3rd Informal Civil Society Hearing – Using 2014 momentum to get 2016 right

This session tries to look at specific areas of policy and practice related to UNGASS. This ession is chaired by Eduardo Hernandez and Thanasis Apostolou.

Allan Clear, Harm Reduction Coalition. My first visit at CND was at the Beyond 2008 event. I was struck by Michel’s statement – as NGOs, we do differ in some things, but we are in agreement on one issue: we want more of what we know works to address drug problems. The harm reduction community has held meetings in Brussels, Bangkok, the US, etc. on what we want to see in 2016. We have come up with a document (HRI and HRC). What we would like to see is for harm reduction to get its due, alongside demand and supply reduction. We have prevention, we have treatment, we have law enforcement, but we do not have people who are working with people who use drugs to the degree that this should be done. Harm reduction has been proven to work and we need to scale it up: we must put money into it. What we are looking for in the next 6 years is for 10% of law enforcement money to go into harm reduction. We would like to see a reallocation of existing money. We are looking for smarter prevention, smarter harm reduction, smarter treatment. The impact of criminal laws on drug users is appalling. It has impacts on housing, voting, welfare, access to employment, etc. It is not just about imprisonment. And criminal penalties must end. Finally, we need to be flexible in our approach to addressing drugs. This is the case for new psychoactive substances – we must respond to those dynamics. And we must focus on specific populations – gay men, women, vulnerable populations.

Vladimir Poznyak, World Health Organization. We want to highlight the importance of CS engagement and value it highly. From all deliberations,public health and health issues and outcomes are more and more central in the drug policy debate. We are talking about different approaches including not only individuals being treated. We must pay more attention to policy options. We must work on the scarcity of data related to health – for now, these data are lacking. The criminalisation of drug use have a huge impact on public health dimensions. We must promote diversion schemes as a core of the public health response. But we should not forget that health outcomes should be measured on the years of life lost due to mortality or loss of years of life. If we talk about alcohol and tobacco, we know that increased affordability and accessibility is related to increased disease burden. The same would go for new psychoactive substances. They may cause dependence, result in intoxication, impact on cognitive functioning, etc. For any substances, you need a combination of approaches to allow society to use them in a way that minimises harms and brings maximum public health benefits. It is not only prevention, or treatment, but also harm reduction services which are particularly important to prevent HIV/AIDS. Naloxone should also be made available to prevent overdose deaths. We must also strengthen systems of monitoring trends, not only for societies and governments to see the impact on health, but also to get a better knowledge on better policy approaches to the drugs problem. We must develop new approaches to tackle drug use disorders and articulate better policy options.

Dr .Eliot Albers. INPUD.  Over the last few years it has been increasingly widely recognised that two bodies of international law, namely human rights law on the one hand and drug control law on the other, exist in “parallel universes”.  Professor Paul Hunt UN Special Rapporteur on the right to the highest attainable standard of health made this remark in a report in which he also noted that “This widespread, systemic abuse of human rights is especially shocking, because drug users include people who are the most vulnerable, most marginal in society. Despite the scale of the abuse, despite the vulnerability, there is no public outrage, no public outcry, no public inquiries, on the contrary: the long litany of abuse scarcely attracts disapproval. Sometimes it even receives some public support.”

To be explicit, the pursuit of repressive drug control in the name of the war on drugs, has inexorably driven rampant human rights abuses against people who use drugs and their communities. That one set of international laws is systemically driving breaches of another is an increasingly untenable situation. Whilst there is no hierarchy of legal systems, it is arguable that human rights law and the principles upon which it is based, principles that are defined as indivisible, inalienable, and universal, should unequivocally trump the pursuit of another set of laws that are producing such gross rights violations. When the pursuit of drug control law becomes a driver of widespread human rights abuses, on what is unquestionably a massive scale, it is without doubt time to call for a thorough review of those laws. As The Global Commission on Drug Policy put in in their report ‘The Negative Impact of the War on Drugs on Public Health: The Hidden Hepatitis C Epidemic’:  “instead of investing in effective prevention and treatment programmes to achieve the required coverage, governments continue to waste billions of dollars each year on arresting and punishing drug users – a gross misallocation of limited resources that could be more efficiently used for public health and preventive approaches. At the same time, repressive drug policies have fuelled the stigmatisation, discrimination and mass incarceration of people who use drugs”. This passage makes clear the mechanism by which repressive drug policies drive and produce violations of the human rights of people who use drugs.

