This section presents the absolute numbers received from the Prison Administrations of the 47 member States of the Council of Europe, as well as the rates, ratios and percentages estimated by the authors of this study on the basis of those numbers. The first version of the database was established on the basis of the data received from the Prison Administrations for each annual SPACE survey.

Prisons in Europe, 2005-2015

In 2008, Harm Reduction International (HRI) released the first Global State of Harm Reduction, a report that mapped responses to drug-related HIV, viral hepatitis and tuberculosis (TB) around the world for the first time. The data gathered for the report provided a critical baseline against which progress could be measured in terms of the international, regional and national recognition of harm reduction in policy and practice.

Since 2008, the biennial report has become a key publication for researchers, policymakers, civil society organisations, UN agencies and advocates, mapping harm reduction policy adoption and programme implementation globally. Over the last decade, reports of injecting drug use and the harm reduction response have increased; harm reduction programmes are currently operating at some level in almost half of the 179 countries in the world where injecting drug use has been documented.

The Global State of Harm Reduction 2018

Prepared by Public Health England, Health Protection Scotland, Public Health Wales, and Public Health Agency Northern Ireland

Drug use in the UK is among the highest reported in Western Europe. In 2017- 2018, around 3.0 million (9.0%) 16-59 year olds in England and Wales reported using a drug in the last year. This proportion has reduced over the past 2 decades, but has remained stable over the last 8 years. The Scottish Crime and Justice Survey (2014- 15) estimated 6.0% of 16-59 year olds reported using a drug in the past 12 months. There were 199,339 people who received treatment for drug misuse in England in 2016-17. Of those who newly presented to treatment, 37% were currently injecting, or had previously injected, drugs. The proportion currently or previously injecting among new presentations to drug treatment differed between those starting treatment for opiates (60%) and non-opiates (9%)

People who inject drugs (PWID) are vulnerable to a wide range of viral and bacterial infections, which can result in high levels of morbidity and mortality. HIV, hepatitis B virus and hepatitis C virus are very effectively transmitted through the use of shared needles and syringes. Unsterile injection practices are also associated with bacterial infections such as Staphylococcus aureus and Group A streptococci. Rare but lifethreatening infections with spore-forming bacteria such as tetanus, botulism and anthrax can be associated with contaminated drugs. Public health surveillance of infectious diseases, and the associated risk and protective behaviours among PWID, provides important information to understand the extent of these infections, the risk factors for their acquisition and for monitoring the effectiveness of prevention measures.

Shooting up: Infections among people who inject drugs in the UK, 2017

Current levels of opioid-related morbidity and mortality in the United States are staggering. Data for 2017 indicate that there were more than 47,000 opioid-involved overdose deaths (roughly similar to deaths from AIDS at its peak in 1995; Centers for Disease Control and Prevention, 2011, 2018a), and the actual figure is likely 20 to 35 percent higher because death certificates do not always list specific drugs (Ruhm, 2018). Furthermore, these fatalities exclude those who die from complications from infectious diseases, such as HIV or hepatitis C, contracted by sharing injection equipment and do not account for the costs associated with opioid use disorder (OUD) and nonfatal overdoses. In contrast to every other developed country, overall life expectancy is dropping in the United States, with opioids being an important driver (Dowell et al., 2017; Centers for Disease Control and Prevention, 2018b). Moreover, one in eight adults now reports having had a family member or close friend die from a prescription painkiller or heroin overdose (Associated Press–NORC Center for Public Affairs, 2018). Since 2014, the increase in opioid-related deaths is primarily associated with illicitly produced synthetic opioids (e.g., fentanyl) being mixed into heroin and counterfeit pills (Centers for Disease Control and Prevention, 2017a). Because fentanyl and other synthetic opioids are much cheaper per morphine-equivalent dose and increasingly accessible from foreign suppliers, that pattern could well spread. The potential diffusion of these substances into nonopioid drug markets, such as for methamphetamine and cocaine, is also alarming.

