An event organised last week by the Criminal Justice Centre, School of Law, QMUL and DrugScience titled “New Psychoactive Substances (NPS): Science, Law and Policy” offered in-depth discussions of NPS by bringing together academics and practitioners from various backgrounds including science, health, law, market involvement, and drug policy advocacy.

NPS can pose serious harms to health. For researchers working in the field of NPS, the limited accessibility to usage information poses a great difficulty.

Dr John Ramsey explained that there are several traditional approaches to discern which NPS are being used, but each of them has serious shortcomings in terms of accuracy and completeness. Relying on self-reporting, questionnaires, and website monitoring is insufficient since users often do not know the specific compound they are taking. Similarly, police reports and hospital admission staff often fail to accurately record the consumed substances reported, making this data source unreliable. Death reports produced by coroners are also insufficient, partly because the role of the coroner is to exclude the possibility of crime rather than accurately report the cause of death, and also because the coroner’s report can take up to a year after the death has occurred, a delay unsuitable for responding to the ever-changing NPS market.

So how are researchers gathering reliable data on NPS? By collecting samples from wastewater (sewage) and pooled urine! There are, of course, limitations to these sources as well. The former can only provide information on commonly consumed substances, as there has to be a high level of drug use for it to be detectable in wastewater. Pooled urine collection allows detection of substances that would not arise in wastewater analysis; however, as one can imagine, the collections are primarily from male subjects.

Drug checking services were not discussed during the event, likely because the speaker was focusing on methods currently used in the UK. However, it is worth highlighting drug checking as a very successful initiative that allows people who use drugs to know which specific compounds they are taking, and therefore improves public health while also gathering critical data on what drugs are being bought, sold, and consumed. Such a scheme would increase researcher accessibility to information about NPS usage in the UK, and would empower people who use drugs to make informed decisions about their use.

Many believe that there are no laws regulating the sale and use of NPS. However, there are several cases in which some “legal” highs may in fact be illegal. In order to develop a sensible legal scheme to deal with NPS, Professor Rudi Fortson QC explained that we must be aware of existing laws.

In the UK, there have been court cases in which NPS were prosecuted through the Misuse of Drugs Act. One such case found that some of the batches created by a chemist and intended to be NPS in fact produced substances banned under the Misuse of Drugs Act. Another case featured a chemist that, while producing NPS, had to go through various banned chemical compound structures.

NPS can also fall under the “medicines” legislation, which covers 1) any substance 

 as having properties of preventing or treating disease in human beings; or 2) any substance that may be used by or administered to human beings with 

 restore, correct, or modify a psychological function. The first part of the definition explains why retailers present NPS as “bath salts” or “plant food”. The second part means that a product can be considered medicinal even if it has no medicinal value. Since the sale and consumption of unauthorised medicinal products is not permitted by law, if NPS are treated as medicinal products, their sale and consumption can be considered illegal.

Several other regulations can be used to prosecute the sale of NPS in the UK, many of which involve packaging deception (although the average consumer taking NPS usually intends to do so and is thus generally not deceived by the packaging). This was illustrated in Belfast, where the General Product Safety Regulations (which essentially ensures that no manufacturer puts unsafe products on the market) have been employed to discontinue the sale of NPS by all but one retailer – and this last retailer is on its way to court.

For retailers, the limitations on product safety labelling mean that they have to rely on users doing their research and using common sense. There are, however, several voluntary actions taken by in-store retailers to enhance NPS safety, including: lab testing, human testing (retailers and customer groups), single dose packaging, minimum age of 18 (verified via social media checks), refusing sale of excessive quantity, and daily monitoring of the internet for policy changes and other information.

Despite these precautions, within the current legal regulations, retailers are stuck between a rock and a hard place. On the one hand, they cannot present NPS as being for human consumption (and therefore provide all the necessary safety information) because the products may then be considered medicinal. On the other hand, they cannot simply label their products as “plant food” as they will then be violating several packaging deception laws, such as the General Product Safety Regulations. The laws must be revised to reflect a pragmatic solution to NPS that recognizes the existing demand for substances and prioritizes public health.

