 Okay, pleasure to welcome you to this afternoon's event entitled drugs. It's about health and not policing. This is not only a timely and complicated issue, but an issue that has vexed policymakers for decades. And it's an area certainly that the School of Public Policy hopes to focus on as it's building up its policy research and teaching portfolio. And we here at the School of Public Policy are very fortunate to have the Open Society Foundations as such a committed partner. And let me highlight in particular the role of the Global Drugs policy program, which has worked tirelessly to shift the paradigm of drug policies away from the war on drugs, a putative approach to one based on public health and human rights considerations. This is the first in this series of three debates, which equally prominent panelists will be continued in early 2013. The next discussion will focus on the international drug control system. And the last and third debate will consider drugs and development. And so without further ado, let me welcome George Soros, CU's founder who has kindly agreed to say a few opening words. George Soros, as you know, does not need any introduction here, except to say that like on so many other issues, critical to public policy, George Soros has been on the forefront of the campaign for global drug policies based on health and human rights. And it's with gratitude that we welcome you here, George, in the midst of this afternoon and the floor is yours. Thank you very much for coming, very good. So there are some problems that actually are insoluble. And then the search for a solution tends to make the problem worse. The drug problem is one of these. Actually, death is an even more fundamental issue, to which this consideration applies. But this is easier because there is no way out. Well, they are actually similar. The death and the drug policy in that sense are, there is no solution. And as I say, the remedy can make the solution can make the problem worse. And that applies to the war on drugs. So I don't know what the solution is. Maybe there is a solution and I'm wrong. But one thing that I'm pretty convinced about that the war on drug has created additional problems which are very severe and have done a great deal of harm. So we need to find some other way to deal with the drug problem. When I talk about the drug problem, I don't just mean drug addiction, although there is a problem of addiction which is something that you can't get rid of. In other words, you can manage to help some addicts to break their addiction but the tendency for people to get addicted to some substances, whether it's drugs or alcohol, is also in that sense an insoluble problem. But it's also a social problem in the sense of how does society deal with drug addiction. And that is the drug problem that I consider insoluble. But certainly treating it as a public health problem, I think, is preferable to the war on drugs. So I don't, as I say, we don't have a foundation. We don't offer a solution, but we are looking for alternative ways which will do less harm to then the current policy. And so it's in that context that I think the CEU studying the problem can be also very helpful to the foundation in understanding what can be done and what can't be done and what are the consequences of following one policy rather than another. And therefore I'm very pleased that the CEU has taken up this issue and is going to study it so I welcome this. Thank you very much, George, for laying out the ground here. You put the bar very high, probably no solution, but certainly we need to look for alternatives. And it's now my pleasure to hand over the floor to Balas Danish, who is the moderator of tonight's debate. Balas, as many of you know, is the executive director of the Hungarian Civil Liberties Union, which has since its establishment in 1994 become a leading NGO in the field of drug policy reform and advocacy in Hungary. And so thank you very much, Balas, for joining us and for agreeing to moderate this panel. Welcome. Thank you very much. Ladies and gentlemen, welcome again to an overall panel discussion of the CEU School of Public Policy and the Global Drug Policy Program. Tonight we will try to divert some attention to the burning issues, burning and surrounding issues of drugs. And I say surrounding because for ages and ages, years and years, members of academia, human rights organizations and human rights activists, public health professionals and just ordinary citizens who use their common sense when talking and thinking about drugs and drug policy are challenging the current system of drug prohibition. And still yet the system is alive and seems to be very hard to change at this point. And I say burning because as a human rights activist, I am fully aware that the issue of drugs and drug policies is a human rights issue. I see no other field where the gap between good practices and evident based approaches and real life practices and policies are bigger than on this field. I see no other field where fear, prejudice and moralization are driving the policies which are causing much more harm than good. And I see no other field when our choice of weapons, I mean after all we are talking about a war with more harm and unintended consequences than their original goals. And their goals, we are talking about tools about which long time ago was proved that they are actually unable to achieve their goals. Our panel tonight set up the goal to examine how and why this is possible. What are the ways out of this loose loose trap, what is called the war on drugs. And if you like the questions we will talk about are as simple as it is. Do we need to use the public health approach and policing or do we need to use the public health approach for policing? What are the alternatives to the current approaches of the global war on drugs? Everything is given to us to be able to learn the most about this issue and to the organizers. We have three very sophisticated, experienced and inspiring speakers tonight. So let me first introduce you Kasia Malinovka-Sampruk who is the head of the Global Drug Policies Program and the Open Society Foundation. Kasia used to be serving on the WHO, the World Health Organization, Strategic and Technical Advisory Committee on HIV-AIDS. She has been a member of the UN reference group on HIV-AIDS prevention and care among injecting drug users and was a member of the technical review panel at the Global Fund. Prior to joining the Open Society Foundation where she was hired to be the head of the international harm reduction development program she used to work at the UNDP HIV units in New York and in her native Poland and she was a co-author of Poland's first national HIV program. Besides her extensive practical experience she is now a doctoral candidate at the Columbia University School of Public Health. We have our second speaker tonight, Michel D. Kadochkin who is now serving at the Global Commission on Drug Policy and serving as the UN Special Envoy for HIV in Eastern Europe and Central Asia. Between 2007 and 2012 he served as the Executive Director of the Global Fund to fight AIDS, tuberculosis and malaria. He has spent the last 25 years, I believe, fighting AIDS as a leading physician, researcher, academic, activist, policymaker and diplomat. His involvement with HIV began in 1983 and by 1985 he started to run a clinic. The clinic which today treats more than 1600 people with HIV. He is a former professor of immunology at the University of Rene Descartes. He has authored and co-authored more than 500 articles on the issue of HIV. And last but not least, let me introduce to you our third speaker who is Roger Fleury, who is now a policy liaison officer of Switzerland to Poland, to Hungary, to the Czech and Slovak Republic. He is a former police officer, an active, he was an active police officer. He used to work with the Swiss Federal Criminal Police. His specialization was drug markets and drug related crime. His job was, and that's very interesting from our point, to combine and link police work to a social, public health policies and science. And at the same time he remained part of the police investigations for combating trafficking groups. So if someone, then he is able to present us the law enforcement side of this story. So let me start to pose a maybe strangely sounding question to all of you. Let's assume that in this room, except the three of you, everyone belongs to a group of alien social scientists, right? So we are coming from Planet Mars. Curiosity hasn't discovered or based yet, but we are living there and we are doing our job. A while ago we were sent to Planet Earth to research these planets, policies and practices around mind altering substances. In the last weeks and months, we read every possible