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TO: MARGARET CHAN, DIRECTOR-GENERAL, WORLD HEALTH ORGANIZATION
ANTONIO MARIA COSTA, EXECUTIVE DIRECTOR, UNITED NATIONS OFFICE ON DRUGS AND CRIME

As HIV and human rights advocates, we are concerned about the abuses committed all over the world in the name of drug treatment. We are also aware that methadone and buprenorphine, the best studied and most effective medications for opiate dependence, are available to less than 10% of people who need them. As we approach the 2009 UN General Assembly Special Session on drugs, we ask you to help States implement drug treatment approaches that respect human rights and are based on evidence rather than ideology.

In many countries, drug-dependent patients and prisoners alike are subjected to harsh measures, including the use of painful withdrawal symptoms as a means of coercing confessions, or long-term detention, caging, and chaining in the name of health. In many countries of Asia, drug users or those suspected of drug use are interned for prolonged periods in locked treatment facilities that offer little treatment save hard labor, military-style exercise, and chants such as "drugs are bad, I am bad." Despite high rates of HIV and hepatitis C, treatment for these blood-borne illnesses is often unavailable. Juveniles are frequently interned for years, often with older drug users and without medical consultation. In many facilities, risk behavior is common and preventive measures such as sterile injection equipment or condoms are unavailable.

Voluntary drug treatment is often not much better. In the former Soviet Union, publicly funded drug treatment often involves little more than heavy sedation, often in locked wards, despite international best practice noting the importance of individualized treatment and ongoing psychosocial support. Patients unable to pay for treatment have their names added to government registries, with subsequent loss of drivers' licenses, employment, or child custody. Those able to pay have also been subjected to punitive and unproven approaches, including partial lobotomy and "flogging" therapy.

While these abuses are committed in the name of treatment and rehabilitation, humane and evidence-based methods of treatment are often unavailable. Many countries prohibit or limit the use of methadone and buprenorphine for drug treatment, even though they are included on the World Health Organization's list of essential medicines and endorsed in other WHO and UNODC documents. Denying these medications to people in need is tantamount to sentencing them to serious suffering or even death for injecting drug use.

While we commend your growing attention to the abuses committed in the name of drug treatment and welcome your jointly published "Principles of Drug Dependence Treatment," which includes medication-assisted treatment, we ask you to go a step further to create guidelines for States to help them implement evidence- based programs that respect human rights. We further ask that you work with States to help them plan and implement these services. The process for creating effective, humane drug treatment should include the most important stakeholder - drug users themselves.

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