{"word_count": 1070, "character_count": 7138}
In this month’s blog post, Abdul Subor Momand and Larissa J. Maier provide a perspective on current drug policy developments in Afghanistan and emphasize how these impact prevention efforts in the country. The authors will explore what it needs to tackle substance use among youth and people with substance use disorders during times of political instability and nationwide grief.Afghanistan is the largest producer and exporter of opiates in the world. Despite long-term international efforts to reduce the opium cultivation in Afghanistan, production increases steadily with an estimated 328,000 hectares in 2017, an increase of 63% compared to the previous year.[caption id="attachment_772" align="alignnone" width="300"] Sources: MCN/UNODC opium surveys 1994-2017. The vertical lines represent the upper and lower bounds of the 95% confidence interval.[/caption]The United Nations Office on Drugs and Crime (UNODC) aims to protect the health of individuals and society from potentially negative effects of psychoactive substances by means of three International Drug Control Conventions introduced in 1961, 1971, and 1988. These conventions require governments to limit the use of narcotic drugs and psychotropic substances to medical and scientific purposes. In other words, the conventions encourage the adoption of a health-oriented approach to non-medical drug use and drug dependence rather than relying solely upon a sanction-oriented approach. If individuals are at high risk of using drugs or currently using drugs, a health-oriented approach may involve providing education and reliable information, assessing their health needs, providing brief motivational and behavioural counselling, and measures to facilitate social reintegration in order to reduce isolation and social exclusion. Following the provisions of the International Drug Control Conventions, treatment, rehabilitation, social reintegration and aftercare should be considered as an alternative to criminal justice sanctions. People suffering from substance use disorders (SUD) who have committed drug-related offences may thus be encouraged to consent to entering treatment.Drug Policy in AfghanistanThe responsibilities of the government are described in article 7 of the Constitution of Afghanistan which was passed in 2004: “The state shall observe the United Nations Charter, inter-state agreements, as well as international treaties to which Afghanistan has joined, and the Universal Declaration of Human Rights. The state shall prevent all kinds of terrorist activities, cultivation and smuggling of narcotics, and production and use of intoxicants.” By then, the U.S. counter-narcotic policies have focused on eradication and interdiction – without success. In 2010, the Afghanistan Counter Narcotics Law introduced in its Article 57 that an individual with a certified SUD that is caught with up to 5 gram of heroin, morphine, or cocaine or 25 gram of opium or 50 gram of cannabis for personal use will not be prosecuted but instead referred to a SUD treatment centre. A 2014 study in 11 urban centres and 52 rural villages showed that one in three households was affected by drug use. Overall, 11.0% of the country’s population tested positive for drugs (urine, hair, and/or saliva)In total, 12.8% of adults had used illicit drugs, which is twice the global average and men were more likely to screen positive (16.0% and 9.5%, respectively). In addition, 9.2% of Afghan children, on average 6.4 years old tested positive for illicit drugs; 90% were exposed to the substances by either environment or caretakers. The Ministry of Counter Narcotics and the Ministry of Justice have recently revised the Afghan Counter Narcotics Law awaiting approval by the Upper House of Parliament before being signed by the President. If the new law comes into force drug use will become a criminal act in Afghanistan where at least 3.5 million people are estimated to use illicit drugs.What if Drug Use Becomes a Crime?Criminalizing drug use and drug dependence in the community may contradict human rights. Long-term incarceration of a large number of people who use drugs is expensive and does not necessarily reduce drug use. However, the pressure on prisons and the criminal justice system will increase in order to provide food, shelter, timely case processing and security in the prison setting. Additionally, long-term incarceration of a large number of people who use drugs will also result in increased risk for the transmission of HIV, hepatitis, and TB and, thus, poses a threat to public health. The Counter Narcotics Police of Afghanistan (CNPA) is responsible for disrupting the drug trafficking, interdiction and eradication. Criminalization of drug use would mean that approximately 2,700 CNPA employees would  sanction 3.5 million people who use drugs instead of focusing on violence prevention and illicit drug trafficking activities. At the same time, trust in the government may decrease so that individuals with a SUD may become less likely to talk honestly about their drug use or engage in prevention and intervention programs fearing not only stigma and discrimination but also punishment.Public Health Approach Wanted To conclude, no individual should be criminalized for using psychoactive substances. A SUD should be treated like other psychiatric or medical conditions. The course and prognosis of SUD’s are similar to other chronic diseases such as diabetes, HIV, cancer, or hypertension. Given that individuals lose control over their substance use, addiction should be treated as a health rather than criminal justice issue. Individuals with untreated SUD’s are more likely to commit crimes, typically low-level crimes used to finance the drug purchase. However, studies have shown that crimes decrease among people in treatment while their health condition improves. In developing countries, it becomes most obvious that the war on drugs has failed. The decriminalization of all illicit drugs along with establishing appropriate low-threshold treatment offers for people with SUD in Afghanistan appears to be the better solution when compared to incarcerating 3.5 million people, as the space in prisons is limited anyway. Instead of investing in law enforcement, financial resources could be used to improve availability, accessibility and attractiveness of addiction treatment services tailored to the needs of people who present at the services. Equally, there is a need for implementing more evidence-based substance use prevention programs such as the Children’s Project. Afghanistan has ratified the UN Drug Control Conventions and participated in the 2016 UNGASS (UN General Assembly Special Session on the War on Drugs) and the country recently became a member of the UN Human Rights Commission. Therefore, Afghanistan would have the support of the international community when choosing a public health approach to tackle the drug problem in the country and could then focus on the prevention of substance use as well as on local initiatives to provide alternative development for people currently engaged in drug cultivation.