article, we met a lot of scientists and researchers, but we simply don't get a thing. We just simply don't understand how something as a policy which goes more harm than good is still in effect. How is it possible, I know it's a difficult question, that in this planet some drugs which clearly cause more harm than others are illegal and states, different governments of this planet get tremendous funding through taxation from the commerce of them. And some other drugs which are much, much less dangerous, which has some medical potential are illegal. So the question as simple as it is, how is it possible, if you have an answer to that, that alcohol which let's say legal for 80% of the population of this planet and which is accountable for so many accidents has linked to violent crime and cause so many death and addiction is legal and cannabis which must lead dangerous at the same time is illegal. And we are ready to put users of cannabis into prison. So what would be your short answer to us as social scientists through this? Okay, so let me start. Welcome to Earth. I think the first thing that you should know about Earth is that we're not very logical and we're not very rational. We make a lot of decisions that are based on fear, prejudice. We are somewhat racist depending on what part of the world you live in. So for example, there's a country which sets the tone of discussions which is called the United States of America where around 50 years ago the president decided that cannabis is a deadly and dangerous drug. He's done so for political reasons and basically began a campaign to tell Americans that cannabis is socially harmful. It was easy for him to do that because it was mostly ethnic minorities that were associated with cannabis use. So as you can see, those decisions were not based on science. This is how some of the story began but it basically continued throughout the Western Hemisphere. But I think what's really important for you to keep in mind is that we're not rational and that our policymaker and king is often not evidence driven. That's not the only example of a policy that would be very difficult, if not impossible to understand for you coming from wherever you came from. So whenever you deal with issues that are hugely complex from a cultural, societal, multi-stakeholder perspective policies are unfortunately very often not based on evidence. But I hope that as you travel to Earth you also got to see the evidence. So I understand your questioning. I hope that this questioning is actually extremely acute because the evidence that the war on drugs has failed is so strong. The health impact that we'll be discussing today has been devastating. The use of drugs has not increased. Decreased has actually increased. And it has led to what I would call an epidemic of incarceration. We will be discussing this. And a huge waste of money. So I see no logic, but I see no logic in many of the policies that deal with such complex issues. But I hope that you have really seen the evidence. And tonight I suppose all of us will be discussing that evidence. It's quite a difficult question in fact. I think it has to be stressed that fear is a very powerful factor. And I understand the fears of parents because they're afraid their children might pick up drug use of politicians because they're afraid that substance abuse could be a widespread aspect of living. And I think this big fear of a loss of control led to this international system of drug control which is now in place. And it can be debated whether it's useful, whether it's working. I think for me one of the most important aspects is that in the beginning it was maybe set out to work fine. It went after an easy solution to create a drug-free society but it didn't work. In fact it produced a lot of unwanted consequences under which we all suffer. Let's talk about these consequences. You're very often using the term that the global drug war is actually fueling the HIV epidemic. And you also use a term which is called real-full-blindness when talking about the drug users and marginalized populations. What do you mean by that? Let me first set the scene and give a few figures. One out of three new infections with HIV that is occurring worldwide outside Sub-Saharan Africa is associated with injecting drug use. There's an estimated number of maybe 16 million people or so injecting drugs worldwide. Out of these one in five is infected with HIV. And if you look at certain parts of Asia or not far from here in Eastern Europe, in more Eastern Europe and Central Asia and particularly in the Russian Federation and Ukraine people who use drugs account for 60 percent or even more of the new infections. The UN released the new figures the day before yesterday on Tuesday, the so-called global report on HIV AIDS that everyone would know that comes a week before World's AIDS Day. And in that report it is clearly apparent that the epidemic is improving in most parts of the world but in that particular region, the epidemic which is largely driven by injecting drug use and now gaining in sexual partners of drug users is increasing. So there is a huge issue there, a health issue and why I'm talking about waiting for blindness it is because we know that that epidemic can be prevented. We actually know that with what is called harm reduction which is a set of interventions. It's not just one intervention. It's a set of interventions. It is providing clean needles and syringes. It is providing substitute therapy for people who would need it. It is informing people. It is associating people who use drugs in the decision-making process. Harm reduction is actually a hugely effective mean to decrease transmission of HIV. And that has been shown throughout the world including in those countries. There is a very recent paper on Ukraine. So I just can't understand how people ignore the evidence and that can only be somehow on purpose to serve their own ideological way of conducting the policies. That's what I mean. The UN has a goal, the UN's General Assembly set up a goal to reduce new HIV transmissions by 50% in the next three years. Do you think it's possible to achieve this goal without a serious shift of paradigm? It's not. Because as Michelle said, this is where HIV epidemic, I mean injecting drug users are where the HIV epidemic is not only improving but deepening continuously. And I think it's really frustrating and let me share some of my experience. If you work with people who focus on HIV prevention through sexual transmission, it's actually difficult and frustrating because I've done this a lot in my younger days where we had conversations with young people about why they should use condoms or why they should, you know, abstain if possible. And in reality, people look at you and say whatever and go on with their lives. I have never met a drug user who would say to me, whatever, when I try to say, well, here are clean needles and syringes. The reality is that we have two sort of interventions. One of them which is extremely complicated around sexual health of human beings. And another one which is simple and where everyone wants it. I've never met a drug user who would say, I don't want a clean needle and syringe. And so having a population that is willing to access your services, knowing how to make those services available and those services not being expensive, it is somewhat insane that we in 2012 had a situation where HIV among drug users continues to spread. You said you simply don't get why people don't understand and don't get the evidence. Do you remember, and this is a question to all of you, when you did get the evidence, do you remember the day or the time when you realized that something is not working here? Yes. And I think as an AIDS physician, I do remember very well. Actually, I would like to draw a parallel with the early days of AIDS where I was seeing basically every patient slowly deteriorating and then eventually dying. And then in 1996, here came triple combination therapy and within just six months to one year, the face of AIDS in the environment where I was in the western country where treatment was accessible, the face of AIDS just changed. Three or four years later, I really started working, doing international work and public health or AIDS international work. And that's where I started traveling for the first time to Eastern Europe particularly and also to Thailand, to Cambodia and countries where the epidemic was severe and driven by drug use. And I saw the contrast in my own country, which is not the very best example. Switzerland will discuss that later and is a bit higher on the scale, I would say. In my own country, there's just from the end of the 90s and of course throughout the 2000s as harm reduction was implemented, there were just