By Chamrid Kpadonou and Maria Goretti Ane-Loglo

Over the past four months, phrases such as “sweet, sweet codeine” and “end tramadol abuse now” have become very popular in Ghana and Nigeria. These terms emanated from a title of a documentary on codeine abuse in Nigeria produced by BBC - Africa’s Eye, and a campaign launched by the GHOne after a series of documentaries on tramadol abuse in the country. These documentaries have played a significant role in shaping public discourse on substance abuse.

Drug use in general is a topic that rarely features in Nigeria media outlets. The focus has mostly been on arrests and seizures of drugs by law enforcement agencies to show how well the government is doing in terms of fighting the “war on drugs”. Aside specific global campaigns such as the Support Don’t Punish Global Day of Action (26 June)1 , very few programmes and documentaries report and discuss drug use from a public health perspective.

The documentary “Sweet Sweet Codeine” is a remarkable piece of investigative journalist. The authors succeeded in exposing how large quantities of codeine-based cough syrup can be illegally bought from crooked agent of pharmaceutical companies. The documentary abetted to reinforce the need of pharmaceutical company to implement strict control procedures to ensure that such products are sold only to accredited retailers. However, the documentary displays more than a few reporting gaps, which may negatively influence the policymaking process within the region. The report claimed that the abuse of codeine causes schizophrenia. This statement is unproven and reinforces the stigma associated with people who use drugs, which further creates barriers to an effective response to the codeine crisis. Several researches concluded that there was no causal effect between substance abuse and schizophrenia. However, people suffering of schizophrenia are much more likely to have a substance or alcohol abuse problem than the general population. Stigma has a harmful effect on the psychological well-being of persons who use drugs and negatively affect their quality of life. This can lead to a complete rejection by society, discrimination or labelling of people who use drugs. In this regard, efforts must be made especially by the media to change the narrative on people who use drugs.

The documentary failed also to capture the views and perspectives of people who use drugs, and the perspectives of this community were entirely overlooked in the documentary.

Stigma has a harmful effect on the psychological well-being of persons who use drugs and negatively affect their quality of life. This can lead to a complete rejection by society, discrimination or labelling of people who use drugs. In this regard, efforts must be made especially by the media to change the narrative on people who use drugs.

Media reporting on substance use: Magnifying or reducing the harm?

By Rafaela Rigoni, Joost Breeksema & Sara Woods

This study builds and collects existing evidence on harm reduction interventions for non-injection stimulant users. Considering social, cultural, political, legislative and religious differences, it seems unlikely that one single intervention will address the many issues experienced by people who use stimulant drugs across the world. Hence, this study looks at specific drugs, routes of administration, groups of users, types of interventions and contextual variations.

Provides a global literature review of harm reduction activities for PWUS;

Documents, describes and analyses seven examples of good practices of harm reduction for PWUS in different world regions;

Contributes to guidance in supporting harm reduction for PWUS.

Stimulates a harm reduction narrative that moves beyond HIV and focuses on human rights and quality of life for PWUS.

In chapter 2 we describe our methodology. Chapter 3 gives more information on the context. This includes information on stimulants, risks and harms of stimulant use, and the risk environment in which stimulant use takes place. Chapter 3 describes the findings of our literature review, presenting twelve different forms of harm reduction interventions for PWUS. Lastly, in chapter 4, we describe seven of these interventions through in-depth case studies in different world regions.

Speed limits: Harm reduction for people who use stimulants

Learn more about our joint work with the Global Partnership on Drug Policies and Development (GPDPD)

The 3rd Brandenburg Forum on Drugs and Development Policies took place from February 13th to 15th 2018 at the Hotel Schloss Lübbenau in Germany. The Forum was organised within the framework of the Global Partnership on Drug Policies and Development (GPDPD) – a programme aiming to enhance evidence-based development and public health-oriented approaches to drug policy. GPDPD is commissioned by the German Federal Ministry for Economic Cooperation and Development (BMZ) and implemented under political patronage of the German Federal Government’s Drug Commissioner. The meeting was co-hosted by the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH on behalf of BMZ, the Drug Commissioner of the Federal Government of Germany, the Ministry of Foreign Affairs of the Netherlands, the Norwegian Ministry of Health and Care Services, the International Drug Policy Consortium (IDPC) and the Transnational Institute (TNI).

