Kasia Malinowska-Sempruch is director of the Open Society Institutes (OSI) Global Drug Policy program, based in Warsaw. She was director of the OSI International Harm Reduction Development Program from 1999-2007, which pioneered technical and financial support for more than 200 harm reduction projects across 23 countries of Central and Eastern Europe and the former Soviet Union. She has many years of experience in dealing with drug issues as well as HIV prevention. She has studied and worked in Poland and the United States of America.
Orange: How is HIV prevention related to drug-issues?
HIV prevention for drug users is easier in comparison to HIV prevention in the area of sexual health. I don’t know any drug-user to whom you would offer a needle and who would give you reasons why not to use it, as is often the case with condoms. It’s a very simple public health intervention: easy to deliver and people want it. Basically there should be no reason for drug users to become infected with HIV. But when you look at data, hundreds of thousands of drug-users are in fact HIV positive.
If a heroin user says, “I don’t want to use drugs anymore. I would like to start treatment”, there is a simple way to deliver intervention that helps people to reduce or stop heroin use: it’s called substitution treatment. It has been studied over the last 40 years and the treatment is cheap. One does not have to stay in a hospital or a long-term rehabilitation to begin treatment. In the best cases the patient also receives psycho–social counselling, maybe also help with job training. Let’s look at Russia: close to two million people there are HIV-infected and the majority of them are drug-users. Even though there are effective tools for HIV prevention, Russia makes a policy decision not to use them.
Orange: What is the War on Drugs?
It’s clearly a policy that is not based on evidence. For example, 50 years ago when the Single Convention on Narcotic Drugs was adopted, there was no HIV. It is somewhat silly that half a century later we are still guided by the same document.
Orange: How and on what basis would you evaluate the current policy on drugs?
I can think of a couple of indicators. The first one would be the health of people who use drugs, especially the danger of infectious diseases. Secondly, there’s the quality of life of drug-users and their families, including questions of discrimination and the availability of social support. For the most part, our policies are now guided by a quest for abstinence. Most medical treatments aim to improve the quality of life of the patient. Why should the goal for drug-treatment be different? If someone has diabetes, you don’t tell him, “You won’t get insulin, because it won’t cure you.” For drug-addiction we expect the solution to be perfect. But we don’t use the same standard for other medical purposes.
Orange: Do you have any examples of successful drug-policy?
There are a number of governments that have done excellent research in this area. Holland was the first to try something different with the coffee shops. The assumption that making cannabis legally available will somehow make people smoke it constantly was proven wrong. When cannabis use in Holland is compared with the neighbouring countries, it turns out that the Dutch use the least. So the assumptions that we make about “what happens if” in real life often turn out not to be true. Another example is Switzerland. It was one of the first countries in Europe to scale up heroin maintenance. And again, the fear was that once you make heroin legally available to addicts, they would keep on increasing the doses until they stop functioning. We now know, that this is not true. These practices have provided a lot of solid data. The question is: Are we willing to look at this data and learn from it? Is our policy to be based on science or ideology? In this case, ideology often stands in the way of science. And regardless of how rigorous the data is that comes out, there are reasons for why it is difficult to accept. Politicians want to be re-elected, for example.
Orange: How much do scientists participate in defining the current policy?
In some countries like Holland, Switzerland, Portugal and some others, there is a clear move in this direction. The German Bundestag voted for expanding the availability of heroin treatment based on data from pilot programs. Czech Republic, based on data from the police and courts, passed a law that clearly defines how much of the given substance you can possess without criminal charges. Allowing people to grow their own cannabis plants is an effort that takes them away from the illicit market, away from the dealers, away from organized crime.
Orange: What else can help to solve the problem of drugs besides prohibition?
Look at tobacco. It’s legal and we are clearly hearing and seeing the significant decline of tobacco usage. You don’t have to put people in prison to get them to stop smoking. Ten years ago nobody would believe that New York City could become almost smoking-free. Right now, bars are full, restaurants are full, and people are not smoking. Social pressure and a lot of public education resulted in a very serious behavioural change.
Orange: But does prohibition still play a significant role?
There is no prohibition on tobacco. Tobacco is regulated. It is a relatively new and an on-going experiment. We have no idea, if complications will arise in five years but so far, anti tobacco efforts are doing well. Alcohol and tobacco provide a useful framework for the regulation of psychoactive substances. In the current drug control system, we basically gave over the regulating power to criminals. They set the price and they control the quality and availability. I somewhat doubt, that this was what the authors of the drug conventions were aiming for.
