Human rights and people who use drugs in the Mediterranean region E-Book

Council of Europe

• Herausgeber: Council of Europe
• Kategorie: Geisteswissenschaft
• Sprache: Englisch
• Veröffentlichungsjahr: 2022

Seitenzahl: 231

Beschreibung

Developing a better understanding of the meaning of human rights in drug policy.

When people have a history of dependence, they often experience stigmatisation and are frequently perceived as criminals. This stigma has a negative impact on their lives, therefore the issue of human rights for people who use drugs is crucial and needs to be taken seriously, and urgently, into consideration. This publication puts into perspective different country situations and practices. It helps countries to enlarge their view on how to integrate a human right approach into the daily life of people who use drugs, in a concrete manner.

This report provides an overview of the situation of human rights and drugs policy in the 18 participating countries of the Pompidou Group’s Mediterranean network for co-operation on drugs and addictions (MedNET). The research was conducted by collecting data in these countries, covering both the northern and southern rims of the Mediterranean, on specifics issues linked to human rights and people who use drugs. It is the second, and more exhaustive, effort to gather information on this important topic which underlies the Pompidou Group’s mission. In 2022, the research includes new topics such as the issue of children of parents who use drugs and children who use drugs themselves, the gender dimension in prevention and treatment, the treatment and care services available in prison and the impact of the Covid-19 pandemic on drug policy.

Leseprobe

 

HUMAN RIGHTS AND PEOPLE

WHO USE DRUGS IN THE

MEDITERRANEAN REGION

 

Contents

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Pompidou Group

The Pompidou Group provides a multidisciplinary forum at the wider European level where it is possible for policy makers, professionals and researchers to exchange experiences and information on drug use and drug trafficking. Formed at the suggestion of French President Georges Pompidou in 1971, it became a Council of Europe enlarged partial agreement in 1980, open to countries outside the Council of Europe. On 16 June 2021, the Committee of Ministers of the Council of Europe adopted the revised Pompidou Group statute that extends its mandate to include addictive behaviours related to licit substances (such as alcohol or tobacco) and new forms of addictions (such as internet gambling and gaming). The new mandate focuses on human rights, while reaffirming the need for a multidisciplinary approach to addressing the drug challenge, which can only be tackled effectively if policy, practice and science are linked.

To better reflect both its identity as a Council of Europe entity and its broadened mandate, the Pompidou Group changed its official name from the “Co-operation Group to Combat Drug Abuse and Illicit Trafficking in Drugs” to the “Council of Europe International Co-operation Group on Drugs and Addictions”. In 2022, it encompasses 38 out of 46 member states of the Council of Europe, plus Mexico, Morocco and Israel.

MedNET

MedNET is the Mediterranean network for co-operation on drugs and addictions of the Pompidou Group. MedNET activities are a permanent feature within the Pompidou Group work programme. It promotes co-operation, exchange and mutual transfer of knowledge between countries on both sides of the Mediterranean, respecting human rights and gender equality. It was created in 2006 following a feasibility study carried out at the initiative of France and the Netherlands. The group was assessed positively and has developed ever since, geographically and thematically, to promote effective and appropriate responses to addictions. Its terms of reference are adopted within the framework of the Pompidou Group Work Programme.

The network consists of 18 countries: Algeria, Croatia, Cyprus, Egypt, France, Greece, Italy, Jordan, Lebanon, Malta, Morocco, Palestine,1 Portugal, Slovenia, Spain, Switzerland, Tunisia and Turkey. Of these, 11 countries are Pompidou Group members. Of the 18 countries, only France, Greece and Tunisia did not provide an update to the 2020 “Human rights and people who use drugs in the Mediterranean region” report. Since 2006, MedNET countries have worked together to initiate and conduct ambitious projects. To ensure their success, they are based on South-South, North-South and South-North co-operation. MedNET aims to promote interaction between policy, practice and science, to adapt their implementation to the context of different countries. The European Commission and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) participate as observers to MedNET’s meetings. The question of addictive behaviours represents a critical issue for our societies and calls for a global response, taking into account human rights and combining prevention, health, the fight against drug trafficking, law enforcement and training and research. It is therefore crucial to develop dynamic co-operation that includes civil society, and that reflects the commitments made by all members of the network.

