As the three-year Regional Program “Harm Reduction Works – Fund It!” draws to a close, EHRN is to hold the fourth and final meeting of the Regional Technical Advisory Group (RTAG) in Druskininkai (Lithuania) on 13-14 June. Among the participants are representatives of international and regional groups, agencies, UN donors, civil and state organizations and representatives of PWUD communities, as well as members of the EHRN Secretariat.

Established in July 2013, the advisory body has provided technical support to the EHRN Steering Committee for four years in order to issue guidelines on how to achieve the Program’s objectives. "The RTAG always acted as a sounding board, letting us hear the results of the work done by a huge team from the project countries and the EHRN team, compared to both national trends and needs, and in combination with other regional initiatives. In fact, this is a key tool for coordinating this project. It was the RTAG decisions that allowed us to adjust the Program every year, making it flexible and responsive to the changing political environment in the region. We are grateful to the RTAG experts for their help and commitment to the goals set," – says Anna Dovbakh, EHRN executive director.

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"Harm Reduction Works – Fund It!”: summarising the results and achievements of the Regional Program

Medicinal cannabis has been made legal in Mexico.

The President, Enrique Pena Nieto, has officially published a bill allowing its use for health and scientific purposes.

The bill was passed in April, with an overwhelming 371 members of the Lower House of Congress voting in favour, with only 19 politicians voting against or abstaining.

Mexico legalises medical cannabis

The World Health Organization (WHO) Department of Mental Health and Substance Abuse organized, for the first time, the global Forum on alcohol, drugs and addictive behaviours (FADAB) with the primary goal of enhancing public health actions in these areas by strengthening partnerships and collaboration among public health oriented organizations, networks and institutions in the era of Sustainable Development Goals 2030 (SDG 2030). International Drug Policy Consortium, Harm Reduction International and International Network of People Who Use Drugs issued a joint statement at the forum. The text of the statement is included herein:

Joint Intervention at the WHO Forum on Alcohol, Drugs and Addictive Behaviours





Thank you for the opportunity to address this forum.



I am speaking today on behalf of the International Drug Policy Consortium, Harm Reduction International, and the International Network of People who Use Drugs. I would like to thank WHO for facilitating the participation of civil society in this important discussion.



Firstly, we acknowledge and welcome the proactive role that WHO played in the 2016 UNGASS on the world drug problem. Dr Margaret Chan spoke at the UNGASS in New York and at this year’s Commission on Narcotic Drugs, speaking in favour of harm reduction and the public health approach.



In implementing the UNGASS outcomes, and in preparing for the high-level meeting on drugs scheduled for 2019 in Vienna, it is crucial that WHO and the in-coming Director-General, continue to remain strongly and visibly engaged, and champion harm reduction in the often fraught international drug policy debate.



There are an estimated 12 million people who inject drugs around the world. 14 percent of them are living with HIV, and 67% with hepatitis C. People who inject drugs are 24 times more likely to be living with HIV than people in the general population. And the situation is worsening: the 2011 Political Declaration on AIDS set a target to reduce HIV transmission among people who inject drugs by 50% by 2015. In reality, new HIV infections among this population increased by a third over this period.



This is a problem of political will. We know that harm reduction works, we also know that unsupportive legal and policy environments impede service access and results in the gross violations of the rights of people who use drugs.



Moving away from a criminal justice approach to drug use, and towards a public health approach instead, is essential. But this does not mean a sole focus on biomedical responses – the health outcomes experienced by people who use drugs are always shaped by social and structural factors. We must stop treating people who use drugs as criminals, but we must also stop assuming that they have a disease. This shift must happen in practice, and not just in rhetoric spoken by governments at UN fora.



WHO’s Consolidated Guidelines for Key Populations call for member states to ensure access to harm reduction services. But they also outline critical enablers to optimise service access and impact, which include removing criminal punishment for drug use. We call on WHO to loudly and consistently advocate for decriminalisation across national, regional and international discussions.



Despite the commitments made last year at the UNGASS on drugs and the High Level Meeting on HIV – the coverage of proven harm reduction services remains far too low around the world. Harm Reduction International’s 2016 report on Global State of Harm Reduction shows that no new countries have implemented needle and syringe programmes (NSP) since 2014, and only three have introduced opioid substitution therapy (OST).



These services need funding, which is why we call for governments to redirect the resources currently being spent on drug law enforcement. This does not require new money, just a better balance in public expenditure towards harm reduction. In fact, modelling data show that a redirection of just 7.5% could virtually end AIDS among people who inject drugs by 2030. We also need international donors to reconsider their withdrawal from middle-income countries where the majority of people who use drugs live, and where governments are too often unwilling to fill the gaps.



