Alex Stevens, The ethics and effectiveness of coerced treatment of people who use drugs, Human Rights and Drugs, Vol.2, No.I, 2012

ABSTRACT

In the context of international debates about ways to reduce the harms related to the use of illicit drugs and their control, this article explores the specific issue of coerced treatment of people who use drugs. It uses established standards of human rights and medical ethics to judge whether it is ethical to apply either of two types of coerced treatment (compulsory treatment and quasi-compulsory treatment,or QCT) to any of three groups of drug users (non-problematic users, dependent drug users and drug dependent offenders). It argues that compulsory treatment is not ethical for any group, as it breaches the standard of informed consent. Quasi-compulsory treatment (i.e. treatment that is offered as an alternative to a punishment that is itself ethically justified) may be ethical (under specified conditions) for drug dependent offenders who are facing a more restrictive penal sanction, but is not ethical for other people who use drugs. The article also briefly reviews evidence which suggests that QCT may be as effective as voluntary treatment.

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This work is licensed under a Creative Commons Attribution-NoDerivs 3.0 Unported License

Parallel Universes: Human Rights and International Drug Control

This video produced by the Hungarian Civil Liberties Union highlights the human rights violations done against people all over the world as a result of the current international drug control system. The activists and researchers interviewed here recount the litany of abuses done in the name of drug control: torture, corporal punishment, overcrowding in prisons, death penalty for drug offences, denial of palliative care and HIV/AIDS treatment, among others.

As explained by the producers, the words of Paul Hunt, former UN Special Rapporteur on the Right to Health (2002-2008), at the 2008 Harm Reduction Conference are more valid than ever. The international drug control seems to be operating in a parallel universe from human rights law and it is the most vulnerable people who pay the price for this.

Click here to read Human Rights, Health and Harm Reduction: States’ amnesia and parallel universes, by Prof. Paul Hunt, member of the International Advisory Committee of the International Centre on Human Rights and Drug Policy.

Follow us on twitter @ICHRDP

Narcotics Watchdog Turns Blind Eye to Rights Abuses

Patrick Gallahue’s most recent op-ed presents a strong argument against the reluctance of the International Narcotics Control Board to condemn the human rights violations done in the name of drug control.

The INCB, a quasi-judicial monitoring mechanism known and ‘guardian’ of the international drug control treaties, has remained silent about the imposition of forced labor at compulsory drug detention centres, despite the condemnation of twelve UN agencies this month. It has also refused to comment on the death penalty for drug offenders, arguing that it was beyond the mandate of the INCB and ’such sanctions were the “exclusive prerogative” of States.’

Read here Patrick Gallahue’s full analysis on the arguments by the INCB and how they contradict international human rights law.

‘Harm Reduction and Human Rights’, D. Barrett and P. Gallahue, Interights Bulletin, Winter 2011.

Human Rights and Abuses to Health Care, Interights Bulletin, Winter 2011, Volume 16, Number 4.

Harm Reduction and Human Rights

Abstract

‘Harm reduction’ is a phrase that may be unfamiliar to many in the human rights field despite the fact that its ethos and way of working is very close to it. Based on pragmatism, evidence, and compassion, harm reduction has been often misunderstood, side-lined, and isolated from human rights discourse. This paper shows how harm reduction has made important strides in human rights bodies of the United Nations. However, its application is critically absent anti-narcotics policy despite evidence of grave human rights violations done in the name of the “war on drugs” . The paper concludes that jurisprudence and scholarship around the human rights dimensions of harm reduction will be critical in understanding what works in protecting people from drug-related harms, but what is appropriate and necessary in a democratic society to achieve this legitimate aim

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Mexican human rights group asks ICC to probe president and top officials

Reuters reported that a group of human rights activits have requested the International Criminal Court (ICC) to open a formal investigation into war crimes and crimes against humanity in Mexico.

They are asking the world’s first permanent war crimes court to investigate “the deaths of hundreds of civilians at the hands of the military and drug traffickers in Mexico, where more than 45,000 have died in drug-related violence since 2006.”

Netzai Sandoval, Mexican human rights lawyer and member of the group that filed the complaint to the ICC, told Reuters: “We want the prosecutor to tell us if war crimes and crimes against humanity have been committed in Mexico, and if the president and other top officials are responsible.”

The petition, signed by 23,000 Mexican citizens, also calls for an investigation on the responsibility of Sinaloa cartel boss Joaquin “Shorty” Guzman, Public Security Minister Genaro Garcia Luna, and Mexico’s army and navy commanders.

President Calderon has deployed 50,000 troops throughout the country since 2006, while the “federal police have swelled from 6,000 to 35,000.”

