The opioid crisis has affected a substantial number of pregnant women in the United States, with the number of pregnant women with an opioid use disorder (OUD) diagnosis at delivery quadrupling from 1999 to 2014 and prenatal opioid exposure resulting in a 7-fold increase in neonatal abstinence syndrome (NAS) from 2000 to 2014. Neonatal intensive care unit admissions for NAS increased nearly 4-fold between 2004 and 2013, and in some hospitals, NAS accounts for approximately half of all neonatal intensive care unit days. There is substantial state-to-state variation in NAS rates, as well as county-level variation associated with structural factors, such as higher rates of long-term unemployment and less access to mental health care practitioners. Neonates with NAS often require prolonged and costly hospitalizations, with total hospital costs for births with NAS exceeding $500 million by 2014.

Many states have long sought to address opioid misuse in pregnancy, the proximal cause of most cases of NAS, by enacting a range of policies intended to reduce opioid use in pregnancy. A number of states recently expanded policies designed to increase the availability of treatment for women with substance use disorder (SUD), adding to the number of states that had enacted such policies in the 1990s. Such policies have likely contributed to an increase in the number of SUD treatment programs specifically for pregnant and postpartum women, although such programs remain uncommon and are not easily accessible for many women. Many states have also responded by enacting policies that are potentially punitive toward pregnant women, such as policies considering substance use during pregnancy to be child abuse or neglect. From 2000 to 2015, the number of states with these punitive policies increased more than 2-fold from 12 to 25, and the number of states requiring health care professionals to report suspected prenatal drug abuse to child protective services or health officials increased from 12 to 23.

Despite the rapidly changing policy environment, there is a paucity of information on the associations of punitive or reporting state policies being increasingly enacted since 2000 with NAS. To support more empirically informed policymaking, this study sought to address a critical gap in the literature by examining the association of states with punitive or reporting policies related to substance use during pregnancy (hereafter, punitive or reporting policies) with rates of NAS, a proxy for maternal opioid use. We hypothesized that punitive policies, which have been shown to discourage women from seeking prenatal care and SUD treatment, would be associated with higher NAS rates as women would be less likely to engage in the health care system and receive interventions that could reduce prenatal opioid use.

Association of punitive and reporting state policies related to substance use in pregnancy with rates of neonatal abstinence syndrome

Naloxone is used to treat respiratory depression caused by opioids. Opioids produce their effects by acting on opioid receptors in the brain and nervous system. Naloxone works by blocking these opioid receptors, thus stopping opioids from acting on them. This reverses the effects of the opioid primarily in their role as CNS depressants. It is a front-line response against overdose. Naloxone may be given by injection into a vein, muscle or under the skin, or via a drip into a vein (intravenous infusion).

This guidance offers best practice for the provision of naloxone for people who might experience or witness an opioid overdose.

Building on the findings from Release’s research on naloxone in England, Release hosted the Naloxone Steering Group 2019 in April 2019, in partnership with the National Addiction Centre at King’s College London. The objective of the steering group was to get key stakeholders together for a day to discuss some of the main aspects of naloxone provision in the UK and to produce guidelines on the provision of naloxone for people who might experience or witness an opioid overdose.

Drug-related deaths are on the rise in every devolved nation and “9 out of 10 overdose deaths (89 %) in the UK involved some form of opioid”1. Naloxone is a critical and life-saving intervention for those at risk of opioid drug poisoning. To mitigate the risk of fatal opioid overdose, we must foster an approach that is grounded in evidence and facilitates the enjoyment of human rights, with a goal of achieving the highest attainable standard of health for people who use drugs. To this end, the following overarching principles will need to be respected, if we are to achieve best practice in providing naloxone to those who might experience or witness an opioid overdose.

Presumption to provide - decisions should be guided by a presumption in favour of providing naloxone.

Duty to provide - naloxone should be part of the basic standard of care offered to people as part of harm reduction.

There are no real external barriers - any barriers that exist in supplying naloxone are internal and can be addressed.

