Public Health England (PHE) have released a free resource to assist prison staff about new psychoactive substances (NPS) in prisons.

The toolkit has been recently released after the HM Inspectorate of Prisons report ‘Changing patterns of substance misuse in adult prisons and service responses’, published in December 2015, which identified NPS as having “created significant additional harm and are now identified as the most serious threat to the safety and security of the prison system.”

The resource is intended to support custodial, healthcare and substance misuse staff by providing information about the extent of NPS use as PHE currently understand it and about the properties of the various categories of NPS, and by providing advice on how to manage the problem from a clinical, psychosocial and regime perspective.

The toolkit also discusses the various challenges that are associated for healthcare staff, such as the covert nature of use, unpredictable effects the various drugs have, the delay in seeking medical help, as well as multiple challenges for the wider prison regime.

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New psychoactive substances in prisons: A toolkit for prison staff

Fom October 1-3, 2015 a regional meeting of NGOs, policy makers and scientists/researchers from the countries of Southeast Europe, was organized by Diogenis Association in Belgrade, to discuss the UN General Assembly Special Session on Drugs (UNGASS, April 2016) and its significance for Southeast Europe. The meeting closed with the formulation of some conclusions relevant for the situation in the SEE countries.

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The UNGASS 2016 and its significance for SEE: Statement of NGOs in South East Europe

Globalisation has facilitated cultural exchange between indigenous traditions and Western practices, which has led to a growing interest in the ritual, religious and therapeutic use of ayahuasca

Indigenous peoples in the Amazon have used ayahuasca for centuries as a remedy for physical and psychological health, and to ensure the life and wellbeing of their communities. In the past two decades, the use of this decoction has expanded beyond Amazon indigenous spheres. Globalisation, and with it the contact between populations, has facilitated cultural exchange between indigenous traditions and Western practices, which has led to a growing interest in the ritual, religious and therapeutic use of ayahuasca.

People who participate in the sessions have a positive perception of its use; while most scientific research over the past decade supports the subsequent benefits attributed to it. But the increased use of ayahuasca has not been free from challenges, such as its excessive commercialisation in the Amazon, linked to ayahuasca tourism, or the exploitation of natural resources used for its preparation. Despite not being a controlled substance at the international level, and not banned in almost any national jurisdiction, in recent years there have been an extraordinary number of detentions and judicial prosecutions in Europe, the United States and Latin America for ayahuasca importation and use. This contradiction has produced a number of uncertainties regarding its legal and political status, which varies between countries.

In this policy brief, ICEERS and TNI offer an analysis of the challenges associated with the globalisation of ayahuasca.

Ayahuasca: From the Amazon to the global village

The Bridging the Gaps programme aims to increase access to HIV prevention, treatment, care and support and ensure full human rights for key populations, who are most affected by HIV but least supported. The right to lead a healthy and fulfilling life is universal but not accessible for all. In order to improve the access to healthcare services for key populations, the Bridging the Gaps programme aims to integrate specific services for these groups into general healthcare systems, because:

In many countries, key populations which include people living with HIV face social exclusion, discrimination and stigma within the general health system. This negatively affects the access to HIV prevention, treatment, care and support.

Evidence shows that integration of services for key populations increases access to health services.

Providing accessible HIV-related health services for key populations shows a significant reduction in a country’s HIV prevalence.

Integration of services has the potential to be sustainable and cost-efficient for both providers and service users, strengthens health systems and

Lastly, all people have the right to equal access to health services.

Although integration of services is not a new theme, evidence related to implementing and evaluating integration programmes is not readily available. There is little guidance for planners and decision-makers on how to plan and implement integrated health service delivery for key populations. Evidence for low and middle income countries is especially scarce. This document provides lessons learnt of the Bridging the Gaps programme linked to the global strategy of the WHO on integrated and people-centred services for key populations. In 2015 Bridging the Gaps, in collaboration with VU University Amsterdam, conducted qualitative research to collect best practices, lessons learnt and critical facilitators for integrating services in South Africa, Kenya, Uganda, Indonesia, Vietnam and Kyrgyzstan.

