Home » Side event. The right to health of people who use drugs: Harm reduction and access to voluntary treatments in a human rights perspective

Side event. The right to health of people who use drugs: Harm reduction and access to voluntary treatments in a human rights perspective

Organised by the Forum Droghe with the support of the International Drug Policy Consortium, Harm Reduction International, the European Network of People who Use Drugs, la Società della Ragione and the Associazione Luca Coscioni

Adria Cots – IDPC: Let me start but trying to share some definitions about harm reduction. Within the context of UN documents, harm reduction has historically been approached through a very technocratic and medicalized paradigm, defining it as a series of interventions that are proven to reduce the health harms associated to drug use, such as drug-related overdoses or the transmission of blood-borne diseases. I have put here this definition by the WHO Guidelines. It is important to remember that these interventions narrowly described as often associated with injecting drug use, which is prevalent in the Global North but not so much in countries in Latin America or Africa. There is a broader definition of harm reduction, which seeks to address holistically the harms that people can experience associated to drug use, but also those associated to punitive drug policies. And they include both traditional health measures as well as interventions that address problems housing, income, support, stigma and criminalisation. It is not about meeting people where they’re in order to take them into a medicalized process, but to just stay with them together as peers, as equals.  So, while when we talk about harm reduction within the UN documents, we traditionally refer to the medicalised interventions. But I would submit that the philosophy of the broader meaning of harm reduction and that of human rights rely on the same logic. They are about recognizing everyone’s equal value and dignity, and to recognize that everyone should be able live their life on their own terms.Historically, human rights bodies have turned a blind a eye to drug policies, but this has changed radically in the last 10 years, and harm reduction has been a big part of the change. I think the clearest formulation is provided by the UN special rapporteur on the right to health on their  statement in April 2020 at the outset of the COVID19 pandemic. It says ‘harm reduction interventions are essential for the protection of the right to health of people who use drugs’. We are having a debate right now at the Human Rights Council on a new resolution on drug policies and human rights, and many Member States have taken the floor to defend introducing language on harm reduction while citing this statement, and saying that harm reduction is central to the right to health. I think that this is the framing that has to stay with us. Harm reduction is central to the right to health of people who use drugs. States are not discharging their obligations if that is not fulfilled. UN treaty bodies, who are charged with monitoring the implementation of the international human rights conventions, have also provided many recommendations to Member States to implement harm reduction as part of their obligations under human rights law. The body that has taken the lead in that regard is the UN Committee on Economic, Social and Cultural Rights, which has for a long while now used all country reviews to enquire about the state of drug responses, and to recommend the adoption of harm reduction. Under the framework of the right to health, it has provided over 15 recommendations in the last 5 years, using formulations such as, and I quote:

“The Committee recommends that the State party pursue its efforts to secure sustainable funding for HIV prevention activities and harm reduction programmes that cover the needs of drug users”(Bulgaria)

“The Committee expresses its concern about the persistence of a predominantly punitive approach to drug use, the lack of harm reduction programmes for drug users and the absence of legislation to facilitate the medicinal use of cannabis (art. 12)” (Bolivia 2021)

Moving beyond CESCR, there are plenty of references to harm reduction in the context of human rights treaties, showing the intersectionality and importance of the concept for all of the international human rights system, not only health. +30 recommendations to provide “youth-friendly harm reduction” by the Committee of the Rights of the Child. This is particularly significant because these recommendations are provided in the framework fo Article 33 CRC, about the right to be from drug use, and is normally used to push for early prevention only. CEDAW has given in several occasions recommendations “to provided gender-sensitive and evidence-based drug treatment services to reduce harmful effects for women who use drugs, including harm reduction programmes for women in detention” (Georgia, 2014)

