AFEW International signed “Civil Society Statement on COVID-19 and People who use Drugs”

We, as community and civil society organisations working in drug policy reform and harm reduction, urge the international community to take proactive and coordinated action to protect the health and human rights of people who use drugs in light of the COVID-19 crisis.COVID-19 infection does not discriminate, but magnifies existing social, economic and political inequities. People who use drugs are particularly vulnerable due to criminalisation and stigma and often experience underlying health conditions, higher rates of poverty, unemployment and homelessness, as well as a lack of access to vital resources – putting them at greater risk of infection. The crisis must be an occasion to rethink the function of punishment, to reform the system and to work towards ending the war on drugs. If we are to ‘flatten the curve’, the health of the most marginalised in society must also be protected as an urgent priority.

In times of crisis, uncertainty and upheaval it is imperative that human rights act as an anchor point. Careful and vigilant attention must be paid to non-discriminatory access to health care, human dignity and transparency. Multiple governments emphasise that we are fighting a ‘war’, the use of such terminology justifying a militarised approach that allows for the suspension of rights and freedoms. History shows that extraordinary powers are routinely deployed against the most persecuted in society, who risk being scapegoated in the name of infection control. As states of emergency are declared, the international community must urge caution on the creation of a ‘new normal’ where States derogate from their obligation to serve and protect all persons.

Failure to effectively steer and manage the COVID-19 response will have disastrous consequences. The international community, including international donors, must act immediately to ensure, through policy guidelines and financial and political support, that national, regional and global responses to this pandemic take the needs of people who use drugs into account and respect the fundamental rights of all. We therefore suggest the following recommendations:

1. Protect the right to health: During times such as these, governments have an obligation to ensure that a public health crisis does not become a human rights crisis due to lack of access to adequate health care. In the wake of COVID-19, however, there is great concern that harm reduction services are being closed, not adapting sufficiently rapidly to changing legal and health contexts and that essential resources will be diverted to the COVID-19 response at the expense of equally life-saving work. Inappropriate and restrictive regulations banning or limiting take-home doses and other supplies make complying with lockdowns and social distancing rules extremely difficult. Harm reduction workers report unease about scarcity of resources, lack of coherent policies and programme guidelines on COVID-19, and potential disruptions to global supply chains of essential medicines and equipment, including methadone, buprenorphine, naloxone, needles and syringes, disinfectant, masks and gloves.

The international community must act swiftly to ensure States meet their international obligations to protect the right to life and health. This can be done by issuing strong political statements and clear and comprehensive technical guidance, building on WHO and UNODC  guidelines and national COVID-10 regulations, which unequivocally calls to:

– Declare harm reduction programmes as life-saving services that must stay open. The closure of harm  reduction centres would deprive service users from accessing life-saving interventions and would ultimately lead to over-crowding of centres that remain open, increasing risk of infection.
– Immediately amend restrictive legal and regulatory policies that ban or limit take-home doses due to fear of diversion and that restrict the provision of take-home naloxone to prevent overdoses.
– Enhance service accessibility, develop and implement safety and hygiene protocols and coordinate efforts within the health system to allow for the effective distribution of resources.
– Recognise harm reduction workers as critical healthcare workers so that they can access government stocks of protective clothing.
– Protect and expand the operation of low-threshold services, including outreach, as well as provide housing and shelter for those facing housing insecurity.
– Adequately fund harm reduction services, particularly low-threshold services.

2. Ensure safe supply: Border closures and travel bans around the world will impact the future supply of unregulated substances such as heroin and cocaine. This will have a range of repercussions, including an increase in demand for opiate substitution therapy (OST). Of particular concern is that synthetic drugs such as fentanyl, which are easier to produce and transport, could replace bulkier substances such as heroin, the corollary of this being an exponential increase in overdose deaths.

