This week UN member states convened at the UN high-level meeting on universal health coverage to agree a political declaration and discuss ways forward towards reaching UHC for all.

Frontline AIDS, in partnership with the Global Network of People Living with HIV, International Civil Society Support and our Partnership to Inspire, Transform and Connect the HIV Response (PITCH) partners, have been pushing for the inclusion of the most marginalised within this declaration, and for strong commitments for people living with, and most affected by HIV.

We welcomed the declaration’s three references to HIV/AIDS, and recognition of the need to support people living with HIV/AIDS in particular, as well as mentions of the additional barriers faced by marginalised and vulnerable groups.

We had pushed for explicit references to key populations (gay men and men who have sex with men, transgender people, sex workers, people who use drugs and adolescent girls and young women), without success. However we’re happy that there is explicit mention of the impacts that stigma and discrimination have on people who are (as the declaration puts it) “vulnerable or in vulnerable situations”.

Strong support for sexual and reproductive health and rights (despite opposition)

Throughout the negotiations on the political declaration there had been resistance from conservative governments against the inclusion of progressive language on sexual and reproductive health and rights (SRHR). Led by the US, a group of 19 governments, issued a statement against the inclusion of sexual and reproductive rights. In response, a much larger group of over 50 supportive governments, issued a strong counter statement in support of comprehensive SRHR and continued to push for the rights of adolescent girls, women and the most marginalised.

Discussions during the high-level meeting revealed continued support for SRHR and particularly for sexual and reproductive rights, which is missing from the political declaration. For example, the UK government made a pledge to spend £600 million on a new program for reproductive health supplies.

Does the UN’s Universal Health Coverage declaration fail the most vulnerable people?

In October this year I will leave Transform, after 25 years of campaigning for drug policy reform. I founded the organisation when I was 32, in 1994, to campaign for an end to global drug prohibition, and to replace it with an effective, just and humane system of regulation and control. It’s been an extraordinary trip. In 1994 I was still ten years away from having kids of my own and South Africa had its first elections in which black people could vote. Many years ago I said that I’d put a quarter of a century of my career into this and my time is now up. I’m not sure where I’m going next, but I’m proud that Transform’s work has helped turn legal regulation from fantasy into reality.

Transform stands on the shoulders of giants and I cannot praise highly enough colleagues past and present with whom I’ve worked. Legalisation and regulation of drugs is now unstoppable – I’m just sorry that we haven’t managed to curtail more of the terrible impacts of drug prohibition. But I’m delighted to say that Transform is in great shape both in terms of personnel and financially, and we are parting on very good terms. The staff team here is particularly strong and we have just filled two new posts.

I want especially to thank all Transform’s donors over the years and to all those who provided support to us in one way or another.

I knew that ours wasn’t going to be a quick win – this is a global war that has the full backing of the permanent members of the UN Security Council, and 180 UN member states. Even so, back in 2004 I suggested that the global drug war would be over by 2020. It isn’t, but we are winning the peace, as more countries leave the prohibition party and adopt both decrim and legal regulation. However, we are also losing the peace in places like North America, Mexico, Colombia and the Philippines, where the drug war leaves tens of thousands dead every year.

Danny Kushlick is leaving Transform

When Rodrigo Velez received a call in 2008 asking him to become Ecuador’s new “Drug Czar,” he thought it was a joke. Velez managed a family-owned agro-business. He had no experience working in the public sector and knew little about illicit drugs.

As a courtesy, he agreed to attend one meeting. Government officials laid out a shocking proposition. The new President, Rafael Correa, of PAIS Alliance, a center-left party, wanted to decriminalize drug use. Would Velez lead national reform efforts?

At first, Velez declined. But officials insisted that the government needed his connections to private industry and skills bringing together diverse actors to solve problems. They explained the issues with overcrowded prisons and lack of drug treatment programs. Velez finally accepted.

When I met Rodrigo Velez in Guayaquil, Ecuador, the mystery surrounding his appointment became clear. What Velez lacks in experience, he makes up for in passion. The charismatic 60-year-old with salt-and-pepper hair loves to problem-solve, to connect people, and to pound new ideas into old institutions—sometimes literally. Throughout our interview, he slammed his fist onto the table for emphasis.

