Urban centres at risk: Prague declaration to merge public health and safety in drug policy

Press release, 30th September 2010.

  • Public health and public safety concerns regarding drugs are not mutually exclusive.
  • Drug policies must be less politically charged and more pragmatically driven.
  • The Prague Declaration calls for greater participation of urban leaders in forming drug policy.

Christine Köhler-Azara, representing the City of Berlin, and Pavel Bem, the Mayor of the City of Prague, have signed the Prague Declaration on the press conference, short before the start of the international conference Urban Drug Policies in the Globalised World, on 30th September, 2010.

The Prague Declaration is now open for the representatives of municipal governments, decision makers responsible for local and municipal drug policies, workers in the field of drug prevention, regulation, treatment, and harm reduction, and researchers in the field of drugs, as well as for the interested public, to be signed.

Press release:

Prague declaration to merge public health and safety in drug policy. Public health and public safety concerns regarding drugs are not mutually exclusive. Drug policies must be less politically charged and more pragmatically driven. The Prague Declaration calls for greater participation of urban leaders in forming drug policy World cities bear the brunt of the globalised flow of illegal drugs and open drug scenes, representing threats to both public health and safety. However, local politicians have little or no say in drug policy as they are driven and designed at both the national and international level, and rather respond to demand of local citizens for fast and simple solutions. Often well-intentioned attempts to manage public safety issues related to drug policy have resulted in pushing drug users to the social periphery, threatening public health. The Prague Declaration will be presented on September 30th in the pearl of Central - European Art Deco, the Municipal House, and sets the principles of effective drug policies that balance law enforcement and public health priorities.

The Declaration calls for a rationale approach to drug policy that avoids the unattainable goal of a “drug free world” and all its associated unintended consequences. Specifically, it calls for greater attention to be paid to human rights, public health and safety issues, and the need for local decision making and evidence based approaches to play a greater role in policy development. The Prague Declaration will be the centrepiece of the international conference: Urban Drug Policies in the Globalised World. During a major plenary session at the conference on October 2nd, the general public, local politicians, drug services workers, law enforcement officials, and drug users will come together to discuss and reach a consensus on ways to optimise public health and safety concerns in drug policy.

The conference will host representatives from the cities of Berlin, Hamburg, Vienna, Kyiv, Minsk, Nicosia, among others. It is reminiscent of the signing of the Frankfurt Resolution in 1990, at which councillors of nine European cities called for greater harm reduction services that prioritised public health over persecution – but not over public safety. Twenty years later and despite growing implementation of these programmes, European cities such as Prague are struggling to maintain harm reduction services and other interventions despite their proven effectiveness due to changing political winds.

The Prague Declaration calls for drug policy to be treated as a public health and safety issue that is driven by science not politicals.

Prague turning back the clock

Shortly after the Velvet Revolution, Pavel Bem, a psychiatrist, who would become the National Drug Policy Coordinator and (the current) Mayor of Prague, introduced the first needle exchange program in the country, then-Czechoslovakia, positioning the city as a pioneer among post-Soviet Europe.

Fifteen years later, Prague syringe centres are facing growing problems and are threatened to be closed down, and police officials are periodically pushing outreach workers away from Prague’s city centre, Venceslav Square.

Due to the successful strategies developed by Bem, the Czech Republic has been able to contain the spread of HIV through injecting drug use, which accounts for 2.5% of new infections compared to 57% in Eastern Europe and Central Asia or 20% in the United States. Successful HIV prevention strategies among injecting drug users (IDUs) also prevent infection through sexual activity.

This is important for the health of the whole Czech public; according to the Harm Reduction Coalition, over 60% of AIDS cases among women are due to injection drug use or the result of sexual contact with someone who contracted HIV through injection drug use.

Some political parties have launched an anti-harm reduction advertising campaign, “tough on drugs, tough on homeless“, for the upcoming municipal elections in the Czech Republic. Should these parties win the election, this may have major implications on public health, public safety, and financing. According to the US Centre for Disease Control, the average lifetime cost of treating HIV/AIDS is in excess of $350,000 compared to $2 per syringe. Furthermore, the lack of prevention services poses a serious health risk to Prague, where half of the country’s drug users live or have lived.

A major policy reversal in the Czech Republic carries the possibility of turning the country from a success story to a country with epidemic levels of HIV, as is the case in other post-communist countries where up to 70% of new HIV infections are among IDUs.1

Zurich from the grassroots

At the time when Bem was defending the first needle exchange programme in Prague in the early 1990s, the city of Zurich, home to one of the world’s largest financial centres and one of Europe’s wealthiest cities, was excessively hit by an expanding drug market. A conservative and prosecutorial country was faced with widespread drug use resulting in a growing HIV epidemic. Despite some vocal opposition, the Canton Medical Association decided to support the opening of the first safe injection-room in Bern. Shortly after, Zurich started syringe and needle exchange programmes supported by the citizens and based upon a federal decision, despite threats of prosecution by law enforcement officials. Eventually, the municipal government of Zurich was convinced by this new harm reduction approach and, inspired by the “Frankfurt Resolution of European Cities on Drug Policy” and successful treatment programmes in cities around the world, started heroin-assisted treatment for addicts.

These drug policy advancements did not go unnoticed by national and international bodies. The Swiss federal government mandated experts in criminal law to assess the impacts of harm reduction strategies, resulting in national political support for these programmes. The United Nations Office of Drug Control, however, expressed grave concerns about this approach.

Following a positive evaluation by the World Health Organisation, these locally based programmes earned the endorsement they needed to achieve national and international implementation. Ambros Uchtenhagen, who has assisted in founding and evaluation of heroin-assisted treatment in Zurich, will be co-chairing both the opening session of the conference where Prague Declaration will be introduced, and the concluding plenary session, where the scientific and political public will meet the citizens of Prague face to face.

In Zurich, the combination of rationally driven local drug policy and proper evaluation of impacts resulted in a consensus among local law enforcement and local citizens, the latter repeatedly supporting service implementation in public referenda. In Prague, local citizens will decide in coming elections whether they support denying successful harm reduction services, critical for public health and safety, or if they want to take the route of the Prague Declaration and endorse effective drug policies that are responsive to local needs and realities.