Addressing the development dimensions of drug policy

There are effective ways to address the harmful health and social consequences of drug use. A substantial body of evidence has shown that harm reduction interventions, including distribution of sterile syringes, drug dependence treatment and HIV testing and counselling, have proved eff ective in preventing HIV and viral hepatitis and preventing and reversing the eff ects of overdose. However, criminal laws, punitive policies and repressive policing practices limit and sometimes exclude altogether people who use drugs from access to these services, thus putting them at risk of serious disease and in some cases, premature death.

A substantial body of evidence shows the effectiveness of harm reduction interventions in preventing HIV and viral hepatitis, and preventing and reversing overdose. In light of this evidence, UNODC, WHO and UNAIDS all recommend that a comprehensive package of harm reduction services should be integrated into national AIDS programmes, both as an HIV prevention measure and to support adherence to antiretroviral therapy and medical follow-up for people who use drugs.

Discrimination, a lack of investment in health and social welfare and laws criminalizing drug use/possession of small amounts of drugs for personal use impede the access of people who use drugs to basic services such as housing, education, health care, employment, social protection and treatment

The international drug control system recognizes the “health and welfare of mankind” as its overarching concern. To succeed in meeting the Sustainable Development Goals (SDGs) as well as drug control objectives, UN organizations and Member States should more effectively align drug control efforts with this goal. They should commit to supporting the provision of viable and sustainable livelihoods for poor people. They should ensure that drug control measures protect human rights and do not impede access to HIV and other health services. As the UN programme on development and with the mission of helping countries to simultaneously eradicate poverty and significantly reduce inequalities and exclusion, UNDP’s engagement in the UNGASS 2016 discussion could contribute to shaping a more comprehensive, effective and humane approach to drug policy and positioning drug control efforts that reduce drug-related harms and promote human development within the framework of the SDGs. The implementation of the SDGs is also another important avenue for advancing development-sensitive drug control policies and practices.

In 2016, the United Nations General Assembly (UNGA) will hold a Special Session on drugs (UNGASS 2016) to assess and debate current and future international drug policies. In anticipation of UNGASS 2016, the Commission on Narcotic Drugs (CND), the UN organ with primary responsibility for drug control policy, adopted a resolution to ensure an adequate, inclusive and effective preparatory process for UNGASS 2016. This includes extensive consultation allowing relevant UN organizations, international and regional organizations, civil society and other relevant stakeholders to fully contribute to the process.

The global community is currently discussing the SDGs Agenda, intended to guide global development efforts for the next 15 years. Many drug policy experts have pointed out potential contradictions between the proposed SDGs and current drug policies stemming from the three international drug control conventions. For example, the SDGs aim to end poverty and hunger, protect the environment and promote sustainable livelihoods as well as health and wellbeing for all. However, current drug policies and their collateral consequences threaten these goals. They have fuelled and escalated violence and diverted limited funds and political attention away from public health and focused them disproportionately on law enforcement. They have also impeded access to lifesaving harm reduction interventions and essential medicines to treat pain and drug dependence. Drug production and trafficking, and related law enforcement activities, damage the environment by polluting water, contaminating soil and harming protected forests. At the same time, the international community, led by international and domestic drug control agencies and experts, is engaged in a global debate in the lead-up to UNGASS 2016.

Alternative development programmes that provide legal options to drug cultivation have been promoted as a way to wean farmers off drug crop production and onto legal crops or other non-agricultural activities. Alternative development policies have been aligned with drug control, public security and trade priorities rather than public health and development ones. The success of these alternative development programmes has been measured as a reduction in drug crop cultivation at the local or national level, without always taking into account human development indicators or the ‘balloon effect’ on other regions.40 Several factors have curtailed their effectiveness and potential impacts on development, as well as increased vulnerability of target communities. These include the failure to ensure that viable, sustainable livelihoods are established and alternative sources of income are in place prior to significant drug crop productions, local ownership or meaningful participation of farmers, as well as poor design, fragmented implementation and poor funding.

(…)To this end, development experts have also pointed out that successful alternative development depends on many factors including long-term investments by governments and international donors; integration of sustainable livelihood strategies in local, regional and national development plans; coordination of drug control and development experts and agencies; existence of sound monitoring and evaluation mechanisms; local ownership; development of markets and infrastructure for crops or products that replace drug crops; and the meaningful involvement of farmers as citizens with rights and partners in development.

Evidence shows that harm reduction interventions not only save lives, they save money. Public health cost effectiveness experts focusing on HIV and drug use have, therefore, consistently and repeatedly called on countries with significant HIV epidemics among people who use drugs to invest immediately in harm reduction. They have also advised that failure to do so will bring enormous and avoidable human and financial costs.

The drug conventions require governments to take steps to reduce supply and demand for controlled drugs. These efforts should be balanced with States’ obligations to ensure an adequate supply of narcotic and psychotropic drugs for medical and scientific purposes and consistent with their human rights obligations. The obligation to provide access to essential medicines is a core component of the right to health.