Human rights organizations, including Human Rights Watch, have documented systematic violations of citizens. According to a report published this November, HRW has documented evidence of 170 cases of torture, 24 extrajudicial killings and 39 forced disappearances in five Mexican states.

The Mexican government denies the complaint arguing that security policy issues cannot constitute an international crime.

To read the full story, click here.

‘Drug Control, Human Rights, and the Right to the Highest Attainable Standard of Health: A Reply to Saul Takahashi’. Simon Flacks, Human Rights Quarterly

Human Rights Quarterly 33 (2011) 856–877

Abstract:

A recent article in this journal [Human Rights Quarterly] challenged claims that a human rights framework should be applied to drug control. This article questions the author’s assertions and reframes them in the context of socio-legal drug scholarship, aiming to build on the discourse concerning human rights and drug use. It is submitted that a rights-based approach is a necessary, indeed obligatory, ethical and legal framework through which to address drug use and that international human rights law provides the proper scope for determining where interferences with individual human rights might be justified on certain, limited grounds.

Download the article from Human Rights Quarterly

Simon Flacks is a Ph.D. research fellow at the Empowerment Through Human Rights College, University of Vienna, Austria. He holds an LL.M. in International Human Rights Law from Birkbeck College, University of London, UK, and formerly worked for the Child Rights Information Network (CRIN) in London.

He is a research associate with the International Centre on Human Rights and Drug Policy

The Limits of Equivalence: Ethical Dilemmas in Providing Care in Drug Detention Centers, R. Saucier et al, International Journal of Prisoner Health, 2010

International Journal of Prisoner Health 6(2):37-43, 2010

Abstract

This article considers the phenomenon of detention centers as a purported means of drug treatment, common throughout much of Asia. It describes the growth of the drug detention center model over the past decade – a system where people suspected of using drugs are rounded up on suspicion of drug use or a positive urine screening, and sent to closed settings without due process or means of appeal. Inside, detainees receive no effective drug treatment, little medical care, and insufficient food. Indeed, they are more likely to face what amounts to torture, cruel, inhuman, and degrading treatment. In some countries, they are forced to work or face severe punishment. This article explores the ethical dilemmas inherent in providing care within an abusive system. For organizations offering health education, food, or even lifesaving medical care inside drug detention centers, what are the limits of providing ethical care, without risking legitimizing the system or building its capacity to detain more people? We explore how organizations might weigh the risks and benefits of their engagement.

Available for download via the Open Society Institute

Cambodians beaten, raped and killed at illegal detention camp funded by UN. Guardian 29 October 2010

‘Undesirables’ are swept from the streets before being detained without trial, say human rights groups

Ben Doherty, 28 October 2010

UN funding is being used to run a brutal internment camp for the destitute in Cambodia where detainees are held for months without trial, raped and beaten, sometimes to death, former inmates have told the Guardian.

The Prey Speu facility, 12 miles from Phnom Penh, the Cambodian capital, is officially described as a “social affairs centre” offering education and healthcare to vulnerable people.

But human rights groups and former inmates say the centre is an illegal, clandestine prison, where people deemed “undesirable” by the government – usually drug users, sex workers and the homeless – are held for months without charge.

Men, women and children are housed together in a single building and are regularly beaten with planks, whipped with wires or threatened with weapons, according to witnesses.

It is alleged that guards have beaten three detainees to death and gang-rapes by the same body of men are reportedly common.

The UN’s own Office of the High Commissioner for Human Rights (OHCHR) has described the conditions at Prey Speu as “appalling” with people “illegally confined and subject to a variety of abuses of power by the staff that included sub-humane conditions of detention, extortion, beating, rape, sometimes resulting in death and suicide”.

But the department that runs Prey Speu still gets money directly from the UN’s children’s fund, Unicef and the centre is also supported by several international NGOs.

Sok Chandara (not his real name) was picked up off the streets of the capital and taken to Prey Speu, “they said because it looked bad for the city to have people sleeping on the streets”. While police told him he was under arrest, he was never charged with an offence nor brought to court.

He was held with more than 100 men, women and children in a bare room and allowed out for just an hour a day. Some inmates were violent and abusive while others were seriously ill or injured.

Detainees were forced to go to the toilet in a bucket and medical care was irregular. Drinking water came from a fetid pond in which untreated sewage was emptied. Inmates were expected to bathe and wash their clothes in the same pond.

“It was like a hell. Many people were sick, people had diarrhoea, stomach aches because they were drinking dirty water, and there were no doctors,” Sok said.

Prey Speu has a daily food budget of 3,000 riels (47p) for each detainee. Generally, they are fed a watery rice gruel in a plastic bag twice a day.

