XXII Conference, Mallorca 13 April 2004 Excellencies, friends and colleagues from the therapeutic communities, About a month ago this country suffered a treacherous terrorist attack: I pay tribute to those who died on March 11 and express the solidarity of the United Nations to the families of the victims. At the outset, I wish to express my appreciation to the World Federation of Therapeutic Communities for the invitation to address this conference. Also, the organizational skills and generosity of Proyecto Hombre are graciously acknowledged. I salute you all for your sterling work in the fight against drugs. By preventing, reducing and treating drug abuse, you make things happen. You are the front lineof the no-drug peaceful army. Let s state it plainly: you, and the therapeutic communities you represent, do reduce the harm caused by drugs. The pro-drug lobby, to the contrary, causes untold harm by talking about harm reduction yet meaning drug legalisation and trivialization of drug consumption. I was invited to share with you my appraisal of the world drug situation. In synthesis I think that important progress is being made in countering substance production and trafficking. Yet the goal of significantly reducing drug abuse -- the key objective, I believe -- is still distant. Better and faster results are needed and can be achieved only if all of society is involved -- complementing and supplementing the work of therapeutic communities. At the moment, in too many countries you are left alone, with drug control results depending only on your dedication, inspiration and good will. 1 / 10
I shall address two sets of topics: the (i) drug supply and (ii) demand situation first; and the (iii) prevention and (iv) treatment work later. (I) The supply of illicit drugs On the supply side, news is generally positive. A significant reduction of coca and opium cultivation has taken place in the Andean region and in Asia, to the point that large scale illicit cultivation now occurs only in Colombia and Afghanistan. a. A major decline of coca cultivation took place in Peru and Bolivia in the 90s. In this decade production has continued to fall also in Colombia, today s main producer. b. The illicit cultivation of opium has also continued to decline in the Golden Triangle. If current achievements are sustained, opium may disappear from the fields of Myanmar and Laos -- closing a tragic chapter of national economic dependence on drugs. Afghanistan has now become the world s largest opium producer: it will take several years before democracy and development will put an end to Afghanistan s drug economy, itself a result of wars, poverty and insurgency. 2 / 10
c. World-wide cannabis cultivation has never been measured. In 2003 UNODC produced the first national survey (for Morocco, the world s leading producer). We are now progressing with a global appraisal of cannabis production, trafficking and related health hazards. d. Because of the economics of supply and the fashion of demand, man-made illicit drugs (amphetamine-type stimulants, ATS) are replacing the natural ones at an increasing pace. Knowledge of these structural changes has not yet reached the Afghan farmers nor the Andean campesinos. These changes have however not escaped mafia s attention. Seizures of clandestine labs, equipment, precursors, finished products (as well as statistics on abuse) show that, since 1998, the ATS market (500 tons/year) has grown in size and in sophistication. Labs are located in North America (the world s largest producer and consumer), in Europe (where the Netherlands is the largest producer), and in Asia (where Myanmar is supplied precursors by its neighbours, India and China). Let me offer one concluding remark with regard to illicit drug supply. As long as demand persists at over 450 tons/y of heroin and at almost twice this amount of cocaine, these substances (or their synthetic counterparts, such as ATS) will be produced somewhere else -- whether Afghanistan, Colombia or elsewhere. Supply control measures are necessary but not sufficient. They must be accompanied by efforts to curb addiction. Let s therefore talk about drug addiction -- my second topic. 3 / 10
(II) Demand and drug abuse In the past few years, there has been a notable reduction in cocaine abuse in North America and heroin abuse in Western Europe -- this success tainted by emerging heroin abuse across the Atlantic, and cocaine abuse on this side. The spreading of ATS has levelled off in all rich countries. Australia s success in curbing addiction for all types of narcotics is remarkable. Treatment facilities have grown everywhere and, most importantly, drug legislation is being improved in many countries, including the remarkable tightening of law enforcement in the Netherlands and Denmark, until recently noted for their benign neglect of cannabis trafficking and consumption. In all these cases it may be too early to talk about a U-turn in drug control: certainly a 90-degree bend in the counter-narcotic road has been reached and successfully negotiated. This is a good omen. It will bring some respite to the many developing countries, particularly in Africa, that have been devoting scarce resources to oppose cannabis cultivation, trafficking and abuse in their lands -- thus paying the price for richer countries social (and administrative) acceptance of cannabis. Negative, very negative, is the fact that drug abuse is rising in Eastern Europe, Russia, other CIS states and China. Cocaine and heroin abuse is also growing along the drug trafficking routes in Africa, Central Asia, Latin America and the Caribbean. Some conclusions can be drawn from all these data: 4 / 10
