Martin Jelsma (Transnational Institute, Amsterdam)

Lo Incb (International Narcotics Control Board) ha condannato la Bolivia per aver denunciato la Convenzione Unica sulle droghe del 1961, con l’intento di sottoscriverla di nuovo in seguito ma con una riserva sulla foglia di coca. Il presidente boliviano si è risolto a questo passo dopo che il tentativo di emendare la convenzione, togliendo la coca dalle sostanze bandite, è fallito per l’opposizione dei paesi del G8, dietro pressione americana (cfr. Salvina Rissa in questa rubrica, 29/6).

“La comunità internazionale non dovrebbe accettare che i governi usino il meccanismo della denuncia/riaccesso con riserva, al fine di non ottemperare ad alcune clausole dei trattati. Questo approccio mina l’integrità del sistema globale di controllo della droga – ha ammonito il Board – e la Bolivia dovrebbe considerare molto seriamente tutte le implicazioni del suo atto”.

Nonostante qualche passo avanti negli ultimi anni, lo Incb ha tradizionalmente interpretato le convenzioni in modo rigido e bigotto tanto da suscitare la contestazione di diversi paesi sotto tiro (si vedano gli attacchi del Board per le scelte di decriminalizzazione del consumo e di riduzione del danno).

Sulla coca, lo Incb si è sempre mostrato inflessibile e inficiato da pregiudizi, fino a ingiungere nel 2007 alla Bolivia, al Perù e all’Argentina di cambiare le legislazioni nazionali in modo da mettere al bando la masticazione della foglia e le bevande come il tè di coca, in ottemperanza alla Convenzione Unica del 1961. E’ un chiaro caso in cui un organismo dell’Onu incita alcuni stati membri a violare direttamente altri trattati e dichiarazioni delle stesse Nazioni Unite: in questo caso la dichiarazione del 2007 che protegge le culture e i diritti delle popolazioni indigene.

Il Board è nel giusto a segnalare il conflitto fra le leggi nazionali della Bolivia, del Perù, dell’Argentina (ma anche della Colombia) che autorizzano l’uso della coca nei territori indigeni, da una parte; e la convenzione sulle droghe che richiede di abolire questo uso tradizionale, dall’altra. Perciò, il Board avrebbe potuto salutare con favore gli sforzi della Bolivia per riconciliare gli obblighi dei trattati internazionali con la tradizione millenaria della coca. Invece lo Incb ha reagito con infinita arroganza. Questo organismo parla come se godesse dell’infallibilità papale e fosse perciò sollevato dal compito di motivare i propri giudizi con argomenti basati su un’analisi razionale. I membri dello Incb non si sentono in dovere di entrare nel merito e di controbattere le ragioni di coloro che si permettono di condannare, o di citare fonti scientifiche e di diritto internazionale a sostegno delle proprie opinioni.

Questa presa di posizione dello Incb è come un giudizio dell’Inquisizione: invoca la punizione della Bolivia per aver commesso peccato contro la sacralità della Convenzione, senza offrire alcuna spiegazione, argomentazione o soluzione. Esattamente come per l’Inquisizione, il proclama dello Incb non mira tanto a correggere il (paese) colpevole, quanto a spaventare gli altri e a distoglierli dal male che potrebbero commettere contro l’integrità del sistema globale di controllo delle droghe.

Il caso della Bolivia non riguarda la procedura di denuncia/riaccesso, che è legittima ed è stata usata in passato. Né riguarda l’uso della foglia di coca, che ovviamente continuerà checché se ne dica a Vienna. La vera questione è la paura di riconoscere che l’attuale cornice legale dei trattati internazionali sulla droga è obsoleta e necessita di riforme.

La Bolivia sotto Inquisizione

On 14 June 2011, the European Commission launched a Public Consultation on a Green Paper entitled "

Strengthening mutual trust in the European judicial area - A Green Paper on the application of EU criminal justice legislation in the field of detention

The Commission wishes to explore the extent to which detention issues (following a criminal offence) impact on mutual trust, and consequently on mutual recognition and judicial cooperation generally within the European Union. Whilst detention conditions and prison management are the responsibility of Member States, the Commission is interested in this issue because of the central importance of the principle of mutual recognition of judicial decisions for the area of freedom, security and justice. Is further action necessary and possible? If yes, what kind of action?

