Get them young

It’s time to overcome our paralysis on tackling young people’s drug use, says Kate Iorpenda of the International HIV/AIDS Alliance. 

Article 3 of the UN Convention on the Rights of the Child declares that in all actions concerning children, whether undertaken by public or private social welfare institutions, courts of law, administrative authorities or legislative bodies, the best interests of the child shall be a primary consideration. With this in mind, the issue of drug use among children – and in particular injecting drug use – is one that raises a number of ethical dilemmas and consequent heated debate among practitioners.

Perhaps it’s because we find the reality of children and adolescents using drugs too difficult to face. Or perhaps it’s because supporting young people to use drugs more safely seems irresponsible and contrary to the values of protecting children. Whatever the reason, the comprehensive services that are available to young people in some countries are not currently translating into service provision in poorer countries.  In such contexts we need to be asking ourselves: have we consulted with young people to find out what they want and are we well enough informed about the types of drugs they take and their patterns of use? Otherwise we run the risk of being paralysed by the ethical dilemmas and conflicting values about what it might mean to be providing teenagers with clean needles.

Injecting drug use is a key driver of HIV epidemics in regions like Eastern Europe and Central and South East Asia, and the little available data we have indicates that in some countries children start injecting at a very young age. The lack of funding and attention to the needs of young people who use drugs has resulted in a situation where we lack concrete data on the extent of their drug use. However we do know that children with histories of abuse, mental health problems, and drug dependence in the family are among those at higher risk.

Adults have rights and choices about services and can be helped to seek other support – counselling, debt advice, housing – but with children there is a duty of care, and so service providers need to think both about safeguarding that duty of care and about how far it extends, given the complex and multiple needs of many young people who inject drugs.

Children and young people are often hidden within harm reduction services due to age restrictions and fears around asking and documenting age. In some countries, legal systems criminalise children as young as eight for drug use but deny them access to harm reduction services until they are 18. Additionally, service providers are often poorly prepared to work with young people, running programmes that don’t meet their needs and which have been designed without their input.

What kind of system punishes a child for drug use by incarcerating them in an adult prison? So many rights are being denied while we make up our minds on such issues. We need to know so much more about young people and their drug use and to recognise the diversity involved: different ages, different contexts, different genders, different drugs. We have to find ways within existing legal frameworks, good or bad, to ensure that we listen and respond. We need to collectively challenge the systems that continue to deny young people access to evidence-based interventions because of their age, but we also need to go beyond global policies.

Instead we must face the problems head on and listen to young people, find the missing data, face the unpalatable truth about the extent of their drug use and the systems that violate their rights. We need to confront uncomfortable choices to ensure that young people have access to information and services that they need and respect, and to support and protect their ability to make decisions. Easy to say and so much harder to do, but we are going nowhere unless we get over our paralysis.

Kate Iorpenda is senior advisor on children and impact mitigation at the International HIV/AIDS Alliance,

The International HIV/AIDS Alliance is supporting the Support. Don’t Punish campaign ( which calls on governments to bring an end to the criminalisation and punishment of people who use drugs.

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