This is the third report of the Global Commission on drug policy after the first report entitled “the war on drugs has failed” and last year’s report on how repressive drug policies are fueling the HIV/AIDS epidemic.
This report is entitled: “the negative impact of the war on drugs on public health: the hidden hepatitis C epidemic”.
Indeed when we talk about hepatitis C, we talk of a hidden or silent epidemic. Silent, because the infection remains clinically silent, with no recognizable symptoms for many years but silent also, because there is so little awareness and so little public attention to it.
A silent, hidden epidemic, and yet an epidemic of huge proportions among people who use drugs: 10 of the 16 million people who inject drugs worldwide are infected with hepatitis C.
The report is available in English. It was launched at a press conference two weeks ago in Geneva – And now in Russian. It certainly is meaningful to Ruth Dreifuss, Alexander Kwasniewski and myself, three members of the Commission present here in Vilnius, to launch the Russian edition of the report at this conference.
The report shows how infection rates are particularly high in countries whose drug policies and law enforcement practices restrict access to clean needles and syringes and OST, which is of course the case in most countries in the region.
And the report emphasizes that early deaths due to hepatitis C and the global burden of advanced liver disease are increasing in people who use drugs. And yet, we know that hepatitis C is a treatable and a curable disease. But practically, very few people currently access treatment worldwide because of poor or restricted access to specialized care and because of unaffordable prices.
But our report is not just about informing on the current situation with hepatitis C. It is to explain and denounce how the war on drugs by placing people who use drugs within a criminal, rather than a public health frame, fuels the epidemic, just as it is the case for HIV/AIDS.
Just as in the case of HIV:
Fear of police and stigma drive people who use drugs away from health services and to unsafe environments for injection.
Health care systems in many countries (EECA) limit access to care for people who use drugs for example by setting arbitrary requirements around abstinence from drug use.
Restriction on the provision of sterile needles and syringes and of OST result in increased rates of injection equipment sharing.
Mass incarceration places individuals in high-risk environments for hepatitis, HIV and tuberculosis, and prisons in most places in the world do not provide harm reduction and prevention measures that would avoid virus outbreaks among incarcerated people.
So we stand against the fact that public funds continue to be wasted on harmful and ineffective drug law enforcement efforts instead of being invested in prove, prevention and treatment strategies.
The report comes with a number of recommendations:
We call on governments to acknowledge the importance of the hepatitis C epidemic and its human, social and economic costs in people who use drugs;
We call on governments to acknowledge that drug policies dominated by strict law enforcement practices perpetuate the spread of hepatitis C and of HIV by exacerbating the social marginalization of people who use drugs and undermining their access to essential harm reduction and treatment services.
We call on governments to improve surveillance and access to testing, to design and fund treatment programs for hepatitis C and to ensure that people who use drugs are not excluded from these programs.
And we call on governments to remove legal or de facto restrictions on the provision of sterile injection equipment and opioid substitution therapy, and to re direct resources away from the war on drugs into public health approaches.
There is no doubt for us that significant public health harms will be averted if action is taken now.