Category Archives: harm reduction

View from the Ground – Harm reduction, drug policy and the law in the Maghreb: focus on Tunisia and Mauritania

View from the Ground – Harm reduction, drug policy and the law in the Maghreb: focus on Tunisia and Mauritania

Khalid Tinasti
Honorary Research Associate, Swansea University
July 2017

Introduction:

The Maghreb countries – Algeria, Libya, Mauritania, Morocco and Tunisia – while seldom discussed, are crucial to global debates on drug control policies. These countries are at the heart of drug trafficking routes for various substances, from Latin America to Europe, from the Middle East to Europe, and from West Africa to North America. The region is also home to the largest producers of cannabis, as well as amphetamine type stimulants (ATS). Illicit drugs are prohibited and drug laws are harsh if not efficient – Mauritania retains death penalty for drug-related offences.

The Maghreb (in green), copyright epidop.com

This blog will focus on two of these countries, Tunisia and Mauritania, who share common religious, ethnic groups, cultural and socio-economic realities, but face clearly different challenges related to illicit drugs.[i] The two countries nevertheless face a drug trafficking framework which is unparalleled. In fact, the Maghreb and its neighbouring Sahel region represent large desert areas, sparsely populated, with porous borders and the existence of terrorist and other separatist groups. These parameters, combined with failed states and inadequate drug control policies, make drug trafficking thrive. This blog attempts – through available data and literature – to analyse the drug situation currently in both countries, review their drug control laws, and evaluate the outcomes of their implementation. The piece also narrates the current efforts to reform the drug law by the Tunisian government.

The current situation:

There are an estimated 140,000 people who use drugs (PWUD) in Tunisia,[1] with around 10,000 people injecting drugs.[2] Other sources report up to 400.000 PWUD in the country.[3] In 2015, 21.44% of new HIV infections were among people who inject drugs.[4] Moreover, HIV prevalence among this same population has increased from 3% in 2011 to 4% in 2014, while it is of 0,1% in the general population.[5] This increase takes place in the absence of a national strategy of harm reduction. There are no opioid substitution programmes, and the distribution of syringes is mainly undertaken by non-governmental organizations. In 2013, the 48.000 syringes distributed in the country were by the ATIOST, the ATUPRET and the ATL-MST.[6] The prevalence of hepatitis C in the same population is 29%.[ii]

Drug control policies are steered through law 52 adopted in February 1992 – referred to as law 92-52. The law, which sentences prison terms even for simple use or consumption, has resulted in an unprecedented prison overcrowding, mainly targeting young males incarcerated on cannabis use charges. Out of the 25.000 inmates in the country prisons, 8.000 are incarcerated for drug offences, of which it is estimated that 9 out of 10 are there for simple possession or personal use,1 the law allowing for urine tests in prisons and in the community to prove the consumption. In 2015, 7.451 people were arrested and prosecuted for drug offences, of which about 70% were related to cannabis possession or consumption.[7] A year later, 8.984 people were arrested on the same charges, with 6.212 of them aged 18 to 30 years old.[8]

In Mauritania, data on the prevalence of drug use is unavailable. Similarly, the prevalence of HIV among the general population reaching 0,6%, the prevalence among people who inject or use drugs is unavailable. More worryingly, the National Committee to fight AIDS does not recognize PWID as a key population most at risk of acquiring HIV.[9], The non-inclusion of PWUD as a key population deters a discussion on evidence-based interventions to respond to AIDS, including prevention, harm reduction services and treatment.

Copyright West Africa Commission on Drugs, 2014

Rather, the debate on drugs focuses heavily on trafficking, with Mauritanian authorities, media and other stakeholders considering that the country is only a transit country. This vision of a country where illicit drugs transit – through the routes of Senegal, Mali, Algeria, Niger, Morocco or the Canary Islands – and where there is no local consumption is emphasized by the geographic position of Mauritania, its limited population (4 million inhabitants), and a large, desert and difficult to control territory. Whether such assertion is true or not – it remains difficult to define in the lack of data on illicit drug use – the country rightly faces challenges related to the smuggling and trafficking of drugs, intertwined with terrorist groups’ financing and their unlawful intrusion in the Mauritanian territory. Drug-related cases often make the headlines in Mauritanian media, due to the large seizures of illicit drugs by customs and law enforcement agents, including cases where relatives of former Presidents or former Presidents themselves are cited.[10][11] The nature of the implication of political authorities in drug trafficking remains anecdotal since it is not proven. Nevertheless, the characteristics of drug trafficking depends on many parameters that are specific to Mauritania and the Sahel region. As stated earlier, the country has a large desert territory that is difficult to control. Moreover, trafficking relies on ethnic groups, their inter-relationships and their control of their territories that transcend the Sahel borders.[12]

Drug seizure in northern Mauritania by the Gendarmerie (military law enforcement). Copyright Sahara Medias

Very limited data shows that there is a small cannabis production in the south of the country near the Senegal River, while cocaine is imported from Latin America and heroin from Asia through Nigeria or other West African countries.[13] Trafficking of illicit drugs includes alcohol, which is a banned substance in Mauritania. Moreover, Mauritania’s authorities address money laundering as the banking system is sensitive to drug profits laundering, mainly due to the important volume of foreign currency circulating from tradespeople and other economic emigrants working mainly in the Gulf countries.

The laws and policies for drug use and trafficking:

Tunisia, country of the Jasmine revolution and youth-driven democratization, has the harshest law in terms of repression of drug use and possession for personal use. Mauritania, on the other hand, is the only Maghreb country sentencing drug traffickers and growers/producers to death penalty.

