Home » Special Event Blog: Leaving No-One Behind: People at the centre of a harm reduction, human rights and public health approach to drug use

Special Event Blog: Leaving No-One Behind: People at the centre of a harm reduction, human rights and public health approach to drug use

Organised by the Governments of the Netherlands and Norway, the United Nations Office on Drugs and Crime, the United Nations Development Programme, UNAIDS, the World Health Organization, the International Drug Policy Consortium, AFEW International, Harm Reduction International, the International Network of People who Use Drugs, Open Society Foundation, Aidsfonds, and Frontline AIDS.

HE Marco Hennis, Netherlands Ambassador: All about human rights, putting people in the centre, public health, Dutch approach to drug use – which very much includes harm reduction. Harm reduction is a proven cost-effective approach – no one can be left behind in achieving the sustainable development goals. We don’t only talk about these things, we put them into practice.

Ann Fordham, International Drug Policy Consortium, Chair of the Strategic Advisory Group to the United Nations on drug use and HIV: Thank you to co sponsors, in particular the WHO and the Netherlands. The group is extremely important in improving health of people who inject drugs. Released a report last week highlighting lack of access of PWUD to harm reduction services. Collaborative work by UN is integral here.

Andrew Ball, Senior Advisor on HIV and Viral Hepatitis, World Health Organization (WHO): WHO really appreciates being invited to this event. I am speaking on behalf of assistant secretary general – WHO going through a big transition this week.

Promoting human rights is good public health practice. To achieve impact, we need to respect human rights. Half a million people die each year from complications with drug use – overdose, blood borne virus and more. This is a huge burden to society and could be prevented. The opioid crisis in North America is important to mention – in some countries, opioid overdoses are now the leading cause of death. Lack of access to essential medicines – 75% of world pop do not have adequate access. Millions of patients and families suffer. 0.03% of worlds morphine are used in developing countries. On one hand, people are dying from drug use, on the other, people don’t have access to essential medicines. We need to balanced this by bringing health to the core of the response. WHO founded with health as a human right for all people, not only a few. Highest attainable standard of health is deserved by all regardless of condition. The health of all people is fundamental. International efforts should be aligned to achieve SDGS – especially SDG3.8. WHOSs general program of work is organized around universal health coverage. Harm reduction and access to medicines can and should be included as core components in health strategies. WHO will support key communities in attending event in New York next month – in particular PWUD, and included in General Assembly. 1 billion more people need to benefit from universal health coverage. UNGASS 2016 outcome document needs to be implemented, but did fail to encourage key areas such as harm reduction. We need more references to harm reduction and human rights in drug policies.

Particular topic of this panel discussion – despite sensitivities around harm reduction. We need to recognize the health of PWUD is paramount to the work we do. Often these are not address as they cannot reach health services. WHO is responding to this by developing guidelines. Harm reduction key element of public health response. Harm reduction is evidence based and plays a critical role in prevention and treatment of HIV TB and Hepatitis. Needle syringe programs and opioid substitution therapy (OST) are high impact interventions. OST is most effective treatment option for dependence. We also recommend naloxone for treatment of overdoses. These are integral parts of the package. Many health interventions cannot be implement because of strategies in countries. Policies that criminalize drugs and people who use them are counterproductive to health goals.

Tanya Kochetkova, Eurasian Network of People who Use Drugs (ENPUD): I want to talk about the importance of the voice of the community at all levels. Today, the world has realised that it is necessary to end the world of drugs, as it has become a war on people. We believe that communities of people who use drugs are essential partners in policy reform.

I want to talk about the Eastern Europe and Central Asia region, where Russia’s repressive approach to drug policy dominates. Following Russia, many countries in the region follow a zero-tolerance approach, with the criminalisation of people who use drugs and harsh disproportionate sentences. Several countries are now also arguing against their existing OST programmes. Instead of focusing on large-scale organised crime, it is people who use drugs are being targeted. Prisons are being filled with people who have nothing to do with drug supply or violent crime.

