(notes about necessity to revise and change modus vivendi & modus operandi
in anti-drug activity).
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Terminology.
Specialists in drug problems, likewise specialists in some other problems, call "Hawks" their intransigent, uncompromising colleagues, combining their efforts under the slogan: "Drug abusing is evil and in all its forms must be prosecuted". "Doves": "Drug addicts are not criminals, rather sick people in all senses of this word, including social. They need treatment and rehabilitation to turn back to normal life, society must never treat and punish them as criminals". "Owls" - middle position between two above extremes.
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Background.
I have been involved in anti-drug law enforcement activity during 22 years from total 30 years of my professional career of police officer. Started in the Department of Illicit Drugs Turnover Eradication; established and headed the Special Drug Control Service under the Ministry of Internal Affairs, first in the Soviet Union; The State Commission on Drug Control under the Government of Kyrgyz Republic; had been working on the position of The Officer of UN International Anti-drug project "Osh knot", aimed to strength law-enforcement activity and cross-border cooperation of the law-enforcement agencies of Central Asian Countries (Kyrgyzstan, Uzbekistan and Tajikistan) against Afghan narco-traffic; trained police officers of Balkan countries in anti-drug police operations. I participated on multiply congresses, symposiums and international conferences on the problem, published number of books, monographs and articles, in 2003 completed a research, defended thesis on "History of Kyrgyzstan integrating into the international efforts against Afghan narco-expansion (1991-2002)" and obtained PhD degree. Almost all this time I advocated positions of uncompromising "Hawks": in the beginning of 1980-th we introduced a new type of forensic expertise, developed in Moscow, and supported by this "know how" prosecuted hundreds of drug-abusers...Our working "achievements" had been supported and recommended for distribution as "best practice" by The General Department for Criminal Investigations of MIA SU. Probably, that years any other approach to the problem, except punitive, was impossible? In the same time governmental officials flatly denied that the problem of drug abusing and especially narco-business existed in the country. In late 70-th, using specially trained for drugs-searching sniffing dogs, my police team detained on one "very promising" check-point 29 narco-couriers during just one shift. Those events draw very close attention of The Central Committee of The Communist Party of Kyrgyzstan. The Central Committee "reasonably" concluded that drug addiction can never attribute to the socialistic society "just by definition" and gently alluded to the republican police officials. All active actions against narco-traffic had been immediately frozen ...
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Changes.
Changes in my attitude did not happen suddenly. First, when I started to travel abroad, got acquainted with my foreign colleagues experience and firstly noticed that drug addicts are different there - not aggressive, not criminalized, really "tame". Very soon I realized that this "transformation" resulted from difference in attitudes and approaches to the problem: society did not treat drug-addicts as criminals, did not drive them to the underground, but applied all possible efforts to get them back to normal life, supported by multiple medical and social programs. And, in contrast with our punitive policy that overcrowded our prisons but did not improve health of society in social or medical sense, they've got considerable positive results. In objection you can say that this will work in wealthy "well-fed" Europe?! Yes, this new approach introduction requires considerable funds. But we need to do and must do firs steps in this direction right now, if not yesterday, as it already happened, for example, in strictly limited in financial resources Kyrgyzstan. They "decriminalized" drug addiction; possessing of illicit drugs in small amounts for personal consumption, not intended for sale with coming changes in criminal code will become not a subject for prosecution, but for administrative penalty. This is intermitted position between "Doves" and "Owls", and very distant from uncompromising "Hawks". About 5-8 years ago a manual, published in Holland "Protect yourself: safety rules for drug-addicts" caused a real shock in Kyrgyz law-enforcement. A List of Content alone ("10 golden rules for mostly safe drug-abusing; how to make a solution for injection; how to take a right dose of drug; how to use a syringe for injection; an overdose; the schematic picture of human blood vessels with marked points, fit for heroin injections...") formed a considerable reason for my colleagues - police officers to demand "the edition' spoliation". Changes in minds and attitudes took systematic long-term joint efforts involved international organizations, domestic specialists, "advanced" police officials. One of the our-days authorities from the Republican Ministry of Interior convinced of the results of Polish humanistic approach, actively supported the new policy in the late 90-th and considerably facilitated it's successive implementing. It was necessary to explain many times on different levels that the practical result of 80 years "cavalry sword' shaking" is over-modest and we are loosing our battle with narcotism. While our society penalizing abusers, blacklisting their names in special police registers, forcing school-pupils to listen lectures about "fatal addiction", affrighting our teenagers with soonest sexual disability and shunless death before 50 (although nothing seems to be horrendous, when you are 15), in the same time, the enlightened Europe establishing philosophical and practical approach of "harm reduction", because they managed to realize, much earlier then we did, that un-repressive, scientifically approved, based on the every citizen' and the whole society' human rights defending approach is considerably more promising and fruitful, than segregation and forced treatment of abusers.
