Supervised consumption services (SCSs) provide hygienic environments in which people who inject drugs (PWID) can inject illegal drugs under the supervision of a health care professional (or a trained allied service provider or peer),1 without the risk of arrest for drug possession. SCSs are part of a continuum of services that address drug-related harms, such as needle/syringe distribution programs, and complementary drug treatment programs, such as withdrawal management, opioid agonist treatment (OAT), and recovery-focused programs (Potier et al., 2014). There are different ways to plan, design and implement a SCS and many issues to consider with respect to the target client population, existing network of services for PWID, and resources available, including funding, space, and staff. SCSs range considerably in size, structure, and staffing.

These guidelines outline and address a range of questions and issues to consider when planning SCSs, as well as examples of existing facilities world-wide. The guidelines are based on the existing evidence, best practices, and lessons learned from SCSs that already exist in British Columbia and elsewhere. However, each SCS is unique, and each potential service must be modified for the specific context in which the service is provided. The goals of these guidelines are to provide health care professionals, service providers, policy makers, peers, advocates, and other stakeholders with the tools to:

• Articulate a rationale for implementing a SCS in their locality, including determining need and feasibility;

• Define organizational goals and objectives of implementing a SCS;

• Plan an overall model of the facility based on need and feasibility;

• Map the range of services that the facility will offer, based on need and feasibility;

• Articulate the role and linkages of the SCS to the broader network of health and care services available in the locality; and

• Operate a SCS, including recommendations for staffing, clinical protocols, and safety policies.

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Supervised consumption services: operational guidance

Há duas décadas, a Comissão Interamericana de Direitos Humanos (doravante “a CIDH” ou “a Comissão”) estabeleceu que a aplicação arbitrária e ilegal da prisão preventiva é um problema crônico na região. Para que este regime seja compatível com os padrões internacionais, a CIDH recorda que a prisão preventiva deve partir do pressuposto de respeito ao direito à presunção de inocência, e considerar a natureza excepcional desta medida; e, além disso, deve ser aplicada conforme os critérios de legalidade, necessidade e proporcionalidade. A privação de liberdade da pessoa imputada deve ter caráter processual, e consequentemente, somente pode estar justificada por seus fins legítimos, quais sejam: assegurar que o acusado não impedirá o desenvolvimento do processo, nem iludirá a ação da justiça. Igualmente, a CIDH recorda que as normativas que excluem a possibilidade de aplicar outras medidas cautelares distintas da prisão preventiva devido à gravidade do ato ou pena prevista em abstrato, são contrárias aos parâmetros internacionais sobre o assunto.

Esta Comissão especificamente manifesta sua preocupação com a adoção de medidas estatais que buscam sancionar condutas relacionadas com drogas – especialmente delitos menos graves vinculados com as mesmas, tais como consumo e posse para uso pessoal – que acabaram resultando em aumento considerável do número de pessoas privadas de liberdade por atos criminais relacionados com drogas. Neste contexto, os crimes relacionados com o uso de drogas são caracterizados como “crimes hediondos”, e consequentemente a prisão preventiva é aplicada de forma automática, sem que as pessoas acusadas possam ser beneficiadas por alternativas ao encarceramento. A CIDH também reitera sua preocupação pelo fato de que os consumidores de drogas são tratados a partir de um ponto de vista criminal e repressivo na região, ao invés de receber um tratamento vinculado à saúde pública. Por outro lado, a CIDH também celebra os esforços realizados por diversos Estados para responder à problemática relativa ao uso excessivo da prisão preventiva através de processos abreviados ou imediatos. No entanto, a CIDH possui informações sobre as diversas violações ao devido processo que caracterizariam tais processos, e resultariam na condenação de pessoas acusadas de forma arbitrária, a fim de reduzir o uso da prisão preventiva, através de processos sumários, sem as devidas garantias, e que violariam o direito a uma defesa adequada

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Medidas destinadas a reduzir o uso da prisão preventiva nas Américas