Funding - there should be a clear and specific funding stream to protect funding and remove fragmentation in funding for naloxone.

Change the narrative - naloxone saves lives. Stigmatising, harmful and damaging messages surrounding naloxone and people who use (or have used) drugs are dangerous and pervasive. It is important the narrative is renewed to one that emphasises the importance of preserving life.

Naloxone is only part of the solution - naloxone should be part of a broader response to preventing drug-related deaths. The quality of drug treatment and harm reduction is also imperative to saving lives

Saving lives: Best practice guidance on the provision of Naloxone for people who might experience or witness an opioid overdose

Developed jointly by UNODC and INPUD, in collaboration with other partners, the guidance document Implementing Comprehensive HIV Programmes with People who Inject Drugs: Practical Approaches from Collaborative Interventions – otherwise known as the Injecting Drug User Implementation Tool (IDUIT) – was published in 2016. It describes how to implement effective programmes and services for HIV and HCV prevention interventions for and with people who inject drugs (PWID).

The IDUIT is based on previously published United Nations (UN) guidance documents, mainly the WHO/UNODC/UNAIDS Technical Guide for Countries to Set Targets for Universal Access to HIV Prevention, Treatment and Care for Injecting Drug Users (rev. 2012) and the WHO Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations (rev. 2016).

In addition to the nine key interventions of the WHO/UNODC/UNAIDS Comprehensive Package for HIV and PWID, it includes prevention and management of overdose and sexual and reproductive health and rights (SRHR). The IDUIT also covers critical enablers, strategies, activities and approaches to increase the accessibility, acceptability, coverage, quality and uptake of interventions and services for key populations.

It contains examples of good practice from around the world that may support efforts in planning programmes and services, describes issues that should be considered and advises on how to overcome challenges.

The IDUIT tool does not seek to ignore the complex policy and legislative environment around drugs and injecting drug use in most countries, nor the need for advocacy to confront the stigma, discrimination and human rights violations faced by PWID. However, it aims primarily to address the question: what can we do now, with the resources we have, in the kinds of environments we face, to prevent the spread of HIV and hepatitis C among PWID?

Click here to access the publication on INPUD's website.

Injecting Drug User Implementation Tool (IDUIT) Training Manual

In the last decade, an increasing number of donors are withdrawing their support for healthcare. This has been especially true for middle-income countries, where the growth of domestic resources was one of the triggers for donor funding reduction. The Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) has termed this process as “transition”, although the terms such as “graduation” (USAID terminology), “sustainability” and “self-reliance” are also used.

Development Assistance for Health (DAH) is decreasing, including for HIV/AIDS. In the Eastern Europe and Central Asia (EECA) region, DAH has decreased by 33% from 2010 to 2017, resulting in the withdrawal of over US$64 million from HIV/AIDS programs . This has created pressure on national ¹ budgets and has resulted in a significant gap in HIV/AIDS funding in low- and middle-income countries where overall growth of a country’s Gross National Income (GNI) has not been accompanied with an equivalent increase in public allocations for health and social services, especially for interventions that target key affected populations.

The Global Fund remains the largest multilateral donor in the field of HIV/AIDS, especially in Europe. From 2003 to-date, it has invested over US $2,573 million in the EECA region, out of which US$1,431 million has been for HIV/AIDS .

Sustainability Bridge Funding (SBF) is an idea that has been discussed among donors and civil society organizations (CSO’s) as a way of mitigating the negative effects of transition and in providing support for key essential services for communities and key populations. As a safety net mechanism, it should respond to gaps in funding and mitigate adverse effects of donor funding withdrawal. Nevertheless, very few donors have provided this type of targeted donor support for countries losing Global Fund support. Open Society Foundations (OSF) first piloted the idea of SBF in Southeastern Europe — a region where the withdrawal of Global Fund has led to the collapse of services in countries including Romania, Bosnia and Herzegovina and Serbia — by supporting civil society to navigate the transition process and engage in effective budget advocacy.

