2019 was a big year for drug policy globally, and especially in Africa. It marked the expiration of the targets set out in the 2009 United Nations (UN) Political Declaration and Plan of Action to ‘eliminate or reduce significantly and measurably’ illicit drug cultivation, trafficking, consumption and money laundering. Yet, as the world’s governments gathered for a High-Level Ministerial Segment of the UN Commission on Narcotic Drugs (CND) in March 2019, it was abundantly clear that these targets had been missed by a staggering margin. This briefing paper aims to outline the ways in which African non-governmental organisations (NGOs) can build on recent developments to enhance their drug policy advocacy work at the international, regional and national levels.

Held only three years after the 2016 UN General Assembly Special Session (UNGASS) on drugs, the UN High Level Ministerial Segment was a critical moment for member states to define the next decade of UN drug policy. Consensus was eventually reached in the form of the 2019 Ministerial Declaration on Strengthening our actions and the national, regional and international levels to accelerate the implementation of our joint commitments to address and counter the world drug problem. A new 10-year timeline running until 2029 was also agreed, with a midterm review scheduled for 2024. At the same time, the Chief Executives of all 31 UN agencies have signed on to a progressive Common position supporting the implementation of the international drug control policy through effective inter-agency collaboration’ – which provides strong commitment to balanced drug policies based on health, human rights and sustainable development.

The last few years have been significant for African drug policies as well. In 2019, a new African Union (AU) Plan of Action and Implementation Matrix on drugs was adopted at the AU Third Specialised Technical Committee on Health, Population and Drug Control (STC-HPDC-3) in Cairo, Egypt. This meeting was well attended by African civil society. For the first time, the words ‘harm reduction’ were explicitly included alongside ‘alternatives to punishment’, civil society engagement, the review of national drug laws, and many other welcome elements (the Plan even includes support for ‘local production of controlled substances and plants for scientific and medical use, in line with the international drug conventions’). The AU continues to demonstrate strong commitment to addressing the drug situation in the region by facilitating the availability of a wide range of evidence-based harm reduction and treatment options.

Elsewhere in Africa, numerous developments have been documented: moves towards the decriminalisation of cannabis for private use in countries such as South Africa; the start of harm reduction programmes in countries such as Nigeria and Mozambique; the tabling of new progressive drug laws and bills in countries such as Ghana; the introduction of programmes in Cote D’Ivoire and Sierra Leone; and the scale-up of existing harm reduction programmes in Senegal – to name just a few.

Building on developments at the international and regional level, 2019 also resulted in the development of the African Civil Society Common Position on Drugs. The Common Position seeks to incorporate the perspectives and guide the work of a wide range of NGOs from across the African continent, and to support, shape and guide civil society and governmental responses over the coming years.

This briefing paper is aimed at civil society organisations and allies across Africa, and serves as a guide on international advocacy, regional advocacy and how to utilise these to advance national advocacy. The paper also proposes advocacy priorities and approaches for 2020 and beyond – divided into three sections for international, regional and national-level work. It is designed to complement the more detailed global advocacy note published by IDPC after the UN High Level Ministerial Segment itself.

‘2020 vision’: Advocating for drug policy reform in Africa

As of 2018, 37.9 million people globally were living with HIV. 74.9 million people had become infected with HIV since the start of the epidemic and 32 million people had died from AIDS-related illnesses. In 2018 alone, 770,000 people died from AIDS-related illnesses, while 1.7 million people became newly infected with HIV. Reductions in new infections are stalling and progress is significantly off track from the goal of only 500,000 people newly infected with HIV by 2020.

Civil society efforts have been critical to overcoming many of the major challenges in the AIDS response. Networks of people living with HIV and AIDS deliver life-changing services to those most affected and provide support for adherence to treatment, prevention and other essential health services.

The involvement of civil society has also been crucial in successfully advocating for sustainable financial resources, improving HIV and AIDS programming, and advancing human rights, as seen in countries such as Kenya, Ethiopia and Uganda, according to the International Centre for Notfor-Profit Law.

But these achievements are at risk. Globally, we are witnessing the harmful effects of rising populism and ultra-conservatism on civil society space, especially for organisations and networks led by stigmatised and marginalised communities.