Acknowledgements

We would like to thank the following respondents

Algeria: Mr Mohammed Benhalla, General Director of the National Office for the Fight against Drug Abuse and Drug Addiction (ONLCDT);

Croatia: Ms Jadranka Ivandić Zimić, PhD, Head of Unit for International Co-operation in the Drugs Field –Department for National Drugs Information Unit and International Co-operation – Service for Combating Drug Abuse;

Cyprus: Ms Leda Christodoulou, Officer in the Policy Department of the National Addictions Authority of Cyprus;

Egypt: Ms Dalia Elsayed Ismail Ibrahim, External Affairs Co-ordinator, General Secretariat of Mental Health and Addiction Treatment (GSMHAT), Ministry of Health and Population;

France: Ms Laura D’Arrigo, Diplomatic Counsellor for the Interministerial Mission for Combating Drugs and Addictive Behaviours (MILDECA);

Greece: Mr Gerasimos Papanastasatos, Head of Research Department and Senior Advisor on Drug Policy to the National Drug Co-ordinator Therapy Center for Dependent Individuals (KETHEA);

Italy: Dr Elisabetta Simeoni, General Director, Head of Technical-Scientific and General Affairs Office, Presidency of the Council of Ministers, Department of Anti-Drug Policies;

Jordan: Lt. Colonel Jamil Al Habaibeh, Head of International Affairs Section, Anti-Narcotics Department;

Lebanon: Professor Ramzi Haddad, Head of Department of Psychiatry, Lebanese University, Co-Founder of Skoun, Lebanese Addictions Centre;

Malta: Professor Marilyn Clark, Department of Psychology, Faculty for Social Well-being, University of Malta, MSC Addiction Studies Course Co-ordinator and President of the Malta Chamber of Psychologists;

Morocco: Professor Jallal Toufiq, Director of the Ar-razi University Psychiatric Hospital and the National Centre on Drug Abuse Prevention, Treatment and Research, Director of the National Observatory on Drugs and Addiction;

Palestine: Dr Saed Balibisi, Acting Director of the Methadone Treatment Centre, Ministry of Health;

Portugal: Ms Ana Sofia Santos, Head of International Relations Division, Head of Portuguese Focal Point to the EMCDDA, General-Directorate for Intervention on Addictive Behaviours and Dependencies (SICAD);

Slovenia: Dr Joze Hren, Secretary – Directorate for Public Health, Ministry of Health;

Spain: Ms Elena Alvarez Martin, Deputy Director of Institutional Relations, Government Delegation for the National Plan on Drugs, Ministry of Health, Consumer Affairs and Social Welfare;

Switzerland: Ms Diane Steber Büchli, Federal Department of Home Affairs, Federal Office of Public Health, Division of International Affairs;

Tunisia: Professor Nabil Ben Salah, Director General of the Anti-Poisons and Emergency Medical Assistance Centre, President of the Tunisian Society of Addictology, President of the Subcommittee on Addictions of the National Mental Health Commission;

Turkey: Ms Peyman Altan, MD, MPH, Tobacco and Drug Control Department, Ministry of Health.

1 This designation shall not be construed as recognition of a State of Palestine and is without prejudice to the individual positions of Council of Europe member states on this issue.

Preface

Substance use is a very complex phenomenon. It is perceived in so many different ways depending on whether you are the person using substances, a parent, relative, neighbour, community member, religious leader, health professional, scientist, public health official, policy maker, law maker or media professional – as well as the country and culture you live in.

Substance use, especially drug use, is very often seen as “illicit behaviour” involving an illicit substance. And because the behaviour of use is considered illicit, so is the person who uses. Thus, the person who uses becomes the person to punish for it. This is how stigma has built up over decades and become, in many countries, the only window through which persons who use are viewed. Not until recently has the world started to move towards an understanding of the mechanisms and factors behind substance use. Addiction as a chronic relapsing brain condition is now, more than ever, being treated as a medical condition rather than “deviant behaviour”. But because substance use tends to become recurrent and addiction takes its toll physically and mentally on the person, criminal offences are common under the influence of the drug or the addiction itself. At some point in their tumultuous lives, persons using drugs are likely to encounter arrest, prosecution, sentencing, incarceration and probation. Is there any alternative to imprisonment? Is there proportionality during sentencing? Is appropriate science-based care available, before, during and after imprisonment? Are the conditions of imprisonment decent with regard to the basic human needs of the person, their gender, health condition and other vulnerabilities? Do prisons provide the path to real recovery? Are in- and after-prison rehabilitation programmes effective? Are post-release rehabilitation programmes into the community accessible? This remains a grey area in many parts of the world. Beyond the issue of alternatives to imprisonment for people using or possessing drugs, there is a need for a broader approach encompassing the right to access and the availability of treatment programmes; the right to proper and evidence-based treatment and care; the right to rehabilitation and harm reduction programmes; the right to information; the right to be heard and listened to when it comes to policy making; and, first and foremost, the right to science-based prevention targeting youth.

