Press Release: Russian policy of breaching international agreements continues, as UN Secretary General arrives in Moscow

Transform's colleagues in the harm reduction field have asked us to circulate this press release on their behalf.

Wednesday, April 20, 2011

More then forty major civil society organizations working in the field of HIV and drugs in Russia and internationally, have sent an open letter to the Secretary General of the United Nations calling to advocate for human rights oriented and scientifically based drug treatment and HIV prevention in Russia. Ban Ki-Moon is arriving to Moscow on April 21, 2011 and has scheduled several meetings with high level Russian officials, including the President Dmitry Medvedev.

Currently, the number of new cases of HIV in the country continues to grow and has long passed a critical point. According to the UN documents Russia remains among a few countries worldwide where HIV epidemics are on the rise. This epidemic is driven by sharing contaminated injection equipment for drug use. At the same time the government denies its drug dependent citizens access to life-saving evidence-based prevention and treatment interventions such as opioid substitution treatment with methadone or buprenorphine and needle and syringe HIV prevention programs, recommended by the UN.

“Neglecting the rights of people who use drugs, especially at the concentrated stage of the HIV/AIDS epidemic, will inevitably lead to serious health and social consequences for the society as a whole”, the letter says. It goes on by pointing out that the Russian government has “failed to ensure universal access to HIV prevention and treatment when millions of people who inject drugs are deprived of medical and social services support because the Government’s rejects the UN-recommended comprehensive package which includes substitution treatment and needle and syringe programs”.

Currently the use substitution treatment is legally banned in Russia which many experts believe is contrary to the letter and spirit of the UN Drug Conventions. Needle and syringe programs are considered by the Government as a threat to the national anti-drug strategy. Public debates on these issues are officially stifled and since recently, officially subjected to a legal ban.

The letter emphasises that efforts of civil society and international organizations are counterbalanced by the Government’s ideology-driven position of “zero tolerance” toward drug use. Numerous violations of human rights stemming from Russia's repressive and ineffective policy toward people using drugs have been documented and submitted to the UN Human Rights bodies”.

The civil society organizations called upon the UN Secretary General to urge the Russian Government to officially recognize the UN-recommended interventions as essential in combating HIV among drug users. According to the UN official documents, needle and syringe programs and substitution treatment are among the nine core interventions to prevent HIV among injecting drug users. Methadone and buprenorphine are included on the WHO Model Essential Medicines List.

It is noteworthy that during his visit to Cambodia at the end of 2010, the UN Secretary General met with patients of a methadone clinic and some of them received methadone from his hands and hands of his wife.

For contacts – Andrey Rylkov Foundation for Health and Social Justice:

In Moscow –

Ivan Varentsov (English, Russian)

Tel: +79166425682, ivan@harmreduction.org

In San-Francisco –

Anya Sarang (English, Russian)

Tel: +1-415-810 1117

The problem with Drug Tsars

I met the US Drug Tsar Gil Kerlikowske recently. It was at a reception at the US Ambassador's residence in Vienna during the UN Commission on Narcotic Drugs. This is an annual event, and a welcome opportunity for the NGOs attending the CND in an official capacity (Transform has ECOSOC special consultative status) to meet various US figures and ONDCP staff.

I asked how the potential tensions between state, federal and international law might play out if one of the US State ballot initiatives to legalise and regulate cannabis/marijuana was passed by voters. Kerlikowske's answer was to list a number of arguments against legalisation - all familiar to those who followed the debate around Prop 19 in California last year.

 

The Drugs Tsar, Gil Kerlikowske at the US Amassador's reception in Vienna, 

with Anita Krug and Aram Barra from YouthRise/Espolea*

I responded by saying that I understood the arguments for and against, but was specifically interested in what would happen in terms of the conflicts between state, federal and international law, given the the likelyhood that one of the various proposed state ballot initiatives would pass in 2012 (the California initiative is set to rerun, as well as initiatives in Colorado, and other states). This time Kerlikowske pointed out that 56% of voters in California had been sufficiently concerned about Marijuana abuse and drug driving to oppose the 2011 prop 19 initiative.

