I. INTRODUCTION

There is a growing appreciation of the importance of relationships between the promotion and protection of human rights and the promotion and protection of health 2 —in particular, the health of people who are disadvantaged, stigmatized, and vulnerable to ill health and to human rights abuses. This includes people who engage in illegal drug use.3 However, little has been written about drug use and human rights. Human rights are rarely mentioned expressly in drug use literature and drug use is rarely mentioned in human rights literature.4 For example, the only express reference to drug use in international human rights conventions and treaties is in the European Convention on Human Rights. Further, the subject of human rights is mentioned only once in the United Nations Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances, the international legal instrument that addresses drug control.5 Not only is there a paucity of discourse on drug use together with human rights, but in at least one instance, an international effort to address this issue was suppressed.6

It is not surprising that so little has been written regarding human rights and drug use, considering the plight of most drug users. Drug use is a highly polarized and divisive puzzle of fact and fiction. There is a wide disparity among the conceptualizations of drug use, which range from conceptualizing drug use as a moral or criminal problem on the one hand, or a disease or medical problem on the other. As the British Medical Association points out:

[A]lmost every psychoactive drug known to humanity, from alcohol to opium, has been regarded by some government and society as a dire threat to public order and moral standards, and by another government and another society as a source of harmless pleasure. Further, nations and governments sometimes change their views completely. Almost every society has at least one drug whose use is tolerated, while drugs used in other cultures are generally viewed quite differently and with deep suspicion. Mexican Indians may have disapproved of alcohol, but they used mescaline. Most Muslim cultures forbid alcohol, but they tolerate cannabis and opium.7

Drug use is also one of the most stigmatized behaviors worldwide. 8

Drug users are among the most marginalized and hidden populations in many countries.9 In addition, drug users are often made into scapegoats 10 and discriminated against.11 Drug users are frequently portrayed as criminals, and many have criminal records because the "production, manufacture, export, import, distribution of, trade in, use and possession 12 of a variety of drugs is illegal, both internationally and domestically. Moreover, the health of drug users is often imperiled by the marginalization, stigmatization, and discrimination they suffer. Perhaps nowhere is this more evident than in responses to epidemic diseases. offering a persuasive model to understand these responses to drug use.13 The panic and uncertainty that accompany epidemic disease may lead to a desperate search for explanations—often, personalized ones. Many people must have theological and moral reasons for their plight—as Albert Camus demonstrated so brilliantly in The Plague. Stigmatization seems to provide a partial (although spurious) answer to essentially unanswerable questions. The convenience of having an already despised or suspect group in the vicinity allows for quick attribution of causality and blame.l4

The dominant society is indifferent to the problems of a stigmatized group as long as they are spared these problems, including the need for research, resources, social support, and legal protection resulting from these problems. When the dominant society is affected, its responses are often to blame and punish the stigmatized group. Those who are affected, whether members of the dominant or stigmatized population, hide or deny their problem and shield themselves from stigmatization, exclusion, discriminatory blame, and punishment. "In fixing blame on individuals. [the dominant society] obscures the social and institutional dimensions so necessary to sound public health measures.''15 Helpful responses may be blunted, avoided, or rejected; those trying to solve the problem may be vulnerable to the same abuses as those who are affected; those who are affected may avoid or refuse help, fearing disclosure and vulnerability to abuse. The affected may develop a hopeless, helpless view of their plight, which becomes a self-fulfilling prophecy, perpetuating or reinforcing the dominant society's views of the affected population.

When people are viewed as being different, marginal, deserving of stigmatization, and prone to discrimination, they are exceedingly vulnerable to abuse, l6 including the abuse of their human rights.l7 There is a "vicious circularity" to this vulnerability. All too often this characteristic underlies and predisposes the use of drugs and it is amplified and reinforced when drugs are used. In this setting, drug users are unlikely to exercise their rights like everyone else in society. Many of them are deeply hidden from society and rarely will claim their rights and less often defend them.l8 This is made worse when a government jeopardizes or infringes upon one's rights in order to control drug use. A government is unlikely to listen to or respect the claims of a drug user when this would allow the drug user to continue an illegal activity which the government is trying to suppress.

It is not only the rights of drug users that may be jeopardized by drug use. There are inner-city residents in the United States who reported their willingness to give up some of their rights so that drug trafficking and drug use could be controlled more decisively by the criminal justice system.l9 Crime, violence, fear, and frustration have hardened attitudes against drug users, especially in inner-city areas where drug trafficking and use are rampant. This has promoted and strengthened criminal justice approaches to control these problems. As the use of intrusive efforts to detect, apprehend, convict, and punish drug traffickers and users increases, the rights of drug users are increasingly jeopardized. For instance:

Today, inner-city residents and minorities are not only victims of ever more dangerous drugs, introduced into their communities by callous profiteers; they are also, along with their civil liberties, the chief casualties of the war on drugs ....

[M]artial law has been declared in our inner cities, with police raids, curfews, and warrantless searches being the order of the day. At the same time, almost nothing is being done to ameliorate the grinding poverty and despair that are the causes of much of the drug abuse our government claims it wants to end.20

This situation, along with the plight of many drug users, and the paucity of discourse about drug use and human rights, points out the urgent need to examine human rights relating to drug use. Human rights principles can provide new insights and a powerful means to examine drug use and responses to it.21 Efforts aimed at promoting and protecting health and human rights are complementary, interdependent, and mutually reinforcing.22 In this regard, "the thinking that led to the Universal Declaration of Human Rights and its list of fundamental and inalienable rights may provide a more useful entry point into a thorough consideration of the 'conditions in which people can be healthy' than the approaches traditionally used in medicine and public health."23 Ensuring that responses to drug use, particularly legal and policy ones, comply with human rights standards and norms is another instance of this approach.