The recent World AIDS Day took place on the 1st December 2017 and was focused on the campaign against stigma. INCB’s own contribution to the events was appropriate to this objective, centred as it was on the right to health. Reaffirming that the ultimate goal of the drug control conventions was the promotion of the health and wellbeing of human kind, the Board reminded States Parties of their obligation to ‘ensure the availability of narcotic drugs and psychotropic substances for medical and scientific purposes, while preventing their illicit cultivation and manufacture, diversion, trafficking and abuse’. It went on to highlight the global imbalance in access to medicines containing controlled drugs: around three quarters of the global population lack adequate access to pain relief.

The INCB notes that article 38 of the 1961 Single Convention refers to drug use prevention, as well as to treatment and rehabilitation. It also points to the importance of preventing transmission of the HIV virus amongst people who inject drugs. The Board goes on to state that – ‘The right to health of individuals dependant on opioids directly relates to the availability and non-discriminatory access to treatments, including opiate substitution therapy with internationally controlled substances, such as methadone and buprenorphine.’

It closes with a call on governments to end AIDS through prevention and treatment, and through overall respect for people living with HIV and AIDS.

This is a very laudable sentiment, with which IDPC in principle cannot but agree. However, we note the Board’s description of health and welfare as the 

 objective of the conventions with a degree of reservation. It should be recalled that these must be also the 

goal of the drug control regime, here and now. After all, it of little use if one has a set of lofty principles which are remote from actual practice on the ground. To this end, we hope that the Board reiterated its call on governments during its mission to the Russian Federation, undertaken just days after World AIDS Day. For the Russian Federation is notorious in its abrogation of the human rights of people who use drugs, including AIDS patients, and its banning of Opioid Substitution Treatment. We await with interest, therefore, the INCB’s report on the mission in the next Annual Report.

World AIDS Day 2017

In March 2017, the Commission on Narcotic Drugs (CND) adopted Resolution 60/1 in which it called on the UNODC to ‘strengthen and streamline its existing data-collection and analysis tools’. The key tool for collecting data on drug control is the Annual Report Questionnaire (ARQ), a long set of questions sent to all countries so that they can report back on progress made in addressing the illicit drug market. The responses received form the basis of the UNODC’s annual flagship publication – the World Drug Report.

This begs the question – what data is UNODC actually collecting? The latest iteration of the ARQ dates back to 2010, when it was amended to reflect the contents of the 2009 Political Declaration and Plan of Action on drugs. The 2009 Political Declaration had set 2019 as the target date to eradicate or reduce measurably the scale of the illicit drug market. Unsurprisingly, the current ARQ focuses mainly on measuring progress made towards the eradication of illicit drug cultivation, production, manufacture, trafficking, sale and use – with little to no attention given to the consequences of such a strategy on affected communities.

The 2016 UNGASS has been a key opportunity to reshape the debate around drug control at the UN – enabling space for discussions on the severe impacts of repressive drug policies on health, human rights and development. As the UNODC is embarked in reviewing the ARQ, it is therefore vital that all the key aspects of the UNGASS Outcome Document are adequately reflected in the new data-reporting mechanism provided to UN member states. This is all the more important as governments will soon be meeting in March 2019 to discuss their drug control strategy for the next decade.

The UNODC will hold an expert consultation to review the ARQ in late January. Although IDPC can only welcome the process of updating the ARQ, there are some critical issues that the Consortium wished to highlight ahead of the meeting (to which civil society was unfortunately not invited). In particular, the UNODC should provide sufficient space for experts to discuss the inclusion of human rights indicators in an updated ARQ, as well as consider other critical issues, such as gender, alternatives to coercive sanctions, harm reduction, and access to controlled medicines to name a few – all of which are incorporated in the UNGASS Outcome Document. Ito highlight these concerns, IDPC drafted a 

 to the UNODC on behalf of our 176 members and Harm Reduction International. The letter also called for better synergy in data collection across all relevant UN agencies, as well as improved civil society participation in the ARQ review process. The letter was accompanied by an 

 with detailed recommendations on how to improve the current ARQ.

IDPC was delighted to receive a response from the UNODC Research and Trends Analysis Branch, in which UNODC welcomed the letter, and offered to share it, along with its Annex, to the participants of their January meeting. The UNODC response ends with a commitment from UNODC to request for additional consultations to the CND Chair so that ‘further opportunities may be identified to ensure involvement of civil society in the technical process to review the ARQ’. The Consortium stands ready to further support the UNODC on this complex but much needed endeavour.

