Which is more mind numbing?
Today we have chosen a very current topic, which must be interesting to a wide public. These days, we are faced with this problem very often. So, we are going to talk about drugs. We will not discuss the effects of drugs on the human body, but instead of a health approach, we'll focus on the relationship between drugs and laws, legislative changes in the recent past, attempts to solve the drug problem as well as the Visegrad states' opinion on drug problems through liberalism or repressiveness. Allow me to introduce the discussants. Dr. Ivan Douda represents "Drop In", the Czech centre for prevention and treatment of drug dependence. Dr. Andrea Pelle, the leader of the legal aid service "Association for Human Rights" comes from Hungary. The Polish Republic is represented by Marek Zygadlo of the MONAR Association. I will describe the situation in Slovakia. My name is Ľubomír Okruhlica, I am the director of the Centre for the Treatment of Drug Dependencies. The first person in the discussion is from the Czech Republic.
During the past few decades, in the Czech Republic there have been many discussions about drugs. In the beginning the discussion was mostly about being either liberal or rather more repressive. The core of the discussion was the question of whether it is necessary to change the law concerning drugs. Until 1999, the law in the Czech Republic allowed the possession of drugs for personal consumption, but not for selling and distribution. Under the pressure of the Christian Democrats, the law
was changed in 1999. Possessing drugs for personal consumption was forbidden, and the penalty was also increased. A special Drug Squad was established. It has relatively strong authority and influence on drug policy. Even before the transition, we started to carry out the first programmes focused on drug users. It was a programme of hypodermic needles. Later, we applied the first programme of substitution, thus the controlled feeding of alternative legal drugs instead of illegal ones. However, the drug policy works on the basis of political decisions all over the world. Therefore, the solution of the drug problem is more or less based on a personal point of view and not on rational and professional arguments. Experts protested against the law which determined that keeping drugs for personal consumption is a criminal act. But the police argued that this situation would be a cradle for dealers who claim they keep drugs just for their own consumption. In the case of more liberal laws, the dealers could not be prosecuted, either. Recently, because of the acceptance of the new law on drugs, the European Union enabled a two-year programme for the Czech Republic. This programme should verify the effectiveness of the new law in terms of acquisitions and deficits. The out put of the research demonstrated that this amendment cost a few ten million crowns more concerning the proximate system but in fact, it did not have any impact on the drug scene at all. However, I have to say that the police and state authorities all the while behaved relatively fairly and the atmosphere is relatively liberal. Many school campaigns focused on drug prevention have been organised during the past twelve years with approximately 1 million, mostly young participants. After ten years of work it seems that the situation has stabilised. The population of drug users is getting older and most of them is on file in one of the contact centres. The chain of these centres works thanks to people such as, for example, the mayor of the capital city, Mr. Pavel Bém, who is a psychiatrist and drug specialist. Today's approach to drugs is very rational and we get support also from the current government. The chain of contact centres was built gradually. At first, professional coordinators started to work at district authorities. Later, where the territorial units of districts were cancelled, the regional anti-drug coordinators took over their tasks. In big cities, there are also town (municipal) coordinators. These experts look over their region and make sure that the chain does not have too many holes in it. Regarding the use of different types of drugs, the position of amphetamines (black beauty) is getting weaker because of other trendy influences. Lately, the price of cocaine has decreased, so the Drug Squad is afraid of a new wave of this drug.
The drug strategy of the Czech Republic relies upon prevention as well as repression. The most part of governmental expenses for anti-drug policy is still paid for criminal investigation. Besides governmental aid, the non-profit sector also plays an important role in the anti-drug strategy. However, we are still waiting for those reforms which were accomplished in Slovakia. The programmes of syringes and substitution have already been running for a long time, the level as well as the number of physicians is continually increasing. Physicians provide private substitution and use different preparations. There were heated discussions about taking drugs under medical control but this debate was rather on a political basis. However, it is interesting that at first, doctors, politicians and the police were very critical concerning controlled drug taking. But finally the results were convincing and the atmosphere is now more tolerant, the police do not focus on "small fry" and let young people smoke marijuana. According to statistics, the Czech Republic ranks at the very top of the list in the number of people who have ever tried some kind of drug, namely marijuana. The positive thing in it is that the number of cases is not increasing and young people experiment with illegal but less risky drugs. The law on drugs, similar to that which was refused 18 months before the election, is being discussed again. Then the Minister of Health asked for the full legalisation of drugs in his election campaign for the liberal party. He was the first health minister in history who wanted to win over young people in this way, since he knew that this exact issue was very important for them. At that time there were failed attempts to legalise marijuana even for medical purposes, but only one vote was missing to accept the proposal. The new draft bill, compared to the unsuccessful one, will be slightly modified. It will consist of sections on marijuana, drug use and sanctions. It will be submitted to the parliament this autumn.