Those efforts are not wasted. Kyrgyzstan still have some problems with harm reduction programs implementing, but international experts consider the republic to be most progressive and keeping leading positions in this development.
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"Harmreduction".
The approach, conditionally called "Harm reduction", involves the wide circle of measures, aimed on the progressive lasting improvement of social conditions and health of drug-abusers. One of them is "Half way shelters" project successfully working during few years in Bishkek and south region of Kyrgyzstan with active support of Harm Reduction International Program. The project offers first aid points with hot food, sterile syringes, medical and psychological care for addicts willing to "raise from the depth". Every positive step toward this way, even a very small one, is sizeable. An absolute recovery remains to be the top success of the program, but (let's be realistic) this is not the only possible positive result. I would like to repeat, the program is first of all aimed on the maximal reduction of harmful consequences for abusers and for society as well, especially in view of AIDS danger. I do not call to copy Western World; I just want to draw your attention to the fact that we still have no other effective strategy to restrain the AIDS infection. In vast majority of cases this fatal disease had been spread not by prostitutes or males, have sex with males, but by dirty syringe of an injection addict. A well-known case from 1980-th: pharmacies in Scottish Edinburgh stopped to sell syringes to the clients looked like drug-abusers by the reason of increased statistics of heroin street-pushing. More over, a special police team initiated number of raids to seize syringes, thus enhanced a deficiency. All these resulted in rapid raise of HIV-spreading - above 1000 new cases in 3 years: every other applied for medical care injection addict. We also have a domestic example to prove these: in mid 1990th a couple of inject abusers, using for solution' oxidation their own blood, infected almost a whole town in Russian Ural. A fatal epidemic in small metallurgists' city - Temirtau in the industrial area of Karaganda of neighboring Kazakhstan was rashly spread by thousands of domestic drugs-injecting abusers (that is why the "harm reduction" projects do not hesitate to spent time and money to educate abusers how to make infusions safely, use sterile disposable syringes and condoms...). All above can be strongly proved by the recent statistical data: in Kyrgyzstan this mechanism of infection spreading counts on 83,3% of all reported cases, in Kazakhstan - 83,5%, in Baltic countries - 80,1%; in Ukraine, Byelorussia, Moldova and Russia, according to the recent information, above 88% of registered HIV-infected are injection drugs addicts. There is no choice! Kyrgyzstan already went through jingoistic declarations that needles and syringes exchanging programs lead to legitimization of drugs. Major countries of Western World came to understanding of these issues many years ago. Considerable police resistance and numerous episodes of NGO activists detaining had marked first steps of syringes exchange and condoms distribution programs almost everywhere. Eventually, partly thanks to number of seminars and special training course, included into curriculum in the Police Academy, Kyrgyzstan realized that there is no other alternative strategy to combat threats of coming epidemics, so law enforcement agencies started to remove barriers and even to cooperate in many ways. More over, the syringes exchange program have been introduced... in penitentiary system. A group of international observers recently received an opportunity to visit one of penitentiary facilities in Bishkek suburb, successfully implemented funded by Soros-Kyrgyzstan "Atlantis" Program, aimed for rehabilitation of alcohol and narcotic substances abusers and for syringes exchange. The last from above is allowed for implementation in Kyrgyzstan solely: narcotic drugs in "barbed wired facilities"- it is a scourge of penitentiary system all over the world. On the moment Kyrgyzstan is the unique country in the Central Asian Region to admit the problem existence officially and to initiate the program to get it under the control. In response on these initiatives, Kyrgystan received considerable support from international organizations for the program implementing and truly worked it off: during two years of the program realization no one participated drug-abuser had been infected.
