Born on 30 April 1949 in Bremen, Germany.
- Studies in Economics and Business Administration, Master in Business Administration, University of Hamburg, Germany (1973); Post-graduate diploma in International Relations and European Affairs, University of Nice, France (1974); Doctorate in International Law, Universities of Nice and Strasbourg (1977).
- Research and Training Assistant at the International Centre for European Education (CIFE), Paris and Nice, France (1974-1977).
- Associate Expert, United Nations High Commissioner for Refugees (UNHCR), Buenos Aires, Argentina (1977-1979).
- Programme Officer, Food and Agricultural Organization (FAO), Ouagadougou, Burkina Faso (1979-1981).
- Social Affairs Officer, International Narcotics Control Board (INCB)
- Chief, Psychotropics Control Unit, International Narcotics Control Board
- Secretary of the International Narcotics Control Board from 1 September 1991 to 31 August 2004.
"Harm Reduction" in the Context of the International Drug Control Conventions
Members of Parliament, Ladies and Gentlemen,
Let me start by thanking the organizers of this conference for having invited me to speak to you as the former Secretary of the International Narcotics Control Board, a function I performed for 13 years until September last year.
Being a former Secretary and not anymore the Secretary, I will express my own personal views and do not represent INCB. My views are of course based on my 23 years of work in the field of international drug control.
First of all I would like to say that it is indeed very encouraging to see European States, members of the European Union having the firm will to work together on Drug Control Strategies and to periodically review achievements in national, European and international drug control. European Union member states have been striving for harmonization of drug policies in the European Union and this is a welcome development.
The international drug control conventions contain the common and basic principles on how national and international drug control and policies should be shaped. The strategies and action plans at national and regional levels have to be a fine-tuning of the provisions of the conventions, have to be dynamic and specific in nature, taking into account the particular circumstances in the country or region.
At the Special Session of the General Assembly of the United Nations in 1998, in a political declaration and in plans of action, all Governments agreed on a number of actions to be taken to achieve progress in addressing drug abuse and trafficking world-wide and the adoptions of the last two European drug strategies have been very much in line with the commitment made by Governments at the 1998 Special Session.
The commitments by Governments at the Special Session have to be seen as a reconfirmation of Governments’ will to work towards the achievement of the aims of the international drug control conventions and a reconfirmation of the adherence to the principles and philosophy of these conventions, on which all countries had agreed upon several decades ago and this consensus has not been put into question by any Government.
As you know, the drug problem is a global problem and therefore needs a global response. This global and internationally agreed response was first of all confirmed by the adherence of a very high number of countries to the international drug control conventions, in fact rates of adherence which rank the international drug control conventions among those international conventions with the highest rates of ratifications and accessions.
( 180 parties to the Single Convention on Narcotic Drugs, 1961 ; 175 parties to the Convention on Psychotropic Substances, 1971; 170 parties to the U.N. convention against illicit traffic in narcotic drugs and psychotropic substances, 1988). All EU member states are parties to the three conventions and therefore have the obligation to adhere to and respect the articles of the Conventions they have ratified or acceded to. The INCB was given the mandate to monitor implementation of the articles of the international drug control conventions by Governments.
It is of utmost importance and an obligation of European States parties to the international conventions to adopt policies in line with the conventions and Governments should not adopt policies that are damaging or counterproductive to the actions taken by others, but on the contrary, harmonize their policies and activities. The framework of the international conventions should enable countries to assist each other in their endeavour to address the drug abuse and trafficking problems.
On some aspects of national and international drug control , the provisions of the conventions are mandatory, very precise and detailed, on others they are more vague, look like guidelines or leave it up to Governments to engage or not to engage in certain activities.
For example the articles of the Conventions on the control of all licit activities related to the production, manufacture, trade and distribution of narcotic drugs, psychotropic substances and chemicals, the volume of which by far exceeds the illicit activities, they are very precise and leave very little flexibility to Governments in the way the control is organized.
In the field of demand reduction and the combating of illicit trafficking, the articles were on purpose kept much more general in order to enable Governments to take into account specific national or regional circumstances when legislating and carrying out their activities.