Moreover, human behaviour is always complicated, for it involves internal and external factors. Most internal factors are not under one’s self-control and pose the philosophical issue of attributability. Many external factors, especially environmental ones, lie heavily on us, and often there is no way out. All these factors contribute to a balance of vulnerability versus resilience that cannot always be predicted or even influenced.

All these issues of human rights for people who use substances are crucial and need to be taken seriously, and urgently, into consideration. The main objective of the United Nations conventions, which all our countries are parties to, remains, after all, the well-being and welfare of humankind. Hopefully, this document will be an eye-opener for the many stakeholders working on both sides of the Mediterranean Sea, and will trigger a new dynamic to compare situations, share practices, and inspire each other for the good of all those who use drugs and suffer in our region.

Professor Jallal Toufiq

MedNET Representative for Morocco

People with a history of dependence often experience the stigma of the “drug addict” and social marginalisation. This stigma leads to feelings of fear and isolation, and often means substance-dependent people feel unwelcome at social engagements and in work environments, resulting in marginalisation, confinement and social exclusion in general. Stereotypical prejudices, discriminations and negative social traits are often attributed to substance-dependent individuals, who may be labelled dangerous, criminal, weak, and lacking skills or interests. The consequences of this unfair treatment are mainly social and professional, but are also psychological, both for substance users and for their families. The stigma experienced by substance-dependent people may have a negative impact on their mental health, as well as on their rehabilitation, leading to unemployment and housing problems.

Stigma may directly affect people’s self-confidence. People with a history of dependence may internalise stigma, feel devaluated and ashamed, and conceal their substance use. In addition, the fear of being confronted with stigma affects their interactions with other people. Fearing rejection, substance users may isolate themselves or hide their situation in order not to be judged. Consequently, people with a history of dependence find it difficult to seek help. And even when they do receive the appropriate help, they face the same difficulties all over again in their reintegration into society, in finding a home, in finding a job or in sustaining a normal social life.

It is for these reasons that the Pompidou Group, MedNET and its member countries promote drug policies and comprehensive actions based on human rights that aim to eliminate stigma. The development of comprehensive drug systems in prisons; the training of policy makers, health professionals, and professionals from the police and the legal sector; the exchange of knowledge and experiences among neighbouring countries; the establishment of a network to facilitate change and in effect ensure the availability of care, treatment and rehabilitation services in prison settings as well as in the community – these are fine examples of actions facilitated by MedNET. The aim is to ensure that the human rights of people facing drug-related problems are protected and that healthcare and support are available at all times, even if they are deprived of their liberty as a result of incarceration.

It is vital that we all continue to join forces to eliminate stigma and otherwise support substance-dependent individuals. MedNET and its members are committed to these goals through their continued co-operation to promote human rights in all policies, and the establishment of new actions, programmes and interventions, so we can gradually create a society of zero discrimination against substance users.

Leda Christodoulou,

National Addictions Authority of Cyprus and MedNET Chair since 2022

Introduction

In 2019, a discussion entitled “Human rights and people who use drugs in MedNET countries: current situation, challenges and the future” was carried out by the Pompidou Group Secretariat during the 25th MedNET meeting. It was chaired by Professor Nabil Ben Salah, MedNET Representative for Tunisia and chair of the MedNET network (2019-21).

In preparation for this discussion, research was conducted by the secretariat, resulting, in 2020, in the report P-PG/MedNET (2020) 4, “Human rights and people who use drugs in the Mediterranean region: current situation in 17 MedNET countries”. This was made possible by a response rate of 70 % from MedNET representatives following the secretariat’s request for information.

