Commissioner Grover: “Removing the drug-use stigma”

Read original article in Myanmar Times


People who use drugs or possess small quantities for personal use engage in a non-violent act that potentially harms only them. Yet out of fear and a limited understanding of the complex nature of drug use and dependence, Myanmar has for many years taken a punitive approach to drug control, subjecting those who use drugs to long prison sentences, compulsory registration and mandatory treatment. Farmers who earn a living by growing opium poppies are also given harsh penalties, while major traffickers remain largely unaffected.

Narcotics Act reform 

In recent years, however, the authorities in Myanmar have made laudable efforts to review their approach, and address drug use as a health concern, in particular as part of the response to HIV viral hepatitis, and other blood-borne diseases.

A draft bill of the proposed revision, adopted in the Upper House of Parliament this summer, included the removal of compulsory registration of people who use drugs, the replacement of prison penalties for drug use with drug treatment and community service, and the delivery of harm-reduction services in programming.

These constitute important steps towards a more people- and health-centred approach. The Global Commission on Drug Policy has long advocated for such an approach, which overwhelming evidence shows is a more effective way to reduce not only the potential harm caused by drugs but also that caused by repressive policies to people, communities and society as a whole, and the right of all citizens to health and dignity.

The draft bill also comprises an exemption from prison for people who possess small quantities of drugs for personal use. This exemption for possession, however, was removed when the bill was discussed in the Upper House in August, even though using drugs necessarily involves possessing at least some amount of them and carrying the paraphernalia to prepare them. This is worrying, since continuing to criminalise possession for personal use, as well as preparatory acts and paraphernalia, perpetuates a model of punishment as the “best way” to address the presence of drugs in society, which needs to be reconsidered.

Fear appears to have trumped fact and reason – the fear that drug dealing and trafficking would increase if harsh criminal sanctions were not imposed for possession. Yet criminalisation has not proved effective in curbing either the supply of, or demand for, drugs, as shown by ever increasing prison sentences since Myanmar adopted its first Narcotic Law in 1974. The decision to remove the exemption for possession therefore directly contradicts the main objective of the reform, since any person who uses drugs, particularly those who are dependent on it, will still be exposed to long prison terms, which do little to help them address their drug dependence. Indeed, extensive evidence from around the world shows that prisons deter access to health services for people who use drugs, fuel more risky drug-use practices – leading to infectious diseases and overdoses – and result in loss of job opportunities, housing and other social needs.

Inhumane management of drugs

The issue at stake is the perception of drugs and people who use drugs, and people who are dependent on them, which remains based on prejudice and dogma. Drugs and dependence are not an “evil” that must be eradicated. They are substances with psychoactive properties that can be used for cultural, recreational or medical uses. Indeed, several drugs – cannabis, opium and kratom – were traditionally used and accepted in many countries in Southeast Asia for centuries.

Likewise, people who are dependent on drugs are not selfish individuals, who only care about the immediate gratification of their desires, and who lack the willpower to seek treatment when they develop problematic use. Dependence is, in fact, a medical condition characterised by the compulsive need for drugs regardless of the consequences whereby the person requires a substance to function, much like diabetes.

Yet people who use drugs, as well as those who develop a dependency, have been regularly arrested, interrogated, and shamed in public – even beaten to death. Drugs have been demonised, rather than being addressed from an evidence-based point of view.

Toward a health-centred approach

What is required to overcome this fear and stigma of drugs and discrimination against people who use them is an approach that offers the prospect of a safer and healthier society. Not a “drug-free society” but a society free, as much as possible, of the harm associated with drugs, including that caused by criminalising drug use and possession.

Such a health-centred approach to drug control means treating people who are dependent on drugs as patients, not criminals. It entails providing harm-reduction measures, such as needle and syringe-exchange programs, and treatment services, such opioid substitution therapy, which can help empower them. There is ample evidence in other countries around the world that such measures are effective in reducing the harm associated with problematic drug use and have huge benefits for overall public health and safety.

To be viable, however, these measures must be taken on board in the law and widely implemented. There are too few methadone programs in hospitals and some harm-reduction services in Myanmar. But many communities reject these services, out of fear and beliefs guided by 50 years of large-scale, prohibition-related propaganda. The primary misconception is that these services promote drug use. In fact, where they have been implemented, there has been no increase in drug use and a substantial decrease in drug-related petty crime.

Also, treatment must be offered on a voluntary basis, and people who are dependent on drugs must be able to access health services without fear of legal coercion. This means pursuing reforms that maintain the original objective of the proposed revision in Myanmar to effectively decriminalise the use and possession of drugs, and eliminate mandatory treatment and penalties for possession. This also means that people who use drugs without developing dependency need to be left out of the criminal and the medical responses, since they do not have any specific need to address and exercise effective control over their use.

Overwhelming evidence elsewhere has proven that decriminalisation does not increase drug use and has huge social and economic benefits. These include a better use of law enforcement resources and direct savings for the criminal justice system, reduced prison populations – which is a major challenge in Myanmar – and better public health outcomes.

Trust between state and citizens

It is therefore essential that when the revision of the law is discussed in Myanmar’s Lower House, evidence replaces fear and ideology, that the full complexity of the issue of drug use be understood, that the exemption for the possession of small quantities of drugs be reinstated, and that the voluntary nature of treatment be clearly emphasised.

Only in this way can the authorities build an effective drug control framework that respects the dignity and right to health of all, including people who use drugs, and allows for a trusting and peaceful relationship between the state and its citizens.

My fellow global commissioner, Ruth Dreifuss, former president of Switzerland, visited Myanmar in April and met with several policymakers, including State Counsellor Daw Aung San Suu Kyi. She was impressed by the quality and dynamism of civil society groups calling for drug policy reforms based on human rights and protection of public health, from the locally based “drug policy advocacy group”, to opium farmers in border states or networks of people who use drugs. She asked all these stakeholders, state representatives and civil society, to let the evidence be examined and seriously considered.

While the response to drug trafficking is a transnational issue, the health, well-being and safety of the citizens are a national responsibility for the state, and best practices from other countries are a compass to guide Myanmar authorities in their reform effort.

Anand Grover, senior advocate practicing in the Supreme Court of India, is a member of the Global Commission on Drug Policy and former United Nations special rapporteur on the right to health.