The materials from harm reduction services are being seen as propaganda, and they are experiencing fines. Grassroots community networks should play a key role in addressing drug-related issues. There is a range of different problems that we face, that can easily be addressed by these networks. But without support and funding, this is a difficult job to do. Our work is reduced to street activism.

I want to tell the story of a women, my friend. In 2011, she stopped using drugs because she wanted to have a baby. But instead of support from doctors, she only received intimidation and stigma – “you cannot have a baby, you are a drug user”. But she decided to have one. Due to the pressure she was under, she delivered the baby prematurely. She later filed a complaint under the right to protection from discrimination, but was sentenced to prison. She then died away at the age of 37.

There are some good examples of partnerships between people who use drugs and the national authorities. In Russia, we have been a key part of the Country Coordinating Mechanism for the Global Fund. We have submitted shadow reports, in several countries in the region. The Eurasian Network of People who Use Drugs unites members from 17 countries and provides them support. The International Network of People who Use Drugs then helps the Eurasian network to engage and connect globally. We will continue our work until our voice is heard at the highest level.

Professor Adeeba Kamarulzaman, Dean of Medicine, University of Malaya: It is my pleasure to present on how Malaysia manages people who inject drugs. There’s been a turnaround a decade ago when Malaysia started supporting harm reduction in 2005. Allowed implementation of methadone maintenance treatment (MMT) and needle syringe programs (NSP) – we were one of 5 countries with major HIV issue. The prime minister then gave us the green light for harm reduction. After a decade of harm reduction in Malaysia (completely funded domestically) and funded by government departments and NGOs. 889 sites providing harm reduction. 100,000 people accessed MMT since 2005. NSP essentially implemented by NGOs and AIDS Council, last few years we are incorporating NSPs in government clinics in order to aid expansion to people particularly in regional areas. Outreach workers, disposal of needles through department of health. There’s been an impressive drop in HIV in Malaysia. 2017, less than 200 new cases. Return on investment analysis on program shows 39% reduction in HIV. Translates to cost saving of $47 million ($10 million USD) in direct health care – anti retroviral treatment (ART) and treatment of opportunistic infections. Harm reduction alone is not enough. 50% of prisoners are in for drug related crime. Realization in new government to relook at our drug policy to view PWUD and PWID as individuals in need of health and social support. Minister of Law made a strong statement indicating a shift towards viewing drug use as health issue.

Mark Vermeulen, Aidsfonds: I am the Executive Director of AidsFonds, and I want to thank the Frontline AIDS and other partners for allowing me to use some of their examples in this presentation too. The Netherlands has a long history with harm reduction, with a pragmatic approach since the 1980s which puts people at the centre. This approach has proven to be effective, with almost no new HIV infections amongst people who inject drugs in the Netherlands.

But what I want to share today is a change in our policies around five years ago, when the Dutch Ministry of Foreign Affairs decided to be more than just a donor for this work. AidsFonds are currently the lead for two partnerships with the Ministry – Bridging the Gaps and PITCH. As the Ambassador mentioned, this is putting our money where our mouth is. Global networks such as INPUD are on the Board of these initiatives, and regional and national networks are involved throughout our work. This way, we ensure services that address the real needs of communities. I want to share two examples of how we are advocating for change.

Firstly, we work with communities in their full diversity. Initiatives providing gender-sensitive responses have increased substantially. In Kenya, we are reaching three times as many women as before. But it is not just about services, we also need to advocate for change – and this is done better when communities are involved. In South Africa, we started with small-scale pilot projects to collect data and show that the harm reduction approach works in the national context. These programmes are now being incorporated into national policies, and the next step will be to see these governments talking about their programmes here at CND.

We cannot fail to understand that the global drug response is leaving people behind, and we cannot end AIDS until we invest in communities to have an impact. In the Rotunda, we have a small photo exhibition of our work with women who use drugs.

Naomi Burke-Shyne, Harm Reduction International (HRI): Thank you, to the World Health Organization, the Dutch and Norwegian governments for their leadership on this side event. We are at an interesting moment; though it is not without limitation and notwithstanding some complex interactions, the Ministerial Declaration incorporates references to some of the key harm reduction themes we have advocated for, for years. This includes seven important CND resolutions focused on the preventing HIV, HCV and overdose amongst PWID – dating back to 2010; as well as the UNGASS Outcome Document. These references are in the pre-ambular and stock-taking sections of the Declaration, not in the commitments.

