By Daniel Brombacher , Jan Westerbarkei

The concept of alternative development (AD) in international drug control has evolved over the past four decades, with several major milestones between the two United Nations General Assembly Special Sessions on the World Drug Problem (UNGASS) 1998 and 2016. However, it was not until UNGASS 2016 that the door for development-oriented thinking in international drug policy was pushed wide open. The Chapter VII of the UNGASS 2016 Outcome Document not only assigns a prominent role to AD, but also seeks to broaden the scope of development towards urban drug markets and drug trafficking, formerly exclusive realms of law enforcement and repressive measures of drug supply control. Therefore, in the field of development a major revolution has taken place through the unequivocal broadening of the scope of development within UN drug control, feeding directly into the much-needed approximation of the UN drug control system and the Sustainable Development Goals. The article sheds light on the evolvement of the German approach of alternative development that has been influential at the international level in the shaping of the global drugs and development nexus.

(This article is part of the first issue of the Journal of Illicit Economies and Development)

From alternative development to sustainable development: The role of development within the global drug control regime

By Allan Gillies , John Collins, Alexander Soderholm

This special issue of the Journal of Illicit Economies and Development builds on a growing, multifaceted research and policy agenda that advances development perspectives of illicit economies in the Global South. Conventional policy discourses have typically framed this issue as a security problem, drawing direct and often simplistic causalities with underdevelopment. Illicit economies frequently drive violence, corruption, exploitation and failures in governance, for example. However, for many communities living in poverty and conflict-affected areas across the globe, involvement in illicit economic activity can also ameliorate the immediate problems they face. Illicit economies may provide vital sources of livelihood and underpin stable political orders and socio-economic development at the margins of the state. Broad, securitised policy responses may cause more harm than good in such contexts. Scoping the complex relationship between illicit economies and development, this introductory article outlines key themes of the special issue.

Addressing the development implications of illicit economies: The rise of a policy and research agenda

By UNODC Regional Office for Southeast Asia and the Pacific.

This report presents the results of the sixteenth opium survey in Myanmar. It was conducted jointly by the Central Committee for Drug Abuse Control (CCDAC) of the Ministry of Home Affairs and UNODC, which has been collecting statistical information on illicit crop cultivation in Myanmar within the framework of its Illicit Crop Monitoring Programme. The methodology used in this report combines satellite imagery and a yield survey to evaluate the extent of opium poppy cultivation and production. The 2018 survey builds on years of data regarding illicit opium production in Myanmar, estimating and comparing the area under cultivation, and assessing yield and production. In 1996 over 160,000 hectares (ha) were used for cultivating opium poppy, making Myanmar temporarily the most prominent country with cultivation in the world. However, cultivation decreased significantly over the following ten years, reaching a low of just over 20,000 ha in 2006.

The area of opium cultivation increased again between 2006 and 2014 to just under 60,000 ha, but it has subsequently been in sharp decline. In 2017, the total area of opium poppy consisted of 41,000 ha, a 25% decrease from the 55,000 ha recorded in 2015. The downward trend has continued in 2018 with 37,300 ha of opium poppy. In the two main producing states, Shan and Kachin, the cultivation area decreased by 12 percent from 41,000 hectares in 2017 to 36,100 hectares in 2018. As in previous years, the majority of opium poppy is again cultivated in Shan State ‐nearly 90%‐ followed at a distance by Kachin State 9%, with negligible cultivation in Chin and Kayah states.

The biggest dropsin cultivation have been seen in areasthat have had relatively good security. However, in parts of Shan and Kachin experiencing a protracted state of conflict, high concentrations of poppy cultivation have continued – a clear correlation between conflict and opium production. For example: in Kachin State, the highest density of poppy cultivation took place in areas under the control or influence of the Kachin Independence Army (KIA); in North Shan, in areas of the Myanmar National Democratic Alliance Army (MNDAA); in South Shan, of the Pa‐O National Liberation Army (PNLA), and the Restoration Council of Shan State (RCSS) Shan State Army South (SSA‐S); and in East Shan, the People Militia’s Force (PMF); with each engaged in conflicts of varying intensity and frequency.

