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Home / Healthcare & Medicine / Drugs and Addictions / Drug Use and Harm Reduction / Harm reduction founded on human rights principles

Harm reduction founded on human rights principles

In this video, Naomi Burke Shyne from HRI introduces how harm reduction is related to the human rights principles
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Harm reduction is deeply connected with human rights. In 1948, following the Second World War, member states of the United Nations set out the bare minimum standards to protect the rights and freedoms for all people of all nations.
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The UDHR identifies a number of key principles protecting all individuals, whatever their race, sex, color, language, religion, political beliefs or national social origins. Initially, more than 50 countries agreed these principles and now as of 2020, more than 150 nations recognize these rights for their citizens. Key to harm reduction, amongst these human rights are human dignity, the right to equality and non-discrimination and the right to participation. But many countries have yet to protect these rights in practice. In terms of harm reduction this means that can be a huge gap between what services the people who use drugs should expect and what is received. The United Nations recognizes that harm reduction flows from the right to health.
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Very much connected to this are the social rights of individuals and across both these areas is the right of non-discrimination. This means equal access to services without fear of stigma, discrimination or punitive drug policies. And I’ll speak to each of these in turn.
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In other words, the right to health is an important starting point for harm reduction. The right to health is focused on ensuring the availability, accessibility, acceptability and quality of health services. In this context, it means people who use drugs have the right to access health interventions provided through harm reduction services or programs, things like sterile needles and syringes, medicines such as opioid agonist therapy and support and links to other health and social services. The right to health means that those harm reduction services should be of high quality and there should be information available so that individuals can make informed choices and consent to any particular health intervention.
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Services led by the community of people who use drugs, often referred to as peer interventions are essential to being able to achieve this. Also, given the stigma surrounding drug use harm reduction interventions and services should ensure measures are in place to protect the privacy of the individual. Few governments know just how many people use drugs in that country, but the vast majority report that they do have a population of people who inject drugs of these countries, about half have put in place harm reduction interventions or programs, for example, in Canada or Western Europe. There are reasonable services for people who use drugs in many urban centers.
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People who use drugs can generally access sterile injecting equipment, opioid agonist therapy, access to overdose reversal medicine such as naloxone in places where they can safely go to consume drugs or get medical help where it’s easier to get referrals for treatment or get access to peer support. Some cities offer drug checking to enable people to understand what is in the substances they are consuming, or considering consuming. However, in many low and middle income countries harm reduction for people who use drugs is more limited. Kenya is a good example of a country in the African region where the government and civil society can work to scale up harm reduction in particular.
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The government has made concerted efforts to introduce opioid agonist therapy, but Kenya is yet to reach the World Health Organization recommendation of offering opiate agonist therapy to 40 out of every 100 people who inject drugs per year. In India, the government provides the majority of funds spent on sterile injecting equipment in the country. Overall coverage remains below the World Health Organization recommendation. 300 sterile needles per person per year. In fact, around the world, when you compare the accessibility of harm reduction services against the World Health Organization’s recommended standards, you find that just 1% of countries achieve those standards, even though many of these services are pretty simple and relatively cheap.
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To say harm reduction is only about the right to health is to oversimplify it, harm reduction is about a person’s overall well-being. It’s about saying to a person, we care about you and we’re here to help you, to make choices for yourself and we trust you to do that.
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In the context of harm reduction, these social rights, or about ensuring that people who use drugs have access to social services the government provides, or should provide, for everyone. Drug use should not limit a person’s ability to enjoy their social rights. The problem is that drug use is not a popular policy platform. It’s easier for politicians to complain about drugs being the enemy than to speak about the health and social rights of people who use drugs. Not many governments want to be seen helping people who use drugs.
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The fact is, if you were a person who uses drugs all your human rights are under assault on a daily basis. This is in part because of the way the international drug control conventions work because the way they are enforced and because of society’s stigmatizing approach to drug use in many countries, arbitrary arrest and detention of people who use drugs or who are suspected of using drugs remains high. State sanctioned punishments, in some cases as extreme as the death penalty, have resulted from punitive drug control policies and the war on drugs. Which effectively operate as if they are exempt from national laws in the Universal Declaration of Human Rights and the human rights framework which flows from it.
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There is now substantial evidence that the war on drugs has disproportionately targeted black and brown communities, resulting in profound racial injustice as Dr. Kojo Koram captures this in his work on colonialism in the War on Drugs
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There’s also the issue of gender in the provision of harm reduction services for women. We know that women who use drugs are particularly vulnerable in terms of their health. The limited data suggests that women are at greater risk of HIV viral hepatitis than men who use drugs. This increased vulnerability is a product of a range of environmental, social and individual factors affecting women, which also restricts their ability to engage with harm reduction services.
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On a small scale around the world, there are tiny hubs of communities and service providers, lawyers and human rights defenders working to change the approach to drug control. But it needs to happen everywhere. And crucially, governments need to get on board. To that end, in 2019 following years of consultation, the United Nations Development Program (UNDP) together with WHO UNAIDS and the International Center on Human Rights and Drug Policy, published the International Guidelines on Human Rights and Drug Policy. Guidelines cover everything from criminal justice to public health and help make clear to governments how harm reduction connects to human rights and why this approach must urgently be adopted.

With its strong ties to the global HIV response, many people primarily associate harm reduction with services that aim at preventing the transmission of infectious diseases. However, even from its early origins, the harm reduction movement has always included a wider perspective of fighting for social justice and equal rights.

The United Nations recognizes that harm reduction flows from the right to health. Maybe some of you have already used this argument and made references to one of the principles of the human rights declaration which states that everyone has the same right to the “highest attainable standard of health”.

In the video above, Naomi Burke Shyne expands on what this means and how it is directly applicable to harm reduction. We will then dive deeper into related components of the human rights frameworks, such as social rights and equality.

As you have learned in Week 1, harm reduction often faces resistance based on moral grounds. On the one hand we usually try to address this by providing clear evidence-based (public health) arguments, but we believe it is also key to understand the human rights’ argument. In some settings we might find a common ground by holding decision makers accountable on a human rights account; they must ensure that everyone has equal access to health and social rights.

Optional

Attached below you will find a guideline on Human Rights and Drug Policy. You will probably recognise some of the principles from the video above. You may find these guidelines helpful in your local context to use as a reference in your local discussions.

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This content is taken from London School of Hygiene & Tropical Medicine online course
Drug Use and Harm Reduction
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