Nonetheless, we welcome this growing body of resolutions concerned with the health of people who use drugs. Most important for the points I am highlighting today is the fact the Ministerial Decl includes a commitment to mobilising resources to address drug-related challenges, following on from CND resolution 60/8 which urges member states and donors to continue to provide bilateral and other funding to address the growing HIV/AIDS epidemic among people who inject drugs.

And yet, notwithstanding these entirely sensible commitments, and widespread recognition of the current failure of health services to meet need (including the increase in deaths related to drug use, and the high rates of transmission of blood-borne diseases); There remains a considerable gap between rhetoric and implementation of these lifesaving measures. We are failing to meet the commitments we have set ourselves.

At national level – Every two years HRI maps global responses to HIV and hepatitis C epidemics related to unsafe injecting and non-injecting drug use and publishes ‘the Global State of Harm Reduction report’. We observe similar pragmatism and political commitment to public health and human rights at national level – 94 countries (more than half of the countries reporting injecting drug use), implement one or more harm reduction interventions, and 85 countries explicitly endorse harm reduction in their national policy documents. Many of these countries have demonstrated through research, that harm reduction is cost effective and saves lives, reduces transmission of blood-borne viruses. Between 2008 and 2014, we observed a steady uptake of harm reduction interventions, with new countries adopting services each year. Over the past five years, this progress has stagnated. And while services stagnate, the World Drug Report indicates that drug markets are expanding and diversifying.

When we look to the reasons for this, a critical contribution is a serious shortfall in financial commitments.

Our latest research found that funding for harm reduction flat-lined between 2007 and 2016. In both 2007 and 2016, US$188 million was allocated for harm reduction in low- and middle-income countries.

This sits in shocking contrast to the $1.5 billion dollars that UNAIDS estimates is required annually in LMICs by 2020, for an effective response to HIV among people who inject drugs. We are funding about 13% of the response.

Most of the funding for harm reduction comes from the HIV sector – in both national government and international donor budgets. Yet harm reduction funding represented just 1% of the estimated US$19.1 billion spent by donors and governments on the HIV response in 2016. This is equivalent to just four cents per day per person injecting drugs in low and middle-income countries.

So where is the money coming from, and where do we go from here? International donors continue to be the most important sources of funding for harm reduction in LMICs. Yet, as a group, international donor funding for harm reduction declined by almost 25% over the past ten 10 years. Donor governments are now more likely to fund via basket funds than they were ten years ago, rather providing funding directly for harm reduction. Given the current crisis in funding, we urge donor governments to consider making an exception to the basket funding approach for harm reduction. We are talking about a population being left behind even within the HIV response.

The Global Fund represents two thirds of the funding for harm reduction from international donors, which makes it the single most important source of funding for harm reduction in LMICs – and yet GF allocations were 18% lower in 2016 than they were in 2011. So in addition to urging donor governments to fund harm reduction directly, when urge donor governments to scrutinise how basket funds (the GF being the largest example of this) fund harm reduction, and in particular urge donor governments to be vocal in pushing the GF to preserve vital funding for harm reduction through catalytic investments and regional grants.

2019 marks a particularly important moment in funding the response to HIV for people who use drugs, with the Global Fund calling for $14billion from donors. We are gravely concerned that this figure is insufficient and that funding for harm reduction will suffer. Now – for a further complexity. The limited funding available is not following the epidemiological data. In other words, we don’t have enough money for harm reduction and could be using the small amount we have better. Upper middle-income countries are home to two thirds of all people who inject drugs, but lower middle-income countries have the greatest share of harm reduction funding. Our funding crisis sits in the middle of broader economic growth and donor withdrawal.