Conference attendees supported the legal actions taken in Belfast, as most believed that the use of existing legislation should be fully employed before the creation of any new law. Attendees agreed that a blanket ban on the sale of NPS until substances could be adequately tested and proven to pose low harm for human consumption was an appropriate strategy moving forward. However, previous experiences have shown that the banning of all substances is often accompanied with the emergence of their sale on the black market to meet demand, both online and offline. For consumers, this means having access to even less information about what they are purchasing – often resulting in greater levels of harms. Shutting down NPS retailers therefore does not equate to shutting down NPS sales. It is important to move harmful substances out of the marketplace, but without giving consumers viable alternatives, many will turn to the black market. This is what New Zealand has tried to do with their NPS legislation, which will enable the least harmful substances to be sold to meet demand. Such a regulatory framework should be considered in the UK.

This event was the first in a series of conferences exploring the future of pharmacological regulation. Look out for future events by following @Drug_Science, visiting http://www.drugscience.org.uk/, and keeping an eye on the IDPC events page.

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

All about NPS – Different sectors come together to learn about “legal” highs

By Farah Diaz-Tello, National Advocates for Pregnant Women (USA) and Sebastian Saville, International Doctors for Healthier Drug Policies

This week, despite an extremely inclusive and far-reaching campaign of multiple agencies both in US and internationally, US state Tennessee passed a law that permits assault charges for women who engage in any ‘unlawful’ act that may result in adverse pregnancy outcomes. Much attention has been on how it will be used to punish women addicted to drugs even though this is against advice and evidence from international medical and public health experts. However, while receiving less publicity, of even more concern is the huge discretion given to prosecutors in the application of the law. Depending on the prosecutor, for the same offence, a woman may be charged with a misdemeanor and diverted to a drug court program or instead charged with aggravated assault and sentenced to 15 years in prison.

It is fair to assume that African-American women, because they are most susceptible to poorer pregnancy outcomes regardless of drug use or socioeconomic status, will be punished most severely.

Cherisse A. Scott, founder and CEO of SisterReach, an advocacy organization focusing on African-American women, said in a statement, “This law separates mothers from their children and is not patient-centered. Tennessee families who are already being hit the hardest by policies such as the failure to expand Medicaid, poverty and a lack of available drug treatment facilities will be most deeply impacted by this bill. Mothers struggling with drug addiction in Shelby County, rural communities throughout Tennessee and poor mothers and their families will be the ones who suffer the effects of this dangerous legislation the most.”

Journal of Health Politics, Policy, and Law

 shows that these concerns are well founded. Documenting 413 cases of arrests, detentions, and forced medical interventions upon pregnant women, the study found that when laws intended to protect women are used against them, the ones who suffer most are low-income, African American women in the US South.

The impact of this law will be felt by women more broadly: the study’s authors conclude that laws and policies that make women criminally accountable for pregnancy outcomes are part of a larger effort to establish that women should have a separate and unequal set of legal rights than others. Tennessee’s new law addresses a health concern as a matter for criminalization but even worse, it treats pregnant women as a population who can be singled out for special control and surveillance by the state.

Although extremely disappointed that the Governor of Tennessee chose not to veto the law, International Doctors for Healthier Drug Policies (IDHDP) will continue to challenge this law and to support health-based policies to replace those that seek to punish already marginalized populations.

IDHDP and National Advocates for Pregnant Women (NAPW USA) ask for your support to continue the challenge of this law, to challenge the arrests that have already happened and will continue to happen, and to build on the coalition led by reproductive justice organizations, including NAPW, SisterReach, Healthy and Free Tennessee, Young Women United, SisterSong, with the powerful support of 

, to expose the appalling harm this law will do.

Keep up-to-date with drug policy developments by subscribing to the 

Unhealthy laws in need of emergency response: Tennessee criminalises pregnant women who use drugs

New Zealand took a step backwards Sunday night with proposed changes to their New Psychoactive Substances (NPS) legislation.

