In all regions of the world, people who inject drugs are disproportionately affected by HIV.1 Globally, people who inject drugs are 28 times more likely to be living with HIV than the general population. The United Nations Office on Drugs and Crime (UNODC), the World Health Organization (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Bank estimate that worldwide as of 2014, about 11.7 million2 people inject drugs, of whom an estimated 14% (1.6 million) are living with HIV.3 Injecting drug use accounts for 30% of new HIV infections outside subSaharan Africa. People who inject drugs also have higher rates of hepatitis C (HCV) and tuberculosis than the general population. The global rate of HCV among people who inject drugs is 52%, greatly surpassing even the high prevalence of HIV among them.

This tool does not seek to ignore the complex policy and legislative environment around drugs and injecting drug use in most countries, nor the need for advocacy to confront the stigma, discrimination and human-rights violations faced by people who inject drugs. However, it aims primarily to address the question: what can we do now, with the resources we have, in the kinds of environments we face, to prevent the spread of HIV and hepatitis C among people who inject drugs?

Keep up-to-date with drug policy developments by subscribing to the IDPC Monthly Alert.

Implementing comprehensive HIV and HCV programmes with people who inject drugs

In 2016, the annual village survey was conducted in 591 villages in Shan state, the main opium poppy cultivating area in Myanmar. An independent area estimation was not part of the survey this year; however, UNODC expanded largely on the socio‐economic analysis of opium cultivation in the context of the UN Guiding Principles on Alternative Development and achieving the Sustainable Development Goals.

UNODC is assisting the Government of Myanmar in implementing an alternative development strategy, and has been requested to increase support in this area. UNODC has therefore developed several projects to improve short‐ and medium‐term accessto food and income. The scale of these programmes requires significant large funds to become effective at a regional level, however.

Successful implementation of a national drug control strategy is also dependent on international efforts to control drug trafficking and organized crime in the region. A comprehensive approach is needed to tackle the challenges that may be posed by the possible links between drug trafficking, corruption and different forms of organized crime. Owing to the transnational nature of drug‐ related crimes, coordinated cross‐border collaboration and alternative development activities are important, where appropriate and feasible, which requires support of the international community

Evidence for enhancing resilience to opium poppy cultivation in Shan State, Myanmar

Cannabis is the most commonly consumed illegal substance. The current system of prohibition and its sanctions do not prevent the use of this substance. The most recent data indicate that about 15% of the Québec population report having used cannabis in the past 12 months. More than half of those who have used cannabis report having used it less than once a month. Those who use it weekly or daily represent about a quarter of cannabis users.

Cannabis is not an ordinary product. It carries risks for public health and safety. Its psychoactive effects affect the ability to drive motor vehicles, can lead to dependence, can impair brain development in youth, and can potentially give rise to mental disorders. Smoking cannabis can also cause respiratory diseases. The legalization of non-medical cannabis provides an opportunity to create a regulatory system aimed at reducing the social and health problems associated with the use of this substance.

There are several possible regulatory scenarios or options. The choices made concerning the production, distribution and consumption of cannabis are necessarily interrelated and should be the subject of integrated reflection. These choices will be key to the success of the legalization process, the flattening of the illicit market and the achievement of public health goals.

The choices made for regulating the distribution and consumption of cannabis should avoid tending toward a trivialization of the substance. In addition, they should not produce setbacks in other areas of public health, for example, by leading to the social renormalization of smoking.

The commercialization of cannabis products, even within the context of a strict regulatory framework, sets up an opposition between the profit motive of businesses and the public health goal of reducing cannabis use within the population as a whole. In contrast, a not-for-profit approach makes it possible to focus squarely on prevention, health and safety.

The legalization of non-medical cannabis carries its share of uncertainties and requires innovation on the part of Canada and Québec. Moreover, flexibility must be built into the system so that it can be adapted to the evolving portrait of cannabis use prevalence and practices within the Québec population. Caution should also guide the choices made concerning the regulation of this substance.

