Harm Reduction Strategy among Crack Cocaine Users in Bogota

(Colombia) Mauricio Albarracín-Caballero

1. Background – Drug policy – Harm reduction– Human rights, health and drugs– Harm and crack cocaine – Colombia Legal Landscape on Drugs /institutional

design2. Problem 3. Strategies harm reduction in the “Bronx”

1. Local political strategy2. Judicial strategy 3. Legislative strategy

Cost/effective strategy?

Violence and drugs

Imprisonment rates in LA

Drugs: The Rebellion in Cartagena

Alternatives

• End criminalization• Model of regulation• Harm reduction strategies• Human rights • Vulnerable populations • Reducing drug market ----- Reducing the harm • Ideology ---- evidence

Harm reduction strategy

Risks/harms Evidence basedCost effectiveIncrementalAutonomy / dignity / Human Rights / participationWrong strategies

Decline in new HIV cases attributableto drug injecting in British Columbia coinciding with public health

interventions

Drug consumption in Colombia

Crack cocaine users

1,09% (in life) / 0,17 (last year) / 0,10 (last month)Use more substances / transition processSao Paulo and Bogota Very complex situations (social, economical, criminal, health, urban development, imprisonment)Profile Violence: 97% (Carvalho and Sibel, 2009)

• Mortality– External causes - 131 crack users is SP. 44% homicide

and 26% AIDS related illness (Ribeiro et at, 2006).

• Morbility – Directly: overdose and cardiovascular problems– Mental health and antisocial personality - 25% more

than cocaine users, (Kessler et al, 2012)– Sex without protection – STD and HIV. 6,6% of HIV

prevalence (Carvalho and Sibel, 2009).

Constitutional rights / Criminal law Courts / National government /

local government / police

Security issues

Problem•“Bronx” (Cartucho). •7000 problematic users in Bogota•277 homicides in the last year (90% related with drugs)•1 dose: 1 dollar (15 or 20 a day). 380-550 dollar a month. 10% users/70% of the market •Security issue: “Gancho Mosco: US 3,8 millions dollars).

Strategies

• Right to health• Social determinants of health • End criminalization • Health inequalities and space

– Knowledge production: framework of rights of the crack cocaine users (stating point)

Local political strategy: Bogota Mayor office

1. Social intervention: Economic and social rights 2. Harm reduction strategy: marihuana replacement.

Control consumption. 3. Urban planning intervention4. Economic investment

Pros: Mayor is progressive; national govermentCons: public opinion; General inspector; security

issues

Judicial strategy

• Framing the problem in constitutional rights• Use the international framework of health, soft

law and the global commission on drugs. • Accion de tutela colectiva (class action)• Unconstitutionality of the situation (estado de

cosas de inconstitucionalidad). Duty to ensure Pros: progressive rulingCons: standing issues; implementation; public

opinion; security issues

Legislative initiative

• National: End criminalization. Finish all of the procedures for minor crimes and release the crack users involved in minors crimes

• Local: regulation of the rights of drugs users.

Pros: end of the debateCons: public opinion