The Middle East and North Africa region is at the centre of many of the burning issues of our globalized and inter-dependent world. When it comes to drug use, infectious diseases and marginalized populations, however, the debate falls short. While the incidence and prevalence rates of drug injection and of related HIV infections remain low compared to other regions of the world, tough drug policies and discrimination against vulnerable populations remain embedded in the social, economic and cultural contexts of the region.

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

Drug policy and human rights in the Middle East and North Africa: Harm reduction, legal environment and public health

Cultivation of cannabis for medicinal or scientific purposes needs considered management before it is rolled out as a therapeutic good

Since the publication in the Journal last year of a perspective on cannabis that stated: “Australia is behind the times on the medicinal use of cannabis”, there appears to have been a palpable change in community attitudes around cannabis as medicine. This has occurred alongside anecdotal reports from people with intractable illnesses who have had symptomatic benefit with cannabis. Palliative care specialists have acknowledged a potential role for medicinal cannabis in their specialty. Internationally, the scene is also changing. For example, the Netherlands Office of Medicinal Cannabis enables dispensation through pharmacies after purchase from a contracted company, which also exports to other European countries. In the United States, 23 states and Washington, DC, have legalised marijuana in some form, mostly for medicinal purposes, since June 2015.

In Australia, the New South Wales Government Terminal Illness Cannabis Scheme (TICS), established in 2014, enables compassionate access to adults with a terminal illness. Under TICS, a registered medical practitioner involved in a person’s ongoing care must certify that he or she has a terminal illness as defined by the scheme. In 2015, the New South Wales Government-funded trials of cannabis in palliative care and in children with a specific type of epilepsy, and in Victoria, a cannabidiol study for paediatric epilepsy is also in process.

Medicinal cannabis in Australia: the missing links

Recognizing the urgent need for strong, forward-thinking action, and evidence-informed, rights-based, well-resourced, community-led HIV responses, civil society emphatically call for a more progressive vision in the 

2016 Political Declaration on Ending AIDS

. It is toward this goal that we, the undersigned civil society advocates and organizations, engage with the process of the 

 in good faith and with hope for ending the HIV epidemic by 2020. We seek to align the HIV response to the 2030 Agenda, and were encouraged by the initial (zero) draft of the Political Declaration, and to that end commend the co-facilitators (H.E. Jürg Lauber from Switzerland and H.E. Mwaba Patricia Kasese Bota from Zambia) and recognize the efforts made by many member states to secure a bold and progressive vision and set of commitments.

Civil society and communities declaration to end HIV: Human rights must come first

The current survey has been designed to capture the level of satisfaction of civil society at large on the work done by the Civil Society Task Force (CSTF) in the preparatory process of and during the United Nations General Assembly Special Session (UNGASS) and its impact in it. We are also interested in your opinion about the future and the role the CSTF could eventually play in view of 2019, i.e. the final review of the 2009 Political Declaration and Plan of Action on International Cooperation Towards an Integrated and Balanced Strategy to Counter the World Drug Problem.

The estimated time to complete the survey is 10 minutes.

Evaluation Survey - Civil Society Task Force for UNGASS 2016

The below text is a response from Keith Scott, medical pratictioner and civil society collegue:

In its three previous declarations on HIV, the General Assembly has repeatedly and unanimously reaffirmed that “the full realization of all human rights and fundamental freedoms for all is an essential element in the global response to the HIV epidemic, including in the areas of prevention, treatment, care and support.” The UNAIDS Reference Group on HIV and Human Rights therefore offers a number of human rights-oriented recommendations to Member States for the 2016 Political Declaration, under three broad headings:

§ removing punitive laws, policies and practices, particularly those targeting key populations, and instead creating a more enabling environment through protective laws, policies and practices;
§ accelerating universal access to treatment; and
§ scaling up the human rights programs that are essential to an effective response to HIV.

In the enclosed brief, the UNAIDS Reference Group on HIV and Human Rights explains why each of these areas of human rights concern requires attention, and sets out, in the Annex, specific proposed language for inclusion in the Political Declaration.

This is a key moment in the HIV response. Extraordinary progress has been made in responding to one of the world’s worst public health crises – and the international community has unanimously agreed on “ending AIDS by 2030” as one of the Sustainable Development Goals. But the crisis of both HIV prevention and treatment continue, with millions of new infections each year and less than half of those in need of life-saving antiretroviral medication receiving it. It is simply not possible to achieve “the end of AIDS” without a political and financial commitment to rapidly scaling up the response to meet ambitious HIV prevention and treatment targets, and, to that end, without taking action to protect and promote human rights, particularly the rights of the populations and communities most heavily affected by the epidemic. Efforts to “fast-track” the end of AIDS through the achievement of ambitious HIV prevention targets, or of the “90-90-90” treatment targets, will not succeed without attention to the structural factors continuing to drive new infections or impeding access to medicines.