Professor Jallal Toufiq, MedNET Representative for Morocco, proposed the topic and facilitated the discussion, framing the multidimensional scope of a human rights approach for people who use drugs.

Drug use must be rightly considered a medical condition to be treated by qualified health professionals.

Treatment must be available, accessible, affordable and science-based, and should use best practices.

Prevention must be grounded in science, facts and best practices.

Data collection must be considered a part of the right to access information for the community of practice and professionals involved.

Rehabilitation and social reintegration must be provided.

Access to treatment and care must be available to specific populations, including people who use drugs in prison, sex workers, pregnant women, migrants, refugees and the elderly.

Combating stigma and raising social awareness is key.

A human rights approach, especially for minors and non-trafficking users, should be incorporated into law.

People who use drugs should have the right to form their own associations and self-help groups.

People who use drugs should have the right to access treatment for all the consequences of drug use.

All strategies aiming at reducing the health, economic, social and legal consequences of drug use should be promoted.

In the country research, the aim was to gather information on the above-mentioned topics. The results presented were not intended to be exhaustive but to provide an overview. The main objective of the discussion was to better understand the meaning of human rights in drug policy and to exchange best practices and ideas. This is consistent with the 2018 “Stavanger Declaration” of the Pompidou Group’s 17th Ministerial Conference, which reaffirms a focus on “human rights as a fundamental cornerstone in drug policy”, in line with the Council of Europe’s core mission.

Due to the importance of the topic, and the focus on human rights within the Pompidou Group work programme, it was decided to proceed in 2022 with a second round of data collection from the MedNET countries. The exercise requested MedNET country representatives to update their replies from 2020 by responding to the following questions.

How is the issue of children considered in drug policy? This topic could include two aspects: children whose parents use drugs and children who use drugs themselves.

How is the gender dimension addressed in drug policy? Are women considered to have special needs? Are specific services available?

An issue for both women and children is the question of pregnant women who use drugs. Are there services available to them? Is there a follow-up for newborns (and up to what age)?

Is the question of the LGBTQI community considered, in terms of the stigma they may face?

Keeping in mind that treatment should not stop at the prison gate, what drug treatment services are available in prison? Is there a rehabilitation programme? Is there continuity of treatment after prison?

From criminalisation to illness, does policy consider drug users to be criminals or people in need of help and treatment? Has the policy evolved, for example is there an increase in the number of treatment centres?

What is the involvement of people who use drugs in the process of decision making regarding drug policies?

What consequences did Covid-19 have for drug policy and what lessons can we learn with regard to the treatment offer and treatment modalities?

The following sections summarise the situation in each MedNET country.

Chapter 1Algeria

1. Health approach at the policy level: drug use considered a medical condition to be treated by qualified health professionals

The Algerian Law 04-18 on the Prevention and Suppression of the Illicit Use and Trafficking of Narcotics and Psychotropic Substances of 25 December 2004 considers drug use to be a medical condition in its own right that requires therapeutic treatment. The “therapeutic injunction as an alternative measure to imprisonment for cases of drug addiction” provided for by the law is a step towards the recognition of drug addiction as an illness.

The law marks an essential step in changing the status of (drug) users: it no longer considers them to be criminals who must be punished, but as sick people who must be cared for. The law emphasises the therapeutic injunction, which it presents as a care and prevention measure and an alternative to a penal response. It thus constitutes a significant development in Algerian legislation.

Article 6 of the same law cited above stipulates that: “Public action shall not be taken against persons who have complied with the medical detoxification treatment prescribed to them and followed it to its conclusion.”

Similarly, public action is not taken against persons who have made unlawful use of narcotic drugs or psychotropic substances when it is established that they have undergone detoxification or medical supervision since the date of the offence committed.

2. Treatment to be available, accessible, affordable and science-based, using best practices

Following the promulgation of Law 04-18, the Algerian Government launched a multi-year programme in 2007 aimed at setting up a vast network of centres specialising in the therapeutic management of drug users.

The residential treatment programmes offer reception and counselling services, motivational interviewing, and assessment of the most problematic drug use habits (early onset, cumulative use, excess use and repetition) and risk factors (personality traits, risky behaviour, and school, family and environmental context, etc.).

