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P U B L I C H E A LT H FA C T S H E E T

Human Rights Abuses in the Name of Drug


Treatment: Reports From the Field
Around the world, governments commit flagrant and widespread human rights violations against
people who use drugs, often in the name of "treating" them for drug dependence. Suspected
drug users are subject to arbitrary, prolonged detention and, once inside treatment centers,
abuses that may rise to the level of torture. In many countries, military and police force people
who use drugs into treatment without any medical assessment, and then rely on chains and
locked doors to keep them there. Drug users who voluntarily seek medical help are sometimes
unaware of the nature or duration of the treatment they will receive. In fact, treatment can
include detention for months or years without judicial oversight, beatings, isolation, and addition
of drug users’ names to government registries that deprive them of basic social protections and
subject them to future police surveillance and violence.
Mechanisms to force people who use drugs into treatment, and the methods of treatment
used, are rarely documented. United Nations or national assessments of drug dependence treat-
ment frequently report numbers of those treated without additional detail about the nature or
quality of what constitutes “treatment.” The accounts below, drawn from published literature and
from those who have passed through treatment in Asia and the former Soviet Union, detail the
range of abuses practiced in the name of drug dependence treatment, and suggest the need for
reform on grounds of health and human rights.

"SCJUSBSZ%FQSJWBUJPOTPG-JCFSUZ t Malaysia’s drug treatment system makes no distinc-


BOE%FOJBMPG%VF1SPDFTT tion between occasional drug users and those actually
dependent on drugs.1 Anyone can be detained for up to
A common way for people to enter drug treatment is
two weeks and forcibly tested by police on suspicion of
involuntarily through the criminal justice system. People
drug use. Those testing positive, even in the absence of
suspected of using drugs, whether actual drug users or
possession, can be flogged and interned for up to two
those simply swept up in police or military raids, are
frequently detained for treatment on the basis of mere years in a compulsory drug treatment center.2
police suspicion or a single positive urine test. They are t In Cambodia, drug users and others are picked up in
remanded to treatment for months or years without medi- police raids and confined in treatment and rehabili-
cal assessment or right of appeal. Even those who enter tation centers run by military staff with no training
treatment voluntarily find themselves confined for years in addiction or counseling. Drug users, people with
at a time without due process. mental disabilities, sex workers, and the homeless

OPEN SOCIETY INSTITUTE


Public Health Program International Harm Reduction Development Program (IHRD)
are sometimes confined together. There is no judicial and being abused and caned by a religious leader
supervision or process for appeal, though detainees while being told that they are “worse than an ani-
report being able to bribe their way out of internment.3 mal.” Overcrowding forces as many as 40 inmates to
There is no clear criteria for release, which may depend sleep in one cell.13
on being able to recite the Cambodian national drug t In Vietnam, detainees are punished for failing to meet
laws from memory.4 work quotas by being denied baths for a month, beaten
t Drug users in Vietnam can be committed by family with clubs, and being chained and forced to stand on
members or community focal points that keep lists their toes for more than 24 hours. Some internees
of known drug users, and there is no due process to report being put in isolation for up to a week in a cell so
appeal commitment or extension of internment.5 In small that they are forced to sleep, urinate, and defecate
response to high rates of return to drug use (as high as in a standing position. Several people interviewed after
95 percent by those leaving the centers6) the govern- completing compulsory treatment said they felt “lower
ment in some cities has extended terms of detention than animals” after serving such sentences.14
to as long as six years, including labor in facilities t In Guangxi province, China, a recent study found
built near the treatment centers.7,8 Between 50,000 reports of sexual abuse of female inmates by guards.
to 100,000 drug users are now interned in Vietnam’s Inmates received mandatory HIV tests but were not
compulsory rehabilitation centers.9,10 told the results. Guards repotedly used the data to know
t As many as 350,000 people are in China’s reeducation which inmates they could sleep with without using a
through labor and compulsory detoxification centers, condom.15
which have recently been renamed, but which continue t In Nagaland, India, drug users have been crammed
to intern people upon suspicion of drug use or a posi- into thorn-tree cages in a sitting position.16 In Punjab,
tive test for illicit substances.11 The involuntary nature drug treatment patients are routinely tortured, and in
of treatment is revealed by one 2004 study, which some cases have been beaten to death.17
found that nearly 10 percent of those apprehended by t Drug users in Nepal recount that being taken for treat-
the police on suspicion of drug use swallowed nails, ment has included suspension by the arms or legs for
metal filings, or ground glass in order to obtain a medi- hours, beatings on the soles of the feet, threat of rape,
cal exemption and escape internment.12 and verbal abuse that includes assertions that they do
not belong in the “new Nepal.”18
t Former detainees in Cambodia report being locked
in cement facilities where they are forced to withdraw
"CVTFTJO$POGJOFNFOU “cold turkey,” and not allowed to use the toilet despite
the diarrhea that is commonly associated with such
What is referred to as “treatment” in many centers in withdrawal, subjected to sexual violence and beatings
fact includes painful, unmedicated withdrawal, beatings,
with batons and boards, and compelled to confess to
military drills, verbal abuse, and sometimes scientific
unsolved criminal cases. Detainees also describe short-
experimentation without informed consent. Forced labor,
ages of food so severe that some eat grass and leaves.19
without pay or at extremely low wages, at times in total
t In Russia, drug users in some facilities are chained to
silence, is used as “rehabilitation,” with detainees pun-
ished if work quotas are not met. These abuses violate the their bed and offered “flogging therapy.”20
right to be free from torture, cruel, inhuman, or degrad- t In South Africa, unregistered treatment centers are
ing treatment and punishment; the right to health; and allowed to operate without government regulation
other fundamental human rights. or medical oversight. Former residents of one center
report being kicked and beaten if they did not main-
1IZTJDBMBOENFOUBMBCVTF tain sufficient speed during physical training, which
t People formerly detained in Malaysian government consisted of carrying boulders on their bare backs,
treatment centers describe being kicked, punched, rolling long distances on hot pavement, or running
made to crawl through animal excrement, “act like while carrying as much as 25 liters of water and then
a whale” by drinking and spitting out dirty water, being forced to drink it all, pausing only to vomit.21

