North America is facing an epidemic of opioid addiction and opioid overdose with an unprecedented level of mortality. The crisis was spurred by a broad expansion of medical use of opioids, which began in the 1990s as a legitimate response to the under-treatment of pain, but which was soon exploited by the unethical behavior of pharmaceutical companies eager to increase their revenue. The rise in supply fed high levels of diversion among an economically stressed and vulnerable population. The present wave of opioid dependence differs from the heroin crises of the 1980s and 1990s, both in the sheer extent and in the social backgrounds of a large part of the affected populations. In Canada, which is second only in per capita opioid consumption to the United States, the rise in fatal overdoses is more linked to higher potency or ad-mixing of other drugs in areas where there was already a relatively high incidence of heroin use.

Initial reactions were to limit prescriptions and to introduce pills that were harder to manipulate. The reduced supply of prescription opioids, however, drove an important minority of people with addiction to less expensive and more accessible street heroin. Under what has become known as the “iron law of prohibition”, cheaper and more potent opioids—including fentanyl and its derivatives— increasingly appeared on the market. This has even further accelerated the rate of fatal overdoses.

Media and government attention has primarily focused on the supply through doctors. The fact that most addictions start with diverted supplies rather than among pain patients has been largely ignored. Policymakers have also failed to address the role of economic upheaval, unemployment, inequality, and other systemic sources of despair in increasing the risk for addiction and decreasing the odds of recovery. Health systems were completely unprepared and treatment is still dominated by abstinence-focused programs, where no regulatory standards have to be met. Furthermore, among other factors, prejudice against the most effective treatments for opioid addiction—opioid substitution therapy (OST)—has translated into lack of treatment for those in need. Opioid substitution therapy has proven effective in treating addictions to heroin and should be offered to those dependent on or addicted to prescription opioids.

The opioid crisis in North America

An update to this paper is available here.

By Jamie Bridge (IDPC), Christopher Hallam (IDPC), Marie Nougier (IDPC), Miguel Herrero Cangas (IDPC), Martin Jelsma (TNI), Tom Blickman (TNI) & David Bewley-Taylor (GDPO)

Diplomatic processes at the United Nations are notoriously slow and difficult, perhaps increasingly so in a modern world of multi-polar geopolitics and tensions. This is certainly no different for the highly charged and provocative issue of international drug control. After the latest high-level UN meeting on drug control – the UN General Assembly Special Session (UNGASS) on the ‘world drug problem’ in New York in April 2016 – many stakeholders came away with mixed feelings at best. Despite acknowledgements of the progress made in certain areas of the debate, and the rich content of some of the country and civil society statements, the UNGASS failed to deliver the ‘wide-ranging and open debate that considers all options’ that had been called for by the UN Secretary-General at the time, Ban Ki-Moon.

In order to help digest and contextualise the UNGASS Outcome Document, it is useful to take a broader look at how the agreed UN language on drug control has evolved and developed over the last quarter of a century. To this end, this IDPC briefing paper explores a selection of key themes by analysing the consensus-based language agreed by UN member states. The briefing studies the evolution in agreed language on: the success/failure of drug control, harm reduction, human rights, development, civil society engagement, criminal justice responses and fexibilities in the conventions, access to controlled medicines and UN system-wide coherence.

This briefing paper was launched in September at the UN in Vienna at the occasion of a round of CND Intersessional Meetings on the Post-UNGASS process. For more information, click here.

Edging forward: How the UN’s language on drugs has advanced since 1990

The International Narcotics Control Board (INCB or Board) Annual Report for 2016 is, as usual, a mixed bag of high quality data and sometimes doubtful political views. It is the final Report of the Presidency of Mr. Werner Sipp, and as such represents a comparatively progressive text, in contrast to many previous Reports. Despite this, the general – if ambivalent – acceptance of medical uses of internationally controlled drugs is contrasted by the Board’s continuing defence of the conventions in their current form and their opposition to any non-medical use.

The INCB Annual Report for 2016 is contextualised by that year’s United Nations Special Session of the General Assembly (UNGASS) on the ‘world drug problem’. As such, 2016 represents an unprecedented period of flux, as the drug control consensus that has lasted several decades continues to crack at the seams, and to reach new depths despite the surface unity.

There are some important new or recent positions included in the Report. Amongst the most significant is the continuation of the INCB to encourage states that retain the death penalty for drug-related offences to abolish the practice.

The Board also condemns outright the government of the Philippines for its implication in the extrajudicial killings of those involved in the country’s drugs trade, or those suspected of being so involved.

This year’s thematic chapter features a discussion on the issue of women and drugs, an important issue that has long received little of the attention it requires. The chapter explores issues including the growing incarceration of women for drug offences, which is increasing more rapidly than that of men.

The Annual Report is characterised by reticence when it comes to positive and progressive developments, a continuing trend in the INCB’ reports. For example, the concerns of the Board that controlled medicines are prone to diversion, rather than their vital therapeutic properties, tend to be given priority in terms of attention. Similarly, those countries having developed or scaled up harm reduction interventions are neither encouraged nor highlighted as models to be followed.

