Leila ThesisFull 12October(Leila's final touches) · 3...
51
Drug Policy and Harm Reduction Programmes for Adolescents in Iran.
Transcript of Leila ThesisFull 12October(Leila's final touches) · 3...
Drug Policy and Harm Reduction Programmes for Adolescents in Iran.
1
Acknowledgements The initial idea for this thesis was inspired by the extra curricular activities and trainings which were
offered by The International Centre on Human Rights and Drugs Policy whilst I was undertaking my
masters programme in Essex. Julie Hannah, Damon Barrett and Rick Lines supported me with their
thoughts, helpful suggestions and connected me with their professional network in the harm reduction field
in general and in harm reduction programmes for youth. Recommending that I choose Professor Nigel South
as my supervisor was among those helpful suggestions. I am so glad that he agreed to supervise my work and
I am truly grateful for his input.
In addition to those colleagues, I am deeply grateful to Dr Kamiar Alaei for being the informant of this
research and generously sharing his unique and first hand experience of working on HIV/AIDS harm reduction
programmes in Iran, and also his recent research on health and human right indicators.
My work could never have been completed without support from colleagues in The Middle East and North
Africa Harm Reduction Association (MENAHRA), especially Elie Aaraj and Micheline Abou Chrouch.
1
Table of Content Chapter 1. Introduction (2-‐6) 1.1 General overview 1.2 Research questions 1.3 Methodology and scope of this work Chapter 2. International drug policy and different approaches (7-‐13) 2.1 Drug control policies; a history of the criminalisation of drug use 2.2 Health and human rights approaches Chapter 3. Background history; When did use of drugs become an issue? (14-‐20) 3.1 Social, economic and historical background of drug use in Iran 3.2 Adolescent involvement in drug use 3.2.1 The complexity of the issue 3.2.2 Unpacking different forms of adolescent involvement in drug related issues Chapter 4. International response to adolescents’ involvement in drug use, with reference to human rights and harm reduction (21-‐28) 4.1 The international legal framework 4.2 Convention on the rights of the child 4.3 Other international legal provisions 4.4 Public health provisions Chapter 5. Iran and the involvement of adolescents in drug use (29-‐40) 5.1 Adolescent drug use and rule of law 5.1.1 Domestic laws 5.1.2 Iran’s international obligations 5.2 Protective measures 5.2.3 Harm reduction programmes 5.3 Role of international organisations Chapter 6. Conclusion and recommendations (41-‐45) 6.1 Situation assessment and data collection 6.2 Comprehensive coverage 6.3 Mobilize regional network
2
Chapter 1. Introduction 1.1 General overview According to the 1998 UN General Assembly Declaration,1 all countries are affected by the
consequences of drug use. It is highly accepted that almost every country in the world ‘plays a
part—as producer, consumer, or transit point—in the multibillion-‐dollar illicit drug trade that
supplies more than 150 million people every year and keeps on growing’.2 Dealing with drug
consumption and responding appropriately to the social, economic and environmental
consequences and potential harms associated with drug use, which affect individuals and
communities, is a global challenge. In recent decades, two clear policy trends have developed
harm reduction initiatives and there has been a decriminalization of personal use and
possession. Both are pragmatic approaches to addressing an immediate necessity similar to the
policies which emerged ‘in the mid-‐1980s in response to the epidemic of HIV among injecting
drug users, and decriminalization in response to resource pressures on overburdened criminal
justice systems’.3
This thesis will focus on harm reduction programmes as pragmatic, non-‐judgmental sets of
strategies to reduce potential individual and community harm associated with drug use, where
the focus is on harm reduction rather than on eliminating drug use.4 This research serves to
emphasise that one of the characteristics of harm reduction policies and programmes is
remaining neutral on the topic of abstinence as it is neither condoned nor condemned.5 As Paul
Hunt, former Special Rapporteur on the right to health, states:
1 The UN General Assembly Special Session (UNGASS), 'Declaration On The Guiding Principles Of Drug Demand Reduction' (1998). 2 Human Rights Watch, 'World Report 2013' (2014) 19. 3 Damon Barrett, Children Of The Drug War (International Debate Education Association 2011) 61. 4 Gerald Thomas, Harm Reduction Policies And Programs For Persons Involved In The Criminal Justice System (Canadian Centre on Substance Abuse 2005). To read more about harm reduction definitions, see: Forward-‐thinking-‐on-‐drugs.org, 'Forward Thinking On Drugs: A Review Of Evidence-‐Base For Harm Reduction' (2015) <http://www.forward-‐thinking-‐on-‐drugs.org/review2-‐print.html> accessed 2 October 2015 and Institute of Medicine, Preventing HIV Infection Among Injecting Drug Users In High Risk Countries (The National Academies Press 2006). 5 Christiane Poulin, Harm Reduction Policies And Programs For Youth (Canadian Centre on Substance Abuse 2006) 2.
3
In seeking to reduce drug-‐related harm, without judgement, and with respect for the
inherent dignity of every individual, regardless of lifestyle, harm reduction stands as
a clear example of human rights in practice.6
Despite the recent progress in approaches to harm reduction interventions and policies
endorsed by international bodies and supported bilaterally, harm reduction programmes are
rarely tailored for young7 drug users and their specific needs. Hence this research aims to
highlight some of those needs and the complexity of involvement of young people in drug use
which require different approaches to effectively address the vulnerability of this group of
people.
Evidence-‐based studies show that most high-‐risk behaviour occurs during youth. Young people
are more willing to experiment with and experience new substances and develop novel ways of
using and mixing them which makes them more vulnerable to high levels of behavioural and
health risks.8 However, this does not necessarily suggest that all recreational drug use will be
dangerous or harmful. Without evidence-‐based interventions and specifically tailored harm
reduction initiatives, young people are put in a particularly vulnerable position with no
adequate support. Additionally, drug related harm among young people, as with adults, is
caused by individual, social and structural factors such as living under extreme poverty, lack of
employment opportunity and social exclusion. These complex root causes can increase levels of
vulnerability of this group and the harm they may experience.9 Furthermore, this research will
argue that acknowledging this complexity should be seen as the starting point for taking action
towards developing specifically tailored harm reduction programmes for young drug users. This
view cannot be operationalized, however, without setting up evidence-‐based studies and data
collection initiatives to identify areas of vulnerability and the contexts in which they exist.
6 Paul Hunt cited in Catherine Cook and Natalya Kanaef, The Global State Of Harm Reduction 2008 (International Harm Reduction Association 2008) 3. 7 The terms ‘youth’, ‘young people’ and ‘adolescent(s)’ are used interchangeably in this thesis and refer to the under 18s age group, especially the 15-‐18 age group. 8 Shripad Tuljapurkar, D. Ian Pool and Wiphan Pračhūapmo Rūpfōlō, Population, Resources And Development (Springer 2005) 63. 9 See Catherine Cook and Adam Fletcher, 'Youth Drug-‐Use Research And The Missing Pieces In The Puzzle: How Can Researchers Support The Next Generation Of Harm Reduction Approaches?', Children of the Drug War: Perspectives on the Impact of Drug Policies on Young People (International Debate Press 2011).
4
1.2 Research questions This thesis will examine the concept of tailored harm reduction programmes for adolescent
drug users in the context of Iran, a young country with more than 28 million people under 18
years of age.10 There is no up-‐to-‐date and comprehensive study or assessment available to
indicate the number of adolescent drug users in Iran and, therefore, the gravity of the situation
but there is evidence suggesting that it is a matter of serious concern.11
Iran has received a considerable proportion of international funding for dealing with drug
related issues, including drug use, through the United Nations Office on Drugs and Crime
(UNODC) programmes12 and was always praised as a pioneer of harm reduction programmes in
the Middle East and North Africa (MENA) region. However most of the international success
indicators used to motivate Iranian decision makers to adopt youth friendly harm reduction
policies are not human rights indicators.
In this context, this thesis examines international human rights legal frameworks and standards,
which can be seen as an endorsement for adolescent harm reduction programmes and how the
international obligations of member States can catalyse the shift in harm reduction policies
towards being more youth friendly. In this desirable and necessary reshaping of the drug policy
process the question of how the human rights principles is best integrated will be explored
along with what the role and contribution of the international community to this process is or
should be. In the specific context of Iran, the research will aim to address what the missing
foundations and challenges to its progressive realization of harm reduction programmes are.
10 Based on the most recent Iran National Population and Housing Census in 2011, more than 37% of the population are under 18. <http://iran.unfpa.org/Documents/Census2011/2011%20Census%20Selected%20Results%20-‐%20Eng.pdf> accessed 5 October 2015. 11 The report from local NGO, see: Imam Ali (P) Popular Students Relief Society, 'Best Practices Of Imam Ali (P) Popular Students Relief Society' (IAPSRS 2012) <http://www.sosapoverty.org/Editor/Documents/Reports/2012-‐IAPSRS-‐Final-‐Report.pdf> accessed 5 October 2015, Committee on convention on the rights of the child showed concerns in its Concluding Observations: Iran(UN Doc CRC/C/15/Add.254 , 2005) paras 49, 58, 66, 67 and even officials started to raise the issue in public platforms, see chapter 5. 12 World Drug Report 2015 (UNODC 2015) and Unodc.org, 'Iran Burns 56 Tons Of Illicit Drugs On The International Day Against Drug Abuse And Illicit Trafficking' (2015) <https://www.unodc.org/islamicrepublicofiran/en/iran-‐burns-‐56-‐tons-‐of-‐illicit-‐drugs-‐on-‐the-‐international-‐day-‐against-‐drug-‐abuse-‐and-‐illicit-‐trafficking.html> accessed 30 September 2015.
5
This research will also examine how Iran’s long background history of determination to
incorporate health interventions and treatments in response to drug use can be seen as
potential for the future of its harm reduction programmes. It will also analyse what the missing
aspects of these programmes and policies are.
1.3 Methodology and scope of this work This thesis comprises six chapters, including introduction and conclusion, which explore themes
relevant to developing an integrated harm reduction response for adolescent drug users in Iran.
Chapter two sets out the background history of how the global response and international drug
control policy was shaped and how that approach has been integrated into national policies
and legislations. An overview of drug policies around the world will be explored through
reviewing the existing legal frameworks and standards including International Human Rights
Law and other UN organs. This overview of the literature includes developing approaches at
international level towards drug policies. This is followed by chapter three which outlines the
history of drug use in Iran including treatment and health interventions. This chapter discusses
the complexity of adolescent involvement in drug related issues by elaborating on the specific
needs of these vulnerable youths and raising the necessity of identifying these needs in finding
the most effective responses. Chapter four details the existing legal frameworks and tools to
address youth involvement in drug use and the specific barriers to accessing services that young
people who use drugs face along with implications for health intervention and harm reduction
programmes. This is followed by chapter five which focuses on Iran and the local situation of
harm reduction programmes including existing responses and legal restrictions on access to
these programmes for those who are under 18 years old. In the final chapter a series of
recommendations will be offered for different stakeholders based on the scope of this thesis
and the findings of the research questions. Within these chapters, this research critically
analyses the goals and objectives behind existing harm reduction programmes that Iran was
internationally praised for by highlighting the main areas for improvement such as outreach,
quality and coverage.
6
The information in this thesis was gathered using existing data sources including research
papers, reports from multilateral agencies, international NGOs, civil society and harm reduction
networks, as well as expert opinion from drug user organisations and those working in the harm
reduction field. This includes sources in the Iranian language (Farsi) and from local NGO social
media platforms in sections where the local context is discussed.
I attempted to approach dominant figures in Iran in this field, such as the Director of the Iranian
National Centre for Addiction Studies (INCAS) and the local office of United Nations Children's
Fund (UNICEF), to arrange an interview with them and gather primary data about their work on
adolescent drug use and the existing barriers restricting young people’s access to harm
reduction programmes. However, this attempt failed.13 For this reason and because of lack of
direct access to Iran and Iranian youths, any first-‐hand data collection or situation assessment
was not possible.
The interview with Dr K. Alaei, the research informant, was necessary to understand the recent
background history and context (Iran after the 1980s) of the new wave of harm reduction
programmes in Iran. In order to gather up-‐to-‐date information with more detailed data on the
current situation of young drug users and the prominent approach to be addressed in the
MENA region, a questionnaire was drafted and circulated among the local network of The
Middle East and North Africa Harm Reduction Association (MENAHRA). Two responses were
received from two local organizations, one in Afghanistan and one in Pakistan.
13 After exchanging emails and explaining the purpose and scope of this research, they neither refused nor responded to the author's requests for interview.
7
Chapter 2. International drug policy and different approaches A review of the history of drug regulation at a multilateral level shows that it was always
associated with national security and economic development, political motivations,
manoeuvring for bureaucratic position, power dynamics and culture. McAllister’s findings
perfectly stated how drug control measures were constructed and which drugs were the
priority to deal with. Based on the evidence, it was highly influenced by ‘attitudes about the
superiority of western scientific methods’, ‘bureaucratic procedures’, and ‘pharmaco-‐industrial
prowess’ which informed participants’ views about which drugs merited attention and how
control measures should be constructed.14 Since the 18-‐19th century, opium was a major cash
commodity but it was in 1909 when, for the first time, controlling the market and managing
opium manufacturing, consumption, import and export brought the political and economic
powers together to discuss the world's narcotics problems internationally.15 The first
international drug control treaty, the International Opium Convention of The Hague, was signed
three years later in 1912.16
For years the idea of supplying, controlling and restricting drug use measures to ‘legitimate’
purposes was advocated and enforced by those who designed the rules. In 1936, ten years
before the transfer of ‘responsibility’ for international drug control from the League of Nations
to the newly created United Nations (UN), certain drug offences were criminalised
internationally for the first time.17
In 1946, the Commission on Narcotic Drugs (CND) was established as the central policy-‐making
body of the UN in drug-‐related matters, hence a political and diplomatic body became in charge
of a very technical issue. Policing of drugs and more restrictive and penal approaches to drugs
policy, besides all the threatening rhetoric about drugs with universal effects, regardless of
circumstances, were proliferated in the drug conventions. It was only after World War II that 14 William B. McAllister, Drug Diplomacy In The Twentieth Century: An International History (Routledge 2000) 2. 15 For more information see: Unodc.org, 'This Day In History: The Shanghai Opium Commission, 1909' (2015) <https://www.unodc.org/unodc/en/frontpage/this-‐day-‐in-‐history-‐the-‐shanghai-‐opium-‐commission-‐1909.html> accessed 9 September 2015. 16 The International Opium Convention was signed in the Hague by representatives from China, France, Germany, Italy, Japan, the Netherlands, Persia (Iran), Portugal, Russia, Siam (Thailand), the UK and the British overseas territories (including British India). See Unodc.org, 'The 1912 Hague International Opium Convention' (2015) <https://www.unodc.org/unodc/en/frontpage/the-‐1912-‐hague-‐international-‐opium-‐convention.html> accessed 9 September 2015. 17 See: Unodc.org, 'This Day In History: The Shanghai Opium Commission, 1909' (2015) <https://www.unodc.org/unodc/en/frontpage/this-‐day-‐in-‐history-‐the-‐shanghai-‐opium-‐commission-‐1909.html> accessed 9 September 2015.