Evaluating global drug control: Reviewing our goals and how we measure progress against them

Drug policy reform in Thailand kicked off early in 2017 with 

 that reduced the conflation of possession and supply offences. The prosecution now must produce sufficient evidence to demonstrate the culpability of people accused of selling/producing illicit substances. At the same time, the overall length of sentences for drug offences was reduced, a welcome and much-needed change in a context of soaring prison population.

More reforms were widely expected, as the military regime mulled substantial changes to the country’s drug policy. Indeed, under the leadership of the Office of the Narcotics Control Board (ONCB), a number of multi-stakeholder discussions underscored the need to shift towards a health-orientated approach. These conversations contemplated the possibility of removing prison penalties for drug use and a strengthening the involvement of the Ministry of Health in the national drug strategy.

The final package of amendments, contained in the 

, remains to be revealed. It is expected that a public consultation on the proposed legislation will take place in early 2018, with a view to finally adopt the new policy in late 2018.

In parallel to governmental efforts, communities of people who use drugs and harm reduction advocates have been working together to draft 

. The bill would enhance the participation of civil society in the implementation of the country’s drug strategy. Crucially, it would create a legal framework for civil society to provide services (e.g. harm reduction) without the fear of criminal liability. The drafting process will continue in 2018, and the bill will have to collect 50,000 signatures for its consideration.

2017 also saw ongoing discussions within the Thai government to 

 on specific prohibited substances, as reported in a press release dated 17 August 2017 by the ‘Sub-Committee on Research and Development of Policies Regulating and Controlling Methamphetamine’. Although the Sub-Committee’s recommendations are not legally binding, their advisory role feeds into the work of the drug control agency. The following recommendations of the Sub-Commmitee have been adopted and some have entered a piloting phase:

: the Sub-Committee supports the enactment of the Ministerial Regulation (in force as of 6 January 2017) under sections 6, 26 and 62 of the Thai Narcotics Act 1979, whereby hemp is allowed to be manufactured and possessed as a commercial crop.

: the Sub-Committee appeared to consider that it should remain scheduled as a type 5 narcotic under the country’s Narcotics Act, but to permit exceptions for its personal use and cultivation for personal use (up to three plants per household) in accordance with traditional practice in the Nasarn district, Surattani Province. However, the mixing of kratom with other substances (e.g. cough medicine) for consumption will not be permitted.

 the sub-Committee made no recommendations to change the scheduling of cannabis as a type 5 narcotic, but the substance can be the subject of research under strict conditions. 

From January 2018, there have been reports in local news outlets about the possibility of a medical cannabis system being implemented by the government. Whether this plan will come to fruition, the conversation reflects a buoyant ongoing national debate on drug policy reform. 

Thumbnail: Ahmad Fuad Morad Mitragyna speciosa (Korth.) Havil. 

A sprint through a year of drug policy developments in Thailand

By Rodan Mecano, Associate Director for the Universal Healthcare Lab, Civika, Philippines

Since the declaration of the War on Drugs by President Rodrigo Duterte, the Philippines has faced increasing international scrutiny. A growing death toll, estimated to be between 3,000 and 12,000 people, has resulted from violence related to the anti-drug efforts. Individuals began to turn themselves into the authorities in order to escape the possibility of death. The national government, overwhelmed by the sheer number of “drug surrenderees”, has scrambled to build upon their initial fragmented response. Community-based drug rehabilitation programs implemented by local government units, NGOs, and churches have begun to address gaps in care. Overcrowded jails and an inundated criminal justice system point to the need to recalibrate policies, anchoring the response to illegal drugs in a health-centered, and not criminal-centered, approach.

 organised a regional training workshop in Malaysia in September, inviting 31 delegates from across the ASEAN region. It aimed to provide an introduction to the concepts of harm reduction and access to justice for people who use drugs. From the perspective of a Philippine delegate, the workshop proceedings addressed two gaps that are found in the country’s community-based drug rehabilitation movement – education and a unified understanding.

A health-centred approach acknowledges that people who experience difficulties related to their drug use should be able to access support and care services

. But it also allows to understand how not every person using drugs will need help. When this point is delivered by skilled facilitators with a history of drug use, it is particularly powerful. Harm reduction concepts are not widely popular in the Philippines and this is reflected by current policies. The Philippines is a country where the stigmatisation of persons using drugs is widespread. In countries where community-based initiatives are just emerging, educating the public is imperative for the creation of policies that support harm reduction.

