The UN Special Rapporteur on the right to health backs legalisation and regulation of drugs


 

Special rapporteurs are appointed by the Office of the High Commissioner on Human Rights and are mandated by the United Nations to "examine, monitor, advise, and publicly report" on specific human rights issues – often relating to a specific right. And in a new paper published this month, the Special Rapporteur on the right of everyone to the highest attainable standard of mental and physical health, Dainius Pūras, made yet another important contribution to the drug policy debate, stating:

“The Special Rapporteur recommends that Governments seek alternatives to punitive or repressive drug control policies, including decriminalization and legal regulation and control, and nurture the international debate on these issues, within which the right to health must remain central.”

This is the latest in a series of important statements on drug policy reform and human rights by Pūras. He has previously provided a detailed and devastating critique of the negative human rights impact of the war on drugs to inform the recent UN General Assembly Special Session (UNGASS) on drugs, which substantially shaped the outstanding official UNGASS submissions from the UN Office of the High Commissioner for Human Rights.

In the UNGASS reports, the Special Rapporteur and High Commissioner had both made a powerful argument that criminalisation of people who used drugs was a violation of state obligations to the right to health. But this new document goes further, welcoming and encouraging the debate on alternatives to prohibition and specifically calling on member states to explore alternatives including regulation and control of currently illegal drugs.  

As independent experts serving in an advisory role, Special Rapporteurs are not bound by any agency or government, and have – in high level policy debates at least – an unusual level of freedom to act as officially mandated critics of whatever they deem appropriate within their specific remit. This page provides more information on the special rapporteur.

The candour on this issue from a senior UN advisor is hugely important. While support for decriminalisation exists across the UN agencies, support for regulation currently does not (decriminalisation is nominally allowable within the overtly prohibitionist UN drug treaty framework, but legalisation and regulation is obviously not). The only equivalent call has come from those who have left the UN, such as former Secretary-General Kofi Annan, and from the Special Rapporteur’s immediate predecessor, Anand Grover, who in 2010 recommended that member states:

“Consider creation of an alternative drug regulatory framework in the long term, based on a model such as the Framework Convention on Tobacco Control.”

Grover has subsequently become more active on the issue, joining Kofi Annan on the Global Commission on Drug Policy.       

The relevant section of this month's report is reproduced below. Aside from the recommendation on regulation, it contains a series of important observations and recommendations for a change in the traditional punitive focus of drug policy and enforcement - specifically as they concern adolescents - which also deserve attention:


Adolescents, substance use and drug control

1. Nature of and problems associated with substance use in adolescence

95. Adolescence is a period of risk- taking and experimentation with greater likelihood of initiation into substance use. Adolescents are at higher risk of drug-related health harms, while substance use initiated in adolescence can more often lead to dependence than during adulthood. The most commonly used substances are alcohol, tobacco and solvents. Illicit drug use, in particular cannabis, is also common and in recent years unregulated novel psychoactive substances have become an important concern.78

96. Outside of high-income countries, data relating to adolescent substance use and related health harms are poor. Important differences exist among and within countries, between adolescents and their older counterparts and among groups of adolescents. For example, heavy episodic or binge use, especially of alcohol, is more common among young people.79 Adolescents’ access to services is limited in comparison to adults, for example, being under the legal age of majority can block adolescents from accessing certain services. Those identified at greatest risk of drug- related harms are those who are street-involved, excluded from school, have histories of trauma, family breakdown or abuse, and those living in families coping with drug dependence. Adolescent girls are at a higher risk of certain kinds of harm than boys, including HIV infection due to both sexual transmission and unsafe injecting practices. These factors demand concerted efforts to gather appropriately disaggregated data to better understand patterns of vulnerability so that services can be targeted and properly budgeted.

97. In addition to substance use, there are significant physical and mental health consequences to adolescents’ involvement in the production of and trade in substances. Adolescents are involved at all stages of the licit and illicit drug supply chains. With regard to illicit drugs, in addition to sometimes hazardous work, adolescents can be exposed to organized crime, violence and counter-narcotics operations. More research is needed into the adolescent health implications linked to the production of drugs and the violence associated with the criminal market.

98. The harms associated with drug use and involvement in the drug trade cannot be disentangled from State responses. Evidence shows that repressive and punitive responses to drugs have not been effective in reducing drug use or supply80 and that they have produced negative consequences, including violence and corruption.81 Criminalization of drug use and personal possession, as well as drug user registries and police violence, drive young people from services, producing a health-deterrent effect. Prevention and education programmes that focus on zero tolerance create an environment where adolescents may be less likely to seek information about harms related to use. Adolescents have lost parents to drug-related violence and to prolonged incarceration for non-violent offences, with significant implications for their mental health.