The Human Rights Committee, which oversees the implementation of civil and political rights, also give a recommendation to provide harm reduction services within the context of a human rights-based general approach to drugs. And the Committee Against Torture has noted how Russia has not access to opioid agonist treatment within centres of detention, and has deplored that it is instrumentalising withdrawal symptoms to extract confessions. Looking beyond the work of treaty bodies, harm reduction has been strongly supported by the UN Working Group on Arbitrary Detention in its 2021 study on arbitrary detention has found that the lack of provision of harm reduction within centres of detention can constitute just by itself a violation of the right to be free from arbitrary detention. If we go beyond human rights experts, I just wanted to touch quickly on the fact that support for harm reduction across the UN is frankly overwhelming. This happens both at technical level, with recommendations for harm reduction at UN agencies by WHO, UNAIDS, OHCHR, etc. , and of course in the 2018 UN Common Position on drugs. We have seen support for harm reduction by the General Assembly with UNGASS, though with the formulation of minimising the adverse risks, to clear and explicit references to harm reduction in the 2021 Political Declaration on HIV and AIDS, as well as in the Human Rights Council resolution. From a human rights perspective we normally frame and classify states’ obligations with regards to each particular human right in a triple category: obligations to respect, obligations to protect, and obligations to fulfil. I think it is useful to apply that same structure to harm reduction. Obligations to respect – negative obligation. The state is obliged to ensure that state actors do not interfere with harm reductions. This includes remove criminalisation of harm reduction services, harassment of harm reduction services, undue restrictions. Obligations to protect – state needs to take active steps to prevent the interference by religious or prohibitionist groups. Obligation to fulfil – invest in harm reduction, ensure access to a broad range of harm reduction services, invest on peer-led services.

 Susana Ronconi – Forum droghe: Working group on arbitrary detention gives a good contribution on the rights for PUD. On mandatory treatment there is alternative measure to coercive. freedom of choice of PUD and their right to health. Alternative sanctions is important to mitigate criminalization and incarceration for minor drug crime. In the current system of alternative od sanction, in the same could regard other contexts. To Threat of imprisonment should not be a coercive tool tyo incentive people in drug treatment. This is an acceptable to refuse or discontinue treatment in any time. Qe have a de facto mandatory treatment in this specific context. 3 aspects of this reach. Which kind of treatments are accepted by the court? What is the cultural approach of the judge? All are abstinence oriented and they don’t consider the wide range of options. For example there are no harm reduction oriented treatment. Relapse is a criminalized, and a reason to stop treatment and send people to prison again. This is a conflict whit what evidence and professional now, that relapse is part of the process. Working group on arbitrary detention says that. Usually there is conflict between health professionals and the court, because courts have more power. Third problem is that some time people don’t need treatment at all (unnecessary treatment) as they are not problematic drug users, but they chose treatment to avoid prisons. In conclusion we should limit the risks of violations, include all treatments and goals, range of possible options for treatment including HR. Balance the power of judges and health professionals, and empower PUD to negotiate. Decriminalize minor drug crimes related to personal use.

