Most Improved (Drug Policy) Player: The USA

One of the thematic threads holding together the 53rd Session of the Commission on Narcotic Drugs (the CND is the UN's global drug policy body) was the "debate" on "demand reduction." The latter term refers to how countries go about reducing domestic illicit drug demand and consumption. And there's no real "debate," just a series of statements read by each country's representatives.

Still, if you like the world of diplomacy, and you enjoy subtext as much as the next person, it's a fascinating exercise.

There was quite a lot of reference this year, both covert and overt, to last year's 52nd CND debacle. As you may recall (and if you don't, I've written about it exhaustively here, here, and here), the term "harm reduction" did not appear in the final Political Declaration that came out of the meeting. Consequently, CND 2009 ended in chaos: 26 countries, mostly European but not only, broke the traditional consensus and publicly distanced themselves from that final document.

This year, in an unscheduled but determined continuation of that very genuine debate, country after country talked about whether and how they do or don't include harm reduction in their national policy. I'd be zoning out and playing on Twitter and suddenly become aware that Romania was extolling the virtue of their harm reduction approach to domestic drug policy. Or that the Japanese were making a point of announcing -- not once, but twice -- that methadone isn't a form of treatment for methamphetamine use and they have a zero-tolerance society. Maybe the "meth" bit confuses them?

Despite those very same great strides I described in my last post regarding the US team's realigned approach to drug policy under the new administration, the US remains doggedly opposed to the actual use of the term "harm reduction." Yet at the same time it supports many of the practices associated with it. This means that the US statement reinforced this administration's support of needle exchange as well as every intervention that appears in the United Nations Office on Drugs and Crime's Technical Guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users.

But it also made clear that the US doesn't support harm reduction interventions that it doesn't consider geared toward decreasing drug use, such as safe injection sites. It's too bad that this view -- so adamantly stated -- isn't based in fact. Take the research on Insite, the safe injection facility located in Vancouver, Canada that has a drug treatment facility within its premises. Research shows that clients of Insite increased their use of both its short-term detox and long-term drug treatment facilities. Add to that the fact that programs providing prescription heroin to users also appear to have been maligned: again, studies show that participants decrease their use of illicitly bought heroin and other drugs. So perhaps a little further investigation on the part of the new administration wouldn't go amiss, eh Team USA? You win my "Most Improved Player" award this year. Why not go for MVP at CND 54?

The same cannot be said for the Russians, whose drug polices and practices remain as murderous as ever. One of the resolutions on the floor supported drug users having access to HIV prevention, treatment, and care. The resolution did not pass as written: even once harm reduction language was removed and the resolution watered down, the Russians did their damndest to block it. (The US, on the other hand, again showed its new found grace by becoming a co-sponsor and shepherding the resolution through.) It's a sinister feeling listening to the Russians speak as you know that the policy behind their words means a death sentence for people who use drugs back in Russia -- a country where, ironically, the abuse of alcohol is normalized, widespread, and entirely accepted. Kudos to Michel Sidibe, the Executive Director of UNAIDS, for taking the decidedly undiplomatic tack during his CND address of telling Russia to change its policies. (I didn't catch the closing of this year's CND, but reportedly the Russians obfuscated to the very end and challenged the final report. Apparently the US and the UK fought back and all ended well.)

I heard more good news about the very real turnaround in US policy while sharing a bus to the airport with the Dominican Republic's Drug Czar -- this time, from the supply side. For the first time in his career, the US has given him money for drug treatment while removing money from the militarized side of supply reduction funding.

Overall what we're witnessing are the beginnings of the changes in drug policy that were promised under Obama last year -- his blueprint -- in action. There's greater emphasis on domestic issues and an expansion of drug treatment and addiction medicine. We're not where we want to be yet, but there is, at least, an openness toward the world of harm reduction at the very top levels of the ONDCP that hasn't been there before.

As someone said the other day, "Maybe I'm optimistic to say the glass is half full now, but at least the glass isn't broken. It's holding liquid now."

Re-posted from Daily Kos