This means, that while international donor funding is our interim game plan for ensuring millions of men and women around the world receive the health services they desperately need, our long term plan is to ensure than national governments take full responsibility for funding the harm reduction response in their countries, with attention to their specific drug use patterns and need. This is of course, easier said than done. Budgets are tight, healthcare systems in many developing countries may be constrained in many areas; but the larger problem is that drug policy is the subject of political grandstanding. We must stop this now. There is an urgent need for action to follow evidence.

Even where national governments do provide funding for harm reduction, determining the extent of funding for harm reduction remains a difficult task. We urge governments to better track their funding. So while there is initial progress, we know that we must ask the question – are tax payer dollars being used most effectively in country? We urge governments to track, and critically evaluate their drug policy spending and to consider reallocating funds from ineffective drug law enforcement to harm reduction. At the same time, we must call on donors to fund in accordance with epidemiological need, and carefully plan for transition in partnership with recipient governments. Incremental, well planned transitions are essential to sustaining quality services, boosting gender-sensitive services, and ensuring sufficient coverage.

We call on MS to uphold the serious commitment of the Min Declaration to continue to mobilise resources to address drug-related challenges –  we consider harm reduction to be core to this. The new UN common position breathes new life into rights-based, evidence-based harm reduction; emphasises inter-agency activities and cooperation, and connects and DIRECTS our efforts to the 2030 agenda. Now is the time for the Commission on Narcotic Drugs to connect with broader movements, and with significant global health targets. It is never really about the drugs, it is about people, and until we recognise that, we will fail to meet our health, human rights and drug policy goals. We will leave people behind.

Ana Maria Rueda, Colombia: The Colombia govt approved in December 2018 a new drug policy, in which harm reduction is integrated transversally within the drug use reduction Pillar, giving continuity to work in harm reduction that started a few years ago. This pillar, on drug use reduction, reinforces Colombia’s commitment to the public health and human rights approaches in drug policy. We recognize the progressive escalation of high-impact health use patterns, as the injected use of drugs such as heroin, as a challenge as well as a priority. It is estimated that around 15,000 people inject drugs, mainly heroin. The studies carried out show a complex panorama related to patterns of high risk drug use. HIV prevalence rates exceed 5% and hepatitis C have been established, exceeding 40% in people who inject drugs. Many people who inject drugs live in conditions of high precariousness and suffering. They do not have ties with their families and street habitability is common. Among the people who inject drugs, approximately 10% are women, in whom the impact is more serious.

As a result, local governments in four cities a few years ago initiated harm reduction actions in Colombia. Some of this actions are:

  • Delivery programs for hygienic injection material. Around 2,000 people are having access to syringe exchange programs at this time.
  • Comprehensive Care including health services and education and HIV pre-test counseling.
  • Opioid substitution treatment. In the country we have 12 methadone treatment services and three of them provide ambulatory services.
  • Drug analysis. Drug testing is being done in parties by ATS, a colombian NGO.
  • The Drug Observatory of Colombia counts with an early warning system that has allowed for the identification of 33 NPS in the country and offers information for drug prevention and harm reduction strategies.
  • The provision of Naloxone for the management of overdose is provide only in one of the cities. We are hoping to overcome the challenges that exist today to provide naloxone widely. These challenges are related to getting the medical professionals to understand the need for naloxone for drug users.
  • We also have training programs for professionals and peer teams where technical assistance and opportunities to exchange experiences are provided.

The actions undoubtedly constitute a huge advance on a harm reduction approach to drug use in Colombia, and are the result of the efforts of civil society organizations, local governments, and the Ministries of Health and Justice, and the support of international cooperation and from countries such as Switzerland and Holland has been definite. Which are the challenges. First, stable funding. We don´t have the local governments completely aware of the need and challenges of this intervention, and funding from the central government is still not secure. This issue clearly affects the sustainability of the programs.  Secondly, the integration between health services and social assistance. We understand that simple and small services such as offering hand washing areas, bathroom service, showers, or even a cup of coffee can contribute to uphold the dignity of people. Furthermore, we don’t have a connection with job opportunities of housing services.  Thirdly, we still in need to develop a joint agenda between drug use and HIV, which is a strategy that has been achieved on the Latin American region. We understand it is crucial to advance on this matter since it is clear that stigma and discrimination of the most vulnerable groups increases inequality in access to early diagnosis, prevention, care and treatment. Another challenge is the need to generate specific actions for women and children, who require special services and in the case of children it is needed to review legal barriers that today prevent them from accessing to opium substitution treatments. The seroprevalence studies that are the baseline before the start of these programs have not been continued, so we do not know if we have achieved a decrease in the incidenceof infections. Finally, strengthening work with the community is essential. There are good experiences in this regard in the cities of Armenia and Cali, in which community networks, leaders, and peer greatly contribute to access and adherence of people to services and programs.