The Tunisian law – to be explored in more detail below – punishes individuals who consume or possess a narcotic or psychotropic drug with imprisonment of one to five years and with a monetary fine between 400 and 1.200 USD (1.000 to 3.000 Tunisian Dinars). It also punishes the attempt to consume or possess drugs with the same sanction. Therefore, the Tunisian law punishes the possession for the purpose of consumption and for the actual consumption even if there is no possession involved. The court may as well force the convicted offender to undergo detoxification for a period set by a medical doctor at a public hospital. If the detoxification is refused, a permit can be issued by the president of the court forcing the offender to undergo this treatment in a compulsory manner.[14] The most problematic provision of the law, until its partial reform in April 2017 (see following section), was article 12 of the law, providing that judges cannot take into account mitigating factors, and have to pronounce a prison sentence for drug use offences. This was problematic as the law 52 was the only one in the Tunisian criminal code to deprive judges of their free choice and of sentencing proportionally to the offences. Under the terms of the law as well, traffickers and growers of narcotics are sentenced to prison terms from 6 to 10 years, while those importing or exporting drugs face a minimum of ten years of incarceration, up to a life sentence.

“Our kids and friends are not criminals #end law 52”[iii]

In Mauritania, the law responds to drug use and possession for personal use by a prison term of a maximum of two years and a monetary fine between 140 and 280 USD (50.000 to 100.000 Mauritanian Ouguiya). Prosecutors also have the obligation to inform health authorities about the arrest of people who use drugs. The health authorities investigate the health conditions and family conditions of the arrested individual, and prescribe mandatory detoxification. Producers and growers of illicit drugs face 15 to 30 years in prison, the same penalty as drug traffickers. This punishment, in case of recidivists, becomes a sentence to the capital punishment. Finally, laundering illicit drugs’ profits is punished by a prison term between 10 to 40 years.[15]

It is also important to note that both laws have been amended and adopted following the adoption of the United Nations Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances in 1988 and right before the adoption of the Arab Convention against Illicit Use of and Traffic in Narcotic Drugs and Psychotropic Substances in 1994. The articles of both countries’ laws and the lack of proportionality vis-à-vis the real severity of the offences represent an example of the interpretation countries make of the international drug conventions, and the impact these conventions have on people’s lives when implemented on the ground, far from the debates of diplomats drafting and negotiating them in multilateral forums.

What reform for the Tunisian drug law?

In Tunisia, the excessive number of young people arrested under the provisions of law 92-52 started a heated debate on the need for its reform. This debate has been deepened through the use of the law provisions to arrest young Jasmine revolutionaries, and by their own capacity to stand for their rights in the post-Revolution era.[16] Movements such as the Sajin52 (prisoner 52) emerged and denounced the law. In his 2014 presidential campaign, the current head of state Béji Caïd Essebsi promised a reform of the law and denounced the use of prison terms for first-time drug use. In December 2015, his government approved a new narcotics bill to amend law 52, and introduce the following provisions: i) the establishment of a national drug observatory to collect data; ii) the establishment of treatment centres, including the introduction of substitution therapy; iii) the diversion of first and second-time offenders, arrested for use, to social services (third-time offenders will serve the same terms as the current law provides, between one and five years); and iv) the possibility of judges to decide on the most appropriate sentences.[17]

Infographic by the movement “Al habes lé” (no incarceration) calling to reform law 52

The latter, targeted at article 12 of law 92-52, has been amended in April 2017 when Parliament gave judges the right to apply Article 53 of the Criminal Code to reduce penalties, not only for consumption, detention and consumer intent (Article 4 of law 52) but also for attending consumption spaces (Article 8 of Law 52).[18]

The process leading to this partial amendment started with the submission to Parliament of bill 79 amending law 52. With the bill not finding a majority necessary for passage into law for more than 12 months, President Essebsi decided in January 2017 to use his executive powers to freeze all the arrests related to Law 92-52, and urged Parliament to find a consensus and vote for the reform. A month later, the President convened a meeting of the National Security Council, which decided to revise the criteria for granting special grace to people charged with drug use or possession, and to have the Grace Committee meet once a month to overturn the judges’ decisions on arrests. The National Security Council also repealed partially law 92-52, and specifically its article 12 leading to the reform of April 2017 by Parliament, giving judges the capacity to take into account mitigating factors.

In the current economic, social and security framework in Tunisia, where tensions among society are numerous – from the declining standards of living of the population, the decline of the industrial, tourism and service sectors, as well as the security and fight against terrorism – the calendar of the adoption of bill 79 in Parliament remains unclear.

Conclusion:

The debate on drug policies in the Maghreb, when it occurs, is usually focused on Morocco, the largest producer of cannabis in the world, and one of the main suppliers of the European Union due to its geographic proximity with Spain. With the deterioration of the security situation in the Sahel and the rise of terrorist risks, along with some evidence that terrorist groups are either involved in trafficking, protect traffickers or benefit from trafficking revenues,[19] combined with the disintegration of the state apparatus in the fifth Maghreb country, Libya, is also beginning to attract some interest.

Nevertheless, as discussed here, other states within the region are increasingly worthy of attention with debate around drug policy emerging for a complex range of internal, societal and social peace reasons.
Tunisia is currently being driven to reform its policies due to the population’s pressure, while this debate does not exist in Mauritania. However, while differences exist on this point,, the two countries seem to share a common lack of understanding of drug policies, providing similar legal responses to people who use drugs (PWUD), to small players in the illegal drug market (small dealers, farmers and other couriers), and to large-scale traffickers and terrorist groups suspected of trafficking illicit drugs to fund their terror actions. Such policies, intended to deter drugs’ presence in society, are failing to achieve their objectives and are extremely costly to society, to the criminal justice and health systems.

While it remains unclear when the Tunisian drug policy reform will take place, it provides the brightest prospect of reform in the Maghreb, as bill 79 will bring along the first policies based on evidence, and provide space for scientific monitoring to inform and fill gaps in the future. The adoption of this bill, its successful implementation and flexibility, as well as its tight monitoring is all highly important not only for the Tunisian society but the whole Maghreb.