8
globalisation of prohibitive policies became top priority in international discourse. Whilst most
of the countries involved were affected and preoccupied by war, the United States was in a
position to shape a new control regime and to a large extent impose its domestic punitive
approach to dealing with drug issues.18 As Sinha argued in his report:
Beginning in an era of morally tainted racism and colonial trade wars, prohibition-‐
based drug control grew to international proportions at the insistence of the United
States.19
2.1 Drug control policies; a history of the criminalisation of drug use
Criminalization of drug use, despite the history of policing and controlling the drug supply, is
not itself an old trend. Until the late twentieth century the problems of drug use and addiction
were not often part of international considerations. Decision makers did not find it necessary to
examine why or how people used drugs. This happened more due to the dominant supply-‐
control mentality and the exclusion of substance users. Despite the fact that there is not much
reliable data available at least until the late 1970s, the statistical evidence about the extent of
drug use and historical epidemiological investigations can, at best, give a rough outline of
trends in drug use.20
International drug policy is underpinned by three UN drug control conventions or treaties21
which are near universally ratified and are geared towards the reduction of supply and demand
for specific scheduled substances and limiting the use of controlled substances to medical and
18 David R Bewley-‐Taylor, The United States And International Drug Control, 1909-‐1997 (Pinter 1999); Kettil Bruun, Lynn Pan and Ingemar Rexed, The Gentlemen's Club (University of Chicago Press 1975). 19 David R Bewley-‐Taylor, The United States And International Drug Control, 1909-‐1997 (Pinter 1999); Kettil Bruun, Lynn Pan and Ingemar Rexed, The Gentlemen's Club (University of Chicago Press 1975). 20 [...] at least the 1970s, is not necessarily reliable. In the United States, the chief purveyor of addiction statistics through the latter 1960s, the Federal Bureau of Narcotics, adjusted the number of addicts reported, sometimes abruptly, to suit its purposes. Few other states attempted systematic assessment before the 1960s. (Footnote omitted) William B. McAllister, Drug Diplomacy In The Twentieth Century: An International History (Routledge 2000) 5. 211. Single Convention on Narcotic Drugs, 30 March 1961, 520 UNTS p. 204 (hereafter ‘Single Convention’); Protocol Amending the Single Convention on Narcotic Drugs, 25 March 1972, TIAS 8118, 976 UNTS p. 3; 2. Convention on Psychotropic Substances, 1971, 32 UST p. 543, TIAS 9725, 1019 UNTS p. 17 (Hereafter ‘1971 Convention’); 3. Convention Against the Illicit Traffic in Narcotic Drugs and Psychotropic Substances 1988 (E/CONF.82/15). (Hereafter ‘1988 Convention’).
9
scientific purposes. This political history behind the legal development of drug policy has led to
collective consent at the international level.
The 1961 and 1971 Conventions brought certain organic and synthetic substances under
international control.22 The 1988 Convention, the most prescriptive and punitive among the
three, encouraged increased international law enforcement and stronger domestic criminal
legislation.23 The penal provisions contained in the three drug control treaties obligate States to
criminalise the entire chain of the drugs market, from cultivation to possession for personal
use,24 and any non-‐medical and non-‐scientific drug-‐related activities. Hence, each treaty
encourages, and at some point requires, criminal sanctions to be incorporated into States’
domestic laws.25 Criminalisation, therefore, represents the approach of the conventions
towards drug addiction and the international environment in which the domestic rules are
encouraged to be designed and national policies to be based upon, as the 1961 Single
Convention states:
… parties to the Convention are "concerned with the health and welfare of mankind"
and are "conscious of their duty to prevent and combat" the evil of drug addiction.26
The provisions of the drug conventions themselves have not been passed through a human
rights filter and, more specifically, the 1988 Convention promotes a punitive approach among
the member States. This means there is no reference to health or any rights-‐based aspect of the
involvement of different stakeholders in drug use. As discussed earlier, human rights were not a
consideration in the drafting of the Conventions either.27
22 Substances such as coca, opium, cannabis, LSD and MDMA. 23 For instance, in Argentina and Ecuador, the Convention had a rapid influence on national legislation: in various countries new laws were passed that criminalized the possession of small amounts of drugs. Some of these regulations were declared unconstitutional years later. María Schujer, 'The Impact Of Drug Policy On Human Rights: The Experience In The Americas' (Center for Legal and Social Studies 2015) 18. 24
See article 3 of the 1988 Convention, which introduced the criminalisation of possession for personal consumption into international law. 25 Damon Barrett and Manfred Novak, 'The United Nations And Drug Policy: Towards A Human Rights-‐Based Approach', The Diversity of International Law: Essays in Honour of Professor Kalliopi K. Koufa (1st edn, Brill | Nijhoff 2009). 26 See the 1961 Single Convention preamble. 27 Aristotle Constantinides and Nikos Zaikos, 'The United Nations And Drug Policy: Towards A Human Rights-‐Based Approach', The Diversity of International Law: Essays in Honour of Professor Kalliopi K. Koufa (1st edn, Brill | Nijhoff 2009).
10
Without any principles to protect vulnerable people, unlike the provision in human rights law,
the drug conventions criminalise specifically vulnerable groups, such as people who are at risk
of HIV, survivors of violence, the homeless and people who are living in extreme poverty.28 This
blanket ban may then cause a range of human rights violations and discriminate against more
vulnerable people. This approach may affect people’s lives in different contexts and also put
their human rights at risk. This may violate economic, social and cultural rights of farmers
whose traditional crop cultivation is listed among the illicit crops,29 or children whose schooling
is neglected due to drug use.
In Afghanistan, opium bans, forced eradication and threats of NATO bombing
contributed to human displacement both internally and into neighbouring Pakistan.
There are now over four million internally displaced people in Colombia, most due to
drug fuelled civil conflict, many as a direct result of anti narcotic efforts and aerial
fumigation campaigns targeting coca.30
The UN drug control organs, namely the Commission on Narcotic Drugs (CND), the International
Narcotics Control Board (INCB) and the UN Office on Drugs and Crime (UNODC), mostly execute
their mandates under the influence of this criminalised environment.31 Lack of human rights
guidance in the core drug control treaties has resulted in poor or non-‐existent human rights
practices among these UN bodies. For instance, the UN’s main policy-‐setting body on drugs, the
CND, as an entity, never condemned any of the above named violations. The INCB, the treaty
body for the drug conventions, has no human rights capacity within its membership and
currently no international lawyers. It has specifically stated that it will not discuss human
rights.32
28 Damon Barrett and Philip E Veerman, Article 33 Protection from Narcotic Drugs and Psychotropic Substances (Martinus Nijhoff Publishers 2012)3. 29 See article 3 of the 1988 Convention, which introduced the criminalisation of possession for personal consumption into international law. 30 Damon Barrett and Philip E Veerman, Article 33 Protection from Narcotic Drugs and Psychotropic Substances (Martinus Nijhoff Publishers 2012) 26. 31 Damon Barrett and Manfred Novak, 'The United Nations And Drug Policy: Towards A Human Rights-‐Based Approach', The Diversity of International Law: Essays in Honour of Professor Kalliopi K. Koufa (1st edn, Brill | Nijhoff 2009). 32 Koli Kouame, Secretary of the INCB, UN Press Conference, 7 March 2007.
11
Only one of the three international drug conventions refers to children.33 The 1988 Convention,
in its preamble, states deep concern about ‘the fact that children are used in many parts of the
world as an illicit drug consumers market and for purposes of illicit production, distribution and
trade in narcotic drugs and psychotropic substances, which entails a danger of incalculable
gravity’.34 The other reference is Article 3(5), which talks about the victimisation or use of
children in certain offences.35
This dominant punitive approach and isolation of the drug control regime from the
international human rights standards, has created an environment for communication and
integration only between two legal frameworks. The following from the report by the United
Nations Office on Drugs and Crime (UNODC)36 in 2008 exemplifies this:
The production, trafficking and consumption of illicit drugs can only be understood
properly if they are seen in their many different dimensions: the political, the social, the
economic and the cultural. The drugs issue thus intersects many different domains: law,
criminal justice, human rights, development, international humanitarian law, public
health and the environment, [...]. [T]he drug Conventions must be implemented in line
with the obligations inscribed in the Charter. Among those obligations are the
commitments of signatories to protect human rights and fundamental freedoms.
Children are one of the most vulnerable groups of people whose lives are highly affected by
punitive laws and policies in different contexts. The following sections analyse and examine
how they are harmed by these punitive measures and discuss more appropriate responses.
2.2 Health and human rights approaches This section, in the context of health and drug use and the ways to reduce the harms associated
with drug use, examines health as a human right and as an approach to understanding and
33 Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances 1988. 34 Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances 1988. 35 Article 3(5) requires that ‘The Parties shall ensure that their courts and other competent authorities having jurisdiction can take into account factual circumstances […], such as: […] The victimization or use of minors’. 36 UNODC, 'Making Drug Control ‘Fit For Purpose’: Building On The UNGASS Decade' E/CN.7/2008/CRP.17 (2008) <https://www.unodc.org/documents/commissions/CND/CND_Sessions/CND_51/1_CRPs/E-‐CN7-‐2008-‐CRP17_E.pdf> accessed 10 September 2015.
12
dealing with drug use. Access to adequate medical care is also related and relevant to health, as
a human right37 for individuals and communities and also as a human rights treaty obligation
for States. Treatment38 and other related States’ obligations under international human rights
law could be interpreted and applied differently in domestic practices.39 This will be discussed
in Chapter 5.
The impact of punitive drug policies on human rights and public health can be traced in
domestic laws and practices. However, in recent years the principles of health and human rights
approaches has entered the sphere of communication within the UN human rights body and
UN human rights mandate holders have raised these violations and arbitrary practices on
different occasions. For example, Special Rapporteur on torture, Juan Mendéz, in his report in
2013, criticized the punitive response to dealing with people who are using drugs. He stated
that the abusive nature of compulsory detention of people who use drugs in the name of
treatment, frequently in facilities offering no evidence-‐based services and instead subjecting
them to forced labour and physical and emotional humiliation is tantamount to ‘egregious
physical and mental abuse’ that may rise to the level of torture.40
The former Special Rapporteur on the right to health, Anand Grover, has also condemned
‘compulsory [drug] treatment programmes that primarily utilize disciplinary interventions,
disregarding medical evidence’, and noted forced labour, flogging, solitary confinement and
other punishments in the guise of treatment as gross violations of human rights.41
In recent years, harm reduction approaches have received increasingly explicit endorsement in
the UN human rights system’s narrative, this can be traced in communications of the
Committee on Economic, Social and Cultural Rights42, the Committee on the Rights of the
37 The Right to Health, Fact Sheet No. 31(WHO and UNOHCHR 2008). 38 In this research the term ‘treatment’ refers to any intervention by medical staff or other practitioner that is intended to improve the health of the person with whom this practitioner is in contact. 39 Compulsory and quasi-‐compulsory treatment, and other alternative voluntary treatment in response to harms caused and associated with drug use. 40 UN Human Rights Council, ‘Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment’ (1 February 2013) UN Doc A/HRC/22/53. 41 UN General Assembly, ‘Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health’ (6 August 2010) UN Doc A/65/255. 42 See UN Committee on Economic, Social and Cultural Rights, ‘Concluding Observations: Tajikistan’ (24 November 2006) UN Doc E/C.12/TJK/CO/1 para 70; ‘Concluding Observations: Ukraine’ (23 November 2007) UN Doc E/C.12/UKR/CO/5 para 28.
13
Child43, the Office of the High Commissioner for Human Rights44 and in the thematic mandate
reports of Special Rapporteurs on Health45 and on Torture.46 The UN Special Rapporteur on the
Right to Health stated that harm reduction is not only an essential public health intervention
but that it ‘enhances the right to health’ of people who inject drugs.47
These endorsements and references can provide civil society, policy makers and public health
officials with the interpretation tools required to reread and revise their existing policies and
interventions through the human rights lens.
43 See UN Committee on the Rights of the Child, ‘Concluding observations: Guinea’ (13 June 2013) UN Doc CRC/C/GIN/CO/2, para 67. 44 See Office of the UN High Commissioner for Human Rights, ‘High Commissioner calls for focus on human rights and harm reduction in international drug policy’ (10 March 2009). 45 See UN Human Rights Council, ‘Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, Paul Hunt, Mission to Sweden’ (28 February 2007) UN Doc A/HRC/4/28/Add.2, para 60; UN General Assembly, ‘Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health’ (6 August 2010) UN Doc A/65/255, paras 50-‐61. 46 UN Human Rights Council, ‘Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, Manfred Nowak’ (14 January 2009) UN Doc A/HRC/10/44,para 74(a-‐c). 47 Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, Paul Hunt, Mission to Sweden’ (28 February 2007) UN Doc No A/HRC/4/28/Add. 2, para 60.
14
Chapter 3. Background history; When did use of drugs become an issue?
Historically, Iran is an agricultural country and from the mid-‐19th century onward, the
cultivation of opium was one of the largest and most profitable parts of traditional Iranian
agrarian economy.48 During the period in which the drug control system was in place, as briefly
reviewed in the previous chapter, Iran was one of the main opium producers and importers,
and was also one of the stakeholders in the multilateral arrangements which meant that it was,
in a way, affected by those policies. Being aware of the long history and traditional patterns of
drug use in Iran and the political history and motivations behind drug controls is beneficial in
identifying actual areas of concerns using an evidence-‐based approach. This approach is also
necessary for advocating any legal reforms or broader interpretation within the exciting legal
framework, aimed at integration of human rights standards.
