By Frankfurt University of Applied Sciences

This work is a product of the project “My first 48 hours out – comprehensive approaches to pre and post prison release interventions for drug users in the criminal justice system”. The project, led by the Frankfurt University of Applied Sciences/Germany, received funding from the European Union for the period 2017-2018. It aims at addressing the gaps in the continuity of care for long-term drug users in prison and upon release, by supporting life-saving interventions for the prevention of overdoses and reduction of other risks related to drug use and for the establishment of a treatment path, which does not get interrupted upon release. For prisoners with a history of drug use, in particular opioid use, the risks related to drug use, in particular overdose and death are extremely high in the immediate period after release due to high rates of relapse and lower opioid tolerance. Much still needs to be done in order to ensure that people with a history of drug use are sufficiently cared for, when released from prisons. Harm reduction measures need to be in place for ex-prisoners to be able to readjust to freedom without relapsing back into problematic drug use and extreme risk of fatal overdose when released. The immediate time after release (“my first 48 hours out”) is a critical time for action, when the cooperation between prisons, healthcare providers and NGOs is key in ensuring continuity of care and where targeted interventions can save lives from overdose and build a path towards engagement into further treatment and rehabilitation for people who use drugs. Among other actions, the project wants to promote the implementation of life saving interventions in prison and upon release with specific reference to harm reduction, overdose prevention and the use of naloxone programmes. This is a key priority to be addressed by both policy makers and practitioners in European countries. The current work aims at producing hands-on guidelines for policy makers and practitioners from prison health services on how to promote, initiate and manage interventions related to overdose prevention through naloxone programmes and related training and capacity building.

Naloxone-on-Release: Guidelines for naloxone provision upon release from prison and other custodial settings

Globally, law enforcement officers have grown increasingly frustrated with the limited effectiveness of traditional drug enforcement approaches that find them arresting or imprisoning individuals without significant impact on illicit drug trade or use. This is a briefing for law enforcement personnel around the world on how to incorporate, support, and create space for approaches that aim to increase public safety and health, reduce harm to people who use drugs, and provide law enforcement alternatives to common punitive models.

Police & harm reduction 

By Minister for Health of Ireland, Simon Harris

The Minister for Health Simon Harris on Tuesday published a new online repository of information on medical cannabis on the Department of Health’s website. The repository provides detailed information for doctors and patients on the existing Ministerial medical cannabis licence scheme, the Medical Cannabis Access Programme currently under development, and relevant legal and policy overviews on wider medical cannabis issues.

The following information is for healthcare professionals, patients and others who are interested in finding out more about cannabis for medical use. It will discuss current and proposed access to potential cannabis treatment and describe the legal and policy status of cannabis. It also describes the Minister for Health’s role in relation to access to cannabis for medical use, as provided for in the Misuse of Drugs Acts 1977-2016 and in line with expert clinical and scientific advice. Cannabis and cannabis-based products which do not have a marketing authorisation are not medicines as defined under national and European legislation. As such, they are not subject to the same rigorous safety, quality and efficacy standards that are in place for medicines, nor are the producers subject to the same responsibilities as the marketing authorisation holders for authorised medicines. This document refers only to cannabis for medical use. Other matters related to cannabis including recreational use, decriminalisation, non-medical research, manufacturing, growing/producing cannabis or any other cannabis-related matters should be considered separate and distinct from the information below.

Cannabis for medical use

In November 2016, Proposition 64 was passed in California allowing for the legalization of recreational cannabis use. The measure came into effect on January 1, 2018 with California joining 28 other US states that have legislated for the medical and/or recreational use of cannabis. Cannabis legalization in California is expected to generate $3.7 billion in sales in 2018, but requires policy initiatives to mitigate potential negative environmental impacts. California is in a unique position to create a sustainable cannabis industry.

The environmental impacts of the legalisation of  cannabis in California

By Hannah Fraser, Christinah Mukandavire, Natasha K. Martin, David Goldberg, Norah Palmateer, Alison Munro, Avril Taylor, Matthew Hickman, Sharon Hutchinson, Peter Vickerman

To reduce hepatitis C virus (HCV) transmission among people who inject drugs (PWID), Scottish Government‐funded national strategies, launched in 2008, promoted scaling‐up opioid substitution therapy (OST) and needle and syringe provision (NSP), with some increases in HCV treatment. We test whether observed decreases in HCV incidence post‐2008 can be attributed to this intervention scale‐up.

Most of the decline in hepatitis C virus (HCV) incidence in Scotland between 2008 and 2015 appears to be attributable to intervention scale‐up (opioid substitution therapy and needle and syringe provision) due to government strategies on HCV and drugs.

Click here for limited access to the full report

Modelling the impact of a national scale-up of interventions on hepatitis C virus transmission among people who inject drugs in Scotland

By Richard A. Grucza, Mike Vuolo, Melissa J. Krauss, Andrew D. Plunk, Arpana Agrawal, Frank J. Chaloupka, Laura J. Bieru

A number of public health professional organizations support the decriminalization of cannabis due to adverse effects of cannabis-related arrests and legal consequences, particularly on youth. We sought to examine the associations between cannabis decriminalization and both arrests and youth cannabis use in five states that passed decriminalization measures between the years 2008 and 2014: Massachusetts (decriminalized in 2008), Connecticut (2011), Rhode Island (2013), Vermont (2013), and Maryland (2014).

The results showed that marijuana use and arrests in the five states that have decriminalised marijuana have not shown a corresponding rise in drug use amongst young people.

