Cannabis legalization is a serious topic of discussion in the Western Hemisphere. Since 2012, voters in eight U.S. states have passed laws to legalize large-scale cannabis production and allow profit-maximizing companies to grow and sell it for nonmedical purposes. Voters in Washington DC also approved legalization, but supply is limited to home production and gifting—retail sales are not allowed. In 2013, Uruguay’s President José Mujica ratified a legalization bill that is noteworthy for at least three reasons. Most importantly, it made Uruguay the first country in the world to remove the prohibition on cannabis supply for nonmedical purposes. Second, Uruguay’s middle-ground approach to cannabis supply falls in between the two options commonly discussed in the United States: prohibition versus the standard commercial model. Third, the law was approved by politicians, not the voters.

Jurisdictions considering alternatives to prohibiting supply have a number of options to consider (See Fig. 1; Caulkins et al., 2015); Uruguay chose three middle-ground options. Uruguayan citizens who are 18 years and older and want legal cannabis can either (1) grow cannabis at home (similar to Washington DC); (2) join a cannabis social club (CSC; similar to some European countries); or (3) purchase cannabis from a pharmacy (not yet operational). Adults are only allowed to choose one supply mechanism and there are limits to the amount grown (six plants) or purchased (no more than 40 g per month, 10 g per week).1 The government will tightly control the cannabis produced for the pharmacies and advertising is prohibited.

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

Uruguay’s middle-ground approach to cannabis legalisation

In deliberations on drug policy in United Nations fora, a consensus has emerged that drug use and drug dependence should be treated primarily as public health concerns rather than as crimes. But what some member states mean by “public health approach” merits scrutiny. Some governments that espouse treating people who use drugs as “patients, not criminals” still subject them to prison-like detention in the name of drug-dependence treatment or otherwise do not take measures to provide scientifically sound treatment and humane social support to those who need them. Even drug treatment courts, which the U.S. and other countries hold up as examples of a public health approach to drug dependence, can serve rather to tighten the hold of the criminal justice sector on concerns that should be addressed in the health sector. The political popularity of demonisation of drugs and visibly repressive approaches is an obvious challenge to leadership for truly health-oriented drug control. This commentary offers some thoughts for judging whether a public health approach is worthy of the name and cautions drug policy reformers not to rely on facile commitments to health approaches that are largely rhetorical or that mask policies and activities not in keeping with good public health practise.

Seeing through the public health smoke-screen in drug policy

This compendium aims to serve as a comprehensive guide for civil society actors engaging in the third cycle of the UPR and is presented in four parts. Part 1 offers a concise introduction to the UPR. Following this, Part 2 provides an up to date guide for civil society on how best to engage with the UPR. Part 3 offers advice, and examples of best practices, for strengthening national CSO coalitions, specifically relating to the UPR. Finally, Part 4 provides non-state actors in the UPR with a resources toolkit for engagement.

The Civil Society Compendium: A comprehensive guide for Civil Society Organisations engaging in the Universal Periodic Review

This study examines the relationship between drug consumption, peace and security at the local and state levels in Nigeria. The purpose of the research was to interrogate popular assumptions related to the use and abuse of narcotics, regulated psychotropic medications and other psychoactive substances in Nigerian communities, and assess their impact on peace and conflict systems in the country. The data that this report is based on were gathered in five states as well as in the city of Lagos, in April and May 2016.

Drug use in Nigeria is analysed from a peacebuilding perspective that suggests a holistic approach to the role that it can play in violent conflicts in the country. This approach results in the recommendation of policies that are aimed at rehabilitating users by reducing social stigma against them and providing effective treatment options, while focusing law enforcement efforts on the targeting of high-volume suppliers of illicit and prescription drugs rather than street users or sellers. The author hopes the findings of this study will assist policy-makers in crafting an appropriate response to drug use and abuse in Nigeria that mitigates its role in exacerbating conflict, while strengthening cooperative bonds across society and respecting the human rights of users.

