International Guidelines on Human Rights and Drug Policy

1. Right to the highest attainable standard of health

Everyone has the right to enjoy the highest attainable standard of physical and mental health. This right applies equally in the context of drug laws, policies, and practices.

In accordance with this right, States should:

i. Take deliberate, concrete, and targeted steps to ensure that drug-related and other health care goods, services, and facilities are available on a non-discriminatory basis in sufficient quantity; financially and geographically accessible; acceptable in the sense of being respectful of medical ethics, cultural norms, age, gender, and the communities being served; and of good quality (that is, with a solid evidence base).

ii. Address the social and economic determinants that support or hinder positive health outcomes related to drug use, including stigma and discrimination of various kinds, such as against people who use drugs.

iii. Ensure that demand reduction measures implemented to prevent drug use are based on evidence and compliant with human rights.

iv. Repeal, amend, or discontinue laws, policies, and practices that inhibit access to controlled substances for medical purposes and to health goods, services, and facilities for the prevention of harmful drug use, harm reduction among those who use drugs, and drug dependence treatment.

In addition, States may:

v. Utilise the available flexibilities in the UN drug control conventions to decriminalise the possession, purchase, or cultivation of controlled substances for personal consumption.


The right to the highest attainable standard of physical and mental health is recognised in numerous international instruments.75 The UN General Assembly and Human Rights Council have consistently reaffirmed this right, and UN human rights treaty bodies have elaborated upon its content.76 The Commission on Narcotic Drugs has repeatedly reaffirmed the importance of the right to health in the development and implementation of national and local drug policies and practices,77 as it is closely related to the object and purpose of the UN drug conventions in furthering the ‘health and welfare of mankind’.78 The UN General Assembly Special Session 2016 Outcome Document also highlights the importance of ensuring the right to health, dedicating a chapter on demand reduction and related measures (including harm reduction interventions) and another on ensuring access to controlled medicines.79

Access to health goods, services, and facilities under the right to health is measured by the ‘AAAQ framework’, a standard developed within the UN human rights system that refers to availability, accessibility (defined as non-discrimination, physical accessibility, economic accessibility, and information accessibility), acceptability (with regard to age, gender, culture, and human rights compliance—that is, services must be non-discriminatory and non-stigmatising), and quality.80 The quality element of the right to health requires that health facilities, goods, and services be scientifically and medically appropriate and of good quality. This requires, inter alia, skilled medical personnel and scientifically approved and unexpired drugs and hospital equipment.81 The International Narcotics Control Board, which is the body tasked with overseeing States’ implementation of the UN drug conventions, affirms that the AAAQ framework clarifies obligations relating to drug treatment and access to controlled medicines as outlined in the drug control treaties.82

Given its complex nature and budgetary implications, the right to health is subject to the principle of ‘progressive realisation’. That is, States must take various measures over time to achieve the full realisation of this right for all. There remain, however, core minimum obligations that must be guaranteed without delay.83 These core obligations include, among others, providing essential medicines as defined by the World Health Organization (several of which are also internationally controlled substances)84 and ensuring access on a non-discriminatory basis, especially for vulnerable and marginalised groups, to those health goods, services, and facilities that are available.

Underlying and social determinants of health

As the Committee on Economic, Social and Cultural Rights has stated, the right to health is an inclusive right extending not only to timely and appropriate health care but also to ‘a wide range of socio-economic factors that promote conditions in which people can lead a healthy life’.85 In this way the right to health supports attention to the ‘social determinants of health’, which drives global health work and underpins Sustainable Development Goal 3. For example, the Committee on Economic, Social and Cultural Rights has raised concern about stigma and discrimination directed against people who use drugs, as these social factors impede access to health services protected under the right to health.86

The Commission on Narcotic Drugs has called on UN entities and Member States to take measures to address the negative effects that social stigma related to drug use has on the availability, access, and delivery of health care and social services for people who use drugs.87 The UN General Assembly Special Session 2016 Outcome Document likewise calls on States to ‘prevent social marginalization and promote non-stigmatising attitudes’ towards people who use drugs in an effort to facilitate access to treatment and care.88

The right to health further includes the right to certain services, goods, and commodities that are outside of health care but are nonetheless essential for health. These elements, referred to as the ‘underlying determinants of health’, include ‘food and nutrition, housing, access to safe and potable water and adequate sanitation, safe and healthy working conditions, and a healthy environment’.89 Each is linked to related human rights (e.g., the right to adequate housing) and is also subject to the AAAQ framework and progressive realisation.