3.1 Social, economic and historical background of drug use in Iran
In a country where doctors are few and far between, opium is a great solace to people in
pain or attacked by malaria.49
There is a long history of using opium for medical purposes in Iran and it was even prescribed
by traditional physicians. The use of opium was so ingrained in Iranian culture that it was not
unusual for mothers to puff opium smoke into their babies’ faces to calm them, help them to
sleep or relieve them of simple teething pains.50 Moreover, during World War I when Iran
experienced the great famine between 1917-‐1919, opium consumption escalated significantly
as it was the cheapest available option for relieving hunger.
Cultivation and production of opium in Iran was shaped and changed along with the collective
political will and post-‐war international drug policy towards managing the opium market.
48 Amir Arsalan Afkhami, 'From Punishment to Harm Reduction: Resecularization of Addiction in Contemporary Iran', Contemporary Iran (1st edn, Oxford University Press 2009) 195. 49 Amir Arsalan Afkhami, 'From Punishment to Harm Reduction: Resecularization of Addiction in Contemporary Iran', Contemporary Iran (1st edn, Oxford University Press 2009) 196. 50 Ram Baruch Regavim, 'THE MOST SOVEREIGN OF MASTERS: THE HISTORY OF OPIUM IN MODERN IRAN, 1850-‐1955' (PhD, University of Pennsylvania 2012).
15
Hence opium became a state monopoly as a result of a parliamentary decision in 1928.
According to the new legislation, the illegal use and distribution of the substance carried severe
penalties. Iran signed the International Convention for Limiting the Manufacture and Regulating
the Distribution of Narcotic Drugs in 1931, four years after passing the 1928 restrictive
parliamentary bill. This policy was followed by imposing a ban on poppy cultivation in 25
districts of the country.51 Despite all of the new drug market controls and policies, Iran
remained one of the main exporters of opium, mainly because of its geostrategic location and
the medical needs of western countries. By 1947–48, reports indicated that Iran produced as
much as 4 million pounds of opium annually (global “legitimate” needs were around 750,000
pounds at that time).52
Unexpectedly, in 1955 an anti-‐opium movement, mainly endorsed by the Minister of Health
and the Shah, banned poppy cultivation and suppressed opium smoking. Years later Iran
announced that opium’s demand was controlled and that the number of drug users had
decreased and, as a result, the Iranian representative at CND meetings gained a new respect
among his colleagues. Despite the self-‐imposed ban on opium cultivation, Iran ratified the 1953
Opium Protocol.53 However, the outcome was not necessarily as expected and the Iranian
opium ban resulted in heroin being smuggled into the country mainly from Turkey and
Afghanistan.54
Following the failure of the opium ban, the Iranian government took an initiative and passed a
law in 1969 allowing for limited cultivation of the opium poppy to be used by registered addicts
over 60 years of age who were considered too medically unstable to be detoxified.55 That
intervention was applied on a limited scale which does not exactly fit the harm reduction
51 Amir Arsalan Afkhami, 'From Punishment to Harm Reduction: Resecularization of Addiction in Contemporary Iran', Contemporary Iran (1st edn, Oxford University Press 2009) 198. 52 William B. McAllister, Drug Diplomacy In The Twentieth Century: An International History (Routledge 2000) 180. 53 ibid 196. 54 McAllister claimed “Iran solicited technical assistance for its enforcement efforts, and requested foreign aid subsidies for crop substitution and economic development. In 1959-‐60 Teheran hinted that, if sufficient international support were not forthcoming, the government might reconsider its prohibition policy”. 55 Hasan-‐Ali Azarkhsh, 'The Nature And Extent Of Drug Abuse In Iran' (CENTO Seminar on Public Health and Medical Problems Involved in Narcotics Drug Addiction, Tehran: Central Treaty Organization, 1972). By 1972 there were 100,000 registered opium addicts.
16
principles56 but, at least, can be seen as a step towards better health approaches in responding
to drug use and the harm associated with it. Chapter 5 of this thesis looks in more detail at the
harm reduction programmes in Iran and how they have been formulated over time through the
political changes that the county has experienced.57
3.2 Adolescent involvement in drug use
Iran is a country with a large population of young people and, at the same time, has one of the
highest proportions of opioid users in the world.58 However, due to lack of data and scientific
study, there is no clear and comprehensive understanding of how the market is operating,
neither about the supply nor demand patterns. Even the data present in UNODC’s reports
focuses only on the amount of drugs seized or covers mostly opiate drug consumption but does
not provide much information on stimulants.59 In both scenarios the data is insufficient and
unhelpful in unpacking and understanding the complexity and trends of adolescent drug use.
Evidence-‐based market and trend analysis of adolescent drug use cannot be performed without
reliable and up-‐to-‐date data.
The Committee of the Convention on the Rights of the Child (CRC) expressed concerns about
the increase of drug use among children and the decrease in the age of children’s involvement
in drug use.60 Locally drafted reports acknowledge that Iranian youth are not exceptional in the
fact that young people are faced with higher risks and the emergence of these risk factors.
56 In Tehran only a 125-‐bed government-‐funded addiction hospital provided methadone detoxification services for voluntarily admitted patients who had undergone the long waiting list. See Amir Arsalan Afkhami, 'From Punishment to Harm Reduction: Resecularization of Addiction in Contemporary Iran', Contemporary Iran (1st edn, Oxford University Press 2009) 197. 57 After the Revolution in 1979, the treatment of substance abuse began to be seen by the government outside the previously held medical paradigm. In accordance with the government’s new standards of morality, which were drawn along the Islamic religious precepts, and in accordance with new ideological rhetoric, stringent anti drug campaigns were launched; elements of these campaigns included the fining of addicts, imprisonment, and physical punishment and even the death penalty for serious offenses. See Ali Gheissari, Contemporary Iran (Oxford University Press 2009) xx. 58 The United Nations Office on Drugs and Crime (UNODC), 'World Drug Report 2015' (UNODC 2015). 59 See United Nations Office on Drugs and Crime (UNODC), 'World Drug Report 2010' (United Nations Publication 2010) 284, 289, 294 and 299 and United Nations Office on Drugs and Crime (UNODC), 'World Drug Report 2015' (United Nations publication 2015) In UNODC 2010 report, there is no data under Amphetamine, cocaine Iran consumption rate and the data given for cannabis dated back to nineties, any information provided on trends for stimulant and new substances. 60See UN Committee on the Rights of the Child, ‘Concluding observations: Iran’ (31 March 2005) UN Doc CRC/C/15/Add.254, para 67.
17
These studies and surveys claim that close to half of young Iranians have experienced at least
one type of high-‐risk behaviour in their youth.61
Additional surveys which state that 13.3% of Iranian students aged 15-‐18 are exposed to drugs
also show that 10% of high school adolescents (age 14-‐19) in Tehran City had used drugs in the
12 months preceding the survey (19.1% of boys and 2.5% of girls).62 Very little is known about
the settings and motivations behind such initiations into high-‐risk practices by urban Iranian
youth. There exists very little accessible data collected from small samples involving only a
couple of cities, mostly the capital, which is not proportionally representative of the diverse
group of young people living in Iran.63
3.2.1 The complexity of the issue Children’s involvement in the drugs cycle is a hugely complex and multidimensional issue and
the range of their involvement in drug related issues varies from one context to another.
Substance abuse sometimes becomes both a means and an end for survival.64
Relaxation, forgetting tension, overcoming fear and living in a dream were common
feelings reported by [street children in Bangladesh] after sniffing glue. Other reasons
included networking, sharing life experiences and avoiding resistance by others.65
61Manijeh Zakariaie, Hossein Mozaffar and Maryam Sabeti, 'Cultural Anomie And Drug Addiction Among 13-18 Young Tehranis' (2010) 3 Journal of social sciences 56. Other studies, cited in this reference, such as (Sediq Sarvestani 2004; Youth National Organisation 2002; Eslami Tabar et al., 2003; Soleymani Nia et al., 2005; Rahimi Movaqar et al., 2006; Momen Nasab et al., 2006; Seraj Zadeh and Feyzi, 2007; Mahmoudian and Sadeqi, 2009; Mohammadi et al., 2011) also show increasing number of youth engaging in drugs abuse, alcoholism, use of psychedelics, smoking, sexual risks, reckless driving and violence. 62Sediq-Sarvestani study (2004) and Soleimaninia et al. (2005), cited in Manijeh Zakariaie, Hossein Mozaffar and Maryam Sabeti, 'Cultural Anomie And Drug Addiction Among 13-18 Young Tehranis' (2010) 3 Journal of social sciences 58. 63There are couple of other issues with the very limited existing and accessible data, such as their judgmental language, lack of gender and minority sensitivity in their work, not so up to date. This will be discussed further in this research, as a general approach to the situation and human rights risk assessment in dealing with the involvement of adolescents in drug use. 64Florence Martin and John Parry Williams, 'The Right Not To Lose Hope: Children In Conflict With The Law – A Policy Analysis And Examples Of Good Practice' (Save the Children International 2005)18. 65The findings of the study assessed the nature of drug use and other risky practices among street children aged 11 to 19 years in Dhaka and Chittagong, the two major metropolises of Bangladesh. See Iffat Mahmud, Karar Zunaid Ahsan and Mariam Claeson, 'Glue Sniffing And Other Risky Practices Among Street Children In Urban Bangladesh' (World Bank 2011)18.
18
For instance, in Afghanistan and Colombia, one of the most common ways in which children are
exposed to the drugs and even the drug trade is through farming illicit crops66 or, in Jakarta,
children in poor families who help to earn a livelihood may do so by becoming informants to
drug dealers.67 In urban areas of Iran among very low-‐income families, children may get
involved in the drug trade as ‘runners’.68 Becoming part of the organised, armed, violent and
life-‐risking drug market in Brazil can be the farthest extent of child involvement in drug related
issues. Hence, the harm and risk associated to each experience differs from the other and
requires appropriate response and protection.
The harms experienced by those young people living with blood-‐borne and sexually transmitted
infectious diseases, or those who are part of the sex trade, and the levels of stigmatization,
victimization, physical abuse and assault can also be hugely different.
Out-‐of-‐the-‐mainstream youth include overlapping groups such as street involved youth,
youth who are homeless or who are largely absent from home, youth involved in the sex
trade, youth in the care of community services or known to the justice system, and
youth who are frequently truant from school. Their substance use patterns are very
different from those of mainstream youth still in school.69
In the context of Iran where the schooling population, aged from 15 to 19, stands at 59.9%70 it
becomes vital to take different approaches in any decision making to address drug use among
those who are in the school setting and those who are out of it. It is also important to
distinguish between the ways in which young children may be involved in drug use. The reason
to make this distinction, as with the distinction between types of drug use, is also to ensure that
the responses are appropriate and targeted.
66Damon Barrett, 'The Impacts Of Drug Policies On Children And Young People' (Open Society Foundation 2015)8. 67Luke Dowdney, 'Children Of The Drug Trade. A Case Study Of Children In Organised Armed Violence In Rio De Janeiro' (Luke Dowdney 2003)8, <http://www.scslat.org, www.vivario.org.br> accessed 11 September 2015. 68 Khorasan.isna.ir, 'كووددكانن كاشمرر ددرر خرريیددووفررووشش موواادد مخددرر موورردد سووءااستفاددهه قرراارر مي گيیررندد' (2015) <http://khorasan.isna.ir/Default.aspx?NSID=5&SSLID=46&NID=74020> accessed 1 September 2015. [Unauthorized translation: ‘In Kashmar children used in drug trafficking are exploited’] 69 Christiane Poulin, 'Harm Reduction Policies And Programs For Youth' (Canadian Centre on Substance Abuse (CCSA) 2006)10. 70 See <http://iran.unfpa.org/Documents/Census2011/2011%20Census%20Selected%20Results%20-‐%20Eng.pdf> accessed 11 September 2015.
19
Additionally, the diversity of the population of young people living in Iran which includes ethnic
minorities, displaced populations after the Iran-‐Iraq War (1980-‐1988), Afghan migrants and
rural migrants adds further dimensions to the complexity of children’s and young people’s drug
use. The characteristics of ethnicity and diaspora amongst this population can increase the risk
of further discrimination and stigmatization against young drug users.
Acknowledging the complexity of children’s involvement in drug related issues endorses the
urgent need to conduct comprehensive studies and situation assessments. Currently the
emergence of youth as a drug-‐using population in the whole region, not limited to Iran, appears
to be an invisible and ignored issue.71 This lack of perspective on the complexities of children
involved in the production, sale and distribution of drugs among various government
institutions is easy to understand. For institutions mandated to provide information and
education, as well as those providing care and support, involvement of children in drug
activities clearly falls currently into the purview of the justice system and law enforcement
agencies.
3.2.2 Unpacking different forms of adolescent involvement in drug related issues
Young people are the most vulnerable social group to drugs abuse due to identity crisis,
psychological issues caused by social problems, and the intrinsic tendencies of their age to
seek adventure, pleasure and variety.72
Unpacking the issue might be helpful in gaining further understanding of the different aspects
of children’s drug use. In addition, it is essential in order to be able to design appropriate data
collection and assessment programmes to respond to the special needs of different
stakeholders including youth, their families and the community. This process needs to start
with identifying the stakeholders then understanding their vulnerabilities and their specific
needs by setting up human rights risk assessment mechanisms. This is the primary step towards
71 Claudia Stoicescu, 'The Global State Of Harm Reduction 2012 Towards An Integrated Response' (Harm Reduction International 2012)139. 72 Shripad Tuljapurkar, D. Ian Pool and Wiphan Pračhūapmo Rūpfōlō, Population, Resources And Development (Springer 2005)58.
20
implementing an evidence-‐based approach that is set apart from social stigmas and judgmental
reactions. In taking this first step, it becomes crucial to identify the root causes which are most
often overlooked and even ignored in the process of decision-‐making, and also to identify
exactly how children may be affected and harmed by drug use. The circumstances, drug use
pattern, networks, social environments and motivations surrounding these initiation events are
just some of the key risk factors.73 Age of involvement in different kinds of drug use is also
important in understanding the risk and harm that children are facing.
The human rights framework on right to health, along with other economic, social and cultural
rights, as well as the principles of the rights of the child should be integrated and promoted in
setting up any mechanisms to deal with children’s drug use.
73 These are the risk factors that are observed and controlled in some to studies such as Isidore S. Obot and Shekhar Saxena, 'Substance Use Among Young People In Urban Environments' (WHO 2005)200-‐201.