Violence was a daily occurrence, Sok said. A guard beat him with a plank when he intervened to stop the guard hitting another man. “Sometimes, the guards just open the doors and come in and just beat people up, for no reason. They know no one can complain about the way they are being treated.”

According to the Cambodian human rights advocacy group LICADHO, three Prey Speu detainees have been beaten to death in front of other inmates.

Another five detainees have killed themselves, including two women who had been separated from their children.

Sok escaped by jumping over a wall and fleeing through rice paddies. He is still homeless, and fears being re-arrested and sent back. “Only the people who are locked up there know how bad it is, how scary it is. It doesn’t help people.”

The usual way out of Prey Speu is for detainees or their families to bribe the guards with sums from $50 to $200 (£32 to £125).

Visiting Prey Speu, the Guardian saw about 100 detainees being allowed out of the main building. There was no separation of men and women and most of the detainees were barefoot. At least 20 were children, some as young as four.

Guards at three-metre gates said the facility was a voluntary welfare centre and detainees were free to leave whenever they wanted. Asked why the gates were padlocked, guards said it was to keep people out.

Reports by Human Rights Watch document numerous rapes by guards and police there.

One sex worker told HRW she was raped by five police officers on her first night in detention, and by six officers the next evening. When she resisted, she was beaten.

Elaine Pearson, HRW’s Asia division deputy director, said the Cambodian government and donors had failed to act to close Prey Speu despite overwhelming evidence of abuse. “For years, there have been credible reports of rape, beatings and even deaths in custody by guards at Prey Speu, but nothing has been done to hold these abusers to account.”

She said international funding for the ministry of social affairs must be withdrawn.

The OHCHR still funds Cambodia’s transcultural psychosocial organisation to conduct psychological assessments in the centre. Mental health workers find many inmates are severely depressed and some are suffering psychosis, the organisation’s executive director, Dr Chhim Sotheara, said.

In July, Unicef called a meeting of concerned parties where international donors outlined the support they were providing to Prey Speu.

Richard Bridle, Unicef’s country director for Cambodia, declined an interview with the Guardian.

But in a statement Unicef said that it “technically and financially supports the ministry of social affairs, veterans and youth rehabilitation (MoSAVY) and related institutions to regulate, oversee and monitor child welfare and ensure provision of social and child protection”.

Last year, Unicef gave £390,000 to the ministry of social affairs. When similar criticisms of the Choam Chao youth rehabilitation centre emerged this year, Unicef withdrew £17,750 in funding and the centre immediately closed.

But Unicef says no direct assistance is given to Prey Speu.

The UN secretary general, Ban Ki-moon, spent two days in Cambodia this week. During a brief press conference in Bangkok in advance of the visit, the Guardian submitted a question to Ban about the UN’s role in supporting the centres, but the request was rejected.

Cambodia’s ministry of social affairs has previously denied all allegations of abuse, saying that centres such as Prey Speu offer rehabilitation and vocational training. It defends its policy of “street sweeps” – removing beggars, the homeless and sex workers from the streets of the capital – saying they “provoke public disorder and affect [the] dignity and morality of Cambodian society”.

See also, International Drug Crime measures ‘lead to executions’

Thematic Factsheets on the Jurisprudence of the European Court of Human Rights

The Press Service of the ECHR has compiled Factsheets by theme on the Court’s case-law and pending cases. These are very useful resources, including links to the cases referred to.

Of particular interest from a drug policy perspective are:

Police arrest

Prisoners’ health rights

Detention and mental health

Prison conditions

Child protection

Death penalty abolition

Mental health

Data protection

For regular updates and commentary on the ECHR, see ECHR Blog.

The Vienna Declaration: A Global Call to Action for Science-based Drug Policy

In Lead Up to XVIII International AIDS Conference, Scientists and Other Leaders Call for Reform of International Drug Policy and Urge Others to Sign-on

28 June 2010 [Vienna, Austria] – Three leading scientific and health policy organizations today launched a global drive for signatories to the Vienna Declaration, a statement seeking to improve community health and safety by calling for the incorporation of scientific evidence into illicit drug policies. Among those supporting the declaration and urging others to sign is 2008 Nobel Laureate and International AIDS Society (IAS) Governing Council member Prof. Françoise Barré-Sinoussi, co-discoverer of HIV.

The Vienna Declaration is the official declaration of the XVIII International AIDS Conference (AIDS 2010), the biennial meeting of more than 20,000 HIV professionals, taking place in Vienna, Austria from 18 to 23 July 2010.

