Health and social responses to drug problems: a European guide 2021

 was developed to support practitioners and policymakers in tackling the negative consequences of drug use. The guide is composed of four sets of 

that look at responses to a range of drug problems in Europe. Framing the miniguides are two central resources: an 

 for developing responses and a set of 

 frame issues cross-cutting the different components.

Action framework and strategies for successful implementation

These two resources provide support to those planning health and social policy or interventions to address drug problems. The 

 helps to clarify current thinking about the response process and the factors to consider at each stage, while the 

(to be published in 2022) detail a number of activities that may help to support successful implementation.

Action framework: health and social responses

Strategies for successful implementation (coming soon)

Miniguides considering problems from the perspective of particular patterns of drug use and the specific substances that are of concern in many EU countries will be published starting on 19 October 2021.

Drug-related harms require specific responses. Miniguides focusing on them will be published at the end of 2021.

An important factor that can influence drug use, the problems that may be associated with use and the selection of appropriate responses is the setting in which use occurs. Miniguides focusing on different settings will be published in 2022.

Some sub-groups of the population have particular drug problems, needs or vulnerabilities that require specific interventions. Miniguides addressing the needs of vulnerable groups will be published in 2022.

A wide range of health and social responses are available for tackling drug problems. These may be used with different populations, at various stages in the drug problem, individually or in combination. Here you will find resources that consider the specific issues that different interventions aim to address.

In addition to the miniguides, a series of short ‘Spotlights’ focus on a number of hot topics requiring special attention:

Addressing sexual health issues associated with drug use

Comorbid substance use and mental health problems

Health and social responses to drug problems during the Covid-19 pandemic

Health and social responses to drug problems: a European guide

This briefing paper by IDPC and the African Law Foundation (AFRILAW) presents new evidence on the physical and mental violence faced by people who use drugs in Nigeria, both at the hands of law enforcement agents and in drug treatment centres.

Drawing on desk research and on a survey of 79 people who use drugs and other stakeholders in Nigeria, the papers shows that in Nigeria people who use drugs are routinely subject to physical, mental and sexual violence, sometimes meeting the definition of torture or ill-treatment under international law.

Many respondents highlighted the gendered aspect of these forms of torture and ill-treatment, while others pointed to a disproportionate impact on those marginalized on the basis of poverty or status.

Although the occurrence of violence is widespread and well known, only one survey respondent brought a formal complaint, and none achieved any form of compensation or redress.

The report concludes with a series of recommendations on how to prevent and provide redress for the forms of torture and ill-treatment documented in this report. We emphasise the need to reform laws and policies that criminalise people who use drugs, and to ensure access to voluntary, evidence-based, and rights-based drug treatment and harm reduction services.

Torture and ill-treatment against people who use drugs in Nigeria

Surviving and Thriving: Lessons in Successful Advocacy from Drug-User Led Networks

 showcases what local and regional drug user-led networks can do when they have adequate resources through accessible and sustainable donor funding. The networks featured in these case studies took on projects that confront the most pressing issues of our time, such as COVID-19, government crackdowns on human rights activists and gender power imbalances. Having directly experienced and survived harms that include discrimination, incarceration, police violence and overdose, people who use drugs and their advocacy networks are uniquely positioned and motivated to implement community-response work. These projects have restored dignity and purpose to the lives they have saved.

Despite their power and achievements, drug user-led networks are not well-funded or valued. This report aims to show how and why peer-led networks should be given primacy by donors and recognised for their work. It demonstrates how peer-led drug user networks have strategised and mobilised to leverage limited resources to positive effect, and how they are thriving in adversity and crisis, in the context of insufficient and unstable resources. Highly restrictive funding, underfunding – and unsustainable funding for drug user-led networks – undermine their ability to do transformative work, are anathema to the universally-held value of the meaningful involvement of key populations, and detrimental to social justice and human rights.

South Africa Network of People Who Use Drugs

 – Bellhaven Harm Reduction Centre, Durban, South Africa

 – Gains in OAT Access in Eastern Europe and Central Asia: Peers as Experts

 – Narcofeminism Storyshare Project: Developing Alternative Narratives, Producing New Knowledge, and Ensuring More Responsive Advocacy

– Budget Advocacy leading to $10 million dollars for key populations through C19RM

Surviving and thriving: Lessons in successful advocacy from drug user-led networks

By Abigail W. Batchelder,Tiffany R. Glynn, Judith T. Moskowitz, Torsten B. Neilands, Samantha Dilworth, Sara L. Rodriguez, Adam W. Carrico / PLOS ONE

The bidirectional associations between negative self-conscious emotions such as shame and guilt and substance use are poorly understood. Longitudinal research is needed to examine the causes, consequences, and moderators of negative self-conscious emotions in people who use substances.

