Side Event: Insights into Treatment and Care for People with Drug Use Disorders in Contact with the Criminal Justice System – Alternatives to Conviction or Punishment

Side event organized by the UNODC Justice Section, with the support of Norway and Vietnam, and the African Union, the UNODC Prevention, Treatment and Rehabilitation Section, the World Health Organization, and the Vienna NGO Committee on Drugs (VNGOC) – and organised back-to-back with another UNODC side event entitled “No-one Left Behind: UNODC-WHO Programme on Drug Dependence Treatment and Care”

Sven Pfeiffer (Crime Prevention and Criminal Justice Officer, UNODC Justice Section):

The rationale for promoting alternatives to conviction or punishment is that people who use drugs should not be punished, in the same way that you would not punish someone living with HIV. But in some cases, alternatives can still have a punitive element. Yet alternatives help to avoid the adverse effects of prison and prison overcrowding, as well as the monetary costs. There is also evidence that alternatives help to reduce recidivism and can increase the likelihood of rehabilitation and reintegration. There are overlapping normative frameworks on this: the drug control conventions (which specifically allow for alternatives to punishment in cases of a minor nature), the UNODC/WHO Treatment Standards, human rights law and standards, and the Tokyo Rules (on non-custodial measures) and the Bangkok Rules (on women and incarceration). In the UNODC handbook, you can find a list of principles behind these alternatives – including the importance of informed consent and proportionality. At UNODC, we support these efforts with research and data, law and policy review, capacity building for justice officials, coordination and collaboration between health and justice sectors, and awareness raising – often to influence public attitudes. Some examples include data collection in South-East Asia and the Middle East, technical assistance on gender-sensitive responses in Thailand and Viet Nam, collaborations on treatment in Kenya, and other programmes in Sri Lanka and Afghanistan (including a public opinion survey). Common challenges identified are the lack of available alternatives in law, the reluctance of criminal justice officials to use alternatives, the lack of capacity, and the lack of gender-sensitive responses. Of note, a higher portion of women in prisons around the world are there for drug offences. We have also explored the COVID-19 responses in prisons.

Charlotte Sisson (Senior Foreign Affairs Officer, Bureau of International Narcotics and Law Enforcement Affairs (INL), USA):

UNODC has done a great deal of work since the 2016 UNGASS Outcome Document to promote these measures and reduce overall levels of crime. The guidance produced is a significant step to advise countries of what kinds of alternatives can be utilised, as are the UNODC/WHO Treatment Standards. There should also be a guide on alternatives to incarceration systems. The US looks forward to continuing to support UNODC with this work, to help those involved with the criminal justice system and provide pathways for actions at the national level. While we know the USA has a long experience of alternative measures since the 1970s, other countries also have created models of success – cost-effective and effective measures to improve access to treatment and re-entry to the community. We also acknowledge the co-morbidities, including mental health issues, faced by many people in contact with the criminal justice system. It is essential that evidence-based treatment is available to those who need it. We work with UNODC and others to promote best practices, and the US also supports worldwide training curriculums. All people with a substance use disorder should be able to access treatment, if we are to break the cycle of harm and burdens. Individual assessment is required – there are several widely-accepted tools for doing this. Treatment systems must be effective, and quality assured by national authorities – with systems of care built to be capable of meeting the need. Quality assurance is about always looking to do more, and to do it better all the time.

Jane Marie Ong’olo (Head of Social Welfare, Vulnerable Groups and Drug Control, African Union Commission):

The African Union (AU) is a collaboration of 55 African states. Our work on prisons is built on the local context of congested and high-risk prisons in the region (especially when looking at COVID-19). Therefore, the AU has been working on a series of recommendations and actions to help member states – within the African Union Plans of Action on Drug Control (2013-2018, and then 2019-2023). The current Plan includes a pillar for alternatives to punishment for drug use, promoting proportionality, and providing services for people who use drugs. The AU development blueprint – ‘Agenda 2063’ – is built on the principle of  leaving no-one behind. In 2016, the AU also developed a continental common position for the UNGASS – including commitment to pursue alternative measures to conviction or punishment for offences of a minor nature. The AU has ministerial meetings every two years to discuss issues, and in 2019 several commitments were also made in this regard. The reports we are receiving from member states show a growing understanding that prisons are not the best place to address drug issues, and the need to decongest prisons. Many countries are also reviewing or revising their national plans – with changes being proposed to legislation, probation or aftercare programmes, drug courts, early release, correctional supervision, etc. In the context of COVID-19, data from IDPC [and others] show that many African countries were decongesting prisons through amnesties, early releases, etc. But is this enough alone? If nothing else accompanies these measures, we may just be encouraging reoffending. In South Africa, for example, they have identified a lead agency for alternatives to incarceration and the High Court made a landmark decision that children cannot be criminalised for possessing cannabis, nor given any criminal record. In Senegal, programmes integrate treatment and harm reduction into prison settings. In Zambia, the government have developed new guidelines in 2020 related to incarceration for drug-related offences – giving access to warnings, bonds, rehabilitation etc, and agencies are working together to provide referrals into treatment instead – with 183 people diverted in 2020 alone. The challenges identified include the application of legislation and policies, the lack of viable treatment options as alternatives, the weak continuum of care in many places, to impact perceptions of the problem, but crucially to adapt local knowledge and understanding of the issues.

