Side event: UNGASS 2016 on the world drug problem: Focus on people, public health and human rights

Side event organised by Colombia, Switzerland and Norway

Ambassador Shamaa, UNGASS Board Chair – The Joint Ministerial Statement adopted in 2014 highlighted that the drug problem continued to pause a serious threat to health and well being of communities. In a special event in September we discussed the lack of availability of controlled substances for medical purposes. In the outcome document for the UNGASS, this issue is also highlighted, including prevention, treatment and HIV prevention, treatment and care. We also organised a scientific consultation on drug prevention and treatment yesterday. Today’s event is another opportunity to exchange views on this key issue.

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Flavia Pansieri, Deputy High Commissioner for Human Rights

HE Claude Wild, Permanent Mission of Switzerland – Today we want to provide a platform of UN agencies based in Geneva to discuss the world drug problem. They can contribute to a human rights and health oriented approach to drug policy, with a strong focus on people, health and human rights which we wish to see as an outcome of the UNGASS. IN the past year we have focused on substances instead of people. We have used metrics of arrests and seizures instead of health measurements. We must focus on people, the ultimate purpose of the treaties is to protect the health and welfare of mankind. We must consider treatment as a disease that can be tackled with a health approach. We are coming together to move to rebalancing drug policy with more emphasis on health and human rights. The UNGASS preparations are an opportunity to ensure system wide coherence. Let me be clear. We do not question the central role of Vienna here, or the role of UNODC. A summary of the event in Geneva is available as a conference room paper. We are very appreciative for the participation of high level representatives of UNAIDS, the OHCHR, WHO and UNODC. The drug problem must be dealt holistically by the UN system. I want to give the floor to our high level Colombian co-host.

HE Carlose Medina Ramirez, Deputy Minister of the Ministry of Justice of Colombia – I want to thank you for the opportunity to address you in this important event which puts on the agenda two important issues – public health and human rights. In 1961, the treaty set the goal of protecting the health and welfare of mankind. But despite best intentions, we are very far from reaching the goals. A world free of drugs is frankly untenable. We have made sacrifices to eradicate the markets. Today, there are persistent problems that affects the lives of people. The perception of drugs has not changed. The application of the death penalty or life sentences is unacceptable in Colombia. We should ask ourselves what is the impact on people. A closer look on drug users is necessary but insufficient. We should include all others who are vulnerable – farmers, human couriers, rural poor individuals under pressure from traffickers. Hundreds of people are not visible and the response has been the imposition of criminal law. In developed countries, there have been steps to recognise the rights and freedoms of drug users, producing countries continue to put pressure on other vulnerable groups. We need to understand this issue as a common and shared responsibility. It does not mean we shouldn’t respond strongly against organised crime. We must understand that prohibitive measures should go hand in hand with measures that impact on these populations – health and human rights. Colombia has made decisions to suspend aerial spraying, as well as a comprehensive strategy for crop substitution through development in territories affected. We also have a comprehensive plan for drug use to strengthen public health throughout drug policy. We must advance towards a new global consensus with smart measures and a better use of efforts and resources to contribute to progress on health, gender equality, reducing inequalities and access to justice. IN Colombia, we have made important steps towards peace. We welcome other voices in supporting this effort, and we hope that the CND will take our contributions into account. the global drug regime can no longer be disconnected from human rights provisions. The role of UN agencies such as UNAIDS, WHO, OHCHR, and the role of civil society should be taken into account. We must humanise drug policies and create a future where people are more important than substances to protect individuals’ health and well being. We must do everything possible to ensure that drug policies are in line with human rights and sustainable development.

