People who use drugs vs Governments of Estonia and Kazakhstan at the 65 session of the CESCR

Geneva, 65 session of the UN Committee on Economic, Social and Cultural Rights

February 18 – March 8, 2019

In February, 2019 during the 65 session of the UN Committee on Economic, Social and Cultural Rights (CESCR*) in Geneva EHRA in partnership with Canadian HIV/AIDS Legal Network, joined by community representatives from Estonia and Kazakhstan and legal experts from the Human Rights Clinic from Miami University School of Law presented the statements on the enjoyment of rights among women who use drugs in Estonia and access to opioid substitution treatment for people who use drugs in Kazakhstan, and addressed the questions of the Committee.

Estonian case

In 2017 EHRA together with Canadian HIV/AIDS Legal Network and LUNEST submitted shadow report and presented it at the 62  Pre-sessional CESCR working group meeting in April, 2018. The report was based on the study conducted in Estonia in 2017. Based on the report, CESCR requested specific information from Estonia regarding women who use drugs in Estonia:

Please provide detailed information on the results of the White Paper on drug prevention policy, especially against the performance indicators listed in the White Paper. Please provide information on the gender-specific interventions targeting women drug users, particularly those who are pregnant or have children, and on the support provided for them, including rehabilitation facilities. Please also provide information, including relevant statistical data disaggregated by sex, on the extent to which drug treatments, such as opioid substitution therapies, are available and affordable to, and accessible by, all persons in need. Please further provide information, including relevant statistical data, on the extent to which steps have been taken to tackle the high prevalence of HIV infection, particularly among persons who inject drugs, and on the availability and accessibility of antiretroviral treatments in the State party”.

The Government of Estonia did not provide such information.

On February 18-20, 2019 representatives from EHRA, LUNEST and the Human Rights Clinic from Miami University School of Law joined the 65 session of the CESCR to speak about the human rights violations faced by women who use drugs in Estonia.

Maria Plotko, EHRA, in her address to the Commission on February 18, 2019, marked: “Drug laws and drug enforcement practices in Estonia, combined with stigma related to drugs and HIV, are the main drivers of systematic and serious violations of health, parental, child protection and labor rights of women who use drugs. We would like to ask the Committee to recommend the state party to reconsider punitive approach to drug use and improve the access to health and social support for people who use drugs, including gender sensitive services for women who use drugs and women with children.”

NN**, a woman, who use drugs from LUNEST, Estonia, made a statement, in which she focused on the problems of stigma imposed by medical staff in OST centers and police, negligent attitude to personal data and violation of parental rights due to drug dependence/OST program patient status.

EHRA is pleased to report that the session ended in a high note: two Committee members pressed the Estonian delegation on all the issues that were presented, including the separation of children, Estonia’s harsh drug policy, the lack of OST and ART access, and the need to end de facto criminalization of drugs, among other issues. (full transcript of relevant Committee questions and government responses is available here).

Today the Committee published the Concluding observations, which contain the recommendations concerning drug policy and HIV in Estonia (Recommendations 45-48). Here are some of them:

  • Combat the social stigma against drug users and guarantee the confidentiality of service users by training the police, social workers, child protection officers and medical professionals and sensitizing the public, especially about their right to health;
  • Investigate the cases where women with children have reportedly been unlawfully forced to terminate opioid substitution therapies, under the threat of losing their parental rights; and provide appropriate remedies to victims;
  • Investigate the cases of abuse and harassment by police against drug users, particularly women, as well as the cases of deprivation of parental rights for using drugs and punish those responsible; and stop the practice of forced drug testing in the street as well as forced drug testing through the use of urinary catheters.

Kazakhstan case

In January 2018 EHRA submitted a report with respect to Kazakhstan and presented it on the 62nd Pre-Sessional Working Group of the CESCR in April 2018. The issue of access to OST and the protection of human rights of drug-dependent individuals and people living with HIV in the country was raised both in the report and session statements. The Government of Kazakhstan was urged to provide information on measures taken to improve the treatment and rehabilitation services for people who use drugs, including through the provision of opioid substitution therapy, but the Government chose no to report to the Committee on this issue.

