Report of the Special Rapporteur on torture Manfred Nowak, 2009 – Applying a Human Rights-based approach to drug policy

In this 2009 report to the UN Human Rights Council, the United Nations Special Rapporteur on torture, Professor Manfred Nowak, calls on UN member states to adopt a rights based approach to drug policies.

Recognising that the human rights and drug policy regimes in the UN have ‘evolved practically detached’ from each other, Prof Nowak’s report submitted for the 10th session of the Council draws the attention of members states to the issues of ‘drug users in the context of the criminal justice system and situations resulting from restricted access to drugs for palliative care.’

In specific, the Special Rapporteur raised concerns relating to:

• The use of the death penalty for drug offences
• Denial of access to opioid substitution therapy and needle exchange in places of detention
• Forced drug dependence treatment
• Forced testing for HIV and HCV
• Lack of access to opiates for pain relief

SR Torture Report A.HRC.10.44AEV

‘The right to health of prisoners in international human rights law’ by Rick Lines, International Journal of Prisoner Health

From the International Journal of Prisoner Health, March 2008; 4(1): 3-53

Abstract

This paper explores the health rights of prisoners as defined in international law, and the mechanisms that have been used to ensure the rights of persons in detention to realise the highest attainable standard of health. It examines this right as articulated within United Nations and regional human rights treaties, non-binding or so-called soft law instruments from international organisations and the jurisprudence of international human rights bodies. It explores the use of economic, social and cultural rights mechanisms, and those within civil and political rights, as they engage the right to health of prisoners, and identifies the minimum legal obligations of governments in order to remain compliant with human rights norms as defined within the international case law.

In addressing these issues, this article adopts a holistic approach to the definition of the highest attainable standard of health. This includes a consideration of adequate standards of general medical care, including preventative health and mental health services. It also examines the question of environmental health, and those poor conditions of detention that may exacerbate health decline, disease transmission, mental illness or death. The paper examines the approach to prison health of the United Nations human rights system and its various monitoring bodies, as well as the regional human rights systems in Europe, Africa and the Americas. Based upon this analysis, the paper draws conclusions on the current fulfilment of the right to health of prisoners on an international scale, and proposes expanded mechanisms under the UN Convention against Torture and Other Cruel, Inhuman or Degrading Treatment to monitor and promote the health rights of prisoners at the international and domestic levels.

Right to Health of Prisoners in International Human Rights Law

Recalibrating the Regime: The need for the human rights-based approach to international drug policy, D Barrett, R Lines, R Schleifer, R Elliott, D. R. Bewley-Taylor

Published by the Beckley Foundation Drug Policy Programme and the International Harm Reduction Association, March 2008

The report looks at the growing tensions between the United Nations drug control system and international human rights law. It highlights that, despite numerous instances of human rights abuses perpetrated in the name of drug control, and the status of human rights in international law, there has been little engagement with this issue by the responsible drug control and human rights bodies. The report presents a series of avenues for reform at the international level to address this imbalance

Available for download via IHRA

Ethical and human rights imperatives to ensure medication-assisted treatment for opioid dependence in prisons and pre-trial detention, R. Douglas Bruce and Rebecca Schleifer

International Journal of Drug Policy 19 (2008) 17–23

Abstract

Opioid dependence is a complex medical condition affecting neurocognitive and physical functioning. Forced or abrupt opioid withdrawal may cause profound physical and psychological suffering, including nausea, vomiting, diarrhoea, extreme agitation and/or anxiety. Opioid dependent individuals are especially vulnerable at the time of arrest or initial detention, when they may, as a result of their chemical dependency, be coerced into providing incriminating testimony, or be driven to engage in risky behaviour (such as sharing needles in detention) in order to avoid painful withdrawal symptoms.

Upon incarceration, many opioid-dependent prisoners are forced to undergo abrupt opioid withdrawal (both from legally prescribed agonist therapy such as methadone as well as illicit opioids). Physical and psychological symptoms attendant to withdrawal may impair capacity to make informed legal decisions, and cause prisoners to risk HIV and other blood-borne diseases by sharing injection equipment. Although prisons must provide at least the standard of care to prisoners that is available in the general population, medication-assisted treatment, endorsed by international health and drug agencies as an integral part of HIV prevention and care strategies for opioid-dependent drug users, is unavailable to most prisoners.

Medication-assisted treatment is a well-studied and validated pharmacological therapy for the medical condition known as opioid dependence.

The failure to ensure prisoner access to this medical therapy threatens fundamental human rights protections against cruel, inhuman or degrading treatment and rights to health and to life. It also poses serious ethical problems for health care providers, violating basic principles of beneficence and non-maleficence (i.e., do good/do no harm). Governments must take immediate action to ensure access to opioid substitution to prisoners to ensure fulfilment of ethical and human rights obligations.

Download via the International Journal of Drug Policy

‘Injecting drugs into human rights advocacy’ by R Lines and R Elliott, International Journal of Drug Policy

Injecting drugs into human rights advocacy
International Journal of Drug Policy, Volume 18, Issue 6, Pages 453-457
R. Lines, R. Elliott

Injecting Drugs into Human Rights Advocacy – Lines Elliott 2007

‘Injecting Reason: Prison Syringe Exchange and Article 3 of the European Convention on Human Rights’ by Rick Lines, European Human Rights Law Review

From European Human Rights Law Review, [2007] E.H.R.L.R. Issue 1, 66-80.

Abstract

High rates of HIV infection and injecting drug use are major concerns in prisons across Europe. There is a broad international consensus that people in prison are entitled to a standard of health care equivalent to that available outside of prisons, yet only four Council of Europe countries provide sterile syringes to prisoners as an HIV prevention measure. This failure places prisoners who inject drugs at increased vulnerability to HIV infection simply because of their status as prisoners, raising serious human rights and public health concerns. Article 3 of the European Convention on Human Rights (ECHR) provides an important tool for advocating for the rights of prisoners to HIV prevention measures, including syringe exchange. The European Court’s recent Art.3 case law indicates that the ECHR can be used to advocate in favour of prison syringe exchange programmes.

‘Injecting Reason’ – R Lines

Shelley v United Kingdom – submission of the Irish Penal Reform Trust and the Canadian HIV/AIDS Legal Network

‘From equivalence of standards to equivalence of objectives: The entitlement of prisoners to health care standards higher than those outside prisons’ by R Lines, International Journal of Prisoner Health

From International Journal of Prisoner Health, December 2006; 2(4): 269-280

Abstract

It is generally accepted that people in prison have a right to a standard of health care equivalent to that available outside of prisons. This ‘‘principle of equivalence’’ is one that enjoys broad consensus among international health and human rights instruments and organisations. However, given the extreme health problems evident in prisons worldwide, the legal obligations of the State to safeguard the lives and well-being of people it holds in custody and the implications of poor prison health on overall public health, this article suggests that – even if achieved -  standards of prison health care only equivalent to that in the community would in some cases fall short of human rights obligations and public health needs. The article argues it is time to move beyond the concept of equivalent standards of health care, and instead promote standards that achieve equivalent objectives. In some circumstances, meeting this new standard will require that the scope and accessibility of prison health services are higher than that outside of prisons.

From equivalence of standards to equivalence of objectives

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