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Getting Unhooked

ICE Graveyard 20/04/2016 Thorvald Stoltenberg
DEPRESSION SHADOW © bugphai via Getty Images DEPRESSION SHADOW

My wife was the first to discover Nini's secret. I was away on a diplomatic mission when she called to tell me. I booked a flight home straight after hanging-up the phone. My hands were trembling. How could our 30-year old daughter have hidden her drug habit from us? How couldn't any of us have seen this coming? The revelation shocked her mother and I, but also her brother and sister. We were -- and remain -- a tight family.

Once home, Nini, her mother and I huddled well into the night discussing her addiction. She had started using heroin like so many others -- recreational at first, and then as a hard-core habit. We hatched a two-year plan to get her clean. We were naive. It took us at least twelve years to get through the tunnel. Our hopes were raised and smashed so often I lost count. But in the end, with her determination and support from those who loved her most, my daughter kicked the habit. She beat heroin. But her life was forever scarred by her addiction.

Even in a small and wealthy country like Norway, it was difficult to find help to treat or care for Nini. There was virtually no reliable research on the subject. What little medical opinion that existed was sharply divided, based more on ideology than evidence. Nor was there a public discussion on the issue. We Norwegians are quite a private people and the question of illegal drugs -- not least heroin -- is still considered taboo. Yet instead of being secretive about her struggle, Nini decided to go public in 2001.

Nini and her partner, Karl John Sivertzen, went on to become two of Norway's most active supporters of drug policy reform. They campaigned fearlessly for more "humane" policies focused on harm reduction. They were ahead of their time, and certainly Norwegian public opinion. Nini proposed strategies to improve access to prescription heroin and to decriminalize cannabis. Despite stiff resistance, she was determined that Norway change course. She was my most important adviser when I started getting involved in the drug reform movement.

In 2010, and at Nini's insistence, I accepted an invitation from our Minister of Health, Bjarne Hakon Hansen, to chair the Stoltenberg Commission. The Commission assembled Norwegian politicians and drug policy experts for the first time to rethink and reform our legislation. It was never going to be easy. Our proposals -- including the creation of safe injection sites and methadone substitution therapy options -- were controversial. At first we were heavily criticized. But with time public opinion began to coalesce around the wisdom of public health approaches to drug addiction rather than ones emphasizing criminal justice.

My hope is that this growing wisdom about what really works in terms of drug policies will influence the upcoming United Nation's special session on drugs (UNGASS), taking place this week in New York. This is the first global meeting of its kind since 1998, when the UN's official slogan was "a drug-free world -- we can do it!" We all know this is not the case.

Both Europe and North America experienced major increases in addiction and overdoses over the past decade. In some countries, bold harm reduction experiments are being tested. Some of them are generating results: for every $1 dollar spent on methadone treatment there is an economic benefit of $38 dollars.

The numbers are staggering and a wake-up call. There are an estimated 1.4 million "problem users" of opioids spread out across Europe alone. Less than a third of them -- about 400,000 people -- are seeking specialized treatment. Nini's story is repeated across Europe: the mean age for first use is 22 and for seeking care, 35. Tragically, as many as 20,000 Europeans using opioids die each year from overdoses, drug-related disease and violence associated with the drug trade.

The situation is no better in the U.S. While data is still of poor quality, experts believe that opioid use has quadrupled since 2000. More than 165,000 people have died from overdose of prescription opioids. Meanwhile, heroin abuse is reaching epidemic levels. According to the CDC, the equivalent of 125 people die a day in the U.S. from overdoses -- 78 of them from heroin and painkillers.

In my years living and working with Nini, I learned that opioid assistance therapy is strongly correlated with a decrease in overdoses from heroin abuse. It is also increases the likelihood of patients completing their treatment and reduces the transmission of infectious diseases due to the sharing of needles. And criminal offenders with drug abuse problems who receive methadone substitution also tend to reduce their drug use after leaving prison and are three times less likely to commit a crime than those who are refused such assistance.

To its credit, the White House recently announced a $1 billion package for 2016-2017 to deal with this crisis, including efforts to expand medication-assisted treatment to up to 45 U.S. states, expand methadone-substitution services to 700 providers, and evaluate outcomes. Still, we can do more. It is imperative that the leaders of at a special session of the United Nations this week recognize the need to put people's health, safety and human rights at the center of global drug policy.

To my eternal sorrow, Nini passed away in July 2014 after a long illness, at the age 51. In the end, heroin exacted a heavy price. During her life my daughter taught us so many lessons. She was a fighter and a passionate defender of the most vulnerable in society. She also showed us how courage, determination and compassion are key ingredients to ending addiction. We never gave up on Nini and she never gave up on changing the world. I knew instinctively that if I lost contact with her, I'd relinquish what little influence I help her take a new path. Even in the darkest moments, dialogue was part of our road to healing.

Thorvald Stoltenberg is a former minister of defense and former minister of foreign affairs for Norway. He is a member of the Global Commission on Drug Policy.

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