Drug Users and the Legal Framework: The Failure of the War on Drugs and its Negative Impact

in the Asia Region from a Community Perspective

October 17, 2011 By Karyn Kaplan Policy and Development Director, Thai AIDS Treatment Action Group, Bangkok This post is excerpted from a plenary speech given at the International Conference on AIDS in Asia/Pacific (ICAAP), Busan, South Korea, August 27, 2011 Here in Asia, home to more than half the worlds opiate users, more than 16 million drug users and at least 6.5 million injectors, where HIV prevalence among injectors is among the highest in the world, where the HIV epidemic is largely driven by unsafe injecting practices, where less than 10% of heroin injectors are on methadone, and where injectors can access an average of just two sterile syringes per month, we lack 90% of the resources necessary to provide the essential harm reduction services necessary for realizing the right to health. But while resources are a significant challenge, I would argue that even when we have the resources, it does not ensure access. Unless and until we address and remove the legal and policy barriers to accessing services for people who use drugs, investing in harm reduction is tantamount to flushing your money down the toilet. No smart investor in harm reduction would ignore the repressive legal and policy environments in which harm reduction services in Asia take place. A good investor would favor interventions that work against the collusion of criminalization, strict law enforcement practices, and the failure to respect, protect, and fulfill human rights for marginalized groups, which undermines and even undoes the benefits of the harm reduction services we are providing.

Thai policeman. Photo by Rico Gustav

Unfortunately, human rights abuses are characteristic of the dominant approaches used by governments to control drugs in this region. The constant threat of police arrest, violence, and incarceration at harm reduction drop-in centers, methadone clinics, and other places where drug users receive services minimizes the impact of these services. Documentation reveals police harassment and interference at health services accessed by drug users; arrest and forced detention at compulsory drug detention centers; a lack of due legal process, unreasonably long pretrial detention, and other breaches of fair trial standards, including false or forced confessions. Forced labor and torture in the name of healthcare is meted out through beatings, chaining, and electric shock; denial of information, prevention tools, antiretroviral therapy, and food are also reported. In Thailand, more than 2,250 people were extra-judicially executed during a 3-month government drug crackdown in 2003; in Cambodia, people who use drugs are forcibly confined in military-run treatment centers where staff have no training in addiction or counseling, and appeal is not an option; in Vietnam, drug treatment centers require detainees to work long hours under extremely harsh conditions with little to no compensation, and severe punishment is meted out for those who fail to meet work quotas. In most countries in the region, police interference with needle and syringe programs and opiate substitution therapy programs prevent many users from getting the health services they require. Failing to provide comprehensive harm reduction services in prisons, which are largely filled with drug offenders, perpetuates unsafe injection, sex practices, and disease transmission among prisoners and their sex and injecting partners. We would never expect someone having sex to reuse a condom, but every day we force injectors to do the equivalent with dirty needles. We would never require a diabetic to visit a clinic daily in order to obtain their insulin, nor deny them insulin for eating a piece of cake; however, we do the equivalent with people who use

drugs when we demand directly observed methadone and deny antiretroviral therapy if they do not quit drugs or even methadone. Government laws and policies in this region are allowing this discriminatory treatment. In June, world leaders, including former Secretary-General of the United Nations, Kofi Annan; Dr. Michel Kazatchkine, the head of the GFATM; and five former presidents and prime ministers, formed the Global Commission on Drug Policy and released a report after reviewing the global body of evidence. They describe their findings succinctly in the reports very first sentence: The Global War on Drugs has failed, with devastating consequences for individuals and societies around the world. The Commission concludes that we must stop the war on drugs and replace drug policies and strategies driven by ideology and political convenience with policies and strategies grounded in science, health, and human rights; and we must adopt appropriate criteria for their evaluation. It suggests that governments hold open debates on alternatives to these failed policies and experiment with humane approaches that do not undermine human rights but rather recognize that drug use is a complex health condition with underlying social, psychological, physical, and other causes for which treatment, and not punishment, is required. Not only are massive human rights violations taking place under the aegis of public security and drug control, but these methods are also failing to achieve their own goals of reducing and deterring drug use. There are more people using different drugs than ever; however we have less capacity to effectively address their harms. The findings of the Global Commission on Drug Policy are not new. For decades, people from around the world who use drugs have been shouting this message as they watched their friends die untreated of HIV, overdose, and hepatitis; as they were arrested and beaten and had money extorted and drugs planted on them by police; as they were detained and imprisoned without respect for their basic rights, as they were denied information and prevention tools, antiretroviral therapy, and humane drug treatment. People who use drugs bravely and publicly implored their government leaders to heed their call for an end to the drug war and human rights abuses, but their message fell on deaf ears. It is a tragedy that we have already lost so many beautiful people who were ignored and despised and misunderstood by their governments and communities. Who is accountable? Antonio Maria Costa himself, the former executive director of the United Nations Office on Drugs and Crime (UNODC), says that governments have a legal obligation to put human rights at the center of their drug policies, noting, Too often, law enforcement and criminal justice systems themselves perpetrate human rights abuses and exclude and marginalize from society those who most need treatment and rehabilitation. This may sound ironic, given the fact that the UNODC is part of a global drug control system that promotes confusion and misunderstanding about the drug conventions, and actively fights against humane approaches to drug control, bullying countries and creating barriers to change.

