…at what cost ? …at what cost ?. Ten year review: Law enforcement at the expense of public health and human rights Major HIV epidemics among IDU

… …at what cost ?at what cost ?

Ten year review:Ten year review:

Law enforcement at the expense of public health Law enforcement at the expense of public health and human rightsand human rights

Major HIV epidemics among IDUMajor HIV epidemics among IDU Lack of drug treatment and abuses in the name Lack of drug treatment and abuses in the name

of drug treatmentof drug treatment

Law enforcement practices block drug users’ Law enforcement practices block drug users’ access to public health servicesaccess to public health services

In Russia and Ukraine, police oftenIn Russia and Ukraine, police oftenharass and arrest drug users whoharass and arrest drug users whoattempt to obtain health information attempt to obtain health information

andandsterile syringes from drug stores andsterile syringes from drug stores andlegal syringe exchange sites. legal syringe exchange sites.

In China, police are known to wait byIn China, police are known to wait bysyringe distribution points to arrest syringe distribution points to arrest

drugdrugusers. Outreach workers have beenusers. Outreach workers have beenfollowed and detained. followed and detained.

In Thailand, police regularly interfere with In Thailand, police regularly interfere with drug users’ efforts to seek health care by drug users’ efforts to seek health care by harassing clients outside of drug treatment harassing clients outside of drug treatment centers and use possession of sterile centers and use possession of sterile syringes, or presence at a methadone clinic, syringes, or presence at a methadone clinic, as a basis for harrassment or arrest. as a basis for harrassment or arrest.

Law enforcement approaches associated with Law enforcement approaches associated with police use of excessive force and human police use of excessive force and human

rights violationsrights violations

Drug enforcement in China, Kazakhstan, Russia, and Ukraine, Drug enforcement in China, Kazakhstan, Russia, and Ukraine, has been associated with police extortion and violence against has been associated with police extortion and violence against suspected drug users. suspected drug users.

In Thailand, a federally ordered police crackdown resulted in In Thailand, a federally ordered police crackdown resulted in reports of thousands of extra-judicial killings of suspected drug reports of thousands of extra-judicial killings of suspected drug users. Many of those arrested report that police planted drugs users. Many of those arrested report that police planted drugs in their pockets, forced them to sign false confessions, or in their pockets, forced them to sign false confessions, or threatened to arrest them simply for not being enrolled in drug threatened to arrest them simply for not being enrolled in drug treatment. Recently, the Thai government announced a re-treatment. Recently, the Thai government announced a re-start of the killings and a few extrajudicial killings have already start of the killings and a few extrajudicial killings have already been reported. been reported.

In Kazakhstan, police come to drug-dealing points to conduct In Kazakhstan, police come to drug-dealing points to conduct body cavity searches, which women IDUs report lead to sex in body cavity searches, which women IDUs report lead to sex in exchange for the return of seized drugs. exchange for the return of seized drugs.

As many as 1.7 million people are living with HIV in Eastern Europe and Central Asia

Injection drug use is the single most significant driving force behind the epidemic in the region

IDU accounts for more than 70 percent of cumulative HIV cases in Eastern Europe and Central Asia

HIV Epidemics: HIV Epidemics: Mostly or Almost Mostly or Almost

Entirely among Drug Entirely among Drug Users, FSUUsers, FSU

IDUs as Share of Total HIV Cases select low/middle income countries

2006

52%

70%62%

44%

83%

00.10.20.30.40.50.60.70.80.9

China Russia Ukraine Malaysia Vietnam

HIV among drug usersHIV among drug users

MethadoneMethadone

Categorization as Schedule 1 (1961 Categorization as Schedule 1 (1961 Convention) not suited to data and Convention) not suited to data and realities of 2005realities of 2005

No comment by INCB on countries that No comment by INCB on countries that ban the treatmentban the treatment

Methadone proven to reduce injecting Methadone proven to reduce injecting & demand for illegal opiates, and & demand for illegal opiates, and increase adherence to ARV treatmentincrease adherence to ARV treatment

Perpetual Pilot or no Perpetual Pilot or no methadone at allmethadone at all

Poland has over 35,000 opiate users but only Poland has over 35,000 opiate users but only about 1000 methadone treatment slotsabout 1000 methadone treatment slots

Russia—1/2 million+ opiate users, no Russia—1/2 million+ opiate users, no substitution treatment. Russian policies substitution treatment. Russian policies often often influence neighboring countries. influence neighboring countries.

Tajikistan still considering, but not Tajikistan still considering, but not treatmenttreatment

Methadone Maintenance Clinic (China)

Over-Control Makes Treatment Over-Control Makes Treatment InaccessibleInaccessible

Treatment philosophy organized around often Treatment philosophy organized around often unrealistic goal of complete abstinenceunrealistic goal of complete abstinence

Waiting lists, age limits, requirement of Waiting lists, age limits, requirement of documented attempts at abstinence, review by documented attempts at abstinence, review by commissioncommission

Prohibitive fees passed to patients; corrupt staff Prohibitive fees passed to patients; corrupt staff demand bribesdemand bribes

Police interferencePolice interference Lack of take-home doses disrupts livesLack of take-home doses disrupts lives Punitive urine testing and body searchesPunitive urine testing and body searches

Abuses in the name of “treatment”Abuses in the name of “treatment” No international standards for evidence-based drug No international standards for evidence-based drug

treatmenttreatment

Any intervention, no matter how inappropriate and Any intervention, no matter how inappropriate and ineffective can be considered “drug treatment”ineffective can be considered “drug treatment”

Photos courtesy Jimmy Dorabjee

Locked wards as Locked wards as treatmenttreatmentMoscow Substance Abuse Moscow Substance Abuse Hospital #17, 46 dead, Hospital #17, 46 dead, December 2006December 2006 http://news.ntv.ru/99430/

Women and drug useWomen and drug use

Global inattention to women drug users:

UNODC 2006 World Drug Report, which relies in large part on national self-reporting, makes more references to the female cannabis plant (14) than to women drug

users (5)

This despite assertions in 2005 report that number of women drug users was increasing and injection-driven

HIV epidemics were feminizing.

HOW ARE WE DOING?HOW ARE WE DOING?

GovernmentsGovernments treat drug users like drugs: as something treat drug users like drugs: as something to be controlled and containedto be controlled and contained

Mass incarceration, forced institutionalization and Mass incarceration, forced institutionalization and registration are a normregistration are a norm

Harm reduction not anywhere near required scale Harm reduction not anywhere near required scale

None of the most affected counties have national scale, None of the most affected counties have national scale, effective substitution treatment, and most do not have effective substitution treatment, and most do not have pilot programspilot programs

Instead, punitive, abusive interventions are considered Instead, punitive, abusive interventions are considered “drug treatment”“drug treatment”

Thank youThank you

[email protected]@sorosny.org