“Many of us in AIDS research and care confront the devastating impacts of misguided drug policies every day,” said AIDS 2010 Chair Dr. Julio Montaner, President of the IAS and Director of the BC Centre for Excellence in HIV/AIDS. “These policies fuel the AIDS epidemic and result in violence, increased crime rates and destabilization of entire states – yet there is no evidence they have reduced rates of drug use or drug supply. As scientists, we are committed to raising our collective voice to promote evidence-based approaches to illicit drug policy that start by recognizing that addiction is a medical condition, not a crime.”

The Vienna Declaration describes the known harms of conventional “war on drugs” approaches and states:

“The criminalisation of illicit drug users is fuelling the HIV epidemic and has resulted in overwhelmingly negative health and social consequences. A full policy reorientation is needed…Reorienting drug policies towards evidence-based approaches that respect, protect and fulfill human rights has the potential to reduce harms deriving from current policies and would allow for the redirection of the vast financial resources towards where they are needed most: implementing and evaluating evidence-based prevention, regulatory, treatment and harm reduction interventions.”

Outside of sub-Saharan Africa, injecting drug use accounts for approximately one in three new cases of HIV. In some areas of rapid HIV spread, such as Eastern Europe and Central Asia, injecting drug use is the primary cause of new HIV infections. Legal barriers to scientifically proven prevention services such as needle programmes and opioid substitution therapy (OST) mean hundreds of thousands of people become infected with HIV and Hepatitis C (HCV) every year. The criminalization of people who inject drugs has also resulted in record incarceration rates placing a massive burden on the taxpayer. HIV outbreaks have also been reported in prisons in various settings internationally. This emphasis on criminalization produces a cycle of disease transmission, along with broken homes and livelihoods destroyed. Yet these costs, along with the more direct costs of the ‘war on drugs’, produce no measurable benefits.

“The current approach to drug policy is ineffective because it neglects proven and evidence-based interventions, while pouring a massive amount of public funds and human resources into expensive and futile enforcement measures,” said Dr. Evan Wood, founder of the International Centre for Science in Drug Policy (ICSDP) and Clinical Associate Professor at the University of British Columbia. “It’s time to accept the war on drugs has failed and create drug policies that can meaningfully protect community health and safety using evidence, not ideology.”

The Vienna Declaration calls on governments and international organizations, including the United Nations, to take a number of steps, including:

• undertake a transparent review the effectiveness of current drug policies;
• implement and evaluate a science-based public health approach to address the harms stemming from illicit drug use;
• scale up evidence-based drug dependence treatment options;
• abolish ineffective compulsory drug treatment centres that violate the Universal Declaration of Human Rights; and
• unequivocally endorse and scale up funding for the drug treatment and harm reduction measures endorsed by the World Health Organization (WHO) and the United Nations.
• The declaration also calls for the meaningful involvement of people who use drugs in developing, monitoring and implementing services and policies that affect their lives.

“As a scientist, I strongly support drug policies that are based on evidence of what actually works,” said Prof. Françoise Barré-Sinoussi, Director of the Regulation of Retroviral Infections Unit at the Institute Pasteur, IAS Governing Council member and recipient of the 2008 Nobel Prize for Medicine. “I join with my colleagues around the world today to sign the Vienna Declaration in support of science-driven policies and human rights.”

The effectiveness of opioid substitution therapy (OST) and needles and syringe programmes is well-documented, though access to such interventions is often limited where HIV is spreading most rapidly. According to various scientific reviews conducted by WHO, the US Institutes of Medicine and others, these programmes reduce HIV rates without increasing rates of drug use. These cost-effective interventions also produce significant savings in future health care costs, and help people who use drugs access health care and drug treatment. No evidence exists demonstrating negative consequences of use of these programmes.

“Reflecting the AIDS 2010 theme of Rights Here, Right Now, the Vienna Declaration is rooted in the belief that global drug policy must respect the human rights of people who use drugs if it is to be at all effective,” said AIDS 2010 Local Co-Chair Dr. Brigitte Schmied, President of the Austrian AIDS Society. “No one who is familiar with addiction would deny the negative impacts it has on individuals, families and entire communities, but those harms do not justify human rights violations. People addicted to illicit drugs have the right to evidence-based drug treatment, to interventions to prevent infection, and, if they are living with HIV, to antiretroviral treatment.”

The Vienna Declaration was drafted by an international team of scientists and other experts, many of whom will participate in AIDS 2010 next month. It was initiated by the International AIDS Society (IAS), the International Centre for Science in Drug Policy (ICSDP), and the BC Centre for Excellence in HIV/AIDS based in Vancouver, British Columbia.

Those wishing to sign on may visit www.viennadeclaration.com, where the full text of the declaration, along with a list of authors, is available. The two-page declaration references 28 reports, describing the scientific evidence documenting the effectiveness of public health approaches to drug policy and the negative consequences of approaches that criminalize drug users.

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