Not sent by God
Cities have the drug problem of their choice
Address to the World Mayors' Conference on Drugs
Gőteborg, 5 February 2009
Ladies and Gentlemen,
This year we mark the 100th anniversary of drug control. In February 1909, representatives of 13 world powers met in Shanghai to take action against an opium epidemic in China that was having global repercussions. In the ensuing 100 years, namely over the course of the 20th century, a number of international agreements and especially the UN-brokered conventions (1961, 1971, 1988) created a legal framework for drug control. The goals were, and remain: (i) to ensure a sufficient supply of drugs for medical purposes, and (ii) to control the supply, trafficking, and use of drugs for illegal purposes.
There is scepticism about how effective these drug controls have been. But when you take an historical and global perspective, you will find the evidence quite convincing. Consider these facts:
- occasional drug use (once a year) has been contained to less than 5% of the world adult population, as opposed to 5-6 times this proportion for people addicted to tobacco or alcohol;
- there are no more than 25 million problem drug users in the world - that's less than 0.5% of humanity. More people are affected by AIDS;
- deaths due to drugs are limited to perhaps 200.000/yr, namely 1/10 of those killed by alcohol and 1/20 of those killed by tobacco;
- world-wide, drug cultivation has been slashed over the past 100 years and it has remained constant (or even declined for some drugs) in the past decade;
- adherence to the international drug control regime is universal, with the principle of shared responsibility unanimously accepted.
International drug control can claim credit for what I would describe as "containment": namely the world drug problem can no longer be assimilated to the run-away train of the early 1900s (namely before Shanghai), or to the late 1900s (namely before the UN General Assembly Special Session of 1998) when drugs were - or they appeared to be - an uncontrolled and uncontrollable problem.
I recognize that containing a problem is not the same thing as solving it. Despite the fact that the global drug problem has stabilized over the recent past, every year world markets are still supplied with 1,000 tons of both heroin and cocaine, half that amount of synthetic drugs (ATS) and untold volumes of marijuana and hashish.
We all see the problems in our cities -- drug-related crimes, trafficking through harbours and airports, the violence of dealers, and the suffering of addicts. Some neighbourhoods are actually out of control because of all this. Drugs are even produced in urban centres - in houses converted to grow cannabis hydroponically or in labs to make amphetamines. This makes your cities unsafe to residents, unattractive for investors, uninviting for tourists, and unhealthy for all. Let me be a bit provocative: is this the result of some sinister force or an act of God? No, the problem is man made. Cities have the drug problem of their choice.
Drugs can even challenge national security, as we see in Afghanistan, Colombia, and Mexico. Entire regions of the world - like the Caribbean, Central America, and West Africa - are caught in the cross-fire of drug trafficking, money-laundering and violence.
Contained but not reduced
You may be thinking: this fellow is right, but not original. We are familiar with all this. Drug control is a government issue, or something for nations to negotiate. What can I do as a mayor?
Mayors of the world: you can do a lot, because drug prevention and drug control are primarily your responsibility. Over half of the world's population lives in cities, and your communities above all face the consequences of drugs -- premature death, long-term disability, lower productivity, infectious diseases, urban insecurity, and traffic accidents.
In 1998, at a Special Session of the General Assembly, Member States pledged to reduce substantially cultivation and demand of drugs, within the next decade. We have reached the end of that decade: the UNGASS outcome will be reviewed at the session of the Commission on Narcotic Drugs next month.
Inevitably, the review will conclude that the job is far from done. That is why we need your help. Cities should take the lead in drug prevention and treatment in order to reduce the harm caused by drugs to individuals and societies.
I urge you to join a campaign that my Office has launched together with the World Health Organization. It starts from the premise that drug abuse is an illness - a preventable and treatable illness. Millions of dollars are being spent on curing cancer, diabetes, and AIDS - all noble causes. But let us do the same for drug addiction, an health condition that physically harms several hundred thousand people every year, and psychologically affects many times more.
The steps leading to successful drug control measures are known.
First, reduce availability of drugs. I salute the valiant work of drug control agencies the world over, for their commitment, dedication and results. Cities cannot be idle. Prevention - especially abstinence - is the best way to keep young people away from drugs. I applaud the family-based prevention pioneered in some US cities, and the work done in Brazilian cities to prevent drug use in the workplace. Many of you have been puzzled by the dissenting behaviours of some European cities which have hit the headlines with drug policies inconsistent with the Conventions. I am optimistic and pleased with the recent decision, for example, by the Amsterdam municipality to close down more and more coffee shops, keeping them away from schools.
Second, increase access to treatment. Provide at least minimum standards of care to prevent people from falling through the cracks. Go even further. Provide low-cost outreach and treatment services. Mainstream drug treatment into the health care system, linking up with NGOs to provide a local network of services.
Third, take a broad view of harm reduction. The harm reduction syllabus must start from A - A for abstinence. Some communities think that they have a liberal (ie superior) approach to drugs because they hand out gadgets like condoms, syringes, needles and a bowl of soup to addicts. These are needed, for sure, but they are a means, not an end. This charity work is not drug control - on the contrary, it perpetuates drug use. Would you tell an obese friend: "here, have some more candy and then get an insulin shot"? Of course not. Therefore I invite mayors to protect communities by offering treatment to addicts like it is done in this country. Do not limit yourselves to create "drug consumption free zones," where addicts shoot up behind legally-sanctioned screens, so that the middle class avoids addicts' dirty looks, stinking clothes and odd behaviour. By the way, such "free zones' are terribly expensive: several thousand/euro/y per addict.