So I essentially repeated the question; quite aside from the debate and public opinion, what is the Federal response or sequence of events, should such an intiative actually succeed? - noting that this was a reasonable question given how close the Californian vote had been and the likelyhood, probable certainty that one of the other initiatives would succeed in the near future. This time Kerlikowske responded that he didn't 'deal in hypotheticals'  - a response familiar to Prop 19 debate watchers.

So, pointing out that those in policy making naturally had to deal with hypotheticals as a matter of routine, I asked a slightly rephrasesd question; had the ONDCP done any scenario planning to explore this particular hypothetical, given its likely imminent move to non-hypothetical status. Kerlikowske replied that he 'couldn't comment'.

This was one of those unenlightening conversations that NGOs have with politically appointed civil servants on an almost daily basis - so largely unexpected. But a curious fact about the ONDCP director's role, that puts these sorts of conversations into some perspective, is that his position on legalisation is specifically mandated:

According to Title VII Office of National Drug Control Policy Reauthorization Act of 1998: H11225:

Responsibilities. –The Director– [...]
(12) shall ensure that no Federal funds appropriated to the Office of National Drug Control Policy shall be expended for any study or contract relating to the legalization (for a medical use or any other use) of a substance listed in schedule I of section 202 of the Controlled Substances Act (21 U.S.C. 812) and take such actions as necessary to oppose any attempt to legalize the use of a substance (in any form) that–

1. is listed in schedule I of section 202 of the Controlled Substances Act (21 U.S.C. 812); and
2. has not been approved for use for medical purposes by the Food and Drug Administration;

Whatever Kerlikowske's views, and whatever evidence he is presented with (as he is not allowed to let the ONDCP gather any) he is duty bound to proffer a blanket opposition to any form of move to legally regulated markets, for any reason.  There is something fundamentally obnoxious and anti-science about this wording, contained as it is in an Act of Congress, especially given the fact that Kerlikowske's statements on legalisation are often superficially factual (as indeed is the risible DEA guide  'Speaking Out Against Legalisation'). How balanced can we expect this analysis to be if all research on non-drug war options is forbidden and all comments subject to Congressional diktat? 

More concerning were recent comments from Kerlikowske in an interview with Foriegn Policy in which legalisation cropped up again;

Foriegn Policy: You've made your views on legalization very clear in the past. How do you respond to the growing number of former Latin American leaders -- former Mexican President Vicente Fox, most recently -- who have come out in favor of legalization or at least a radical overhaul of the current policy?

Gil Kerlikowske: Isn't if funny how people who no longer have responsibility for anyone's safety or security suddenly see the light? I think it's not a lot different from what we've heard in recent years in the United States, which is: We've had a war on drugs for 40 years and we don't see success. If we have a kid in high school, they can still get drugs or there's drugs on the street corner. So legalization must be an answer.

What we in government fail to do is to show that there really are quite successful, cost-effective programs we can use, so we don't have to go from the "war on drugs has failed" to "let's legalize."

By the way, I've never seen any of the legalization arguments that say, here's how it will work and here's how we'll regulate it. Heaven knows, we're not very successful with alcohol. We don't collect much in tax money to cover the costs. We certainly can't keep it out of the hands of teenagers or people who get behind the wheel. Why in heavens name do we think that if we legalize marijuana, we'd have a system where we could collect enough tax revenue to cover the increased health-care costs? I haven't seen that grand plan.

The first comment from Kerlikowske here is, I would suggest, an entirely misplaced and innappropriate ad hominem aimed at Fox and other former public servants who differ with Kerlikowske's (legally imposed) prohibitionist perspective. More importantly, from Transform's perspective, is the comment about never having seen 'any of the legalization arguments that say, here's how it will work and here's how we'll regulate it.'  As Transform's widely distributed and cited 2009 publication 'After the War on Drugs; Blueprint for Regulation'  addresses precisely this question in some detail (50,000 words, 215 pages), I found this statement a little surprising.