Although the Green Paper covers a wide range of detention issues which are not necessarily drugs-related, it does allow for reflection and input on probation & alternative sanctions and pre-trial detention periods which may be relevant for drug-law offences. It also covers detention conditions and the monitoring of detention conditions by Member States. These issues are of relevance for the EU Drugs Action Plan (2009-2012), and in particular in regards to the actions related to alternatives to prison (action 16), the development and implementation of drug-related health services in prison (action 21) and the monitoring of drug use, drug-related health and drug services delivery in prisons (action 22). The press statement and the Green Paper can be found on the news section of the DG Justice website.

The Green Paper contains 10 questions, and the European Commission is interested in receiving feedback, comments and replies from practitioners, such as judges, prosecutors and lawyers and other legal practitioners, police officers, directors of prison administrations, people working in the social and probation services, pre-trial detention centres and prisons, academic circles, relevant NGOs and government bodies. In short, all persons and entities with an interest in DG Justice's activities are welcome to contribute, including other European institutions and organisations, such as the Council of Europe, agencies and committees and the United Nations.

The drug policy coordination unit of the European Commission would like to encourage you to further disseminate this call for public consultation in your networks and to submit your views, expertise and contributions on those issues that are relevant for drug policies and responses in relation to prison settings to the Commission through the communication channels as identified and explained on the website of DG Justice.

Please note that responses should be sent, by 30 November 2011, to:

European Commission, Director-General Justice, Unit B1, Procedural Criminal Law, MO59 03/068, B-1049 Brussels, Belgium

or by e-mail to: JUST-CRIMINAL-JUSTICE@ec.europa.eu.

European Commission public consultation - Green paper on detention

Associated Press, JULIANA BARBASSA, July 18, 2011

RIO DE JANEIRO (AP) — In the dark before dawn, social workers advance slowly down a narrow road dividing two vast slums, entering a landscape of littered streets and broken-down shacks, where an open-air crack cocaine market does business among piles of rubble.

Escorted by police through this "cracolandia," or crackland, they look behind cardboard lean-tos, in corners hidden by overgrown weeds for drug users who emerge, dazed, from ragged blankets. Some fight and run. One frantic young woman, her pregnant belly bulging under her short top, starts crying and pulling at her hair as police officers securing the area try to pacify her.

"Calm down, Taiane. Calm down," says an officer who knows her. "Look at me. It's me."

About two decades after the U.S. emerged from the worst of its own crack epidemic, Brazilian authorities are watching the cheap drug spread across this country of 190 million people. They have far fewer resources to deal with it, despite a booming economy that expanded 7.5 percent last year.

No corner of Brazil has been spared. A recent survey by the National Federation of Counties found 98 percent of them had registered traffic or consumption of crack.

In Sao Paulo, the first place in Brazil to have a large consumer market for the drug beginning in the 1990s, police seizure of crack went from 595 kilos in 2006 to 1,636 kilos in 2009, according to federal police.

In Rio de Janeiro, arrests related to crack jumped from 546 in 2009 to 2,597 in 2010, according to the research arm of Rio's public safety department.

This spike happened even as consumption of the drug started to dwindle in the U.S. According to the U.N.'s World Drug Report 2011, a squeeze on supplies coming from Mexico drove prices up by more than 80 percent between 2006 and 2009.

Meanwhile, Brazil became the main transit country for cocaine streaming from the producing Andean nations to Europe, the report said. With a growing economy after years of hyperinflation, Brazilians also had more cash to spend on drugs.

Soon, more crack was being seized in Brazil than in the U.S. The U.N. report indicates 163 kilos were seized in the U.S. in 2009, only 10 percent of what Brazilian police say they seized in Sao Paulo alone in the same year.

"For us doctors, there is a crack epidemic," said Ricardo Paiva, who monitors the spread of the drug for the National Council of Medicine, a group representing doctors. "We feel we're losing the war."

