Basic elements for a national comprehensive plan for drug abuse control in Peru
Nature and extent of the problem
Review of national responses to the problem: mplications for future action
New national comprehensive plan for drug abuse control
Medium-term plan for drug abuse control
Author: R. FLORES AGREDA
Pages: 37 to 49
Creation Date: 1987/01/01
The first part of the article describes the nature and extent of drug abuse in Peru, with particular reference to the illicit cultivation of the coca plant and the national responses to these problems. It is estimated that between 150,000 and 200,000 hectares are under illicit coca plant cultivation, although less than 18,000 hectares are sufficient for meeting the legitimate needs for this plant in the country. It was estimated that 1.3 million children and youth were at risk of drug abuse in 1985. Both the problems and national responses are analysed in the context of historical and current developments that have influenced Peruvian drug abuse control policy, as well as in terms of the adequacy of programmes carried out within the social sectors involved in such control. The second part of the article summarizes the salient points extracted from the new national comprehensive plan for drug abuse control, which is intended to achieve a maximum reduction in drug abuse concurrently with the elimination of drug trafficking and the eradication of illicit coca plant cultivation in the country. The plan clearly defines the objectives, the strategies and the division of responsibilities in its implementation, involving the following four major sectors of activity: prevention, treatment and rehabilitation; control and monitoring of substances used for legitimate purposes; suppression of the illicit drug traffic; and the eradication of illicit coca plant growing together with the promotion of agricultural, agro-industrial and forestial development. It is pointed out that the whole nation needs to be mobilized in the implementation of the plan in order to achieve its objectives fully.
It is necessary to take into account certain basic factors that have influenced Peruvian society in order to understand properly the policies and measures that have been undertaken in Peru to combat drug abuse. These include the difficulties that the country has been facing since the last century in connection with the consolidation of the structure of the State, the affirmation of a democratic society and the search for a national identity. But it also involves an ethical consideration of responsibility, as well as the need to distinguish between traditional coca leaf consumption and the unhealthy and illegal use of coca derivatives  ,  . The drug problem in Peru can be viewed in terms of its nature and extent and the policies and intervention by which the country has attempted to cope with it.
In addition to the large extent of the drug problem, attention should be paid to its nature, particularly to the links of the so-called drug chain involving production, traffic and consumption. For example, the increasing demand for coca products, which to a large extent originates in developed countries, and the organization of criminal trafficking networks are the major factors that lead to the increasing production of coca paste. Among other important factors that contribute to the complexity of the problem are the ease with which the coca plant can be grown in marginal districts, the traditional mastery of its cultivation by the peasants and the still inadequate presence of the State in the areas in which the coca bush is illicitly grown. For its part, drug trafficking acts at the macro-marketing and the micro-marketing levels. The first is represented by international criminal bands, which dominate the illicit markets, operating with nearly unlimited resources; the second is represented by suppliers of a clientele of drug abusers.
Another facet of the problem lies in the medical, social and religious significance of coca. For the population of the Peruvian Andes the coca leaf plays an important role in interpersonal relationships, at the workplace, in festivities, commerce and production, and in spiritual life. Coca has in this regard been increasingly studied by the social sciences  .
Excessive alcohol consumption has traditionally been regarded in Peru as the nation's number one problem, because of its public health and economic consequences  ,  . Towards the end of the 1970s, a changing pattern began to emerge in the incidence and prevalence of drug abuse, with an increasing spread in the abuse of coca paste. The findings of a methodologically well-prepared study  indicate that in 1986 there was an increase in the abuse of coca paste over the 1979 level  .
Coca paste and cocaine are generally found in greatest abundance in urban areas, where students and young adults account for the highest percentage of users. Knowledge of the prevalence of cocaine abuse is based on research by physicians and psychologists who have conducted their studies mainly at colleges and institutions of higher education  ,  . These studies indicate that the primary prevention programmes in Lima and Callao should be directed at children and youth, approximately 1.3 million of which were estimated as being at risk of drug abuse in 1985.
According to studies by E. Oliver in 1985, there were approximately 60,000 drug addicts in Lima and Callao. They accounted for approximately 4.1 percent of the consumer population. Of addicts nearly 80 per cent were addicted to coca paste  .
It should be pointed out that there is still a notorious insufficiency of information regarding the epidemiological, biological, clinical and psychosocial aspects connected with the most widely abused drugs. An information gap also exists with regard to illicit production and traffic, the economic and social aspects of the coca leaf, as well as the most effective programmes for crop eradication and substitution. It is hoped that better training will help to overcome this insufficiency.