Building on this work, in 2018 OSF, through the Eurasian Harm Reduction Association (EHRA), initiated the project, Budget Advocacy and Monitoring in countries of South East Europe³. It provided funding to three transitioning countries in the Balkan region – Bosnia and Herzegovina (BiH), Montenegro, and Serbia — through the sub-regional network organization, Drug Policy Network South East Europe (DPNSEE), to support budget advocacy for harm reduction services.

This case study looks at the implementation of this project as one of the demonstrations of the SBF mechanism, with the objectives to:

Document the SBF pilot in 3 Balkan countries and to analyze the strengths and weaknesses of this approach and to develop suggestions for improvement; and, Document the results, successes, and

Document the challenges of the budget advocacy projects supported through the SBF approach.

Interviews were recorded between April and July 2019. During the development of this case study, project implementation was not completed, although it was at an advanced stage, allowing for the interpretation of results.

Sustainability Bridge Funding: Case Study from Bosnia and Herzegovina, Montenegro and Serbia

In July 2016, the Colombian government enacted Law 1787, which regulates the use of medicinal cannabis and its trade in the country. With this decision and a series of subsequent resolutions, Colombia joined the more than a dozen countries that have put into practice different types of regulation to explore the advantages of this plant as an alternative pharmaceutical. Through the issuing of four types of licences (for the cultivation of psychoactive cannabis and non-psychoactive cannabis, for the use of seeds for planting and for the manufacture of by-products), the door was opened not just to scientific research but to a business that is going from strength to strength all over the world, and that some predict will be worth about $54 billion (US dollars) by 2025.2 More than 300 licences have been issued since the law entered into force and the country is experiencing a ‘green gold’ fever, which has attracted the attention of large investors who see cannabis as the business of the future. The country’s geography and climate, the cost of labour and inputs, and a robust long-term legal framework have made Colombia an ideal place for growing cannabis and an appealing location for transnational corporations to do business.

The entry into force of this law signified a change in the country’s drug policy. Colombia’s recent history has been marked by the presence of drug trafficking and violence associated with social conditions in the country. During the 1960s and 70s Colombia was one of the world’s main marijuana producers, and for the last 40 years it has been the leading producer of cocaine.3 This went hand in hand with a social and agrarian conflict that continued for more than half a century. The conflict lead to a war between guerrilla organisations, who saw drugs as a way to finance their political project, and other drug trafficking groups, whose leaders set up their own armies to defend themselves against extortion and threats from these insurgents. Compounded by a prohibitionist national drug policy, this situation led to new outbreaks of violence, the infiltration of drug traffickers into pre-existing social conflicts, and clashes with state security forces, ultimately resulting in about 6 million casualties.4 For decades, the Colombian government’s response to the problem of drug trafficking focused on prohibition and military attacks, causing even more negative effects rather than providing a real solution.

This is why this change in the law not only offers an alternative in terms of public health but also represents a key component in the rebuilding of a society that has suffered armed conflict for decades. In addition to this shift, in 2016 the Colombian government put an end to more than 50 years of armed conflict with the FARC guerrilla movement by signing a peace agreement. One section of this agreement focuses precisely on crop substitution and the need for a change in drug policy. Although the approach to cocaine is still punitive, Law 1787 was also designed to offer an alternative to families who were involved in drug trafficking, enabling them to move into a legal business by growing medicinal cannabis.

Although it is not clear how many people depend on this crop, the figures show that marijuana is the most commonly used drug in Colombia. The national market for medicinal cannabis is estimated to comprise some 5 million patients5 – a demand which small-scale growers can undoubtedly help to meet. However, this opportunity has been swiftly seized by large national investors, such as those formerly in the flower industry, and has attracted an influx of foreign capital. Due to the type of regulation introduced by the law, which aims to develop a pharmaceutical industry, small- and medium-scale growers have found it difficult to enter the market because they are unable to invest the millions that the business requires.

