 Thank you Rick. Well that last trailer of a movie was really moving. I'm happy to see these things. Let me start by saying that it is indeed an honor for me to be present here amongst all of you at this very important conference. Indeed I'm privileged to deliver the plenary address at this opening ceremony on an issue which is very close to me and my heart. I'm thankful to the Harm Reduction International, especially my very old friend Rick Lyons. I still remember meeting him in London where he gave me a pep talk on a number of issues for inviting me to present this address. I also want to thank the local organizers in Kuala Lumpur, the Malaysian AIDS Council for the generous hospitality that I have experienced since I arrived in Kuala Lumpur yesterday morning. I was also privileged to meet people who used drugs yesterday who gave us an idea of the problems in Malaysia. Let me also thank the Honorable Minister of Health of Malaysia, Baibi Datuk Siri, Dr. S. Subramanyam for being present here and to engage and his promise to engage further in deliberations about the issue of drug use and I may note and he made that clear to engage with the people who use drugs in the policy that is to come in the future in Malaysia. It is indeed important that communities and persons working for drug users, people using drugs must be engaged in the dialogue. That was the reason that the Malaysian government was able to change its policies in harm reduction and provide leadership in the region. It is indeed appropriate that the 24th International Harm Reduction Conference is being held in Malaysia which embraced harm reduction services for people who inject drugs and on this I must acknowledge the leadership of my very close friend Dr. Adiba Kamarazam and of course Dr. Raj Karim. Hopefully this conference will allow us in the Asian region an opportunity to critically examine the laws, policies and practices invoked today in our region, reflect on them and consider what we should do at the UN gas which will debate the issue in April 2016. The UN gas initiative was taken by the Latin American countries to make corrections to let me make it very clear disastrous laws, policies and practices relating to drug use internationally and domestically and which affects all people not only people using drugs but everybody in a very adverse way. Since we are in Asia then we say that traditionally in our region drugs such as opium, cannabis, kratum, kath and other drugs have been used traditionally for medical, religious or cultural purposes. For example opium were used for medical purposes across Asia from Persia to China including Indonesia. In Persia Avikana's treatise Canada on Medicines discusses the therapeutic use of opium extensively. Smoking it with tobacco as madak became common in China particularly in ritualistic and social gatherings. Cannabis too has been used for hundreds of years in Asia particularly in India where it has been described by one of our parliamentarians as a way of life besides being a medicine in indigenous medical systems such as Ayurveda, Tibetan medicines and Chinese medicine. Kratum has been used traditionally both in Thailand and Malaysia for medicinal purposes, cultural and other purposes. I was informed yesterday that there was an attempt to ban kratum fortunately that did not succeed. Similar cultural practices existed in South America amongst native communities particularly relating to drugs like coca. The present laws, policies and practices the world over are a product and mandated by the UN conventions of 61, 71, 88. However their origins lie in the 19th century notions among moral and evangelical groups about the use of opium and cannabis in the erstwhile colonies whose lobbying amongst governments and international organization culminated in universal drug prohibition. This was despite that it be noted the findings of the opium and hemp commission in the late 19th century that mild and moderate use of these substances is not deleterious to health. However the prejudice of Western moralists and evangelists against local practices was so much that the therapeutic benefits of cannabis for example were not acknowledged in modern medicine for a long time. It is therefore ironic that countries in Europe and North America are now rediscovering as it were the medical use of cannabis and even changing the laws to allow medical dispensation whereas our traditional medical practices are lost on our governments. I have no hesitation in saying that for societies in Asia drug prohibition is a historic wrong which needs to be corrected. Significantly all the three drug conventions recognize that their primary objective is protecting the health and welfare they use the worst mankind but I'm using humankind. Surely the measure of success of these policies adopted pursuant to these conventions should be judged on health and human indices. Unfortunately evaluation of drug policies is done on the basis of enforcement measures, the number of seizures, the amount of seizures, numbers of persons arrested and convicted. This is because conventions mandate criminalization of activities relating to narcotic drugs and psychotropic substances including cultivation, manufacture, trade and transport and more particularly the use and possession of drugs outside the medical and scientific use. All the evidence shows that while seizures of drugs and arrests and incarcerations have increased over the years yet the world has not become drug-free. While short-term successes may have been achieved the long-term effect is actually producing a stimulus to illicit drug production. Illegal drug manufacture and use is simply increasing. Thus for example global opium production has doubled every decade 1200 tons in 1971, 2,600 tons in 87, 4,800 tons in 1997 and predicted to be 40,000 tons in 227. The inevitable conclusion is that the prohibitionist drug laws, policies and practices have simply failed to achieve the objective of a drug-free world or getting rid of drug addiction. However the irony is that most public servants, be it police or judges, believe that they are doing the right thing by arresting and jailing person for using drugs. Let me tell you recently I was arguing a case of a person, a Japanese young person in India who was arrested and convicted for possessing cannabis. When I argued the matter in the Supreme Court the judge's reaction was cannabis. Well I'm sorry we are not going to entertain your opinion. That's the prejudice in most societies amongst the establishment. According to some authors the failure of war on drug strategy is because of the failure to appreciate the market dynamics of drug production, the establishment and that of increasing demand. This view in my view rightly argues