Ecuador’s new task force launched in 2008. Velez used his connections and charisma to gather industry leaders, academics, researchers and international law experts. One glaring omission from this group, however, was people directly impacted by drug policy and criminalization. Strict class divisions in Ecuador ensure that few policymakers invite marginalized populations to the table.

Ecuador’s drug decriminalisation bid has lessons for the world

Last August, 35-year-old Sophea sat on the edge of a wooden bed frame that occupied most of the single-room home she and her husband, Piseth, shared with their five children, who ranged in age from an infant son to an adult daughter.

The smell of burning plastic from a nearby dump wafted into the tiny, tin-roofed house in a slum on the outskirts of the Cambodian capital, Phnom Penh. Since Piseth lost a leg after stepping on a landmine while serving in the Cambodian army, the money from his street begging and Sophea’s ragpicking – about 10,000 riels (US$2.40) a day – had not been enough to make ends meet. Sophea was pregnant with her sixth child.

A railway line separates the slum from a high-security gated complex. The pair often crossed the tracks to scavenge among the refuse of their wealthy neighbours. So when a woman who had arrived in the slum several months earlier, and who always seemed to be a little bit better off than everyone else, showed up with a proposal, a desperate Sophea was willing to listen.

“The woman said she came together with a few others and did pickpocketing in markets,” Sophea says, looking down at the concrete floor of her house while nursing her youngest child. “I joined her to steal people’s wallets, but soon the police caught us and I was in jail, charged with petty theft.”

In Cambodia’s prisons, pregnant women and young children are inmates

Finland, the happiest country in the world, and the new EU president, had national elections. Did cannabis have a place in the political debate?

Medical cannabis has been available in its modern form in Finland since 2006 through a judicial decision made during a patient case which went all the way to the Supreme Administrative Court (Mikkonen 2016). Finland was the first Nordic/Baltic country to legally allow some forms of cannabinoid therapeutics, but instead of seizing the opportunity, the country has fallen short in harvesting the full medicinal potential of the plant.

By way of a bit of a background to this Nordic country and its relation to cannabis, Cannabis indicae herb (Intianhamppu or Indian hemp), was still listed in the Finnish Pharmacopeia in 1937 (Pharmacopoea Fennica 1937: 304-305) but removed from subsequent editions until Sativex® was approved around 2012. Bedrocan® products from the Dutch medical cannabis company are also available but only through a special permit.

The number of prescriptions for medical cannabis products are still low, despite rising from 57 in 2011 to 223 in 2014 (Eklund 2015) and 373 in 2017 (Malin 2019). The prescription rates fell in 2018 to 269 prescriptions, partly due to governmental authorities adopting a strict approach to the regulation of cannabis as medicine.

Cannabis is a difficult fit in the current medical model and the voice of patients is often forgotten in the debate. A recent article by Suomen Kuvalehti revealed that Finnish medical authorities and the Social Insurance Institution of Finland (Kela) have pressured doctors to discontinue prescriptions on the grounds that there is not sufficient evidence or clinical guidelines for using cannabis as medicine.

In addition to prescription holders, in 2017 there were an estimated 2000-5000 cannabis users in Finland who used cannabis for medical reasons without a prescription (Hakkarainen & Karjalainen 2017, p. 23). Cannabis also remains the most used “illegal drug”; according to a recent national survey 24 per cent have at least tried cannabis in their lifetime. 42 per cent of Finns think the use of cannabis should not have criminal penalties and 72 per cent think cannabis should be allowed at least for medical use.

Grass roots: Cannabis decriminalization campaign in Finland pushing towards public agenda

Damian Sobczyk is a Polish videoblogger and a drug user activist whose mission is to help young people to reduce the risks of drug use. His channel had 137,000 subscribers when YouTube decided to ban it without any concrete explanation. Read Drugreporter’s interview, conducted by Adam Stasiak!

How did you get involved in harm reduction?

