Stability in use of traditional drugs, alarming rise in new psychoactive substances

The 2013 World Drug Report released in Vienna on 26th June shows that, while the use of traditional drugs such as heroin and cocaine seems to be declining in some parts of the world, prescription drug abuse and new psychoactive substance abuse is growing. In a special high-level event of the Commission on Narcotic Drugs, UNODC Executive Director Yury Fedotov urged concerted action to prevent the manufacture, trafficking and abuse of these substances.

Marketed as 'legal highs' and 'designer drugs', NPS are proliferating at an unprecedented rate and posing unforeseen public health challenges. The report shows that the number of NPS reported to UNODC rose from 166 at the end of 2009 to 251 by mid-2012, an increase of more than 50 per cent. For the first time, the number of NPS exceeded the total number of substances under international control (234). Since new harmful substances have been emerging with unfailing regularity on the drug scene, the international drug control system is now challenged by the speed and creativity of the NPS phenomenon.

The global picture for the use of traditional drugs such as heroin and cocaine shows some stability. In Europe, heroin use seems to be declining. Meanwhile, the cocaine market seems to be expanding in South America and in the emerging economies in Asia. Use of opiates (heroin and opium), on the other hand, remains stable (around 16 million people, or 0.4 per cent of the population aged 15-64), although a high prevalence of opiate use has been reported from South-West and Central Asia, Eastern and South-Eastern Europe and North America.

Africa is emerging as a target for the trafficking as well as production of illicit substances, although data are scarce. Mr. Fedotov called for international support to monitor the situation and to prevent the continent from becoming increasingly vulnerable to the drugs trade and organized crime. There is also a need to help the large number of drug users who are the victims of the spill-over effect of drug trafficking through the continent.

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2013 UNODC World Drug Report

Drug abuse in Japan began after World War II and has been characterized by three epidemics of methamphetamine abuse; in addition, solvent abuse has been prominent for a long time. Since 1995, with the beginning of the third epidemic of methamphetamine abuse, drug abuse or dependence in Japan changed, with a marked decrease in solvent abuse, stabilization of methamphetamine abuse, an increase in the abuse of such drugs as cannabis or 3,4- methylenedioxymethamphetamine (which do not have high potential of causing drug-induced psychosis), and the emergence of designer drugs. Furthermore, the abuse of medical drugs such as Ritalin became a major issue in 2007.

These changes reveal an increase in the abuse of drugs that do not as easily produce a psychotic state, underlain with a shift from personal conduct that leads to arrest to conduct that does not. Japan, therefore, needs to deal with drug abuse and dependence using not only a medical model, but also a criminal model as well.

Click here to read the full report (restricted access).

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The history and current state of drug abuse in Japan

The Drug Matrix is concerned with the treatment of problems related to the use of illegal drugs by adults (a similar table deals with alcohol-related problems). It maps the terrain within which relevant evidence may be found and for each location tries to find the most important UK-relevant research and guidance. In widening contextual circles, across the top of the matrix the columns move from specific interventions through how their impacts are affected by staff, the management of the service, and the nature of the organisation, to the impact of whole local area treatment systems. Down the rows are the major intervention types implemented at these levels. At the intersections, inside each cell is our pick of the most important documents relevant to the impact of that intervention type at that contextual level.

Drug Matrix: Evidence for effective treatment

A daily tablet of tenofovir, a drug otherwise used to treat HIV infection, reduced the risk of HIV acquisition among people who inject drugs by 49% in a clinical trial. Those who took the medication most consistently had higher levels of protection, report scientists from the Centers for Disease Prevention and Control (CDC) in 

These findings from Thailand come from the only pre-exposure prophylaxis (PrEP) trial ever conducted with injecting drug users, and show that PrEP can reduce infections associated with sharing injecting equipment as well as sexual transmission among drug users.

Incidence was 0.35 per 100 person-years in the PrEP group and 0.68 per 100 person-years in the placebo group, representing a 48.9% reduction in infections.

Read the full publication here (restricted access).

Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand 

The report, 'Preventing the deaths of women in prison: the need for an alternative approach', was written in response to the large number of suicides of incarcerated women in the last decade. They believe these deaths could have been prevented with the right support.

In suicides or "self-inflicted" deaths in particular, the report found that in some cases previous documents evidencing past attempts at suicide and self-harming behaviour were either ignored or were not presented to staff opening new assessments.

In the instance of Kerry Devereux, a case study for Inquest, previous self-harming documents failed to come to light during her incarceration and three new documents made during her time in prison were never collated together, meaning there was often no visible record of former self-harming behavior.

Mental health issues were also cited as a precursor to self-harm and suicide. One of the case studies involved a female prisoner who had suffered from post natal depression and had a history of self-harm. Despite prison authorities being told by the judge during sentencing that she was a "serious suicide risk", and later by hospital staff that she was "at high risk of self-harm and needed constant observation", the staff made the decision to check in on her just once every hour based on an assessment meeting. After her body was discovered an inquest found "failures in communication between the prison and the hospital, and internally within the prison".

