Two recent studies show how the attempt to curtail drug abuse by discouraging and restricting opioid prescriptions has hurt bona fide patients by depriving them of the medication they need to ease their pain. The harm inflicted on these innocent bystanders, which would not be morally justified even if the opioid crackdown did what it was supposed to do, is all the more appalling because limiting legal access to these drugs seems to have accelerated the upward trend in opioid-related deaths by driving nonmedical users toward black-market substitutes.

Jon Furuno, an associate professor of pharmacy practice at the Oregon State University College of Pharmacy, looked at prescribing patterns among 2,648 terminal patients who were transferred from an academic medical center to hospice care from January 2010 through December 2018. During that period, regulators and legislators responded to the "opioid crisis" by directly and indirectly limiting analgesic prescriptions, often in ham-handed ways. While that was happening, the study found, the share of hospice-bound patients who had opioid prescriptions when they were discharged fell from 91.2 percent to 79.3 percent—a 13 percent drop.

Should dying cancer patients suffer from undertreated pain because of 'concerns regarding addiction'?

In the last few weeks, three US states have legalised cannabis for recreational purposes, all via the legislature and not via public ballots. New York, Virginia and New Mexico will begin by permitting cannabis use in private and home cultivation, for adults aged over 21 (out of sight and away from children). The intention is to introduce commercial markets in the coming years, after detailed regulatory requirements are agreed.

Legalisation of cannabis in 3 US states: New York, Virginia, New Mexico

In November 2020, Vancouver City Council unanimously passed a motion to request that the federal government decriminalize the simple possession of illicit drugs in Vancouver. For over two decades, we at the Vancouver Area Network of Drug Users (VANDU) have been fighting to end all forms of illicit drug criminalization and related policies that target drug users.

We have needlessly lost thousands of our family members, comrades, friends, and loved ones to the drug war. VANDU members were briefly vindicated and relieved by news of the City’s announcement, but the feeling was bittersweet. Too many have already lost their lives and we’ll never get them back. This long-overdue attempt to change the status quo came too little too late, and now the proposed changes risk worsening the situation for illicit drug users in Vancouver and across Canada.

Now, City staff are rushing the so-called “Vancouver Model” of decriminalization in its final submission to Health Canada without the involvement or knowledge of drug users, the very people this initiative purports to serve. The decisions that have already been made by the City in this process have been alarmingly ill-informed and their top-down process has been fatally flawed. If Vancouver does not correct its course immediately, the proposed model for decriminalization set a dangerous precedent for drug users across Canada.

The “Vancouver Model” of decriminalization will set a dangerous precedent for drug users across Canada

Over the course of the last decades, peer work has been increasingly recognised as the most efficient model of intervention in any HIV or HCV cascade and is deeply embedded in the Harm Reduction approach. Despite this recognition and numerous global recommendations to expand peer work, adequate funding for peer work as well as ensuring the security, capacity building and meaningful participation of peer workers in programming and strategy-making spaces is lagging behind. Often, contexts do not have an administrative framework to recognise peer work in a job-structure, neither is peer work recognised as being part of the national health systems. Many peer workers find themselves in precarious and unfavourable employment situations and receive an extremely low daily wage, despite the fact that they are often the low threshold point of engagement for harm reduction services and exposed to the most risk.

It is recognised that peer workers’ expertise and engagement within the community is invaluable in delivering outreach and ensuring access to services. Peer workers are people with lived experiences who also have privileged access to marginalised communities and active drug scenes. As such, these models need to be scaled up in order to meet current health targets. Furthermore, the engagement of the community must be appropriately recognized and supported. Meaningful participation should be factored into all aspects of planning, design and implementation of harm reduction interventions. Peer workers are also essential in this process.

What can we do to strengthen and sustain interventions with peer workers for people who use drugs and sex workers?

This video summarises discussions from a multi-stakeholder consultation process organised by the International Network of People Who Use Drugs (INPUD), CoAct, the European Network of People who Use Drugs (EuroPUD), the International Committee on the Rights of Sex Workers in Europe (ICRSE) and Médecins du Monde.

Strengthening and sustaining peer work interventions for people who use drugs and sex workers

By Constanza Sánchez, José Carlos Bouso, & Natalia Rebollo

In March 2020, the results of a significant trial related ayahuasca importation in Spain concluded with an acquittal that paves the way for the future of ayahuasca in this country. There is one additional case in process in Spain, which we hope will be the last, based on the results of this trial, along with other historical precedents.

