REMARKS OF JOHN P. WALTERS
48th ANNUAL MEETING OF THE COMMISSION ON NARCOTIC DRUGS
VIENNA, AUSTRIA
MARCH 7, 2005
A COMPASSIONATE AND EFFECTIVE POLICY AGAINST DRUGS AND DISEASE
The toll of illegal drug use is an inescapable fact that every nation must confront. The costs are measured in human suffering, in economic loss, in threats to national security, and in degrading the meaning and quality of social life. Moreover, we must confront the fact that the threat of illegal drug use is no longer confined to the impact of the drugs themselves and the criminality that they occasion. There is now the additional specter of global epidemic diseases which continued drug use abets and accelerates.
Countries confronting the threats of drug use have before them a limited number of choices. They can deny that the threat exists, and suffer the consequences. Or they can choose to push back against illegal drug use with proven policies of prevention, treatment, and judicial sanctions. This second choice is difficult, but experience in the United States and elsewhere demonstrates that it works, and ultimately, reduces costs in human and in capital terms.
Some nations have chosen, however, what they imagine to be a third option managing the consequences of drug addiction, while tolerating, or even enabling, its continuation in their presence. This option, frequently referred to as harm reduction, has seductive appeal, but delivers only an illusion.
Those who have chosen this path (which encompasses government actions such as decriminalizing drugs, enabling and facilitating drug use through distributing injection equipment, establishing drug consumption rooms, or even dispensing heroin to heroin addicts), apparently seek to make a deal with the addiction in their midst, and acquiesce in its continuation.
Their argument is that by sustaining drug use yet mitigating its consequent harms, society can somehow minimize the impact of behavior that it must resign itself to accept as an unyielding fact. This thinking is perilous.
Those who follow this path will neither escape drug addiction nor its harmful social consequences. They will surely not be able to treat and save those who could be treated and saved, nor will they be able to evade the burden of crime and disease that accompany addiction. Moreover, by potentially undermining the message of deterrence, they will put at increased risk their own future generations. Further, policies of toleration for drugs not only maintain markets for illegal drug use, they undermine the supply and control efforts carried out at great risk in many countries. Lastly, a life of addiction is incompatible with full citizenship; to sustain addiction jeopardizes the freedom of the addict, as it likewise undermines the rights of the community.
The United States currently spends $3.5 billion a year on drug abuse treatment and research, with an additional $2 billion on prevention. Every year and this does not include the additional funds spent by state and local governments and private individuals that are extensive but not systematically reported. We have learned a lot from that investment in research and practice.
We have learned that addiction is a fundamental disease of the brain, according to the best medical science. But even more importantly, we have learned that it is a treatable disease, and a preventable disease. Left untreated, it spreads, and carries with it a host of additional pathologies that threaten the well-being not only of users themselves but of their families and communities.
Seeing addiction as a contagion leads us to a fundamental epidemiological understanding we can interrupt the vectors of contagion, and stop the spread of the disease, as we treat those afflicted and restore them to health and acceptance in their communities.
Under a regimen of effective treatment, lives can be restored in their fullness and productive vigor. Some see this as the miracle of recovery. It is the miracle of successful treatment of a deadly disease. From the perspective of both public health and moral responsibility, we must intervene with prevention and treatment for the disease of addiction. To do so is both compassionate and rational.
Instead of turning away from our responsibilities, instead of acquiescing in continued addiction, we offer drug policies that, backed with political commitment and scientific understanding, can make a fundamental difference.
We have funded the research and implementation of effective drug treatments that lead to full recovery and re-integration in society for millions, and have made that treatment accessible for anyone who seeks it.
We have researched and implemented fundamental prevention campaigns, turning young people away from a life of drugs at moments when they are most vulnerable. We have supported drug testing in schools, as a means of deterring the spread of drug use, and as a means of non-punitively identifying and getting help for those early in dependency.
We have reached out, through a national media campaign as well as in the workplace, schools, community coalitions, neighborhoods, religious settings, and family life to overcome the deadly denial that characterizes addiction, and have pointed out the pathways of recovery, and the need for each of us to take responsibility for those who struggle and get them help.
We have used the criminal justice system as an ally in achieving treatment referral and recovery, using the power of courts to effect sanctioned and supervised treatment, the most successful mode of intervention and restoration, relying on compassionate coercion that will not turn a blind eye to an addicts struggle.
And we have waged a battle against those who produce and traffic in drugs, the narco-terrorists who destroy nations and the street-corner pushers who destroy neighborhoods and families.
The United States still faces tough challenges and has much work left to do. Our efforts are not perfect, but from these efforts we have seen much progress. At a time when many nations are realizing with alarm that their young people are sliding into greater danger, youth drug use is strikingly down in the United States.
