Rethinking the War on Drugs

Ending the War on Drugs: A Rights Perspective


For more than fifty years the world has pursued a so-called War on Drugs. Its goal—a world free of illicit use of drugs—has proven elusive: Despite billions of dollars spent, illicit drug use is up and illicit drugs today are cheaper and more accessible than ever before. Moreover, the War on Drugs has had disastrous unintended consequences, fueling the spread of violence, human rights abuses and infectious disease in much of the world. In 2013, Colombia, Guatemala and Mexico, some of the countries hardest hit, called for a special session of the United Nations General Assembly on drugs arguing that “revising the approach on drugs…can no longer be postponed.” This session will be held in April 2016. In the run-up, Human Rights Watch will be publishing a series of articles that will highlight the consequences for respect and protection of human rights of the War on Drugs.

The War on Drugs – A Cure Worse Than the Disease

The so-called War on Drugs has been lost. So what now?

That’s the vexing question United Nations member states have been grappling with over the past 10 weeks, as they have engaged in intense negotiations over the future of the international response to drugs, in preparation for a UN General Assembly special session in April.

Confronted with the fact that policies pursued over the last 50 years have failed to “eliminate or significantly reduce” illicit drugs, countries are drawing wildly differing conclusions. For some, it is time to try something new; for others, it’s to double down on the criminal law enforcement approach. On opposite sides of this debate are countries like Uruguay – open to legalization and regulation of marijuana – and Russia, which opposes even references to a previously agreed – and spectacularly missed – global goal to reduce drug-related HIV transmission.

Health and human rights are at the center of this polarized debate. The UN drug control conventions were established, along with the UN Office on Drugs and Crime and the International Narcotics Control Board, out of concern for the harms drugs can do to the “health and welfare of mankind.” But with a growing body of evidence highlighting the negative impacts on health and human rights of an over reliance on a criminal law enforcement-based response to drugs a critical question has arisen: What does more harm – drugs themselves or the response to them?

In the run-up to the April meeting, Human Rights Watch will publish a series of articles examining the range of serious human rights abuses – from torture and killings in the name of drug control to disproportionate and arbitrary imprisonment of drug users to denying cancer patients access to morphine for pain – the War on Drugs has caused. Ending these abuses need to be at the center of the deliberations at the UN General Assembly session on drugs.
 

A Missed Opportunity to End the War on Drugs

The biggest United Nations summit on drugs in almost 20 years is over, and while there are signs many countries are stepping back from the destructive “war on drugs” approach to drugs, it’s hard not to conclude that overall the meeting was a missed opportunity.

Three years ago, Colombia, Guatemala, and Mexico called the meeting, arguing that the cost of the “War on Drugs” had become too high and a new approach was urgently needed. Unfortunately, the document the UN General Assembly approved on Tuesday does not represent a real break with the past but rather business-as-usual, with some shifts in emphasis.

The increased focus on health and human rights in the document is welcome, but as long as the dominantly courts-and-cops approach to fighting drugs continues, the toll from the fight will far outweigh the damage from the drugs themselves. There is little doubt that tens of thousands of people will continue to suffer from drug-related violence and human rights abuses in the coming years; that drug users and those involved in minor trafficking will continue to fill our jails; and that HIV and hepatitis C will continue to wreak havoc among people who inject drugs.

The glass-half-full view is seeing the summit as a key step in the long, complicated process of changing the way the world sees drugs. Importantly, the once-unshakable global consensus on the War on Drugs has been shattered. Much to the chagrin of countries that sought to protect the status quo, led by Russia, a critical mass of reform-minded countries powerfully challenged long-standing orthodoxies on drugs and forced open a debate that had been notoriously insular. Decriminalization of personal use and possession – the key to ending widespread abuses against drug users – is now a mainstream issue. Discussion of the benefits and risks of legalization and regulation of marijuana, unimaginable just a few short years ago, is now firmly part of the debate. While falling far short of what was needed, the summit did unleash winds of change that are gathering force.

So what happens next?

In all likelihood, we will see a further fracturing of the approach to drugs around the world. Some countries will continue down the path of reform – legalizing (medical) cannabis, decriminalizing drug use, and favoring effective health over criminal justice interventions – while others will double down on harsh law enforcement approaches. But ultimately the reformers are likely to have the advantage. Their approach is based in science rather than ideology, and the evidence suggests strongly that they will attain the better public health outcomes.

In 2019, the current global drug strategy will expire. The key question is how many countries will by then be willing to follow the evidence even if it necessitates politically inconvenient steps. The human rights of tens of thousands of people depend on the answer.

Drug Users Face Abuse in Russia’s Private Treatment Facilities

Experts estimate that three to six million people use illicit drugs in Russia with the number of heroin users topping a million, according to official estimates. Drug users are stigmatized and jailed frequently for possession of very small amounts of drugs. The hardnosed approach by police prompts drug users in Russia to avoid health services for fear of arrest and harassment.

Viktor Ivanov, head of Russia's Federal Drug Control Agency, speaks during a news conference in Moscow October 7, 2009.

The Russian government stubbornly refuses to provide drug treatments like opiate substitution that have proven effective. Even funding for treatment that doesn’t involve the use of substitute drugs – an approach the government prefers – is limited. Only a few Russian regions offer state-provided rehabilitation treatment. As a result, treatment is often left in the hands of private companies or organizations.

The government has a duty to regulate these privately-owned facilities to ensure they do not endanger or abuse patients. The Russian government has failed to do this – with predictable consequences. Over the last few years, there have been numerous reports of abuse in these facilities: People are sedated, taken from their homes by force to remote facilities, usually in the countryside, and forced to stay there for months, often without their consent (which family members give for them instead). Some of the “treatment” methods used at such centers are more reminiscent of torture than medical care. According to press reports, drug users at one center  were put in a hole in the ground filled with icy water and forced to stay for up to an hour, even in winter. Other methods included physical violence, electroshock, verbal abuse and public humiliation. The media have even reported that people have died in such centers.