no more new infections among drug users. It is now somewhere less than 2% of new infections occurring are in people who use drugs. You travel to these countries, you realize that as I was just saying, it's over 60%. Whereas the evidence is not only there but it's the most compelling evidence we have in HIV about any mean of prevention of transmission. So it is the shock of contrast, which to me is as powerful as the shock that I had when I saw the change that the drugs can bring. So then I don't understand why these drugs are not accessible to the world and I don't understand why these interventions are not accessible to the world. I think it's important to add that from a law enforcement perspective, there is no reason whatsoever to object to needle and syringe distribution. The evidence which was gathered in many European countries is quite clear that distributing clean needles does not lead to an increase. It's one of the arguments that you hear over and over again and it's quite clearly. Although for example in Switzerland we distribute needles and syringes, it did not lead to an increased use. Also, and I think that's more important for me to say as a police officer, is that it makes a difference whether you have to make a body search on a person who is maybe addict but apart from this healthy and also maybe had a shower in the last two or three days, or to have to carry out body searches on persons who are ill in many ways and living on the very bad social and hygienic circumstances. It does make a change to police work. Talking about Switzerland, we are not only talking about distribution of needles. Let's be clear about it. We are talking about heroin assisted treatment, which means people who are seriously addicted to heroin can get heroin prescriptions from the state. How and why the Swiss police officers and law enforcement are supportive of this. Every single police officer joins the Swiss National Police in favour of drug policy reform. How is this applied? I think the majority of police are supporting the current policy in Switzerland which includes heroin assisted treatment but above all a broad coverage with opioid maintenance therapy and also policy that allows for injection rooms where drug users consume the drugs and it's tolerated inside this room and then the premises again. This is why it's accepted by the police because it brought along many changes which are very favourable to public safety. You know, I think this is... we had this solution for a very specific problem. It's opiate dependency and it worked very well in this area. With opiate addicts, you don't have a flexibility of demand. These people will go back to the streets looking for drugs no matter what you do against it. You can police them, you can arrest them, you can send them to prison. You can affect on them because they are addicts and we just found that taking the core group out of the black market, out of the streets, it was a big relief to public safety. It changed a lot. And also, I think I have to admit that police, they cannot stop everybody from using drugs. It's just not possible. There is just not enough of us around to prevent people from using. The difference with our work is where drugs are used. Are they used everywhere, scattered all over the streets? Are they used near schools? Are they used in public spaces? Or are they used in a very confined, separate space where it's tolerated? And I think that's something that we did. We used public drug use to a confined space out of the view of the children of public. It generated a big support. Question? Well, when did I think that it's a failure? Well, I went to college in the United States and to graduate school. And my first AIDS job, other than my internship with pediatric AIDS, has been the American Red Cross. So basically I've learned to do HIV education, mostly focusing on sexual transmission. And then so it happened that I began a job at the UN and an opportunity came that I could go home. You know, for someone who left the US at 18, finished college, I mean, left Poland at 18, finished college in the United States, an opportunity to go back home with the UN was like a dream come true. It was really a very exciting moment for me. And so I went back with all of this knowledge from New York City, where gay men were getting infected, where American Red Cross education was going to school, talking to kids about condom use and so on and so on. And I went back home to Warsaw and I started to look at the data. And it was all people who were drug-using. None of my knowledge was that relevant, frankly speaking, at that time in Poland, 15, 16 years ago, because it was all injecting drug use. So I had to learn and relearn about HIV and think about what interventions make sense in that context because what I had to offer was utterly irrelevant. And I think the part that's really frustrating to me is that, you know, when you think about Russia, we talked about Russia, Michelle, what's frustrating is that we know, in the former Soviet Union, it's almost like a train coming and we all saw that train coming and we all knew how to stop it and we couldn't. And so I think that's sort of the frustration and now the question is, you know, can we turn it somehow to make sure that the damage and the harm is not as extensive as it could still be? You talked about over a million people infected. You know, if we do nothing, two million and three million, this is going to keep moving. It's not as though, you know, this is going to stop anytime soon. So that's why I think it's important that we make every effort to shift the discussion. The figure was 200,000 10 years ago. It is 1.4 million today, HIV infection. So that's just for everyone to get a sense of the rate of increase of the epidemic. Seems to be got the unintended consequences part is the human rights cost, the public health consequences, HIV. But what about the sunny side? Is there a sunny side of the war on drugs? I mean, after all, there is a reason why governments, pan-a-third are pursuing this policy. There are original goals, you know, eliminating drugs, eliminating drug use. There are we regarding this. I think, I mean, we have to admit that there are some effects. I mean, there is an overall effect of deterrence. Maybe many people who would use drugs are not using it because they're afraid or they're using it in other places than where there is a risk of police patrolling. Also, there is some effect on the availability of drugs. Drugs are not available virtually everywhere, but I think people who are interested in drugs are able to find it in a very short time. So, I mean, there is an effect of law enforcement. And I would also say that no matter which direction you take drug policy-wise, law enforcement remains a very valuable instrument to drug policy. I mentioned before the injection rooms in Switzerland and it was not so easy to convince users to go to these rooms to use drugs. Actually, we had to establish a lot of police patrols around those centers to make sure that they actually move their views and they don't use it in the open public anymore. So, what I want to say is that law enforcement does produce a result and it's very useful also in a very progressive drug policy as we have in Switzerland. But I'm afraid if you calculate all the effects we had with this purely prohibitive approach to the drug problem, we have huge impacts on the public health side and also interesting for me as a law enforcement officer again, you have a big effect, a negative, an unwanted effect on public safety and organized crimes. Of course, money from trafficking of illegal drugs it ends up in the wrong hands and fuels even more crime. Karakasian, do you agree that? Is there a real deterrent attack of drug policies? Well, I agree that law enforcement brings results the question is, are those the results we want? And I think this is where I would disagree somehow. So, deterrence question. You know, it's really difficult to argue this point because if we had half of the world where drugs were illegal and the other half of the world where drugs were illegal we can compare the two. We can do a study, we can know what it is that we're talking about. We're not in this situation. So, basically, whatever it is that people are trying to articulate there's little data to support it one way or another. But there is some data and I think we should think about it. So, let's look at Portugal, a country that decriminalized personal possession of every single substance not just cannabis, heroin, amphetamine and what do we see from there? The drug use, you know, people were not, did not go crazy and didn't say, whoa, it's now not illegal so I'm going to start smoking. The reality is that if you compare Portugal to all the other countries