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II. RECOMMENDATIONS

To the government of the state of California

Human Rights Watch calls on all state governments to facilitate access to sterile syringes by legalizing statewide the possession and distribution of sterile syringes for the purpose of prevention of HIV, hepatitis C and other blood borne infections, and working with city and county officials, including law enforcement, to ensure the unimpeded implementation and use of sterile syringe programs. In California, these recommendations may be fulfilled as follows.

  • Legalize statewide the possession and distribution of sterile syringes for the purpose of disease prevention. Amend both drug paraphernalia laws in the Health and Safety Code and pharmacy practice laws in the Business and Professions Code to protect providers and participants in sterile syringe programs from prosecution for possession or distribution of drug paraphernalia. Extend this protection not only to syringes, but also to other injection equipment.

  • Enact specific legislation permitting individuals to purchase and possess syringes for the purpose of disease prevention without a medical prescription. Protect individuals who buy and sell syringes for this purpose from prosecution for possession or distribution of drug paraphernalia.

  • Ensure statewide access to syringe exchange programs by eliminating any requirement that local jurisdictions declare a “local health emergency” in order to establish these programs. Instruct counties lacking syringe exchange programs to evaluate the magnitude of their injection drug use-driven AIDS epidemic and to implement sterile syringe programs accordingly. Follow the recommendations of county public health officials regarding the establishment of these programs.

To city and county governments in the state of California

Human Rights Watch calls on city and county governments to facilitate access to sterile syringes by implementing syringe access programs and sending a clear signal to law enforcement officials not to interfere with these programs. These recommendations may be fulfilled as follows.

  • Work with police departments to ensure that individuals are not arrested, harassed, searched, detained, or otherwise punished based on their possession of sterile or used syringes obtained from legal syringe exchange programs.

  • Where syringe exchange programs do not operate legally, immediately assess, through local boards of health, the magnitude of the injection drug use-driven AIDS epidemic and the extent to which sterile syringe programs would address this epidemic. Follow the recommendations of county public health officials regarding the establishment of state-sponsored syringe access interventions.

  • Amend city planning codes to ensure that health facilities seeking to provide services to drug users are not discriminated against in planning and zoning decisions. Ensure that all ordinances pertaining to these facilities include a meaningful process of public consultation and debate.

  • Establish a municipal plan of action for the safe disposal of used syringes. Ensure that this plan includes the installation of biohazard containers in public places, as well as a police protocol for the safe handling of syringes. As part of this plan, protect all individuals from prosecution for possession of drugs or drug paraphernalia on the basis of possession of a used syringe or other injection equipment.

To police departments in the state of California

Human Rights Watch calls on all police departments to refrain from interfering with the implementation or use of programs that provide access to sterile syringes. This recommendation may be fulfilled as follows.

  • Cease all arrest, harassment, search, detention, and other punitive action against individuals for possession of sterile or used syringes obtained from sterile syringe programs. Instruct all officers patrolling relevant neighborhoods that participation in a sterile syringe program constitutes a bar to arrest or questioning for possession of syringes. Where sterile syringe programs issue cards identifying clients as participants in these programs, respect these cards as evidence of such participation.

  • Establish a “safe zone” through which individuals may freely enter and leave legal syringe exchange sites. Regularly update police officers about safe zones, and work with syringe exchange providers to ensure continued respect for their existence and purpose.

  • Develop training protocols for all narcotics, vice, and street officers on the basic principles of sterile syringe programs. Work with syringe exchange and other harm reduction service providers on the development of this protocol. Provide regular refresher training as well as mandatory training for new officers. Regularly update the protocol to reflect the emergence of new harm reduction services in the community.

  • Develop and implement a protocol for the safe handling of syringes found in the course of investigative searches. Allow clients of sterile syringe programs to keep sterile syringes in their possession, and to keep used syringes in their possession for the purpose of returning them to syringe exchange sites. Refrain from arresting people for possession of controlled substances based on trace amounts of narcotic drugs contained in a used syringe.

  • Take steps to ensure that private security agents who patrol Business Improvement Districts (BIDs) and other areas not interfere with the operation of legal syringe access interventions. Take immediate action against private security agents who are alleged to stop, “arrest,” search, detain, or otherwise harass and intimidate individuals in violation of the law.