The principal illicit cocaine markets are in North America. Such markets have recently been increasingly established in Western Europe, Latin America and the Caribbean.
A critical aspect in the effort to combat the illicit drug traffic in Peru is the emergence of an economic force as a result of the illegal transactions. Although there is no reliable information on the amount of money in circulation generated by the illicit traffic in coca products  ,  , the large number of illicit installations, airstrips, laboratories and aircraft that have been impounded or seized in police operations seems to suggest that the amount of such money is enormous. The increasing number of persons involved in drug trafficking (drug-related offences account for one third of the national prison population), and more than a thirtyfold increase in the price of coca paste as it moves from the production site to its point of sale in the form of cocaine hydrochloride, can also help in estimating the amount of money in illicit circulation.
Because of the varied geographical features of the extensive Peruvian frontier, most of the border area is difficult to patrol. Drug traffickers, operating by the so-called ant system (involving individually transported quantities of the drug), mainly at non-authorized border-crossing points, are able to smuggle out of the country thousands of kilograms of coca paste for further processing and distribution to international illicit markets.
The inaccessible nature of the areas in which the coca bush is illicitly grown has led to the establishment by traffickers of a large number of clandestine airstrips. In addition, the pressure exerted by the Colombian police in the territory under their jurisdiction has prompted drug-trafficking organizations to relocate their operations from Colombia to Peru, where they have set up illicit laboratories with a weekly production capacity of from 100 to 200 kg of cocaine hydrochloride  .
Aerial reconnaissance of clandestine fields is of only limited value in identifying such fields. While somewhat less than 18,000 hectares of coca bush are enough to provide coca products for medical and other legal needs and for traditional consumption, it is estimated that between 150,000 and 200,000 hectares are under illicit coca bush cultivation in Peru.
The new plant is harvested after six or eight months. The harvesting is carried out from three to four times a year over a period of 15 to 30 years  . A large percentage of the small-scale farmers in Peru, and also in Bolivia, are engaged in the cultivation of coca bush, which appears to be their main source of income  . In both countries, the official register of legitimate coca producers is incomplete and urgently needs to be brought up to date to properly serve its purpose.
At present, there is no known crop in the region whose yield can be compared with that of the coca bush. The grower on illicit coca plantations is financially compensated by illicit trafficking organizations for sowing the plant. He has a guaranteed buyer for his crop and is paid in cash with no time lost in troublesome sales procedures. Another factor that favours the illicit drug traffic in coca products is the relative ease with which the coca leaf can be transported and transformed into paste.
In Peru, in addition to the Department of Cuzco and the Alto Huallaga, coca-growing areas have been located in the basins of the Ene-Urubamba, Maranon and Tambopata rivers. There are, however, still areas in the country that can potentially be used to expand the cultivation of coca plant.
The national responses to the drug problem have included measures for information and education, treatment, rehabilitation and social reintegration, as well as various measures by the courts and police forces, including action to suppress the cultivation of the coca plant and trafficking in coca derivatives.
Prior to 1985, the country had no comprehensive national plan to combat drug abuse and illicit drug trafficking. The Multisectoral Committee on Drug Control (COMUCOD)  , the agency responsible for proposing policy guidelines, formulating plans and supervising, co-ordinating and monitoring activities, lacked the necessary resources to perform its duties effectively.
The country's drug control laws had gaps requiring supplementary provisions that could facilitate the planning and implementation of measures in the areas of prevention, treatment, control, enforcement, eradication and comprehensive development. Also, external technical co-operation to support national resources was not sufficient to cope with the large and increasing problem. Above all, there was a need for a comprehensive plan to implement drug control policies and measures, and to co-ordinate properly the activities of the various sectors and institutions involved.
A more detailed review of national responses by sector of activity is given below.
The planning and implementation of national programmes for the prevention of drug abuse has required the support of the psychiatric services available in Peru. The proposals to promote mental health have not been fully implemented however, particularly with regard to psychiatric services at general hospitals and to community mental health care  .
An assessment of the drug abuse prevention programmes undertaken by the health sector since 1975, when the first phase of multisectoral programmes supported by the United Nations Fund for Drug Abuse Control (UNFDAC) began, shows that the achievements have been rather modest, even though considerable efforts have been made. The programmes for prevention, treatment and rehabilitation have been only partially co-ordinated.
The programmes for information and education have specifically focused on the young and been designed to alert them to the danger of drugs. So far, however, these programmes have involved only isolated and unsustained activities.