However, a number of general principles of the conventions must be respected , such as for example the fundamental and overriding principle of the Conventions that the use of drugs must be limited to medical and scientific purposes only. All non-medical use of drugs is therefore by definition of the conventions drug abuse and Governments have the obligation to prohibit such non-medical use and take measures to reduce it. I regret that over the last decades the terms use and abuse became blurred in many national and international documents, partly certainly on purpose. The main argument has been that those who take drugs for non-medical purpose should not be stigmatized and blamed, but should be gotten into treatment, like any other person who suffers from a disease. The danger is of course that through such lack of distinction between the legal medical use of drugs and the illegal non-medical use, non-medical use may become perceived to be normal, just as any other illness or disease which just has to be and can be cured.
Therefore the lack of distinction between use and abuse is certainly in the interest of those who accept drug abuse and focus their attention just on the reduction of the harm which is caused by drug abuse and not focussing on the reduction and prevention of drug abuse as such.
The conventions do not use and define a term of so called “ harm reduction”. Therefore this term has been defined and understood in different ways by different players which has caused a lot of debate. We can certainly agree that all the articles of the conventions are meant to reduce the harm which drugs causes to the individuals and the societies. When adopting the Single Convention on Narcotic Drugs, as amended by the 1972 Protocol, the Parties made a clear reference in the preamble to the Convention that the purpose of the Convention is to address health and welfare of mankind and that therefore the use of drugs has to be limited to medical use only, through an adequate system of control and other measures.
In some national policy papers the term” harm reduction” is used in very broad terms such as for example in Australia:
In the present National Drug Strategy, based on several previous ones, dating back to the eighties, the Government underlines that Australia’s harm-minimisation strategy focuses on both licit and illicit drugs and includes preventing anticipated harm and reducing actual harm. Harm-minimisation is understood in Australia as a balanced and comprehensive approach of demand reduction and supply reduction supplemented by strategies to reduce drug- related harm to individuals and the community.
The present European Union Drugs Strategy also makes references to what may be called “ harm reduction”. It refers to one of two principal aims being the “attainment of a high level of health protection, well-being and social cohesion by complementing the member states’ action in preventing and reducing drug use, dependence and drug related harms to health and society”. The last part seems to be a reference to what may be understood as” harm reduction”, but without being specific on the measures envisaged. The wording “harm reduction” is also included into the list of components of a demand reduction system, without specifying the concrete measures. The measures are stipulated at national levels.
Many groups in many countries however use the term in different ways and cover under the term of “ harm reduction” also certain measures which cannot be seen as being in line with the international conventions. Some groups openly argue that the general principle of the prohibition of the non-medical use of drugs has failed and should be given up and that measures should concentrate on addressing primarily the negative effects of non-medical use of drugs instead of prohibiting it. By propagating measures of ”harm reduction”, they have given up what should be the primary aim of drug control, as agreed by the international conventions, namely the prevention and reduction of drug abuse and the provision of education, treatment and care to those who have become addicted with a view to lead them to a drug free life. Such groups simply accept the use of drugs for non- medical purposes as a choice of lifestyle, for which they want simply the negative consequences to be reduced.
Under the guise of “harm reduction”, some groups are working towards other goals completely different from those of the international drug control conventions. Some groups, pushing for more focus on what they call” harm reduction” measures, at the same time call for ending the illegality of cannabis, poppy and coca bush cultivation. They openly propagate that consumers and producers should become allies in a global legal drug market and argue that that would lead to sustainable economies both in Europe and in developing countries in which the crops are grown. They openly advocate for regulating illicit drugs in a similar way as this is done for legal drugs as a much more effective way of reducing drug related harm than the present system agreed upon under the international conventions.
Unfortunately, this raises the suspicion that” harm reduction” measures are propagated to lead the national and international drug policies towards accepting and legalizing the non-medical use of drugs. Such propagation also may contribute to the spread of the wrong perception that drugs are not that dangerous, that one can live with drugs as long as the negative consequences are being addressed. Perceptions of young people about the harmfulness and effects of drugs largely contribute to the spread of drug abuse. The more a drug is being socially accepted, the more widespread becomes abuse. The spread of cannabis abuse in the last decades in Europe has to do with the perception acquired by an increasing number of people that the drug is harmless. Stigmatisation, not of a person, but of drug abuse as an activity, on the basis of correct information on the harmfulness of drug abuse, has an influence on the level of non medical use of a drug. This has also been shown for example in the case of tobacco, in recent years, smoking becoming less and less acceptable.
