This is the first issue of Drugs – Policies and Practices. Healthy Options Project Skopje (HOPS) put together this magazine quite quickly, but we went a long way until it materialized. The authors of the articles are people who have been working on drug related issues for a long time and are very well informed about both the situation in Macedonia, and about global trends and currencies. Their knowledge is supported by their long-term experience and hands-on work and contacts with people who use drugs, and also by their participation in initiatives related to the creation of a more humane drug policy and treatment for drug dependent persons. Of course, this magazine presents the experiences, opinions and needs of people who use drugs, also.

This magazine aims to serve as an incentive to widen the debate and produce more responsible actions towards the implementation of policies and practices for a humane treatment of people who use drugs, and at the same time will serve as a source of knowledge and information regarding drug related topics.

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HOPS Magazine - Treating drug dependencies

Advances in medicine, nutrition, and other factors have allowed people to live longer. Yet one aspect of life is constant. Human mortality remains 100 percent; we all eventually die. While where and when we die is regularly studied, how we die is often avoided or ignored. This has led to an unacceptable amount of unnecessary suffering worldwide during the last year of life. Each year, over 100 million people would benefit from palliative care, yet fewer than 8 percent of those in need access it.

This is a global tragedy, but it is one that can be effectively remedied. We recognize that different countries are at different stages of establishing end-of-life care – for some the creation of 24/7 community services will be the key development. For others it will be providing access to pain and symptom-controlling essential medicines and staff trained to administer them.

This report present a five-step strategy for improving quality of life at the end-of-life with specific examples of innovations that have proven effective at reducing unnecessary suffering and improving end-of-life care in different settings and cultures.

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

Dying healed: Transforming end-of-life care through innovation

SE European countries have adopted –to a greater or lesser extent– a national strategy within the limits of international conventions and the European Strategy on Drugs model, but much room exists for substantial changes and improvements. The major problems encountered arise from the differences that emerge between the institutional framework formally declared and the policies ultimately applied in practice. Furthermore, these issues deteriorate because most of these legal orders fall short in assessing their relevant strategies and formal mechanisms.

According to the majority of national strategies, the importance of the role NGOs need to play is emphasized. It is noteworthy that, according to most National Strategies of SE European countries, it is acknowledged that NGOs and civil society should play an important and active role, especially in the fields of treatment and rehabilitation, but also in harm reduction policies. However, a significant deviation is observed between the provisions of national strategies and their practical application, mainly attributed to lack of or insufficiency of relevant funding. The influence of NGOs in legislative decision-making is still quite limited. Neverthe-less, while positively recognizing the need for an interdisciplinary and multi-sector approach and addressing of the drug legislation issue, criminal law firmly persists as a determining factor and the chief regulator of the situation in most coun-tries of the region.

Trends and developments in drug legislation in South Eastern Europe

The report on the current state of play of the Council Recommendation of 18 June 2003 on the prevention and reduction of health-related harm associated with drug dependence PDF has been finalised. The report results of the work of experts from Gesundheit Österreich Forschungs - und Planungsgesellschaft mbH (GÖ FP GmbH) and SOGETI, in close collaboration with EAHC, EMCDDA, DG SANCO, and DG JUST.

It presents the updated overview of the implementation of the Council Recommendation in the EU countries, Croatia and several candidate countries, including country profiles, as well as analyses of regional and EU epidemiological trends.The study also assesses the availability of - access to- and -coverage of- harm reduction measures based on the answers to a policy survey.

The available scientific evidence regarding interventions to prevent and reduce health-harms associated with drug dependence was analysed and five systematic Literature Reviews PDF were produced.

The epidemiological background data, using data available at the EMCDDA, as well as other relevant information, and trends from 2003 to 2011 were analysed as well as main trends in availability and coverage of harm reduction measures introduced by the Council.

Current state of play of the 2003 Council recommendation on prevention and reduction of health related harm associated with drug dependence 

By 2012, UNAIDS estimated that 270 000 people were living with HIV in the countries of the MENA region. With the exceptions of Djibouti and Somalia, the majority of HIV epidemics in this region, are concentrated among key populations at higher risk, typically among people who inject drugs, men who have sex with men and sex workers.

