“Tackling Problem Drug Use in Europe.”

Conference Report back from Wilton Park by Andria Efthimiou-Mordaunt

First a few notes about Wilton Park (in their own words.)

” W.P. Conferences cover the key political, security and economic issues confronting the world. Global concerns such as the environment and terrorism are also addressed, as well as issues like social reforms and the impact of the information revolution. Conferences are kept deliberately small, with 50-70 people present for round-the-table discussions in which everyone is encouraged to join in. Participants come from a wide range of nationalities and professions. Most are in a position to make a direct impact on policy; on average over 60% are from government. The others are mostly from NGOs, business, universities, Parliaments and the media. Nearly 80% come from outside the UK.

Wilton Park’s long tradition of academic independence is guaranteed by Academic Council, and International Advisory Council of Ambassadors and High Commissioners from OECD countries in London. As an academically independent and non-profit-making Executive Agency of the British Foreign and Commonwealth Office (FCO), Wilton Park is underwritten financially by the FCO, which also provides advice and contacts. A reduced rate may be negotiable for participants from NGOs, universities etc.”

Following some negotiations between the organisers and ENCOD, we were given a place and Andria Efthimiou-Mordaunt represented us.

There were about 70 people there from Afghanistan, Iran, Belgium, America, Holland, U.K. Portugal, Estonia, Jamaica, Ukraine, Czech Republic, Italy, Spain, Sweden, Poland, Albania, Hungary, Romania, Switzerland and France.

During the welcome and introductions, we were told that it was a conference run by Chatham House Rules, which essentially means that you protect the anonymity of the participants. Outside of the meeting, you can talk about the contents – what was said etc, but not who said what. The idea is to enable governmental figures and others to say possibly radical things they otherwise would not.

A Dutch delegate livened up the first day by asking the speakers whether they had read the 3 articles appearing in the Guardian that week, written by Nick Davies, that were clearly organised to coalesce with the conference. Since it was only the second day of his series of 3, he added, “well you only should have had read to read 2 at this point!!”

U.K. Home Office presented their strategy

Ecstasy (e) is a still a Class A drug in the U.K, which theoretically (at least) means 7 yrs for possession and 14 for dealing.. so I commented that I was “trying to imagine an ecstasy user in a Drug Treatment and Testing Order (DTTO).” These community-based orders are given to drug users in the Criminal Justice System (CJS), and mean that the user must visit a probation officer once a week and jump over all sorts of obstacles including regular random drug testing to prove they will not use drugs anymore. Some will have landed there because they have committed an ‘acquisitive’ crime.. The order is specific to class A drug users so e-users could be caught in this. So the comment was really a question as to why e is still a class A drug in the U.K. The answer was annoying if honest; “it was a political decision.”

(In the U.K) we have parents who talk repeatedly about the dangers of e following the death of their teenage child who seemingly over drank water during an e experience. As hellishly sad as this is for them, they attracted huge media-coverage, which has denounced e for the dangerous drug that it isn’t. (While there is some evidence that long-term OVER-use of e can lead to serotonin-depletion, the vast majority of users do o.k.) Anyway, that’s what he meant by political; media populism won again and they kept e in class A, regardless of the recommendations of the U.K. Home Affairs Select Committee (HASC) report.
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A leading U.K. Law Enforcement officer spoke of the ‘cultural shift’ that cops are finding difficult to manage, meaning their increased involvement with users – referring them to drug treatment and actually implementing harm reduction strategies at some police-stations. In
general, he said there was less interest in ‘enforcement’ and more on diversion to treatment. (At some point, I piped up in my inimitable way – “well you want to see what it’s like for us!”)

It was also recommended then, that like Brugerforeningen, the Danish Users Union, the British Police allow drug users to train them about drugs/users-lifestyles, in order to breakdown the gridlock of fear and hatred that they find themselves in so they could begin to stop
seeing each other as enemies. He mentioned that of 220 crack-related arrests, 36% were of Jamaicans and 30% were of E.Europeans, and that some of his officers were disinterested in infiltrating some ‘drug-networks’ for fear of being called racist. He reiterated that government and/or the police should be broadening the drug policy debate, and admitted that the problem with all the Criminal Justice Intervention Programs (CJIPs) was the “time-lag between strategic objectives being set and putting the resources
behind it.” That there is a debate amongst the police about Safer Injection Rooms..(SIRs)

He also said that ‘sexy policing’ was about arresting uses and disturbing drug-markets, which made one researcher ask whether they were having success with ‘denting’ the latter? He concluded by saying that the police feel exhausted and quite hopeless about
reducing drug-related crime.

At the end of his session, one researcher suggested that it might be difficult for the police to talk about legalisation, as they might fear their role would become redundant, but that this was not true, as drug markets would always need regulation, as there would always be an illicit market. However, he added, ‘do we need to do this by maintaining global drug prohibition?’