In light of the above, international and regional bodies must work with member states to:

– Monitor trends of illicit drug markets to provide a rapid response to dangerous and emerging trends, such as increased risk of overdose deaths.
– Ensure increased access to OST to respond to changes in drug supply, through accelerated and flexible entry procedures.
– Deprioritise the enforcement of supply-side control in order to retain some stability in illicit drug markets and prevent market saturation with synthetic drugs.
– Respond to potential disruptions in the production of methadone and buprenorphine and step in when early signs of issues with supply chain management are detected.

3. Protect the right to be free from arbitrary detention: The COVID-19 crisis has spotlighted the public health dangers of overcrowding in prison and detention facilities which are traditional hotbeds for infectious diseases. According to UN data, at least 470,000 persons are incarcerated worldwide for drug use and possession only, while an additional 1.7 million people are incarcerated for other drug offences, many of which are non-violent. In addition, across East and South-east Asia, hundreds of thousands of people who use drugs are detained in compulsory drug detention facilities, with tens of thousands more detained in private drug treatment centres, often against their will, across Asia and Latin America. In such contexts, COVID-19 prevention measures, such as physical distancing, cannot be implemented effectively. Further restrictions on family visits and supervised releases increase isolation and stress during a time of fear, leading to an increase in violence, riots and assault.

The UN High Commissioner for Human Rights has urged governments to reduce the number of people in detention, particularly those without sufficient legal basis. In view of this, the international community must ensure States take action to:

– Decriminalise drug use and possession for personal use as promoted by the UN system and outlined in the UN Common Position on Drugs.
– Reduce the prison population through early release, pardons, amnesties and non-coercive alternatives to incarceration for people detained for drug-related non-violent offences, particularly those on remand, and those most-at-risk individuals, including people living with HIV, TB and COPD, as well as older people.
– Immediately release people who use drugs from compulsory drug detention centres and from private drug treatment centres that apply coercive measures, including involuntary detention.

4. Protect civil and political liberties: Many governments, as part of COVID-19 containment measures, are restricting civil liberties in unprecedented ways, through mass surveillance, including tracking mobile phone data, restricting movement and banning public assembly. Authorities such as police and army personnel are permitted to stop anyone on the street, increasing the chance of hostile interactions with people who use drugs, particularly when they need to purchase drugs or travel for health appointments. The potential misuse of personal data, particularly when it comes to criminalised populations, is of acute concern.

In a joint statement, UN experts have urged States, in accordance with the Siracusa Principles, to exert caution when applying COVID-19 related measures and restrictions that may impinge on human rights, as well as to limit their duration and subject them to regular review. Based on this, we urge the international community to:

– Ensure that emergency declarations and broader extraordinary powers granted under COVID-19 responses are not used to target specific populations or deployed to silence and repress human rights defenders.
– Establish rights-based legal safeguards to govern the appropriate use and handling of personal data to  protect privacy and confidentiality.
– Ensure that exorbitant fines and imprisonment should only be used as a last resort and personal circumstances taken into account, in the event of breaches to protective measures.

5. Protect community and civil society organisations: The COVID-19 pandemic has showed the critical role of communities in the response, as they can react quickly and reach those who are otherwise unreachable, easing the burden on the healthcare system. Furthermore, communities play important watchdog functions when it comes to government transparency and accountability. UN and donor agencies must act to:

– Protect human rights defenders, communities and civil society organisations during this crucial time, by highlighting their critical role in public statements and in their interaction with governments.
– Ensure governments do not impose disproportionate restrictions or obstructions on the work of community  and civil society organisations.
– Establish mechanisms for monitoring human rights compliance, with a particular focus on populations whose rights are commonly violated.

Global problems such as the COVID-19 pandemic require global solutions. We urge the international community to take urgent action to ensure the inherent rights and dignity of people who use drugs are respected and defended in the time of COVID-19. The pandemic has laid bare the failures within our societies. Undoubtedly a serious challenge, COVID-19 must not be exploited by governments to suspend basic rights and freedoms indefinitely, but be a wake-up call to change and repair a broken system that has been overly focused on the punishment of people who use drugs, a policy that is now exacerbating the dangers of COVID-19. The failed war on drugs must end, and health and political systems must be reformed to ensure the health and wellbeing of all.