that in the 18th century opium was transformed from a luxury commodity to a commodity of mass consumption just like coffee and tobacco. Over the last 200 years opium has emerged as a major global commodity similar to other stimulants such as coffee and tea and I would like to add alcohol and tobacco. Suppression of demand operates like the application of a pressure on a balloon. You squeeze one part of the inflated balloon on the other side. This is exactly what is happening in the war on drugs where suppression of drugs in one region leads to the emergence of production and supply in other regions and more so as also the emergence of new psychoactive substances which are impossible to control. Portunately the prohibitionist regime spawned criminal syndicates and gangs who thrive on exorbitant profits to be made because the drugs are illegal and because the illegal market operates. Prohibition has also been responsible for trade shifting from opium to heroin and from opium smoking to injecting heroin and the consequential transmission of communicable diseases including HIV and hepatitis B and C. If one were to evaluate the prohibitionist regime in terms of health and welfare of mankind which is its primary objective the failure of the war of drugs is even more compounded. Criminalization results in the incarceration of large number of people for drugs related offenses. In a number of countries nearly half or more of the prison population comprises drug users. Apart from the fact that it's quite a burden on the taxpayers to maintain prisoners drug users do not have any access to the preventive and treatment health services like needle syringe and OST. The already high prevalence of hepatitis C and HIV amongst drug users in prisons is only exacerbated. Harm reduction, promoting and making available and accessible needle syringe and other facilities are well known evidence-based methods known to reduce risk transmission of communicable diseases like HIV and HIV. Similarly evidence-based treatment for drug dependence namely buprenorphine substitution and methadone maintenance or opium substitution therapy is well known. Thankfully because of the HIV epidemic a number of developing countries with a significant push from UNAIDS and the global fund on TB HIV and malaria were able to provide harm reduction and OST services for IDUs in safe havens. Thus in most Asian countries harm reduction and OST service do exist for IDUs. However in most of them they have not been scaled up and are not made accessible to the people who really need them. As criminalization of drug use persists in some of the countries and most of them rather drug users are stigmatized not all of them are able to access harm reduction services. This increases the risk of transmission of communicable diseases. Thus levels of serial prevalence of HIV and hepatitis C is very amongst very high amongst injecting drug users in developing Asian countries compared to say developed countries for example Australia. The position for hepatitis C is much worse than HIV. While governments across the world were constrained to introduce harm reduction services because of the HIV epidemic with the waning of HIV which is no longer an issue in a country like India there is a real danger that such services may not be available in the future to drug users in such countries. This is going to be exacerbated by the withdrawal of the global fund from middle income countries who will not be able to have the money to provide such services. This is a matter of urgent concern. While HIV has been addressed in the past hepatitis C a larger and a rising epidemic has been completely ignored in the developing countries and this actually afflicts injecting drug users the most. This is because we have seen the problem from the perspective of the disease in a silo and not holistically addressing the problem of the drug user or the patient comprehensively. The roots of transmission for HIV and hepatitis C are very similar but hepatitis C is more transmissible than HIV. However serial prevalence of HIV is over four times higher than HIV. Vulnerable groups particularly people who use drugs are co-infected with HIV and TB and now with HCV. There's an urgent need to address hepatitis C epidemic and make available not only facilities for testing but also make treatment available for those people. Fortunately now with the advent of new and better drugs hepatitis C is completely curable across genotypes within a short period of time. The traditional treatment of Pagylated Interferon with Rebevrin to which not all genotypes respond positively is now superseded by treatment of direct anti antivirals amongst them sofasavir, decretasavir and adipasavir. With the combination of all these drugs all genotypes can be cured. However the drugs are prohibitively expensive. Sofasavir is available in the US at $84,000 for a course of treatment. In India multinational drug maker Gilead has entered into voluntary licensing arrangements or agreements with Indian generic companies with restrictive conditions. Significantly they don't allow exporter of those drugs to high burden hepatitis C countries like those in Latin America, the Mina region, Central Asia, Eastern Europe and Southeast Asia. The availability of medicines from Indian generic companies to those in the developing world which was taken for granted in the HIV era is now under threat particularly in the context of hepatitis C. This is a major problem which has to be addressed by treatment activists. That apart in some countries in the region treatment that is administered to people using drugs on the basis that all of them are drug dependent persons and not based on OST which is evidence based. Authorities in the region resort to compulsory detention and treatment programs of persons who are allegedly drug dependent. Firstly there is no scientific basis of determination of drug dependence in these countries in their laws. Only urine analysis are resorted to. Thus even persons who are not drug dependent are forced into compulsory detention centers. Sometimes these are accompanied by punishment, sometimes were forced unpaid labor, solitary confinement and even experimental treatment without consent. A vast majority of drug users who pass through such compulsory detention centers return to drug use after the period of compulsory detention and the so-called detoxification programs. As the UN special reputer on the right to health I reviewed these practices of compulsory drug treatment centers and found them incompatible with and indeed in violation of the right to health enshrined in the International Covenant on Economic, Social and Cultural Rights. The punitive approach to drug use has resulted in a large number of countries