It's a deadly battle. Research by the Federal University of Sao Paulo showed that after five years, one-third of crack users had died, most of them from violence.

A federal government plan to fight the drug was signed in May 2010, with a budget of $253 million. Critics said from the beginning the resources weren't nearly enough. A year later, implementation was lagging. Of the funds budgeted, only $57 million had been allocated, and of that, only $3 million spent.

"It's been just talk," said Paiva. "This is a serious public health problem, and the government cannot be absent."

Calls and emails to the federal department of drug control, under the Justice Ministry, were not returned, though officials agree the situation is critical.

In a recent deposition before Congress, Pedro Delgado, the Health Ministry's coordinator for mental health, drug and alcohol abuse, said Brazil has about 600,000 crack users.

Crack is cheap enough, at $3 a rock, to reach street children and the unemployed, Delgado told the representatives.

In the recent sweep of the cracolandia between the Manguinhos slum and the Mandela complex of shantytowns in Rio, 58 users who had been living in the streets were picked up.

Ten were teenagers or children. At least three women were far along in their pregnancies. They had little schooling, scant or no access to health care and no contact with the social programs that could have helped them.

Sitting in the sun a few feet away from the pile of drugs and weapons seized in the raid, Pricila Nascimento ate her fill of crackers washed down with soda. Only 17, she bore the marks of four years spent in the streets: missing teeth, a couple of long scars on her legs. She toyed with her hair clips as she spoke.

One of eight children, she studied until 5th grade, then left home. In the streets, she met young men who ran drugs and introduced her to crack, at first mixed with marijuana or tobacco, then straight.

"My mother always taught me to take care of myself," she said. She begs for money, and steals when she has the chance. "I tell you, I don't go hungry."

Until March, minors like Nascimento were picked up by police then released back to the streets, where a girl will prostitute herself just to inhale smoke from a man's pipe, said Valeria Aragao, head of the police's juvenile section.

She and Rodrigo Bethlem, the city's head of social welfare, teamed up with police in a pilot program aimed at changing the abusive, violence-prone life, at least for the minors.

"When parents can't take care of their children, their welfare is everyone's responsibility," Aragao said. "We have to guarantee their right to dignity and life."

The children and teenagers picked up since May 31 are being returned to their families, if a family can be found, or forced into shelters especially set up to detox them with medical support.

Four centers with 145 beds in all are set aside for the program, and 40 more are planned. The adults are offered treatment, but aren't forced into a shelter.

Walter Maierovitch, a former drug czar, proposes programs that offer adults health services and a safe place to use drugs. "Insisting on programs that demand abstinence doesn't work," he said. "The government can't just sweep people up."

Bethlem says "There's been a real abandonment, an absence of the state" in dealing with the crisis. His fear is that Rio's crackland will become a fixture like Sao Paulo's. "We can't start to think this is common, acceptable, to have people living like this," he said.

In the heart of Sao Paulo, an area roughly 10 blocks by 10 blocks is the oldest example of Brazil's crack problem. Addicts gather in groups of hundreds or break off into smaller bands, smoking rocks.

On a recent evening, a 23-year-old man calling himself Mario lay on a sidewalk, naked under a ragged blanket. He took a hit on his homemade pipe and apologized for how he smelled. "I soiled myself, but I can't get clean," he said.

Mario, a paraplegic, lifts his blanket to reveal two shrunken legs. His wheelchair was stolen while he slept, so he cannot get anywhere to bathe.

In Rio, even the briefest look into the lives of the crack-addicted kids reveals the magnitude of the challenge ahead.

A skinny, restless teenager, Junior Gomes de Santos looks smaller and younger than his 14 years. His eyes are yellow and bloodshot; he grinds his teeth as he talks, looking down and away.

His story is a familiar one around here; he left home because his father beat him. A cousin introduced him to crack — he doesn't remember when. He can write his name, but little more. He knows he'll be taken to a shelter, but won't stay.

"I'm going to eat, drink and bolt, go back to where I was," he said.

Yes, he knows it's dangerous on the streets, he said, but he doesn't care.

"From this world, I'm not going to take anything," he said, looking up, flashing a brief, eerie grin. "Just a coffin as a souvenir."