Even though the law stipulates that 10 per cent of production should come from small- and mediumscale growers, the reality is that most of the business has been dominated by large local and foreign investors. Although there are cases of associations of small-scale farmers who have come together to obtain a licence, the majority have only managed it by going into partnership with transnational corporations, most of them Canadian, which already have experience in the business. Because of this, since the law was enacted the government has passed resolutions that seek to incentivise and promote local production. However, the situation is far from ideal for local producers and discontent has already arisen. This article analyses Law 1787’s entry into force in 2016 and the challenges posed by implementing the arrangements for medicinal cannabis, especially with regard to the involvement of small- and medium-scale producers.

The first section of the paper briefly reviews the recent history of cannabis and its use in Colombia. It then focuses on the changes in the legislation that led to the approval of Law 1787 in 2016. The third section provides an in-depth analysis of the law’s implications, the types of licence and subsequent resolutions. It goes on to present an overview of the current situation in the cannabis business, the companies involved and the role of small- and medium-scale rural producers. The final section offers suggestions for how this legislation could provide more benefits to the first links in the supply chain – the people who have not only suffered the most from the negative impacts of drug trafficking but also from problems related to land distribution.

The challenges of medicinal cannabis in Colombia

THE WORLD DRUG REPORT 2019: PERSPECTIVES ON PROTECTING PUBLIC HEALTH

With the Ministerial Declaration of March 2019 having ostensibly set the direction of international drug policy for the next decade or so, the launch of the 2019 World Drug Report only three months later was arguably surrounded by less expectation than the year before. Then, while missing the opportunity to provide a review of progress made in the 10 years since the Political Declaration, its contents still had the potential to feed directly into the deliberations surrounding the UN’s latest soft law instrument pertaining to drugs. Nonetheless, as is the case regardless of the UN’s own review cycle, the World Drug Report remains significant. Not only does it provide much needed information to member states about the global drug situation, generally referred to simply as the ‘world drug problem’, but its contents also do much to set the ‘mood music’ for debates within the Commission on Narcotic Drugs (CND or Commission), the UN’s central policy making body on the issue, as well as signpost key points for discussion beyond the rarefied conference rooms of the United Nations Office in Vienna. And so it was that this year’s edition of the United Nations Office on Drugs and Crime (UNODC or Office) flagship publication was launched in the Austrian capital on – as is traditional – 26 June; the United Nations International Day against Drug Abuse and Illicit Trafficking.

While retaining the separate ‘reader-friendly’ booklet format introduced in 2017, for the first time in the publication’s history this year’s Report groups drugs by their psychopharmacological effect. As such, following on from the summary and overview of latest estimates of, and trends in, supply, use and ‘health consequences’ contained within booklets 1 and 2 respectively, the three subsequent booklets look more specifically at recent trends in the markets for depressants (including opioids, sedatives, tranquilisers and hypnotics), stimulants (including cocaine, amphetamine-type stimulants and new psychoactive substances) and cannabis and hallucinogens. The substantial section on cannabis in booklet 5 also includes a full and largely unpoliticised review of the latest developments in the increasing number of jurisdictions that have adopted measures permitting non-medical use of the substance. Despite this relatively substantial re-ordering of data and related analysis, the central themes remain familiar, if more nuanced.

As one has come to expect from the UNODC, the 2019 Report – to borrow Mr. Fedotov’s words in the Preface – certainly does a great deal to ‘shed further light on the world drug problem’ (1, p. 2) across the broad spectrum of what is a multi-faceted issue area. In line with the now usual high standards, when read together, the set of booklets provide full and detailed sets of data and analysis about, among other things, fluctuations in drug crop cultivation, shifting and increasingly complex trafficking patterns (including in relation to the darknet) and the worrying and ongoing boom in the synthetic opioid market, particularly in North America. Following previous years’ practice, the Office also offers quite detailed ‘Conclusions and Policy Implications’ (1, pp. 23-29) and, acknowledging enduring uncertainty concerning many aspects of the illicit market, continues in many instances to integrate discussion of market interventions with the pursuit of the Sustainable Development Goals (SDGs). Our focus here, however, relates to several specific issues raised at various points and to varying extents within the Report. Rather than exclusively critiquing the publication itself and in its entirety, this analysis uses selectively the Report’s contents as entry points to not only highlight ongoing issues of concern but also to help initiate discussion about aspects of dynamic drug markets and associated policy responses that receive less attention. As such, using the issue of public health as a unifying theme, analysis here begins with the familiar issue of the adverse health consequences associated with the use of drugs. It then moves on to more in-depth discussion of emerging legal frameworks around regulated cannabis markets, the non-medical use of tramadol in Africa and some related discussion of data, metrics and law enforcement.