In this post, we analyze the details of the case, the legal route it took, as well as the implications of the sentence on the future of the legality of ayahuasca and other traditional plants in Spain.

A common case, with a disproportionate pre-trial detention

The sequence of events in this case were very similar to dozens of other ayahuasca legal incidents that have occurred in Europe over the last two decades.

A person living in southern Spain ordered approximately five liters of ayahuasca from their traditional doctor in Peru. The package arrived through a well-known international parcel delivery company via Germany, where customs authorities alerted the Spanish police to the contents of the shipment, “with a net weight of 5,746 grams of dark brown viscous liquid known as ayahuasca containing DMT.”

The Spanish police tested the sample again, which came back positive for amphetamine, a common occurrence in ayahuasca samples that undergo basic testing. It was determined that 22,864 doses of the illicit substance of 250 milligrams each could be derived from the more than five kilograms seized, with a total estimated value of 103,000 euros on the market. It took more than two months for the confirmatory analysis of the seized material to be conducted, the results of which showed that the liquid contained DMT, not amphetamine.

The procedure followed by Spanish authorities was also typical — a controlled and monitored delivery of the package was carried out, and the accused was arrested at the time when the delivery was received. As it was assumed that the contents were methamphetamine, he was held in pre-trial detention.

From that moment on, a series of events unfolded that under the guise of “protecting public health,” led this over 60-year-old man into a legal and judicial labyrinth of drug control. Unaware of drug control measures, the defendant had ordered ayahuasca for his own consumption to treat a health condition. Following arrest, he spent three months in one of the most complicated prisons in southern Spain (Alhaurín de la Torre). In this region drug law enforcement is particularly severe, because it is a very active transit area for international illicit drug markets, and where numerous criminal organizations dedicated to the large-scale drug trade (primarily cannabis resin and cocaine) operate.

“ICEERS gave us, and me in particular, the support I could rely on, because we had been told that everything was irreversible. By supporting me, I was then able to support my husband, because in those conditions he did not have the strength to continue, his health condition worsened and his physical appearance deteriorated seriously. He was no longer the same from any perspective. From our point of view, it was impossible. And from ICEERS, which is made up of wonderful people, I received reassurance that I could trust. And they have been proven right. I am infinitely grateful to each of its members, to ICEERS for existing, and to life that connected them to me.”

The long road to determining ayahuasca legality

Ayahuasca is a beverage that is not under international control, nor is it prohibited in Spain. However, the fact that one of the plants traditionally used in its preparation (chacruna, or 

) contains dimethyltryptamine (DMT), a substance included (in its synthetic form) in Schedule I of the 1971 Convention on Psychotropic Substances. What this means is that when DMT is detected by the analytical instruments of the National Institute of Toxicology (INT), the entire quantity of the infusion is often interpreted as being DMT and, therefore, as prohibited.

If five liters of seized ayahuasca are considered to be the equivalent of five kilograms of DMT, this leads to petitions for high penalties by the Prosecutor’s Office. In Spain, penalty levels correspond to the commission of a crime against public health of substances that cause serious damage to health, as stated in the Article 368 of the Spanish Penal Code. In this case, the Anti-Drug Prosecutor’s Office requested four years’ imprisonment and a fine of 309,000 euros. Furthermore, the pre-trial detention was unjustifiably extended, as it took more than two months for the confirmatory analyses to be carried out.

The defended was represented by the lawyer Francisco Azorín, from the Brotsanbert law firm that specializes in the legality of traditional plants. The defense strategy, in which ICEERS participated actively and to which we contributed expert reports and testimonies in the trial, was effectively focused on two lines of argument. The first being that ayahuasca is not subject to control, neither in the international context nor in Spain. The second argument was that the scientific evidence published in recent decades has illustrated that ayahuasca does not pose a risk to public health. Moreover, research indicates that it can provide considerable benefits for the physical and mental health of people, when used in a ceremonial, controlled and safe context.

“We decided to put all the available information in the hands of the court, instead of opting for a strategy based on the non-quantification of DMT. The contribution of expert reports on ayahuasca’s legality, on the absence of risk to public health, as well as its therapeutic benefits, was key for the drafting of the sentence.”

Ayahuasca: Toxic, narcotic or psychotropic drug?

A few weeks after the trial, we received news of the acquittal and we were able to read in detail the arguments of the court that led to this conclusion. We noted with satisfaction how many of the arguments used by the judge were taken from the expert reports that we provided. This is a direct result of findings from research conducted by ICEERS, both in the political-legal and health fields.

