The United Nations' Commission on Narcotic Drugs (CND) meeting this week in Vienna became the latest battleground in an effort led by the United States to de-legitimize harm reduction strategies in general and needle exchange programs in particular. The CND is the UN's policy-making body on drug issues and is charged with developing proposals aimed at dealing with global drug use. While the formal agenda item is strategies for slowing the spread of injection drug use-related HIV, the clear subtext is the fight over the role of harm reduction.
The practices under fire from the Bush administration are those that seek not to repress drug use but to reduce its adverse consequences for drug users and society alike. Similar to the notion that one way to reduce sexually transmitted diseases and unwanted pregnancies is through condom distribution, harm reduction strategies for drug use include needle exchange programs, safe injection sites, and drug maintenance programs.
The Vienna meeting came against a backdrop of heightened US efforts to attack harm reduction and its practitioners led by US drug czar John Walters, congressional drug warrior Rep. Mark Souder (R-IN), and State Department Assistant Secretary of State for international narcotics matters Robert Charles. Last fall, Charles met with UN Office of Drug Control Policy head Antonio Mario Costa to urge him to strike all references to harm reduction from UNODC materials. Rep. Souder has been using his post as chairman of the Subcommittee on Criminal Justice, Drug Policy and Human Resources of the House Government Reform Committee to demand investigations of possible US funding of harm reduction activities abroad, while czar Walters is using his office as a bully pulpit to sound the alarm about harm reduction.
Last week, in preparation for this week's Vienna meeting, AIDS groups, human rights groups, policy analysts and researchers from 56 countries urged the commission to "support syringe exchange, opiate substitution treatment, and other harm reduction approaches demonstrated to reduce HIV risk." The letter was distributed by Human Rights Watch, which accused the Bush administration of exerting pressure on the UNODC to stop supporting needle exchange programs.
But Walters, undeterred by the critics, took his road show to Vienna this week, where he addressed the CND on Monday. In a coded slap at harm reduction, Walters said the international community should not "acquiesce or practice appeasement with addiction." Instead, Walters argued, "drug use is both a preventable behavior and one that we can intervene against and stop." When it comes to HIV, the best approach is not to provide clean needles, he said: "The single greatest way of preventing the spread of HIV/AIDS through drug users is taking those addicted and getting them to recover. Continued drug use is a fundamental cause of the dangers we face from blood-borne diseases."
Walters rejected the idea that opposition to needle exchanges is "somehow an impediment to efforts addressing another global crisis, the spread of HIV/AIDS and other blood-borne pathogens such as Hepatitis C." And he addressed critics of the UN conventions on drugs, the legal backbone of global prohibition, which UN agencies read as prohibiting harm reduction activities such as safe injection sites and opiate maintenance therapies. "This charge is wrong. The conventions (opposing such programs) are a bulwark against the public health tragedy of blood-borne diseases and the public health tragedy of drug use and addiction," Walters said.
But although UNODC head Costa had appeared to buckle under to US pressure to remove references to harm reduction last fall, he gave at least rhetorical support to harm reduction and needle exchanges in particular in his speech Monday. Needle exchanges are "appropriate as long as they are part of a comprehensive strategy to battle the overall drug problem. We must not deny these addicts any genuine opportunities to remain HIV-negative," Costa said.
Costa may have had his spine stiffened by near unanimous support for harm reduction practices by countries attending the session. Besides the US, only Japan spoke out forcefully against harm reduction, arguing instead for more effort toward creating "drug-free" societies.
On the other side of the debate were UN agencies and much of the international community. The European Union and several of its member states voiced explicit support for harm reduction. Even staunchly prohibitionist Sweden "fully associated itself" with the EU's pro-harm reduction statement. Australia, Brazil, Norway, and Switzerland also supported harm reduction efforts, according to on-the-scene reports from Hungary's Peter Sarosi and England's Andria Efthimiou-Mordaunt, who were representing the Hungarian Civil Liberties Union and the European Coalition for Safe and Effective Drug Policies, respectively. In contrast to previous years, harm reduction also drew support from Moslem countries, with Iran and Morocco reporting they were working together to forge a response to injection drug use. China reported that methadone maintenance programs were underway and that "exchange of needles and syringes is expanding step by step."
UNAIDS, the program in charge of global HIV/AIDS prevention supported access to sterile syringes and condoms as part of a comprehensive approach to HIV, and the World Health Organization, which recently released a new report finding needle exchanges were an effective means of HIV prevention, called for six harm reduction measures that should be accelerated in countries with injection drug use epidemics: needle exchange, substitution therapy, HIV testing and counseling, outreach and peer education, services for preventing sexual transmission (including condom distribution), and HCV vaccination.
But if harm reduction appeared to be winning the debate, UNODC director Costa could not resist referring to and attacking the "pro-drug lobby," as he labeled critics of prohibition and the UN conventions. Critics make "a false dichotomy between drug control and crime control," he said, "namely, on the argument that drugs are a matter of choice, and that the legalization of drugs would curb organized crime."
Despite the resistance to the US' effort to attack harm reduction, European drug reformers were less than thrilled about this week's session. "As always, the CND meeting is about maintaining the impression that there is total consensus among governments that the UN drug conventions are untouchable, and that everybody is on the same track concerning the goal of diminishing the supply and demand for drugs," said ENCOD's Oomen. "In the meantime, there is a growing feeling of unrest among governments that want to apply harm reduction about the efforts of US and UN to discredit this strategy. This feeling is strengthened by the comments of NGOs and international experts like the WHO and UNAIDS," he told DRCNet.
The dispute over harm reduction language, said Oomen, "looks like a simple detail that will be solved by adjusting the wording. Costa is willing to obey US pressure to eliminate harm reduction as a concept from UNODC statements and programs, but he feels the pressure from other UN organizations to maintain needle exchange. There is still a long way to go before we can expect some significant debate going on inside the CND -- at least publicly -- about the fundamental course of drug policies."