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Where drug policy disproportionately emphasizes preventing diversion and non-medical use of controlled substances over ensuring their availability and access for medical and research purposes, it risks violating the right to health. The Committee on Economic, Social and Cultural Rights CESCR , for example, considers access to essential medicines, as defined by WHO, to be a core obligation within the right to health, meaning that access should be immediately prioritized by all state parties and not just added along the way toward progressive realization.

Further, CESCR has clarified that the right includes both freedoms and entitlements, as well as immediate and progressive obligations to ensure healthcare facilities, goods and services are available, accessible, acceptable and of sufficient quality. The global state of access to controlled medicines for pain relief illustrates the detrimental impact restrictive drug controls have on realizing the right to health. The INCB estimates that 5. Indeed, when we consider the effects of the drug conventions on the right to health, we see an incursion of the restrictive control and criminal justice mindset into the medical realm.

The result is the de facto criminalization not only of controlled substances and those who use them, regardless of their licit use or status, but also of those who prescribe them.

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De jure and de facto criminalization weigh heavily upon the work of health professionals. In many jurisdictions, health professionals face disproportionate penalties for errors in the handling or prescribing of controlled medicines; are burdened by onerous security-related storage requirements; and are often subject to law enforcement oversight beyond what is prescribed in law or regulation.

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The negative impact of de facto criminalization reaches beyond health professionals: In the case of people who seek treatment for opioid dependence, the deforming influence of criminalization means that patients in need—like the controlled substance itself —become something to be contained and controlled.

Many countries require patients to attend a clinic on a daily basis for their dose of methadone, rather than making take-home doses available as is the case for most medicines. And, while a number of treatment options for opiate overdose or dependency exist such as medicines that block intoxication like buprenorphine and medium-term control options such as injectable extended-release naltrexone , treatment choices are often guided by overly punitive and restrictive policies and provider prejudice rather than medical need.

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The overemphasis on regulating controlled medicines and patients who need them extends beyond those seeking drug dependence treatment. Use of morphine and other opioids for pain relief, for example, is heavily stigmatized in Armenia, Kenya, and many other low- and middle-income countries.

These medicines are mythologized for their capacity to cause dependence. The implication is that a patient becomes criminal should dependence occur, though technically, a patient only becomes a criminal when denied a legal source of controlled substances. Rigid laws also mean that overbearing efforts are made to prevent the diversion of controlled medicines to illicit markets, even when there is a lack of evidence about diversion or the development of dependence in those to whom these medicines are prescribed.

How Drug Control Policy and Practice Undermine Access to Controlled Medicines

A systematic review demonstrates that, among patients with no history of substance misuse who were treated with opioid analgesics, only 0. Indeed, such measures undermine the right to health, not only by impeding access to essential controlled medicines, but because they fly in the face of the notion of health as a fundamental constituent of human dignity. The following case studies further highlight the de facto criminalization of patients and healthcare professionals, in violation of the right to health. Oral morphine is not available, and outpatient out of hospital access to injectable opioids is available in limited doses to cancer patients only as prescribed by an oncologist.

In flagrant violation of patient confidentiality, oncologists reported being required to provide written monthly reports to the police disclosing details of patients who receive opioid pain relief, including their names, addresses, and ID numbers. While steps to reform oncologist reporting practices were initiated in , the de facto criminalization of patients, caregivers, and health professionals continues via excessive regulatory requirements.

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For example, oncologist prescriptions must be approved by a standing commission of multiple doctors and bear four different stamps of authorization. Patients or their caregivers are also required to return the empty ampules before a new prescription is issued. These barriers unnecessarily limit access to medicines for pain relief, in violation of both the right to health and the prohibition of cruel, inhuman, or degrading treatment. The overreach of restrictive control into the realm of health also plays out at the international level.

Cannabis and cannabinoids are examples. In a later report, the WHO Expert Committee concluded that dronabinol was useful for the treatment of chronic pain, multiple sclerosis, neuropathic disorders, arthritis, and AIDS-associated anorexia, and that other medical uses were likely to be found. Hence, overly restrictive drug control can impede research into the medical benefits of controlled substances, thus infringing also on the right to science, as discussed below.

Fortunately, in the WHO Expert Committee outlined its intention to conduct a pre-review within the following 18 months on whether or not to consider re-scheduling cannabis under the conventions, a move which could influence domestic legal regimes. Since , the United States has seen a nearly fourfold increase in opioid overdose deaths, in which both drug control policy and a confluence of other factors have played a part. In at least some parts of the country, it seems that periods of increased legitimate prescription of opioids for pain relief, perhaps with inadequate monitoring of these prescriptions, led to crackdowns on prescription opioids, which in turn led to the wider use of heroin and other street opioids, of which the purity and toxicity are unknown.

Overly restrictive drug control policy may promote overdose deaths in several ways. Various human rights bodies have interpreted a requirement to ensure access to medication-assisted treatment under the right to health.

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In Russia, as mentioned above, methadone and buprenorphine for treatment of addiction are illegal: The ban on these medicines is a clear violation of the right to health, and equating education about the medicines with propaganda further violates the right to information. The right to health and the right to enjoy the benefits of scientific progress are interrelated and interdependent. Under ICESCR, the right is supplemented by a negative obligation under Article 15 3 , which provides that states must respect the freedom indispensable for scientific research.

This has been interpreted to mean the state is obliged not to interfere with choices and priorities decided by scientists and not to impose a certain topic or method of research on the academic community. In terms of access: In terms of freedom of inquiry: In the context of drug policy, the incursion of criminalization and overly restrictive control into research restricts the scope and implementation of scientific inquiry.

This frequently occurs via heavy administrative and bureaucratic regulation of controlled substances under the auspices of anti-diversion measures, which effectively impede freedom of inquiry. Furthermore, de facto criminalization engenders bias and tends to politicize issues related to controlled substances.

China's Drug Problem Is Growing (1995)

This impacts judgment and decision-making from scientific review to funding. For example, Article 4 of ICESCR provides that rights in that covenant can only be restricted in a manner that is according to law, consistent with the nature of the right, pursuant to a legitimate aim such as the protection of public health , and strictly necessary for the promotion of general welfare in a democratic society. The following case studies highlight the de facto criminalization of patients and researchers, in violation of the right to enjoy the benefits of scientific progress.

In the UK, researchers require a special license in order to hold Schedule 1 controlled substances those subject to the most stringent level of control. Obtaining such a license may take up to one year, cost GBP plus an additional GBP for security equipment and police checks , and furthermore may require additional import licenses, since most suppliers of controlled substances are located outside the UK.

Bibliography Includes bibliographical references p. Contents Preface-- The consumption and control of illegal substances-- Social conditions and opium in Imperial China before Drug law and its context in the Republic sra-- Narcotics control in the People's Republic of China-- Theoretical explanations of the drug laws-- Conclusions-- Appendices-- Selected Bibliography-- Glossary-- Index. Nielsen Book Data Publisher's Summary In the context of global efforts to control the production, distribution, and use of narcotic drugs, China's treatment of the problem provides an important means of understanding the social, political, and economic limits of national and international policies to regulate drug practices.

In the nineteenth and early twentieth centuries, China was known for its national addiction to opium, but its drug-eradication campaigns from the s to the s achieved unprecedented success that ultimately transformed China into a 'drug-free' society. Since the economic reforms and open-door policy of the late twentieth century, however, China is now facing a re-emergence of the production, use, and trafficking of narcotic drugs.