Considering heroin-assisted treatment and supervised drug consumption sites in the United States

1. One of the objectives of the European Union Drugs Strategy 2013-2020 is to further strengthen dialogue and cooperation between the EU and third countries and international organisations on drug issues.

2. The European Action Plan on Drugs 2017-2020 provides specific actions to reach this objective, including:

- to ensure that the policy priorities and the balance between demand and supply reduction are well reflected in policy options and in the programming, implementation and monitoring of external assistance, through projects involving notably alternative development measures; and

- to promote and implement the EU approach to alternative development in cooperation with third countries.

3. The draft Council Conclusions on alternative development aim at supporting these actions. In these Conclusions, alternative development is considered as an important strategy to address the underlying root causes of illicit drug economies through an integrated approach.

4. The draft Council Conclusions were presented and examined during the Horizontal Working Party on Drugs (HDG) at its meetings on 5 July, 18-19 September and on 19 October 2018, where the amended text was endorsed by the working party.

5. Consequently, COREPER is invited to adopt the text of the draft Conclusions as set out in annex and to submit it to the Council for adoption.

Council of the European Union conclusions on alternative development

It been another tremendous year for the IDPC network, in an increasingly complex political environment where the space for civil society continues to shrink in the face of rising populism in many parts of the world. In these challenging times, IDPC’s core mandate of empowering and strengthening our network of civil society organisations in advocating for the reform of damaging drug policies and for the human rights of those affected is more critical than ever.

History has shown us that civil society that is empowered and informed is fundamental for fighting inequality, injustice and spearheading transformative social change. Civil society actors hold a mirror up to governments, reflecting back to them the real impact of policy decisions on people and communities. The watchdog role of civil society in being vigilant in policy formulation, implementation and evaluation cannot be underestimated if the interests of society’s most marginalised are to be central to decision making processes. The IDPC Secretariat remains deeply committed to our core mandate and will continue to work alongside our members and partners to fight for civil society space in drug policy forums at the national, regional and UN levels.

Reform-orientated civil society has made important strides in recent years and this success has been built upon increasing international solidarity, shared objectives, collaboration and networking. The drug policy reform movement, while still relatively young, has gained in strength, diversity, visibility and credibility – and the recent momentum of the 2016 UNGASS has been a major catalyst for this. There is now solid and fertile ground on which the movement can continue to grow. Drug policy reform is increasingly seen as one of the key social justice issues of our times and new actors from different disciplines and sectors are joining the calls for change.

In these coming years, reform-orientated civil society effort must continue to ‘beat the drum’, speak truth to power and leverage the growing international solidarity on this critical social justice and human rights issue.

For this year’s Progress Report, we have decided to switch to a new format, providing monthly highlights to showcase some of the most exciting and impactful advocacy events and activities from the IDPC membership. I hope you will enjoy reading it!

IDPC progress report 2017-2018

, please click here. Apologies for the confusion)

Societal stigma and punitive legal frameworks often severely impede key populations’ rights to raise families free from interference and discrimination. The experiences of key population groups (gay, bisexual and other men who have sex with men, people who use drugs, sex workers, and transgender people) are diverse, and are informed by varying levels of criminalisation, stigma and discrimination, and individual factors such as socioeconomic status, gender, race, and health status. This paper explores these challenges, and provides recommendations for policymakers.

This Policy Brief is a joint effort by three global key population-led networks (INPUD, MPact, and NSWP) to bring attention to the lived experiences of key populations and their families, and highlight the ways that stigma and discrimination inform these experiences. The Policy Brief is available here.

A Community Guide is also available here. It provides an overview of the full Policy Brief, and provides key recommendations for policymakers and other stakeholders. As with the Policy Brief, this paper is a collaborative effort between the International Network of People who Use Drugs (INPUD), MPact Global Action for Gay Men’s Health and Rights (formerly MSMGF) and the Global Network of Sex Work Projects (NSWP).

The impact of stigma and discrimination on key populations and their families

The Government Inquiry into Mental Health and Addiction was announced early in 2018. The catalyst for the inquiry was widespread concern about mental health services, within the mental health sector and the broader community, and calls for a wide-ranging inquiry from service users, their families and whānau, people afected by suicide, people working in health, media, Iwi and advocacy groups.