Using parallel process latent growth curve modeling, we assessed bidirectional associations between shame and guilt and substance use (i.e., number of days in the past 30 used stimulants, alcohol to intoxication, other substances, or injected drugs) as well as the moderating role of positive emotion. Emotions were assessed using the Differential Emotions Scale. The sample included 110 sexual minority cisgender men with biologically confirmed recent methamphetamine use, enrolled in a randomized controlled trial in San Francisco, CA. Participants self-reported emotions and recent substance use behaviors over six time points across 15 months.

Higher initial levels of shame were associated with slower decreases in stimulant use over time (b = 0.23, p = .041) and guilt was positively associated with stimulant use over time (β = 0.85, p < .0001). Initial levels of guilt and alcohol use were positively related (b = 0.29, p = .040), but over time, they had a negative relationship (β = -0.99, p < .0001). Additionally, higher initial levels of other drug use were associated with slower decreases in shame over time (b = 0.02, p = .041). All results were independent of depression, highlighting the specific role of self-conscious emotions.

Shame and guilt are barriers to reducing stimulant use, and expanded efforts are needed to mitigate the deleterious effects of these self-conscious emotions in recovery from a stimulant use disorder.

The shame spiral of addiction: Negative self-conscious emotion and substance use

By Barrot H. Lambdin PhD, Peter J. Davidson PhD, Erica N. Browne MS, Leslie W. Suen MD, Lynn D. Wenger MSW, MPH & Alex H. Kral PhD / Journal of General Internal Medicine

Safe consumption sites (SCS) are an evidence-based intervention to prevent drug use–related harm. In late 2014, an organisation in an undisclosed location in the USA opened an unsanctioned SCS.

To evaluate whether use of the unsanctioned SCS affected medical outcomes.

People who injected drugs were recruited and interviewed at baseline and 6 and 12 months from 2018 to 2020.

People using the SCS could bring pre-obtained drugs to consume via injection, which were monitored by trained staff with naloxone.

Any overdose, number of non-fatal overdoses, skin and soft tissue infections, emergency department utilisation, number of emergency department visits, hospitalisation and number of nights spent in hospital.

A total of 494 participants enrolled in the study; 59 (12%) used the SCS at least once. We used propensity score weighting to analyse the association between SCS utilisation and measures. People using the SCS were 27% (95% CI: 12–46%) less likely to visit the emergency department, had 54% (95% CI: 33–71%) fewer emergency department visits, were 32% (95% CI: 4–57%) less likely to be hospitalised, and spent 50% (95% CI: 1–85%) fewer nights in hospital. Though not significant, people using the SCS had a lower likelihood of overdosing and slightly higher likelihood of skin and soft tissue infections.

Our findings support the use of SCS in the USA to reduce the growing burden of acute care service utilisation related to injection drug use.

Reduced emergency department visits and hospitalisation with use of an unsanctioned safe consumption site for injection drug use in the United States

• The Misuse of Drugs Act 1971 is 50 years old but has never been subject to a formal government evaluation or review.

• More than three million criminal records have been issued under the Misuse of Drugs Act, with people sentenced to more than 680,000 years in prison since 1986.

• Drug use has risen dramatically, while drugs have become cheaper, more potent and more available.

The Misuse of Drugs Act 1971 (MDA) underpins all UK drug policy, establishing criminal offences for a range of activities including possession, supply and production of specified ‘controlled drugs’. It brought the UK into line with the global prohibition regime established under the UN Single Convention on Drugs of 1961 (which the UK ratified). The MDA also established the Advisory Council on the Misuse of Drugs, and set out powers for the police to stop and search individuals on suspicion of drug possession.

Over the last five decades, vast financial and police resources have been directed towards enforcement of the MDA, while drug consumption, health harms and deaths have increased dramatically. The UK’s illegal drug markets - and associated criminality - have expanded to meet this growing demand, now valued at £9 billion annually.1 Yet, despite the evidence that the MDA has strikingly failed in its primary aims of reducing drug availability, use, and health harms, this legislation has never been subject to formal government evaluation or review, and no meaningful evaluation framework has been established to report on, or scrutinize, outcomes.