A plan on drug abuse prevention drawn up in the early 1980s defined the problems and determined the objectives in the field of health, but the proposals, being too broad, were difficult to implement in a systematic fashion  ,  . In 1982, the educational authorities also formulated and approved a plan for drug abuse prevention, but that plan was of little practical significance  .
From 1979 to August 1983, the customs authorities had in operation two special brigades with responsibility for the suppression of the illicit drug traffic, one at Jorge Chavez International Airport, and the other at the Callao marine terminal. A Central Office for Narcotic Drugs was also established. As a result of training received by the customs personnel under an agreement with the Government of the United States of America, a sizeable pool of qualified instructors currently exists  . The existing resources of the customs authorities, however, are not sufficient to deal with the current magnitude of the illicit traffic and its increase.
Within the police forces dealing with drug trafficking there is an evident need for improving the intelligence-gathering systems, the tactical and logistical operations, and the activities aimed at interdicting the illicit traffic in drugs. The confiscation of the financial proceeds generated by the illicit traffic is still at the preliminary stage.
In accordance with the legal provisions for the control of the production and marketing of chemical products capable of being used in the manufacture of drugs, the commercial sector has been responsible for monitoring these products. The functions of the industrial sector include the monitoring of the industrial manufacture of the chemical inputs used in drug production: sulphuric acid, acetone and hydrochloric acid. In order to promote this programme there is a need for an evaluation of drug control action undertaken by the Ministry of Industry, Commerce, Tourism and Integration and of the co-ordination maintained with the police forces  .
In a number of countries crop substitution programmes have been initiated. The evaluation of these programmes is still in the preliminary stage. In the coca-producing areas of Bolivia, Colombia and Peru crop substitution projects supported by UNFDAC and the Government of the United States have also been undertaken. An evaluation performed by UNFDAC in 1985 of the experience gained in several countries made it possible to identify a set of criteria to be taken into account when planning and executing programmes of this kind  .
In Peru, an agreement was signed in 1981 with the Government of the United States for the purpose of destroying illicit coca-growing plantations in the Alto Huallaga region, followed in 1982 by the establishment of a special project for the control and reduction of coca farming in Alto Huallaga. By April 1986, 9,783 hectares out of a total of 44,889 had been eradicated. This project was implemented in the absence of a comprehensive plan [23, 24]. The manner in which the coca problem had been dealt with in the past revealed certain gaps and contradictions, among the most significant of which were the policy with respect to traditional coca-leaf chewing, a proliferation of overlapping agencies and a certain ambiguity in the assignment of functions. The registration of the coca-growing areas to be eradicated was deficient, and there was inadequate coverage of the crop reduction and substitution programmes.
The new national comprehensive plan for drug abuse control is based on two fundamental premises. The first is the determination of the Government, which has been clearly enunciated, to face up unshrinkingly, and with the support and participation of all its citizens, to the serious drug-related problems confronting the nation; and the second is the necessity for uncompromising performance by State civil servants of their responsibilities in implementing this plan. This means that the State is being called upon to mobilize its entire available capacity, including all the people of the nation, who must become actively involved in the implementation of the plan in order to achieve its objectives fully. The responsible officials must also discharge their obligations to their country.
The Executive Office for Drug Control (OFECOD), supported by representatives from related fields as indicated in the General Drug Law (Decree Law No. 22095), is the agency of the Ministry of Interior responsible for drug-related affairs and for the preparation and consolidation of the new plan. OFECOD must be provided with the necessary material and human resources and it must act in conformity with the functions assigned to it under the law. It includes officials from each of the services involved in drug abuse control, the support of which is necessary for appropriate implementation of the plan.
The decision-making function lies with COMUCOD, which includes the Ministers of Interior (who serves as the presiding officer), Economics and Finance, Education, Industry, Commerce, Tourism and Integration, Agriculture and Health. It is the task of COMUCOD to approve policy guidelines, issue complementary regulations, propose measures designed to ensure compliance with the law and appoint representatives to international meetings. In December 1986, membership of COMUCOD was approved for the Minister of Justice, the Minister of the President's Office and the Head of the National Planning Institute.
OFECOD performs functions in the areas of planning, sectoral communication, supervision, management of donated or impounded resources, promotion of international co-operation and the maintenance of relations with international agencies with which agreements have been concluded. Implementation of the new plan is a matter of sectoral, multisectoral and inter-agency competence.