The human rights approach has brought great success and saved millions of lives. Now is not the time for national governments, donors or the United Nations to back away from the fundamental principles of human rights. We all want to achieve the end of AIDS, but in speaking of an end, we must speak boldly and honestly not only of the successes of the HIV response, but also of the failures—including the ongoing human rights failures—because both successes and failures offer key lessons to galvanize future commitment and action, not only to end AIDS eventually but also to transform and advance global health more broadly, in keeping with the Sustainable Development Goals. Otherwise, we risk falsely declaring “the end of AIDS” while the epidemic becomes another disease of those who are poor and marginalized.

About the UNAIDS Reference Group on HIV & Human Rights
The Reference Group was established in 2002 to advise UNAIDS on all matters relating to HIV and human rights. The membership of the Reference Group brings together people from the HIV and human rights community, including advocates, jurists, ethicists, people living with HIV, people working in the NGO and community sector, people working in the government sector, and academics. The Reference Group speaks with an independent voice. Thus, its views do not necessarily reflect the views of the UNAIDS Secretariat or any of the UNAIDS Cosponsors. The Reference Group advises UNAIDS on how it can strengthen the capacity of governments, civil society and the private sector to protect and promote human rights in relation to HIV, and how it can best operationalize human rights and GIPA (Greater Involvement of People Living with HIV) principles in UNAIDS’ policies and technical support.

High-level meeting on HIV: Contribution of the UNAIDS Reference Group on HIV & Human Rights

This is the second annual edition in our 

 series produced by Penal Reform International, describing key global trends in the use and practice of imprisonment and the pressing challenges facing states that wish to organise their penitentiary systems in accordance with international norms and standards.

Topics include for example: developments in international criminal justice policy; notable changes to policy at the national level; prison population trends; prison management issues (eg. security and violence, radicalisation, corrections in fragile and conflict states, corruption) and new technologies. The 2016 also has a new section on the provision of food in prisons, with some representative data on food expenditure.

Significant international developments and recent research projects are highlighted throughout.

The report also includes a Special Focus pull-out section – 

Working in a prison requires specific skills, but prison staff can be poorly paid, under‑trained and experience high levels of work‑related stress and violence. This special feature provides a global perspective on prison staff recruitment, pay and conditions, professional training, and issues relating to their health, safety and well‑being.

Global Prison Trends 2016

This publication is a chapter from a four-part Report, Roadmaps to Regulation: Cannabis, Psychedelics, MDMA, and NPS, that will be published later this year. The Report was convened by Amanda Feilding, and principally funded by the John Paul Getty Jr. Foundation with further assistance from the Open Society Foundations (OSF).

The Report aims to bring together the best available evidence on the regulation of psychoactive drugs in a rigorous, yet accessible way. In part, it is an invitation to think differently about drug policy options.

The wealth of expertise that we have gained from our work in the drug policy field strengthens our conviction that the strict legal regulation of drugs is the ultimate goal of drug policy reform. The governments of the world, duty-bound to safeguard their citizens’ well-being, surely would do a better job of minimising the overall harms of drugs than the criminal organisations currently profiting from the illicit market. It is no longer acceptable to simply assume that the risks of a legal market will exceed those of prohibition, especially when there is already the beginnings of a scientific evidence-base to show that a regulated market can provide effective ways of reducing harms. In view of this, the Report was established to provide policymakers with tools to move beyond the blanket application of reactive prohibition. Our aim is to provide guidelines for considering the best available evidence, and for utilising this knowledge in supporting decisions about how to move forward with the complicated issues surrounding the regulation of different categories of psychoactive substances.

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

Roadmaps to regulation - New psychoactive substances

The analysis presented in this report describes a European drug market that remains resilient, with some indicators for cannabis and stimulant drugs, in particular, now trending upwards. Overall, supply data suggest that the purity or potency of most illicit substances is high or increasing. The majority of recent survey data on prevalence also show modest increases in the estimated use of the more commonly consumed drugs.

The drug marketplace is also more complex, with new substances available to consumers alongside more established drugs, signals that medicines are becoming more important, and with polydrug use patterns the norm among those experiencing drug problems.

Interdiction efforts are challenged by the fact that production of cannabis, synthetic drugs and even some opioids and new psychoactive substances now takes place within Europe, near to consumer markets. Taken together this new analysis highlights the need for Europe’s drug policy agenda to embrace a broader and more complicated set of policy issues than has historically been the case.

European drug report 2016 - Trends and developments

The current prescription opioid and heroin overdose epidemic has brought greater attention to injection drug use in public spaces. A recent New York Times article noted incidents of public injecting reported by local media in several states, stating:

“With heroin cheap and widely available on city streets throughout the country, users are making their buys and shooting up as soon as they can, often in public places. Police officers are routinely finding drug users — unconscious or dead — in cars, in the bathrooms of fast-food restaurants, on mass transit and in parks, hospitals and libraries.”1

Public injecting poses a significant policy challenge for public health and safety. Injecting in public spaces has been associated with greater risk of overdose and HIV transmission. Many people who use drugs are unable to use them in safe and private environments but instead must turn to venues such as public bathrooms, empty warehouses, and parks. The reasons are complex. Drug use is both illegal and stigmatized; some people who use drugs are homeless, unstably housed or risk loss of housing if found using drugs. This lack of privacy and dignity, particularly when drugs are injected, compromises the health, wellbeing and safety of the people injecting the drugs and of the surrounding community.

