SNUD Committee Report

CHAPTER 8: DRUG POLICIES ABROAD

The Special Committee travelled to the United States, Switzerland, Germany, and the Netherlands in order to experience, first-hand, policies as applied by these other countries and to consult with their experts in the field of substance use, harmful use and dependence. During these visits, the Committee conferred with drug policy experts, elected representatives, law enforcement personnel, and government officials, as well as research institutes, addictions experts, and treatment providers. This Chapter provides a brief commentary on the policies of each country, and how they are implemented, as well as a brief description of some of the more innovative, low-threshold treatment services that Committee members were able to visit.

1. THE UNITED STATES

Reduced to its barest essentials, drug control policy has just two elements: modifying individual behaviour to discourage and reduce drug use and addiction, and disrupting the market for illegal drugs. Those two elements are mutually reinforcing.²⁷²

This White House 2002 statement on United States drug policy recognizes the need for both demand reduction and supply reduction, also one of the “basic principles” of Canada’s Drug Strategy.²⁷³ The same National Drug Control Strategy document estimates that the total economic cost of illegal drug use in the United States in 2000 was $160 billion, a 57% increase since 1992. That estimate was comprised of three major components: health care ($14.9 billion), productivity losses ($110.5 billion) and others ($35.2 billion), including crime, the criminal justice system and social welfare.²⁷⁴ The same document finds it “deeply disturbing” that over 50% of high school seniors experimented with illegal drugs at least once prior to graduation and points out that “an engaged government and citizenry” was instrumental in reducing drug use in the late 1980s and early 1990s, “with declines observed among 12th graders in every year between 1985 and 1992.” In an attempt to recover lost ground, the 2002 National Drug Control Strategy sets a two-year goal of reducing by 10% current use of illegal drugs by youth (12 to 17-year-olds) and adult populations. The stated five-year goal is a 25% reduction in use of illegal drugs by both age groups.²⁷⁵

The White House Office of National Drug Control Policy (ONDCP) was established by the Anti-Drug Abuse Act of 1988, “to set priorities, implement a national strategy, and certify federal drug-control budgets.”²⁷⁶ The office of Director of the ONDCP was later established, by executive order, as “the president’s chief spokesman for drug control.” The present “drug czar,” John P. Walters, was sworn in on December 7, 2001.

The National Institute on Drug Abuse (NIDA) was established in 1974 and is part of the National Institutes of Health of the United States’ Department of Health and Human Services. NIDA “supports over 85% of the world’s research on the health aspects of drug abuse and addiction.”²⁷⁷ NIDA promotes and conducts clinical and epidemiological research “aimed at developing practical treatments, prevention strategies, and educational efforts to address the problems of drug addiction and abuse.”²⁷⁸ It is important to note that NIDA has supported numerous research projects relating to substance use, in Canada, as well as in other countries.

The Controlled Substances Act (CSA) is the major federal legislative instrument of control over licit and illicit substances in the United States.²⁷⁹ The CSA places controlled substances into five Schedules, based on the substance’s “medical use, potential for abuse, and safety or dependence liability.”²⁸⁰ For example, Schedule I substances, including heroin, marijuana, psilocybin, LSD, etc., are those deemed to have a high potential for abuse and no accepted medical use. Schedule II substances, like morphine, codeine, and some stimulants and depressants, have a medically accepted use, albeit with a “high abuse potential.”²⁸¹ Although many states have adopted most provisions of the Uniform Controlled Substances Act (1994), sentences vary and some states have laws supporting the medical use of marijuana.²⁸²

Although there is no doubt that the official federal policy in the United States promotes a prohibition model and is focused on strategies to reduce the use of all illicit substances, it would be wrong to suggest that there are no dissenting voices in areas of policy, treatment or law enforcement. For example, the governor of New Mexico has called the war on drugs a failure and promoted treatment as the preferred response to substance abuse. There are also national organizations, like the Drug Policy Alliance, that are dedicated to developing “public health alternatives to the criminal justice-based policies promoted by the war on drugs.”²⁸³ Arguing that “drug abuse is bad but the drug war is worse,” the Drug Policy Alliance advocates for treatment instead of incarceration, as well as drug laws that are based on the relative harms associated with a given substance.

While in the United States, the Committee visited a “syringe exchange program” (SEP) operating in New York City under the auspices of the Harm Reduction Coalition (HRC). The HRC is a national organization “committed to reducing drug-related harm among individuals and communities by initiating and promoting local, regional, and national harm reduction education, interventions and community organizing.”²⁸⁴ Material produced by the Coalition points out that in order to receive state funding and to be authorized by the New York State Department of Health, syringe exchange programs must offer a comprehensive range of services, including treatment referrals and health education. Although some federal funds may be used for “non-exchange services” the Committee was told that there has been a ban on federal funding of SEPs since 1988. The same HRC publication also points out that, in January 2001, it became legal in New York State to purchase syringes at a pharmacy without prescription, although pharmacies cannot advertise the sale of syringes and the cost is not covered by Medicaid.

