Translating realities faced by women who use drugs into human rights language is never an easy task

Dasha Matyushina, Drug Policy and Human Rights Advisor, EHRA

On March 2-3 2018 International Women’s Rights Action Watch Asia Pacific (IWRAW Asia Pacific) organized a workshop – which they call a ‘writeshop’, and I like this name – on developing reporting guidelines for NGOs to report to CEDAW on the violations of rights of women who use drugs.

I decided to make these 34 hours of travel to Kuala Lumpur and back for a 16 hours writeshop because of the study we have organized in Estonia in 2017. It was clear from the very beginning that the amount and harshness of the violations of rights of women who use drugs in Estonia we discovered, created an obligation upon us to produce a shadow report to CEDAW.

What IWRAW Asia Pacific does best is making you feel you are an expert in the Convention on the Elimination of All Forms of Discrimination against Women. They don’t tell you violation of which of the Convention’s articles the case implies, but they give you the text of the Convention and then you tell them whether it’s Article 12 (on health) or Article 16 (on family life).

Translating realities faced by women who use drugs into human rights language is never an easy task but having lawyers in the rooms really helps.

Deprivation of child custody solely because of drug use, which we found to be so prevalent in Estonia, violates Article 16. Non-provision of quality drug treatment services for women with children is the violation of Article 12. Arbitrary arrest and detention of women whom police know as drug users, which we surprised to discover in an EU state, violates Article 2. There is more of cause, but I will always remember CEDAW articles 2, 12 and 16.

EHRA’s research on human rights violations in the EECA will continue, and so our partnership with IWRAW Asia Pacific will. Our next field research is going to happen in St. Petersburg and Leningrad oblast in Russia – a border region with Estonia’s city Narva. We will compare the situation in Russia and Estonia through the lens of CEDAW articles – and we will probably to find more similarities between the policies of these two states that the human rights movement would expect.

Harm Reduction Beyond Numbers

Author: Péter Sárosi, Drugreporter

How cultural attitudes, the political environment, and donor expectations shape harm reduction – and how they can divert it from its original mission as a movement.

We have been producing movies about drug policies since 2007. Through all these years, we have been traveling a lot across the world, visiting harm reduction sites and interviewing hundreds of harm reduction activists, professionals, and decision makers in various countries.

It is easy to make premature judgments about harm reduction in a country. I always have my own preconception about it before actually traveling there, based on articles and reports I have read. Most of the time, I have to admit that the reality is much more complex than my expectations. My experience tells me that sometimes countries labelled as retrograde in terms of drug policy and harm reduction can amaze you with vivid, vibrant local harm reduction scenes. And countries praised for their progressive drug policies can equally disappoint you with their rigid, medicalised systems.

Sometimes you learn the most cutting edge lessons about harm reduction and human rights among the people living in disadvantaged countries. A mistake often made is that the experience of these people is underestimated, and only success stories are highlighted and celebrated by reports from international organisations. Exchanging experiences and knowledge among decision makers and harm reduction professionals working in similar, difficult environments is often as useful as presenting best practices from Western countries. Lack of measurable success in changing policies is not necessarily a sign of the failure of advocacy efforts.

Harm reduction is of the people, for the people, and by the people. Assessing scientific data about trends of infections or access to services is necessary when measuring the social impact of harm reduction as a set of interventions. But statistical data in itself is far from sufficient to have a real insight into how harm reduction works as a movement, how is it embedded into the local political and cultural context, and how it affects the lives of individuals and communities.

We can identify some main factors shaping and framing harm reduction. These structural factors are actually not so different from those shaping the individual drug experience. Since the 1960s it has been a commonly accepted wisdom that the drug experience depends on three factors: set (the mindset of the drug user), setting (the physical and social environment), and dose (of the substance used). Similarly, three factors can largely determine harm reduction in a country:

1) Cultural environment – Social attitudes to drug use, historical development of the drug treatment system, education and attitudes of public health and social professionals, the influence of abstinence-culture, and the role of religion and church.

2) Political environment – State of democracy, freedom of association & power of civil society, type of government, the state of development of the welfare state, drug laws, law enforcement practices, public health regulations, and the external influence of neighbouring countries.

3) Funding environment – Who is funding harm reduction, what is the framework of the funding, what are the donors’ expectations about supported activities, how the money is distributed.