Fourth, provide a continuum of care. Drug dependence takes many forms. Treatment should address the specific needs of every patient, and address related health conditions (like other forms of addiction, mental health, blood-borne or sexually-transmitted diseases) through a wide range of interventions. Shanghai has piloted an excellent programme in this regard.
Fifth, take an evidence-based approach. Gather data to better understand the prevalence of drug use in your communities. Involve universities and health experts to support research and training, and promote the dissemination of good practice. I salute the good work done by Lisbon's Observatory established by the European Union to monitor trends, and the NIDA Institute established in the US to promote better understanding and more efficient addiction control policy.
Sixth, seek alternatives to imprisonment. Drug treatment courts, for example, aim to stop drug abuse and related criminal activity of offenders through court-directed treatment and rehabilitation programmes. They give addicts a clear choice: choose treatment rather than going to jail - this has been the message from the Italian legislation. Drug treatment courts are cost effective, address the healthcare needs of offenders, and prevent courts and prisons from overflowing with people who need help. In Toronto, for example, it costs around $8,000 a year to provide substance abuse treatment to a drug court participant, and $45,000 to incarcerate the same person for a year.
Seventh, involve the entire community. Since drugs affect us all, we should all rally together to build safer and healthier communities. Community coalitions, like the one in Dublin, give parents and other concerned citizens a platform for keeping their streets and children safer.
Such initiatives can reduce the health and social burden that drugs put on cities, and address the underlying problems of drug dependence.
Many of your cities may already have such programmes in place - and I salute you. But you are in a minority. That is why the UNODC-WHO programme aims to scale up evidence-based drug prevention services around the world, particularly in the most vulnerable communities. I urge you to be part of this health-centric, evidence-based approach to drug control in order to build safer and healthier communities.
Ladies and Gentlemen,
Thus far I have concentrated on the health side of drug control. A quick word on security in relation to drugs.
Urban child solders
Two weeks ago I descended into hell - meeting a group of former child soldiers in the jungle of northern Uganda, and eastern Congo. Their personal tragedies will be forever etched in my memory - young people whose lives, and sometimes their bodies, have been ripped apart: boys who learned to shoot and kill before they learned to read; girls, raped and disfigured before becoming women.
But child soldiers are not only in the jungles of Asia or Africa. There are child soldiers being recruited in our cities - the foot soldiers of drug cartels and criminal groups for whom drugs and violence are a way of life. As Roberto Saviano chillingly describes it in Gammorra: "Boy capos, clan kamikazes who go to their death not for any religion but for money and power, at all costs, in defence of the only way of life they believe it is worth living - given their hopeless condition".
I am not just talking about neighbourhood thugs who fight each other for turf or machismo. I am talking about youngsters being part of organized criminal groups, using sophisticated methods of trafficking weapons, drugs and people. This is not a problem confined to certain ghettos. It is a threat that is going global. There is growing evidence of youth gangs - for example from West Africa and Central America - hooking up with criminal groups operating in North America and Europe that traffic cocaine.
Youth and criminal groups are also coming together on the margins of social and political protests, as we have seen in recent violence from Athens to the slums of Nairobi, and from the rioni of Naples and the banlieues of Paris to the favelas of Rio. A deepening economic crisis could create an even bigger and angrier pool of young people who are vulnerable to the allure of organized crime and extremist groups.
I therefore urge you to focus on the youth in your urban drug and crime prevention strategies - through job creation and training programmes, social integration, environmental design, and empowering young people through sport - in order to give them the skills and confidence to good citizens.
When Doitung met San Patrignano
To give you some inspiration, let me tell you about an exciting new initiative.
You may have heard of San Patrignano. It is a small community in Italy whose mission is to help people overcome their drug abuse problems by offering them a home, healthcare, legal assistance, and the opportunity to study, learn a job, change their lives, and reintegrate into society. The community produces a growing range of products including wine, cheese, and crafts.
On the other side of the world, in beautiful Doitung, Thailand, the Mae Fah Luang Foundation (of the late Princess Mother), supports alternative development projects in a region once notorious for opium cultivation. Now Doitung produces flowers, nuts, coffee, clothes and other wonderful goods. It is also a thriving tourist destination (which I highly recommend).
Recently, I brought the folks from San Patrignano together with the folks from Doitung to see how they could combine their experience in tackling both ends of the drug control spectrum (supply and demand). They are now looking at how they can apply their approach to inner cities - to improve drug treatment, empower recovering addicts, and contribute to urban renewal. Next time we meet, I hope to report on what progress has been made. I hope the initiative works, and spreads to all of your cities.
Local leadership for safer, healthier cities
Mayors, ladies and gentlemen,
The last decade - if not the last century - has taught us that drug control can only be successful with the engagement of a broad coalition of stakeholders.
Yes, the inter-governmental process is crucial. But so too is the role of law enforcement personnel, development agencies, health care professionals, teachers, mentors, parents, and role models.
You, as mayors, can make a difference in your cities by providing leadership on a health-centred approach to drug control, and crime prevention strategies that reduce the vulnerability of youth to drugs. Otherwise, as I said before, cities get the drug problem that they deserve.
Thank you for the important work that you do, and for your support.
Finally, thanks to our host - the Lord Mayor of Gőteborg - whose beautiful city is one of the most active European Cities Against Drugs.