The Forum brought together 56 expert participants, including government representatives from Brazil, Bulgaria, Canada, Colombia, France, Germany, Ghana, Guatemala, Mexico, Netherlands, Norway, Peru, Switzerland, Thailand, Trinidad and Tobago, and the United Kingdom. The Forum was also attended by representatives from the European Union, the Executive Office of the UN Secretary General, the Office of the United Nations High Commissioner for Human Rights (OHCHR), the Joint United Nations Programme on HIV/AIDS (UNAIDS), the United Nations Office on Drugs and Crime (UNODC), UN Women and leading civil society organisations. In order to promote open dialogue, the discussions were conducted under ‘Chatham House Rule’ whereby the contents can be shared and used, but neither the identity nor the affiliation of any participants may be revealed..

3rd Brandenburg Forum on Drugs and Development Policies ‘The run-up towards 2019’

Supervised-consumption services are known to be effective in reducing drug-related harms, and several dedicated services now exist in Canada.

It is now time to move from asking whether such services are effective to asking whether, how and under what conditions their benefits can be maximized.

Integrated and co-located health service models — effectively “one-stop shops” — could improve health outcomes for people who inject drugs by combining the prevention of immediate drug-related harms with access to primary care, mental health care and social service programs.

The opioid overdose crisis in North America demonstrates a need to scale up supervised-consumption services, as well as to experiment with a mix of potential service models. A range of new-to-Canada models have been implemented over the past two years. In some cities, including Toronto and Ottawa, health authorities initially focused on embedding the services within community health agencies to provide a continuum of health care and treatment for substance use disorders, but there are no data on the effectiveness of this model. With an increasing diversity of models of supervised-consumption services in operation, there exists a window of opportunity for a second generation of research in this area that moves from asking whether such services are effective in reducing drug-related harms — which we know them to be1 — to asking whether, how and under what conditions their benefits can be maximized.

Models of supervised-consumption services operating in Canada include peer-run “overdose-prevention sites,” stand-alone storefronts, mobile vans, co-location with harm-reduction programs or social housing, in-hospital services, women-only sites and the aforementioned integrated model. Some of these operate within community health centres that also offer services for populations that do not use drugs. The plurality of models raises questions as to their relative effectiveness. These questions are not answered by the existing scientific literature, which is dominated by reports from two stand-alone sites in Vancouver and Sydney, Australia, employing comparable models.1 The evidence base on alternative models is insufficient to guide policy in this area, and it would be premature to consider service models interchangeable. Nevertheless, officials in Seattle recently announced they will operate a mobile supervised-consumption service because no fixed location could be secured.

Insite, Canada’s first formal supervised-consumption service, opened in Vancouver in 2003 and remained the only sanctioned site in Canada for 12 years.2 Insite is a stand-alone, storefront model that offers basic nursing care (including initial prescriptions for opioid agonist therapy) and a small co-located medically supervised detoxification facility. Extensive evaluation has established Insite’s public health benefits.1 However, it is also evident that stand-alone models have limited reach.3They serve a small geographic area (the distance clients will walk), and even among regular service users, only a proportion of injections are covered (43% of Insite users accessed the site for fewer than one-quarter of injections4). Moreover, stand-alone models attract a highly socially vulnerable population,5 and clients continue to face disparities in health status, homelessness and access to opioid agonist therapy.6 This suggests a need for greater scale-up of existing models as well as for new models that offer a larger suite of on-site health services.

Integrating supervised consumption into a continuum of care for people who use drugs

Harm reduction programmes in Indonesia have been officially recognised and in operation since 2007, beginning with their implementation in primary-level healthcare facilities. Harm reduction programmes differ from the majority of drug rehabilitation programmes in Indonesia, with the latter focussed on the achievement of abstinence. From when they were established in the late 1990s, rehabilitation programmes in Indonesia typically adopted the approach of setting behavioural change and abstinence from drug use as the only goals. No compromise on these goals were allowed in determining a client’s successful completion of a rehabilitation programme. Harm reduction on the other hand, refers to a set of policies, programmes and practices aimed primarily at reducing the harms associated with drug use, which could range from health, social to economic harms, without necessarily focussing on ending drug use.

This policy paper is based on an analysis of data and evidence produced from a desk review of literature, and focus group discussions and in-depth interviews with clients who have undergone both types of programmes: abstinence-based rehabilitation programmes, and those integrated with harm reduction services in Indonesia. The paper concludes with recommendations for the Indonesian government to implement policy reforms that enable the integration of harm reduction measures into drug rehabilitation programmes.

Integration of harm reduction into drug rehabilitation programmes in Indonesia

By Toni Makkai, Gino Vumbaca, Penny Hill, David Caldicott, Matt Noffs, Stephanie Tzanetis, Frank Hansen

On behalf of our STA-SAFE consortium partners, Harm Reduction Australia would like to advise that the report on the first officially sanctioned pill testing trial to be held in Australia that took place in Canberra is now available.

