Prohibition has failed, let’s put people first

Former South African President Kgalema Motlanthe opens Africa Policy Week with a call to end repressive policies of the past in favour of placing value on dignity and human rights 

Introducing Kgalema Motlanthe as keynote speaker at Africa Policy Week, Dr Shaun Shelly said this was something he never thought would happen, which seemed a little ironic since few South Africans are as experienced as Shaun in tackling things most people think will never happen. (Africa Policy Week is a good example of this.)

Motlanthe responded with the famous Mandela quote: “It always seems impossible until it is done”. And then added with a wry smile: “Even when they write your obituary and they write RIP, you must know that RIP doesn’t only mean ‘Rest in peace’, it also means ‘Resurrection is possible’.”

This fleeting flirtation with probabilities and possibilities seemed a fitting start to a week of discussions focused on changing perceptions around drug use and policy, and ultimately making the improbable possible.

Africa Policy Week was launched in 2016 by Shelly, who is also a founding member and the chairman of the South African Network Of People Who Use Drugs (Sanpud).

The annual event brings together people from Southern, East and West Africa who influence and develop policy and those who have a vested interest in promoting people-centred public policies that ensure the safety and wellbeing of all.

Kgalema Motlanthe is often described as the former president of South Africa, but he is much more than that, as even the most cursory look at the work of his foundation (https://motlanthe.org/) will attest. From installing vegetable gardens in school grounds and hosting Artificial Intelligence Bootcamps for high school girls, to playing a leading role in the fight globally to apply evidence and compassion in drug policy, South Africans are perhaps lucky that Motlanthe was not confined to the Presidency for too long.

FROM PROHIBITION TO PUTTING PEOPLE FIRST

In his opening address at Africa Policy Week, Motlanthe outlined the vision of the Global Commission on Drug Policy, of which he is a member, of “moving away from prohibition and advocating for policies based on scientific evidence, human rights, public health and security to effectively leave no one behind”.

Crediting Kofi Annan as the source of the quote “drugs have destroyed many lives but wrong government policies have destroyed many more”, he welcomed “the much-needed focus on our beloved continent of Africa”.

Motlanthe, who is also the chair of the Eastern and Southern African Commission on Drug Policy, also called for rejection of “blanket approaches which, by their nature, rely on assumptions and fail to acknowledge why insight into particularity and uniqueness is key to delivering a more equitable inclusive and sustainable outcome”.

He talked about how we all know that in all the countries that make up the continent it is not possible to find two that are the same, despite similarities in their histories and in current hazards and difficulties faced.

Motlanthe also talked about how “the international drugs control system contains a deep-lying imbalance that favours punitive approaches over ensuring access to controlled medicines”.

Then he dropped a little bomb about developments in the global environment – including, but not limited to, the opioid crisis in America – that “have the potential to cause more harm to children in developing countries, who may be left abandoned in their hour of agony to die in extreme pain”.

Motlanthe had outlined what he called a “pain inventory of the world” and access to pain-relief by stepping into the recent past, using data in the Lancet Commission on Palliative Care and Pain Relief https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30082-2/fulltext, published in 2018).

The report found that about 25.5 million of 56.2 million people who died in 2015 experienced serious health-related suffering, and another 35.5 million experienced serious health-related suffering due to life-threatening and life-limiting conditions. A disproportionate number (more than 80%) of these 61 million individuals live in low-income and middle-income countries, of which Africa makes up a large proportion, with severely limited access to any palliative care, even oral morphine for pain relief, the report found.

Of the 298m tonnes of morphine-equivalent opioids distributed in the world each year only 0.1 tonnes are distributed to low-income countries, and 50% of the global population, ie about 3.6 billion people, who reside in the poorest countries receive less than 1% of the morphine distributed worldwide.

Lancet Commission on Palliative Care
and Pain Relief

“But as the pain inventory is attended to, filled out and ticked in wealthier countries, ” Motlanthe added, “let us also recognise the other side of that coin of privilege, and acknowledge the suffering of the opioid crisis in the US and how this … has caused global alarm and perhaps in some countries, such as countries in our continent, has added a layer of misinformation, anxiety and excessively cautious knee-jerk reaction to morphine treatment.

“In a region such as sub-Saharan Africa, where many people live in poverty and die in agony as a result of Aids-related illness – many of them young people – a restrained and over-cautious reaction to the opioid crisis across the Atlantic can result in the most poor and vulnerable, including children, not receiving palliative care due to misguided fear and lack of education and training on how to prescribe and administer morphine treatment.”

Quoting Felicia Knaul of the University of Miami, chair of the Lancet Commission, Motlanthe said: “Policies that work to deny access to necessary pain relief medication in low and middle-income countries because of the situation in the US are akin to denying food to people suffering from malnutrition because there is an obesity epidemic in the US.”

With Putting People First, the theme of the Africa Policy Week conference, in mind, he said, a number of questions arose, including: How does denying access to necessary pain relief in Africa because of the situation in America put people first? and Which people are at the head of the queue?

Motlanthe said: “The Eastern and Southern African Commission on Drugs believes that drug policy must be grounded in a public health approach based on scientific evidence and human rights, and always putting people first.”

He outlined five pathways of drug policy reform that the Global Commission on Drug Policy has advocated for since its inception in 2011 “that fully fit in with such an approach that places human rights at the centre”:

1. Put peoples’ health and safety first
2. Ensure access to essential medicines and pain control
3. End the criminalisation and incarceration of people who use drugs
4. Refocus enforcement responses to drug trafficking and organised crime, and
5. Regulate drug markets to put governments in control

Saying that drug prohibition, in general, had failed in its goal of a drug-free world, while causing more harm than good, Motlanthe expressed a hope that governments “of our region” would consider a variety of reforms in drug policy approaches.

“We must replace our existing harsh measures based on repressive ideologies with more humane and effective policies. These must be informed by scientific evidence, public health principles and human rights standards.”

What this means, he said, is: We must stop the practice of arresting people just because they use drugs, or might have a small amount of drugs on them for personal use; we must stop prosecuting and imprisoning people who use drugs and alongside the war on drugs, the war on people who use drugs must also end.

Africa Policy Week is being held in Cape Town. Visit the website for more information:   https://www.sadrugpolicyweek.com/