Preventing the deaths of women in prison: The need for an alternative approach

These interactive maps shows patterns of drug use throughout Europe. You can choose between heat maps and bubble maps. Data displayed is the most recently reported data to the EMCDDA. Full details on the source data along with any notes can be found in this downloadable notes sheet. Notes for specific countries can be found in this country notes document.

Prevalence maps on drug use in Europe

In December 2012. the European Council adopted the EU Drugs Strategy for 2013-2020. Subsequently,the Irish Presidency prepared a draft proposal for a new EU Action Plan on Drugs (2013-2016) which was finalised at the Horizontal Drugs Group meeting on 23 May 2013.

The Action Plan, like the EU Drugs Strategy, is based on the fundamental principles of EU law and it upholds the founding values of the Union - respect for human dignity, liverty, democracy, equality, solidarity, the rule of law and human rights.

The Plan sets out the Actions that will be implemented to achieve the objectives of the strategy in the areas of demand reduction, supply reduction, coordination, international cooperation, and information, research, monitoring and evaluation.

European Union Action Plan 2013-2016

From 2011 to 2050, maintaining current interventions will incur an estimated 18,115 new HIV infections, and will cost USD 22.1 million (reference scenario). Annual HTC and immediate treatment, if offered to all adults, will reduce new HIV infections by 14,513 (80%) and will cost USD 76.9 million. Annual HTC and immediate treatment offered only to PWID, will reduce new infections by 13,578 (75%), and will cost only USD 23.6 million. Annual HTC and immediate treatment for key populations, combined with scale-up of MMT and condom use, will reduce new infections by 14,723 (81%) with similar costs (USD 22.7 million). This combination prevention scenario will reduce the incidence to less than 1 per 100,000 in 14 years, and will result in a relative cost saving after 19 years.

Click here to read the full publication (restricted access)

The potential impact of expanding antiretroviral therapy and combination prevention in Vietnam: Towards elimination of HIV transmission

The number and diversity of new psychoactive substances reported in Europe in recent years represents a major challenge for Europe’s policymakers. This analysis looks at countries’ legal responses to the new drugs phenomenon.

Legal approaches to controlling new psychoactive substances

The European Association of Palliative Care (EAPC) recently held its 13th Annual Congress in Prague, attended by thousands of clinicians, public health care providers, and advocates from all over the world. Palliative care, a relatively new medical discipline, is a multidisciplinary “approach” according to the World Health Organisation (WHO) definition. It supports the physical, psychosocial and spiritual well-being of patients and their families facing serious illness. It is provided in teams ideally consisting of physicians, nurses, social workers, spiritual counsellors, pharmacists and volunteers. Palliative care often aims to control a patient’s distressing symptoms and pain, rather than to cure a disease. In order to accomplish this, providers must have adequate access to medical opioids, which are regulated under the UN drug conventions and the domestic laws of all UN Member States. The European Society of Medical Oncologists recently called the lack of access to medical opioids in 80 percent of the world a “global pandemic of untreated pain”.

Dr Willem Scholten, formerly of the WHO essential medicines project, shared the latest research on global inequality of access to pain medicine. Just over one-fifth of the world’s population consumes 93.8 percent of all licitly produced morphine. At the same time, 4.7 billion people (out of a total world population of 6.5 billion) live in countries where medical opioid consumption is near to zero. Following a detailed analysis of current global consumption levels versus projected adequate consumption levels, Dr Scholten asked if “global production will be able to keep pace with medical demand.

There was concentrated focus at the Congress on promoting palliative care as a human right, including the launch of the Prague Charter. Several sessions discussed barriers to opioid medicines, and particularly the international laws that control access on the one hand, and guarantee human rights on the other.

Report of the European Association of Palliative Care international congress in Prague 2013

Dos etados membros da OEA, reunidos em Antígua, Guatemala, por ocasião da realização do Quadragésimo Terceiro Período Ordinário de Sessões da Assembleia Geral da OEA.

A o declaracao incentivam a abordagem de novos enfoques sobre o problema mundial das drogas nas Américas, com base no conhecimento e na evidência científica.

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Declaracao de Antigua Guatemala "Por uma politica integral frente ao problema mundial das drogas nas Americas

Synthetic drugs contain chemical substances which have been artificially developed to mimic the effects of illicit drugs. A wide variety of products containing these drugs are available for retail sale in NSW. There is very limited information about the short and long term health effects related to their use; however there have been media reports of negative side effects and dependency following their use. In recent years an increase in their detection and use has been noted not only within NSW but around Australia and across the world.

The absence of sufficient information available to the public regarding synthetic drugs in NSW was highlighted by many inquiry participants. It was noted that users of synthetic drugs are often unaware of the legal status of these drugs and the dangers that their use could pose to their health. In order to address this gap in public awareness, the Committee has recommended that the NSW Government develop a public awareness campaign to educate the community about synthetic drugs. In addition, the Committee has recommended the development of a tailored government website, which would publicise warnings about synthetic drugs as they are identified and allow the public to provide information to government agencies about synthetic drug products being sold in the community. Greater public awareness about emerging synthetic drugs will help to alert the public to new drugs as they are identified and to the health risks that these drugs can pose to users.

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