Across Canada, far too many people are dying from drug overdoses. Deaths related to overdose due to opioids, whether used medically or non-medically, have risen sharply and are now the third leading cause of accidental death in Ontario. Drug overdose is not confined to one group of people but can affect anyone, including people taking prescribed opioids.

The tragedy is that many of these deaths could have been prevented with measures such as training, increased availability of naloxone (an emergency medication that reverses the effects of opioids), improved efforts to encourage people to call 911 during an overdose event, and better prescribing practices.

The purpose of this policy brief is to discuss the multi-jurisdictional policy barriers that hinder the scale-up of opioid overdose prevention and treatment initiatives in Canada. This brief provides an overview of the scant available data on drug overdoses in Canada and discusses key initiatives and policy changes that could mitigate the high number of injuries and deaths among people who use opioids. We close by offering recommendations to both the federal and provincial governments. This brief can be used to advocate for changes to the policy context of overdose. Readers interested in implementing overdose prevention programs are directed to an emerging set of excellent Canadian resources on this issue.

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

Opioid overdose prevention and response in Canada

Injecting drug use drives the huge HIV/AIDS epidemic in the region, but Russian law does not permit the substitution treatment that is shown to help. The end of its provision on 1 May will have huge repercussions, says Michel Kazatchkine.

Ten years ago 170 000 people in the Russian Federation had HIV.The estimated number is now 1.2 million.More than 2% of men aged 30-35 are infected, says Vadim Pokrovsky, the head of the Russian Federal AIDS Centre. Russia now accounts for over 55% of all new HIV infections reported in the European region.

This epidemic was mainly caused by injecting drug use, but it is now spreading to the general community. And it could have been avoided if Russia had implemented large scale harm reduction programmes including opioid substitution therapy (OST).

Treatment with methadone or buprenorphine and the provision of clean needles have saved the lives of millions of injecting drug users worldwide in the past 30 years of the HIV/AIDS epidemic.

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

Russia’s ban on methadone for drug users in Crimea will worsen the HIV/AIDS epidemic and risk public health

The proposed UK ban represents an approach to drugs that has not worked in the past. Prohibitionist responses to intoxicants have resulted in the criminalization and stigmatization of the users they are intended to help as well as the growth of illicit black markets. That expert views were side-lined in the process reveals a troubling approach to law-making and one that is all too familiar in drug policy.

Khat is a mild stimulant derived from the plant Catha edulis grown in countries of the Arabian Peninsula such as Yemen and in the Horn of Africa (Somalia, Ethiopia and Kenya). Migrants and refugees from these countries are the principal consumers of khat in North America and Europe, with the UK being the last to criminalise the shrub. The Netherlands, previously a key distribution point for khat supplies to immigrant communities in countries such as Norway, Germany and Sweden, introduced legal measures against khat in January 2013.

Drug policy-makers should benefit from lessons of policies that have succeeded in reducing the harms associated with drug use and repressive law enforcement approaches to drugs.

European policy on khat: Drug policy lessons not learned

This summary of recommendations was prepared by the Secretariat of the UNAIDS Reference Group on HIV and Human Rights after its fifteenth meeting (December 2013). Topics discussed and recommendations made on the following:

Human rights leadership remains critical in the HIV response,

Intellectual property access to medicines and human rights,

Issues raised by the Lancet-UNAIDS Commission,

Human rights and drug policy in advance of the 2016 UNGASS on drugs,

Presentation of Reference Group recommendations to Tim Martineau, UNAIDS Chief of Staff, and

Reference Group interaction with UNAIDS Secretariat staff.

Summary and recommendations from the 15th meeting of UNAIDS Reference Group on HIV and Human Rights

It is time to end the ‘war on drugs’ and massively redirect resources towards effective evidence-based policies underpinned by rigorous economic analysis.

The pursuit of a militarised and enforcement-led global ‘war on drugs’ strategy has produced enormous negative outcomes and collateral damage. These include mass incarceration in the US, highly repressive policies in Asia, vast corruption and political destabilisation in Afghanistan and West Africa, immense violence in Latin America, an HIV epidemic in Russia, an acute global shortage of pain medication and the propagation of systematic human rights abuses around the world.

The strategy has failed based on its own terms. Evidence shows that drug prices have been declining while purity has been increasing. This has been despite drastic increases in global enforcement spending. Continuing to spend vast resources on punitive enforcement-led policies, generally at the expense of proven public health policies, can no longer be justified.

The United Nations has for too long tried to enforce a repressive, ‘one-size-fits-all’ approach. It must now take the lead in advocating a new cooperative international framework based on the fundamental acceptance that different policies will work for different countries and regions.

This new global drug strategy should be based on principles of public health, harm reduction, illicit market impact reduction, expanded access to essential medicines, minimisation of problematic consumption, rigorously monitored regulatory experimentation and an unwavering commitment to principles of human rights.

Ending the drug wars - Report of the LSE Expert Group on the Economics of Drug Policy

This briefing paper presents a summary of findings from the evaluation of the pilot Family Drug and Alcohol Court (FDAC) in the UK.

FDAC provides a problem-solving, therapeutic approach to care proceedings in cases where parental substance misuse is a key element in the local authority decision to bring proceedings. Parental substance misuse is a major risk factor for child maltreatment. It features in up to two-thirds of care applications and parents with substance misuse problems are often involved in repeat care proceedings on subsequent
children.

FDAC aims to improve outcomes for children by helping parents change the lifestyle that has put their children at risk of harm. It seeks to improve parental substance abuse cessation rates, achieve safer and more sustainable family reunification, and ensure swifter placement with permanent alternative carers when reunification is not possible.