Out of the shadows: Adopting a peacebuilding approach to the social effects of drug use in Nigeria

Opioid overdose is a major cause of premature mortality and life-years lost not only in eastern Europe but in Scotland, as confirmed by the Global Burden of Disease Study 2015.1

Scotland's opioid-related deaths averaged 400 per year in 2006–10,2 and 10% of them occurred in the 4 weeks after prison release. Annually, around 30 000 clients receive methadone-substitution therapy,3 which is continued in Scottish prison custody.4

In 2005, the opioid antagonist naloxone was added to the UK's exempt list of prescription-only medicines that could be administered intramuscularly by anyone in an emergency to save life. In January, 2011, Scotland became the first country to introduce a centrally funded, evaluated National Naloxone Programme, designed to have 80% power within 3 years to detect a 30% reduction (from 10% to 7%) in its primary outcome: the proportion of opioid-related deaths within 4 weeks of prison-release.2 By 2014–15 (calendar years), the proportion had reduced to 4%,5 a 60% reduction compared with 2006–10 (table).

Prison-based prescriptions aid Scotland's National Naloxone Programme

This independent review, commissioned by the Community, Rights and Gender (CRG) Department at the Global Fund Secretariat, shares findings, conclusions, and recommendations for enhancing the meaningful engagement of communities in all phases of Global Fund grants, with an emphasis on grant making and grant implementation. The review synthesizes lessons learned and good practices for how communities (see definition below and Figure 1) engage meaningfully, and identifies key principles and strategic actions the Global Fund can take to ensure greater accountability between communities, Country Coordinating Mechanisms, other key stakeholders, and the Global Fund itself.

The Community Rights and Gender Advisory Group (CRG AG), a body that provides advice to the CRG Department, oversaw this independent review, which was carried out by the Community Action and Leadership Collaborative (CLAC), and led by MSMGF (the Global Forum on MSM & HIV). A team of three consultants was responsible for the research, analysis, and writing of this report. Further, preliminary findings and recommendations were validated by way of community consultations in seven countries: Cameroon, the Dominican Republic, Kenya, Moldova, the Philippines, Suriname, and Tunisia.

Independent multi-country review of community engagement in grant making & implementation processes

The Regional Center for Technical Assistance (CRAT in its Spanish acronym) has developed a strategy to support civil society organizations (CSOs) and community groups in Latin America and the Caribbean (LAC) to plan for sustainability of their outreach strategies to control HIV, TB and malaria. CRAT is the host of the regional communication and coordination platform under the Global Fund’s Community, Rights and Gender (CRG) Initiative. The initiative provided the funding for the development of the strategy.

Several countries in the region will receive transition funding in 2017-2019 (see GFO article). A key component of the transition process is the sustainability of programs implemented by CSOs and community groups. The governments of countries preparing for transition are expected to work with civil society and communities to ensure their programs are funded after Global Fund support ends.

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

Latin America: Strategy developed to support civil society to transition to sustainability

Ensuring availability of narcotic drugs for medical purposes

1. Some decades ago the international community made a solemn commitment with the Single Convention on Narcotic Drugs of 1961 and the Convention on Psychotropic Substances of 1971: to ensure the availability, to make adequate provision and not to unduly restrict the availability of drugs that were considered indispensable for medical and scientific purposes. Over the past decades that promise has not been fully met. . Too many people suffer or die in pain or do not have access to the medications they need. Unnecessary suffering because of the lack of appropriate medication due to the inaction, lack of know-how or unnecessary administrative requirements is a scandal that shames us all.

2. Around 5.5 billion people still have limited or no access to medicines containing narcotic drugs such as codeine or morphine, leaving 75 per cent of the world population without access to proper pain relief treatment. Around 92 per cent of morphine used worldwide is consumed by only 17 per cent of the world population, primarily living in the United States, Canada, Western Europe, Australia and New Zealand. Inadequate access violates the notion of article 25 of the Universal Declaration of Human Rights, including the Right to medical care, which also encompasses palliative care.

3. The imbalance in the availability of opioid analgesics is particularly worrying as the latest data show that many of the conditions requiring pain management, particularly cancer, are prevalent and increasing in low- and middle-income countries.

4. This situation is caused by a variety of factors, including health care professionals, that means doctors and nurses, not receiving adequate education and training as part of their professional education, lack of know-how and capacity of government authorities, concerns about overprescribing and addiction and overly onerous regulatory and administrative requirements. Many patients in most of the countries in Africa, Central America and the Caribbean, and South Asia are affected, but patients in other parts of the world are also affected.

5. Concrete steps and rapid action by Member States, the international community and the pharmaceutical industry can go a long way to remedy the situation. The most important and urgent actions would involve providing specialised training for health care professionals enabling them to prescribe and administer pain medication as well as training for the competent national authorities.