IDPC response to the 2018 World Drug Report

IDPC response to the 2017 World Drug Report

IDPC response to the 2016 World Drug Report

IDPC response to the 2015 World Drug Report

IDPC response to the 2014 World Drug Report

IDPC response to the 2013 World Drug Report

IDPC response to the 2012 World Drug Report

IDPC response to the 2011 World Drug Report

IDPC response to the 2010 World Drug Report

IDPC response to the 2009 World Drug Report

IDPC response to the 2008 World Drug Report

IDPC response to the 2007 World Drug Report

IDPC response to the 2006 World Drug Report

The World Drug Report 2019: Perspectives on protecting public health

We recommend a radical change in UK drugs policy from a criminal justice to a health approach. A health focused and harm reduction approach would not only benefit those who are using drugs but reduce harm to and the costs for their wider communities. Responsibility for drugs policy should move from the Home Office to the Department of Health and Social Care.

We recommend that the Government should consult on the decriminalisation of drug possession for personal use from a criminal offence to a civil matter. The Government should examine the Portuguese system, where decriminalisation was implemented as one part of a comprehensive approach to drugs, including improving treatment services, introducing harm reduction interventions, and better education, prevention and social support. Decriminalisation of possession for personal use saves money from the criminal justice system that is more effectively invested in prevention and treatment.

Decriminalisation will not be effective without investing in holistic harm reduction, support and treatment services for drug addiction. Doing so would save lives and provide better protection for communities.

Evidence based guidelines for treating people with drug dependency do exist, but there is an unacceptable gap between best practice and what services are actually able to deliver to people, as well as wide variation.

Many people using drug treatment services are growing older and living with complex illnesses. Those living with both addiction and underlying mental illness find it difficult to access adequate treatment and services.

Drug treatment services have faced funding cuts of 27% over the past three years, at a time when costs are rising.

Although our inquiry has focused on the harms caused by illicit drugs, dependency on prescription medicines is an emerging and worrying issue which requires greater attention from government.

Harm reduction interventions–including needle and syringe programmes, drug checking services, naloxone, drug consumption rooms and heroin assisted treatment–can all play an important role in preventing deaths amongst drug users as well as protecting their communities by reducing the harm from discarded syringes and drug related crime.

We call on the Government to direct significant investment into drug treatment services as a matter of urgency, and to also make sufficient funding available to ensure that heroin assisted treatment, naloxone, and needle and syringe programmes are available. Drug consumption rooms should be piloted in areas of high need. There should be greater efforts to support those at higher risk, including people in prison and at the point of release from prison.

We recommend that the Government conduct a review of the commissioning of drug treatment services to consider how they should be strengthened to enable them to co-ordinate and deliver the much-needed improvements to drug treatment services as effectively as possible. The Government should also address the current and predicted future workforce shortfall.

UK House of Commons Health and Social Care Committee report on drug policy

1. The Human Rights Council, in its resolution 32/31, emphasized the essential role of civil society in subregional, regional and international organizations. In that regard, the Council reaffirmed the right of everyone, individually and in association with others, to unhindered access to and communication with subregional, regional and international bodies, and their representatives and mechanisms. The Council further asserted that civil society facilitated the achievement of the purposes and principles of the United Nations and that undue restriction of civil society space therefore had a negative impact upon their achievement. In that respect, the Council requested the United Nations High Commissioner for Human Rights to prepare a report compiling information on the procedures and practices in respect of civil society involvement with regional and international organizations, and the contribution of civil society to their work and challenges and best practices.