21
Chapter 4. International response to adolescents’ involvement in drug use, with reference to human rights and harm reduction
It is highly acknowledged that drug issues primarily affect those who are most vulnerable such
as youths.74 Young people around the world get involved in drug use not for all the same
reasons.75 On one hand rapid physical, emotional and mental development, complex
psychosocial and socioeconomic elements, poor access to and uptake of health services
increase adolescents’ vulnerability and risk76 and they tend to have less knowledge of safer
injecting practices and of services that support these. On the other hand, however, in practice
the distribution pattern of health and drug related services and existing harm reduction
programmes suggests that the focus is mostly on activities for youth in general rather than at
targeting the most vulnerable at risk group.77
As it is easier to bend the twig than the tree, young and “new” injectors represent the
greatest hope for reducing many of the harms associated with drug injecting among
new populations of drug users. If we are to respond meaningfully and effectively to
young people’s drug use, we must, first of all, accept that a significant proportion of
young people will take drugs before the age of consent. We must furthermore develop
a clear understanding of young people's drug taking, risk and protective behaviours,
the motives, values and beliefs that may drive their drug use, as well as their concerns,
aspirations and expectations of society and its institutions.78
74 UN Commission on Narcotic Drugs, Youth and Drugs: A Global Overview, Report of the Secretariat, UN Doc. No. E/CN.7/1999/8, para 14. 75 This can be because of their innate curiosity and thirst for new experiences, peer pressures, their resistance to authority, sometimes low self-‐esteem and problems in establishing positive interpersonal relationships, and makes young people in particular susceptible to using drugs. Whereas for some might be considered as a strategy to cope with problems of unemployment, neglect, violence and sexual abuse. See UN Commission on Narcotic Drugs, Youth and Drugs: A Global Overview, Report of the Secretariat, UN Doc. No. E/CN.7/1999/8, para 15. 76 World Health Organisation (WHO), 'Consolidated Guidelines On HIV Prevention, Diagnosis, Treatment And Care For Key Populations' (WHO 2014)7. It happens so often that due to policy and legal barriers related to age of consent, the access of young people to a range of health services, counselling (HTC), harm reduction and other services become prevented. Such restrictions also limit adolescents’ ability to exercise their right to informed and independent decision-‐making 77 UN Commission on Narcotic Drugs, Youth and Drugs: A Global Overview, Report of the Secretariat, UN Doc. No. E/CN.7/1999/8, para 61. 78 Simona Merkinaite, Jean Paul Grund and Allen Frimpong, 'Young People And Drugs: Next Generation Of Harm Reduction' (2010) 21 International Journal of Drug Policy,113.
22
Adolescents who are involved in drug use are not all equally vulnerable. In any policy setting
and decision making process for this group of people it is vital to acknowledge first this diversity
and then bring the focus and priority to the differing levels of vulnerability and risk. The first
step towards a youth-‐focused and effective response to the needs of adolescents who are using
drugs would be improved data collection on an international level. Developing a clear
understanding of the different dimensions of the situation is essential to achieving non-‐
judgmental and structural interventions with a holistic approach towards the adolescent’s drug
use and to reduce the potential associated harm.79 This approach should be encouraged from
the international community, especially the international human rights community, and aimed
at establishing targeted, meaningful and effective action based on levels of vulnerability and
actual risk.
4.1 The international legal framework As discussed earlier in Chapter 2, the drug control conventions80 are focused on limiting the use
of controlled substances to medical and scientific purposes. The penal provisions of the three
drug control treaties obligate States to criminalise non-‐medical and non-‐scientific drug-‐related
activities ranging from cultivation to consumption.81 Only one of the three international drug
conventions refers to children. The 1988 Convention, in its preamble, expresses deep concern
about the increasing use of children in drug use and the drugs market.82 The other reference is
Article 3(5), which talks about the victimisation or use of children in certain offences.83
At international policy level the focus is more often on prevention and youth drug reduction
programmes.84 Each year, member states report to the UN Commission on Narcotic Drugs
79 Stoicescu C (Ed), 'The Global State Of Harm Reduction 2012 Towards An Integrated Response' (Harm Reduction International 2012)144. 80 The three UN drug conventions: the 1961 Single Convention on Narcotic Drugs; the 1971 Convention on Psychotropic Substances; and the 1988 Convention Against the Illicit Traffic in Narcotic Drugs and Psychotropic Substances. 81 Damon Barrett and Philip E Veerman, A Commentary On The United Nations Convention On The Rights Of The Child, Article 33 (BRILL 2012) 3. 82 See preamble of Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances 1988. The Parties to this Convention, [...] Deeply concerned also by the steadily increasing inroads into various social groups made by illicit traffic in narcotic drugs and psychotropic substances, and particularly by the fact that children are used in many parts of the world as an illicit drug consumers market and for purposes of illicit production, distribution and trade in narcotic drugs and psychotropic substances, which entails a danger of incalculable gravity [...]. 83 See Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances 1988, art 3(5). 84 For instance see International Narcotics Control Board, Annual Report for 2009, UN Doc E/INCB/2009/1; or
23
about their anti-‐drug and preventive provisions. Hence involvement of children in using drugs is
still a serious issue of concern85 which at least suggests the necessity for other forms of
intervention.86 Proportionate provisions to the harm associated with and caused by the use of
drugs are, therefore, required.
4.2 Convention on the rights of the child Convention on the Rights of the Child (CRC) is the core international human rights obligatory
document regarding drug related issues not only as the only international convention which
had a direct reference to drugs, but also as the UN human rights treaty with most signatories.
Article 33 of the CRC specifically invites States’ parties to take ‘all appropriate measures,
including legislative, administrative, social and educational measures, to protect children from
the illicit use of narcotic drugs and psychotropic substances as defined in the relevant
international treaties, [...]’.87 However, lack of any official commentary from the CRC
Committee to define what exactly ‘appropriate measures’ are, and the ambiguity about the
level of protection, has left the application of most of these obligations open to interpretation
by States.88
The Convention acknowledges ‘the right of the child to the enjoyment of the highest attainable
standard of health’ and emphasises that no child should be ‘deprived of his or her right of
access to such health care services’ under Article 24. However, some of the interpretive
statements from the Committee on the Rights of the Child can be read as authoritarian legal
A Political Declaration was adopted at a General Assembly special session on the world drug problem (1998) which declared the intention of Member States to “give particular attention to demand reduction, notably by investing in and working with youth through formal and informal education, information activities and other preventive measures”. General Assembly, twentieth special session, 10 June 1998, A/RES/S-‐20/2, para 6; or The outcome document of the General Assembly’s special session on children in 2002 undertook that States would: “Urge the continued development and implementation of programmes for children, including adolescents, especially in schools, to prevent/discourage the use of tobacco and alcohol; detect, counter and prevent trafficking, and the use of narcotic drugs and psychotropic substances except for medical purposes, by, inter alia , promoting mass media information campaigns on their harmful effects as well as the risk of addiction and taking necessary actions to deal with the root causes.” Ad Hoc Committee of the Whole of the twenty-‐seventh special session of the General Assembly, 2002, A/S-‐27/19/Rev.1, para 11. 85 See 'Implementation Handbook For The Convention On The Rights Of The Child' (UNICEF 2007)504. 86 Damon Barrett, Children Of The Drug War (International Debate Education Association 2011)172. 87 Convention on the Rights of the Child (CRC) 1989, Art 33. 88 Further analysis on this is beyond the scope of this research, for in depth discussion see: Damon Barrett and Philip E Veerman, Article 33 :Protection from Narcotic Drugs and Psychotropic Substances (Martinus Nijhoff Publishers 2012) 48-‐84.
24
additions to the context. For instance, General Comment 15 emphasises ‘the importance of
adopting a rights based approach to substance use and recommends that, where appropriate,
harm reduction strategies should be employed to minimize the negative health impacts of
substance abuse’. 89 Additionally, the Committee shows its concern by stating that ‘health
services are generally still insufficiently responsive to the needs of children under 18 years of
age, in particular adolescents’.90
CRC also introduced some general key principles which should be applied to the understanding
and operationalization of the child’s right to health. These are the core interpretive tools
provided under the Convention; the right to non-‐discrimination (Article 2)91, the right of the
child to have his/her interests taken as a primary consideration (Article 3)92, the right to life,
survival and development (Article 6) and the right to have his/her views respected (Article 12).
Therefore, any treatment should be provided in the best interests of the adolescent concerned
and in consultation with her or him in a non-‐discriminatory and not arbitrary process.
The level of protection of children in the context of drug use should be read and understood
within the framework and principles of the CRC and cannot be limited to and minimized into
prevention as the primary level of protection. Adequate and effective protection will not
happen without including children who are currently using drugs, their drug using families and
the communities in which these children live. 93 Both the drug conventions and the CRC are
silent on harm reduction as an effective and evidence-‐based form of protection94. This is
89 Committee on the Rights of the Child, GC 15, CRC/C/GC/15 (2013) under ‘Preventive health care’. 90 Committee on the Rights of the Child, GC 3, CRC/GC/2003/3 (2003) para 20. 91 This principle and its operationalization has not been crystallized in the Committee’s periodic reporting guidelines and “fail to adequately apprise or require reporting on States parties’ attendance to the health consequences specific to adolescents in conflict with the law.” Brendan Conner, '“First, Do No Harm”: Legal Guidelines For Health Programmes Affecting Adolescents Aged 10–17 Who Sell Sex Or Inject Drugs' (2015) 18 Journal of the International AIDS Society, 80. 92 Assessment of the child's best interests must also include consideration of the child’s safety, that is, the right of the child to [...] protection against sexual, economic and other exploitation, drugs, labour, armed conflict, etc.(arts. 32-‐39). Committee on the Rights of the Child, GC 14, CRC/C/GC/14 (2013)para 73. 93 Damon Barrett and Philip E Veerman, Article 33 :Protection from Narcotic Drugs and Psychotropic Substances (Martinus Nijhoff Publishers 2012)91. 94 See Ralf Jürgens and others, 'People Who Use Drugs, HIV, And Human Rights' (2010) 376 The Lancet; Chris Beyrer and others, 'Time To Act: A Call For Comprehensive Responses To HIV In People Who Use Drugs' (2010) 376 The Lancet.
25
inevitable as harm reduction as a policy and practice has really only emerged in the last two
decades, mostly in the field of HIV prevention.95
The Committee has started to explicitly recommend the application of harm reduction
programmes for youths to the member States through concluding observations, such as
recommendations to Guinea to ‘develop specialized and youth-‐friendly drug-‐dependence
treatment and harm reduction services for children and young people’.96
4.3 Other international legal provisions
It seems that the UN human rights machinery, with a few notable and recent exceptions, has
been all but silent on drug control issues to the point where drug control and human rights in
the UN system have been described as ‘parallel universes’.97 Although there is no direct
reference to children’s drug use in human rights conventions, the relevant obligations defined
under these conventions contain widely acknowledged standards. These obligations can,
therefore, be cited as strongly supporting a human rights response to children’s involvement in
drug use, especially from a health approach. The Universal Declaration of Human Rights,
International Covenant on Economic Social and Cultural Rights (ICESCR) illustrates the right of
children to the highest attainable standards of health:
The right to the highest attainable standard of health requires all States to
provide, as a matter of priority, national, comprehensive harm reduction services
for people who use drugs. An appropriate policy, plan, budget, monitoring and
accountability must support the services. As the services, policy and so on are
formulated and implemented, mechanisms must be in place to enable the active
and informed participation of those most affected. One size does not fit all. Harm
reduction initiatives must respond to national and local needs. Also, as already
95 André Alen and Garton Kamchedzera, A Commentary On The United Nations Convention On The Rights Of The Child (Nijhoff 2012) 85. 96 Committee on convention on the rights of the child, Concluding Observations: Guinea(UN Doc CRC/C/GIN/CO/2, 2013)para 67; or for more example see Ukraine (UN Doc CRC/C/UKR/CO/3-‐4, 2011)para 61; Austria (UN Doc CRC/C/AUT/CO/3-‐4, 2012) para 51; Austria (UN Doc CRC/C/AUT/CO/3-‐4, 2012) para 49; Albania (UN Doc CRC/C/ALB/CO/2-‐4, 2012) para 63. 97 Paul Hunt, ‘Human Rights, Health and Harm Reduction: States’ Amnesia and Parallel Universes’, Speech delivered at the 19th International Harm Reduction Conference, Barcelona, May 2008.
26
observed, the right to health places greater demands on high income than low-‐
income States. All States, however, are obliged to have an effective, national,
comprehensive harm reduction policy and plan, that delivers essential harm
reduction services.98
More reflections of these standards can be traced in the Concluding Observations of the CESCR
Committee99, which facilitates the application of Article 12 (the right to health) and Article
15(1)(b) (the right to benefit from scientific progress and its applications) to the issue. General
Comment No. 14 on the right to health100 also provides a helpful interpretation tool for the
context of drug policies.101 Complementing this, the UN Committee on Economic, Social and
Cultural rights continued to strengthen its positions on harm reduction, raising concerns with
Ukraine in 2014 about ‘the punitive approach taken in the State party towards persons who use
drugs, which results in high numbers of such persons being imprisoned’.102
Additionally, the World Health Organization (WHO)103 as the directing and coordinating
authority on international health within the UN’s system provides member States with a variety
of interpretive and guiding principles for the scientific basis of health services for youth.104
WHO also emphasises the need to introduce specific and more creative and engaging strategies
to promote the uptake of health services and harm reduction programmes for adolescents who
use drugs, free from stigmatization and discrimination.105 ‘Drug abuse prevention and health’ is
98 Paul Hunt, Human Rights, Health And Harm Reduction. States' Amnesia And Parallel Universes(International Harm Reduction Association 2008)8. 99 Committee on Economic Social and Cultural Rights, Concluding Observations: Mauritius (UN Doc E/C.12/MUS/CO/4, 2010) para 27(c). 100 Committee on Economic Social and Cultural Rights, General Comment No. 14: The right to the highest attainable standard of health, (UN Doc No E/C.12/2000/4, 2000) para 15. 101 Commenting on Mauritius in 2010 the CESCR Committee recommended that the State party, in order to progressively realise these rights, must ‘Remove age barriers to accessing opioid substitution therapy and develop youth-‐friendly harm reduction services tailored to the specific needs of young people who use drugs’. 102 Committee on Economic, Social and Cultural rights, Concluding Observations: Ukraine(UN Doc E/C.12/UKR/CO/6, 2014) para 24. 103 At a global level, the World Health Organization (WHO) was one of the first multilateral bodies to endorse the underlying principles of harm reduction in a meeting in Stockholm in 1986 (WHO, 1986). As early as 1974, the WHO Expert Committee on Drug Dependence had made reference to ‘concern for preventing and reducing problems rather than just drug use’ (Wodak, 2004). See Tim Rhodes and Dagmar Hedrich (Eds), 'Harm Reduction: Evidence, Impacts And Challenges' (European Monitoring Centre for Drugs and Drug Addiction 2010) 42-‐43. 104 For instance see World Health Organisation, 'Quality Assessment Guidebook. A Guide To Assessing Health Services For Adolescent Clients' (WHO 2009); World Health Organisation (WHO), 'Consolidated Guidelines On HIV Prevention, Diagnosis, Treatment And Care For Key Populations' (WHO 2014); World Health Organization, 'Adolescent-‐Friendly Health Services: An Agenda For Change' (WHO 2003). 105 World Health Organisation (WHO), 'Consolidated Guidelines On HIV Prevention, Diagnosis, Treatment And Care For Key Populations' (WHO 2014)30.