  • Monitor the implementation of the foregoing recommendations by ensuring that police officers who do not comply with them are appropriately disciplined.

To the government of the United States

Human Rights Watch calls on the United States government to give official recognition to the importance of access to sterile syringes to stopping the spread of HIV/AIDS and other infectious diseases, and to encourage and support state and local efforts to implement syringe access interventions. Human Rights Watch also calls on the United States government to advance international recognition of the importance of public health and harm reduction-based approaches to addressing illicit drug use. These recommendations may be fulfilled as follows.

  • Lift the ban on federal funding for syringe exchange program services. Reissue the government’s earlier findings that syringe exchange decreases HIV and hepatitis C transmission without contributing to crime or drug use. Include funding for syringe exchange services in any appropriations pertaining to AIDS prevention among high-risk populations. Encourage and support research on the effectiveness of syringe exchange and other HIV prevention interventions for injection drug users and other high-risk populations.

  • Amend the Americans with Disabilities Act of 1990 to guarantee explicitly the right of people with substance-related disabilities to protection from discrimination whether or not they are in recovery.

  • As part of the reporting requirement under the International Covenant on Civil and Political Rights (ICCPR), report on state interference with access to sterile syringes and other HIV prevention programs for injection drug users as a form of discrimination against persons with substance-related disabilities. Ensure the broad participation of nongovernmental organizations in this reporting process.

  • Ratify the International Covenant on Economic, Social and Cultural Rights (ICESCR). Pursuant to the right to the highest attainable standard of health, issue amended model drug paraphernalia legislation encouraging state governments to legalize the distribution and possession of sterile syringes for the purpose of disease prevention. Provide impetus to state and local efforts to implement syringe access interventions.

  • Work with the United Nations Commission on Narcotic Drugs, the United Nations Office of Drug Control and Crime Prevention and other multilateral organizations to amend international drug conventions to recommend the legalization and implementation of syringe exchange programs and other methods of sterile syringe access.

To the United Nations

Human Rights Watch calls on the United Nations system and member states to recognize access to syringe access interventions, without fear of arrest or punishment, as part of the right to the highest attainable standard of health. Human Rights Watch also calls on member states of the United Nations to support amendment of the international drug conventions to encourage states parties to adopt public health approaches to drug use, including expanded access to sterile syringe interventions. These recommendations may be fulfilled as follows.

  • The United Nations Commission on Narcotic Drugs (CND), in cooperation with the Office of Drug Control and Crime Prevention (ODCCP), should support the amendment of international drug conventions to call explicitly for the legalization and promotion of syringe exchange services and other methods of sterile syringe access. They should call on all states parties to the U.N. drug conventions to deregulate syringes and ensure that agents of the state do not in any way interfere with access to sterile syringes.

  • The World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) should work with the CND and the ODCCP to include guarantees of access to sterile syringes in international drug conventions. These organizations should, with active input from public health experts and nongovernmental organizations, issue specific recommendations on the deregulation of syringes, including the legalization of syringe exchange services, the legalization of nonprescription pharmacy sales of syringes, the repeal of drug paraphernalia laws, and the development of safe syringe disposal policies and protocols.

  • The Office of the High Commissioner of Human Rights (OHCHR) should issue a fact sheet on the link between access to sterile syringes and respect for fundamental human rights under the ICCPR and the ICESCR. The OHCHR should work with UNAIDS to make explicit in the “International Guidelines on HIV/AIDS and Human Rights” the right not to be penalized for distributing, obtaining and possessing sterile syringes. This guideline should be expanded with the input of nongovernmental organizations and should include specific recommendations to law enforcement officials as well as local, state and national governments.

  • The U.N. special rapporteur on the human right to health should gather information and issue findings on the value of sterile syringe programs and other harm reduction approaches to addressing HIV/AIDS and other health consequences of illicit drug use. The special rapporteur should encourage countries to adopt these programs as good practices, and encourage the United Nations General Assembly, the Commission on Human Rights, and United Nations treaty bodies to recognize access to these programs as part of the right to the highest attainable standard of health.

  • As part of its monitoring of compliance with the ICESCR, the U.N. Economic, Social and Cultural Rights Committee should report on states’ interference with access to sterile syringes.


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September 2003