in Europe there is a trend of slight increase but it's very consistent with all of the European countries. What's interesting is the youngest folks kids between 13 and 16 for them the drug use reduced. Less policing, in fact, the number of new drug users among the youngest went down. So, I think this argument that we need police to deter people from drug use I actually am not sure that it's that correct. Look at Holland, right? Coffee shops in Holland, one would expect again thinking that police is what's needed to deter people that the Dutch are continuously high on cannabis. Well, if you look at the data again it's interesting because the number of Dutch users is lower than all of the neighboring countries France, Belgium, Italy, Germany. So it doesn't seem that low enforcement is really necessary for people to make rational decisions. You know, let's look at tobacco, right? We don't have to put anyone into prison to start smoking. There are public health interventions. There's taxation. There is a wide range of tools that we can use. None of them include policing. So again, I think, I mean, it's not to argue that there is no role for policing because I actually am a big fan of what happens in Switzerland and the policing in Switzerland. But I think this assumption is that police serves as a deterrent or that restrictive law serves as a deterrent. I think it's somehow untested. We are just assuming that this is the case. Balazs, HCL, you did the study a couple of years ago where you compared European countries when you asked people why it is that they don't take drugs. And it turns out that it's for health reasons. It's for many reasons. It's not necessarily because drugs are illegal. It's interesting though, most of the people would say no, it's not the police. But they also assume that the deterrent effect exists for others. So they are clever enough, they think they are clever enough to decide whether drugs are good or bad for them and they don't need a police officer to say that this is a no, no, don't do it. But they do think about the others that the deterrent effect exists. This brings us to the perception, the public perception and actual realities. The Netherlands is considered the liberal black sheep of the international community in many sense. But Switzerland, which is really leading the way in harm reduction isn't considered at least a very liberal country. And as far as I know, human rights, tolerance and solidarity warrant the driving forces behind the Swiss harm reduction interventions. So what were they? What was the reason Switzerland chose another path? I think quite simply, finding quick fixes and solutions to problems which were all over the cities. I mean, Switzerland was quite badly hit by this heroin wave in the 1980s, beginning of the 1990s. And it just created open drug scenes in all major cities in Switzerland. Open drug scenes meaning places where addicts would gather around the clock trying to buy drugs, shooting up. And also around those drug scenes we had a big problem with petty crime and high genic circumstances. So the Swiss drug policy actually only wanted to solve these problems. And I think human rights at US was not in fact the driving factor. I quite agree. I would agree with this. There was a very pragmatic approach somehow in Switzerland. I now have been living in Geneva for five years and I see Switzerland as very pragmatic in general. But I'd like to say that in Switzerland the other driving factor has been the awareness of the health crisis and HIV. And so to me the turning point is when a society or country will actually switch from considering drugs as criminal to considering this as a social and public health issue. And that has to be the starting point. Once you're there, if you then from there start moving budgets from prohibition law enforcement to support health interventions then it's the beginning of a process. Drug policies will not change like this from one day to another. It isn't a Berlin wall that will fall. It will be as any social change a slow process. But if you look back and that's my way of looking sunny or positive here if you look back some countries started decriminalizing drugs actually in the end of the 70s and the number of countries that are introducing harm reduction interventions the number of countries that have been decriminalizing two more states in the recent referendum in the U.S. decriminalizing cannabis all of that is I think somewhere I want to think an irreversible movement. You are a commissioner of the Global Commission on Drug Policy and it's a very substantive initiative. I counted no less than eight former country leaders former presidents and prime ministers mayors, state secretaries but I'm really sorry to put the emphasis on the former and don't take it personal it's not about you being the head of Global Fund you've always been an advocate of harm reduction but what is this thing with politicians who are behaving as either drug warriors either just executors of the current system and then leaving them to terms turned to be reformists. Yes well I have to be careful here and I can't speak on behalf of the fellow commissioners but you're absolutely right to say that this is a hugely powerful group let's recognize it there are as you said about eight former heads of states from all over the world that's in America, Europe Central Europe as well with former President Krasniewski of Poland you have people like Kofi Annan, Luiz Arbor you have a number of former ministers I'm just the doctor on the group but what I heard I heard very clearly President Cardoso of Brazil former president of Brazil former president Gaviria of Colombia speaking and former president Zedillo of Mexico tell us in the commission that it took them some time to realize and when they were so but they now acknowledge and you know they really turned into real activists now when you're actually in power you're accountable to your parliament you're accountable to your people and it's extremely difficult to be in a position of an open advocate particularly if the public opinion is not supporting you so I can't really, you know what I'm saying is that I have really heard these people talk about this something one day that we realized and changed the way we think and they became hugely committed commissioners to the cause Kasia would you agree? I agree that they're hugely committed and I'm not on the commission but I can share with you my experience of talking President Krasniewski into being on the commission and for us it was important because this is a president that in 2000 signed the drug law that we are still struggling with the drug law which basically puts you to prison for any amount of any substance so we now have roughly 400,000 people with criminal records in Poland as a result of that drug law that he signed in 2000 so we thought that it was really important to approach him and to see how he feels about the decision that he has taken then and it was two one and a half hour conversations with a lot of data about basically showing the results listen here is what happened and you know it's interesting because it was clearly a process but it was a relatively fast process once the data is there it's difficult to argue with it and I think President Cardoso says the same thing you know he says the same thing he invited DEA the American law enforcement into Brazil and now he sees the results so I think like any human being mistakes were made, quite serious ones and people are trying to rectify it just a quick word because we were talking about incarceration and that came again just in Krasniewski's words what I missed in the film and I would like everyone to be aware of because today we talk about health is that not only is it absurd to have these millions of people incarcerated for minor drug offenses but prison has now become one of the places where you are at higher risk of actually acquiring HIV, hepatitis or tuberculosis I came across an amazing figure recently in the Russian Federation if you're incarcerated your risk for a drug offense your risk of acquiring tuberculosis is 25 times higher than in the general population and as you know in Russia this is even more frightening somehow and scary because a large fraction of the new cases of tuberculosis are so called multi-drug resistant tuberculosis I just wanted to sort of bring that addition to the debate on prisons prisons are not a safe environment and Balazs not all the presidents are apologizing because President Dreyfus is not apologizing because she indeed is the person that stood behind drug policy at the time when she was in fact in the office but I guess you know what I meant President Clinton did not think basically when he was in charge and today he's wording what he used at the