This year’s International Overdose Awareness Day (IOAD) has seen our movement continue to grow and achieve real change. The final total of 874 events held in 39 countries is a new record, surpassing the previous high of 747 set last year.

And, just as in previous years, International Overdose Awareness Day is a chance to raise awareness of overdose, remember those we have lost, and call for change.

In addition to the final tally of events, there are several headline statistics which show how much our movement has grown.

As of today, the International Overdose Awareness Day Facebook page has more than 40,000 followers, while our Twitter page has more than 4,000.

This year’s campaign brought more than 273,000 visitors to the IOAD website, www.overdoseday.com Visitors to the website downloaded our online resources – posters, fact sheets, and event support kits – more than 20,000 times.

And our supporters bought and distributed close to 60,000 individual pieces of merchandise (in the form of wristbands, badges, and lanyards) – 30 per cent more than in 2018.

The other findings of the 2019 Partners’ Report are based primarily on a survey conducted by Penington Institute, the convenor of IOAD, which asked participants about their events and their experiences. Key findings gathered from responses to the survey include:

Knowledge about the IOAD community: our movement is made up of people who use drugs, loved ones of people who have been affected by drugs, harm reduction and health workers, advocates, and activists. Often, these communities overlap.

Motivations: raising awareness of overdose, reducing stigma, and commemoration or memorial of those we’ve lost were the most popular responses.

Events: almost 95 per cent of respondents had held an IOAD event before. Close to two-thirds of respondents said their event was attended by the general public, while 80 per cent said their event was attended by family and friends of people affected by overdose, and health or community workers.

Satisfaction: 95 per cent of respondents believed their event was successful or very successful, while 96 per cent were satisfied or very satisfied with the resources on offer.

Media coverage: 75 per cent of respondents said their event received media coverage, and the campaign overall generated 2,550 news stories.

Outputs and Outcomes: increased awareness, naloxone training, the creation of shareable resources, Mayoral Proclamations, and politicians promising to do more to end overdose.

The Partners’ Report concludes by reflecting on this year’s campaign and setting some ambitious targets for next year, which will be the 20th International Overdose Awareness Day.

These targets include 1,000 registered events held in 50 countries, a greater number of real-world policy outcomes, and continued growth in key target areas such as the United Kingdom, South-East Asia, South America and Africa.

International overdose awareness day: A vision to end the global overdose crisis

Policymakers in the United States increasingly recognize that drug use should be treated as a public health issue instead of a criminal issue. Most, however, continue to support harsh criminal sentences for people who are involved with drug selling or distribution. Many imagine these people are “predators” or “pushers” who force drugs on the vulnerable, contributing to addiction, overdose and violent crime.

With more than 68,000 people in the U.S. dying from accidental drug overdose in 2018 alone, many people are searching for someone to blame. Pointing the finger at people who sell drugs is, in some ways, a natural emotional response to loss of this magnitude. It is also consistent with decades of drug policies based on the assumption that people who sell or distribute drugs are responsible for causing drug use.

Politicians of all stripes have argued that long sentences for drug sellers will reduce drug availability and make remaining drugs more expensive, driving down demand. But this is not how drug markets actually work.

Imprisoning people who sell drugs does not reduce the drug supply, increase drug prices, or prevent drug use. As Mark Kleiman, a highly-regarded drug policy expert, has explained, “We did the experiment. In 1980, we had about 15,000 people behind bars for drug dealing. And now we have about 450,000 people behind bars for drug dealing. And the prices of all major drugs are down dramatically. So if the question is do longer sentences lead to higher drug prices and therefore less drug consumption, the answer is no.” When a person who sells drugs is imprisoned, they are inevitably replaced by a new recruit or by remaining sellers, as long as demand remains unaffected. A Maryland police officer once described arresting drug sellers as “playing whack-a-mole” and “banging your head against a wall,” because they can be so efficiently replaced.

Framing people who sell drugs as perpetrators and people who use drugs as victims is also misguided because there is extensive overlap between these two groups. A 2012 survey found that 43% of people who reported selling drugs in the past year also reported that they met the criteria for a substance use disorder. In addition, laws against drug selling are so broadly written that it is easy for people caught with drugs for personal use to get charged as dealers, even if they were not involved in selling at all. Politicians and prosecutors who say they want a public health approach to drug use, but harsh criminal penalties for anyone who sells, are in many cases calling for the imprisonment and non-imprisonment of the very same people.