I conclude by saying that harm reduction saves lives, and that is why Colombia is very committed to strengthening this strategy, which is clear way to concretize the public health and human rights approaches and that addresses international mandates and guidelines.

Judy Chang, International Network of People who Use Drugs (INPUD): My name is Judy Chang, Executive Director of the International Network of People who use Drugs, a peer-based global network working to promote the health and defend the human rights of people who use drugs, speaking on behalf of my colleague Brun Gonzalez.

I would like to thank the Chair, the CND and the civil society task force for the opportunity to express our voice here. Drug policies cannot continue to be debated and developed, without meaningful participation of those most directly impacted by drug policies, that is, people who use drugs. The Outcome Document, ratified by member states, reaffirms a commitment to the, I quote, “comprehensive, far-reaching and people-centred set of universal and transformative Goals and targets” embodied in the 2030 Sustainable Development Goals; signalling an unprecedented shift towards ensuring that public health, development and human rights are prioritized and become central to all policy development. We celebrate the commitment in paragraph 4 of the outcome document to work towards drug policies that respect human rights, fundamental freedoms, and the inherent dignity of all individuals, including people who use drugs who are negatively impacted by the current criminalizing and stigmatizing paradigm.

The international community should recognize that existing punitive drug policies fuel violence and unrest, and threaten democracies, welfare and wellbeing for all. Going forward, drug policies should instead seek to reduce violence, strengthen governance, strengthen community systems, the rule of law, and promote the well being of society at large and those who are most marginalized and vulnerable. If we truly are now preparing to take stock of progress made and delineate the global drug strategy for the next decade, we need to stop harmful policies that rely on prohibition through criminalization. Continuing the “war on drugs” means a continuation of militarization along with armed confrontation and disproportionate spending on security, enforcement and supply reduction strategies. These not only fail to achieve their goals, but are also at the expense of establishing and promoting peaceful and just communities and societies.

Prohibitionist models and “drug-free” objectives actively undermine the SDG Agenda, “determined to foster peaceful, just and inclusive societies which are free from fear and violence” so that “all human beings can fulfil their potential in dignity and equality and in a healthy environment”. In other words, and I quote “There can be no sustainable development without peace and no peace without sustainable development.” Drug-free objectives are not only unrealistic, they are dangerous and harmful; used to justify widespread human rights violations, and an overly punitive approach that directly undermines health, development, peace and security. It is people who use drugs that are most directly and severely impacted, as drug-free objectives contradict and interfere with the rights of autonomy, self-determination and the free development of the individual. The SDGs principle on Partnership tells us that further steps should be “based on a spirit of strengthened global solidarity, focused in particular on the needs of the poorest and most vulnerable and with the participation of all countries, all stakeholders and all people.”

Paragraph 8 of the Declaration of the 2030 Agenda reads: “We envision a world of universal respect for human rights and human dignity, the rule of law, justice, equality and non-discrimination; of respect for race, ethnicity and cultural diversity; and of equal opportunity permitting the full realization of human potential and contributing to shared prosperity. This should be used to guide decision making in drug  policy development.

Right now, our communities are still subject to actions that directly undermine progress toward achieving sustainable development goals, which include: compulsory drug detention that uses torture and/or forced and unpaid labor; death penalty for drug offences and open promotion of violence targeting people who use drugs; an epidemic of preventable drug overdose deaths that grows each year. Extreme examples of the harmful impacts of current policies include state sanctioned extrajudicial killings of people who use drugs in numerous contexts adding to the loss of hundreds of thousands of lives in the last couple of years alone. This needless loss of lives continues unabated, and has led to widespread mass murder and disappearances amongst citizens, including youth, women and indigenous communities.

