As the world continues to grapple with an unprecedented pandemic that has crippled countries, one of the many issues that has emerged is the gap that is our prison response—and how our shortcomings in this area may very well render the rest of our COVID-19 response useless. The International Drug Policy Consortium recently held a webinar covering countries in Southeast Asia to examine just that.

Southeast Asia suffers from some of the most overcrowded jails in the world. The Philippines stands at over 500% capacity, with 75% of people in detention still awaiting their sentence. Indonesia and Thailand are not far behind housing around 150% of their capacities.

Dr. Raymund Narag, one of the panelists in IDPC’s webinar on “Reducing Incarceration in the Time of COVID-19,” notes how one of the primary contributors to the continuously increasing prison population remains the harsh drug laws in the region. This is compounded by case delay due to the sheer number of people our justice systems have to process and the long prison sentences that are the norm for nonviolent drug offenses—among many other institutional issues exacerbated by disproportionate drug policing. Yohan Misero of Indonesian Act for Justice (AKSI) and Dr. Nang Pann Ei Kham of Drug Policy Advocacy Group Myanmar echo these frustrations, noting how easy it is to arrest people who use drugs in Indonesia and how 50% of people in Myanmar’s prisons are detained for drug offenses.

The poor state of jails and prisons in Southeast Asia make people in detention some of the most vulnerable for COVID-19. Overcrowding, malnutrition, and poor sanitation in the facilities have already left them with poor health and immunity. The difficulty in accessing health services and limited resources to prevent the spread of infections among the prison population only make it worse. In Cebu where Atty. Cathy Alvarez of StreetLaw in the Philippines resides, even prior to the pandemic, the eleven detention centers that spanned three of their islands were only covered by one lone doctor. As of the webinar, more than 300 people in detention in Cebu have tested positive for COVID-19.

In Myanmar, almost 25,000 people were pardoned and released from prison following the largest ever presidential amnesty granted, during local new year celebrations. In Indonesia, about 50,000 people will be freed through an early release process. The Philippines has begun this process as well with 10,000 people released from detention so far and hearings of further cases ongoing. The Philippines has also taken steps to lower the threshold for release through reducing bail amounts, with advocates aiming to have it reduced even more, and to conduct hearings through video conferencing. These initiatives are brave and important steps for countries in protecting the health of their people, but more needs to be done.

In the Philippines, although the Board of Pardons and Parole have recommended vulnerable populations in detention (such as the elderly) to be granted executive clemency, this also excludes those charged with drug offenses as they’re classified as “high-risk.” And despite having one of the highest number of releases, Indonesia’s director-general has emphasized that most people imprisoned for drug crimes are excluded (only people imprisoned for less than a 5-year term and who have completed at least ⅔ of that term are eligible for release, and due to the high level of penalties for possession any quantity of drugs, most people in prison for drug offences have greater than a 5 year sentence. Typically only people charged or convicted of consumption alone will be sentenced with less than 5 years in prison). Those who have been released have been met with hostility and discrimination in their communities, with community members still wary of those who have come out of prison and jails.

As countries navigate the COVID-19 crisis, we’re faced with the impact of our overreliance in the criminal justice system in dealing with drug-related issues. Systems that had been left behind prior to the pandemic might just be the gap that exacerbates the outbreak. We need to strengthen our health and justice institutions now to ensure that we’re not faced with the same crisis in the future.

At the same time, the stigma against people who use drugs continues to blind the justice sector from seeing just how important it is to include people involved with drugs in our emergency release responses. We cannot leave them behind. The need to advocate for better drug laws has always been urgent, but now it’s even more apparent as a matter of life and death for our communities.

Leave no one behind bars in the time of Covid-19

If you or someone you know is struggling, please consider contacting support. This list inventories suicide crisis lines around the world.

The COVID-19 pandemic is prompting extraordinary, unexpected and even contradictory responses by the health and criminal justice systems. On the one hand, some States are releasing thousands of prisoners in order to prevent the outbreak of infection. On the other, they are also expanding their repressive arsenal in the name of protecting public health.

In India, which has been under a lockdown since 24 March 2020, Police officers are arresting people for not wearing masks, for walking the streets in search of food or for trying to make their way back home from cities, where they’re facing destitution. These normal, rational human acts have suddenly become ‘wrongs’ to warrant a response from the criminal justice system.

In relation to drugs, Police action has also become absolutely baffling, as reported in a recent news article.

On 17 April 2020, a young man believed to have been living with drug dependence, died by suicide in his home in the North Indian city of Gurugram. The substance involved or the state of his health condition is not known. The reporter covering the story, however, noted:

According to the police complaint, the man was under stress for some time after three men did not give him anything despite taking his money after promising to supply him some narcotics. The police have booked the three men for abetment to suicide.’