Integrated services for key populations: Lessons learnt from the Bridging the Gaps programme

The Scottish National Naloxone Programme has proven to be effective in lowering the number of Opioid-Related Deaths (ORDs) in people recently released from prisons according to a newly published report.

The report entitled ‘Effectiveness of Scotland's National Naloxone Programme for reducing opioid-related deaths: a before (2006-10) versus after (2011-13) comparison’, was published in the Society for the Study of Addiction's journal 'Addiction'.

The study aimed to assess the effectiveness for Scotland’s levels of ORDs between the two time periods, as well as to assess cost-effectiveness of the programme.

The report found that In 2006-2010, 9.8% of ORDs (193 out of 1,970) were in people released from prison within 4 weeks of death, whereas only 6.3% of ORDs in 2011-2013 followed prison release (76 out of 1,212); this represented a reduction of 3.6%.

This reduction in the proportion of prison release ORDs translates into 42 fewer prison release ORDs during 2011-13, when 12,000 naloxone kits were issued at current prescription-cost of £225,000.

In conclusion, the report found that Scotland's National Naloxone Programme, which started in 2011, was associated with a 36% reduction in the proportion of opioid-related deaths that occurred in the 4 weeks following release from prison.

Click here to read the full article (restricted access).

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Effectiveness of Scotland's National Naloxone Programme for reducing opioid-related deaths

The Scottish Drugs Forum's Annual Report 2014/15 has been published following the successful Annual General Meeting and seminar event that took place on Wednesday the 11th of November.

The document includes reports from the Chair at SDF George Allan and SDF Director David Liddell, alongside articles explaining key aspects of work carried out by the various departments of SDF and a number of the exciting highlights from the past year.

The Scottish Drugs Forum's Annual Report 2014/15

The Third Myanmar Opium Farmers’ Forum was held in September 2015 in Pyin Oo Lwin, Myanmar. It brought together around 30 representatives of local communities involved in poppy cultivation in Myanmar’s major opium growing regions: Chin State, Kachin State, northern and southern Shan State and Kayah State. Farmers and community representatives from Chin, Kachin, Kayah, Kayan, Pa-O, Shan and Ta-ang (Palaung) ethnic communities took part in the forum.

Current drug control polices in South-east Asia are repressive and criminalise opium farmers, greatly affecting the lives of communities cultivating opium. Most policy responses – including from some armed opposition groups – focus on eradication of poppy fields and the implementation of strict bans on opium cultivation. As these communities depend on opium as a cash crop to solve immediate food security problems and sustain their livelihoods, such repressive policies are driving communities further into poverty. Currently only very few Alternative Development (AD) programmes are offered to opium-growing communities to address these problems. Furthermore, opium cultivation often takes place in conflict-affected areas, and links between drugs and conflict affect local communities.

Until now these communities have had little or no influence on the design of the drug control policies that have great impact on their lives and livelihoods. They have also had little participation in the design, implementation and monitoring and evaluation of AD programmes that are supposed to help them. The forum’s aim was to identify the main concerns of opium farmers, and formulate alternative policy options that respect the rights of producer communities and involve them in the decision-making processes. To this end the forum adopted a statement with recommendations to policy makers nationally and internationally.

Report from third Myanmar opium farmers’ forum

Sex workers and people who use drugs are subject to widespread violations of their human rights, which, for the most part, go unchallenged. Globally, these groups are subjected to repressive and discriminatory laws, policies and practices. These policies and practices fuel stigma, discrimination, widespread violence, and significantly increase the risks and vulnerabilities of both populations to sexually transmitted infections and blood borne viruses, notably HIV and hepatitis B and C. In settings that have detrimental and punitive drug and sex work laws and policies, sex workers who use drugs1 2 experience interconnected layers of risk and vulnerability, caused by the compounded effects of criminalisation, stigma, and discrimination.

