There is an increasing tendency to get service users, such as Drug Users (DU’s) involved in health services and health policies. Participation is seen as an indispensible ingredient for good and effective policymaking and there exist numerous best practice examples of peer involvement in the field of health promotion and prevention. Health policies and health interventions are considered to be more effective and supported, when all relevant parties and communities (including civil society and the final target group) are being involved equally. In addition, policy makers and professionals realise that it is no longer appropriate to talk about and not with the final target group. All kind of communities and also DU’s demand their rights: they want to be heard and they want to be taken serious.

There are numerous ways and forms of participation and also the purpose varies from case to case. One could think of information sharing and consultation or focus on empowerment and joint decision-making. Saying this, it can be assumed, that participation is not only a tool and a method, but also a process and a principle. Yet there are numerous drawbacks which jeopardize the process and make it difficult to respond appropriately. DU’s are often poorly represented in service provision and decision making, although there is evidence that their knowledge and expertise is important and most useful for the development of tailored responses and policies.

‘Nothing about us, without us’ - Participation and involvement of drug users in health services and policy making 

By Zara Snapp Jorge and Herrera Valderrábano

Historically, the poppy plant has had multiple uses including as a food product and with medical uses in pain relief; today it is most commonly known as the plant from which heroin is derived. The United Nations international drug control regime currently only allows legal poppy production for medical use in 19 countries. Although Mexico is the third largest illegal poppy producer in the world, no Latin American country is currently allowed to legally produce poppies.

Meanwhile, the United States and Canada are experiencing an overdose crisis due in large part to the adulteration and substitution of heroin with fentanyl and its analogues, while the price of opium gum has dropped 80% in the last two years in poppy producing areas of Mexico. The prohibition of opium has wide ranging health and development impacts that bring up a moral imperative regarding the safe supply of diverse opium-based products –including opium gum and heroin– that urgently need to be explored and addressed. Opium gum can be used orally or smoked, reducing riskier modes of administration and possible fatal overdoses.

Tracing a path for opium gum from Mexico as a safe supply harm reduction measure for Canada

Women who use drugs are exposed to higher rates of violence than other women. This violence includes, (but is not limited to) rape, sexual harassment, extortion, loss of child custody, imprisonment for mere personal possession, extra judicial killing, capital punishment and penalisation for drug use in pregnancy. Prohibition either directly causes or greatly exacerbates conditions for all of these violations. Gender-based violence cannot be eliminated if those most affected are not directly and meaningfully involved at all levels in relevant policy and programming.

Women who use drugs are boldly stepping out to take their place in the women’s movement and efforts to stop gender-based violence. Collectively we and our allies call for governments to end the gendered, failed and murderous policy of drug prohibition.

The elimination of violence against women who use drugs (EVAWUD) - 2020 campaign report

During the lockdown that followed the arrival of COVID 19, many local drug services closed their doors to clients, contacting them instead by internet or telephone. Alongside this, People Who Use Drugs who had attended pharmacies to collect their prescriptions were permitted to cut visits to the pharmacy and being observed by the pharmacist or staff, they visited on a weekly or two-weekly basis. The reduction in attendance at the pharmacy has proved to be useful for drug users, offering a more humane, dignified and therapeutic arrangement.

This fits in with the overall goals of good drug Opioid Substitution Therapy, which should involve a therapeutic partnership between drugs services and those who use them. Therapeutic arrangements should be negotiated and agreed upon, not forced upon clients by the drug service.

Senior policy makers and managers and professional leaders in OST have acknowledged that people on OST in the UK have responded overwhelmingly with responsibility to the opportunity of take-home doses. EuroNPUD has been assured that OST services will focus on reaching the 50% of people with opioid dependence who are not currently accessing OST rather than reintroducing take home dispensing.

Take-home opiate substitute therapies (OST) - EuroNPUD advocacy brief

Medications like buprenorphine, methadone, and morphine bind to the opioid receptors and stop the withdrawal symptoms and cravings. These medications are known as Opioid Substitution Therapies or OST for short. If you have developed a dependence on short-acting opioids, such as heroin, you will get sick about 6-8 hours after you last used. However, OST is longacting and buprenorphine and methadone both work for at least 24 hours. With the right dose, someone with opioid dependence will usually only need to take OST once a day and with the new long acting depot buprenorphine only once per week or per month.

OST is a life-saving medication that takes you away from the challenges of raising money and the risk of going into withdrawals. It also reduces your risk from viruses like HIV and hepatitis and your vulnerability to opioid overdose and police arrest.

We're in this together - All about treatment for opioid dependence from people who have lived it - Client guide

In their Global State of Harm Reduction: 2019 updates, HRI note that the spread of harm reduction services is still stalling globally in continuation of a trend observed since 2012. The 2018 Global State of Harm Reduction 2018 briefing, highlights that although women are estimated to account for one third people who use drugs globally and are consistently reported to have less access to harm reduction services and to be at higher risk of HIV and hepatitis C infection, robust data on this subject is scarce, and research on drug use and related health issues rarely produces information about women.