The Commission expresses its special concern over the adoption of state policies that seek to punish drug-related conduct – specifically such conduct as related to minor offenses, such as consumption and possession of drugs for personal use – and that this has likely resulted in an increase in the number of persons deprived of liberty for drug-related criminal acts, mainly women. In this context, offenses related to drug use are characterized as “grave offenses” (“delitos graves”) and, therefore, pretrial detention is applied automatically, without the accused being able to benefit from alternatives to incarceration. In this respect, the IACHR reiterates that pretrial detention should be justified in the specific case, and that legislation that considers applying precautionary measures based on the type of offense – in this case, any drug-related criminal act – ignores the principle of proportionality enshrined in the American Convention. The Commission recalls that the principle of proportionality implies “a rational relationship between the precautionary measure and the purpose sought, so that the sacrifice inherent in the restriction of the right to liberty is not exaggerated or excessive compared to the advantages obtained from this restriction and the achievement of the purpose sought.

Establish a drug policy with an approach that is comprehensive and focused on social reinsertion, that ensures that treatment for persons who have been arrested for drug use or possession or who have committed minor offenses because of their problematic or dependent use not be repressive and criminalizing, but rather from a public health approach.

In relation to minor crimes committed by problematic or dependent use, or for drug consumption or possession for personal use, States should promote non-custodial measures that prioritizes public health, human rights and are based on scientific evidence.

The IACHR urges the States to establish a drug policy with an approach that is comprehensive and focused on social reinsertion, that ensures that treatment for persons who have been arrested for drug use or possession or who have committed minor offenses because of their problematic or dependent use not be repressive and criminalizing, but rather from a public health approach.

Measures aimed at reducing the use of pretrial detention in the Americas

The Annual Regional Drug Policy Conference in South East Europe 2017 is organised in Thessaloniki from 8-10 June 2017. The Conference is held at Holiday Inn Hotel, Monastiriou 8, Thessaloniki, Greece. The Regional Conference aims to: bring together NGOs, policy makers and researchers active in the field of drugs across the region of South East Europe, in order to discuss drug policy developments and trends, exchange experiences and best practices in the region, Europe and the United Nations. Invited are members of NGOs active in the field, members of the Drug Policy Network in South East Europe (DPNSEE), policy makers and academics. This regional conference was part of the regional project “Strengthening NGO capacity and promoting public health and human rights oriented drug policy in South East Europe”, supported financially by the European Commission and the Open Society Foundations.

At the last Annual session of the Commission on Narcotic Drugs (60th CND) has been decided that countries will implement the outcomes of the UN General Assembly Special Session on Drugs (UNGASS) and report to the CND. This was the 7th Regional conference on drugs in South East Europe organised by the Association Diogenis, Drug Policy Dialogue. Forty Five (45) participants from several disciplines and countries of South East Europe took part at the conference. The discussion focussed on items that have been subject of deliberations during the 60th session of the Commission on Narcotic Drugs in March 2017. The UN member-states committed themselves to implement the outcomes of the UN General Assembly special Session and so contribute to the realisation of the aims of the UNGASS. The states decided, also, to invite civil society organisations, the scientific community and grassroots organisations to actively participate in the dialogue and contribute with their experience and knowhow in shaping drug policy at the national and international level.

Drug policy challenges and implementation in South East Europe

A major impediment to any nation abandoning the policy of drug prohibition has been the fact that international drug treaties to which the majority of UN member states are signatory prohibit the non-medical use of amphetamines, cannabis, cocaine and heroin. The future of these treaties is now uncertain because of decisions by Uruguay, eight US states and Canada to legalize cannabis use. This paper:

provides a brief account of the international drug control treaties;

outlines the major criticisms of the treaties;

analyses critically proposals for treaty reform; and

provides a personal viewon policies that nation states could adopt to minimize the harms from the use of cannabis, party drugs and hallucinogens, opioids, stimulants and new psychoactive substances.

It is argued that a major risk of cannabis legalization in the United States is promotion of heavy use and increased harm by a weakly regulated industry; some cautious national experiments with the regulation of party drugs and hallucinogens would be informative; a strong case remains for prohibiting the non-medical use of opioids while mitigating the adverse effects that this policy has on opioid-dependent people; stimulant legalization will probably increase problem use but prohibition is difficult to enforce, highlighting the urgency of finding better ways to reduce demand for these drugs and respond to problem users; and that it is unclear what the best approach is to reducing possible harms that may arise from the use of new psychoactive substances.

