Trillions of dollars have been spent attempting to tackle illicit drug economies, but the problem continues to grow. Globally, opium production has doubled since the turn of the century. According to the latest estimates, the global value of the illicit drug market could be between US$300 and US$600 billion a year. In Afghanistan, Colombia and Myanmar, illicit drug cultivation has continued to grow even after the signing of ceasefires and peace agreements.

By any measure, this is a failure of counter-narcotic policy. Law enforcement (including policies associated with the “war on drugs”) rather than development and peacebuilding are at the leading edge of efforts to combat drug economies in fragile, borderland regions.

This paper supports the case that the two strategic pillars of the “war on drugs” – the eradication of illicit crops and the militarisation of the fight against drug gangs – have both been a disaster. Globally, the fragile consensus surrounding the “war on drugs” is falling apart.

There are increasing efforts to establish counter-narcotic strategies that prioritise pro-poor development, align antidrugs policy with the Sustainable Development Goals (SDGs) and move away from the militarised approach inherent in the “war on drugs”.

While these iniatives are welcome, to date, the evidence base to support such policy reform remains weak. It is unclear how these seemingly opposed policy fields – drugs and development – can be reconciled in practice.

Peace, illicit drugs and the SDGs - A development gap

The Geneva Drug Policy, the first of its kind, took place between the 24th and 28th of June 2019. The Week was organised by the Geneva Platform on Human Rights, Health and Psychoactive Substances, supported by the Groupement Romand d’Etudes des Addictions (GREA) and the Institute of Global Health of the University of Geneva.

The main objective of the Week was to bring together relevant local and international actors working in the field of drug policy: permanent missions to the United Nations, United Nations agencies, academia, networks of people who use drugs, civil society and people from the field in Geneva, in order to talk about current local and international drug policies and share their experiences and work. In doing so, the Geneva Drug Policy Week contributed to consolidating Geneva’s position as a key player in the international drug policy world.

In total, fifteen events, in the form of conferences, debates, round tables, film screenings, site visits and cultural events, were offered, free of charge to the general public in places across Geneva, such as the Graduate Institute of International and Development Studies; the University of Geneva (UniMail and Campus Biotech), Quai 9 and the CAAP Arve. The topics that were covered included health, conflicts, human rights, access to medicines, and others.

The University of Geneva Summer School entitled “Drugs, Health and Human Rights” constituted the “academic” part of the Week and was organised by the Institute of Global Health and partners. The Geneva Platform on Human Rights, Health and Psychoactive Substances would like to thank the Swiss Confederation and the Republic and Canton of Geneva for their support to the Geneva Platform and this Week in particular. It would also like to thank all the organisations and actors that participated in the Week and made its content so substantive.

Geneva drug policy week: When local and international actors meet in Geneva

 is again presented in five separate parts that divide the wealth of information and analysis contained in the report into individual reader-friendly booklets in which drugs are grouped by their psychopharmacological effect for the first time in the report’s history.

Booklet 1 provides a summary of the four subsequent booklets by reviewing their key findings and highlighting policy implications based on their conclusions. Booklet 2 contains a global overview of the latest estimates of and trends in the supply, use and health consequences of drugs. Booklet 3 looks at recent trends in the market for depressants (including opioids, sedatives, tranquillizers and hypnotics), while Booklet 4deals with recent trends in the market for stimulants (including cocaine, amphetamine-type stimulants and new psychoactive substances). Booklet 5 contains a review of recent trends in the market for cannabis and for hallucinogens. The section on cannabis also includes a review of the latest developments in the jurisdictions that have adopted measures allowing the non-medical use of cannabis.

 is aimed at improving the understanding of the world drug problem and contributing towards fostering greater international cooperation for countering its impact on health, governance and security.

World Drug Report 2019

Every year, Forward empowers over 10,000 prisoners with drug and alcohol problems to break the cycle of crime and addiction and to achieve transformational change – from initial advice, harm minimisation and clinical treatment, to intensive programmes that instil and sustain recovery, and access to networks of support upon release to the community.