Western European cities are the best propagated examples of how we can reverse drug related death and disease by investing in harm reduction. Services are well funded by the government, well connected, and coordinated to municipal health, social and criminal justice systems. The political and cultural environment is tolerant or supportive. However, city leaders often embraced harm reduction from a cosmetic point of view: to get rid of street nuisance and bad press coverage. In developed countries high-tech, well-funded services often work without real mobilisation and involvement from drug user communities. The best services are sometimes not only the well funded services – but those operated by NGOs investing a lot of time and energy into advocacy, community mobilising, and peer involvement.

Harm reduction has been mainstreamed in much of Western Europe. It is business as usual, operated by technocrats or public health officials paid by the government, working according to official standards. If you attend a harm reduction conference in Europe you will meet social workers, public health pundits, and law enforcement officials discussing research findings, grant systems, and professional protocols. The contrast is stark if you attend a harm reduction conference in the US, where harm reduction is still an underground movement challenging the status quo of the mainstream abstinence culture and tough-on-drugs policies. Funding is unstable, whilst federal funding for needle exchange was banned until recently. You will see way more rebels and punks at these events who discuss social justice and structural racism. While harm reduction is – sometimes grudgingly – accepted by even social conservatives in Western Europe, it is more like a Leftish guerrilla movement in the US, driven by drug user activists and radical social workers. The opiate overdose epidemic has been recently helping harm reduction become part of the mainstream – at a terrible cost in human lives and suffering.

In most Eastern European and Asian countries you often see broken down hospitals, burnt out and underpaid health professionals, and understaffed and under-equipped services. HIV infection and overdose death rates can be rampant. Criminal laws are repressive. Drug users are often coerced into so-called treatment programs. In this hostile environment, harm reduction could only lay down roots with the help of international donors, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria. Its positive impact is tremendous in reducing new infections and scaling up HIV treatment and prevention among the so-called key populations. Without the support of the Global Fund, these communities would have no voice and no future.

However, harm reduction dependent mostly on international donors is like a plant nurtured indoors by artificial light, with no deep roots in the cultural and political soil of the hosting society. Whilst the funding environment is favourable it may flourish. But as soon as it is deprived from international support and is exposed to the harsh outdoor environment, its fragility will be revealed. This happened when the Global Fund changed its funding policy after the financial crisis and many countries lost their eligibility. This resulted in the sudden collapse of many community-based harm reduction services and the further marginalisation of injecting drug users. Many people died as a consequence. Service providers tend to follow the flow of the money. Many abandoned harm reduction services and chose a different survival strategy. It soon appeared that by only focusing on funding services without investment into public education and community advocacy, international donors could not make harm reduction sustainable.

Donors do not only fund and shape harm reduction – they can also distort it.

For example, they often put harm reduction in the framework of HIV prevention and thus into the realm of public health interventions. National donors often subordinate harm reduction to treatment and prevention. These reductionist interpretations of harm reduction as a set of public health interventions are devoid of many other important dimensions of psychoactive substance use. For example, the social dimensions of poverty, exclusion, institutional racism and segregation, homelessness, and unemployment. Or the legal-political dimension of repressive criminal laws that are pushing substances and people who use them underground. To address these systemic factors harm reduction must go beyond public health interventions and mobilise marginalised communities against repressive and exclusive government policies and laws. Criminal justice reform must be an essential part of harm reduction – but it has not been on the agenda of many harm reduction organisations.

Second, putting harm reduction into the context of HIV prevention reduces its focus to only injecting drug use. While injecting drug users are far more marginalised than any other groups of drug users, harm reduction as a philosophy and practice must go beyond injecting use and transform the way we perceive drug use in general. It should include pragmatic and compassionate programs to reduce the harm of recreational drug use as well, for example in a party setting – even if it has nothing to do with HIV prevention directly. The vast majority of drug users are non-injecting recreational drug users, reaching them is not only important to avoid accidents, but can do a lot to promote the acceptance of harm reduction as a guiding principle among the general population. In countries where harm reduction is dependent on Global Fund, programs supporting party-going young people are underfunded and scarce. When streets were swamped with new psychoactive drugs, and new patterns of drug use and distribution started to trend among young people, programs designed to serve opiate injectors could not cope with these problems.

Third, big donors shape their grantees in their own image. It is very easy for NGOs competing for limited resources to lose sight of their mission and to follow the expectations of the donors in order to secure funding. But donor expectations about ideas, supported activities, regions and groups do not shape how NGOs and community groups work alone. To apply for grants, to manage grants, and to report to the donors requires huge investment in time and human resources. The bureaucratic processes required by donors change the perception of time, staff, services – and in the end, the mission of the organisation. Many grantees realise that for the donor it is not the real social impact that matters but organisational stability in managing and reporting grants. Community activists often transform into technocrats who lose the connection to the communities they serve. When activists speak a language full of jargon and acronyms only the selected few understand, their arguments do not appeal to the general public or to hostile neighbourhoods.

