A significant positive outcome has already emerged from next year’s UN General Assembly Special Session (UNGASS) on drugs in the form of much more direct engagement in key drug policy issues from a range of UN agencies - beyond the prohibitionist silo of the UN Office on Drugs and Crime (UNODC). Civil society organisations have, for years, been attempting to highlight the negative impacts of the international drug control system on issues relating to the core UN pillars of human rights, development, and peace and security. But these are not thematic areas that have been routinely evaluated or reported on in any consistent or in-depth way by the key UN drug control bodies – the UNODC, the International Narcotics Control Board (INCB) or the Commission on Narcotic Drugs (CND). You will not, for example, find chapters on the human rights or development implications of drug enforcement in the UNODC’s flagship annual 'World Drug Report'.
But the invited submissions to the UNGASS process from the wider family of UN agencies, representing a much more diverse body of thematic expertise, have not held back in tackling what has previously been off limits in the high-level UN drug debate. Stand out contributions include those from the UN Development Program, UN Women, the Office of the High Commissioner on Human Rights, and UNAIDs. And another outstanding submission has arrived this week from the UN Special Rapporteur on the Right to Health, Dainius Pūras.
Special rapporteurs are appointed by the Office of the High Commissioner on Human Rights and are mandated by the United Nations to "examine, monitor, advise, and publicly report" on specific human rights issues – often relating to a specific right, in this case the right of everyone to the highest attainable standard of mental and physical health. As independent experts serving in an advisory role they are not bound to any agency or government, and have – in the high level debate at least – an unusual level of freedom to act as officially mandated critics of whatever they deem appropriate within their specific remit. This page provides more information on the special rapporteur.
I recommend you read the special rapporteur’s letter – which is short (6 pages) and clearly written. But here are a few highlights with commentary:
It opens with a harsh comment directed squarely at the UNGASS board at the Commission on Narcotic Drugs leading the drafting of the UNGASS outcome document. To learn more about the process see here, but essentially the UNGASS board is controlled by hardliners keen to stifle any criticisms of the status quo, and prevent discussion on contentious issues around reform. The highly politicised negotiations around this document are playing out right now – at the CND intercessional meeting in Vienna this week – so the raporteur's letter could not come at a more opportune moment:
"As Special Rapporteur on the right to health, I am concerned about the lack of explicit and clear human rights standards and commitments in the current negotiations for the UNGASS outcome document. While human rights is included as a theme, it has played a very minor role in the negotiations to date, and risks becoming a hollow opening paragraph with no meaningful debate, development or follow up.”
The main body of the letter then opens with a sweeping critique of the health harms fuelled by the different facets of repressive drug enforcement:
“Repressive responses to....drug use, rural crop production, and non-violent low level drug offences pose unnecessary risks to public health and create significant barriers to the full and effective realisation of the right to health , with a particularly devastating impact on minorities, those living in situations of rural and urban poverty, and people who use drugs.
A range of drug control measures undertaken to reduce the supply of illicit drug crops have had significant impacts on the mental and physical health of communities, particularly those affected by crop eradication. Epidemic levels of violence in communities located along illicit transit routes and affected by militarised State responses are of particular concern.”
The letter, unsurprisingly, restates well established UN opposition to the use of the death penalty for drug offences, and extra judicial killings in drug enforcement, but adds that:
“I am seriously concerned that State policies can contribute to and worsen violent criminal drug markets within which homicides increase significantly, and I call on States to focus their attention during the UNGASS on the reduction of violence related to the drug enforcement.”
The letter’s clear analysis on the right to health and decriminalisation of people who use drugs should further support the UNODC in re-issuing its clarification paper on decriminalisation (controversially withdrawn pre-publication last month). It will allow the UNODC to defend the position to member state objectors or, depending on how the opaque UNODC internal politics are playing out, it will make it impossible for the UNODC to backtrack on its right to health analysis – now supported so clearly by the UN’s Office of the High Commissioner on Human Rights, and the Office's appointed Special Rapporteur. It again makes it clear that criminalising people who use drugs is a violation of member state ratified treaty commitments to the right to health – an incredibly important fact to highlight in domestic and international advocacy.
