A recent global drug conference in Vienna-Austria unsurprisingly revealed the fact that the so called ‘war on drugs,’ or the effort to reduce drug use simply by using law enforcement, policing and prohibition, has failed.

The conference was aimed at evaluating the results of a decade-long war on drugs. A UN report presented at this conference stated that anti-drug policies have in fact indirectly created a wider criminal market of macro-economic size related to drug dealing and drug consumption.

Supporting the report, Antonio Maria Costa, head of the UN Office on Drugs and Crime, said the estimated value of the illicit global drug trade had increased to more than US$300 billion a year. “We need law enforcement. But the heart of the matter is to bring back health, prevention and treatment to the centre of drug control,” Costa argued on the sidelines of the ministerial-level meeting of the UN Commission on Narcotic Drugs. “It’s not done in a lot of countries,” he added.

Addressing the dual epidemics of injection drug use and HIV infection in many countries around the world, Costa also underlined the need for large scale harm-reduction measures such as needle and syringe exchange programs (to reduce the spread of HIV and other blood-borne viral infections through the use of unsterile needles and other injecting equipment) as well as clinical treatment and outreach work.

In line with the UN statement, a European Commission (EC) report published prior to the conference, maintained that it had found no evidence that the global drug problem was declining because of the war on drugs during the period from 1998 to 2007.

Instead of significant success, the EC report stated that the situation has worsened, and for some it has worsened sharply and severely, particularly among many developing and transitional countries. The reports also revealed that in many developing countries, including Indonesia, the threat of twin epidemics of unsafe drug injection and HIV infection are real.

Here are some facts related to drug use and HIV epidemics in Indonesia: A national survey found that approximately 13 million people had consumed illicit drugs at least once in their life time, and 2.2 million used drugs on a regular basis. The vast majority of those who use drugs are young people aged between 15 to 24 years old. Furthermore, it was estimated there are between 145,000 and 170,000 injecting drug users (IDU) in Indonesia.

Risky injecting practices, such as sharing of needles and other injecting equipment, are common among IDU in developing countries, including Indonesia. It is not surprising there is a rapidly increasing number of IDU who are infected with HIV and the hepatitis C virus (HCV) in the country. In 2008, it was estimated that more than half of new HIV cases in Indonesia were linked to risky injecting practices.

The above facts should be tackled urgently and intelligently but our response should be based on evidence and take a rational approach. In this context the warnings and lesson learned from the UN and the EC are highly relevant for our efforts to reduce the scale and harm of drug use in Indonesia. The UN and the EC warnings are becoming more important due to the tendency of many government officers, politicians, community and religious leaders in Indonesia to respond to drug issues with moral panic and militaristic, blanket approaches.

Over-generalizing drug use, especially among young people, is a common phenomenon. Many people cannot distinguish young people who are simply testing and experimenting with soft drugs like marijuana based on curiosity with those who use drugs more persistently or those who are problematic drug users or addicts in the long term. Many assume that those who are experimenting with soft drugs will definitely end up as addicts though there are abundant studies maintain that only minority of those experimenters end up as recreational let alone problematic drug users.

The vast majority of experimenters do not consume drugs after their first time use and do not escalate to recreational or problematic use. The myth of the gateway theory (that the use of one drug will spontaneously lead to the use of other drugs) is over-emphasized.

Rather than applying a militaristic, blanket approach such as the war on drugs, public health intervention should be prioritized. Primary intervention needs to be applied for those abstainers (non-users) to stay off drugs or delaying drug experimentation. For those who are using drugs on a recreational or persistent basis, secondary intervention is needed. This could include providing support to avert their transition into harder or more dangerous drugs.

For the minority of young people who are problematic drug users, tertiary intervention such as needle and syringe exchange schemes, substitution programs and clinical treatment should be provided. These kind of rational and concerted efforts have been proven to reduce the scale and harms related to drug use (including reducing the spread of HIV) in developed countries such as Australia, New Zealand, Canada, and Western Europe.

The writer is a lecturer/researcher at the faculty of Public Health, Hasanuddin University, Makassar and a PhD candidate at School of Population Health, the University of Melbourne, Australia.

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