To its credit, the government has prosecuted some of the worst cases. But most cases of abuse likely never come to light. The government should take immediate steps to adequately regulate private rehabilitation facilities. If they engage in kidnappings and abuse, they should be shut down. The government should also ensure people with drug dependence have access to a range of treatments - including drug substitution – that are based on evidence. Only then, will Russia be able to start to address the problem of drug dependence.

 

Guatemala: Where (Legal) Pain Relief is all but Impossible

Guatemala’s regulations on opioid painkillers, essential medicines for the relief of cancer pain, are among the strictest in the world. Doctors must write prescriptions on special forms, which can only be obtained from a single office in Guatemala City, 25 at a time, and each prescription must be approved by the Ministry of Health. Imagine: each time someone needs an opioid prescription filled they must travel to the ministry office in Guatemala City – often hundreds of miles away – during business hours and obtain a validation stamp. Only then can they go to a pharmacy to fill it.

For many patients and their families this is impossible. As a result, we estimate, many thousands of Guatemalans suffer severe, untreated pain in the last months of their lives. “The pain was so intense [at some points] that [my son] would grab his hair screaming and run through the streets calling for help,” the mother of a young man with a brain tumor told us.

Besides the senseless suffering, the excessive bureaucratic requirements pose an acute ethical dilemma for physicians and pharmacists: They are obligated to offer proper care to patients but many feel they cannot do so without stretching – or outright breaking – the law, and exposing themselves to possible disciplinary or even criminal penalties.

We documented examples of health care workers putting themselves at serious legal risk out of a feeling of obligation to their patients. “These patients are literally dying and in pain,” said a pharmacist in Guatemala City who admitted to filling prescriptions not validated by the ministry of health. “I can’t send them to the Ministry of Health on a bus [to get a stamp validating their prescription for morphine].”

A doctor from a rural town said he had stopped writing prescriptions for morphine because “it is practically impossible to get it legally.” Instead, this doctor admitted, he helped patients get morphine on the black market, where it is readily available.

No health care worker should have to risk jail time to prescribe essential medications. No patient should have to suffer needlessly because regulations make it impossible to get necessary medications. It is high time for Guatemala to change its drug control regulations. 

Abusing Drug Users in Tanzania

In June 2012, a police officer in Tanzania arrested Mickdad, 28, for carrying unused syringes. Mickdad had just visited an organization providing clean needles and syringes to people who use drugs in an effort to address sky-high HIV prevalence among that group. To the police officer, however, the fact that the government supported this needle and syringe program was of little consequence.

A syringe sucks up a mixture of heroin and water prepared on a foil wrap as addicts shoot up in Stone Town Zanzibar, December 22, 2009.

“The sergeant [arrested me and] took me to Mamboleyo Police Post,” Mickdad told Human Rights Watch. “There, he beat me with his hands, a stick, and also [kicked me] with his boots.” Mickdad’s mother had to bribe the officer to secure her son’s release. “Even now I have pain in my spinal cord... I am HIV positive, so when people beat me it’s a problem,” Mickdad said.

The prevalence of HIV among people who use drugs in Tanzania is estimated at 36 percent – dramatically higher than the prevalence of about 5 percent of adults in the country’s overall population. The government has taken steps to address this problem. Tanzania is only the second African country to provide opiate substitution treatment, the most effective form of drug treatment for opioid dependence, and its authorization of needle and syringe programs sets it apart from many of its neighbors.

But the fact that drug use is punishable in Tanzania by up to 10 years in prison undermines these efforts. While prosecutions do occur, many drug users told us that more frequently, police – or members of semi-official vigilante groups – simply rough them up, extort them for every shilling they can get, and release them.

This abuse drives people who use drugs underground, away from essential health services. “The police are a problem,” a health worker said. “In our HIV prevention work, we had to convince them [people who use drugs] that we’re not coming with the police to arrest them.”

In February, police in Dar es Salaam, Tanzania’s largest city, launched a crackdown on people suspected of drug use. Outreach workers told Human Rights Watch that they witnessed police conduct a mass arrest at a camp where heroin users hang out. The outreach workers had come to educate drug users on HIV prevention and harm reduction.

Police harassment undermines government efforts to bring HIV transmission among people who use drugs under control. The Tanzania Network of People Who Use Drugs, an advocacy group, is calling on the Tanzanian government to end arrests and ultimately decriminalize personal drug use. Tanzania should focus on what has been proven to work: harm reduction and expanded access to treatment. 

A New Approach to Drug Policy and Human Rights

As world leaders gather this week for the United Nations General Assembly special session on drugs, they would do well to closely examine the Lancet Commission report that exhaustively details the failures of the so-called “war on drugs.”

Policemen and villagers use sticks and grass cutters to destroy a poppy field above the village of Tar-Pu, in the mountains of Shan State January 27, 2012.

The report shows how current drug policies have failed to eradicate drugs, reduce the harms of drug use, offer treatment to drug users or ensure access to pain medications. At the same time, these policies have led to massive incarceration and undermined the health of people in many countries. Not surprisingly, the report calls for a thorough reevaluation of international drug policies.

As a member of the commission and a long-term researcher on Burma, I was struck hearing the perspectives of experts from Colombia, Mexico, the United States and African and Asian countries. Burma has been both a major producer and exporter of illicit drugs and is currently beset by a growing epidemic of drug use and punitive eradication efforts. Many of the experts spoke of the same disastrous approaches to drug control I have seen in Burma: policies that view drug policy largely as a crime issue. This approach has clearly failed as drug production, illicit use and its effects on domestic crime, health problems and drug-related violence have only expanded in recent decades in regions such as Latin America.