The 17-page ruling argues that “ayahuasca as a plant preparation is not subject to prohibition or control either internationally or nationally in Spain, as a psychotropic substance, drug, or narcotic.” Or, in other words, the concept of “intoxicating drug, narcotic or psychotropic substance” in Article 368 of the Spanish Penal Code cannot be interpreted as including ayahuasca.

This builds on the interpretation that has been extensively documented in the book by professors of Criminal Law at the University of Malaga, Dr. Antonio Martín Pardo and Dr. Juan Muñoz, 

El estatuto legal de la ayahuasca en España

 (The Legal Status of Ayahuasca in Spain, 2019).

The verdict is fundamentally significant for two reasons. First, because it is a recognition that the regulation of certain prohibited substances could bring more benefits than problems. Literally, the reporting judge stated that “a policy of greater tolerance accompanied by rigorous controls and regulation, avoiding absolute prohibition, could be more effective or, on the whole, bring more benefits than harm.”

The judge’s statement points to the fact that this change should be made in the political sphere, not in the judicial sphere. The judge’s message could be interpreted as, “Ladies and gentlemen, political decision-makers, as long as you do not change this policy, we, as judges will continue to apply the law. We are ready and prepared to apply a more efficient approach. Please get on with it.”

“During the oral trial, the Court was very attentive to the testimonies, with the aim, as we saw later, of applying the law according to current scientific knowledge. The judge drafted a judgment that can be considered a theoretical manual on drug trafficking and interpretation of the international drug control conventions. These rules are not clearly drafted, which means that situations of preventive imprisonment for ayahuasca continue to take place. We will be seeking compensation for damages for our defendant, who spent almost three months in prison because the administration took a long time to carry out the confirmatory analysis.”

The second reason why this ruling is very relevant within the Spanish context is because it settles once and for all the legal complexity in which plants with psychoactive effects are entangled. While they are not controlled as plant products, they contain a compound that is. This is the case, among other ethnobotanicals, such as khat, which contains cathinone, mescaline cacti such as San Pedro or peyote, or psilocybe mushrooms, which contain psilocybin.

This sentence also settles the question of the possible theoretical inclusion of ayahuasca as being a controlled as a “preparation” of DMT. The INCB, according to the report, “provides us with a mechanism of authentic or at least qualified interpretation” that “contradicts this initial conclusion.” It concludes, therefore, that “ayahuasca cannot be understood to be covered by the 1971 Convention, even though DMT is.” This idea, supported for years by those of us who work for change in drug policies, who advocate that drug laws should not be applied to the field of traditionally used psychoactive plants, had been supported in some previous rulings in relation to ayahuasca, but never so carefully argued and substantiated as in this ruling.

“Over the last few years, ICEERS has collaborated with with lawyers and experts in traditional plants to develop we have developed defense strategies that are based on scientific evidence and human rights. Together we’ve supported movement away from classic arguments related to public health in these trials. Sustained research and strategic litigation efforts have borne fruit in Spain, where we have managed to turn around several disproportionate accusations and requests for sanctions, and obtained sentences such as this one, which further clarifies the legal status of ayahuasca in Spain.”

- Constanza Sánchez, Director of Law, Policy and Human Rights, ICEERS

While we hope that this is the last legal case in Spain regarding ayahuasca, there are still several legal processes underway for other defendants and ayahuasca seizures continue to take place.

“In 2020 and to-date in 2021 we have been informed of fourteen legal incidents in Spain. While it is true that the trend towards filing ayahuasca-related cases is becoming more frequent, the confusion among airport, customs and judicial authorities still persists.”

- Natalia Rebollo, Ayahuasca Defense Coordinator, ICEERS

However, the resolution of this case is a further step in the right direction and suggests that this may be, if not the last, then the second last trial related to ayahuasca in Spain. Efforts to educate justice system officials and policy makers must continue and these legal cases in Spain can be used to inform legal and policy directions in other countries.

“Expert reports and the defense strategy convinced the court that ayahuasca is not subject to control. But it is still rare for a sentence to consider or clearly state that ayahuasca does not pose a risk to public health, despite the abundant scientific evidence that illustrates this. It is now time to think of new strategies so that in the next trial, which we hope will be the last one, that it will be described in this way.”