The Sustainable Development Goals hold the promise of a people-centred, transformative agenda centred on transparency, participation and inclusion. This is a unique opportunity to ensure that the health and social needs of people who use drugs are met, and that governments are held to account. Target 3.3 pledges to end AIDS and combat hepatitis, but we will not achieve this – nor Target 3.5 to strengthen drug treatment – if people who use drugs continue to be left behind. Crucially, the Goals are inter-related. Achieving public health targets requires progress on poverty reduction, gender equality, reducing inequalities, and so forth. We urge WHO to recognise the inherent dignity of people who use drugs – who suffer more than most from economic and political inequalities, social marginalisation and criminalisation.



It is also important to acknowledge the role that communities must play in achieving the SDGs. Examples of the central role of communities abound in public health – from the HIV response to Ebola to Yellow Fever. Communities are not just beneficiaries of services, but also vital contributors and they must be fully resourced and engaged. To quote our colleagues at the Stop AIDS Alliance and the Free Space Process, “Communities stay where donors leave and governments change, which leads to long-lasting change and results”.



Finally, I conclude by mentioning the crucial and unique role of the WHO within the international drug control system. The WHO’s Expert Committee on Drug Dependence is mandated by the 1961 and 1971 drug control conventions to undertake scientific reviews, and recommend the appropriate scheduling of substances to the Commission on Narcotic Drugs, taking into account both risks related to non-medical use and therapeutic usefulness. Scheduling decisions are central to ensuring access to controlled medicines, and the ECDD has taken a laudable stance in its evidence-based defence of therapeutic access to ketamine. The Outcome Document of the 2016 UNGASS gives due prominence to the issue of access to controlled drugs by assigning its own pillar or theme, thereby raising the profile of the ECDD, whose work in maintaining the principle of scientific review is critical and in increasing demand. The Committee needs to be strengthened, supported and funded by member states.



The classification of substances is not a matter of dry legislation, but impacts upon people’s lives. As such, the classification of substances should never be the result of arbitrary or politically driven actions. Drug control can only be truly fit for purpose once it is aligned with the imperatives and outcomes of public health and human rights; both of which are core values of the United Nations. We saw this in action in the recent deliberations on ketamine, and we eagerly await the results of the forthcoming pre-review of cannabis which is long overdue.



Thank you again for the opportunity to address you today, which is also the 5th annual Global Day of Action for the Support. Don’t Punish Campaign. This year there are actions in over 200 cities from every continent with thousands of people participating to call for an end to punitive and damaging drug policies.



We look forward to working alongside WHO and other UN agencies in striving towards putting health and human rights at the centre of this important debate.



Thank you.

WHO Forum on Alcohol, Drugs and Addictive Behaviours statement on behalf of IDPC, HRI and INPUD

The AFEW network in conjunction with the ‘Bridging the Gaps: health and rights for key populations’ project, is kicking off its regional approach. In this regional approach they will focus on three main areas:

Labor migrants who are using drugs in Eastern Europe and Central Asia (EECA).

Harm reduction friendly rehabilitation in the EECA region.

The assessment on harm reduction friendly rehabilitation will take inventory of what type of rehabilitation is now available and what types of methods for treatment are used in Ukraine, Georgia, Russia and Kyrgyzstan. Desk research will also provide an overview of international applied evidence based methods. Together with partners in the summer school, 

 will analyze if capacity building on rehabilitation can be provided to improve the results and to make rehabilitation services more harm reduction friendly.
The assessments will take place this summer. The results and conclusions will be shared during AFEW’s regional autumn school that will take place in Almaty, Kazakhstan from October 30th untill November 3rd. Click here for more information.

AFEW network’s regional approach will focus on harm reduction

Montreal has launched the first mobile supervised injection clinic in North America, as part of a package of services aimed at fighting back against an opioid crisis that has claimed thousands of lives across Canada.

On Monday – after years of lobbying by community organisations – the city opened its first safe injection site, alongside a two-booth mobile unit that will make its way through the downtown core. The services, which offer a medically supervised space and sterile equipment for people who use drugs intravenously, are Canada’s first such facilities outside of British Columbia.

“It’s an emotional day,” said Louis Letellier de St-Just of Cactus Montréal, the organisation responsible for one of the sites. “These people need services. They’re people that have had a hard life – most of them – and they need to be supported.”

