From a punitive to public health drug approach

In May 2020, at the height of the COVID-19 pandemic, a man in Singapore was sentenced to death for a drug offense via a remote hearing on Zoom. This incident personifies the approach to drugs in Asia. Countries in Asia hold the unfortunate distinction of being among the most prolific users of the death penalty for drugs, and for having some of the most punitive drug laws in the world.

Despite the proven ineffectiveness of the death penalty as a deterrent to drug use or sale, its use for drug offenses has continued, with Bangladesh expanding the death penalty to cover the manufacture and trafficking of yaba (methamphetamine). Sri Lanka’s former President Maithripala Sirisena sought to reinstate the death penalty for drug traffickers last year, and Indonesia continues to hand out death sentences for drug-related offenses.

While executions sometimes receive media attention, much less is said of the plight of people on death row for drug offenses. At least 3,000 people convicted of drug offenses are languishing on death row. Government data is insufficient and inaccessible so the actual figure is likely to be much higher. Many of these people have been on death row for a decade or more, and hundreds more continue to be sentenced to death every year.

Drug policy in Asia has long been characterized by punishment. The region continues to aim for a “drug-free world” as seen in the drug policies of countries like Bangladesh, Indonesia, the Philippines, Singapore, and Sri Lanka, as well as regional organizations like the Association of Southeast Asian Nations. Rhetorically, leaders speak of drugs as a moral evil, reflecting and reinforcing negative—and even dehumanizing — attitudes toward people who use them.

The punitive drug policies in Asia are ostensibly aimed at reducing drug supply, but have disproportionately impacted people living in urban poor communities. In Bangladesh, 391 people were killed in extrajudicial killings in 2019 alone, and in the Philippines tens of thousands of people still continue to be killed and many others are jailed, orphaned, or widowed in the name of the drug war. Women who use drugs are particularly vulnerable to punishment, abuse, stigmatization, and human rights violations. In several countries in Asia, women constitute the fastest growing demographic group in prisons.

Governments in the region use the medical harms associated with drugs to justify punitive drug policies, but there remains little or no data on drug mortality and overdose. This punitive approach to drugs negatively impacts health services and systems. The threat of punishment doesn’t deter drug use but drives people to hide their drug use, including from their doctors. And instead of providing people who use drugs with health services that they need and want, we put them in jail or into compulsory drug detention centers.

There are approximately 4.35 million people who inject drugs in Asia. Yet, as a new report from Harm Reduction International reveals, the services for this huge population of people are grossly insufficient. Only 14 of the 25 countries/territories in the region have existing needle and syringe programs—a proven and effective public health intervention that decreases overdose deaths as well as the spread of HIV and tuberculosis. Despite the rise of methamphetamine, there are very few programs that aim to reduce harms surrounding its use; instead, the focus is on punishing people who use it. Even when these services are available, they are often inadequate and unevenly distributed, often concentrated in big cities or inaccessible to marginalized groups, including women who use drugs.

Sadly, COVID-19 has not slowed down Asia’s deadly drug wars. Far from solving any of our societies’ programs, the punitive approach to drugs is preventing us from achieving good health for all — and we must demand humane, effective, people-centered alternatives.

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Suchitra Rajagopalan is the Communications Officer at Harm Reduction International (HRI). Gideon Lasco, MD, PhD, is the author of the Asia chapter of HRI’s Global State of Harm Reduction 2020 report, and is a columnist in this paper.