Injecting reason: Advancing rightsbased public health policy and programs related to use of illicit

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Injecting reasonAdvancing rights-based public
health policy and programs related to use of
illicit drugs

• Joanne Csete, PhD, MPH

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Overview

• Obstacles to human rights-based health policies
  and services related to illicit drug use
• Application of human rights standards to the
  challenge of treatment of drug dependency
• Research and advocacy related to changes in legal
  frameworks
• Example of effective rights-based research and
  advocacy on UN oversight
• Directions for future work

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New HIV infection in adults by transmission type,
1993-2001, Eastern Europe
Injecting drug use
Heterosexual
MTCT
MSM
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Human rights of people who use illicit drugs

• Harsh anti-drug laws fail to distinguish minor
  and major crimes high rates of incarceration
• Easy targets for police extortion and abuse,
  torture, false arrest, lack of due process
• Extra-legal crackdowns collateral damage in
  war on drugs
• Drug policy often based on abstinence but without
  adequate treatment for drug dependence
• Women especially demonized

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Context gets more difficult

• If you quit drugs, you join the fight against
  terrorism.
• --George W. Bush, Dec. 13, 2001
• (Are you with us or against us?)

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Few IDUs in need receive opioid maintenance
therapy (courtesy Open Society Inst., 10/06)
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HUMILIATION AS TREATMENT
Photos Courtesy Jimmy Dorabjee
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Photo courtesy Jimmy Dorabjee
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Treatment for drug dependence International
treaties

• Intl Covenant on Economic, Social and Cultural
  Rights (1966) widely ratified right to
  highest attainable standard of health
• UN drug control conventions of 1961, 1971 and
  1988 commitment to provide treatment,
  education, after-care, rehabilitation and social
  reintegration of drug abusers

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Right to health (ICESCR, art. 12)

• Includes
• reduction of infant mortality and promotion of
  child development
• ensuring environmental and industrial hygiene
• prevention, treatment, control of epidemic,
  endemic, occupational and other diseases
• ensuring medical service and medical attention
  in the event of sickness.

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General Comment 14 (2000)

• Progressive realization How to establish
  standards to assess government compliance?
• Gen. comment 14 of the UN Committee on Economic,
  Social and Cultural Rights recommends minimum
  standards for government responsibility on the
  right to health
• ?How might the standards of the General Comment
  help in assessing government action in protecting
  right to treatment for drug dependency?
  (Dependent on rights, Can. HIV/AIDS Legal
  Network, 2007)

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Gen Comment 14/Tx for drug dependence (1)
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Gen Comment 14/Tx for drug dependence (2)
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Gen Comment 14/Tx for drug dependence (3)
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Indicators of state compliance

• Varied, affordable services with on-demand
  availability?
• Are there guidelines, standards approved by
  medical oversight and professional assns?
• Discrimination based on criminal record, other
  grounds?
• Treatment services for women?
• Compulsory practices?
• Confidentiality of records?
• Decision-making on tx by law enforcement
  officials?
• Meaningful involvement of people who use drugs?

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What would rights-based drug law be?

• Canadian HIV/AIDS Legal Network model law on
  illicit drugs
• Based on human rights principles
• Derived from best existing laws as possible
• Consultation with drug policy experts from around
  the world
• Some focus on issues of concern in the Soviet
  Union (model law translated into Russian)
• Presented in several international meetings

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Model drug law 8 themes

• Criminal law and procedure
• Treatment of drug dependence and management of
  overdose
• Services in prison
• Syringe programs
• Supervised drug consumption facilities
• Prescription of heroin
• Information and outreach
• Discrimination

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Model drug law application

• Used as standard in UNODC-supported review of
  drugs laws in Azerbaijan, Kazakhstan, Kyrgyzstan,
  Tajikistan, Turkmenistan and Uzbekistan.
• 6 review teams, including police and MPs, have
  made recommendations for drug law reform (3 of
  these without methadone, none have treatment as
  alternative to prison).
• Human rights arguments seem to have been
  important.

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Research and advocacy The UN role

• UN General Assembly resolutions pledging harm
  reduction services for drug users
• International Narcotics Control Board (INCB)
  monitors compliance with UN drug conventions,
  questions harm reduction, fails to support
  methadone programs
• Challenged Stephen Lewis on Canadas supervised
  injection facility

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Closed to Reason (2007) INCB role

• Research on INCB statements on needle exchange,
  health services for drug users
• Research report published 6 weeks before INCB
  press launch of its annual report
• Closed to Reason launched at UN with Stephen
  Lewis
• Journalists at INCB launch ask questions raised
  in Closed to Reason
• Member states question role of INCB at CND
• Lancet commentary

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Does human rights add anything?

• Sometime, in some places, some people prefer not
  to be accused of violating rights (advances due
  to EU membership aspirations)
• Sometimes gives ammunition to someone willing to
  take a stand
• Where there are no existing international
  standards, useful to introduce rights at early
  moment in devt of standards
• Meaningful participation of drug users in public
  health decision-making has been transformative

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Future research directions

• Torture and drug users
• Following development of standards for treatment
  of drug dependence, including for women
• Public health and the intersection of the war on
  drugs and war on terror
• Unblocking opioid maintenance therapy can public
  awareness help break down myths?
• Opioid therapy, syringe programs in prison
• Drug injection in eastern and southern Africa

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Acknowledgments

• Canadian HIV/AIDS Legal Network, Toronto (R.
  Elliott, R. Pearshouse, G. Betteridge, R.
  Jürgens, L. Utyasheva, L. Mar)
• Open Society Institute (D. Wolfe, K.
  Malinowska-Sempruch, J. Cohen)
• Stephen Lewis, former UN Special Envoy on
  HIV/AIDS in Africa co-chair, AIDS-Free World
• www.aidslaw.ca