Associated Press writer Bradley Brooks in Sao Paulo contributed to this report.

Keep up-to-date with drug policy developments by subscribing to the IDPC Monthly Alert.

Crack hits Brazil late but hard

The Global Drug Policy Program of the Open Society Foundations is accepting applications for the position of Communications Associate.

The position will be based in London and involved with the design and implementation of the communications and outreach strategies of the Global Drug Policy Program.

Please click here for more information on this opportunity.

Open Society Foundations recruits Communications Associate

Program Coordinator (M/F), Tanzania
Closing Date: Wednesday, 31 August 2011
Location: Dar es Salam

Medecins du Monde France (MdM-France) has been present in Tanzania, in the Kagera Region, since 1992, first covering paediatric primary health care, then HIV related activities such as Counselling and Testing (C&T), Prevention of Mother to Child Transmission (PMTCT) and HIV Care & Treatment.

Following an exploratory mission, MdM started a Harm Reduction Project for IDUs in Temeke district, Dar Es Salam in September 2010. A Memorandum of Cooperation was signed between MdM, MoHSW and Temeke Council, stipulating the launch of a pilot Needle and Syringes Exchange Program. A mapping exercise of consumption sites of IDUs took place in November and December 2010 in Temeke. Since January 2011, outreach work has intensified and a Drop in Centre has been opened to the target group. After meetings with stakeholders and communities, the NSEP has also started. To accurately adapt its program, MdM conducted a Rapid Assessment and Response from March to June, interviewing and testing (HIV and HCV) more than 400 Drug Users. An experienced Program Coordinator has trained MdM team (7 Outreach Workers) on Harm reduction. She has also trained some medical personnel on the basic of Harm Reduction.

She/He is in charge of the operational management of the program.

She/he supervises and organises the implementation together with the Program Assistant and reports to the General Coordinator.

She/he participates in program proposal writing and in preparation of the program budget; reporting and may represent action of MDM in meetings and other forum.

She/he supports outreach work and interventions/activities within the cultural context and legal limits of the locality in order to reach the most hidden IDU population.

She/he with the general coordinator ensures staff development plans are created, supported and delivered.

She/He participates in developing partnerships with local partners; ensure the good relations with them and the respect of the commitments.

She/he advocates for harm reduction programs amongst the local populations and local authorities.

She/he collects, defines and analyses through incoming information from beneficiaries, medical and mental needs of the beneficiaries in order to achieve effective service focused programs for beneficiaries.

She/he defines and ensures with staff and volunteers the involvement of IDUs and development of peer activities.

She/He is in charge together with the General Coordinator and the Program Assistant of the monitoring and evaluation of the program and the possible publications; planning, management, implementation.

She/He carries continuous on the job training of MdM personnel on Harm reduction issues and other regular training sessions on agreed topics.

She/he initiates community HIV intervention activities.

She/He provides and designs Information, Education and Communication (IEC) materials regarding HIV/AIDS and drug related harms to drug users.

She/he contributes with research data and update articles to advocate for harm reduction programs and understanding of addiction care.

She/he contributes to the referral network among the existing health services for program beneficiaries and inform/train key persons in the referral network on harm reduction, addiction care and program activities in the light of HIV prevention; Initiates, advocates and participates in community HIV and hepatitis C intervention and harm reduction activities within geographical area of intervention and on national or program-exchange level if required.

A degree in Public Health or related field

At least 3 years of working in Harm Reduction

Experience in the management of diverse and creative teams of staff

Experience in addiction related (medical) care and IDU contact

Experience in community based programming

Working on capacity building of local organizations

Sound knowledge of HIV/AIDS, hepatitis C and harm reduction

Proven interest/ experience in advocacy and local counterpart cooperation/alliance building, capacity building.

Understanding of monitoring and evaluation

Good verbal and written communication skills

Good computer skills including MS Word and Excel PPT

Experience in training and scientific presentation

Fluent English (oral and written) mandatory
French and/or Swahili an asset

Ability to work in a multi-cultural environment

Ability to effectively communicate with other professionals and organisations

Ability to make decisions and solve problems

Ability to manage multiple tasks and responsibilities

Self-motivated and able to motivate others

12 months (renewable)
Starting date : 01/09/2011

915 euros / months (+ perdiem)
Family posting possible

To apply, please send a CV and a cover letter via our website.