Through collaboration and discussion, delegates gained a broader awareness of the current situation of the drug issue at both the local and international level. 

While the Philippines has dominated the international headlines, it is not the only country in the ASEAN region that is currently faced with similar challenges

. In an era of globalisation, we can draw ideas from the lessons learned in countries such as Malaysia and Thailand. Similarly, discussions on the local context between the Philippine delegates highlighted the need for information sharing. With individuals from a myriad of organizations and backgrounds, not everyone had access to the same information on the current status of the anti-drug campaign in the Philippines. In addition, varying levels of expertise on the concepts of harm reduction made the workshop discussion engaging and informative. As a platform for candid discussion, the workshop promoted an atmosphere where delegates could attempt to reach a mutual understanding.

The Philippines moves towards a critical pivot point as recognition of community-based initiatives continues to grow. The creation of policies that support a continuum of treatment and care for people who use drugs is the next step. In that sense, the 

Introduction to Harm Reduction and Drug Policy Advocacy & Access to Justice for People Who Use Drugs

 regional training workshop came at the perfect time.

Building support for community-based responses to drug use in the Philippines 

From 20 to 24 November 2017, the INCB President visited the Russian Federation to assess how the country is implementing its obligations under the international drug control treaties. Disappointingly, it seems that the INCB only met with NGOs focusing in the areas of drug prevention and rehabilitation, and failed to discuss drug policy with NGOs focusing on harm reduction.

The lack of access to harm reduction is a critical issue in a country where methadone continues to be prohibited and the distribution of clean needles continues to be controversial. HIV prevalence among people who use drugs in Russia has increased exponentially in the past five years, and will continue to do so unless the Russian government reviews its overly prohibitionist approach to drug control, and stops cracking down on harm reduction service providers. It is our hope that these issues will be duly reflected in the INCB Annual Report for 2018.

Below is a short article published by the INCB on the visit.

An INCB mission visited the Russian Federation from 20 to 24 November 2017. The mission was carried out byProfessor Viroj Sumyai, President of the International Narcotics Control Board, accompanied by Ms. Beate Hammond of the INCB secretariat. The objective of the mission was to review the implementation of the international drug control treaties by the Russian Federation and to examine drug control developments since the last mission of the Board in 2005.

The mission, which was organized by the Ministry of Foreign Affairs, held consultations with several high-level officials of the Russian Federation, including the Deputy Minister of Foreign Affairs, the Deputy Minister of Health, the Deputy Minister of Industry and Trade and the Chief of the Ministry of Internal Affairs General Administration as well as senior officials from these authorities. The mission visited the Moscow Endocrine Plant, a state-owned manufacturer of pharmaceutical preparations as well as facilities which provide emergency care, treatment, counseling and rehabilitation of drug users. In addition, the mission met with non-governmental organizations (NGO) active in the area of drug prevention and rehabilitation and visited a therapeutic community operated by an NGO.

The findings of the mission are expected to be reviewed by the Board at its forthcoming session in February 2017 and will be reflected in the INCB Annual Report for 2018, to be released in March 2019.

INCB mission: Russia's implementation of the UN drug conventions

On 20-22 November 2017, the INCB sent a delegation to Switzerland to discuss its drug policy and the country's implementation of the UN drug conventions.

Switzerland's drug policy has been praised for its balanced approach towards drug control, as reflected in its four-pillar policy focusing on prevention, treatment, harm reduction and law enforcement. The country is also known for its innovative approaches towards drugs, including the early opening of safe injection facilities, heroin-assisted treatment programmes and - in some cantons - discussions on pilot programmes for the legal regulation of cannabis. We therefore welcome the INCB's visit of drug injection facilities and its engagement with the NGO Contact Foundation.

The INCB's position on safe injection facilities has evolved positively over the years, with a significant shift in favour of this harm reduction approach in its Annual Report for 2016. We hope that future INCB missions will continue to visit life-saving harm reduction facilities and reflect the positive impacts of these interventions on the health and social welfare of people who use drugs in its future Annual Reports.

Below is a short article published on the INCB website about the mission.

