Harm Reduction International Conference 2019

Statement by UN High Commissioner for Human Rights Michelle Bachelet

28 April 2019, Porto, Portugal

Chairpersons,
President Sampaio,
Minister Duarte,
Mayor of Porto,
Distinguished panellists,
Excellencies,
Colleagues, friends,
Harm Reduction and Human Rights Activists

I’m pleased to be at this gathering of people working at the heart of harm reduction, drug policy and human rights.

The theme of this meeting – “People before politics” – is a call to mobilise energy and conviction to shift the world’s focus from the current emphasis on punitive law enforcement to one that emphasizes the wellbeing and rights of people who use drugs.

It is particularly important that we're meeting in Portugal – where use of drugs, or possession for personal use, is no longer a criminal offence; syringe exchange and substitution treatment are widely available; and much has been done to ensure better access to health-care for people who use drugs.

At the centre of these legal and policy changes has been concern for the wellbeing of the individuals concerned – and to the degree possible – addressing the underlying factors, which drive drug dependence. The result has been a striking drop in new HIV infections, mortality from overdose and incarceration.

The so-called “war on drugs” is driven by the idea that crackdowns on people who use drugs – or who are involved in the trade of drugs – will make drug use go away. But we know, from experience, that this is simply not true. After decades of this approach, the countries, which adopted it are no closer to being "drug-free". On the contrary, the range and amount of substances being produced and consumed is greater today than ever before.

A combination of poverty, limited opportunities for marginalized and rural communities, and political instability have continued to drive high levels of supply, and a marked increase in drug-related deaths. Between 2000 and 2015 there has been a 60% increase in drug-related fatalities, with a harrowing 450,000 deaths in 2015. On the demand side, repressive policies have actually impeded policies which could address some of the social factors which aggravate an individual’s vulnerability to drug use and its harmful outcomes.

We are witnessing continuing – and in some cases, increasing –human rights violations related to drug control measures. They include reports of extensive extrajudicial killings, torture and enforced disappearances in some countries; use of the death penalty for drug-related conduct not considered to constitute “most serious crimes” under international law; discriminatory practices in law enforcement; and arbitrary detention.

The criminalisation of drug use deters people from accessing treatment and other health and social services. Together with the stigmatizing attitudes and discrimination which it fuels, criminalisation is also likely to lead to higher rates of risky injection practices and higher risks of overdose, due to the need to inject quickly and in unsafe places.

Criminalisation of drug use also fuels mass incarceration: the number of people currently incarcerated worldwide is reportedly at the all time high of ten million, with 1 in 5 inmates incarcerated for drug offences – most of them, possession of drugs for personal use. The incarceration of large numbers of people in overcrowded and underfunded prisons is likely to increase the probability they will commit crimes on their release. Imprisonment is also very costly – far less cost-effective than treatment and counselling. In this context, it frequently appears to be an unjust or disproportionately severe penalty. And although prisons represent high-risk environments for the transmission of blood-borne viruses, there are typically even fewer harm reduction services on offer in prisons than there are in the community – aggravating the risk of harm to health.

Harm reduction measures have been recognised as essential for people who use drugs – by the General Assembly of the United Nations, the Human Rights Council, the World Health Organisation, , UNAIDS, and multiple human rights Treaty Bodies and Special Rapporteurs.

Excellencies,
Governments need to safeguard and improve the wellbeing of societies. And when a set of policies clearly fails to achieve its goals, it is time to change them.

As the example of Portugal demonstrates, policies grounded in evidence, and guided by concern for public health and human rights, are more effective in addressing both the supply of drugs, and the demand for them – as well as their most damaging effects on society.

In 2001, Portugal had Europe's highest rate of HIV among injecting drug users. President Sampaio, and my colleague the Secretary General António Guterres, then Prime Minister of Portugal, introduced non-criminal responses to the possession of drugs for personal use that same year. Greater resources were allocated to prevention, treatment – including harm reduction measures – and programmes for the reintegration of people who use drugs into society. The rates of all sexually transmitted diseases decreased dramatically. Overall rates of drug use fell. Portugal now has one of the lowest death rates for drug use in Europe.

Excellencies, Colleagues and Friends,
Looking specifically at harm reduction programmes, the evidence is clear. Where they exist – and receive adequate funding – they have been markedly successful in reducing harm to the health and wellbeing of people who use drugs.

Needle exchange, quality treatment, education, counselling, and drug substitutes like Methadone or Naxolene have been effective in decreasing addiction, overdose and the spread of HIV and Hepatitis C.

Progress has been reported when national authorities have managed drug use and dependence as a public health problem which requires treatment, counselling and medical interventions.

Drug treatment and counselling programs are not only far more effective than prison at reducing drug dependence and abuse; they are also more cost effective. And they do not produce the massive social and economic impact on poor and minority communities that we currently see in many countries that rely on discriminatory policing and mass incarceration.

In March this year, at the High Level Ministerial Segment of the 62nd session of the Commission on Narcotic Drugs in Vienna, all Member States unanimously expressed concerns regarding drug control policies that are not in conformity with international human rights obligations.

In November last year, the International Narcotic Control Board reiterated in the clearest possible terms that if drug-control measures adopted by States violate internationally recognised human rights, they also violate the international drug control conventions. In June 2017, twelve UN agencies issued a statement recommending the review and repeal of punitive laws criminalising, or otherwise prohibiting, drug use or the possession of drugs for personal use.