Providing appropriate services to address adolescent substance use

99. States should adopt appropriate measures to protect children from illicit drug use and involvement in the illicit drug trade.82 However, this must be read in the context of the protections afforded by the Convention on the Rights of the Child and other human rights obligations.83 Almost all States have obligations under the three United Nations drug control conventions, which must be read in conformity with concurrent human rights obligations.84 The Framework Convention on Tobacco Control contains specific provisions aimed at the protection of children and young people, and which complement the right to health.

100. States should provide prevention, harm reduction and dependence treatment services, without discrimination, and allocate a budget sufficient to the progressive realization of the right to health. These are not competing or alternative strategies but required components of a comprehensive approach to enable adolescents to seek the health services and information they are entitled to receive. All such services should comply with the availability, accessibility, acceptability and quality framework.

101.With regard to the prevention of substance use, children and young people should be provided with accurate and objective information,85 which should be available in easy-to-understand formats or Braille. Scare tactics and misinformation are known to be ineffective, whereas building resilience and trust while focusing on those demonstrating risk-taking behaviours has delivered promising results. The United Nations Office on Drugs and Crime (UNODC) has produced guidance on drug prevention standards 86 to be used when designing prevention policies and programmes.

102. Prevention cannot justify disproportionate infringements of adolescents’ rights, including their rights to privacy, bodily integrity and education. States are encouraged to continue to restrict and, when necessary, ban alcohol and tobacco advertising, which has too often targeted young people.

103. Substance dependence treatment must be tailored to the specific needs of adolescents. Adolescents must not lose their participation rights in any circumstance, including because of their substance use or dependence. Adolescents have the right to be heard when expressing opinions on their own health care and to give consent to treatment in accordance with their evolving capacities.87 Confidential counselling and information must be available without parental consent. All drug detention centres where adolescents are arbitrarily detained and suffer extreme abuses must be closed.

104. There is an alarming lack of HIV-related harm reduction services designed for adolescents who inject drugs, as well as multiple barriers to accessing such services, including age restrictions in law, and absence of data on injecting drug use among children and young people in most countries.88 Technical guidelines on HIV prevention, treatment care and support for young people who inject drugs have been developed,89 and should form the basis of States’ efforts in this regard.

105. The growing international debate and efforts by certain States to seek alternatives to punitive or repressive drug policies, including decriminalization and legal regulation, are welcome.

...

114. In  connection  to substance  use  and  drug  control,  the  Special  Rapporteur recommends that Governments:

(a)Close without delay all drug detention centres for adolescents, ensure the provision  of  prevention,  harm  reduction  and  dependence  treatment  services,  without discrimination,  and  allocatea  budget  sufficient for the progressive realization of  the  right to health;

(b)Seek   alternatives   to   punitive   or   repressive   drug   control   policies,  including   decriminalization   and   legal   regulation   and   control, and nurture the  international  debate  on  these  issues, within  which  the  right  to  health  must  remain  central

(c)Use  the  right  to  health  framework  to  pursue  strategies to  prevent drug use  among  adolescents  through  evidence-based  interventions  as  well  as  accurate  and objective educational programmes and information campaigns."

 

78 UNODC, World Drug Report 2015 (United Nations publication, Sales No. E.15.XI.6) .

79 WHO, Global Status Report on Alcohol and Health 2014 .

80 Louisa Degenhart and others, “Toward a global view of alcohol, tobacco, cannabis and cocaine use: findings from the WHO World Mental Health Surveys”, PLOS Medicine , vol. 5, No. 7 (2008) ; and European Commission, Netherlands Institute of Mental Health and Addiction and Rand Europe, A Report on Global Illicit Drugs Markets 1998-2007(2009).

81 E/CN.7/2008/CRP.17.

82 Convention on the Rights of the Child, art. 33

83 Damon Barrett and John Tobin, “Article 33: protection of children from narcotic drugs and psychotropic substances”, in A Commentary to the United Nations Convention on the Rights of the Child, John Tobin and Philip Alston, eds.(Oxford University Press, forthcoming).

84 See A/65/255, para. 13.

85 See CRC/C/GUY/CO/2-4, para.50(d); CRC/C/ALB/CO/2- 4, para.64 (b);CRC/C/ROM/CO/4, para.71; CRC/C/SWE/CO/4, para.49(a); and CRC/C/BGR/CO/2, para.50.

86https://www.unodc.org/unodc/en/prevention/prevention-standards.html.

87 Committee on the Rights of the Child general comment No.15.

88 Harm Reduction International,Global State of Harm Reduction 2012 (2012), p.140.

89  http://apps.who.int/iris/bitstream/10665/179865/1/WHO_HIV_2015.10_eng.pd...