Last year, the Psychoactive Substances Act was introduced. This piece of legislation regulates the sale, manufacture, and importation of New Psychoactive Substances (NPS) or drugs commonly referred to as ‘legal highs.’ After numerous attempts to simply ban legal highs, only to see them quickly replaced by new substances, the New Zealand government decided to take a new approach. The Act turned the tables, placing the onus of proof onto manufactures to prove the substances are ‘low risk’ before they can be sold.

While the bill was going through Parliament, the select committee decided that an interim period was needed between the Act coming into force and the introduction of regulations and rules around a clinical testing regime. The rationale behind this was to prevent people (particularly those who were dependent on these products) from turning to the black market and to ensure manufacturers had faith in the system. Once the Act was passed, products which appeared to be the least harmful were given temporary licenses and could still be sold until the testing process was in place.

Forty-seven products were initially granted temporary licenses. The Act provided the government with the power to instantly remove products from sale should they prove to be causing harm. The decision to revoke licenses had to be based on evidence provided by the National Poisons Centre and Centre for Adverse Reactions Monitoring (CARM). In the first nine months of the Act being in place, five products had their interim licenses revoked for these reasons.

However, on April 27, the Associate Health Minister Peter Dunne announced plans to change the Psychoactive Substances Act to revoke 

 interim product approvals. The amendment has not been tabled in Parliament yet, but it is expected that it will remove provisions for the interim period, thus making all currently approved products unapproved until they can go through the clinical testing process.

This would mean that no NPS products could be legally sold in New Zealand until the regulations for the clinical testing process are in place and products can prove they can pass. At a minimum, this will take 12–18 months.

Minister Dunne said that because the reports of severe reactions received by the National Poisons Centre and CARM cannot be attributed to any particular products, the government has decided to remove all products off the market. This is a departure from the legislation which focused on the need for evidence and due process to remove a product from sale.

The reasons for this change from the Minister are political. It is an election year in New Zealand and the continued sale of NPS products has created a perfect storm of NIMBYism, media fuelled hysteria and genuine concern about their effects. Two opposition political parties announced policies to change the law if they were in Government after the election. This forced the Minister’s hand in announcing the law change because he did not want to be seen to be giving the opposition parties a win on this issue.

Parliament is starting a two week recess period, which means that in the lead up to the change, retailers are likely to heavily discount products in firesales and people who use the products, or plan to distribute them, will be stocking up. New Zealand has already seen cases of discounting and there have been media reports of stockpiling. One shop which sells NPS products has been broken into and their entire inventory stolen.

The New Zealand Drug Foundation’s Executive Director, Ross Bell, explained that he suspects the decision to push through this amendment is about looking “tough on drugs,” as the Act already allowed the government to ban any substances that posed a danger to health. Mr. Bell has called on the government to use existing powers under the Act to remove the products that are causing harm, not to simply ban them all.

Find out more by following @nzdrug and visiting http://www.drugfoundation.org.nz/.

IDPC wishes to thank the New Zealand Drug Foundation for its inputs in this article.

U-turn in New Zealand legal highs regulations

On April 17, representatives from the development sector gathered to discuss the negative impacts of current drug policies on impoverished populations, and the importance of bringing the development perspective to the UN General Assembly Special Session (UNGASS) on illicit drugs in 2016. Broadening civil society engagement by including the development sector at the UNGASS will emphasize the cross-sectoral nature of drug policy and bring more power in numbers. Martin Drewry of Health Poverty Action and Eric Gutierrez of Christian Aid presented on the importance of recognizing international drug policy as a pertinent development issue.

Drewry began the discussion by highlighting the impacts of law-enforcement led drug policies on poverty. Although the intersections of drug policy and development are abundant, Drewry focused on three key categories of negative outcomes. First, current prohibitionist drug policies undermine governance, and therefore breed activities common to states with weak institutional structures, such as corruption and human rights abuses. Second, the authority of governments is limited by the power of drug cartels, which inhibits the state’s ability to protect and provide services to their citizens. Third, limited financial resources are wasted globally on fighting the war on drugs - this unintended consequence, known as “policy displacement”, means that available resources are diverted from both public health and socio-economic programmes.