1. Higher incomes and greater social mobility are accompanied by higher addiction (in such transition countries as the Ukraine, Russia and China). At the other extreme, poverty and availability of drugs (along the traffic routes) also lead to higher addiction (for instance in Central Asia, Iran, Caribbean and part of Africa). 2. Better-educated individuals learn how to protect themselves, by switching to substances or to methods of abuse thought to be less harmful (including those with lower risks of blood infection). In this logic, ATS abuse is a prime candidate to increase, replacing other drugs especially heroin; 3. Positive is the fact that more countries now consider addiction a health problem, with all attendant consequences and measures to deal with (including enhanced testing for presence of drugs); 4. The public safety consequences of addiction (abuse at the work place for example, or driving under the influence of drugs) are further evidence that drugs cause collateral damage that needs to be tackled on as broad a front as possible; 5. Addiction can cause side effects even more damaging than the direct health risks posed by abuse. Fighting the spread of HIV/AIDS must be part of drug control, and vice-versa. Drug abuse by injection threatens to create a major HIV/AIDS pandemic in Eastern Europe, Russia, the Far East and the Caribbean. 5 / 10
6. The international community must give more attention to the fact that: world-wide only 5% of the 12 million injecting drug abusers are reached with HIV/AIDS care. (In some countries up to 90% of those drug users are HIV positive) in prisons (especially in countries where addicts are jailed) and in brothels (especially as a result of trafficking in women) the risk of HIV/AIDS infection is massive. When we put together income and social trends, public health factors, detection and treatment approaches, the collateral damage caused by drug abuse, together with evolving values, fashions and perceptions, one message emerges loud and clear: society needs to invest more in prevention and in treatment. Let s look at these matters, now. (III) Prevention can work: learning from three success stories Contradictions are frequent in human history. Paradoxes are even more plentiful in substance abuse. Three are particularly striking. 6 / 10
A. Compare tobacco and drug controls. In a few rich countries there are small, vocal and well-funded groups advocating the relaxation of drug controls. These pro-drug lobbies argue that cannabis and ATS are soft drugs and, therefore, that compliance with the international conventions should also be soft. In a small number of super-rich countries -- every other human need having been met -- these views have favoured non-compliance to UN treaty obligations. Oddly enough, in the same rich countries a consensus has emerged in favour of tightening regulations against tobacco use. This process began with the banning of smoking in most public places, later leading to the 2003 WHO Convention on Tobacco Control. We can draw some important lessons from half-century of developments against smoking, and apply these lessons to drug control. First, efforts to reduce substance abuse take time to achieve results. It has taken 1/3 century to get results against smoking. Second, just as in the case of tobacco, drug abuse prevention needs to involve society at large: schools, sports centres, work places, media, leisure settings, the courts, life insurance policies, the places of faith and, above all, the family. This consensus approach has produced tangible results against tobacco: smokers are on the defensive, as public support for banning 7 / 10
smoking is asserting itself more and more. We need the same consensus against drug abuse. Third, the impact of measures to curb illicit drugs will be enhanced if there is broad consensus in their favour. Today s pro-drug lobby has become quite loud, in some cases driven by venture capitalists counting on the money that could be made if cannabis (once legalised) would replace tobacco (now close to being outlawed). I am sure that you, active on the ground, agree that the pro-drug lobby has become part of the drug problem, making your efforts in prevention, treatment and rehabilitation more difficult. My next example refers to the successful measures against substance abuse at the work place and in schools. B. Prevention measures can reduce drug abuse. UNODC ILO studies have demonstrated that substance prevention at the workplace is effective: it reduces accidents and absenteeism. It increases productivity and competitiveness. No wonder a growing number of business are testing their work forces for drug abuse. Similarly, drug addiction is lowering pupils performance at schools: are we doing anything about it? Since drug abuse is also a health problem, why not determine if students are abusing drugs just as we determine if they are affected by HIV/AIDS, TB or other diseases? Addiction risks are mostly experienced at an early stage. Once contracted, the condition tends to become more serious, leading to ever-greater consequences like most other diseases. The role of 8 / 10
families is essential, as parents are (often) the last people to know of problems -- including health problems -- with their kids. As for other health tests, privacy would need to be protected. C. What about the other major, collateral damage caused by drug abuse: namely road accidents? Ways and means to check alcohol abuse could be used to counter drug abuse behind the wheel. The road code against drunken driving, for example, has improved safety. Why not enforce the same vigilance against driving under the influence of drugs, given the fact that road accidents related to drug abuse are no less frequent or serious? (IV) Treatment also works: learning from your experience It is a fortunate coincidence that the motto of the 2004 international day against drug abuse (June 26) is treatment works. As you know, this is factually correct. Indeed, every dollar invested in treatment and prevention saves a multiple (7-10 dollars) for drug-related crime and health costs. But it is not only a matter of money. Treatment and rehabilitation reduce drug abuse, improve health and the social functioning of people. The risk of infectious diseases is lower, and so is crime. In the next days, you will discuss the successes and the failures in treating people dependent on drugs and in bringing them back to society as responsible and productive citizens. I hope this statement may help your deliberations. 9 / 10
I thank you for your attention. 10 / 10