Beyond being merely ineffective, the harsh criminalization of supply-side drug market activity may actually make drug use more dangerous, increasing overdose deaths and leading to more violence in communities. Law enforcement crackdowns on drug trafficking may incentivize the introduction of more potent, riskier drugs such as fentanyl – a synthetic opioid 30 to 50 times as potent as heroin– into the drug supply. Aggressive prosecution of people who sell drugs may undermine 911 Good Samaritan laws, making it less likely that people will call 911 at the scene of an overdose. Indiscriminately putting people who sell drugs in prison also means removing trusted sellers from communities, forcing users to buy from people they don’t know and making an already unregulated and unpredictable drug supply even less predictable.

The relationship between drug markets and violence is complicated. In some contexts, drug prohibition has fueled organized crime and been associated with horrific violence and corruption. But drug markets are much more diverse than stereotypes suggest: many of them experience little or no serious violence, while many markets that sometimes do experience violence operate relatively nonviolently most of the time. Law enforcement crackdowns may actually increase violence in these markets by disrupting the interpersonal relationships and territorial agreements that keep some drug markets operating smoothly.

While different individuals who work on the supply side of the drug economy have differing goals, priorities and knowledge levels about drug safety and harm reduction, there is evidence that some people who sell drugs take steps to ensure that their clients stay as safe as possible. Some people who use drugs report high levels of trust in the people from whom they buy, although in an unregulated drug market even the most ethical drug sellers have limited ability to know the composition of the product they are selling.

The current system of supply-side criminalization disproportionately impacts people at the lowest levels of drug supplying hierarchies. Available data suggest that the vast majority of people in prison for drug selling or distribution are not high-level suppliers or “kingpins” and have no history of violent conduct. The current system also has a discriminatory impact on communities of color, despite the fact that the available data suggest that white people are slightly more likely than either Black or Latinx people to report having sold drugs.

Our current approach to people who sell or distribute drugs in the United States does not reduce the harms of drug use or improve public safety. It is built on a foundation of stigma, ignorance and fear rather than evidence, and creates new problems while doing nothing to solve those that already exist. The Drug Policy Alliance believes it is time to rethink the “drug dealer”. We must urgently assess what type of people actually fall into this category and how we as a society can respond to them in ways that will keep people and communities safer and healthier. Despite the challenges of discussing supply-side drug policy reform in the midst of an overdose crisis, we cannot be silent while policymakers repeat the discriminatory, ineffective, expensive and dangerous mistakes of the past.

Rethinking the “drug dealer”

Coinciding with the United Nations international day to eliminate violence against women, and the subsequent 16 Days of Activism against Gender-Based Violence Campaign (25 November to 10 December), women who use drugs and their allies around the world unleashed a diverse and dynamic series of actions under the uniting themes:

The war on drugs enables violence against women

Drug use is NOT an excuse for violence and abuse.

also utilising orange (reflecting international ‘orange the world’ theme colour for eliminating violence against women. Women who use drugs are exposed to higher rates of violence than other women).

This violence includes, (but is not limited to) rape, sexual harassment, extortion, loss of child custody, imprisonment for mere personal possession, extra judicial killing, capital punishment and penalisation for drug use in pregnancy. Prohibition either directly causes or greatly exacerbates conditions for all of these violations. Gender-based violence cannot be eliminated if those most affected are not directly and meaningfully involved at all levels in relevant policy and programming.

Women who use drugs are boldly stepping out to take their place in the women’s movement and efforts to stop Gender-based violence. Collectively we and our allies call for governments to end the gendered, failed and murderous policy of drug prohibition.

The following summary features actions performed in Indonesia, Burundi, Australia, Ukraine, Nigeria, Greece, Mexico, Spain, USA, Mauritius, Nepal, Lithuania and Seychelles.

Elimination of violence against women who use drugs - Global campaign summary

According to the estimated needs to sustain HIV and TB responses in Albania, approximately US$3 million is required per year to address the two epidemics effectively. The implementation of the current Global Fund HIV and TB grant of approximately US$5.8 million is ending in December 2019. The last transition grant is expected to start in January 2020, but its level of investment will only be in the region of one-third of the value of the current grant.