Gutierrez continued the conversation by presenting the work Christian Aid has been doing to increase their understanding of drug policies within the development context. He pointed out that those who grow illicit substances do so as a survival mechanism and make the decision at a household level. Restricted access to land, and lack of food security and other sources of income, leaves farmers and their families with no other choice. Gutierrez stressed the importance of going deep into understanding the local context and the “messy politics” in order to address illicit drug situations. Although the UN Office of Drugs and Crime (UNODC) annually produced World Drug Report offers a comprehensive overview of the latest developments in drug markets, it is little more than an “impressive collection of snapshots.” Looking at illicit drug situations at one point in time is not useful without understanding the circumstances which led to the current situation, and projecting future scenarios. In order to enhance the collection of “messy politics” research in drug policy, Christian Aid is producing a series of case studies.

Jane Slater of Transform Drug Policy Foundation highlighted the failures of prohibition and made the case for regulating illicit markets. She echoed the concerns of the development sector, particularly those presented by Drewry and Gutierrez, regarding the distortion of development interventions by drug war objectives.

Jamie Bridge of IDPC then proceeded to provide an overview of the international drug control regime and the unique opportunity presented by the 2016 UNGASS to have an open debate about current drug policies and the way forward. For the development sector, the UNGASS is a crucial opportunity to advocate on an issue with so many ties to development and to the future of developing countries.

Please click here for more information about the 2016 UNGASS.

Please click here to read the briefing document created for the development sector about engaging at the 2016 UNGASS.

Development sector recognizes importance of advocating for drug policy reform at UNGASS 2016

In this HCLU video, Allan Clear, from the Harm Reduction Coalition, explains that we do need to regulate illicit drug markets to bring more control over these substances.

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

Harm Reduction Coalition: "We need a regulated market to control drugs"

The Economic and Social Council (ECOSOC) met on 23rd April 2013, and elected by secret ballot five members for five-year terms beginning on 2 March 2015. Four members were elected in the first voting round:

Following a subsequent special ballot to break a tie between Zhimin Liu (China) and Flore Ndembiyembe (Cameroon), 

ECOSOC elects INCB members

An INCB mission visited Iceland from 25 to 27 March 2014. The mission was conducted by the First Vice-President of the Board, Dr. Galina Korchagina, accompanied by Ms. Beate Hammond of the INCB Secretariat. The purpose of the mission was to discuss specific issues related to the country's implementation of the three international drug control conventions, to which it is party. This was the first mission of the Board to Iceland.

The mission met with senior officials from the Ministry of Welfare, the Directorate of Health, the Icelandic Medicines Agency, the Ministry of Foreign Affairs, the Ministry of Education, Science and Culture, the Ministry of Interior, the Directorate of Customs and the Metropolitan Police. The mission also had the opportunity to visit Vogur Hospital which is managed by SAA, the National Centre of Addiction Medicine. Meetings were also held with representatives from the Icelandic Red Cross as well as FRÆ, the Center of Drug and Alcohol Prevention.

Deliberations focused on recent developments in drug trafficking and abuse in Iceland, the Government's cooperation with INCB, measures taken by the Government to control narcotic drugs, psychotropic substances and the chemicals needed for their illicit manufacture and policies to reduce the demand for illicit drugs and to treat and rehabilitate drug users. The consumption of methylphenidate in Iceland was also discussed with the national authorities.

The findings of the mission will be reviewed by the Board at its forthcoming session in May 2014 and will be reflected in the INCB Annual Report for 2014, which will be published in early 2015.

INCB visits Iceland

INPUD: "Drug conventions are not biblical texts"

On the 26th June 2013, people in 41 cities around the world gathered for a ‘Day of Action’ as part of the Support. Don’t Punish campaign – a global advocacy campaign to raise awareness of the harms caused by the criminalisation of people who use drugs.

To promote the ‘Day of Action’ for this year, the campaign team have worked with the professional video producers Not by Hook to create a new video – a call to all those who want to get involved in the campaign in 2014.

