Earlier this fall, an international team of researchers sounded a grim warning about the state of the global HIV epidemic among people who inject drugs. In two long-awaited research papers published in the Lancet, they laid out the evidence that not only is the scale of this epidemic worse than we thought, but that most countries are failing to provide the basic harm reduction interventions, like needle and syringe exchange programs and opioid substitution therapy, that are crucial to halting its spread.

In light of this evidence, world leaders and global agencies charged with leading the HIV response need to recognize that they can’t continue with business as usual. It’s time for them to call on governments to rethink their approach to drug policy and invest in harm reduction.

At Harm Reduction International, we’ve been tracking the global state of harm reduction since 2006, but the new data still surprised and alarmed us. The research shows that just one percent of the world’s people who inject drugs live in countries with widespread availability of two lifesaving harm reduction measures. Only 16 percent of them have access to opioid substitution therapy or medicines prescribed for opioid dependence—which is proven to significantly reduce transmission of HIV and hepatitis.

Meanwhile, harm reduction programs across the globe provide only a third of the number of sterile needles and syringes the World Health Organization deems necessary. The failure to invest in effective harm reduction measures has had a devastating effect. The new data suggests the UN has significantly underestimated the scope of the epidemic—the number of people who inject drugs who are living with HIV could be as high as 2.8 million worldwide, a huge leap from the 1.6 million figure currently used by UN agencies.

Although some of this gap may be the result of different research methods, it should still set alarm bells ringing. By providing a global snapshot of the experiences of people who use drugs, these studies also hint at the reasons behind the shortcomings in the worldwide HIV response. For example, the second of the two papers estimates that a staggering 57.9 percent have a history of incarceration—proof that in far too many countries, there is always money for police raids and prisons, even as harm reduction services go unfunded. Governments continue to focus on drug control, even as the evidence mounts that the “war on drugs” has been a public health catastrophe.

Why harm reduction is crucial to the fight against HIV

Are you passionate about global drug policy? IDPC is looking for a dynamic and motivated new volunteer to support our communications work!

The selected candidate will help us enhance IDPC’s visibility by helping our communications work, and providing some research and administrative support to our small team of advocates. Ideally, the volunteer would commit to work at IDPC for a minimum period of three months (either part- or full-time, depending on the person's availability). For more information about the position, have a look at the full description below.

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to Juan Fernandez Ochoa at jfernandez@idpc.net. Please note that we can only welcome volunteers who have the right to volunteer in the UK.

IDPC does not currently have the capacity to pay its volunteers. However, we will reimburse travel costs and lunch expenses incurred during the volunteer’s working days.

IDPC is searching for a new communications volunteer

Deaths from the potent prescription drug fentanyl have rapidly increased in Australia, with a senior doctor calling the trend a "national emergency". A report from the National Coronial Information Service (NCIS), commissioned by Background Briefing, shows 498 fentanyl-related deaths occurred between January 2010 and December 2015. This figure marks an 1,800 per cent increase on the previous decade, where NCIS data records 27 fentanyl-related deaths.

The increase reflects data in the United States,where the opioid crisis was recently declared a national emergency. Over 71 per cent of Australia's recorded deaths were men, with the majority of deaths occurring for those aged in their 30s (37.3 per cent) and 40s (29.1 per cent). Bastian Seidel, the president of the Royal Australian College of General Practitioners, said the figures were a "national emergency" and should prompt concern. "Those deaths are entirely avoidable," he said.

Overdose fatalities 'completely unacceptable'

Fentanyl is a synthetic opioid, roughly 100 times more potent than morphine. Historically used for the treatment of chronic and severe cancer pain, the patch form of fentanyl has been listed on the Pharmaceutical Benefits Scheme for other types of chronic pain since 2006. Dr Seidel said some GPs, emergency doctors and specialists were overprescribing the opioid, as they wanted to make sure they were not introducing harm. "Certainly, the opioids that are out there now are causing more harm than any good. In some cases they're causing death — and that's completely unacceptable," he said.

Fentanyl crisis: Figures show 1,800% rise in overdose deaths from potent painkiller in Australia

United Nations (UN) human rights experts, including special rapporteur Agnes Callamard, have renewed their call for the Philippine government to promptly investigate the killings in the country despite President Rodrigo Duterte’s strong condemnation and threats against the group for criticizing his brutal drive against illegal drugs.