- José Carlos Bouso, ICEERS’ Scientific Director

In recent years we have seen that, although in a large number of countries legal cases related to ayahuasca do not reach a custodial sentence or result in the enforcement of criminal prosecution, the packages are destroyed in almost all the cases. This leads us to reflect on why judicial authorities, even after they determine that it is not controlled by domestic law, continue to allow for the destruction of the ayahuasca that is seized. ICEERS continues to work to reverse this contradiction, which is inconsistent with the requirements of due process. After seven years of work by the Ayahuasca Defense Fund (ADF), the concern has gone from avoiding a conviction to recovering the seized ayahuasca. Remarkable progress, but there is still some way to go.

Spain’s (second to) last ayahuasca trial

The damaging impacts of punishment for drug possession that disproportionately impact Black lives are wide ranging. Imprisonment leads to isolation, an exacerbating factor for drug misuse, addiction, and relapse. It also raises the risk of early death from a wide variety of causes.

Besides leading to incarceration, an arrest for possession of even a small amount of cannabis—a much more common outcome for Black youth than White youth—can leave the individual with a criminal record that severely limits their future opportunities such as higher education and employment. This excess burden of felony drug convictions and imprisonment has radiating impacts on Black children and families. Parents who are arrested can lose custody of their children, entering the latter into the child welfare system. According to another analysis by the Pew Charitable Trusts, one in nine African American children (11.4 percent) and 1 in 28 Hispanic children (3.5 percent) have an incarcerated parent, compared to one in 57 White children (1.8 percent).

This burden reinforces poverty by limiting upward mobility through impeded access to employment, housing, higher education, and eligibility to vote. It also harms the health of the incarcerated, their non-incarcerated family members, and their communities.

Addiction should be treated, not penalized, says NIDA Director

The overdose crisis continues to affect communities and families across Canada. Tragically, we have seen significant increases in overdose deaths and related harms during the COVID-19 pandemic, including in Toronto where overdoses deaths increased significantly between January 1 and November 30 last year. The Government of Canada continues to support increasing access to safer supply projects in communities across Canada to help prevent drug overdoses during the pandemic and beyond.

Today, the Honourable Patty Hajdu, Minister of Health, and John Tory, Mayor of Toronto, announced more than $7.7 million for three projects to increase access to safer supply and provide a new harm reduction and treatment option for people living with opioid use disorder in Toronto. These innovative projects will provide a pharmaceutical alternative to the toxic illegal drug supply and help prevent overdoses.

Government of Canada supports first of its kind safer supply project in Toronto

From the State Assembly of Putumayo, Colombia

The State Assembly of Putumayo, Colombia has appealed to the US Department of State Bureau of Western Hemisphere Affairs to cease US support and financing to the Colombian government for the forced eradication of coca via the aerial spraying of glyphosate.

Aerial spraying has consistnely demonstrated an inherent risk of severely damaging the local biome. This impacts the prospect of growing alternative crops, which Colombian farmers depend on for their livelihoods. Through the aerial spraying of glyphosate, there is no sustainable path for the environment that farmers may utilize to transition away from producing coca.

The application of glyphosate causes long-term damage to all affected parts of the Amazon jungle. It poisons the soil; contaminates rivers; sickens livestock, amphibians and fish; and adversely impacts the region's biodiversity. At the human level, local residents within the fumigated areas have experienced a wide range of alarming health concerns. These range from skin conditions, eye damage, spontaneous abortions and complications in prenatal development.

By 2015, 242,065 of Putumayo’s 363,967 residents had experienced forced displacement from their homes, primarily fleeing areas affected by aerial spraying. During this same period, 1,790 small-hold farmers were forced to abandon their land entirely, due either to environmental damage or armed coercion, according to the National Information Network from Colombia’s National Victims Unit.

Governmental support for crop substitution, as well as protection from armed groups who profit off of the production of coca in the region, would better serve the interests of the farmers, the Colombian government, and the region's overall security. According to the United Nations Office on Drugs and Crime, cultivators in Putumayo overwhelmingly support voluntary substitution away from coca, with 23,523 families agreeing to voluntarily eradiate 9,542 hectares of coca in exchange for support transitioning to legal livelihoods – the largest number of families from any department in Colombia. This negotiated, non-violent approach is the only sustainable path toward the true construction of peace in Putumayo.

Colombia's Putumayo Department Legislative Assembly calls on the US State Department and Congress to stop support for forced eradication programme

The Bill proposes strictly regulated coca leaf production in existing production areas with a strong emphasis on sustainable development and supporting marginalised and indigenous communities involved in coca production.