Cannabis decriminalization: A study of recent policy change in five U.S. states

This bulletin summarises data from a nationally representative survey of Australians (The National Drug Strategy Household Survey) which asks people their opinions about the legal status of drug in 2016. We differentiate what Australians think about “legalisation” versus “decriminalisation” for four different types of drugs (cannabis, ecstasy, heroin and meth/amphetamine) across three survey years: 2010, 2013 and 2016. We also explore how the Australian public think money should be directed in responding to illicit drugs.

Support for decriminalisation and legalisation has grown in Australian between 2010 and 2016, particularly for cannabis

As of 2016 there is strong public support amongst Australians for decriminalisation of possession for personal use of all illicit drugs: 50-78% support such actions

Echoing this trend there has been growing public support to invest in treatment and education not law enforcement

Similar trends are observed in most parts of Australia.

What does the research evidence tell us about what Australians think about the legal status of drugs? A 2018 update

Instalações supervisionadas de consumo de drogas visam reduzir os riscos agudos de transmissão de doenças através de injeção não higiênica, prevenir mortes por overdose relacionadas a drogas e conectar usuários de drogas de alto risco com tratamento de dependência de drogas e outros serviços de saúde e sociais. Mais informações, em inglês, estão disponíveis abaixo.

 Salas de consumo de drogas: uma visão geral da provisão e evidência

By Fernanda Palhano-Fontes,Dayanna Barreto, Heloisa Onias, Katia C. Andrade

In a recent open-label trial, 17 patients with major depressive disorder attended a single dosing session with ayahuasca. Depression severity was assessed before, during and after dosing, using the Hamilton Depression Rating scale (HAM-D) and the Montgomery–Åsberg Depression Rating Scale (MADRS) (Sanches et al., 2016). Significant reduction in depression severity was found already in the first hours after dosing, an effect that remained significant for 21 days (Osório et al., 2015; Sanches et al., 2016). Although promising, these studies have not controlled for the placebo effect, which can be remarkably high in clinical trials for depression, reaching 30–40% of the patients (Sonawalla and Rosenbaum, 2002). To address this issue, and to further test the antidepressant effects of ayahuasca, we conducted a randomized placebo-controlled trial in patients with treatment-resistant depression. Additionally, we explored for correlations between the antidepressant and the acute effects of ayahuasca.

Rapid antidepressant effects of the psychedelic ayahuasca in treatment-resistant depression: a randomized placebo-controlled trial

Harm reduction programmes in Indonesia have been officially recognised and in operation since 2007, beginning with their implementation in primary-level healthcare facilities. Harm reduction programmes differ from the majority of drug rehabilitation programmes in Indonesia, with the latter focussed on the achievement of abstinence. From when they were established in the late 1990s, rehabilitation programmes in Indonesia typically adopted the approach of setting behavioural change and abstinence from drug use as the only goals. No compromise on these goals were allowed in determining a client’s successful completion of a rehabilitation programme. Harm reduction on the other hand, refers to a set of policies, programmes and practices aimed primarily at reducing the harms associated with drug use, which could range from health, social to economic harms, without necessarily focussing on ending drug use.

This policy paper is based on an analysis of data and evidence produced from a desk review of literature, and focus group discussions and in-depth interviews with clients who have undergone both types of programmes: abstinence-based rehabilitation programmes, and those integrated with harm reduction services in Indonesia. The paper concludes with recommendations for the Indonesian government to implement policy reforms that enable the integration of harm reduction measures into drug rehabilitation programmes.

Integration of harm reduction into drug rehabilitation programmes in Indonesia

Both the range of drugs and drug markets are expanding and diversifying as never before. The findings of this year’s World Drug Report make clear that the international community needs to step up its responses to cope with these challenges. We are facing a potential supply-driven expansion of drug markets, with production of opium and manufacture of cocaine at the highest levels ever recorded. Markets for cocaine and methamphetamine are extending beyond their usual regions and, while drug trafficking online using the darknet continues to represent only a fraction of drug trafficking as a whole, it continues to grow rapidly, despite successes in shutting down popular trading platforms. Non-medical use of prescription drugs has reached epidemic proportions in parts of the world. The opioid crisis in North America is rightly getting attention, and the international community has taken action. In March 2018, the Commission on Narcotic Drugs scheduled six analogues of fentanyl, including carfentanil, which are contributing to the deadly toll. This builds on the decision by the Commission at its sixtieth session, in 2017, to place two precursor chemicals used in the manufacture of fentanyl and an analogue under international control.

2018 World Drug Report

By Emily Tweed, with Rebekah Miller and Catriona Matheson

Drug-related deaths have increased significantly in Scotland in recent years. Although men still account for the majority of cases, over the last 10 years the percentage increase in deaths among women has been much greater than among men. This report draws on routine data, published research, conversations with professional stakeholders, and interviews with women with lived experience of problem drug use to examine potential explanations for this phenomenon, and to identify priority areas for future work. The evidence reviewed as part of this project indicates that the observed trend is likely to reflect multiple, interacting causes. Most data sources indicate that the number of women in Scotland with problem drug use is declining, suggesting the increase in deaths is unlikely to be due to an increase in the size of the population at risk. However, some concerns were raised about a potential group of people at risk who may be less likely to be identified through existing routine data sources and by clinical services, particularly older women using prescription drugs: this possibility may merit further investigation. The same data sources indicate that the average age of people who use drugs in Scotland is increasing, and there is some evidence that this trend might be more marked among women than men. Some studies have found that the increase in drug-related death risk associated with increasing age may be more pronounced among women than among men, which may contribute to the rising rates of deaths observed.

Publications