• hear the voices of the community, people with lived experience of mental health and addiction problems, people afected by suicide, and people involved in preventing and responding to mental health and addiction problems, on New Zealand’s current approach to mental health and addiction and what needs to change

• report on how New Zealand is preventing mental health and addiction problems and responding to the needs of people with those problems

• recommend specifc changes to improve New Zealand’s approach to mental health, with a particular focus on equity of access, community confdence in the mental health system and better outcomes, particularly for Māori and other groups with disproportionately poorer outcomes.

The full Terms of Reference are set out in Appendix A.

New Zealand’s mental health and addiction problems cannot be fxed by government alone, nor solely by the health system. We can’t medicate or treat our way out of the epidemic of mental distress and addiction afecting all layers of our society. We need to ensure practical help and support in the community are available when people need it, and government has a key role to play here. But some solutions lie in our own hands. We can do more to help each other.

Wellbeing has been a theme during this Inquiry and in national conversation in recent years. It’s hard for people struggling with poverty, abuse and deprivation to take steps to become well – yet, every day, people recover from distress, overcome addictions and fnd strength in their lives. Sleep, nutrition, exercise and time outdoors help recovery. So too does strengthening one’s cultural identity and helping others.

We have a solid foundation to build on: New Zealand’s mental health and addiction system has valuable strengths. Many people in the system receive good care and we have a skilled and committed workforce. But the system is under pressure and unsustainable in its current form. Signs include escalating demand for specialist services, limited support for people in the community and difculties recruiting and retaining staff.

Despite the current level of investment, we’re not getting the outcomes we want for our people. The outcomes for Māori are worse than for the overall population, and Māori are subject to much greater use of compulsory treatment and seclusion. There are also unmet mental health needs for Pacifc peoples, disabled people, Rainbow communities, the prison population, and refugees and migrants. The estimated reduction in life expectancy of people with severe mental health or addiction challenges is 25 years. Our persistently high suicide rates are of major concern.

Our mental health system is set up to respond to people with a diagnosed mental illness. It does not respond well to other people who are seriously distressed. Even when it responds to people with a mental illness, it does so through too narrow a lens. People may be ofered medication, but not other appropriate support and therapies to recover. The quality of services and facilities is variable. Too many people are treated with a lack of dignity, respect and empathy.

We do not have a continuum of care – key components of the system are missing. The system does not respond adequately to people in serious distress, to prevent them from ‘tipping over’ into crisis situations. Many people with common, disabling problems such as stress, depression, anxiety, trauma and substance abuse have few options available through the public system. By failing to provide support early to people under the current threshold for specialist services, we’re losing opportunities to improve outcomes for individuals, communities and the country.

We also fail to address people’s wider social needs. Initial expansion of culturally appropriate services has stalled, and there has been little investment in respite and crisis support options, forensic step-down services in the community, and earlier access to a broader range of peer, cultural and talk therapies.

Despite a lot of consensus about the need for reform, we are yet to take a bold, healthoriented approach to the harmful use of alcohol and other drugs and to provide a wider range of community-based services to help people recover from addiction. Our approach to suicide prevention and the support available to people after a suicide is patchy and under-resourced. Tackling the social and economic determinants of mental health and wellbeing requires a coordinated, integrated approach from social services.

It’s time to build a new mental health and addiction system on the existing foundations to provide a continuum of care and support. We will always have a special responsibility to those most in need. They must remain the priority. But we need to expand access so that people in serious distress – the ‘missing middle’ who currently miss out – can get the care and support they need to manage and recover.

The new system should have a vision of mental health and wellbeing for all at its heart: where a good level of mental wellbeing is attainable for everyone, outcomes are equitable across the whole of society, and people who experience mental illness and distress have the resilience, tools and support they need to regain their wellbeing.

We set out Whakawātea te Ara, clearing the pathways that will lead to improved Māori health and wellbeing. We outline Vai Niu, a vision of Pacifc mental health and wellbeing. We believe that many dimensions of the aspirations of Māori and Pacifc peoples, especially the call for a holistic approach, point the way for all New Zealanders.

