Soft war on drugs
ROMESH BHATTACHARJI
Portugal shows how drug addiction, when treated as an illness and not as a crime, can be controlled effectively.
The reception centre at TAIPAS, a rehabilitation centre in Lisbon.
Immediate attention is provided here to any drug user seeking it.
THE life of a drug addict is tough. And an addict in India is usually from a poor and broken home. It is, therefore, pointless to victimise him or her by jailing, as is done in India. Had incarceration reduced addiction, this penal system could have been tolerated. But, year after year drug addiction has only increased, and so has drug trafficking. It is time for India to revise its policy of heaping indignity on an already defeated person.
Drug addiction has to be treated as an illness and not punished as a crime. The reasons for addiction are many. In Nagaland and Kashmir, it could be the continuous harassment by security forces. Or even the lack of sports facilities. In Punjab and in cities like Mumbai and Delhi, it could be unfulfilled ambitions, unemployment or peer pressure. In Arunachal Pradesh, Rajasthan and Madhya Pradesh, drug use is also a tradition. For overworked truck drivers it has become a necessity. And all over India one common reason is terrorised childhood. Addiction gives temporary protection from pain and freedom from anxiety.
Most of the 110,000 or so narcotics cases in courts across India are against drug addicts, some of whom are petty peddlers and couriers. They are being prosecuted for keeping small quantities, such as 5 grams of heroin or one kilogram of ganja (cannabis, or marijuana). For this they can be jailed for up to six months or fined Rs.10,000 or both. Only juveniles can escape prison. Fewer than 200 of these cases are against traffickers. Not a single trafficker has been prosecuted as yet. Two people have been sentenced to death in drug-related cases, but they, too, were mere couriers.
Happy ending
In October 2008, about 250 young people were arrested in Mumbai for having taken some kind of narcotics. All of them were released after they paid bail amounts that averaged Rs.20,000 for each person. The police said that they had taken a sympathetic view of them as they were young. What was not said was that they were all from wealthy and influential homes. There are thousands of not so advantaged addicts languishing in jails throughout India.
Seven peddlers were also arrested in the Mumbai case. But no follow-up investigation was done to find the suppliers of the drugs. There have been similar well-publicised mass arrests at parties elsewhere, with the same happy ending. A "sympathetic" police force lets off the drug users, and beyond arresting a peddler or two no effort is made to go up the trafficking ladder. It is both by design and because of inefficiency.
For about two decades, a movement to decriminalise addiction has been becoming popular. It started in Europe, and Portugal was the first country to take the step, despite being reviled by the United States, the United Kingdom and their lobbyist, the United Nations Office on Drugs and Crime. They screamed that this would encourage drug tourism.
Patients vs criminals
In Portugal, addicts are treated differently - as patients, not as criminals. They are asked to appear before the nearest and most convenient Drug Addiction Dissuasion Units (CDT) within 72 hours of detection.
At a centre in Setubal, where addicts are given food and administered recovery medicine. A psychologist then talks to each addict and records improvement, if any.
The CDT is assisted by a technical support team. Here, each person, whether a recreational/occasional user or an addict, first has a lengthy discussion with the technical support team. This team comprises a doctor, a psychiatrist, an educationist and a social worker.
They investigate the reasons for the addiction, even recreational use.
After this session, the addict appears before the main CDT, which has a sociologist, a psychiatrist and a lawyer. The CDT's guiding rule for treatment is to have a clear grasp of the reasons for drug use, for only then can the user be cured.
The CDT studies the recommendations of the technical committee and discusses all options before deciding on a course of action. A repeated recreational drug user is normally released with a warning, asked to pay a fine (in rare cases), or asked to do social work. The hardened addict is sent for rehabilitation after he or she has been kept under observation for some time.
In the case of addicts booked for the first time, proceedings are suspended for four months, and the case is closed if there is no repetition of drug use during this period. There are no prison sentences. There is not even a fine for those who are dependent on drugs. At a CDT hearing in March in Lisbon, this writer saw a 29-year-old airline employee caught with one gram of hashish outside a party. She was allowed to go after a short lecture. Not even a warning was given.
The police may interrogate the addict about the source of supply, but he or she is never taken to a police station. They treat the addict as a victim and addiction as an ailment. They do not penalise it. The new law, which decriminalises addiction, Law 30/2000, has in one stroke done away with about 30,000 prosecution cases. Jails have emptied out.
Enforcement has more time to follow the main traffickers. And they have not been disappointed. Fewer cases are being made but larger quantities are being seized, and bigger traffickers are being put in limbo.
Argentina, Brazil and Mexico have similarly decriminalised the possession of controlled drugs. And the Cassandras on either side of the Atlantic who had predicted drug tourism have been proven wrong. Yet, they do not give up their propaganda. The latest report of the International Narcotics Control Board worries that such steps will "send the wrong message". This criticism was included despite overwhelming evidence that enforcement and ferocious laws have failed to prevent the availability of drugs.
