Interview with i.t.a.
INPUD works for the human rights of people who use drugs. What rights exactly and how are these rights being undermined?
In most countries three international treaties that together comprise the global regime of drug prohibition criminalize the possession of certain drugs and non-medical drug use. At the same time, an almost global failure to address the risks associated with drug use has led to a human rights crisis among people who use illegal drugs that fuels our vulnerability to abuse, discrimination, incarceration, blood borne viruses, and death. The so called war on drugs has been in practice a war on people who use drugs and their communities, it is this war on drugs that has fuelled the systematic abuse of the human rights of people who use drugs. Harsh national and international drug laws and repressive policies are widely implemented in a fashion that makes the violation of drug users’ human rights systemic and inevitable. This repression of people who use, and specifically, inject drugs, doesn’t just lead to rights violations, but in the context of HIV/AIDS and hepatitis C is lethal as it drives people who use drugs away from appropriate HIV and hepatitis C prevention programs (where they are provided) as well as from appropriate treatment and care services. A marked example of the rights that are violated is the right to the highest attainable standard of health as in many countries around the world, the evidence based programs (often called harm reduction programs and including needle and syringe programs, opiate substitution therapy, and provision of the drug naloxone that can be used to reverse opiate overdoses) that can protect the health of people who inject drugs are illegal, or are poorly implemented.
Other examples of rights violations include the use of withdrawal syndrome to extract false confessions from opiate users in police custody; the refusal to provide treatment for HIV and HCV on the basis of an individuals’ drug use; the denial of access to Federal aid for higher education for those convicted of drug related crimes in the US; mass incarceration for what is effectively a victimless crime; and notably in Thailand in 2003 a bid to make the country “drug free” that led to the murder by the police and armed forces of nearly 3000 people who were, or were suspected to be, users of illegal drugs. Finally, across South East Asia tens of thousands of people who use drugs are thrown in to forced “treatment centres” where they are subject to well documented torture, forced labour, a lack of access to medical treatment, and other widespread human rights abuses. In March 2013, Juan Mendez, the United Nations Special Rapporteur on Torture found that the denial of methadone to opiate dependent people is in and of itself “ill treatment and possibly torture”, and that the “common practice of withholding anti-retroviral treatment from HIV-positive people who use drugs […] amounts to cruel and inhuman treatment”. Anand Grover the UN Special Rapporteur on the right of everyone to the highest attainable standard of physical and mental health found that “criminalizing drug use or imposing punitive measures against drug use has a disproportionate impact on the health of people who use or are dependent on drugs”. I quote these two eminent authors of official UN reports to show that recognition that criminalization of drug use drives systematic abuses of the rights of people who use drugs is not confined to a small fringe but is widely accepted at the highest international levels. Unfortunately, the international laws that maintain the conditions in which such abuses flourish show little sign of being seriously revised or scrutinized, still less dismantled.
Some people would say that people who use drugs forgo their rights because of their usage; how would INPUD respond to this?
Human rights are by definition universal, inalienable, and indivisible. This means that they belong to every human being without discrimination or discretion – one can no more lose one’s entitlement to human rights than one can cease to be human, and finally, one cannot be denied rights because someone, or a government, decides that one group of people is “less human” or “less deserving” than another.
What is the Vancouver Declaration? How and when did it come about and what has its impact been?
There have been several attempts to set up an international network of drug user activists over the last two decades. The first attempt was in 1992 when a group of activists gathered in Melbourne for the 1st World Meeting of Injecting Drug User Groups (this was held, as have most other major gatherings of drug user activists, alongside the International Conference on the Reduction of Drug Related Harm, or IHRC), this meeting led to the short lived International Drug User Network – members continued to meet for some years at the annual international conferences, but without funding it became impossible to sustain the network.
In 2005 the IHRC was held in Belfast, and here a meeting identified the creation of a new network as a priority – a core group of activists was formed and tasked with setting up the International Network of People who Use Drugs (INPUD).
The Vancouver Declaration came about at the International Harm Reduction Conference in 2006 during which the first International Drug Users’ Congress was held; this was the first major face-to-face opportunity for activists to define the goals, concept and values of the network. More than 120 activists took part in the process that resulted in the Vancouver Declaration, which became INPUD’s founding document. A second International Drug Users’ Congress was held in Warsaw in 2007, shortly after which INPUD was legally registered as an organization with an office, one paid member of staff, an elected Board, and a growing membership. This iteration of INPUD did not last and so a third congress was held at the premises of the Danish Drug Users’ Union on International Drug Users’ Day 2008.