With the support of the ACT Government, including ACT Health & ACT Police, as well as the University of Canberra (where the festival was held) and the Groovin the Moo (GTM) Festival promoters (Cattleyard), the STA-SAFE Consortium was able to successfully deliver a pill testing pilot at the GTM Festival on 29th April 2018.

The service was very well received by festival goers and the pilot provided a very important range of information to be provided to key stakeholders in the ACT.

Report on the ACT GTM Pill Testing Pilot: a Harm Reduction Service

While men are more likely to be targeted by drug law enforcement, many of the drug war’s victims are women. Largely as a result of draconian drug laws, women are one of the fast growing segments of the U.S. prison population. Most women behind bars are mothers, many of them sole caregivers. Women, and particularly women of color, are disproportionately affected by drug law enforcement, by social stigma, by laws that punish those unable or unwilling to inform on others, by regulations that bar people with a drug conviction from obtaining public assistance, and by a drug treatment system designed for men. Incarcerated women also have lower incomes than their male counterparts, making it more difficult for them to be able to afford cash bail, phone calls from prison, and ancillary services (such as babysitters) which they might require to meet all of their probation requirements.

Women are one of the fastest-growing segments of the prison population. Between 1978 and 2014, the number of women in state and federal prisons grew by nearly 800 percent. The U.S. accounts for 5 percent of the world’s female population but it represents almost 30 percent of the world’s incarcerated women. Globally, the 25 jurisdictions that have the highest rates of women incarcerated are all U.S. states.

More than a quarter of women in state prison were incarcerated for drug offenses at the end of 2015, compared to 15 percent of men. More than 61 percent of women in federal prison are incarcerated for drug offenses, compared to approximately 50 percent of men. Currently, there are 8,500 women in federal prisons on drug charges, 24,700 in state prisons and 27,000 in local jails. Of the 27,000 women in local jails on drug charges, a staggering 63 percent have not been convicted.

United states: Women, prison, and the drug war 

In regards to current drug trends, particularly methamphetamine (both in crystal and pill form) has become increasingly accessible and affordable throughout Asia, reflecting the trend of rising use of amphetamine-type stimulants (ATS) in the region.

Governments in the SEA region have implemented different kinds of national drug policy reform, including diversion programmes (Indonesia and Cambodia), harm reduction measures (Malaysia and Myanmar), and steps towards decriminalisation of cannabis cultivation and use for medical and scientific purposes (Thailand).

The scale of illicit cultivation of crops continues to be largely influenced by various socioeconomic and political factors such as poverty, conflict, and weak institutions, both in Myanmar and Afghanistan. In areas affected by conflict, households often grow opium poppy as a means of survival in an environment where markets are not accessible.

Lessons can be learned, for instance, from experiences in Thailand or Colombia. The Thai experience demonstrates the importance of integrated rural development as a foundation of AD measures, addressing short-term needs as well as long-term sustainability. This includes community planning, inclusive value-chain development and sustainable land management, among other aspects. Experiences regarding coca cultivation areas and the recent peace agreement in Colombia confirm that multi-stakeholder dialogue is important for being able to access local communities and building trust.

The 9th Asian informal drug policy dialogue

Regulating and legalising cannabis is an idea whose time has come

The so-called ‘war on drugs’ was always built on shaky foundations. Now countries and jurisdictions around the world are dismantling it piece by piece and starting to build a new drug policy architecture that ushers in a new era of health-based policy making fit for the 21st century.

Nowhere are the foundations of this new approach to drugs more obvious than in the global movement towards regulated, legalised cannabis markets. And despite the US being the ostensible leader of the ‘war on drugs’, it has been US states at the forefront of this move. Since Colorado and Washington states legalised cannabis for non-medical use in 2012, and Uruguay became the first country do so in 2013, seven more US states and the District of Columbia have followed in their footsteps.2 The results so far, particularly from the US, are generally positive: confounding critics whilst bringing in additional tax income to fund public services. And this is just the start: in the summer of 2018 Canada will become the first G7 country to legalise cannabis.

Regulating and legalising cannabis is an idea whose time has come. The UK public supports it too: in recent polls 47% of people support selling cannabis in licensed shops. Regulation also has the support of a range of groups from across the political spectrum.

