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Public Health Language on Drugs Has Been Co-opted for Prohibitionist Means

An insidious trend is emerging among public officials around the world: using public health language around drug policy as a cover for punitive approaches.

In early October, a spokesperson for Philippines President Rodrigo Duterte claimed that the government’s drugs strategy was “shifting very quickly from the national security mode into the public health mode”.

However, in light of the approach taken in recent months, one cannot reasonably expect this shift to suddenly instil a genuine concern for the welfare of people who use drugs. President Rodrigo Duterte has made it abundantly clear that he has no interest in this, and since taking office on June 30, around 5,000 people have been killed – either by police or in extrajudicial vigilante killings – because of his violent drug war rhetoric.

With the fear of such violence, people who use drugs are being forced to retreat as far from public spaces as possible. Organisations that once provided sterile needles are under pressure to stop doing so as Duterte has threatened the lives of human rights activists who seek to help people who use drugs. People who inject drugs are thus more likely to reuse and/or share needles with each other, increasing the risk of HIV.

This spread of HIV, while harming people who use drugs, is of course increasing the risk of infection for the wider population too. Not exactly a “public health” approach.

Many Filipinos who use drugs have submitted to authorities for fear of being murdered. They have been forced to enter so-called “rehabilitation centres”, where the true nature of the government’s “public health mode” can be seen. In a Guardian photo essay, photographer Erik de Castro reveals people in these facilities being subject to harrowing instances of abuse and humiliation, including being blindfolded, isolated, and hosed with water.

The dire situation is bound to continue, as Chinese billionaire Huang Rulun has recently pledged funding for further "rehabilitation" centres that can hold a total of 20,000 people.

The dichotomy between rhetoric and policy around the world indicates that the Philippines, though an extreme example, is not unique.

The deputy executive director of the United Nations Office on Drugs and Crime (UNODC), Aldo Lale-Demoz, told a conference in October that “we advocate for the abolition of punitive approaches [to drug use] … and we seek actions rooted in the right to health and human rights”.

This remark may sound promising to some human rights advocates, but it diverges significantly from the UNODC’s behaviour. The UN office provides funding for several governments’ drug policies, including that of the repressive Iranian regime.

In 2015 alone, Iran executed at least 977 people, the majority of whom were killed for drug offences. Then, in early 2016, the UNODC signed a $20 million agreement with Iran which involves the provision of funding and equipment for the country’s counter-narcotic law enforcement.

Human rights non-profit, Reprieve, wrote a damning statement to the UNODC:

“The apparent hanging of every man in one Iranian village demonstrates the astonishing scale of Iran’s execution spree. These executions – often based on juvenile arrests, torture, and unfair or non-existent trials – show total contempt for the rule of law, and it is shameful that the UN and its funders are supporting the police forces responsible. UNODC must urgently make its new Iran funding conditional on an end to the death penalty for drug offences”.

The UNODC did not respond.

Under President Obama’s authority, the United States has presented a similar dichotomy between its officials’ rhetoric and its policy implementation.

Gil Kerlikowske, director of the Office of National Drug Control Policy between 2009 and 2014, told Reuters in 2012 that his country must "address [its] drug problem as a public health issue, not just a criminal justice issue". Yet under Kerlikowske’s tenure, the government maintained a ban on federal funding for needle and syringe programmes, and the number of drug overdose deaths increased every single year.

The dichotomy has held true under Kerlikowske’s successor, Michael Botticelli, who has been praised as one of the most progressive drug czars to hold office. In 2015, he told CBS News that the War on Drugs has been "all wrong", and that "we can't arrest and incarcerate addiction of out of people".

Despite this seemingly progressive rhetoric, criminalisation of people who use drugs is rife in the US. Someone is arrested for drug possession every 25 seconds, and almost half of these arrests are for cannabis possession. A report by Human Rights Watch points out that, in 2015, more people were arrested for simple cannabis possession (574,000) than for violent crimes (505,681), such as rape and murder.

Given the federalised nature of US policymaking, the ONDCP cannot be solely to blame for states’ repressive drug policy implementation. Nonetheless, the ONDCP has been woefully ineffective at countering the overdose epidemic with targeted funding or initiatives.

A vital first step in the implementation of a genuinely health-focused approach to drugs is the decriminalisation of possession for personal use. No authority can claim to be implementing a “public health” approach without removing the threats of prosecution and stigma that accompany continued criminalisation.

Furthermore, a public health approach must take into account the complex factors that drive problematic drug use, and ensure that international standards for human rights are respected.

By advocating a health-oriented approach without backing decriminalisation, governments and international institutions are undermining the potential for progress; officials are using progressive language as a cover to continue, or even increase, the human rights abuses of people who use drugs.

It is essential for public health language around drug use to be reclaimed by officials who are truly committed to it.

In time, the deception of those who co-opt health-oriented rhetoric for their prohibitionist means will become publicly apparent. But how many more lives must be lost along the way?

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