The CIVICUS Monitor, a cutting-edge research tool developed within civil society, which provides reliable, current data on the state of civil society freedoms in all countries, shows a precipitous decline in civic space, with only three per cent of the world’s population living in countries with open civic space. As noted by the United Nations Office of the High Commissioner for Human Rights, civil society actors are facing opposition across the world, and the space for marginalised groups is increasingly shrinking.

Activism and AIDS: Protect civil society's space to end the epidemic

According to reports in 2018 from African Union Member States, the consumption and trafficking of controlled substances have escalated in all five (5) AU Regions. Growing use of cocaine, tramadol, amphetamine type stimulants (ATS), new psychoactive substances (NPS) have been stated. Heroin consumption and injection is rising in Eastern and Southern Africa resulting (in the absence of the necessary health services) in high transmission rates of HIV and hepatitis among people who inject drugs, particularly women and young people.

Large shipments of heroin are transhipped on the high seas of Eastern Africa, and that of cocaine off-shore in the Atlantic Ocean, while on-shore shipments are made through harbours and airports across the continent. Women, especially those from lowincome backgrounds, continue to be vulnerable to recruitment as drug couriers. In West, East and Southern Africa trafficking of and/or diversion from licit batches of precursor chemicals for illicit use, especially ephedrine and pseudoephedrine, occurs frequently. This takes place in areas where ATS drugs are manufactured in clandestine laboratories on a large scale, resulting in online sales of these and other drugs, including NPS.

The African Union has since 1996 adopted Action Plans to address drug control and associated crime prevention on the continent, resulting in the establishment of institutional mechanisms in Member States, Regional Economic Communities and at the AU Commission to coordinate balanced and integrated responses to the mentioned drug control challenges.

The responses encapsulated in the AU Plan of Action on Drug Control and Crime Prevention (2019-2023) (AUPA) mirrors that of the African Common Position for the 2016 UNGASS General Assembly Special Session (UNGASS) on the World Drug Problem, as well as the seven (7) chapters of Operational Recommendations of the UNGASS Outcome Document. In addition, the AUPA contains two additional pillars with objectives and activities to address crime prevention, and coordination of the implementation of the AUPA at national, regional and continental levels, respectively.

The overall objective of the AUPA (2019-2023) is to improve the health, security and socio-economic well-being of the people of Africa by addressing drug trafficking and problematic drug use in all its forms and manifestations and preventing the onset of drug use.

Objectives and outputs/activities under the nine (9) chapters or pillars address the following:

Measures to tackle drug demand reduction and health issues associated with drug use, focusing on prevention and treatment of drug use with provisions for training of workers and professionals in these fields, parental skills training, life skills training for children and young people, reducing harm associated with drug use and implementing alternatives to punishment for drug use.

Availability and access to controlled substances for medical and scientific purposes while preventing their diversion, with emphasis on erasing barriers that suppress accessibility to medicines, including for the relief of pain and suffering, as well as reducing non-medical use of medicines and availability of counterfeit medicines

Measures to address drug supply reduction along with countering enablers of drug trafficking: firearms, corruption and money laundering which addresses illicit trafficking in drugs, drug law enforcement and intelligence sharing and ratification of AU instruments on combating corruption, money laundering, terrorism and trafficking in small arms.

Measures to address crime prevention and criminal justice reform, with emphasis on international cooperation on combating transnational organized crime, fighting emerging organized crime such as cybercrime, rise in gangs, extortion, violence and criminal governance. It involves continuous assessment of fragility and vulnerability, and analysis of risk, pressures and stress factors in societies.

Criminal justice reform, particularly addressing prison decongestion and noncustodial sentencing, is of critical importance to prevent reoffending, among others.

Cross cutting issues on drugs and human rights pertaining to all vulnerable groups, especially youth, women, children and communities, and this pillar provides for policy makers and law enforcement authorities to be oriented on human rights to health and safety as it relates to the field of drugs, emphasizing respect for and dignity of those in treatment, as well as protective and risk factors for vulnerable girls, women, children and youths. In this regard, national epidemiological surveillance on drug use, production and trafficking, research and data collection and national drug control coordination mechanisms are critical.