The future of the international drug control system and national drug prohibitions

Incredible progress has been made in the HIV response: paving the way for an ambitious target within the Sustainable Development Goals (SDGs) to end AIDS as a public health threat by 2030. But progress is beginning to slow. New infections remain stubbornly high and in 2016 1.8 million people became newly infected with HIV1. AIDS-related deaths have decreased as treatment has improved but amongst some age groups, notably adolescents, AIDS-related deaths are actually increasing2. Many countries continue to impose discriminatory legal frameworks on people living with HIV and people most affected by HIV. At this critical time support from donors for the HIV response is also diminishing, and in 2016 donor government funding declined for the second consecutive year, this time by $500 million

DFID’s overall funding for HIV is declining (22% between 2012 and 2015). 

Cuts to country offices have cancelled out DFID’s increased Global Fund contribution. Funding for civil society has been particularly hard hit, declining from £30m in 2011 to just £8m in 2015.

In response to parliamentary questions and letters, DFID have articulated an ambitious set of priorities closely aligned with UNAIDS strategy 

but are struggling to measure and demonstrate cumulative impact within the HIV response. DFID do not have an effective mechanism to assess whether HIV has been successfully integrated into wider health and development programmes.

DFID’s political commitment to the HIV response has been inconsistent.

 HIV is absent from significant DFID strategies, and DFID have missed several international HIV conferences. But there are some positive indications that the tide is beginning to change

A stocktake review of DFID’s work on HIV and AIDS

An earlier version of this report was published in 2014 and is available here

In this new consolidated guidelines document on HIV prevention, diagnosis, treatment and care for key populations, the World Health Organization brings together all existing guidance relevant to five key populations – men who have sex with men, people who inject drugs, people in prisons and other closed settings, sex workers and transgender people – and updates selected guidance and recommendations.

provide a comprehensive package of evidence-based HIV-related recommendations for all key populations;

increase awareness of the needs of and issues important to key populations;

improve access, coverage and uptake of effective and acceptable services; and

catalyze greater national and global commitment to adequate funding and services.

Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations (2016 update) 

Over the past decade, a new approach to organizing and mobilizing campaign supporters has drawn guarded admiration from the world’s largest advocacy organizations. Tried and tested with success by early adopters such as climate campaigners 350.org and further developed in the Bernie Sanders primary campaign, this model of sweeping supporter-led activities and bottom-up agency presents a distinct move away from the command-and-control management structures that still represent a comfort zone for most nonprofit institutions. Though this more-distributed approach to campaigning has generated impressive results in terms of membership growth and campaign impact, most established organizations still see it as the unique domain of small upstart groups.

Challenging popular wisdom on radical campaigning is the International Drug Policy Consortium (IDPC), a policy-oriented NGO working on addiction and harm reduction—complex issues that do not generally mobilize crowds. Whether it’s the fact that the IDPC was organized as a network of groups, rather than a vertical institution, or that its 40-and-under leadership team is open to new organizing models, the organization’s relatively recent Support. Don’t Punish. campaign runs on many of the innovative principles that have helped earlier upstarts scale vast networks of supporters rapidly and with relatively few resources. This model has certainly worked to the organization’s advantage. In just four years and with only a handful of London-based staff, the IDPC has managed to foster a constellation of groups in 93 countries that now actively promote a more humane approach to drug laws and treatment of drug-related health issues.

Beyond command-and-control campaigns

Two main needs emerged from this revision. First, the importance of strengthening operational systems and linking services. The idea is to strengthen links with existing partners in the implementation of programmes which are already underway, to ensure that those reached on the field are redirected to the services offered by PILS or the government. On the one hand, PILS has revised its internal organisation in order to develop synergies between the various functions that comprise the association today. Particular attention is given to collaborative work, with the setting up of several committees within the association, so that everyone can contribute as much as possible to decision-making.