This case study looks at the challenges faced in sustaining HIV prevention programmes among KAPs, implemented primarily by civil society organisations (CSO’s), as a result of the withdrawal of the Global Fund through the transition period of 2020 to 2022 and the lack of government capacity and resources to maintain the already limited services that will likely result in the re-emergence of HIV epidemics among people who inject drugs (PWID), sex workers (SW) and men who have sex with men (MSM).

Based on the issues raised in this case study, it is evident that the Global Fund, bilateral donors and private foundations need to establish a ‘safety net‘ through which sustainable bridging funds can be made available that are able to address the challenges faced in those countries, such as Albania, which can no longer rely on Global Fund grants in the future. If such a mechanism is not forthcoming, there will be a serious risk that Albania will become re-eligible for Global Fund support due to re-emerging epidemics among vulnerable groups, as has been the case in Montenegro, Serbia and certain other countries of South Eastern Europe.

The challenges of Global Fund transition in Albania: Harm reduction services on the brink of collapse

By Robert Csák, Irena Molnar, Péter Sárosi, Jovana Arsenijević, Bojan Arsenijević

Our results emphasize that drug related harms are generated in a complex system with intricate connections amongst diverse, heterogeneous actors, in an ever-changing assemblage. We tried to illustrate in this paper how the diverse everyday practices of injecting, combined with the different substances available, the social context of injecting, the physical environment where the substance use occur, could shape the risk behaviours of PWID and the risks of substance use as such. The differences in the prevalence of individual risk behaviours represent the differences in injecting practises in the two communities, and these differences underline the importance of tailoring harm reduction services to the specific needs of the local PWID community. Nevertheless if we would like to implement interventions that can effectively reduce the health risks of substance use, it is necessary to consider environmental, structural factors influencing the consequences of substance use, and aim for responses that could promote an enabling environment, despite it could be hard to transform these factors into variables affecting public health indicators directly

Some of the lessons learnt from our research:

Although the demographic characteristics of drug users were the same (mostly men in their mid-thirties, with low educational attainment, and poor labour market position), there were differences in drug use. Whilst in Belgrade most people still inject heroin, in Budapest mostly new psychoactive (cathinone-type) stimulants are injected.

Access to sterile injecting equipment declined significantly in both cities. In Belgrade 78 percent of drug users bought their clean needles in pharmacies. In Budapest, where a few NSPs remained open, this figure was only 51 percent.

The overwhelming majority of users share their equipment in both cities. The situation was more severe in Belgrade, where half of our sample practiced seven or more types of risky behaviour (compared to one quarter of the Budapest sample).

Our research confirmed that injecting drug use is a community activity, shaped by the environment and by mediated drug-sharing practices amongst the same marginalised, criminalised groups. Any future interventions should consider these environmental, structural factors.

In both cities, fewer people have access to HIV/HCV screening and counselling, vein-care products, and social services (eg. housing, employment). The closure of NSPs severely exacerbated the social isolation of their former clients: they reported significantly less access to “a place to sit for a while” or “speaking with social workers”.

The study was conducted by the Rights Reporter Foundation, in co-operation with the NGO ReGeneracija from Belgrade.

Different environments, different risk behaviours: Consequences of decreased coverage of needle exchange programmes in Budapest and Belgrade

The phenomenon of new psychoactive substances (NPS) started decades ago with the growth and production of drugs that replicate the effects of controlled drugs (such as amphetamines, cocaine, cannabis and heroin) but avoid legislative control based on different chemical structures.

In recent years, the increasing use of NPS has led to new threats for health of people who use drugs (PWUD) – including overdose, psychotic reactions, high HIV risks due to multiple injections and increased number of sexual contacts. However, in many countries service providers such as harm reduction, drug treatment programs and ambulance services are not prepared to provide PWUD with quality support and counselling to reduce risks of NPS.

In the Central and Eastern Europe and Central Asia (CEECA) region the situation with NPS is truly alarming and has become one of the major challenges for the national public health systems, local NGOs, communities PWUD.