Ligia Praodi EuroPud / INPUD: Harm reduction has long been practiced and developed among drug users. I bring you three examples of actions developed by our communities. The first one is from the grassroots period (1980-2000) In 1981, in Rotterdam, Netherlands there was a group of drug users called Junkiebond. They inspired the creation of many others. As early as 1981, Junkiebond started an underground needle and syringe programme with the aim of protecting people who inject drugs from hepatitis B. They took an activist approach campaigning for effective services for drug users, challenging discrimination and defending human rights. You all know what else emerged in the 80’s. Human Immunodeficiency virus was identified in 1985, having already made many, many victims. Needle sharing soon started to be identified as one of the main causes for the rapid spread of HIV among injecting drug users. In 1985, when the first drug user in the Netherlands was diagnosed with AIDS, Rotterdam had an estimated 3000 regular heroin users, of whom about 30% injected drugs. In 1986, the first HIV study among Rotterdam drug users found 12% HIV-positive. This rate never got any higher. In Amsterdam, one hour’s drive from Rotterdam, HIV-prevalence among IDUs was already 30% in 1986, a figure which gradually declined in the second half of the nineties. This context was relatively supportive for self-organization of drug users. Most drug users had homes. Police were harsh, but there was no extreme scapegoating of drug users. Methadone maintenance provided addicted users with new options for spending their time, including organising protest against ‘old’ policies and programmes which were considered harmful. Drug users who started to organise also found allies, including church groups, who gave them places to meet and other resources. Junkiebond operated primarily through peer networks, often well integrated and engaged with drug supply networks, and provided a whole array of mutual aid functions. Including advocacy with drug treatment providers, peer education, needle and syringe programmes, legal advocacy and consumer advocacy with local drug suppliers. 2000-2016 = Coming of age Why 2016? Harm reduction was recognised by UNGASS in 2016. To exemplify this stage, I chose a campaign that started? (2014) Support don’t Punish. Support. Don’t Punish is a global grassroots-centred initiative in support of harm reduction and drug policies that prioritise public health and human rights. The campaign seeks to put harm reduction on the political agenda by strengthening the mobilisation capacity of communities targeted by the “war on drugs” and their allies, opening dialogue with policy makers, and raising awareness among the media and the public. Every year, an increasing number of activists in dozens of cities all over the world join this unique and multifaceted show of force for reform and harm reduction. The Support. Don’t Punish campaign highlights some key messages: The drug control system is broken and in need of reform. People who use drugs should no longer be criminalised. People involved in the drug trade should not face harsh or disproportionate punishments, where retained. The death penalty should never be imposed for drug offences. Drug policy should focus on health, well-being and harm reduction. Drug policy budgets need rebalancing to ensure health and harm reduction-based responses are adequately financed. The Convention for the Elimination of all forms of Discrimination Against Women sets the standard of Human Rights regarding women and girls. It can be described as the international declaration of Women’s Human Rights. Portugal presented country developments last year and we presented a shadow report entitled Issues affecting women who use drugs in Portugal describes some of the problems and inequalities faced by women who use drugs in Portugal, elaborating on priority issues, evidence and recommendations. Includes information on institutionalized discrimination and violations of the rights of women who use drugs, including those associated with gender-based violence, access to health care, parental custody rights and disproportionate sentencing. Recommendations to the Portuguese authorities: The Portuguese government still does not have adequate resources for women-specific harm reduction services, which amounts to discriminating against women who use drugs in accessing health services. Adjust existing harm reduction and other HIV prevention programs to allow for greater uptake by women who use drugs by hiring female staff, providing on-site childcare support, women-specific information, education and communication resources, flexible service hours, and expanding health in care fixed sites to include mobile outreach services. Ensure meaningful involvement of women who use drugs in the design, implementation and evaluation of services. I finish with this message: Sisters, brothers, own your space, own your role.

Michelle Wazan – Sokoun Lebanon: Hard to challenge right to health when there is criminalization. Lebanese drug laws criminalize drug use. Establishes the principle of treatment as an alternative to persecution and punishment. Mandatory treatment is coercive. In 1992 law acknowledged the right to health. It is a progressive law. Drug addiction Committee. Rom the criminal justice system to the right of public health. Problems between judiciary and treatment services. Judges oversees treatment until program is completed. Ensures that the person referred to treatment is nor sentenced by a court of law. Criminal record free of drug use sanctions. Challenges: only 1 to 4% of people arrested for drug are forced to treatment as an alternative. Durga addiction committee is inactive for 15 years. It was activated till 2013. Committee centralized in Beirut. Judges did not know of its activation. Judges’ personal beliefs in the sanctions.  Oversees and drug related emergencies. Obstacles to accessing hospital. Majority of hospitals report overdose cases to the police, generating dree of arrets and send aways PUD. Circulars form public minister of health remind hospital their duty to take care toward patients and clarifies that should not call police in cases of overdoses. 27 of 107 can be considered safe hospital for PUD. Criminalization should never get in the way of harm reduction. Necessity to decriminalize drug use. Crisis of OAT: financial, buprenorphine not considered essential. shortage in medication, over 20 individuals at risk.

Marco Perduca. Since and the research and the right to health. Cannabis and psychedelics. Right to science. Article 15 of ECOSOC. Revolve 1. freedom of research regradlesss of the topic, 2. access to the knowledge produce (share). 3. Enjoy scientific progress and its applications. What we hear today show a violation of this rights.

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