Drug consumption and treatment is arguably most broadly addressed by the Constitution of India. Addressing the role of the State in public health, Article 47 reads: “The State shall regard the raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties and, in particular, the State shall endeavour to bring about prohibition of the consumption except for medicinal purposes of intoxicating drinks and of drugs which are injurious to health.”

Article 21 of the Constitution guarantees protection of life and personal liberty to every citizen. The Supreme Court has held that the right to live with human dignity, enshrined in Article 21, derives from the directive principles of state policy and therefore includes protection of health. Further, it has also been held that the right to health is integral to the right to life and the government has a constitutional obligation to provide health facilities.

Harm reduction programs, which improve public health while reducing the use of drugs and also has been proven to substantially contribute in reducing morbidity and mortality caused by use of intoxicating drugs, should arguably fall under the scope of both these Articles.

Recent developments : New National Policy on Narcotic Drugs and Psychotropic Substances

In February 2012, the Ministry of Revenue introduced the New National Policy on Narcotic Drugs and Psychotropic Substances. Approved by the Union Cabinet in January, the policy claims to address a dissonance found between the many ministries that have a mandate related to drug consumption. With regards to harm reduction, the Ministry of Revenue emphasizes the need to employ such strategies only to the extent that they help to de-addict PWUD. While allowing for the continuation of NSP and OST programs (including both buprenorphine and methadone), the policy rejects the establishment of shooting galleries and harm reduction programs in prisons.Of further concern is its insistence that “If drugs for oral consumption or drug paraphernalia (such as syringes) are distributed freely on the streets, it will be seen as an official sanction and patronage to drug addiction and can promote drug addiction. If any NGO or person is allowed to promote ‘harm reduction’, there is a great risk of it being used as a cover to actually push drugs or promote them. Hence, harm reduction will be allowed only as a step towards de-addiction and not otherwise.”

The policy further threatens organizationsproviding harm reduction services. According to Section 73, only centers in hospitals and those “supported by or recognized by the Central Government or any State Government” may provide harm reduction treatments. Any other organizations will be “treated as abetting consumption of drugs.” The policy also requires that centers offering harm reduction keep records of those seeking services. In addition to its focus on drug consumption and treatment, the policy provides prescriptions for handling the large illicit cultivation of opium poppy in India and proposes the production of concentrate of poppy straw and low or noalkaloid poppy varieties so as to keep up with demand for legal opium substances while discouraging the expansion of illicit production and cultivation.

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

India law and policy update

It is estimated that between one and three million people use drugs in Thailand. As a major trafficking hub, Thailand experiences significant drug-related crime and imprisonments for narcotics-related crimes make up nearly 70% of sentences, with over 175,000 arrests in 2010 alone. Seizures of narcotics and psychotropic substances in recent years continue to increase in both volume and quantity.

Over the past thirty years, Thailand’s approach to drug policy has been overwhelmingly one of criminalization and punishment instead of treatment and care. Despite advocacy, changing norms, and international pressure, the situation in Thailand remains little improved. This review examines and analyzes existing laws and policies which affect drug policy and harm reduction in the country as well as recent events and changes in policy which affect the drug policy and harm reduction movements in Thailand.

Thailand law and policy update

Laws against narcotics and psychotropic substances in Japan, particularly for minor offenses such as possession of small quantities or distribution, are tremendously strict. Offenders on the wrong side of the law for stimulant consumption face up to ten years in prison for their first transgression; those caught using marijuana in violation of the Cannabis Control Act can be imprisoned for five. A recent case involving a famous actress and her husband, covered breathlessly by the media, hinged on 0.008 grams of amphetamines found in her apartment. For such a small quantity, she received a suspended sentence of 18 months and media hounding that follows her years later.

First-time offenders frequently receive sentences of two or more years for simple charges of consumption. The share of prisoners serving sentences for drug-related offenses, particularly methamphetamine abuse, has continued to increase, increasing overcrowding and straining the country’s correctional system. Even when offenders manage to avoid years in prison through suspended sentences, their chances are grim. Outside of prison, there are nearly no support systems to help people-who-use-drugs (PWUD) seek help or manage their addictions. The Drug Addiction Rehabilitation Center (DARC), established and run by former drug users, is the only non-governmental organization working with PWUD in society. Yet like rehabilitation programs in prison, DARC is entirely abstinence-based.