Drug-related deaths in England and Wales are at record levels: 3,756 deaths in 2017/18, of which 53% involved an opioid (e.g. heroin) overdose. Death rates among prisoners (especially those on post-release supervision) are many times higher than in the general population. There were 955 deaths of offenders in the community in England and Wales in 2017/18. The few weeks immediately after release from prison is a particularly high-risk period for drug-related death.

In response to these findings, and as part of our commitment to continually improve services and to deliver the best care possible, Forward have instigated a highly-targeted initiative to increase the number of service users being released from prison with Take Home Naloxone (THN), a drug that can save lives by reversing the reduced breathing rate caused by an opioid overdose.

Take Home Naloxone: Best practice in preventing fatal opioid overdoses for prison leavers

Three years into the Philippine government’s “war on drugs,” extrajudicial executions at the hands of the police and their associates continue. The vast majority of those who have been targeted are poor and marginalised people. Amid constant incitement from the highest levels of government and rampant impunity, only one unlawful killing, that of a 17 year old, has resulted in the prosecution and conviction of police officers. The international community must push for an independent investigation to put an end to these crimes and provide justice and reparations for countless families and victims.

Philippines: ‘They just kill’. Ongoing extrajudicial executions and other violations in the Philippines’ ‘war on drugs’

 especially because of the 22nd International AIDS Conference ‘Building Bridges, Breaking Barriers’ in Amsterdam. With the focus on EECA, the 

 contributed to the EECA buzz during plenary sessions, panel discussions and the communities’ zone at the conference as well as across the city of Amsterdam through various cultural activities. Together with our partners we did a great job and increased representation from the EECA region from 3,9% to 10,5%, compared to AIDS 2016.

We continued to implement a lot of projects. One of them was “Bridging the Gabs: health and rights for key populations 2.0’, which programs have been executed in 4 countries: Georgia, Kyrgyzstan, Tajikistan and Ukraine. We piloted an innovative approach in the project ‘Improved TB/HIV prevention & care – Building Models for the Future’, we had a lot of activities in Russia and supported the Andrey Rylkov Foundation for Health and Social Justice to deliver services to people who use drugs in Moscow. Also, within the project ‘Fast-track TB/HIV responses for key populations in EECA cities’ we organized study tour to Amsterdam for healthcare professionals, municipal representatives and NGO staff from Kazakhstan, Georgia and Ukraine, and supported 3 training seminars within the Cities Project in Georgia.

Elton John AIDS Foundation Emergency Support Fund

 together with Aidsfonds received funding for 3 years from the Elton John AIDS Foundation to manage the Emergency Support Fund for Key Populations in Eastern Europe and Central Asia. This is an important Fund for us because nowadays not more than 30% of people living with HIV in EECA can currently access the treatment.

All these results are only a small part of what we have done over the past year. Our goal is to keep the attention to the EECA region and its challenges. Therefore, we will continue to advocate at the international, regional and national levels for support for the key populations at risk for HIV, TB and viral hepatitis.

Eastern Europe and Central Asia: Right in the spotlight - Annual Report 2018

By Oliver Stevens, Monty Moncrieff, Mitsy Gafos

Recreational and sexualised drug use in lesbian, gay, bisexual, and transgender (LGBT) populations is higher than that of the wider British heterosexual population. The past decade has seen the evolution of sexualised drug use in men who have sex with men (MSM), with new psychoactive substances superseding the drugs of yesteryear, chiefly among them gamma-hydroxybutyric acid (GHB)/gamma-butyrolactone (GBL), mephedrone and methamphetamine: the emergence of ‘chemsex’. While many MSM engage in chemsex relatively safely and incur comparatively little harm, there are similarly many who shoulder the plethora of possible drug-related, sexual, and psychosocial harms.