Evolving reality: trends and circumstances, emerging and persistent challenges and threats mainly focusses on countering the availability and use of NPS and ATS, sales of these drugs through the internet, and the importance of interregional forensic drug testing cooperation.

Alternative development and alternative means of livelihood, also targeting grower communities in the agricultural sector with a specific focus on Technical, Vocational Education and Training (TVET) for youth and women employment, including economic and social infrastructure development.

International and regional cooperation based on the principle of common and shared responsibility which makes provision for engagement with international partners for technical and financial support, for participation in regional, continental and international fora and for fast-tracking of extradition and mutual legal assistance arrangements.

Continental, regional and national management, oversight, reporting, monitoring and evaluation of the AU Plan of Action on Drug Control and Crime Prevention (2019-2023) entails actions by the African Union Commission to account to the AU Policy Organs on the implementation and impact of the AUPA (2019-2023).

African Union Plan of Action on Drug Control and Crime Prevention (2019-2023)

The DPA proposal for decriminalization, the Drug Policy Reform Act, takes these first steps in dismantling the punitive apparatus built up over the past 50 years. To begin refocusing federal drug policies, the legislation shifts the authority for classifying and regulating controlled substances from the Drug Enforcement Administration (DEA) to the National Institutes of Health (NIH) within the Department of Health and Human Services (HHS).

The legislation eliminates criminal penalties for all possession of personal-use quantities of controlled substances, and shifts federal resources away from futile enforcement strategies to supportive initiatives to protect the public health and safety.

Eliminates the inequitable and harsh sentencing constructs, such as mandatory minimums drug conspiracy offenses, that have significantly led to mass incarceration;

Provides for decarceration and expungement of records for those imprisoned under the current system;

Eliminates collateral consequences of drug convictions, including denial of public benefits and educational loans, for individuals who have been convicted of drug offenses; and,

Abolishes the enforcement agencies that have been primarily responsible for creating the harmful enforcement strategies of the past.

Dismantling the federal drug war: A comprehensive drug decriminalization framework

By H.R. Sumnall, A.M. Atkinson, K.M.A. Trayner, S.H. Gage, A. McAuley

There is evidence to suggest that medically supervised drug consumption rooms (DCRs) may form part of responses to reduce drug-related harm. Although DCRs have been established globally, they are perceived by some to be a controversial approach in the UK, and Government has repeatedly rejected proposals to establish one in Glasgow, Scotland. As public support is an important component of policy development and enactment, we sought to investigate the effects of different types of message framing on public support for DCR.

We undertook a cross-sectional online study with a randomised design, conducted with a nationally representative sample. Participants were randomised to one of six message conditions comprising combinations of four components. All conditions included i) a 

 description of a DCR, and conditions included combinations of ii) 

 of common public concerns about DCR; and/or iv) a 

 narrative describing a mother whose son died from a heroin overdose. After reading each message, participants completed a bespoke measure assessing support for DCR. Data were analysed using ANCOVA.

Complete data were obtained from 1591 participants (50.3% Female; mean age 44.9 ± 16.1 years). Compared to reading a basic description of DCR alone, there was greater support for DCR in participants receiving the 

 < .001) message conditions. Presenting 

 messages alone were not associated with increased support.

Our findings suggest that public support for DCRs is not improved through communication of factual statements outlining potential benefits of the intervention alone. Advocates seeking to foster public support, and thus influence policy making, should also consider communication campaigns that address common concerns that the public might have about DCRs, and present the intervention in relation to potential benefits that they hold for people indirectly affected by drug-related harm.

Effects of messaging on public support for drug consumption rooms in Scotland, UK

This assessment has been initiated by the Eurasian Harm Reduction Association (EHRA) to assess the progress in reaching sustainability of the opioid agonist therapy (OAT) programme in the Republic of Belarus in the context of transition from donor support to domestic funding. The sustainability assessment of the OAT programme in the Republic of Belarus in 2020 was implemented with the funding provided through the technical support mechanism (TSM) of the Joint United Nations Programme on HIV/AIDS (UNAIDS).