Sex workers and people who use drugs – specifically, people who inject drugs – are now recognised as key populations in the global HIV response. However, this recognition often fails to translate into funding commitments of appropriate scale and reach, and at times results in health programmes that are not implemented from a rights-based perspective.

Furthermore, there is a worrying lack of recognition of the intersections between various communities. Sex workers who use drugs are often overlooked, crudely categorised as being within one community or the other. This approach fails to engage with people’s nuanced realities.

In a context where services are designed and implemented through the targeting of one key population or another, there is a substantial risk of sex workers who use drugs’ needs going unmet. This group is rendered invisible in research, epidemiological statistics and policy discussions, which results in invisibility in policy and programming. This invisibility was highlighted by sex workers who use drugs at the 

International AIDS Conference in Melbourne 2014

, where conversations reflected the frustration of this community. Notably, sex workers who use drugs (particularly those who inject drugs) experience stigma and discrimination from within sex worker communities and communities of people who used drugs. Even among sex workers who use drugs, some non-injecting sex workers actively distance themselves from the stigma of injection drug use.

These discussions resulted in the development of this joint INPUD and NSWP briefing paper.

This joint briefing paper highlights the specific needs and rights of sex workers who use drugs, as a community that spans two key populations. This document provides an overview of some of the most endemic and substantive ways in which sex workers who use drugs face double criminalisation and associated police harassment, intersectional stigma, compounded marginalisation and social exclusion, heightened interference and harassment from healthcare and other service providers, infantilisation, pathologisation, and an associated undermining of agency, choice, and self-determination.

This paper also examines how compounded stigma and discrimination, as well as issues specific to sex workers who use drugs, place this community at heightened risk of negative health impacts and human rights violations.

This paper uses case studies that highlight efforts to meet the needs, and advocate for the rights, of sex workers who use drugs. These case studies draw on in-country examples of joint work between sex worker and drug user networks/communities. These case studies were developed from INPUD and NSWP consultations for the purposes of this document. Alongside references to secondary sources, these case studies demonstrate the positive outcomes of partnerships meeting the intersectional and overlapping needs, and advocating for the rights of sex workers who use drugs.

Sex workers who use drugs

Beckley Foundation collaborator Jordi Riba and his team at Sant Pau Hospital in Barcelona have just published a study in the journal Psychopharmacology, co-authored by the Beckley’s Executive Director, Amanda Feilding, which shows that one of the ways ayahuasca achieves its reported therapeutic effects is by increasing people’s capacity for mindfulness – the same capacity that is cultivated through regular meditation practice.

Ayahuasca is the DMT-containing psychedelic plant brew from the Amazon that has been traditionally used for religious, magical, and healing purposes by indigenous peoples, but is now rapidly gaining popularity in the Western world. It can produce introspective and dream-like experiences, visions, and reliving of personal and emotional memories, and many people experience improved insight, personal growth, and emotional healing as a result of their ayahuasca experience. Not surprisingly, these features are beginning to be harnessed for therapeutic purposes (albeit not government-approved), including treatment of addiction and depression.

This newly published study, which is part of a larger research programme exploring the mechanisms of action behind ayahuasca and DMT, provides some insight into exactly which psychological mechanisms underlie the beneficial effects. It examined 25 experienced ayahuasca users before and after an ayahuasca session, using questionnaires to assess, among other traits, their mindfulness capacities. Following ayahuasca, participants rated themselves as being less judgmental about their inner experience and less emotionally reactive, and better able to ‘decentre’ themselves (i.e., observe thoughts and emotions as temporary events of the mind). Amazingly, the post-ayahuasca scores were comparable to those observed in experienced meditators, suggesting that similar benefits may be gained from a pharmacological intervention as from meditation. This probably doesn’t mean that one can replace the other, but it would be an immense benefit if they could work in combination.