As a lawyer and a leader of a legal aid service, I gained both theoretical and practical experience on the legislation of drug problems in Hungary. This legislation has changed many times during the past fifteen years. At first, the criminal statute was amended in 1993. It was necessary because the number of drug users increased. Until then, drugs were used mostly by groups belonging to the art sphere, or socially disadvantaged groups. From the beginning of the 90s, drugs spread also among other groups of society. Young people at first started to use a decoction made from poppies. Later they discovered classic drugs like heroin, cocaine, amphetamines and marijuana. However, I would like to emphasise that we can call only those who are drug dependent, "druggies". Though statistics are less reliable, since figures on addicted and occasional users depend on estimations, it is sure that the number of addicted people is under 10%. The most frequently used drugs are heroin and cocaine. However, most drug users are not addicted to drugs. Younger generations typically smoke marijuana. In most cases, it does not cause any health problems if young people occasionally smoke marijuana when partying. Also amphetamines belong in this group because most of the young people can control their use. These users do not get in touch with health care service, since the drug does not cause problems for them. There is only one sphere where they can have contact with the state because of their drug use and it is the sphere of criminal law. In Hungary, practice concerning drugs is steady: it is a criminal act to keep drugs even for personal consumption purposes. If a policeman finds a drug while checking somebody's identity, a criminal procedure immediately starts. I would like to give some information about the development of legislation during the last fifteen years in Hungary.
In 1993, the most important amendment was introduced, that is the term of diversion. In the case of the user, the criminal procedure starts but it also can be cancelled if the person concerned confirms that he participated in a 6-month treatment or public work. In the case of addiction, it is mandatory to take part in rehabilitation. In the case of occasional users who do not have health problems, it is useful to participate in preventive and community activity. This deflection is in function these days as well. However, one change has occurred. After the elections in 1998, the first task of the right wing government was to tighten the rules regarding drugs in the criminal legislation. The diversion was allowed only for addicted users. Their number is much smaller than the number of occasional users. Occasional users had to face legal proceedings. In most cases they were not sentenced to prison, but the proceeding itself took years and they had to reimburse legal charges. After the next elections in 2002, the left wing government came into power. The criminal statute was amended again and the diversion for occasional users was given back. As you see, the drug issue in Hungary is a very popular topic among politicians, especially at the time of elections. Right wing politicians struggle to enforce repressive measures, while left wing politicians are more liberal. Regarding drugs, Mr. Viktor Orbán had a famous saying: "whoever flirts with drugs, gets together with the devil". This saying determined the attitude toward drugs in the Criminal Statute for a fouryear period starting in 1998. In 2002 the very strict penalties were liberalised. In the case of drug dealers, the very strict punishment still holds, that is, the possibility of imprisonment for life. Generally, no judge applies this punishment, as it is not possible to compare selling drugs with brutally committed robbery or murder. The judicial practice accurately resolves the criminal act of drug trade, but the senate dares not touch this part of the legislation, because of the political sensitivity of this issue. Recently, keeping drugs even in small quantities is a felony and the diversion is possible for everyone. In 2006, there were 6,735 proceedings regarding drug abuse, which is a slight decrease compared to the year 2005, when the number of proceedings was 7,616. That means 10%. In 2007 the number of opened legal proceedings is even fewer. It is worth mentioning the number of proceedings started against those who kept drugs for personal consumption. In 2006, from 6,735 proceedings 5,409 were against those who kept drugs for their own consumption and only the rest were against drug dealers. To solve the issue of drug dealing is not so simple, because we have to differentiate between the real drug trade and the so-called "distribution just among friends".