This assessment was carried out in Belarus in February – April 2020. It covers the current situation, progress made, risks and opportunities to ensure the sustainability of OAT programs in the Republic of Belarus, with a focus on programmatic aspects and a focus on the following three areas: politics and management, finance and resources, and services. The assessment includes a review section, analysis of progress, obstacles and opportunities in each of the areas, as well as general conclusions and recommendations for government ministries and departments, national coordinating bodies, practitioners, civil society, technical partners and donors. The evaluation also includes relevant recommendations on adaptation of the OAT programs in the context of the COVID-19 pandemic.

Аssessment of the sustainability of the opioid agonist therapy programme in the context of transition from donor support to domestic funding in Belarus

On the path toward building up its internal security, on 24 July 2020, the European Commission adopted a new EU Agenda and Action Plan on Drugs 2021-2025 (and the Annex) as part of the Security Union Strategy. The new EU Agenda and Action Plan on Drugs 2021-2025 sets out the political framework and priorities for action in the next five years.

The objective is to protect citizens through better coordinated actions to address the security and health implications of drug trafficking and drug use. It reinforces the evidence-based, integrated and balanced approach to demand and supply reduction of drugs, through a comprehensive, multidisciplinary lens.

The current drugs situation in the EU requires comprehensive security and health responses covering the scientific, environmental, socio-political, technological and international dimensions of the issue.

The EU Agenda on Drugs outlines 8 strategic priorities which are divided under

Enhanced security (focused on all aspects of illicit trafficking of drugs).

Increased prevention (of the adverse effects of drugs including link to violence).

Addressing drug related harms (through access to treatment, risk and harm reduction, and a balanced approach to the issue of drugs in prisons).

It is accompanied by an Action Plan covering concrete operational steps and activities.

EU Agenda and Action Plan on Drugs 2021-2025

By Dr James Rucker, Dr Jesse Schnall, Dr Daniel D’Hotman, David King, Timmy Davis, Professor Joanna Neill / Adam Smith Institute / Conservative Drug Policy Reform Group (CDPRG)

Even before the Covid-19 emergency, global rates of depression were staggeringly high. It would be surprising if they did not rise further still in response to the measures taken to contain the virus. Since the advent of modern antidepressants in the late 1980s, the use of these medications has become so widespread that they are almost ubiquitous in the treatment of depression. This is despite their often severe side effects, and the fact that they are so regularly ineffective; usually working to minimise the symptoms of depression rather than alleviate the disease itself.

Psychedelic medicines such as psilocybin act in an entirely different way, being administered once or twice by a clinician in a clinical setting and getting to the root of the suffering. Patient access to this novel psychiatric intervention remains totally illegal in the UK, outside of the small sample sizes of the very few and hugely costly on-going clinical trials. The reports of those lucky enough to have received this treatment legally read as unequivocal endorsements, yet the possibility of scaling up the research necessary to roll out these treatments on the widespread scale so desperately needed remains at almost impossible reach.

Medicinal use of psilocybin: Reducing restrictions on research and treatment

This assessment has been initiated by the Eurasian Harm Reduction Association (EHRA) to assess the progress in reaching sustainability of the opioid agonist therapy (OAT) programme in the Republic of Tajikistan in the context of transition from donor support to domestic funding. The sustainability assessment of the OAT programme in the Republic of Tajikistan in 2020 was implemented with the funding provided through the technical support mechanism (TSM) of the Joint United Nations Programme on HIV/AIDS (UNAIDS).

This assessment was carried out in Tajikistan in February – March 2020. It covers the current situation, progress made, risks and opportunities to ensure the sustainability of OAT programs in the Republic of Tajikistan, with a focus on programmatic aspects and a focus on the following three areas: politics and management, finance and resources, and services. The assessment includes a review section, analysis of progress, obstacles and opportunities in each of the areas, as well as general conclusions and recommendations for government ministries and departments, national coordinating bodies, practitioners, civil society, technical partners and donors. The evaluation also includes relevant recommendations on adaptation of the OAT programs in the context of the COVID-19 pandemic.