An Eastern European govt-employed psychologist spoke about youth and drug prevention. She said Hungary had a 10-yr plan, including
· Community Cooperation
· Prevention
· Social Work; therapy and rehab (includes needle exchange)
· Supply Reduction
Treatment is provided for dependent as well as non-dependent users….

Several questions were put to the speaker
· What is the relationship between the Ministry of Youth & Sport and the Intelligence Agencies
· Some comment about the ‘threat of Russia’ dismantling of borders and drug tourism including HIV+ users.
· Why do they have such strict criminal courts?
· She was also asked if she knew how useful drug user groups had been in the development of quality drug services.

Most of the questions were sidetracked, but she did say that they had developed indicators to measure whether their policy was working but there was not much data yet. Outside of the meetings themselves, where the best conversations tend to happen, I met and re-met a no. of people. One of them was from the Hassela Nordic Network: a woman, who asked me questions about the leader of the Swedish Drug Users Union… as I assumed she would have been part of the reason that they nearly lost all their funding last year, I didn’t answer her. I did however get to tell her exactly what I thought about her brainwashing a 15 yr old girl to denounce Harm Reduction in front of the world press at the CND meeting last year.. saying it was “like giving a serial killer a machete and allowing him to do whatever he will..”

She became defensive and started to tell me that in terms of nos. of drug-users in serious drug-related trouble; Sweden’s policy was clearly not a failure in comparison to most other European countries. I asked about prison statistics but she didn’t have an answer to that one, or to the one about HIV and/or HCV figures. Towards the end of the conference, a Swedish researcher presented a paper, which essentially said that the Swedish govt. had so little research on its’ drug policies, it was therefore impossible to know whether they worked or not.

Then it was the turn of the Portuguese. We were told in the first minute that since the implementation of (their more progressive policy) was in the last phase of evaluation, she would not be able to give us all the data yet. So she began by giving a history, which explained WHY they came to develop a less draconian policy:

· High death levels amongst ‘problem drug users.’
· Some of the highest figures of HIV and Hepatitis in any European country
So a commission was set up, which included all govt. ministries with mandates in the areas of social policy. The final document came from their council of ministers, (socialist government at the time) Parts of this strategy were not implemented, as they wanted to see whether the evaluations were successful first.

She said that they had tried to stay within the UN Conventions, though Portugal had considered all policy possibilities including a complete liberalisation of the drug laws. Their strategy includes most tiers of harm reduction including outreach (but not SIRs.)

Delegates questioned her about the ‘Commission’ that Injection Drug Users (IDUs) are sent to, which decides their fate when they are caught in the CJS, and something ‘must be done. Particularly, after second or third offences, she said, this might mean they get a fine, a mandatory community order meaning having to take part in a drug treatment centre. User Involvement is not formalised there yet – she said it was hard to find User reps, but she said they have positive discrimination in employment for ex-users.
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A psychiatrist presented data about another Swiss heroin ‘protocol’
· 80% (high) retention rates
· That many were maintained on heroin; they had methadone too.
· That all aspects of patients lives improved, crime reduction, improved family relationships increased uptake in work and education as well as reduced infection rates and illicit drugs use.
· That it cost 50 Swiss Francs a day per patient, which, was mostly paid by health insurance.
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A leading Dutch user advocate presented his paper about a User Advocacy project, which has 600 members’ – third largest in the world. The doors of the project are opened five mornings a week to mainly homeless users, in an attempt to reduce ‘street nuisance.’ Ten volunteers supervise the mornings, where people are able to use drugs in peace and if somebody hasn’t enough money to buy drugs, somebody else normally helps them out. The cops are usually supportive and dealers (of both heroin and cocaine) must be respectful of clients as in fair prices and quality product. The atmosphere is relaxed and in five years, he had only witnessed three incidences of violence. Clients treat the project like their own home, and a welfare worker comes regularly to the project to meet clients who have social problems.

A Few Other issues raised ..

* In the U.K, private trusts may be stopped from setting up User rooms. (That these rooms are not wanted till after the heroin protocols have been piloted.)
* ‘They’ have a decade to eliminate Opium production…
* They want to have 55% of ‘problem drug users’ in treatment this year.
* It was argued that the Criminal Justice Interventions (CJIP) are predicated on the fact that 75% of persistent offenders also ‘misused’ drugs. Hence they are targeting areas with the highest levels of crime.
* Drug Testing Treatment Orders (DTTOs) are 30% successful.. This is viewed as a success ‘given the ‘chaotic nature’ of the problem.’
* Accordingly, 75% of all property/acquisitive crime in the U.K. is drug-related
* 50% of violent crime is related to rival heroin gangs & drug-markets..
* Home Office are making efforts to reduce the bureaucracy so that treatment-modalities needed NOW can be established more speedily.
There is some controversy amongst the ‘great and the good’ as to the classification of methamphetamine; should it be class A or B? Who should decide this?
* It was pointed out that there are empty beds in residential treatment settings, as a result of bottlenecks in the administrative organisation of services, but waiting lists were high!
*It was admitted again that there is no full-proof way of stopping drugs getting into prisons..