What's more Transform's efforts on this front have been built on previous work including ‘A Public Health Approach to Drug Control’ (2005) by the British Colombia Health Officers Council, and Effective Drug Control: Toward A New Legal Framework' (2005) by the King County Bar Association. The latter is based in Seattle, and produced the document whilst Kerlikowske was Seattle police chief. 

We have sent Kerlikowske a letter drawing attention to this work, and a copy of Blueprint, which he is presumably allowed to read - even if he must do so in his own time and never mention it in public.  

*photo: Steve Rolles

IHRA Counts the Costs of the War on Drugs

A key cost of the war on drugs is the the lack of access to to harm reduction (including needle exchange and opiate substitution treatment) and treatment, and the still high prevalence of HIV/AIDS amongst injecting drug users, that results where such access remains inadequate. Drug war politics continue to prioritise punitive enforcement over proven public health interventions, even when these have been clearly and unequivocally advocated in widely adopted declarations by UN health agencies. Worse still, it is invariably the the most vulnerable groups in society who carry the greatest burden of these costs - in terms of their health and wellbeing, freedoms and human rights.

Transform is pleased to support this year's IHRA conference declaration (sign here , download the pdf here) copied below, that highlights many of these issues and calls upon Governments to meet their commitments to address them. We encourage all interested parties to do the same.

IHRA is a partner organisation in the new Count the Costs project, launched this March at the UN Commission on Narcotic Drugs in Vienna. They are part of the grouping of organisations helping to gather and present more resources over the coming year, highlighting the health and human rights costs of the continued political commitment to a global war on users, suppliers and producers and the communities in which they live.

The Official Declaration of the 2011 International Harm Reduction Conference

Of the 33.3 million people living with HIV globally, an estimated three million are people who inject drugs.^{12 3} They account for 30% of HIV infections outside of sub-Saharan Africa, and up to 80% of infections in Eastern Europe and Central Asia.


The 2001 UNGASS Declaration of Commitment and the 2006 Political Declaration on HIV/AIDS established time-bound targets to be met and reported on by countries worldwide. The commitments aimed to address the needs of people who inject drugs, their families and the communities in which they live through an “urgent, coordinated and sustained response.” ^{4 5} These commitments remain unfulfilled. People who inject drugs are increasing as a percentage of global HIV infections with devastating consequences for individuals and communities.

The mobilisation of an “intensified, much more urgent and comprehensive response”⁵ to HIV for people who inject drugs requires strong global leadership, concrete national policies and adequate funds to implement and scale up evidence-based services. The targets and commitments set in the 2006 Political Declaration must be met to address the needs of, and to fulfill the human rights of people who inject drugs living with and at risk of HIV. World leaders gathering at the June 2011 UN General Assembly High Level Meeting on HIV/AIDS must ensure that these commitments are met as a matter of urgency.

At the 2011 United Nations High Level Meeting on HIV/AIDS, we, the undersigned, call for:

1. Acknowledgement that people who use drugs, as a key population group affected by HIV and AIDS, have not reached universal access to HIV prevention, treatment, care and support;
2. Renewed commitment and action toward the goal of universal access to comprehensive HIV prevention, treatment, care and support for people who inject drugs through the financing, implementation and scale-up of evidence-based harm reduction interventions; and
3. Commitment to removing legal and policy barriers to achieving the aims above, particularly a reorientation of punitive drug policies toward evidence- and human rights-based approaches.

It is time for action on HIV-related harm reduction. It is time for accountability for the rights of people who inject drugs.