World AIDS Conference is really heartwarming, inspiring except now he's not a president anymore You mentioned Russia, Michel which in itself is a big chunk of the problem Russia doesn't allow opiate substitution treatment Matadom is prohibited in that country Is there a Russian way of solving the problems or the epidemic is out of control? At this time I feel very pessimistic I mean to be very frank Yes, Matadom is illegal and I just don't see any dialogue possible and whenever you present the evidence that we've been talking about this afternoon to the Russian authorities the answer is, well, yes, okay but that doesn't mean that this would work Russia in our environment and the number of pilot trials have been started but the results of those are not acknowledged I remember as the head of the Global Fund following some of the work from OSF we funded a large number of NGOs at a relatively big scale to start programs of harm reduction needle exchange, particularly and after three years that program called the Globus program showed clear results of decreasing numbers of new HIV infections in the provinces the oblasts where it was implemented and when we had a high-level meeting with the Minister of Health to present her with these results she came with the Russian results saying we also know how to count and according to her results it's actually in the very oblasts where harm reduction was implemented that there was the fastest increase in infections so it was just lying just dishonest arrogant and if that is the debate today there I just don't see any way out so let's be patient this is an island somewhere in the world and one day it will give up I'm sure, I don't know when meanwhile we have to continue to patiently talk about the evidence talk as we do this afternoon and also at one point try and put pressure on the top I had a bit of a sunny sky last year we actually discussed it with George when the Russians the Deputy Prime Minister the Minister of Foreign Affairs and the Minister of Finance Lavrov Kudrin came together for two hours to talk about HIV and then every sort of hope that could be raised disappeared the day after so my answer is pessimism at this time before turning the floor to taking questions I have one question to you Roger we haven't touched the money side the side of the economics but when someone is reading the Swiss results and the first experimental and now mainstream ways of treating drug addiction in Switzerland it's really striking how much money it can be saved with harm reduction services and operations aren't law enforcement representatives sorry for losing some percentage of their funding which is actually coming because of the need of being tough on drug users? Not at all, it's not an issue I think the burdens which are put on the shoulders of police are quite numerous and in many European countries drugs are no longer a priority for police work it's now more than a decade that a subject like terrorism came in or hooliganism or financial crimes so many new priorities have pushed away drugs so I feel that many of the investigating groups lose personnel, lose support lose also the support from the prosecutors so they're not afraid of losing the job I must make clear that in Switzerland we didn't turn Switzerland into a heroin supermarket this was very controlled it was a small group of about 1200 persons getting access to heroin treatment it was a very controlled and closely supervised group of 18,000 persons getting access to a broad to an opioid maintenance therapy and all other drug use apart is still regarded as illegal and is prosecuted what we do now in Switzerland is what we try to make the process of prosecution more effective so instead of having a criminal procedure for everybody lighting up a joint we would very much like to have a system which just foresees for fines so this is like immediate punishment of I don't know 100 euros or around this this is a close deal for the police and for law enforcement so we are not losing our jobs in fact we still have quite a lot to do I really think it's important to stress this that I don't think that police justice will lose resources or jobs due to changes in drug policy it's not the Swiss experiences it is even as interactive as it is possible so at this point I would like to ask you to pose questions if you have any few basic rules we would be very happy if you could introduce and identify yourself and pose any questions priority would go to questions if you have interventions please try to limit it to two minutes and we would take up two questions at the same time we have two mics there and there so please the floor is yours Hello my name is Peter Schausche I work for the Hungarian Civil Defense Union I have two questions first is that Misha mentioned that a few weeks ago in two states of the United States marijuana was legalized and how do you see the impacts of these two initiatives that passed and especially the impacts on Latin America which is now kind of rebelling against the American approach of drug policies the second question is to Misha the global fund played a very active role in promoting harm reduction in Eastern Europe and Central Asia how do you feel about the appointment of the new director do you think it will change the role of the global fund place in the region thank you I don't see anyone in the moment so please so what are the implications for cannabis one thing to keep in mind is Peter I don't think they legalized they voted to legalize so I think when it actually happens is a matter for further discussion so just so everyone knows along with the presidential during the presidential elections two states voted for legalization of cannabis now what are the implications the first one and my favorite one is the international one which is extremely difficult for the US to carry the torch of prohibition when it's own people spoken in two states that they don't want the prohibition and I think this is what Latin Americans are now pointing out Mexico is clearly saying that they have to rethink the approach in the life of the referendums there were many other countries that basically said well don't send your DEA agents to my country if you can't deal with your own drug problem and you need to now figure out how to regulate so I think that this really sort of undermined the US position of the prohibition is now what are the implications it will have you know I actually think that I mean my hope is that there is not a long drawn out battle that will end at the supreme court because I think the bottom line is we already have seen this in the US with medical cannabis it started with two states moved on to three, five we now have 19 so my hope is that basically we'll follow that model that in the next two years we're gonna have another two states in the next two years we're gonna have another two states and so the process has begun so those would be my my two quick thoughts the strategic decisions in the large amounts of money that the fund is spending in fighting AIDS come from the board not from the executive director I was sort of lucky to have a board that let me work what I'm saying now is that in times of financial and economic constraints at a time where a number of development agencies represented on the board consider that the so called high impact countries for interventions are the poorest countries of the world with the highest burden epidemic rather than some of the transitioning countries with concentrated epidemics the ball somehow is with the board and so my answer to your question would be let us strengthen the board of the global fund let us mobilize that board you are represented and your constituencies are represented on that board and have to speak out be very careful and make sure that the investments continue as they are needed in the eastern European and Central Asian region and they're particularly needed because it will take as we've been discussing for Russia a long time before these countries will actually come with investments from the national budgets to cover the public health needs thank you I have two questions first for the panelist and second for the moderator the first one is what were the arguments that allowed to shift the public opinion and the public policy in Switzerland for instance and how translatable are these two different contexts and then because we are in Budapest what's the situation in Hungary and what can you aim for realistically in the immediate or medium term future Kristof Varga from the CUSF he is an office I'd like to piggyback on Balaji's Mars parallel a bit and let's imagine that we are conquering Mars so it's a clean slate and a new human civilization is being built would you be against legalizing all drugs under those circumstances and if yes why? who