2. SWITZERLAND

Inevitably, the co-existence of law enforcement and therapy is not without its contradictions. Given the illegal nature of drugs and the fact that drug use is punishable, consumers are, of course, considered as criminals. On the other hand, within the field of public health, drug addicts are treated as ill people who require treatment.²⁸⁵

Like most other western countries, Swiss law has prohibited substances not used for medical purposes since the early 1900s. Following the first wave of increased substance use in the 1960s, the Narcotics Law was revised in 1975 to differentiate between drug use (a misdemeanour) and drug dealing. Needle exchange programs were initiated in the early 1980s, in response to the rapid spread of HIV/AIDS among injection drug users and, by 1991, the Swiss government had approved a national program to reduce the drug problem. Known by the acronym “MaPaDro”, it introduced the concept of harm reduction to the fight against substances in Switzerland.

Scientifically monitored clinical trials of controlled heroin prescription were initiated in Switzerland in 1994. By then, the “open” drug scene in Zurich was receiving worldwide publicity and political parties were calling for decriminalization of substance use, more widely available medically prescribed heroin, greater prevention, and “harsher punishment of drug traffickers.”²⁸⁶ That same year, the federal government declared its support for a “fourfold” drug policy model, focusing on prevention, therapy, harm-reduction and law enforcement. At the same time, organized crime was included in the penal code and “measures to counter money laundering were intensified.” By 1995, the open drug scene in Zurich was “dispersed” and a second national conference had “ratified the strategic keystones of Switzerland’s fourfold drugs policy.”²⁸⁷ The results of the heroin prescription clinical trials, published in 1997, “showed that heroin-assisted therapy was viable and that heavily dependent users who had failed to respond to other forms of therapy could achieve major physical, mental and social improvements with this approach.” In October 1998, the Swiss Parliament passed a resolution allowing for controlled heroin prescription as a new form of therapy.

While in Switzerland, the Committee visited KODA-1, a heroin-assisted treatment centre in Berne, operating under the auspices of the Swiss Federal Office of Public Health. In Switzerland, heroin assisted treatment (HAT) admission criteria require patients to be at least 18, with a history of at least two years of opiate addiction and at least two unsuccessful treatment attempts, as well as “deficiencies” in medical and/or social conditions.²⁸⁸ Heroin is administered in a controlled setting by health care providers working under the supervision of physicians specially trained in the treatment of substance dependence.

The United Nations’ Report of the International Narcotics Control Board for 2001 notes that draft legislation is under consideration in Switzerland to decriminalize “both the non-medical consumption of cannabis and the cultivation, manufacture, production, possession, detention and purchase of cannabis as long as they constitute preparatory acts for personal consumption and have not created for third parties the opportunity to consume.”²⁸⁹ In its report, the International Narcotics Control Board (INCB) takes the position that the draft legislation would not be in conformity with the international drug control treaties because, if it is adopted, “the personal consumption and the cultivation, manufacture, production, possession, detention and purchase of cannabis for non-medical purposes would cease to be prohibited.”²⁹⁰

3. GERMANY

Germany’s drug policy until recently was guided by the 1990 “National Plan to Combat Narcotics,” based on a consensus between the federal and state governments. Following the elections in September 1998, the bulk of the responsibility for Germany’s federal involvement in formulating drug policy passed from the Interior Ministry to the Ministry for Health. In April 2001, a press release for the Federal Ministry for Health indicated that the “National Plan to Combat Narcotics” no longer corresponded to the current findings of research, or the practice of the addict assistance services and was “aimed one-sidedly at illegal drugs.” Furthermore, that one-sided fixation on illegal drugs disregarded “the serious social and physical effects of the misuse of legal addictive substances.” The same press release expressed the need for a new addiction and drug strategy with binding objectives and concrete measures for attaining them. A new prevention concept, which would make children and young people “strong enough to learn to handle anger, sadness and failures without reaching for the bottle, pill or other drugs” was to be key to the new strategy.²⁹¹

Along with others in Europe, large German cities follow a policy of harm reduction. “Frankfurt, Amsterdam, Hamburg and Zurich, for example have signed the Frankfurt Resolution which states that attempts to eliminate the consumption of drugs in society has failed and, that criminal prosecution policies should be pursued which permit drug users to live a life of dignity.” Injection rooms are available and federal law has been changed accordingly.²⁹²