There are many examples of successful epidemic restraining by means of timely initiated syringes exchange program. It seems to be a strong argument in support of the "Harm Reduction" philosophy and practice.The confronting positions had been drawn together by regrettable events: number of inexperienced police officers already died because they pricked fingers with contaminated needles while doing a personal search (that is a reason why the Harm Reduction International Program plans to start in the nearest time the specialized training seminars for law enforcement, especially for sentry-service and patrol officers, and district police inspectors). It does not mean that law-enforcement must be immediately smitten with love for drug-abusers. I really felt some discomfort when participants of the recent conference on Harm Reduction in Kiev commemorated in silence the sudden death of one injection drug addict, caused by overdose, although he was a very talented person... But the burning necessity to introduce number of rational changes into existing national drug policies in the benefit of public health is obvious and invariable. Continuous steady programs for prevention must support all these. Special anti-drug programs must be intended for kinder-gardens, schools, universities, and military forces. All sides of society life to be covered by drug-preventive activity, number of "half-way" and rehabilitative centers, psychological and medical care programs, everything to safe everyone stumbled.
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Substitution maintenance therapy.
This issue deserves a special discussion. We had long discussions and number of surveys in implemented the Substitution Maintenance Therapy (most common - Methadone Programs) countries in order to assess and evaluate the program availability and effectiveness. Austria, Germany, Netherlands, United States, Israel. I had an opportunity to watch an every-day cycle of a big center for rehabilitation, attached to one of the central hospitals in Israel. Drug-addicts waited near the door since 5AM. Very quiet security-man inspected everyone and let them in, without any rush and squash. The first step inside is to get a tube for express urinalysis: in case there is no opium traces in test results the client will not get methadone. This is to rule out all opportunities for "free methadone addiction" developing: the state program is never to be blamed in drugs distribution - only those who really need treatment will get medication. Each abuser, who passed the test with positive result, will get a tube with liquid methadone and ingest it immediately, under the medical staff supervision. The program staff - doctors, social workers are always here, ready to respond to any timid wish of the client to discontinue drug abusing, to involve him into number of programs for rehabilitation. Once the addict gets his daily dose of methadone, he comes back to his every-day life within the community. Till the next morning... The similar programs in New York moved further. The client, periodically controlled by the social worked straight at his home place, is allowed to get a few days dose of methadone in one visit. The program participants receive the numbered ID cards, officially recognized by police office, that allows the program members to avoid problems with police (the participants of programs for substances abusers rehabilitation in Bishkek (Kyrgyzstan) recently started to receive the similar ID cards). From the point of view of professional police officer, the greatest achievement of all these programs is decriminalization of addict's environment. They do not need to steal or to rob anymore to pay for their shots. According to specialists, these programs facilitate success of treatment strategy. So, what are we afraid of? Methadone programs in Kyrgyzstan started few years ago and already demonstrated some positive results. During this period, due to the very close control of methadone distribution, no one episode of "leaking" to the black-market had been recorded. As I had been told recently, one patient of this program in Osh discontinued to waste money for drugs, started a successful private business and got married... Don't you think this is the best evidence of abusing cessation!?