EHRA in partnership with School of Law, Swansea University conducted a research “New Psychoactive Substance Use in Moldova and Belarus”. It aimed to analyze and determine the presence of new psychoactive substances (NPS) in Belarus and Moldova. Results from this project will supplement scarce international data on the use of NPS in these countries, present a more accurate picture of its use, and provide information to national civil society organizations for political advocacy.

In 2020, research will be expanded into 4 more countries: Kazakhstan, Kyrgyzstan, Georgia and Serbia.

New psychoactive substance use in Moldova and Belarus

MDMA is well established as a popular psychoactive substance across much of the Western world. Hundreds of thousands of people break the law to access its effects, which include increased energy, euphoria, and enhanced sociability. The categorisation of MDMA as a Class A drug in the UK and Schedule I drug internationally – categories reserved for drugs deemed to pose the highest risk to individuals and society – has never meaningfully disrupted its supply, nor its widespread use. MDMA is cheaper and purer than ever before and is available at the click of a mouse via darknet drug markets.

For several years, MDMA-related adverse events and fatalities have been increasing in the UK, with some claiming that taking MDMA today is the riskiest it has ever been. Responses are polarised between those who assert that the risks of MDMA use necessitate mitigation through prohibition and increased law enforcement, and those who perceive prohibition to be exacerbating these risks by exposing users to an unregulated market of pills and powder of unknown strength and quality. Whichever view you take, current policy is not meeting its goal of reducing harms, and greater control of MDMA production, distribution, purchase, and consumption is needed in order to prevent MDMA-related emergencies.

This report examines the acute, sub-acute, and chronic harms related to MDMA use in detail. We examine the production, distribution, purchase, and consumption of the drug; related risks and harms; and the impact prohibition has on these, as well as the potential impact of alternative policies. Crucially, our evidence shows that most harms associated with MDMA use arise from its unregulated status as an illegal drug, and that any risks inherent to MDMA could be more effectively mitigated within a legally regulated market.

Under prohibition, people purchase MDMA pills, crystal, and powder from an illegal market, with little certainty as to what these contain. Given that illegal drugs are not subject to strict production standards, consumers are exposed to the risks of poisoning or accidental overdose as a result of contamination, adulteration, and unknown strength and purity. Naïve commentators demonise the drug and simply urge young people to ‘just say no’, whilst failing to account for those who say ‘yes’. In the meantime, preventable deaths continue to occur, and otherwise law-abiding people are punished for non-violent offences such as the possession or social supply of MDMA. Governments and the mainstream media persist in perpetuating the myth that the War on Drugs is winnable if it were fought harder, and those calling for drug policy reform – as we do here – are framed as ‘radicals’ who have little or no regard for the health and wellbeing of citizens.

This characterisation could not be further from the truth. Those calling for careful reform to existing drug policy include the parents of young people whose lives have been lost or ruined by harms related to the prohibition of MDMA. We incorporate their voices in this report alongside those of academics and former police officers, highlighting the ‘broad church’ of those dedicated to fighting for reform. This includes scientists undertaking ground-breaking research into the therapeutic potential of MDMA, who work within a regulatory regime that makes such research exorbitantly expensive and time-consuming, because of the Schedule 1 status that MDMA holds in the UK.

As we enter the fourth decade of MDMA’s widespread use, new thinking is needed on how to better control production and distribution, and on how to reduce the risks associated with its consumption. There is growing evidence to support reorienting drug policy away from an ideologically driven criminal justice-led model to one rooted in pragmatic health and harm reduction principles. This is reflected in the widespread reform of cannabis laws occurring in numerous jurisdictions around the world, and the growth of treatment programmes for heroin users which include prescription heroin and supervised injecting rooms. These hard-fought policy changes acknowledge the failure of prohibition to meet its goals and produce a ‘drug-free world’. They are built on a robust and ever-growing evidence base which demonstrates how permitting or prescribing the use of legally regulated drugs improves health and safety outcomes for people who use drugs and their communities at a reduced cost to the state, whilst also providing wider employment and economic opportunities. This logic can be extended to the use of MDMA and other currently prohibited psychoactive substances.

follows this pragmatic path and pursues policy aims which many of us share, such as improvements in public health promotion, targeted harm reduction, evidence-informed policy and practice, human rights, social justice, participatory democracy, and effective governmental expenditure. For the first time, we outline detailed recommendations for drug policy reform to better control the production, distribution, purchase, and consumption of MDMA products. Reform and the reduction in MDMA-related harms this will bring cannot happen overnight. The changes we outline here, which culminate in a strictly regulated legal market for MDMA, are to be phased in gradually and closely evaluated through independent policy research to ensure health and social outcomes are properly documented, with findings folded back into the ongoing reform process.