 I became interested in the topic of psychoactive substances in college. I wrote my master’s thesis on the drug problem in the European Union. Writing it, I discovered how little material on this subject was available and how many things had to be done in the field of drug policy. We have examples of countries that are good at it and we should follow their examples. I decided to deal with this topic more extensively. I was thinking about publishing a book, but I figured that I would reach more people thanks to new media, in particular through a YouTube channel. For a few years I couldn’t make up my mind if I should do it or not. I was afraid of how this would affect my professional life. My fears turned out to be true because 9 months after the foundation of the channel, when it began to gain popularity, my superiors gave me an ultimatum – either I close the channel, or I have to leave work. They were afraid of losing contracts since their employee was dealing with a controversial topic. I chose to work on the channel then because I believed that its mission is right and socially desirable. Your channel is called “I know my dope” – an interesting choice of name, maybe even controversial for some people in Poland. Could you tell us what your channel is about and who it is directed at?

The channel’s goal is to reduce negative consequences that may result from the use of psychoactive substances, addiction prevention, and supporting a rational drug policy based on world-proven solutions. Young people are the dominant audience among my viewers. 90% of people watching me are 18-35 years old. I think that content can be interesting for everyone because even if someone is not a user, it is very likely that they know such people in their surroundings.

YouTube removed my channel for promoting harm reduction – An interview with Damian Sobczyk

If you’ve had cause to wonder whether opioids are helpful or harmful in your life right now, you’re definitely not alone.

People take opioids for many reasons. A lot of people take opioids like codeine and oxycodone for chronic pain, illness and injury because of the therapeutic benefits of opioids.

As much as they can make us feel better, in other circumstances, they can make you feel worse. Sometimes much worse.

Getting on top of opioid dependence or addiction is difficult for a lot of us.

The stigma we encounter definitely doesn’t help. If you feel like it’s time to learn more about dependence on or addiction to opioids, read on.

This website provides information about opioid dependence (which may be diagnosed as Opioid Use Disorder or OUD) and about different options for treatment.

Opioids include pain medications that are often prescribed by doctors, such as codeine, morphine, oxycodone and fentanyl, and drugs that are usually illegal, such as heroin and opium. They are usually used to treat pain, but they can also be used to treat opioid dependence.

Some people use opioids for the pleasant, relaxed feeling that they give, even if they don’t have any pain. Some people may start using opioids to treat a medical problem, but continue to use them even after their problem has gone.

Anyone can develop a dependence to opioids. It doesn’t matter why or how they use opioids, how old they are, what their background is, or their life experience – 

Life Savers: Your one-stop website for information about opioids and opioid dependence

Zero-tolerance messaging tuned out by most teenagers

For many parents, talking to their children about substance use is like navigating a field of landmines. It’s difficult to know exactly what to say and how to say it.

But a new study from researchers at the University of British Columbia and University of Calgary is showing the way forward. Emily Jenkins, a UBC professor of nursing who studies youth substance use, and her colleagues interviewed 83 teenagers across B.C. Interestingly, they found that a harm reduction message resonated the most with teens, instead of the typical “don’t do drugs” talk.

“Teens told us that they generally tuned out abstinence-only or zero-tolerance messaging because it did not reflect the realities of their life,” said Jenkins. “Either they or their peers were already using substances, or substance use was happening in their own family circles.”

Harm reduction is a philosophy and set of practices that acknowledge that substance use – be it drugs, cigarettes or alcohol – is a part of life. It aims to reduce the harmful effects of substance use, rather than simply ignoring or condemning it.

“Youth were more receptive when their parents talked – in a non-judgmental way – about substance use or could point to resources or strategies to help minimize the harms of use. This approach seemed to work better in preserving family relationships and youth health,” said Jenkins.

Canadian teens prefer harm reduction messaging on substance abuse

The War on Drugs has fewer battle lines more clearly defined than those in Afghanistan, which is still the world’s greatest heroin producer and exporter after almost two decades of U.S. attempts to eradicate the trade.

And in May this year, after a reported local boom in crystal methamphetamine production, U.S-led forces did what they always do: they dropped some bombs. U.S. and Afghan forces dropped laser-guided missiles on what they said were 68 Taliban-run meth labs in the southwest of Afghanistan.

Abdul Rahman Rahmani, deputy spokesperson for Afghanistan's Ministry of Defense, said the strikes would deny the insurgency of “$1 million a day” in lost revenue. Local media said 150 “Taliban terrorists” were killed in the raids.