Le Duy Tran (Viet Nam Mission to International Organizations in Vienna):

(…)

Jonas Aga Uchermann (Senior Adviser, Norwegian Ministry of Health and Care Services):

Correctional services in Norway include community sentences, home detention, and prisons of various security levels. Alternatives to prison for people with substance abuse include drug courts, program against intoxicated driving, and transfers to substance abuse treatment in specialized health care. The key principles behind these models are:

  • All citizens have equal rights to education, health services, etc.
  • Prisoners do not lose their legal rights to receive help, services and support.
  • Prisoners should have access to health at the same level as the general population.
  • The correctional service shall facilitate health and other services providers.
  • Prisoners are in need of services to a larger extent than the general population.

The Norwegian health care system comprises primary health and care services, dental services and specialised healthcare – and the latter is where substance abuse is located and managed by the State. State-owned regional health trusts have responsibility for ensuring specialized health care to everyone, including prisoners. This includes acute mental illness and overdoses, which are treated by hospital admission outside of prison. Substance use problems are partly treated inside prisons, often as out-patients and/or in separated units (which exist in 18 prisons).

The key challenges and questions are: what does it require to facilitate treatment for dependent prisoners? How to balance the needs of the prisons system with the needs of health care? And how to address the lack of psychiatric health and substance abuse treatment personnel in the prisons, and the lack of admissions to hospitals for substance abuse and mental health needs. There are also challenges when patients are discharged from the psychiatric wards too early, and as a result their problems return after they return to the prison. To move forward, there are plans for more sentencing to alternative sanctions such as drug courts, and increased capacity for drug treatment in prisons – with services to be established in all prisons.

Philippe Jose Garcia (Program Manager, Fondazione Villa Maraini, Italy):

Speaker selected by the Vienna NGO Committee on Drugs (VNGOC)

Fondazione Villa Maraini has been taking care of people who use drugs, applying the Red Cross / Red Crescent fundamental principles, since 1976. We are the IFRC Reference Centre on Substance Abuse. Abstinence is not a precondition for treatment – rather, we listen and treat each individual as a unique entity, adapting the therapy to the individual (not vice versa). As such, we provide a wide range of possibilities from very low to higher threshold services, reaching 600 people who use drugs every day. These range from outreach units, emergency units and prison projects, to our orientation centre, drop in centre, night shelters and mobile clinics, to high threshold services such as semi- and full-residential rehabilitation programmes, and outpatient rehabilitation. Our emergency unit is a specific service for drug related emergencies in the city of Rome – comprising a professional team with a medical car, a free 24-hour phone number, naloxone to overcome overdoses, and medicines to help with withdrawal symptoms. There were 1,038 calls in 2019 and 572 in 2020. Our prison project is another specific service to bring psychotherapy and counseling inside prison for drug offenders (in groups and individually) – with the aim to support people towards eligibility for alternative measures to detention. Each year, we have been able to divert around 20-30 people into treatment at Villa Maraini instead of prisons. Our residential rehabilitation programmes are also provided as alternatives to detention. It is a therapeutic program with individual tailoring for each client after assessment by a psychologist. Activities include cleaning, gardening and park maintenance, catering and sports – alongside individual and group counseling and the involvement of families in the programme. When provided as an alternative to detention, there are also police checks and drug tests built in, and regular reporting to the supervision judge. There were 40 inmates in 2019, and 45 in 2020. Looking forward, a formal agreement with the local Chief of Police is on the way to formalise the collaboration between Villa Maraini and the police through the development of an operational protocol on drug-related emergencies. We seek to promote a humane and non-stigmatizing approach towards people who use drugs, which facilitates their management and involvement in treatment. We are also launching pilot actions on the model of the “pre-arrest diversion strategy” developed in the USA, and recommended by UNODC. We also seek to reduce overdose deaths by training the police on how to manage overdoses in the street.

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