Compulsory Drug Detention and Drug “Treatment”

United Nations entities call on States to close compulsory drug detention and rehabilitation centres and implement voluntary, evidence-informed and rights-based health and social services in the community.[1]

 

In recent years several countries, particularly in East and South East Asia, have changed their policies and reclassified people who use drugs as “patients” or people with a “health” problem, rather than as criminals. Although this may seem to be a positive step, in most cases it has changed very little, and in some cases even made the situation worse for PUD. PUD in these countries have very little access to evidence-based drug treatment services such as voluntary detoxification and rehabilitation services. Instead, people who are labelled as drug users, whether they are dependent on a drug or are just caught with something that indicates they use drugs, are locked up in compulsory drug detention centres (CDDC) disguised in word but not in practice as “rehabilitation”.

There are more than 350,000 people estimated to be incarcerated in about 1000 CDDCs in countries including China, Vietnam, Thailand, Burma, Cambodia and Lao PDR[2]. The way the centres operate varies from place to place. They can hold less than a hundred people or more than 10,000. People can be detained for six months or up to five years. Commonly, people who have been caught by the police at some time in their life become registered in a system that means they will be targeted and urine tested by the police for years and years to come, sometimes for life. There is no judicial process. You can be walking down the street minding your own business when a police officer demands you do a urine test, sometimes on the street but usually at the local police station where you will be locked up until you comply. If you test positive you will be locked in one of the CDDCs within the day for a period of time that is usually decided by the arresting officer. People may also be incarcerated if they are found (or believed) to have used other illicit drugs such as amphetamines or ecstasy, again regardless of whether the person is dependent on them. In many Asian countries, marijuana use carries similar or the same penalties as the other illicit drugs. There is no right to appeal, no allowance for false positive results, and no recognition that the positive result for codeine or morphine might be from a drug other than an illegal drug.

According to eleven United Nations agencies who formed a statement asking for an end to the use of CDDCs, “compulsory drug detention and rehabilitation centres raise human rights issues and threaten the health of detainees, including through increased vulnerability to HIV and tuberculosis (TB) infection”[3].

The CDDCs are usually run by the police or military, people with no training or expertise in drug treatment. However, without the judicial process, the CDDCs are not restricted by the usual laws that apply to prisons. Inmates can be underage, even as young as ten years old, when they are incarcerated with adults. Schooling and other education is not provided, and health care is usually inadequate or non-existent[4].

The CDDCs are known to be places in which human rights abuses are common including staff beating and torturing the detainees. Many people have reported being electrocuted, flogged and whipped. There are also many reports of isolating and denying access to health care, food, exercise, and evidence based drug treatment. Sexual assault has been found to be common with one report in which CDDC guards admitted to using the results of HIV tests to know with which women they could “safely” have sex[5].

Another common element of the centres is that inmates in many countries are forced to labour within them. Labour can be anything from embroidery and making of trinkets for market, to farm work. The prisoners may be forced to fulfil daily quotas, with people sometimes having to work for around sixteen hours a day. The CDDCs, through this labour, often make money out of the inmates.

They have extremely low rates of “success” if you define success as a person achieving abstinence from drugs. Within the centres, as in any prison in the world, many of the inmates continue to use drugs though with even less access to new injecting equipment than they have on the outside. Condoms are also not available.

Private and “voluntary” clinics in countries such as Russia, Nepal, India, and South America have similar practices to the CDDCs including incarceration without the freedom to leave. Families will pay significant amounts of money for their family members to be “rehabilitated” in these centres. There is rarely anywhere else for people to get drug treatment, and they and their families believe this to be the only option they have. The people who run the private clinics usually have no experience or training in managing drug withdrawal and rehabilitation, and inhumane conditions in these centres is commonly reported. For example, people have no access to health care, there is no clinical management of withdrawal symptoms, people are chained to a wall or to their bed, have little access to food, and they are frequently beaten and tortured. Several cases of people dying after beatings have been reported. In recent years, more than one “voluntary” rehabilitation centre in South America has burned down with its “clients” trapped inside, chained to the walls. While some of the centres have been closed and the people responsible have been prosecuted, others continue without any repercussions.

Many international organisations such as UN agencies, now openly oppose the use of CDDCs and other human rights abusing drug “treatment” centres and have called for countries to close them down. There is an international and national push to replace the CDDCs with voluntary, community based treatment for people dependent on drugs. However, some of these agencies have also continued to provide funding to the centres despite the continuing human rights abuses. According to the report, Torture in Healthcare, “despite increased criticism of drug detention centers and recent pledges by international organizations and national agencies to ensure respect for human rights when providing such assistance, donors continue to provide support for both existing and new facilities. Accordingly, U.N. agencies, as international organizations, and donor States may be complicit in violations of international law through their ongoing support of drug detention centers”[6].

In some countries, more methadone and other opioid substitution treatment programs are becoming available for people who are drug dependent. The numbers of people able to access these are still far too low, making up only approximately eight percent of the people who need them worldwide[7]. The percentage of people able to access methadone or other substitution treatment in countries where CDDCs are common is likely to be far lower, and treatments for other types of drug dependence are almost non-existent. However, as long as the centres provide a good source of income for police and other government law enforcement departments, and are popular in the community for their ability to keep drug users “off the streets”, they are unlikely to be closed down with any urgency.



[1] United Nations Office of Drugs and Crime, et al., (March 2012).  Joint Statement: Compulsory drug detention and rehabilitation centres.
[2] Centre for Human Rights and Humanitarian Law (2014). Torture in Healthcare Settings: Reflections on the Special Rapporteur on Torture’s 2013 Thematic Report. American University, Washington College of Law, Washington.
[3] United Nations Office of Drugs and Crime, et al., (March 2012).
[4] Centre for Human Rights and Humanitarian Law (2014).
[5] J.E. Cohen & J.J. Amon, Health and Human Rights Concerns of Drug Users in Detention in Guangxi Province, China, 5 PLoS Med (2008), available at http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.
pmed.0050234.
[6] Centre for Human Rights and Humanitarian Law (2014).
[7] United Nations Office of Drugs and Crime, et al., (March 2012).