1. …at what cost ? …at what cost ?

2. Ten year review:  Law enforcement at the expense of public health and human rights  Major HIV epidemics among IDU  Lack of drug treatment and abuses in the name of drug treatment

3. Law enforcement practices block drug users’ access to public health services In Russia and Ukraine, police often harass and arrest drug users who attempt to obtain health information and sterile syringes from drug stores and legal syringe exchange sites. In China, police are known to wait by syringe distribution points to arrest drug users. Outreach workers have been followed and detained. In Thailand, police regularly interfere with drug users’ efforts to seek health care by harassing clients outside of drug treatment centers and use possession of sterile syringes, or presence at a methadone clinic, as a basis for harrassment or arrest.

4. Law enforcement approaches associated with police use of excessive force and human rights violations  Drug enforcement in China, Kazakhstan, Russia, and Ukraine, has been associated with police extortion and violence against suspected drug users.  In Thailand, a federally ordered police crackdown resulted in reports of thousands of extra-judicial killings of suspected drug users. Many of those arrested report that police planted drugs in their pockets, forced them to sign false confessions, or threatened to arrest them simply for not being enrolled in drug treatment. Recently, the Thai government announced a re- start of the killings and a few extrajudicial killings have already been reported.  In Kazakhstan, police come to drug-dealing points to conduct body cavity searches, which women IDUs report lead to sex in exchange for the return of seized drugs.

5.   As many as 1.7 million people are living with HIV in Eastern Europe and Central Asia   Injection drug use is the single most significant driving force behind the epidemic in the region   IDU accounts for more than 70 percent of cumulative HIV cases in Eastern Europe and Central Asia HIV Epidemics: Mostly or Almost Entirely among Drug Users, FSU

6. HIV among drug users

8. Methadone  Categorization as Schedule 1 (1961 Convention) not suited to data and realities of 2005  No comment by INCB on countries that ban the treatment  Methadone proven to reduce injecting & demand for illegal opiates, and increase adherence to ARV treatment

9. Perpetual Pilot or no methadone at all Poland has over 35,000 opiate users but only about 1000 methadone treatment slots Russia—1/2 million+ opiate users, no substitution treatment. Russian policies often influence neighboring countries. Tajikistan still considering, but not treatment

10. Methadone Maintenance Clinic (China)

11. Over-Control Makes Treatment Inaccessible  Treatment philosophy organized around often unrealistic goal of complete abstinence  Waiting lists, age limits, requirement of documented attempts at abstinence, review by commission  Prohibitive fees passed to patients; corrupt staff demand bribes  Police interference  Lack of take-home doses disrupts lives  Punitive urine testing and body searches

12. Abuses in the name of “treatment”  No international standards for evidence-based drug treatment  Any intervention, no matter how inappropriate and ineffective can be considered “drug treatment” Photos courtesy Jimmy Dorabjee

13. Locked wards as treatment Moscow Substance Abuse Hospital #17, 46 dead, December 2006 http://news.ntv.ru/99430/

14. Women and drug use Global inattention to women drug users: UNODC 2006 World Drug Report, which relies in large part on national self-reporting, makes more references to the female cannabis plant (14) than to women drug users (5) This despite assertions in 2005 report that number of women drug users was increasing and injection-driven HIV epidemics were feminizing.

15. HOW ARE WE DOING?  Governments treat drug users like drugs: as something to be controlled and contained  Mass incarceration, forced institutionalization and registration are a norm  Harm reduction not anywhere near required scale  None of the most affected counties have national scale, effective substitution treatment, and most do not have pilot programs  Instead, punitive, abusive interventions are considered “drug treatment”

16. Thank you kmalinowska@sorosny.org