Pompidou Group - Combating drug abuse and drug trafficking

Platform on Ethical issues and professional standards

The Platform’s mission and objectives are to undertake reflections and to devise opinions in addressing ethical and professional issues in specific drugs and drug abuse-related areas. It is made of experts of various different professional origins - ministries, civil society, practitioners - from some 20 member states of the Group. The originality of its reflection makes it a unique body on the international scene.

Since its creation, the platform discussed specific themes, such as drug screening at school, in the workplace, and on recruitment, the role of insurance companies in the practice of drug testing, the right to care, the quasi coerced treatments, the "vaccines" against drugs, the consent of drug users in research, the question of choice in drug policies.

Opinion on the "vaccines" against certain addictions
The Platform finalised its work on immunotherapy of addictions in June 2010. It focused mostly on the "vaccine" against cocaine and considered that the prospect of their marketing (at present, most practical experiments are conducted on cocaine and nicotine) raises fundamental issues, which call for some thought about human rights and ethics, particularly because they will have the power to interfere with the preferences of individuals and affect their physical and psychological state.
Furthermore, the Platform wished that its work allows anticipating the rapid developments that may take place. "Vaccines" are on clinical trial in several countries and this research already raises a huge interest. This may prompt industrial lobbying and require politicians to take crucial decisions. The Platform’s work in this area is intended to provide the authorities with reliable information and considered opinions which help them to make the right choices.

The Platform published the whole of the reports produced in this context in November 2010 on the occasion of the Ministerial conference

1) The challenges
Immunological treatments or “vaccines” are designed to alter human beings’ receptiveness to given substances, especially cocaine and nicotine and, in some cases, amphetamines and heroin. Work in this area began in 1992 and has expanded considerably in recent years. Clinical trials have been conducted in the United States and several European countries to assess the tolerance and the effectiveness of future “vaccines” but the most recent findings have not yet been published. The research work has generated enormous interest though.

2) The impact on addicts
The administration of immunological treatment raises questions both about the effect that it will have and the circumstances in which it is administered, including questions of consent and the legitimacy of possibly coercing persons into treatment. The Platforms points out that the greatest possible care should be taken to ensure that the privacy and freedom of persons being treated are respected as they are likely to be subjected to considerable pressure from bodies such as judicial authorities to accept the administration of a “vaccine”. Considering that “vaccines” will not directly reduce the user’s craving for a drug such as cocaine, the experts believe that users may increase their consumption so as to counteract the effect of the antibodies generated by the “vaccine” or use other stimulants or alcohol instead. They also point out that, even if a person manages to stop taking any form of stimulant, this does not necessarily remedy the underlying personal problems which may be the cause of their drug use. Particular attention must therefore be paid to the impact of the potential alteration of the psychological state of people treated through the regular administration of a “vaccine”.

3) The impact on other stakeholders
The development of these treatments generates expectations and reactions among various other members of society, which are disseminated in particular by the media. They affect the general public (who see the hope of a “cure”), the manufacturers of “vaccines” (who see a lucrative market), the authorities (who see a means of eliminating the need for other activities) and research workers (who see the promise of fame or funding). The attitudes and actions of these social categories should therefore be carefully scrutinised to ensure that they do not use “vaccines” as a way of promoting their own interests under the guise of helping people or promoting the public interest.

4) Conclusion
The Ethics and Professional Standards Platform considers that the anticipated availability of drug “vaccines” opens up interesting prospects in terms of treatment but the implications have not yet been sufficiently investigated and weighed up. The use of the word “vaccine” is unfortunate and leads to misunderstandings about the mechanisms involved and to unfounded expectations. The Platform warns against the temptation of giving simple or simplistic answers to complex questions and points out that all use of such “vaccines” should in any case take full account of the psychological and social background of the persons concerned.
In any case, its use would have to be subject to the same ethical principles which underlie individual autonomy, showing due regard for the fundamental rights enshrined in international treaties.
As to preventive treatment, the Platform considers that it should not be considered under any circumstances.
Consequently, it calls for immunotherapy treatments for addictions to be treated with the utmost caution and warns against exaggerated expectations and possible side effects. It considers that if “vaccines” were put on the market, very strict application frameworks would have to be set up to avert the risk of misuses.

5) Press analysis

6) Informed and conscious consent in medical research
Informed, conscious and free consent is the main guarantee of a patient’s rights and a protection against arbitrary and possibly harmful medical treatment or other activities. It is important for all subjects of medical research, but especially important for people who are dependant on various substances and whose level of consciousness and ability to make a free choice is often very limited.