Within drug distribution there also exists a so-called "distribution among friends" which is not a real distribution. The number of legal proceedings which are directed towards wholesale trade in quantities of kilograms, is only about a hundred cases annually. The activity of police is mostly directed towards the group that can be caught in the easiest way, that is the users. The police are often under the illusion that capturing users has a preventive effect. In 2007 the attitude of police has changed a little. It means that there are a few more proceedings against dealers compared to the past few years. That is probably because there are more young people among the leaders of the police who have already conducted an investigation of drug issues.
I would like to say something about the diversion. The diversion is for young people who sometimes try or occasionally use drugs but do not have any health problems. According to my opinion, these diversions appear to be folly. If young people have problems due to drug use, they can visit other medical institutions. The diversion is not even a school prevention. The diversion actually ensures a back door for users not to be punished. It is basically a farcical attitude of lawmakers to the drug issue: we do not want to punish users but we do not have the courage to modify the legislation and say openly that drug taking is not a criminal act. In many states, drug taking is considered to be a violation and not a criminal act, and only in cases where drug consumption is in a public place and in a group. Nobody should care about the things we do in our house or flat, it is a completely private thing. In my opinion it would be the first step to the optimisation of the situation in Hungary. Also from an economic aspect it would be more effective budget-wise to send those who need it to rehabilitation, and start criminal procedures against those who commit a dangerous crime. Due to recent legislation, the source distribution is very unequal. From expenses expended on drug policy, 76% of the total sum is used for fighting crime and only the rest for prevention, education, therapy and rehabilitation. I think that the given amount of money could be used in a more effective way.
Thank you very much for the interesting presentation about the situation in Hungary. Now, I ask our next guest, Dr. Marek Zygadlo to describe the situation in Poland.
We have almost all kinds of drugs in our country. It think it is an important information that Poland, Belarus and the Ukraine are the biggest producers of the highest quality amphetamine in the world. It is a dangerous drug, more dangerous than heroin. We have many institutions in Poland which are responsible for solving the drug problems. We are very proud that we can cover the treatment of the non-insured drug users. We have also had a national programme of health since 1995 which talks about drug demand reduction and limitation of accessibility to drugs. We started to think on the level of ministry and government about the approach to the drug problem, and we have a national bureau for drug prevention established in 1993 as a response to the worrying trends in the Polish drug scene. The aim of this organisation is to reduce the use of narcotics, drugs, psychotropic substances, and implement a co-ordinated national strategy against drug addiction. We have a national board of health, this institution covers the costs of treatment of patients. In July 2005 a new law was adopted to counter drug addiction. In my opinion this document is unacceptable because for any dose of drugs people can get into prison. So instead of helping them we put drug users into jails. But this act of law also has a useful part, which is introducing obligation to adapt provincial acts to avoid drug addiction. So not only the government is responsible for solving the problem but also the regional governments in the cities and villages. We have had many "shamans" in Poland-so-called experts-who tried to help the users but many of them did not have any experience and practice. We hope that this system will bring quality into this activity.
The national programme for counteracting drug addiction from 2006 to 2010 focuses on five fields, which are prevention, treatment, rehabilitation, supply reduction and international co-operation. We also have public health services like special inpatient and outpatient clinics, we offer counselling, individual and group therapy, detoxification and care.
And now a few words about what kind of role the non-government organisations play in solving the problems connected to drug users and drugs. The non-government organisations in Poland can set up non-public services for drug users. Most of them offer very good health programmes for their clients, like drug education, needle-exchange, harm reduction, psychotherapy or substitution treatment. Community prevention is also implemented through community clubs, education and training as well as through social campaigns.
In MONAR we run low-threshold assistance programmes for active drug addicts which are aimed at improving their health and social conditions. Drug related harm is also addressed and through this work we aim to counteract the spread of HIV and other infectious diseases and reduce crime connected with drug use.
Drug education is a very important part of harm reduction, because many people are using drugs without knowing anything about them, or believing several myths which are not true. Our needle-exchange programme in Krakow was the first professional of its kind in Poland. We started it in 1996, and now we have several exchange-centres all over the country.
As far as the substitution treatment is concerned, two years ago it became possible to provide substitution by non-government organisations, and nonpublic health services could establish such projects. Now we have about ten substitution programmes in Poland, last year we introduced two new projects made by NGOs. So at the moment we have about a thousand clients attending these programmes.