A ceasefire agreement providing a degree of self‐administration has been concluded with most of the armed groupsin Myanmar, and the Government haslimited accessto, and limited influence in, territories controlled by many militias. There are also several drivers for the illicit cultivation of opium poppy in Myanmar. The most recent UNODC socio‐economic survey identified insecurity, lack of employment opportunities, income inequality, and lack of infrastructure (access to markets, availability of clinics) as conditions associated with the cultivation of opium poppy. Illicit cultivation is also linked to limitations on access to areas of cultivation and the absence of a process for independently monitoring compliance with ceasefire provisions which include, among other conditions, the non‐engagement in drug production. The presence of organized crime groups in the same areas is also associated with the manufacturing and trafficking of heroin. According to the Government of Myanmar, criminal activity in the country is estimated to generate US$15 billion per year – the equivalent of approximately 24% of Gross Domestic Product (GDP)15 – with 84% or US$12.6 billion related to organized crime of which a significant portion would be transnational and drug related.

However, the illicit drug economy is increasingly diverse and revenue is not only generated from opiates. There has been a sharp increase in the supply of, and demand for, synthetic drugs and particularly methamphetamine across East and Southeast Asia and neighbouring regions, and the downward trend in opium cultivation and related heroin production in Myanmar needs to be understood in this context. Of the 11 countries in the region systematically sharing drug data and information with UNODC, 9 are now reporting methamphetamine as their primary drug of concern, as opposed to 10 years ago when there were 4 countries reporting methamphetamine and 7 reporting heroin. Even countries with traditionally large heroin markets, including China and Malaysia, have reported this dramatic change.

Most countries in the region do not have reliable data on drug use making it difficult to determine if the rapid expansion of methamphetamine and synthetic drugs has happened at the expense of, or in addition to, heroin, but findings of the opium survey point to the shrinking of the market for opiates originating from Myanmar: between 2015 and 2018, farm‐ gate prices of fresh and dry opium have decreased by 34 and 45 % respectively. Declining prices considered together with a reduction in the supply of opium and heroin are a possible indication of decreased demand for opiates from Myanmar, although data on other opioids which may be in the regional market are limited.

The 2018 opium survey report finds that the current value of Myanmar’s opiate economy is a noticeable share of the overall national economy, ranging from 1.5%‐3.3% of GDP.16 with geographic pockets of Shan and Kachin where the opiate economy dominates. Where drug‐ related proceeds comprise a sizeable portion of the total economy of an area or community, dynamics are distorted with unfair competition, skewed income and wealth distributions, and increased corruption.

Myanmar is the major supplier of opium and heroin in East and Southeast Asia, and Australia, and the value of opiates in the region is much higher than the US$1.1‐$2.3 billion estimated inside the country given the escalation of value as it approaches retail level. Manufacture and trafficking of heroin within the borders of Myanmar constitutes the largest value of the Myanmar opiate economy with a value range of US$1.0 to $2.2 billion – although this estimate does not take into account certain input costs including smuggled precursor chemicals. Traffickers and organized crime groups are the main beneficiaries of the opiate economy in Myanmar, with farming’ income, or the farm‐gate value of opium, comparatively small and estimated between US$62 and $103 million.

Efforts to eradicate opium poppy decreased in 2018, with a reported total of 2,605 ha eradicated. This is 26% less than in 2017, and follows a continuous annual decline in the hectares of opium poppy eradicated since 2015. The slowdown in eradication efforts is reportedly linked to the existence of protracted conflict and limited access to areas under thecontrol of non‐state armed groups. Opium poppy is now mainly concentrated in areas where government action against cultivation and organized crime groups is inhibited.

Opium cultivation, heroin manufacturing and the drug economy are important elements to consider in the context of the peace process and the establishment of long‐term stability in Myanmar. There is a direct connection between drugs and conflict in the country, with the drug economy supporting the conflict and in‐turn the conflict facilitating the drug economy. Providing solutions to the conflict requires breaking this cycle. The influence of the drug economy can be mitigated through, among other things, scaling‐up alternative development programmes that provide viable sources of legitimate income, as well as by addressing the presence of transnational organized crime groups that continue to produce and traffic heroin and that have significantly scaled‐up the production of methamphetamine and synthetic drugs for the Asia Pacific market. Countering drug production and organized crime networks active in Myanmar are also vital for providing sustainable peace and security to Shan and Kachin states, and border areas of the surrounding Mekong region.

The annual opium survey remains an essential tool for assessing the extent of opium poppy cultivation in Myanmar, as well as understanding changes in patterns and the links between drugs and the economy. This information is useful for understanding farming techniques and rural livelihoods, and for designing effective alternative development options and programmes. It is also essential for supporting decision makers to develop effective strategies to sustain the transition from an illicit to a licit economy, and as a basis for understanding the connection between the drug economy and ongoing conflict.

