John-Peter Kools, the current Chair of the Board of Directors of Harm Reduction International and a former Steering Committee member of the European Harm Reduction Network (EuroHRN), has been working in the field of drug use, harm reduction and HIV prevention since 1983. As a staff member of the drug users’ interest group in Amsterdam, he was involved in starting the first needle exchange service and early community-based HIV responses. In 1990 he co-founded Mainline, a harm reduction NGO in the Netherlands. Since 1996 he has been mainly involved in initiating and supporting HIV prevention services in Central and Eastern Europe and has coordinated a multi-country program on HIV, drug use, and poverty reduction in Asia.
Mr. Kools also used to be a board member of Health Connection International, a web-based platform to support non-English-speaking communities and health practitioners in low-income countries. Since 2008 he has worked on an independent basis on developing various responses to drug use and HIV in transitional and developing countries, as well as conducting an explorative study into substance use and related HIV in sub-Saharan Africa, and coordinating the development of HIV responses for people who use drugs and for prisoners in southern Africa. Currently he is the Senior Drug Policy Advisor for the Trimbos Institute, the Dutch national knowledge center for mental health and addiction.
You have seen first-hand the evolution of the concept of drug harm reduction from a hopeful idea to one of the four pillars of modern, evidence-based, progressive drug policy. What, in your opinion, have been some of the more significant milestones on that journey, and what will be the main challenges for the harm reduction movement in the next decade (especially in the CEECA region)?
The biggest achievement in this field, I think, is that the community started to organize itself, and people found ways to collaborate and learn from the experience of other countries. Of course, the situation in the region progressed in the 1990s, so there was a kind of a history, examples of good practices and bad practices in parts of Europe, like in the Netherlands, but also England and Switzerland. I think the initial perspective was to learn from international experience, from international recommended guidelines and international best practices.
In the beginning, it all worked well in the region. It used to be a bloc, but it isn’t a bloc anymore, which is great for the people. In the end, it’s both the people and the governments who make the decisions, and there are lots of differences in the region when it comes to the structures of government and governmental development — it’s a kind of maturing into democracy… That’s something we have seen in many aspects in many countries, also in my own country.
Would you say that democratization and harm reduction go hand in hand?
They might. After all, democratization gives people civic rights; it gives them the opportunity to decide about their own lives, their today and tomorrow, their emancipation. I think that you could say that harm reduction is a matter of human rights, and acknowledging them as an essential element in society. Is that a part of democracy? I, for one, think that it is.
Harm reduction is about enabling people to decide for themselves; it’s about giving citizens options to decide over their own lives, to protect their health, and to have access to ways of staying healthy, of moving towards abstinence when it’s needed, and deciding about their own day, their own future.
The concept is not well understood everywhere in the region. There are lots of misconceptions about harm reduction. People have ideological ideas, or simply a poor conception of harm reduction. It’s not only about drug law reform! Harm reduction is about offering options by providing access to medical and social support, and about drug policies that regulate rather than prohibit drug use.
What do you think is the reason for such discrepancies, and how could the problem be countered?
One thing that’s important is collaboration. It’s very important to have meetings, like we’ve had here over a couple of days, where organizations and countries come together, where people exchange ideas, where research is discussed with communities and politicians, and where there is, let’s say, inter-professional exchange and discussion on viable options and alternatives.
I don’t think harm reduction is the only way, or even the best way, to tackle the problem of drug addiction in society, but until we find a better one, it’s good to have the second-best option.
Mr. Michel Kazatchkine, the United Nations Special Envoy for HIV/AIDS in Eastern Europe and Central Asia, said in his keynote speech that reasonable market regulation is the logical culmination of the philosophy of harm reduction. Do you agree?
I fully agree. I think there’s a big task for governments to take responsibility for the health and well-being of their citizens — and I mean all citizens, including the people who use drugs. And they should take responsibility for organizing the market well, taking it out of the hands of the mafia and putting it in the hands of people who can regulate it properly, like we regulate anything that’s being sold in the supermarket or provided by a doctor, or that people can buy online.
We’ve got thousands of ways of regulating medicine, petrol, drinks, traffic, nicotine, consumer goods, you name it, and we don’t apply any of these very highly sophisticated mechanisms when it comes to illegal substances; we simply call them illegal, and that’s it. I think that we should make them legal, and then start using the thousands of options of regulating the production, sale, and use of these substances by establishing age limits, restricting opening hours and locations of sales establishments, and setting up rules for the producers and importers, as well as the consumers.
Everything that’s already being used daily in the wider context of the economy and the consumer market should be applied. Right now, we’re simply ignoring it.
In a regulated market, consumer protection is at least partially financed, if not provided by, the producers, the importers, and resellers. Do you think it’s possible to incentivize the grey and black markets to compensate for some of the health and social consequences of their trade — in a manner similar to the way that deep web marketplaces have been motivated to provide safe use tips and list the exact contents of their products? In other words, how can we make dealers who care for the health of their clients disseminate harm reduction information, or even provide certain services?
Any step that will improve the health and well-being of consumers is a step in the right direction, but in the end, I think, the main objective should be state regulation, whereby the State fully regulates the market, or is at least responsible for it. There might be certain corners of the market where the government decides that there is no need for regulation — and then they should let it go. But in the end, it’s the government that should have final responsibility.
[Picture: An example of public health notices regarding contaminated, dangerous cocaine posted in Amsterdam in November 2014]
I know of many events or situations where there has been collaboration between health professionals and drug dealers, and I’ve even seen collaboration between law enforcement and drug dealers. On several occasions in my home country, the Netherlands, poisoned or heavily adulterated substances made it onto the black market; the latest such incident happened a year ago. The government decided that this was a serious health issue, and their first priority was to get that poisoned stuff off the market. Of course, it was addressed as a criminal issue, too, but the most important goal was to protect the health of the citizens. So the police put out big billboards around Amsterdam that educated people, telling them not to buy from street dealers. I consider that a minor form of collaboration between law enforcement and the black market forces, or at least involvement of the latter in practical harm reduction. I’m glad to see that these days it’s happening more often.
But in the end, it’s about the State taking responsibility for regulating things properly for all of their citizens, not just for the majority. The more complicated users should not be excluded.
Interviewer: Mart Kalvet from the Estonian drug users’ union LUNEST