A number of commitments made in the 2006 Political Declaration to address the international response to HIV remain unmet for people who inject drugs. Among them:

Commitment: “Ensure that a wide range of prevention programmes...including sterile injecting equipment and harm-reduction efforts related to drug use...is available in all countries, particularly the most affected countries” [paragraph 22]

Of the 158 countries and territories with reported injecting drug use globally, almost half lack essential harm reduction services.⁶ In most countries where needle and syringe programmes and opioid substitution therapy are available, coverage is still poor, reaching far below the numbers needed to have an impact on the epidemic.^{7 8} The situation for people held in places of detention is dire. Thirty-nine countries currently provide opioid substitution therapy in prisons, while only ten provide needle and syringe exchange, often reaching small numbers in few institutions.⁹

Action required: Evidence-based programmes targeting people who inject drugs need to be implemented and scaled up urgently across all settings in order to effectively prevent the further spread of HIV.

Commitment: “Reduce the global HIV/AIDS resource gap” [paragraph 39]

Less than 10% of the estimated need for harm reduction funding globally is presently being met. Current expenditure works out to less than three US cents per day per person injecting drugs.^{1011 12}

Approximately US$160 million was spent on HIV-related harm reduction in low and middle income countries in 2007, falling far short of the US$2.13 billion that UNAIDS estimates was needed in 2009, and the $3.2 billion in 2010.

Action required: National and international resources for HIV-related harm reduction must be scaled up as a matter of urgency.

Commitment: “Eliminate gender inequalities, gender-based abuse and violence; increase the capacity of women and adolescent girls to protect themselves from the risk of HIV infection, principally through the provision of health care and services” [paragraph 30]

Women and girls who inject drugs are more vulnerable to drug-related harms, including HIV infection, than are men who inject drugs.¹³ In a number of regions globally, injecting drug use is often perceived to conflict with the “socially derived roles of women as mothers, partners and caretakers”, exposing them to greater stigma and human rights violations than men who inject drugs.^{13 14 15} Most women do not have access to services that meet their sexual and reproductive health needs and increase their capacity to protect themselves from HIV infection.¹⁶ Incarcerated women who inject drugs face elevated health risks, including HIV infection, than do non-incarcerated women, yet have little or no access to legal frameworks and services that address their particular needs.^{17 18 19}

Action required: Gender-specific services and policies that facilitate their implementation are urgently required to ensure that women who inject drugs can effectively protect themselves from HIV infection.

Commitment: “Address the rising rates of HIV infection among young people to ensure an HIV-free future generation through the implementation of comprehensive, evidence-based prevention strategies” [paragraph 26]

Young people are increasingly affected by HIV and other harms associated with drug injecting.^{20 21} While we know that early intervention is necessary across age groups, legal barriers often prevent their implementation.^{22 23} In accordance with recent recommendations by the UN Committee on the Rights of the Child, there remains a need to provide “specialised and youth friendly...harm reduction services for young people” and to “amend laws that criminalise children for possession or use of drugs” in countries where such policies continue to be enforced.²²

Action required: In order to effectively address drug injecting among young people, legal age restrictions for accessing sterile equipment and opioid substitution therapy must be lifted. Services integrating harm reduction, HIV testing and prevention, and sexual and reproductive health for young people must be made widely accessible.

Commitment: “Overcome legal, regulatory or other barriers that block access to effective HIV prevention, treatment, care and support” [paragraph 15]

There is clear evidence that criminalisation of people who use drugs and law enforcement have not only failed to reduce the prevalence of drug use, but have created harms that fuel the HIV epidemic.^{23 24 25 26} Many countries continue to prohibit the provision of sterile injecting equipment and opioid substitution therapy and criminalise drug possession and paraphernalia.^{2728 29 30}

Such measures can drive people who inject drugs away from prevention and care services and increase the risk of HIV infection. People who inject drugs face further discrimination in terms of access to effective HIV treatment.