While understanding of the nature of the region’s HIV epidemics has increased, critical gaps still exist and need to be addressed.In recent years many countries have been affected by social and political unrest and conflict. Cumulatively, these have potentially serious implications for the region’s HIV epidemics. Not only do unrest and conflict disrupt implementation of prevention and advocacy programmes and interfere with service delivery (e.g. including distribution of anti-retroviral therapy), they can also create the kind of conditions and vulnerabilities that exacerbate HIV epidemics. While some countries are primarily affected by internal unrest, others are affected by the consequences of unrest within neighbouring countries.

Some, such as Egypt, are affected by both. Several countries have adapted their responses to HIV to reflect these new realities. Eleven countries undertook Mid-Term Reviews5and assessed their progress in relation to each of the ten targets. The table that follows this section demonstrates the extent to which each target has been identified as a priority, whether or not it is included in the national strategic plan and whether or not countries consider themselves to be on track to achieve the target. The overall tone in these self-assessments is one of optimism but for several targets this appears to be unwarranted.

As this report shows, some countries have made significant and impressive progress and achievements. However, in still too many countries, denial, stigma and discrimination appear to determine the nature of the response, in some cases even preventing gathering of the basic information necessary to plan appropriate responses.

2013 regional report for the Middle East and North Africa 

Drug trafficking is not a new phenomenon in the Argentinian city of Rosario. Since the 1990s, and largely under the public radar, the distribution of illicit drugs in the poor, peripheral neighbourhoods of the city has been managed by family-run gangs and small-time dealers; poverty and social marginalisation have facilitated the trade; young gang members, known as

, have fought over territory; local demand for illegal drugs has provided the engine; illicit profits have been laundered in collaboration with local lawyers and financial advisors; and corruption among the police and local officials has ensured that the main traffickers, while their identities are widely known, can operate with few concerns other than threats from rivals. This last element appears to explain why, until the issue was forced into the public domain, there had been a conspicuous lack of political concern with drug trafficking in the city.

The change came on New Year’s Day 2012. That day, three community activists were shot and killed in the Villa Moreno neighbourhood by gang members who mistook them for rivals. The killings were not unique, but the victims were: unlike the usual casualties, the activists had a movement behind them. Their deaths led to local demonstrations and calls for action. The press and local officials were suddenly impelled to pay attention to drug trafficking and related violence. Since then, a spate of official investigations has deepened public understanding of the nature of the drug trade in the city. They have also provided further evidence of the complicity of the security forces and the negligence of the state that have long been known to facilitate trafficking.

Maintain the focus on the leadership of the most powerful and violent gangs, including following the money trail, and reverse the trend where simply increasing the number of security forces in violent areas is considered a sufficient policy response.

Re-focus the judiciary away from a two-tiered approach: recognize underage gang members as a vulnerable population, and that confronting the culture of violence will require special initiatives.

Root out corruption in the local and provincial security forces, recognise the way the state's approach facilitates this complicity, and produce more reliable statistics to better inform policymakers.

Eyes wide shut: Corruption and drug-related violence in Rosario

India has a long history of opium and cannabis use, especially for medicinal, religious and recreational reasons. State regulation and community tolerance ceased after the enactment of the Narcotic Drugs and Psychotropic Substances Act (NDPS) in 1985, which created a restrictive regime around drugs. Clampdown on cannabis and opium in the late 1980‟s purportedly triggered more dangerous use – chasing and injecting heroin and other opioids.

The NDPS Act, 1985 is one of the harshest laws in the country. It prohibits cultivation, production, possession, sale, purchase, trade, use and consumption of narcotic drugs and psychotropic substances except for medical and scientific purposes under license. The Act has been amended twice; in 1989 and 2001. The first amendments in 1989 leaned towards greater stringency by introducing mandatory minimum sentences of 10 years, restrictions on bail and mandatory capital punishment for repeat offenders. Following the amendments, persons caught with small amounts of drugs faced long prison sentences, without the possibility of release on bail. Courts criticized the harsh and disproportionate sentencing structure, which led to a fresh set of reforms in 2001 to rationalize punishment on the basis of whether the quantity of drugs involved is ‘small’, ‘commercial’ or ‘intermediate’ and provide some leniency towards drug offenders who also use drugs.

