On 17th June, I attended the final annual meeting of the Partnership Cooperation Programme between the European Union and Latin America (COPOLAD) – a four-year project funded by the European Commission, aiming to consolidate the mechanism between the EU and CELAC (the Community of Latin American and Caribbean States), exchange evidence and best practice on demand and supply reduction, and strengthen national drug observatories. IDPC, as an associate body, has been involved in this mechanism since 2012. Other members include government officials, and multilateral organisations such as the Pan-American Health Organization (PAHO) and others.

This specific meeting was focused on exchanging information and best practice around health-based drug policies. It was refreshing to hear so many government officials both from Latin America and Europe discussing the need for evidence-based drug treatment, but also for access to harm reduction services and for the decriminalisation of drug use. Last year, opinions were already shifting away from tough prohibition when participants attending the third COPOLAD annual conference discussed the over-incarceration of women for minor trafficking offences throughout Latin America. Then, government officials could not help but acknowledge the failure of the war on drugs and the need to review drug policies so that those most vulnerable and marginalised should not bear the costs of a failed approach.

This June, government and regional representatives used the COPOLAD platform to promote examples of best practice from Europe and Latin America on how to best protect health in the framework of drug laws and policies. Luis Alfonzo Bello, from PAHO, made a particularly strong call in his pre-recorded presentation on the need to review the focus of our policies to include a wide range of health and social interventions for people who use drugs, with the active involvement of civil society. Subsequent panel discussions were marked by presentations from Chile, Spain, Colombia and Brazil, all calling for evidence-based approaches to reduce harms. Portugal was also given the chance to present its decriminalisation policy and the beneficial effects in terms of improved health and social outcomes in the country since 2001. As for Uruguay, the new cannabis regulatory regime was not mentioned here, but the Drug Coordinator rather focused on the health-based approach it has adopted for the past decades to ensure that people who use drugs have access to the health services that they need, without fear of stigma or arrest – drug use has never been criminalised in the country.

As a representative of IDPC, the only NGO representative alongside RIOD (Red Iberoamericana de ONG que Trabajan en Drogodependencias) involved in COPOLAD, I was given the opportunity to present IDPC’s project on “Modernising drug law enforcement”. The objective of my presentation was to explain how policing and drug law enforcement efforts can support, rather than undermine, programmes aimed at improving the health of people who use drugs. I gave a range of concrete examples, such as the London police support for NSPs in the 1980s-1990s, or the role of the police in Geneva or Vancouver in encouraging people to use their drugs in the city’s safe injection facility to reduce overdose deaths and risks of HIV and hep C infections. Overall, this new focus for police and law enforcement officers was well received by the participants, although these examples will clearly need to be adapted to fit in the Latin American context.

The meeting ended with some key information about what to expect out of Phase 2 of COPOLAD, which is planned to start in early 2015. Teresa Salvador-Llivina, the coordinator of COPOLAD – who has been fantastic in moving this ambitious project forward over the past four years – made two welcome announcements. Firstly, the regional scope of the project will be expanded to include countries from the Caribbean. This will be an interesting addition to the project and a way to promote more information sharing with the region. And second, there was a welcome acknowledgement that civil society should be better involved in the second phase of the project. IDPC will continue to engage in this interesting mechanism and, alongside RIOD, will continue to promote the voice of civil society in the debate.

Marie Nougier, IDPC Senior Research and Communications Officer

COPOLAD: Protecting health, rethinking policies

As it its customary practice, the UNODC released its flagship publication on June 26th, the UN's designated 'International day against drug abuse and trafficking' as well as the occasion of the 'Support Don't Punish' day of action, which seeks to draw attention to the collateral damage of the 'war on drugs'. So the growing debate over the failure of the international drug control system, which has now entered mainstream political discussion, provides the context for the publication of the most recent World Drug Report.

UNODC Executive Director Yuri Fedotov acknowledged that the Report is being published at a key moment for drug policy. As ever, the UN claims to be external to these disputes and to constitute a neutral source of data, the Report continues to position the UNODC as a supporter of the current drug control regime and the international treaties that underpin it. In his Foreword, Mr. Fedotov refers to the recent Commission on Narcotic Drugs as providing a 'much needed forum for an open and inclusive dialogue', and to 'a shared understanding of a way forward' to counter the 'world drug problem'. This, at best, is wishful thinking. The Report's fundamental terms are not up for negotiation. What exactly the 'world drug problem' 

 (i.e. the lack of access to essential medicines for billions of people, the alienation produced by drug law policing, the market opportunity the system offers to organised crime) is a question that the Report does not ask, let alone answer.