“Criminal laws relating to drug use and related policing also have the clear health-deterrent effect of driving people away from the health services they need, impeding responses to HIV, hepatitis C, overdose, and drug dependence. The ineffectiveness of such criminal laws in delivering health benefits or deterring drug use is also now well established by evidence-based research.”
“At the root of many health related problems faced by people who use drugs is criminalisation itself, which only drives issues and people underground and contributes to negative public and individual health outcomes. As a step towards the fulfilment of the right to health, drug use and possession should be decriminalized and de-penalized alongside increased investment in treatment, education, and other interventions discussed further below.”
On access to treatment the letter makes it very clear that:
“The right to health requires that drug dependence treatment be available, accessible (physically, economically, geographically), acceptable (culturally, for women, for children and other key populations), and of sufficient quality, meaning based on the best available evidence."
The letter makes it clear that all treatment should be voluntary and based on informed consent, and also offers tacit support to Harm Reduction International’s 10by20 campaign calling for reallocation of counterproductive drug enforcement spending to treatment and harm reduction:
"Progressive realization of the right to health necessitates adequate budgetary allocation. It is disturbing to see that worldwide drug dependence treatment remains significantly under-resourced as compared with drug enforcement."
The letter makes clear demands on the issue of access to controlled medicines (for more on this topic see this recent report from the Global Commission on Drugs and this report from the OSF Global Drug Policy Program):
“Given the clear legal mandate within the drug treaties to ensure access to controlled medicines, and the concurrent obligation under the right to health, I urge the relevant UN drug control bodies to take a proactive role and focus on setting realistic targets for improving access on the ground by 2030, in line with the sustainable development goals.”
In a specific section on access to harm reduction the letter further underlies what is set to be a major flash-point at the UNGASS between the pragmatic public health position and the old-school drug war ideologues and denialists:
“...despite the strong emphasis on the provision of harm reduction programmes, the evidence of their effectiveness in achieving positive health outcomes, and the increasing number of Members States implementing a harm reduction response, the issue continues to be unproductively politicized within UN drug control debates.
The provision of harm reduction must not be seen as merely a policy option for States. Rather, the provision of these programmes for people who use drugs, including but not limited to the core UNODC/WHO/UNAIDS interventions, constitute a legal obligation as part of State obligations to progressively realize the right to health. Given the low priority assigned to harm reduction globally, reflected by the low levels of funding and implementation of these programmes in communities and prisons, I urge States to commit the maximum available resources to scale up investment.”
This above section has specific relevance to the UK Government (amongst many others) which still does not have needle and syringe programes available in prisons, despite both evidence of effectiveness, and a clear requirement under UN human rights treaty obligations - as the OHCHR and other UN agencies have repeatedly made clear.
Finally there is a particularly clear and welcome section on the rights of the child. The letter notes that whilst children have been named as the focus of the UNGASS, engagement with the issue of drug policy enforcement and child rights has in fact been ‘very limited’. It states:
“Historically, there has been insufficient attention to the many other ways in which children and their right to health are affected by drugs, the drug trade, and punitive State models. This includes children of incarcerated parents, incarcerated children, children in streets, children experiencing drug-related violence, children involved in the drug trade, children in families coping with drug dependence, and children who already use drugs for whom services remain inadequate.
One of the arguments used in support of the “war against drugs” and zero-tolerance approaches is the protection of children. However, history and evidence have shown that the negative impact of repressive drug policies on children’s health and their healthy development often outweighs the protective element behind such policies, and children who use drugs are criminalized, do not have access to harm reduction or adequate drug treatment, and are placed in compulsory drug rehabilitation centres.”
This letter is another devastating critique of the war on drugs, echoing much civil society analysis but now with the authority and imprimatur of UN agency expertise - building momentum for meaningful debate and change during the UNGASS process and beyond. These UN agency contributions in combination, make it more than clear that bland restatements of previous empty political declarations will not be acceptable for the UNGASS. There can be no more business as usual.