Nobody knows how many heroin addicts we have in Poland, it is not easy to count users in any country. According to the 1995 national health programme there was about 25 000 heroin users who needed some kind of treatment in the health system.
The NGO services provide consulting for outpatients and detoxication and rehabilitation for inpatients. They also provide postrehabilitation programmes, housing programmes, hostels for clients who finished treatment and try to find their way back to society.
I would like to end with two questions which are very important for this discussion. The first one is: What results can we expect from prohibition? The second one is: Why do we create narcofobia? Narcofobia in my opinion is the main problem of the last few years, and it exists because of ignorance and laziness. There is a great fear of drugs and drug addicts. People simply do not want to hear about these problems, while for example alcoholfobia does not really exists among them.
Mr. Marek Zygadlo, thank you for the interesting presentation. I would like to make a brief description of the situation in Slovakia. Regarding the drug issue, in Central Europe we have a lot of features in common and we also have dissimilarities. After the transition in 1989, when the iron curtain fell down, access to drugs became much easier. Contrary to in Poland, heroin became popular only after 1989, especially in Bratislava. In Poland it was earlier, in Hungary and in the Czech Republic approximately at the same time. Contrary to the Czech Republic, in Slovakia heroin was dominating compared to pervitin, which was available in small quantities even before the transition and it was practically pushed back to the periphery by the police and dealers. So during the 90s we had a huge epidemic of heroin, especially in Bratislava and later in the whole of Slovakia. Ninety percent of treated persons had a problem with heroin. At the turn of the millennium, the situation had gradually changed and the use of pervitin gained ground, which is less addictive than heroin. If somebody becomes addicted to pervitin, he/she does not have as many physical symptoms as one addicted to heroin, so the demand for treatment is not so big. Nonetheless, since 2000 we have noted a sudden increase in demand for pervitin, i.e., amphetamine addiction treatment. The situation has become stable during the last three years, the number of treated people has not increased. Obviously we always have new patients. They make up approximately 25% of those who request treatment. At the same time, the request for cannabis addiction therapy has also increased. Regarding cannabis, there are lot of discussions. This substance is not as addictive as some other drugs. Only a smaller percent of occasional marijuana users--or people who use other forms of cannabis-become addicted. Although, besides the growth in demands for pervitin addiction therapy, between 2000-2006 we noted an increased number of demands for cannabis addiction treatment. Taking into consideration the number of users, of course, it is just a small part but in terms of therapy it is a significant growth. Recently, in Slovakia these groups make up for more than 50% of treated people due to illegal addictive drugs. It means that heroin went down to under 50%. In Slovakia, approximately 2,000 people seek medical help because of drugs every year. Out of that, approximately 900 people use heroin, which has the highest addictive power. Moreover, it is usually used intravenously, so it poses the highest risk to public health. Concerning criminality, heroin is one of the most serious drugs. Lately, we can observe the increase of cocaine use, but at the moment, the number of people treated for cocaine addiction is still less than 3% of the total number of those who need medical help. The situation with HIV is similar to the Czech Republic. We started early with prevention and harmreduction.
In 1994 we had less than a hundred intravenous users in Bratislava who requested medical help, and already at that time we started to change the spikes and needles. Recently sterile needles and syringes are available in drug-stores. Of course, not every drug-store is willing to help the users, it mostly depends on the pharmacist. In most cases users can buy syringes for a low price and there is no legal ground to forbid their sale to users, so the harm-reduction is ensured mainly through drug-stores. Syringe exchange programmes operate in the biggest drug centres. Regarding the political solution of the drug problem, there are two strategies to approaching drugs. The first is a repressive force-police, customs officers0-which is aimed at supply reduction, while the second is a non-repressive way, that is, prevention and demand reduction. We who work in the non-repressive sphere divide users according to if they have health problems or not. The health problem category, besides drug addiction, consists of drug overdose and infections. The repressive approach takes a different view of it. They take into consideration the relationship between users and the law.
Andrea Pelle (advocate, the leader of the legal aid service "Association for Human Rights", Hungary), Ivan Douda (represents "Drop In", the Czech centre for prevention and treatment of drug dependence), Marek Zygadlo (MONAR Association, Poland) and Ľubomír Okruhlica (director of the Centre for the Treatment of Drug Dependencies, Slovakia.