It is time to accept that prohibition is not only ineffective and expensive,but that regulation could – if it is done well – protect vulnerable groups and promote public health. It would also generate both taxes (at least £1 billion annually, but potentially more) and savings, which taken together would mean more resources for health, harm reduction and other public services. It is time for the UK government to catch up with the global shift and take the responsible approach by bringing in a regulated, legal market for cannabis.

Cannabis: Regulate it. Tax it. Support the NHS. Promote public health.

Thank you for your help in the birth of the Eurasian Harm Reduction Association! 2017 has become almost revolutionary for harm reduction activists in the Central and Eastern Europe and Central Asia (CEECA) region.

Within the association of activists, there has been a challenging process of renovation, the building of a democratic organization with clear processes, and opportunities for activists from all countries of the region to influence the organization’s strategy, policies and activities. It has been possible not only to build a transparent decision-making process, but also to develop an ambitious strategy for our organization through the harmonious and well-coordinated work of the EHRA Steering Committee alongside members and EHRA’s Secretariat. A clear-sighted vision of what is required for sustainable harm reduction programs, and for decent lives of people who use drugs, has helped EHRA to gain strong support from global and regional communities, allies and partner organizations that has encouraged us to build from scratch a solid management system for the organization. From the very beginning of its active operation in 2017, EHRA has already started to implement 9 advocacy projects and has been supporting community groups of people who use drugs in countries of our region; EHRA has also maintained its leadership in regional advocacy to ensure sustainability and efficiency of harm reduction services and for drug policy reform to shift towards being based on public health and human rights.

Now it’s time to mobilize all resources. Drug policy in countries has not improved, but rather has worsened. In most cases, governments are more likely to pay for policemen and prisons than provide social and medical assistance to people who use drugs. In all countries of the region, it has become obvious that we need to change the approach to harm reduction services because the drug scene is changing and people who use drugs are also changing. The issue of government funding of harm reduction services has become very relevant for most of the countries of the CEECA region with international funding rapidly declining and, therefore, EHRA sees its priority in supporting communities in their advocacy for sustainable funding of quality harm reduction services from national sources.

I am proud to be a part of a cohesive and strong team which is ready to fulfill an ambitious strategy!

A good start gives hope for further success!

Ganna Dovbakh, Executive Director of the Eurasian Harm Reduction Association

EHRA in 2017: A good start

On 23 March 2018, the Human Rights Council (HRC) adopted resolution 37/42. The resolution requests the Office of the High Commissioner to prepare a report, in consultation with States, the United Nations Office on Drugs and Crime (UNODC) and other United Nations agencies, civil society and other relevant stakeholders, on the implementation of the joint commitment to effectively addressing and countering the world drug problem with regards to human rights, and to present it to the Human Rights Council at its thirty-ninth session, and also requests the Office of the High Commissioner to share the report with the Commision on Narcotic Drugs (CND), through the appropriate channels, as a contribution to their work in this field and in preparation for the sixty-second session of the Commission, which will include the 2019 Ministerial Segment.

The Office of the High Commissioner on Human Rights launched a call for submissions (Deadline: 18 May 2018) to facilitate civil society contributions. Below are some of the contributions from IDPC members and allies.

Submission by the Rights Reporter Foundation.

Civil society submissions to the Report of the OHCHR on the implementation of the UNGASS Outcome Document with regard to human rights

is the fourth edition in Prison Reform International's annual flagship 

topical developments and challenges in criminal justice and prison policy and practice

. It is published in collaboration with the Thailand Institute of Justice, and features a foreword by the Rt Hon Helen Clark, Member of the Global Commission on Drug Policy, Former Prime Minister of New Zealand and Former Administrator of the United Nations Development Programme.

, including the use of pre-trial detention as an automatic response to suspects; the ongoing challenge of prison overcrowding; and the steady growth in the number of life-sentenced prisoners around the world.

, such as the specific needs of women, children and LGBTI prisoners.

Developments and challenges in prison management

, including record levels of prisoner violence in a number of prison systems; healthcare challenges and shortages of qualified healthcare staff; and the need to address violent extremism and prevent radicalisation in the prison system.

The role of technology in criminal justice and prison systems

, such as the use of ‘telemedicine’ to provide mental healthcare and treatment, and the rise in access to online education and training.

, including community service orders and electronic monitoring, and a growing trend in the use of restorative justice.

rehabilitation and reintegration of offenders in the era of sustainable development

, exploring how the rehabilitation and reintegration of offenders back into their communities can incorporate a broader developmental perspective, contributing to the goals set out in the 2030 Agenda for Sustainable Development.

was launched at the UN Commission on Crime Prevention and Criminal Justice on 15 May 2018.

Publications from IDPC Members