While tools exist to enable harm reduction services to institute a gender lens and gender mainstreaming in their programming in order to improve relevance and reach to women who use drugs, services that have introduced such approaches are thin on the ground. Where they do exist, there is not necessarily scope to document and promote experience. In order to leverage greater accountability from governments that have endorsed UN guidelines and resolutions around provision of services for women who use drugs, it is important to document and promote such services where they do exist, so that models of replication can be resources and established at other harm reduction programmes, while pressure builds to reverse the stalling of actions that improve respectful access to health for women who use drugs. With this in mind, WHRIN undertook a survey, in order to attempt a ‘mapping’ of women friendly services around the world.

Mapping harm reduction services for women who use drugs - WHRIN regional survey results

By Gabriel Moshenska & Shaun Shelly - Archaeology International/UCL Press,

This article explores the values and challenges of an archaeological approach to illicit drug use, based on the study of discarded drug paraphernalia. It builds upon recent archaeological studies of homeless people, refugees and other marginalised communities that have used participative methods to challenge societal stigma and erasure. Following a critique of previous archaeological studies of drug use, the core of the article is a detailed analysis of an assemblage of drug paraphernalia in Oxford, UK. In interpreting this assemblage and its material and emotional contexts we draw on our respective contemporary archaeological and drug user activist experience and expertise. By providing a critical overview of previous studies and a detailed case study, this article aims to provide a practical and conceptual foundation for future archaeological studies of illicit drug use.

Notes for an archaeology of discarded drug paraphernalia

By Ernst Wisse et al. / International Journal of Drug Policy

COVID-19 holds the world in a tight grip. In these unprecedented times, health and health-system capacities have been on the top of the global agenda for several months. Many countries have rolled out far-reaching prevention measure such as physical distancing and ‘lock- downs’ to prevent (further) overwhelming of health system capacities.

In many contexts, people who use drugs are a vulnera- ble population, prone to poor access to health services com- pounded by criminalization, and stigmatisation in health-care settings.( UNAIDS, 2019 ) , ( Van Boekel, Brouwers, Van Weeghel & Garretsen, 2013 ) This is illustrated in poor health outcomes and persisting high risk of infectious diseases. For instance, people who inject drugs are left behind in the progress of the global HIV re- sponse with less than 1% living in a country with high level of critical prevention services, such as access to sterile syringes and low-threshold opioid treatment programmes or opioid agonist therapy (OAT).

Marginalised and criminalised communities have greater challenges accessing health services.( UNAIDS, 2019 ) Consequently, a health sys- tem under too much pressure would likely disproportionally impact peo- ple with already established barriers, such as people who use drugs. Looking back at the conceptual building block framework, the notion of equity has been explicitly integrated in the goals of improved health outcome. This underlines that perhaps health systems have a tendency to ‘serve the mass’, and additional attention is needed to ensure equi- table access for all, including criminalised and marginalised communities such as people who use drugs.

COVID-19 and people who use drugs; seizing opportunity in times of chaos

By Correlation European Harm Reduction Network

Harm reduction centres are often the only point of access to health and social services for many PWUD. Preliminary research on the effects of the COVID-19 pandemic on drug services and PWUD has noted decreases in available harm reduction services.

European harm reduction services needed to be innovative and adapt very rapidly in response to the fast-changing landscape of the pandemic and its associated national control measures.

Frontline harm reduction workers play a crucial role in public health response during COVID-19 and are instrumental in implementing these rapid-scale changes required to keep vital services operational.

Their experiences during the pandemic provide critical data to understanding the effect of the pandemic on the vulnerable population of PWUD and the health services they depend on.

Voices of frontline workers: Harm reduction responses in the European region during the COVID-19 pandemic

By Rafaela Rigoni et al. / Harm Reduction Journal

Civil society organisations (CSOs) is assumed to function as intermediaries between citizens and policymakers. CSOs can act as transmission belts that filter societal preferences and channel them to policymakers. In practice, however, their capacity to effectively interact with policymakers varies considerably. In the field of harm reduction, CSOs play an essential role in developing and implementing effective measures to address the negative consequences of drug use. They work directly for, and with, people who use drugs (PWUD) and have a good understanding of their daily needs.

Due to the provision of low-threshold services, civil society-based harm reduction agencies are usually the first contact point for PWUD. For this reason, a functioning relationship between CSOs and decision-makers is crucial in ensuring that the public policy responds to the actual needs of PWUD. The inside knowledge and information of communities and grass-root organisations are critical in developing adequate drug policies and practice. Currently, however, a constructive and respectful relationship between policymakers and CSOs is missing in several European countries. In these countries, decision-makers may have minimal knowledge about what PWUD need, resulting in a lack of adequate, inclusive policies, based on mutual understanding and real needs.