FDAC was piloted in central London between January 2008 and March 2012. Originally funded by government departments and three local authorities (Camden, Islington and Westminster), it now runs as a consortium of five local authorities and the model is beginning to be adopted by courts and local authorities outside London.

Catalysts for the FDAC pilot were the unsatisfactory response to parental substance misuse through ordinary proceedings; poor child and parent outcomes; insufficient co-ordination between adult and children’s services; late intervention to protect children; delay in decision making; and the soaring cost of proceedings, linked to the cost of expert evidence.

Changing lifestyles, keeping children safe: An evaluation of the first FDAC in care proceedings

On 2 July 2013 the Home Secretary launched a consultation on the use of the powers of stop and search. These powers included the most common ones used by the police, covering offences from theft and drugs to serious violence and public disorder. The consultation aimed to gauge the views of the public, police, campaign groups and other organisations. These views were considered under the themes of:

balancing public protection with the preservation of personal freedoms;

The consultation generated considerable interest and debate and attracted over 5,000 responses from a diverse demographic. It also made use of a number of different media to engage the public and encourage as many people as possible to make their views known. The Government has now analysed the responses which are summarised in this document. As a result of the analysis and on the basis of other evidence submitted to the consultation, the Government has developed a number of proposals which it will implement.

Police powers of stop and search in the UK

This report by the Guideline Development Subcommittee of the American Academy of Neurology was conducted to determine the efficacy of medical marijuana in several neurologic conditions.

The following were studied in patients with MS: (1) Spasticity: oral cannabis extract (OCE) is effective, and nabiximols and tetrahydrocannabinol (THC) are probably effective, for reducing patient-centered measures; it is possible both OCE and THC are effective for reducing both patient-centered and objective measures at 1 year. (2) Central pain or painful spasms (including spasticity-related pain, excluding neuropathic pain): OCE is effective; THC and nabiximols are probably effective. (3) Urinary dysfunction: nabiximols is probably effective for reducing bladder voids/day; THC and OCE are probably ineffective for reducing bladder complaints. (4) Tremor: THC and OCE are probably ineffective; nabiximols is possibly ineffective. (5) Other neurologic conditions: OCE is probably ineffective for treating levodopa-induced dyskinesias in patients with Parkinson disease, Oral cannabinoids are of unknown efficacy in non-chorea-related symptoms of Huntington disease, Tourette syndrome, cervical dystonia, and epilepsy. The risks and benefits of medical marijuana should be weighed carefully. Risk of serious adverse psychopathologic effects was nearly 1%. Comparative effectiveness of medical marijuana vs other therapies is unknown for these indications.

Systematic review: Efficacy and safety of medical marijuana in selected neurologic disorders

Cannabis is neither completely harmless, nor is it a cure-all. But with polls showing that there is a growing support to cannabis policy reform, it's fair to assume that most people no longer believe that legalisation would lead to the end of the world. Yet, some who support the reform, nonetheless have concerns that adding yet another legal drug (alongside alcohol, tobacco and pharmaceuticals ) for society to struggle with might result in an increase in use.

Cannabis: The exit drug

Romania is a country located at the intersection of Central and South East Europe, bordering the Black Sea, finding itself along one of the main trafficking routes for heroin destined for Western Europe from Afghanistan. Consequently, heroin has been the illicit drug associated with the highest level of drug-related problems in Romania, with injection being the most common method of use. While cocaine (shipped from South America), ecstasy and amphetamines (from Western Europe) and cannabis are also commonly used, new psychoactive substances (NPS) have become increasingly popular in the country, with the proportion of those who inject NPS substantially increasing. Recent estimates suggest that these substances were being used by a third of all people dependent on drugs in 2010-2011. However, following the enforcement of Law 194/2011, the availability on NPS was substantially reduced among occasional people who use drugs, as the costs of these substances dramatically increased.

The information presented in this paper is drawn from the experiences of local service providers, young people who use drugs and a review of the available literature. This case study is designed to offer a snapshot of the drug policy and harm reduction landscape in Romania in relation to young people. Based on the findings of this case study, we offer a series of key recommendations for effective policy reform that can improve the health of, and reduce stigma towards, young people who use drugs in Romania.

IDPC/Youth RISE case study series - The impacts of drug policy on young people: Romania

Since the 1980s, Mauritius has experienced increasing levels of injecting drug use and has now one of highest per capita rates of illicit opiate use. Whilst Mauritius does have an established harm reduction response to drug use, young people who use drugs are denied access to these life-saving services and receive little support, leading to poor health outcomes and lost opportunities. Instead of supporting and protecting the health and well-being of young people who use drugs in Mauritius, drug policy has had a marginalising effect, both in the immediate and longer term.

This case study looks at these issues, presenting information drawn from surveillance data, policies and experiences of both local service providers and young people who use drugs themselves. In light of the challenges that young people face, this paper concludes with a series of recommendations for policy reform.

IDPC/Youth RISE case study series - The impacts of drug policy on young people: Mauritius

The Bahia School of Public Defense (Escola Superior da Defensoria Pública da Bahia – ESDEP) created its Criminal Justice Observatory (Observatório da Prática Penal) on May 2013. Its main goal is to collect, analyze, publish and discuss relevant data about how the Criminal Justice System works in Bahia (fourth most populous state in Brazil), starting with data from its capital and largest city, Salvador (third most populous in Brazil, largest in the northeast region).

This report, written as a cooperative effort with the International Drug Policy Consortium, is destined to provide the English-speaking readers with data on a relevant country, with the world’s fourth largest prison population, and a recent spike in incarceration rates for drug-related crimes.

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