With such persuasive evidence, and a clear international consensus in favour of human rights based drug policies, why are so many people being deprived of their rights as human beings because they have been caught up in drug use?

Why do so many countries still have legal and policy barriers to life-saving harm reduction services – including laws that make needle and syringe exchange and opioid substitution treatment illegal?

Distinguished Chairs, Colleagues and Friends,
In view of the presence in this audience of so many distinguished experts in the field of health, I want to take a moment to discuss the question of access to controlled medicines – not only for opioid substitution therapy, but for health needs unrelated to illicit drug use.

The medical use of controlled narcotic drugs continues to be indispensable for the relief of pain and suffering. Ensuring their availability for such purposes is essential: the denial of pain relief may constitute ill-treatment amounting to torture. It is also vital to ensure that opioid substitution therapy can assist people, who have become dependent to distance themselves, from the many dangers to life and health associated with illegal sources of narcotics.

Making internationally controlled drugs available for medical and scientific purposes has been at the heart of the international drug control conventions since the Single Convention on Narcotic Drugs of 1961. And I am certain that all Member States have the capacity to devise legislation that ensures compliance with this vital element of the right to health.

Alongside the excessive restrictions on access to opioids in several countries, an epidemic of opioid dependence in North America has been generating unprecedented levels of mortality. This crisis has been spurred by the over-prescription of opioids by doctors.

Clearly, there is a need for well-designed regulation and training regarding the prescription of opioids, including monitoring, so that the goal of adequate pain relief can be achieved. Treating opioid dependence with programmes that focus on abstinence is likely to be much less successful than opioid substitution therapy.

Complete abstinence from drug use has also been the primary message of prevention in many countries, to date. But whether as treatment or as prevention, there is very little evidence that this message is effective. Honest information; encouraging moderation in youthful experimentation; and prioritizing safety through knowledge are far more likely to lead to positive outcomes – as all States noted in the outcome document of the UN GA Special Session on Drugs in 2016, when they committed to take effective, practical and evidence-basedprevention measures, and to provide accurate information about the risks of drug abuse. It is also essential for every prevention and awareness campaign to promote non-stigmatizing attitudes towards people who use drugs.

Distinguished Chairs,
In a number of countries, significant reforms are needed to bring criminal justice systems in compliance with international human rights law on issues related to drug use.

There has been some positive movement with respect to the use of the death penalty, including a significant decrease in reported executions for drug offences since 2015. But at least 3,940 people were executed for a drug offence in the last decade. I remain concerned about the continuing use of capital punishment for drug offenses in a number of States, and moves towards its re-introduction in others. Thirty-five States maintain the death penalty for drug offences, in violation of international human rights law. We strongly recommend States amend their penal codes and no longer impose the death sentence for any crimes, including for drug-related offences.

In recent years we have seen a sharp increase in reports of extrajudicial killings of people perceived as users of drugs, or otherwise involved in the illicit drug trade, and I want to be very clear here. Every human being accused of an offense has the right to due process in a court of law. Anyone who is responsible for killing such a person – whether or not the perpetrator or those responsible are agents of the State – is committing a serious offense that must be investigated, prosecuted and sanctioned.

People who use drugs are also frequently subjected to arbitrary detention or related abuses by law enforcement agencies. Compulsory drug detention centres are inconsistent with human rights law, often involving multiple forms of human rights abuse, and they require comprehensive review and replacement with voluntary services in the community. We also receive frequent reports that people who use drugs are required by police to give money, or sex, in exchange for not being arrested. And members of minority communities, people of African descent, or LGBT people may also be targeted for discriminatory policing, in violation of human rights.

People do not lose their human rights because they use drugs. They have the same rights as all of us: to health and to life; to non-discrimination; to freedom from arbitrary arrest and detention; and to freedom from torture and other forms of ill treatment, among others.

It is important to ensure that drug policies and programmes take into account the specific circumstances faced by women and girls in this context. These include the very sharp increase in the number of women in prison in many countries -- which is frequently due to rising numbers of women being incarcerated for drug-related offences, although in many cases their role was non-violent and relatively minor. Their high rate of convictions may be due in part to failure to ensure that the administration of justice is gender-sensitive, taking into account factors such as women’s relative lack of access to effective legal representation; poverty and gender-based violence.

Excellencies,
Last year, 31 principals of agencies and entities in the UN system adopted a UN System Common Position, to provide coordinated support to Member States on human rights, rule of law, public health, development and security matters in the context of drugs. It seeks to promote prevention and treatment, including harm reduction; and enhance action by justice and law enforcement systems to stop organized crime and protect – rather than target – people who use drugs.

I strongly encourage Member States, civil society, health professionals and others to support the work of the UN Coordination Task Team in rebalancing drug policies towards a public health approach.

People who have fallen into the trap of drug dependency need help to rebuild their lives. Government policies should not become a greater threat to their wellbeing than the drugs, which they are using: disproportionate and unjust punishments can only increase their suffering and drive them into deeper marginalisation and misery.

I have no doubt that principled and comprehensive policies which respect dignity, human rights and justice will reduce both demand and supply; protect health; and – as envisaged in the outcome document of the 2016 UNGASS on the World Drug Problem – contribute to achieving the Sustainable Development Goals.

They will also help build more respectful governance and justice systems and societies, and may help to repair some of the profound human misery and trauma, which so often can be found in the experiences of people who become dependent on drugs.

We are with you in this struggle.

Thank you.