The Vienna Declaration: A global call to action for science-based drug policy

The Vienna Declaration is the official declaration of the XVIII International AIDS Conference (AIDS 2010), the biennial meeting of more than 20,000 HIV professionals, taking place in Vienna, Austria from 18 to 23 July 2010 (www.aids2010.org).

"Many of us in AIDS research and care confront the devastating impacts of misguided drug policies every day," said AIDS 2010 Chair Dr. Julio Montaner, President of the IAS and Director of the BC Centre for Excellence in HIV/AIDS. "These policies fuel the AIDS epidemic and result in violence, increased crime rates and destabilization of entire states -- yet there is no evidence they have reduced rates of drug use or drug supply. As scientists, we are committed to raising our collective voice to promote evidence-based approaches to illicit drug policy that start by recognizing that addiction is a medical condition, not a crime."

The Vienna Declaration describes the known harms of conventional "war on drugs" approaches and states:

"The criminalisation of illicit drug users is fuelling the HIV epidemic and has resulted in overwhelmingly negative health and social consequences. A full policy reorientation is needed…Reorienting drug policies towards evidence-based approaches that respect, protect and fulfill human rights has the potential to reduce harms deriving from current policies and would allow for the redirection of the vast financial resources towards where they are needed most: implementing and evaluating evidence-based prevention, regulatory, treatment and harm reduction interventions."

Outside of sub-Saharan Africa, injecting drug use accounts for approximately one in three new cases of HIV. In some areas of rapid HIV spread, such as Eastern Europe and Central Asia, injecting drug use is the primary cause of new HIV infections. Legal barriers to scientifically proven prevention services such as needle programmes and opioid substitution therapy (OST) mean hundreds of thousands of people become infected with HIV and Hepatitis C (HCV) every year. The criminalization of people who inject drugs has also resulted in record incarceration rates placing a massive burden on the taxpayer. HIV outbreaks have also been reported in prisons in various settings internationally. This emphasis on criminalization produces a cycle of disease transmission, along with broken homes and livelihoods destroyed. Yet these costs, along with the more direct costs of the 'war on drugs', produce no measurable benefits.

"The current approach to drug policy is ineffective because it neglects proven and evidence-based interventions, while pouring a massive amount of public funds and human resources into expensive and futile enforcement measures," said Dr. Evan Wood, founder of the International Centre for Science in Drug Policy (ICSDP) and Clinical Associate Professor at the University of British Columbia. "It's time to accept the war on drugs has failed and create drug policies that can meaningfully protect community health and safety using evidence, not ideology."

The Vienna Declaration calls on governments and international organizations, including the United Nations, to take a number of steps, including:

• undertake a transparent review the effectiveness of current drug policies;
• implement and evaluate a science-based public health approach to address the harms stemming from illicit drug use;
• scale up evidence-based drug dependence treatment options;
• abolish ineffective compulsory drug treatment centres that violate the Universal Declaration of Human Rights; and
• unequivocally endorse and scale up funding for the drug treatment and harm reduction measures endorsed by the World Health Organization (WHO) and the United Nations.

The declaration also calls for the meaningful involvement of people who use drugs in developing, monitoring and implementing services and policies that affect their lives.

"As a scientist, I strongly support drug policies that are based on evidence of what actually works," said Prof. Françoise Barré-Sinoussi, Director of the Regulation of Retroviral Infections Unit at the Institute Pasteur, IAS Governing Council member and recipient of the 2008 Nobel Prize for Medicine. "I join with my colleagues around the world today to sign the Vienna Declaration in support of science-driven policies and human rights."

The effectiveness of opioid substitution therapy (OST) and needles and syringe programmes is well-documented, though access to such interventions is often limited where HIV is spreading most rapidly. According to various scientific reviews conducted by WHO, the US Institutes of Medicine and others, these programmes reduce HIV rates without increasing rates of drug use. These cost-effective interventions also produce significant savings in future health care costs, and help people who use drugs access health care and drug treatment. No evidence exists demonstrating negative consequences of use of these programmes.

"Reflecting the AIDS 2010 theme of Rights Here, Right Now, the Vienna Declaration is rooted in the belief that global drug policy must respect the human rights of people who use drugs if it is to be at all effective," said AIDS 2010 Local Co-Chair Dr. Brigitte Schmied, President of the Austrian AIDS Society. "No one who is familiar with addiction would deny the negative impacts it has on individuals, families and entire communities, but those harms do not justify human rights violations. People addicted to illicit drugs have the right to evidence-based drug treatment, to interventions to prevent infection, and, if they are living with HIV, to antiretroviral treatment."