A May 2002 report published by the Drug Commissioner of the Federal Government notes the opening of the 20th drug consumption room “where it is possible to inject drugs from the street under hygienic conditions.”²⁹³ Respecting a model project on heroin-based treatment, the same document reports that trials have been underway in seven towns, since March 2002, involving seriously ill long-term opioid addicts whose treatment with conventional abstinence or substitution therapies had previously been unsuccessful. The report also noted that roughly half of all opioid addicts were receiving either drug-free or substitution-based treatment.²⁹⁴

In an initial evaluation of drug consumption rooms, the Federal Ministry of Health determined that they were meeting Parliament’s main objectives “to ensure the survival, to stabilize the health and to achieve the rehabilitation of a large number of persons from the target group of hard-to-reach narcotics addicts.” The report also noted that “[t]he fall in the number of drug-related deaths last year is an encouraging sign that the Federal Government is on the right track with this scheme.”

In force as of January 1982, Germany’s Narcotics Act lists all the substances scheduled in the UN Conventions on Narcotic Drugs and Psychotropic Substances. Schedule I includes illicit narcotics “without medical benefit” including cannabis and heroin. Schedule II includes “narcotics which are used commercially for the manufacture of other products, particularly pharmaceuticals,” and Schedule III includes “marketable narcotic drugs available on special prescription,” including opium, morphine and methadone.²⁹⁵ As is the case with Canadian legislation, the German Narcotics Act also regulates the legal trade, manufacture and prescription of narcotics, and contains both penal and administrative offences. German law also combats large-scale trafficking with legislation targeting organized crime and money laundering. Although consumption of narcotics is not an offence under German law, possession for private consumption can be. As a consequence of a 1994 decision of the German Federal Constitutional Court, based on “the ‘ban on excessive punishment’ inherent in German Basic Law,” possession of small amounts of cannabis for personal consumption is generally not prosecuted.²⁹⁶

While in Germany, the Committee visited several treatment facilities in Frankfurt. One of them was “Eastside,” the largest drug aid centre in the city. Founded in 1992, in response to the “open” drug scene, Eastside provides long-term, homeless addicts with shelter, work opportunities, and “using space” (injecting rooms) as well as a bus shuttle to bring clients from the downtown area. The Committee also visited two downtown facilities of the Narcotic Emergency Centre. One of those facilities contained a substitution program and a separate “consuming facility room” for injection drug users over 18 who are not enrolled in a substitution program. Although the stated principle aim of such facilities is the prevention of narcotic-induced emergencies, they also provide clients with access to psychological and physical treatment for their addiction.

4. THE NETHERLANDS

Investing in a policy that aims to protect health pays for itself in terms of mortality, morbidity and the existence of marginalization. A situation like that in a number of other countries, where the mostly youthful users run the risk of coming into contact with the judicial system, is seen as highly undesirable in the Netherlands. The harm done by a criminal record is greater than the harm caused by (generally) a few years of experimental drug use.²⁹⁷

Living in one of the most densely populated countries in the world, Dutch society is characterized by a strong belief in the separation of church (or morality) and state, and an extensive social welfare system. Dutch drug policy acknowledges drug use as a fact that must be dealt with in a practical manner, by preventing or limiting the risks or harms associated with drug use.

Coordinated by the Ministry of Health, the Netherlands’ drug policy is implemented through the Opium Act, which contains penalties based on the relative harmfulness of a given drug and also the nature of the offence. Possession of up to 30 grams of cannabis is a minor offence, but is generally not prosecuted. Although dealing in small amounts of cannabis is an offence, the Public Prosecutor will refrain from prosecuting outlets, known as “coffee shops,” so long as there is no advertising, no sales of hard drugs, no admittance or sales to persons under 18 and no sales exceeding 5 grams per transaction. The prosecution of all other forms of dealing and production are given high priority, in a manner comparable to neighbouring European countries.

In order to treat more effectively those addicts who are in poor physical condition or have psychiatric problems, the Netherlands is conducting heroin prescription trials, involving approximately 600 substance-dependent individuals, with evaluation results expected in 2003. To deal with the social and judicial nuisance created by a small group of users, the government has also developed better shelter facilities and experimental user rooms (safe injection rooms) and began experimenting with forcible treatment of hard-core “nuisance addicts” frequently convicted for petty crimes.

While in Amsterdam, the Committee consulted with staff and administrators of the Jellinek Institute. The Jellinek Institute is the oldest treatment institute for alcohol and drug addiction in the Netherlands and one of the largest in Europe. In addition to offering treatment for drug and alcohol addiction, the Jellinek also treats people with gambling problems and provides services in prevention, training and research.²⁹⁸ The Committee also visited a treatment centre for substance users operated under the auspices of the Jellinek Institute, where vocational training is offered as an integral part of the recovery program.