“Documentemos lo adverso de la represiòn sobre las drogas”

Ministerio de Salud y Proteccion Social24/05/2016

– En la Asamblea Mundial de la Salud, Alejandro Gaviria manifestó que las políticas de drogas deben enfocarse en salud pública, derechos humanos y evidencia científica.

Ginebra, 24 de mayo de 2016.- El ministro de Salud y Protección Social de Colombia, Alejandro Gaviria Uribe, advirtió hoy sobre la urgencia de documentar y entender mejor los efectos adversos de la criminalización y las políticas represivas sobre las drogas.
En su intervención durante el evento “Implementación de nuestra agenda compartida sobre las dimensiones de la salud pública en la problemática mundial” –llevada a cabo en el contexto de la Asamblea Mundial de la Salud que se celebra en Ginebra, Suiza–, el jefe de la cartera de Salud señaló que las políticas orientadas a combatir la oferta de drogas pueden tener consecuencias letales, crear círculos viciosos de incremento de violencia, disminuir las capacidades del Estado y erosionar la cohesión social.
En este contexto, el ministro señaló que las aproximaciones desde la perspectiva de la salud pública buscan garantizar la vida de las personas, mientras que las aproximaciones represivas pueden tener consecuencias opuestas: “Pueden matar a la gente. Literalmente”.
Lo anterior, de acuerdo con el titular del ministerio de Salud, pone en evidencia el gran vacío entre las políticas ideales y las políticas actuales: “Los análisis basados en la evidencia muestran que las políticas basadas en la evidencia no son comunes, por decir lo menos”.
El evento también permitió al ministro mostrar las intervenciones llevadas a cabo en Colombia, que han tenido en consideración las diferencias de los ambientes socio-culturales, la necesidad de enfoques intersectoriales y la importancia de la evaluación y la experimentación.
Aunque el consumo ha aumentado en Colombia, el jefe de la cartera destacó la significativa reducción del consumo del tabaco gracias a la combinación de políticas regulatorias y comportamentales; la inclusión de tratamientos en el Plan Obligatorio de Salud; y los progresos en la regulación de los centros de tratamiento, aun cuando persiste el problema de disponibilidad en las poblaciones pequeñas.
Gaviria Uribe también recordó que, en diciembre del año pasado, Colombia expidió un decreto que regula el proceso de licenciamiento para el cultivo de cannabis y la producción de derivados para usos médicos y científicos.
Al finalizar su intervención, el ministro manifestó: “Tenemos muchos retos por delante. Pero estamos convencidos de que este nuevo énfasis en salud pública, derechos humanos y evidencia científica, en última instancia, dará sus frutos. Hemos recorrido un largo camino, y estamos dispuestos como país para liderar esta importante lucha sobre la necesidad de una política de drogas más inclusiva”.
Abajo, la intervención completa del ministro Alejandro Gaviria.
Boletín de Prensa No 110de 2016
Good morning to everyone. For me it’s a great honor and a privilege  to be part of this event.
I want to start my presentation by describing some small but significant steps we have taken towards more sensible and humane drug policies. 
First of all we are focusing on prevention. We are convinced that preventive interventions should emphasize problematic use rather than the utopian goal of preventing all drug use. As President Juan Manuel Santos said in New York City one month ago, “A world free of drugs is impossible, as it’s impossible a world free of tobacco and alcohol”. 
Along these lines, we are implementing some interventions which take into account (i) the differences in social and cultural environments, (ii) the need for inter-sectoral approaches, and (iii) the importance of evaluation and experimentation. We face some difficult challenges. Drug consumption is rapidly increasing in Colombia, and state capabilities in many regions are weak and vulnerable to political cycles. But we are not doomed. We have been able, for example, to substantially reduce tobacco consumption, using a combination of regulatory and behavioral policies. 
Parallel to this, we have promoted the inclusion of several treatments into the package of health benefits available to all Colombians. We have also made good progress on the regulation of treatment centers, even though  most centers are concentrated in big cities and some centers  are still of dubious quality. . Treatment availability in small towns remains a big challenge since we lack nurses, psychologists and other health professionals.  
In a smaller scale, we have put in place some needle exchange programs, and some pilot programs on opioid substitution therapy. The available evidence on these programs is promising, but these initiatives are still small and underfunded. We are also working on a set of guidelines to ensure distribution, accessibility and availability of opioid medications for pain management. 
Last but not least, in December last year, we enacted a decree regulating the licensing process to grow cannabis and to produce and export derivatives for medical and scientific uses. This week we will have the first licensed producers of derivatives of Cannabis for medical and scientific purposes in Colombia. 
Finally, I want to make now a more general and political (if you will) reflection. Let me start this reflection with a paradox. We have, on one hand, taken an evidence-based policy approach, with the utilitarian imperative of doing what it works and discarding what it doesn’t. But we also have, on the other hand, the uncomfortable truth about drug policy in practice, which is often driven more by prejudices than by evidence. There is a big gap, we have to acknowledge, between ideal policies and actual policies. An evidence-based analysis of drug policy shows that evidence-based policies are not common, to say the least. 
To overcome this paradox, we have to change our focus. What we need is not so much evidence-based policies, as evidence-based discussion and controversy. Our imperative should not be capturing the ear of the prince, but convincing the people and their representatives. Sometimes I think that we spend too much time preaching to the already convinced. That’s why there is a divergence between the academic consensus and the reality of public policy. 
In sum, we need more evidence-based debates, more evidence-based dialogue, more evidence-based discussions. This is not about a neat technocratic discussion, but a messy democratic fight.
In this fight, we need to greater emphasize the relationship between supply policies and public health outcomes. Supply policies can have lethal consequences, can create vicious circles of increasing violence, can diminish state capabilities and can erode social cohesion. As the US Surgeon General put it in UNGASS a few weeks ago, “the war on drugs is also a war on people”.
A recent article published in the British Journal, The Lancet, documented this reality. But we have to study the mechanisms in greater detail, and we have to tell our stories more often. The story of Medellin. The story of ciudad Juarez. The story of Guatemala city. The story of Baltimore. Paraphrasing Robert Trivers, and evolutionary biologist, the world needs to know, to better know, the roots of our suffering. 
In sum, we need to better document and understand the adverse effects of criminalization and repressive drug policies. The public health approach is about keeping people alive. Repressive approaches can have the opposite consequences, they can kill people. Literally. 
Let me finish with a simple statement. We have many challenges ahead. But we are convinced that this new emphasis on public health, human rights and scientific evidence will ultimately pay off. We have come a long way, and are willing as a nation to be in the lead of this important fight about the need of a more inclusive drug policy.