The three rapporteurs – Callamard as special rapporteur on extrajudicial, summary or arbitrary executions; Michel Forst as special rapporteur on the situation of human rights defenders; and Diego García-Sayán as special rapporteur on the independence of judges and lawyers – issued a joint statement last Thursday from Geneva, Switzerland seeking probe into the killings in the Philippines.

The most recent attack was Duterte’s threat to slap Callamard if the latter would investigate him for the alleged extrajudicial killings in the Philippines.

UN rights experts renew plea for Duterte gov’t to probe EJKs in PH

PETALING JAYA: Padang Serai MP N Surendran has slammed amendments to the Dangerous Drugs Act 1952, saying the new bill tabled for first reading in Parliament today does not remove the mandatory death penalty and breaches the doctrine of separation of powers.

Surendran, who is also a lawyer, said according to the new Section 39B (2A), only those who received a certificate from the public prosecutor verifying that they were only the couriers and had assisted in disrupting drug trafficking activities would be spared the death penalty.

“The court still has no option but to sentence to death all those accused persons who are denied the attorney-general’s certificate.

“Thus, the attorney-general and his prosecutors will effectively hold the power to decide whether an accused person faces the hangman’s noose or not,” he said in a statement.

He added that the court would be unable to question the giving or denial of the certificate, as the bill provides that this be done at the “sole discretion” of the public prosecutor.

On Aug 7, the cabinet unanimously agreed to allow judges to impose an appropriate penalty on drug traffickers instead of the mandatory death sentence under an amendment to Section 39B of the Dangerous Drugs Act 1952.

Minister in the Prime Minister’s Department Azalina Othman Said said the cabinet had decided that the act should allow judges the right to decide on more appropriate sentences such as jail terms.

In the past, she said, judges had been forced to pass the death sentence on drug traffickers as no other sentences were available.

Death penalty for drug traffickers: New bill in Malaysia not enough, says MP

MEXICO CITY, Mexico – Mexican drug cartels are forcing indigenous children and teens to join their ranks, torturing or killing those who refuse, the United Nations warned Friday, November 17.

The UN's special rapporteur on indigenous rights, Victoria Tauli-Corpuz, said she is "particularly worried" about violence against minors after speaking with indigenous communities around Mexico during a 10-day tour.

"In areas affected by organized crime and the production and trafficking of drugs, the only choice left to young people is to join these groups or be tortured, disappeared or killed," she told a press conference at the end of her visit.

Mexico drug cartels force-recruiting indigenous children – UN

In October 2017, authorities in Berlin repealed their zero tolerance policy towards cannabis possession in a city park – bringing cannabis legislation into the headlines, and reigniting the debate. So what exactly is happening with cannabis in the German capital?

In April 2015, Berlin authorities introduced a zero-tolerance policy on cannabis possession in Görlitzer Park – affectionately referred to as 

 – in the Kreuzberg district. Authorities decided to crack down in Görli because it had “become a symbol of drug selling in Berlin,” according to the mayor of Kreuzberg, Monika Herrmann. Due to its location, in between two of Berlin’s party hotspots, the park had become known as a “24 hours drug supermarket”, Herrmann added, attracting tourists and locals alike. People who wanted to smoke in public or sell small amounts avoided Görli and went elsewhere in the city; the approach simply resulted in a shift of sale and consumption areas, and a rise in law enforcement costs.

This made the park the only area in the city in which Berlin’s narcotics law was fully enforced. Officially, the cultivation, possession, and trade of cannabis are criminal offences in Berlin. However, if someone is found to be carrying up to 15 grams of cannabis, they are very unlikely to be prosecuted – unless they are deemed to be promoting cannabis use to minors.

Berlin has acknowledged the futility of fighting cannabis use – what comes next?

The war raging in Rocinha, Latin America’s largest favela, has already been lost. Rooted in a dispute between gangs for control of drug trafficking, it has disrupted the daily life of the community in Rio de Janeiro since mid-September. With the sound of shots coming from all sides, schools and shops are constantly forced to close. Recently, a stray bullet killed a Spanish tourist. The war is not the only thing being lost.

For decades, Brazil has had the same drug policy approach. Police, weapons and numerous arrests. It does not take an expert to conclude the obvious: the strategy has failed. Drug trafficking and consumption have only increased. Einstein is credited with a saying – though apparently it is not his – that applies well to the case: insanity is doing the same thing over and over again and expecting different results.