U.S. forces have occupied Afghanistan for nearly two decades, but have nonetheless failed to prevent an unprecedented growth in opium cultivation, heroin production and now methamphetamine supply.

Even so, U.S. military officials claim they are winning big. They say their aerial assaults on Afghan drug labs have denied the Taliban tens of millions of dollars in revenue.

Behind the United States' bogus war on Taliban drug labs

Once a year we get a glimpse of how many people are using drugs such as heroin and cocaine in England and Wales. The Home Office conducts an annual household survey that asks people if they have used drugs and, if they have, to provide some details about which drugs and how often they have consumed them. For the fourth year in a row, overall drug use has risen. An interesting fact on its own, but as always, the devil is in the detail.

Class A drugs including cocaine are proving to be popular, second only to cannabis in popularity. Nearly a million people now report using the drug. Fewer people report using opiates, such as heroin – but this is largely due to limitations of the survey which, as a household exercise, will not pick up certain groups, such as the homeless or other transient populations. Equally, the survey will not capture the experience of students – another important cohort.

One of the most striking elements of the data is the ease with which people, especially young people, can obtain controlled drugs. In 2018-19, almost 19% of respondents to the survey reported that it was “very easy” to get drugs within 24 hours. This a significant increase on the previous year’s figure of 14.5%.

More than half of all young people, aged 16-24 years, said they could get drugs within 24 hours. This increased access to the drugs market could be as a result of more online availability through the dark web. Equally, the drugs market has developed in the way other legal markets have in the 21st century. Drugs can now be delivered straight to your door, often faster than pizza and there have been reports that suppliers are offering loyalty cards to customers.

Class A drugs such as cocaine carry the most severe penalties under current drug laws, so why are an increasing number of people willing to break the law? Perhaps recent high-profile political confessions of drug use have added to people’s perception that it’s acceptable – or at least not as frowned upon – to use drugs.

Drug use in England and Wales is up for the fourth year in a row

Night has fallen on Rio de Janeiro’s Albert Schweitzer hospital, and in its 11th-floor intensive care unit Enzo Coutinho dozes in his aunt’s lap.

“Sometimes it takes a mountain to trust and believe in you,” Merielle Ventura, a 24-year-old nursery teacher, sings gently into her nephew’s ear.

It has been five days since baby Enzo became one of the youngest victims of a new and deadly chapter in Rio de Janeiro’s intractable war on drugs – gunned down with his teenage mother, Margareth Teixeira, as she carried him to church. His mother was killed.

Doctors have placed a television beside the injured infant’s bed, hoping Tom and Jerry cartoons will distract Enzo as they sedate him to clean the bullet wound that nearly cost him his left foot.

When he cries out for his mother, family members still struggle to respond. Sometimes it is Enzo’s aunt he calls mum; sometimes his grandmother. Only 48 hours have passed since weeping relatives laid his mother to rest. She was 17 years old.

Margareth was one of at least four innocent teenagers shot dead during police operations between 9 and 13 August – an eruption of killing that was shocking even by Brazilian standards, where there were over 57,000 homicides last year.

'Caught defenseless in the crossfire': Rio families cope with deaths by police violence

For many years, evidence has shown the effectiveness of opioid maintenance therapy in the treatment of opioid dependence and the effectiveness of opioid maintenance therapy and needle syringe programmes in preventing HIV infection among people who inject drugs.

Recent evidence shows that both opioid maintenance therapy and needle syringe programmes can also prevent people who inject drugs from getting hepatitis C.

The spread of HIV/AIDS among people who inject drugs and their partners has been contained in Western Europe, Australia, Canada, China and other countries of Asia, because interventions such as clean needle exchange and opioid maintenance therapy programmes became mainstream government health policy sanctioned by the World Health Organisation.

Harm reduction is receiving increasing attention from policy makers across Sub-Saharan Africa. Unsafe drug injection is recognized as an underestimated component in preventing HIV and hepatitis C infection in vulnerable groups in high prevalence settings across sub-Saharan Africa and Asia.

However, in Eastern Europe and central Asia, harm reduction policies are conspicuous by their absence, even though there are high rates of HIV and hepatitis C infection.

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