As to the main body of the 2014 World Drug Report, the most prominent headlining issue recalls a familiar narrative at the UNODC: the stability of global drug use, its containment by the present drug control arrangements, which restrict drug use to about 5 per cent of the world population – some 243 million individuals having illicitly consumed drugs in 2012. 'Problem drug users' have meanwhile continued to represent about 0.6 per cent of the global population, around 1 in every 200 individuals. Opium production in Afghanistan and Myanmar has expanded, while Novel Psychoactive Substances continue to proliferate. Global use of cannabis 'seems to be down', but has increased in North America. Although these data can inevitably only provide us with approximations, they are impressive enough, and will be analysed in depth when IDPC produces its annual response to the World Drug Report (to be released in early October).

But for now, in the build up to the UN General Assembly Special Session (UNGASS) on Drugs in 2016, when the consensus of which the UNODC speaks is fast disappearing, a more clear-eyed recognition of the facts is needed. As countries around the world grow weary of a system devised in very different circumstances and that fails to meet the policy needs of the contemporary age, the time for platitudes is surely past.

2014 The World Drug Report: The Titanic sails at dawn

I met Apit for the first time when I visited Penang, Malaysia, in December. He is the President of the Malaysian Welfare Association of Recovering Drug Users (WARDU), which was set up to provide care services for people who use drugs after the Malaysian Network of People who Use Drugs (MANPUD) was forced to adopt a lower profile due to sensitivities with drug user organising in the country.

Apit talked about his experience as a drug user in Malaysia, saying that he first started using cannabis when he was a teenager, knowing that he was not dependent on it. But when police enforcement made getting cannabis more difficult, he tried heroin and got ‘hooked’ on it. He later got arrested and was detained in a compulsory treatment centre for three years, during which he took part in ‘work therapy’ (working as an electrician in buildings and homes in return for fees at below market rates) and therapeutic communities. Apit says the forced detoxification process while in compulsory detention was very hard, and it did not involve medically assisted withdrawal.

Upon release from compulsory detention, Apit was not offered any assistance with reintegration, but placed on a two year supervision order which involved reporting to both police and the national anti-drug agency (NADA), and undergoing a urine test for drug use, every 2 weeks. It felt like he was still criminalised even after completing the three years of ‘compulsory treatment’. Apit could not find a job because his record of having been in compulsory detention for drug use shows up during security vetting processes by employers, which is regarded the same as having gone to prison. He ended up living at the town’s dumpsite, along with many other people who use drugs, trying to make a living from collecting and re-selling trash. Drug suppliers go there to sell drugs, and there are high rates of HIV and Hepatitis C amongst the people living there.

Now, Apit does odd jobs to make a living to help support his son and daughter together with his wife, who has a full-time job. He says that conditions are better now because people who use drugs can get referred to NADA’s voluntary treatment centres instead of compulsory detention (although Malaysia still retains its ‘compulsory treatment’ system and the drug law only allows for people who use drugs to be sent to prison or compulsory treatment centres). But there remains many challenges for people who use drugs, particularly being able to access health, harm reduction and job opportunities free from stigma and discrimination. Apit now works with WARDU to provide welfare assistance for people who use drugs and their families, and is focusing on three key issues in their advocacy activities:

Increasing coverage of harm reduction services (MMT and needle & syringe programmes) and Hepatitis C treatment

Providing income generation opportunities for people who use drugs, especially those who completed terms in compulsory detention centres, and

Changing public perceptions about people who use drugs to increase support for the provision of health services and jobs for people who use drugs.

WARDU will be joining the Support. Don’t Punish. campaign in Kuala Lumpur, Malaysia on 26 June 2014. Show your support and join them too!

Support people who use drugs in Malaysia - Join Support. Don’t Punish. on 26 June 2014!

Two years ago, I was invited by Kofi Annan – the former UN Secretary-General – to join a group of high-profile political and public figures from West Africa to review the region’s drug problems and drug policies. We were to be among the first voices from the region calling for a change in approach, and it was a daunting task. But one that I was happy to accept.

This month, the West Africa Commission on Drugs launched its report – “Not Just in Transit: Drugs, the State and Society in West Africa”. The Commission is chaired by Olusegun Obasanjo (the former President of Nigeria), and includes Kofi Annan, the former President of Cape Verde, the former Prime Minister of Togo, and Oumou Sangaré (the Malian singer/songwriter), among others. After much deliberation and consultation – including visits to some of the most affected countries in the region – our final report makes clear calls in support of harm reduction and policy reform in West Africa.