This video reviews the past year of the Support. Don't Punish campaign -- a global call to raise awareness of the harms caused by the criminalisation of people who use drugs -- and looks forward to what you can do in 2014.

Please click here to read more about this event.

Support. Don't punish-Let's make 2014 even bigger!

Coletta Youngers, a Senior Fellow at the Washington Office on Latin America says the International Narcotics Control Board overstepped its mandage in its criticism of Uruguay's legalization of cannabis. In addition, she emphasizes that the INCB is the only UN agency that works in secrecy.

Coletta Youngers says that the INCB is a tool of the Member States not the contrary and it is the only UN agency that does not have any transparency.

The INCB must be transparent 

Mike Trace, the chair of the International Drug Policy Consortium (IDPC) is sending a message to the International Narcotics Control Board (INCB) - a body that monitors the compliance to the UN drug conventions.

INCB should focus on its original mandate

The President of the INCB, Raymond Yans, accused Uruguay of acting as a "pirate" after having approved the autocultivation and legal trade of cannabis. However, Uruguay does not only have international obligations with regards to drugs, but also with regards to human rights.To read the full arcile by Rodrigo Uprimny in El Espectador (in Spanish), please see below.

EL presidente de la Junta Internacional de Fiscalización de Estupefacientes (JIFE), Raymond Yans, acusó a Uruguay de actuar como un “pirata”, por haber aprobado el autocultivo y el suministro legal, pero estrictamente regulado, de marihuana.

La JIFE es la institución encargada de supervisar el cumplimiento de las convenciones sobre drogas y Yans opina que la decisión tomada por Uruguay las viola. Una interpretación aislada de las convenciones parece darle la razón, pues éstas sólo admiten el consumo legal de marihuana para fines médicos o de experimentación científica, mientras que la nueva ley uruguaya prevé también formas legales de acceso a la marihuana para usos recreativos. ¿Significa eso que Uruguay es un pirata que desprecia el derecho internacional por admitir un suministro legal de marihuana para fines recreativos?

No lo creo, pues Uruguay, al igual que las demás naciones, no sólo tiene obligaciones internacionales en drogas sino también en derechos humanos. Y estas obligaciones en derechos humanos prevalecen sobre los mandatos derivados de las convenciones sobre drogas, como lo sostuve en una reciente columna. No puede entonces acusarse a la ligera como pirata a un Estado que decide adoptar una política que entra en tensión con lo prescrito hace más de 50 años por la Convención Única de Estupefacientes de 1961, si ese Estado justifica razonablemente que esa nueva política es necesaria para garantizar los derechos humanos. Ese Estado, en el fondo, busca respetar en mejor forma el derecho internacional pues prefiere cumplir con las obligaciones en derechos humanos, que son prevalentes.

Esto sucede en Uruguay pues la nueva ley tiene una clara perspectiva de derechos humanos y de salud pública; su propósito es evitar que los consumidores adultos de marihuana sigan sometidos a redes ilegales y mafiosas de distribución, pero sin crear un mercado libre de esa sustancia, que podría tener riesgos sanitarios. La ley prevé entonces formas legales pero estrictamente reguladas de autocultivo y distribución de marihuana. Por ejemplo, al igual que con el alcohol, no está autorizado el acceso a la sustancia por menores de edad; quienes produzcan sin autorización o manejen trabados serán sancionados; la publicidad está prohibida, etc.

Dados los desastrosos efectos sociales y humanos que ha tenido el prohibicionismo, los Estados tienen derecho a experimentar nuevas políticas en este campo, como la que está intentando Uruguay, a fin de garantizar en mejor forma la salud pública y el respeto a los derechos humanos.

La política uruguaya es controvertida y requerirá evaluaciones y ajustes, pero que Yans acuse a Uruguay de comportarse como un pirata por intentarla no habla mal de Uruguay sino de la JIFE. Muestra que en el fondo el pirata es Yans, que con su interpretación aislada y fundamentalista de las convenciones de droga, desprecia el derecho internacional, pues ignora las obligaciones prevalentes que tienen los Estados en derechos humanos.

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