Evaluation of a century of international efforts invested in controlling drugs, done by UNODC, showed that the system of drugs controlling and its application had some sideffects. One of these is lack of investments solving the question of harmfull consequences for public health caused by drug use. With global acceptance of the fact that drug dependence is a chronical, but preventable disease, but also a disease that one can be cured or recovered from, a widely accepted standing point is that measures and interventions directed towards achieving apstinence and recovery have to be accompanied by measures that can significantly contribute to decrease of risks and harmfull consequences of drug use. Today, interventions in the area of risk prevention and harm reduction are considered fundamental and necessary, due to the fact that there is a wide scope of evidences that can prevent disease, save lives and protect the community. On a global level we have a highly present tendency that the practice of drug use harmful consequences’ reduction is being spread and finds its application in the area of illegal, but also legal psychoactive substances use, as well as in the work of the law enforcement services. In the same time the concept of harm reduction became a mean to achieving golas of the public health policies, policies in the area of community security, policies of social protection aiming to decrease social, legal and economic problems related to psychoactive substances use.

Harm reduction approach and interventions derived from it have been introduced on a larger basis, principally as a response to a high number of overdose cases as well as fast spread of HIV&AIDS and other STIs due to intrevenous drug use. From the perspective of public health, subpopulations with a high infections burden have direct and indirect onerous effect on the society, and prevention can substantially limit these effects. The first effect is direct morbidity due to heavy forms of chronical infections, having high treatment expenses as a result. The second is reflected in the lost of human productivity, which increases social expenses. The third is high prevalence of diseases among persons who use drugs, which, especially if sustained a long period of time, can increase the risk in the wider population. Practice shows that harm reduction measures represent a noteworthy input to the conventional public health approach, can have a strong effect on spreading blood-borne and other infections among people who inject drugs, therefore the society in general. Prevention is feasible and effective if populations most at risk of acquiring infection have been provided with adequate services, in an adequate manner, in their own surrounding and in the adequate time.

Harm reduction measures, i.e. prevention and reduction of mortality, reduction of health and social risks and harms, as well as general feeling of insecurity of the community due to drug use,in most countries of Europe and world represent an integral part of national strategies and policies of fight against drugs, applied in different scope and combinations, dependant to drug policies’ goals. All European and international refferent organizations and bodies strongly support harm reduction as an efficient, evidence based approach to prevention of infective diseases transmition and treatment of persons who use drugs.

Harm reduction approach has been supported by the “Strategy of Montenegro for prevention of drug abuse 2013 – 2020”, but there is no unique national doctrine, i.e bylaws that regulates this particular area. Although there are the most important harm reduction services set in place, which proved their worth and necessity on multiple occasions, ending of a nine year long donation program of the Global Fund for Fight against AIDS, Tuberculosis and Malaria in July 2015, brought the sustainability of certain services into question and the same are facing closure. This is especially related to service functioning within the NGO sector, without which the harm reduction approach in a certain country can not be neither complete nor efficient, daily centers i.e. drop in centers for people who inject drugs and outreach work with most at risk populations in respect to HIV, Hepatitis C and B. In order to make services mentioned mentainable and developed according to growing needs, it is necessary to permanently secure their functioning and sustainability. Due to all things mentioned it is necessary to adopt this document as a referent conceptual and practical framework for further development and improvement of the national policy in the domain of reduction of harm caused by drug use in Montenegro, according to strategic goals set. Drug users’ access to adequate treatment must not be a priviledge, but a right coming from the fundamental right to health, as well as an obligation of every responsible system. Likewise, the possibility of access to programs and measures of decreasing drug related harm represents the right of every individual, which must be recognized as such.

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

Reduction of drug related harm in Montenegro

By Lenka Vavrincikova, Hana Fidesova, Barbara Janikova & Jean-Paul Grund

New Psychoactive Substances (NPS) are becoming a major challenge to public health and drug policies in Europe and have become a high priority in Europe. The “new psychoactive substances in Europe” project (NPSinEurope.eu) aims to contribute to the development of innovative and effective health promotion interventions targeting emerging NPS use in Europe, in particular in response to more hazardous patterns of use and in vulnerable populations. The overall project objectives are:

 provide an overview of the use of new psychoactive substances (NPS) in populations of People Who Use Drugs Heavily (PUDH) in the EU28 countries and identify the associated risks for harm and the existing legislative, preventive and harm reduction responses;

 assess, identify and describe harmful patterns of NPS use among PUDH, NPS related risks and harms in 5 selected countries, as well as identify and prepare adequate tailored public health responses;

 develop and implement targeted pilot interventions for prevention, demand reduction and harm reduction targeting NPS use among PUDH;

 build best practice guidance and capacity among harm reduction workers towards improving harm reduction responses; and,

 disseminate the results of the Europe-wide inventory, 5 country assessment and local pilots on public health responses, through an online resource centre and a training manual, and at regional and national conferences.