27
described as part of the UNODC mandate, upon which it tries to convince Governments to see
drug use as a health problem and not a crime, with an approach to solving it based on scientific
findings.
4.4 Public health provisions In 2007, the UN Special Rapporteur on the Right to Health named harm reduction as an
essential public health intervention106. However, there are still many other strategies and
interventions being applied to respond to health and social drug related issues with public
health justification. The notion of protecting individuals and the population’s health through
the surveillance, identification and management of risk to health is at the core of public
health:107
Mainstream public health approaches recognise the need to create ‘enabling
environments’ for risk reduction and behaviour change, including through the
strengthening of community actions and the creation of public policies supportive of
health. Harm reduction is an exemplar of mainstream public health intervention.108
This new vision of public health is developed towards acknowledging health and harm as
products of one’s social and policy environment, and places greater emphasis on community-‐
based and ‘low-‐threshold’ interventions. Despite so many other interventions focused on
treatments and “cures”, the harm reduction approach focuses on the risks and consequences of
substance use rather than on the use itself. Under this approach abstinence is considered as
only one potential strategy among a broad range of options that can reduce the health and
social harms associated with drugs, and is applicable to both adults and youths.109 The main
implementation issues which distinguish youth harm programmes from adults is the ‘fledgling
106
Paul Hunt, ‘Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, Mission to Sweden’ (UN Doc A/HRC/4/28/Add. 2, 2007)para 60. 107
The Ottawa Charter for Health Promotion, First International Conference on Health Promotion (Ottawa 1986). 108
Tim Rhodes and Dagmar Hedrich (Eds), 'Harm Reduction: Evidence, Impacts And Challenges' (European Monitoring Centre for Drugs and Drug Addiction 2010)20. 109
Christiane Poulin, Harm Reduction Policies And Programs For Youth (Canadian Centre on Substance Abuse 2006)2.
28
autonomy and ability of youth to make wise decisions concerning substance use, the specific
risks and harms associated with youth substance use’.110
There is still a gap in the evidence and rights-‐based technical guidelines for interventions
among adolescent drug users from international public health actors. There is now a significant
amount of research to indicate that domestic and international legal constructs that rely on
law-‐enforcement based interventions dependent upon arrest, pre-‐trial detention, incarceration
and compulsory ‘rehabilitation’ escalate the stigma, discrimination, criminalization and affect
life and wellbeing of these adolescents.111 Age should be considered as an issue in risk
assessment, the appropriateness of certain treatments, and the threshold of intervention, as
well as a factor in deciding treatment options and interventions, but not a criterion of
exclusion.112
International response to adolescent drug use and health provisions in dealing with the harm
related to drug use has improved a great deal over recent years. However, there is still a long
journey to achieving and implementing evidence-‐based, participatory, non-‐discriminatory and
adolescent-‐friendly harm reduction services for young people.113
110
Christiane Poulin, Harm Reduction Policies And Programs For Youth (Canadian Centre on Substance Abuse 2006)2. 111 Brendan Conner, '“First, Do No Harm”: Legal Guidelines For Health Programmes Affecting Adolescents Aged 10–17 Who Sell Sex Or Inject Drugs' (2015) 18 Journal of the International AIDS Society 78. 112 Methadone, for example, would not be the most appropriate intervention for a very young opiate user. Damon Barrett and Philip E Veerman, A Commentary On The United Nations Convention On The Rights Of The Child, Article 33 (BRILL 2012) 86. 113 For instance, as some progressive statements, see: World Health Organisation, 'Making Health Services Adolescent Friendly: Developing National Quality Standards For Adolescent Friendly Health Services' (WHO 2012); World Health Organization, 'Adolescent-‐Friendly Health Services: An Agenda For Change' (WHO 2003); World Health Organisation, 'Quality Assessment Guidebook, A Guide To Assessing Health Services For Adolescent Clients' (WHO 2009). UNESCO, UNODC, EMCDDA and WHO are currently cooperating to disseminate the best available evidence based drug use prevention and early interventions. WHO is currently developing guidance to countries, focusing on the educational sector, on evidence based universal (targeting the whole age group for example, of all women), targeted (targeting children and young people at risk and women at risk ) and indicated prevention ( targeting children and young people, women and vulnerable people that started to use drugs mostly screening and brief interventions).Based on the communication made for the purpose of drafting this paper with WHO Department of Mental Health and Substance Abuse, the result supposed to be released by Summer 2016.
29
Chapter 5. Iran and the involvement of adolescents in drug use
The root causes behind adolescent involvement in drug use is still debatable in an environment
in which there is not much reliable and comprehensive data available.114 Most countries’
responses to youth drug use is shaped mainly by assuming all kinds of drug use as dangerous,
equally harmful and threatening:
But while drug use among young people can be an indicator of later problems,
experimenting with drugs is becoming increasingly common among young people, and
most young people who experiment with drugs or use them recreationally do not
develop serious drug problems.115
Usually the lived experiences of recreational users are ignored without responding to their
needs by measures that focus on the worst-‐case scenario. A level of tolerance in policies and
legislation dealing with drug use may require the creation of an environment which accepts the
reality of drug use and is able to respond to that which is, however, unlikely considering the
current rhetoric.116
Iran has undeniable records of running harm reduction programmes and health interventions in
the MENA region but the quality, effectiveness and scope of coverage of these programmes are
often discussed.117 This chapter aims to review these programmes through the human rights
lens and health indicators based on limited available sources.
114 For instance see Fiona Measham and Michael Shiner, 'The Legacy Of ‘Normalisation’: The Role Of Classical And Contemporary Criminological Theory In Understanding Young People's Drug Use' (2009) 20 International Journal of Drug Policy and Damon Barrett, Children Of The Drug War (International Debate Education Association 2011)4. 115 European Monitoring Centre on Drug and Drug Addiction, 'Drug Use Amongst Vulnerable Young People' (EMCDDA 2003) <http://www.emcdda.europa.eu/publications/drugs-‐in-‐focus/vulnerable-‐young> accessed 27 September 2015. 116 Damon Barrett, Children Of The Drug War (International Debate Education Association 2011) 186. 117 Afarin Rahimi-‐Movaghar and others, 'Assessment Of Situation And Response Of Drug Use And Its Harms In The Middle East And North Africa' (MENAHRA 2012)29.
30
5.1 Adolescent drug use and rule of law 5.1.1 Domestic laws The background history of Iran’s drug control policies and legislation, as briefly discussed in
Chapter 3, evidences a long history of criminalization of the whole cycle of the drug market.
National anti-‐narcotic laws became even more restrictive after the Islamic revolution in 1979.118
Whilst even possession of drugs can be punished by death, under some circumstances119 and
according to the Anti-‐Narcotics Law of 1988, as amended in 1997 and 2011, drug users can
become free from persecution by registering onto health prevention programmes.120 Hence the
law allows some provision for alternative interventions under Article 15, and compulsory
treatment under Article 16 for those with drug dependence who have not registered onto any
treatment programme.
Although some health interventions and even harm reduction provisions exist under this law,
the by-‐laws for practical implementation set an age restriction for accessing these services.121
These by-‐laws have tried to offer definitive health strategies set within anti-‐narcotics law, and
the harm reduction service is one of them. However as all of these provisions were designed to
respond to the needs of adult drug users, they do not necessarily address the specific needs of
youths.
The concept of harm reduction services along with other health interventions has been
introduced and developed in Iran, as in the rest of the world, initially in response to the spread
118 After the Islamic revolution, considering the revisions made in the public penal law [... and] Islamic rules and punishment verdicts had replaced some forms of former punishments. Such cases could be seen in applying corporal punishments, including lash and capital punishment. In drug related offences the mentioned new forms of punishments are more apparent while the public courts jurisdictions are referred to the revolutionary court. In early 2013 when Iran’s judiciary implemented an amended penal code under which children convicted of “discretionary crimes” such as drug-‐related offenses would no longer be sentenced to death. See Rahmdel, 'International Judicial Criminal Cooperation In Combating Narcotic Drugs Crimes In Iranian Law' (2002) 10 European Journal of Crime, Criminal Law and Criminal Justice. 119 See Amnesty International, 'Addicted To Death Executions For Drugs Offences In Iran' (Amnesty International Publications 2011)45 and Ota Hlinomaz, Scott Sheeran and Catherine Bevilacqua, 'The Death Penalty For Drug Crimes In Iran: Analysis Of Iran’S International Human Rights Obligations' (Iran Unit in the School of Law at the University of Essex 2014). 120 Anti-‐Narcotics Law of 1988 as amended in 1997 and 2011, Art. 15. 121 Rc.majlis.ir, ' -مررکزز پژژووهھھھشهھا ااصالحح قانوونن هھيیااصالح ١۱۵ ماددهه کيی تبصررهه مووضووعع هھھھا رروواانگرردداانن وو مخددرر موواادد بهھ ادديیااعت ببيیآآس کاهھھھشش وو ددررمانن مجازز مررااکزز يییااجرراا نامهھ ننيیيیآآ
مخددرر موواادد با مباررززهه قانوونن ' (2015) <http://rc.majlis.ir/fa/law/show/847667> accessed 29 September 2015. [Unauthorized translation: Research Centre-‐ Regulations for authorized centres, treatment and harm reduction addiction to narcotics and psychotropic substances are mentioned in the Article 15 amendments to the Drug Law Reform].
31
of HIV especially through IDUs (Injection Drug Users). The purpose of initiating such services
should not overshadow the broader idea of harm reduction as a pragmatic, non-‐judgmental set
of strategies to reduce individual and community harm associated with drug use, where
abstinence may or may not be its end goal.122 The whole dominant narrative around harm
reduction services in Iran, seems to follow the narrow and restrictive interpretation of harm
reduction programmes which reduced the whole concept into syringe/needle exchange
programme or methadone treatments.
5.1.2 Iran’s international obligations
Iran is a member of both CRC and ICESCR, therefore it has a responsibility to uphold the
international treaty obligations, as discussed in Chapter 4. Hence, as a State, Iran is responsible
for integrating the core human rights principles rooted into these treaties. International human
rights law establishes a threefold typology of State obligations known as ‘respect, protect and
fulfil’123 which was developed in relation to economic, social and cultural rights. The CESCR
adopted this position and stated that all human rights impose these three types or levels of
obligations on States’124 responsibility to respect, protect and fulfil.
The obligation to respect requires States to refrain from interfering directly or indirectly with
the enjoyment of human rights and is typically characterised as a negative obligation. Not
restricting the access of child drug users to health interventions and harm reduction services
can be recognized as a step towards meeting the State’s obligation to protect the rights of its
children.125 The obligation to protect is usually characterised as a positive obligation as it
122 See Gerald Thomas, Harm Reduction Policies And Programs For Persons Involved In The Criminal Justice System (Canadian Centre on Substance Abuse 2005) and Public Awareness Task Group, Non Prescription Needle Use Initiative, 'Working With People Who Use Drugs: A Harm Reduction Approach' (Canadian Liver Foundation 2007). 123 The idea was originally developed by Henry Shue, who introduced the obligations ‘to avoid depriving’, ‘to protect from deprivation’ and ‘to aid the deprived’: see Basic Rights: Subsistence, Affluence and US Foreign Policy (Princeton University Press 1980) 51-‐2. However, Asbjørn Eide is known as the originator of the tripartite terminology of the obligations to respect, protect and fulfil: see The Right to Food (Final Report) UN Doc E/CN.4/Sub.2/1987/23, 7 July 1987, paras 66–9. The CESCR frequently applies the threefold typology in its General Comments as well. See for example, General Comment No. 12: The Right to Adequate Food (Art. 11)’ (12 May 1999) UN Doc E/C.12/1999/5. 124 Committee on Economic Social and Cultural Rights, General Comment No. 14: The right to the highest attainable standard of health, (UN Doc No E/C.12/2000/4, 2000) para 33. 125 See Damon Barrett and Philip E Veerman, A Commentary On The United Nations Convention On The Rights Of The Child, Article 33 (BRILL 2012) 84.
32
requires the State to take actions by means of adopting legislative and other measures which,
in this context, can be read as integrating the special needs of the population. The obligation to
fulfil under international law requires States to adopt all appropriate measures for the full
realisation of this right;126 developing specifically tailored harm reduction programmes for
youths would be an essential step towards meeting this obligation.
Additionally, the concept of progressive realisation is strictly interrelated and complementary
to the concept of the obligation to fulfil. It represents the expression of an extended effort to
achieve the full realisation of these rights.127 Both CRC and CESCR talked about progressive
realisation by encouraging State parties to promote international co-‐operation with a view to
progressively achieving full realization of the right to the highest attainable standard of health.
One of the former UN Special Rapporteurs on the rights of everyone to the enjoyment of the
highest attainable standards of health raised some key challenges in operationalization of this
obligation by asking:
How is that consistent with your government’s duty to progressively realise the right
to the highest attainable standard of health? Do you listen to people who use drugs
to learn about their views and experiences? [H]uman rights do provide a way of
holding States to account -‐ of making sure that people who use drugs are not
invisible -‐ of exposing stigma, discrimination and other abuse -‐ of asking tough
questions and demanding clear answers -‐ and so I respectfully suggest that you
consider the strategic use of human rights and their procedures.128
[...]articles 38 of the 1961 Convention and 20 of the 1971 Convention require States parties to put in place drug dependence treatment for those in need.328 If this obligation is to have relevance to children, and if their rights are to be respected, protected and fulfilled, it must be read in the light of the CRC. 126 Committee on Economic Social and Cultural Rights, General Comment No. 14: The right to the highest attainable standard of health, (UN Doc No E/C.12/2000/4, 2000) para 33. 127 Committee on Economic Social and Cultural Rights, General Comment No. 3: The nature of States parties' obligations , (UN Doc No E/1991/23, 1991) para 9. 128 Paul Hunt, Human Rights, Health And Harm Reduction. States' Amnesia And Parallel Universes(International Harm Reduction Association 2008) 6 and 7.
