editorial comment One day, in a galaxy far, far away, there will be a zero-tolerance policy for stupidity. Not many people working for the CND will make it there....

A LEADING Scottish drugs professional is to challenge the adoption of zero-tolerance drugs policies by the United Nations at an international drugs conference in Vienna this week.
David Liddell, director of the Scottish Drugs Forum and chair of ERIT, a European body working in the field of drug abuse, believes the UN’s increasing embrace of abstinence programmes for drug addicts is threatening harm reduction programmes in Scotland and beyond.

Liddell says the United Nations Office on Crime and Drugs (UNODC) is approving American-style abstinence initiatives, sidelining needle exchange and harm reduction programmes which have proved effective in the treatment of addicts.

Last November, UNODC executive director Antonio Costa wrote to US state department narcotics head Robert Charles after a meeting, stating: “We [UNODC] neither endorse needle exchange as a solution for drug abuse, nor support public statements advocating such practices.”

Costa promised to “review all statements ... and be even more vigilant in the future”. T he US has donated over $140 million to UNODC programmes.

Many drugs professionals believe this marks a U-turn by the UN. As a result, they have established the International Drug Policy Consortium (IDPC), a new association of specialist non-governmental bodies.

The IDPC has prepared a paper challenging this zero-tolerance approach, which it will present at the annual meeting of the United Nations Commission for Narcotic Drugs (CND) hosted by UNODC in Vienna this week.

Liddell, who has lent his signature to this petition, said: “Costa is being leant on extremely heavily by America, who say they will withdraw their funding if the organisation continues to support harm reduction programmes.

“If this zero tolerance approach becomes a widespread movement, there’s the potential to have a negative impact, not only globally but in Scotland and the rest of the UK. It could encourage a response which, rather than taking an evidence-based approach, moves towards one based on dogmatic, moralistic views of how we should respond to drug problems.

“We have spent an awful long time in Scotland encouraging and cajoling the government to take on board evidence that we have built up over the years as to how effective needle-exchange and prescribing services can be.

“The Just Say No campaign set Scotland back many years in developing pragmatic evidence-based approaches to tackling drug problems. UNODC’s stance may not be immediately apparent but over time, has the potential to be extremely destructive in dismantling hard-fought-for harm reduction programmes.”

Co-founder of the IDPC, Mike Trace, former head of demand reduction at UNODC and previously second in command to Keith Hellawell, the UK’s first drugs tsar, shares Liddell’s views. Trace, who resigned from his post at the UN over allegations he was promoting a liberal drugs policy against the wishes of some US donors, said: “The US can and has made it clear that it will remove funds from UNODC if it is unhappy with their performance.”

The global consequences of this, he asserts, would be drastic, with increased HIV infection and death.

Dr Richard Simpson, former deputy justice minister in Scotland, who now works on the front line of drug treatment as a consultant psychiatrist and lead clinician for alcohol and drug services in West Lothian, said: “The harm reduction approach has served public policy in Scotland very well and has substantially reduced the problem with both HIV and hepatitis, although there are still nearly 40,000 people here positive for hepatitis C.

“If the UN don’t follow a harm reduction policy, there will be an even bigger problem on a worldwide scale. If there is any opposition to prescribing methadone at a UN level, they would be totally out of tune with all the evidence that methadone is an effective treatment – it stabilises patients, it reduces their chaos, it improves their family lives and it improves their capacity to look after their children.

“Methadone certainly isn’t the only treatment, and having abstinence as a goal to work towards with patients is entirely reasonable, but it is not a process which should be forced on the patient.”

Scotland’s first pilot needle exchange programmes started in 1987 and there are now over 40 needle exchanges across the country. Although there are no centrally held statistics, it is thought there are around 20,000 people on methadone in Scotland.

A Scottish Executive spokesperson said: “We are expanding both the number and the range of drug treatment services because a successful programme of drug treatment is likely to comprise a range of approaches – abstinence, residential, detox and harm reduction approaches.

“The problems caused by drugs are great but we cannot wish away our drugs problems. We need to deal with them.”

Germany, Switzerland and the Netherlands have taken harm reduction a step further by operating rooms where addicts can inject in safe conditions. Other EU countries, such as Sweden and Italy, support zero tolerance and abstinence.

The US banned the use of federal funds to support needle exchange programmes in 1988. Last week, the Bush administration urged the UN to reject abortion rights.

UNODC declined to comment on these issues.

06 March 2005

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