An INCB mission visited Switzerland from 20 to 22 November 2017. The mission was conducted by Dr. Galina Korchagina, Member of the Board, accompanied by Ms. Ha Fung NG (Cilla) of the INCB secretariat. The objective of the mission was to discuss the implementation by Switzerland of the three international drug control conventions and to review drug control developments in the country regarding the implementation of the international drug control conventions since the Board's last mission in 2000.

The mission, which was coordinated by the Federal Office of Public Health, held consultations with the directors and senior officials of the Federal Office of Public Health, Swissmedic, Foreign Affairs, Federal Police and Cantonal Police Berne. Meetings with members of Federal Commission on Addiction and NGO representatives were also held. The mission also visited a company manufacturing internationally controlled substance and the drug injection facilities provided by the NGO "Contact Foundation" in the Canton of Berne.

Discussions focused on latest developments in drug control situation in Switzerland, trafficking and abuse of narcotic drugs, psychotropic substances and control precursor chemicals, and measures taken to address them, as well as challenges regarding access and availability of substances under international control for medical purposes.

The findings of the mission will be considered by the Board at its session in February 2018, transmitted to the Government, and reflected in the INCB Annual Report for 2018, expected to be released in March 2019.

INCB visits safe injection facility during its mission in Switzerland

This article was first published on the Blog of the West Africa Civil Society Institute (WACSI).

By Charles Kojo Vandyck and Chamrid Kpadonou

Drug trafficking has become a visible threat to governance and development in West Africa. The region is increasingly becoming a hub in the global drug trade and a transit point for narcotics from Latin America through to Europe. Organized crime syndicates are also operating in West Africa with substantial increases in local drug production especially methamphetamines.

West Africa is no longer just a transit zone for drugs from Latin America to Europe. Local production and drug use continue to be major issues. This situation poses a threat to good governance, peace and stability, economic growth and public health in a region that has only recently emerged from decades of violent conflict.

In response to these growing threats, Kofi Annan, former UN Secretary General, convened the West Africa Commission on Drugs (WACD). After eighteen months of research, consultations, and visiting some of the most affected countries and communities in the region, the Commission released their flagship report in June 2014, including a series of evidence-based recommendations for drug policies across the region.

The report suggests that policies crafted to combat the phenomenon must be firmly rooted in the public health sphere. Therefore, removing criminal sanctions for drug use is one of the most effective ways to reduce drug-related harms, to facilitate access to treatment, and to free up resources for law enforcement to focus on more selective deterrence and targeting of high-value traffickers.

The report also recommended that there was the need for more systematic collaboration between West African states and civil society in the fight against drugs. However, civil society in the region lacked the necessary expertise to make a meaningful contribution to the effort.

This situation led to the creation of the West Africa Drug Policy Network (WADPN), which advocates for evidence-based drug policy reform that seeks to reduce harm, protect public health and human rights, and educate the public on the impact of drug trafficking and abuse in the region.

In preparation for the United Nations, General Assembly Session (UNGASS) on the world drug problem that took place in April 2016, West Africa Drug Policy Network organized a series of National Multi-Sectoral meetings on drug policy reform in three target countries; Benin, Senegal and Ghana, to shape discourse among key stakeholders in these countries from relevant public-sector institutions. The national meetings culminated in a regional consultation that shaped and consolidated a West Africa position for UNGASS.

The network’s engagements have translated into action with the new Ghana Narcotics Commission Bill, which is due to be presented before parliament before the end of 2017. Under the prospective legislation, people will not face criminal sanctions for possessing drugs for personal use. If the law passes, Ghana will become the first Sub-Saharan country to decriminalize personal drug use and possession.

However, during these engagements, it became clear that there was a need to develop standards and guidelines for new drug laws within the region based on evidence to support advocacy and policy influencing efforts. It is within this context that the West Africa Commission on Drugs (WACD) and the International Drug Policy Consortium (IDPC) conducted a desk review of existing drug legislature from the fifteen (15) ECOWAS countries (Benin, Burkina Faso, Cabo Verde, Côte D'Ivoire, the Gambia, Ghana, Guinea, Guinea Bissau, Liberia, Mali, Niger, Nigeria, Senegal, Sierra Leone and Togo), as well as Mauritania and Morocco. The report highlighted the punitive nature of the current legislation in the region and the current discrepancies with the sentencing regime in the region. For example, in Benin, drug supply, trafficking and production is punishable by 5-10 years prison sentence; however, in Mauritania drug supply is punishable by 15-30 years prison sentence and the death penalty for repeat offenses.