That the pursuit of drug control, the maintenance of punitive prohibition, and the war on people who use drugs is indeed driving such breaches is now beyond question. When you define the pursuit of public policy, defined by both national and international law, as a war you are going to produce war casualties, and arguably unintended, and in this case, decidedly negative consequences. In response to this war we are calling for a peace, we are calling for an amnesty for drug war prisoners, an end to the violence and rights violations that have been heaped upon our community, and we are calling for an intelligent and open debate on alternatives. The state of war in which we are living is one waged in the name of morality, of social order, and in defence of the right of the state to control the bodies of its citizens. This war against the supposed threat to society that the “evils of drugs” pose has in reality made communities of people who use drugs the real targets, has made us into casualties of war, it has stigmatised us, discriminated against us, pathologised us, and made us scapegoats for much of society’s ills.

It can no longer be claimed that human rights violations occurring in the name of the war on drugs are aberrations, they are rather a logical consequence of the pursuit of this war. As such, we all upon the human rights community, and society at large not to remain silent, but to join us in calling for an end to the war on drugs, an end to the war on our communities, and an end to the endemic stigmatisation, marginalisation, discrimination and structural violence that it has entailed.

These conditions have fostered an environment in which people who use, and in particular, people who inject drugs, have suffered from systemic denials of their rights to health, to privacy, to integrity of body and mind, to be free from discrimination, torture, cruel, degrading and inhuman treatment, and to liberty. The deep stigma that people who use drugs are subject to has seen us denied access to appropriate health care services (including access to sterile needles and syringes, opiate substitution programmes, and treatment for HIV and hepatitis C), education, and the right to vote, denied the right to enter, stay and reside in numerous countries, has seen us flung into jails, prisons, and forced detoxification centres that are nothing more than forced labour camps, has seen us denied access to our children, and subject to corporal and capital punishment. 

All of this for what is in reality a victimless crime, for we would argue that what drugs an adult chooses to use should not be the business of the police, or judicial authorities, or that of any other agent of the state. That it has become so has fuelled an epidemic of imprisonment, incarceration, denial of appropriate medical care, and ill treatment that defies, and makes a mockery of human rights norms.

The combination of repressive legal environments, structural barriers and impediments to health care, legal redress and support has directly fuelled the twin epidemics of HIV and viral hepatitis currently raging through the drug using, and in particular, injecting, community. The skewed and disproportionate burden of these blood borne viruses carried by the injecting community is directly attributable to the legal environment in which we live and the discrimination to which we are subject. HIV is as much a biological fact as it is an exploiter of social vulnerability, poverty, and structural faultlines. That it thrives amongst communities who by dint of their sexual orientation (the LGBT community), choice of profession (sex workers), gender identity (transgender people), or choice of drugs and mode of administration (people who inject drugs, and in some contexts people who smoke stimulants, particularly people living in poverty who smoke crack) are criminalised, marginalised, and discriminated against makes its prevention and the fight against it, first and foremost a human rights issue. As such, a socio-political, human rights respecting, and community based response is as, if not more imperative, than a purely bio-medical one.

The extent of the human rights violations to which people who use drugs are subject is extensive. Beyond the criminalisation of drug use and possession which is in and of itself a legally enshrined violation of the right not to be interfered with or to privacy, in terms of what drugs one chooses to use, these violations range from, and include, the hundreds of thousands of actual or suspected drug users thrown into drug detention or ‘rehabilitation’ centres in South East Asia in which torture, forced labour, abuse, violence and degradation are the norm; the prisons in the USA, Russia and countless other countries that are filled with non-violent drugs offenders, with a disproportionately large number of those in the USA being people of colour, African Americans and Latinos; denial of access to health care, most notably denial of access to treatment for HIV and for hepatitis C; the denial of our agency and ability to make decisions about our well being; and arbitrary police violence and harassment.