This document concerns the second objective, a “Rapid Assessment and Response” (RAR) of harmful patterns of NPS use and the associated risks and harms in the 5 selected countries, as well as the identification and preparation of adequate tailored public health responses.

NPS Correlation report

Drug policies have traditionally sought to achieve a ‘drug‑free world’ through crop eradication campaigns, drug seizures and the incarceration of all actors involved in the illicit drug market. This has resulted in law enforcement targeting those at the lowest levels of the drug chain, such as drug couriers, low‑level dealers, subsistence farmers engaged in illicit crop cultivation, and people who use drugs. This approach has led to an increase in drug‑related violence, corruption, mass incarceration and prison overcrowding, while patterns of drug production, trafficking and consumption have tended to evolve in order to evade law enforcement actions.

According to United Nations estimates, one in five people currently in prison around the world are there because of a drug offence, 83 per cent of whom are imprisoned for possession offences. The criminalisation of people who use drugs has had little effect on the overall prevalence of drug use worldwide, while it has driven people away from health‑based interventions in the community.

The mass incarceration of low‑level drug offenders has led to an overloading of the criminal justice system in many countries – rendering courts unable to tackle serious crime cases. This ten‑point plan details how states can effectively and appropriately deal with the issue of drugs through a health and human rights‑based approach rather than solely a criminal justice response.

The publications below initially stated that, according to the UN Commission on Crime Prevention and Criminal Justice (CCPJ), 83% of all people convicted for a drug offence had been sentenced for drug possession. In May 2020, this was amended to reflect the accurate interpretation of the CCPJ’s findings, which is that 83% of all recorded drug offences are offences related to possession, with no reference to sentencing. According to more recent UN data from 2019, one in five people incarcerated worldwide are detained for a drug offence, of which 21.65% (or 470,000 people) were detained for drug use and drug possession only.

Ten-point plan on reforming criminal justice responses to drugs

The Council of Europe’s Co-operation Group to Combat Drug Abuse and Illicit Trafficking in Drugs (“Pompidou Group”) promotes public health and the implementation of a drug policy which respects human rights and supports gender mainstreaming.

By holding a first symposium in 1988 on women and drugs, the Pompidou Group was a pioneer in Europe regarding the gender aspect of drug policies.

Within the framework of its 2014-2018 mandate, the Pompidou Group resumed its activities in this field with the introduction of a gender dimension in drug policies.

This would not have been possible without the political and financial support of the Department for Anti-Drug Policies of the Presidency of the Council of Ministers of Italy.

The activities cover three different fields consistent with the Pompidou Group’s mission of promoting the link between research, policy and practice;

Research on the gender dimension in the Non-Medical Use of Prescription Drugs in Europe and in the Mediterranean Region (NMUPD)

 which resulted in an ISBN 2015 publication covering data from 17 countries: The study reveals that women are a high-risk category for NMUPD and that no standardised monitoring system for NMUPD exists in Europe and in the Mediterranean Region. It addresses recommendations to national authorities and calls for a better understanding of the link between drug use among women and violence.

Improving the management of violence experienced by women who use psychoactive substances

As jurisdictions enact reforms creating legal access to cannabis for purposes other than exclusively “medical and scientific,” tensions surrounding the existing UN drug treaties and evolving law and practice in Member States continue to grow. How might governments and the UN system address these growing tensions in ways that acknowledge the policy shifts underway and help to modernize the drug treaty regime itself, and thereby reinforce the UN pillars of human rights, development, peace and security, and the rule of law?

Cannabis regulation and the UN drug treaties: Strategies for reform

This document presents a number of results and recommendations collected from “Austerity and the Portuguese Drug Policy Model: an exploratory study”, a research study undertaken by Agência Piaget para o Desenvolvimento (APDES) and co-financed by Open Society Foundations.