The Copenhagen meeting started work on drafting a constitution, and brought in a consultant to set up the necessary internal structures, begin networking with multilateral agencies, and other key partners, and raise funds to support a fully staffed network. The current Executive Director was recruited in November 2011, with the other two staff members joining in the subsequent 4 months.
The Vancouver Declaration has had an enormous impact in that not only did it galvanise the bulk of the world’s most respected user activists around a common manifesto, but it gave legitimacy to the concept of “nothing about us, without us” as it applies to people who use drugs. The declaration has impressed on the UN bodies responsible for HIV, public health more generally, and human rights the imperative of meaningfully involving people who use drugs in all policy decisions and processes that impact upon our lives.
INPUD works through the UN system and other mechanisms to ensure that the voices and concerns of the drug using community are heard and taken into consideration when drafting policy, and writing guidelines that relate to our health, human rights and well being. Whilst we have a long way to go to achieve these aims, we have at the very least made it impossible for any respected body to hold a meeting discussing any issue that relates to our lives without involving INPUD in some way. In addition to the international network, there are also sister Asian, Eurasian, European, Middle Eastern, and Latin American networks, as well as groups in two sub-Saharan African countries dedicated to the same aims and united by the same principles.
What is INPUD’s view of the prohibitionist system?
As far as INPUD is concerned the vast bulk of the health and human rights problems that people who use drugs face are systematically driven by the prohibitionist system – they are not accidents or occasional abuses, but are systematically driven by it. In most countries, the three drug control conventions are implemented in the most punitive fashion possible, often criminalizing the very harm reduction interventions that are proven to prevent the transmission of blood borne viruses amongst the drug injecting community. Prohibition furthermore makes it impossible to ascertain the quality of the drugs that one is using or to ascertain whether or not they have been cut with dangerous contaminants – this risk has led to such diverse tragedies as the recent deaths of up to 50 heroin users due to anthrax contaminated heroin, and more recently the deaths of tens of young people who use drugs as a result of PMA contaminated ecstasy.
The fact is that millions of people around the world choose to use drugs that were quite arbitrarily made illegal a little over a hundred years ago, and most of them do so without any problem or health consequences. What prohibition has done is to gift the third most lucrative set of commodities in the world (after weapons and fuel) to organized crime and terrorist organisations. The last thing that these groups have on their minds is the health of those who consume the products that they traffic, or the welfare of the peasant farmers who produce drug crops. This has produced massive corruption, the creation of a series of failed narco-states, and massive violence as rival drug crews fight for territory. The profits available to them are immense and if regulated could be put to enormous good use. As I said above, these policies also drive massive, sustained human rights abuses and public health problems by preventing people who use drugs from accessing appropriate health care, and give many governments an excuse not to provide them at all.
However, the pursuit of drug war politics means that the only drug users that are visible are those that have run into problems associated with their drug use – however more often than not, those who do have such problems, also have a complex combination of other problems, mental ill health, poverty, lack of education, homelessness. The profound stigma that is directed against people who use drugs means that those who do so without problems choose to conceal the fact of their drug use, indeed they never become visible to the authorities unless they do run into problems, and more often than not those problems (and most authorities agree on this) are created by the repressive legal environments that prohibition creates, rather than the drugs themselves. However those who have been ‘outed’ as users of illegal drugs find themselves the victims of massive, systemic stigma and discrimination that can range from being denied housing, employment, education, and access to appropriate health care. It is, in our view, the global system of prohibition, or the war on people who use drugs, that creates or at least exacerbates most of the problems that we face. To quote one of our early documents “The spread of HIV, hepatitis C, and the incarceration of hundreds of thousands of people are all a direct result of completely misguided policies driven by dogma. The International Network of People Who Use Drugs (INPUD) calls for an end to this war on our people and for a new period of peace and intelligent open debate.”
What is an alternative paradigm that INPUD espouses?