The war on people who use drugs has fallen most heavily on ethnic minorities, the poor, and women who use drugs. These multiple markers of stigma and exclusion have fuelled mass incarceration, forced sterilisation, police victimisation, violence, and actively driven the twin epidemics of HIV and viral hepatitis amongst these sectors of our community.

This tidal wave of flagrant, systemically driven human rights abuses must be brought to an end, and the only way to do so is to attack the problem at its root.  In this case this means calling for a thorough overhaul of the three UN conventions that together comprise the global regime of drug prohibition. Superficial redress, and minor reform will not staunch the flow of systemic rights abuses directed at people who use drugs, their families and communities. Only the end of the war on people who use drugs through international legal reform will suffice to end this panoply of rights violations. To ensure that this war ends we are calling upon human rights defenders and advocates to join with drug user activists, harm reduction and drug law reform advocates in working to ensure that ending the architecture of global prohibition is firmly on the table at the UN General Assembly Special Session on Drugs in 2016.

Kevin Sabat.  Director of Drug Policy Institute. University of Florida. Announcing new coalition of organizations that will launch on Tuesday.  Drug Policy Futures.  21 countries five continents.  Director couldn’t make it today.  New global platform for drug policy debate based on health.  Reject dichotomy between war on drugs and legalization.  Have to be open dialog about strengths and weaknesses of global drug policy.  Will advocate for health based policy for drug users and families.

3 areas of interest.
1. How can we establish prevention as top priority?  Over 90% of the worlds citizens are not regular drug users.  World system has kept rates far below rates of legal drugs, alcohol and tobacco.  Urge UNGASS to focus on prevention.
2.  How can system of criminal justice and public health be better integrated.  Often presented with false choice of imprisoning drug users or looking the other way and tolerating or facilitating drug use on the other.  If we decriminalize all drug possession, US would still left with 87% of current incarceration.    Legalization will not solve systemic problem.  Recidivism for crimes beyond simple drug use.  Often directly or indirectly related to use.  Criminal system underutilized in many ways.  Untapped resource for offering drug addiction treatment.  SHould not be endorsing death penalty forced prison labor camps.  DPF wholeheartedly against.  Does mean that global community should take note of strategies that are happening.  Don’t pay attention to these changes throughout the world.  Incremental but have massive consequences.  Justice reinvestment program saved TX hundreds of millions of dollars.  Did not have to put up a new prison.  Invested a fraction into jobs and placement programs for prisoners.
Call for More robust data systems.  “What we don’t know keeps hurting us” title of report.  Multiple jurisdictions never before implemented in modern era.  We have data systems set up for previous era.  Wish that states going down path of legalization should be investing in data systems to monitor effects of policy.  Relying on outdated measurements.  Trying to scrap together a knowledge base not working out.

Plea for balance.  Drug Policy Futures.  Balance between demand and supply and risk reduction.  Repeated calls for opening up drug availability need to be rejected in favor of evidence based strategy that don’t embrace false dichotomy between legalization or criminalization.

Linda Nielson.  World Federation Against Drugs.   WFAD.  Founded in 2009.  Aim to work for a drug free world.  120 member organizations 43 countries.  All continents represented.  Truly global united behind conventions.  UN Conventions good framework for reducing non-medical use.  Solid foundation on which we can develop best practice.  World not perfect.  Many aspects can be developed.  UNGASS a great opportunity to do that.  Members spread in different areas of the world.  Prevention, rehab, treatment and research.  Members all have different geograpphical areas gives us great knowledge base.  Differs from higher level knowledge — grassroots.  NGOs doing well with demand reduction on the ground.  Can do what states cannot.  Experience we need to make use of for UNGASS.  Stress that one of the most important angles is to make NGOs part of UNGASS 2016.  They have different views than state delegations.  These need to be represented from whole world.  Most NGOs are just from the rich parts of the world now.  Majority of western men in dark suits here.  Nothing wrong, but not representative.  Lack of resources means they can’t be here usually.  Many organizations doing great work with no resources.  Scarce resources should be used for demand reduction.  Slum child foundation in Nairobi.  To guide children form risky behavior.  Another one in Freetown and Sierra Leone.  Those voices and those of children needed in part of global debate.  Basic human right that all voices count equally.  Urge UNODC to provide resources to facilitate truly global NGO participation.

