, PhD, represented the International Association for Hospice and Palliative Care (IAHPC) at the Vienna NGO Coalition on Drug Policy in Austria. She explains how the Commission on Narcotic Drugs is changing its view of access to essential medicines for palliative care.

The issue of lack of access to opioid analgesics in 80% of the world, drew unprecedented attention at the recent High Level Segment of the Commission on Narcotic Drugs (CND) and the annual (57th) session held on 13/14 March in Vienna. Although the WHO (World Health Organization) classifies opioids such as morphine, used for the relief of severe pain, and methodone used for dependency treatment, as “essential medicines,” access to both is internationally restricted, since they are “scheduled” under the three drug control treaties supervised by the CND. Palliative care physicians in lower and middle-income countries confront multiple legal and regulatory barriers in accessing controlled medicines.

Two side events and a series of speeches by member states in plenary sessions educated delegates on the harmful health effects of national and international drug control policies. Member states were urged to make public health the cornerstone of drug policy and to review the effects of harsh law enforcement on access to essential medicines for palliative care and harm reduction.

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Access to essential medicines for palliative care: Report from the 57th Commission on Narcotic Drugs

Poland's drug law is the second most restrictive in Europe, after that of Belarus. The Polish Drug Policy Network is arguing for an immediate change to the Law on Counteracting Drug Addiction, while seeking to ease the draconian rules with temporary measures.

Until 2012, the harsh Polish drug law gave prosecutors and judges only one option in respect of illicit drug use and low-level possession - to send Polish citizens to prison, in line with Article 62 of the Law on Counteracting Drug Addiction. A year and a half ago, amendment 62A was passed, giving prosecutors discretion not to proceed with minor cases involving "small amounts" of a drug. The amendment did not, however, provide any definition of a “small amount”, nor did it include a drug quantity table as an Appendix. This omission has led to a situation where the provision has not been widely used, despite the large number of relevant cases, with someone being arrested on suspicion of possessing illegal drugs every seventeen minutes in Poland today - a total of 30,000 people a year.

Polish legal system needs a clear definition of "small amounts" of drugs

A court in the Czech Republic has set precise new standards for prosecuting the possession of illegal drugs, replacing a vague limit of "more than a small amount."

A Supreme Court ruling released Wednesday makes it illegal to possess more than 1.5 grams (0.05 ounce) of heroin, 1 gram of cocaine, 10 grams of marijuana or 1.5 grams of methamphetamine. Lesser amounts will be considered a misdemeanor punishable by a fine.

Wednesday's ruling came after the Constitutional Court last year canceled part of the penal code that allowed the government to set such rules.

Czech court sets rules on drug possession

The rural farmers who are negatively impacted by aerial fumigation in Colombia are one of the most overlooked groups affected by the continuing drug conflict in the South American nation.

The livelihoods and health of small-scale farmers are continuously threatened by the damaging effects of chemical pesticides dropped from government-contracted planes in Colombia’s remote regions. ‘Aerial fumigation’ targets the rural areas where coca cultivation is possible.

Colombia is one of the largest producers of cocaine in the world. The profitability of drug growing, production and trafficking has contributed to a decades old conflict in the country between left-wing, right-wing groups and non-ideological drug gangs struggling for control of the trade.

The victims of Colombia's aerial fumigation

Federal health regulators approved a drug overdose treatment device on Thursday that experts say will provide a powerful lifesaving tool in the midst of a surging epidemic of prescription drug abuse. Similar to an EpiPen used to stop allergic reactions to bee stings, the easy-to-use injector — small enough to tuck into a pocket or a medicine cabinet — can be used by the relatives or friends of people who have overdosed.

The hand-held device, called Evzio, delivers a single dose of naloxone, a medication that reverses the effects of an overdose, and will be used on those who have stopped breathing or lost consciousness from an opioid drug overdose. Naloxone is the standard treatment in such circumstances, but until now, has been available mostly in hospitals and other medical settings, when it is often used too late to save the patient.

US Federal health regulators approved the use of a substance that reverses the effects of drug overdoses.

Hand-held treatment for overdoses is approved in the USA

Russia is home to the world's fastest-growing HIV epidemic. Driven by injection drug use, it is now becoming generalized. A zero-tolerance policy toward drug use in the country bans harm reduction tools and treatment. For many drug users, the only choice is to quit drugs entirely or go to prison.

Outreach workers like Max supply clean needles and health information. Now, with the help of an online network, Max, a former intravenous drug user, also provides legal advice to help people access treatment and overcome abuses in the justice system.

This video features the situation of drug users in Russia and the will of a former drug user to provide legal advice to help people who use drugs to have access to treatment.

In Russia, the fight against HIV goes online 

Monitoring and responding to HIV and hepatitis C among people who inject drugs (PWID) is the focus of two new reports from the EU drugs agency (EMCDDA) and the European Centre for Disease Prevention and Control (ECDC). The reports are the result of two expert meetings organised by the agencies last autumn which brought together key stakeholders from the areas of drug monitoring and infectious disease surveillance.

The meetings had their roots in an ECDC–EMCDDA regional assessment of HIV trends, risks and prevention coverage among PWID conducted in mid-2013. This assessment had identified a low level of prevention coverage in at least one third of European countries, constituting a potential risk of increased HIV transmission among this group.