33
In a diverse society such as Iran, integration of the essential principles of the right to health129 is
especially essential, as it will help to achieve a higher level of acceptance and ownership by the
community, and programme sustainability.130 The concept of progressive realization, therefore,
has many practical implications for health systems, including (but not limited to) having a
comprehensive national plan and encompassing both the public and private sectors for the
development of its health system. The State has an obligation to generate health research and
development that addresses the needs of its population, such as the health needs of adolescent
drug users, as well as ‘operational research into the social, economic, cultural, political and
policy issues that determine access to medical care and the effectiveness’131 of these health
interventions. Integration of the outcome of these operational research practices in national
policies and plans can maximize the effectiveness of these programmes to address the specific
needs of these youths.
5.2 Protective measures Different health interventions and services have been drafted under Iran's Anti-‐Narcotics Law
such as outpatient, inpatient and residential centres providing a range of services including
various types of detoxification, maintenance treatment, psychosocial interventions, self-‐help
groups and even compulsory treatment. Iran’s harm reduction policies, especially those in
response to IDU and HIV/AIDS infection issues, have often been embraced by other countries in
the region.132 Apart from the recent criticisms against the high rate of executions for drug
related offences,133 Iran is still among those countries in the MENA region that receives a
considerable amount of international aid for its anti-‐drug policies.
129 The right to health has many interconnected essential principles including: Availability of services, which not only includes the availability of health services, but also the underlying determinants of health. Accessibility has four components: non-‐discrimination; physical accessibility; economic accessibility (affordability); and information accessibility. 130 Maysoon Melek, Culture Matters (United Nations Population Fund 2004)v. 131 Paul Hunt, 'Report Of The Special Rapporteur On The Right Of Everyone To The Enjoyment Of The Highest Attainable Standard Of Physical And Mental Health' (UN Human Rights Council, A/HRC/7/11,2008) paras 47 and 95. 132 Afarin Rahimi-‐Movaghar and others, 'Assessment Of Situation And Response Of Drug Use And Its Harms In The Middle East And North Africa' (MENAHRA 2012) 72 and 77. 133 See Saeed Dehghan, 'UN To Fund Iran Anti-‐Drugs Programme Despite Executions Of Offenders' (the Guardian, 2015) <http://www.theguardian.com/world/2015/mar/19/un-‐fund-‐iran-‐anti-‐drugs-‐programme-‐executions-‐unodc-‐death-‐penalty> accessed 29 September 2015; Brophy, 'Ireland Ceased Funding For Iran Anti-‐Drug Programme Over Death Penalty Concerns' (TheJournal.ie, 2015) <http://www.thejournal.ie/ireland-‐iran-‐drugs-‐1166152-‐Nov2013/> accessed 29 September 2015; Iranhr.net, 'Iran Human Rights | Article:
34
However, there is not much information available about the quality, scope and even the
effectiveness of harm reduction programmes in Iran. Most of the information provided in
UNODC annual drug reports is about the anti-‐drug trafficking control policies and programmes,
amounts of drugs and substances seized with too little on harm reduction programmes and
without any reference to health intervention and/or harm reduction for young drug users.
The Farsi sources and news and reports published on different national platforms, especially
those by the Drug Control Headquarters (DCHQ) which is the main decision-‐making body on
drug control in Iran, suggest that some new initiatives are developing to address the drug use of
young people (under 18). What follows is a review of the different potential strategies to
address adolescent drug use by putting them into three groups based on the scope and the
audience of each programme. These protective measures and programmes comprise the
recently introduced packages and services as well as harm reduction programmes.
5.2.1 Prevention There is common agreement on the lack of awareness about the harm associated with drug use
among adolescents.134 This, along with growing concerns about the age of involvement in drug
use,135 had led to the development of educational programmes and advocacy for raising
awareness.
In 2014 during its first session, the Committee for the prevention of social harm and drug use of
the Department of Education talked about launching a school-‐based preventive pilot project.
This initiative planned to include educational and counselling interventions, training for the
Human Rights Groups Urge UN To Cease Anti-‐Drug Trafficking Funding Until Iranian Authorities Renounce Use Of Death Penalty For Drug-‐Related Offences |' (2015) <http://iranhr.net/en/articles/878/> accessed 29 September 2015. 134 For instance, this year on the International Day against Drug Abuse and Illicit Trafficking, it was discussed by high State officials and also some health and human rights issues raised by the UNODC field representatives. Unodc.org, 'Iran Burns 56 Tons Of Illicit Drugs On The International Day Against Drug Abuse And Illicit Trafficking' (2015) <https://www.unodc.org/islamicrepublicofiran/en/iran-‐burns-‐56-‐tons-‐of-‐illicit-‐drugs-‐on-‐the-‐international-‐day-‐against-‐drug-‐abuse-‐and-‐illicit-‐trafficking.html> accessed 29 September 2015. 135 Iran Drug Control Headquarters, conducts a recent survey from women in rehabilitation camps, which indicated that %37.06 of them are between 15-‐20 and also suggested that the most popular drug was Methamphetamine first followed by opium and heroin.
ااستت سالگي 20 ززيیرر معتادد ززنانن ااغلبب ددرر مخددرر موواادد مصررفف شررووعع سنن, 'ااددنا ییخبرر گاههيیپا ' (2015 <http://adna.ir/news/505/%D8%B3%D9%86-‐%D8%B4%D8%B1%D9%88%D8%B9-‐%D9%85%D8%B5%D8%B1%D9%81-‐%D9%85%D9%88%D8%A7%D8%AF-‐%D9%85%D8%AE%D8%AF%D8%B1-‐%D8%AF%D8%B1-‐%D8%A7%D8%BA%D9%84%D8%A8-‐%D8%B2%D9%86%D8%A7%D9%86-‐%D9%85%D8%B9%D8%AA%D8%A7%D8%AF-‐%D8%B2%D9%8A%D8%B1-‐20-‐%D8%B3%D8%A7%D9%84%DA%AF%D9%8A-‐%D8%A7%D8%B3%D8%AA-‐> accessed 24 September 2015. [Unauthorized translation: ADNA News Agency: ‘Age involvement among women drug users is under 20’].
35
educational staff and parents, using different advocacy tools to raise awareness on drug use
and students’ involvement in drug use.136 This project intends to focus on the mainstream
youth who are still at school. As stated earlier, in a country with a schooling population (aged
between 15-‐18) of 59.9% the school-‐based provision programmes fail to reach a large group of
adolescents out of school settings who might be in a more vulnerable situation. Introducing and
developing any programme without prior assessment and evidence-‐based studies to identify
stakeholders, their needs and behaviour, may fail to address their needs and end up not
providing the support those stakeholders require and deserve. The intended outcome will be
essential in drawing and drafting the educational materials, choosing the most effective
advocacy tool for this group of young people and also developing the best way to actively
involve them in this process.
There is an openness among youth to information, if it is factual and does not
contrast too sharply with their personal experience of drugs. Scare tactics used in
some information material do not serve the purpose for which they are intended,
but rather significantly reduce the trust that youth may have in the advice of adults
and in some cases even encourage risky behaviours.137
In 2015 on the International Day against Drug Abuse and Illicit Trafficking, as part of the Drug
Demand Reduction programme, over 70,000 text messages with the 2015 World Drug Day
motto were sent to youths all over Iran.138
136 Medu.ir, ' یغررب جاننيیآآذذرربا ررپووررتالليی/ززشدد بررگززاارر ااستانن پررووررشش وو آآمووززشش للک ااددااررهه یااجتماع ییهھھھا ببيیآآس اازز ییرريیشگيیپ تهھيیکم جلسهھ ننيی/ااوولیغررب جاننيیآآذذرربا ' (2014) <http://www.medu.ir/portal/Home/ShowPage.aspx?Object=NEWS&ID=e11ef86b-‐325f-‐4db5-‐be2a-‐f3b65b491e17&WebPartID=fb361b49-‐2ac0-‐4df0-‐adc6-‐ac8936fb4703&CategoryID=c5e27a08-‐8da3-‐4cfd-‐a884-‐51a10f7bd9ec> accessed 24 September 2015. See<http://iran.unfpa.org/Documents/Census2011/2011%20Census%20Selected%20Results%20-‐%20Eng.pdf> accessed 11 September 2015. [Unauthorized translation: ‘The first meeting of the Committee for the Prevention of social problems and drug abuse Department of Education in the academic year 2014/15’]. 137 UN Commission on Narcotic Drugs, Youth and Drugs: A Global Overview, Report of the Secretariat, UN Doc. No. E/CN.7/1999/8, para. 65(f). 138 On 26th of June 2015, the United Nations Office on Drugs and Crime in collaboration with the Drug Control Headquarters (DCHQ) adopted a more contemporary approach to create awareness for the Word Drug Day (WDD) by sending text messages (SMS) to youth and the focal points of NGOs in the field of Drug Demand Reduction (DDR). Unodc.org, 'Using SMS To Raise Awareness About World Drug Day In The Islamic Republic Of Iran' (2015) <https://www.unodc.org/islamicrepublicofiran/en/using-‐sms-‐to-‐raise-‐awareness-‐about-‐world-‐drug-‐day-‐in-‐the-‐islamic-‐republic-‐of-‐iran.html> accessed 25 September 2015.
36
5.2.2 Treatment Recently public health officials announced a prevention and treatment package for adolescent
drug users which will start in four cities in Iran as a pilot project.139 This package will be more
focused on street children but the first step of identifying these vulnerable individuals is not
covered within the scope of this programme. This package includes empowerment workshops
and drafting health service guidelines for children who use drugs. However, the health package
will not offer shelter and any further medical care and support. This programme will support
these vulnerable children only if they already have a referral from the State Welfare
Organisation which is officially responsible for protecting them.140
In mid 2014, the first rehabilitation camp for adolescents started operating with the capacity
for admitting fifty children in one of the cities in central Iran.141 This health intervention
package may not be able to effectively address the basic needs of street children due to its
narrowed scope of work, and providing a health intervention package to the most vulnerable
group of adolescents will not be effective without structural interventions and a holistic
approach with close collaboration between different institutions. Among other reasons that
necessitate running assessments and studies before setting up such initiatives would be the
opportunity to run comparative studies and learn about other experiences to come up with a
tailored programme for the local context.142
139 شوودد یم ییااندداازز ررااهه نووجوواانانن وو کووددکانن ادديیااعت تررکک یتخصص فووقق کيینيیکل نددههيیآآ ماهه ددوو, 'تا ااددنا ییخبرر گاههيیپا ' (2015) <http://adna.ir/news/222/%D8%AA%D8%A7-‐%D8%AF%D9%88-‐%D9%85%D8%A7%D9%87-‐%D8%A2%DB%8C%D9%86%D8%AF%D9%87-‐%DA%A9%D9%84%DB%8C%D9%86%DB%8C%DA%A9-‐%D9%81%D9%88%D9%82-‐%D8%AA%D8%AE%D8%B5%D8%B5%DB%8C-‐%D8%AA%D8%B1%DA%A9-‐%D8%A7%D8%B9%D8%AA%DB%8C%D8%A7%D8%AF-‐%DA%A9%D9%88%D8%AF%DA%A9%D8%A7%D9%86-‐%D9%88-‐%D9%86%D9%88%D8%AC%D9%88%D8%A7%D9%86%D8%A7%D9%86-‐%D8%B1%D8%A7%D9%87-‐%D8%A7%D9%86%D8%AF%D8%A7%D8%B2%DB%8C-‐%D9%85%DB%8C-‐%D8%B4%D9%88%D8%AF> accessed 24 September 2015. [Unauthorized translation: ADNA New Agency: ‘In the next two months a clinic for children and adolescents drug users will be launched’]. 140 Adthasso.ir, ' الننيیگ ااستانن ادديیااعت ددررمانگرراانن یصنف اانجمنن یررسم تتيیووبسا| کووددکانن ادديیااعت ییبرراا بهھددااشتت ووززااررتت یددررمان بستهھ اتتيیيیجزز ' (2015) <http://adthasso.ir/?p=741> accessed 24 September 2015. [Unauthorized translation: ‘Details of Health Ministry treatment package for children's addiction’]. 141 Javanonline.ir, ' ااررااکک ددرر نووجوواانانن وو ززنانن ژژههيیوو ادديیکمپپ تررکک ااعت ییررااهه ااندداازز ' (2014) <http://javanonline.ir/fa/news/672977/%D8%B1%D8%A7%D9%87-‐%D8%A7%D9%86%D8%AF%D8%A7%D8%B2%DB%8C-‐%DA%A9%D9%85%D9%BE-‐%D8%AA%D8%B1%DA%A9-‐%D8%A7%D8%B9%D8%AA%DB%8C%D8%A7%D8%AF-‐%D9%88%DB%8C%DA%98%D9%87-‐%D8%B2%D9%86%D8%A7%D9%86-‐%D9%88-‐%D9%86%D9%88%D8%AC%D9%88%D8%A7%D9%86%D8%A7%D9%86-‐%D8%AF%D8%B1-‐%D8%A7%D8%B1%D8%A7%DA%A9> accessed 24 September 2015. [Unauthorized translation: ‘Start-‐up Addiction Camp for women and young people in Arak’]. 142 Here is an example of a good practice from Preble Street Youth Services ‘Using a trauma-‐informed approach, it becomes clear to our staff that for many youth, substance abuse and some other risky behaviours can be mechanisms to cope with past trauma, but these behaviours can also create new trauma. At Preble Street Youth Services, we have found that to help break this cycle we first need to get youth in the door. To do that, we offer whatever it is a youth needs at the moment. Usually this is
37
5.2.3 Harm reduction programmes The background history of health interventions for adult drug users was discussed in Chapter 3.