Within this context, it should come as no surprise that many fall back on the old habits. Nearly 50% of first-time offenders of the Stimulants Control Law, for example, are convicted of another crime, one-third within a year of their first conviction. Caught up again within the draconian penal system, they face doubled prison sentences and little chance of rehabilitation. Many cycle in and out of prison, unable to access services that would help them to break the pattern of their behavior. In 2004, over 70% of those imprisoned under the Stimulants Control Law had previously been jailed for the same violation.

Harsh laws but drug use persist: A need for better options for PWUD in Japan

People who inject drugs (PWID) in India represent a core group most at risk of contracting HIV, hepatitis C and other blood borne pathogens. Though a minority amongst four (4) classified most-at-risk populations in the country, the injecting drug use population is rapidly increasing, affecting new areas and populations including the younger generation and women. According to recent estimates there are roughly 177,000 PWID in India, accounting for at least 2.2% of all new HIV transmissions. Interventions critical to manage HIV transmission in PWID subpopulations include scaling up needle and syringe exchange programs (NSP), expanding opioid substitution therapy (OST), and ensuring PWUD (people who use drugs) living with HIV receive antiretroviral treatment (ARV).

Over the past year, drug treatment centers throughout Asia have been heavily criticized and scrutinized by various organizations due to its inhumane and unconstitutional modality of treatment. This has led to modifications up-to some extent (e.g. Conversion of CCDUs to CBTx in Cambodia) but these are still deemed substandard and lack quality. In India, the Ministry of Health and Family Welfare (MoH) and the Ministry of Social Justice and Empowerment (MSJE) sponsor both state government and voluntary organization run de-addiction centers. Despite decades of involvement by these ministries, infrastructure for drug treatment in India remains poor and woefully inadequate. While the Ministry of Health, for example, has supported the establishment of 122 treatment centers, the results of the two evaluations conducted in 2002 and 2008 were discouraging and revealed a large amount of variability in the functioning of Government de-addiction centers.

In general many are of the opinion that very few treatment centers in India are actually operational. In partnership with local nongovernmental organizations, the MSJE claims to currently operate 376 de-addiction and rehabilitation centers. Those working in harm reduction, however, assert that many of these centers are neither functional nor effectively operate, and that there is an extreme diversity in the quality of programs between those operated under the government health care settings and voluntary or non-governmental run treatment and rehabilitation centers. Both these settings have its own merits and demerits, but both lack clear deliverables, established minimum standards of care and robust monitoring and evaluation mechanisms.

A time for better laws, policies & practices in India

This article by Katherine I. Pettus, PhD, identifies key rhetorical dimensions of the legal framework governing access to “essential medicines” and analyzes how they obstruct effective public health strategies for palliative care worldwide. The World Health Organization (“WHO”), palliative care physicians from around the world, and civil society organizations such as Human Rights Watch, the Open Society Institute, and the Pain Policy Studies Group at the University of Wisconsin, have focused attention in recent years on the fact that essential medicines are unavailable for palliative care in “low and middle income countries” (LMICs).

Identified barriers to access include lack of effective systems for assessing medical needs; laws and regulations and their administration or interpretation that unduly impede the availability of opioids; under-resourced healthcare systems; fear of addiction among professionals and the public, and lack of up-todate professional training in the use of opioids to treat pain.

These “external barriers” are distinguished from what I consider to be the true source of the problem of access, the internal barriers, or tensions within the mandates of the global narcotics regime itself.Efforts to remove the external barriers will be unproductive and incoherent until tensions between the internal barriers are addressed and resolved. To begin this process key texts of the regime are analyzed as well as more recent conceptual additions such as the socalled “principle of balance,” which has become an integral part of the palliative care advocacy discourse.