[I] This is the second and last blog on drug policy in the Maghreb. The first blog was published in October 2016 and titled “View from the Ground – Harm reduction, drug policy and the law in the Maghreb: focus on Morocco and Algeria”.

[ii] In Mauritania, HIV key populations are female sex workers and their clients, women and youth, inmates, people living with STIs, truckers, sailors and fishermen.

[iii]Protest against law 52 in front of the Assembly of the Representatives of the People (Parliament) on 28 December 2015. Copyright Nawaat

[1] Amraoui, A. Drogues : une jeunesse victime de l’échec de la politique de prévention. Nawaat.org; September 2015. Available from: https://nawaat.org/portail/2015/09/05/tunisie-drogues-jeunesse-victime-echec-politique-prevention/ (accessed 10 July 2017) 

[2] Tunisie Numérique. 10 000 toxicomanes usagers de drogue intraveineuse en Tunisie. Turess; April 2012. Available from: http://www.turess.com/fr/numerique/119208 (accessed 10 July 2017) 

[3] Bentamansourt, N. Tunisie-Drogue : 3,9% des consommateurs contaminés par le VIH! African Manager; October 2016. Available from: https://africanmanager.com/mots-cles/association-tunisienne-de-la-prevention-contre-la-toxicomanie/ (accessed 10 July 2017)

[4] Africaine Santé. VIH/SIDA en Tunisie: Où en est-on? December 2015. Available from: http://africaine-sante.com.tn/a-la-une/vihsida-en-tunisie-ou-en-est-on/ (accessed 10 July 2017)

[5] UNAIDS. Key Populations Atlas: Tunisia- People who inject drugs: HIV Prevalence 2014. UNAIDS; 2014. Available from: http://www.aidsinfoonline.org/kpatlas/#/home (accessed 10 July 2017)

[6] National HIV/AIDS Programme of Tunisia. Rapport d’activités sur la riposte au sida 2012-2013. UNAIDS; 2014. 

[7] Human Rights Watch. « Tout ça pour un joint » La loi répressive sur la drogue en Tunisie et comment la réformer. Tunis; December 2015. Available from: https://www.hrw.org/sites/default/files/report_pdf/tunisia0216fr_sumandrecs_.pdf (accessed 11 July 2017)

[8] African Manager. Tunisie-stupéfiants : Le bilan de 2016 en chiffres. March 2017. Available from: https://africanmanager.com/tunisie-stupefiants-le-bilan-de-2016-en-chiffres/ (accessed 10 July 2017)

[9] Comité national de lutte contre le Sida. Rapport d’activité sur la réponse au sida en Mauritanie 2014. Nouakchott; March 2014. Available from: http://www.unaids.org/sites/default/files/country/documents/MRT_narrative_report_2014.pdf (accessed 10 July 2017)

[10] Berghezan, G. Panorama du trafic de cocaïne en Afrique de l’Ouest. Group for Research and Information on Peace and Security: Brussels; June 2012.

[11] Attar, A. Mauritanie : fin de parcours pour Mohamed Ould Abdel Aziz ?. Afrik.com; February 2013. Available from: http://www.afrik.com/mauritanie-fin-de-parcours-pour-mohamed-ould-abdel-aziz (accessed 10 July 2017)

[12] Simon, J. « Le Sahel comme espace de transit des stupéfiants. Acteurs et conséquences politiques ». Hérodote, 142 (3); 2011: pp. 125-142.

[13] Dialogues, propositions, histoires. « La situation des drogues en Mauritanie ». DPH: Paris; citing the Observatoire géopolitique des drogues; November 1994. Available from: http://base.d-p-h.info/fr/fiches/premierdph/fiche-premierdph-2016.html (accessed 11 July 2017)

[14] Official Journal of the Tunisian Republic No. 33 of 1992. Law No. 92-52 of 18 May 1992 on Narcotic drugs. Tunis; 1992.

[15] République Islamique de Mauritanie. Loi No. 93-37 relative à la répression de la production, du trafic et de l’usage illicite des stupéfiants et substances Psychotropes. Nouakchott ; July 1993.

[16] Tinasti, K. Are cannabis laws used for political repression in the Arab Spring countries?.  Addiction, 110 (12); 2015: p. 2037.

[17] Tunisian government. Projet de loi N 79 de l’année 2015 relatif aux stupéfiants. Tunis; 2015.

[18] Huffpost Tunisie. Tunisie-La loi 52 a été amendée: “Une étape considérable franchie” se félicite l’avocat Ghazi Mrabet. Huffpostmaghreb.com; April 2017. Available from: http://www.huffpostmaghreb.com/2017/04/25/tunisie-loi-52-stupefiant_n_16231606.html (accessed 12 July 2017) 

[19] UNODC. World Drug Report 2017, booklet 5. Vienna; June 2017

British System, American Century: A short case study

British System, American Century: A short case study

Chris Hallam

This blog shows the intimate ties between the international and domestic domains of drug control. This is a well-known phenomenon; however, it involves considerable complexity. The lengths to which governments will go to reduce potential tension at the international level are apparent. This is especially so when states – as in the following case – are wary of the US position. At the same time, powerful domestic forces can counteract the influence of international powers, even when the United States is concerned, as in the aftermath of the Second World War.
The blog selects the example of Britain during that period in which the negotiations leading to the Single Convention were taking place. The then-famous ‘British System’ of drug treatment was a key aspect of Britain’s drug policy relationships; stemming from Sir Humphrey Rolleston’s inquiry into addiction that reported in 1926, the ‘British System’ permitted any doctor to supplyheroin, morphine, cocaine and other drugs to those who were dependent upon them. Unlike the present mode of ‘Heroin Assisted Treatment (HAT), the British System imposed few requirements on patients, who could take their prescription to a pharmacy, collect their drugs and consume them more or less at will. This depended on the regulatory context, the liberal views and the largesse of the doctor, but these were generally forthcoming.
Both the international and the domestic domains played a part in the changes that overtook the British regulatory framework in the 1950s and 60s, leading to the demise of the ‘British system’ of prescribing and its replacement with a much more restrictive ‘clinic’ system in 1968. The international dimension was always important, but in the period preceding the agreement of the 1961 Single Convention, it was especially significant as countries sought to shape the draft treaty to suit their national interests, or (less rationalistically) to forge the global order of intoxication according to their mythological image.