Myanmar Opium Survey 2018: Cultivation, production and implications

The Global Fund to Fight AIDS, Tuberculosis and Malaria is the largest donor for harm reduction in low and middle countries (LMICs), providing two-thirds of all international donor support. In May 2019, the Global Fund Board will approve the 2020-2022 allocation methodology and catalytic investment priorities, ahead of replenishment for the Global Fund in October 2019. These will have significant implications for harm reduction in LMICs and as such, the ability of the Global Fund to step up the fight and get back on track to end AIDS by 2030.

This briefing, developed in collaboration with the International HIV/AIDS Alliance, compiles evidence of the crucial nature of catalytic investment funds for harm reduction. In the briefing, we urge the Global Fund Board to safeguard catalytic investment funds—including multi-country grants, matching funds and strategic initiatives—regardless of the replenishment outcome, in order to sustain life-saving services for people who inject drugs and to incentivise domestic investment in harm reduction.

Harm Reduction International joint briefing on Global Fund catalytic investments for harm reduction

The distribution of death as an organised exercise of state power, militarised topographies where experiencing the early burial of peers is part of the socialisation of generations of people, the vocabulary of homicide and slaughter integrated into the formation of black people’s experience from the time of their childhood in war-torn territories and necropolitics, which promotes a set of racialised and racialising categories and undertakings, define the political agenda, permeate televised narratives and distribute fear to market the idea of social peace. These are all part of a broad range of actions legitimised by the idea of war, including against other peoples, under another spectre of war – the so-called 

. The selectiveness of prohibitionist drug policies is one of the tools used to perpetuate a series of injustices that are the result of a perverse regime that operates today via an economy marked by violence, which continues to have effects even today.

The massacre of black Brazilians in the war on drugs

Por Nathália Oliveira e Eduardo Ribeiro

A distribuição da morte como exercício organizado do poder de Estado, as topografias militarizadas onde gerações passaram a ser socializadas pela experiência do enterro precoce de seus pares, o vocabulário do homicídio e da chacina na formação da experiência negra desde a infância em territórios de guerra e a necropolítica que impulsiona um conjunto de categorias e empreendimentos racializados e racializantes definem a agenda política, percorrem as narrativas televisivas, distribuem o medo para comercializar a paz social e cabem no amplo leque de ações legitimadas pela ideia da guerra, inclusive contra outras populações, sob outro espectro da guerra, os chamados efeitos colaterais. E a seletividade da política de drogas proibicionista é um exemplo de instrumento da manutenção de um conjunto de injustiças que são fruto de um perverso regime realizado por meio de uma economia de violências que produz efeitos ainda hoje.

O massacre negro brasileiro na guerra às drogas

The first edition of these Standards was published in 2013, summarizing the evidence of drug use prevention at the global level with a view to identify effective strategies, ensuring that children and youth, especially the most marginalized and poor, grow and stay healthy and safe into adulthood and old age.

Member States and other national and international stakeholders recognised the value of this tool, with the Standards acknowledged multiple times as useful basis to improve the coverage and quality of evidence-based prevention. In addition, in 2015, the Member States of the United Nations made a series of wide-ranging commitments in the Sustainable Development Goals to be achieved by 2030 and Target 3.5 pledges to strengthen the prevention and treatment of substance abuse. In April 2016, the Special Session of the United Nations General Assembly on the world drug problem heralded a new era for addressing drug use and drug use disorders through a balanced and healthcentred system approach.

In the context of this renewed emphasis on the health and wellbeing of people, UNODC and WHO are pleased to join forces and present this updated second edition. As in the case of the first edition, the Standards summarize the currently available scientific evidence on the basis of overview of recent systematic reviews, and describe interventions and policies that have been found to improve drug use prevention outcomes. In addition, the Standards identify the major components and features of an effective national prevention system. This work builds on, recognizes and is complementary to the work of many other organizations (e.g. EMCDDA, CCSA, CICAD, CP, NIDA) which have developed other standards and guidelines on various aspects of drug use prevention.

It is our hope that the Standards will continue to guide policy makers and other national stakeholders worldwide to develop programmes, policies and systems that are a truly effective investment in the future of children, youth, families and communities.

International standards on drug use prevention - Second updated edition


The New Zealand Drug Foundation’s vision is for an
Aotearoa free from drug harm.

This State of the Nation is the first of what will be an annual report. It’s intended to track how New Zealand is dealing with alcohol and other drugs, and show a starting point against which we can assess the impact of any policy changes.