This mapping report served as baseline for a 2-day expert workshop on a model drug law for West Africa. The workshop was organised by the West Africa Commission on Drugs (WACD) in collaboration with the West Africa Civil Society Institute (WACSI) with support from the Open Society Initiative in West Africa (OSIWA) and the Global Commission on Drug Policy (GCDP). The workshop interrogated the findings of the mapping exercise and strategized on the way forward. The meeting provided an opportunity for stakeholders within the drug policy space to intervene and proactively shape a model drug law that responds to the particularities of the region. According to experts an effective model drug law should take into cognisance and leverage on current initiatives by institutions such as ECOWAS and the UNODC. It is also noteworthy to emphasize that the work already done by the WACD and ongoing reform efforts in Senegal and Ghana can be used as a foundational framework.

During the meeting, experts agreed that a regional model drug law must be responsive to the major challenges government will face as they implement reforms. The law should define an effective approach to ensure that various government ministries, departments and agencies responsible for drug control work in tandem with other non-state actors. Other issues that need to be addressed are access to essential medicines for palliative care and pain relief, access to treatment for problematic users, provisions to enable harm reduction, alternatives to criminal sanctions for possession for personal use and a proposed integration with existing frameworks and existing models, e.g. ECOWAS model law for money laundering.

It has become apparent that a comprehensive model drug law for West Africa is an important step to advancing drug policy reform efforts and sustainable development goal three (SDG-3) that seeks to ensure healthy lives and wellbeing for all. Therefore, efforts to harmonise drug laws within the region must be given the necessary support by governments and non-state actors. These efforts can only bear fruit if there is cross-border multi-sectoral support from governments and drug policy stakeholders within the region.

Charles Kojo Vandyck is Head of Capacity Development at the West Africa Civil Society Institute (WACSI).

Chamrid Kpadonou is Project Coordinator (Drug Policy) at WACSI.

Reforming drug control in West Africa through a model drug law

Today, on World AIDS Day, we call on governments, communities and families to stand with people living with HIV. Taking this stand means acting to protect the dignity and value of every life. This means not attacking nor marginalising people in situations of vulnerability; including gay men and other men who have sex with men, sex workers, transgender people and people who inject drugs. It also means ending the war on drugs, which continues to rage in many parts of the world.

This war on drugs is waged with notorious brutality in the Philippines. More than 12,000 people are estimated to have been killed by police and vigilantes in the 16 months since Rodrigo Duterte became President. They were killed because of alleged drug use or dealing, but the circumstances of these executions remain obscured by generalised impunity. Thousands more have been forced to surrender themselves to authorities after being arbitrarily listed as suspects, many of whom are now locked up in inhumane, over-crowded prisons and detention facilities. The threat of mandatory drug testing of students, reinstating the death penalty for drug offences, and reducing the minimum age of criminal responsibility from 15 to 9 still hangs over the country.

On the weekend just passed, Philippines Drug Enforcement Agency (PDEA) officers, accompanied by a camera crew, raided a hotel room and arrested 11 men alleged to be engaged in group sex and drug use. The ‘mug shots’ of all men as well as their names, professions and age were released by the PDEA and widely reported in the media. The fact that one of them was living with HIV was also disclosed, contravening national and international norms, and fuelling virulent attacks on social media.

The drug war normalises stigmatisation and violence against vulnerable groups, subjects people living with HIV to indignity and fear, and fuels HIV transmissions. Indeed, the number of people diagnosed with HIV has risen dramatically in the last 10 years, from 1 person a day in 2008, to 31 in 2017.

A person’s sexual orientation, private life, and HIV status must not be exploited for media sensationalism and political gain. People who use drugs should not be treated as criminals. The HIV epidemic will only subside if the dignity and value of every life is respected and protected. For this to be realised, UNAIDS recommends that governments:

remove punitive laws against vulnerable populations such as men who have sex with men and people who use drugs

take a public health and harm reduction approach to drug use.

It is time to leave behind harmful politics, ideology and prejudice; and prioritise the health and welfare of affected populations, their families and communities. #SupportDontPunish.

In the Philippines and beyond, the war on drugs fuels the HIV epidemic.  Let’s end it.