It was argued that the establishment of basements/users rooms militate against crack-related violence or disorder. In arguing that user rooms mitigated against crack-related crime, the speaker was trying to wake us up to the fact that the ‘street’ is not the easiest place to make illicit drug transactions, particularly because the surveillance will make interactions fear-filled, not to mention other tensions felt by users and sellers.
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An Afghan doctor, now working for an anti-drug UN-funded project made a moving short speech about drug problems they face, though it is believed that there are only a few thousand injection drug users there. This may be to do with the fact that heroin is cheaper, higher quality and thus many are smoking it or ingesting it in other ways, but the data is still very sparse. HIV figures were also low, but again rather hard to believe. It was pointed out that given that Afghanistan had suffered greatly as a result of war for the last two decades and more, even some of the basic health infrastructures were lacking so drug treatment was not high on the country’s list of priorities. One harm reduction advocate suggested that if resources are an issue there, they should get onto AIDS prevention speedily in order to ensure health care monies were not being competed over in desperate circumstances later. Though it was clear that there are a few advocates who would address these issues, the war on drugs rhetoric generally wins the day, (partially as a way to ensure funding does arrive…) though of course, that was not stated.
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American researcher’s main points:

* The only way we may be able to respond appropriately to its drug war failure is to hit them with how many tax dollars are being wasted on maintaining the ‘war on drugs.’
* Ecstasy, as well as methamphetamine use, it was suggested, has peaked, in the U.S.
* 25% of IDUs in the US are living with HIV disease, BUT AIDS does not even show up once in the government’ drug strategy & overdose comes up twice in passing …
* Faith-based ‘treatment’ is where Bush’s official drug treatment budget is largely going these days
* 20% only of opiate addicts receive methadone, but most treatment slots are for cannabis users!!
* The public perception is that the drug problem is worsening, and that nothing works very well to make things better.
*Cannabis arrests have more than doubled in ten years…. no wonder there are more cannabis users in treatment then! [Ed]
* It was argued that reforms were more likely to come from the bottom up.
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KEY POINT: One recurrent theme of the meeting was that we have not agreed what we mean by harm; do we mean physical, psychological, socio-economic, legal or what? AND what do we mean by problem drug user? Problem to whom? When? How?
It was pointed out that overdose deaths of users are rarely recorded partly due to lack of political interest in them.
Less than 25% of all Europe’s ‘problem drug users’ have access to treatment, though low threshold, ands outreach care were becoming a priority in a majority of European countries. ` Compulsive drug users are imprisoned in almost all European countries, though many opt for therapeutic responses regardless of the so-called legal solution.
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Apologies for the dryness of this report, hope you all find some of it useful and informative anyways. As the key drug user representative honestly disclaimed his role as drug user, but rather as ‘working director’ of the advocacy project he worked at, I felt obliged to take on that role, which I had not expected to do. (I don’t know if it’s age or watching the intensification of the war on some addict drug users in my own country or what,) but I find myself feeling less safe/comfortable in that role as I get older.. certainly there, it felt quite lonely though people were mostly cordial and genuinely interested in the work of User Activists.
There was much talk between European bureaucrats about the way money was used and/or how decisions were made to prioritise it for particular drug interventions. Somehow there was little concern, certainly little concern expressed, about how governments drug funding is distributed – something like 66% on Law Enforcement, Customs and Excise etc and the rest of education, prevention and treatment. There was however, in depth discussion on the need for more focused research about what drug policy is currently achieving, (or not) and thus how the money might better be utilised.

Important was the fact that though there was clearly a strong presence of reformers, there were also a few people who appeared to be drug policy naïve, and/or simply continuing to tightly support global drug prohibition. It was a treat to not be simply preaching to the choir (as we often are)

I couldn’t help noticing the way many delegates chose to relax – walking around the beautiful grounds and over to the sprightly little lambs playing on the lawn. (I don’t know what the marks on these ones meant though I know generally a marked sheep often means one that has been chosen to be killed for its meat) which made me think about the drug users all over the world who will die for even lesser reasons..

The really scary part of all this is recognising that most of humanity doesn’t even know about this. Neither do most of us consider that global drug prohibition is literally murdering users, or inadvertently, in the guise of ‘treatment’ disempowering most of the rest. Such has been the effect of many decades of punitive prohibition strongly supported by scape-goating (lambing?) media populism, the often-unwarranted fear of drugs and successive governments inability to humbly admit that something is profoundly wrong with the system as it stands.

This too shall pass.

www.usersvoice.org.uk
A.Efthimiou-Mordaunt@lse.ac.uk
Member of ENCOD’s Steering committee, April 2004

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