We are clear that drugs represent a challenge and a threat in West Africa, but not one confined to transit and trafficking, but also to drug use and drug production. In the report, we conclude that drug use must be regarded as a public health issue – in line with the Support. Don’t Punish messages. We state that “the consumption and possession for personal use of drugs should not be criminalised” and that “West Africa must not become a new front line in the failed war on drugs”. We call on politicians across West Africa to change laws and policies that have not worked, and in partnership with civil society. Drugs have harmed many people, but bad drug policies are harming many more.

The launch event itself attracted a lot of local and international media attention. We launched a series of engaging videos to complement the report, and will spend the next year reaching out to governments to promote and discuss our recommendations.

The launch was followed by an engaging meeting for around 30 West African civil society partners to discuss the report and to forge a new drug policy network for the region. I was privileged to be part of this meeting, at which IDPC presented alongside other partners. Civil society organisations in the region have an important role and responsibility to hold governments accountable for failed or harmful drug policies that impact greatest upon the most vulnerable – because when the elephants fight, the grass suffers.

This is a new conversation and a new debate for many West Africans, and I look forward to continuing this work alongside the Commission, IDPC, the Kofi Annan Foundation and other partners in the coming years.

Keep up-to-date with drug policy developments by subscribing to the IDPC Monthly Alert.

Opening up the policy debate in West Africa

The room was full at “How the war on drugs impedes economic development,” an event organised in New York City by Open Society Foundation’s Global Drug Policy Program in partnership with the Permanent Mission of Colombia to the United Nations and the Permanent Mission of Mexico to the United Nations. The intention of the event was to foster open dialogue and debate about the links between drug policy and development, particularly in preparation for joint advocacy at the 2016 UNGASS. Speakers discussed the costs of the war on drugs and the negative effect prohibitionist drug policies have had on the development of countries in the global south.

Alejandro Madrazo Lajous (Centro de Investigación y Docencia Económica) argued that we have underestimated the cost of the war on drugs by excluding constitutional costs from the tally. These costs arise from undermining key constitutional commitments that exist in political communities, and have had a very real impact on day-to-day life in Mexico. The curtailment of rights, for example, is a constitutional cost that is borne when certain groups give up some of their rights. This is apparent when fighting the war on drugs, as it is not uncommon for drug offenders (particularly low-level drug traffickers) to be denied due process and therefore not receive all the legal rights they are owed. A second constitutional cost is the conflation of functions, such as using the military to do police work. The real impact of this cost is most evident in the lethality index, a ratio that demonstrates how lethal the force used by law enforcement is by calculating how many people were killed compared to how many people were injured by the police. The lethality index in Mexico has risen to levels similar to war zones since the military were employed as policemen, and now stands at an average of 7.3! When altering the relationship between the military and citizens, the specific training of the military and how it contrasts with that of police is often not considered. Since the military are trained to kill the enemy rather than do police work, this example of how constitutional costs play out on the street should not be unexpected. Changing core political commitments in order to fight the war on drugs is problematic not only because this essentially leads to a change in the identity of communities, but also because they are often changed without any explicit discussion or acknowledgement. Fundamentally altering the constitutional commitments agreed upon in a society without making an active and inclusive choice to do so is simply unacceptable.

Daniel Mejía Londono (Universidad de los Andes and Research Centre on Drugs and Security) asserted that prohibitionist drug policies pass the cost of the war on drugs from consumer countries to producer and transit countries. In a regulated market, consumers would bear a great deal of the costs associated with illicit substances, as prices would take into consideration externalities. However, in a prohibitionist regime, higher prices only arise as a result of the supply reduction efforts in producer and transit countries. Hence, producer and transit countries take on a great deal of the work not only in supply reduction, but also in demand reduction by raising the price of substances. This is done at a very high cost to the main engines of economic growth and development, namely human and physical capital accumulation and institutional stability. Significantly increased violence, environmental and health costs, loss of confidence in the state, and direct fiscal expenditures are all associated with prohibitionist drug policies in the global south. Importantly, in addition to hampering economic development, supply reduction tactics often do little to curb the drug trade. In the case of aerial spraying for example, only about 0.15 hectare of coca is actually removed from the drug trade for every hectare sprayed, meaning that a hectare must be sprayed between 7 and 10 times before it is truly destroyed! Resources used on ineffective drug strategies, which have serious negative consequences on the environment and on the health and economic wellbeing of farmers and communities, could be used for programmes that promote socio-economic development – a point that is especially salient when one considers that Colombia spends more than two times what it does on social programmes (which include health, education, and everything in between) on fighting the war on drugs.