Sir Humphrey Rolleston

Following the war and the continuing rise of the United States as an international military, political and economic superpower, there was friction between it and Britain over aspects of the latter’s drug policies. The 1955 American attempt to impose a global prohibition on heroin was eventually faced down by the British government after internal pressure from the medical profession in support of the drug’s retention in medical therapeutics, including in the treatment of drug dependence. The medical profession was a powerful force in British politics and culture, sufficient to bring the government to resist US pressure.
Britain’s representative at the Commission on Narcotic Drugs (CND), the policy-making body for the new UN international drug control system, was J.H. ‘Johnnie’ Walker. Bing Spear, the Home Office civil servant who had written extensively on UK drug policy, identified Walker as providing the initiative that led to the first Brain Committee, which, commencing its meetings in 1958, reviewed the British drug control system for the first time since Rolleston did so in the 1920s. Government documentation from the mid- to late-1950s supports this claim. The context for Walker’s views was largely international, with the British System undergoing criticism from a number of countries, particularly the United States, through the mechanism of the new United Nations drug control regime.
In 1955, Walker sent a lengthy and thoughtful memorandum to the Home Office suggesting that it was time to look again at the British drug control system. Despite the system’s smooth domestic running, said Walker: ‘It so happens that a number of problems have arisen, or are on the horizon, which indicate that this is a suitable moment to review the present system of control.’ These problems or potential problems included the proliferation of new synthetic drugs such as pethidine and methadone; the UK policy on addiction (by which was meant in particular the Rolleston-inspired regulations permitting the long term of maintenance of opiate habits and the belief in the ‘stabilised addict’); addict doctors; and improper prescribing and supplies to addicts (the issues surrounding ‘script doctors’). The memorandum paid the greatest attention to the second and the fourth of these categories, replicating the situation that obtained when the Rolleston Committee reported and showing that the issue of doctors prescribing dangerous drugs to addicts had remained at the heart of governmental anxieties. Walker claimed that the Rolleston Committee never intended the ‘lavish supply of dangerous drugs to addicts merely for the maintenance of addiction’. He then made reference to a ‘small but potentially dangerous group of drug addicts (mainly heroin addicts) in London at the present time’. This group was ‘disturbing’, as it represented ‘the first real sign of a significant increase in heroin addiction for very many years’. The group’s members had become addicted young and were mostly under thirty – often nearer twenty; many shared an involvement in one particular field of entertainment and therefore met socially at regular intervals – a reference to the jazz club scene. The social context of this drug use made it ripe for proselytism, contended Walker, ‘always one of the more dangerous features of drug addiction’.
He continued that many ‘appear to obtain supplies from a small number of doctors who make no attempt whatever at cure or even, so far as can be judged, at reduction of the dose. In other words, their addiction is deliberately fed, almost certainly in some instances for purposes of gain.’ Walker concluded that: ‘The “script doctor” who thus makes drugs freely available to addicts represents a special problem…’
Walker’s memorandum showed that the Home Office was by this time fully aware of the flourishing new London addict subculture, a full ten years before these facts were published in the Second Brain Report. As noted by Spear, the peculiar thing is that the first Brain Committee did not address it in their deliberations nor their report. At the Home Office, it was Tom Green (who succeeded Walker at the Drugs Branch) who led the drafting of the advice and information sent to the Ministry of Health, from which emerged the shape of the review. For ‘some inexplicable reason’, while drawing heavily on Walker, Green did not include evidence of the emergence of London’s expanding heroin subculture.
One possible reason for this startling omission lay in the international relations around the topic of drug control. Walker points out that US medical opinion was firmly against maintenance and the notion of the stable addict. The ‘strongly held’ view in the American medical profession was that it is ethically unacceptable to condemn a patient, especially a young patient, to perpetual addiction by offering this form of treatment. It was also remarked that the CND and World Health Organisation were highly critical of ambulatory treatment of the kind practiced in the UK. Indeed at its 10th session, the CND ‘expressed the view that ambulatory treatment (including the so-called “clinic” method) was not advisable and asked the World Health Organization to prepare a study on the appropriate methods of treatment.’ Furthermore, a clause had recently been inserted into the draft Single Convention which spoke of treatment being given on ‘a planned and compulsory basis, in properly conducted and duly authorised institutions’. However, by virtue of a qualifying clause that was initiated by the UK, such measures would be applicable only in those countries having a large addict population; it was this proviso that permitted the UK government to sign the 1961 treaty despite its differences with respect to drug treatment. Notwithstanding this, Walker expressed concern that the general trend at the CND was toward compulsion, and that there may in due course be concerted pressure for the removal of the UK clause. He added that, ‘it is unlikely that the United Kingdom could ever accept an obligation to require compulsory treatment of drug addicts in a closed institution’. In fact, Walker made it clear that such a measure could prevent the UK from signing the treaty, and would have been in conflict with the overall trend of mental health policies in Britain at this time, as expressed in Lord Percy’s 1957 Report of the Royal Commission on the Law relating to Mental Illness and Mental Deficiency. This optimistic document led the trend away from confinement, toward voluntary and community based mental health treatment, and fed into the 1959 Mental Health Act. In relation to addiction, Walker commented in closing that: ‘There is a limit to what the State should attempt, and the deprivation of personal liberty for medical reasons is far too serious a matter to contemplate unless there is overwhelming evidence of the need for it because of some widespread and particularly virulent social problem. This need does not exist in the United Kingdom’.
This last sentence is the key one. In order to fight its corner at the CND, the UK government needed powerful evidence that the domestic drug problem continued to be so small as to be negligible, a point which some other countries disputed. Consequently, ‘there would be much to be said from the point of view of strengthening our case in international circles for obtaining an authoritative opinion from a body of experts on the necessity for, and the feasibility of, providing special treatment for drug addicts in this country.’77 In other words, a Committee set up to review Britain’s arrangements could prove very useful in providing the government with ammunition which to fight its international drug policy corner, so long as this evidence indicated that the problem was tiny and relatively insignificant.
Although, as Spear claims, Walker’s superiors at the Home Office were initially unreceptive to his argument, the Brain Committee may well have been influenced by it at the meetings which produced the first report. Green led the way in producing the documentation for the Committee; mention of the expansion of the opiate subculture was entirely absent, and the growth in heroin addiction strongly downplayed. Accordingly, its Report was structured on precisely the lines that would support the government in its negotiations at the CND. It stated baldly: ‘After careful examination of all the data put before us we are of the opinion that in Great Britain the incidence of addiction to dangerous drugs… is still very small.’
This argument remains for the present a speculative one; nonetheless, the omission of the West End heroin subculture from the Home Office memorandum of evidence to the first Brain Committee, and the Report’s conclusion, which supports the UK’s requirements at CND in the run up to the 1961 Single Convention, are highly suggestive. Beyond this specific question, however, it is clear that the construction of international drug policy is a matter of both international and domestic (and transnational) domains, and that it is impossible to understand countries’ conduct in international fora without taking into account international politics and culture. And vice versa.