Legal determinants: Criminalisation and health

Legal frameworks can hinder or support health outcomes, and there is therefore increasing attention to the ‘legal determinants of health’.90 In this context, the criminalisation of drug use and possession for personal use affects the realisation of the right to health.91 The criminalisation of drug use and possession for personal use, as well as related law enforcement practices, can lead people who use drugs to be displaced from areas served by harm reduction programmes, thereby impeding their access to sterile syringes, opioid agonist therapy, and outreach workers. Such criminalisation can also increase risky behaviours – including the sharing of needles and syringes, hurried injecting, and the use of drugs in unsafe places – that are associated with HIV, viral hepatitis, and premature death due to overdose.92 The stigma created or reinforced through punitive enforcement and treatment regimes (including targeted abuse and violence towards people who use drugs) and policing practices that include the use of excessive force may also increase the risk of physical and mental illness for people who use drugs.93

In addition, once a person has a conviction for a drug-related offence, they may face considerable obstacles in obtaining employment and may lose access to government benefits, such as basic income assistance, student loans, public housing, and food assistance, or may face difficulties travelling abroad. The Committee on Economic, Social and Cultural Rights, the Special Rapporteur on the right to health, the Working Group on Arbitrary Detention, and the Office of the UN High Commissioner for Human Rights have recommended the decriminalisation of drug use and possession for personal use as an important step towards fulfilling the right to health.94 The UN system common position on drug control policy, adopted in November 2018, commits to ‘stepping up our joint efforts and supporting each other … [t]o promote alternatives to conviction and punishment in appropriate cases, including the decriminalization of drug possession for personal use’.95 Twelve UN agencies have committed to supporting States in reviewing and repealing laws criminalising drug use and the possession of drugs for personal use, on the basis that they have been proven to have negative health outcomes and that they counter public health evidence.96 In 2014, as part of its recommendations to increase HIV prevention, testing, and treatment for people who use drugs, the World Health Organization recommended that countries work towards the decriminalisation of drug use as a strategy to reduce incarceration and support access to HIV-related services for people who use drugs.97

The International Narcotics Control Board has raised concern that many State policies ‘to address drug-related criminality, including personal use, have continued to be rooted primarily in punitive criminal justice responses, which include prosecution and incarceration and as part of which alternative measures such as treatment, rehabilitation and social integration remain underutilized’.98 At the same time, many States have come to see drug use and dependence as a public health issue requiring health-centred, not punitive, responses.99 This is consistent with States’ obligations under the drug conventions, which require them to establish certain behaviours as punishable, subject to the constitutional principles of the State and the principle of proportionality.100 The conventions thus do not oblige States to adopt a punitive response or to incarcerate those who commit minor drug-related offences, including possession of small quantities of drugs for personal use.101

The UN General Assembly Special Session 2016 Outcome Document also encourages States to provide ‘alternative or additional measures with regard to conviction or punishment’, mentioning the UN Standard Minimum Rules for Non-custodial Measures (also known as the Tokyo Rules), as a relevant standard to follow.102

Relationship to the UN drug control conventions

Under the UN drug control conventions, States have an obligation to undertake demand reduction measures, which are measures aimed at the prevention of illicit drug use.103 The drug control conventions do not prohibit harm reduction interventions – that is, policies, programmes, and practices aiming to minimise negative health, social, and legal impacts associated with drug use, drug policies, and drug laws.104 Indeed, such interventions are consistent with the conventions’ stated objective of protecting the health and welfare of mankind.

The UN drug control conventions grant some flexibility with respect to how States treat the possession and use of controlled substances in law, policy, and practice. To a limited degree, and subject to important caveats, these conventions require States Parties to adopt measures to criminalise the possession of controlled substances other than for medical or scientific purposes.105 However, the conventions also note the importance of measures to protect the health of people who use drugs, requiring governments to ‘take all practicable measures’ to provide ‘treatment, education, after-care, rehabilitation and social reintegration’ of people who use drugs.106 States may provide measures for treatment, education, rehabilitation, after-care, and social reintegration as alternatives to conviction or punishment for the possession, purchase, or cultivation of drugs for personal use and in ‘appropriate cases of a minor nature’.107 This flexibility is reflected in the UN General Assembly Special Session 2016 Outcome Document.108 Therefore, even if such behaviours are considered illegal, they need not be subject to criminal or administrative punishment.

The UN drug conventions also contain sufficient flexibility to decriminalise possession and other activities related to the personal consumption of controlled substances, even if not for medical or scientific purposes. The 1988 Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances requires only that each State Party establish criminal liability for the intentional ‘possession, purchase or cultivation of drugs for personal consumption’ that is ‘contrary to the provisions of the 1961 Convention, the 1961 Convention as amended or the 1971 Convention’ (e.g., for non-medical or non-scientific use).109 Furthermore, this obligation is subject to any ‘constitutional limitations’ of the State Party110 and to the ‘constitutional principles and basic concepts of [the State Party’s] legal system’.111 States therefore have the latitude to determine whether imposing criminal liability or sanctions for possession, purchase, or cultivation for personal consumption contravenes constitutional provisions – such as the right to privacy or the right to health – or otherwise offends against the basic concepts of their legal system, including basic concepts of criminal law.