The consumption centers will not solve all problems
International experts support Mayor Gustavo Petro’s proposal on “controlled consumption centers”. They recommend working together with health and police authorities.
With two experts on controlled consumption centers for drug addicts and a Uruguayan member of parliament who has lead a bill in his country that would permit the cultivation and consumption of marijuana, Mayor Gustavo Petro seeks to keep the debate alive on the controversial initiative to establish Medical Attention Centers for Drug Addicts (CAMAD) in Bogota.
Donald McPherson, founder of consumption center programs in Vancouver (Canada) where addicts receive drugs and substitution substances as part of their rehabilitation process; Laura Thomas, expert in similar programs to reduce HIV and Hepatitis among heroin addicts in California (United States); and Uruguayan representative Sebastian Sabini, member of the Broad Front lead by President Pepe Mujica, participated in a talk in the Huitaca auditorium in the City Hall to share their experiences with the mayor and Bogota citizens interested in alternative policies to reduce the harms of drug consumption.
El Espectador talked with both activists and experts about the discussion taking place in Bogota.
Many people are asking: what are controlled consumption centers exactly and what do they do?
Donald McPherson: Some people think that health centers are the same as consumption centers but they are different. This is a common problem when the idea is introduced into the discourse. The same happened in Vancouver and Europe. People didn’t know what they were meant for and for this reason, clarification on the issue was needed multiple times.
Donald, when you founded these centers in Vancouver, did you encounter much resistance?
DM: There was support and resistance. The resistance was based more than anything on lack of information or fear of change but we confronted it through public discussion, being very clear on what these centers do, and bringing people from other centers to talk about their experience. It was important to explain what the centers are and what they would involve.
Laura Thomas: It is important to have this conversation in public, responding to all the questions that people have. Furthermore, something that Bogota needs to decide is what centers are needed and why. What you create here will be different to what Vancouver created and Amsterdam created, for example.
What options does a city like Bogota have?
LT: We need to know what types of services the city is capable of offering: what types of doctors are there? What types of clinics can be connected with the center? Are the consumers being treated addicted to crack or heroin? A program must be proposed based on the context of the city.
Something that has been very controversial is the idea that through these centers, illegal drugs will be used as the basis of treatment. Is this a possibility? In what type of scenarios is this methodology used?
LT: For those that consume drugs, consumption centers are places where they can enter and be totally accepted. Instead of being judged and excluded, they are welcomed. This is the first step for change, leaving social exclusion aside for the people that use drugs. The consumers don’t have houses, don’t have the same access to public services…therefore we need to open the door and acknowledge them as humans and from there connect them with other treatments. They are humans and they have rights.
I understand. Is it a way of building an environment for drug consumers and creating conditions for their rehabilitation?
DM: The old school dictates that consumers should only be helped if they stop using drugs. This is different; this is opening the door and saying to them: we won’t judge you for what you consume, we will help you. You build a constructive relationship with these people. They may be very addicted but they almost never have positive relationships with anyone…that is what this is based on: you try to construct a positive relationship, a bridge for change.
But is there a risk that the centers become the state Coffee Shop where the consumption of drugs is acolyte?
DM: What we have found in our research in Vancouver is that the people that have access to supervised injection are more open to the possibility of treatment to stop using drugs. In our studies, when we compare those that went to the centers and those that didn’t, the first group more frequently accepted entering treatment.
LT: I think, furthermore, that the evidence is that those that entered the centers were more stable and their situation changed positively.
How did they handle the fact that they were working with illegal drugs prohibited by the state in which they operated?
DM: Canada’s legislation permits the Ministry of Health to exclude programs that work with medical and scientific proposals from criminal law. In this case, Insite (MacPherson’s program in Vancouver) is showing very good results. Therefore the government makes an exception so that Insite can continue working. This is all legal globally. The international treaties are not an obstacle, they are there for this purpose, they support projects in each country that improve people’s quality of life.
LT: Yes, in fact, when you enter Insite, you stop being someone who is breaking the law.
It is curious that Bogota has centered much of the debate on the use of methadone when, according to statistics, only 3 or 4% of the consumers inject heroin. Here there is a higher percentage of cocaine and “bazuco” consumers. With what type of substance, equivalent to methadone, that could facilitate the rehabilitation of these people?
LT: First of all, it must be recognized and not discouraged that methadone is still needed for the people that consume heroin. Currently, for cocaine, science has not found an equivalent to methadone. There is much research being done and I hope that we obtain results.
Let’s return to the topic of the centers. Do they work or do they not? And for what do they work?
LT: According to our studies and research, centers such as Insite in Vancouver, or those that exist in Sidney, Australia, help to reduce HIV infections as well as the number of overdoses among the consumer population. Also, the number of people that receive treatment and stop using drugs has increased. Under these criteria, we can say it has been a success.
And does it help reduce crime?
DM: The consumption centers are one step in solving a complex problem. Other factors must be looked at, such as the health system and security.
Have the mafias been reduced in Vancouver?
What these centers do is change the culture of the area. The centers operate very closely with the police and public health authorities. In a street or in a neighborhood with consumption centers, organized crime is less accepted, they don’t go there, but they remain in other areas, they lose control of the street. In this sense, there can be a change…the police has to be present; in Vancouver when we started the program, they put two policemen with phones and everything so that they could respond quickly. In Europe it is very common to see police in the consumption centers.