Dr John Petro

[1] Departmental Committee on Morphine and Heroin Addiction: Report (London: HMSO, 1926). (Rolleston Report)

[2] 59 D. R. Bewley Taylor, The United States and International Drug Control, 1909-1997 (London and New York: Continuum, 1999) p.141.

[3] Spear, H. B. & (ed) Mott, J. Heroin Addiction, Care and Control: The British System. London: Drugscope, 2002. Pp.65-89.

[4] Spear, H.B., Heroin Addiction, Care and Control p.90

[5] The National Archives HO 319/1 and MH 58/565.

[6] McAllister, W. B. Drug Diplomacy in the Twentieth Century: An international history. London and New York: Routledge, 2000. Pp.185- 211.

[7] TNA HO 319/1 ‘Dangerous Drugs Administration and Policy in the United Kingdom’ 25 October 1955.

[8] Ibid.

[9] Ibid.

[10] Ibid.

[11] Ibid.

[12] Ibid.

[13] Spear, H.B., Heroin Addiction, Care and Control, p.92.

[14] Ibid.

[15] The Tenth Session of the Commission on Narcotic Drugs, 1955. http://www.unodc.org/unodc/en/data-and-analysis/bulletin/bulletin_1955-01-01_2_page005.html Accessed 3rd September 2016

[16] TNA HO 319/1, ‘Dangerous Drugs Administration and Policy in the United Kingdom’ 25 October 1955. In this passage, Walker was quoting from a 1954 CND draft of the Single Convention.

[17] Ibid.

[18] E. Percy Baron of Newcastle Report of the Royal Commission on the Law relating to Mental Illness and Mental Deficiency (London: HMSO, 1957).

[19] TNA HO 319/1, ‘Dangerous Drugs Administration and Policy in the United Kingdom’ 25 October 1955.

[] Report of the Interdepartmental Committee on Drug Addiction 1961 London: HMSO. Paragraph 24.

Preparing for 2019: Drug Policy Objectives and Indicators, System-wide Coherence and the Sustainable Development Agenda

Preparing for 2019: Drug Policy Objectives and Indicators, System-wide Coherence and the Sustainable Development Agenda

Side event held at the 60th Commission on Narcotic Drugs offers insights into how drug policy indicators could aid in achieving the sustainable development agenda.

Nazlee Maghsoudi, Knowledge Translation Manager at the ICSDP

Click here to visit the CND Blog’s live reporting from this side event.

With the UNGASS on the World Drug Problem now a year behind us, member states are looking towards the next international drug policy milestone, a High Level Ministerial Meeting in 2019. Simultaneously, member states are over a year into efforts to achieve the Sustainable Development Goals (SDGs), a set of global targets to end poverty, protect the planet, and ensure prosperity by 2030. Given increasing recognition that the impacts of global drug policy are intrinsically linked to a number of SDGs, the Government of Switzerland, Health Poverty Action (HPA), International Drug Policy Consortium, Centro De Estudios Legales Y Sociales (CELS), Social Science Research Council, Global Drug Policy Observatory (GDPO), and the International Centre for Science in Drug Policy (ICSDP) came together at the 60th Session of the Commission on Narcotic Drugs (CND) to explore how drug policy indicators could aid member states in more effectively achieving the sustainable development agenda.

Natasha Horsfield, Policy & Advocacy Officer from HPA, outlined crucial ways in which drugs and drug policy interact with several of the SDGs, and suggested that metrics for measuring how drug policies are contributing to the SDGs should be prioritized in preparations for 2019. Speaking about goal 1 on poverty, goal 2 on food security, and goal 5 on gender equality, Ms. Horsfield explained that marginalization and inequality are important elements in the drug trade, with poverty and food insecurity a frequent factor in involvement in illicit drug markets, and women particularly becoming involved as drug couriers because of their gendered social and economic vulnerabilities. Gender inequality is reflected in the disproportionate and alarming increase in the incarceration of women for minor drugs offences. Given these and other intersections between drug policy and the SDGs, the clear, measurable, and internationally agreed framework of targets and indicators contained within the sustainable development agenda could be adapted to measure drug policy outcomes. For example, new indicators could be adopted at national level under goal 5 to measure women and girls involved in the drug trade or incarcerated for drug crimes. Ms. Horsfield also stressed that the High Level Ministerial Meeting in 2019 presents an opportune moment to align the timeline for the next drug policy framework with the 2030 deadline for implementing the SDGs.

