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Mandatory addiction treatment for people who use drugs: global health and human rights analysis

BMJ 2016; 353 doi: (Published 09 June 2016) Cite this as: BMJ 2016;353:i2943
  1. Karsten Lunze, assistant professor1,
  2. Bulat Idrisov, fellow1,
  3. Mikhail Golichenko, senior policy analyst2,
  4. Adeeba Kamarulzaman, professor3
  1. 1Boston University School of Medicine, Boston, MA, USA
  2. 2Canadian HIV/AIDS Legal Network, Toronto, ON, Canada
  3. 3University of Malaya, Kuala Lumpur, Malaysia
  1. Correspondence to: K Lunze karsten.lunze{at}
  • Accepted 20 April 2016

Global evidence indicates that mandated treatment of drug dependence conflicts with drug users’ human rights and is not effective in treating addiction. Karsten Lunze and colleagues argue that drug treatment policies must be evidence based and meet international standards

During 2013 to 2015 the Russian Federation (Russia) amended its laws to enable courts to force people who use drugs to have treatment for addiction.1 2 3 4 The laws give courts the ability to mandate sentenced offenders with drug dependence to undergo dependence treatment in combination with non-custodial measures such as fines or coercive labour. Russian authorities have stated that the new laws were enacted as motivation for treatment. Our analysis globally examines the acceptability and efficacy of legislative approaches mandating treatment of drug dependence.

Increasing drug use in Russia led to parallel HIV epidemic

Drug use in Russia, consisting mostly of injectable heroin, increased after the break-up of the Soviet Union.5 There were over 540 000 drug users registered in Russia 6 but the United Nations Office on Drugs and Crime estimated that were about 1.8 million opiate users in the country in 2014.7 The prevalence of injecting drug use (2.29%) among 15-64 year olds is almost 10 times the global prevalence estimate of 0.27%.8

The deleterious effects of addiction on health are well recognised, including the risk of blood borne infections.9 Over the past decade, there have been few effective HIV prevention measures targeted at people who use drugs in Russia.10 HIV infection rates have been growing rapidly, and over half of all people with newly acquired HIV became infected through unsafe injecting of drugs.11 Over a million people living with HIV were registered in Russia at the beginning of 2016.12 Behind these numbers lies a substantial burden of ill health and stigma for affected people and their families.

Lack of evidence based treatment

Addiction treatment …

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