The Bill was debated in the Senate committee (consisting of 22 senators - with 20 present) last week and again this week. It won a first procedural vote allowing the debate to happen with 15 senators in favor and 5 against. The debate itself led to some amendments. Among them; the possibility that any interested person could grow coca within the designated areas (in the original proposal only indigenous communities and those already living in those areas were allowed to grow), the inclusion of communities of African descent as a priority population, and the elimination of any reference to gender, and the Peace Agreement.

Letting external actors grow coca plants in designated areas would make the proposed regulation easier to enforce, but also risks reducing the benefits for historically impacted communities (it is unclear whether it would include corporate actors). There was a concern that the cocaine regulation part of the Bill could be sacrificed; the thinking being that a Bill focusing on coca-leaf regulation alone might have a better chance of being passed into law. But in the end this did not happen. The final committee vote on the amended Bill passed unanimously by 12-0 (those opposed to the Bill left the room attempting, unsuccessfully, to ensure there would not be enough Senators to hold a vote).

Historic win for coca/cocaine regulation bill in Colombian state

There exists a lack of published academic research with and for young people who use drugs, including research focused on harm reduction. This is despite a majority of the global population of people who use illicit drugs being adolescents and young people—according to the latest (2018) statistics provided by the UN World Drug report—and the fact that they are disproportionately impacted by a range of drug- and drug policy-related harms. Sub-optimal services for young people exacerbate this. Youth-specific harm reduction programs, general service providers, policymakers and peers would all benefit from more perspectives and data from youth who use drugs.

—a peer-reviewed publication established in 2004 and affiliated with Harm Reduction International, the National Harm Reduction Coalition and the Eurasian Harm Reduction Association—is partnering with Youth RISE and 

 for a special series: “Young People, Drugs and Harm Reduction.” We are now seeking research submissions with a view to publishing this work throughout the coming year. We will also be holding a number of events with authors to discuss their research and findings with the wider community.

The initiative, partially funded by the Robert Carr Fund, aims to center the voices of young people who use drugs and include them in the scientific process. It aims to address evidence gaps by providing an academic forum to highlight the diverse voices of young drug users in research, service delivery and policy formation. It also seeks to identify how certain barriers currently prevent the publication of such research.

Please consider submitting your work on “Young People, Drugs and Harm Reduction” to this special series, and spread the word amongst your colleagues and partner organizations to do the same. The submission platform can be accessed here; please read the submission guidelines first. Please ensure the correct collection series title is chosen from the “additional information” tab, and also indicate in the covering letter that the manuscript is to be considered for the “Young People, Drugs and Harm Reduction” thematic series. For more information, please feel free to contact the editors of the 

There’s too little research on harm reduction and youth. Help us put that right.

Haryati Jonet, known as Yatie, has been using drugs since she was a teenager.

At the age of 15, she was thrown out of her home. Pregnant and a lone she began using drugs.

“My first taste of drugs was when I was 15. I was involved with drugs problematically, for 20 years,” says, Jonet, now 46.

Jonet is a member of the International Network of People who use drugs, a global NGO working to promote the health and defend the rights of people who use drugs. She was featured in a video presented during a side-event of the 64th session of the United Nations Commission on Narcotic Drugs. The event focused on why people should be at the centre of any policy towards decriminalisation of drug users.

Participants heard speakers explain why and how people who use drugs should be at the centre of advancing policy towards decriminalisation of drugs as well as the findings of a new report on the subject.

Experts: Drug policy needs a human rights-based approach

This survey is a part of a larger research project by the Civil Society Forum on Drugs aiming to assess the state of implementation of the EU Action Plan on Drugs 2017-2020 in the EU Member States and beyond. It is addressed to civil society organisations working in the field of drug policy.
The Civil Society Forum on Drugs (CSFD) is an expert group of the European Commission. Its members are selected by the Commission for a three-year mandate based on their competencies, knowledge, and expertise. One of its thematic working groups is concerned with the EU drug strategies and action plans.
Following the survey conducted at the beginning of the Action Plan 2017-2020 implementation (report can be accessed here), the CSFD continues the monitoring of accessibility and quality of key demand reduction and harm reduction measures. This survey aims to collect the data allowing for the evaluation of the current situation and identify the potential changes taking place during the last three years. Its results, complemented with other elements of this research project, will be published on the CSFD website.
Please, fill in the questionnaire providing answers according to your best expert knowledge. If you have any questions, please contact Iga Jeziorska, the Chair of the Working Group on the EU Action Plan, at:iga.kender-jeziorska@euro-yoda.org Thank you for your contribution!

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