Elaborating on Ms. Horsfield’s remarks, Luciana Pol, Senior Fellow in Security Policy & Human Rights from CELS, pointed to improvements that could be made to drug policy indicators to support the achievement of SDG 5 on gender equality. Ms. Pol noted that the Special Rapporteur on violence against women has identified anti-drug policies specifically as a leading cause of the rising rates of incarceration of women globally, and data demonstrates that a portion of women incarcerated for drug offences are coerced into trafficking and others engage as a result of lacking viable economic opportunities. Ms. Pol described concrete ways to improve the quality of data on how drug policies impact women. First, prison data should have a gender perspective by including, for example, information on the amount of pregnant women, of children incarcerated with their mothers, and access to health services for these groups. Second, since laws in many countries don’t distinguish between different types of drug offences, small and large scale trafficking are categorized together. Differentiating between the conduct for which they are incarcerated and the roles women play will improve our understanding of incarcerated populations. Ms. Pol reminded the audience that improving our understanding of how drug policies impact women is not only essential to ensuring the achievement of SDG 5, but is also a central component of last year’s CND resolution 59/5. Ms. Pol therefore called on member states to take these and other concrete steps to mainstream a gender perspective in their collection of data relevant to drugs and drug policy, and urged UN agencies to guide member states in this process of broadening and expanding their drug policy metrics.
As a contributor on law enforcement indicators to the World Drug Report, Christian Schneider, Strategic Analyst at the Federal Office of Police in Bern, Switzerland, shared his firsthand knowledge that the incomplete nature of data on drug markets can prohibit efforts to derive meaningful policy recommendations. In addition to communicating uncertainties, Mr. Schneider proposed that gaps in the data could be addressed by adopting a more comprehensive set of indicators. Sharing technical recommendations for implementing Mr. Schneider’s suggestion, Dave Bewley-Taylor, Director of GDPO, focused on how a review of the Annual Report Questionnaires (ARQs) could support the achievement of the SDGs by aligning drug policy metrics with the sustainable development agenda. According to Prof. Bewley-Taylor, despite the limitations of self-reporting, the ARQs are a useful mechanism through which member states report on their efforts to address the world drug problem. As the nature of the world drug problem has evolved, however, there have been increasing gaps in the data collected by the ARQs. This recently came into sharp focus, as the UNGASS Outcome Document included an operational recommendation to use relevant human development indicators in alignment with the SDGs to increase understanding and improve impact assessments. Within this context, Prof. Bewley-Taylor stressed that there is a clear need to review the structure and questions of the ARQs to bring them into alignment with the SDGs by incorporating indicators related to human rights, public health, and human security. Such a review could be conducted through an interagency expert group established by the Statistical Commission, which has already begun considering these issues.

Discussions on drug policy indicators and their relationship to the sustainable development agenda are undoubtedly of utmost importance at the CND, and in other forums, such as the meeting of the high-level political forum on sustainable development in July 2017. Yet, much more than discussion is needed. As Ms. Horsfield said, advancing past this critical juncture will require political will from member states beyond simply reaffirming their commitment to SDGs, but towards deemphasizing drug control efforts that undermine the SDGs and funding those that contribute positively to their achievement. Aligning drug policy metrics with the SDGs is an important step in this direction.

Click here to visit the CND Blog’s live reporting from this side event.

View from the Ground – Harm reduction, drug policy and the law in the Maghreb: focus on Morocco and Algeria

View from the Ground – Harm reduction, drug policy and the law in the Maghreb: focus on Morocco and Algeria

Khalid Tinasti, Geneva
Global Drug Policy Observatory, Swansea University
October 2016

As WordPress doesn’t allow referencing, full PDF with references available here: khalid_blog-maghreb-drug-policy_final

Introduction:

The Maghreb countries, part of the Arab Maghreb Union, are Algeria, Libya, Mauritania, Morocco and Tunisia and form the largest part of North Africa. These countries are currently in the centre of the boiling issues of the world including terrorism, human trafficking and drug trafficking. These countries are large consumers and producers of plant-based and synthetic l psychotropic substances, Morocco being the largest cannabis producer in the world in 2014. But when it comes to discussing the issue of drug use, the legal response to it, and its impact on society, the debate focuses on ideological issues of morality and the rejection of illicit drugs, as data on the prevalence of drug use and the patterns of the use in these countries are missing.

The Maghreb is also part of the MENA region (Middle East and North Africa), which is one of the two regions in the world in which new HIV infections are increasing (with Eastern Europe and Central Asia) and largely driven by drug injection. In 2014, the region has seen HIV infections related to drug injection represent 28% of all new infections, and this represents a minimum since it is based only on often incomplete data submitted by governments. The region is also home to an estimated 630,000 people who inject drugs. This blog will analyze the current situation in two major countries of the region, Algeria and Morocco, which have chosen different approaches to drugs, and compare the outcomes of their policy choices. The blog will finally highlight the current drug policy reform discussions in both countries.