We describe a vision for mental health and addiction services, with people at the centre; responsive to diferent ages, backgrounds and perspectives; centred on community-based support and local hubs, using a mix of peer, cultural, support and clinical workforces; providing support for people in crisis; a comprehensive harm-minimisation approach to alcohol and other drug use; more community-based addiction services to help people recover; and a broader range of therapies for people who are detained and support for their transition back to the community. Psychiatrists and appropriate medications will continue to be important – but they are only part of the picture.

Honouring the voices of the people who shared their stories with the Inquiry means there must now be decisive action. Our approach is to focus on a few critical changes to shift the system. In addition to the gains in health and wellbeing, a strong economic case exists for further investment in mental health and addiction. The key principles that underpin our recommendations are a commitment to equity and the Treaty of Waitangi; putting people with lived experience and consumers at the centre of the system; recognising a shared responsibility for improving mental health and wellbeing in our society; and building on the foundations already in place, with mental health and addiction services remaining part of the health system.

He Ara Oranga : Report of the government inquiry into mental health and addiction

The medical use of preparations derived from the Cannabis sativa plant has a long history. However, by the twentieth century, medical use of cannabis had largely declined, and its consumption for medical purposes was already very limited when in 1961 cannabis was included in the United Nations Single Convention on Narcotic Drugs and classified as a drug that had no medical uses (see ‘A brief history of the medical use of cannabis and cannabinoids’, on page 7). In the past 20 years, however, there has been a resurgence of patient interest in using cannabis and cannabinoids to treat a variety of conditions, including chronic pain, cancer pain, depression, anxiety disorders, sleep disturbances and neurological disorders, the symptoms of which are reportedly improved by using cannabis (NASEM, 2017).

Increased patient interest in the medical use of cannabis has been accompanied by renewed scientific interest in the medical use of substances found in the cannabis plant, namely cannabinoids. This followed the discovery, in the early 1990s, of a cannabinoid system in the human brain and body that was implicated in the control of important biological functions, such as cognition, memory, pain, sleep and immune functioning. However, the classification of cannabis as a drug without medical uses made it difficult to conduct clinical research (NASEM, 2017).

In the mid-1990s, citizens in several US states responded to patient demand for cannabis by passing referenda that legalised the medical use of cannabis for people with a variety of illnesses, such as chronic pain, terminal cancer and multiple sclerosis. A similar approach was later adopted in many other US states. In 1999, Canada introduced a medical cannabis programme that expanded over the subsequent decades in response to court decisions. In the early 2000s, Israel (2001) and the Netherlands (2003), and later other countries, such as Switzerland (2011), Czechia (2013), Australia (2016) and Germany (2017), legislated to allow the medical use of cannabis under specified conditions. Over a similar period, clinical trials have provided the basis for granting an authorisation for marketing in many EU Member States of a medicinal product, primarily based on cannabis extracts, that has proven effective in the treatment of muscle spasticity due to multiple sclerosis.

Most EU countries now allow, or are considering allowing, the medical use of cannabis or cannabinoids in some form. However, the approaches taken vary widely in terms of both the products allowed and the regulatory frameworks governing their provision. In this context, this report aims to provide a brief overview of current knowledge and the latest developments relating to medical use of cannabis and cannabinoids.

The report is intended to help a broad audience of interested readers, such as policymakers, practitioners, potential patients and the public, to understand the scientific, clinical and regulatory issues that arise when consideration is given to making cannabis or cannabinoids available to treat the symptoms of medical illnesses.

Medical use of cannabis and cannabinoids: Questions and answers for policymaking

This report details the results of a two-day workshop on the EMCDDA’s trendspotter methodology held in Lisbon in November 2017. The workshop involved representatives from national drug observatories based in countries from the Community of Latin American and Caribbean States (CELAC), along with experts from European countries and regional and international organisations active in the drugs field. In two parts, today’s report gives the background, purpose and an introduction to the trendspotter methodology, followed by indicative results from a simulation exercised performed at the workshop to test the method. The results are presented by drug type and provide insight into the current trends and developments active in the region, along with the drivers behind these phenomena. The report concludes by considering the challenges and opportunities that the CELAC region is facing in terms of monitoring the drug situation. The report is available in Spanish and English.

