Alternatives to imprisonment from a health perspective

59th Session of the Commission of Narcotic Drugs

15 March 2016 Special Event:

Alternatives to Imprisonment and Proportionate Responses for Drug Offences

Presentation made by Aldo Lale-Demoz, Deputy Executive Director, Director of Division for Operations and Global Coordinator for HIV/AIDS, UNODC 


Protecting the health of individuals and society from the dangerous effects of drugs is a fundamental aim of the international drug control conventions. But whereas the conventions provide an excellent basis for the application of the principle of proportionality to drug-related offences, the international community has also developed standards, norms and expertise that provide further guidance to States in the application of alternative measures to conviction or punishment.

The right of people to the highest attainable standards of health - enshrined in numerous international and regional human rights treaties-- is closely related to the topic of this special event. The right to health is not, and should not be, dependent on the legal status of a person. 

 From a public health perspective, the recommended approach is not conviction or punishment, but rather the provision of treatment and care for people with health disorders, including people who use drugs for non-medical purposes, or people who have drug use disorders.

By focusing on health we ensure that we look at these people first and foremost as members of our communities who live with a chronic disease.  They are in need of support and treatment.  Before anything else, they are patients.

Science suggest that the onset of drug use disorders is associated with a high number of risk factors and a small number of protective factors. People who developed drug dependence, usually have been through a range of adverse life events.  Many of them have experienced marginalization and stigmatization, already early in their lives. To bring them back to a full life in the midst of their communities they need to know that they are respected as fellow human beings, as friends, neighbours, fathers, mothers, colleagues, grandparents, and that they have easy access to evidence-based drug dependence treatment, health care and social services.

A pragmatic public health response to the drug problem must therefore consider alternatives to incarceration of people with drug use disorders. In line with the international drug control conventions, people affected by drug use disorders do not need to be punished.

Many countries have expressed an interest in developing systems to divert people with drug use disorders away from the criminal justice system and into the healthcare system. A major barrier, however, is the fact that treatment services are often not widely available in the community.  Therefore, investments need to be made to make treatment and care services more available throughout the healthcare system.

On the basis of our operational experience, imprisonment of people for non-medical drug use should be avoided, as it increases their vulnerability to develop drug use disorders, and numerous other adverse health conditions, including HIV, tuberculosis and viral hepatitis.

 We should bear in mind that the fear of being arrested constitutes a major barrier for people who use drugs when it comes to accessing essential science-based psychosocial and pharmacological drug dependence treatment, as well as HIV prevention and treatment services, including needle and syringe programmes, opioid substitution therapy and antiretroviral treatment. Evidence shows that, in practice, incarceration is often responsible for the interruption of drug treatment and HIV services, including antiretroviral treatment. Tearing down these barriers to right to health is essential to enable an efficient and human rights-based drug treatment and HIV response, and to end AIDS by 2030, as Member States have committed to by endorsing both the Sustainable Development Agenda and the UNAIDS Fast-Track Strategy.

 The provision of drug dependence treatment is an effective strategy from both a public health and a public safety points of view. Just days ago, UNODC and WHO published the " International Standards on the Treatment of Drug Use Disorders" as a draft for field testing. This document will provide further guidance on what evidence-based treatment actually means, and how it can be best implemented.

We would also encourage Member States to rely on available international tools, such as the United Nations Standard Minimum Rules for Non-custodial Measures (the "Tokyo rules") and the United Nations Rules for the Treatment of Women Prisoners and Non-custodial Measures for Women Offenders (the "Bangkok rules"), when developing systems for the provision of alternatives to conviction or punishment.

When people with drug use disorders commit a crime for which no alternative measures can be considered, and when imprisonment is indeed necessary, then effective drug dependence treatment must be provided also within the prison setting. In line with the principle of equal access, all detained persons have the same right to healthcare and professional standards as is available to the wider community, as emphasized in the recently adopted "Nelson Mandela Rules", or the revised United Nations Minimum Rules for the Treatment of Prisoners. Comprehensive strategies that make prisons a safer and healthier environment will largely impact prison health and overall public health strategies.  This is important, also because upon release from prison, people with drug use disorders, are at high risk of overdose, and it is precisely at this juncture that effective strategies for overdose prevention, as defined by UNODC and WHO, should be in place.

 As our extensive technical assistance experience suggests, the implementation of effective strategies and policies on treatment and care, as an alternative to criminal justice sanctions for people with drug use disorders, requires the close cooperation between the justice and health systems.

 In this connection, it is our pleasure today to launch an initiative under which UNODC and WHO are working together to identify practices and experiences from around the world on how treatment and other services are actually being applied, as an alternative to conviction or punishment, for people with drug use disorders when they are in contact with the criminal justice system.

 At a minimum, we would like to compile these experiences,  subject them to expert consultation and reviews, and then elaborate a publication aimed at assisting Member States to have information on the variety of practices that are available for the treatment and care of people with drug use disorders, especially when in contact with the criminal justice system.  This, in turn, could help the development and implementation  of  models that are particularly suited to specific legislative, cultural, health and social care systems.

 In closing, I should like to draw your attention to a concept note that has been made available to the audience.  My colleagues Valérie Lebaux and Giovanna Campello, as well as Mr. Vladimir Poznyak from WHO, will remain available at the end of this event with their teams, to give more details about this new joint initiative, linked to the ongoing UNODC-WHO Programme on Drug Dependence Treatment and Care.

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