In a case still before the Brazilian supreme court, I voted for decriminalising the possession of marijuana for private consumption. The case has been suspended and no date has been set for its resumption. I also proposed to open a broad debate on the legalisation of marijuana, to begin with – and then, if successful, cocaine. The subject is extremely delicate, and the outcome hinges on a decision from the legislature.

Brazil must legalise drugs – its existing policy just destroys lives

A controversial trial of drug testing welfare recipients will almost certainly be postponed after the Turnbull government conceded it was unlikely to win sufficient support from the Senate crossbench.

The trial was to have applied to new welfare recipients from January 1, 2018, but Social Services Minister Christian Porter on Wednesday indicated he was prepared to excise the trial from omnibus welfare legislation so other measures could be approved by Parliament before the end of the year.

"The sticking point, fundamentally, in the legislation has been the drug testing trials for welfare recipients. The bill is critical," Mr Porter told the National Press Club in Canberra.

"So the bulk of that bill, which reforms the compliance system, is so critical to what we are trying to achieve that I wouldn't want to sacrifice the bulk of that in terms of timeliness while we are still negotiating around drug testing."

The package of welfare changes includes the drug test trial but also seeks to replace seven payments with one, impose tougher compliance measures on working-age recipients and remove drug and alcohol abuse as valid exemptions for meeting mutual obligation requirements for payments.

Labor, the Greens and several members of the crossbench are opposed to the drug test trial.

Although the Senate will sit for another two weeks before the end of the year, one of those weeks will be devoted to debating same-sex marriage legislation, leaving only four days to deal with other legislation.

Negotiations have been further complicated by the citizenship soap opera engulfing the Parliament with another key member of the crossbench, South Australian senator Skye Kakoschke-Moore, resigning on Wednesday.

As many as 1750 young people and job seekers in western Sydney, 2500 in Logan, Queensland and 750 in Mandurah, Western Australia, would be drug tested and face strict welfare quarantining measures should the Senate approve the government's contentious welfare crackdown.

Under the two-year trial - a policy that was first unveiled in the May budget - 5000 new recipients of Newstart Allowance and Youth Allowance will be drug tested for illicit substances such as ice, ecstasy and marijuana across three locations.

The trial would be accompanied by strict income management measures. People who test positive to two drug tests will have 80 per cent of their welfare payment redirected to a cashless welfare card, which quarantines the money for use on essential goods and services such as groceries.

Controversial drug trial for welfare recipients in Australia to be postponed

Under President Joko Widodo (Jokowi), Indonesia’s war on drugs has taken on a deadly edge. Initially, Jokowi focused on judicial executions, declaring in December 2014 that his government would empty death row of its 64 prisoners sentenced on drugs charges in order to tackle a ‘drugs emergency’. Action followed quickly — his government executed 14 narcotics prisoners within six months.

Only four further prisoners have faced the firing squad for drugs crimes since, with no executions now for 15 months. But as judicial executions have receded, fatal shootings of narcotics suspects have surged. Indonesian human rights monitor Kontras estimates police and the National Narcotics Agency (BNN) fatally shot 106 drugs suspects between September 2016 and September 2017, with the vast majority of these shootings taking place in 2017. The shootings have continued since the release of their data, with at least a further six drugs suspects shot dead during October.

As with the judicial executions, this uptick in killings has coincided with hardline rhetoric from Jokowi and his senior law enforcement officials. Jokowi himself was one of the first to speak approvingly of shootings, calling on police on World Anti-Narcotics Day in 2016 to shoot narcotics criminals if the law allowed it (before noting it was fortunate the law did not). National police chief Tito Karnavian was one of those to echo the president’s call. In January, he held a press conference at the police mortuary, telling drugs distributors they would end up there if they resisted arrest.

Indonesia’s fatal war on drugs

Everyone knows the story. There is the body, there is the bullet, there is the man who will alternately be called addict or suspect or junkie or pusher or dealer, allegedly or otherwise, depending on who tells the story.

“We will not stop,” said President Rodrigo Duterte, “until the last drug lord… and the last pusher have surrendered, or are put either behind bars or below the ground, if they so wish.”

This is Quezon City, millions strong, sprawling over more than 16,000 hectares, the largest in Metro Manila and the most populated of the country's highly urbanized cities. Two former presidents still live inside its borders, along with a handful of senators and the grandchildren of the late Commonwealth president Manuel L. Quezon, in whose imagination bloomed the vision of a graceful capitol in the city that now carries his name. It is also the city where at least 511 people were recorded killed during the first seven months of Duterte's drug war.

