Stoking the harm reduction debate while lawmakers stall decriminalization

By Pablo Cymerman, Intercambios (Argentina)

In August 2013, Intercambios organized the 11th National Conference on Drug Policy at the Argentine Senate in Buenos Aires, highlighting debates surrounding laws on drug use. Progress appears to be stalled as key lawmakers seems torn between the current punitive approach on drug-use, on the one hand and a rehabilitative approach, on the other hand.

Horacio Pietragalla of the Addiction Prevention and Drug Trafficking Control Commission was vocal about the pressure from some segments of society, despite sharing the views of several civil society organizations: “We have decided not to move forward with decriminalization because relatives of those with problematic drug use have told us, ‘You want to legalize when it is the only resource we have to treat our children.’”

Intercambios is convinced that the amendment of Narcotics Act No. 23,737, which continues persecuting and criminalizing drug users, and whose regulations were declared unconstitutional by the Supreme Court more than three years ago, should be discussed urgently. The position that proclaims that “there must be guaranteed treatment first” implies that the decriminalization of possession increases consumption, a statement refuted by the statistics of the countries where it is already applied. There must be broad, comprehensive, diverse, public and free care services across the country, as a basic human right for all people, inclusive of people who use drugs. And people should not have to risk being approached by law enforcers, whilst accessing these same health services.

Although in its last report UNAIDS said that since the beginning of the millennium, global rates of new HIV infections remain stable, we must not forget the significant rate of the human immunodeficiency virus (HIV) transmitted by sharing injection equipment, especially in the eighties and nineties in the south of Latin America.

Since the curve of infections among injecting cocaine users related to sharing injecting equipment began to decline in Argentina – whether it was because they had transformed their practices with new care measures, or because of a change in the way of using drugs – the idea of focusing on HIV prevention among people who inject drugs began to spread.

At the same time, studies were conducted with non-injecting cocaine users (consumption via inhalation), which resulted in an average of 5% HIV prevalence in this population, which is certainly a higher percentage compared to the prevalence of the general population measured in blood banks.

Although this evidence has been around for at least ten years, there are still few public health initiatives aimed at reducing the harm of cocaine or other drugs that are not injected. Moreover, the non-injecting category has not been incorporated in epidemiological surveillance of HIV/AIDS, in spite of the recognition of most Latin American countries of a growing problematic use of coca paste or ‘crack’.

Intercambios has been campaigning for the decriminalization of drug-use and institutionalization of a Comprehensive National Program on Care for Drug Users. The latter facilitates universal health access and services for drug users and provides resources for prevention, treatment, rehabilitation, harm reduction and social integration. In its position paper, Intercambios explained that a National Program of Comprehensive Care for Drug Users must have adequate budget and human resources which will allow the integration of diverse and related services such as universal and selective prevention, low-threshold services, crisis aid, outpatient services, detoxification centers, day centers, therapeutic communities, and services for social support, education, and labor.

Prior to the 2013 elections, Intercambios ran a survey among politicians, mapping their positions on drug-use policy. Each candidate was asked two questions.

The first one was if he/she would support the approval of a law decriminalizing drug possession for personal use. 85% of the respondents were in favor of decriminalization.

The second question was if he/she considered that the bill proposing the creation of a National Program of Comprehensive Care for Drug Users -approved by the Chamber of Deputies- should be passed. 70% of the respondents answered that they supported the initiative.

There was an almost unanimous agreement that drug use should be approached as a public health issue and not as a criminal one. Regarding the creation of a National Program of Comprehensive Care for Drug Users, there was majority support, but the need of improving the bill was highlighted by several candidates. Major concerns included the need to pay more attention to imprisoned populations, lack of existing treatment options according to the type of substance, and the importance of promoting greater involvement of civil society.

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