2. According space to civil society is not optional. Everyone has the right, individually and in association with others, to promote and to strive for the protection and realization of human rights and fundamental freedoms at the community, national, regional and international levels, to exercise the freedoms of opinion and expression, of peaceful assembly and association, and to have access to information and participate in public affairs. International law also protects the lives, liberty, physical integrity and privacy of civil society actors. Article 5 of the Declaration on the Right and Responsibility of Individuals, Groups and Organs of Society to Promote and Protect Universally Recognized Human Rights and Fundamental Freedoms (the Declaration on Human Rights Defenders) recognizes the right of everyone, individually and in association with others, at the national and international levels, to communicate with civil society and intergovernmental organizations.

3. Human rights impose obligations on States to respect, protect and fulfil the rights of every individual to freedom of opinion and expression, access to information, peaceful assembly and association and the right to participate in public affairs and to protect individuals from interference, including by non-State actors. Those rights apply to domestic and other levels of decision-making, including in the intergovernmental sphere. 1 United Nations entities have to respect the norms and freedoms they helped to enshrine in human rights instruments, including the rights and freedoms that are indispensable for civil society to develop and operate. More and more decisions that affect the lives of ordinary people — sometimes profoundly — are taken at the regional and international levels, including in United Nations forums. In practice, having unhindered rights to form or join groups, have access to information, express one’s views and participate in decision-making is indispensable for effective civil society engagement at all levels. Limiting meaningful and effective participation of civil society essentially silences the voices of the people whom the organizations are meant to serve.

4. The Human Rights Council, in its resolution 32/31, recognized the crucial importance of unhindered access to international and regional processes and of transparency and accountability at all levels, which are indispensable for building peaceful, prosperous and democratic societies. In a statement to the Council, the Secretary-General asserted that the Council’s growing engagement with civil society strengthened much of its work and was especially vital at a time when civil society space was shrinking in so many places.2 He also noted the vital role of civil society on the Sustainable Development Goals,3 Goal 16 of which called for the promotion of peaceful and inclusive societies for sustainable development, the provision of access to justice for all and building of effective, accountable and inclusive institutions at all levels (target 16.6), and for ensuring responsive, inclusive, participatory and representative decision-making at all levels (target 16.7).

5. The present report is based on 82 written submissions received by the Office of the United Nations High Commissioner for Human Rights (OHCHR) following its requests for inputs sent on 31 November 2016 to Member States, national human rights institutions, civil society organizations and international and regional organizations.

Procedures and practices in respect of civil society engagement with international and regional organizations

The drug use landscape is dynamic and changing. Changes in public attitudes and laws towards drug use have occurred in an increasing number of countries. Global drug production and consumption are increasing as are the risks and harms to health, while new substances continue to emerge. This Series focuses on opioids, cannabinoids, stimulants, and new psychoactive substances. The Series authors review the evidence on the epidemiology of drug use and related harms and interventions (treatment and policies) to address them. They highlight issues that are likely to become increasingly important in the next decade.

The global drug problem: change but not progression

Strategies to reduce drug-related harm: responding to the evidence base


Louisa Degenhardt, Daniel Wolfe, Wayne Hall, Matthew Hickman, Judy Chang, Julie Bruneau, Michael Farrell, Paul Griffiths

Global patterns of opioid use and dependence: harms to populations, interventions, and future action


Louisa Degenhardt, Jason Grebely, Jack Stone, Matthew Hickman, Peter Vickerman, Brandon D L Marshall, Julie Bruneau, Frederick L Altice, Graeme Henderson, Afarin Rahimi-Movaghar, Sarah Larney

Public health implications of legalising the production and sale of cannabis for medicinal and recreational use


Wayne Hall, Daniel Stjepanović, Jonathan Caulkins, Michael Lynskey, Janni Leung, Gabrielle Campbell, Louisa Degenhardt