Medecins du Monde recruits Harm Reduction Programme Coordinator - Tanzania

Azadeh Momenghalibaf, Open Society Foundations

“Hepatitis affects everyone, everywhere. Know it, confront it.” This is the slogan for this year’s first-ever World Health Organization–sponsored World Hepatitis Day, slated for this Thursday, July 28.

It is a fitting message for the day—the reality is viral hepatitis does, in fact, affect everyone, everywhere. Consider, for instance, that three percent of the world’s population is infected with the hepatitis C virus, a leading cause of liver disease. That’s 130 to 170 million people chronically infected globally. In the United States alone, as many as 3.9 million Americans are living with hepatitis C, and about half are unaware of their status.

Although hepatitis C is curable, most patients outside of the developed world are unable to access treatment. In countries as diverse as Thailand, Indonesia, Georgia, Ukraine, Russia, India, and many parts of Africa, where hepatitis C is a major public health problem, access to diagnostics and treatment barely exists. This is particularly true for people living with HIV/AIDS, for which hepatitis C is now becoming one of the leading causes of death.

One of the critical drugs in the standard treatment regime for hepatitis C today—pegylated interferon-alfa— is under patent protection and costs as much as $50,000 per course. Because of a duopoly held by the pharmaceutical giants Roche and Merck—the two companies which currently produce pegylated interferon-alfa—there is no competition by generic manufacturers that could deliver desperately needed cheaper alternatives to hepatitis C treatment. Two new hepatitis C treatments were recently approved by the FDA, yet they have to be used with pegylated interferon, adding another $30,000 to $50,000 to the cost of treatment. At these prices, how can a country like Ukraine, with more than 1 million people infected, really commit to treating its citizens?

Prohibitive pricing of lifesaving medicines is unethical and unacceptable. The only way to increase access to hepatitis C treatment is if pharmaceutical companies—in this case, Roche, Merck, and the firms with new hepatitis C drugs in the pipeline—commit to reducing their prices substantially to levels that become affordable to the majority of people in need of treatment. And because millions of people need access to these lifesaving treatments, national governments and international bodies, including the WHO, must provide the political push to make this happen.

More than a decade ago, HIV/AIDS patients marched the streets of South Africa, Thailand, and Brazil demanding affordable access to medicines that could save their lives. And with success—in a matter of months the cost of AIDS drugs dropped from over $10,000 per person per year to less than $100 today, resulting in more than 5 million people currently on treatment in low- and middle-income countries. Today, these same people are surviving on cheap generic AIDS drugs only to die from their untreated hepatitis C.

Demanding greater access to treatment is a primary reason that strong civil society groups, including people living with hepatitis C, initiated World Hepatitis Day. Roche and Merck must support people living with hepatitis C by substantially lowering the prices of pegylated interferon-alfa.

Hepatitis C: A viral time bomb

28 July 2011 marks first official World Hepatitis Day. The World Health Organization (WHO) refers to hepatitis C (HCV) as a “viral time bomb” due to the remarkable toll in worldwide infections and the extent of time it takes for HCV to become symptomatic. Globally, between 130-170 million people are chronically infected with HCV and there are approximately 10 million people living with HCV in Eastern Europe and Central Asia (EECA).

Unlike hepatitis A and B, a vaccine for HCV does not exist. As a result, every year 3-4 million people are infected with the virus (WHO, 2011). However, there is a cure for HCV. Yet, access to HCV treatment for lower middle-income countries, such as most countries in EECA, is severely limited by high drug prices. HCV antivirals are extremely costly for governments let alone the individuals in EECA where the average household monthly wages and salaries per capita range from US $277 in Ukraine to US $564 in Kazakhstan. Globally, inaccessibility to HCV treatment has contributed to liver cirrhosis among 50% of people living with the disease and liver cancer among 5% of those living with the disease. Furthermore, 350,000 people per year needlessly die from these and more HCV-related diseases (WHO, 2011).