Speaking about Africa, Isidore Obot (University of Uyo) cautioned that nations are headed towards making the same mistakes, and bearing the same costs, as countries in Latin America. Although heroin and cocaine were originally limited to trafficking in Africa, consumption of these substances is now a growing problem. Unfortunately, nothing effective is being done in response. The focus remains on law enforcement, with success measured by the number of arrests and seizures. Policies are punitive, with all use and possession being criminalised. Rather than being driven by evidence of effectiveness, polices are designed to meet external considerations and optimise foreign relations. This is most evident by the lack of adequate access to treatment, while those that are available are run by psychiatric hospitals or churches and are abundant with human rights abuses. Harm reduction is nearly nonexistent and has no support from governments in the region. Although there is often general agreement about changes that must be made, such as the implementation of effective prevention and treatment, little is actually done. For a continent that is already confronted with a myriad of obstacles to economic development, ineffective drug policies are a problem Africa does not need.

Representing UNDP, Nicola Palmer stated that their stance on the drug policy discussion is that all efforts to respond to the world drug problem must be in line with the three UN drug conventions, but also with human rights. UNDP advocates for rebalancing the policies of member states to emphasize interventions that target effective prevention, treatment and social integration. Rather than an exclusive focus on demand and supply reduction, integrated responses to the drug problem are necessary. The UNGASS presents a crucial opportunity to refocus international drug policies in this way. Therefore, Ms. Palmer stated, we must capitalise on the preparations for the UNGASS to make the links between drug policy and development clearer.

As the UNGASS approaches, there has been significant focus on connecting drug policy to other issues, especially to economic development. We know a great deal about the harms of current drug policies on economic development, both in terms of direct costs (such as the resources spent on these policies and the elimination of crucial sources of income without creating viable replacements) and indirect costs (by escalating violence, destroying land resources, and damaging the health of affected communities). Understanding these linkages is crucial, but as was revealed in the question and answer session, a great deal of work remains. How the development and drug policy communities can work together in preparation for the UNGASS remains to be seen. One thing is certain – development of life in the global south cannot occur without changes in current drug policies.

Keep up-to-date with drug policy developments by subscribing to the IDPC Monthly Alert.

War on drugs in the global south – Standing in the way of development

At a regular ‘drug policy watch’ meeting organised by Thai CSOs in April, attended also by IDPC and the Law Reform Commission of Thailand (LRCT), I reported on some of the key outcomes of the UN Commission on Narcotics Drugs held in March (CND). None of the Thai CSOs, including IDPC member the 12D Network, had attended and it seemed relevant to share with them our perspective on Thailand’s role in the global drug policymaking body, especially their priorities and position on key topics such as the death penalty, controls on ketamine and civil society engagement.

We had met with members of Thailand’s delegation at CND and noted their statements during the plenary and roundtable sessions, particularly the fact that Thailand remained neutral on whether to call for abolition of the death penalty for drug offences, and sponsoring of resolutions on controls over ketamine, the new MOU between countries in the Greater Mekong Subregion, the UN Guiding Principles on Alternative Development, and drug use prevention. For a record of these statements, please refer to our blog on statements made during CND: www.cndblog.org.

In response, the CSO representatives at the Thailand drug policy watch meeting asked IDPC and the LRCT to co-organise a dialogue involving Thai delegates to the CND and Thai CSOs. They were keen to hear more from Thailand’s delegates on the outcomes of CND and the implications for Thailand. To prepare for the meeting, IDPC drafted a briefing paper on the role and function of CND, key outcomes of CND 2014 relevant to Thailand, and suggested discussion points to help prepare for CSO engagement in CND 2015 (prospects for civil society participation, and open and objective drug policy debate, especially in preparing for the 2016 UN General Assembly Special Session on the world drug problem).

At the meeting, Thailand’s drug control agency (ONCB) presented their priority issues (decriminalisation of kratom and other drugs, alternatives to prison, death penalty, harm reduction, drug use prevention based on scientific evidence, controls on new psychoactive substances and CSO participation) and key engagements (resolutions on the new MOU with Greater Mekong Subregion countries and using sport to prevent drug use, and meetings with countries such as Colombia on alternative development and organisations such as the Colombo Plan about training on drug treatment) at CND 2014.

Other delegates from other ministries such as health raised the possibility of amending Thailand’s approach to drug treatment in response to international criticism about the use of the criminal justice process to assess drug dependence and treatment needs which provoked a lively debate between government representatives.

