Open Letter to Ghada Waly – signed by 130+ organisations – Promoting Evidence-Based and Equal Healthcare as a Human Right

In light of the start of the 66th Commission on Narcotic Drugs (March 13-17), we have shared our open letter to Ghada Waly, the Executive Director of the UNODC, urging the need to promote Health Services that are non-discriminatory, evidence-based, trauma-informed, gender- and culturally sensitive, and age-appropriate. Simultaneously, we highlighted the need to continue to promote evidence-based prevention, access to treatment, and recovery, while encouraging monitoring and evaluation with disaggregated data by gender.

The letter has been supported and signed by 130+ organisations and various individuals. As it is a living document, more signatures are coming in. Read the full letter below:

To: Ghada Waly, Executive Director, United Nations Office on Drugs and Crime

Date: 10/03/2023

Subject: Open Letter to Reassure Human Rights are being adhered to in a fast-changing environment – Pleading for safety, health, well-being, and dignity

Dear Ghada Waly,

We commend your opening remarks at the CND Thematic Intersessional in September 2022 and acknowledge “the need to uphold the international drug control system, side-by-side with international human rights obligations” while prioritising people and their wellbeing. Together with our members, almost 400 civil society organisations, we urge the United Nations Office on Drugs and Crime (UNODC) to reinforce the essence of the Universal Declaration of Human Rights.

Generally, the extensive international debates on drug policies provide new insights and realities that different regions face regarding illicit substances, its use, effects, and impact on people and society. It is widely recognised that “human rights are rights inherent to all human beings, regardless of race, sex, nationality, ethnicity, language, religion, or any other status”[1] and that the Universal Declaration on Human Rights “is a milestone document in the history of Human Rights”.

Health is a fundamental human right. As emphasised by the WHO, “acknowledging health as a human right recognises a legal obligation on states to ensure access to timely, acceptable, and affordable health care”[2]. Every person deserves the right to security, access to health services, and obtain medical care while it is being ensured that their dignity is being respected. It is also imperative that the responsibility and capacity of all human beings are fortified in developing and protecting the right to best-practice health care and is not enabled, equipped, or empowered to undermine good, physical, and psycho-social health. Thus, it is important to note that the human right to freedom is strengthened by focusing on strengthening prevention, ensuring access to treatment, and promoting recovery. Hence, we call upon the Member States to uphold and promote prevention, treatment, rehabilitation, and recovery services with a comprehensive, integrated, inclusive, evidence-based, and balanced approach.

In a “post-covid era” filled with ongoing and emerging conflicts and increased illicit trafficking across borders, the dynamic world is riddled with increased accessibility of illicit substances and consequently an increase in people who have problematic drug use and/or addiction. Suggested greater permission models and supply models continue to drive and not diminish demand. This, in turn, further entrenches normalisation and effecting youth’s perception of risk. Hence, the necessity to adhere to the fundamental right to [access to] preventive and restorative health is more important than ever. Even though not all persons who use drugs develop a substance use disorder, the percentage of people facing a substance use disorder is steadily increasing. Additionally, it is important to highlight, as shared by the World Drug Report 2022 (booklet 1, page 18), that “young people continue to use more drugs than adults and have higher levels of use than in past generations”. The latter is a concerning development that requires global attention and international cooperation to ensure that steps are taken to avoid further increase of substance use disorders among youth and within society as we strive to support children and youth to grow healthy and safe.

Following the Universal Declaration of Human Rights, the widely adopted Sustainable Development Goals and the Convention on the Rights of the Child acknowledge and further emphasise that “all human beings [should be able to] fulfil their potential in dignity and equality in a healthy environment”, with a particular focus on allowing children and youth to flourish into healthy adulthood. With the increase in drug use, especially among the younger generation, it is significantly important to adhere to the Human Rights of the young person. Especially children should be offered the necessary protection to live a healthy and substance-free life. The need for prevention, protection, and provision of health care is reiterated in the two-above mentioned conventions. The ratification of Article 33 in the Convention on the Rights of the Child highlights the need to protect children from the illicit use of narcotic drugs and prevent children from being used for the illicit production or trafficking of illicit substances. Besides this, Article 3.5 in the Sustainable Development Goals promotes the need to strengthen the prevention and treatment of substance use. Therefore, we urge the UNODC to continue to promote evidence-based prevention, access to treatment, and recovery, while encouraging monitoring and evaluation with disaggregated data by gender.

Ms Ghada Waly, as you shared in your earlier statement, access to treatment is not available to everyone in need, causing a treatment gap. Especially women and children face such treatment gaps. Various causes lead to limited access to treatment and need urgent attention, allow us to state a few below.

Stigma and discrimination

Drug dependence is ranked among the five most stigmatised health conditions in the world. Stigma manifests on personal, societal, and community level and often affect people with substance use disorders and their families. Internalised stigma, being marginalised, discriminated against, and facing structural barriers pose barriers to accessing treatment and can accentuate negative feelings of shame and isolation. Therefore, it is essential that stigma and discrimination are decreased among society, health care providers, media, communities, institutions, etc. through awareness raising and structural change while making recovery visible in the community.