Legalisation of non-medical cannabis: A public health approach to regulation

Opening letter from the President and Executive Director

The work of the Drug Policy Alliance is both all about drugs and ultimately not really about drugs at all.

We are at the front lines of much larger struggles in U.S. and international society – over what it means to remain a free society and how we deal with both real and phantom threats to health, life and security.

Donald Trump’s election and his appointment of drug war extremists to senior positions are going to make it harder to consolidate our marijuana legalization victories, and to make progress in Congress on rolling back harsh drug laws, repealing civil asset forfeiture laws, reducing overdose fatalities, and integrating harm reduction principles into federal drug policies.

But what most concerns us is the assault on the values for which we’ve fought for so long.

We advocate for drug policies grounded in science, compassion, health and human rights because we believe those values should infuse all public policies. Only through our shared strength and vision can we uproot the drug war and advance the broader values that guide our struggle.

Drug Policy Alliance Annual Report

The HAT clinic model, initially developed by the Swiss, differs from the old “British System” (still in place for around 100 people in the UK) in that rather than being given ‘take home’ heroin prescriptions, patients attend a clinic once or twice a day, and use their prescriptions on site, under medical supervision.

The first Swiss pilot HAT clinics opened in 1994. In 1997, the federal government approved a large-scale expansion, aimed at 15% of the nation’s estimated 30,000 heroin users, specifically long-term users who had not succeeded with other treatments. Other countries followed suit, with the UK opening three pilot NHS supervised injecting clinics (London, Brighton and Darlington) in 2009 - the Randomised Injectable Opiate Treatment Trial (RIOTT) - extended to 2016 after proving successful.

Heroin Assisted Treatment (HAT): Saving lives, improving health, reducing crime

Morocco continues to be the world’s largest producer of cannabis resin (hashish). Over the past 50 years, the Moroccan cannabis growers shown a remarkable resilience to government attempts to eradicate or reduce cannabis cultivation as well as a noteworthy ability to adapt to changing international market conditions.

Since Morocco’s independence the government has practiced a policy of containment regarding cannabis cultivation, allowing no new areas but tacitly allowing those already in production to be maintained.

The rapid increase in illicit cannabis cultivation in the Rif during the last decades, as well as poor soil conservation practices, have taken a heavy toll on the Rif’s already threatened forests and fragile ecosystems.

The unregulated cannabis market in Morocco has negative social consequences. Some 48,000 growers have arrest warrants hanging over their heads, which is a source of corruption and repression. An amnesty and decriminalization could be effective measures to diminish negative social consequences and open the debate about regulation.

Cannabis farmers in Morocco should have access to emerging legally regulated cannabis markets that are gaining ground worldwide. The challenge is to find a sustainable development model that includes cannabis cultivation in Morocco, instead of excluding cannabis and ignoring the realities of more than 50 years of failed attempts to eradicate the only viable economic option in the region.

Morocco and cannabis

The sharing of drug injecting equipment most often occurs between sexual partners, but the ways in which couples manage risks and care for each other have been largely ignored by harm reduction services, say Australian researchers.

In-depth interviews showed that drug users’ relationships were based on mutual trust, honesty and care. Couples tried to avoid sharing their equipment but when they did, they took into account what they knew about each other’s hepatitis C status and genotype to minimise risks. This could be described as a form of ‘negotiated safety’, say the researchers.

Jake Rance, Tim Rhodes, Carla Treloar and colleagues have published the findings in articles published online ahead of print in 

The programmatic implications are summarised in a document from the University of New South Wales.

Harm reduction should address the specific needs of couples who inject drugs

At a time of increased debate on the laws controlling the use of cannabis in the European Union, this report answers some of the questions most often asked about cannabis legislation. Using a question and answer format, basic definitions and the obligations of countries under international law are set out in a section on ‘What is cannabis and what are countries’ obligations to control it?‘ Two following sections examine the links and disparities between the content of the laws and their guidelines on the one hand and the actual implementation of the laws on the other. The final question and answer section considers whether changes in law have affected cannabis use and how much public support for legal change exists, as it looks at the future direction of cannabis legislation in Europe.