The pragmatic response to the epidemic of HIV in the 1980s is the closest practice to what we
understand from harm reduction programmes these days. Very little is known about the
characteristics, scope and guideline principles of the organisations who are pioneers of harm
reduction programmes in Iran and it is not even clear how they interpret harm reduction. One
of the very first comprehensive situation assessments was conducted in 1998-‐1999 and its
findings are still used as a point of reference.143
Dr. K. Alaie,144 a prominent figure in the harm reduction programmes for people living with
HIV/AIDS in Iran, referred to the socio-‐political environment of Iran in the late 1990s as a key
factor in the more tolerant and open policies towards health and harm reduction approaches in
dealing with PLWHA. It was in 1997 when a reformist government came into power that led to
the creation of openness in social spaces and a supportive atmosphere for community-‐based
initiatives.145 At the same time, several other NGOs ran community based initiatives with a
harm reduction approach more focused to address the needs of injection drug users. Their
work was encouraged and gained attention from international organisations and media.146
There is no doubt about their valuable contribution to promoting health awareness approaches
food, but it can also be clothing or a bed. Once we get them in the door, they end up using more services than they initially said they were interested in, and the more services they use the better chance they have of having a positive outcome.’ See Usich.gov, 'Harm Reduction: Advice From Leaders In The Field | Harm Reduction For Youth | Youth | Population' (2015) <http://usich.gov/population/youth/harm_reduction_for_youth/harm_reduction_advice_from_leaders_in_the_field/#what> accessed 29 September 2015. 143 See for the initial RSA: Emran M. Razzaghi, 'RAPID SITUATION ASSESSMENT (RSA) OF DRUG ABUSE IN IRAN' (MINISTRY OF HEALTH, IR OF IRAN and UN INTERNATIONAL DRUG CONTROL PROGRAM 1999) and Emran M Razzaghi and others, 'Profiles Of Risk: A Qualitative Study Of Injecting Drug Users In Tehran, Iran' (2006) 3 Harm Reduction Journal. 144 He is an expert on HIV/AIDS, drug policy and International Health and Human Rights. He and his brother Arash co-‐founded the first "Triangular Clinic" for three target groups in Iran, Drug users, People Living with HIV/AIDS (PLWHA) patients, and Sexually Transmitted Diseases (STD), in 2000. This initiative documented by the World Health Organization as a "Best Practice Model" for HIV/AIDS and injecting drug users prevention and care. The Triangular Clinic was welcomed and documented by WHO for incorporating some of the key elements of best practice in HIV prevention and care with injecting drug abusers into its approach. These include advocacy to create a public health policy environment that promotes HIV prevention with drug abusing populations, the integration of services and adopting a “patient-‐centric” approach. M. Suresh Kumar, 'Best Practice In HIV/AIDS Prevention And Care For Injecting Drug Abusers The Triangular Clinic In Kermanshah, Islamic Republic Of Iran' (WHO EMRO 2004). 145 Dr K. Alaie, as part of his contribution to this work as an informant gave an interview to the author speaking about his experience as a dominant member of a harm reduction clinic and also co-‐founder of "Triangular Clinic". 146 For instance see: News.bbc.co.uk, 'BBC NEWS | Middle East | Tackling Iran's Growing Drugs Problem' (2015) <http://news.bbc.co.uk/1/hi/world/middle_east/4054703.stm> accessed 30 September 2015 and Jonathan Miller, 'Iran And Heroin: A Lesson For The West?' (Channel 4 News, 2006) <http://www.channel4.com/news/iran-‐and-‐heroin-‐a-‐lesson-‐for-‐the-‐west> accessed 30 September 2015.
38
towards drug use and introducing other strategies to deal with drug related issues rather than
just an abstinence approach.147
Harm reduction programmes in a broader and more inclusive form can learn a lot from all the
grass roots and community based initiatives surrounding HIV/AIDS, including advocacy work,
family support plans, engaging religious and community leaders and the affected
stakeholders.148 However, after almost two decades of having these programmes, developing
and expanding the scope and coverage of the services is necessary. This is not only about the
State obligation of progressive realisation, it is also a vital need within society.149 Setting up and
developing harm reduction services for adolescents can be a significant and necessary step
towards fulfilling this obligation and responding to an immediate need. However, this cannot be
achieved without setting up a situation assessment at a national level to identify the
stakeholders and assess their levels of vulnerability, human rights risks and the harm that may
be involved. Vulnerability is not a unified characteristic as numerous factors make young people
vulnerable. These factors and the interaction between them form different levels and degrees
of vulnerability.150 Hence any harm reduction programme or health intervention for youth has
to be able to address this by conducting at least a rapid situation assessment and national
study.151
147 Perspolis is one of the examples of successful practices of needle exchange and Methadone Maintenance Treatment programmes(MMT), but they had no specific provisions even for having women, neither for under 18 drug users and they only cover some areas in Tehran. More interviews cited in this source: Amir Arsalan Afkhami, 'From Punishment to Harm Reduction: Resecularization of Addiction in Contemporary Iran', Contemporary Iran (1st edn, Oxford University Press 2009) 189. 148 To read more see: Vinh-‐Kim Nguyen and Jennifer Klot, The Fourth Wave ([United Nations educational, scientific and cultural organization (UNESCO) Division for gender equality, Bureau of strategic planning [etc] 2008)329 and Suad Joseph and Afsaneh Najmabadi, Encyclopedia Of Women & Islamic Cultures (Brill 2005)155. 149 Head of Rebirth Society, a leading NGO in running different harm reduction approach programmes, showed his deep concerns about drug epidemic among students, which was reflected in the outcome of a survey done during 2012-‐2013 academic year. He criticized lack of data and study on the children's drug use trends and also existing legal restrictions, which deny the access of children drug users to harm reduction and health services. He specifically raised the age restriction and also parent’s consent as legal restriction on the children’s access to those services. See: Sara.jamejamonline.ir, ' جمم سرراا | نووجوواانانن معتادد کمپپ تررکک ااعتيیادد نددااررندد جامم ' (2013) <http://sara.jamejamonline.ir/NewsPreview/1646506383394689270> accessed 24 September 2015. [Unauthorized translation: ‘No Addiction Camps for Teens’]. 150 See more on layers approach: Florencia Luna, 'Elucidating The Concept Of Vulnerability: Layers Not Labels' (2009) 2 International Journal of Feminist Approaches to Bioethics. 151 For instance, in a context that study shows: “[...] in recent years, a sudden rise in stimulant use has occurred and has been associated with new mental health problems, such as stimulant psychosis”, almost every existing harm reduction programmes are focused on opioids. Afarin Rahimi-‐Movaghar and others, 'Assessment Of Situation And Response Of Drug Use And Its Harms In The Middle East And North Africa' (MENAHRA 2012)29.
39
5.3 Role of international organisations UNODC as a main international body ‘in the fight against illicit drugs’152 has the most powerful
and influential presence amongst other UN organs that have a representative office in Tehran.
UNODC introduced the focus of its latest programme by stating:
Facilitating dialogue and exchange at the bilateral, regional and international level,
along with the promotion of international conventions, standards and best practices
are the objectives of the UNODC integrated programme of technical cooperation on
drugs and crime in the Islamic Republic of Iran.153
Although there is traceable evidence of shifting the language and approach of UNODC into a
more health and human rights approach,154 the success indicators are still focused on the
amount of drugs and substances seized and other indicators relevant to controls on drug
trafficking and policing. Integrating health indicators155 makes the health and human rights
approach to drug use more meaningful and effective. The integration of health indicators as
success indicators can be seen as a powerful means to promoting human rights principles and
in achieving the goals of promoting a public health prevention approach and protecting
individuals, families and communities from drug addiction and HIV which are the themes of
Iran’s UNODC Sub-‐Programme 2.156
Targeting vulnerable groups in collaboration with other international organizations as well as
local NGOs is also defined under the goals of this Sub-‐Programme, which can be seen as the 152 Unodc.org, 'About UNODC' (2015) <https://www.unodc.org/unodc/en/about-‐unodc/index.html?ref=menutop> accessed 30 September 2015. 153 Unodc.org, 'International-‐Regional Cooperation' (2015) <https://www.unodc.org/islamicrepublicofiran/en/international-‐regional-‐cooperation.html> accessed 30 September 2015. 154 See The United Nations Office on Drugs and Crime (UNODC); Leik Boonwaat, UNODC Representative to the IR of Iran: ‘It is important to understand that drug use is a social and health condition that requires sustained prevention, treatment and care. Access to evidence based prevention and treatment can be the difference between life and death.’ 'World Drug Report 2015' (UNODC 2015) and Unodc.org, 'Iran Burns 56 Tons Of Illicit Drugs On The International Day Against Drug Abuse And Illicit Trafficking' (2015) <https://www.unodc.org/islamicrepublicofiran/en/iran-‐burns-‐56-‐tons-‐of-‐illicit-‐drugs-‐on-‐the-‐international-‐day-‐against-‐drug-‐abuse-‐and-‐illicit-‐trafficking.html> accessed 30 September 2015. 155 Paul Hunt, 'Report Of The Special Rapporteur On The Right Of Everyone To The Enjoyment Of The Highest Attainable Standard Of Physical And Mental Health,' (UN Economic and Social Council 2006) para 66. 156 Unodc.org, 'Country Programme-‐Sub-‐Prog2' (2015) <http://www.unodc.org/islamicrepublicofiran/en/country-‐programme-‐sub-‐prog2.html> accessed 30 September 2015.
40
best opportunity to encourage and support adolescent harm reduction programmes. Local
capacity building and facilitating regional and international cooperation to conduct a
comprehensive and scientific-‐based study on the situation of young drug users would be an
effective intervention. The outcome of that study can create an opportunity for member States
who cut off their support aid in objection to the death penalty for drug related offences in Iran
to reshape their policies, such as targeted and evidence-‐based funding for harm reduction
programmes rather than a blanket ban.
41
Chapter 6. Conclusion and recommendations After reviewing an overview of drug policy in both international and national level and also the
human rights and health approach towards young drug users in practice, it is believed that it is
vital to give visibility to this vulnerable group of people. The population that always named as
“asset” to each society. Giving the adolescent drug users visibility, provide them with the care
and support based on their special needs and allows them enough control to make their own
positive decisions by offering a support system is essential to protect their rights from being
abused.157
It is also necessary to emphasise that principles of harm reduction believes in providing a range
of different approaches and maximizing interventions options and also there is not only one
intervention option that works for everyone. It is choice and prompt access to a broad range of
interventions that help to keep people alive and safe, and promote health.158To conclude what
was discussed so far in this paper, the following recommendations aimed at achieving a
comprehensive, specific and effective response to adolescent drug users’ needs.
6.1 Situation assessment and data collection Before starting any initiative or change in policy dealing with involvement of youth in drug use
it is vital to set up comprehensive data collection and situation assessment programmes and
also scientific and evidence-‐based research. Without having a clear understanding of the scope
and drug use trends, age involvement, the way that young people getting involvement in drug
use and the layer of vulnerability within them, any effective response cannot be made.
This paper recommends that:
1-‐ The methodology should be carefully chosen in order to outreach different group of
vulnerable young people, not the only ones who are in school setting, all over the country, not
only couple of big cities.
157Paul Hunt, Human Rights, Health And Harm Reduction. States' Amnesia And Parallel Universes(International Harm Reduction Association 2008)4. 158Public Awareness Task Group, Non Prescription Needle Use Initiative, 'Working With People Who Use Drugs: A Harm Reduction Approach' (Canadian Liver Foundation 2007).
42
It is also necessary to make sure that the outcome and situation analysis of these studies
shared and discussed with public respecting transparency and make the findings publically
available and accessible.
2-‐ Special mechanism should be applied to make sure that the staffs that are part of the
programme have got relevant trainings and ready to work with vulnerable group of people. The
whole programmes should be vulnerable oriented.
3-‐ During the whole process, integration of the principles of CRC, especially principle of non-‐
discrimination should be among top priorities. Identifying the roots of discrimination would be
necessary for integration of those principles159, which was ignored so far in current health
provisions for young people.
4-‐ To maximize the outreach, the participatory approach is needed such as involving families,
communities, the youth itself, community and religious leaders.
5-‐ Multi-‐dimensional collaboration is needed to operationalize this mandate in a national level.
UN organizations, especially UNODC, should play an active role not only by encouraging the
state officials but also by providing them with technical support, including training workshops
for the staff, providing resources and facilitate involvement of the independent local observers.
The local NGOs with their network among different communities of vulnerable people should
be invited and got involved in the whole process from the early decision making process to the
implementation and also application of the outcome.
CRC also should provide Iran with specific, time-‐bound and detailed recommendations on
setting up a scientific-‐based and comprehensive data collection and situation assessment at
national level. It is vital for community based organization and NGOs to follow up
implementation and intergradation of the Committee’s recommendation.160
Conducting comprehensive and scientific-‐based data collection and situation assessment
cannot effectively applicable without active participation of different stakeholders. 159
Iran is a diverse country with different ethnic and religious minority groups, where minority rights where mostly ignored in policymaking process. There is also a documented evidence of child marriage and forced marriage among girls under 13 which is hardly ever seen as another layers of vulnerability and a considerable potential of further discrimination against young girls. See Girls Brides, 'Iran - Child Marriage Around The World. Girls Not Brides' (Girls Not Brides, 2015) <http://www.girlsnotbrides.org/child-marriage/iran/> accessed 8 October 2015. 160None of the concerns raised by the CRC Committee within its recommendations to Iran in 2005 -CRC/C/15/Add.254, paras 58,66 and 67- did not appear whiting the List of issues related to the coming periodic reports of Iran in 2016. See Committee on the Rights of the Child CRC/C/IRN/Q/3-4.
43
6.2 Comprehensive coverage The coverage of existing harm reduction programmes urgently needs to be reformed. It is vital
to address the special needs of adolescents drug users among other vulnerable people and
provide them with specific supportive health and rights approach interventions. Critically
evaluating the effectiveness of dominant and established harm reduction programmes will help
to identify the areas where either missed or ignored and create an environment to fill the
unaddressed gaps.
This paper recommends that:
1-‐ The outcomes and findings of the situation assessment and evidence and scientific based
data collection should be integrated in forming any policies for harm reduction programmes for
youth.
2-‐ One of the priority of critical evaluation process is to make sure that there is a clear
understanding of main principles of harm reduction. This also includes reviewing how the
existing harm reduction programmes define their goals and objectives and whether they are
compatible with the core idea of harm reduction. Identifying these areas will open a space for
integrating more evidence and scientific-‐based approaches, especially for young drug users.