Responding to global stimulant use: challenges and opportunities


Michael Farrell, Natasha K Martin, Emily Stockings, Annick Bórquez, Javier A Cepeda, Louisa Degenhardt, Robert Ali, Lucy Thi Tran, Jürgen Rehm, Marta Torrens, Steve Shoptaw, Rebecca McKetin

New psychoactive substances: challenges for drug surveillance, control, and public health responses


Amy Peacock, Raimondo Bruno, Natasa Gisev, Louisa Degenhardt, Wayne Hall, Roumen Sedefov, Jason White, Kevin V Thomas, Michael Farrell, Paul Griffiths

Rebecca McKetin: global leader in methamphetamine research

The Lancet: Drug use series

This document is a compilation of better practices for the use of ayahuasca in non-Amazonian contexts. It covers individual, collective and legal responsibilities.

Ayahuasca is a decoction of different plants with a long history of use in the Amazon, where very old records of its use by native peoples exist. In the last few decades the use of this preparation has been expanding beyond its original context, now reaching many countries outside of the Amazon. One of the consequences of this expansion has been the appearance of new forms of use, which in turn have brought new therapeutic potentials as well as new risks.

It is evident that native communities of the Amazon and other peoples with a long history of ayahuasca use do not need a guide like this. Ayahuasca is part of their cultural and spiritual systems, which include safe ways of working with the effects of the preparation, as well as methods for integrating them into the everyday life of the community. On the contrary, this document is aimed at people who organize or participate in ayahuasca sessions outside of Amazonian contexts.

The objective of this guide is to present a series of minimum safety standards to support ayahuasca sessions in non-Amazonian contexts, as well as to inform potential participants of ayhausca sessions, so that they can better assess the safety and responsibility of the sessions in which they are going to participate, and thus make informed choices.

Towards better ayahuasca practices: A guide for organizers and participants

The Eurasian Harm Reduction Association (EHRA), as part of the implementation of the EECA Regional Platform for Communication and Coordination project supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria, has collected information concerning the availability of HIV and TB-related technical support (TS) for NGOs and CBOs in the EECA region.

All of the information presented in this document was provided, and confirmed, by the organizations listed below and was collected between May and August 2019.

Availability on HIV and TB-related technical support in the EECA region

By the British Columbia Centre on Substance Use

If you are reading this handbook, then you, or someone you know, may need help to deal with opioid use disorder – a situation where you need to keep using heroin, fentanyl, or similar opioids because you feel physically sick if you don’t have them. Taking more opioid drugs will stop the pain, but over time, your body may need more to get the same effect.

This handbook talks about opioid agonist treatment (OAT) – including buprenorphine/naloxone (brand name Suboxone®), methadone (brand name MethadoseTM or Metadol-D®), slow-release oral morphine (brand name Kadian®), and injectable treatment options (hydromorphone or Dilaudid® and diacetylmorphine or prescription heroin). These medications are also opioids, but they provide stable, long-acting relief from withdrawal and cravings. They replace the street heroin or fentanyl that you or someone you know are taking with a regular dose of a medication that allows for a stable life.

A lot has changed since the first edition of this handbook came out in early 2017, so it has been updated and re-written to share all the new things we know about treating opioid use disorder and saving lives. In the past, methadone was the main medication prescribed to people with opioid use disorder (sometimes called opioid dependence or opioid addiction). However, harsh government policies existed that made it hard for doctors to prescribe it. Now, more OAT options are being scaled up and barriers to access are being removed (including barriers to accessing different types of methadone). Policies are changing to increase people’s access to these medications. More people can make choices in their drug use that don’t involve using street drugs that might be contaminated.

Throughout this handbook, OAT options may be referred to by their brand names (for example, Suboxone) or their generic name (for example, methadone), depending on which name is more commonly known. However, even though we might use specific brand names in this guide, we do not represent or endorse any pharmaceutical companies.

This resource sets out to answer some of the common questions that people have when they need help in dealing with opioid use or opioid dependence.

Publications