“Narcofailure” as in the old times

Poland keeps fighting marijuana users and not drug dealers, while available treatment is mostly based on isolation, i.e. very outdated. These are the conclusions of the latest Report of the Polish Addiction Ombudsman (a  social institution set up by the Polish Drug Policy Network and the JUMP  93 Association).

The Report shows that Poland implements anachronistic and ineffective drug policy, aimed mostly at repressions and not prevention or harm reduction, contrary to the recommendations of international organizations working in the field.
The activities of Police and prosecutors are mostly focused at prosecuting for possession. According to the estimates of the Institute of Public Affairs, before 2011 eighty million Polish zlotys were spent annually for that purpose.
Out of 97 randomly selected persons seeking the assistance of the Addiction Ombudsman, 81 were arrested for possession of marijuana. Almost all of them possessed less than 3 grams, i.e. an amount considered a ‘consumer dose’ in the Czech legislation. Only five people were arrested for possession of amphetamine, and three for possession of heroin.
Mostly university and high school students are arrested. Their troubles begin when one evening police raids a club or a park. Most often they are detained, taken to a police station where they spend up to 48 hours. Then they are invited to voluntarily accept punishment, mostly a suspended sentence of 6-8 months’ imprisonment with two-four years’ probation.  And a fine.  More than half of them agrees to this as they do not know the law and are unaware of the fact that criminal proceedings maybe discontinued when a person possesses a ‘minor’ quantity of illegal substance for personal use and  the punishment appears to be pointless .
The law (Article 62a of the Act on Counteracting Drug Addiction) came into force in December 2011. Since then prosecutors have used it only in 11 percent  of cases analyzed for the purposes of the Report ( according to the prosecutor’s office, until June 2013 the article had been applied in 1.3 thousand  cases).
Prosecutors also did not apply another amendment  introduced in 2011,i.e. having an examination in order to verify whether the detained person is addicted and should be referred for treatment.
Agnieszka Sieniawska, the author of t he Report, stresses that the new regulations, aimed at more rational  implementation of drug enforcement policy, do not work as they should, while police and prosecutors just stick to their old habits.
The Report shows that 16 percent of analyzed cases that involved small quantities of illicit drugs were discontinued by the courts (based  on art. 62a). In 32 percent of the cases proceedings were discontinued and two-three years’ probation was  given with additional fine in the amount of  500 – 800 zlotys and payment of proceedings’ costs. 27 percent  of cases were dropped unconditionally.
In total, 86 percent of cases analyzed during the Report preparation were discontinued. Although part of discontinuations still result in a criminal record which can have serious consequences for the individual’s ability to secure employment in the future. Besides, what could have been resolved “on the spot” and at a very low cost (thanks to Art. 62a) instead sat in motion a several-month-long, expensive and stigmatizing process of prosecution and adjudication.

Other clients of the Addiction Ombudsman got suspended sentences , which means that in case of recidivism they will go to jail, most often, just for a single joint.
The Report recommends introducing a four-pillars ‘Swiss approach’:
* Harm reduction ;
* Involvement in the justice system ;
* Treatment , including the treatment with substances substituting illicit drugs
* Prevention. The Report also suggests legalizing marijuana for medical purposes. As well as clarifying what ‘insignificant amount’ for personal use is, making thus discontinuation of proceedings a much easier decision to take.

The second part of the Report , written by Jacek Charmast, describes available therapies, mostly based on a late70s-model, i.e. detoxification in the hospital followed by a stay in a closed treatment center. Although today’s picture of addiction, i.e. a variety of substances, dependence on multiple substances, is totally different from the one from 35 years ago, when people were mostly addicted to Polish  ‘compot’ (a crude preparation of heroin made from poppy straw). And regardless changed approach to treatment of medical doctors and addiction therapists. It is been acknowledged that in case of many addicts the model of isolation forced by abstinence is not working. They are unable to stay till the end of the treatment program at the center (only 13% finish the treatment cycle in Monar centers), and even if they do stay, later they return to the addiction, as they have not learnt to cope with addiction while being ‘free’ (for 73 % of Polish centers’ patients  their current treatment program is a subsequent attempt at treatment).
In some cases addiction is so strong that patients cannot be completely cured. Hence,  the substitution treatment programs, when illicit drugs are substituted with other substances, making family life and work possible. It can be compared to insulin therapy for diabetics: it does not cure the disease, but allows to have life as close to normal as possible.
Meanwhile in Poland over 60 percent of Public Health Insurance money  is spent for treatment in closed centers. In six regions the figure amounts to 80 percent , and in three more to as much as 90 percent. Thus, every third European drug addict treated in a closed center is a Pole. Because the European model is primarily based on outpatient therapy programs, psychological and social support both to drug addict and his family. Basically, it is about learning how to cope with the addiction in real life. According to the European Drug Report 2012, in Europe 400 thousand  people are treated in outpatients programs, while 50 thousand in closed centers (including 14 thousand in Poland).
“In Poland social narcophobia fuels long-term isolation”, the Report says . This is the result of lobbying activities undertaken by closed treatment centers (established in the 80s and 90s), which need patients in order to continue their activities. Counseling and support programs, initially working with the patient, most often refer them to closed treatment centers.
The stay in such a center lasts between one and two years. Out of 77 centers in Poland, 41 run a program that lasts longer than a year, and 21 run a program that lasts two years. National Healthcare Fund still signs contracts for two-year programs, although the National Bureau for Drug Prevention describes stays exceeding one year as pointless. In 2012 16.3 million was allocated for outpatient treatment, 62.4 million for treatment in closed centers, 19 million for substitution (i.e. drug replacement) treatment, and  2.3 million for re-integration (mainly, hostels).
The Report states that the Polish model of drug addiction treatment is one-sided , and thus violates the rights of a patient who cannot get help adequate to his needs and in line with medical standards. The system prefers those with strong dependence, and does not provide support  to young occasional users.
The Report outlines the following recommendations:
* Freezing spending on closed treatment centers and shortening treatment time in them ;
* Doubling spending on outpatient medicine;
* Each outpatient facility should also run a substitution therapy program ;
* Hostels should be established only in large cities, with better employment and study opportunities.
The Report of the Polish Addiction Ombudsman also suggests legalizing marijuana for medical purposes as well as clarifying what ‘insignificant amount’ for personal use means.

Ewa Siedlecka
Gazeta Wyborcza, issue 194, of Aug. 21,2013/Country, p. 3