A similar tendency may be discerned with respect to cannabis. Whether real or imagined, the negative elements of cannabis are emphasised at the expense of the possible benefits of the substance. Moreover, the potential contravention of the international treaties is stressed alongside the harmful health effects – ironic since public health is the driving force behind many countries’ movement toward regulated markets.

For the first time, the INCB acknowledges that drug consumption rooms can be lawful under the international conventions, though to do so they must aim at effectively reducing the negative compact of drug use and lead to treatment and rehabilitation. Moreover, they must not condone or encourage drug use or trafficking.

IDPC response to the 2015 INCB Annual Report

IDPC response to the 2014 INCB Annual Report

IDPC response to the 2013 INCB Annual Report

IDPC response to the 2012 INCB Annual Report

IDPC response to the 2011 INCB Annual Report

IDPC response to the 2010 INCB Annual Report

IDPC response to the 2009 INCB Annual Report

IDPC response to the 2008 INCB Annual Report

IDPC response to the 2007 INCB Annual Report

IDPC response to the INCB Annual Report for 2016

A abordagem predominante de controle de drogas usada no mundo foi baseada em respostas punitivas da justiça penal, em detrimento aos direitos humanos e à saúde – nunca os gastos foram tão grandes com polícia, juízes, promotores e prisões como atualmente. Nunca se prendeu tanto por produção, tráfico, venda ou uso de drogas como agora, e os problemas ainda continuam sem solução: hoje no mundo há um número sem precedentes de produtores e consumidores de drogas. O Escritório das Nações Unidas sobre Drogas e Crime identificou abertamente um certo número de consequências negativas indesejáveis’ da chamada ‘guerra às drogas’, incluindo graves violações de direitos humanos diretamente relacionadas à criminalização e estigmatização de pessoas que usam drogas e pessoas vulneráveis envolvidas na produção ilícita e tráfico de drogas.

Essa situação levou Paul Hunt (Relator Especial das Nações Unidas sobre o direito à saúde entre 2002 e 2008) a concluir que o sistema de direitos humanos da ONU e o regime global de controle de drogas se comportaram ‘como se existissem em universos paralelos’. O controle global de drogas está baseado em três convenções internacionais de 1961, 1971 e 1988, que iniciam com o compromisso de promover a ‘saúde e o bem estar da humanidade’. Ainda que as Convenções de 1961 e 1971 não façam referências sobre os direitos humanos, e o termo apareça uma vez na Convenção de 1988 no contexto de erradicação de cultivos. No sistema de direitos humanos da ONU, o termo foi mencionado na Carta da das Nações Unidas de 1945, a qual foi realizada com base em três pilares: direitos humanos, paz, e segurança e desenvolvimento. Nos Artigos 55 e 56, as Nações Unidas e os países-membros se comprometem a promover o desenvolvimento social e o respeito universal pelos direitos humanos e pelas liberdades fundamentais para todos, bem como a observância deles. Três anos depois da adoção da Carta, a Declaração Universal dos Direitos Humanos também foi aprovada, descrevendo 30 direitos universais que estabelecem ‘um padrão comum de conquista para todos os povos e nações’. Décadas mais tarde, em 1981, a Carta Africana dos Direitos Humanos e dos Povos’ (também conhecida como Carta de Banjul) foi aprovada, e ratificada por todos os países africanos, exceto pelo Sudão do Sul. A carta de Banjul descreve mais de 20 direitos – diversos dos quais são abordados neste relatório.

Esta nota para advocacia pretende dar uma visão geral não exaustiva de como as políticas de droga violam os direitos humanos universais e o que é, na prática, uma abordagem de direitos, com base na Carta de Banjul. Esta nota para advocacia deve ser lida em paralelo a sua publicação correspondente: ´Política de Drogas na África: O que é uma abordagem baseada em saúde?’.

Registe-se para recever as Alertas mensais do IDPC e obter informação sobre questões relacionadas com as políticas de drogas.

Política de Drogas na África: Rumo a uma abordagem baseada em direitos humanos

"It always seems impossible until it’s done.” One of the most famous quotes attributed to Nelson Mandela (1918-2013) perfectly fits the increasingly forceful and persuasive debate that is questioning prohibitionist drug policies all around the world. Among the list of issues informing the debate, one deserves special attention: why should human rights organisations participate in this debate and in what way?

In 1971, then United States President Richard Nixon announced that “America’s public enemy number one is drug abuse.”1 This moment marked the beginning of the so-called “war on drugs”. Today, however, a young resident of Denver, Colorado can go to the corner and legally purchase up to 28 grams of marijuana per month for recreational use. If the same youth were in San Francisco, California, he would have been able to use medical marihuana to fight chronic pain since 1996.

Why are so many things changing at a relatively fast pace not only in the US, but also in countries as diverse as Portugal, the Netherlands, Finland, Spain and Uruguay? These countries have approved drug policies that move – some more than others – in the opposite direction of prohibitionism.

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

NGOs and drug policy

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.

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

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.

Publications