More than 100,000 Americans died from drug overdoses between July 2020 and June 2021, according to provisional figures released by the Centres for Disease Control and Prevention on January 12th. That is the highest number on record. Some 75% of these deaths were caused by opioids, a class of drug that includes heroin and fentanyl, a prescription pain-killer that has flooded the black market. In an attempt to prevent more deaths, New York has become the first American city to open officially authorised safe-injection sites where people can inject drugs under the supervision of trained staff. On November 30th two clinics opened their doors. They provide access to clean needles and disposal facilities, and staff can administer naloxone, a drug that rapidly reverses the effect of an opioid overdose. Since they opened naloxone has reversed at least seven overdoses—each time potentially saving a life. Health officials have since proposed to introduce vending machines around the city that dispense the drug. What is naloxone, and how does it work?

Opioids work by attaching to receptors in nerve cells, altering the cells’ activity. They block pain signals sent from the brain and can cause feelings of euphoria, making them highly addictive if taken regularly. Opioids also relax a person’s breathing. During an overdose a person’s breathing can stop entirely, killing them. Naloxone, which is administered as an injection or nasal spray, has a stronger binding affinity with opioid receptors than the opioid itself, and so displaces the drug. The medicine causes no reaction, allowing the nerve cell to revert to its normal state. But dislodging the opioid can cause users to feel painful withdrawal symptoms if they are addicted. In the case of overdoses, naloxone allows users to breathe again, hopefully in time to save their lives.

What is naloxone, and how does it reverse opioid overdoses?

Nearly 92,000 Americans died of drug overdoses in 2020, marking a 30% increase from the year before, a 75% increase over five years and by far the highest annual total on record, according to the Centers for Disease Control and Prevention (CDC). Preliminary figures suggest that the 2021 death toll from overdoses may be even higher.

While overdose death rates have increased in every major demographic group in recent years, no group has seen a bigger increase than Black men. As a result, Black men have overtaken White men and are now on par with American Indian or Alaska Native men as the demographic groups most likely to die from overdoses.

There were 54.1 fatal drug overdoses for every 100,000 Black men in the United States in 2020. That was similar to the rate among American Indian or Alaska Native men (52.1 deaths per 100,000 people) and well above the rates among White men (44.2 per 100,000) and Hispanic men (27.3 per 100,000). The overdose death rate among men was lowest among Asians or Pacific Islanders (8.5 per 100,000).

Recent surge in U.S. drug overdose deaths has hit Black men the hardest

In a progressive move, the Department of Thai Traditional and Alternative Medicine plans to have local cannabis strains registered as a national heritage item before seeking Unesco recognition.

The department has gathered over 30 local strains and recorded the DNA of each one to make a database of the strains grown here with the information to be used to register geographical indications.

The move, if successful, will help de-stigmatise the plant, a traditional herb, away from being an illicit drug under the original anti-narcotics law.

Mr Anutin has also set up a panel comprising experts from various fields to find ways to put the policy into practice. Cannabis legalisation was a flagship policy of Mr Anutin's Bhumjaithai Party during the 2019 election campaign which will allow each household to grow a maximum of six cannabis plants.

Thailand: rethinking cannabis

By the London School of Hygiene & Tropical Medicine, Médecins du Monde and the International Network of People who Use Drugs (INPUD)

Unpack the harm reduction approach, its connection to public health and human rights, and how it works at addressing drug use.

Over the past decades, drug use is increasingly recognised through a public health and human rights perspective. The evidence-based harm reduction approach is based on years of global experiences and evaluated by extensive research. This three-week course provides great insight into why it is such an effective solution.

See how human rights and public health relate to harm reduction

Public health measures focus on improving the overall health of a population, changing regulations, and increasing government support.

You’ll learn how harm reduction is a vital part of this approach, using an effective intervention model that saves lives, as well as protecting dignity, individual agency and other human rights.

Understand the importance of support instead of punishment

At its core, the harm reduction approach is based on empowering people to better protect themselves from potential risks associated with drug use.

It acknowledges the role of people who use drugs as a vital component of a public health response and promotes the idea that government and community support decrease potential risk factors.

On this course, you’ll see real best-practice examples and explore how you can advocate scaling up harm reduction to make a real impact on individual and public health issues, as well as protecting the human rights of people who use drugs.

Study harm reduction at a recognised leader in global and public health

The London School of Hygiene & Tropical Medicine (LSHTM) is strongly connected to the peer-reviewed International Journal of Drug Policy, with much of the research in this field coming from the LSHTM, while also being a world-renowned leader in global and public health.

You can trust their expert guidance as you learn more about using harm reduction to address drug use.

Drug use and harm reduction - Online course

With 2021 now receding in the rear view mirror, we look back at the good, the bad, and the ugly in the arena of drug policy around the world.