While we are doing well in some areas, there is massive room for improvement. Top of the list is the horrifying number of deaths (as many as 50) linked to synthetic cannabinoids since mid-2017.

There is room for hope, though, with some welcome announcements from the government in December. They plan to ensure Police no longer prosecute people for possession and personal use of any drug “where a therapeutic approach would be more beneficial, or there is no public interest in a prosecution”. This could be a game-changer for ensuring people can get the help they need.

Also in December, the government passed new medicinal cannabis legislation and declared the 2020 cannabis referendum will be binding. And already this year, the Police Minister acknowledged the importance of drug checking at festivals.

However there is no room for complacency. Illicit drug convictions are creeping up again after falling for many years, with 5,710 people convicted in 2017. It’s concerning that 61% of those convictions were for low-level offences, such as possessing or using drugs. And Māori continue to suffer disproportionate harm both from drugs and our drug laws.

And a note on drug statistics: New Zealand does not have adequate ones. With all that is going on, it’s essential we rectify this in a hurry. How else will we know what’s working and what’s not working?

New Zealand Drug Foundation’s State of the Nation report 2018

The drug crisis our country faces today is unprecedented. It has evolved over the past several decades and has steadily worsened with time. Every state and county, and every socioeconomic group in our country, is directly affected by the negative consequences of illicit drug use. However, today we can see American ingenuity across the Nation, sparked by the commitment to save lives, at work to establish lasting solutions to this monumental problem. Law enforcement and public health innovators working side-by-side at the local level, assisted and inspired by families who have lost loved ones to the scourge of drug use, resourced by government agencies at every level working with private sector partners, are already making a difference. This National Drug Control Strategy, the Trump Administration’s first, establishes the President’s priorities for addressing the challenge of drug trafficking and use, now and in coming years. It also provides the strategic direction necessary for the Federal government to prevent initiates to drug use through education and evidence-based prevention, provide treatment for those suffering from the disease of addiction so they can reach long-term recovery, and reduce the availability of these dangerous drugs in every American community.

The President’s top priority is to address, head on, the current opioid crisis and reduce the number of Americans dying from these dangerous drugs. This crisis alone has resulted in more American deaths in just two years than in the course of the entire Vietnam War. In 2017, there were more than 70,200 drug overdose deaths in the United States according to the Centers for Disease Control and Prevention (CDC). More than 47,500 of these deaths involved an opioid, and more than half of these deaths involved a synthetic opioid such as illicit fentanyl or one of its analogues. From 2014 to 2017, the number of deaths attributed to synthetic opioids like fentanyl and its analogues increased 413 percent, and these synthetic opioids are now involved in more deaths than any other drug such as prescription opioids, heroin, or cocaine. Along with the current opioid crisis, overdose deaths involving heroin, cocaine, methamphetamine, and prescribed opioid painkillers have all increased since 2014 as well, and many of these deaths involved more than one drug.

The Trump Administration is matching the magnitude of today’s historic crisis with a historic level of focus and resources. In addition to providing an array of Federal grants across the spectrum of drug issues the Presidentincreased resources in his Fiscal Year(FY) 2019 Budget dedicated to the opioid crisis, held two opioid summits at the White House, established The President’s Commission on Combating Drug Addiction and the Opioid Crisis (herein referred to as the Commission) via Executive Order in March 2017, and announced his Initiative to Stop Opioid Abuse and Reduce Drug Supply and Demand in March 2018.

While confronting today’s drug crisis to arrest its growth and reduce its effects, we must also further develop the capability, knowledge, and infrastructure to respond to the evolving nature of the drug threat aswemovedeeperintothe twenty-first century.Drug traffickerswill continue toattempttosecure ever-greater profits by expanding their customer base, reducing overhead, and mitigating risks to their supply chains. The exponential growth in the availability and use of synthetic drugs in the United States, especially synthetic opioids like fentanyl and its analogues, provides a window into the likely future of drug use and trafficking. Drug trafficking organizations can avoid the costly process of harvesting illicit crops and producing plant-based drugs by the much cheaper and faster process of chemical synthesis. Potent synthetic drugs can be smuggled across our borders in small quantities that can be more easily concealed than bulkier plant-based drugs. They can also be purchased cheaply on the dark web using cryptocurrencies that provide anonymity, and shipped into the United States through international mail or as express consignment shipments. The combination of low production cost, the anonymity of the darkweb and cryptocurrencies, and drugs with higher potency than plant-based drugs, creates a favorable risk-reward structure that drug traffickers will embrace to an even greater degree in the years to come.