The narcotic drugs and psychotropic substances act: Ignoring health, infringing rights

This year’s Southeast Asia Opium Survey shows that despite eradication efforts, opium poppy cultivation in the region continues to increase. Poppy cultivation in Myanmar rose 13% from the previous year to 57,800 hectares, more than doubling since 2006. In Lao cultivation levelled off but remains a concern.

The combination of an increase in both cultivation and yield of opium poppy in Myanmar in 2013 resulted in a rise in opium production of some 26% in comparison to 2012. The best estimate for 2013 opium production in Myanmar alone is some 870 tonnes, the highest since assessments by UNODC and the Government began. Heroin seizures in East and Southeast Asia in 2012 were just over nine tonnes, compared to 6.5 tonnes in 2010, while there were 2.7 tonnes of opium seized in 2012 compared to two tonnes in 2010.

Surveys of farmers in poppy-growing villages, indicate that the money made from poppy cultivation remains an essential part of family income. Villagers threatened with food insecurity and poverty need sustainable alternatives, or they will continue out of desperation to turn to growing this cash crop. Another troubling trend that must be addressed is the rise in demand in nearby markets, which may be fuelling the resurgence in cultivation and production.

In Myanmar and Lao PDR, the use of opium, heroin and synthetic drugs – another growing threat in the region –, remains high. Moreover, the number of registered heroin and synthetic drug users in China has been going up since 2007.

Southeast Asia opium survey 2013

The OAS Secretary General Insulza stated at the 54th Regular Session of the Inter-American Drug Abuse Control Commission (CICAD) that took place from December 11-13, 2013 in Bogota, Colombia, that the hemispheric debate on drugs should focus on four main topics: security; alternatives to incarceration; a public health issue; and judicial cooperation.

The Secretary General emphasized the necessity to promote new models of security in the region and clarified that the addict suffers from a chronic illness and should receive adequate medical treatment. He urged the authorities to apply a public health approach as a basis of any public health strategy and encouraged Member States to work on the strengthening of judicial cooperation in the areas of money laundering and the administration of confiscated property.

Finally, the Secretary General highlighted the relevance of the Report on the Drug Problem in the Americas, which has been presented to several Heads of State as well as different international forums.

Click here to read all the documents of the conference.

Conclusions of the 54th session of the CICAD

How can we encourage activism for the improvement of the quality of addiction treatment programmes among the most stigmatised group of citizens in Macedonia?

How can institutions be made to accept that people using drugs can be constructive participants in the process of improving the quality of drug addiction treatment programmes? How can drug policies be freed from ideological models of thinking and adapt to current trends and the needs of those concerned the most? According to the literature describing community monitoring and advocacy available on the internet, an impression is formed that disenfranchised communities should have the necessary motivation and capacity to independently mobilise themselves and jointly fight issues of common interest, but it is hard to bring this ideal model into reality in
which, evidently, wider social and political factors should be taken in consideration.

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Community monitoring and advocacy in highly stigmatising circumstances: Eliminating institutional barriers for the improvement of quality of drug addiction treatment programmes in Macedonia

The European Association for Palliative Care (EAPC), the International Association for Palliative Care (IAHPC), the Worldwide Palliative Care Alliance (WPCA) and the Human Rights Watch (HRW) are working together to advocate for access to palliative care as human right.

Access to palliative care is a legal obligation, as acknowledged by the United Nations conventions, and has been advocated as a human right by international associations, based on the right to the highest attainable standard of physical and mental health.

The Prague Charter: Urging governments to relieve suffering and recognize palliative care as a human right

This issue brief about HIV, harm reduction and the sexual and reproductive health and rights of women who use drugs is part of a series of briefing papers, commissioned by the Global Coalition on Women and AIDS (GCWA), and is designed to provide up-to-date information around key issues concerning HIV prevention, treatment and care related to women and girls.

The brief seeks to bring attention to policies, laws and practices that undermine the rights of women who use drugs, and to promote the realisation of their human rights in terms of an e#ective harm reduction response to HIV. !e brief also outlines some of the challenges speci"c to protecting women who use drugs from HIV transmission that need to be considered when designing interventions, as well as the principles that must be upheld when striving to meet the goal set in the declaration, and lists recommended actions for moving forward from the programmatic level, through to national policies and global responses.

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