Several Algerian doctors have taken part in training on substitution treatment, organised by the Pompidou Group in several countries in the region as part of the activities of MedNET. On 5 January 2021, Algeria introduced opiate substitution treatment (OST) with methadone. Two centres for the treatment of drug addiction were selected, and 100 patients benefited from methadone treatment that year. This number will increase to more than 320 patients by 2023, according to the Ministry of Health. Under the work programme established by the ministry in 2007, 44 intermediate care centres out of the 53 planned and 4 drug treatment centres out of the 15 planned are operational.

The health sector is making constant efforts in the following areas:

information provision and awareness raising on social problems, including drugs, as part of the activities carried out by screening and monitoring units in co-ordination with the Ministry of Education;

a continuing education programme for professionals specialising in the fight against addiction.

A certificate of specialised studies in addictology was launched in 2017 for two groups composed of more than 40 doctors from the intermediate care centres in the medical faculties of Algiers and Blida. Furthermore, 40 more doctors and psychologists were trained in 2021 in motivational interviewing with the support of the Pompidou Group. Thirty general practitioners working at the level of Centres Intermédiaires de Soins (CES) spread throughout the country, constitute a third group, and are currently undergoing training at the Faculty of Medicine in Badji Mokhtar Annaba University to obtain a diploma in addictology (specialised study certificate CES in addictology). Meanwhile, the provision of healthcare to drug users seeking care fell from 24 424 in 2018 to 23 416 in 2019 and 21 638 in 2020.

The national sexually transmitted infection (STI)/HIV/Aids strategic plan includes the following two objectives:

to include injecting drug users (IDU) in priority target groups classified as vulnerable or at high risk of exposure to HIV;

to develop measures to prevent and reduce the risk of STIs and/or HIV/Aids among this population group, with a view to encouraging the adoption of less risky behaviour.

3. Prevention grounded in science, facts and best practices

The ONLCDT has developed a new strategy for the period 2020-24. The National Strategy for the Fight against Drugs in Algeria emphasises prevention and asks all actors to focus their activities on information, education and communication. A sub-committee on “preventing addiction in schools and among young people” has been created under the ONLCDT’s evaluation and monitoring committee, along with a second sub-committee to address “addiction prevention for vulnerable groups (women and children)”. An epidemiological survey on drugs in universities was conducted.

Training courses are also available on the prevention of and fight against drugs and drug addiction in Algeria. Support has been regularly requested on this subject and requests have been made to international bodies for capacity building. To this end, the ONLCDT has made it possible for senior representatives of the Directorate General of Customs and doctors specialising in drug addiction to participate in training courses abroad.

4. Data collection a part of the right to access information for the community of practice and professionals involved

The ONLCDT centralises data on the prevention and control of drug use and the treatment of drug users. An annual report and the Office’s website present statistics on drug seizures, the processing of drug offence cases by the courts and the care of drug users.

The ONLCDT collects data from different sectors, such as the Ministry of Justice, the Ministry of Health, the General Directorate of National Security, the National Gendarmerie and the Directorate General of Customs, and ensures that they are processed and used across sectors.

5. Rehabilitation and social reintegration provided

The ONLCDT has two objectives: to organise training and information seminars on the fight against illicit trafficking and the abuse of drugs and psychotropic substances, and to provide for the therapeutic care or rehabilitation of drug users. A substitution programme has enabled the start of psychosocial support for IDUs in a treatment centre with the support of civil society. In Algeria, rehabilitation and reintegration schemes are offered to former prisoners convicted of drug-related offences or to prisoners who use drugs.

6. Access to treatment and care available to specific populations, including people who use drugs in prison, sex workers, pregnant women, migrants, refugees and the elderly

The Ministry of Health has opened treatment centres, as foreseen in its 2007 multi-annual action programme to improve the systems of therapeutic care for drug users. Addiction treatment centres are regularly evaluated by the authorities. Detoxification centres in hospitals are run by qualified professionals and civil society actors. In order to prevent infectious diseases, the Ministry of Health provides different services to drug users and they are cared for in a way that preserves their dignity and physical integrity. The therapeutic services provided to drug users are free of charge, as is all healthcare in Algeria.