Cannabis legislation in Europe: an overview

The prohibitionist approach imposed on cannabis by the international drug control system still persists in nearly all of the Latin American and Caribbean countries examined. In almost all of them, possession falls under criminal law. Some countries’ legislation establishes thresholds below which cannabis possession should not be considered a crime. Only in Uruguay does the law include regulation of the entire chain.

Although cannabis organizations and other groups have managed to place the issue on the agenda, in most countries reforms are still pending or have been inadequate. The inclusion of relatives and users of cannabis for medicinal and therapeutic purposes has helped give impetus to the movement and to raise awareness among both political stakeholders and the public.

Many of the reforms under way do not recognize the need to regulate the recreational and cultural use of cannabis and run the risk of perpetuating the current consequences, with the persistent impact on health, security, institutionality and human rights that the prohibition of cannabis and the lack of state regulation allow and encourage.

The countries of Latin America and the Caribbean should prepare for future reform scenarios, instead of considering temporary measures that will perpetuate the same harmful consequences. Limiting reform solely to medicinal cannabis is only a partial, inadequate and temporary solution. If change is truly sought, it is necessary to move toward models of state regulation of cannabis for all purposes.

Cannabis in Latin America and the Caribbean: From punishment to regulation

Since its establishment in the 1970s, TNI has always believed in the need to find global answers to global problems, been a strong defender of multilateralism and an advocate of a well-functioning United Nations which stands as the guarantor of universal human rights. On the drugs question, our position is straightforward: drug control should respect human rights.

We defend the rights of farmers caught in the illicit economy to live a life in dignity.

We favour the decriminalisation of use, possession for personal use and minor trafficking offences. We defend harm-reduction approaches and advocate differentiation among substances on the basis of health concerns.

We also defend the principle of proportionality: a basic principle that should be obvious to all but got lost in the process of the escalation of the war on drugs: everyone involved in the illicit drugs market, farmers, traders and users alike, are fully protected by human rights.

Any drug control measure that violates their basic human rights is illegitimate and TNI will always reject measures that violate the right to live a life in dignity.

Click here to read the full publication.

Keep up-to-date with drug policy developments by subscribing to the IDPC Monthly Alert.

Human rights and drug policy

The size of populations with specific risk factors and behaviours is one of the most important components of HIV surveillance. Not only is size a critical determinant of the likely extent of HIV spread and the contribution of different key populations to new HIV infections, it is also crucial for defining programme resource needs and setting priorities and targets.

Estimating the sizes of key populations most at risk for HIV is challenging because it involves counting people who are hidden, or whose activities are hidden. It is particularly challenging in countries of the World Health Organization (WHO) Region for the Eastern Mediterranean and the UNAIDS Middle East and North Africa Region (EM/ MENA region), where conservative social and religious values can mean harsh judgment, increased levels of stigma and severe punishment for people engaging in behaviours that can expose them to HIV. Despite the challenges, many countries in the EM/MENA region have taken steps to understand more about people who are at risk for HIV, including estimating their numbers. However, more guidance is needed on how to collect size estimation data and use it to improve the effectiveness of HIV programming.

Estimating sizes of key populations: Guide for HIV programming in countries of the Middle East and North Africa

2016 was a productive year for the Vienna NGO Committee on Drugs (VNGOC), one that saw our standing and meaningful contribution towards addressing the world drug problem recognised and valued.

We started off the year working hard together with our partner – the New York NGO Committee on Drugs (NYNGOC) - to ensure the participation of the Civil Society Task Force (https://www.cstfondrugs.org/) in the preparatory process of, and during, the United Nations General Assembly Special Session (UNGASS) on the world drug problem (April 2016).

The CSTF, a global network of 31 member organizations from nine global regions and nine affected populations/global voices, facilitated a comprehensive, structured, meaningful and balanced participation of civil society during the UNGASS process, providing grass roots organisations the opportunity to report on what is working and what can be improved in addressing the world drug problem.

Publications