The commission suggests policy solutions that are being debated more openly now than in previous years, especially in regions where drugs have had a disastrous social impact. These include decriminalizing minor drug offenses such as petty use and sale, reducing the violence of drug policing, and making harm reduction a central pillar of health services and drug policy. It recommends that UN member countries also need to integrate health, human rights and development concerns into drug policy planning; make greater investment in treatment for drug users; end involuntary detention; ensure access to controlled medicines; develop specific policies to reduce harm to women: and fund research on drug policies and their impact on human rights.

The theme of this week’s drug summit is youth and young people, a perfect opportunity to agree on new approaches informed by evidence and guided by human rights norms so we don’t burden another generation with the predictable results of rigid and abusive approaches to dealing with drugs.

Brazil’s Senseless ‘War’

On February 2, 2014,  Alda Castilho, a 27-year-old military police officer  died after suspected drug traffickers opened fire on her squad in a shantytown in Rio de Janeiro. “Her death was in vain,” her mother, Maria Rosalina da Silva, told us last month.

A 17-year-old Brazilian drug gang member poses with a gun atop a hill overlooking a slum in Salvador, Bahia State on April 11, 2013.

Castillo was one of the almost 60,000 homicide victims in Brazil in 2014. It is unknown how many were the victims of drug traffickers. In Niterói, São Gonçalo and Itaboraí, three cities within Rio de Janeiro´s metropolitan area, about 400 of the 480 homicides  in 2014 were drug-related, estimates Fábio Barucke, the Civil Police’s chief of homicide investigations in that region.

Brazil’s approach to criminalizing drug production and distribution has fueled the growth of criminal organizations and weakened the rule of law.

The “war on drugs” is the main driver of police operations in shantytowns, which often end in death. Brazil´s police killed more than 3,000 people in 2014, according to official data. While the police routinely say these deaths resulted from shootouts with criminals, Human Rights Watch has documented dozens of cases in the last decade in the states of Rio de Janeiro and São Paulo in which the evidence strongly suggests they were extrajudicial executions. In some instances in Rio de Janeiro, according to prosecutors and police officers Human Rights Watch interviewed, corrupt police officers involved with drug traffickers committed the killings. 

Apart from contributing to the spike in homicides and the strengthening of deadly gangs, Brazil’s “war on drugs” has also failed to achieve its objectives. Drugs are more plentiful now and stronger than in the 1970s, when the United States began pushing the rest of the world to fight the illegal drug trade.

Police officials described to us the futility of anti-drug operations. Military Police Major Roberto Valente, for example, told us that if they capture a low-level operative, such as a lookout, his gang will give him a gun and promote him once he leaves prison.

Often, top traffickers simply continue their trade from prison. If the police kill them, they are likely to be replaced before the body is stiff.

Having suffered so much in the name of fighting drugs, Brazil should encourage a new approach during the UN´s Special Session on this issue, which starts today in New York. It is time to decriminalize possession of drugs for personal use and to take a look at legalizing drugs.

Opponents of decriminalization argue that it will increase drug use, but the experiences of other countries do not support that assertion. In Portugal, which decriminalized possession of drugs for personal use 15 years ago, the number of people dependent on drugs decreased, as did HIV transmission among drug users and incarceration rates.

Some countries are trying out the legalization of production, distribution and use of marijuana, the most commonly used illegal drug. Early evidence suggests this may cut into the profits of drug traffickers without firing a single bullet. Brazil should consider doing the same.

A new approach to drugs may save the country millions of reals that could be used for drug treatment and the prevention of violence. Most important, it could save thousands of lives every year. It is time to put an end to the current senseless policy.

Why Asia’s Drug Detention Centers Need to be Shuttered

Human Rights Watch has spoken to hundreds of people who use drugs throughout China and Southeast Asia. Typically soft-spoken and polite, despite the many hardships they had suffered, these people rarely sounded bitter – except when describing their time in government drug detention centers.

An “intervention” truck from the Daun Penh district police in Phnom Penh. Such trucks are used to transport the police who carry out “street sweeps” of drug users and other people considered “undesirable” by authorities.

A new report from UNAIDS, the United Nations program on HIV/AIDS, estimates that in 2014 – the last year for which the agency has data – about 450,000 people were being held in centers in China and other countries in Southeast Asia. These centers are supposed to provide treatment for people who use drugs, although their “treatment” consists primarily of arduous physical exercises and military-like drills. Former detainees also describe sadistic violence – being shocked with electric batons, whipped with twisted electrical wire, beaten, and being chained while standing in the sun. One former 16-year-old detainee of a center in Cambodia told us that a staff member would use a cable to beat people: “On each whip the skin would come off and stick on the cable.”

In Cambodia, there are at least eight drug detention centers that hold about 1,000 people at any given time, almost none voluntarily. About 10 percent of the detainees are children, some as young as 6, according to government statistics. Human Rights Watch’s investigations in 2009 and 2013 found the main “therapy” at the centers is hard labor and exhausting physical exercise.

In Vietnam, more than 20,000 people, including children, are detained in these centers, forced to perform labor, often husking cashews, a major export earner for Vietnam. These detainees are either not paid or paid well below minimum wage. One adult detainee told us he spent five years at one center and worked with children as young as 12. He said each detainee was forced to meet a quota of skinning three and a half kilos of cashews every day. Detainees must work to meet these daily quotas, or they are beaten.

Laos is believed to have eight such centers. Information about practices there are very limited. We investigated the Somsanga Treatment and Rehabilitation Center near Vientiane, which calls itself a “health-oriented facility.” But most detainees – 1,100 to 2,600 per year – are held in locked cells inside a compound with high walls and barbed wire. Many face detention without due process and ill treatment. Disturbingly, the US embassy continues to support the center.