The report is available on the Beckley Foundation's website.

Roadmaps to regulation: MDMA

In recent years, services and options for people with opiate dependence have expanded to include a range of prolonged-release buprenorphine formulations. Although these new options can represent the right solution for some individuals, a significant risk of a coercive use exists, especially in countries where people who use drugs are highly criminalised and discriminated against. In such contexts, these medications could be used as a means to reduce people’s choice with regard to their bodily integrity and their drug use. In return, this could essentially enforce prohibition and morally-driven ideas of abstinence. This paper outlines the position of the International Network of People who Use Drugs (INPUD), developed after extensive research and in consultation with people who use drugs and our allies.

Extended-Release Opioid Agonist Products: A community position statement 

The UN Common Position on drug policy is available here.

In November 2018, the UN System CEB adopted the ‘UN system common position supporting the implementation of the international drug control policy through effective inter-agency collaboration’, expressing the shared drug policy principles of all UN organisations and committing them to speak with one voice. The CEB is the highest-level coordination forum of the UN system, convening biannual meetings of the heads of all UN agencies, programmes and related institutions, chaired by the UN SecretaryGeneral. The CEB’s mandate dates back to the early days of the formation of the UN system, when ECOSOC in 1946 requested the UN Secretary-General to establish a standing committee to coordinate the activities of the multiple specialised entities of the UN system. The resolution led to the establishment of the Administrative Committee on Coordination (ACC), the predecessor of today’s CEB.

The 2000 Millennium Summit represented the first significant streamlining of inter-agency structures, away from individual programme areas, and focusing on cross-sectoral policy objectives, such as sustainable development and gender mainstreaming. It marked ‘the beginning of a new phase, where the organizations of the system now have, in the United Nations Millennium Declaration, a single overarching policy framework, to which they are individually and collectively committed’. The CEB, the new name given to the ACC in 2001, ‘intended to reflect this new state of play and this collective commitment’: ‘The expression “Chief Executives Board” rather than Committee is meant to reflect the transition from a collection of organizations that come together to “compare notes”, to a collegial body whose participants share a collective responsibility for nurturing the new reality that the system has come to represent’.

The subsequent 2005 World Summit Outcome Document called for ‘stronger system-wide coherence’ by strengthening linkages between the normative work of the UN system and its operational activities, and invited the UN Secretary-General ‘to launch work to further strengthen the management and coordination of United Nations operational activities so that they can make an even more effective contribution to the achievement of the internationally agreed development goals, including the Millennium Development Goals’.9 In response, UN Secretary-General Kofi Annan set up the High-level Panel on UN System-wide Coherence, which published its report with recommendations in November 2006 under the title ‘Delivery as One’, focusing on the areas of development, humanitarian assistance and the environment. The work of the UN ‘is often fragmented and weak’ and, according to the Panel: ‘Inefficient and ineffective governance and unpredictable funding have contributed to policy incoherence, duplication and operational ineffectiveness across the system. Cooperation between organizations has been hindered by competition for funding, mission creep and by outdated business practices’. The Panel also called on the CEB to review its functions ‘with a view to improving its performance and accountability for system-wide coherence’, because although the CEB ‘has led to some improvement in interagency coordination […] the Board’s potential has been underexploited and its decision-making role has been underused’.

The transition from the ‘Millennium’ to the ‘Sustainable’ Development Goals in 2015 was accompanied by a policy review of operational activities for development in the UN system, because ‘the integrated nature of the 2030 Agenda for Sustainable Development requires a United Nations development system that works in a coordinated and coherent manner’. The General Assembly also requested the UN SecretaryGeneral to present proposals to improve the collective support of the UN development system for the implementation of the 2030 Agenda, including through a more robust Resident Coordinator system.