The current official drug prevalence:

Morocco is the country with the most widely available data in the region, with an estimated injecting population of 3000 to 4000 according to the Ministry of Health. Drug injection is concentrated in the North and East of the country, in the transit regions that export cannabis to Algeria and Spain, and import amphetamines (mainly from Algeria) and heroin (mainly from Spain). The country is also the first Arab country, and the second in Africa, to have introduced methadone substitution therapy in six centers in 2011. Furthermore, it is among the two only countries that have a national harm reduction policy in the Arab world, the other being Lebanon. The prevalence of HIV in the general population is of 0.14% (0.1%-0.2%), and mainly concentrated among key affected populations, with people who inject drugs (PWID) representing 10.17% of this total. The country has introduced methadone therapy in prisons as a pilot project , but the author has been informed that the experiment will be extended to five penitentiary centers throughout the country in the coming months.

In Algeria, the situation of PWID or people who use drugs without injection is undocumented. There is no official data on the prevalence of drug use in the country, but it is known that cannabis is the most widely used substance in the country and its use has doubled in the course of two years, between 2012 and 2014. PWID living with HIV represents 1.1% of those tested in 2014, for a prevalence rate among the general population of less than 0.1%. In 2014, a study by the National Office on Drugs and Addiction (Office national de lutte contre la drogue et la toxicomanie) showed that the number of people who use drugs (PWUD) is 250.000, while simultaneously independent research by the FOREM (Fondation nationale pour la promotion de la santé et le développement de la recherché), a non-governmental organization, estimated PWUD to be one million people in the country. A 2006 study on the number of PWID in developing countries reveals that Algeria is the second highest burden country in all North Africa following Egypt, with a number of PWID reaching 40,961.

The two neighboring countries, the largest demographically in the region, hegemons politically and dynamic economically, are at odds largely due to their conflict on the Western Sahara, Morocco claiming its territorial integrity includes the said territory, while Algeria hosts and supports, diplomatically and financially, the separatists. The conflicting relationship between the two countries is also represented in the cooperation against drug trafficking, where they accuse each other of knowingly enriching their respective black markets of illicit drugs. Publicly and through official press conferences, Algeria accuses Morocco of the impact of the large amounts of cannabis being smuggled by the Rif traffickers, while Morocco reminds Algeria that it is one of the largest producers of psychotropic substances that flood the Moroccan black market.

The narcotic laws and drug use:

The laws in Algeria and Morocco punishing drug use and possession are harsh, as they are in the rest of the African and MENA regions. The Algerian law (Law No. 04-18 of 25 December 2004) imposes incarceration between two months to two years in addition to a fine from five to fifty thousand Dinars (fifty to five hundred US dollars) or one of the two sentences for personal use or possession. For a similar offence, a Moroccan convict will face imprisonment of between two months and one year in addition to a fine (Dahir No. 1-73-282 of 21 May 1974), or one of the two sentences. Meanwhile, the Moroccan law remains the least harsh policy in the region. In 2014, 31% of the cases treated by tribunals in the country were related to illicit drugs.

The Algerian narcotics law differs highly from its Moroccan counterpart since it gives precedence to prevention over punishment, as it states preventive and treatment measures before penal judgments. It makes treatment the basis of the legal response to drug use, and sanctions are not enforced if and until the treatment is refused. In addition, returning to treatment when necessary is not prevented even in cases where the treatment decision was previously refused (Article 9 of the law). Sanctions on drug consumption have been reduced for the following reasons: First, punishment for possession or consumption would be imprisonment of between two months and two years. This is a lighter sentence than lockup or hard labor and indicates that drug consumption or possession for personal consumption is considered a misdemeanor rather than a felony; second, the law authorizes the judge to choose between imprisonment and a fine and does not force him to combine the two and third, the judge’s authority to determine the sanction provides some autonomy as to whether imprisonment or a fine is chosen, as there are large differences between the minimum and the maximum limits.

These parameters of the law, that are presented as a prioritization of public health over punishment in drug policy, are still problematic as they allow for the institutionalization of mandatory treatment. According to Article 7 of the law, the examining magistrate or juvenile judge may order detoxification, accompanied by medical surveillance and rehabilitation for “any drug user whose condition requires these measures”. The court’s judicial authority, in this case the specialized judicial authority, may also rule exemption from sanctions (Article 8). According to Article 9, incarceration and fines shall only be applied to anyone who refrains from executing the decision to undergo detoxification. The law as it is today gives judges the power to decide on medical conditions and how they should be treated. Despite every effort, it is still difficult to find data on how many people are diverted from tribunals to treatment centers in both countries.

The findings of on-the-ground research:

To face this complex situation, in countries that produce large quantities of illicit drugs, consume heavily and carry the burden of epidemics related to drug injection, non-governmental organizations on the ground have started researching the situation and gathering evidence. The Association de Lutte contre le Sida (ALCS) in Morocco has launched on-the-ground research as early as 1996 in the Northern provinces of the country to map the injection drug use, and respond to the HIV situation. At the time, drug injection has been found to be limited. A 2003 national survey on mental health and addiction, with a sample of 6000 people over 15 years old, has shown that cannabis is the most widely used substance with a prevalence rate of 3.94%, the age of first use was decreasing, and the prevalence of heroin was of 0.02%. In 2006, with the changing nature of drug use and the spread of HIV through drug injection as transmission mode, the Ministry of Health launched situational studies on drug injection, in order to establish the first harm reduction national plan. The first action was to launch needle and syringe programmes, followed by methadone treatment. The harm reduction programme includes several advances, such as the inclusion of civil society in the delivery of services, the dispensing of harm reduction training, and the delivery of services during the night hours. For instance, the ALCS delivers through its mobile unit a needle exchange programme in three cities in the Rif. Nevertheless, the programme faces tremendous challenges, be it within the harsh legal environment or through the obstacles for the scaling up the services delivery.