Questions and answers

Joanne Csete, Open Society Foundations: The practice of incorporating criminal justice and health is good. But there are concerns from the part of practitioners that judges, in drug courts, are making health decisions that should not be made by them. These should be made by clinicians and methadone providers instead. We don’t want a criminal justice system to take decisions out of the hands of health professionals. If you fail the programme, you are thrown back into the system where you might receive harsher sentences than if you had gone through the criminal justice system.
o   Kevin: this is a problem among the criminal justice system since judges don’t have adequate training. Access to medication in the context of opiate addiction is crucial and should be facilitated through drug courts. The issue is that these things don’t operate in a vacuum – people don’t just go there for cocaine or marijuana use. It is often for driving recklessly and you are on probation and are using cannabis, etc. So multiple offences are at hand, and drug treatment courts then have to deal with illegal behaviour that may be filled with drug use. Overall, since the implementation of drug treatment courts, the incarceration rate has fallen.
 
ACLU: some people spend more time behind bars than if they had pleaded guilty if they do not manage to complete treatment through drug courts.
 
IDHDP: Kevin Sabet said that decriminalisation would not make a difference in the USA, I don’t agree, it will for many people caught for drug use.
o   Kevin: For incarceration for drug possession, it will have a minuscule impact on incarceration rate since there are 250,000 who are there for trafficking, but very few for use.
o   Allan: the issue with drug courts is that people are getting punished for drug use. The reason why people go to the drug court is that they have a health issue. And the point is that the criminal element of the courts should be removed entirely. In addition, the practice of drug courts varies from US state to US state. And we are exporting this practice to other countries without really looking at how they are being used.

Role of NGOs if the State is not doing its job?
o   Linda: NGOs often have the ability to react faster. They should be there and compliment the State.

From WHO’s position, what would happen if we legalised cannabis or other drugs in terms of health outcomes?
o   Vladimir: We know for sure that if access to produces and substances is more lax, then consumption would likely increase. Tobacco and alcohol are in the top 5 risk health factors, while illicit drugs are in the top 20 (although it is getting more important now). What would be the restrictions for advertising and access, etc. This would impact on levels of use .But policies that restrict availability, increase costs, and community based interventions such as harm reduction would also have an impact. Not sure what would happen.

Gloria Lai, IDPC: Nobody is presenting the debate between prohibition and full legalisation. A lot of approaches today have focused on alternative policies to address the damaging aspects of drug policy.
 
ACLU: The risk of drug courts is that people are behind bars in state prisons, and the data are not necessarily taken into account. In addition, it is interesting to get back to the issue of availability. We have struggled with tobacco labelling and advertising, etc. But we have been able to address some availability issues with tobacco and alcohol without making them illegal. It would be useful for us to have a conversation on what are the levers that influence use rates, both in the USA and also globally going into 2016.
 
UNAIDS: Is there an assumption that everybody arrested for taking drugs has a health problem? If not, who takes the decision? Is there any point for those people to go to prison?
 
IAHPC: For contributions to UNGASS, 80% of people have no access to pain medication – as Ann Fordham said. CND should add a fourth pillar (in addition to demand reduction, supply reduction and money laundering) to meet the goal of the conventions – it is to provide access to essential medicines to the whole world.

We have to push for evidence based practices are robustly discussed and funded in every country – as Fay Watson said. Social norms do also play a role in that, in addition to perception of drug use, in particular with kids.
 
Diogenis: How can we move member states and motivate them to have an open discussion on these issues, or are we prisoners of our system?             
o   Vladimir: The engagement of CSO in the process has made a significant difference in the system. I observed personally a significant change in the UN system and member states, with the opportunity for them to listen CSOs contributions to the debate. But this is a matter of government policy. We must make sure that all parts of society have their voices heard and can contribute to the debate. And it is not just about CND, but at national level, CSOs are more and more engaged in the debate. 

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