starts? maybe I will start the first question why? you know the policy change in Switzerland occurred at the time when I was too young to witness it personally but as far as I understand the drug problem was like the number one issue in the public debate in Switzerland it was very prominent it affected public safety and public health so there was an underlying attitude for change in Switzerland in the end of the 1980s when you go back and look at the single steps which were taken I have to admit that it was not the police who made the first steps it was courageous doctors and social workers who started programs of needle distribution doctors who started with methadone treatment and also University of Zurich I think it was starting with a trial, a research program on heroin-assisted treatment so it was similar subjects and municipalities who in fact started to change and then the federal government just going after it once they had a good evidence and I think it's not such an exception it's not exceptional that in Switzerland it worked like this you often have first and important steps taken at the local level taken by some specialists and then once the evidence is good enough governments following it we had a second question quite frankly for me it's not the question is not about legalizing substances or prohibition I think what I still try to do as a member of police practical solutions that suits to everybody I see with many substances a problem in legalizing them from a medical point of view and also I don't see much room from politics but I think that we really need to readjust our priorities we need to keep in mind what were the basic principles of the international control system the basic principles or the ideas behind the international control system was not to lock up people or to punish them the good we are trying to protect here is the health of the individual and the general public and once you remember behind the international control system I think you automatically jump to conclusion that yes prohibition there is a way prohibition can work but only if you have the top priority at the same time on harm reduction making sure that people have access to the treatment they need that users have a place where they can use the drugs if users have access to clean needles that must be the first priority sorry to interrupt you Roger but isn't there a contradiction what you are saying that can harm reduction services work in a prohibited environment prohibition means that we are actually aiming to put people behind bars because of drug use how can you expect from those people to appear to harm reduction services we have this we have this situation on a daily basis in Switzerland we have the consumption rooms we have a techno dance parties we have laboratories where users can go and have the drugs tested and the police know about this and of course if we turn up in front of those facilities and carry out controls systematically nobody will go to the social counseling nobody will go to the consumption room or to have the drugs checked at the party so we strike a deal with the social workers the informers beforehand we restrain from carrying out controls but at the same time if we learn about people taking advantage of this if people start selling drugs in front of a drug check program or at the consumption sites it's often the social workers who call the police that they come and deal with the situation so I think there is a way that provision can work but only if social workers public health officials and police officers are working together quite closely and on the regular basis question Misha if we enter that new planet before thinking of what sort of policy you would wish there and what it is that you would wish to be legal or illegal you will ask yourself the questions why are you actually putting forward policies and laws and what I'm saying is that when it comes to drugs we need to shift from a criminal and legal perspective and then low enforcement perspective to a health and social perspective so that has to be the driving force behind the policies so if it was just a matter of whether you should legalize or whether your drugs should be illegal to me is not the issue as Roger just said is what it is that you want at the end you want a society with people that are healthy you want less crime you want people to develop in safe communities and in safe environments and the evidence that we have at this time is that this starts with this public health and social approaches to the issues rather than being solved just by law you cannot impose by law to someone to be healthy so to me the problem can't just be the question can't be asked in the way you put it sorry to escape somehow the problem but I you have to ask a question the question of why is it that you need the law and why is it that you need the policy so here's how I would here's what I would offer I think that the planet X should regulate all substances and the more dangerous the substance the more regulated it should be so if we're talking about heroin maybe the way to regulate it is through what Switzerland has done people who are heavily addicted have regulated access in medical facilities because I think the problem that we have now is we assume that not regulating makes it more less available well I think it's exactly the opposite the more I'm worried about how dangerous the substance is the more regulation it should require but it should be available to those that make a conscious choice adult grownups make a conscious choice they want to use it this is for that other planet for our planet earth I think regulating everything right now or legalizing is not possible and I think it's not possible for many reasons one of them is the out of control drug market which I think will be it'll take a long time to in fact try to find the way to to regulate but if we were starting from zero I would say heavily regulate the more the most dangerous substances and then play with regulation around others however with the synthetic drugs and new drugs and homemade drugs coming every day you can't have a list of things that would be updated to regulate so I would follow you very much but let's say all of this is unrealistic even on planet X homemade drugs and synthetic drugs will also come so let's focus on reducing harm topic tonight is reign of Hungary but I can ask you very shortly and bring three examples and that will tell you where are we now and where are we are heading Hungary I believe is the only country in the European Union which currently lacks international drug strategy one and two years ago the strategy was removed and the government decided to wrote a new one that still didn't happen so for two years without we are without a national action plan and drug strategy that's one thing few years ago there was a study which proved that countries spent about 40 million USD per year on drugs related cost of the drug issue that means persecuting drug users most of the procedures are started against small scale users of cannabis at the same time this study proved that the amount of money spent on harm reduction prevention, treatment and rehabilitation is about 4 million altogether now this amount I believe is now 2 million USD and at the same time I don't have reason to think that cost of law enforcement related procedures were seriously used so that's the second thing and the third thing is that even if the future and the situation is not bright it will look and can look bright because the current topic we are dealing with and that's a scandal among the professional circles in Hungary that the drug report the national drug report what the country about to send to the European Union European monitoring central drugs and drug addiction was actually censored the draft version of the report which was sent to the professional community is different than the actual report which was sent to the EU agency important pages are missing from that report including parts which deals with the hepatitis C epidemic among intravenous drug users among the about the problems of the so-called new designer drugs so even if the situation is not good it can look good that's where we are at the moment and I have no reason to think that this picture will change dramatically in the future let's go back to our topic do we have questions from the floor yes welcome with the evidence base at hand and with the prospective cost savings can each of you give us including you Balazs can each of you give us some of the reason and they marry they may well differ across different countries how do you explain the different positions between former members, former politicians former heads of states and the commission and acting politicians what are the pressures, what are the forces