This report presents a summary of key available data on which to assess the effectiveness, in terms of costs and impacts, of the UK’s Misuse of Drugs Act 1971, covering: criminalisation and incarceration; enforcement spending; drug-related deaths; prevalence of drug use; and drug availability.

Behind these statistics lie human stories: To learn how peoples’ lives have been impacted by the UK’s drug laws, please visit anyoneschild.org.

Britain's Misuse Of Drugs Act 1971: Counting the costs

By David Otiashvili, Irma Kirtadze, Tamar Mgebrishvili, M.A.,a Mzia Tabatadze, Nikoloz Otiashvili, Allison J. Ober, Martin Y. Iguchi

Syringe vending machines (SVMs) are intended to supplement the standard syringe exchange programs to access hard-to-reach groups and to cover unserved geographical areas. This report describes how we adapted SVMs to deliver interventions and collect research data as part of a study of smart SVMs (SSVMs) in Tbilisi, Georgia.

To create SSVMs, we upgraded commercial vending machines and developed a computer program to track and record interactions and to display messages related to study procedures. Preferred locations for SSVMs, product specifications, and the mode of operation were determined through formative input from people who inject drugs (PWID). SSVMs were installed near pharmacies and serve both the general population and PWID. The “hidden” interactive menu for the PWID prevention kits was displayed on the screen only when a special plastic card was used. The plastic cards were distributed to the clients of fixed syringe exchange programs and to their peers who were not in contact with harm-reduction services.

Ten SSVMs were operational in Tbilisi as of March 2021, with more than 800 PWID using them on a regular basis. More than half of sterile equipment kits were distributed during weekends and night hours.

Our innovative SSVM integrates features for intervention delivery and research data collection. It can be used for testing a variety of interventions beyond syringes (e.g., distribution of HIV/hepatitis C virus self-tests) and provides opportunities for serving various at-risk groups that might not otherwise access these products and services (e.g., men who have sex with men, commercial sex workers).

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

Smart syringe vending machines: Research capabilities and implications for research data collection

Harm Reduction International has monitored the use of the death penalty for drug offences worldwide since our first ground-breaking publication on this issue in 2007. This report, our eleventh on the subject, continues our work of providing regular updates on legislative, policy and practical developments related to the use of capital punishment for drug offences, a practice which is a clear violation of international law.

The Death Penalty for Drug Offences: Global Overview 2021 found that:

35 countries still retain the death penalty for drug offences.

At least 131 people were executed for drug offences in 2021 – a 336% increase from 2020. However, due to a severe lack of transparency, if not outright censorship, this is only a partial picture. This figure likely represents only a fraction of all drug-related executions carried out globally.

There was an 11 percent increase year in known death sentences for drug offences from the previous year. A minimum of 237 death sentences for drug crimes were reported in atleast 16 countries.

Roughly a tenth of all known death sentences for drugs were given to foreign nationals. This brings with it a host of fair trial and human rights concerns, as well as heart-breaking stories of people stuck outside of their home countries.

No drug-related executions were carried out in Saudi Arabia, for the first year in over a decade.

No one was executed in Singapore for the second consecutive year and in Indonesia for the fifth consecutive year.

At least 3000 people are believed to be on death row for drug offences.

A number of individuals on death row for drug offences experience physical and/or mental health issues. At least three people with mental health issues or intellectual disability are currently on death row for drug offences in Singapore.

After a year-long hiatus, drug-related death sentences were confirmed in Bangladesh (3+), Egypt (11+) and Kuwait (1+). Death sentences for drug offences were also reported for the first time since 2018 in the United Arab Emirates (1+), and in Iraq (2+).

View and download the full report and executive summary below.

Death penalty for drug offences: Global overview 2021

VIENNA, 10 March - The INCB Annual Report, prepared in accordance with the three international drug control treaties, examines the global drug control situation and makes recommendations to Governments and regional and international organizations.

The thematic chapter of the INCB Annual Report for 2021 is on illicit financial flows related to drug trafficking and their impact on development and security.

The Report reviews the functioning of the international drug control system and includes an analysis of the availability of controlled substances for medical and scientific purposes, particularly in humanitarian emergencies. Important differences between the concepts of legalization, decriminalization and depenalization are highlighted, as is the link between exposure to social media and drug use. Regional developments are also addressed.

The Report is accompanied by the 2021 Precursors report on the implementation of article 12 of the 1988 convention.