To conclude, drug policy must align with the sustainable development agenda. The loss of life and atrocities committed in the name of the war on drugs must end. As people who use drugs, we promote the incorporation of full spectrum harm reduction strategies and policies such as NSP, OST, substance analysis services, harm reduction for non-injected substances, stimulants or supply side harm reduction. We, as the voice of people who use drugs all over the world strongly affirm and believe that the post-2019 strategy should focus on inclusion, participation and community involvement. Drug policy should not continue to be encapsulated in a “parallel universe” that is isolated from the broader global governance agenda. People who use drugs are in integral part of the world, we are citizens, we are human beings, we are community.

Zaved Mahmood, Human Rights and Drug Policy Advisor, Office of the High Commissioner for Human Rights (OHCHR): In the last few decades, the international system of drug control has focused on creating a drug free world, almost exclusively through use of law enforcement policies and criminal sanctions. Mounting evidence, however, suggests this approach has failed. Primarily because it does not acknowledge the realities of drug use and dependence. While drugs may have a pernicious effect on individual lives and society, this excessively punitive regime has not achieved its stated public health goals, and has resulted in countless human rights violations.

In the last autumn, the UN Human Rights Office submitted a report (A/HRc/39/39) to the Human Rights Council on the implementation of UNGASS 2016 commitments from human rights perspective. In my this presentation, I will largely share with your findings and recommendations of the report. The enjoyment of the right to health of all people who use drugs — and are dependent on drugs — is applicable irrespective of the fact of their drug use. The right to health is provided for in article 12 of the International Covenant on Economic Social and Cultural Rights. Under articles 2 (2) and 3 of the Covenant, States are required to implement the right to health on a non-discriminatory basis, which includes extending that right to drug users.

Health aspects in the drug control efforts should also be look at from the perspective of the right to life. In its General Comment 36, the Human Rights Committee discussed States’ duty to protect life. The duty to protect life implies, inter alia, that States parties should take appropriate measures to address the general conditions in society that may give rise to direct threats to life or prevent individuals from enjoying their right to life with dignity. These general conditions may include, among other issues, the prevalence of life threatening diseases, such as AIDS, tuberculosis or malaria, extensive substance abuse, and extreme poverty and homelessness. The measures called for addressing adequate conditions for protecting the right to life include, where necessary, measures designed to ensure access without delay by individuals to essential goods and services such, health-care, and other measures designed to promote and facilitate adequate general conditions such as the bolstering of effective emergency health services. (CCPR/C/GC/36, page 7). Such health care should be affordable, accessible and good quality.

Human Rights Violations in Treatment: Some of the most severe violations of the right to health have occurred in the context of “treatment” for drug dependence. Instead of evidence-based medical management, enforcement authorities in many jurisdiction reportedly coerce or force drug-dependent individuals into treatment centres. Evidence shows that what is referred to as “treatment” in many treatment centers in fact includes painful, unmedicated withdrawal, beatings, military drills, verbal abuse, and sometimes scientific experimentation without informed consent. Forced labor, without pay or at extremely low wages is used as “rehabilitation,” with detainees punished if work quotas are not met. These abuses are flagrant violations of the right to be free from torture, cruel, inhuman, or degrading treatment and punishment and the right to health. Reported human rights abuses in so-called drug treatment and rehabilitation centers (“rehabs”), established and run by private individuals or organizations in many countries, are disturbing development. They must be investigated and remedied.