Action required: Ineffective and punitive drug policies, particularly criminalisation of drug possession, must be reformed to ensure the realisation of human rights, and to support the implementation of evidence-based interventions for people who inject drugs, as outlined in the Vienna Declaration.³¹

Commitment: “Eliminate all forms of discrimination against and ensure the full enjoyment of all human rights and fundamental freedoms by people living with HIV and members of vulnerable groups” [paragraph 29]

People who inject drugs, particularly women, continue to experience multiple layers of stigma and discrimination that effectively undermine HIV prevention, treatment and support efforts.^{3233 34 35 36} Record incarceration figures due to drug law enforcement have led to overcrowding and poor conditions in prisons.^{37 38}

Severe human rights violations against people who use drugs, such as cruel, inhuman and degrading treatment, arbitrary arrest and detention, and extortion and police violence have been documented widely in a number of countries.

Action required: Punitive and discriminatory measures must be discontinued, and adequate resources dedicated to promoting health and human rights-based responses to drug use and HIV.

References

¹ UNAIDS (2010) Global Report on the AIDS Epidemic. View report Geneva: The Joint United Nations Programme on HIV/AIDS.
² Mathers B et al (2008). The global epidemiology of injecting drug use and HIV among people who inject drugs: A systematic review. Lancet, 372 (9651), 1733-1745.
³ Mathers B et al (2010). HIV prevention, treatment, and care services for people who inject drugs: A systematic review of global, regional, and national coverage. Lancet, 375, DOI:10.1016/S0140-6736(10)60232-2.
⁴ 2001 Declaration of Commitment on HIV/AIDS, UN GA Special Session on HIV/AIDS, 25-27 June 2001, paragraph 7.
⁵ Political Declaration on HIV/AIDS UN GA Res 60/262, 2 June 2006, paragraph 14.
⁶ Cook C. (2010) The Global State of Harm Reduction: Key Issues for Broadening the Response. London: International Harm Reduction Association.
⁷ Mathers, B. Degenhardt, L. Ali, H. Wiessing, L. Hickman, M. Mattick, R. P. Myers, B. Ambekar, A. Strathdee, S. A. HIV prevention, treatment, and care services for people who inject drugs: a systematic review of global, regional, and national coverage. The Lancet. 2010 Mar. 20: 375(9719):1014-28.
⁸ WHO, UNODC, UNAIDS (2009) Technical Guide for Countries to Set Targets for Universal Access to HIV Prevention, Treatment and Care for Injecting Drug Users. Geneva: World Health Organisation.
⁹ Jurgens R. (2010) ‘Out of sight, out of mind: Harm reduction in prisons and other places of detention.’ In The Global State of Harm Reduction: Key Issues for Broadening the Response. London: International Harm Reduction Association.
¹⁰ Stimson G., Cook C., Bridge J., Rio-Navarro J., Lines R., Barrett D. (2010) Three Cents a Day Is Not Enough: Resourcing Harm Reduction on a Global Basis. London: International Harm Reduction Association.
¹¹ Stimson G., Cook C., Bridge J., Rio-Navarro J., Lines R., Barrett D. (2010) Three Centre a Day Is Not Enough: Resourcing Harm Reduction on a Global Basis. London: International Harm Reduction Association.
¹² UNAIDS (2007) Financial Resources Required to Achieve Universal Access to HIV Prevention, Treatment, Care and Support. UNAIDS Inter-agency Task Team on Young People. World Health Organisation: Geneva.
¹³ Roberts A., Mathers B. and Degenhardt L. (2010) Women who inject drugs: A review of their risks, experiences and needs. Secretariat of the Reference Group to the UN on HIV and Injecting Drug Use. National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, Australia.
¹⁴ Sherman, S.G., Women and drugs across the globe: A call to action. International Journal of Drug Policy, 2008. 19(2): p. 97‐98.