On World Hepatitis Day, the Eurasian Harm Reduction Network (EHRN) calls for civil society to demand HCV treatment price reduction in Eastern Europe and Central Asia in order for the millions of people living with HCV to gain access to life saving drugs.

The full text of call to action is available online in English and Russian.

Mobilize civil society to demand affordable and accessible HCV treatment

Begin a HCV treatment price reduction dialogue by becoming more self-informed and educating the harm reduction community on the high prices of HCV treatment. Document facts of denial of HCV testing and treatment. Frame access to HCV treatment as a human right. Network and build alliances with HCV treatment price reduction advocates including human rights and harm reduction organizations and activists, and people living with HIV and/or HCV; and those impacted by drugs.

Put pressure on governments to develop and implement a national HCV program. Make sure that adequate funding is allocated for treatment of injecting drug users. Accumulate international expertise for HCV national protocol development.

Advocate for WHO leadership in improving access to HCV treatment

Put pressure on WHO to ensure it takes the lead in making HCV treatment universally available. Demand technical support from WHO in developing national HCV programs and treatment protocols. Demand inclusion of HCV drugs in the WHO Model List of Essential Medicines.

Study intellectual property regulations and prepare to negotiate HCV treatment prices when generics become available

Study intellectual property legislation and strategize country-specific actions to make sure generic HCV drugs are registered for when they become available.

Follow EHRN’s HCV Treatment Advocacy Efforts by visiting the EHRN website.

EHRN calls for action to reduce prices for Hepatitis C treatment

28 июля 2011 года отмечается Всемирный день борьбы с гепатитом. Один из основных типов гепатита – гепатит С (ВГС). Всемирная организация здравоохранения называет это заболевание «вирусной бомбой замедленного действия», так как, с одной стороны, заболеваемость ВГС растет во всем мире и, с другой стороны, длительное время инфекция протекает бессимптомно. По оценкам, во всем мире 130‐170 миллионов человек инфицированы вирусом гепатита С (World Health Organization (WHO), 2011). Регион Восточной Европы и Центральной Азии (ВЕЦА) в значительной степени затронуты эпидемией гепатита С. В странах ВЕЦА проживает около 10 миллионов человек, живущих с гепатитом С (Hoover, 2009).

В отличие от гепатитов А и В, против вируса гепатита С не существует вакцины, в результате чего 3‐ 4 миллиона человек ежегодно инфицируются ВГС (World Health Organization (WHO), 2011). Однако это заболевание излечимо. Учитывая достижения в лечении гепатита С, существует повод для оптимизма в отношении снижения распространенности этого заболевания. Однако доступность лечения ВГС в странах с уровнем дохода ниже среднего, к которым относится большинство стран региона ВЕЦА, крайне ограничена по причине высоких цен на лечение. Препараты для лечения ВГС слишком дороги даже для государств, не говоря уже рядовых гражданах в ВЕЦА, где средний месячный уровень доходов составляет к примеру в Украине US $2771, в Казахстане ‐‐ US $5642. Рынок препаратов для лечения ВГС контролируется двумя фармкампаниями – Мерк и Рош – которые удерживают стоимость одного курса лечения, в среднем, на уровне 10,749 – 16,123 долларов США. В условиях ограниченного доступа к лечению ВГС в мире, до 50% инфицированных заболевают циррозом печени, и до пяти процентов получают диагноз «рак печени» (European Center for Disease Prevention and Control (ECDC), 2010). Недостаточный доступ к лечению ВГС уже приводит к разрушительным последствиям в виде 350 000 смертных случаев в связи с заболеваниями, ассоциированными с ВГС, ежегодно (WHO, 2011).

Снижение цен на препараты для лечения ВИЧ стало возможным в течение последнего десятилетия благодаря активной позиции гражданского общества, ВИЧ‐активистов и правительств стран, затронутых эпидемией, и явилось результатом давления, которое они оказали на фармкомпании. Подобная стратегия поможет остановить эпидемию ВГС и спасти жизни миллионов людей, живущих с гепатитом С.

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