Thai AIDS Treatment Action Group protestors. Photo by Rico Gustav

Drug law reform activists are often encouraged to take the long view on policy change. In meeting rooms, we are asked to be patient, to forget about legal reform, or to just wait. Society isnt ready, we are told. The government isnt ready. But as my hero, Reverend Martin Luther King, Jr., wrote in a letter from an Alabama jail, this word, Wait, which he too heard for years, has almost always meant Never. Justice too long delayed is justice denied, he wrote. Freedom is never voluntarily given by the oppressor; it must be demanded by the oppressed. King also said that we have a moral responsibility to disobey unjust laws. I propose that if, in our country, the provision of life-saving prevention tools such as clean needles or opiate substitution therapy is found illegal, it is our moral obligation not to comply. Thankfully, we have strong examples of ways that countries are moving away from punitive, abstinence-based approaches to drugs and experimenting with legal and policy reform. Countries in Latin America, North America, and Europe have promoted: decriminalization of drug possession for personal use, proportionality in sentencing,

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alternatives to incarceration for drug possession, the removal of paraphernalia laws, the establishment of safer injecting facilities and heroin assistance programs as part of a range of low-threshold services for people who use drugs, adequate financing for harm reduction, and the abolition of the death penalty. These progressive countries are finding that their reforms do not result in increased drug use, as their opponents feared, but rather lead to increased uptakes in drug treatment, reduced harms from drug use, and also reduced drug use. Countries such as Australia and Switzerland, where criminalizing laws have been reformed or removed, boast low HIV prevalence, while countries such as Thailand, China, and Vietnam, where governments have failed to remove these outdated and ineffectual laws, have extraordinarily high prevalence rates. As Dr. King reminds us, there is no time to wait. Let us fearlessly advocate for drug law reform so that we may to achieve universal access in Asia. The time is now.

Here in Asia, home to more than half the worlds opiate users, more than 16 million drug users and at least 6.5 million injectors, where HIV prevalence among injectors is among the highest in the world, where the HIV epidemic is largely driven by unsafe injecting practices, where less than 10% of heroin injectors are on methadone, and where injectors can access an average of just two sterile syringes per month, we lack 90% of the resources necessary to provide the essential harm reduction services necessary for realizing the right to health. But while resources are a significant challenge, I would argue that even when we have the resources, it does not ensure access. Unless and until we address and remove the legal and policy barriers to accessing services for people who use drugs, investing in harm reduction is tantamount to flushing your money down the toilet. No smart investor in harm reduction would ignore the repressive legal and policy environments in which harm reduction service