As the so called harm reduction measures are not internationally defined , we have to say what we mean by them, if and when we talk about them. In my opinion, the best would be to avoid using the term which has become so blurred, has been misused and has made discussions not at all fruitful, since people understand different things, cover different ranges of measures under the term and have different goals in mind. Instead of using the blurred term , we should be precise on the measures we want to talk about and we should have clear in our mind what are the ultimate aim and purpose they would serve for. “Harm reduction” measures should never be an end in themselves but must contribute to the achievement of the overall ultimate aim of having an individual or group or society to be free from the non-medical use of drugs.
Groups propagating “harm reduction” measures often include a wide range of measures without asking the question whether their adoption is compatible with the international agreements. They have strongly criticised the International Narcotics Control Board, which is the international body mandated to look into questions of compatibility with and adherence to the provisions of the international conventions to reject all ”harm reduction” measures. However, depending on what is understood by” harm reduction” and what is meant to be the final aim of such measures, they can be rejected or accepted in terms of compatibility with the international drug control conventions.
The Board has pronounced itself since the 90ies on the compatibility of those measures, which are often called “harm reduction” with the provisions of the international drug control treaties, although, as I said, the conventions do not refer in any way to such term. The three conventions refer to measures against drug abuse. Article 38 of the 1961 Convention refers to the need of a state to take measures for the prevention of drug abuse and for the early identification, treatment, aftercare, rehabilitation and social reintegration of drug abusers. Article 14 of the 1988 Convention requires parties to adopt appropriate measures aimed at eliminating or reducing illicit demand for narcotic drugs and psychotropic substances, with a view to reducing human suffering. The Board clearly states that the ultimate aim of the conventions is to reduce harm.
The Board has acknowledged that certain measures included into what is often called “harm reduction” could play a part in a comprehensive drug demand reduction strategy, but such programmes should not be carried out at the expense of other important activities to reduce the abuse of drugs. So called harm reduction measures cannot replace demand reduction measures. Since some of the so called harm reduction measures became controversial they diverted not only the attention but even funds of Governments from most important activities such as primary prevention or abstinence-oriented treatment.
As regards a specific measure often called harm reduction, namely the exchange of needles and syringes for drug addict, with the aim of limiting the spread of HIV/AIDS, the Board already in the 1980s called on Governments to adopt measures that may decrease the sharing of hypodermic needles among injecting drug abusers. At the same time the Board has been stressing that any prophylactic measures should not promote and/ or facilitate drug abuse. The Commission on Narcotic Drugs in a recent resolution also called on all states to strengthen efforts to reduce the demand for illicit drugs, taking into account in their national drug control policies the drug related spread of HIV infection.
Although the latest EMCDDA report says that the number of new HIV infections has been declining in Eastern Europe, in Eastern Europe and parts of Asia, the spread of HIV/AIDS and other diseases through drug injection has been very noticeable in recent years. Low levels of awareness about these diseases and the way of their transmission must be addressed through effective measures. Drug Control policies in the respective countries have to take into account the requirement for effective countermeasures to stop the spread of such diseases. But measures to prevent the spread of diseases should not facilitate drug abuse and should not raise the perception that drug abuse is an acceptable activity. Drug abuse is at the origin, is the root problem of the spread of such diseases. In medicine it is always better, if possible, to remedy the root problem instead of addressing and curing the symptoms. Needle exchange is certainly not a solution for drug abuse , but might prevent the spread of HIV/ AIDS.
It is of utmost importance to harmonize and balance the approaches in drug policy with those in the field of HIV/ AIDS. Policies, at best, should lead to benefits in all areas. What has to be avoided is that the policies adopted for one area become counterproductive for others.
Substitution and maintenance treatment of drug addicts is also a measure often called ”harm reduction”. In Europe and also in a number of other countries in other parts of the world, Governments have introduced drug substitution and maintenance treatment, whereby a drug with similar action to the drug of dependence, but with lower degree of risks, is prescribed by a medical doctor. Prescription of such drugs does not constitute any breach of treaty provisions, whatever substance may be used for such treatment in line with established national sound medical practice.
Treatment is not defined by the treaties and therefore it is up to the parties to determine what constitutes sound medical practice. Other parties, the INCB and international organizations have of course the right to pronounce themselves on medical practices and can express doubts about the effectiveness of certain treatment approaches.