Representatives from quasi-governmental organisations working on drugs called for a more open, objective drug policy dialogue on alternative options, including decriminalisation, reducing harsh sentences for drug offences and involving people who use drugs in making drug laws and policies, reiterating the need for change from drug policy approaches that have repeatedly proven to be ineffective. CSO representatives focussed on calling for the government’s support for civil society engagement in CND processes.

The ONCB seemed reluctant to welcome the engagement of Thai CSOs. However as chair of the meeting, the LRCT urged the ONCB to work to find ways of enhancing civil society engagement and promised to help maintain the momentum of drug policy dialogue in Thailand. Though now under military control, it is hoped that some space for open, inclusive drug policy debate can be sustained, especially as Thailand is likely to chair the next CND in 2015, a key moment in preparations for UNGASS 2016.

Promise of civil society engagement from Thailand in global drug policy debates

At its recent session, the International Narcotic Control Board elected a new bureau and new President. This signals a farewell to Mr Raymond Yans, who served as the INCB’s last President. While the organisation is generally viewed as a highly conservative one, strongly opposed to reform and apparently viewing the international drug control conventions as eternal Truths carved in stone, the Presidency of Raymond Yans was a particularly controversial one. His interpersonal manner was often considerably less than diplomatic, referring to the elected government of Uruguay as 'pirates'. He was consistent in his resistance to the place of human rights in drug control, and openly hostile to those elements of civil society whose views he did not share. Amongst those who believe that some level of reform is necessary if the drug control system is to engage the realities of drug consumption in the globalised world of the twenty-first century, it is fair to say that Mr Yans will probably not be missed.

His successor is Mr Lochan Naidoo, a Family Practitioner from Durban, South Africa, who is something of an unknown quantity for civil society. On the positive side, Mr Naidoo immediately took the opportunity to state his passionate commitment to ensuring that adequate access to essential medicines is achieved. On the negative, he is rumoured to share many of Raymond Yans’ attitudes and beliefs. At IDPC, we hope that it will be possible to achieve a more productive and mutually respectful relationship with the new President, and welcome him to his post at the critical juncture for international drug policy.

Farewell Mr Yans

Speech by Yury Fedotov, Director General/Executive Director, UNODC

Mr. President,
Members of the Board,
Ladies and gentlemen,

Allow me to begin by congratulating President Naidoo on his election, and to say thank you to President Raymond Yans for his hard work and dedication.

I look forward to continuing our work together, particularly in this important period following the High-Level Review of the CND and leading to the UNGASS on the world drug problem in 2016.

As you may know, the 2014 World Drug Report will be launched on 26 June in Vienna at a special event of the CND.

The report devotes a thematic chapter to the control of precursors. My thanks to the INCB Secretariat for the good cooperation in this area.

This chapter notes the success of improved monitoring, strengthened international cooperation and joint actions, often undertaken under the auspices of the INCB.

It also highlights the vulnerabilities leading to diversion, stemming from a globalized trade involving the use of ever-more intermediaries and brokers in the supply chain.

There are instruments available at the international level to deal with these challenges. But they have yet to be effectively used in a number of countries, and their universal implementation would be an important step forward.

The report also addresses the new regulatory frameworks in the States of Colorado and Washington, and in Uruguay.

While it may still take some time to evaluate the overall impact of these changes, based on existing research it appears likely that, with declining risk perceptions and increased availability, use may increase. We will continue to follow developments closely.

Additional challenges identified in the report include the continued increase in the production of amphetamine-type stimulants, and a strong rise in the production of NPS.

Furthermore, there remain serious gaps in service provision, with only one in six problem drug users having access to or having received drug dependence treatment services.

Every year, up to 200,000 people die as a result of drug abuse, mostly as a result of overdose - a preventable condition if adequate measures are in place.

Moreover, 13% of the total number of people who inject drugs are living with HIV, and 52% are living with hepatitis C.

The new set of data on access to services for prevention, treatment and care of HIV presented in this year's World Drug Report can support Member States in addressing this crucial area more effectively.

As we saw at the recent High-Level Review, there is broad understanding and agreement among Member States on the importance of evidence-based, health-centred approaches to address the world drug problem.

I particularly welcome the clear recognition of the value of science in these efforts.

The Scientific Consultation organized by UNODC during the High-Level Review helped to further strengthen links with the academic community, and we are considering ways to maintain this engagement on a regular basis.

The UNODC model law is also being revised to better reflect the health and human rights-centred approach to drug control, and we hope to conclude this process by October.