INPUD supports and advocates for the full scale dismantling of the system of global prohibition and its replacement with a regulated market for drug products – in other words we call for an immediate ceasefire in the war on our people. This would ensure that people who use drugs would know that the products that they are consuming are what they claim to be, that they do not contain dangerous contaminants, and that they are of a known quantity. This would immediately cut the ground away from organized crime by denying them of the massive profits that they are currently making, would help to stabilize narco-states, and would guarantee drug crop producers a fair price for their crops. Under the present system young people are not given accurate information about drug use, only the known to be useless, counterproductive, “just say no” messages.
What is the Drug User Peace Initiative and what does it seek to achieve?
The Drug User Peace Initiative is our campaigning arm dedicated to calling for an end to the war on drug users – it is open both to people who use drugs, as well as our supporters.
As the prohibitionist stance is unlikely to change overnight what changes should be implemented now under the current system?
The international treaties that comprise global prohibition do have some flexibility in them, however these are rarely used, and in the main states interpret them in the most punitive fashion possible. So, in the interim and before their dismantling, we call for the immediate end to all criminal sanctions for people who use and possess drugs; for an amnesty for, and the immediate release of, all drug war prisoners; for a closure of the forced treatment centres that exist across South East Asia. We advocate for universal access to quality, user friendly, peer run harm reduction services including safe consumption rooms for smokers as well as injectors, the expansion of heroin prescribing, as well as Dexedrine and other stimulants for dependent stimulant users – under the old ‘British System’, cocaine users were prescribed pharmaceutical cocaine, more research is needed to look at such provision, we call too for harm reduction services to provide sterile crack smoking equipment, as well as for publicly accessible places to safely dispose of used drug consumption materials; in addition we call for the widespread and easy availability as well as peer distribution of naloxone, the drug whose sole and only use is to reverse opiate overdoes (all of these things are legal under the current regime, but most governments refuse to implement them) both inside and outside of prisons; we call for the widespread provision of pill testing at clubs and parties so that ravers will know what is in the pills that they are using; we call for an end to the widespread human rights abuses to which we are subject; a systematic and widespread attempt to combat the stigmatizing, discriminatory attitudes that are directed against users of illegal drugs, and a dismantling of the systemic barriers that prevent people who use drugs from living healthy, fulfilled lives. We call for an abolition of national registries of drug users where they exist, and for an end to mandatory and compulsory HIV testing and forced treatment for people who use drugs. We call upon governments that maintain punitive conditions to repeal them such as the US government’s federal ban on funding needle and syringe exchange programs, or the Russian government’s ban on opiate substitution programs. We also call upon governments everywhere to make decisive and concerted efforts to begin the process of reviewing, reforming, and abolishing the three conventions that together underpin the war on people who use drugs.
There is a high level of diseases such as HIV/AIDS and Hepatitis C found within the community of people who use drugs. Is this due to the drug use itself or other factors?
Yes there is a very high level of both HIV/AIDS and hepatitis C amongst the community of people who use, and in particular those who inject illegal drugs – in some regions prevalence rates of both can be as high as 90%, one in three new HIV infections outside sub-Saharan Africa is amongst people who inject drugs, and in many parts of the world the epidemic is being driven by transmission amongst our communities. However neither disease is in any way caused by the use of drugs themselves, and nobody claims that this is the case. Both diseases are caused by blood to blood contact with somebody carrying either the HIV or HCV virus. The reason why the drug using, and in particular, the injecting community has such a high burden of both diseases is entirely due to a massive lack of access to, and willingness to provide, sterile injecting equipment, this has meant that people who inject drugs have been forced to share injecting equipment. What this means is that these two entirely preventable diseases (both of them treatable and one of them, HCV, curable) which lead to millions of totally unnecessary deaths, and immense suffering are being systematically created and driven by an irrational politics driven by morality that refuses to provide sterile injecting equipment to those that need it. Nobody who injects drugs wants to share a needle or syringe, but many are forced to do so because of a sheer intransigence on the part of their governments and the moralistic refusal to do what all of the evidence has proven to be effective. Governments know, scientists know, public health experts know how to prevent the transmission of HIV and HCV amongst the drug injecting community, yet there remains a stony resistance to do what is right, what is effective, and what is necessary. It is no exaggeration to say that the war on people who use drugs is a massacre in slow motion, a massive breach of human rights on a catastrophic scale.
It is a common perception that drug usage and drug addiction are a disease. What is INPUD’s take on the disease model?
