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The US & Harm Reduction

By John Clarke

This post has been robbed in its entirety with per­mis­sion from the always-elo­quent Neuro­bonkers.

newly leaked cable exposes the intense inter­na­tional pres­sure the United States placed on the United Nations to block the suc­cess­ful drug harm reduc­tion strategies we have in Europe. The sci­entific facts are astound­ingly clear regard­ing this issue. Harm reduc­tion is a par­tic­u­larly serious issue because it does not only save the lives of drug users but pre­vents the spread of HIV. Due to our strategies of harm reduc­tion such as meth­adone pro­grammes and needle exchanges for intra­ven­ous drug users Europe has some of the lowest HIV rates in the world. America and Russia have the worst HIV rates in the developed world because both of these coun­tries do not prac­tice harm reduc­tion meas­ures. This message is par­tic­u­larly serious coming from the US because accord­ing to US law items which prevent HIV being trans­mit­ted are not only denied to health author­it­ies but they are actu­ally illegal to possess, there­fore pushing harm reduc­tion char­it­ies such as needle exchanges under­ground. If this were to happen here we would see levels of HIV sky-rocket towards the appalling levels seen in the United States and Russia. If this is not wor­ry­ing enough the rhet­oric being used to support the US strategy is frankly sick­en­ing. The rhet­oric is that the more dan­ger­ous drug taking is, the less people will take drugs. The fact that this results in count­less unne­ces­sary deaths and trans­mis­sion of HIV which would oth­er­wise be com­pletely pre­vent­able is not con­sidered.

In the cable the European stand­ard of harm reduc­tion is described as an “EU Crusade on Harm Reduc­tion” (sic). The irony here is on a number of levels. Firstly, a “crusade” is a war based on the impos­i­tion on moral/​religious values. The US is con­duct­ing a crusade based on the mor­al­ity of drug abuse yet it is the US however who are accus­ing Europe of a “crusade on harm reduc­tion”. Secondly, this is clearly not a European crus­dade on harm reduc­tion, perhaps it could con­ceiv­ably be a crusade for harm reduc­tion but def­in­itely not on harm reduc­tion. Thirdly, assum­ing that is what they meant, a “crusade for harm reduc­tion” is perhaps the most poet­ic­ally, para­dox­ic­ally absurd descrip­tion of a basic health care prin­ciple I’ve ever heard. Fourthly, it is pat­ently obvious that it is the US and not Europe who is actu­ally enter­ing a “crusade on harm reduc­tion” namely because they are the only ones cru­sad­ing in any way shape or form with regard to this issue. (Ok, so are the Rus­si­ans but they’re just as barmy). Finally, I hope I need not explain the final tragic irony of describ­ing the impos­ing of a new morally driven blanket ban on a basic health care prin­ciple that stops the spread of HIV as a “crusade”. The ori­ginal cru­sades res­ul­ted in a still exist­ing blanket ban on the primary barrier to HIV trans­mis­sion and this is of course, the main reason we have a global HIV crisis in the first place. My only con­clu­sion is that this wording was a failed attempt at very dark humour. Trust the Amer­ic­ans to fail at irony. Damn, I’ve just pissed off both of the world’s largest super­powers and the world’s largest reli­gion in one fell swoop. Maybe we should keep the nukes after­all. At least nukes don’t give us AIDS.

Foot­note: The title of para­graph four of the leaked cable is “Is it EU Solid­ar­ity or (the) UK Leading the Crusade?“. If the Amer­ic­ans insist on calling life saving harm reduc­tion a crusade and sug­gest­ing it is us that are leading the charge then this is perhaps the first crusade in our history that we can actu­ally be proud of.

Addendum: Alan Clear, the dir­ector of The Harm Reduc­tion Coali­tion repor­ted the actual events that res­ul­ted from this only now released cable…

“Would the UN Member States assemble a polit­ical declar­a­tion almost identical to the last one? The 1998 version dealt with drug demand reduc­tion by adopt­ing what we now know to be the expens­ive, inef­fect­ive, and dis­astrous law-and-order route that has cost the US alone 40 billion per year – without sig­ni­fic­antly redu­cing either supply or demand – and made us the world’s largest jailer of our own people.

…Or would this be the year that member states would move towards a public health and human rights approach to drug policy?…

…to reject the inclu­sion of the term “harm reduc­tion” in the Polit­ical Declar­a­tion being endorsed at this meeting is extremely short sighted and prob­lem­atic. It puts the US in the pos­i­tion of sitting in judg­ment of suc­cess­ful pro­grams being run by many coun­tries glob­ally; it also ignores the very suc­cess­ful use of harm reduc­tion in the United States to stem the tide of over­dose deaths, low threshold drug treat­ment and Hep­at­itis C treat­ment and care in major centers includ­ing New York City. Worst of all, it negates the sound science behind inter­ven­tions like safer injec­tion spaces or heroin pre­scrip­tion pro­grams.