English to Indonesian

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Di sini di Asia, rumah bagi lebih dari setengah dunia % u2019s candu pengguna, lebih dari 16 juta obat pengguna dan setidaknya 6,5 juta injector, di mana prevalensi HIV di antara injector adalah yang tertinggi di dunia, di mana epidemi HIV dikendalikan oleh menyuntikkan tidak aman praktek, di mana kurang dari 10% dari injector heroin di metadon, dan di mana injector dapat mengakses rata-rata hanya dua jarum suntik yang steril per bulan, kita kekurangan 90% dari sumber daya yang diperlukan untuk menyediakan kerugian penting pengurangan layanan yang diperlukan untuk mewujudkan hak untuk kesehatan. Tapi sementara sumber daya yang tantangan yang signifikan, aku berpendapat bahwa bahkan ketika kita memiliki sumber daya, itu tidak menjamin akses. Kecuali dan sampai kita mengatasi dan menghapus hambatan hukum dan kebijakan untuk mengakses layanan untuk orang-orang yang menggunakan obat-obatan, berinvestasi dalam pengurangan dampak buruk adalah sama disiram uang Anda ke toilet. Tidak ada investor yang pintar dalam pengurangan dampak buruk akan mengabaikan lingkungan hukum dan kebijakan represif di layanan pengurangan kerusakan yang

English to Indonesian

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di sini di asia , rumah untuk lebih dari setengah world s pengguna candu , lebih dari 16 juta pengguna narkoba dan setidaknya 6 . 5 juta pengguna jarum suntik , di mana prevalensi hiv di antara pengguna jarum suntik di antara yang tertinggi di dunia , di mana wabah hiv adalah sebagian besar didorong oleh tidak aman menyuntikkan praktek , di mana kurang dari 10 % jarum suntik heroin berada di metadon , dan di mana pengguna jarum suntik dapat akses rata rata hanya dua jarum suntik steril per bulan , kami masih kekurangan 90 % dari sumber daya yang diperlukan untuk menyediakan layanan kerugian pengurangan penting yang diperlukan untuk merealisasikan hak untuk kesehatan . tetapi sementara sumber daya adalah tantangan yang signifikan , saya berpendapat bahwa bahkan ketika kita memiliki sumber daya , itu tidak menjamin akses . kecuali dan sampai kita alamat dan menghapus hukum dan kebijakan hambatan untuk mengakses layanan untuk orang yang menggunakan obat obatan , berinvestasi dalam bahaya pengurangan serupa dengan pembilasan uang anda di toilet . investor tidak cerdas dalam bahaya akan represif pengurangan mengesampingkan hukum dan kebijakan lingkungan di mana kerugian pengurangan layanan

English to Indonesian

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di sini di asia , lebih dari separuh orang yang pulang ke rumah untuk para pengguna world s candu , lebih dari 16 juta pengguna narkoba dan yang paling tidak 6 . 5 juta pengguna jarum suntik , di mana prevalensi hiv di kalangan pengguna jarum suntik itu adalah satu di antara yang tertinggi di dunia , di mana wabah hiv yang sebagian besar didorong oleh praktek menyuntikkan lebih tidak aman lagi , di mana kurang dari 10 % dari pengguna jarum suntik yang berada di metadon yang ditimbulkan oleh heroin , dan di tempat di mana pengguna jarum suntik dapat mengakses rata rata per bulan hanya dua jarum suntik steril , kita tidak memiliki 90 % dari sumber daya yang diperlukan untuk menyediakan layanan yang tidak esensial yang diperlukan untuk menyadari bahwa pengurangan yang tepat untuk kesehatan . tetapi sementara sumber daya adalah sebuah tantangan yang signifikan , saya akan berpendapat bahwa bahkan ketika kita memiliki sumber daya , hal itu tidak menjamin akses . kecuali dan sampai kita alamat dan menghilangkan hambatan hukum dan kebijakan untuk mengakses layanan untuk orang yang

menggunakan obat , penurunan adalah investasi dalam bahaya yang sama saja dengan pengeluaran uang anda di toilet . tidak ada investor yang cerdas dalam bahaya akan represif pengurangan orang yang mengabaikan hukum dan kebijakan pengurangan layanan di mana kerusakan lingkungan yang Unfortunately, human rights abuses are characteristic of the dominant approaches used by governments to control drugs in this region. The constant threat of police arrest, violence, and incarceration at harm reduction drop-in centers, methadone clinics, and other places where drug users receive services minimizes the impact of these services. Documentation reveals police harassment and interference at health services accessed by drug users; arrest and forced detention at compulsory drug detention centers; a lack of due legal process, unreasonably long pretrial detention, and other breaches of fair trial standards, including false or forced confessions. Forced labor and torture in the name of healthcare is meted out through beatings, chaining, and electric shock; denial of information, prevention tools, antiretroviral therapy, and food are also reported. In Thailand, more than 2,250 people were extrajudicially executed during a 3-month government drug crackdown in 2003; in Cambodia, pe