7. Combating stigma and raising social awareness prioritised

In the early stages of the Covid-19 pandemic, awareness-raising and anti-stigmatisation activities were reduced to their simplest form. Prior to the pandemic, however, the ONLCDT had been conducting information and awareness-raising activities. It regularly organised conferences and seminars at the local level in order to raise awareness among local authority officials and residents in general on the danger of stigmatisation of drug users and the obstacle this poses to their proper treatment and social reintegration.

8. A human rights approach, especially for minors and non-trafficking users, incorporated into law

Law 04-18 is a comprehensive law in that it addresses the issues of drug abuse and addiction from the perspective of both prevention and control. With regard to drug use, it distinguishes between the victim and the criminal and does not prosecute persons who accept the therapeutic injunction provided for in the law. In addition, the provisions of Articles 6 to 11 allow for the termination of criminal proceedings against drug users, provided that they agree to undergo detoxification treatment in a specialised institution, as ordered by the competent court.

9. People who use drugs have the right to form their own associations and self-help groups

Although drug users are not forbidden to create their own associations, there is no evidence that this has actually happened in Algeria.

10. People who use drugs have the right to access treatment for all the consequences of drug use (such as HIV/Aids)

In Algeria, risk reduction is based on preventive actions as well as on measures for the care and rehabilitation of drug users. The expansion of OST will contribute to the fight against the spread of infections among IDUs. The prison health system provides care for prisoners addicted to opioids, and co-ordination with pilot OST centres should be considered as soon as possible. An objective of the National STI/ HIV/Aids Strategic Plan 2020-24 is to ensure universal access to prevention, diagnosis and treatment. Specifically, it aims to:

reduce the number of new HIV infections by 500 new infections per year by 2024;

stabilise HIV-related mortality at less than 5 %;

keep 90 % of HIV-positive mothers and children alive;

intensify prevention efforts with a special focus on key populations, vulnerable individuals and pregnant women;

accelerate HIV and other STI testing activities with particular focus on key populations, vulnerable individuals and pregnant women;

ensure gender integration at all levels of the implementation of the national HIV response programme.

11. All strategies aiming at reducing the health, economic, social and legal consequences of drug use promoted

The health consequences of drug use can be reduced by carrying out as many preventive actions as possible. For example, a programme on prevention in the educational environment is being considered by the Ministry of Health. In terms of risk reduction, a programme is being implemented for HIV/Aids. The ONLCDT is working to develop a programme to reduce drug use.

Furthermore, the national action to increase the number of care centres for drug users and bring them closer together, and to facilitate access to care for all applicants, will undoubtedly help to address the drug issue.

New identified topics for 2022

12. How is the issue of children considered in drug policy? This topic could include two aspects: children whose parents use drugs and children who use drugs themselves.

A preventive approach is taken towards the issue of drugs among children in Algeria. The Ministry of Education has programmes designed to address the issue, including specific preventive actions.

A national survey on the phenomenon of drugs in schools was carried out by the ONLCDT in 2016. It showed that the rate of drug use (of cannabis) among schoolchildren in the 12-15 year age group was 0.9 %. This jumped to 3.61 % for the 15-17 year age group. However, the percentage of drug-using children under 15 years of age who seek care was just 4.69 % in 2018, 3.55 % in 2019 and 4.3 % in 2020, according to the Ministry of Health’s annual report on care seekers.

Pupils who use drugs are treated by multidisciplinary teams within the structures dedicated to the treatment of addiction under the Ministry of National Education (Unités de dépistage et de Suivi –UDS). The issue of children whose parents are drug users is not yet on the agenda in Algeria.

13. How is the gender dimension addressed in drug policy? Are women considered to have special needs? Are specific services available?

There are specific hospitalisation units for women drug users. Particular discretion is ensured during their therapeutic treatment.

14. An issue for both women and children is the question of pregnant women who use drugs. Are there services available to them? Is there a follow-up for newborns (and up to what age)?

Pregnant drug users are treated equally to other women who come to the gynaecology department for childbirth. Their number is unknown because they do not generally declare that they use drugs. There are no specific services dedicated to this category of women, nor to the newborn babies of addicted mothers.

15. Is the question of the LGBTQI community considered in terms of the stigma they may face?

This category of people is received in addiction treatment centres like all other drug users without any distinction, with all the necessary discretion and confidentiality.

16. Keeping in mind that treatment should not stop at the prison gate, what drug treatment services are available in prison? Is there a rehabilitation programme? Is there continuity of treatment after prison?