Exploring new and emerging drug trends and developments in CELAC countries: Joint report from the EMCDDA and COPOLAD workshop on trendspotter methodology

This report reviews research on substance use in recreational settings across Europe, using cuttingedge theoretical and empirical advancements within the field of contemporary drug research. Drug researchers and those responsible for monitoring the drug situation in Europe need to know which substances are being consumed, by whom, where, for what effects, and, if possible, under what circumstances. It is important to reflect on how best to measure people’s drug-using practices, and the challenges that these efforts may involve.

Drug consumption incorporates the non-medical use of psychoactive substances, including legal drugs such as alcohol and tobacco; emergent or ‘novel’ psychoactive substances (NPS); ‘traditional’ illicit drugs such as cannabis and cocaine; and prescription medications such as (the illicit use of) opiate painkillers. Given the multifaceted, complex and highly dynamic nature of the drug situation, the research methods and tools used to gather data for monitoring require constant review and development.

The report begins by considering the role of general population surveys (GPSs) but largely concentrates on targeted population surveys (TPSs), as these are the key research tools for gathering data on substance use in recreational settings across Europe. Additional innovative research practices are also highlighted through case studies. The main empirical data sources for this report are TPSs of drug use among those frequenting recreational settings, EMCDDA national reports from 2013 to 2014, and workbooks from 2015 to 2016. Knowledge gaps are identified and recommendations are made on improving existing monitoring tools ‘by integrating new data sources and novel measurement methodologies’ (EMCDDA, 2017a:1). Where relevant, other studies are incorporated alongside TPSs, such as work on GPSs, on in situ TPSs compared with online TPSs, and on biomedical markers used to supplement self-report surveys.

Monitoring drug use in recreational settings across Europe: Conceptual challenges and methodological innovations

The total opium poppy cultivation area in Afghanistan was estimated at 263,000 (242,000 – 283,000) hectares in 2018, a 20% or 65,000 hectares decrease compared to the previous year. It is the second highest measurement since the beginning of systematic opium poppy monitoring and recording in 1994. The level of 2018 exceeds the third highest level of 2014 by 17% or 39,000 hectares.

Opium poppy cultivation decreased by some 24,000 hectares (-56%) in the Northern region, by 23,200 hectares (-43%) in the Western region and by 15,000 hectares (-8%) in the Southern region. The strong decreases in the Northern and parts of the Western regions were mainly attributed to the adverse effects of a drought. Most of the opium poppy cultivation took place in the Southern region (69%), followed by the Western region (12%). The Eastern and Northern regions accounted for 8% and 7% of total cultivation, respectively. The North-eastern and Central regions together accounted for 4% of the total cultivation

Hilmand remained the country’s leading opium poppy cultivating province, followed by Kandahar, Uruzgan,2 and Nangarhar. The number of poppy-free provinces in 2018 remained at 10, the same number as in 2017. Nuristan province regained its poppy-free status but Takhar province, which had been poppy-free since 2008, lost it. The number of provinces affected by opium poppy cultivation remained at 24. Crops in the Northern region and in Badghis province were heavily affect ed by a drought.

Cultivation of opium poppy in Balkh decreased by 30% from 12,100 hectares in 2017 to 8,500 hectares in 2018. In Jawzjan, opium poppy cultivation decreased by 90% from 3,200 hectares in 2017 to 338 hectares this year, and in Badghis cultivation decreased by 72% from 24,700 hectares in 2017 to 6,970 hectares in 2018. In 2018, 406 hectares of opium poppy were eradicated in four provinces, compared to 750 hectares in 14 provinces in 2017. During the 2018 eradication campaign, five lives were lost, and two persons were injured (six lives were lost and eight injured in 2017).

Publications