Luiz Loures, Deputy Executive Director, UNAIDS – Thank you Carlos, your intervention is crucal because this is a leadership issue. I have only three points here because what is important is debate here and I want to hear form you. The UNGASS is a major event on the implementation of the SDGs. When people ask what the difference is between MDGs and SDGs. SDGs are about exclusion and inequality, this is new. Global health is one of the best opportunity to fulfil the SDGs. If we were more inclusive and had worked more closely with civil society we would be in a different place. We need to apply a broader perspective when we talk about health. Regarding people who inject drugs, we are not talking about drug policy, we are talking about people. Sometimes, we have the impression that PWID are something far from us, we’re talking about “Junkies”. This is not  the case. I want to tell you about a young girl who was very bright, her dad died in prison because he was injecting drugs, her mother also injects drugs and left her. I did everything I could to extend support, but she lost everybody she loved. And she also started to use drugs. This is why we are here today. Yesterday I saw in the subway a young boy who was injecting drugs, he is the same age as my son. Keep this in mind – we are talking about people, very young people. This epidemic is younger than any other. Rates of HIV among PWID are 10 times higher than among the general population. It is the biggest epidemic outside of Africa. The most important point is, can we do something about this? And the response is definitely yes. This is all about implementation, to change the reality, move faster in the implementation of the SDGs. We do have the knowledge, the experience, the evidence. There is something called harm reduction, and let me tell you, it is not ideological, it is a medical, health intervention. Clean needles can change the reality on HIV and hepatitis C. You can fundamentally change the health of a person. A person can also walk away from drug use thanks to harm reduction. See the example of the Netherlands, where they invested heavily on health, instead of investing on the police. A last point on that is that it is good for business – if you do harm reduction, you can save money on health costs. Australia invests 3 million US dollars and have avoided 22,000 HIV infections among this population, and 9,000 cases of hepatitis C, and have saved billions of dollars in health costs. The money speaks. If we do better for the health of people who inject drugs, it works and we will bring these people back to us. It is possible, we have the instruments and the evidence. It is unacceptable to implement the SDGs without bringing back these people to us.

 

Flavia Pansieri – Deputy High Commissioner for Human Rights – It is a pleasure for me to be here today. I want to thank the organisers for making this possible. Before I go into my speech, allow me a personal remark. I used to be with the drug control programme for 5 years and I am now in the human rights programme. It is incredible how much closer we have become. There was much less coordination with other parts of the UN before. If we look at the multi-dimensions of the drug problem, it is necessary that all UN agencies regard the drug issue together. We should look at drug policies from the individual stand point – PWUD are individuals with rights. We must look at the entirety of the issue and the 2030 Agenda is an important opportunity to look at the interconnectedness of the many issues this addresses. The fact that it recognises exclusion as one of the challenges to sustainability is important, including exclusion as a result of discrimination, and PWUD can be victims of discriminatory practices. These are embedded in some of the policies that are being pursued in a number of countries. It is recognising this reality that the OHCHR presented a report to the Human Rights Council on the impact of the drug problem on human rights. We focused on 5 areas: how policies need to be rethought and adjusted to ensure that we respect and promote the values enshrined in the Universal Declaration of Human Rights which recognises that everybody is equal in dignity and rights – we cannot exclude PWUD. What we focused on was:

  • the right to health – we have a strong partnership with UNAIDS, WHO and UNODC to recognise drug policy should take a health approach. We should encourage the introduction of harm reduction programmes. These have been proven in a number of contexts as being very effective in reducing injections and guaranteeing access to health facilities and services to make sure that we can provide all information required for PWUD to become actors towards their own recovery. We shouldn’t forget the important dimension of availability of controlled substances for medical purposes. We see serious shortages in supply in developing countries. We shouldn’t have diversion to the illicit market as a disinsentive to the availability of these substances for legitimate uses.
  • the criminalisation – this is very different form legalisation. It is an important element for accessing the right to health. At the moment drug use is criminal, people cannot access services that would allow them to overcome health challenges. This discriminates against individuals and does not address the world drug problem.
  • criminal justice – too many countries have prisons bursting with drug offenders for long periods of time, but for minor drug related offences linked to personal use. We are not talking about not pursuing as necessary drug trafficking. But we must look at individuals who use controlled substances. And when drug offences become the first source of imprisonment among young people who retain a criminal record, this leads to a far greater threat to their well being than occasional drug use (quote from Kofi Annan). We must be mindful of the need to distinguish between drug trafficking and drug use. But even when we talk about drug trafficking, the penalty must be commensurate with the crime. The use of the death penalty does not meet the threshold of most serious crimes. We are against the death penalty in all contexts and we promote the imposition of a moratorium. We must also bear in mind the necessity to be commensurate on how the criminal justice system deals with trafficking offences.
  • the rights of the child and imprisonment of minors for drug related offences – this is a matter of serious concern for us.
  • the imprisonment of indigenous people – there are contexts where the use of certain substances is part of a culture, religious and traditional purposes, these should be taken not account when designing drug policies. I have been privileged to work in Laos on drugs issues, where there are national minorities who use opium in social contexts. We must look at abuse creating dependency, and the fact that when there is dependency we should address the issue.