Referring to the Secretary-General’s ‘overall vision to focus on root causes and the prevention of crises and vulnerabilities across all pillars’, Deputy Secretary-General Amina Mohammed ‘emphasized that tangible results achieved on the ground benefitting the people that the United Nations system served would be the true test of the reform efforts’. She underscored that the UN system ‘would have to embrace change in order to live up to the ambition set by Member States through the 2030 Agenda and other commitments’ and that ‘a common understanding of the direction of change was emerging towards a better coordinated, integrated and coherent country presence, with real accountability for system-wide results’.

Within this broader UN reform context, and following up on the outcomes of the 2016 UNGASS, the drugs issue came to the agenda of the CEB as one of the cross-cutting issues for which a more coherent approach needed to be developed. The resulting UN System Common Position on drug policy, released in January 2019, commits to ‘supporting Member States in developing and implementing truly balanced, comprehensive, integrated, evidence-based, human rights-based, development-oriented, and sustainable responses to the world drug problem, within the framework of the 2030 Agenda for Sustainable Development’. It supports ‘policies that put people, health and human rights at the centre’ and promotes ‘measures aimed at minimizing the adverse public health consequences of drug abuse, by some referred to as harm reduction’, ‘sustainable livelihoods through adequatelysequenced, well-funded and long-term developmentoriented drug policies in rural and urban areas affected by illicit drug activities’, and ‘alternatives to conviction and punishment in appropriate cases, including the decriminalization of drug possession for personal use’. It also calls ‘for changes in laws, policies and practices that threaten the health and human rights of people’ and ‘to cooperate to ensure human rights-based drug control and address impunity for serious human rights violations in the context of drug control efforts’. The CEB members also committed to stepping up their joint efforts to ‘provide Member States with a necessary evidence base to make informed policy decisions and to better understand the risks and benefits of new approaches to drug control, including those relating to cannabis’.

The CEB Common Position – not a binding document for Member States but a powerful instrument to harmonise the voice and activities of all UN entities – represents a significant step towards improving UN system-wide coherence and can guide the global drug policy debate towards a more health, development and human rights-based approach. Crucially, to ensure that the Common Position does not simply remain a piece of paper, a UN system coordination Task Team has been established to ensure that coherent efforts are undertaken to realise its commitments, and it will serve as an authoritative policy directive to UN Resident Coordinators for implementing drug-related programmes on the ground and assisting Member States in policy development.

Achieving more system-wide coherence under the banner of ‘Delivering as One’ or ‘One UN’, and aligning with the overarching SDG framework has been a particularly difficult challenge in the area of drug policy. This briefing paper reconstructs the long and troubled process that led to the adoption of this ground-breaking UN System Common Position.

UN Common Position on drug policy - Consolidating system-wide coherence

From South Africa to Myanmar, from Brazil to Kyrgyzstan, women are resisting the war on drugs. Killings, criminalization, incarceration, denial of medical care, and social stigma are just a few of the effects the war on drugs has had on communities around the world. It targets particular groups, with gender-specific impacts. The war on drugs is clearly a feminist issue.

Yet the effects of repressive drug policies on women, trans and gender-diverse people are rarely discussed in feminist spaces.

Our purpose with this documentation is to share AWID’s experience of strengthening relationships and building trust between feminist movements and women who work on humane drug policy in Eastern Europe and Central Asia (EECA) region, and supporting the inspiring global movement-building process led by women who use drugs

We are keen to share this experience because it has been a valuable and deep learning process for AWID as an organization. We believe this process could be useful to groups and movements involved in other cross-movement conversations, and to strengthen relationships and build new alliances.

How feminism can be enriched by the experiences of women who use drugs

How we designed a movement-support process with women who use drugs

The key learnings we drew from this experience

It is critical for feminist movements to develop awareness of the gendered, racial and class aspects of repressive drug policies and the associated criminalization and stigmatization of people who use drugs.

Harm reduction movements intersect with movements of sex workers, people living with HIV, racial justice, and LGBTQI+ movements, among others.

We must expand what feminist logistics mean to us, and make feminist spaces more accessible, safe and welcoming for women who use drugs. This is a particularly important lesson for us in AWID, as an organization that hosts convenings.