A third safe injection site will open in the coming days, while plans are in the works for another site to be set up in the autumn. Together the services are expected to accommodate up to 300 visits per day.

Montreal, home to 1.7 million people, sees about 70 overdose deaths a year, said Letellier de St-Just. “And it’s too much. We have between 4,000 and 5,000 injecting drug users. This is a huge community and they need services.”

Montreal opens first mobile supervised injection clinic in North America

Hepatitis and other drug-related infectious diseases will be the focus of ‘Hepatitis week’, taking place at the EU drugs agency (EMCDDA) in Lisbon from 12–16 June (1). The initiative will bring together some 100 specialists from: EU Member States, candidate and potential candidate countries to the EU, as well as partner agencies, civil society and professional organisations.

Viral hepatitis, particularly infection caused by the hepatitis C virus (HCV), is highly prevalent among injecting drug users across Europe. For every 100 people infected with HCV (antibody-positive), 75 to 80 will develop chronic infection (2).

The week will kick off with a two-day meeting of the hepatitis B and C network of the Stockholm-based EU agency, the European Centre for Disease Prevention and Control (ECDC) (12–13 June). It will close with the regular annual meeting of the EMCDDA drug-related infectious diseases (DRID) network of national experts (15–16 June).

A joint session on 14 June will provide the two networks with an opportunity to share expertise and experience and to discuss how Europe can improve its surveillance of, and response to, hepatitis among people who inject drugs (PWID). The experts will also discuss practical evidence-based strategies, share examples of good practice and identify solutions to common challenges.

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

EMCDDA and ECDC join forces to address the challenge of hepatitis

Misconception 1: “Central America is an important vector for heroin trafficking.”

If we could snap our fingers and halt all drug trafficking through Central America’s “Northern Triangle” region, it would have no effect on the opioid crisis devastating communities across the United States. U.S. officials estimate that 90 to 94 percent of heroin consumed in the United States today comes from Mexico, which is now producing about 70 tons per year. Another four to six percent comes from Asia, principally Afghanistan, the origin of most heroin consumed elsewhere in the world. About two percent of heroin that reaches the United States comes from Colombia, and a negligible amount is made in Guatemala.

Central America is south of Mexico. Mexican heroin is unlikely to travel south on its way north to the United States. The only portion of U.S. heroin consumption that is likely to transit Central America is the roughly two percent produced in Colombia or Guatemala. The dynamic is similar for methamphetamine, which is overwhelmingly synthesized in Mexico, and fentanyl, which is mostly produced in Asia but passes through Mexico.

By far the main drug that does pass through Central America is cocaine, which is produced in the Andean nations of Colombia, Peru, and Bolivia. About 90 percent of cocaine seized in the United States in 2015 was of Colombian origin. Of cocaine trafficked to the United States, the State Department reported in March, about 90 percent “first transited through the Mexico/Central America corridor.” Central America’s relevance to the opioid crisis, however, is marginal.

Misconception 2: “Building a wall would greatly reduce heroin, methamphetamine, cocaine, and fentanyl trafficking.”

Proponents of a border wall often claim that it would help the United States solve its opioid addiction problem by blocking heroin smugglers from Mexico. This reveals a misunderstanding of how cross-border smuggling works.

The vast majority of the drug that enters from Mexico does so through “ports of entry”—the 48 official land crossings through which millions of people, vehicles, and cargo pass every day. “Heroin seizures almost predominantly are through the port of entry and either carried in a concealed part of a vehicle or carried by an individual,” then-U.S. Customs and Border Protection Commissioner Gil Kerlikowske told a congressional committee last year. “We don’t get much heroin seized by Border Patrol coming through, I think just because there are a lot of risks to the smugglers and the difficulty of trying to smuggle it through,” he said.

“The most common method employed by Mexican TCOs [Transnational Criminal Organizations] involves transporting drugs in vehicles through U.S. ports of entry (POEs),” the U.S. Drug Enforcement Agency (DEA) reported in its 2016 National Drug Threat Assessment. “Illicit drugs are smuggled into the United States in concealed compartments within passenger vehicles or commingled with legitimate goods on tractor trailers,” according to the document.

Heroin is small in volume. “It’s a relatively small amount—40-50 tons, we think—of heroin that feeds the heroin epidemic in the United States,” Gen. John Kelly, then the commander of U.S. Southern Command, told a Senate committee in 2015. The amount has probably increased somewhat today, but still takes up little space: all the heroin consumed in the United States in an entire year could probably fit into two 40-foot shipping containers.