Along with the emergence of the greater availability and trafficking of synthetic drugs, we must also confront an emerging crisis of cocaine availability and use in the United States. The increased cultivation of coca and production of cocaine in Colombia, the source of more than 90 percent of the cocaine in the U.S. market, has once again reached record levels. Moreover, the suspension of aerial eradication programs in Colombia during its peace process, from 2015 until today, has led to even greater yield from coca plants,resulting in increased production and purity levels. Cocaine use in the United States started rising again after many years of decline. From 2016 to 2017, overdose deaths in which cocaine was the primary contributing drug increased 34 percent according to the CDC, and the National Survey of Drug Use and Health (NSDUH) shows that in 2017 past-month users of cocaine aged 12 and above increased from 1.9 million Americans to 2.1 million and new initiates to cocaine use increased to 1 million, averaging approximately 2,800 per day

Given the current drug crisis facing America, and the President’s priorities, this Strategy adopts a strong bias toward action. It focuses on leveraging our understanding of the complex interplay between the availability of drugs in the U.S. market and their use, anticipating changes in the drug environment in both the public health and law enforcement domains, and adapting our actions to seize the initiative to make lasting progress against this historic challenge. The global drug trafficking enterprise is vast, dynamic, and adaptable, but it is not without vulnerabilities. It is only through a unified effort in which the Federal government works with, and in support of, creative and resourceful individuals and organizations across the country, that can we address this complex national security, law enforcement, and public health problem.

United States national drug control strategy - 2019

By Sedona Sweeney, Zoe Ward, Lucy Platt, Lorna Guinness, Matthew Hickman, Vivian Hope, Lisa Maher, Jenny Iversen, Sharon J. Hutchinson, Josie Smith, Rachel Ayres, Ingrid Hainey & Peter Vickerman


To evaluate the cost‐effectiveness of needle and syringe programmes (NSPs) compared with no NSPs on hepatitis C virus (HCV) transmission in the United Kingdom.


Cost‐effectiveness analysis from a National Health Service (NHS)/health‐provider perspective, utilizing a dynamic transmission model of HCV infection and disease progression, calibrated using city‐specific surveillance and survey data, and primary data collection on NSP costs. The effectiveness of NSPs preventing HCV acquisition was based on empirical evidence.


UK settings with different chronic HCV prevalence among people who inject drugs (PWID): Dundee (26%), Walsall (18%) and Bristol (45%)


Current NSP provision is compared with a counterfactual scenario where NSPs are removed for 10 years and then returned to existing levels with effects collected for 40 years.


HCV infections and cost per quality‐adjusted life year (QALY) gained through NSPs over 50 years.


Compared with a willingness‐to‐pay threshold of £20 000 per QALY gained, NSPs were highly cost‐effective over a time‐horizon of 50 years and decreased the number of HCV incident infections. The mean incremental cost‐effectiveness ratio was cost‐saving in Dundee and Bristol, and £596 per QALY gained in Walsall, with 78, 46 and 40% of simulations being cost‐saving in each city, respectively, with differences driven by coverage of NSP and HCV prevalence (lowest in Walsall). More than 90% of simulations were cost‐effective at the willingness‐to‐pay threshold. Results were robust to sensitivity analyses, including varying the time‐horizon, HCV treatment cost and numbers of HCV treatments per year.


Needle and syringe programmes are a highly effective low‐cost intervention to reduce hepatitis C virus transmission, and in some settings they are cost‐saving. Needle and syringe programmes are likely to remain cost‐effective irrespective of changes in hepatitis C virus treatment cost and scale‐up.

Evaluating the cost‐effectiveness of existing needle and syringe programmes in preventing hepatitis C transmission in people who inject drugs

By FIDH - International Federation for Human Rights

Thailand’s prison population has steadily increased over the years and the country has the dubious distinction of having the largest prison population and the highest incarceration rate among Association of Southeast Asian Nations (ASEAN) member states.

For more than a decade, United Nations (UN) human rights mechanisms have expressed concern over prison conditions in Thailand. Regrettably, successive Thai governments have failed to make any progress in the implementation of the UN’s recommendations and to uphold their own commitments to improve prison conditions. In addition, since the 2014 military coup, Thailand’s junta has enforced measures that have caused conditions in the prisons to deteriorate. The junta also increased the use of military facilities to detain civilians.