Gender

According to UNODC data, only 1 out of 8 people who use drugs receive treatment worldwide. However, the percentage of women who use drugs accessing treatment is even lower, with some countries facing a lack of treatment options for women. Besides stigma and other barriers relating to normative ideas of gender withholding women to enter treatment, many treatment programmes are catered to meet the needs of men. Research has shown that women have specific needs and require gender-sensitive treatment. Hence, treatment should include a gender-sensitive and trauma-informed approach while acknowledging barriers, stigma, and normative expectations based on gender.

Parenthood

Parents can face difficulties accessing treatment as residential centres often deny access to the residents’ children while, simultaneously, the parental responsibilities make it difficult for the parent, particularly the mother, to regularly participate in outpatient programmes. Additionally, parents face additional barriers due to the perceived fear to lose custody of the child. Therefore, family-centred and strengthening programmes are essential. These programmes must provide tools for rehabilitation, such as vocational training, job opportunities, support in home seeking, and support family reunification, if possible, as this is an important factor in remaining motivated to sustain recovery.

Justice/Crime

Those incarcerated often are denied access to treatment for their substance use disorder while being in an environment where drugs are more prevalent and overcrowding is an issue. Condemning discriminatory or violent practices in criminal justice, it is important to allow and promote access to treatment and rehabilitation services.

Children

Children and adolescents with substance misuse face a higher urgency for treatment. As they are in their developmental stage, early intervention and treatment can prevent long-term negative effects. However, young persons facing substance use disorders are often unaware of the procedures to access treatment, face financial barriers and stigma, and do often not have availability to age-appropriate treatment. Hence, social support systems should increase drug awareness, including preventive measures, while providing active support for appropriate treatment when a child faces a substance use disorder to ensure the full rights of the child.

Beyond these bullet points, it is important to highlight that many sub-groups face discrimination and are denied their human right as they face difficulties to access the needed health services. The sub-groups include but are not limited to, people living in street environments or are without a home, people with disabilities, the elderly, and members of the LGTBQIA++ community. We urge more research on the impacts of denied treatment, rehabilitation, and reintegration services supporting the pathway of recovery for these sub-groups. Additionally, more sensitised programmes/policies need to be established to ensure their right to access a healthy life is adhered to.

Overall, is it important to continue highlighting the need to increase access to treatment while promoting the pathway of recovery, including harm reduction as a continuum of care, alternatives to incarceration, and rehabilitation and reintegration services. Health services offered need to be non-discriminatory, evidence-based, trauma-informed, gender- and culturally sensitive, and age-appropriate. There is not a ‘one-size fits all’ and treatment needs to be centred on the individual. Recovery services should be integrated into society rather than being distanced from the community, this will allow for reintegration and reduction of judgements and stigma. A person should not be denied their human right to access the necessary health services due to limited resources, discrimination, gender, etc. and the international community is obliged to establish programmes and policies that adhere to these rights.

Yours Sincerely,

Amy Ronshausen (International President, World Federation Against Drugs)

Co-signed by:

134 organisations and various individuals (as it is a living document, more co-signatories will be added)