 

In March 2012, 12 UN agencies issued a joint statement condemning compulsory drug detention and calling for their immediate closure. More than four years later, little progress has been made. The UN General Assembly Special Session on drugs this week is a crucial opportunity to end detention and punishment in the name of drug treatment – practices that deny the humanity and the rights of people who use drugs.
 

Indonesia’s Drug Trafficker Executions Aren’t Over Yet

International human rights law is absolutely clear: Countries should not use the death penalty for drug-related offenses. Yet, Indonesia’s Minister of Foreign Affairs, Retno Marsudi, recently confirmed that her country would continue to put drug traffickers to death due to the country’s “drug emergency.”

Catholic nuns pray beside the coffin of Brazilian Rodrigo Gularte at a funeral home in Jakarta, Indonesia April 29, 2015.

Last year, Indonesia prompted a major international outcry when it executed 14 drug traffickers. Six convicted drug traffickers were put to death in January 2015, including five foreigners. On April 29, over the objections of numerous foreign governments, Indonesia executed eight convicted drug smugglers – including seven foreign nationals, from Australia, Ghana, Nigeria, and Brazil – by firing squad. Non-Indonesians make up the majority of the country’s 64 death row prisoners convicted of drug crimes.

Jakarta defends the death penalty as “shock therapy” against drug trafficking. “We must finish drug dealers or we're losing a generation,” a government spokesperson said in late 2014.

Yet, the death penalty’s deterrence effect has been repeatedly debunked. Most recently the United Nations assistant secretary-general for human rights, Ivan Šimonovi, said, there was “no evidence that the death penalty deters any crime.” A University of Oxford analysis concluded that capital punishment does not deter “murder to a marginally greater extent than does the threat and application of the supposedly lesser punishment of life imprisonment.” That renders continued use of the death penalty merely cruel and irrevocable.

The death penalty has become a contentious issue in the negotiations in preparation for the April 2016 UN General Assembly session on drugs. While the European Union and Latin American countries have spoken out strongly against capital punishment for drug offenses, countries like Indonesia, Iran, and China have blocked any attempts to include language about ending the use of the death penalty for drug offenses in the outcome document.

Indonesia’s current execution spree is no judicial accident. Since taking office in November 2014, President Joko Widodo has made the death penalty for convicted drug traffickers a signature policy issue.

It is overdue for Widodo to recognize the well-documented failure of the death penalty as a crime deterrent and join the growing number of countries that have abolished capital punishment.

 

The Dark Ages of Drug Treatment in Russia

It is bad enough that the Russian government denies opium users one of the most effective dependency treatments – methadone, a drug used to treat people dependent on heroin. Now, Russia’s government is targeting drug users who sue for their health rights in court.
 

Alexey Kurmanaevsky

Alexey Kurmanaevsky, a social worker, found this out the hard way.

Kurmanaevsky has a long history of opioid dependence. He has repeatedly sought help from Russia’s public clinics, but frequently relapsed into drug use shortly after – not surprising as treatment in these clinics ignores scientific evidence of what works and what doesn’t.

As a result of injecting drug use, Kurmanaevsky is HIV positive.

Between 2011 and 2014, he and two other Russians struggling with drug dependence filed an application with the European Court of Human Rights, arguing that banning opioid substitution therapy violates international human rights law.

In 2014, the European Court informed the Russian government about the case. The fallout for Kurmanaevsky and his fellow plaintiffs happened rapidly. Kurmanaevsky, at the time in remission, was working as a peer counselor at a state-funded drug rehabilitation center, the Health Country Foundation. One day, his boss called him to say that a government official had been in touch. The official told his boss that Kurmanaevsky’s employment at Healthy Country “damaged” its reputation. His boss then ordered Kurmanaevsky to withdraw the European Court case and publicly admit that he had been mistaken regarding substitution therapy. Otherwise, he had to cut ties to Healthy Country.

Kurmanaevsky refused and lost his job. The other applicants to the European Court were also pressured to drop the case by authorities, they said. When the employer of one of them, a nongovernmental organization, refused to yield, the organization suddenly faced inspections and fines that have paralyzed its work.

Evidence is mounting that Russia’s punitive approach to drugs does not work – the number of drug related deaths has remained steady recent years and 70 percent of Russia’s inmates are drug users. At the same time, the government has grown increasingly intolerant of critics. Using vaguely worded anti-drug propaganda laws, it has censored public discussions regarding substitution treatment.

Now it has also evidently decided to go after those who go to court to protect their rights.

But Kurmanaevsky is going forward with the case. He hopes the European Court of Human Rights will decide in his favor and force Russia to enter the 21st century when it comes to treating opioid dependence.

 

 

Criminalizing Drug Use By Pregnant Women Increases Harm

Imagine a law that makes pregnant women afraid to seek prenatal care or go to a hospital to give birth. Crazy? In fact, that’s exactly what is happening in numerous U.S. states.

In 2015, I researched the impact of the Tennessee law criminalizing the use of certain drugs by pregnant women. Under child welfare law, healthcare providers may test women for illegal drugs and, if found positive, report them to child services, which may then alert law enforcement. As a result, these women may go to jail on charges of “assault” –ostensibly on the fetus—and risk losing parental rights.

These laws try to address a real public health issue: Children born to mothers who are drug dependent may develop conditions such as neonatal abstinence syndrome, a temporary and treatable health condition that results from prenatal exposure to opioids. But our research shows why a criminal justice approach is the wrong way to tackle this problem. Rather than protecting the health of the women and their children, we found that this approach makes things worse by prompting drug-dependent women to avoid healthcare entirely.