what are the fears of politicians standing up and exposing this problem and saying I'm prepared to make an issue because from what I understand you're saying the evidence would change relatively quickly so it cannot be fear of not being re-elected on such an issue you could relatively short period of time demonstrate that these elements and these policies would have a positive effect what from your experience explains the stark difference between former retired politicians and active politicians thank you my name is Victor Rochatis I'm a professor here, I have a question but I would be very happy to give the mic to any student that would want to ask a question if I were a student here then I will talk by default I have two questions, one question is to primarily to Michel it's about actually Russia and Switzerland I would love that Switzerland occupy Russia but I think now you have the popular Guertina which is efficient but isn't that primarily the difference between moralistic and pragmatic cultures and if you know why go off into Russia on alcohol treatment and I see that the groups and people that are more effective and efficient are small protestant communities because they are more pragmatic and orthodox moralistic culture and of course in moralistic culture not only there but everywhere I guess that former politicians don't have to fight for votes and they believe that they may lose vote when they are in office by wanting to change the drug policy my second question is to Roger I disagree with you that this entire drug policy is irrational, it's extremely rational and logical it gives profits to so many people it controls so many things and three are related to police everywhere number one that it gives incredible discretionary power to policemen in this spot he can prosecute one person not another person and police in many countries likes that a lot second is statistics police are made accountable on solving crimes and the crime of the drug possession is the only crime under the earth which is solved by definition because there is no crime before it is solved so if police anywhere wants to repair and increase statistics they want desperately to criminalize drug possession because that makes their life easier and then effective finally, how about the money what did you do in Switzerland because in the US, other countries the money for drug problems which is rational, logical went from the health and prevention into police and law enforcement and that's really increased and multiplied by great fraction and the final thing controlling the underclass drug laws are the best possible to control the underclass and prisons and the prohibited laws how did you deal, how did you went out of that trap for police and law enforcement in Switzerland that would be lesson for others let me start on the first question let's not forget that in Switzerland we've been talking about the remarkable leader but this is not the country where the president just decides things on his or on her own the process in Switzerland has been an extreme a process over months where the evidence that Roger mentioned previously was actually presented to the population things were explained patiently and then the people voted what I would feel that is that at this time leaders in different countries in Europe in a climate of tension linked to the economic and financial crisis to communitarism to more homophobia xenophobia fear of uncertainty in that climate I don't feel the acting politicians are ready to open a serene debate as the debate presenting the evidence debating on the evidence and then having the people democratically decide they don't want to take that risk I'm just thinking for example of my own country France where we had sort of great hopes with the election of President Hollande and as soon as two ministers of his government in two months of the new administration started the debate they were asked to shut up and so that would be my answer let's not forget that in Switzerland it's been a very patient informed democratic debate and Victor this maybe is also what I would sort of answer to you I agree on how you define the dichotomy between Switzerland and Russia but I would add that it's also between democracy and non-democracy Russia is a country where currently you just cannot democratically challenge what the power will say even with an evidence base to challenge those decisions before you cannot open that democratic debate and I'll just end by saying that I think the lesson from Switzerland and from Portugal is that you can't just change the situation with a decree again or one simple decision it is a progressive change that has to be really have the endorsement of the population in a democratic environment that's why it's so difficult one of them I just want to make sure that we did not leave an impression that it's only the former that are engaging because I have a print out here of a report from Iberio American summit that just took place in Cadiz in Spain where we read current governments, current presidents other key agreements that came out of the summit include an agreement by all members to push for a special UN general assembly session no later than 2015 to discuss the international drug problem so it's a different way of speaking obviously but these are these are presidents of Latin America plus Spain and Portugal that are also in some way revolting against the UN I think that debate is going to look differently but I think it's important to know that we now have sitting presidents who are speaking against it so if you look at president Molina from Guatemala he's talking about everything including legalization if you look at president Santos from Colombia again he is talking about starting a real debate Colombian government is actually putting money into a process that will be Latin America the outgoing president of Mexico he's leaving so I already forgot his name president oh my god president of Mexico Calderón president Calderón outgoing but also not terribly impressively and bravely but does say maybe it didn't work think about what's next so I guess I just want to make sure that we don't give an impression that it's only the former president but I think the important question in this context is what happens in Latin America that allows for those statements and I think what happens in Latin America is really a true feeling that people are fed up with a drug policy that has been imported exported by the US and in fact is doing actual damage to the countries and I think the debate it's clear that there's a lot of civil society and academic expression that what's happening now is just not acceptable so I think these are the two somewhat important spaces that have been created for those leaders to actually say those things and I think that's actually quite important something else I want to escape basically you're saying Catholic Latin America is joining the pragmatic protestant part of the drug reformist but let's hear the pragmatic protestant just to Victor, I actually think that Switzerland, Russia for all of these reasons that Michelle outlined complicated to analyze, but Poland's Czech Republic talk about moralistic versus pragmatic so I think that we're super Catholic, they're not look at our drug policy, look at their drug policy so I think that that's an important philosophical view that plays into how we implement policies I would like to start with remark that I think religious backgrounds don't influence drug policies too much I mean Switzerland is a mixed country half Catholic half protestant and you have all the cantons with the predominant religion and I don't see that protestant cities are necessarily more progressive than Catholic ones it's a higgledy-piggledy Catholic pragmatics also but but we know the weight of the Russian Orthodox Church so coming back to the questions I mean although it's a bit far away from my daily work, I would like to make a comment on attitudes of politicians in power or a leading office I think for me one simple reason is that why drug policy changes are such a hot iron for people in power is that you are really running the risk to fall victim of a political campaign or a media campaign once you stop prosecuting drug phenomenons I would like to make an example there was this mysterious case I think this summer when a man attacked a fellow man and started biting him and the media coverage went into direction that in fact this man was under the influence of bath halls so one of the research chemicals being around we started getting those by medias and I mean the story was the same actually for more or less every journalist who called it was well we have this case in the United States a man an atheist fellow man under the influence of bath halls and what are you doing