On November 25, we commemorate the International Day to Eliminate Violence Against Women, which this year takes place under the banner of “Leave No One Behind”. That such a day is taking place this year amidst controversies involving acts of sexual harassment and abuse by prominent male celebrities and other high-profile public figures speaks volumes of the continued, structural, oppression of women worldwide, thirty-six (36) years after the entry into force of the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) in 1981.

While we can only laud the courage of the women speaking out against sexual violence, a large number of women remain invisible and extremely vulnerable to different forms of abuse – Among them, women incarcerated for drug-related offences.

Women make up a small percentage of the global prison population, but the number of women in prison are increasing and at a much faster rate than their male counterparts. Many women in prison are incarcerated for low-level, non-violent drug-related offences, ranging from about 25% in Europe and Central Asia, to as high as two-thirds (2/3) of women in federal prisons across the United States. A Thailand Institute of Justice study shows that a whopping 80% of women in Thai prisons are incarcerated for drug related offenses.

Punitive drug laws and the criminalisation of drug use and possession have resulted in overcrowded prisons, including facilities for women. Many women in prison do not have access to basic health care and other gender-specific services. They are vulnerable to physical and sexual abuse and potentially-fatal infectious diseases. Moreover, the stigma against women incarcerated for drug offences is magnified exponentially by stereotyped ideas on womanhood and femininity, and intersecting forms of discrimination. Women imprisoned for drug use, possession or low-level drug trafficking are often ostracised by their own families and communities, with terribly negative impacts on life outcomes.

As we call for the elimination of violence against women, let us not forget the women who are invisible because they are locked up in prisons. Aside from pushing for the full implementation of universal standards for the treatment of women prisoners, like the Bangkok Rules, we must not lose sight of the main culprit – punitive drug policies that prioritise criminalisation over human dignity.

Thumbnail: Jessamine Bartley-Matthews/Washington Office on Latin America

“Leaving no one behind”? For women incarcerated for drug offences, there is no justice without reform.

At the Lisbon Addictions Conference in October 2017, a team of researchers launched two ground- breaking new global reviews: one looking at the prevalence of injecting drug use and various sociodemographic factors, and the other estimating the global, regional and national coverage of harm reduction services. Both papers have been published in The Lancet and are currently available through open access, to ensure their widespread use and dissemination. They represent long overdue updates to the previous Lancet papers by the former UN Reference Group on HIV and Injecting Drug Use from 2008 and 2010.

After considering tens of thousands of articles, sources and datasets, the headline figures include:

Evidence of injecting drug use found in 179 countries (31 more than in 2008)

A new global estimate of 15.6 million people who use drugs (range: 10.2 – 23.7 million)

An estimated 18% of people who use drugs are living with HIV – with prevalence as high as 25% in Eastern Europe, and 36% in Latin America

More than 50% of people who use drugs globally are living with hepatitis C – and in Eastern Europe this affects two third of people who use drugs

Needle and syringe programmes were available in 93 countries: but with low coverage in most cases

Around 16% of people who inject drugs are receiving opioid substitution therapy

60% of people who inject drugs reported being arrested in the past

The numbers – and particularly the coverage data – are a stark reminder of the continuing funding gap for harm reduction services, despite their increasing acceptance around the world. Reassuringly, the research team found more and better quality data than before, but significant gaps remain (hence the large ranges provided for most of the estimates they have made). Most of the new reports of injecting drug use came from countries in Sub-Saharan Africa: 13 of which reported this behaviour in 2007, compared to 36 in 2017.

Crucially, the research also estimated the global rates of incarceration and arrest of people who inject drugs – identified as two of the main risk factors and “structural barriers” for this population. A staggering 60% of people who inject drugs reported being arrested in the past (equating to more than 9 million people), and just fewer reported being incarcerated. Arrest rates were higher than 90% in the Americas, and the incarceration rate was as high as 82% in the Caribbean and 81% in the Middle East and North Africa. These data show the negative impact that current drug laws are having on this population. As the authors note:

“roughly three in five [people who inject drugs] surveyed globally report exposure to incarceration, where high levels of risk often occur both in terms of drug use and other risks to wellbeing.Prisons often have limited or no health-care services, an issue of importance given that risk of drug withdrawal, suicide, and overdose following prolonged abstinence can all be elevated in that environment”.

“Our data highlight the substantial exposure of [people who inject drugs] to risk environments, suggesting that efforts to reduce harms among [them] also need to address structural and environmental factors”.