numbering about 33 out of which a large number are in our region resorting to death penalty for certain drug-related offenses. Apart from the fact that death penalty does not achieve its stated objective of deterrence, resorting to it for drug-related offenses is contrary to international law which mandates first the progressive reduction of capital crimes aimed at the abolition of death penalty and secondly and more importantly restricting it to the more serious of crimes such as those that result in the death of another person. International law does not recognize drug offenses as the most serious crimes. Unfortunately despite that that death penalty continues to be used in a number of countries. Moreover about 10 countries have mandatory death penalty for drug-related offenses again a majority in the Asian region. In constitutional jurisprudence, mandatory death penalty has no place as it takes away the judicial discretion in sentencing. The other very serious and deleterious consequence of criminalization of drug use is that millions of people worldwide who require essential medicines for treatment and palliative care are unable to access them. Excessive restrictions and sanction imposed by law instills fear in the medical community of falling foul of the law. This results in the lack of availability and accessibility of drugs like morphine required as a painkiller for patients suffering extreme pain in the terminal stages of cancer and HIV. The lack of access is particularly acute in developing countries. Now the most common used anesthetic ketamine is also sort of be included as a restrictive substance internationally. Significantly over 90% of all the legally controlled medicines are consumed in North America and Europe. As a result over 70% some say even 90% of the patients in developing countries who require such essential medicines do not have access to such medicines. Tomorrow the global commission on drug policy is releasing a report on this issue and I hope you'll be able to access that report and find out more about that. While all these are serious and unfortunate consequences of drug prohibition the most profound impact and I speak this from a personal experience interacting with my clients the most profound impact of criminalization is an impairing and impinging on the dignity of people who use drugs. Seen as morally depraved and blame worthy the people who use drugs are treated less than human undeserving of respect rights and opportunities. Not only do others state in society treat people who use drugs with contempt sometimes they themselves imbibe these values of unworthiness and denigrate themselves. Nothing can be more sadder than that. So what is the way forward? The conference this conference in the context of Ungas in April 2016 in New York is an opportune moment for all of us particularly the activists particularly the people who use drugs and who are here to dialogue with the government to take the issue forward and propose necessary changes in the laws policies and practices which exist not only in our own countries but all over the world. First of all as the global commission has mentioned there must be a debate on these vital issues beyond if I may say so of harm reduction. In all circles political and legal and social. Secondly the fundamental premise of any response has to be that the people who use drugs must be accorded all respect and dignity and be treated without discrimination. Third there must be a recognition that the strategy which has been used till today the so-called war on drugs has completely failed and has had disastrous consequences on the health and welfare of humankind. Unfortunately in our region the recent ASEAN ministers meeting failed to acknowledge this and announced that the flawed prohibitionist policies must continue. It is our duty as activists to engage in a dialogue with our respective governments to change that point of view. Fortunately there are winds of change. The United States which initiated and has been in the leadership on the war of drugs is seeing those very changes. A number of states there have seen the futility of those and started legalizing the use of marijuana. The response again must be based on the primary objective of the conventions that is the health and welfare of humankind and on the right to the health framework enshrined in article 12 of the International Covenant on Economic, Social and Cultural Rights which mandates that health, good services and facilities be made available, accessible and be of good quality and be available and accessible without discrimination. The punitive regimes of drug laws must be replaced with regulatory measures. If we can deal with alcohol and tobacco there is no reason why we cannot do this for other drugs. Please appreciate that for tobacco which is very very harmful smoking it there is a framework convention on tobacco control which actually says that you should educate people not to smoke tobacco or not to chew tobacco. Why can't we have that for other drugs? As you remember I mentioned early on in the last century the Indian Hem Commission, a British government body said that mild and moderate use of opium and cannabis is like alcohol. So why can't we have a regulatory system? Health, goods and facilities and services must be made available and accessible without any discrimination. Preventative and treatment services including harm reduction must be again made available without discrimination and most importantly and this is my respectable submission, death penalty for drug related offenses must go. It has no place in a civilized society. This can be the basis of discussions with our respective governments. They may not agree with us today but the persistence and the determination of our activists, our comrades who are working and who are people using drugs, their passion, their courage and determination like Robert Bruce will knock on the heads of the governments and change their policy in time to come. I'm sure that these policies will change. Never give up hope. In the era of HIV epidemic we learnt that the rights-based approach works. The key component of that strategy was the involvement of the affected communities in shaping the response. It is my respectable submission that it is our duty here and now to learn what we can go back to our respective countries and inform and have a dialogue with the government and tell them nothing about us without us and change their policies towards drug use. I've learnt that we can change laws, policies and practices on a number of issues if you are passionate about our cause and I've seen the passionate determination amongst the persons who receive the awards. I know you can do it and don't give up. Thank you very much.