So-called treatments for drug users and the disabled in some places of the world—including the U.S.— are far from helpful, says a new United Nations (U.N.) report.
The U.N. special rapporteur on torture, Juan Mendez, presented the report to the agency’s Human Rights Council in Geneva this week, and says that some practices used to treat autism and addiction are “tantamount to torture or cruel, inhuman or degrading treatment.”
The report [PDF] singled out tactics such as forced labor, punitive use of electric shock, prolonged restraint and isolation, rape and other sexual violence in detention, as well as and denial of maintenance medications like methadone or buprenorphine (Suboxone) in treating addiction. It also reported on failures to provide adequate pain treatment as potentially constituting torture. Even when these practices fall short of outright torture and are merely “ill treatment,” they should be banned in health settings because they “frequently facilitate torture,” the report says.
Citing accounts from human rights organizations on centers in Asia where drug users and homeless people are rounded up for “treatment,” the special rapporteur details sickening abuses including “[s]tate-sanctioned beatings, caning or whipping, forced labour, sexual abuse and intentional humiliation,” and ‘flogging therapy,’ ‘bread and water therapy’ and electroshock resulting in seizures, all in the guise of rehabilitation.”
The report notes that these “[c]ompulsory treatment programmes that consist primarily of physical disciplinary exercises, often including military-style drills, disregard medical evidence.” Both the World Health Organization (WHO) and the United Nations Office on Drugs and Crime (UNODC) say that that simple incarceration and forced labor are not “recognized by science as treatments for drug use disorders.”
While the U.S. does not place drug users in brutal work camps without trials— as has been documented in countries like Vietnam, Laos and China— there are some American correctional boot camps, rehabilitation centers and treatment facilities for the disabled and mentally ill that rely on tactics Mendez wants banned.
The special rapporteur, who is responsible for bringing international attention to inhumane practices wherever they are found, met in December with addiction and disability advocates in Washington. His report specifically mentions the use of punitive electric shock treatment, which is practiced at the Judge Rotenberg Center (JRC) in Canton on autistic children, as a therapy that should be prohibited internationally.
The facility—the only one in the world still using such tactics— has long been targeted by advocates for the disabled because of its use of electric shocks. The “treatment” is delivered by a device on the skin whenever patients break rules, even for violations as mild as talking or moving restlessly during class. Of JRC, Mendez said, “the rights of the students of the JRC subjected to…electric shock and physical means of restraints have been violated under the U.N. Convention against Torture and other international standards.” Mendez had previously called for a U.N. investigation of the facility and an investigation by the U.S. Department of Justice is ongoing.
In December, the FDA sent a letter to the program warning officials that the shock devices were not approved and must be removed. That same month, the Centers for Medicaid and Medicare Services announced that it would no longer pay for treatment of any type at Rotenberg.
Nonetheless, many parents of children at the center want to continue the shock treatment because they claim it is the only thing that works for their children. But the center has never published randomized controlled trials documenting that the treatment is better than non-punitive alternatives.
The U.N. report also criticizes more widespread treatment approaches used in the U.S. Many treatment programs — including those demonstrated on television by Dr. Drew in programs like Celebrity Rehab and Sober House — oppose the use of long term maintenance with methadone or buprenorphine (Suboxone), which are considered among the most effective treatments for heroin or painkiller addiction.
“A particular form of ill-treatment and possibly torture of drug users is the denial of opiate substitution treatment,” the report says, noting that this is considered a human rights violation when done in jails and prisons. “Similar reasoning should apply to the non-custodial context,” it says, meaning that provision of such treatment should be required when desired by patients and where evidence suggests it would help. Some countries — like Russia — completely ban the use of maintenance treatments, despite the fact that they have been shown to cut overdose deaths dramatically. American prisons also routinely deny access to maintenance medications, citing concerns about inmates selling them, which puts them in violation of these human rights.
“I think this is the most powerful U.N. statement calling denial of opioid substitution treatment a denial of the right to be free from cruel, inhuman or degrading treatment or punishment,” says Rebecca Schleifer of Human Rights Watch, which exposed many of the international treatment abuses.
Mendez also cites denial of access to pain treatment as a torturous practice in health care settings. According to the WHO, 83% of the world’s population has little or no access to treatment for severe pain with the most effective medications like morphine, even at the end of life. Poor and middle income countries house half the world’s cancer patients and 95% of all new HIV cases, but only use 6% of the world’s supply of morphine. “Failure to ensure access to controlled medicines for the relief of pain and suffering threatens fundamental rights to health and to protection against cruel, inhuman and degrading treatment,” the report says.
Mendez says such treatment can constitute torture in many cases. “Medical care that causes severe suffering for no justifiable reason can be considered cruel, inhuman or degrading treatment or punishment, and if there is State involvement and specific intent, it is torture.” Based on this argument, the report calls for bans on inhumane practices and prosecution of people who continue to carry them out.
While it is highly unlikely that a U.N. report will eliminate all of the abuses that continue in the name of treatment, simply acknowledging that they are unacceptable represents an important first step in addressing, and potentially eliminating them.