I interviewed women who gave birth in circumstances that were dangerous to themselves and their child. One woman described being in labor while her partner quickly looked up how to do a home birth. Some women said they tried to detox at home—something that can actually put the health of their pregnancy at greater risk than the use of illegal drugs itself. A gynaecologist told me some of her drug dependent patients were showing up later for prenatal appointments or simply stopped showing up at all.

The fact that there are few affordable drug treatment facilities in much of the US—especially ones that accept pregnant women—and some may only accept certain insurance policies, makes these laws particularly unfair. How can a woman with drug dependence enter into treatment when it is not available or accessible? A woman from east Tennessee told me she called drug treatment providers across the state but was unable to find any that would accept her insurance. She tried to leave the state when she went into labor but did not have enough time; she ended up giving birth on the side of the road.

In Tennessee, about 100 women have been charged under the “fetal assault” law since 2014, mostly in rural eastern Tennessee, an area severely lacking in drug treatment facilities, and in Memphis, a majority African American city. In Alabama, almost 500 women have been arrested under a similar law. More than three-quarters of US states have such laws in place and prosecutions have occurred in most.

Confronted with the detrimental impact of its law, Tennessee recently decided to let some of the most harmful provisions expire in July. Other states should follow suit and repeal such laws. Instead of criminalizing women who use drugs they should offer them meaningful access to affordable drug treatment and other drug-related health care without discrimination. Such approaches that make pregnant women facing drug dependency feel safe to seek treatment and prenatal care lead to better health outcomes for women and their children.

Gordon’s Story: Denial of Treatment, then Punishment, in Prison

Kidney stones nearly cost Gordon his life.

In pain from the ailment, the 20-year-old history major at University of North Carolina was prescribed Oxycontin, a strong opioid painkiller. When that ran out, his cravings drove him to buy Oxy on the street. Soon he switched to heroin and within a year he had slid into full-fledged drug dependence. It got worse – he robbed banks to feed his habit and was arrested and sentenced to 47 months in federal prison.
 

Gordon sought help for his drug dependence while awaiting trial. His doctor prescribed suboxone, a form of medication-assisted therapy proven to reduce cravings for opioids, and it provided the relief that Gordon had prayed for. But when he entered prison in March 2013, his budding recovery from drug dependence was abruptly disrupted. As is common in US prisons, the medium security facility where Gordon was sent only had an abstinence-based drug treatment program, so he was cut off from his medication – that, despite the fact that 1 in 10 inmates dependent on opioids do not respond to this sort of treatment, according to Bureau of Prisons data.

Gordon participated in the treatment programs but soon relapsed and began using drugs again. He was caught and punished – including 45 days of solitary confinement and loss of family visitation privileges for one year. He appealed, pointing out he had been in recovery before being sent to prison and begging for the medication that had worked for him outside. The prison authorities refused and later transferred him to a higher security prison where he was stabbed by another inmate and placed in protective custody.

Gordon was released in March and is now on probation. He works at a restaurant and is back on suboxone under the care of a physician. Unfortunately, his experience while behind bars is all too common. Inmates like Gordon continue to use drugs behind bars when prisons fail to provide effective treatment. But most US prisons do not offer medication-assisted therapy for opioid dependence and many delay any type of drug treatment until the final months of an inmate’s sentence.

In New York State prisons, Human Rights Watch documented lack of access to treatment for opioids and other drugs, with inmates spending months, sometimes years, in solitary confinement for drug offenses within their facilities. Denial of medical care for drug dependence, followed by punishment for possession of drugs, is a particularly cruel injustice that nearly cost Gordon his life. Until prisons respect the right of prisoners struggling with drug dependence to access the treatment they need, many others will continue to suffer unnecessary harm.
 

How Punitive US Drug Laws Tear Families Apart

Last July, US President Barack Obama gave a speech in which he criticized the United States criminal justice system’s unduly harsh sentences for drug offenses, saying “If you’re a low-level drug dealer…you don’t owe 20 years. You don’t owe a life sentence.”
 

Melida Ruiz, a lawful permanent resident, pictured with her daughter, Mercedez Ruiz, and her grandson, Christopher Gonzalez. In 2011, Melida was held in immigration detention for seven months while she fought deportation based on a 2002 misdemeanor drug conviction, her sole conviction in more than 30 years in the United States.

The Obama administration has placed health interventions at the heart of its drug policies, enacted new prosecutorial policies to minimize sentences for federal drug crimes, and called for reforms to harsh sentencing laws, which have been welcome. Yet, that same administration has also deported hundreds of thousands of immigrants, including green card holders with US citizen family members, for drug offenses. Many were deported for offenses that were several years or even decades old, or for offenses so minor that even under US law – which is generally quick to resort to incarceration – they led to little or no prison time.

The administration deported Marion Scholz to Germany, for example, because of misdemeanors for drug possession stemming from drug dependence. Ms. Scholz had lived in the US as a legal permanent resident for over 45 years and was enrolled in treatment when deported; she left behind her son, father, and siblings. Raul Valdez, a permanent resident from Mexico who grew up in the US, was deported in 2014 because of a 2003 conviction for possession of cannabis with intent to deal, for which he had been sentenced to 60 days in jail. He was separated from his US citizen fiancée, parents, and siblings. “Antonio S.,” who came to the US from Mexico when he was 12, and was eligible for a reprieve from deportation under an executive program for people brought to the US as children, was deported in his early 20s after a conviction for possession of marijuana, a municipal violation to which he pleaded guilty without an attorney.

These cases are not unique. Between 2007 and 2012, the US government deported over a quarter of a million people after convictions for drug offenses. Deportations of people for drug possession spiked 43 percent during the same period. And like the examples above, many were not drug cartel leaders or major dealers, but immigrants with convictions stemming from personal use or low-level sales offenses. Many also had deep ties to their communities, and were forced to leave behind US citizen children, spouses, and other close relatives.