The main aim of this project was to monitor what is happening in the Drug phenomenon, in the lives of people who use drugs and in related public care services, while austerity measures are being applied in Portugal. The Portuguese Drug Policy Model has been under international attention and scrutiny and is frequently pointed out as a possible example to follow because of promising related indicators. Nevertheless, its complex and integrated nature of care services and programmes might be at risk because of the currently restrictive public policy framework. In that case, the Portuguese Model itself is also at risk. By losing its inner and idiosyncratic traits, it might become inadequate and inoperative. This project took place at a very critical and decisive moment, in which it was possible to understand in real time how comprehensive policies react to the undermining process of the resources to which they are anchored.

Austerity and the Portuguese drug policy model

Evidence supports the need for a shift in the global approach to drug use. In this report, Do no harm: health, human rights and people who use drugs, UNAIDS shows what works to reduce the impact of HIV and other harms related to drug use.

Countries that have moved away from laws and policies that are harmful to people who use drugs and that have increased investment in harm reduction have reduced new HIV infections and improved health outcomes. These policies also deliver broader social benefits, such as lower levels of drug-related crime and reduced pressure on health-care and criminal justice systems.

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

Do no harm. Health, human rights and people who use drugs

Statement on the Greek positions for the UN Special Session of the General Assembly on Drugs (UNGASS 2016) New York: 19-21 April 2016.

On April 7 (World Health Day), the open informational meeting on the occasion of the UN General Assembly Special Session on Drugs (UNGASS 2016) organized by DIOGENIS-Drug Policy Dialogue, concluded in great success, with more than 50 participants.

The event was attended by representatives from organizations, civil society, local authorities, secondary education, professionals working in the field of prevention, harm reduction, treatment and social reintegration, and from the office of the National Coordinator for Drugs.

During the meeting, suggestions and experiences were presented by the speakers and the participants on the background, objectives, preparations and expectations concerning the upcoming UN Special Session on Drugs, the current drug policy and the challenges both in international and national level.

The meeting decided to send a text with the main points of the proposals made at the meeting to the competent authorities, who will represent Greece at the UN Special Session.

We hope that the Greek delegation will take into account and include in its presentation at the Special Session, the following proposals:

The UN Special Session of the General Assembly on Drugs should provide new guidelines for drug policies to effectively address and encounter the world drug problem. It is necessary to shift from repressive measures to policies oriented towards health, security and respect for human rights.

. Currently, governments allocate disproportionate amounts of resources to repression than to prevention, treatment and social rehabilitation. This has to change. A Balanced and comprehensive approach to drug demand and drug supply reduction requires an equitable distribution of resources.

The use of punitive measures, prosecution and imprisonment for people who use substances promotes stigma, marginalization and has been proven to be ineffective. They should not be punished, but, on the contrary, be supported and promoted to ensure a life with dignity, respect and perspectives for social integration. Criminal sanctions for possession of drugs for personal use should be removed and be replaced by measures that promote and enhance health and social integration.

Cooperation among the competent service providers and law enforcement authorities is necessary in order to effectively and properly respond to people who use substances. The cooperation of all involved parties must be based on trust and mutual support.

. It is necessary to effectively address problematic substance use and the related negative and harmful consequences, such as the spread of HIV/AIDS, viral hepatitis and other infectious diseases. The existing legislation is, in many cases, an obstacle for the implementation of harm reduction practices. Harm reduction should be legally regulated and all the related interventions, such as, inter alia, supervised injection sites, be included in the national law (Law 4139/2013 on Addictive Substances).

. Support the abolition of death penalty for offences related to drugs.

. The UN Special Session of the General Assembly on drugs will discuss the issue of the availability of controlled substances to treat and fight pain. The Greek delegation should strongly support the proposal for their availability. The Greek Law concerning the availability of controlled substances should be evaluated and adapted according to modern standards.

Cultivation and supply of cannabis for medical and scientific purposes is in accordance with the three international drug control conventions. The Greek state should legally establish the use of cannabis for medical and scientific purposes, following the example of many European countries.

. Increase the access to medication-assisted treatment of addiction for those who need it, including access to such services in prisons and hospitals, taking also into account the specific needs of women and youth.

Click here to access the statement online.

Diogenis statement on UNGASS

On 19th April 2016, 193 UN member states will come together at a UN General Assembly Special Session (UNGASS), and will formally approve an Outcome Document on “the world drug problem”. This document was finalised a few weeks ago by the 54 countries of the UN Commission on Narcotic Drugs (CND) in Vienna.

