, the real controversy is about the enforcement of the prohibitionist conventions and the everyday practice of harm reduction, which requires the official recognition of drug users as a target group of public health and not of law enforcement. The everyday reality for an injecting drug user in the U.S. or in Russia is that harm reduction is a controversial issue indeed. While WHO included methadon to the list of essential medicines in 2005, it is still illegal in Russia for treating opiate addiction. Despite repeated statements from UN public health agencies about the effectiveness of needle and syringe exchange programs, the U.S. government still refuses to fund NSE services from the federal budget. Both governments think that harm reduction is contradicting the principles of the UN drug control system, and they are not pushed by UNODC to revise their attitude. Harm reduction is even more controversial issue in some EU countries. How would you call it other than controversial when you can enter a government-funded needle exchange center where you are treated as somebody who needs help, but at the moment you leave the service and walk on the street the government-funded police can arrest you and treat you as a criminal – just because you possess the same needles?
The first thing UNODC should have done to really dissolve controversies about harm reduction is to call for the abolishment of criminal sanctions against drug users and the revision of the UN drug conventions. Of course UNODC is also aware of these simple facts, but it was not willing to address these problems in its discussion paper. On the contrary, it tries to present the drug control system as a consistent, all-encompassing structure which is completely based on scientific evidence and common sense, while we know it simply isn’t. As Upton Sinclair, a devoted prohibitionist put it, people don’t understand something if their salary depends on not understanding it. UNODC argues that harm reduction is not controversial – but it even doesn’t dare to name harm reduction in its official documents but uses the ridicolous euphemism: „reducing the adverse health and social consuequences of drug abuse.” This language does not reflect what harm reduction really is. First, harm reduction as a philosophy and practice cannot be reduced to a mere complementary tool of demand reduction policies as „tertiary prevention” (as the UNODC paper does), or subordinated to the goal of abstinence as „low thresehold services” (as the EU drug strategy does). What harm reduction actually is a double-edged sword designed to fight not only the direct harmful consequences of drug abuse, like overdose deaths or blood born diseases, but also against the harms created by prohibition, also spreading through the world like a contagious disease. In fact, many harms the UNODC contributes to the simple use of illicit drugs is generated by the drug control system per se: crime, poisonings, infections, overdose deaths, corruption and many others.
Second, the essence of harm reduction as an approach does not lay in the denial of abstinence as a possibly feasible and valuable goal, but in the refusal of abstinence as an absolute and fundamental goal of drug related interventions. „Provisions of appropriate evidence-based clinical services for rehabilitation of patients dependent on drugs who are motivated to stop drug abuse should be considered as the highest priority,” states the UNODC paper. But how can you call this approach evidence-based and compassionate if you know that the vaste majority of problem drug users are simply not ready to stop drug use but they are in an urgent need of services reducing the harms of their drug use? It doesn’t sound evidence-based and compassionate to prioritize services not appropriate for the majority of your target group while life-saving, badly needed services are lacking and you say they are not the priority. To avoid any misunderstandings: I m not saying that abstinence-based treatment is not an incredibly important service which should be made available for everybody who needs it. But there are millions of people for whom abstinence is not a feasible goal of treatment and for them the top highest priority is the access to harm reduction services. As an Afro-American minister said well: „If you want to save souls, first you have to save lives.” If somebody dies today of AIDS or overdose, you cannot rehabilitate him tomorrow: the absolute priority is to save his life and improve his health condition. I think it is not the goal of treatment (abstinence or harm reduction) what should be made the fundamentum of drug policy but the right to health of drug users and the community. We cannot subordinate the health and well-being of drug users to the goal of abstinence.
And here we face the core problem of the UN drug control system: it was not created to serve the human rights, health and well-being of people who use drugs and who are affected by drug use, but to pursue an ideology-driven agenda to eradicate drug use from the surface of the globe. Peter Cohen is right when he compares the global prohibition regime to a church with irrefutible dogmas laid down by the Holy Synods a long time ago, with its own Holy Inquisition, the INCB, persecuting all heretical interpretations of the conventions. I m a regular participant of the Commission on Narcotig Drugs (CND), a major decision making forum of the UN drug control system, and as I m sitting in the large, solemn hall as an NGO observer surrounded by government delegates, I almost feel like an atheist attending a charismatic Christian community meeting, or rather like a pagan visiting a church council. The „bishops” and „cardinals” of remote countries are reiterating the dogmas and litanies laid down by the holy synods of New York and Vienna, either with an eschatological zeal or with a dispassoinate monotony. Aberrations from the dogmas in the name of science, compassion or basic common sense is not tolerated, dissidents and heretics are intimidated by the Holy Inquisition and are liable for self-criticism. There is another analogy for UN drug meetings: the last congresses of the Communist Party in my region of Europe, where party functionaries were gathering to discuss ideologically selected issues which have nothing to do with the urging everyday reality of their people. There are many delegates tired of the old ways and old rhetorics, meaningless slogans and commonplaces. Many know that this system became an outdated, self-contradicted memorial of an idea which was once percieved by the founding fathers in a beatific vision as the key to a new, more humane world. After passing the five and ten year plans, one after another, each failed to build socialism/prohibition agaisnt human nature, they had to realize that it just doesn’t work. The system once they believed to be a solution for all problems became the problem itself. There are not many though who dare to speak out against the system and they only whispering in the corridors about the new heresy, harm reduction. We know that one day Arianism was considered orthodoxy in the Roman Catholic Church and the Nicean Creed was persecuted as a heresy. However, times were changing, and today Arianism became a heresy while the Nicean Creed triumphed as orthodoxy. Today harm reduction is a heresy, but I strongly believe that it is the orthodoxy of tommorrow.