about it so that was the question and if you say well nothing because we don't know about it or we don't know what substance or whether the man was under influence or anything at all it's difficult to sell these news people won't listen to it they want a clear answer to it and it's always easy to provide simple answers second question was a bit trickier for me where does Switzerland invade Russia an example of imperial over-stretching I think and no about I mean the law enforcement having a profit from the war on drugs I mean I agree with some of the things you said like statistics is very persuading you make an arrest you have a criminal procedure you have a judgment and it gives a nice statistics statistics in the end of the year and quite frankly that's usually what happens if you have an international law enforcement gathering when it comes to drugs we compare statistics and it all looks very nice but I don't think that police work is so much subjugated to statistics in all the countries I don't think so in Switzerland it doesn't play such a big role and the users and convictions are not viable I think there are more measured for example in regard do we provide for public safety or not discretionary power was another thing you mentioned it's a very thickly subject practical example you make an arrest you stop somebody who is using a substance maybe he is snorting cocaine this is a simple situation that police officers have day and day again if it's a person you have been arresting for 20 times you maybe are more likely to think well let's not lose time with this again and let him go if it's a young person you meet for the first time you are likely to really make a confiscation and make sure that the authorities are alarmed about this case because they might be as a punishment some sort of social counseling going on at least in Switzerland I mean this is an example of discretionary power and sometimes it's very useful it makes police work easier in the future where this can bring along problems I agree that for many for many countries maybe also for Switzerland it would be more fair and a better idea to have one offence and the same punishment for everybody but I think for me it's not a point where I think that police are very convinced about or very fond of this discretionary power and policemen openly speaking against it it brings them into the situation where they have to decide whether this is a problematic user or somebody where we can let go it's a difficult situation you find yourself in yes I would like to comment on Victor's question very interesting listening to a Swiss policeman answer if you ask an American policeman the answer would be different because the situation in the United States is very different you have for instance a confiscation of drug arrests which actually directly to the police cars houses houses and so on I have attended a court in New Orleans which basically lives on the income it gets by finding drug offenders so I think it would be very interesting for you to go to the United States and make a study and then you would have a really interesting insight into why the United States follows the policies that it does and of course it's a well known fact that for instance in California the police the prison warms union is the largest political force in California so the situation in United States is very different from Switzerland and there in lies I think the explanation a large part of the explanation because there are all sorts of other issues and racial considerations which are very important in America and probably less so in Switzerland but that's a large part of the explanation of why Switzerland has a what I would call a more enlightened policy than the United States if you permit I would also like to comment on the last point you Victor made regarding minorities on the class I quite agree that you know there might have been some influence of an overarching aim to subjugate minorities or classes in some countries in the past it's difficult for me now speaking in 2012 where drug use is so widespread where you can find it on all social levels with bankers with students virtually everybody I cannot think that at least in European countries that you really single out this policy to go after a distinctive minority class is it class you know of the people before they started using drug I mean in the end you start policing the people who are in the streets the persons who are homeless in the streets they have no income those are the people you focus on because politics tell you to you have to look for public order and safety that's your order to this point to carry out arrests to produce a visible result but I think it's not class bias it's a mathematical solution which is class bias but you know probably from what the lastment of my daughter was a bartender in the class for highest elite all of them were snorrikes it was in Warsaw in 1999 all of them police never came there not even once and on the corner where the people from lowest classes were doing much less dangerous thing because they were just it was easier and because this are them this are them and this is us these are high level people they make money for transition for all this shit you know but these guys are them and then come to populist populist ask them and fear them and who will save you because in my experience how did you avoid all this crap in Switzerland that was my question I want to go to Switzerland I know I personally know the situations that's why I would like to try to explain that I think it's not a class bias driving police forces to do their work for example in most of the cities in Europe the drug problem is visible in poor areas so what we actually do we are policing there in order to relieve the local on the class neighborhood of the drug problem so this is not I mean for me this is not bias and as for the other things there is not this bias as for the other thing you know going into a club and carry out searches you can do that as a police force but I mean you enter a building which is dark where you find 300 or 400 persons dancing drinking using the minute you enter the club but the drugs you find them on the floor and you can't prove possession to anybody in the club that's why it's really difficult to carry out such a search in a closed dark confined space at night it's a practical difficulty you have as a police officer if you are a Swiss police officer if you are a Hungarian police officer you force all the 400 to your impact and then it's easy I'm afraid we are close to the end of the session but I would like to read the photo question and Michelle I just wanted to bring back the debate to the health issues and what George said around the racial bias should not be underestimated because in the US the bias that is the highest risk for someone who is an Afro-American to be arrested for a minor drug offence is such that given the risks I've been discussing before of acquiring HIV in prison that bias in the rest is considered now as one of the causes why the HIV epidemic is predominant among Afro-Americans in the US so these biases are very big issues and of course I also wanted to add that we work from the US to Switzerland and if we go to Russia there of course for the policemen finding is also a good way that there's a lot of bribery and corruption so I was going to say that I would really love all of us to support Russian policemen if they were one day to demonstrate in the street for higher salaries okay I guess my part in comments would be that I think there is a space for police for smart policing and we've seen that in some communities and actually it's been quite impressive I think a part of the problem that we have is the other side of it which is you know police officers standing outside of a Netadon program in China and people wondering why is there no uptake so I think that discussion needs to happen and I do think that academia is extremely important to this discussion so Wolfgang, I actually hope that couple of years from now will be answering the question you asked by some policy data that has been generated in you because I think one of the reasons why it's hard to answer that question is because there's actually very little academic knowledge in the area of drugs policy and I think it's really great to be here and it's great to have George Walkamas here and I think the spirit of this conversation will continue to see you Thank you, thank you so much that was about it please watch out for the next two events there will be other ties on the website of the School of Public Policy and thank you very much for your attention and presence we prepared a small reception outside please enjoy everything including the refreshments some of them are legal drugs thank you so much