Ruth Dreifuss in The Jakarta Post: “Discourse: Decriminalizing drugs for public health”

Read original article in The Jakarta Post

Switzerland’s drastic change in drug policy followed soaring HIV infection rates related to a heroin epidemic in the late 1980s and 1990s. Switzerland introduced substitution treatment and other harm reduction measures such as supervised injection rooms, which reportedly decreased incidences of drug users with HIV among other outcomes. On Jan. 29, former Swiss president Ruth Dreifuss, who chairs the Global Commission on Drug Policy, talked to The Jakarta Post’s Ardila Syakriah. The following is an excerpt from the interview:

Question: You have been among the drivers behind Switzerland’s drug policy reforms. What has changed in the fight against drug abuse there?

Answer: We fundamentally changed the focus. We are putting […] the people’s health and also the people’s freedom first, because […] people can [decide] to use drugs and they will still belong to our community. […] I was happy enough to be in charge of introducing universal coverage for healthcare. We open new therapeutic possibilities for drug users. We can also finance them through health insurance.

[…] In Indonesia, I’ve heard some treatments are not paid for by insurance. We should really offer them what they need.

How have such measures changed the drug scene in Switzerland?

[…] AIDS and Hepatitis C are now at the same […], very low level, among people who inject drugs and the general population. [The spread of the diseases] was problem number one […]. There is no longer a source of contamination among the people who use drugs.

Those who are really addicted are considered patients receiving treatment, because our main problem was heroin and injecting heroin. We have people who have been on substitution treatment for many years, living a balanced life, some with jobs that they had not found previously […]. [They] gain control over their lives.

Heroin consumption decreased massively, but we still have consumption of cannabis […]. Most importantly, we are in contact with the people [who] can receive what they need. For some it is just reduction, for others it is treatment, for others it is a job and housing.

You have repeatedly stressed the importance of evidence-based policies. Have they been a point of evaluation as new substances emerge?

Absolutely, because we must explain to people what we are doing […] as it is counterintuitive […]. The substances are changing, [bringing] new challenges. We are on our way to finding alternatives.

What are the core principles of public health and drug decriminalization?

Health measures are far cheaper than repressive measures. Treatment for people dependent on heroin is perhaps 10 times lower than the cost of trying to stop them through repression. It is about not wasting money […] because if you have health measures and a good infrastructure in health services, the added cost of treating drug users who need medical help will have no relationship to budget affairs. However, having police specialized in harassing and fighting petty criminals can waste a lot of money.

You said Switzerland was once conservative, similar to some groups in Indonesia. So, how were the reforms possible?

Conservative means that you need to have time to change, that you are cautious and skeptical about new things, but you are also ready to be pragmatic, to recognize a problem and to look for solutions. In an emergency like the AIDS epidemic and overdoses, Switzerland could move very fast.

In Switzerland, where speaking about sex is something you don’t do in families and even less in public spaces, there was pioneering advertising and information on during TV prime time showing how to have safe sex. It was very useful to show young people to fight prejudice, to create a climate of solidarity with people affected by HIV and to explain how to protect themselves.

Speaking clearly and being pragmatic are also possible in a conservative country. We had strong support from the religious circles. Because for them, compassion toward people in difficulty is the greatest command. I am very grateful for this support not only from medical professionals, not only from the police [who accept] the changed drug policy, but also from the churches.

Many still consider decriminalization permissive toward drug abuse.

It is not permissive; it is realistic. It is to abandon an illusion [of] a drug-free society. Humanity is attracted by the promise to suffer less, to dream about things, to enlarge the consciousness, to answer anguish […]. There are so many reasons humanity is attracted to psychoactive substances, so to say that we want a drug-free society is far from reality.

But controlling the phenomenon to help people know what they are doing, being ready for debates that this is not ideological but respectful of people’s choices — this is important.

What is permissive is that the state doesn’t take the responsibility to control the drug market.

Are such policies possible in Indonesia? What needs to be done first?

I think first Indonesia has to lower, very strongly, the harsh punishment for drug offenses, to stop applying the death penalty in these cases but also to divert people from punishment to community services — to treatment needed to make them really efficient. So, that is the key; to have political leaders, cultural leaders, religious leaders fighting prejudice against drug users, because prejudice worsens the problems of society and of these people.

It is very important to show that they are part of the community. They deserve help, they deserve respect, and it is the role of the leaders to take up this discourse. Leaders pointing their fingers at these people and saying they are evil are just making the problem worse.

Are you optimistic about policy reform in Indonesia?

[…] I met the National Commission on Violence Against Women [Komnas Perempuan], the National Commission on Human Rights [Komnas HAM], so yes, this makes me optimistic.

The free media and free speech here show that change is possible because there is this debate. [..] What is important is to overcome the silos of the different ministries, to try to have a real common position oriented toward heath, social integration, inclusiveness and so on.