Punitive Approach Endangering Public Health
May 30, 2013
“Punitive drug laws expose drug users to unnecessary illness and even death from hepatitis C. The epidemic makes it urgent for governments to reform these laws to protect both drug users and the public health.”
Rebecca Schleifer, health and human rights advocacy director

(New York) – Governments should ensure that efforts to reduce illicit drug use do not increase vulnerability to infection with hepatitis C or impede access to treatment, Human Rights Watch said today in response to a report by the Global Commission on Drug Policy. The report, released on May 30, 2013, urges reform of existing drug policies to protect public health, minimize human rights violations, and ensure access to health care for drug users.

The 20-page report, “The Negative Impact of the War on Drugs on Public Health: The Hidden Hepatitis C Epidemic,” was released in advance of the 23rd International Harm Reduction Conference, Vilnius, Lithuania, June 9 to 12.  Lithuania lies on the frontiers of the world’s fastest growing hepatitis C and HIV epidemics in Eastern Europe and Central Asia.

“Punitive drug laws expose drug users to unnecessary illness and even death from hepatitis C,” said Rebecca Schleifer, health and human rights advocacy director at Human Rights Watch. “The epidemic makes it urgent for governments to reform these laws to protect both drug users and the public health.”

The report recommends urgent and wide-ranging reforms of international drug control policies to protect the health and other human rights of drug users. 

The report says that repressive drug policies have failed to reduce the worldwide illicit drug supply, and fueled the growth of organized crime, violence, and mass incarceration of people who use drugs. These failed policies have also fueled a “viral time bomb” – a massive hepatitis C epidemic that threatens serious and long-term global human, social, and economic costs. 

Human Rights Watch research in many countries including the US,Ukraine, Russia, Thailand, Canada, Kazakhstan, and Bangladesh – has documented how criminal laws relating to drug use and possession for personal use, and related law enforcement practices drive people away from lifesaving information and health services.

In some countries, many people who inject drugs do not carry sterile syringes or other injecting equipment, even though it is legal to do so, because possession of such equipment can mark an individual as a drug user and expose him or her to punishment on other grounds. Many do not seek treatment or get other needed health services, again for fear of arrest and conviction.

In prison, many people continue to inject drugs, but prevention and treatment services are scarce. The relatively high prevalence of hepatitis C and HIV in prison, coupled with the inadequate services, make incarceration a particularly lethal combination.

The Commission’s key recommendations call for governments to acknowledge that strict law enforcement practices perpetuate the spread of hepatitis C, HIV, and other harm to people’s health.

It calls on governments to immediately redirect resources to public health approaches that maximize hepatitis C prevention and care, developed with the involvement of the most affected communities. The commission also called on the UN to demonstrate leadership to promote better national responses to achieve these reforms.

International health and drug control experts – including the UN Office on Drugs and Crime, UNAIDS, the World Health Organization, and the UN special rapporteur on health– all endorse comprehensive services known as harm reduction, including in prison, as essential to prevent hepatitis C and HIV among people who use drugs.

These include providing opioid substitution therapy – for example, with methadone or buprenorphine – sterile injecting equipment, and information about hepatitis C, as well as testing and treatment. The WHO’s guidance on prevention of hepatitis B and C among people who use drugs also emphasizes the importance of access to justice, acceptable health services, and integrated service provision as critical to hepatitis C prevention, care, and treatment.

These services are rarely provided to people who use drugs, with foreseeable dangerous consequences, Human Rights Watch said. Hepatitis C affects an estimated 10 million people – or more than 60 percent of people who inject drugs. Most of the three million drug users living with HIV are also living with hepatitis C, and in some countries co-infection rates are estimated to be more than 90 percent. This is a deadly combination, as hepatitis C can exacerbate HIV infection and complicate medical treatment.

The commission noted that hepatitis C treatment has proven to increase adherence to HIV treatment among people who use drugs. But the treatment rate is “unacceptably low” for people with both HIV and hepatitis C, which threatens their chances of survival.

“We know how to prevent hepatitis C and HIV among people who use drugs,” Schleifer said. “Failure to do so is a deadly political choice.”

The Global Commission’s report joins a growing chorus of national, regional, and international leaders calling on governments and the UN to open up a debate on alternative strategies for drug control policy. 

It follows UN experts’ concerns about health and other human rights-related rights harm linked to international drug control, including by the UN special rapporteur on health. Earlier in May, the Organization of American States issued a groundbreaking report considering alternative legal and regulatory policies to address drug-related violence and prevent and treat problematic drug use.

“There is increasing recognition that current approaches to drug control threaten the health and lives of millions of people, and at a massive financial and social cost,” Schleifer said.  “Governments worldwide should heed experts’ calls for critical rethinking of the global drug approach.”