Obama and other political leaders in the US are starting to recognize that locking people up is not the way to solve the societal harms of drug use. Deporting people and separating families is not the answer either.

 

The Unexpected Casualties of Mexico’s “War on Drugs”

In late 2006, the newly elected president of Mexico, Felipe Calderon, launched a “War on Drugs” by sending 6,500 soldiers to the state of Michoacán to battle drug cartels, ushering in a decade of drug-related bloodshed.

A member of the Federal Police stands guard atop a vehicle in downtown Iguala, southern Mexican state of Guerrero, to keep the peace after a series of disappearances.

Some 70,000 people have since died in drug-related violence throughout the country – a total that surpasses the number of combat deaths that the United States suffered during the entire 20-year Vietnam War. One study suggests that the enormous spike in homicides in Mexico since 2005 has been severe enough to reverse a decade of improving health statistics, causing median male life expectancy nationwide to drop by several months.

Moreover, as Human Rights Watch has documented, Mexico’s police and military involved in the “drug war” have perpetrated widespread abuses, including torture, enforced disappearances, and extrajudicial executions. For example, in September 2011, navy officers arrived at the Nuevo Leon home of 31-year-old Gustavo Acosta and his family and promptly shot him when he opened the door. As of September 2015, no members of the navy were charged for the crime. Impunity for these abuses is the norm.

All that violence and lawlessness has failed either to break the power of the cartels or reduce supply of drugs to the US. In fact, the US Drug Enforcement Administration now claims Mexico’s drug cartels control the drug trade not only south of the Rio Grande but throughout the US, where drugs are cheaper than ever. Moreover, drug use among Mexicans rose by about a third, and dependence by more than half, during the period of its militarized drug war.

In March, Interior Minister Miguel Ángel Osorio Chong – calling the Drug War “badly designed” and a product of “false diagnosis” – blamed it for causing “unprecedented violence.” General Salvador Cienfuegos Zepeda, commander of Mexico’s armed forces, said that sending “soldiers prepared for war” to confront criminals was a “mistake” that has caused “serious problems.”

Although President Enrique Pena Nieto promised to change course when he came to power in December 2012, little has changed on the ground. The way it’s currently being fought, this “war on drugs” will only have casualties. 

Stuck in a US Prison – for a Small Amount of Marijuana

The first time Corey saw his daughter was in a courtroom, a two-week old asleep in her grandmother’s arms. It was another year before he could finally hold her, in a visitation room at Louisiana’s infamous Angola prison. His daughter, Charlee, is four now and thinks she visits her father at work. “She asks when I’m going to get off work and come see her,” he says.

A picture of Corey, taken one year ago. 

Corey is one of thousands of Americans serving long prison terms for drug possession—in his case 17 years without possibility of parole for a half-ounce of marijuana, the weight of 3.5 sugar packets. Because of prior drug possession convictions, he was sentenced as a “habitual offender.”

By the time Corey comes home Charlee could be almost 17.

All U.S. states criminalize drug possession and many aggressively prosecute drug users. Over the past several months I have interviewed 150 people, including Corey, prosecuted for the sole offense of possessing a controlled substance that was for personal use, not for sale. Their punishment often begins long before formal conviction—and lasts long after their sentence is served. In addition to harsh criminal penalties many suffer family separation, job loss, housing problems, financial debt, health complications, and deep insecurity and stigmatization.

Shortly after Corey was sentenced, Louisiana amended its marijuana laws. But the changes aren’t retroactive, and Corey can’t petition the governor for clemency until he has served at least 10 years.

While decreased sanctions for marijuana in many states is a welcome move, around the country possession of “harder” drugs like cocaine, heroin, meth, and pills is met with harsher penalties.

Human Rights Watch opposes the criminalization of drug possession for personal use. This practice violates the right to autonomy and is inherently disproportionate. It is also a waste of resources—not only of government budgets and personnel but, more importantly, of the human lives it impacts. Instead of criminalizing drug possession, countries should ramp up access to effective treatment and other health services for those users who need them.

In two weeks the United States will participate in a rare United Nations General Assembly Special Session on the World Drug Problem. At the last one—in 1998—the United States led the charge for harsh law enforcement approaches to drugs and drug use. This is the approach that is responsible for many of the abuses chronicled on this blog. This time the US government should set a positive example and commit to the full decriminalization of personal use of drugs.

Corey, in prison for drug posession, drew this Christmas card for his young daughter. 

 

Forget a Drug Free World, Time to Focus on Harm Reduction

Maria Phelan, deputy director at Harm Reduction International

Eighteen years ago, the United Nations General Assembly set an ambitious goal: To rid the world of illicit drugs within 10 years. It adopted the slogan: “A drug free world – We can do it!” We did not do it, of course. But some of the methods employed ostensibly to achieve a drug free world – such as criminalizing drug use – resulted in catastrophic health and human rights consequences in many countries. While the so-called ‘war on drugs’ was wreaking havoc in many countries, an alternative approach to drugs was slowly taking hold, one which saves lives, saves money, and respects the human rights of people who use drugs. This approach is called harm reduction.

The core premise of harm reduction is that the goal of a drug free world is an illusion; there will always be people who use drugs. Rather than jailing them, this approach seeks to reduce the impact of drug use on their health. This involves measures such as distributing sterile needles and syringes to prevent HIV transmission; teaching people who use drugs and their loved ones how to treat and reverse overdoses; and helping people with drug dependence enter into effective treatment.

My organization, Harm Reduction International (HRI), has tracked global data on harm reduction for 10 years. In 2014, we found some form of harm reduction programming, such as needle and syringe programs or opioid substitution therapy, in more than half the 158 countries with documented intravenous drug use. Countries which have implemented these services have seen important public health gains such as reductions in HIV rates and overdose deaths. Where such services aren’t provided, HIV rates and other costly health related harms among this vulnerable population have gone virtually unchecked.

