Table 10: Harm reduction and the right to the highest attainable standard of health

Table 10: Harm Reduction and the Right to the Enjoyment of the Highest Attainable Standard of Health

Examples of Human Rights Violations

  • Drug users or suspected drug users are turned away from hospitals or treated with stigma and judgmental attitudes in the health care system.
  • Government officials ban needle exchange programs or confiscate syringes from drug users, claiming they promote illegal activity.
  • Government bans substitution therapy with methadone.
Human Rights Standards Treaty Body Interpretation
ICESCR 12(1): The States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.

ICESCR 12(2): The steps to be taken by the States Parties to the present Covenant to achieve the full realization of this right shall include those necessary for: . . . (c) The prevention, treatment and control of epidemic, endemic, occupational and other diseases.


CRC General Comment No. 3: Has commented that governments “are obligated to ensure the implementation of programs which aim to reduce the factors that expose children to the use of substances, as well as those that provide treatment and support to children who are abusing substances.”

CESRC: Recommending that Estonia “intensify its efforts with regard to preventing drug use, including through education and awareness-raising programmes, and expansion of the provision of drug substitution therapy. Furthermore, the committee encourages the state party to continue expanding the needle exchange programme.” E/C.12/EST/CO/2 (CESCR, 2011).

CESCR: After expressing concern about the spread of drug addiction and the ban on certain medical treatments for drug dependence, recommended that Russia “apply a human rights-based approach to drug users so that they do not forfeit their basic right to health.” They also recommended that Russia “provide clear legal grounds and other support for the internationally recognized measures for HIV prevention among injecting drug users, in particular the opioid substitution therapy with use of methadone and buprenorphine, as well as needle and syringe, and overdose prevention programmes.” E/C.12/RUS/CO/5 (CESCR, 2011).

CESRC: Recommending that Kazakhstan “ensure that methadone as substitute drug dependence therapy is made accessible to all drug dependents.” E/C.12/KAZ/CO/1 (2010).

CESRC: Recommending to Mauritius to “undertake a comprehensive approach to combat its serious drug problem. In order to achieve the progressive realization of the right to the highest attainable standard of physical and mental health for people who inject drugs and to ensure that this group may benefit from scientific progress and its applications (art. 15, para. 1(b)), the State party should implement in full the recommendations made by the World Health Organization in 2009 designed to improve the availability, accessibility and quality of harm reduction services, in particular needle and syringe exchange and opioid substitution therapy with methadone. People who use drugs should be a key partner in this initiative. As a matter of urgency, the State party should:

(a) Scale up needle and syringe programmes to all geographical areas. The Government should amend the Dangerous Drugs Act of 2000 to remove prohibitions on distributing or carrying drug paraphernalia as these impede HIV prevention services; (b) Implement pilot prison needle and syringe exchanges and opioid substitution therapy programmes based on international best practice standards; (c) Remove age barriers to accessing opioid substitution therapy and develop youth-friendly harm reduction services tailored to the specific needs of young people who use drugs;

(d) Remove restrictions on access to residential shelters for women who use drugs; (e) Make hepatitis C treatment freely available to all injecting drug users; (f) With regard to addicted persons, consider decriminalization and public health-based measures such as prescription of buprenorphine. E/C.12/MUS/CO/4 (2010).

CESRC: Recommending that Poland “take measures to ensure that effective treatment of drug dependence is made accessible to all, including to those in detention.” E/C.12/POL/CO/5 (2009).

CESRC: Recommending that Ukraine “make drug substitution therapy and other HIV prevention services more accessible for drug users.” E/C.12/UKR/CO/5 (CESCR, 2008).

CESCR: Expressed concern in Tajikistan with “the rapid spread of HIV…in particular among drug users, prisoners, sex workers,” and recommended that the government “establish time-bound targets for extending the provision of free testing services, free treatment for HIV and harm reduction services to all parts of the country” (2006).

Other Interpretations

SR Health: Chapters of this report include the impact of drug control on the right to health including deterrence from accessing services and discrimination; and a human rights-based approach to drug control, including harm reduction and decriminalization. A/65/255 (2010).

SR Health: After an in-depth review of harm reduction in Poland, recommends that Poland:

(a) Ensure that needle and syringe programmes, opioid substitution therapy and other harm reduction strategies become widely available throughout the country; (b) To establish, without further delay, an opioid substitution programme in the Tri-City region of Gdansk, Sopot and Gdynia; (c) Amend the National Law on Counteracting Drug Addiction to avoid penalization of the possession of minute quantities of drugs, in order to foster access to substitution therapy for people using drugs; (d) Ensure the informed and active participation of people using drugs and other marginalized groups at the national, regional, and local level in the establishment of policies and programmes; (e) Include the participation of people living with HIV and those groups most at risk of HIV in HIV/AIDS-related educational projects and campaigns; (f) Ensure the enactment and implementation of a comprehensive antidiscrimination and equality law to help ensure the full enjoyment of the right to health, based on equality and non-discrimination within the State. A/HRC/14/20/Add.3 (2010).

SR Health: Recommending to Sweden that “the Government has a responsibility to ensure the implementation, throughout Sweden and as a matter of priority, of a comprehensive harm-reduction policy, including counselling, advice on sexual and reproductive health, and clean needles and syringes. A/HRC/4/28/Add.2 (2007).

SR Health: Expressed concern that the Anti-Narcotics Campaign in Thailand, coupled with limited access to harm reduction services, had inadvertently created the conditions for a more extensive spread of HIV] in Thailand. (2005).

SR Health: Expressed concern in Romania that “the stigma associated with commercial sex work and injecting drug use, for example, affects how people engaged in these activities are often treated by health-care workers, especially when requesting services such as tests for sexually transmitted infections” and encouraged the government to combat discrimination that creates barriers to services (2005).

Decision 74/10, Flexibility of Treaty Provisions as Regards Harm Reduction Approaches, prepared by UNDCP ’s Legal Affairs Section, E/INCB/2002/W.13/SS.5, September 30, 2002,

Declaration on the Elimination of Violence Against Women, G.A. Res. 48/104, UN Doc. A/RES/48/104 (December 20, 1993): Women are entitled to the equal enjoyment and protection of all human rights and fundamental freedoms in the political, economic, social, cultural, civil or any other field. These rights include, inter alia: . . . (f) the right to the highest standard attainable of physical and mental health.

WHO 1978 Declaration of Alma-Ata: The Conference strongly reaffirms that health, which is a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity, is a fundamental human right and that the attainment of the highest possible level of health is a most important world-wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector.

World Health Organization Constitution, preamble: The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.

Protocol San Salvador 10(2): In order to ensure the exercise of the right to health, the States Parties agree to recognize health as a public good, and particularly, to adopt the following measures to ensure that right: (a) Primary health care, that is, essential health care made available to all individuals and families in the community (b) Extension of the benefits of health services to all individuals subject to the State’s jurisdiction; (c) Universal immunization against the principal infectious diseases; (d) Prevention and treatment of endemic, occupational and other diseases; (e) Education of the population on the prevention and treatment of health problems, and (f) Satisfaction of the needs of the highest risk groups and of those whose poverty makes them the most vulnerable.

The Declaration on the Promotion of Patients’ Rights in Europe, Art. 5.3: “Patients have the right to a quality of care which is marked both by high technical standards and by a humane relationship between the patient and health care provider.”

Charter of Fundamental Rights of the European Union 35: Everyone has the right of access to preventive health care and the right to benefit from medical treatment under the conditions established by national laws and practices. A high level of human health protection shall be ensured in the definition and implementation of all Union policies and activities.