The successful achievement of the objectives set by the new plan depends not only on the explicit political decisions of national authorities, to which the co-ordinating and supervisory agency OFECOD is expected to subordinate its activities, but also on the determination and competent implementation of the plan by the various services involved. The volume of the resources involved and the complex and delicate nature of the tasks undertaken require these services to provide leadership that is both qualified and committed to the tasks to be performed in their fields of work. The following four broad sectors of work are involved in the implementation of the new plan: prevention of drug abuse, treatment and rehabilitation of addicts; control and monitoring of narcotic drugs and psychotropic substances used for medical and scientific purposes; prevention and suppression of the illicit traffic in drugs; and eradication of illicit coca growing, as well as the promotion of agricultural, agro-industrial and forestial development. In order to implement the plan effectively, the services involved in these four sectors, which constitute the major components of the plan, must rely on intersectoral or multisectoral co-operation and the participation of private organizations, and they must open up permanent channels of co-ordination with OFECOD.
The objectives of the new plan are to achieve a maximum reduction in drug abuse, to eliminate the illicit drug traffic and to eradicate the illicit cultivation of coca plants. More specifically, its objectives are to prevent and end drug trafficking and to eradicate the illicit growing of coca plants as part of an intensive programme for rural development. The plan concurrently seeks to prevent drug abuse, to promote control and monitoring of drugs used legally for medical and scientific purposes and to provide effective treatment, rehabilitation and social reintegration of drug-addicted persons.
Among the principal policy guidelines that have been adopted for the implementation of the new plan are the following:
To a major extent, the success of the plan will depend on the timely introduction of measures, the presence of genuine control and co-ordination, and the initiation of specific actions under the responsibility of the services involved, and also on the activities jointly conducted by the different services, as well as on the active involvement of the people in a nation-wide effort;
Real community participation will depend on enhancing public awareness of the health, social and economic hazards caused by drug abuse, of the disruptive and corruptive nature of illicit trafficking, and of the national significance of the government efforts to respond to the problem;
Technical and financial assistance from external sources must be significantly increased to make it possible to cope with the drug problem in all its aspects; this is to be accomplished through the formulation of comprehensive programmes and the harmonization of national interests with those of the international community;
The campaign to combat the indiscriminate use of drugs and other toxic substances is to be principally based on preventive programmes that are incorporated within the overall educational process; these programmes should employ the primary health care approach;
The elimination of the illicit drug traffic will require the co-ordinated and complementary support of the police authorities, the participation of the armed forces and the willingness of the population to support planned police action;
Co-operative measures and joint police action will be carried out with as little delay as possible together with those countries with which co-operation agreements have been signed; as for those countries with which no such agreements exist, new ones should be concluded or those countries should be encouraged to adhere to the existing agreement;
The eradication of the illicit cultivation of the coca plant will be initially undertaken in zones that have experienced a dramatic increase in such cultivation, beginning with the Alto Huallaga; at the same time, the register of legal producers must be brought up to date and the system for monitoring production and marketing made more efficient;
In co-ordination with other sectors, a comprehensive programme of agricultural, agro-industrial and forestial development will be carried out, while at the same time the provision of such social services as education, health care and housing is to be expanded.
The objectives and strategies of the medium-term plan for drug abuse control are summarized below by sectors of activity.
The objectives in this sector of activity are to reduce the incidence and prevalence of drug addiction and to develop preventive programmes involving the participation of the population, especially young people. The objectives also include the training of the personnel who are to be responsible for planning, prevention, treatment, rehabilitation and epidemiological research on the nature and extent of drug use and its associated problems [25, 26].
Preventive measures form part of the overall educational process and they involve a primary health care approach. Preventive measures and treatment should be made available within the broader perspective of education for living and health. The primary health care approach has been assigned a central role in dealing with health problems.
In pursuit of these objectives, the following principal strategies are envisaged: the enactment of laws clearly assigning authority with respect to the planning and execution of programmes and setting forth the areas of competence of the various sectors involved; the promotion of anti-drug attitudes among the public through national prevention programmes; the provision of public information and counselling; the formulation and implementation of programmes to be carried out as part of the primary health care activities; and the establishment of assistance and rehabilitation services for drug-dependent patients at outlying health centres.
The national prevention programmes must be co-ordinated within the health, education, interior and justice departments as well as with related activities of the private and State-operated communications media and community organizations. Young people and family groups are intended to play a key role in the programmes and activities undertaken by the private and State-operated prevention centres.