Several drugs subject to control under the international drug control conventions are also on the WHO’s Model List of Essential Medicines, including morphine for pain treatment, and methadone and buprenorphine for OST.70 WHO has recognized that strong opioids, such as morphine, are essential for the relief of moderate to severe pain, and that providing methadone or buprenorphine for the treatment of opiate drug dependence is essential to meet minimal standards of health care provision.71 Despite this, worldwide, only a fraction of people who inject drugs have access to OST.72 Three quarters of the world’s population has no or insufficient access to treatment for moderate to severe pain, and each year tens of millions of people suffer untreated moderate to severe pain. Unnecessarily restrictive drug control regulations and practices are a significant barrier to access to effective pain treatment, as recognized by the INCB and WHO.

The death penalty for drug-related crimes is a violation of international law.

Excessive use of criminal justice mechanisms, the disproportionality of penalties for drug offences, including the death penalty and longterm incarceration, abuse of pre-trial detention and the enforcement of mandatory sentencing laws contribute to overload the judicial and prison systems, making them even more inefficient and undermining people’s confidence in them.

The absence of comprehensive harm reduction and effective prevention, treatment and care services and policies for people who use drugs contributes to increased prevalence of HIV and other infectious diseases.

UNDP could build on its experience working with Member States to review and shape laws and legal practices to create legal and human rights environments supportive of effective responses to HIV for people who use drugs and other marginalized populations. This work could provide a model for meaningful engagement with civil society and, in particular, with those most affected by drug-related problems to address drug laws, policies and practices that affect their lives and the communities in which they live.

Initiatives that result in higher levels of employment, more equitable access to resources, better protection against economic and environmental shocks, peaceful settlement of disputes, progress towards democratic governance, and comprehensive HIV and health responses that include harm reduction all can mitigate the negative impacts of drug production and trafficking and problematic drug use.

Promote the meaningful participation of communities including people who use drugs and  indigenous communities affected by drug control policies in the development and implementation of policies that affect them.

Address legal, regulatory and policy barriers to access to narcotic drugs for pain relief (e.g. morphine) and drug treatment (e.g. methadone and buprenorphine for opioid dependence)

(…) Take advantage of flexibilities available in the drug conventions on penalization of possession and use of controlled substances, including decriminalization of drug use and possession of small amounts of drugs for personal use

Support the provision of viable and sustainable livelihoods for small farmer-producers of illegal drug crops and ensure that alternative development programmes are nondiscriminatory and based on economically realistic alternatives

Advocate that illicit crop eradication not be undertaken until small-farmer households have been supported to adopt viable and sustainable livelihoods

Possible metrics to consider include, for example: (…) targets that address progress towards ensuring the “health and welfare of mankind”, including a decrease in the number of overdose deaths and infection rates for HIV, hepatitis B and C and other communicable diseases among people who use drugs; an increase in access to harm reduction, treatment demand and treatment access; an increase in investments in health and social welfare benefits, and in the number of people receiving such assistance; and a reduction in excessive and disproportionate punishments

The proposed SDG on health which calls for ensuring healthy lives and well-being for all at all ages does include a specific target on narcotic drugs to “strengthen prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol.” However there are some concerns among drug policy experts that the OWG proposal parcels drug-related issues across the different goals in a way that may undermine a coherent and comprehensive approach to drug policy and make it more difficult to evaluate the impact of drug-related issues on these goals.

Topics and principles at the core of the post-2015 agenda that cut across numerous SDGs and should be considered in relation to drug policy include:

• poverty eradication, sustainable consumption and production, and protection of the natural resource base of economic and social development;
• people-centred approaches: just, equitable and inclusive economic growth, social development and environmental protection to benefit all;
• freedom, peace and security, the rule of law, good governance, gender equality, women’s empowerment and commitment to just and democratic societies for development; respect for the Universal Declaration of Human Rights;
• the importance of international cooperation and of common but differentiated responsibilities; the need for different approaches depending on national or local circumstances and priorities; the need for additional resources for sustainable development; and
• improvement of the quality, coverage and availability of disaggregated data to ensure that no one is left behind.
  • Development/SDGs

According to drug policy experts, there are contradictions between the targets established in the global development agenda being debated for the post-2015 period and current drug policies emanating from the three drug conventions. The SDGs aim to promote sustainable development, including health and well-being for all. However, as described above, global drug policies and their unintended consequences have fuelled and escalated violence; disproportionately diverted limited funds and political attention away from public health to law enforcement; and impeded access to lifesaving harm reduction interventions and medications essential to treat pain and drug dependence.

Several SDGs aim to end poverty and hunger, protect the environment and promote sustainable livelihoods, but drug production and trafficking, and related law enforcement activities, degrade the environment by contaminating water and soil and harming protected forests.

A number of SDGs aim to promote human rights by combating discrimination, promoting gender equality and strengthening access to justice and government accountability at all levels. However, the illicit drug trade, and efforts to control it, have devastating impacts on indigenous people and on women and girls, have undermined democratic governance and the rule of law and threatened the human rights of people who live in communities where drugs are produced, through which they are trafficked and where they are sold. These contradictions need to be clearly presented and debated in the process of defining the new global agenda for sustainable development and, more intensely, during the evaluation of the international drug control system and its implementation on the road to UNGASS 2016.

Drug control policy should not be a negative factor hampering the attainment of national aspirations to advance human development and the post-2015 development agenda more broadly; instead, it must play a positive role in advancing these goals and objectives. The post-2015 development agenda provides an opportunity to establish different measures of success for drug policy, with a clear articulation of metrics related to the impact of drug policies on peace, development and human rights.