In its annual report, the International Narcotics Control Board scolds the US and Uruguay for reforming cannabis laws. At the same time, it fails to criticise Russia for blocking opiate substitution treatment in occupied Ukrainian territories, thereby endangering the lives of hundreds of people who use drugs. In our open letter, we ask the president of the INCB to act in order to protect the core principle of the international drug conventions: public health.
OPEN LETTER TO THE PRESIDENT OF THE INTERNATIONAL NARCOTICS CONTROL BOARD (INCB) ABOUT THE CLIENTS OF OPIATE SUBSTITUTION PROGRAMS IN UKRAINE
To: Dr. Lochan Naidoo
President
International Narcotics Control Board (INCB)
Vienna International Centre
International Narcotics Control Board
Room E-1339
P.O. Box 500
A-1400 Vienna
Austria
Dear Mr. President
We are writing you on behalf of more than 800 drug-dependent people who, until May 2014, were patients of Crimean opiate substitution programs (OST). As service providers and the international press have reported, as many as 80 people (10 percent of all patients) have already died since the occupation of Crimea, because of the closure of OST programs by the Russian authorities. (1) The surviving patients and their families are going through a very difficult time, because of lost health, jobs, homes and human relationships. (2) In Eastern Ukraine, at least 10,000 patients are facing the risk of interruptions to treatment because of the fighting between government and separatist forces. (3)
Contrary to what the Russian authorities claim, opiate substitution treatment is effective in substantially reducing illicit opiate use, HIV risk behaviours, death from overdose, and criminal activity, as well as financial and other pressures on drug users and their families. The joint position statement of WHO/UNODC/UNAIDS emphasises that, “substitution maintenance therapy is one of the most effective treatment options for opioid dependence”. (4) It reminds us that, “opioid dependence is a complex condition that often requires long-term treatment and care. No single treatment modality is effective for all people with opioid dependence. Adequate access to a wide range of treatment options should be offered to respond to the varying needs of people with opioid dependence”. The joint Technical Guide of WHO, UNAIDS and UNODC lists OST as part of the comprehensive package for the prevention, treatment and care of HIV among injecting drug users. (5) The UN High Commissioner for Human Rights has stated that denying access to evidence-based treatment is a violation of the human rights of drug users. (6)
Article 38 of the 1961 Single Convention underlines that, “the Parties shall give special attention to, and take all practicable measures for, the prevention of abuse of drugs and for the early identification, treatment, education, after-care, rehabilitation and social reintegration of the persons involved, and shall co-ordinate their efforts to these ends”. (7) Similarly, Article 14, Paragraph 4 of the 1988 treaty against illicit drug trafficking urges member states to “adopt appropriate measures aimed at eliminating or reducing illicit demand for narcotic drugs and psychotropic substances, with a view to reducing human suffering and eliminating financial incentives for illicit traffic”. (8) The Commentary on the 1988 Convention lists methadone maintenance programmes within the definition of legitimate treatment programs. (9)
The UN conventions were created primarily to improve the health and welfare of mankind. By banning legitimate, UN-endorsed OST programs, Russia is not only refusing to accept scientific evidence, it is not only abusing human rights, but it is breaking the letter and spirit of the UN drug conventions. The INCB – an agency responsible for monitoring compliance with these UN drug conventions, as well as ensuring that controlled substances are available for medical and scientific use – can no longer close its eyes to Russia’s violation of the conventions.
The drug treaties have given the Board legitimate reasons and legitimate tools to intervene in support of the methadone and buprenorphine patients of Crimea. If “the Board has objective reasons to believe that the aims of this Convention are being seriously endangered by reason of the failure of any Party”, Article 14 of the Single Convention mandates it “to propose to the Government concerned the opening of consultations or to request it to furnish explanations”. In the event that “the Board finds that the Government concerned has failed to give satisfactory explanations when called upon to do so”, it may “call the attention of the Parties, the Council and the Commission to the matter”.
The Board has been enthusiastic in the past, in its criticism of member states for opening drug consumption rooms or reforming their cannabis laws, but it has been reluctant to speak up against countries which deny access to evidence-based treatment. On this occasion, we ask you to use your mandate to protect the interests and rights of hundreds of drug-dependent people who have benefited from opioid maintenance programs, with consequent improvements to their health and well-being. If OST programs are shut down, the likelihood is that these people will revert to buying illicit drugs on the streets, risking the health and lives of themselves and others.
– We ask you to speak out against the closure of OST programs and initiate a consultation with the Russian government to ensure that it complies with the conventions;
– We ask you to initiate a consultation with the Ukrainian government to organise a safe corridor for delivery of life-saving medicines, with the support of the International Committee of the Red Cross, to ensure that treatments are not interrupted in Eastern Ukraine;
– We urge the INCB, in its annual report, to condemn the denial of access to OST programs as a violation of the international drug conventions, and to address the issue at the 58th Session of the Commission on Narcotic Drugs (CND) in Vienna this year.
Best regards,
Pavlo Skala, Associated Director on Policy and Partnership, International HIV/AIDS Alliance in Ukraine
Peter Sarosi, Drug Policy Program Director, Hungarian Civil Liberties Union
Igor Kuzmenko, Member of Managing Committee, Eurasian Network of People Who Use Drugs
REFERENCES
[1] Richard Hurley, “At least 80 people have died in Crimea since Russian law banned opioid substitutes, says UN special envoy,” Britis Medical Journal 2015;350:h390.
[2] The First Crimean Victims. A film by Igor Kuzmenko: https://www.youtube.com/watch?v=G9zhiLK5AGY
[3] International HIV/AIDS Alliance in Ukraine, Lives at stake in Eastern Ukraine – Emergency medical support needed to prevent deaths in Donetsk and Luhansk. 2015. http://www.aidsalliance.org.ua/ru/news/pdf/_2015/01/Eastern%20Ukraine%20-%20final_eng.pdf
[4] WHO/UNODC/UNAIDS position paper Substitution maintenance therapy in the management of opioid dependence and HIV/AIDS prevention. http://www.unodc.org/documents/hiv-aids/Position%20Paper%20sub.%20maint.%20therapy.pdf
[5] WHO, UNODC, UNAIDS Technical Guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users, 2009; http://www.unodc.org/documents/hiv-aids/idu_target_setting_guide.pdf
[6]High Commissioner calls for focus on human rights and harm reduction in international drug policy
http://www.ohchr.org/documents/Press/HC_human_rights_and_harm_reduction_drug_policy.pdf
[7] Single Convention on Narcotic Drugs, 1961, http://www.incb.org/documents/Narcotic-Drugs/1961-Convention/convention_1961_en.pdf
[8] United Nations Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances, 1988. https://www.unodc.org/pdf/convention_1988_en.pdf
[9] Commentary on the United Nations Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances, 1988. http://www.unodc.org/documents/treaties/organized_crime/Drug%20Convention/Commentary_on_the_united_nations_convention_1988_E.pdf