National and international donors must learn the lesson and invest more into community organising, public education, and advocacy to change social attitudes and policies about people who use drugs. Without transforming the set and setting, that is, the cultural and the political environment, harm reduction is vulnerable and cannot adapt to new challenges. Where harm reduction is not well embedded into and accepted by society, and not well connected to the community, sudden changes in the political environment can lead to collapsing services even in countries where national funding for services is available, as exemplified by my own country, Hungary.

Rigid rules by international donors about governance and co-funding favour big organisations based in wealthy countries over community activists living and working in repressive environments. These rigid rules do not guarantee the social impact of grants. Investment into people rather than just organisations, services, and projects can do. Sometimes the best ideas and initiatives come from grassroots activists and community groups without well established governance structures. Instead of requiring grantees to transform into grant processing companies, obsessed with Western-type management methods completely alien from community activists working on the ground, new flexible rules and modes of funding should be developed. Forging synergies among social movements is also important – they cannot win in isolation. They can learn a lot from each other about innovative advocacy methods to mainstream their messages. Only together they can fight austerity measures, rising right-wing populism, and the new authoritarian crackdown on civil society. In the end, the success of harm reduction as a movement depends on the larger context of social justice movements, the state of democracy, and the existence of a strong civil society.

Source: Drugreporter

Pilot OST Programs in Kazakhstan – How to Avoid Being Thrown Overboard

Author: Dasha Matyushina, Drug Policy and Human Rights Advisor, EHRA

In my almost twenty years of working in harm reduction I have visited many opioid substitution therapy sites in different countries. One of the first programs I was lucky to see was an OST site in New York. A likeable doctor was enthusiastically telling me about his patients – some of them were allowed to collect a two-week methadone supply because “they worked so hard and could not spare the time to come for therapy more often”. That very week I happened to visit another OST site in New York. I saw a huge queue to an armoured window where methadone was dispensed and a uniformed man with arms at the ready standing behind the queuing people. I just could not grasp the existence of two such absolutely different sites in one city.

Since then I have seen dozens of OST sites and talked to hundreds of their clients. The sites were more or less different but the talks I had all seemed an extension to my very first conversation with a girl client of a New York OST site from so long ago. I came from Russia, the country where OST was non-existent at the time, where people could only hope it would be available at some point, so it was really weird to hear people complaining – like, “I am a regular here but sick of this bloody methadone, no adequate care here, the drug quality is not as it used to be, the opening times suck and they don´t treat us as human beings here”…So I no longer idealized those programs and saw not only their value but also the restrictions they impose on people with opioid addictions.

On my way to Pavlodar I did not expect to see an exemplary OST site – I am aware of the challenges such programs face in Kazakhstan and how hard it was to open and keep sustaining OST sites there. I also know what a „pilot OST site“ really means: minimum clients, maximum rules.

Oxana from the Foundation “Ty ne odin” (“You are not Alone”) and I came to an opioid substitution therapy site at 9 o´clock in the morning.  There was a constant flow of people, some stopped to chat with me at the entrance, some passed by with a nod to an acquaintance and paid me no attention, some went away and came back with a coffee. There were too many names to remember. At some point there were only about ten of us left – men and women of different ages, some were with kids in buggies, some people were in wheelchairs themselves. They were talking about how much their lives had changed with the introduction of OST. They were sharing their problems – impossible to go visit people in other cities, hospitals still did not have methadone on stock and one had to come here by taxi practically from intensive care to get some. However, that conversation was different from everything I had heard from hundreds of other OST clients before.  These people were absolutely convinced of the necessity of this site, they were in dire need of it and ready to fight for it at all cost. They, the patients, were defending their doctors, explaining to me how vulnerable health care workers were in the face of all sorts of monitoring raids. They knew the OST program inside out – what funding sources covered which costs and which options they would have if the Global Fund withdrew the funding. They know everything because it is their program.

Pavlodar OST site is on the ground floor of the local narcology clinic and occupies a tiny room with a small anteroom with benches for clients to sit and chat. It´s a multi-storied building, the rest of it, as I am told, belongs to an in-patient facility for compulsory treatment. There are about seventy OST clients. Methadone doses are high – 70, 80, 100 mg and more. The same room is used for HIV and TB patients who come for ART and TB treatment. Almost all of the clients either work or study. Most of them have families.