3-‐ Establishing and introducing specific harm reduction programme to address the needs of this
group of vulnerable people should become a first priority in national policy level. For Iran, this is
an essential step towards fulfilling progressive realisation of right to health of children.
Local NGOs and international community should play an active role to encourage and support
this priority. This will not happen before this becoming a top priority in the national agenda of
policy makers and officials.
4-‐ Introducing specific interventions for youth need raising awareness at the national level, as
the idea of harm reduction for under 18s may raise concerns that should be addressed.
Innovative and engaging approach towards raising public awareness is needed. UNODC should
44
play a more active role in this area as part of its programmes in Iran161, such as (not limited to)
introducing other good practices of harm reduction programmes elsewhere in the world,
establishing mobile awareness campaigns around the country engaging different local
communities to broaden the outreach of these awareness programmes.
5-‐ In setting up tailored programmes for youth, the approach should be skills-‐based interactive
and participatory. Reviewing effective practices in the context of young PLWHA could be
beneficial.162
6.3 Mobilize regional network
Despite the drug policy development happening in MENA region in recent years, there are still
so many issues remained unaddressed, especially when it comes to harm reduction programme
and tailored programmes for youth. It is vital to mobilize the regional resources and network
for a collaborative action to address a considerable gap between essential needs and available
interventions. Using the existing network on injecting drugs harm reduction in the region163, is a
great potential for collaborative actions. It is vital for international donors and human rights
community who are focusing on drug policy to effectively develop and encourage these
regional potentials.
This paper recommends that:
1-‐ Call for a regional study on social, economic and legal barriers who restrict access of young
drug users should be set up. This will not happen without an international support and
meaningful collaboration from the technical support, lobbying, advocacy work at different
levels and granting fund. The UN General Assembly Special Session on Drugs (UNGASS) 2016
161Drafting text-based leaflets without any interaction, which are not even accessible online and downloadable through UNODC website and circulating “don’t use” SMSs may not be considered as the most effective advocacy tools. See Unodc.org, 'Documents-Training-Pac' (2015) <https://www.unodc.org/islamicrepublicofiran/en/documents-training-pac.html> accessed 7 October 2015. 162World Health Organization (WHO), 'Consolidated Guidelines On HIV Prevention, Diagnosis, Treatment And Care For Key Populations' (WHO 2014). 163Menahra.org, 'Menahra, Harm Reduction,Needles, Syringes, Drug User, STI, Advocacy' (2015) <http://www.menahra.org/en/> accessed 7 October 2015.
45
can be a unique opportunity to discuss serious lack of data and evidence-‐based study on youth
and their involvement in drug use, especially in MENA region.
2-‐Iran should play a more active role in the region, benefiting its long history of running health
interventions for PLWHA, through sharing experiences and skills. In this process involvement of
the local and community-‐based organisations should be facilitated, this includes providing easy
and free access to events, resources and campaign materials. Active participation of young
people itself, their families and communities who may affect by associated harms with drug use
should be ensured.
3-‐ Allocate regional funds to small community based organisations and independent NGOs in
the MENA region for developing regional, bilateral and multilateral studies such as (but not
limited to) research project, data collection, situation assessment and evaluation and
observation mechanisms. Transparency and participatory approach are the essential element in
this process.
46
Bibliography: Books: Alen A and Kamchedzera G, A Commentary On The United Nations Convention On The Rights Of The Child (Nijhoff 2012) Barrett D and Novak M, 'The United Nations And Drug Policy: Towards A Human Rights-‐ Based Approach', The Diversity of International Law: Essays in Honour of Professor Kalliopi K. Koufa (1st edn, Brill | Nijhoff 2009) Barrett D and Veerman P, Article 33: Protection from Narcotic Drugs and Psychotropic Substances(Martinus Nijhoff Publishers 2012) Barrett D, Children Of The Drug War (International Debate Education Association 2011) Berridge V, Opium And The People (Free Association Books 1999) Bewley-‐Taylor D, The United States And International Drug Control, 1909-‐1997 (Pinter 1999) Bewley-‐Taylor D, International Drug Control (Cambridge University Press 2012) Bruun K, Pan L and Rexed I, The Gentlemen's Club (University of Chicago Press 1975) Cook C and Kanaef N, The Global State Of Harm Reduction 2008 (International Harm Reduction Association 2008) Coomber R and South N(Eds), Drug Use And Cultural Contexts 'Beyond The West': Tradition, Change And Post-‐Colonialism (Free Association Books 2004) Gheissari A, Contemporary Iran (Oxford University Press 2009) Hoekstra M and others, Young People & Injecting Drug Use (Euroasian Harm Reduction Network 2009) Hunt P, Human Rights, Health And Harm Reduction. States' Amnesia And Parallel Universes(International Harm Reduction Association 2008) Institute of Medicine, Preventing HIV Infection Among Injecting Drug Users In High Risk Countries (The National Academies Press 2006) MacDonald R and Marsh J, Disconnected Youth? (Palgrave Macmillan 2005) McAllister W, Drug Diplomacy In The Twentieth Century: An International History (Routledge 2000) South N(Ed), Drugs: Cultures, Controls And Everyday Life (SAGE Publications 1999) Petersen A and Lupton D, The New Public Health (SAGE Publications 1996) Poulin C, Harm Reduction Policies And Programs For Youth (Canadian Centre on Substance Abuse 2006) Sinha J, The History And Development Of The Leading International Drug Control Conventions(Library of Parliament, Canada 2001) Szirom T, King D and Desmond K, Barriers To Service Provision For Young People With Presenting Substance Misuse And Mental Health Problems (Successworks 2004) Thomas G, Harm Reduction Policies And Programs For Persons Involved In The Criminal Justice System (Canadian Centre on Substance Abuse 2005) Tuljapurkar S, Pool D and Rūpfōlō W, Population, Resources And Development(Springer 2005)
47
Articles, reports and other publications: Abbasi-‐Shavazi M and others, 'Demographic And Socio-‐Economic Status Of Youth In I.R. Iran' (UNODP/ UOT / Static Tical Research and Training Centre 2013) Amnesty International, 'Addicted To Death Executions For Drugs Offences In Iran' (Amnesty International Publications 2011) Amnesty International, 'Death Sentences And Executions In 2014' (Amnesty International 2015) Azarkhsh H, 'The Nature And Extent Of Drug Abuse In Iran' (CENTO Seminar on Public Health and Medical Problems Involved in Narcotics Drug Addiction, Tehran: Central Treaty Organization, 1972) Barrett D and others, 'Harm Reduction And Human Rights The Global Response To Drug-‐Related HIV Epidemics' (International Harm Reduction Association 2009) Barrett D and others, 'Recalibrating The Regime: The Need For A Human Rights Based Approach To International Drug Policy' (The Beckley Foundation Drug Policy Programme, 2008) Barrett D, '‘Unique In International Relations’? A Comparison Of The International Narcotics Control Board And The UN Human Rights Treaty Bodies' (International Harm Reduction Association 2008) Barrett D, 'The Impacts Of Drug Policies On Children And Young People' (Open Society Foundation 2015) Beyrer C and others, 'Time To Act: A Call For Comprehensive Responses To HIV In People Who Use Drugs' (2010) 376 The Lancet Bozicevic I, Riedner G and Calleja J, 'HIV Surveillance In MENA: Recent Developments And Results' (2013) 89 Sexually Transmitted Infections Calabrese J, 'Iran's War On Drugs: Holding The Line?' (Middle East Institute (MEI) 2007) Conner B, '“First, Do No Harm”: Legal Guidelines For Health Programmes Affecting Adolescents Aged 10–17 Who Sell Sex Or Inject Drugs' (2015) 18 Journal of the International AIDS Society Cook C (Ed), 'The Global State Of Harm Reduction 2010 Key Issues For Broadening The Response' (International Harm Reduction Association 2010) Dowdney L, 'Children Of The Drug Trade. A Case Study Of Children In Organised Armed Violence In Rio De Janeiro' (Luke Dowdney 2003) <http://www.scslat.org, www.vivario.org.br> accessed 11 September 2015 Human Rights Watch and the International Harm Reduction Association, 'International Support For Harm Reduction An Overview Of Multi-‐Lateral Endorsement Of Harm Reduction Policy And Practice' (HRW and IHRA 2009) Human Rights Watch, 'World Report 2013' (2014) Jürgens R and others, 'People Who Use Drugs, HIV, And Human Rights' (2010) 376 The Lancet Karabanow J and others, 'Can You Be Healthy On The Street? Exploring The Health Experiences Of Halifax Street Youth' (2007) 16 Canadian Journal of Urban Research LaMarre A, 'Youth Harm Reduction Programs In Ontario' (The Research Shop 2012) Luna F, 'Elucidating The Concept Of Vulnerability: Layers Not Labels' (2009) 2 International Journal of Feminist Approaches to Bioethics Mahmud I, Ahsan K and Claeson M, 'Glue Sniffing And Other Risky Practices Among Street Children In Urban Bangladesh' (World Bank 2011) Martin F and Parry Williams J, 'The Right Not To Lose Hope: Children In Conflict With The Law – A Policy Analysis And Examples Of Good Practice' (Save the Children International 2005)
48
Measham F and Shiner M, 'The Legacy Of ‘Normalisation’: The Role Of Classical And Contemporary Criminological Theory In Understanding Young People's Drug Use' (2009) 20 International Journal of Drug Policy Melek M, Culture Matters (United Nations Population Fund 2004) Merkinaite S, Grund J and Frimpong A, 'Young People And Drugs: Next Generation Of Harm Reduction' (2010) 21 International Journal of Drug Policy National Institute on Drug Abuse, 'Principles Of Drug Abuse Treatment For Criminal Justice Populations -‐ A Research-‐Based Guide' (National Institutes of Health(NIH) and US Department of Health and Human Services 2009) Nissaramanesh B, Trace M and Roberts M, 'The Rise Of Harm Reduction In The Islamic Republic Of Iran' (The Beckley Foundation 2005) 'Policy Forum: The Cannabis Potency Question' (2007) 7 Drugs and Alcohol Today Poulin C, 'Harm Reduction Policies And Programs For Youth' (Canadian Centre on Substance Abuse (CCSA) 2006) Public Awareness Task Group, Non Prescription Needle Use Initiative, 'Working With People Who Use Drugs: A Harm Reduction Approach' (Canadian Liver Foundation 2007) Rahimi-‐Movaghar A and others, 'Assessment Of Situation And Response Of Drug Use And Its Harms In The Middle East And North Africa' (MENAHRA 2012) Rahimi-‐Movaghar A and others, 'HIV, Hepatitis C Virus, And Hepatitis B Virus Co-‐Infections Among Injecting Drug Users In Tehran, Iran' (2010) 14 International Journal of Infectious Diseases Rahmdel, 'International Judicial Criminal Cooperation In Combating Narcotic Drugs Crimes In Iranian Law' (2002) 10 European Journal of Crime, Criminal Law and Criminal Justice Regavim R, 'THE MOST SOVEREIGN OF MASTERS: THE HISTORY OF OPIUM IN MODERN IRAN, 1850-‐1955' (PhD, University of Pennsylvania 2012) Rhodes T, 'The ‘Risk Environment’: A Framework For Understanding And Reducing Drug-‐Related Harm' (2002) 13 International Journal of Drug Policy Rhodes T and Hedrich D (Eds), 'Harm Reduction: Evidence, Impacts And Challenges' (European Monitoring Centre for Drugs and Drug Addiction 2010) Roberts A and others, 'Review Of Drug And Alcohol Treatments In Prison And Community Settings' (The University of Manchester 2007) Room R (Ed), 'Roadmaps To Reforming The UN Drug Conventions' (A Beckley Foundation 2012) S. Obot I and Saxena S (Eds), 'Substance Use Among Young People In Urban Environments' (WHO 2005) Schujer M, 'The Impact Of Drug Policy On Human Rights: The Experience In The Americas' (Center for Legal and Social Studies 2015) Souleymanov R and Allman D, 'Articulating Connections Between The Harm-‐Reduction Paradigm And The Marginalisation Of People Who Use Illicit Drugs' [2015] British Journal of Social Work Spooner C, 'Structural Determinants Of Drug Use—A Plea For Broadening Our Thinking' (2005) 24 Drug and Alcohol Review Stevens A, 'The Ethics And Effectiveness Of Coerced Treatment Of People Who Use Drugs' (2012) 2 Human Rights and Drugs Stoicescu C (Ed), 'The Global State Of Harm Reduction 2012 Towards An Integrated Response' (Harm Reduction International 2012)
49
STOPAIDS, 'FACTSHEET Harm Reduction' (STOPAIDS 2014) The Global State Of Harm Reduction 2014' (Harm Reduction International 2014) United Nations Educational, Scientific and Cultural Organization (UNESCO), the United Nations Population Fund (UNFPA), the Joint United Nations Programme on HIV/AIDS (UNAIDS), the United Nations Development Programme (UNDP) and Youth Lead, the Asia-‐Pacific Network of Young Key Affected Population, 'Young People And The Law In Asia And The Pacific: A Review Of Laws And Policies Affecting Young People’S Access To Sexual And Reproductive Health And HIV Services' (UNESCO 2013) United Nations Office on Drugs and Crime (UNODC), 'World Drug Report 2010' (United Nations Publication 2010) United Nations Office on Drugs and Crime (UNODC), 'World Drug Report 2015' (UNODC 2015) Watt G and others, 'SERVICE EVALUATION OF SCOTLAND’S NATIONAL TAKE-‐HOME NALOXONE PROGRAMME' (Scottish Government Social Research 2014) World Health Organisation (WHO), 'Consolidated Guidelines On HIV Prevention, Diagnosis, Treatment And Care For Key Populations' (WHO 2014) World Health Organisation, 'Making Health Services Adolescent Friendly: Developing National Quality Standards For Adolescent Friendly Health Services' (WHO 2012) 'WHO, UNODC, UNAIDS Technical Guide For Countries To Set Targets For Universal Access To HIV Prevention, Treatment And Care For Injecting Drug Users' (WHO 2012) World Health Organisation, 'Quality Assessment Guidebook. A Guide To Assessing Health Services For Adolescent Clients' (WHO 2009) World Health Organization, 'Adolescent-‐Friendly Health Services: An Agenda For Change' (WHO 2003) Zakariaie M, Mozaffar H and Sabeti M, 'Cultural Anomie And Drug Addiction Among 13-‐18 Young Tehranis' (2010) 3 Journal of social sciences