English to Indonesian

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Sayangnya, pelanggaran hak asasi manusia merupakan karakteristik dari pendekatan dominan yang digunakan oleh pemerintah untuk mengontrol obat-obatan di wilayah ini. Ancaman konstan penangkapan polisi, kekerasan, dan penahanan di pusat-pusat drop pengurangan kerusakan, klinik methadone dan tempat-tempat lain di mana pengguna narkoba menerima layanan meminimalkan dampak dari layanan ini. Dokumentasi mengungkapkan polisi pelecehan dan gangguan pada kesehatan diakses oleh pengguna narkoba; penangkapan dan memaksa penahanan di pusat penahanan wajib obat; kurangnya karena proses hukum, tidak masuk akal lama praperadilan penahanan dan pelanggaran lain standar pengadilan yang adil, termasuk palsu atau dipaksa pengakuan. Kerja paksa dan penyiksaan in the name of kesehatan diberikan melalui pemukulan, chaining dan sengatan listrik; penolakan informasi, alat-alat pencegahan, terapi antiretrovirus, dan makanan juga dilaporkan. Di Thailand, orang-orang lebih dari 2.250 extra-judicially dihukum selama 3-bulan pemerintah obat tindakan keras pada 2003. di Kamboja, pe

English to Indonesian

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sayangnya , pelanggaran hak asasi manusia adalah karakteristik dari dominan mendekati digunakan oleh pemerintah untuk mengendalikan obat obatan di wilayah ini . konstanta ancaman dari polisi menangkap , kekerasan , dan penahanan pada kerugian pengurangan drop in pusat , klinik metadon , dan tempat tempat lain di mana pengguna narkoba menerima jasa meminimalkan dampak dari layanan ini . dokumentasi mengungkapkan pelecehan polisi dan gangguan pada pelayanan kesehatan diakses oleh pengguna narkoba ; penangkapan dan dipaksa penahanan di pusat penahanan wajib obat ; kurangnya karena proses hukum , panjang praperadilan penahanan tidak masuk akal , dan lainnya fair percobaan melanggar standar , termasuk palsu atau dipaksa pengakuan . kerja paksa dan penyiksaan dalam nama healthcare adalah meted keluar melalui menanggung , chaining , dan sengatan listrik ; penolakan informasi , alat pencegahan , terapi antiretroviral , dan makanan yang juga melaporkan . di thailand , lebih dari 2 , 250 orang extra judicially dieksekusi selama 3 month obat pemerintah penindasan di 2003 ; di kamboja , pe

English to Indonesian

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sayangnya , pelanggaran hak asasi manusia yang dominan adalah karakteristik dari pendekatan yang digunakan oleh pemerintah untuk mengendalikan obat di dalam wilayah ini . ancaman dari polisi yang menangkap orang yang konstan , kekerasan , dan pengurangan drop in pusat penahanan pada kerugian , klinik metadon , dan tempat tempat lain di mana pengguna narkoba menerima layanan yang meminimalkan dampak dari layanan ini . dokumentasi yang mengungkap gangguan pada pelecehan polisi dan pelayanan kesehatan yang diakses oleh pengguna narkoba ; penangkapan dan penahanan yang dipaksa di pusat penahanan obat yang wajib ; kurangnya karena proses hukum , praperadilan yang panjang dan penahanan yang tidak masuk akal , dan pelanggaran yang lain dari standar yang diajukan ke pengadilan yang adil , termasuk pengakuan yang dipaksa atau palsu . tenaga kerja paksa dan siksaan itu dalam nama meted keluar melalui perawatan kesehatan yang menanggung , chaining , dan sengatan listrik ;

penolakan dari informasi , alat langkah pencegahan , terapi antiretroviral , dan makanan yang juga melaporkan . di thailand , lebih dari 2 , dua ratus lima puluh orang yang ada di dalam sebuah 3 month extra judicially yang dijalankan pemerintah yang obat keras pada tahun 2003 ; di kamboja , pe