Closure of compulsory treatment centres: In 2012,  twelve United Nations entities, including the UN Office on Drugs and Crime, the World Health Organization, the UN Children’s Fund, the Office of the High Commissioner for Human Rights  and UNAIDS  called for the closure of drug detention centers and the release of the people detained there without delay. Despite this call, many States still continue to use such detention centres. Donors continue to support such initiatives, despite recorded the human rights consequence, As an alternative to compulsory drug detention and rehabilitation centres, States should make available voluntary, evidence-informed and rights-based health and social services in the community. Where a State is unable to close the centres rapidly, without undue delay, measures should be established immediately. Such measures should include a process to review the detention of those in the centres to ensure that there is no arbitrary detention and that any detention is conducted according to relevant international standards of due process and provides alternatives to imprisonment. State should also establish judicial and other independent oversight and reporting over the review and closure process of the centres; and moratoria on further admission into compulsory drug detention and rehabilitation centres of people who use drugs; and should adopt gender-sensitive and evidence-based drug treatment services , including harm reduction programmes, for women in detention”.

Decriminalization: A major obstacle to accessibility of treatment is the criminalization of personal use and possession of drugs. UN human rights bodies have recommended to decriminalizing the personal use and possession of drugs for removing obstacles to the right to health. Decriminalizing drug use and possession, together with the provision of a continuum of support, prevention and treatment measures, can result in a decrease in overall drug use and in the drug-induced mortality rate. In June 2017, twelve United Nations agencies, including our office, issued a joint statement. In the joint statement, they have recommended States to review and repeal of punitive laws such as those criminalize or otherwise prohibit drug use or the possession of drugs for personal use.

Decriminalization of harm reduction measures: State must repeal laws against harm reduction services. Many countries still have legal barriers to important life-saving harm reduction services. Illegality of needle and syringe programmes, opioid substitution treatment limits access to services. UNAIDS’ devasting report from yesterday notes that 99% of all people who use drugs around the world do not have access to adequate coverage of harm reduction services

Opioid crisis: The opioid crisis shows the need for well-designed regulation with proper implementation, including guidelines and training on prescription, and regular monitoring. This includes, inter alia, regulation enabling the improvement of the relationships between the pharmaceutical industries on the one hand and doctors and lawmakers on the other.  All businesses, including pharmaceutical industries involved in opioid business, should apply the UN Guiding Principles on Business and Human Rights  to address adverse human rights impacts with which they are or may become involved  and should carry out human rights due diligence.

Drug courts and treatment: In some States, “drug courts” offer people accused of drug use a choice between imprisonment and treatment. Given that the decision to undertake treatment is made under the threat of imprisonment, coercion may influence such a decision. The Inter-American Commission on Human Rights considered that drug courts which offer treatment as an alternative to imprisonment fail to conform to a public health approach and do not tackle mistreatment and human rights violations that occur in treatment centres, which are rarely investigated or properly supervised. Evidence shows that drug court system causes considerable harm to participants and frequently results in serious human rights violations. Such violations are exacerbated by racial and gender biases. The propensity for human rights violations in the context of drug courts is such that the report cautioned against the continued roll out of drug courts in countries where oversight and monitoring mechanisms are absent.

Measuring drug policies from a human rights perspective: There is a growing realization that the traditional indicators regarding arrests, seizures and criminal justice responses are inadequate to show the real impact of drug policies on communities. Our office has developed a set of human rights indicators for the realization of human rights, and a guidance on a human rights-based approach to data collection in the implementation of the Sustainable Development Goal. Both can provide guidance in strengthening and streamlining existing data-collection and analysis tools in drug control efforts. The Special Rapporteur on the Right to Health recommended several indicators for assessing the drug policy from human rights perspectives (A/65/255, paragraph 72)

In the conclusion, I would like to highlight that the Sustainable Development Goals. i.e. the 2030 Agenda is putting people, health and human rights at the centre of development. Drug matters are intertwined with all aspects of sustainable development. All areas of the 17 Sustainable Development Goals should shape measures in countering the drug problem. People who use drugs are not just left behind; but deliberately kept out. They are kept out from policy discussion and  development. They arekept out policy implementation.  Let us all together work to supporting States, civil society and people who use drugs to implement a well designed drug policy which is based on evidence, human rights and public health; and help to implement to the 2030 Agenda for Sustaintable Development Goals. In this regard, the UN Human Rights Office stands ready to cooperate with States, UN agencies, civil society organisations and effected communities, including the people who use drugs, to implement the recently adopted UN System Common Position on supporting the implementation of the international drug control policy through effective inter-agency collaboration.