This action follows a CND resolution requesting UNODC to carry out a review of the drug control model provisions in consultation with the INCB and WHO, in particular with the aim of improving access to controlled medication.

The review covers several issues that are directly related to the mandate of the INCB, and we look forward to receiving your feedback on the current text.

At the same time, UNODC is continuing its efforts to enhance regional and inter-regional coordination to pursue and dismantle drug trafficking networks.

Our new "networking the networks" initiative aims at promoting closer cooperation between existing law enforcement coordination centres and platforms to help leverage their combined strength.

The Joint Ministerial Statement resulting from the High Level Review reaffirmed the international drug conventions as the health and human rights-centred cornerstone of the drug control system.

I think we can all agree that this provides a strong basis for the continued dialogue on global drug policy as we head towards the 2016 UNGASS.

The CND at its 57th session adopted by consensus a resolution entitled "Special session of the General Assembly on the world drug problem to be held in 2016", which paves the way for the UNGASS preparations, and specifies the leading role to be played by the CND.

The Commission, under its chair, Ambassador Shamaa, has immediately started implementation of the resolution, in particular through the initiation of a broad process of consultation with all stakeholders.

A new website, ungass2016.org, has also been created to support this.

INCB has been invited to actively participate, and I am looking forward to receiving the contribution of the Board to this very important process.

Thank you for your attention, I wish you a productive session.

Assessment of the drug control situation by UNODC 110th session of the INCB

At its 110th session INCB will examine overall treaty compliance by selected countries; the supply of opiate raw materials and demand for opiates for medical and scientific purposes; as well as new psychoactive substances.

VIENNA, 19 May (UN Information Service) - The new President of the International Narcotics Control Board (INCB), Lochan Naidoo of South Africa, said today he was passionate about ensuring adequate prevention and treatment of addiction and the availability of internationally controlled medicines for pain treatment and for treating mental and neurological illness.

Mr. Naidoo was elected today, in accordance with the Board's rules of procedure and practice, at the Board's 110th session that is taking place in Vienna from 19 to 30 May. The INCB also elected the members of its Bureau. The new President underscored his commitment to fulfilling the INCB mandate of promoting and monitoring the implementation of the international drug control treaties, which, he noted, "is all the more challenging at a time of increased debate at the national and regional levels on drug policy, and as the international community prepares for the 2016 General Assembly Special Session on the world drug problem". "I am passionate about ensuring adequate prevention and treatment of addiction and the availability of internationally controlled medicines for pain treatment and for the treatment of mental and neurological illness worldwide," he said.

The International Narcotics Control Board elects new President and Bureau

An event organised last week by the Criminal Justice Centre, School of Law, QMUL and DrugScience titled “New Psychoactive Substances (NPS): Science, Law and Policy” offered in-depth discussions of NPS by bringing together academics and practitioners from various backgrounds including science, health, law, market involvement, and drug policy advocacy.

NPS can pose serious harms to health. For researchers working in the field of NPS, the limited accessibility to usage information poses a great difficulty.

Dr John Ramsey explained that there are several traditional approaches to discern which NPS are being used, but each of them has serious shortcomings in terms of accuracy and completeness. Relying on self-reporting, questionnaires, and website monitoring is insufficient since users often do not know the specific compound they are taking. Similarly, police reports and hospital admission staff often fail to accurately record the consumed substances reported, making this data source unreliable. Death reports produced by coroners are also insufficient, partly because the role of the coroner is to exclude the possibility of crime rather than accurately report the cause of death, and also because the coroner’s report can take up to a year after the death has occurred, a delay unsuitable for responding to the ever-changing NPS market.

So how are researchers gathering reliable data on NPS? By collecting samples from wastewater (sewage) and pooled urine! There are, of course, limitations to these sources as well. The former can only provide information on commonly consumed substances, as there has to be a high level of drug use for it to be detectable in wastewater. Pooled urine collection allows detection of substances that would not arise in wastewater analysis; however, as one can imagine, the collections are primarily from male subjects.

Drug checking services were not discussed during the event, likely because the speaker was focusing on methods currently used in the UK. However, it is worth highlighting drug checking as a very successful initiative that allows people who use drugs to know which specific compounds they are taking, and therefore improves public health while also gathering critical data on what drugs are being bought, sold, and consumed. Such a scheme would increase researcher accessibility to information about NPS usage in the UK, and would empower people who use drugs to make informed decisions about their use.