INPUD completely rejects all of the various disease models used in an attempt to explain drug usage and dependence. In our view, drug use is a completely natural, universal part of human behaviour, and one that has been found in every documented civilization and society since the dawn of history. The use of opiates and cannabis is known to date back to 3000BC, widespread usage of coca leaves (the source of cocaine) is an intrinsic and very ancient part off meso-American culture. The usage of a wide range of mood altering, performance enhancing and consciousness expanding plant derived drugs is as ancient and widespread as humanity itself.
The attempt to define various forms of drug dependence as a disease dates back to the seventeenth century and has gone through many forms. The current models define it as a “brain disease”. However it is a very strange disease that is not diagnosed through the use of any diagnostic tools or clinical tests – no one has a brain scan when they visit a drug treatment centre, if it really was a “brain disease” it would need an MRI to confirm the diagnosis. What happens instead is that you tell a story about your drug use patterns, and if your use conforms to a pattern that has been found to be morally and socially unacceptable you are told that you are suffering from the disease of addiction. On the other hand, most people who are supposedly suffering from this “disease” ‘recover’ from it without any intervention whatsoever, whether it be medical or the voodoo of the 12-steps movement. Put it this way, if ‘addiction’ (and that word itself is not one that we use as it is so problematic, and used more often than not in a derogatory, stigmatizing fashion) is a disease, and the 12 steps movement (as well as much of the medical establishment, with some notable exceptions, concur on this) believes that it is, how on earth could it possibly be ‘cured’ by the simple act of declaring oneself to be suffering from it and attending meetings where one repeats one’s diagnosis (a diagnosis, by the way, that has not been made on the basis of any clinical test, by the analysis of any tissue or blood samples, and without any brain scan) ad nauseam.
No! Drug use, even dependent drug use is a behaviour, and like many behaviours it can become all-embracing and all consuming, a bit like the pursuit of a passion – violin playing or mountain climbing. We accept that some drugs, notably the opiates, can be heavily habit forming, and that once one has acquired a habit, ceasing the use of opiates can be extremely uncomfortable, even life threatening, however it is a habit that people choose to give up at will. Imagine if you could do the same with cancer, or any other real organic disease? In addition to there being no real diagnosis, there is no identifiable pathogen, clearly heroin is not a dangerous pathogen, in fact it is a widely used painkiller, and like the other opiates essential to the treatment of acute and chronic pain (although, one of the other, as yet unmentioned, side effects of prohibition has been to jeopardise the supply of opiates to people who need them for the treatment of pain and in palliative care). So no, we do not believe that drug use, even when it is dependent and daily is a disease, it is rather a behaviour. However, even dependent opiate use has no negative physical side effects – indeed heroin is an incredibly benign, non-toxic drug (when properly pharmaceutically manufactured and without contaminants) which does no damage to any bodily tissue or organ. The problems that one faces as a dependent user of illegal drugs are by and large artefacts of prohibition – the drugs upon which one is dependent are illegal which means that you are forced to become a criminal (as well as being defined as “diseased”), and often because of the exorbitant prices charged by the black market many people are forced into crime in order to fund their habits. The fact is that when people are prescribed opiates in a non-restrictive, non-coercive and human rights compliant fashion so that they can get on with their lives, they are able to do so perfectly well, those of us who are dependent opiate or stimulant users with access to medical quality drugs of our preference are perfectly capable of holding down responsible jobs, raising families, and living productive lives. However, the vast majority of those who do find that their drug use is becoming problematic for them are more often than not socially disadvantaged in many other ways, and or living in environments in which repression is strong, and lack of services predominates.
Medical models have been used to pathologise a widespread range of socially frowned upon groups including people who use drugs, LGBT, and transgendered people. Homosexuality is no more a brain disease than is drug use; both are simply different ways of being human.
What are some of the current campaigns INPUD is involved with at present?
INPUD is involved with a wide range of campaigns on the various issues that affect our lives – apart from the Drug Users’ Peace Initiative, we are sponsors of the ‘Support. Don’t Punish’ campaign; we were recently involved in the MISSING campaign which sought to highlight the lack of attention being paid to hepatitis C by the World Health Organization; we are also involved in a number of other projects and advocacy efforts around HIV, human rights, and peer led, high quality harm reduction provision.
Eliot Ross Albers, Executive Director,
International Network of People who Use Drugs
For more information about INPUD, including how to become a member please contact firstname.lastname@example.org
image by Nigel Brunsdon