Аssessment of the sustainability of the opioid agonist therapy programme in the context of transition from donor support to domestic funding in Tajikistan

As of 2020, North America is now into the fifth year of an unprecedented increase in drug overdose deaths driven by a toxic, unpredictable, and unregulated drug supply. While the genesis and drivers of and response to the opioid overdose crisis have wide regional variations, structural violence, prohibitions against illicit drug use, and stigma consistently play a central role. The criminalization of users of illicit drugs has led directly not only to users’ incarceration, but also to their marginalization and isolation and to violence, entrenched poverty, and a vicious cycle of trauma. This policy has created an environment wherein any initiatives to prevent and reverse overdoses have been severely restricted. While a war on drugs and the people who use them has been widely criticized as destructive and unwinnable, the criminal policies that support the war on drugs have not changed even in response to this unprecedented crisis.

How Structural Violence, Prohibition, and Stigma Have Paralyzed North American Responses to Opioid Overdose

By Andréanne Bergeron, David Décary-Hétua and Luca Giommoni

The COVID-19 pandemic has had unprecedented consequences on the world economy. The impact of the pandemic on the illicit drug market remains scant. We expose the potential consequences the COVID-19 pandemic could have on the ability of people who use drugs to source their illicit drugs via cryptomarkets.

We analyzed 262 self-reported submissions of illicit drug transactions on the darkweb. The self-reports include the date of the transaction, the types of illicit drugs bought/sold, and whether the shipment of the illicit drugs succeeded, had issues (ex. unusually long delivery, an error in the type of drug shipped, quantity or concentration of the drug), or failed.

Between January 1st, 2020 and March 21, 2020, successful deliveries represented 60% to 100% of transactions. Starting on March 21 however, the share of shipments that had issues or failed increased rapidly and represented a majority of all shipments. At the peak of the market disruption, the successful deliveries represented only 21% of all transactions.

Illicit drug transactions on the darkweb were disrupted at the same time as lockdowns were put in place in the United States and in the United Kingdom. While no causation link can be established, the correlation suggests that lockdowns could have disrupted drug cryptomarkets activities. We discuss the market disruption in light of the literature.

Preliminary findings of the impact of COVID-19 on drugs crypto markets

Harm reduction is often a response to crisis. A public health approach which emphasizes reducing the negative effects of drug use rather than eliminating drug use or attaining abstinence (Riley et al., 1999), harm reduction has been adopted around the world to mitigate the effects of epidemics and emergencies, such as the HIV/AIDS pandemic and hepatitis outbreaks, on people who use drugs (PWUD) and the broader community (Des Jarlais & Friedman, 1993; Marlatt, 1998; O'Hare, 2007). Throughout harm reduction's long history, PWUD have effectively improved their lives in the face of public health crises. PWUD are no strangers to managing risk of infection let alone the risks of withdrawal, arrest, stigma, or marginalization. One of the ways this is achieved is through creating intimate connections based on care, trust, and respect amongst PWUD and between PWUD and harm reduction providers.

In the face of the current crisis caused by the global COVID-19 pandemic, PWUD and harm reductionists are now faced with new challenges. A significant consequence of the pandemic is the way that individuals, communities, and organisations have been forced to rethink how they interact with each other. Formal and informal interactions are influenced by the guidelines issued by public health agencies to limit the spread of COVID-19, such as social distancing, handwashing, and masking. These guidelines, however, may be complicating public health efforts that directly affect PWUD.

In this Viewpoint, we discuss the effects of COVID-19 guidelines on the practice of harm reduction in the United States. We argue that there are several contradictions between the guidelines for curbing the transmission of COVID-19 and the highly physically, socially, and emotionally intimate nature of drug use, particularly injection drug use. These intertwined forms of intimacy often enable people to survive physically and mentally through marginalization associated with their drug use. With public health agencies and harm reduction organisations recommending social distancing practices, such as limiting contact between peers who use drugs and other risk reduction practices, PWUD are now asked to choose between avoidance of COVID-19 and the intimacies of drug use that contribute to their survival. Moreover, we argue that the guidelines necessitate a reconfiguration of the intimacy and care so central to harm reduction, which may impede organisations from still meeting the health and social needs of the PWUD that they serve.

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