P U B L I C H E A LT H FA C T S H E E T
Human Rights Abuses in the Name of Drug Treatment: Reports From the Field
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Despite the reported deaths of two teenage patients, the reports of adverse effects and widespread condemna-
center still in operation.22,23,24 Methods used to at other tion of such procedures as experimental and unethical.
centers in South Africa include stranding patients in t One treatment center in India runs on the motto
remote areas for three days, or prohibiting them from “changed when chained,” and shackles participants’
talking to, looking at, writing messages to, or touching legs together and loosens links the longer they remain
another person while in treatment.25 drug free.35 Some centers administer drugs that have
been discontinued in Europe due to their adverse
/POFWJEFODFCBTFEBOEFYQFSJNFOUBMUSFBUNFOU effects, while treatment with methadone or buprenor-
t Malaysia’s drug treatment centers are commonly run by phine, both on WHO’s list of essential medicines, is
ex-army personnel, and there are few trained paramed- often not available.36
ics or counselors.26 Treatment is largely military-style t Throughout Eastern Europe and Central Asia, “narcolo-
discipline and drills in the hot sun. Methadone, a gists” charged with treating drug and alcohol addiction
proven treatment for opioid dependence, is unavail- administer hypnoid therapies used in Soviet times,
able in most centers.27 Condoms are also unavailable where patients have ampoules or substances injected
in many centers, despite accounts of sexual behavior under the skin and are told that they will explode
among residents and between residents and guards.28 and poison them if they drink or use drugs, or where
t Antiretroviral treatment is not available in most of patients are shown films with subliminal anti-addiction
Vietnam’s treatment centers, although HIV prevalence is messages.37 Prescription of methadone or buprenor-
reported at 75 percent.29 Some centers conduct manda- phine, either for maintenance or detoxification, is
tory HIV testing without informing those tested of their illegal in Russia.
results.30 Treatment of tuberculosis and other oppor-
tunistic infections is also unavailable, except through 'PSDFEMBCPS
bribes, and there is no access to sterile injection equip- t Human rights groups assert that drug treatment cen-
ment despite documented drug use in many centers.31 ters in Vietnam are in reality forced labor camps, with
t Those interned in China’s centers are often offered little inmates required to work long hours under extremely
treatment other than mandated chants such as “drugs harsh conditions38 at far below market wages. Tasks
are bad, I am bad,” long hours of forced labor, and included carrying heavy buckets of water and excre-
military-style drills.32 Private and voluntary treatment ment, hauling clay on their shoulders,39 or making
methods include partial lobotomy through the insertion trinkets for market sale. Those who fail to meet work
of heated needles clamped in place for up to a week to quotas are isolated and punished severely.40
destroy brain tissue thought to be connected to crav- t One study in China found that detained IDUs reported
ings.33 The technique is a variation of a Russian tech- working from 7 a.m. to 2 a.m., seven days a week,
nique in which very cold, rather than heated, rods were performing unpaid factory labor, with the threat of
used to destroy brain tissue.34 This surgery is one for punishment, including beatings, if production quotas
which families save and pay significant money, despite were not met.41

“The Special Rapporteur wishes to recall that, from a human rights perspective, drug dependence should
be treated like any other health care condition. Consequently, he would like to reiterate that denial of
medical treatment and/or absence of access to medical care in custodial situations may constitute cruel,
inhuman or degrading treatment or punishment and is therefore prohibited under international human
rights law. Equally, subjecting persons to treatment or testing without their consent may constitute a vio-
lation of the right to physical integrity. He would also like to stress that, in this regard, States have a posi-
tive obligation to ensure the same access to prevention and treatment in places of detention as outside.”
— Manfred Nowak
Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment (Geneva, January 14, 2009)

P U B L I C H E A LT H FA C T S H E E T
Human Rights Abuses in the Name of Drug Treatment: Reports From the Field
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P U B L I C H E A LT H FA C T S H E E T
Human Rights Abuses in the Name of Drug Treatment: Reports From the Field
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