UNAIDS: Excellencies, civil society partners, UN colleagues, ladies and gentlemen. UNAIDS thanks the Netherlands, Norway and WHO for organizing this special event. UNAIDS is honoured to co-sponsor and join today. We recognize and thank all the other co-sponsors (whom Ann listed) for your continued leadership on this issue. Thank you Ann for showcasing the publications launched by UNAIDS and UNDP and touching on the elaboration of the UN Common Position and the lessons learnt over the last 10 years which the Secretary General alluded to in his message at the opening plenary.  Thank you also to the panellists for their presentations. 1. The world is failing to protect the health and human rights of people who use drugs. One result of this failure is an HIV response that has left behind people who inject drugs. Globally, there was no decline in new HIV infections among people who inject drugs between 2010 and 2017. This goes against the global trend of declining new HIV infections. 2. Evidence supports the need for a shift in the global approach to drug use. We need to create spaces for dialogue and action to heal the harms caused by drug policies. We need to also broaden our vision of harm reduction that extends beyond prevention and risk reduction to strategies that address trauma, social division, injustice and inequities. 3. UNAIDS reiterates its call for the global adoption of a people-centred, public health and human rights-based approach to drug use. We cannot end AIDS if we do not end it among people who inject drugs. UNAIDS is committed to harm reduction. Harm reduction works. Harm reduction saves lives. 4. We have a unique opportunity to adopt a new course of action—to treat people who use drugs with dignity and respect; to provide them with equal access to health and social services; to greatly reduce the harms of drug use; and to contribute to the end of the AIDS epidemic and the achievement of the Sustainable Development Goals. I thank you.

European AIDS treatment group: the titles don’t matter now, what matters is that I am an active drug user. We face every day the stigma and discrimination as mentioned by Judy and Mahmood. One of the first steps in emancipation is the right of choice in treatment and use of substances. I am one of the recorded incidences of the HIV outbreak at the centre of Athens between 2011 and 2013. We learn as civil society that the Greek society under the terms of economic recession seems to be forgetting all these things. We are under attack in Greece. They burned our checkpoint 5 days before. It is the place where me and my colleague Zachary works, where Zachary was lynched. We are under attack. We have to be united. We don’t need intermediaries, people speaking for us without us. We are citizens as Judy just said, and we are here, present and active.

Chair: Thank you very much, the right of choice, very important,

Mat Southwell, EuroNPUD: I want to highlight a project we are working on that highlights the role of drug users in the ham reduction responses, which covers 6 countries where drug uses are engaged in peer-to-peer distribution of naloxone. We are lucky in the UK that drug users are able to hand out naloxone to peers. We can’t do this until drug users can be part of the response. It’s great to have first responders help with this but the most important is to have peer users engaged in this.

EHRA: for our countries in Eastern Europe and Central Asia, the key priorities of the state are funding priorities. Now that donors are leaving, states are showing their priorities by keeping people in prison but not providing harm reduction such as OST. We need people from the international community to tell them that they need to show their commitment by giving money behind the response.

H.E. Ms. Kjersti Andersen, Permanent Representative of Norway to the UN in Vienna

Thank you for all your interventions. It’s impossible to sum up all the interventions but I will share with you some of the sentences underlined in my notes:

  1. Harm reduction is cost effective
  2. Promoting human rights is good public health
  3. War on drugs has become a war on people. This needs to change
  4. Be more than just a donor. Work with civil society. Focus on health and human rights. Build local and regional networks.
  5. Donors are encouraged to fund harm reduction directly. There is limited funding.
  6. Actions must follow evidence.
  7. Drug policies cannot be developed without the meaningful involvement of people who use drugs
  8. People who use drugs are citizens.

Harm reduction must influence the way we implement our programmes. This is our joint task.

Chair, the Netherlands: Thank you very much to some of your voices, Judy and Tanya. I’m also looking at some of you, who help bring us closer to the response. I thank you also, Monique Middlehoff. Thank you Ann for doing this together with me.

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