The first expert meeting held in Bucharest (18–19 November 2013) — 

Detecting and responding to outbreaks of HIV among PWID

 — provided an important opportunity for sharing knowledge and best practice among experts from six countries in the south and south-east of the European region (Cyprus, Greece, Hungary, Malta, Romania and Slovakia). The participants heard about the Greek response to an HIV outbreak among PWID, which started in 2011, and the subsequent scaling up of prevention interventions. This had been guided by monitoring data and research findings and resulted in significant progress in curbing the epidemic. Participants also discussed the situation in Romania, the second country to report an HIV outbreak since 2011. This outbreak has seen additional challenges associated with: high rates of co-infections; changing patterns of drug use among PWID; and the need to address funding gaps through a coordinated country-level response.

The second meeting, a regional Reitox Academy held in Tallinn (21–22 November 2013) — 

Monitoring trends in and responses to drug-related infectious diseases among people who inject drugs

 — contributed to maximising synergies at national level between institutions and experts in the fields of drug monitoring and infectious disease surveillance in four countries (Estonia, Latvia, Lithuania and Poland). The event helped participants from both fields to deepen their knowledge and mutual understanding of the situation; fostered joint initiatives at national level and further strengthened collaboration between neighbouring countries in the Baltic Sea region.

Both meetings acknowledged the critical role and added value of collaboration between the EU agencies in assessing risk and providing technical support to countries as well as in informing policies with evidence-based guidance.

Experts examined progress and defined common priorities regarding actions to be taken forward at national level (e.g. improvements in screening and prevention coverage) and recognised the key role of monitoring and surveillance for evaluating whether prevention efforts to are adequate to avert outbreaks.

EMCDDA and ECDC facilitate sub-regional exchange of knowledge and best practice in monitoring and preventing drug-related infections

This video features information on drug use and harm reduction services for young people in some European countries.

Drugs, harms and youth 

Uruguay is considering using medical marijuana to treat prison inmates addicted to a crude and cheap form of cocaine, one of the country's top health officials said at the United Nations.

The South American country made headlines last year when it became the first in the world to legalize the sale of marijuana. Now, as Uruguay prepares to implement its pioneering legislation, health leaders are considering possible uses for medical forms of marijuana -- including in prisons, where many of the incarcerated are addicted to drugs.

"Pasta base" -- also known as "paco" -- is cocaine base paste, a byproduct of the cocaine refining process. The cheap drug swept through Uruguay and neighboring Argentina during the 2000s, leaving public health officials struggling to control its fallout.

Research on medical marijuana's efficacy in treating addiction to other, "hard" drugs like pasta base appears limited. But other countries, such as Colombia, have begun considering projects seeking to use marijuana to treat addicts.

Uruguay considers using medical marijuana to treat cocaine dependent users in prison

The New Zealand government says its radical new approach to controlling psychoactive substances has led to fewer drugs, fewer retailers, and less harm to health.

New Zealand regulates drugs

Whether it was transporting silk, spices, tobacco, or opium, for centuries, the Silk Road from the Far East towards European countries passed through Serbia. Read how heroin permeated the country and made the region a transport hub for illicit substances.

During the 1970s, injecting drug users in Belgrade and Serbia used opium originating in the former Yugoslavian Republic of Macedonia. Macedonia and Serbia were at the time part of the same country, Yugoslavia, so opium was transported without much trouble, satisfying 90 percent of the opiate drug market. The remaining 10 percent consisted of heroin reaching Belgrade in small quantities. Belgrade's heroin market grew slowly, since at that time there was no organised supply. Dealers were themselves users, and in many cases they were buying heroin in the Middle East and Asian countries. A smaller part of the market was covered by heroin coming from Kosovo. Albanians from Kosovo, with family connections in the Middle and Far East, were trying to organise their (at that time, rather poorly-developed) network of heroin distribution towards Western Europe. Heroin was transported to Yugoslavia from the Middle and Far East via Turkey and Bulgaria. It was then repackaged in Kosovo, to continue its journey towards Western Europe.

At that time, according to drug users, it was harder to arrange contacts with suppliers in Kosovo, due to ethnic and religious distrust, than with suppliers in the Middle East. Students from countries in the Middle East brought heroin to Belgrade for the first time. The street price at that time was 65 – 80 euro per gram.

The role of heroin in Serbian history

For the first time ever, a key human rights body in the Americas has begun studying the impact of drug policies on human rights.

In a hearing before the Inter-American Commission on Human Rights, 17 organizations from across the Americas, including Open Society grantees Conectas, DeJusticia, and the Washington Office on Latin America, among others, argued that the war on drugs has worsened violence, strained criminal justice systems, and reinforced hardline security policies.

The commission’s effort is another step forward in the drug policy reform debate in Latin America. In some countries, this debate is well underway. In others, it is just beginning.

The problems with current drug policies are well established and common across the region. The militarization of efforts to counter drug trafficking in countries such as Colombia and Mexico has fueled violence and resulted in serious human rights violations by armed forces and law enforcement. The eradication of illicit crops has provoked clashes between armed forces and farmers, environmental damage due to aerial fumigation, and abuses against rural populations in Bolivia, Colombia, and Peru, among others.

The Inter-American Commission hearing creates a path to focus on the impact of drug policy on human rights through dialogue among government and civil society representatives.

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