But progress is frustratingly slow. To date, investments in harm reduction have been minimal in most countries: Just US$160 million in low- and middle-income countries, about 7 percent of the estimated need – peanuts compared to an estimated US$100 billion spent annually on drug control around the world.

A recent report by HRI using statistical modelling suggests if just 7.5 percent of global drug control funding were to be redirected to harm reduction by 2020, there would be 94 percent fewer new HIV infections among people who inject drugs by 2030, and 93 percent fewer HIV-related deaths among people who inject drugs.

It is time for world leaders to leave behind the misguided approach of pursuing a drug free world. Instead they should commit to a Harm Reduction Decade and all but wipe out HIV/AIDS among people who inject drugs.

 

Russian Drug Policies Fuel Europe’s Worst HIV Epidemic

Russian Drug Policies Fuel Europe’s Worst HIV Epidemic

The human immunodeficiency virus (HIV) is in retreat almost universally – but not in Russia. As infection rates drop globally, Russia has seen increases of 8 to 10 percent annually over the last decade. The number of Russians living with HIV surpassed 1 million, according to official data release in January, but experts believe the real number to be closer to 1.5 million. The head of Russia’s Federal AIDS Center recently described the situation as a “national catastrophe.”

Used needles being returned to a needle exchange point in St. Petersburg, Russia.

One of the main reasons behind the spread of the virus is the Russian government’s obstinate refusal to implement HIV prevention measures, such as needle exchange, that have helped other countries drastically reduce – and in some cases almost eliminate – transmission of HIV among injecting drug users. Sixty percent of HIV infections in Russia occur through injections.

Yet, two weeks ago, Russia’s top drug official said he strongly opposes harm reduction programs in the country, such as distribution of free syringes to limit drug injectors’ risk of HIV infection. Russia also bans methadone replacement therapy for drug users dependent on opioids such as heroin. Despite overwhelming evidence from numerous countries of their effectiveness, the Russian drug agency calls harm reduction programs ineffective and dangerous to the general population.

During negotiations in preparation for the April United Nations General Assembly session on drugs, Russia has even blocked inclusion of the term “harm reduction” in the document, even though UN agencies, such as the UNAIDS, the UN Office for Drugs and Crime, and the World Health Organization, have all endorsed the approach.

Ironically, a week after Russia vetoed mention of harm reduction in the UN document, Moscow hosted the Fifth Eastern Europe and Central Asia AIDS Conference. At the conference, the Russian government pledged to help combat the HIV epidemic worldwide but failed to announce any measures to counteract the sharing of needles among drug users, the driving force behind its own epidemic. Meanwhile, 20 regions in Russian are now considered to have “generalized epidemics,” meaning that more than 1 percent of the general population is infected. UNAIDS considers this to be the threshold where an epidemic concentrated in a high risk group, such as injecting drug users, can start spilling over into the general population –  and spread rapidly through sexual contact.

It is high time for the Russian government to start acting in a manner consistent with the right to health, and abandon its opposition to evidence-based HIV prevention strategies. Its own citizens – and not just those who use drugs – are paying the high price.

Farmers the Losers in South Africa’s War on Marijuana

Farmers the Losers in South Africa’s War on Marijuana

By Scott Bernstein, Open Society Foundations

In the rolling hills of South Africa’s Pondoland, Cannabis sativa – marijuana, known locally as “dagga” – has been grown for as long as people can remember, in part because they have few other options to earn an income.

Residents of Mkumbi gather to share stories about chemical spraying.

Consider the arid village of Mkumbi, where about 100 families live in grass-thatched huts with neither electricity nor access to clean water. With little to live on, villagers here grow marijuana, one of few crops that somehow manages to flourish in this dry environment. They are subsistence farmers trying to feed their families. The crop, which is collected by middlemen, is destined for South Africa’s urban markets.

As in most of the world, marijuana is illegal in South Africa. For years, police have taken aggressive measures in communities across Pondoland to dissuade them from cultivating the crop. Mkumbi residents describe how police break down the doors of their homes, make arrests, and beat them. In the last decade, the South Africa Police Service has taken to indiscriminate spraying of the cannabis fields from helicopters using glyphosate – the same substance that Colombia recently banned after a World Health Organization (WHO) report linked it to cancer in humans.

Cannabis growing in the village of Mkumbi.

Villagers say that the helicopters not only spray the cannabis fields, but waterways, food crops, animals, and even people. One woman said she saw helicopters chase a man who was fleeing and doused him with glyphosate. Another described how police routinely land helicopters and ransack houses in search of cannabis. Villagers have started fighting back, documenting their experiences in videos, creating a Facebook group, and engaging legal counsel to seek an injunction against spraying.

In response to a letter from a lawyer, the police have defended the practice, saying they refuse to be “derailed” from their mission to eradicate illicit cannabis. The police say their actions are supported by their constitutional mandate to combat crime and approved by environmental experts. They also refuse to warn villagers about upcoming spraying campaigns saying it is “unaware of any situation in the world where the police must pre-warn offenders before law enforcement operations can be conducted.”

South Africa has an obligation to protect the health and living environment of its people, including villagers who grow illegal cannabis crops. Indiscriminately – and even deliberately – spraying villages, non-cannabis crops, water sources, and villagers themselves is clearly inconsistent with this obligation.

For more information on cultivation of illegal crops and the impact of eradication efforts, please visit:
https://www.opensocietyfoundations.org/reports/drug-crop-production-poverty-and-development

Tunisia’s War on Drugs: Jail for a Joint

Tunisia’s War on Drugs: Jail for a Joint

“My nephew was arrested yesterday. He is an engineering student in Paris on vacation in the south [of Tunisia]. Police forced him to do a urine test, which came back positive [for cannabis].”

