Drug Use and Drug Policy

The world over, the use of and addiction to narcotics and psychotropic substances are public health matters. Unfortunately, these are too often treated as primarily criminal law concerns. Over-reliance on criminal law and its enforcement undermines public health programs that have proven effective at improving the health of people who use such drugs and reducing the spread of infectious diseases like HIV and hepatitis C.

Policymakers are passing anti-drug laws that result in the rapid growth of people in prison – where they often face even greater health risks (including HIV infection). In the name of public safety, scarce financial resources are poured into law enforcement – money that would be better spent on harm reduction measures, such as needle exchange and opioid substitution therapy programs, and on ensuring access to a full range of voluntary, evidence-based addiction treatment programs. Unfortunately, despite the emphasis on enforcing legal prohibitions on drugs, many communities have yet to experience greater safety, and some are plagued by increased violence linked to expanded law enforcement. Deep-rooted stigma against people who use drugs, and the fear of loss of confidentiality and of discrimination, already operate as powerful barriers for many people who use drugs in seeking or receiving health or social services. In some instances, the stigmatization of drug users and political opportunism of policymakers even blocks the provision of needed health services in the first place. The fear of criminal prosecution – and in some countries the fear of torture or other inhuman or degrading treatment upon detention – makes the situation worse.

The UN’s three major drug control conventions permit approaches that treat drug use as a health concern, including various harm reduction measures. These conventions allow states some flexibility in the extent to which they criminalize and punish the possession and use of controlled substances. Furthermore, in enacting and implementing domestic law and policy, governments must consider their obligations under international law to respect, protect and fulfill human rights.

For more than fifty years, UN member states have repeatedly reaffirmed their obligations under the Universal Declaration of Human Rights to ensure everyone’s right to a standard of living adequate for health and wellbeing, which includes medical and social services. At the 1998 UN General Assembly Special Session on Drugs, states declared that action against drugs requires “an integrated and balanced approach in full conformity with the purposes of the Charter of the United Nations and international law, and particularly with full respect for … all human rights and fundamental freedoms.” Ten years on, after a review of global drug control efforts, member states at the UN Commission on Narcotic Drugs reiterated, in the 2009 Political Declaration and Action Plan, that measures to reduce drug supply and demand reduction must respect human rights. States that have ratified the International Covenant on Economic, Social and Cultural Rights (ICESCR) are committed to ensure every person’s right to the highest attainable standard of physical and mental health. This necessarily requires efforts to ensure access to health services for people who use or are dependent on drugs. States also have a binding legal obligation to take the necessary steps to realize this right, including prevention, treatment and control of the HIV epidemic. In addition, the International Covenant on Civil and Political Rights (ICCPR) states that every person has the inherent right to life, requiring governments to adopt positive, proactive measures to protect human life, including measures that can help reduce the spread of epidemics. Given the role of drug use, especially by injection, in fuelling the global HIV epidemic, states are obliged to take action, based on the best available evidence, to prevent these harms.

The International Guidelines on HIV/AIDS and Human Rights, produced by UNAIDS and the Office of the UN High Commissioner for Human Rights, provide expert guidance to states on how to respond to HIV/AIDS through legislation, policies and practice to protect human rights and achieve public health goals. One of the basic recommendations is that “[c]riminal law should not be an impediment to measures taken by States to reduce the risk of HIV transmission among injecting drug users and to provide HIV- related care and treatment for injecting drug users.”

The spreading HIV epidemic, and the other harms encountered by people who use drugs in unsafe ways or conditions, highlight that governments have good public health and human rights reasons to ensure that their domestic legislation and policies on drug control do not contribute to these harms and do not impede health promotion efforts among people who use drugs.