Reducing public injection of drugs requires a multipronged approach ranging from accessible drug treatment to affordable supportive housing. This consultation on Alternatives to Public Injection was focused on one solution that has been implemented in a number of countries: supervised injection facilities (SIFs), also known as drug consumption rooms. Supervised injection facilities have received increased attention and consideration in recent months. Legislation to support the establishment of SIFs has been introduced in Maryland and California. SIF proposals are actively under discussion in Seattle, WA and Ithaca, NY. Outside of the United States, new SIFs are expected to open in France, Ireland and Canada.

Currently, there are nearly 100 SIFs in operation outside the United States, but as yet no U.S. jurisdiction has established a supervised injection facility. In light of growing policy interest in this strategy, Harm Reduction Coalition collaborated with Open Society Foundation and amFAR, The Foundation for AIDS Research to convene a consultation on Alternatives to Public Injection on September 30, 2015. Representatives from the NYS Department of Health AIDS Institute and the New York City Department of Health and Mental Hygiene participated in the consultation, along with stakeholders representing harm reduction, drug user health advocates, law enforcement and social service providers. Harm Reduction Coalition invited experts from several countries to share their various SIF models, planning and policy development process, implementation challenges, and evaluation results.

This report by Harm Reduction Coalition is a summary of the proceedings of the consultation. The report provides insights on the potential role of supervised injection facilities in the United States, and considerations for advancing policy, planning and implementation of SIFs based on experiences in other countries.

Alternatives to public injecting

Civil society organizations (CSOs) in Middle East and North Africa (MENA) are the principal partners of government in scaling up the response to HIV and in implementing national policies. In return, CSOs expect endorsement of their work by the governments. Some CSOs face weaknesses and need capacitybuilding in order for them to reach the level of response required for reducing drug-related harm in this region. Substance use and the transmission of HIV are increasing in the MENA region. The limited data available on drug use show that there are approximately 630,000 people who inject drugs (PWID) across the region. The HIV epidemic remains concentrated among PWID and other key populations in the region. Comprehensive harm reduction programs which include prevention, care, and HIV treatment for PWID are being implemented by CSOs. This could not happen without the presence of a conducive environment which has been facilitated by the CSOs, and which aims to lead to a positive response in health policies, and thus to harm reduction programs in some countries in the region. However, based on the international data, antiretroviral therapy (ART) coverage remains low in these countries, even if the number of people living with HIV (PLHIV) receiving ART is increasing. This increase can sometimes mask important challenges in equity: in several countries PWID are the most likely to be infected with HIV while being the least likely to be receiving care and ART. Therefore, concentrated efforts need to continue toward the goal of having mainstream harm reduction approaches in region.

Drug policy and harm reduction in the Middle East and North Africa: The role of civil society

In this manifesto, the Scottish Police Federation proposes some changes in the approach to the problem of drug users. Of particular importance, the document suggests authorities should not focus law enforcement efforts on people who use drugs.

Tackling drug and alcohol misuse Scotland has had a long, turbulent relationship with alcohol and drugs. But decades of arresting and prosecuting those with dependency problems has failed to tackle the root cause.

There will always be those who end up in the criminal justice system as a consequence of their actions. Where prosecutions are necessary, the punishment should be swift and decisive.

The SPF is not advocating the legalisation or decriminalising of drugs, but efforts should be better directed in trying to help those with problems overcome addictions.

Courts should be free to impose disposals that mandate participation in health and education programmes, with traditional criminal sanctions preserved for those preying on the vulnerable and peddling misery.

The SPF believes it is time to stop persecuting users and start concentrating on the dealers. Working in collaboration, the SPF believes that health, education and justice services stand a better chance of ending cycles of offending.

While intoxication is not a medical emergency, the consequences can be. Locking up drunk people in cells is no longer an acceptable way to manage that risk.

The SPF believes that safe, secure facilities should be created to manage those who present themselves as intoxicated and avoid the need to shuttle people between police cells and hospitals. Such facilities should be managed by skilled personnel from across the police, health and social care services, charities and other appropriately skilled personnel.

Scotland: Manifesto - Programme for policing 2016 - 2021

Injecting drug use is a global health and social issue from which various health and social harms often arise. These harms include health problems, such as HIV/AIDS, viral hepatitis and fatal overdose, as well as social and legal problems, and others. In recent years, an increase in drug use has been reported in many countries in the Middle East and North Africa (MENA) region. The number of People Who Inject Drugs (PWID) from the 20 countries covered by the Middle East and North Africa Harm Reduction Association (MENAHRA) is estimated to be around 570,000 (MENAHRA, 2014).

In many countries of the MENA region, unprotected sex and unsafe injecting drug use are the primary drivers of the HIV epidemic. However, the response has not been appropriate to the size of the problem (MENAHRA, 2014).

An estimated 90,000 people who inject drugs are living with HIV/AIDS within the region, which represents an HIV prevalence of over 15 percent in this population. There is also sufficient evidence showing that injecting drug use contributes significantly to the Hepatitis C Virus (HCV) epidemic in this region (MENAHRA, 2014).

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