Now, imagine the contents of those containers broken up into tiny amounts and scattered across vehicles, luggage, and cargo shipments and sent through 48 land crossings, plus airports, over the course of 365 days. The difficulty explains why in 2015, the DEA reported that U.S. authorities managed to seize 6.8 tons of heroin, an amount equal to perhaps one-seventh of Gen. Kelly’s demand estimate.
The dynamic is similar for other compact-volume drugs like cocaine, methamphetamine, and fentanyl, which are overwhelmingly seized at ports of entry. Cannabis, which is larger and bulkier, appears to be trafficked more frequently in the areas between the ports.
With a small, compact, and expensive product, and a six-sevenths chance of avoiding detection and seizure, it’s unsurprising that most heroin smugglers don’t bother to transport it between the ports of entry, in the sparsely populated or wilderness zones where proposed border fencing might be built.
The ports of entry are a big part of the picture. Yet while the Trump administration is loudly proposing ambitious, expensive wall-building plans, its budget requests would do very little to address the US$5 billion in documented needs, from renovations to staffing, at the ports of entry.

Misconception 3: “Gangs like MS-13 are moving a lot of drugs from Latin America into the United States.”

Central America’s hyper-violent street gangs, especially the Mara Salvatrucha (MS-13) and Barrio 18 organizations that originated in the United States, make their money primarily from extortion, in addition to other criminal activities like theft and human trafficking. While they do engage in street-level drug sales in the neighborhoods in which they are active, known as “narcomenudeo,” these gangs are not the ones behind the multi-kilogram or even multi-ton shipments of cocaine that pass through Central America en route to the United States from Andean countries.
“Wholesale” cocaine transshipment is mostly the work of cartels. Amb. William Brownfield, the Assistant Secretary of State for International Narcotics and Law Enforcement Affairs, makes the distinction:

“There are two driving factors that are creating a vast amount of corruption in Honduras, and quite frankly throughout the Northern Triangle. First are the organized—the transnational criminal organizations, largely drug trafficking. They are professional criminals, and their objectives are economic in nature. The second are the criminal gangs.”

The first group, the drug-transshipment organizations (sometimes called “transportistas”), are also violent in areas that overlap with trafficking routes, but are largely not responsible for the high levels of crime and violence in urban centers. The investigative organization InSight Crime profiles some of those most active in Central America: El Salvador’s Perrones and Texis Cartel; Guatemala’s Illegal Clandestine Security Apparatuses and Lorenzana, Mendoza, and León crime families; Honduras’s Atlantic cartel, Cachiros, and Valle family; the Reyes Aragón and Reñazco families in Nicaragua; and the Bagdad and Calor Calor gangs in Panama.
These transshipment groups can have a relationship with gangs like MS-13, sometimes hiring gang members as hitmen and providing them with the drugs they sell in the neighborhoods they control. But while the gangs may desire to participate more in large-scale international drug transshipment, they rarely get to do so.
Inside the United States, when Central American gangs sell drugs on the streets, they are not selling drugs that they have brought from the region on their own. Instead, they get their inventory from the cartels, the DEA reports: “The cartels remain the main source of drug supply for the gangs, while the street gangs, prison gangs, and OMGs [outlaw motorcycle gangs] generate street-level sales for the cartels."

Misconception 4: “Mexico seizes more cocaine than most Latin American nations.”

With so much Andean cocaine flowing through the Mexico-Central America vector, one might expect Mexico to be finding and stopping a large amount of the drug. Seizure data, in fact, indicates otherwise: once smugglers reach Mexico, their probability of losing control of their cocaine drops.
The following list of reported 2016 cocaine plus cocaine base seizures is taken from the text of the State Department’s March 2017 International Narcotics Control Strategy Report. It’s notable for a few things. First, Mexico and Honduras—two countries closely aligned with U.S. counter-drug efforts—appear far down the list. Second, these two countries, plus Venezuela, lack reliable current public reporting on cocaine flows and seizures. And third, proximity to Colombia seems to correlate with higher cocaine seizures, which may explain in part why Mexico is near the bottom.


These misconceptions show how complex it is to minimize the damage done by addiction, organized crime, and impunity all along the routes that lead from coca and poppy fields to U.S. neighborhoods. There is no magic solution, like eradicating farmers’ plants, building high walls, cracking down on street gangs, or legalizing without tight regulation. The past 40 years’ experience points to less flashy strategies, among them: breaking corrupt links between states and organized crime through judicial reform; creating economic and civic opportunities in violence-prone territories; bringing a civilian state presence to abandoned zones where illicit crops are cultivated; reforming police and prisons; and expanding access to treatment at home. Pursuing these strategies requires patience, a long-term commitment, and a willingness to measure the right indicators—without being led away by misconceptions.