Finally, the global estimates for injecting drug use are also notable for being significantly higher than the UNODC data from their World Drug Report 2017 (which reports an estimated 11.8 million people who inject drugs, and a HIV prevalence of 13.1%). While the new Lancet reviews employ a systematic analysis of the available scientific data, the cross-UN estimates are predominantly reliant on self-reporting from governments. This demonstrates the value and need for independent scientific analysis on these issues. It is worth noting that, while the previous 2008 and 2010 reviews were performed under the guise of a UN Reference Group on HIV and Injecting Drug Use, this Group was defunded by the UN soon after. Thankfully, these latest independent reviews were at least part-funded by the Open Society Foundations, the Global Fund, the World Health Organization, UNAIDS and UNODC – due in part to their collective participation in the UN Strategic Advisory Group on HIV and Drug Use (which IDPC currently chairs).

New reviews show global extent of criminalisation among people who inject drugs

0n 7th September 2017, the Ugandan Ministry of Health authorized the Uganda Harm Reduction Network (UHRN) and Community Health Alliance Uganda (CHAU) to pilot needle and syringe programmes (NSP) in a few designated health facilities in the country.

This passage was the culmination of years of work by UHRN and our partner organisations. Although it has long been recognized that Uganda has a problem regarding drug use, unsafe injecting drug use was something that most of the people had limited knowledge about. In Uganda, people who inject drugs are one of the key population groups who together account for about 21% of new HIV infections. Recent studies estimate that HIV prevalence among this group is between 17-20% - much higher than the 6% prevalence in the general population.

Through advocacy by UHRN in partnership with CHAU and other stakeholders, the Government and general public have started recognizing the issue of unsafe injecting drug use in relation to HIV and hepatitis transmission. UHRN and CHAU have engaged with Uganda’s Ministry of Health and the Parliament’s committee for health, culminating with a realization of the need for NSP as a key intervention for strengthening Uganda’s HIV/AIDS response. As a result of several engagement meetings, Standard Operating Procedures (SOPs) are being drafted to allow for a demonstration NSP project in the designated health facilities in Mulago MARPI Clinic, Mbarara Regional Referral Hospital, Mbale Regional Referral Hospital, Gulu Regional Referral Hospital, and Butabika National Referral Hospital in Uganda.

The introduction of these supervised injecting facilities will have a real and positive impact in Uganda, both for people who inject drugs and for the wider community.

Slowly but surely, harm reduction programming is taking shape in Uganda and across the region, and we look forward to working with different partners and stakeholders to give UHRN the necessary support for implementing NSP in Uganda. The struggle continues – Support Don’t Punish!

Keep up-to-date with drug policy developments by subscribing to the IDPC Monthly Alert.

Thumbnail: Support. Don't Punish action, Mozambique

Finally, the Ugandan Government agrees to start harm reduction!

The INCB was once regarded as the ‘dinosaur’ of the international drug control regime, opposed to policy-innovation and unwilling to speak out on human rights issues. However, its has recently condemned the Philippines over its continued acts of violence toward those suspected of involvement in drug-related crimes. The previous President, Mr Werner Sipp, was critical of the Philippines actions.

This year, however, the current INCB President, Professor Viroj, had spoken out on the Philippines as part of his presentation on the ‘International Day against Drug Abuse and Illicit Trafficking’ which takes place each 26 June. However, the recent speech is more explicit and more radical than any previous dialogue.

‘The Board’, states the INCB, ‘is also deeply troubled by allegations that these acts have been condoned and encouraged by senior Government officials’. It goes on to reiterate in ‘the strongest possible terms’ that such extrajudicial responses that drug-related crimes are ‘in clear violation of the international drug control conventions’, and reaffirms its ‘categorical rejection’ of extrajudicial acts of any kind.

The Board reminds the Government of the Philippines of the conventions’ commitment to prevention, treatment, education and aftercare, and to a humane and balanced approach to people who use drugs. The President of the INCB, Dr Viroj Sumyai, calls on the Government of the Philippines to cease immediately perpetrating and supporting acts of violence against those suspected of drug-related crimes and to ensure that due process is fully observed. An equivalent message appeared in the INCB Annual Report.

This statement by the INCB represents an encouraging example its progressive position, and its support for human rights and due process in the carrying out of drug control policy. It demonstrates the newly energised and radical force that the INCB has become.

The ‘dinosaur’ has evolved into a progressive force.