Compulsory "treatment" for drug addiction in some parts of the world is "tantamount to torture or cruel, inhuman or degrading treatment," according to report last month from the UN's special rapporteur on torture and other degrading treatments and punishments. The report was delivered to the Office of the UN High Commissioner for Human Rights in Vienna.





drug "rehabilitation center," Vietnam (ohchr.org)

Authored by Special Rapporteur Juan Mendez, the report takes special aim at forced "rehabilitation centers" for drug users. Such centers are typically found in Southeast Asian states, such as Vietnam and Thailand, as well as in some countries in the former Soviet Union. But the report also decries the lack of opiate substitution therapies in confinement setting and bemoans the lack of access to effective opioid pain treatment in large swathes of the world."Compulsory detention for drug users is common in so-called rehabilitation centers," Mendez wrote. "Sometimes referred to as drug treatment centers or 'reeducation through labor' centers or camps, these are institutions commonly run by military or paramilitary, police or security forces, or private companies. Persons who use, or are suspected of using, drugs and who do not voluntarily opt for drug treatment and rehabilitation are confined in such centers and compelled to undergo diverse interventions."The victims of such interventions face not only drug withdrawal without medical assistance, but also "state-sanctioned beatings, caning or whipping, forced labor, sexual abuse, and intentional humiliation," as well as "flogging therapy," "bread and water therapy," and forced electroshock treatments, all in the name of rehabilitation.As Mendez notes, both the World Health Organization (WHO) and the UN Office on Drug Control (UNODC) have determined that "neither detention nor forced labor have been recognized by science as treatment for drug use disorders." Such forced detentions, often with no legal or medical evaluation or recourse, thus "violate international human rights law and are illegitimate substitutes for evidence-based measures, such as substitution therapy, psychological interventions and other forms of treatment given with full, informed consent."Such centers continue to operate despite calls to close them from organizations including the WHO, the UNODC, and the UN Commission on Narcotic Drugs. And they are often operating with "direct or indirect support and assistance from international donors without adequate human rights oversight."Drug users are "a highly stigmatized and criminalized population" who suffer numerous abuses, including denial of treatment for HIV, deprivation of child custody, and inclusion in drug registries where their civil rights are curtailed. One form of ill-treatment and "possibly torture of drug users" is the denial of opiate substitute therapy, "including as a way of eliciting criminal confessions through inducing painful withdrawal symptoms."The denial of such treatments in jails and prisons is "a violation of the right to be free from torture and ill-treatment," Mendez noted, and should be considered a violation in non-custodial settings as well. "By denying effective drug treatment, state drug policies intentionally subject a large group of people to severe physical pain, suffering and humiliation, effectively punishing them for using drugs and trying to coerce them into abstinence, in complete disregard of the chronic nature of dependency and of the scientific evidence pointing to the ineffectiveness of punitive measures."The rapporteur also noted with chagrin that 5.5 billion people, or 83% of the planet's population, live in areas "with low or no access to controlled medicines and have no access to treatment for moderate to severe pain." While most of Mendez' concern is directed at the developing world, he also notes that "in the United States, over a third of patients are not adequately treated for pain."Mendez identified obstacles to the availability of opioid pain medications as "overly restrictive drug control regulations," as well as misinterpretation of those regulations, deficiencies in supply management, lack of concern about palliative care, and "ingrained prejudices" about using such medications.