…This meeting is unfor­tu­nately timed. Whereas the new Obama admin­is­tra­tion is making steps to move in a more pro­gress­ive human rights based dir­ec­tion, the ground­work for the draft­ing of the Polit­ical Declar­a­tion has taken place with State Depart­ment employ­ees who took their dir­ec­tion from the pre­vi­ous admin­is­tra­tion and haven’t yet been presen­ted with a new agenda. Sadly it will be another 10 years before there will be an oppor­tun­ity to revisit UN drug policy again.”

The full Leaked cable


Ref­er­ence IDCreatedReleasedClas­si­fic­a­tionOrigin

DE RUEHUNV #0031/01 0271621
R 271621Z JAN 09

E.O. 12958:  N/A
SUBJECT:  Breaking the UNGASS Impasse on "Harm Reduction"
REF:  A) UNVIE 00001, B) Tsai-Pala 1/23 email
¶1. (U) This is an action message for INL/PC and IO/T.  Please see
paragraph 7.
¶2. (SBU) Negotiations for the UNGA special session have hit an
impasse, created by EU insistence on adding the controversial term
"harm reduction" to various parts of the draft UNGASS action plan
and political declaration.  While Canada, an opponent of the term's
inclusion, is considering conceding to EU demands, other opponents
are standing firm with the U.S. in preventing such a problematic
element's inclusion.  Mission has engaged counterparts at every
level, from experts to ambassadors in an attempt to break the
impasse and find compromise language.  Mission believes there is
increasing pressure within the EU to resolve this gridlock and avoid
an embarrassing showdown at the March Commission on Narcotic Drugs
(CND) but some delegations will be inclined to hold this issue
hostage up until the opening of the CND, in hopes the US will
relent.  To facilitate EU compromise, Mission recommends that the
Department reach out to various capitals and the European Commission
to help underscore the firmness of U.S. resolve-both to our allies
and to the EU, before the EU horizontal group meeting in Brussels on
February 4.  Mission has urged like-minded countries here (Japan,
Russia, Colombia) to take similar actions.  End Summary.
EU Crusade on "Harm Reduction"
¶3.  (SBU) There have been difficult negotiations in Vienna on the
"harm reduction" issue in the demand reduction chapter of the draft
UNGASS action plan (Ref A) and political declaration.  The Czech
Republic reiterated this demand on January 26 on behalf of the
presidency.  The plan will be annexed to the political declaration
expected to be issued by ministers attending the high-level segment
of the UNGASS review meeting in Vienna March 10-12, 2009.  The main
divide is between EU advocates for including "harm reduction" in the
plan, and those who oppose such inclusion, namely U.S., Russia,
Japan, Colombia and possibly Canada.  Although opposed to harm
reduction, Canada's experts in Ottawa are receptive of a recent
compromise (including the term in a footnote rather than in the
text), and we understand that Ottawa will have a discussion on the
political level to decide how to handle this issue.
Is it EU Solidarity or
UK Leading the Crusade?
¶4. (SBU) Recent meetings to reach a compromise with EU had been
inconclusive.  The USG (United States Government) cannot accept including the specific term
"harm reduction" in any part of the action plan.  The USG also wants
the section to focus on "prevention, treatment and rehabilitation"
in the consideration of any demand reduction strategy.  The EU, on
the other hand, appears less concerned about treatment and
rehabilitation.  The EU presented a very hard-line position in the
opening rounds of these negotiations in mid-January.  Subsequently,
Mission conducted extensive consultations at all levels, including
between Ambassador and the DCM with their counterparts.  Mission's
conclusion is that the EU may not have a tightly united front.  The
UK is the primary and most vocal crusader on this issue, although
Netherlands does lend occasional support, as do Spain and the EC.
Importantly, other EU countries, initially implacable, appear to be
wavering (e.g., Germany).   Still others have expressed varying
degrees of flexibility, including France, Belgium, Ireland, and
Italy, as well as Sweden, which is closest to the U.S. position.
Next Steps for Mission
¶5. (SBU) Mission continues to engage with both skeptics and
proponents of "harm reduction."  To that end, Mission plans to
offer alternative language, previously sent to INL/PC (Ref B) at the
next informal consultations.  Mission's language is based on the
November 2008 UNGA resolution on international drug control
(A/63/432), which found consensus in New York.  Importantly, that
language was co-sponsored by 58 countries, including  the U.S. and
at least 7 EU countries.  Mission will propose inserting "care" into
the language as a way to address EU concerns.  U.S. proposed
language for paragraph 9 of the draft Action Plan, therefore, would
 "Develop, review and strengthen, as appropriate, prevention,
treatment, care and rehabilitation of drug use disorders and to take
measures to reduce the social and health consequences of drug abuse
as governmental health and social priorities, in accordance with
international drug control treaties, and where appropriate, national
(Note:  The 7 EU co-sponsors of the November 2008 UNGA resolution