The document negotiations have been a fraught and difficult process of consensus-based decision making, and diplomatic horse trading taking place behind closed doors and excluding UN agencies, regional bodies and civil society. More than 100 member states, either not part of the CND or without permanent representation in Vienna – mostly from the Global South – played no role whatsoever in the negotiations. These member states will have no opportunity to debate the UNGASS Outcome Document draft at the UNGASS itself because, bizarrely, the document is set to be agreed at the 

Substantive contributions to the UNGASS process did, however, come from a wide range of stakeholders. But any proposed language that challenged the failings of the current system, or called for meaningful changes to the status quo, was systematically ignored, marginalised, vetoed, watered down or overlooked in the negotiations.

The document below highlights just a small selection of the strong, progressive and evidence-based language on issues that are overlooked or insufficiently reflected in the Outcome Document. All of this language was on the table during the negotiations – submitted by member states, regional bodies, UN agencies and others.

Diplomacy or denialism? The language that the UNGASS Outcome Document overlooked

Harm reduction aims to reduce the health, social and economic harms associated with drug use. Where scaled up sufficiently harm reduction interventions, such as needle and syringe programmes and opioid substitution therapy, have had a significant impact on reducing new HIV infections, mortality, and rates of crime.

The success of harm reduction is rooted in the fact that it goes beyond a set of highly effective interventions. It is an approach that is underpinned by the principles of pragmatism, dignity, human rights and public health, and one within which people who use drugs are firmly at the centre. This approach, often implemented in the face of resistance, has saved countless lives and helped people to stay healthy.

Despite such success harm reduction programmes remain underfunded and coverage falls short of what is required to impact HIV epidemics among people who inject drugs. Of the 158 countries or territories which report injecting drug use around 90 countries or territories have at least one needle and syringe programme, and 80 provide opioid substitution therapy. In prison settings the situation is far worse with just 7 countries providing needle and syringe programmes, and only 44 providing opioid substitution therapy, in at least one prison.

The potential to end AIDS among people who inject drugs

Towards the end of 2014, as NATO was preparing to cease formal combat operations in Afghanistan, the U.N. Office on Drugs and Crime (UNODC) announced Afghan farmers had cultivated a record 209,000 hectares of opium poppy over the course of the previous year. This level of production had occurred, a Reuters report commented, ’despite years of counter-narcotics efforts that have cost the United States $7.6 billion’.1 The US Department of Defense put the blame squarely on their local allies who, officials said, had not properly implemented the chosen policies. The drug policy community generally considers technical problems to have undermined ‘counternarcotics’ efforts, which are, it is commonly argued, poorly chosen, under-funded, and lacking in appreciation of local context. This conception of an occupying army committed to counter-narcotics but failing in its wellintentioned efforts has little basis in fact. It is sustained by a general tendency within the drug policy community to accept the boundaries of debate handed-down by policy-makers. Not just in Afghanistan but around the globe, investigating vitally important context such as 2 the strategic and economic objectives of the occupying powers has been considered strictly off-limits. Taking these factors into account, and locating ‘counter-narcotics’ operations within the wider war effort, suggests the picture most commonly presented has little relation to what has actually been taking place in Afghanistan over the past 14 years.

Through a broken glass, darkly: Drug policy and the war in Afghanistan

Compiled by Students for Sensible Drug Policy with collaboration from Canadian Students for Sensible Drug Policy, Students for Sensible Drug Policy UK, Youth Organisations for Drug Action, and YouthRIse

Recognizing our common goals of working towards evidence-based drug policies that reduce the harms of drug use and are grounded in human rights principles, including the right to health, the organizations listed above, working in informal coalition and representing thousands of youth in every region of the world, acknowledge the many impacts of drug use, drug markets, and drug control on our communities. Punitive drug policies have failed our generation and our society, impeding the development of young people and our full enjoyment of basic human rights. Governments typically justify their drug policies by invoking the need to protect young people. But we can speak for ourselves, and if policies are being implemented in our name, our voices must be heard.

Despite extensive efforts to reduce the consumption and supply of illicit substances, drug use and drug control policies continue to be major causes for concern, impacting the health and well-being of young people globally. While one of the main goals of drug policy has always been to protect the world’s youth, the voices of young people have often been absent from the debate. We therefore welcome the UN’s effort to provide a space for open debate around drug policy at the upcoming UNGASS, where SSDP and coalition partners are best suited to represent issues that directly affect youth populations.

Publications