While this is a relatively simple study showing a pre/post-ayahuasca effect in a non-controlled trial (i.e., there was no ‘placebo’ group to compare against), it is part of a nascent but persistent effort to build a scientific evidence base for the usefulness of ayahuasca in addressing mental health conditions, and it certainly lends legitimacy to the idea that there are meaningful therapeutic benefits that could, and should, be explored further.

Click here to read the publication (restricted access).

Exploring the therapeutic potential of Ayahuasca: acute intake increases mindfulness-related capacities

Significant changes in the global drug policy landscape are shaping up in the UNGASS 2016 preparations, in the direction of more humane and proportional responses based on health, human rights and development principles. But few countries are willing to openly acknowledge the existence of structural deficiencies with regard to UN system-wide coherence, the institutional architecture and the legal treaty framework. In spite of more and more cracks in the Vienna consensus and treaty breaches in the area of cannabis policies, questioning the basic principles of the international drug control system is still largely a political taboo.

UNGASS 2016: Background memo on the proposal to establish an expert advisory group

Statement made jointly by: Amnesty International, Harm Reduction International, International Drug Policy Consortium, Penal Reform International, Reprieve, the World Federation Against the Death Penalty and the Anti Death Penalty Asia Network

We, the undersigned organisations, oppose the death penalty in all cases without exception and under all circumstances. Within the context of drug policies, and in light of the forthcoming UN General Assembly Special Session on drugs to be held in April 2016, we call on States to:

Take immediate measures to halt executions, commute death sentences, and abolish the death penalty for drug-related offences as a first step towards its full abolition.

Promote the abolition of the death penalty, including for drug-related offences, and the implementation of effective and evidence-based drugs policies that respect and protect human dignity, the rule of law and human rights.

Ensure that drug policies and programmes are implemented in full compliance with international law and standards and that programmes to implement the UN Drug Conventions do not contribute to the use of the death penalty.

Ensure transparency with regards to death sentences and executions.

Request UNODC to conduct an annual review of the implementation of its human rights guidance in States receiving programmatic funding, the findings of which should be published annually to the CND by the Executive Director.

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Joint statement at reconvened CND: The death penalty for drug-related offences

Joint statement also released in partnership with the International Community of Women Living with HIV (ICW)

Women-identified drug users and those also living with HIV face significant challenges accessing a broad set of healthcare services, including HIV treatment, care, and support, as well as harm reduction services. These challenges stem from structural, social, and cultural prejudice stemming from punitive drug policies around the world. As Anand Grover, UN Special Rapporteur on the right of everyone to the highest attainable state of health, has pointed out, ‘The criminalization of [the practice of using drugs] hinders the right to health of all persons.’ Additionally, the World Health Organization (WHO) recently published a statement in the 2014 Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations, ‘Countries should work toward developing policies and laws that decriminalize injection and other use of drugs and, thereby, reduce incarceration.’

HIV prevalence is disproportionately high among women who use drugs when compared to other women of reproductive age. In many countries, HIV prevalence among women who inject drugs is significantly higher than in men who inject drugs, especially where harm reduction services are not widely available. Women who use drugs also face restrictive laws, which reduce access to necessary harm reduction services; this includes opiate substitution treatment (OST) programs, wherein women are disproportionately underrepresented.

In Europe, the male to female ratio of drug users in treatment was 4:1 in 2010, significantly higher than the ratio between the male to female users. In Eastern Europe, only 0.003 per cent of women who inject drugs have access to OST. Women who inject drugs also have poor access to sterile injecting equipment and condoms, as well as limited access to sexual and reproductive health (SRH) services. These service shortfalls are particularly acute in prisons and other closed settings. Vertical transmission of HIV amongst women who use drugs is significantly higher than among other women living with HIV.

Publications from IDPC Members