are: Austria, Belgium, Czech Republic, Denmark, Ireland, Italy, and
Latvia.  End Note.)
¶6.  (SBU) Mission has shared this language with Japan, Russia, and
Colombia, as well as the CND chair Namibia, who is chairing the
current negotiations on the political declaration.  Offering this
language will allow Mission to more constructively engage the EU and
the chair of the working group (Iran) (who has taken a very active
role in trying to find consensus).  Although Iran chair had
originally scheduled another informal meeting for the afternoon of
January 27, Namibian ambassador told Missionoffs and their Japanese
and Russian counterparts the morning of January 27 that she would
announce the cancellation of that meeting until further notice.  She
said she had heard from many delegations that there should be a
"cool down" period on this issue.  According to her, many
delegations are opposed to the EU position, even though they did not
speak up on the floor.
¶7. (SBU)  Mission has suggested like-minded countries (Russia,
Japan, Colombia) to intervene at the ambassadorial level in Vienna.
We have also suggested that their capitals demarche relevant
countries.  Mission will also ask the G-8 chair in Vienna, the
Italian ambassador, to convene a meeting of the G-8 members to
underline the same.  By engaging EU member states in a different
context, it may help them to reevaluate their dogmatic and
unproductive approach.
Recommended Actions
¶8. (SBU)  Action Request:  The EU's horizontal group will have its
next coordination meeting on drugs in Brussels on February 4.  In
order to break EU unity on this issue, and thereby create a climate
in Vienna conducive to compromise, Mission recommends engagement
both with skeptics and supporters of the issue.  Specifically,
Mission recommends;
 (i)  Department instruct USEU to contact the European Commission's
horizontal group on drug control (Carol Edwards at the EC).
Instructions should note that the potential for embarrassment is
great for the EU, should the EU hold hostage an entire document
because of one sub-issue in one section of the action plan..
Mission believes that each passing week without compromise will add
increasing pressure within the EU to resolve this issue and prevent
embarrassment for national ministers planning to attend the CND.
Instructions should also note that the March CND will be the first
foray of the Obama administration into the international drug arena,
and all sides should be keen to make it a positive one.
(ii)  Department instruct U.S. Embassies Tokyo, Moscow, and Bogota
to reach out to host governments and emphasize our need to continue
supporting each other, as well as the firmness of U.S. resolve and
the continuity of our policy vis-`-vis "harm reduction."  It is
important that our allies on this issue remember that the burden is
on the EU, as the proponent of the term, to convince other
delegations-not the other way around.
(iii)  Department instruct U.S. Embassy Ottawa to persuade Ottawa at
a political level that it should at least consider remaining silent
on the EU proposal for the time being, and/or until the EU shows
more flexibility.  Although there is pressure in Vienna on all
delegations to commit to the EU proposal, Ottawa should remember
that there is no need to accede to hard-ball tactics, and that the
goal is for all sides to find common ground.
(iv)  Department instruct U.S. Embassy London to underscore the need
to find common ground.  Mission believes that UK's expert in Vienna
is a driving force behind the current EU approach, and that she may
find herself isolated within the EU as other delegations begin to
feel the urgency for compromise.
(v)  Department instruct U.S. Embassy Prague to reaffirm with the EU
presidency the importance of finding common ground.  Instructions
should note the importance the USG places on getting US-EU relations
off on the right foot, and that nothing related to the CND
jeopardizes that common goal. Instructions should also note that the
Czech Republic was one of the co-sponsors of the November 2008 UNGA
resolution on International Drug Control (A/63/432).
(viii)  Finally, that Department instruct U.S. Embassies Berlin,
Brussels, Paris, Dublin, Rome, and especially Stockholm (as well as
any other capital who may be more sympathetic to the need for
compromise) to underline the firmness of our position, and the
importance of finding common ground for the March ministerial
meeting.  Instructions should also note that Belgium, Ireland and
Italy co-sponsored the November 2008 UNGA resolution A/63/432.  In
particular, it should be noted that the current EU proposal
effectively eliminates the draft's previous focus on prevention,
treatment and rehabilitation.  Although there may be some
disagreement on "harm reduction," Mission believes all delegations
should be concerned that the elimination of prevention, treatment
and rehabilitation from their prominent place in the draft may give
the wrong signal that member states are no longer focusing on the
critical need to reduce the demand for drugs.

If you liked that, you’ll love the rest of Neuro­bonkers, so go and read it all. You can also follow him on twitter if you’re that way inclined..

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