This is not the first time that CESCR is dealing with the issue of OST in Kazakhstan: in 2010, the Committee called on the Government to ensure that methadone as substitute therapy is made accessible to all people with opioid dependence. However, by the end of 2018, OST was available to less than 1% of all people in need, contrary to World Health Organisation’s recommendations of at least 20% coverage.

The situation in Kazakhstan worsened since the report of January 2018. Although in June 2018 the Inter-agency OST Assessment Group recommended to continue OST program in 13 cities of Kazakhstan, the ban to accept new clients into the program remains in effect as of February 2019; the number of OST clients decreases, because of expel of the patients for illicit drug use. Thus, the Republic of Kazakhstan did not fulfill CESCR recommendations to ensure that methadone as substitute drug dependence therapy is made accessible to all in need. Moreover, the decision not to scale up OST program directly contravenes the CESCR recommendations and article 12 of the International Covenant on Economic, Social and Cultural Rights.

Oksana Ibragimova from Kazakhstan Union of People Living with HIV in her statement at the Committee session on February 25, 2019, addressed the issues of criminalization of drug possession for personal use, due to which the main focus of Kazakhstan drug policy is on law-enforcement, but not on health care. Oksana called the Committee to recommend to the Republic of Kazakhstan to change the repressive focus of drug policies in regard to people who use drugs and, in particular, to decriminalize drug possession without intent to sale.

Maria Plotko, EHRA, in her statement with the respect to OST situation in Kazakhstan on February 27, 2019, draw the Committees attention to the recent escalation of the situation with county deputy prosecutor visiting opioid substitution treatment clinics in Ust-Kamenogorsk and called the Committee to recommend the Government of Kazakhstan to provide legal, political and financial support to HIV prevention programs among people who inject drugs, including OST as recommended by WHO, and to advise international actors such as the UN agencies and programs, and international financial institutions such as the Global Fund to Fight AIDS, Tuberculosis and Malaria to ensure sustainable transition to domestic funding for essential HIV prevention programs among key populations mostly affected by HIV, including by establishing key populations monitoring mechanisms to keep national authorities committed to programs initiated with help of international actors.

During the session with the government the Committee asked the delegation about the government’s intent to continue and ensure the sustainability of OST program, decriminalize drug use and  also about the actions the government plans to undertake to deal with the police and procecutors invasion to OST centers. The delegation’s answer was very vague (full transcript of relevant Committee questions and government responses is available here).

Yesterday the Committee published Concluding observations which contain the recommendations to State party. Kazakhstan recieved two recommendations concerning drug use:

  • The Committee is concerned by the high number of persons who are dependent on opioids and the increasing HIV prevalence among people who inject drugs. The Committee is also concerned that access to harm reduction programs, rehabilitation and treatment remains limited for people who need them, in particular the opioid substitution therapy. The Committee is also concerned that criminalization of drug use deters many users from accessing these programs. It is further concerned by reports about the incidences of the police and prosecutors accessing medical records of drug users who were receiving treatment in medical centers (art. 12).
  • The Committee recommends that the State party intensifies its efforts with regard to preventing drug abuse, including through education and awareness-raising programmes. The Committee also recommends that the State strengthens harm reduction programs and provides appropriate health care, psychological support services and rehabilitation including expansion of the provision of opioid substitution therapy to drug users. The Committee recommends that the State party ensures the confidentiality of medical records of drug users and considers decriminalization of drug use. The Committee refers the State party to its general comment No. 14 (2000) on the right to the highest attainable standard of health.

 

* Established in 1985, CESCR is a UN human rights body consisting of 18 independent experts that monitor implementation of the International Covenant on Economic, Social and Cultural Rights by its States parties, which are obliged to submit regular reports to the Committee on how the rights are being implemented in their countries. The Committee’s rules allow for international, regional, and national organizations and human rights institutions to submit parallel reports with questions for governments in advance of the dialogue with the states.

**-NN asked not to disclose her name because of the fear of prosecution and further discrimination in healthcare and social services settings. NN is also concerned that OST program staff’s attitude to her may be worsened in case of her name disclosure.