As documented in this report, Thailand’s ongoing failure to enact a comprehensive prison reform has created conditions for human rights violations to be rife in its prison system in breach of the country’s obligations under international instruments to which it is a state party

The Thai Department of Corrections’ motto, ‘Caring Custody, Meaningful Rehabilitation, International Standard Achievement’,1 could not be further from the reality of the Thai prison system. Research conducted by FIDH and UCL on two large prisons in Bangkok suggests that Thailand’s prison conditions fail to meet international standards and to create an environment conducive to the rehabilitation of prisoners.

Overcrowding remains the most pressing issue in Thai prisons. Thailand’s average yearly prison population has steadily increased over the years and, aside from the periodic royal amnesties, no other effective and sustainable measures have been adopted to significantly reduce the population. Based on a standard to provide a surface area per prisoner of 2.25m2 , available official statistics representing 74% of Thailand’s prisons and 91% of its overall prison population show that these prisons are operating with a prison population of more than double the intended capacity – with an occupancy level of 224%.

Inadequate access to medical treatment, insufficient food and potable water, and poor sanitation facilities continue to plague the prisons examined in this report. It is likely that similar conditions exist in other prisons across Thailand. Medical care and special arrangements for pregnant women are particularly lacking. Prisoners are often subjected to exploitative labor practices characterized by harsh working conditions and insufficient remuneration. Punishment in prisons contravenes international standards and, in some cases, may amount to torture and ill-treatment. Prisoners’ statements indicate that restraining devices, such as shackles, have been excessively used. Finally, inmates have reported unreasonable restrictions placed on visits and correspondence with family and friends. While procedures for making complaints exist, prisoners are afraid to lodge complaints out of fear of retaliation at the hands of prison officials.

The situation has not improved since the 22 May 2014 military coup. Under the National Council for Peace and Order (NCPO) access to prisons has become more difficult. In addition, based on interviews with former prisoners and families of current inmates, FIDH and UCL were able to document that prison authorities have enforced stricter prison regulations and further curtailed prisoners’ rights. Of particular concern is the increased use of military bases to detain civilians, which do not afford detainees many of their basic rights. The use of the Nakhon Chaisri temporary detention facility inside the 11th Army Circle base in Bangkok illustrates this trend. Since the establishment of Nakhon Chaisri less than two years ago, there has been a lack of access for independent monitors, two custodial deaths, and allegations of torture have surfaced.

This report recommends numerous measures to improve detention conditions, including providing independent inspection bodies unfettered access to all prisons and allowing non-governmental organizations with a relevant mandate to conduct visits to places of detention, interview inmates, and assess conditions without undue hindrance.

Behind the walls: A look at conditions in Thailand’s prisons after the coup 

By David Stuart and Ignacio Labayen De Inza

If you feel a person is too high on G, what can you do? Firstly, what does “too high” mean? Respecting a person’s autonomy over their own actions, choices, behaviour is very important; even if that behaviour might manifest as (what you believe to be) not in their best interests. But; if their behaviour suggests that they might acutely harm themselves or others, or that they might not be able to consent to things that are currently happening/about to happen – you might choose to intervene. Of course there is a difficult judgment call here. Are they upright, or mobile? When you speak to them do they respond, or acknowledge you? If so, there are some dos and don’ts and suggestions here. (If they are completely nonresponsive, there is a section below about what to do; pages 5 and 6). Don’t induce vomiting.

Although there is a logic to forcing a potentially fatal dose of GHB/GBL out of the stomach by vomiting, it carries other risks to do with aspiration, breathing, infection of the lungs, choking. Vomiting can be a helpful thing when the body does it naturally (and that should never be prevented if it occurs), but forcing a vomiting episode upon oneself (or someone else) is a violent thing to do to the stomach, oesophagus and airway, and is not advised in a chemsex environment. Call an ambulance; in London, an ambulance can be with you in approximately eight minutes guaranteed. Tell the telephone operator that the person has ingested a potentially fatal dose of a toxin. Don’t give them any more drugs; one myth is that giving them a stimulant (eg, methamphetamine, cocaine or mephedrone) can be helpful; this isn’t true, and just adds to the toxicity that is causing the problem in the first place. (Even if this method seems to have worked in the past, don’t do this; the negative consequences outweigh the positive consequences, so best not. Giving the person more drugs will increase the person’s toxicity, and it is toxicity that is causing the problem; it is more likely to complicate the situation. Simple rule of thumb; don’t give a person who is too high, more drugs.

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