The clients say that not a single program participant “gets extra high” – that would be a breach of the rules and several such slips result in exclusion from the program. The frequent checkups prove – the people on therapy have indeed stopped using street drugs. I must say it is very impressive – the hard proof that OST works towards full abstinence. But what happens to those clients who could not for one reason or another stop using drugs completely or resumed their consumption? If they are excluded from the OST program, do they have a chance to continue on ART or TB treatment? If OST did not succeed in helping them, does it mean they are simply thrown “overboard”, again?

The Pavlodar OST program as well as most other OST programs in EECA and in many other parts of the world is a high threshold program.  This means strict admission criteria – one should prove that other addiction therapies failed to work for them many times, bring official confirmation of being infected/non-infected by HIV, hepatitis etc. This means frequent and unannounced urine tests for presence of drugs – and if they prove positive the clients will either be forced to attend additional therapies aimed to stop their drug consumption altogether (this is what they do in the USA and Canada) or they are excluded from the program for “breaking the rules”.

Clients who „break the rules“ may be facing serious, overwhelming problems such as depression, home violence, a life crisis, bad social factors. Such people should have access to low threshold OST programs, so they can go on receiving methadone, ART and TB therapy. Such programs are increasingly popular in Canada, they put forward fewer demands „on admission“, there is no queuing and no waiting lists, more tolerance to relapses. Testing for drugs is done less frequently and the clients are informed beforehand. If the client is found using drugs, no reprisals follow. And such programs that do not aim to stop people from consuming drugs help saving lives, too – and to improve the quality of life as well. A recent Canadian study showed that despite the absence of sanctions in such low threshold programs one sees a steady decline in the usage of street opioids  and stimulants. The clients feel supported and see they can be accepted as they are today. Their social environment is gradually changing, bringing changes in their lives as well.

There are no low threshold programs in Kazakhstan to date. They may come. However, the number one priority at the moment is to keep what we already have, which means to get the state allocate funding to the existing high threshold programs. Otherwise hundreds of people and their families will be thrown overboard.


Author: Eliza Kurcevic

„After the New Year, for the smallest amount of marijuana – criminal liability and immense fines, „In one of Vilnius bars, police made a raid: Some of the bar visitors were scared, some were laughing“, „A young man was sentenced for the distribution of drugs, committed a suicide in the Lukiškės Remand Prison“, „Penalties in Lithuania: for one shared joint – imprisonment from 2 up to 8 years“ – those are just a few titles of the headlines in the news portals, during this year (2017). This is definitely a year of failures and regress in the terms of drug policy, where policy makers started to treat people in Lithuania, as drugs itself: isolating, controlling and containing. And while some of the European Union countries already have a great experience in the process of the drug liberalization by creating tolerant, human rights based approach of the psychoactive substances possession for the personal use (such as Czech Republic, Portugal, The Netherlands), opening drug consumption rooms (The Netherlands, Germany, Denmark, Spain, France, Luxembourg) or prescribing heroin-assisted treatment (Denmark, Germany, UK, Spain, The Netherlands), Lithuania is coming back to the rotten roots of old laws, where punitive and prohibitionist policies were worshiped. And here I speak about Soviet Union times, when for the possession of drugs you could get up to 15 years imprisonment. So what‘s happened in Lithuania (or should I say WITH Lithuania?)?


I can’t call the beginning of 2017 as a great start of the New Year in the context of the drug policy. Before 1st January, 2017 provision on the possession of the small amounts of the psychoactive substances was considered as a matter of the administrative liability by the Administrative Offences Code. But starting from the 1st of January, 2017 possession of the psychoactive substances (any amount of it) is regulated by the Criminal Code and considered as a crime or misdemeanour[1]. Unfortunately, I can’t get in the heads of our policy makers and rational explain what kind of blackout they had so they decided to move these provisions from administrative to criminal liability. But seems they got confused about separation of criminal and administrative liabilities and just moved all that kind of provisions to the Criminal Code. And this is the best example of the punitive mentality: if you don’t know how to treat a person – give him/her the worst penalty. So, Lithuanian policy makers did it and the bedlam started in the heads of the Lithuanian citizens.