In Algeria, and as stated earlier, data and monitoring of current drug policies is missing. The Association de Protection Contre le Sida (APCS) has reached out to the Moroccan ALCS to conduct a rapid diagnostic mission to map the drug situation in the capital city Algiers. For this research, 43 PWUD were interviewed, of which 5 were women, 62% were students or unemployed at the time of the qualitative interview, and represented 6 communes of the capital city. The findings concluded that outside of the squats in the Blida neighborhood, drug injection remains a personal activity, that it concerns all ages and all socio-professional categories of society. Regarding PWID, 70% injected Subutex (buprenorphine) and 30% heroin, and poly-consumption was the most shared behavior of the study participants (100%). 33% of those interviewed were incarcerated at some point in their lives, and up to 5 times for some, and for over 25% the imprisonment resulted of a simple possession offence. The study finally has shown that PWID do not access the services they need, since pharmacists refuse to sell them clean syringes, increase substantially their price, or do not have a stock in remote areas. Finally, only the national hospital of Blida offers rehabilitation and abstinence based programmes which are limited in number and do not respond to the needs of PWID.

This first study highlights the situation in Algiers, and is being currently used to advocate for drug policy and harm reduction reform with the Algerian authorities and civil society. In a consultation entitled “the role of civil society in harm reduction” held in Algiers on September 26-27, 2016 attended by the author, the representative of the Office national de lutte contre la drogue et la toxicomanie, the drug control organ under the chairmanship of the Prime Minister, announced that the country will open the first methadone induction service in Algiers in the coming months. No details were given. Moreover, NGOs collaboration between the two countries is in vivid contrast with the non-cooperation of the states on the drugs issue.

Conclusion:

Algeria and Morocco share the same languages (Berber and Arabic), similar colonial historical patterns, and the longest border for both countries. They also share the drug production, use and trafficking since they both produce large amounts of plant-based (Morocco) or manufactured (Algeria) illicit drugs; they share the same trafficking routes from the Sahara or from the Middle East towards Europe; and cannabis is the most used substance in both countries. Nevertheless, the countries have taken different public policies to respond to drugs. Morocco, a traditional and large producer of cannabis, faced with a heroin crisis in the 2000s developed the first harm reduction strategy in North Africa. Algeria, where heroin injection has not been seen as a health crisis until recently, has focused its efforts on the rehabilitation of PWUD.

khalid_blog-maghreb-drug-policy_finalAfter years of designing drug policies, mainly focused on eliminating drugs and curbing the HIV infections among PWID, drug policy reform is becoming a mainstream discussion in Morocco. The political parties PAM and Al Istiqlal have introduced parliamentary bills to legalize the medical and industrial use of cannabiskhalid_blog-maghreb-drug-policy_final. In Algeria, the debate still focuses on the issues related to trafficking and illicit production, and the announcement of a methadone service has been recurrent since 2015 without details on the location or the conditions required to enroll PWID in need of this service.

Human rights, harm reduction and you

GPDO FINAL

The UN has declared Tuesday, 10 December as Human Rights Day. The theme this year is ’20 Years Working for Your Rights’, to celebrate the 20th anniversary of the Office of the UN High Commissioner for Human Rights has been established. Among the 30 articles of the Universal Declaration of Human Rights is article 25, stating that ‘everyone has the right to a standard of living adequate for the health and well-being’ of themselves and their family. The Blue Point Foundation has been striving to uphold article 25 since 1996, and aims to celebrate 20 years of operation in 2016.

The Blue Point Foundation is a Hungarian NGO that provides a range of services for one of the most stigmatized groups in society: injecting drug users. Blue Point’s needle exchange programme, the largest in Hungary, is located in the impoverished VIII district in Budapest. The programme responds to the needs of the client population living in the area by providing services such as needles exchange, outreach and prevention programmes, as well as pioneering programmes including a women’s only day at the needle exchange location, a City Art Workshop for young people, and harm reduction party services.

The work of Blue Point is recognised internationally. The MAC AIDS Fund has recently awarded Blue Point the equivalent of almost £14,000 to continue their services in the VIII district, including the implementation of on-site rapid HIV and hepatitis C testing. This is the second year in a row Blue Point has been granted this award by the MAC AIDS Fund.

This year Blue Point was also awarded a grant from the Norway Civil Fund to develop innovative peer-led services at the needle exchange location. This project is based on an intervention model of care, and is the first of its kind in Hungary. The uniqueness of this pilot project is the key role needle exchange clients have in developing and adapting the centre’s services and outputs in partnership with volunteers and workers of Blue Point.

While international funders continue to acknowledge and support the valuable work of Blue Point, the local VIII district council in Budapest has chosen to ignore the centre’s collaborations within the community. During a council meeting in mid-September of this year, the representatives of the council voted to terminate the 2010 agreement that covered cooperation between Blue Point and the local government. This agreement will end on 31 December 2013. Blue Point already operates in an unfavourable political environment in Hungary, as the new National Drug Strategy that was enforced in July 2013 includes criminalising the consumption of drugs and enforcing more strict penalties for drug related offences.

International evidence has consistently affirmed that needle exchange programmes and other harm reduction initiatives are effective public health measures and reducing drug related harms including the spread of infectious diseases. It is baffling that the VIII district council has chosen ideology over evidence-based research to make their decision. Human rights organisations such at the Hungarian Civil Liberties Union have voiced their opposition to the decision of the VIII district council’s decision.

On Human Rights Day 2013, the Budapest council of the VIII district should be reminded that their decision to end the agreement with Blue Point is a statement against supporting the most vulnerable people in their district. Taking steps to ensuring human rights of all citizens, especially those in most need of help, means continuing to cooperate with health and social services designed to respond to those needs.

Every signature counts; please show your support to Blue Point by signing the Correlation Network petition here.

This blog was written by Camille Stengel who is a member of the GDPO PG Network

It originally appeared on the IDPC blog – http://idpc.net/blog/2013/12/human-rights-harm-reduction-and-you