 Four common misconceptions about US-bound drug flows through Mexico and Central America

The Robert Carr civil society Networks Fund (RCNF) has launched the call for the RCNF Program Advisory Panel (PAP) membership for the period 2017- 2019. This invitation for nominations aims to identify 9 members of the PAP for the years of 2017, 2018 and 2019.

The PAP is appointed by the International Steering Committee (ISC) and operates independently as the main advisor to the ISC. The PAP reviews all funding proposals to the RCNF and based on those reviews provides funding recommendations to the ISC. The PAP also works closely with the secretariat and ISC to support RCNF activities such as monitoring and evaluation and communications. The PAP is provided with logistic support by the RCNF secretariat, including travel arrangements and meeting costs related to proposal review. To learn more about the role and responsibilities of the PAP and who should apply for membership, please read our Invitation for Nominations.

To apply for PAP membership please fill out the online application form and upload a resume. Interested applicants should be aware that a PAP meeting is scheduled to take placed on the 25th and 26th of September 2017. If possible these dates should be kept available for meeting participation.

The deadline for applications is August 1st , 2017. The RCNF ISC will make a decision on the composition of the PAP by mid – August 2017.

Invitation for nominations for individuals to serve on the RCNF Program Advisory Panel

Asia Regional Harm Reduction & Drug Policy Advocacy Fellowship Programme

 (the Programme), which aims to support the development of policy advocacy champions through mentoring and capacity building in India, Vietnam, Indonesia, Cambodia, Thailand, Nepal and the Philippines. Three fellows from amongst these countries will participate in the Programme, selected against criteria demonstrating passion and commitment to policy advocacy, and potential for stimulating policy change in their existing roles and country context. The Programme this year will run from 

. Fellows will each be matched with a mentor possessing a strong record of advocacy in harm reduction and/or drug policy in Asia. The Programme is limited to applicants working in one of the project countries: India, Vietnam, Indonesia, Cambodia, Thailand, Nepal and the Philippines. Fellowship applicants should outline their proposed workplan, including objectives, expected outcomes, workplan activities and timeline with milestones, to be implemented throughout the programme year. If you wish to apply for a fellowship in this year’s programme, please send a cover letter containing the proposed workplan (maximum 2 pages), and attach your CV, to Sof Akbar (pakbar@idpc.net) by 

Asia regional harm reduction & drug policy advocacy fellowship 

It is evident that it is the way in which we regard drugs which is highly problematic. We emphasise legal and illegal, ignoring the fact that we are all drug users in some form, and that some legal drugs are more harmful than many illegal ones.

Even for those who do experience addiction, we should turn our attention to helping them with their problems rather than imprisoning and criminalising them – focusing not on the drug, but on the pain that their drug use may be attempting to diminish. For those with problematic drug use, we advocate a harm reduction approach—rather than punishing behaviour or trying to enforce abstinence.

Shivani Joshi, a graduate from the University of East London, wants a compassionate drug policy

The annual Harm Reduction International Conference was recently held in Montreal, Canada from 14- 17 May 2017. The conference brings together people from around the world who are involved in providing health and social support services for people who inject drugs. I was able to attend and represent STOPAIDS to discuss the important areas of cross-over with the global HIV response.Harm Reduction strategies aim to reduce the harms associated with drug use and commonly include needle exchange programmes and opiate substitution therapy. Harm Reduction is a well evidence essential component of HIV prevention.

Harm reduction funding is in crisis

A draft bill of amendments to the 1993 law published in newspapers in March proposes that drug users will no longer be punished with long prison sentences and will instead be offered treatment and rehabilitation.

The amendments provide for police to be able to send drug users to receive treatment at Ministry of Health and Sports medical facilities before being sent to rehabilitation centres. Adults will be required to attend the centres for two hours a day until they have completed a minimum of 180 hours and a maximum 240 hours of rehabilitation. Minors will be sent to child rehabilitation centres.

Drug Policy Advocacy Group-Myanmar coordinator Dr Nang Pann Ei Kham welcomed the government’s move to decriminalise drug use but said she was concerned some sections of the draft law lacked clarity. In particular, it is essential for the amendments to stipulate that treatment and rehabilitation programs are voluntary and appropriate to the needs of users, she said.

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