6. Governments must bring about partnerships with the pharmaceutical industry, which has a duty to act in a socially responsible manner, to ensure access to and availability of affordable medications, placing emphasis on generics.

7. Governments need also ensure that the training curricula of doctors and nurses contain, ab initio, content on the prescribing and rational use of medicines containing controlled substances.

8. At the same time, where necessary, legislation and regulations should be revised, prescribing practices brought up to day and the capacity of national agencies involved strengthened.

9. If Governments, together with the relevant international agencies, were to put together a sufficiently well-resourced plan of action, Member States would be on their way to significantly contributing towards achieving a major element of Sustainable Development Goal 3 on Ensuring healthy lives and promote wellbeing for all at all ages.

Ensuring availability of narcotic drugs for medical purposes 

Application of principle of proportionality for drug-related offences

1. The application of the principle of proportionality in the context of drug offences is a key aspect of a sound and effective drug policy. Some States have made extensive use of incarceration of low-level drug offenders, despite the fact that this approach is not mandated by the international drug control treaties, and some have even applied extrajudicial responses to drug-related offences, notwithstanding the fact that such actions are contrary to the treaties. It is essential to distinguish between the criminal justice provisions contained within the Conventions, and the criminal justice policy measures which have been taken by some Governments.

2. Implementation of the international treaties is subject to the internationally recognized principle of proportionality, which requires that a State’s treatment of illegal behaviour to be proportionate and that a punishment in response to criminal offences should be proportionate to the seriousness of the crime.

3. The INCB has repeatedly called upon States to give due regard to the principle of proportionality in the elaboration and implementation of criminal justice policy in their efforts to address drug-related crime.

4. While the choice of legislative or policy measures to address drug-related crime, including the determination of sanctions is the prerogative of States, the international drug control treaties require that these sanctions should be adequate and proportionate, taking into account the gravity of the offence and the degree of responsibility of the alleged offender.

5. The international drug control treaties do not automatically require the imposition of conviction and punishment for drug-related offences, including those involving the possession, purchase or cultivation of illicit drugs, in appropriate cases of minor nature or when committed by drug users. While “serious offences shall be liable to adequate punishment, particularly by imprisonment or other penalties of deprivation of liberty”, offences of a minor or lesser gravity need not necessarily be subject to harsh criminal sanctions, such as incarceration. The Conventions afford discretion for Parties to provide, either as an alternative to conviction and punishment or in addition to conviction and punishment, that drug users undergo measures of treatment, education, after-care, rehabilitation and social reintegration.

The 9th annual report by Iran Human Rights (IHR) on the death penalty provides an assessment and analysis of the death penalty trends in 2016 in the Islamic Republic of Iran.

The report sets out the number of executions in 2016, the trend compared to previous years, charges, geographic distribution and a monthly breakdown of executions. Lists of the women and juvenile offenders executed in 2016 are also included in tables at the end of the report. Drug-related executions, the status of the cooperation between the United Nations Office for Drugs and Crime (UNODC) and Iran in fighting drugs and the ongoing debate inside Iran, and the new legislation proposed by the Iranian Parliament, Majles, will be briefly reviewed. We will also look into whether Hassan Rouhani’s presidential period, which will end in June 2017, has had any impact on the issue of the death penalty.

The issue of due process will be discussed. Revolutionary Courts have received much attention as regards the mass executions in the 1980s. In this report, we will provide data which, in particular, sheds light on the role of the Revolutionary Courts in recent executions.

2016 Annual Report on the death penalty in Iran

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?

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

Publications

Uruguay’s middle-ground approach to cannabis legalisation

Seeing through the public health smoke-screen in drug policy

The Civil Society Compendium: A comprehensive guide for Civil Society Organisations engaging in the Universal Periodic Review

Out of the shadows: Adopting a peacebuilding approach to the social effects of drug use in Nigeria

Prison-based prescriptions aid Scotland's National Naloxone Programme

Independent multi-country review of community engagement in grant making & implementation processes

Latin America: Strategy developed to support civil society to transition to sustainability

Ensuring availability of narcotic drugs for medical purposes

Application of principle of proportionality for drug-related offences

2016 Annual Report on the death penalty in Iran

Implementing comprehensive HIV and HCV programmes with people who inject drugs

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