PUNITIVE approaches to drug use are aimed at deterring it by way of strict sanctions. Currently, the most extreme of the punitive drug policies is in the Philippines, where drug users are being murdered in the streets.
According to Human Rights Watch, President Duterte’s violent war on drug users has led to the murders of more than 22,000 civilians since June, 2016, and the President vows to continue this policy until his term ends in 2022.
America, the country responsible for coining the term ‘war on drugs’, has some of the toughest laws pertaining to drug possession in the world. The ‘war on drugs’ has been in play since the late 1960s, when the Nixon administration associated drug use with the anti-war left and the hippie counter-culture, and the decades that followed led to the mass incarceration of mainly ethnic minority males.
America has some of the harshest minimum sentencing guidelines for drug convictions, but trends in drug use continue to climb.
Another punitive approach is in Sweden, though they have much better outcomes. Though it does treat drug use as a criminal matter, it provides social supports for those trying to recover from their drugs use. Sweden is a strong advocate for prohibition and is a state with harsh minimum sentencing laws. The difference between it and other prohibitionist states is that Sweden invested in treatment options and housing for drug users trying to recover.
The Netherlands has somewhat of a different view of drug use where they differentiate between soft and hard drugs and employ a policy of depenalisation for the former.
Drug policy expert Alex Stevens defines depenalisation as ‘the decision in practice not to criminally penalize offenders, such as non-prosecution or non-arrest’. Dutch drug policy can be characterized as normalising, pragmatic, and non-moralistic. The Dutch accept that drug use is a characteristic of society that will always be present, and refuse to use law enforcement as their primary tool for drug control, except for traffickers and dealers.
Despite its liberal drug policies, the country has seen a reduction in opiate use in the last decade. Also, prisons have been closing in the Netherlands because of falling rates of incarceration and recent years have seen a transnational prisoner program where Norway ship some of their prisoners to empty Dutch prisons. Such low crime rates are attributed to relaxed drug laws and a focus on rehabilitation over punishment.
Portugal differs from the Netherlands in that it has decriminalised drug use for all drugs as opposed to soft drugs only. Portugal became the first country in the world to adopt a policy of decriminalisation of all drugs in 2001.
Pre 2001, it had some of the highest rates of HIV in Europe and was fighting a losing battle with heroin use while the criminal justice system was clogged up with drug users.
Since decriminalisation became official policy, Portugal has seen a substantial reduction in rates of problematic drug use and drug-related harms. Law ‘30/2000’ changed how it responded to drug use and the main points were that users would no longer be penalised for possession for personal use and would be referred to Commissoes para a Dissuasao da Toxicodependencia (Commissions for the Dissuasion of Drug Addiction).
These commissions operate under the Ministry of Health and consist of lawyers, doctors and social workers in a model that aims to provide social, physical and psychological support to the drug user. Portugal did not achieve its target by decriminalisation alone. A coherent response by government involving social supports for users and attitudinal shifts in how drug users are perceived helped to decrease a lot of the harms of drug use.
Supervised injection facilities (SIF) is a harm reduction policy currently employed in Australia, Canada and various European countries such as The Netherlands, Switzerland and Denmark. SIFs are defined as ‘legally sanctioned and supervised facilities designed to reduce the health and public order problems associated with illegal injection drug use’.
One such example is in Vancouver where a 10-year study to determine if such a facility was cost effective found that it had significant economic savings as well as lives saved and decreased rates of overdoes and HIV and users ceased to share needles.
Another, more recent study on the cost-effectiveness of SIF found that for every $1 spent $2.33 would be saved. SIFs have a sterile ambience and on site are community drugs workers and health workers who not only supervise drug use and provide safe equipment but also act as a signpost for further treatment options. Currently in Ireland there are no SIFs, though in December last year Merchants Quay Ireland did get planning permission for one in Dublin. This will be a pilot and it will likely be two or three years before we see a SIF here in Cork.
Heroin assisted treatment (HAT) is a form of treatment for long term heroin users who have not responded well to other forms of treatment such as methadone maintenance and residential rehabilitation. HAT involves administering pharmaceutical grade heroin to drug users by doctors which can be done more than once a day, seven days a week, which is an expensive but still cost-effective policy. Research shows that those who engage with HAT reduce or eliminate their criminal activity as they leave the street drug scene. The point of HAT is to not get users to stop using heroin but instead it is ‘intended to stabilise the lives of people who use heroin, decrease their participation in the illicit market, and reduce their risk of overdose, disease transmission, and other health harms associated with using adulterated heroin and unsterile injection equipment’.
Several countries across Europe have included HAT in their service provision as well as Canada. Switzerland was the first to adopt it in the 1990s and it is now in practice in Belgium, Spain, The Netherlands and Switzerland.
It should be noted that heroin had been officially prescribed by doctors in Britain since the 1927 Rolleston Report, which defined addiction as a medical illness therefore to be treated by medical professionals.
The popularity of prescribing heroin to patients declined as doctors began moving towards methadone maintenance as their preferred prescribed medication for addicts.
Though some of these policies may seem radical, other countries are thinking outside the box, something our new government will need to do to address the issue of drug use.
* James Leonard works at Cork Education and Training Board Youth Services.