Drug policy in Eastern Europe anya sarang Regional consultation workshop towards UNGASS 2016 November 26-27, Istanbul

Overview What is Eastern Europe? Some indicators related to drug policy Two policy ‘extremes’: characteristics and outcomes Russia and its role on the international arena Toward UNGASS 2016: what are the hopes and realities?

Eastern European region Very diverse region politically and economically “there are as many definitions of Eastern Europe as there are scholars in the region” UN discusses EE as a “social construct” UNODC: EE (4 countries) UNAIDS: EECA (31 country) UNICEF: CEE/CIS (20 countries) Etc Hard to say what keeps these countries in common except for the shared geography The region consists of XX countries, very diverse Historically part of the region belonged to the ‘communist camp’ but political and economical paths have diverged. Part of the countries belongs to the EU, part is CIS, Russia and Belarus are part of the Таможенный союз (?) Countries have different traditions of public health – from very centralized, vertical and specialized systems in FSU countries to more integrated systems

Drug policies Illegal drugs legal drugs Despite differences, on the drug policy spectrum, all our countries tend to cluster somewhere in between ultra prohibition and prohibition with harm reduction in terms of ‘illegal drugs’ (drugs prohibited under the Conventions) and between light market regulation and commercial promotion in terms of legal drugs (alcohol, tobacco, pharmaceuticals) – there is actually quite a large gap between those two categories And the most ‘progressive’ and most ‘repressive’ countries place within this spectrum Global Commission on Drug Policy Report 2014

The Czech Republic Population: 10,5 mln Stable level of drug use: varying for different drugs, eg 9% cannabis use in last year, 5% ecstasy, below 1% other drugs In 2013 aprx 45 thousand problem drug users (10.7 thousand opiate/opioid users). 42.7 thousand PWID

The Czech Republic: policy principles National Drug Policy Strategy for the Period 2010-2018 Destigmatization: decreasing acceptance or tobacco smoking; increasing acceptance for marijuana use/ decriminalization Decriminalization: 2009 removed criminal penalties for personal drug possession, following an impact assessment that demonstrated the failings of previous punitive approaches Massive support to harm reduction services Treatment and social reintegration 250 addiction treatment services, of them ~200 outpatient/outreach and 50 also feature a residential component. There has been a continuous increase in the percentage of the population who oppose the criminalisation of cannabis users, particularly people who use cannabis for medical purposes.

Czech Republic: accent on harm reduction Needle and syringe programs: 2013 there were a total of 111 low-threshold programmes – 57 drop-in centres and 54 outreach. 6.2 mln needles and syringes supplied In 2013, 72 low-threshold programmes offered HIV testing, 78 HCV testing, and 52 HBV testing, and 51 programmes offered testing for syphilis. HCV treatment available for drug users. In 2013 - 536 patients, 246 HCV treatments in prisons Take-home naloxone programs increasing coverage

The Czech Republic: health outcomes HIV prevalence in PWID stable below 1% 6 new cases of HIV in PWID in one year HCV prevalence in PWID 15-50% Mortality – 45 deaths from all illicit drugs in 2013

Russia Total population: 143 mln Est 5 mln use illegal drugs (FDCS, 2010) The largest population of PWID in the world, est 2.3% (WDR, 2012) Est 1.7 mln use opiates (UNODC, 2011)

Russia: main policy principles State Anti-Drug Policy Strategy of the Russian Federation in the Period until 2020 Zero tolerance to drugs /drug users ‘Social pressure’ on drug users (promote stigma and discrimination) Restricts access to information on drugs Restricts access to drug treatment Substitution treatment and harm reduction - threat to the strategy Emphasis on drug control and heavy policing Court system tuned to punishment and imprisonment Zero government funding for HIV prevention among PWID

Russia: accent on criminalization 3d largest prison population in the world - 676 400 (Walmsley, 2014) Over 150 000 sentenced for drug related crimes N of prisoners decreases, N of drug related imprisonments increases. by 151% between 2005 - 2012 In 2010, more than 75% convictions for drug crimes = for possession and drug sell in “small amounts” Up to 65% of drug users have had prison experience Federal Drug Control Service estimates that 80% of inmates use drugs (Rossiiskaya Gazeta, 2011). Drug use and needle sharing in prisons is common; drug treatment, HIV and TB prevention not available Alternative sentencing doesn't’t work due to lack of treatment options In 2010, more than 75% of 104,000 convictions for drug crimes were for possession for personal use and for drug trafficking in “small amounts”

Russia: health outcomes 1 million officially registered HIV by the end 2015 (Pokrovskiy, this week) 200+ new HIV cases registered every day from 1987 to 2008 about 80% of HIV cases associated with the use of injecting drugs

Russia: health outcomes HIV prevalence in PWID: 18% - 31% (UNAIDS GAP Report) Reaching 74% in some cities (Mathers et al. 2008) Up to 90% of PWID infected with hep C (ARF, 2013) TB is the main cause of death among HIV positive people, TB in PWID practically not treatable. HCV treatment not available for PWID 9263 drug related deaths in 2010 (UNODC)

Summary: health outcomes Czech Republic: accent on decriminalization and harm reduction Russia: accent on criminalization HIV prev in PWID 1% ~31% (up to 74%) HCV prev in PWID 15-50% up to 90% New HIV cases 6 per year 200 per day Drug related deaths 45 deaths per year 9263 deaths per year

Russia: access to EM Methadone banned either for drug treatment or pain management 82 place in the world in access to NA Criticized by INCB for inadequate access No national strategy to ensure access to pain medications Only 12% of cancer patients and 9% of AIDS patients (of those in need) has access to NA FDCS / MH inhibit prescription and use of NA – doctors are afraid to prescribe NA complicated and bureaucratized and dangerous process March 2014: In 2 weeks 8 cancer patients in Moscow committed suicide

Russia: international ambitions Pressure on int drug control machinery (through INCB; head of UNODC) Pressure on WHO (eg recent threats to cut off funding if WHO doesn’t review its position on OST) Threats to create an international alliance against OST Regional influence through “RusAID”

UNGASS 2016 What is our dream? What can we hope for? What expectations are realistic?