Public Health

ICOS Public HealthDrug policy as a public health issue and a  development challenge

ICOS supports a public health approach to drug use and, since 2002 has been working towards the establishment of new international approaches to tackle drug use and drug production by promoting and advocating for public health, rather than criminal justice oriented responses to drug use.

Despite a growing move at the international level to approach drug use as a significant and escalating public health concern with drug addiction being seen as a treatable condition, a trend of concern is the shift from drug consumption from developed to the poorest countries.

Because poor countries lack the resources and infrastructure to deal with drug addiction, problem drug use is causing a growing public health crisis in developing countries. The World Drugs Report 2010 from the United Nations Office on Drugs and Crime warns of rising levels of heroin use in Eastern Africa, and a rapid increase of cocaine use in West Africa and South America, whilst there has been dramatic growth in the use of synthetic drugs in the Middle East and South East Asia.

Underdevelopment also renders countries vulnerable to drug trafficking and other types of organised crime, violence and insecurity. In regions that produce illegal drugs, drug policy efforts must therefore also address poverty reduction.

Illegal drugs are simultaneously a symptom and the cause of high levels of insecurity, which in turn hinders the development of stable and prosperous communities: as a symptom, drugs are largely produced and often consumed in countries with high levels of social inequality, unbalanced economic development and weak institutions; as a cause, drugs engender poverty and crime, fuelling insurgencies, corrupting public institutions and threatening the rule of law, democracy and development.

Current trends in drug use and drug addiction

Recent trends suggest global drug consumption is set to rise dramatically in the coming years and that it is already fuelling a growing worldwide public health crisis. At the heart of this crisis lie the ‘problem drug users’ who are dependent on the drugs they use. Despite their evident need for assistance to deal with their addiction, UNODC estimates that in 2008 (most recent available data) between only 12% and 30% of problem drug users received treatment, meaning that between 11 and 33.5 million problem drug users did not benefit from the treatment they needed for their addiction.

Despite the apparent stabilisation in the numbers of users of cocaine and heroin, there is growing evidence that drug use and drug addiction is shifting to other drugs.  The misuse of prescription drugs is now of major concern in many parts of the world, and it is estimated by UNODC that in future years the global number of people using amphetamine-type stimulants (ATS) could exceed the number of opiate and cocaine users combined.

Recent data from UNODC suggests that the worst affected are low-income earners and citizens of less economically developed countries who are suffering the consequences of this trend. While expanding economies such as India and Brazil are likely to drive rising consumption levels in the growing middle classes, the stable high demand for drugs in Europe and North America is impacting usage by poorer communities in the most vulnerable regions along transit routes.

These transit regions are severely afflicted as they often lack adequate infrastructure and information for tackling the growing problems caused by drug use. Parts of West Africa, an important hub for cocaine trafficked to Europe from South America, are recording an increase in drug dependence in their populations. This is exposing the affected countries’ deficiencies in dealing with the resultant social and health problems. Similarly, in Asia, the illicit narcotics trade is increasing demand for intravenous drugs in ill-prepared transit countries such as Uzbekistan which are witnessing rising HIV/AIDS levels.

According to the latest available statistics for Britain, one of the most advanced countries for drug treatment in the world, of the 61,384 drug treatment clients in the period 2008/09, only 41% were discharged successfully. This indicates that the process is inefficient even where some of the most sophisticated treatment systems exist, further research is required to scrutinise current techniques.

Given these trends in drug use and drug addiction, it is increasingly urgent to identify new ways of treating drug addicted individuals if the health crisis associated with drug use is to be alleviated.

The potential for research into drug addiction and effective new drug treatments

The number of people using drugs (currently estimated at 155-250 million) is set to increase as drug use rises in emerging countries as economies grow and new middle classes possess newly acquired disposable incomes, whilst in poor producing countries or in countries on drug trafficking routes it is the very poorest who are most at risk of becoming addicted.

Research into drug addiction and effective treatments to treat addiction to drugs such as cocaine, crack cocaine, amphetamine type stimulants or cannabis is becoming urgent. Cocaine and crack cocaine, for example - two highly addictive and widely used substances - do not yet benefit from medical substitution treatments similar to the use of methadone in treatment of heroin addiction. Treatment is currently reliant on psychosocial techniques that are difficult to replicate in countries with limited numbers of trained specialist therapists. A substitution treatment equivalent to methadone for opiate addiction is an example of a potential research priority.

Rome Consensus for a Humanitarian Drug Policy

Red Cross National Societies of twenty European countries launch the second phase of the Rome ConsensusAn initiative of ICOS and the Italian Red Cross, the Rome Consensus for a Humanitarian Drug Policy was developed to respond to the health disaster caused by drug use and drug addiction. In many countries and regions of the world, injecting drug use has become one of the main modes of transmission of HIV, by means of sharing needles and other drug paraphernalia.

The Rome Consensus works with 121 National Societies of the Red Cross-Red Crescent Movement from all around the globe to build the Movement’s capacity to develop health responses to the spread of HIV though injecting drug use. The initiative aims to contribute to the global effort to reduce the spread of HIV by mainstreaming public health policies that prevent transmission of the virus - such as the distribution of clean needles - within the Red Cross-Red Crescent’s established and wide-reaching health delivery network.

The Rome Consensus provides the support that enables National Societies of the Red Cross–Red Crescent movement to promote and implement a humanitarian response to drug use. It provides a framework that clearly lays out health principles and practices, information and research on drug consumption issues and best practices in drug policy responses and assist National Societies in implementing effective responses within their communities.

How does the Rome Consensus work?

The Rome Consensus is articulated in regional “Chapters” to tackle the specificities of each geographical zone. To obtain a tailored response in each region, a three-pronged approach has been developed:

Research and Knowledge Development

To assess the drug consumption landscape and drug policy issues in the different regions, the Rome Consensus Coordination team conducts field research and develops publications.

Knowledge Sharing and Capacity Building

To foster exchanges of knowledge and know-how in different regions and strengthen capacity among health practitioners, The Rome Consensus Coordination organises conferences, seminars and training courses.

Humanitarian Drug Policy Implementation

To implement public health based humanitarian approaches to drug policy, the Rome Consensus Coordination implements in cooperation with local partners a series of pilot projects in different regions.

Rome Consensus Europe benefitted from the support the European Commission

In 2008, the European Commission selected the Rome Consensus for a Humanitarian Drug Policy as a privileged partner to promote a public health based drug policy in Europe. With the support of the European Commission, the Rome Consensus established the Rome Consensus Europe initiative to bring together Red Cross National Societies and European Institutions to promote health based responses to drug related suffering in Europe. Rome Consensus Europe’s activities will focus on bridging the gap between the European Drug Strategy and the Red Cross-Red Crescent engagement in drug policy. To achieve this goal the Rome Consensus Europe initiative will focus on research, publications and dissemination of information and training and pilot project implementation.