Project Double Barrel went into effect in July of 2016. The leadership went to the police, who were promised protection by the President as long as "you do your duty." The daily broadcasts ran footage of wailing mothers, while corpse after corpse filled the feeds of night shift reporters until operations were suspended in January.

Rappler reviewed police spot reports for 368 incidents of deaths under investigation and fatal armed encounters in Quezon City between July 1, 2016 and January 30, 2017, the first seven months of Project Double Barrel and Barrel Alpha. The reports were accessed at the Criminal Investigation and Detection Unit at the Quezon City Police District (QCPD) headquarters after a request for all reports filed between June 2016 and January 2017.

A request for later reports within the time frame of the drug war's second onslaught was initially approved by the QCPD. It was subsequently denied by higher authorities, who cited “ongoing investigations.”

A spot report is filed in the immediate aftermath of an incident, and includes the date, time, and type – whether it was a stabbing or a shooting, whether it was a police operation or a corpse left by the side of the road, whether the dead were drug suspects or unidentified. It includes the facts of the case as determined by the police. It lists the police personnel present, whether responding or involved, as well as possible perpetrators. When available, the addresses and names of suspects killed are included, as well as the place of incident.

Quezon City's dead fall into two categories. The first are the deaths under investigation. The perpetrators are listed as largely unknown. Some of the bodies were found in street corners and alongside highways, garroted with galvanized wire or stabbed in the chest, faces sometimes wrapped in duct tape, with crystal meth in their pockets and signs calling them addicts or dealers. Others were shot point-blank by riding-in-tandem assailants, or murdered by masked men as they watched television inside shanties.

Although it cannot be categorically said that the victims were involved in drugs, some were on drug watch lists, while a number of others had already surrendered to local authorities.

Rappler identified 216 deaths under investigation in a review of QCPD spot reports. Joy Belmonte, the Vice Mayor of Quezon City, under whose office the anti-illegal drug campaign falls, admitted she was alarmed by the sudden rise of killings. She cautioned against seeing the trend "from a black and white perspective."

Some of the dead, she said, were probably uninvolved in drugs but were targeted because "of the opportunity" to kill with impunity. Others were possible informants murdered by corrupt policemen she called "ninja cops." Still others were victims of vigilante killings.

This is where they do not die: An investigation into the Philippines war on drugs

On nights when the November rain poured down and he had not slept at all, Jhonny Arcentales had visions of dying, of his body being cast into the dark ocean. He would imagine his wife and their teenage son tossing his clothes into a pit in a cemetery and gathering at the local church for his funeral. It had been more than two months since Arcentales, a 40-year-old fisherman from Ecuador’s central coast, left home, telling his wife he would return in five days. A cuff clamped onto his ankle kept him shackled to a cable along the deck of the ship but for the occasional trip, guarded by a sailor, to defecate into a bucket. Most of the time, he couldn’t move more than an arm’s length in either direction without jostling the next shackled man. “The sea used to be freedom,” he told me. But on the ship, “it was the opposite. Like a prison in the open ocean.”

By day Arcentales would stand against the wall and stare out at the water, his mind blank one moment, the next racing with thoughts of his wife and their newborn son. He had not spoken to his family, though he asked each day to call home. He increasingly felt panicked, fearing his wife would believe he was dead.

Arcentales has wide muscular shoulders from his 25 years hauling fishing nets from the sea. But his meals now consisted of a handful of rice and beans, and he could feel his body shrinking from the undernourishment and immobility. “The moment we would stand up, we would get nauseated, our heads would spin,” he recalled. The 20-some prisoners aboard the vessel — Ecuadorians, Guatemalans and Colombians — would often stand through the night, their backs aching, their bodies frigid from the wind and rain, waiting for the morning sun to rise and dry them.

In the first weeks, Arcentales had turned to his friend Carlos Quijije, another fisherman from the small town of Jaramijó, to calm him. They were chained side by side, and the 26-year-old would offer some perspective. “Relax brother, everything is going to work out,” Arcentales remembered Quijije saying. “They’ll take us to Ecuador, and we will see our families.” But after two months of being shackled aboard the ship, Quijije seemed just as despondent. They often thought they would simply disappear.