Chemsex-related drug use and its association with health outcomes in men who have sex with men: A cross-sectional analysis of Antidote clinic service data

By The Institute for Criminal Policy Research (ICPR)

In the year 2000, the world’s prison population numbered around 8.7 million; less than two decades on, it stands at well over 11 million. The steady growth in prisoner numbers has given rise to severe prison overcrowding in much of the world, in both developed and less developed countries. Our World Prison Brief data show that prison systems are now overcrowded in well over 60 per cent of the world’s countries. When prison population growth is not matched by increased investment in built capacity, staff and other resources (as it almost never is), living conditions quickly deteriorate, as do standards of sanitation, healthcare, wellbeing and safety. The consequences for health – not only the health of prisoners and staff but also of their families and wider society – are serious.

Towards a health-informed approach to penal reform?

In Canada, the rise in prescription opioid (PO) overdoses and addiction is a major public health concern. Various health authorities have recently recommended that physicians use caution when prescribing opioids, especially to people with histories of substance use. As a result, fewer therapeutic options are available for people who use drugs (PWUD) and suffer from chronic non-cancer pain (CNCP). This paper examines how PWUD describe their experiences with CNCP management in the context of the opioid crisis.

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

Chronic pain management among people who use drugs: A health policy challenge in the context of the opioid crisis

The plight of children affected by intractable epilepsy and the efforts of the families of Alfie Dingley and Billy Caldwell to access to medicinal cannabis led to a change in Government policy. In November 2018 medicinal cannabis was changed from Schedule 1 to Schedule 2 of the Misuse of Drugs Regulation 2001, allowing specialist doctors to prescribe it and for products to be available for further research to be conducted.

This rescheduling was widely welcomed but there was a failure to communicate what this would mean in practice for the availability of medicinal cannabis. Expectations were raised that these products would become widely available and there needs to be far clearer communication that this is not the case.

Very few prescriptions have been issued for medicinal cannabis since the rescheduling in November 2018. This is because most of these products are not licensed by the Medicines and Healthcare products Regulatory Agency (MHRA) or the European Medicines Agency (EMA) and neither have they been approved by the National Institute for health and Care Excellence (NICE).

There are major gaps in the research base for medicinal cannabis in part because research was very difficult under the previous scheduling. There were restrictions on accessing products to conduct the robust clinical trials necessary to test efficacy and safety. Without a thorough research base products remain unlicensed and may only be prescribed if the individual prescribing doctor is satisfied that there is sufficient evidence for the product’s safety and efficacy for an individual patient.

Drugs policy: Medicinal cannabis

 Classification of Drugs: when science was left

, the Global Commission on Drug Policy explains how the biased historical classification of psychoactive substances has contributed to the "world drug problem". It is the first-ever comprehensive report providing a political reading of the current evaluation and classification, or "scheduling" of drugs according to their harms.

Psychoactive substances should be classified with regard to their potential for dependence and other harms. This is not the case today, where some substances are legally available because they are considered beneficial (medicines) or culturally important (alcohol), while others are seen as destructive, and are strictly prohibited. The classification of drugs is at the core of the international drug control system. As such, governments must ensure that such a classification is pragmatic and based on science and evidence, makes clear the benefits and harms of drugs, and allows for responsible legal regulatory models to control drugs.

Classification of psychoactive substances: When science was left behind

WHO estimates that 71 million people worldwide were chronically infected with hepatitis C virus (HCV) in 2017. Globally, 23% of new HCV infections and one in three HCV deaths are attributable to injecting drug use (PWID). HCV is also a major concern for people detained in prisons and other closed settings – available data demonstrate that one in four detainees are HCV positive.

This policy brief highlights the current landscape of country hepatitis policies for harm reduction and HCV testing and treatment in PWID and people in prisons. It aims to capture how governments are translating the WHO 

Global health sector strategy on viral hepatitis, 2016-2021

 into national plans, and provides a summary of the enablers and barriers to HCV testing and treatment in these populations.

Publications