We are honored to share our learnings and experience. It has been an incredible opportunity to build new relationships with a growing and inspiring movement led by and for women who use drugs and are affected by drug policies. We have learned a lot, and hope you will too!

Feminist movements and women resisting the war on drugs

This is the second edition of our annual report on how New Zealand is dealing with alcohol and other drugs. While we are doing well in some areas, in others there is significant room for improvement.

More than 70 deaths have been linked with synthetic cannabinoids since mid-2017. The death rate has dropped in recent months, but there is no room for complacency. Synthetic cannabinoids continue to cause significant harm across the country, and dangerous new substances still regularly enter the market.

Alcohol is still the most harmful drug in New Zealand. Twenty percent of New Zealanders drink hazardously, and it’s the substance most people seek help for. Alarmingly, alcohol is more affordable now than in the 1980s. The Government must prioritise minimum prices, and phase out alcohol advertising and sponsorship.

Methamphetamine use is an ongoing issue: August 2019 saw the biggest methamphetamine seizure on record. While overall use remains low, across the total population methamphetamine causes huge amounts of harm in some communities.

Māori continue to suffer disproportionately from the harms caused by alcohol and other drugs, bearing the brunt of our criminal justice approach to drug use, with high rates of arrest and conviction.

However, there is a lot to be hopeful about.

A new amendment to the Misuse of Drugs Act, passed in August, means Police may only prosecute for possession and use of drugs if it is ‘required in the public interest’. They must determine whether a health-centred or therapeutic approach would be more beneficial to the public interest than a prosecution. How this will affect prosecution rates remains to be seen, but we’re hopeful low-level drug offences will decrease, or be eliminated altogether.

We’d like to see a massive overhaul of our outdated drug laws. Next year’s cannabis referendum is a great opportunity: people are still being arrested and convicted for cannabis. In the past decade 45,665 people were convicted of a cannabis offence, and 6,583 of those were sent to prison. We look forward to moving towards health-focused legal regulation.

State of the Nation 2019: A stocktake of how New Zealand is dealing with the issue of drugs

Naloxone is used to treat respiratory depression caused by opioids. Opioids produce their effects by acting on opioid receptors in the brain and nervous system. Naloxone works by blocking these opioid receptors, thus stopping opioids from acting on them. This reverses the effects of the opioid primarily in their role as CNS depressants. It is a front-line response against overdose. Naloxone may be given by injection into a vein, muscle or under the skin, or via a drip into a vein (intravenous infusion).

This guidance offers best practice for the provision of naloxone for people who might experience or witness an opioid overdose.

Building on the findings from Release’s research on naloxone in England, Release hosted the Naloxone Steering Group 2019 in April 2019, in partnership with the National Addiction Centre at King’s College London. The objective of the steering group was to get key stakeholders together for a day to discuss some of the main aspects of naloxone provision in the UK and to produce guidelines on the provision of naloxone for people who might experience or witness an opioid overdose.

Drug-related deaths are on the rise in every devolved nation and “9 out of 10 overdose deaths (89 %) in the UK involved some form of opioid”1. Naloxone is a critical and life-saving intervention for those at risk of opioid drug poisoning. To mitigate the risk of fatal opioid overdose, we must foster an approach that is grounded in evidence and facilitates the enjoyment of human rights, with a goal of achieving the highest attainable standard of health for people who use drugs. To this end, the following overarching principles will need to be respected, if we are to achieve best practice in providing naloxone to those who might experience or witness an opioid overdose.

Presumption to provide - decisions should be guided by a presumption in favour of providing naloxone.

Duty to provide - naloxone should be part of the basic standard of care offered to people as part of harm reduction.

There are no real external barriers - any barriers that exist in supplying naloxone are internal and can be addressed.

Funding - there should be a clear and specific funding stream to protect funding and remove fragmentation in funding for naloxone.

Change the narrative - naloxone saves lives. Stigmatising, harmful and damaging messages surrounding naloxone and people who use (or have used) drugs are dangerous and pervasive. It is important the narrative is renewed to one that emphasises the importance of preserving life.

Naloxone is only part of the solution - naloxone should be part of a broader response to preventing drug-related deaths. The quality of drug treatment and harm reduction is also imperative to saving lives

Publications from IDPC Members