I would like to say that we have now, as we look toward the UNGASS, an opportunity to recognise and respond with concrete decisions to the fact that the drug problem is frankly more complex than initially believed. It touches on so many social, economic, civil ad cultural issues. We have to come together to address it in the spirit of recognising the legitimacy of any individual to see his or her rights respected, promoted and protected. The basic rights of every individual as human beings should be respected. I hope that the UNGASS outcome document will reflect the human rights dimensions of the world drug problem.

Marie-Paule Kieny – Assistant Director General, WHO – WHo is already carrying out important work in this domain. We are entering a new era on human rights with the SDGs with the call of leaving no one behind. Our goals are: universal access to essential medicines and effective prevention and treatment for drug users. We must strike a better balance between restricting diversion and improving access to essential medicines. Many internationally controlled substances are essential medicines critical for treating pain and palliative care, including for OST. We have learned from the UNODC WDR that the annual estimated deaths was 170,000. 34 million people suffer or die every year without palliative care. Cancer patients needing palliative care will only increase. Numerous countries are adversely affected by lack of access to essential medicines, violating numerous human rights obligations. For he 4th time, we analysed the issue of ketamine. We always recommended not to schedule ketamine because of its medical purposes, which far outweigh its abuse. This would constitute a public health crisis where there are no other alternatives. We made it clear that we must expand access to narcotic substances to treat pain. Civil society’s role is critical to this effort to raise awareness and change attitudes of stigma and fear. We must use legal instruments and the human rights framework to change the situation. Policies should be expanded to make them fit for purpose: training is necessary, as well as more integrated, functional health services, public health oriented policies centred on universal coverage. These objectives will not be achieved only by UNAIDS and WHO. We must work together to fulfil the objectives of the human rights and health in the drug conventions.

We must tackle drug use in accordance with SDG Target 3.5: prevention of drug use through socially and culturally policies, access to voluntary evidence-based treatment with counselling, and reducing harm. Repressive drug laws do not decrease use and increase vulnerability of PWUD. Our approach must include ethical and human rights consideration. OST and methadone are unavailable in many countries because of overregulation and cultural beliefs. WHO, UNESCO an UNODC are working together to provide the best evidence and standards to address drug use among young people. We are working on a comprehensive package on preventing HIV and hepatitis C among PWUD, including overdose. We work at the structural level to help revise laws and policies.

Global drug policies have failed us. They must move towards public health and development outcomes. The conventions are intended to protect human rights and mandate WHO to support drug policies. The evidence supports the rational use of controlled substances for palliative care, OST, mental health and anaesthesia including the use of ketamine. The 1961 and 1971 conventions were visionary and balanced in ensuring the welfare of mankind. It is time we rebalance the way they have been implemented to put public health and human rights first. We will discuss this in the WHO Executive Board. We work with UNODC and member states, as well as CSOs to tackle new challenges and to put people first. We look forward to work with you all in making the UNGASS a success.

Aldo Lale-Demos, Deputy Executive Director of UNODC – As is plain to see, we have worked hard to make this process as inclusive and informe as possible and to make the UNODC outcome document concise and action oriented. This should not be missed to give space to UN agencies, CSOs, scientists. Let me spell out 7 critical issues and lessons learned that have a reason for our many years of our technical assistance from all over the world. These should be addressed as we finalise the UNGASS outcome document:

  • there is still a manifest need to recognise that drug use, hep C and overdoses should be addressed as a health issue. It requires humane and evidence based treatment, not punishment. People who use drugs are often denied social and healthcare support. They are vulnerable to stigma, discrimination and violence, without protection from criminal justice. Together, we at UNODC work hard to remove such obstacles at both policy and operational levels. Punishing and denying healthcare for people who use drugs has many negative effects – deaths from HIV and hep C, death, social exclusion
  • law enforcement should focus on the most serious offences – trafficking and money laundering. We provide technical support for this. We encourage member states to seek alternatives to imprisonment for minor, non violent offences. Provisions available in the conventions are not implemented by many member states. The excessive use of imprisonment is ineffective and has contributed to the overloading of criminal justice systems and prison overcrowding, exacerbating health harms for PWID. Yet, evidence exists on the success of evidence based treatment. Even the most costly forms of alternatives such as drug courts are less costly than imprisonment. We must an evidence based and human rights based approach. We negotiated a document encouraging alternatives to incarceration. Relevant international standards were developed with the Mandela Rules, the Tokyo Rules, the Beijing Rules (for juveniles), and the Bangkok Rules (for women) – the latter adds an important gender perspective. We promote the implementation of these rules and standards. We provide legal assistance, as well as proportionality of sentencing. By implementing alternatives to incarceration, we need to liberate resources so that criminal justice systems can tackle more important crimes. The links to trafficking, organised crime and terrorism have been identified as a threat to peace and security by the Security Council.
  • Attention must be given to women incarcerated for drug offences. They are rarely major players in the global drug trade. They perform low-level, high risk tasks such as smuggling. The factors motivating them is typically drug dependence, poverty, manipulation and coercion. Drug policy has a detrimental effect on them and their family and community. Alternatives must be developed. A good example is that of Costa Rica, which provides alternatives to incarceration.
  • UNODC works with other partners to strongly advocate on the rights of the child, protecting them from drug use, and from engaging in illicit trafficking. This requires education, poverty alleviation and protection from violence. More cooperation between health, social and law enforcement sectors is necessary.
  • We promote the provision of legal aid, assistance and representation to those who have no means to get a criminal defence. Access to legal aid at early stages is critical as it is at this point that decisions are made. UNODC’s work with UNDP to strengthen legal aid in Kenya has been useful.
  • We strongly advocate on the access to essential medicines while simultaneously preventing diversion. UNODC, WHO and the Union for International Cancer Control are working hard on this issue to provide technical assistance.
  • The drug problem includes many challenges. NPS and ATS for instance require evidence gathering and analysis. We published a study on these and are committed to conducting further global research and analysis.

The SDGs are only possible if we put people first. We must have effective, fair and humane drug policies,with a health approach including prevention, treatment, care and harm reduction. We stand ready to continue working with all stakeholders including CSOs and scientific community to continue providing support to member states on this issue.

Heather Haase, Civil Society Task Force

It is not easy to give a statement on behalf of all civil society, but based on the Beyond 2008 and consultations so far, CSOs are most united around the need for a public health approach and the need for a human rights based approach. We are advocating for a person centred drug policy. In the zero draft outcome document, we have expressed the need for a public health outcome, including prevention, harm reduction and evidence-based treatment, increased funding for services for PWUD, the need to address stigma which has real life consequences, the need to access essential medicines. Many also pointed the need to re-evaluate indicators of policy success around public health and well being. We must acknowledge the human rights of people who use drugs, they should be treated with respect. CSOs are united in calling for the end to the death penalty. Preparations for UNGASS should address youth and children including prevention, treatment and care. Women are also a main area of concern in unequal access to treatment and care services, the need to support pregnant women or women with children – they are arrested for seeking treatment if pregnant in some countries. Women romantically involved with partners who use drugs are vulnerable. Finally I am happy to inform you that the PGA has agreed to convened an interactive civil society dialogue on 10th February which will focus on health and human rights, as an opportunity for member states and CSOs to exchange views on drug policy and I encourage you to participate in this dialogue at the highest possible level.

Questions from the floor

Mike Trace, International Drug Policy Consortium – I want to recognise a remarkable set of presentations and consistency in messaging. The job now comes for CND to reflect this in the UNGASS negotiations. I want to emphasis 2 aspects we’ve heard – first we heard from all that we need a reorientation from sanctions towards a public health and humane based approach. this is a broad concept but it is essential for the UNGASS to reflect that change. The second point I want to draw out is that this saves money. What we have done so far has been very expensive. Investing in health is cheaper and has better outcomes. Finally, these are less and less policy options, they are policy obligations – we are breaching our obligations under human rights treaties. The new letter from the Special Rapporteur on the right to health clearly highlights the breaches of our obligations around the right to health.

Luciana Pol, CELS – The report reminds us that drug policies don’t only affect drug users but also many other populations affected by trafficking and production, in particular in Latin America. We are talking about policies that affect many more populations than drug users.

Luiz Loures – At the UN we are clearly behind UNODC’s leadership. It is now in your hands to make the change. it is our opportunity to shift to the SDGs. Aldo, we are behind you. I hope that you take this debate to New York.

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