Training in prevention techniques is to be provided to personnel of specialized hospitals and psychiatric services in Arequipa, Callao, Chimbote, Cuzco, Huancayo, Huanuco, Ica, Iquitos, Lima, Piura and Trujillo.
Epidemiological surveys of drug abuse are to be conducted at local, provincial and national levels, focussing on children, youth and the disadvantaged urban population. These surveys will include research on the harmful effects of acute and chronic drug use.
In this sector of activity the objectives are to prevent both the illegal use of substances intended for medical and scientific purposes and the diversion of such substances into illegal channels. For this purpose, a special service will monitor these substances in accordance with the requirements of the system of international drug control. The plan is also intended to make timely and accurate assessments of the requirements for narcotic drugs and psychotropic substances and to ensure the availability and lawful distribution of the amounts required  .
Other strategies that are designed to achieve the foregoing objectives include: the promotion of the gathering of information on the monitoring of narcotic drugs and psychotropic substances for the purpose of adjusting or, where it does not yet exist, establishing control machinery; the optimization and control of narcotic drugs production; the improvement of the registration and control of the import and export of drugs, for example through annual forecasts and licensing arrangements, in co-ordination with the police and customs authorities; the tighter control of pharmaceutical laboratories and establishments to ensure their compliance with the Health Code and other regulatory provisions.
Given the magnitude and complexity of illicit trafficking and its grave economic and social consequences, the objectives and strategies in this sector of activity cover a wide range, including: the stepping-up of police activities to improve the detection of illicit drug-trafficking operations and profits, as well as to destroy illegal laboratories, airstrips and equipment; the enactment of laws to facilitate more effective monitoring of the manufacture and marketing of chemical inputs and precursors; the updating of information on the production of, and illicit traffic in, narcotic drugs and psychotropic substances; improvements in intelligence-gathering systems and in the execution of tactical and logistical operations; the introduction of more rationally organized personnel arrangements by the specialized agencies, together with the creation of new sub-units in critical areas; and the promotion of personnel training [22, 28, 29]. The police forces should closely co-ordinate their activities in the prevention and suppression of drug trafficking with those of the customs authorities and where necessary with the armed forces. The population is expected to become more actively and directly involved in these activities in line with a policy of community participation.
Joint border operations should be mounted, mainly in co-operation with Brazil, Bolivia, Colombia and Ecuador, and closer ties should be established between Peruvian drug law enforcement and that of other countries facing similar drug-related problems.
Furthermore, a more effective exchange of information is needed between the industrial and commercial sectors, on the one hand, and the police forces, health authorities and customs service, on the other. The control of export and import programmes covering chemical inputs, precursors and equipment should be formulated. The introduction of an international control system for this purpose would be desirable.
Eradication of illicit coca plant growing and the promotion of agricultural, agro-industrial and forestial development
The objectives in this sector of activities are: to design and implement effective programmes in the area of agricultural, agro-industrial and forestial development that can serve as a viable economic alternative to coca plant growing in rural areas; to rationalize, monitor and supervise the legal cultivation of coca plants and the transport, marketing and industrial processing of coca leaves; to eradicate the illegal cultivation of coca plants; and to secure the collaboration of the farmers engaged in illicit coca plant cultivation in order to facilitate their abandoning such cultivation and becoming integrated within the economy as legal producers  .
The recommended strategies are based on the formulation and implementation of a comprehensive rural development programme designed to raise the living standards of the rural producer. This programme should include: the extension of the agricultural frontier, the boosting of production and productivity, adequate and timely technical and financial assistance, and the provision of the necessary marketing services and infrastructural facilities. In addition, there must be permanent co-ordination between the agencies involved in national coca plant control and those responsible for eradication, for marketing and for the development programmes. There is also a need for a merging of the efforts being made in the agricultural sector, including the entire range of activities of its technical agencies, with those in other sectors, and especially in the Ministry of the Presidency with its special projects and the Peruvian Development Corporation.
Close co-ordination must also be established between the various departments and bureaux of the State and the public agencies in order to achieve the necessary political and social consensus in support of the eradication and crop substitution programmes and to increase the effectiveness of these programmes. A new type of international technical and economic co-operation needs to be promoted with a view to providing strong support for the measures and activities to be undertaken. In addition, the public needs to understand more the ancestral and social significance of the coca leaf for the people of the Andean region.
In summary, what is involved is a multifaceted process in which the social sectors have important roles to play and in which strong and consistent action by the State, coupled with acceptance and commitment on the part of the population, are essential conditions for success.
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