Rhetoric and the road to hell: The International Narcotics Control regime and access to essential medicines

Proximity to the largest producers of heroin and hashish-the Golden Triangle and Golden Crescent (Afghanistan Pakistan-Iran) has made India's Pborder vulnerable to drug trafficking. Indigenous production of low grade heroin as well as various psychotropic and prescription drugs and their growing demand in the neighbouring countries and international market have added a new dimension to the problem of drug trafficking. Trends and patterns of drug trafficking in the country demonstrate that there is a gradual shift from traditional/natural drugs towards synthetic drugs that are being trafficked.

Trafficking of drugs takes place overwhelmingly through land borders followed by sea and air routes. Given the vulnerability of the borders to drug trafficking, India has tried to tackle the problem through the strategy of drug supply and demand reduction, which involves enacting laws, co-operating with voluntary organisations, securing its borders and coasts by increasing surveillance, as well as seeking the active cooperation of its neighbours and the international community.

Drug trafficking in India : a case for border security 

UNODC Executive Director Yury Fedotov presented a new UNODC study entitled /Transnational Organized Crime in Central America and the Caribbean: A Threat Assessment/ to country representatives from the region. The event, held in New York, was attended by the Under-Secretary of State for Foreign Affairs of Italy, Mr. Staffan De Mistura.

The study examines the impact of the major trafficking flows of cocaine; women and children coerced into the sex trade; migrants smuggled for labour; and firearms.

"For the people of Central America and the Caribbean, violence fuelled by transnational organized crime and illicit drugs is one of the most urgent threats they face. We must recognize that criminals and their networks can hijack social and economic development. Democracy, criminal justice and strong anti-corruption strategies can help prevent this from happening," said Mr. Fedotov.

Central America has some of the highest homicide rates in the world. In El Salvador the homicide rate is 69 killings per 100,000, in Guatemala it is 39 per 100,000 citizens, and in Honduras it is 92 per 100,000. It is against this troubling background that UNODC commissioned a threat assessment for Central America and the Caribbean.

Based on the report, around 80 per cent of cocaine is seized in Central America, while 20 per cent is seized in the Caribbean. This is a reversal of the 1980's. More than 90 per cent of cocaine entering Mexico transits through Guatemala.

The revenue generated by migrants from Central America for smugglers is around USD$85 million. In 2010, 87 per cent of migrants were apprehended at the US border were Mexican.

The report further reveals that in Central America, 77 per cent of all murders are committed with a firearm. There are an estimated 2.8 million unregistered firearms within the region, while the value of the annual trade is thought to be around USD$14 million with police in the region presently seizing 16,000 guns per year.

In terms of violence in the region, Mr. Fedotov noted that the 2006 Mexican security strategy disrupted the cocaine supply to the United States' market, forcing dealers to cut purity and prices. These changes undermined United States demand for cocaine. Between 2006 and 2010, the number of annual cocaine users declined by 26 per cent. But this has not yet reduced the violence associated with the flow. For these reasons, where violence is related to illicit drugs, it flows from the fight for a share in a reduced cocaine market.

Mr. Fedotov called on every country in Central America and the Caribbean to fully implement the Convention against Transnational Organized Crime and its related protocols, as well as the Conventions on drugs and anti-corruption.

"We also need to remember that the countries in Central America are caught between the consumption countries in the North and the production countries of the South. They are hurting and they are suffering. The international community needs to recognize this. We must listen and we must continue to offer our assistance," concluded Mr. Fedotov.

Transnational organized crime in central America and the Caribbean 

How are countries tackling the new drugs phenomenon? Are school children consuming drugs more or less than before? How many Europeans are using cannabis on a daily basis? To what extent have national responses to the drugs problem been effective?

These are just some of the issues under the spotlight in the Annual report 2012 from the EU drugs agency (EMCDDA) to be released in Lisbon on 15 November. Launching the annual assessment of Europe’s drugs problem will be European Commissioner for Home Affairs Cecilia Malmström, Chairman of the EMCDDA Management Board João Goulão and EMCDDA Director Wolfgang Götz.

