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
design
2. Problem
3. 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

8. Alternatives
• End criminalization
• Model of regulation
• Harm reduction strategies
• Human rights
• Vulnerable populations
• Reducing drug market ----- Reducing the harm
• Ideology ---- evidence

9. Harm reduction strategy
Risks/harms
Evidence based
Cost effective
Incremental
Autonomy / dignity / Human Rights /
participation
Wrong strategies

10. Decline in new HIV cases attributable
to drug injecting in British Columbia coinciding with public health
interventions

13. Drug consumption in Colombia

14. Crack cocaine users
1,09% (in life) / 0,17 (last year) / 0,10 (last
month)
Use more substances / transition process
Sao Paulo and Bogota
Very complex situations (social, economical,
criminal, health, urban development,
imprisonment)
Profile
Violence: 97% (Carvalho and Sibel, 2009)

15. • 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).

16. Constitutional rights / Criminal law
Courts / National government /
local government / police

17. Security issues

19. Problem
•“Bronx” (Cartucho).
•7000 problematic users in Bogota
•277 homicides in the last year (90% related
with drugs)
•1 dose: 1 dollar (15 or 20 a day). 380-550 dollar
a month. 10% users/70% of the market
•Security issue: “Gancho Mosco: US 3,8 millions
dollars).

20. 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)

21. Local political strategy: Bogota
Mayor office
1. Social intervention: Economic and social
rights
2. Harm reduction strategy: marihuana
replacement. Control consumption.
3. Urban planning intervention
4. Economic investment
Pros: Mayor is progressive; national goverment
Cons: public opinion; General inspector; security
issues

22. 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 ensure
Pros: progressive ruling
Cons: standing issues; implementation; public
opinion; security issues

23. 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 debate
Cons: public opinion

24. 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