On the other is the strengthening of community systems and the involvement of communities at all stages of business processes and decision-making. This is reflected in the development of our community health services in 2017. This unit already offers de-medicalised and community-based screening services, as well as counseling and referral care services. In addition, a patient committee composed of community leaders will be set up, which will be at the heart of the reflections on the needs, priorities, implementation, management and evaluation of these services.

Our actions and efforts, I am sure, will be supported by the new government in Mauritius and the Minister of Health, who has demonstrated his willingness to work with civil society. We will never cease to say that only full collaboration between the different actors in the fight against AIDS can ensure an effective national response. We are also delighted with the reintroduction of the methadone induction program announced by the Minister of Health, and we are pleased that those who have been waiting for some for the past two years can finally participate in this harm reduction program.

Prévention Information Lutte contre le Sida (PILS): Annual Report 2016

By International Center for Enthnobotanical Education Research and Service

Ayahuasca is the Quechua word referring to a liquid produced by the slow decoction of the Amazonian Banisteriopsis caapi vine – as well as to the vine itself – which contains harmine, harmaline and tetrahydroharmine. It is traditionally used throughout the Northwestern Amazon, originating from indigenous cultures that have used it for hundreds of years for medicinal and ritual purposes. At the beginning of the last century, syncretic religions combining Amerindian shamanism, African religiosity, European esotericism, and Christianity began to use ayahuasca. In the 1980s, these churches expanded from the Amazon into Brazilian urban centers (Labate 2004) and, since the 1990s, globally (Labate & Jungaberle, 2011).

Based on the intended use of the decoction of the vine called ayahuasca, Amazonian group or healer with experience using ayahuasca, adds different plants to the decoction with the objective of communicating with a specific spirit depending on the disease to be healed or ritual to be performed. Ethnographic studies suggest that there are more than 5000 different recipes of ayahuasca (Fericgla, 1997) and more than 200 admixture plants to ayahuasca, all using B. caapi as their base (McKenna et al., 1986). Some of the traditional recipes involving ayahuasca, considering both the indigenous cultures and the religions that use ayahuasca as their sacrament (or “ayahuasca religions”), include adding leaves of the Psychotria viridis bush, which contains DMT (N,N-Dimethyltryptamine), along with the B. caapi vine (Schultes & Hofmann, 1992). Ayahuasca is currently being popularized as the combination of B. caapi and P. viridis, likely because the international expansion of ayahuasca practices was initiated by these churches (Sánchez y Bouso, 2015).

Ayahuasca: Technical Report 2017

Psychoactive drugs have mind altering properties. They are often consumed to produce a wide range of desirable physical and psychological effects and there are hundreds of substances available.

Psychoactive drugs can occur naturally (e.g. cannabis and psilocybin); be extracted from natural sources (e.g. cocaine and heroin) or produced synthetically (man-made) in a laboratory (e.g. MDMA and methamphetamine).

People choose to take drugs for many reasons including relaxation, insomnia, pain relief, escapism, peer pressure and social norms, to get high, self-medication, to have fun, to lower inhibitions, to feel different, because they want to, to increase connection with others and music, to increase creativity, increase sexual arousal, curiosity, tradition, religious or spiritual beliefs, to lose/gain weight, to cope with grief, loneliness, trauma etc.

People from all strata of society have the potential to consume drugs and we must avoid stereotypes. Most drug use is recreational and not recorded; however, pockets of problematic use exist in a range of settings. The use of drugs is widespread and includes not just illegal substances but alcohol, nicotine, caffeine and medicines - which many people do not consider to be drugs.

Psychoactive Drugs

The prevention of drug use is one of the primary goals of the War on Drugs. However, despite investment in high-profile interventions such as social marketing campaigns and enforcement-based deterrence, these efforts have generally failed. With the emergence of novel policy frameworks to control and regulate drug use, a window of opportunity exists to test approaches to drug prevention that take into account existing evidence and the rights of individuals who use drugs. Specifically, there is a growing consensus that entry into drug use is a socially-defined event that individuals experience within particular socio-structural contexts. This understanding, coupled with a distinction between the value of preventing problematic drug use rather than all drug use, provides a useful framework within which to develop effective and rights-based approaches to drug prevention.

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