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Harm reduction strategy among crack cocaine users in bogotá (colombia)

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  • 1. Harm Reduction Strategy among Crack Cocaine Users in Bogotá (Colombia) Mauricio Albarracín-Caballero
  • 2. 1. Background – Drug policy – Harm reduction – Human rights, health and drugs – Harm and crack cocaine – Colombia Legal Landscape on Drugs /institutional design2. Problem3. Strategies harm reduction in the “Bronx” 1. Local political strategy 2. Judicial strategy 3. Legislative strategy
  • 3. Cost/effective strategy?
  • 4. Violence and drugs
  • 5. Imprisonment rates in LA
  • 6. Drugs: The Rebellion in Cartagena
  • 7. Alternatives• End criminalization• Model of regulation• Harm reduction strategies• Human rights• Vulnerable populations• Reducing drug market ----- Reducing the harm• Ideology ---- evidence
  • 8. Harm reduction strategyRisks/harmsEvidence basedCost effectiveIncrementalAutonomy / dignity / Human Rights /participationWrong strategies
  • 9. Decline in new HIV cases attributableto drug injecting in British Columbia coinciding with public health interventions
  • 10. Drug consumption in Colombia
  • 11. Crack cocaine users1,09% (in life) / 0,17 (last year) / 0,10 (lastmonth)Use more substances / transition processSao Paulo and BogotaVery complex situations (social, economical,criminal, health, urban development,imprisonment)ProfileViolence: 97% (Carvalho and Sibel, 2009)
  • 12. • Mortality – External causes - 131 crack users is SP. 44% homicide and 26% AIDS related illness (Ribeiro et at, 2006).• Morbility – Directly: overdose and cardiovascular problems – Mental health and antisocial personality - 25% more than cocaine users, (Kessler et al, 2012) – Sex without protection – STD and HIV. 6,6% of HIV prevalence (Carvalho and Sibel, 2009).
  • 13. Constitutional rights / Criminal law Courts / National government / local government / police
  • 14. Security issues
  • 15. Problem•“Bronx” (Cartucho).•7000 problematic users in Bogota•277 homicides in the last year (90% relatedwith drugs)•1 dose: 1 dollar (15 or 20 a day). 380-550 dollara month. 10% users/70% of the market•Security issue: “Gancho Mosco: US 3,8 millionsdollars).
  • 16. Strategies• Right to health• Social determinants of health• End criminalization• Health inequalities and space – Knowledge production: framework of rights of the crack cocaine users (stating point)
  • 17. Local political strategy: Bogota Mayor office1. Social intervention: Economic and social rights2. Harm reduction strategy: marihuana replacement. Control consumption.3. Urban planning intervention4. Economic investmentPros: Mayor is progressive; national govermentCons: public opinion; General inspector; security issues
  • 18. Judicial strategy• Framing the problem in constitutional rights• Use the international framework of health, soft law and the global commission on drugs.• Accion de tutela colectiva (class action)• Unconstitutionality of the situation (estado de cosas de inconstitucionalidad). Duty to ensurePros: progressive rulingCons: standing issues; implementation; public opinion; security issues
  • 19. Legislative initiative• National: End criminalization. Finish all of the procedures for minor crimes and release the crack users involved in minors crimes• Local: regulation of the rights of drugs users.Pros: end of the debateCons: public opinion
  • 20. Otros temas: Legalización de las drogas ¿Ud. Personalmente está de acuerdo o en desacuerdo con la legalización de las drogas? (Respuesta Única) T o ta l 19% 78% 3% N S E B a jo ( 1 y 2 ) 17% 80% 3% N S E M e d io ( 3 y 4 ) 19% 77% 4% Ns/Nr, De N S E A lto ( 5 y 6 ) 29% 69% 2% 3% acuerdo, 19% D e 18 a 24 años 25% 74% 1% D e 25 a 34 años 28% 68% 4% D e 35 a 44 años 19% 80% 1% D e 45 a 54 años 10% 86% 4% M ás de 54 años 13% 85% En des- acuerdo, H o m b re 23% 74% 3% 78% M u je r 16% 80% 4% E n 2 a v u e lta v o ta r o n p o r S a n t o s 15% 82% 3% E n 2 a v u e lta v o ta r o n p o r M o c k u s 37% 59% 4%Base: 1.006 encuestas ponderadas; total muestra. E n 2 a v u e lt a n o v o t a r o n , b la n c o , n o 21% 72% 7% re c u e rd a 92

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