This was the second thematic report on drug control from a UN human rights mechanism (See also the report on the Special Rapporteur on Torture submitted to the UN Human Rights Council in 2009). The report strongly endorses harm reduction as an aspect of the right to health.
Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health (A/65/255)
6. The Special Rapporteur recommends that human rights be integrated into the international response to drug control, through use of guidelines and indicators relating to drug use and possession, and that the creation of an alternative drug regulatory framework should be considered. Additionally, Member States should ensure that harm-reduction measures and drug-dependence treatment services are available to people who use drugs, especially focusing on incarcerated populations. They also should reform domestic laws to decriminalize or de-penalize possession and use of drugs, and increase access to controlled essential medicines.
30. Some of the most egregious violations of the right to health have occurred in the context of “treatment” for drug dependence. Criminalization of drug use fuels the perception that people who use drugs are unproductive criminals or moral degenerates, which in turn allows disciplinary treatment approaches to proliferate. In place of evidence-based medical management, Governments and enforcement authorities coerce or force drug-dependent individuals into centres where they are subject to ill-treatment and forced labour. This approach discriminates against people who use drugs, denying them their right to access medically appropriate health-care services and treatment.
31. The present report concerns compulsory treatment programmes that primarily utilize disciplinary interventions, disregarding medical evidence. In such settings, medical professionals who are trained to manage drug dependence disorders as medical illnesses are often inaccessible.48 Forced labour, solitary confinement and experimental treatments administered without consent violate international human rights law and are illegitimate substitutes for evidence-based measures such as substitution therapy, psychological interventions and other forms of treatment given with full, informed consent.
32. The enjoyment of the right to health includes, inter alia, access to health facilities, goods and services that are scientifically and medically appropriate and of good quality and the “right to be free from interference, such as the right to be free from torture, non-consensual medical treatment and experimentation”.49 Moreover, article 7 of the International Covenant on Civil and Political Rights declares that “no one shall be subjected without his free consent to medical or scientific experimentation”. States are obliged to respect, protect and fulfil the enjoyment of the right to health, including by refraining from using coercive medical treatments, except in the narrowest possible circumstances for the treatment of mental illness or the prevention and control of communicable diseases.50 The requirements of informed consent must be observed in administering any treatment for drug dependence — including the right to refuse treatment.51 33. Compulsory treatment primarily infringes the right to health in two ways. First, this “treatment” generally disregards evidence-based medical practices, and thus fails to meet the quality element of the right to health, as elaborated by the Committee on Economic, Social and Cultural Rights.52 Second, treatment is often conducted en masse and disregards the need for informed consent to be given on an individual basis.
33. Compulsory treatment primarily infringes the right to health in two ways. First, this “treatment” generally disregards evidence-based medical practices, and thus fails to meet the quality element of the right to health, as elaborated by the Committee on Economic, Social and Cultural Rights. Second, treatment is often conducted en masse and disregards the need for informed consent to be given on an individual basis.
38. As examined in a previous report of the Special Rapporteur, informed consent to treatment is a cornerstone of the right to health, the requirements of which would be satisfied on extremely rare occasions in forced administration of punitive treatment. Decisions regarding capacity and competence, and the need to obtain informed consent, must be made on a case-by-case basis. Treatment en masse prima facie fails to meet this requirement.
41. The Single Convention on Narcotic Drugs recognizes the medical use of narcotic drugs that are indispensable for “the relief of pain and suffering”. UNODC and the International Narcotics Control Board possess oversight functions over States to ensure that drug control treaty obligations are implemented. As many barriers to adequate access to controlled essential medicines are regulatory, they can be changed quickly and inexpensively. However, many countries have failed to adapt their drug control systems to ensure adequate medication supply; those systems were often enacted before contemporary treatment methods for chronic pain and drug dependence were known or devised.66 That constitutes an ongoing infringement of the right to health, as the Committee on Economic, Social and Cultural Rights has elaborated that access to essential medicines is a minimum core obligation of the right, and States must comply immediately with this non-derogable obligation regardless of resource constraints.
42. Restricted access to opioids has an obvious impact on the availability of OST (see discussion in section VI below). However, there are three other primary areas in which access to controlled medicines is essential: (a) management of moderate to severe pain, including as part of palliative care for people with life-limiting illnesses; (b) certain emergency obstetric situations; and (c) management of epilepsy.
76. Member States should:
See paragraphs 50-61 of the report for a detailed discussion.