According to our most recent national surveys, we have experienced a significant downturn in youth drug use over the last three years of this administration cannabis use rates (past month use for all figures) falling 18 percent, overall use of any drug down 17. These are declines that we havent seen in a decade. Strikingly, youth use of methamphetamine fell fully 25 percent. Even more compelling is the decline the use of MDMA (Ecstasy), which plummeted by 60 percent (as did LSD).
This impact was achieved by a balanced strategy of demand reduction (with increased perceptions of risk in drug use) and supply reduction (successful market attack and interdiction efforts disrupted availability). We know how to solve much of this problem, but in our global community, we cannot act alone and achieve as much as we can when working in concert.
The support we seek need not be crafted anew; it already exists, in the form of promises and mutual pledges that we have already made to each other.
Each nation in attendance at the Commission on Narcotic Drugs (CND) has made commitments, the meaning of which is clear. Drug use is governed by international agreements that direct signatories on how to regulate and respond to this problem. Three instruments known collectively as the U. N. Drug Conventions (the 1961 Single Convention on Narcotic Drugs as amended in 1972, the 1971 Convention on Psychotropic Substances, and the 1988 Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances) carry the force of law.
If commitments are indeed binding, then we must observe these Conventions and reject national actions which are incompatible with them. For instance, the International Narcotics Control Board (INCB), the guardian of our conventions, has consistently rejected programs such as government-approved or supported injection rooms, government fostering or sustaining injection drug use, and the dispensing of drugs for anything other than medical or scientific research purposes consistent with standards for the ethical treatment of human subjects.
These Conventions and agreements are our safeguard, protecting against the epidemic of drug use. Yet some contend that these very conventions and agreements are somehow an impediment to efforts addressing another global crisis, the spread of HIV/AIDS and other blood-borne pathogens (such as Hepatitis C). This charge is wrong -- the Conventions are a bulwark against a public health tragedy.
Moreover, continued drug use is a fundamental cause of the dangers we face from blood-borne diseases. Those who drafted these Conventions, those who committed our nations to these Conventions, and we who are charged to keep faith with these Conventions are linked by a fundamental truth: stopping drug use is our paramount medical and humanitarian responsibility.
We have also responded to the second crisis of epidemic disease, and at a level unmatched in the world community. The United States accepts its global responsibility in the fight against HIV/AIDS, as well as other global infectious diseases.
In his 2003 State of the Union address, President Bush proclaimed an unprecedented commitment of U. S. resources to fight HIV/AIDS. His Emergency Plan for AIDS Relief commits $15 billion over the next five years to fight the disease internationally. In 2004 alone, the U.S. spent $2.4 billion to fight HIV/AIDS, tuberculosis, and malaria abroad, a sum far beyond that committed by any other nation. The Presidents Emergency Plan for AIDS Relief assists more than 100 countries throughout the world. Among these countries are 15 that receive special emphasis and account for more than half of the worlds infected population, with $865 million programmed for these countries in 2004, and a planned $9 billion for these countries alone still forthcoming.
The Emergency Plans ambitious five-year goals for these 15 countries are supporting lifesaving anti-retroviral therapies (ART) for 2 million people, averting infection of 7 million people, and supporting care for 10 million people affected and infected with HIV/AIDS, including orphans and vulnerable children.
This is the largest commitment ever by a single nation toward an international health initiative. The U. S. contributions to the global AIDS emergency continue to be greater than those of all other donor governments combined. Specifically, and in addition to the new resources committed to the Emergency Plan for AIDS, the U. S. has pledged almost $2 billion to the Global AIDS Fund through 2008 far more than any other nation.
We must recognize that our fight against illegal drugs is part of our fight against HIV/AIDS. It is essential, precisely because of the way that HIV/AIDS and other pathogens are transmitted, that we intensify our commitment to stopping drug use. Injection drug use is a major risk factor in HIV/AIDS transmission, through direct blood contamination by means of injection equipment, as well as through the high-risk behaviors of injection drug users. And the threat of drug use increasing HIV/AIDS infection is by no means solely attributable to injection risk. Transmission of HIV/AIDS in the context of ingesting crystal methamphetamine, in the context of pervasive intoxication with cannabis, in the context of crack and powder cocaine use, all show the conjunction of compromised judgment, impaired health, and high-risk sexual behaviors that lead to Sexually-Transmitted Infections (STI).
In each case, the most powerful response is to reduce the prevalence of drug use, thereby reducing not only the social harms that attend drug use, but as well, the devastating harm found within the drugs themselves.
The case before us is clear, as are our choices. The hard choice is the right one. President Bush has recently called for the United States to engage the world in a renewed campaign to realize the core values of our nation and of the United Nations: human rights, human dignity, and human freedom. There can be no victory for a nation choosing the pathway of political freedom for its citizens when it continues to allow some citizens to remain in thrall to continued addiction. When we choose to push back against illegal drug use, we establish these values of rights, freedom, and dignity more securely. This is a time to reaffirm our commitments and our responsibilities. Effective policies can do more than merely hold the line against the drug threat. They can prevail.