ADIC Sri Lanka – Sri Lanka
Africa Bridge Initiatives – Nigeria
Africa Foundation for Development and Tolerance – Zimbabwe
African Council on Narcotics (ACON) – Nigeria
African Youths Initiative on Crime Prevention – Nigeria
Alcohol policy Alliance Gambia – Gambia
Arabella Stars Foundation Against Drug Abuse & Human Trafficking – Nigeria
ARTM – Associacao de Reabilitacao de Toxicodependentes de Macau – Macao SAR
Association Izlazak – Serbia
Association Parents Contre la Drogue – France
Bashiran Munshi Foundation – Pakistan
Bethesda Reincarnation Centre – Sri Lanka
Blue Cross Kenya – Kenya
Brain Care Foundation, Nigeria
Cap, ahmed ali foundation – Pakistan
Carlton Hall Consulting – United States
Center for youths mental health and drug abuse prevention – Nigeria
Centre for Youth Support Against Drug Abuse – Malawi
Change Agents South Africa – South Africa
Child Space Organization – Kenya
Children Education Society (CHESO) -Tanzania
Civil Development Organization -CDO – Iraq
Community Alliances for Drug Free Youth – United States
Community anti-drug Coalitions of Kenya (CADCKE) – Kenya
Community Development & Entrepreneurship Foundation – Pakistan
Community Outreach Burundi (COB) – Burundi
Comunidad La Roca – Chile
Congo Charity and Development – Democratic Republic of Congo
Crisis Resolving Center – Tanzania
C-Sema – Tanzania
CWIN-Nepal – Nepal
D.A.R.E. America International – United States
Dalgarno Institute – Australia
Dhaka Ahsania Mission – Bangladesh
Drug Advisory Council of Australia Ltd – Australia
Drug Free America Foundation, Inc. – United States
Drug Free Australia – Australia
Drug Policy Centre in Sweden – Sweden
Drug Prevention Network of Canada – Canada
EURAD, Belgium
European Cities Against Drugs (ECAD) – Sweden
Family Wellbeing Centre – Sri Lanka
FORUT – Norway
Foundation for a Drug-Free Europe (FDFE) – Sweden
Foundation for a drug-free world Ghana – Ghana
Foundation for Rescue of Abandoned African Children – Nigeria
Foundation for Rural and Urban Transformation – Sierra Leone
Fourth Wave Foundation – India
Freedom treatment and rehabilitation center, Gujranwala – Pakistan
FRIENDS- Forum for Rural Income & Enviornmental Development Services – Sri Lanka
Global Action for Sustainable Development – Liberia
Green Crescent Health Development Initiative (GHI) – Nigeria
Hepatitis Coalition of Ghana – Ghana
Hepatitis Foundation of Ghana – Ghana
Hope Foundation – Nepal
Human Rights Protection Volunteer Association – India
Humanitarian Organization Providing Effective Services – Pakistan
Impact Her World Foundation – Nigeria
Institute for Research and Development “Utrip” – Slovenia
International Centre for Leadership Development Nigeria – Nigeria
International Network for Progressive Elimination of Poverty/ R.I.E.P.P (Réseau International pour l’Élimination Progressive de la Pauvreté) – Senegal
Junis – Sweden
Just say no Nepal – Nepal
KKAWF- Karim Khan Afridi Welfare Foundation – Pakistan
Komphash – Denmark
KOTHOWAIN (Vulnerable Peoples Development Organization) – Bangladesh
LEEDO – Bangladesh
Life Foundation – Pakistan
LP-vännernas Kamratförening – Sweden
Menorah Foundation (LBG) – Ghana
Mercy Community Centre – Sri Lanka
Mian Afzal Trust Hospital (MATH) – Pakistan
Mithuru Sewana Counseling and Treatment center – Sri Lanka
Muskan Foundation – India
Nakuru Drop-In Center CBO – Kenya
Narconon Nigeria initiative – Nigeria
National Alliance for Drug Endangered Children – United States
National Council on Alcoholism and Drug Dependence- Maryland Chapter – United States
New World Hope Organization (NWHO) – Pakistan
Nusroto Al Anashid Association – Lebanon
OPADEC – Democratic Republic of Congo
Option2world initiative Against Drug Abuse – Nigeria
OVOM – One Voice One Message – Gobal Support for a Drug Free Lifestyle – Sweden
PACTA UGANDA – Uganda
PaHukama National Youth Oryxes Foundation, Zimbabwe
Pakistan Youth Organization – Pakistan
Parent-Child Intervention Centre – Nigeria
Peace Inn – Pakistan
Peace Point Development Foundation – Nigeria
Phalombe Youth Arms Organization (PYAO) – Malawi
Preporod – Montenegro
Professional Driving and Safety Academy – Nigeria
Proslavi Oporavak/ Celebrate Recovery – Bosnia and Herzegovina
RAHAMA – Sri Lanka
Rape Hurts Foundation – Uganda
REAL Women of Canada – Canada
Recovery Solutions Treatment and Counselling Centre – Uganda
Right Mind Empowerment Initiative – Nigeria
RNS – Sweden
Rural Development and Youth Training Institute – India
Rural Development Tuki Association – Nepal
Rural Renaissance Development Initiative – Nigeria
Safe Care Trust International – Pakistan
SAF-TESO – Uganda
San Patrignano – Italy
Securing the Creative Goldmine in Youths Initiative – Nigeria
Slum Child Foundation – Kenya
Smart International – Sweden
Social Linkages for Youth Development and Child Link – Sierra Leone
Sortedlife Husika Africa Group – Kenya
STAND – South Africa
Support Persons in Trauma Initiative, Nigeria
Sustainable Action for the Emancipation of Vulnerable People – Cameroon
Talk to Save Youth – Kenya
The Association for Promoting Social Action – India
The Jordan Anti Drugs Society – Jordan
The Reformed Drug and Substance Abuse Initiative (REDSAI) – Nigeria
Tiaty Youth Development Association CBO – Kenya
Total Health Advocacy Foundation – Kenya
Tuinuke na Tuendelee Mbele CBO – Kenya
Udruga PET PLUS – Croatia
Udruga Porat – Croatia
Uganda Youth Development Link (UYDEL) – Uganda
UTTHAN – (Unprivileged To The Humanitarian Action Need) – Bangladesh
Vision for Alternative Development (VALD) – Ghana
WABHARM Foundation – Ghana
WCTU – Woman’s Christian Temperance Union – Australia
Women and Children’s Legal Aid Organisation – Tanzania
Women’s Christian Temperance Union New Zealand – New Zealand
World Federation of Athletes Against Drugs – Turkey
World Woman’s Christian Temperance Union – USA/Norway
YAHI Foundation – Nigeria
Youth Achievement Village In Tanzania (YAVT) – Tanzania
Youth for Development and Human Rights Advancement – Rwanda
YP2MP – Indonesia