Drug policies based on ideology rather than
science are fueling human rights abuses of drug users, according to a panel of
experts speaking at last week’s Eighteenth International AIDS Conference which
took place in Vienna, Austria.
Violations of physical and legal rights
coupled with poor outcomes mar many countries' drug treatment programmes, which
can include forced labour or exercise and prison-like conditions.
Asia acts as the epicentre of such mandatory programmes, in which drug
users are forcibly removed from their communities and kept in centres for
months or years. Currently, the continent boasts an estimated 400,000 to 500,000
detainees. Considering programmes in China and Cambodia, public health researcher Richard Pearshouse claims that these programmes have seen a “massive scale-up”
in recent years.
China is home some of the highest rates of
drug use the world, with five to six million of the country’s citizens considered
users. Known for its now banned 'rehabilitation through labour' programmes,
mandatory confinement of addicts continues to be the norm. Police have also
experienced expanded powers of detention and arrest in recent years, with
compulsory urinary testing and extended detention time also on the rise.
According to Pearshouse, users can spend up to three years in such centres.
Pearshouse contends that the now-defunct
forced labour programmes were used as a source of cheap labour under the guise
of being an effective way to “re-teach” users discipline and schedule. Detained
individuals often worked up to 18 hours a day, experiencing beatings if they
were unable or refused to work. Such programmes are simply an “efficient and
effective way to… detain… a labour force”, he said.
While Cambodia hosts much smaller
mandatory drug treatment programmes and boasts shorter sentences than those of
their Chinese counterparts, the country is also party to many human rights
abuses. Pearshouse notes that a quarter of all individuals in the centres are
children, with none seeing a judge or lawyer or given the opportunity to appeal.
A quarter of individuals detained, purportedly for methamphetamine abuse, are
not actually addicted, by admission of the Cambodian government. While the
country does not practice forced labour, compulsory exercise is common to make
users “sweat out the drugs”, Pearshouse claimed.
TM Hammet of USAID voiced similar
concerns as he described the situation of detainees in Vietnam’s '06
Centres', who also experience no due process and may spend up to four years
within the programme. Countrywide, 33,000 users are currently detained.
Despite these harsh conditions and forced
detox, the programmes have an extraordinarily high failure rate. This type of
“drug treatment is profoundly unscientific”, contends Pearshouse. As such,
there is “almost a 100% relapse rate”. The Vietnamese centres also practice
“little or no evidence-based substance abuse programmes”, according to Hammet.
“These centres are largely a moral and punitive approach to a medical and
psychosocial problem,” he said.
Both Pearshouse and Hammet consider these
programmes “a challenge to human rights”. Minimal access to health care is of
particular concern. While some antiretrovirals are available for HIV-positive
detainees, there is limited testing and treatment within Cambodian and Chinese
centres, and mandatory HIV testing within Vietnam’s. Given that roughly half of
all new HIV infections in China
result from drug use, and that 30% of Vietnamese IDUs are HIV-positive, scarce
medical care and no harm-reduction programmes within the centres are
potentially fueling the epidemic, said speakers.
The limited dissemination of legal and
essential substances, as a result of ideological policies, is also of concern.
According to Diederick Lohman of Human
Rights Watch, considering the accessibility of morphine and methadone within
“poor availability and accessibility of controlled medications is a common consequence
of drug laws and policies”.
He contends that the severe penalisation of
drug mishandling within the country ensures that doctors often under-prescribe
morphine and methadone, which the World Health Organization considers
“essential” and which are commonly required by AIDS and cancer patients.
While the UN 1961 convention on narcotic
drugs outlines policies that are “not especially restrictive”, Ukraine
practises extremely rigid laws, which include superfluous requirements such as
four doctors required to sign every prescription and an “extremely complicated
licensing system”, making it difficult and costly for medical practitioners to
be able to legally prescribe some medicines.
When prescriptions are given, rather than
allowing patients to self-administer as is the international norm, nurses are
required to visit patients’ homes, often several times a day, to disseminate
drugs. As such, many doctors will simply not prescribe morphine or methadone if
patients live far from healthcare centres. This rule “is a gigantic waste of
health resources, which in Ukraine are already very limited”, said Lohman, who
claims that the immense number of regulations make it “almost impossible for
healthcare workers to provide good care”.
While many of the most ineffective policies
are relics from other political and social eras, some restrictive and
non-evidence-based laws are still being enacted today. Mikhail Golichenko of
the United Nations Office on Drugs and Crime, Russia, explained that in 2009
the Security Council of the Russian Federation announced that so-called
“propaganda” promoting substitution therapy was now illegal. While methadone
treatment was already considered illegal, the new policy ensured that anyone
condoning substitution therapy was acting against the law. This “ban on harm
reduction” must be challenged, said Golichenko, “because it’s unconstitutional,
it’s against international law. As soon as civil society start challenging
these documents, the better the situation.”