The International Criminal Court Eyes Philippines Drug War Killings

Afghanistan's Government Falls, Opium Remains

Mexican Drug War Violence Just Keeps Going

Mexico Didn't Get Marijuana Legalization Done (Again)

Bangladesh Drug War Killings Draw Pushback

Malta Becomes First European Union County to Legalize Marijuana -- Germany, Luxembourg Next?

Italy's Pending Referendum on Marijuana and Plant Psychedelics

Cocaine Production Has Doubled in the Course of a Decade

World Health Organization Declines Move Toward Labeling Kratom a Controlled Substance

StopTheDrugWar.org: Top ten international drug policy stories of 2021

Paola left her home when she was 13 to escape abuse and violence. She lived on the streets for five years until she became pregnant. Her boyfriend left her when he found out. Without work and food, Paola agreed to deal drugs for a neighbourhood kingpin.

She only had to deliver the drugs when her boss’s clients appeared on a street corner. With the money she made in the first few months, she was able to rent a room and live there with her newborn son. With a new partner and her family’s basic needs covered she felt she could abandon her dealer job.

A pattern is developing in Latin America: aggressive drug policies are filling the region’s prisons with women, many of whom are forced into the drug business because they have no other alternatives to support their families.

In Argentina 43% of female prisoners are serving time for drug possession, according to the Ministry of Justice and Human Rights. It is, by far, the leading cause of imprisonment for women in Argentina. As a comparison, the second leading cause of incarceration – theft – represents only 9% of convictions.

Selling drugs is a survival strategy for women in Latin America. They are the most visible face – and the most exposed – of the region’s drug trade. They are also, in most cases, the product of their circumstances: violence, lack of education, poverty, asymmetric power relations, and inequity.

The women filling jails in Argentina for drug offences – A photo essay

As of October 31, government data shows that 6,215 people have been killed in police anti-illegal drug operations alone, while human rights groups estimate the number to reach 30,000 to include those killed by vigilantes.

In September, the pre-trial chamber of the International Criminal Court (ICC) green-lit a formal investigation into Duterte’s drug war, saying that it was apparent that killings “took place pursuant to or in furtherance of a state policy.”

The Duterte government, despite insisting that the ICC had no jurisdiction over the Philippines, actually requested a deferral of the probe. As a matter of procedure, ICC Prosecutor Karim Khan temporarily paused his investigation, but asked the Philippine government to prove it was genuinely investigating the war on drugs.

The war on drugs didn’t stop even as the Department of Justice’s interagency review panel found lapses in protocols during police operations. No cases have been filed by the review panel against erring policemen. Many criticize the panel for being just a tool of the Duterte government to shield itself from international bodies like the United Nations and the ICC.

Philippines: No let-up in Duterte’s drug war in 2021

In 1974, scientists at the University of Chicago immunized a rhesus monkey against morphine. After training the monkey to self-administer both heroin and cocaine by hitting buttons that delivered small, separate doses into a surgically-placed catheter, they administered the vaccine. The monkey’s heroin use plummeted, but it continued to use cocaine the same as before—a sign that the vaccine was working.

The effects started wearing off in a matter of hours, and it wasn’t long before the monkey required boosters. If offered a high enough dose of heroin, its interest in using it returned.

This wasn’t the most sophisticated methodology. But in the decades since, as our technology and grasp of vaccine science advanced, the idea of a vaccine against addiction lingered. Researchers have attempted immunizations for tobacco and cocaine, both of which were tested on humans but failed to receive Food and Drug Administration approval because they were found no more effective than placebo.

Human trials are currently underway for a vaccine against oxycodone, oxymorphone and hydrocodone—better known as OxyContin, Opana and Vicodin. The University of Minnesota Medical School team behind the research sees this as an additional treatment option for addiction to those pharmaceuticals.

The vaccine is intended for people with opioid use disorder. It would train immune cells to treat opioid molecules like an invading pathogen, and destroy them before they can make it to the brain. It would not reduce cravings, but would block people from feeling any effects of the opioid after they used it. If effective, they would experience no pain relief; no euphoria; no overdose.

An opioid vaccine is not the answer 

A section of civil society organisations (CSOs) have asked the government to stop the arraignment of drug addicts in court.

The Uganda Harm Reduction Network (UHRN), an organisation that provides treatment and care for people affected by drugs, says such repressive actions have proven to be counterproductive.

UHRN adds that such actions contravene international standards on human rights and public health.

“The suspects in drug cases are subject to violence or torture by the police. The hostile legal environment drives both brutal human rights violations and epidemics of HIV, TB and viral hepatitis among people who use drugs in Uganda,” Mr Twaibu Wamala, the UHRN executive director, said yesterday.

The Global Drug Policy Index that came out in November 2021 shows that Brazil keeps Uganda off the basement when it comes to poor drug policies and their implementation.

The index serves as a tool for accountability and evaluation in the field of drug policy.