In some countries, mainly in Europe, facilities have been established, where injecting drug abusers can inject drugs that they have acquired illicitly. Such facilities have been allowed by national drug control legislation or such activities have simply been allowed or tolerated when carried out by local governments or institutions. The existence of these facilities raises important legal and ethical problems. Drug injection rooms are legal facilities for the purpose of facilitating behaviour that is both illegal and damaging. The drugs used in those facilities come from the illicit market. For these reasons, most EU member states have opted against the establishment of drug injection rooms. The INCB has clearly stated that such activities violate the provisions of the international drug control conventions. Article 4 of the 1961 Convention obliges states parties to ensure that the production, manufacture, import, export, distribution of and trade in, use and possession of drugs is to be limited exclusively to medical and scientific purposes.
Germany and Switzerland have challenged the findings of the Board, formulating their own legal opinions. But can we accept such individual national opinions? If we do, we thereby even challenge a fundamental component of the international drug control treaties, which have established a quasi- judicial organ, which has been mandated to monitor compliance with treaty provisions and which should judge whether or not treaty provisions have been adhered to.
Also under the umbrella of “harm reduction”, in some countries in Europe , authorities have provided facilities for having the composition and quality of drugs, usually of the amphetamine type and in tablet form, to be tested and then returned to the drug abusers. The drug abuser is informed about the results and, in particular, is warned about impurities or adulterations.
Not only is this contrary to drug abuse prevention efforts required from Governments under the international drug control conventions, such practices clearly send a wrong message and make the authorities accomplices of drug abuse, providing false sense of safety to drug abusers. They are also potentially dangerous, as such on site testing is not accurate and might not identify all substances included into the tablet.
Fortunately, many of those measures have been discontinued.
Any measures which may be called “harm reduction”, before they are introduced into demand reduction strategies, should be carefully considered as to its compatibility with the international drug control conventions and its overall impact. Some may sometimes be positive for an individual or for a local community, while having far-reaching negative consequences at the national and international level.
Let me take the example of rooms established by government authorities, where drug abusers can inject the drugs they have acquired illicitly, mostly opiates.
From the international point of view efforts of drug control do not seem to be balanced, if on the one hand side, extreme tolerance and acceptance is shown as regards the abusers, but at the other end of the trafficking route we require that effective measures be taken against cultivation and trafficking. How can this be justified?. Should we allow drug abusers in rich countries to illicitly acquire drugs and then invite them to abuse them in a sterile and not so risky way at a clean place, away from the eyes and required actions of the law enforcement, when developing countries are urged and financially supported to take more stringent measures against cultivation and trafficking? I think such approach is completely out of balance.
The running of so-called coffee shops for cannabis products as well as the many cannabis shops you find in most European cities, mostly disguised as shops selling legitimate hemp products , plants and seeds for decorative or horticultural purposes, not only send the message to young people that the drug cannabis is different from all others and fine to use, but discourages further efforts to combat illicit cultivation, particularly in developing countries with overall very scarce resources.
What is the overall message we are sending out to young people if we encourage or even tolerate such development? Haven’t studies shown that the perception of people about drugs and about the risks and that the degree of social acceptance of drugs has an overall impact on the level of abuse? Is there no relationship between the public attitude towards cannabis abuse in many European countries in the last years and its steady increase?
We have to make sure that drug abuse as such remains stigmatised and remains rejected by an even larger majority of people through systematic educational efforts in schools, the media and elsewhere, otherwise drugs will become more and more a normal part of our life.
There was the conclusion that two of the objectives of the European Drug Strategy, which were a considerable decrease in drug abuse and a substantial reduction in the availability of drugs, were not achieved. This cannot be used, as some people do, as an argument in favour of abandoning the aims of the EU strategy and the agreements reached by the international treaties. On the contrary a more thorough analysis has to be made on why we failed to achieve them. In my opinion, there is often a big gap between the aims stated in national policy papers and the measures designed therein to achieve them, on the one hand side, and the daily practice of drug control at the local and grass root levels, where in fact many groups operate with objectives neither in line with the strategy papers nor with the international conventions. Let us take the example of activities in the field of drug abuse prevention. How and to which extent activities are really carried out to reduce f .e. cannabis abuse and illicit cultivation. Even when there are campaigns calling on people to refrain from abusing drugs, it can be noticed that in most European countries very little is done to stop the incitement to drug abuse and trafficking at internet sites, the media and specific shops, which can largely contribute to the perception which an increasing number of people may get that drugs are fine products. No wonder that some goals are not met and that cannabis abuse has been kept on a high level and that illicit cannabis cultivation has spread in many European countries. In this context I can say that the recent policy revisions in the Netherlands have certainly taken these relationships into account.
Thank you for your attention.