Many believe that there are no laws regulating the sale and use of NPS. However, there are several cases in which some “legal” highs may in fact be illegal. In order to develop a sensible legal scheme to deal with NPS, Professor Rudi Fortson QC explained that we must be aware of existing laws.

In the UK, there have been court cases in which NPS were prosecuted through the Misuse of Drugs Act. One such case found that some of the batches created by a chemist and intended to be NPS in fact produced substances banned under the Misuse of Drugs Act. Another case featured a chemist that, while producing NPS, had to go through various banned chemical compound structures.

NPS can also fall under the “medicines” legislation, which covers 1) any substance 

 as having properties of preventing or treating disease in human beings; or 2) any substance that may be used by or administered to human beings with 

 restore, correct, or modify a psychological function. The first part of the definition explains why retailers present NPS as “bath salts” or “plant food”. The second part means that a product can be considered medicinal even if it has no medicinal value. Since the sale and consumption of unauthorised medicinal products is not permitted by law, if NPS are treated as medicinal products, their sale and consumption can be considered illegal.

Several other regulations can be used to prosecute the sale of NPS in the UK, many of which involve packaging deception (although the average consumer taking NPS usually intends to do so and is thus generally not deceived by the packaging). This was illustrated in Belfast, where the General Product Safety Regulations (which essentially ensures that no manufacturer puts unsafe products on the market) have been employed to discontinue the sale of NPS by all but one retailer – and this last retailer is on its way to court.

For retailers, the limitations on product safety labelling mean that they have to rely on users doing their research and using common sense. There are, however, several voluntary actions taken by in-store retailers to enhance NPS safety, including: lab testing, human testing (retailers and customer groups), single dose packaging, minimum age of 18 (verified via social media checks), refusing sale of excessive quantity, and daily monitoring of the internet for policy changes and other information.

Despite these precautions, within the current legal regulations, retailers are stuck between a rock and a hard place. On the one hand, they cannot present NPS as being for human consumption (and therefore provide all the necessary safety information) because the products may then be considered medicinal. On the other hand, they cannot simply label their products as “plant food” as they will then be violating several packaging deception laws, such as the General Product Safety Regulations. The laws must be revised to reflect a pragmatic solution to NPS that recognizes the existing demand for substances and prioritizes public health.

Conference attendees supported the legal actions taken in Belfast, as most believed that the use of existing legislation should be fully employed before the creation of any new law. Attendees agreed that a blanket ban on the sale of NPS until substances could be adequately tested and proven to pose low harm for human consumption was an appropriate strategy moving forward. However, previous experiences have shown that the banning of all substances is often accompanied with the emergence of their sale on the black market to meet demand, both online and offline. For consumers, this means having access to even less information about what they are purchasing – often resulting in greater levels of harms. Shutting down NPS retailers therefore does not equate to shutting down NPS sales. It is important to move harmful substances out of the marketplace, but without giving consumers viable alternatives, many will turn to the black market. This is what New Zealand has tried to do with their NPS legislation, which will enable the least harmful substances to be sold to meet demand. Such a regulatory framework should be considered in the UK.

This event was the first in a series of conferences exploring the future of pharmacological regulation. Look out for future events by following @Drug_Science, visiting http://www.drugscience.org.uk/, and keeping an eye on the IDPC events page.

All about NPS – Different sectors come together to learn about “legal” highs

By Farah Diaz-Tello, National Advocates for Pregnant Women (USA) and Sebastian Saville, International Doctors for Healthier Drug Policies

This week, despite an extremely inclusive and far-reaching campaign of multiple agencies both in US and internationally, US state Tennessee passed a law that permits assault charges for women who engage in any ‘unlawful’ act that may result in adverse pregnancy outcomes. Much attention has been on how it will be used to punish women addicted to drugs even though this is against advice and evidence from international medical and public health experts. However, while receiving less publicity, of even more concern is the huge discretion given to prosecutors in the application of the law. Depending on the prosecutor, for the same offence, a woman may be charged with a misdemeanor and diverted to a drug court program or instead charged with aggravated assault and sentenced to 15 years in prison.

It is fair to assume that African-American women, because they are most susceptible to poorer pregnancy outcomes regardless of drug use or socioeconomic status, will be punished most severely.

Cherisse A. Scott, founder and CEO of SisterReach, an advocacy organization focusing on African-American women, said in a statement, “This law separates mothers from their children and is not patient-centered. Tennessee families who are already being hit the hardest by policies such as the failure to expand Medicaid, poverty and a lack of available drug treatment facilities will be most deeply impacted by this bill. Mothers struggling with drug addiction in Shelby County, rural communities throughout Tennessee and poor mothers and their families will be the ones who suffer the effects of this dangerous legislation the most.”