Let me remind some "anti-methadone" arguments:
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We, actually, develop a new substance addiction - methadone, besides, we distribute free drugs - means we legalize drug abusing. But we can decriminalize drug addicts; we get them up from the underground. We can define some limits: to get methadone addicts must be enrolled into special social, rehabilitating programs. How soon a program participant will develop methadone addiction? According to doctors, methadone is considerably less addictive than heroin, for example. What about legalization... Let's be realistic, drug abusing is almost legalized de facto because of its easy availability! In the bordering with Afghanistan regions of Central Asia one shot of heroin is cheaper than a can of beer, how do you feel about this!? And, according to experts, a new coming wave of Afghan narcoexpansion expected to be much higher...
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"Methadone narco-cartels" expanding from west in parallel with heroin "made in Afghanistan". Let's produce domestic methadone and use "High-Tec" to rule out all possible leaking. According to specialists, this process will not involve incredibly complicated technology or unaffordable investments.
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Thus, a major "anti-methadone" argument: "Today we get free western methadone shipments. But who knows, what is going to happen tomorrow?" seems to be less frightening."The Cold War" ended years ago, Western World developed a high public awareness about AIDS danger and really opened to the constructive cooperation. Fortunately, in spite of still existing barriers, this cooperation already started and actively develops in many ways.
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"Harm Reduction": international recognition.
Continuously strengthening its positions in the civilized world, proved by practice the "Harm Reduction" philosophy actually does not need and excessive advocacy. That is why I'll just list the main research results and international documents, highlighting its invariable usefulness and necessity. In the same time, the parallel measures to reduce drugs supply and demand are undoubtedly essential, as we stressed before.
According to the World Health Organization, the successful program for the illicit drugs abuse prevention does not exist yet. In the same time, the results of researches in criminology, had place during last 30 years, proved that depenalization and decriminalization did not increase the number of illicit drug abusers, as well as no severe penalty measures resulted in these statistics improving. Considering all above plus seems to be absolutely real danger of HIV/AIDS epidemic spreading, further progress of the "Harm Reduction" strategy has an outstanding value. By this reason the strategy have been actively implemented during last few years, besides of number western countries, in Bosnia, Herzegovina, Croatia, Czech Republic, Estonia, Hungary, Kyrgyzstan, Latvia, Lithuania, Poland, Macedonia, Romania, Serbia and Monte Negro, Slovak Republic, Slovenia, Ukraine. Some strategy elements, like the positive legislative changes, had been implemented in Russia.
The United Nations many times declared its adhesion to the "Harm Reduction" strategy (I'm going to mention just a few documents) -
а) Declaration on the senior principles of demand reduction (resolution S/20-3 of Assembly General) stressed that demand reduction measures must be comprehensive and involve all areas of preventive activity, from initial drug-abusing prevention to reduction of its negative consequences for public health and social sphere ...
b) Declaration on HIV/AIDS epidemic restraining (resolution S-26\2 of Assembly General) contained a call to initiate a wide range of preventive programs, aimed besides all to provide with wide access to essential supplies, including sterile syringes for injections; measures to reduce harm, linked to illicit drug-abusing.
c) Resolution number 45\1 of UN Commission on Narcotic Drugs admitted that the effective strategies for prevention, care and management need considerable behaving changes and wide, non-discriminatory access to... the sterile medical instruments for injections, medications, includingretro-virus therapy...
d) The UN Conception on HIV-infection spreading prevention in addictive substances abusers environment (АСС\2001\6, point 35). The conception mentioned that the comprehensive scope of preventive measures for HIV-infection spreading prevention in addictive substances abusers environment must include education in AIDS problem, teaching in life-support skills, condoms distribution, voluntary consulting and testing on HIV-infection, access to the sterile syringes, needles and disinfectants,easy referral for medical services.
e) WHO, UN Office on Drugs and Crime, UN HIV/AIDS Program conception "Replacement Therapy and Opium Substances Addiction".
The 26th chapter of above document states that there are strong evidences that methadone replacement therapyresults in reduction of illicit drugs consuming, mortality, risk of HIV/AIDS spreading;improving of physical and mental health, social functioning,and reduce crimes.