The report, the agency’s flagship publication, provides the latest data and commentary on the drug situation across the 27 EU Member States, Norway, Croatia and Turkey. Key challenges are discussed along with some of the promising practices used to address drug problems today.

The Annual report is part of a comprehensive package of information. Full details available on 15 November.

Time: 10:00 Western European Time (Lisbon) (11:00 Central European Time)

Press conference venue: Conference Centre, Cais do Sodré, 1249-289, Lisbon

Interviews: European Commission and EMCDDA representatives will be available on the day of the launch in Lisbon to answer journalists’ questions. Across Europe, staff at the Reitox national focal points will answer country-specific queries (interview details available at above link)

Social media: http://twitter.com/emcdda • www.facebook.com/emcdda

Annual report 2012: the state of the drugs problem in Europe

EHRN’s newsletter “The Voice of Harm Reduction“ is a tool for our members to network, exchange best practices, promote successes and advocate for what we collectively consider the most urgent regional matters related to harm reduction and drug policy in CEECA.

This edition of the newsletter is focused on the topic of overdose and covers:

An update from Eastern Europe and Central Asia

EHRN newsletter : « The voice of harm reduction » 

The present study provides a comparison of patterns of cannabis use and self-reported cannabis market indicators from detainees surveyed in 2010 through the DUMA and ADAM II programs. The data include urinalysis results from respondents in both programs as well as self-reported information about drug market participation.

Cannabis is the most widely produced and commonly used illicit drug in the world

Comparing cannabis use and market indicators across different countries can assist drug law enforcement agencies to respond more effectively to drug-related crime in their areas

Patterns of cannabis use and self-reported cannabis market indicators from detainees surveyed through the Drug Use Monitoring in Australia (DUMA) program and the Arrestee Drug Abuse Monitoring II (ADAM II) Program in the United States were compared, with similar rates of cannabis use being found among offenders in both countries. The age of first use was also similar across both samples

In terms of drug markets, Australian detainees were on average more likely to source their cannabis from a regular dealer and more frequently received cannabis without paying cash than their American counterparts. This suggests a more socially dynamic cannabis market in Australia, where a considerable quantity of cannabis is shared or traded informally between family and friends

Both groups were equally as likely to test positive to cannabis, purchase cannabis with cash on approximately the same number of days in a month and experience roughly the same number of failed cannabis purchases

While both countries have the potential to share information regarding effective policy decisions due to the overall similarities in drug use and cannabis markets, the diversity of individual cities and data collection sites, both within and across the two countries, serves as a timely reminder of the need for the development of local solutions to localised drug markets

Cannabis use and market indicators: A comparison between detainees from Australia and the United States

The National Cannabis Prevention and Information Centre (NCPIC) has released a new factsheet designed for those seeking help for cannabis use problems. It covers a range of issues that clients need to be aware of, such as knowing their rights in regards to confidentiality and giving consent, as well as the responsibilities of their health professional. We hope this will assist people in making informed decisions about their care. [NCPIC website]

Seeking help for cannabis use problems : your rights as a client

In 1998, the United Nations Commission on Narcotic Drugs adopted the slogan “A drug-free world, we can do it!” for its ten-year drug strategy. By 2008, the strategy had ended, along with any possibility that the world could be deemed drug-free. The best claim that can be made for the achievements of the past decade was that for certain types of drugs, and in some areas of the world, the market had stabilised or been ‘contained’.

This belief that eradication or significant reduction of drug markets was possible, has justified severely punitive policies and law enforcement measures against people who use drugs – leading to many negative consequences for public health and communities, including escalated HIV transmission risks and criminalisation of a large number of already vulnerable individuals.

As the Association of Southeast Asian Nations (ASEAN) undertakes a mid-term review of its current drug strategy, regional leaders need to acknowledge these realities. In envisaging the successful implementation of the existing drug strategy, ASEAN leaders need to refocus their efforts away from eradicating drug markets, and towards tackling the health and social problems associated with drug markets and drug use.

This note makes recommendations for ASEAN to shift towards drug policies that can more effectively tackle drug-related crime, while ensuring the health and social integration of people who use drugs.

The note is available below in English and Indonesia Bahasa.

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