The photograph shows a banner in a protest against Law 52 about the use of drugs, in December 28, 2015, in front of Tunisian parliament building, in Bardo. It says:”Our Children and our Friends are not Criminals, “and articulates the demand to abrogate the law. 

I have received many calls like that since we released a report on the harsh sentences imposed for possession of any amount of cannabis in Tunisia. The callers want to know how we can help their children or friends who have been arrested.

The truth is there’s little we can do. Until the parliament changes the so-called “Law 52,” which imposes a mandatory one-year prison term for first-time use or possession of cannabis, the police will continue jailing people while awaiting results of a urine test. A positive test usually results in a year in prison.

Adopted in 1992, “Law 52” allows judges no discretion to reduce the sentence or consider penalties other than prison. It imposes a minimum five-year term on repeat offenders.

In 2015, Tunisia’s prisons held 7,451 people convicted of drug-related offenses, according to official statistics. About 70 percent of them – about 5,200 people – were convicted of using or possessing cannabis, known locally as “zatla.” That means thousands of mostly young people with no criminal record end up in overcrowded prison cells with hardened criminals; when freed, they face a job market that is tough even for people with no criminal record. The cost to the Tunisian state is significant: People convicted of drug offenses constitute 28 percent of the total state prison population.

These problems are not unacknowledged by the Tunisian government. In late 2015, it sent a draft drug law to parliament that would abolish prison terms for first-time offenders in drug use or possession cases. It would also do away with mandatory sentences, allowing judges to impose noncustodial sentences. But, three months later, the law has yet to be scheduled for debate in parliament, and there is no apparent justification for the delay. Meanwhile, police enforcement of Law 52 continues to upend the lives of many young Tunisians. Parliament should move swiftly to change this, or if it continues to drag its feet, a moratorium on enforcing possession laws on first time offenders should be considered.

 

Armenia’s Cancer Patients are Victims of War on Drugs

“I cry, scream, feel like I’m walking on fire all the time. I try to endure the pain when someone is at home, but when I am alone, all I can do is cry…”

That was how Gayane, a 46-year-old cancer patient from Armenia’s capital, Yerevan, described her pain to me. “I can’t sleep at nights and can only do so after several sleepless nights, when I am fully exhausted. I live in pain all the time...”

About 8,000 people die from cancer in Armenia every year, many spending their last days in excruciating pain, a July 2015 Human Rights Watch report found. But fewer than 3 percent of those who need morphine get it. That’s because the government has put in place nearly insurmountable bureaucratic barriers around the prescribing and dispensing of morphine – all in the name of fighting the illicit drug trade. (Morphine is essential treatment for cancer pain but is made from the same poppy plant as heroin).

Armenia is not the only country where the response to illicit drugs severely restricts access to critical medicines for patients with cancer and other diseases. The United Nations estimates that about 5.5 billion people – a staggering 75 percent of the world’s population – live in countries with limited or no access to proper pain relief treatments.

But Armenia is a case study for how regulations drafted for law enforcement purposes by officials with no public health knowledge can severely complicate valid medical use of controlled substances. Under Armenia’s regulations, oncologists can prescribe these medications only after multiple doctors have visited the patient at home – almost impossible in an under-resourced health care system as Armenia’s – and have signed off on the prescription. Patients or their relatives must then collect multiple signatures and seals before the prescription can be filled. Doctors only prescribe the medications for two or three days at a time, forcing patients on their death bed or their relatives to spend hours every few days to obtain and fill new prescriptions.

As a result, most cancer patients in Armenia end up like Gayane – abandoned at the most vulnerable times of their lives, trapped in a world of pain, fear, and anguish.

 

Iran’s Deadly Drug Penalty

By Tara Sepehri Far

Last month, Iran's vice president for women and family affairs, Shahindokht Mowlaverdy, made a disturbing allegation in an interview. She claimed that all men in a village in Sistan and Baluchestan province had been executed for drug offenses.

Young Iranian boys play under a tree beside a well outside Zabol in Iran's Sistan-Baluchestan province, July 17, 2001.

Her comments have circulated widely in the Iranian media. Mohamad Javad Larijani, secretary general of Iran’s High Council for Human Rights, confirmed the incident—albeit trying to downplay it—saying  in a CNN interview that he believed that “only” five families lived in the village.

Iran’s drug trafficking laws have a disproportionate impact on the country’s marginalized populations. Sistan and Baluchestan province shares a long border with neighboring Pakistan and Afghanistan and is saddled with the highest unemployment rate in the country. It is the country’s point of entry for drugs. And with few economic opportunities, many residents take on small jobs in the drug trade to try to scratch out a living.

In 2014, the province’s prison director said in an interview that more than 4,000 prisoners—about 50 percent of the province’s prison population—were detained for drug-related offenses. These were not drug barons. Rather, he claimed, 90 percent “were breadwinners for their families, and committed these offenses to provide for their families’ needs.”

Some of them may face the death penalty. Iran’s anti-narcotics law imposes a mandatory death sentence for manufacturing, trafficking, possession, or trade of as little as 30 grams of heroin, morphine, or various other controlled substances. In 2015 alone, Iran executed more than 966 people, the majority for drug offenses.

International human rights law bans the use of the death penalty for drug offenses. UN drug agencies, such as the UN Office on Drugs and Crime and the International Narcotics Control Board, have urged countries to stop imposing the death penalty in such cases.

Iranian officials have also questioned the effectiveness of draconian anti-narcotic laws in combating drug trafficking. In December, a group of parliament members submitted a proposal to eliminate the death penalty for drug offenses -- with the exception of armed smuggling. Approving these amendments may save thousands of people, including those from marginalized areas like Sistan and Baluchestan province.