Journal of Health Politics, Policy, and Law

 shows that these concerns are well founded. Documenting 413 cases of arrests, detentions, and forced medical interventions upon pregnant women, the study found that when laws intended to protect women are used against them, the ones who suffer most are low-income, African American women in the US South.

The impact of this law will be felt by women more broadly: the study’s authors conclude that laws and policies that make women criminally accountable for pregnancy outcomes are part of a larger effort to establish that women should have a separate and unequal set of legal rights than others. Tennessee’s new law addresses a health concern as a matter for criminalization but even worse, it treats pregnant women as a population who can be singled out for special control and surveillance by the state.

Although extremely disappointed that the Governor of Tennessee chose not to veto the law, International Doctors for Healthier Drug Policies (IDHDP) will continue to challenge this law and to support health-based policies to replace those that seek to punish already marginalized populations.

IDHDP and National Advocates for Pregnant Women (NAPW USA) ask for your support to continue the challenge of this law, to challenge the arrests that have already happened and will continue to happen, and to build on the coalition led by reproductive justice organizations, including NAPW, SisterReach, Healthy and Free Tennessee, Young Women United, SisterSong, with the powerful support of 

, to expose the appalling harm this law will do.

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Unhealthy laws in need of emergency response: Tennessee criminalises pregnant women who use drugs

New Zealand took a step backwards Sunday night with proposed changes to their New Psychoactive Substances (NPS) legislation.

Last year, the Psychoactive Substances Act was introduced. This piece of legislation regulates the sale, manufacture, and importation of New Psychoactive Substances (NPS) or drugs commonly referred to as ‘legal highs.’ After numerous attempts to simply ban legal highs, only to see them quickly replaced by new substances, the New Zealand government decided to take a new approach. The Act turned the tables, placing the onus of proof onto manufactures to prove the substances are ‘low risk’ before they can be sold.

While the bill was going through Parliament, the select committee decided that an interim period was needed between the Act coming into force and the introduction of regulations and rules around a clinical testing regime. The rationale behind this was to prevent people (particularly those who were dependent on these products) from turning to the black market and to ensure manufacturers had faith in the system. Once the Act was passed, products which appeared to be the least harmful were given temporary licenses and could still be sold until the testing process was in place.

Forty-seven products were initially granted temporary licenses. The Act provided the government with the power to instantly remove products from sale should they prove to be causing harm. The decision to revoke licenses had to be based on evidence provided by the National Poisons Centre and Centre for Adverse Reactions Monitoring (CARM). In the first nine months of the Act being in place, five products had their interim licenses revoked for these reasons.

However, on April 27, the Associate Health Minister Peter Dunne announced plans to change the Psychoactive Substances Act to revoke 

 interim product approvals. The amendment has not been tabled in Parliament yet, but it is expected that it will remove provisions for the interim period, thus making all currently approved products unapproved until they can go through the clinical testing process.

This would mean that no NPS products could be legally sold in New Zealand until the regulations for the clinical testing process are in place and products can prove they can pass. At a minimum, this will take 12–18 months.

Minister Dunne said that because the reports of severe reactions received by the National Poisons Centre and CARM cannot be attributed to any particular products, the government has decided to remove all products off the market. This is a departure from the legislation which focused on the need for evidence and due process to remove a product from sale.

The reasons for this change from the Minister are political. It is an election year in New Zealand and the continued sale of NPS products has created a perfect storm of NIMBYism, media fuelled hysteria and genuine concern about their effects. Two opposition political parties announced policies to change the law if they were in Government after the election. This forced the Minister’s hand in announcing the law change because he did not want to be seen to be giving the opposition parties a win on this issue.

Parliament is starting a two week recess period, which means that in the lead up to the change, retailers are likely to heavily discount products in firesales and people who use the products, or plan to distribute them, will be stocking up. New Zealand has already seen cases of discounting and there have been media reports of stockpiling. One shop which sells NPS products has been broken into and their entire inventory stolen.

The New Zealand Drug Foundation’s Executive Director, Ross Bell, explained that he suspects the decision to push through this amendment is about looking “tough on drugs,” as the Act already allowed the government to ban any substances that posed a danger to health. Mr. Bell has called on the government to use existing powers under the Act to remove the products that are causing harm, not to simply ban them all.

Find out more by following @nzdrug and visiting http://www.drugfoundation.org.nz/.

IDPC wishes to thank the New Zealand Drug Foundation for its inputs in this article.

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