When the first cases, related to the possession and distribution of the small amounts of the psychoactive substances in 2017 appeared in the courts, judges didn’t feel like they want to punish young Lithuanian citizens with the custodial sentence for a term of up to two years (in case of the possession) and custodial sentence for a term of two up to eight years (in case of distribution). Special attention during investigations was taken in the cases where famous Lithuanian person’s children were caught or children from “good families”. So what courts did in the most of the cases – they gave a fines or based on the principle of justice gave a suspended sentence (when imposition of the penalty provided for in the sanction of an article is evidently in contravention to the principle of justice, judge can impose a commuted penalty subject to a reasoned decision). But these decisions actually didn’t help young persons, as they got criminal convictions for several years. Just to imagine, how messed up we are: approx. 800 pre-trial investigations on the possession of the psychoactive substances have already started this year. 537 suspended sentences were imposed in pre-trial investigations. But let’s move on, as there were more consequences of these harsh laws.

One May evening, popular bar in Vilnius „Peronas“ was „visited“ by the police. It lasted about 15 minutes. All this time police were distracted by not knowing what to do, were running around the bar. Please, check video (really worth to see this ridiculous raid). „Some of the bar visitors were scared, some were laughing“, says the owner of the bar. After raid there was no more information from the police, no warnings. So what was the point of this raid? What the police wanted to show by organizing it? Instead of concentrating on the catching up large-scale dealers, police started to organize bars visitors frightening actions. But…that’s only one example from dozens, which happened this year.

Situation started to get worse in autumn. One morning I woke up with a new “A young man sentenced for the distribution of drugs, committed a suicide in the Lukiškės Remand Prison“. I couldn‘t believe that this is real, that this is happening in the XXI century in Lithuania. He was only 21-year-old. After the decision (custodial sentence) was made, the young man was found dead in the camera. He made a suicide. NOT drugs killed him, but draconic and disproportionate laws, which take off any hope! The fear of cruel, brutal, inhuman conditions in the prison made a young person to make a suicide.

And for the end I left the newest updates, which made a lot of families, lawyers, judges, members of the society to rethink towards where we are moving on. Starting from the 6th October 2017 Criminal Code was „patched“/amended. The policy makers decided that it‘s time to fight with corruption. How it is related with the possession of the psychoactive substances? These amendments prohibited to suspend a sentences for a serious crime. But as judge A. Cininas commented „The motives were beautiful: the fight against corruption, fraud. But serious crimes also include activities such as sharing joints of cannabis between the teenagers”. So basically, if one day I will be smoking joint and my friend will ask to share it with him/her, and we will be caught by police, this will be interpreted as a possession of a psychoactive substance with the purpose to distribute it. And by amended laws judge will be obligated to give me a custodial sentence for a term of two up to eight years (no suspension, as this crime is included into the „serious crimes“ category). Which as you already understood, means, that I will go to the prison from two to eight years. Does it make sense? Well, in the country where drugs are criminalized and punitive mentality can‘t leave it roots – probably it does.

Until now, Lithuania has done little to reduce crime or to take attention on the large-scale dealers. Starting with the new law (amendment of the Criminal Code from 6th October, 2017) we will have prisons filled in with young, low-level, non-violent individuals.

So maybe instead of putting low-level „criminals“ into the jail, let‘s take a look to the progressive approaches, let‘s check how other European Union countries deal with the issue. A variety researches showed that treatment-based, education and simply human rights based approaches are the most effective and giving the results.

Next month I will update you with the situation in Lithuania and using the Portuguese model of decriminalization, will show what changes we can make in our system.


[1] Article 259. Unlawful Possession of Narcotic or Psychotropic Substances for the Purpose Other than Distribution 1. A person who unlawfully produces, processes, acquires, stores, transports or forwards narcotic or psychotropic substances for the purpose other than selling or otherwise distributing them shall be punished by a fine or by arrest or by a custodial sentence for a term of up to two years. 2. A person who <…> a small quantity of narcotic or psychotropic substances for the purpose other than selling or otherwise distributing them shall be considered to have committed a misdemeanour and shall be punished by community service or by restriction of liberty or by a fine or by arrest.
Article 260. Unlawful Possession of Narcotic or Psychotropic Substances for the Purpose of Distribution Thereof or Unlawful Possession of a Large Quantity of Narcotic or Psychotropic Substances 1. A person who unlawfully produces, processes, acquires, stores, transports or forwards narcotic or psychotropic substances for the purpose of selling or otherwise distributing them or sells or otherwise distributes narcotic or psychotropic substances shall be punished by a custodial sentence for a term of two up to eight years. 2. A person who <…> a large quantity of narcotic or psychotropic substances for the purpose of selling or otherwise distributing them or sells or otherwise distributes a large quantity of narcotic or psychotropic substances shall be punished by a custodial sentence for a term of eight up to ten years. 3. A person who <…> a very large quantity of narcotic or psychotropic substances shall be punished by a custodial sentence for a term of ten up to fifteen years.