¹⁵ Olszewski, D., Giraudon, I., Hedrich, D., Montanari, L., Women's Voices: Experiences and perceptions of women who face drug‐related problems in Europe. 2009. European Monitoring Centre for Drugs and Drug Addiction.
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¹⁷ Ashdown J. and James M. (2010) Women in Detention. International Review of the Red Cross. Volume 92: 877.
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¹⁹ WHO, UNODC (2009) Women’s health in prison: correcting gender inequity in prison health. Download PDF. Copenhagen, Denmark.
²⁰ EHRN (2009) Young people and injecting drug use in selected countries of Central and Eastern Europe. Eds. Jean-Paul Grund and Simona Merkinaite. Eurasian Harm Reduction Network View PDF.
²¹ WHO (2006) Preventing HIV/AIDS in Young People: A systematic review of the evidence from developing countries. Eds. David A. Ross, Bruce Dick and Jane Ferguson. UNAIDS Inter-agency Task Team on Young People. World Health Organisation: Geneva.
²² Committee on the Rights of the Child (2011) Fifty-sixth session: Consideration of Reports Submitted by States Parties Under Article 44 of the Convention.
²³ Degenhardt L, Chiu W-T, Sampson N, et al. (2008) Toward a global view of alcohol, tobacco, cannabis, and cocaine use: Findings from the WHO World Mental Health Surveys. PLOS Medicine. 5:1053-67.
²⁴ Jurgens R, Ball A, Verster A. (2009) Interventions to reduce HIV transmission related to injecting drug use in prison. Lancet Infectious Disease. 9:57-66.
²⁵ The National Centre on Addiction and Substance Abuse at Columbia University (2009). Shoveling up II: The impact of substance abuse on State budgets. New York: Columbia University.
²⁶ Reuter P. (2009) Ten years after the United Nations General Assembly Special Session (UNGASS): assessing drug problems, policies and reform proposals. Addiction 2009;104:510-7.
²⁷ Reuter P. (2009) Ten years after the United Nations General Assembly Special Session (UNGASS): assessing drug problems, policies and reform proposals. Addiction. 104:510-7.
²⁸ Lert F. and Kazatchkine M.D. (2007) Antiretroviral HIV treatment and care for injecting drug users: an evidence-based overview. International Journal of Drug Policy. 18:4.
²⁹ IHRD (2008). Harm Reduction Developments 2008: Countries with Injection Driven HIV Epidemics. New York: International Harm Reduction Development Program (IHRD) of the Open Society Institute.
³⁰ Wolfe D., Carrieri P. and Shepard D. (2010) Treatment and care for injecting drug users with HIV infection: a review of barriers and ways forward. Lancet. 376: 9738, 355-366.
³¹ The Vienna Declaration (2010) View declaration.
³² Ahern J, Stuber J, Galea S. (2007) Stigma, discrimination and the health of illicit drug users. Drug and Alcohol Dependence. 88:188.
³³ Gallahue P. and Lines R. (2010) The Death Penalty for Drug Offences: Global Overview 2010. The International Harm Reduction Association. London: International Harm Reduction Association (IHRA).
³⁴ Open Society Foundations (2010) Human Rights and Drug Policy Briefings for the UN Commission on Narcotic Drugs “Briefing 2: Human Rights and Drug Policy: Drugs, Criminal Laws and Policing Practices.” Download PDF. December 2010.
³⁵ Human Rights Watch (2010) Where Darkness Knows No Limits: Incarceration, Ill-treatment and Forced Labour as Drug Rehabilitation in China. Ed. Joseph Amon. New York: Human Rights Watch.
³⁶ IHRD (2009) Human Rights Abuses in the Name of Drug Treatment: Reports from the Field. New York: International Harm Reduction Development Program (IHRD) of the Open Society Institute.
³⁷ United Nations General Assembly. A/65/255 Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. Paragraph 68.
³⁸ C. Hughes and A. Stevens (2007) The Effects of Decriminalization of Drug Use in Portugal. The Beckley Foundation Drug Policy Programme. Briefing Paper 14.