Many African countries fared poorly on the index because their policies do not align with the UN principles of human rights, health, and development.

Do not take people living with drug dependency to court, Ugandan CSOs urge government

INPUD and Drugreporter are excited to announce the five winners of our #Morethan video contest!

The contest, which launched in September, is intended to be a continuation of the #MoreThan campaign launched on 2021 International Drug Users Remembrance Day, highlighting that people who use drugs are more than the sum of all labels attached to us by broader society. The contest was supported through the Robert Carr Fund for Civil Society Networks.

In total we received an incredible 22 submissions from 17 countries. It was not easy to select five winners among all of these fantastic videos, which highlighted some incredible human stories as told by members of the community. An independent board of five community activists were asked to rate the videos according to: eligibility, appropriateness, relevance, message and quality.

Below please find the five winners with links to view their videos on YouTube. Congratulations to all the winners!

1st Prize: Delirium a choice
Directed by Sania Zehra & Aisha Kasiri, Pakistan

This short film is based on the life events of a woman who by profession is a nurse, portraying her struggles during the pandemic and how isolated she became even among family and friends due to the negative connotation attached to drug use. The fact that she was juggling her responsibilities of home and work life were simply negated because of her inclination towards drug use as a way to cope with daily challenges of life and the havoc that COVID-19 pandemic brought on her mental health.

2nd Prize: 6 Women, 1 Seed
Directed by Larissa Lewandovski, Portugal

This documentary features violence against women who use drugs and sex workers. The documentary was made as part of the campaign against violence on women using drugs (WUD) launched by WHRIN and EuroNPUD – SisterWUD. Since then, a new group, GAMEM (Peer support group among women experiencing violence) has been created, representing WUD, including migrants, sex workers, homeless women and non-binary people. GAMEM has a weekly meeting at a safe space provided by a cultural association, Sirigaita, at a neighbourhood where drugs, sex work and tourism coexist in Lisbon.

3rd Prize: Living With Stigma
Directed by Dhojo Wahengbam, India

This is a short documentary film about a person who use drugs in Manipur, India, narrating his personal real life experience.

4th Prize: Confession
Directed by Tengku Raka, Indonesia

This short documentary video is about stigma and discrimination experienced by woman who use drugs. We meet a mother and daughter, who both suffered the consequences of Draconian drug laws and mass incarceration from different perspectives.

5th Prize: Should I say that I use other drugs?
Directed by Raúl Lescano Méndez and Dana Bonilla

This short film, based on Carl Hart’s essay ‘Get Out of the Closet: Stop Behaving Like Children’, calls on drug users to use self-examination and the power of their own voice as an urgent step to fight the stigmata related to drug use. Instead of waiting for the world to change, it might be time for ourselves to start changing.

Announcing the winners of the #MoreThan video contest

Malta will this week become the first European country to legalise the cultivation and possession of cannabis for personal use, pipping Luxembourg to the post, as the continent undergoes a wave of change to its drug laws.

Possession of up to seven grams of the drug will be legal for those aged 18 and above, and it will permissible to grow up to four cannabis plants at home, with up to 50g of the dried product storable.

A vote in favour of the legislation in the Maltese parliament on Tuesday will be followed by the law being signed by the president in order for it to be enacted by the weekend, Owen Bonnici, the minister responsible, told the Guardian.

The move by Malta, the EU’s smallest member state, is likely to be followed by reform across Europe in 2022. Germany recently announced a move to establish a legally regulated market, following announcements from the governments of Switzerland, Luxembourg and the Netherlands. A referendum in Italy is planned, while Canada, Mexico and 18 US states have already enacted similar legislation.

Malta to legalise cannabis for personal use in European first

In our last INHSU 2021 satellite session, we welcomed a global panel of experts to discuss the decriminalisation of drugs. The lively session gave real-life examples of decriminalisation models and shared valuable insights into how decriminalisation could positively impact the health and wellbeing of people who use drugs globally.

The session was chaired by Professor Alison Ritter from the Drug Policy Modelling Program at the University of New South Wales, Sydney. Alison was joined by Jean-Maxence Granier, Chair of Asud, Dr. Marie Jauffret-Roustide from Inserm, A/Prof Caitlin Hughes from Flinders University, Hon. Fortune Daniel Molokela-Tsiye, Member of Parliament of Zimbabwe and National Assembly Movement for Democratic Change Alliance, Caitlin Shane, Lawyer at Pivot Legal Society and Shaun Shelly, chair of the South African Network of People Who Use Drugs (SANPUD).

“There has been a long history of criminal penalties, discrimination and multiple forms of surveillance against people who use drugs,” Alison said, opening the session. “One solution that is gaining more traction is to remove the penalties for personal drug use.”

As the subject of decriminalisation becomes a hot topic globally, common questions, concerns and considerations have appeared. This session aimed to delve into each of them.

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