The first impression of the rehabilitation centres in and around Lisbon is of friendliness without condescension. The guiding theme is that every addict is a human being and has a dignity that has to be salvaged.
The beds, rooms, hall, kitchen and toilets are spotlessly clean and have plenty of light. The "patients" are offered opportunities to do something useful, without compulsion. They have music, reading, sculpture, and, of course, computers. The addicts are given methadone as a substitute for drugs. Though no drugs are allowed inside, the addicts can go out and consume them. The addicts in these centres pay for the treatment only if they can afford it.
In spite of the bright and friendly environment, the air of despondency that surrounds most of the addicts is all too apparent. It tests one's patience and fortitude to help them recover. And it takes a year or even more. Dr Gabor Mate, a well-known Canadian recovery specialist and author, was once told by a victim of severe addiction: "I am not afraid of dying. Sometimes, I am more afraid of living." There are many like him all around the world. In India, they are not only victimised, but brutally exploited.
Dr Joao Castel-Branco Goulao, the President of the Institute of Drugs and Drug Addiction, Ministry of Health, and Chairman of the European Monitoring Centre for Drugs and Drug Addiction, is one of the driving forces behind this new policy of decriminalising addiction. There was a long process of consultations and debates in the media and in Parliament and then discussions with the President before Portugal adopted the law.
It was implemented in November 2001. The law has done away with imprisonment for drug possession and has introduced a system of referral to the CDT.
Dr Goulao stressed that the law did not legalise addiction, but it did not penalise it either.
The prohibition of drug possession through administrative regulation rather than criminal penalties was one of the dozen objectives of the National Strategy to Combat Drugs Portugal adopted in 1999. It included increased enforcement of laws prohibiting the trafficking and distribution of drugs, increased efforts for social and vocational reintegration of drug users, and doubling of public funds for treatment and prevention services. This plan depended solely upon the guiding principles of humanism and pragmatism and accepted the right of the people who have drug problems to receive treatment.
Effective strategy
It was very effective. Portugal, which had the highest human immunodeficiency virus (HIV) cases in Europe in 1998 because of needle sharing, had reduced such instances to zero by 2007. Portugal still has a high level of HIV cases, but now they are only because of unsafe sex.
Cannabis usage had increased by 2007, but addiction to heroin, cocaine and synthetic drugs had decreased. Deaths due to overdosage came down by 60 per cent in 2007. The fall in deaths due to overdosage has been linked to the big increase in the number of heroin users who opted for substitution treatment.
Most encouraging of all, drug-related crime showed an impressive decline of about 30 per cent until 2007. Along with decriminalisation was the philosophy of harm reduction, which is slowly being accepted as a panacea in many countries. Pakistan and Iran are also experimenting with it. It is the prescription to reduce adverse health and social consequences for drug users and their families, without necessarily ending drug consumption.
This writer visited two rehabilitation centres in Lisbon, TAIPAS within the government hospital, Julio de Matos, in north Lisbon, and Teen Challenge, a church-run centre, in south Lisbon. At both centres, free methadone was being administered to both outpatients and inpatients as part of substitution treatment. The recovery rate at these centres is about 30 per cent. The people involved are optimistic that the figures will improve soon. Every eight years this scheme is reviewed.
Most governments treat addiction as a crime and use repressive measures that deny drug users human rights rather than put public health needs first. And despite years of ruin and failure, they persist with these.
Human rights abuses in the case of people who use drugs are widespread.
This is the biggest fault of the Indian enforcement system. No concerted attempt has ever been made to target the trafficker. If attempts are made to decriminalise the possession of drugs by addicts, there will certainly be a howl of protest from bureaucrats, for then where will their statistics come from? One senior enforcement officer who successfully supervised large and repeated seizures of Afghan heroin from low-level couriers in Punjab until last year told this writer that if they went after the big fish they would not be able to seize so much so consistently.
If, by some bureaucratic sleight of hand, drug addicts are exempted from punishment, imagine the relief in the jails and courts and for the enforcement people. They will then have the resources and time to chase the major traffickers.
India has more than five million people addicted to narcotics and their synthetic substitutes. Theoretically, all of them, except those under 18, can be sentenced to six months in jail. Imagine what havoc it would have created in our already overcrowded jails if the enforcement authorities were well staffed and then followed this legal provision. To penalise the already suffering drug addicts with imprisonment, even though it is for six months, is to make him or her an irrecoverable human flotsam.
In many countries, including the developed ones, there is an intense debate on decriminalising drug abuse. Even in the U.S., which has 30 per cent of the world's prisoners despite having just 4 per cent of the world's population, many States are examining the ideas of harm reduction and decriminalising drug possession by addicts.
The guiding principle is that people who are sick or who are victims themselves ought not to be imprisoned, for they will certainly be criminalised. The Indian bureaucracy may need a few more years to rethink its strategy, but by then the problem will be insurmountable.
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