Civil society is increasingly assuming the role of holding governments and donors, among others, accountable, by engaging in independent monitoring and evaluation of services and programmes. It has long been shown that community monitoring can play an essential role in improving service delivery. Moreover, in combination with advocacy, monitoring tools are crucial strategies to hold governments accountable and to improve the implementation of policies and programmes in line with the needs of PWUD and their environments.

Harm reduction in Europe: a framework for civil society-led monitoring

By Susanne Hiller-Sturmhoefel, Ph.D. / NIDA

One of the most common symptoms associated with coronavirus disease 2019 (COVID-19), which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is impaired lung function. People with substance use disorders (SUDs) also frequently have diminished lung function or are at risk for respiratory depression from opioid use. Therefore, it had been hypothesized early in the COVID-19 pandemic that people with SUDs may be particularly vulnerable to COVID-19 and its most severe health outcomes. A recent analysis of health records confirms this assumption. “It is clear from our analysis that people with SUDs are indeed at higher risk of contracting and suffering worse consequences from COVID-19. This is especially true for African Americans,” says Dr. Nora D. Volkow, Director of NIDA and senior author of the study.

Among all patients whose data were analyzed, 12,030 had been diagnosed with COVID-19. People who had ever had an SUD were significantly overrepresented in this group, making up about 16 percent of the COVID-19 patients compared with about 10 percent of the total sample. At the same time, people with a lifetime SUD diagnosis were 1.5 times more likely to develop COVID-19 than were people without SUD. COVID-19 risk also depended on the specific SUD diagnosis (see Figure 1). People with a lifetime diagnosis of OUD had the highest risk, and those with a lifetime diagnosis of CUD had the lowest risk, of COVID-19.

COVID-19 risk was particularly high among those with a recent SUD diagnosis (i.e., within the past year); their risk was more than 8 times higher than that of people without a recent SUD. Again, risk depended on the specific SUD. People with a recent OUD diagnosis were about 10 times more likely than people without recent SUDs to have COVID-19, whereas people with a recent CUD diagnosis were about 5 times more likely to have the disease.

People with SUDs have increased risk for COVID-19 and worse outcomes

World Report 2021 is Human Rights Watch’s 31st annual review of human rights practices around the globe. It summarizes key human rights issues in more than 90 countries and territories worldwide, drawing on events from the previous year.

In his keynote essay, “Biden’s Challenge: Redeeming a US Role for Human Rights,” Human Rights Watch Executive Director Kenneth Roth addresses the shortcomings and human rights violations of the outgoing Trump administration, while setting forth recommendations for how the incoming Biden administration may help the US reclaim its role as a world leader through global partnerships and recommitting to human rights at home.

One step, as Roth suggests, is to set such commitments to upholding human rights via legislation. Narrow Democratic majorities attained in both houses of Congress from the 2020 election will be invaluable to Biden as he hopes to hit the ground running in his first 100 days. Other commitments, however, such as the ratification of core human rights treaties, will require a degree of bipartisanship not seen during Trump's term in office, since they will require the support of two-thirds of the Senate in order to be passed. As Roth summarizes, "Biden’s task is to find a way, through policy and practice, to make upholding human rights more central to US government conduct in a way that has a better chance of surviving the radical changes in policy that have become a fixture of the US political landscape."

Perhaps the greatest challenge before Biden, is the task of reframing how fundamental human rights are understood in the US. In Trump's final year at the helm, thousands of families seeking asylum at the US-Mexico border were forcibly separated from each other and children were segregated into cages, systemic racism was brought into the spotlight once again as deep-seated racial injustices continued to act with apparent impunity, and the COVID-19 pandemic revealed glaring deficiencies in the country's ability to provide universal access to health care and other basic necessities during a crisis.

The rest of the volume consists of individual country entries, each of which identifies significant human rights abuses, examines the freedom of local human rights defenders to conduct their work, and surveys the response of key international actors, such as the United Nations, European Union, African Union, United States, China, and various regional and international organizations and institutions.

More specifically in relation to drug policy, the report highlights numerous human rights violations, including:

Drug policy shortcomings disproportionally punishing those who have the smallest influence in sustaining the illicit drug trade (in Azerbaijan, Georgia, Mexico, the Philippines, Russia, Saudi Arabia, Singapore, Thailand, and the United States).

False drug charges and police raids weaponised for political purposes (in Azerbaijan and the Philippines).

Racial disparities in policing (in the United States).

Widespread violence and killings perpetrated by state and non-state actors (in Colombia, Democratic Republic of Congo, and Syria).

Lack of access or limited access to essential medicines due to conflicts, global health crises, or stigma (in Argentina, Brazil, Bangladesh, Indonesia, Iran, Israel and Palestine, and the United States).

Publications