Opinion and Appendices
Opinion on the practice of drug testing
In March 2008 the Platform finalised, with the adoption of an Opinion, the work in progress since 2004 in this field. In September 2008 it published the whole of the reports produced in this context, notably a survey of the situation in European schools and a comparative study of Europe’s relevant national legislation.

a) Drug testing at school
In the course of their examination, the experts endeavoured to determine the relationship between testing and combating of drugs, and whether testing might have a preventive function. This function being unproven, they stress that testing does not shield a young person from being caught up, at some point in time, in a situation of psychoactive substance abuse, and are anxious about the risk of stigmatisation and exclusion. They recall that teachers are vested with an educational mission which is meant to provide knowledge and assistance in the child’s maturation process, and are not designated for as a police function. They conclude that the precautionary principle cannot justify what they regard as an infringement of pupils’ personal integrity.

b) Drug testing in the workplace
The Platform considers that testing may be akin to an invasion of the worker’s privacy, even though the danger to the worker personally, as well as to co-workers, of being under the influence of a psychoactive substance could possibly warrant such testing. It recommends in this connection that States adopt common rules for determining occupations carrying a risk. It considers that the precautionary principle invariably justifies referral to the occupational medicine department, where there is a doubt as to the worker’s fitness, and stresses confidentiality in order to safeguard his or her private life. It accordingly encourages States to legislate on the independence and professional secrecy of occupational medicine.

c) Testing on recruitment
The Platform considers this a more serious interference with fundamental rights given that international conventions unexceptionally recognise in principle each person’s right to work and prohibit discriminatory recruitment. It points out the risk of stigmatisation and recalls that unemployment may become a factor triggering problematic consumption.

d) Finally, in all situations the Platform stressed the unreliability of the tests and the difficulty for a non-professional to interpret them. It further noted that while a market in tests freely sold on the Internet was thriving and profitable, it had also permitted the development of another directly related market in methods of concealing the effects of consuming a substance before a test.

e) The role of insurance companies in the testing of drugs
The Platform also finalised in June 2008 an overview of "drug testing by insurance companies: national legislation, regulations and practices in Europe as well as an opinion aimed at linking this work to the 2008 publication on Drug testing at school and in the workplace. Among the countries that have submitted their information, the Platform found major differences in the measures to protect fundamental rights in the light of insurance companies’ legitimate interests, and shortcomings in the regulation and supervision of these companies’ practices. The Platform submits that it would be a good idea for these practices to be harmonised at European level so that a proper balance can be struck between the need for insurance companies to collect relevant information and the need to promote social cohesion.

Opinion and Appendices
Other recent work
Debate on ethical aspects of drug-related issues was launched in February 2003 by the Seminar on “Ethics, professional standards and drug addiction

In 2005 the members of the Platform took part in the writing of a book called “Drug addiction” and published under the Council of Europe series “ethical eye”.

Ethics and research
Since the end of 2006, the Platform has embarked on consideration of the ethical issues raised by biomedical, social and psychological research in the field of addiction and drugs. In this framework, it organised in October 2008 a Round Table with the participation of representatives from the other Pompidou Group platforms and two experts. On the theme "Research and its implications for methods of dealing with drug addiction: the ethical challenges", this exchange of views has allowed to identify large categories of ethical problems specific to research in this field.
Publications & Documents
Proceedings of the Seminar on "Ethics, Professional Standards and Drug Addiction"
February 2003
Reference of the document : P-PG/Ethics(2003)
Read the document

Ethical eye - Drug addiction (2005)
ISBN : 92–871–5638-7
Available of the Council of Europe publications Website's

Opinion on the practice of drug testing at school and in the workplace and Appendices
March 2008
Reference : P-PG/Ethics(2008)5
Publication

Opinion on Ethical questions raised by immunotherapy of addiction – the example of cocaine “vaccine”
November 2010
Reference : P-PG/Ethics(2010)11
Publication

Reports of the last meetings:
14th meeting, 22–23 June 2010, Paris
13th meeting, 23–24 March 2010, Paris
12th meeting, 21–22 October 2009, Paris
11th meeting, 25-26 March 2009, Paris
10th meeting, 3 October 2008, Cavtat (Croatia)

suite
All documents of the Platform
suite All publications from Pompidou Group