INCB Annual Report 2021

What’s the role and position of women in opium cultivation areas in Myanmar? What is life like for women who use drugs in Myanmar? This primer maps out the gendered dynamics of drug policy in Myanmar, drawing from on-the-ground conversations with women involved in the drugs market.

When it comes to drugs and related policies, women and their experiences are often rendered invisible, or presented merely as an afterthought even though in many cases women tend to face harsher effects of punitive policies. This primer emphasises the need for a rights-based approach for these specific populations of women – women using drugs, women dealing drugs or couriering (sometimes to support personal use), and women engaging in the drugs market through opium cultivation.

But women’s positions are not limited to being the receiving end of repressive policies and practices. In most contexts, despite their lack of visibility, women play a wide variety of active roles within the drugs market, and more importantly within their families and communities, as we will show in this primer. Having said that, there is clearly a need to situate (drug) policy discussions within a broader look at women’s roles in leadership and decision-making processes, as opposed to only spelling out the impacts of drug policy and drug markets on women in Myanmar.

This primer aims to map out the gendered dynamics of drug policy in Myanmar, drawing from on-the-ground conversations (conducted between 2018 and 2021) with women who use drugs, women who grow opium, as well as women engaging in sex work and/or involved in the drugs market. These women must work to survive both in rural and urban areas. They come from various age groups (between 19 and 72 at the time of interviews) and ethnic backgrounds, residing in different areas in (Southern) Shan State, Kachin State, and Mon State.

Women and drugs in Myanmar

Despite rapid scientific advances the world failed to achieve the global HIV goals set for 2020 and is not on track to reach the goal to end AIDS as a public health threat by 2030. This can be explained, at least in part, by the significant gap that remains between science on the one hand, and law and policy on the other. The HIV Policy Lab’s annual report presents the state of HIV policy across 194 countries for key HIV-related laws and policies. With not one country in the world having fully aligned its laws and policies with those recommended, significant change is still needed.

Global HIV policy report: Findings from the HIV Policy Lab

Over 1 million women are controlled by the criminal justice system and over 741,000 women are in prison worldwide. There are at least 800 women on death row. The global female prison population is estimated to have increased by about 59% from 2000 to 2020. Over the past decade, the number of women in prison has grown at a faster rate than that of men. Poverty, abuse, discriminatory laws and punitive drug policies are the key drivers behind the alarming increase in women’s incarceration. Thirty-five percent of women imprisoned worldwide are imprisoned for drug offences, compared to just 19% of men.

Incarceration has a devastating impact on women and their families. The rate of selfharm in women’s prisons is higher than in male prisons. The majority of women in prison are mothers. There are at least 19,000 children living in prison with a parent, most often with their mothers.

Despite these stark statistics, as this exploratory report highlights, work with and for incarcerated/formerly incarcerated women and girls is flourishing but desperately underfunded.

Organisations working with and for incarcerated women and girls are already operating in a difficult funding context. In 2018, a study by the Overseas Development Institute (ODI) found that development aid funding for justice had decreased by 40% over the past 4 years.

Research by the Association for Women’s Rights in Development (AWID) found that 99% of development aid and foundation grants still do not directly reach women’s rights and feminist organisations. In particular, those groups working on intersecting forms of marginalisation (LGBTIQ, indigenous, migrant and refugees, young feminists, and sex workers) are funded even less. Only 0.42% of foundation grants are allocated towards women's rights.

Beyond this foundational funding challenge, the issue of women’s incarceration is also deprioritised. Work with and for incarcerated women and girls is far too often left out of mainstream women’s rights and human rights dialogues, convenings and movements. A prime example was the recent Generation Equality Forum, billed as the biggest convening on women’s rights in the last 25 years. Women’s incarceration did not feature in any of the six action coalitions - key thematic action areas chosen for the global community to focus on for the next five years - in spite of the relevance of the action coalitions on ending gender-based violence, economic justice and rights and feminist movements and leadership.

Notwithstanding this lack of prioritisation and resourcing, vibrant, innovative, impactful and critical work is being done, in particular by women with lived experience of the justice system as well as lawyers, researchers and activists. In August 2021, Women Beyond Walls reached out to 34 organisations working with and for incarcerated women and girls to better understand the funding challenges they face, both in terms of quantity and quality of funding. These organisations span 24 countries across five continents.

Our research found that resourcing for work with and for incarcerated women and girls has failed to adequately address the needs and capacities of these groups, including resourcing by feminist and women’s rights funders. The findings below present a compelling case for why work with and for women and girls impacted by the criminal justice system urgently needs increased resources and more effective funding.

Publications