A careful review of the facts shows that:

The young man was dependent on illicit drugs. The lockdown prevented him from procuring the substance from his regular supply-chain. Desperate and struggling with withdrawal syndrome, he reached out to some suppliers, who took money, but did not deliver the drug. Without recourse to help or treatment, the man ended his life. The Police filed a criminal case against unknown persons for 

The young man in Gurugram and others like him, who live with dependence, are undergoing terrible suffering under the lockdown. According to the National Survey on Extent and Pattern of Substance Use in India, the findings of which were released in February 2019, around 

people in the country live with dependence to opioid substances and another 

 need medical assistance for cannabis use.

Depending on the drug and the length of use, the lack of access can lead to the onset of painful and agonising withdrawal. If untreated, this stressor can trigger dangerous consequences, including death by suicide.

International human rights norms go to the extent of characterising the denial of medical care during withdrawal and the suffering inflicted on people who are drug dependent as acts of torture or ill-treatment.

While announcing the COVID-19 lockdown, the Government was under an obligation to make drug dependence treatment widely available and accessible. While health authorities issued an advisory on managing alcohol dependence, there was none for managing drug dependence.

The only guidance provided by the National AIDS Control Organisation was to allow take-home doses of Opioid Substitution Therapy (OST) for a week for clients who are already enrolled in the HIV prevention programme. While accurate estimates are hard to come by, research suggests that OST coverage remains woeful in India.

The Government seems to have forgotten about the millions of people who are dependent on drugs but are not in treatment. Bereft of medical support, the restrictive measures of the lockdown can be a death sentence; like it seems to have been the case for the young man in Gurugram.

The other paradox in the case is that the Police have blamed alleged drug suppliers for 

 providing drugs! The Narcotic Drugs and Psychotropic Substances Act, 1985 (NDPS Act) criminalises, among other things, unauthorised sale and purchase of narcotic drugs and psychotropic substances. Surely, a person who does not supply illicit drugs is complying with the law and not violating it? Even if a supplier has taken money, an agreement to commit an unlawful act 

The Police seems to have forgotten that the drug market has been made illegal by public authorities. In this state of affairs, buyers and sellers are under no obligation to keep their ‘promise’.

For someone to be charged for abetting suicide, the prosecution must show that they instigated the victim to commit suicide or intentionally aided the commission of suicide through an act or illegal omission. The facts do not disclose any such thing. On the contrary, if the narcotic substance had indeed been supplied, both the dealer and the young man would be in jail for offences under the NDPS Act. All this is lost on the Police, who have done a quick fix by registering a case against the drug suppliers.

Addiction-related suicides in times of corona cannot be wished away, nor can they be blamed on people who supply drugs.

The unfortunate death of the young man in Gurugram calls for a reorientation of our health and criminal justice policies. The Government must become serious about securing effective, evidence-based treatment for people who use drugs, which is its constitutional and legal responsibility.

Authorities must also reassess the legal status of the drug market, before it can hold suppliers accountable for 

 people who use drugs in the country, policy shifts that prioritise health are long due.

Fixing responsibility or shifting blame? Drug policy and suicide in the time of corona

As the international community grappled with the first major outbreaks of COVID-19, and before the whole world turned upside down as a result of the pandemic’s escalation, the 63rd Session of the Commission on Narcotic Drugs (CND) went ahead as planned in the first week of March in Vienna.

It was a quieter event than usual, partly because some government delegations stayed away due to the risk of spreading coronavirus, and partly because the vote on the recommendations on cannabis from the WHO’s Expert Committee on Drug Dependence (ECDD) did not go ahead as planned. Seemingly in anticipation of the contentious cannabis vote, only five resolutions had been tabled, which is about half the usual number.

At the time of the CND, only a few countries had gone into lockdown and the guidance from the UN Office in Vienna was that it was fine to travel but to adhere to cough etiquette and public health measures, such as avoiding shaking hands and regular hand washing. This gave confidence to the many civil society representatives to attend the CND in force as usual.

Side events: Compelling cases for reform and accountability

The relatively slow cadence of the main proceedings stood in sharp contrast to more than 100 side events, many organised by civil society, covering an increasingly diverse range of issues that continue to push the envelope in Vienna.

From a progressive perspective, the most heartening side event this year showcased the moves in Norway towards the decriminalisation of drug use and possession for personal use. Health Minister, Bent Høie, presented the findings of the government-mandated committee tasked with assessing how Norway could shift away from criminalising people who use drugs. The committee’s report ‘From punishment to support’ recommends that Norway remove criminal sanctions for drug use and possession for personal use and transfers the corresponding oversight from the justice to the health sector. While police referral to drug counselling is part of the proposed model, the committee has recommended that no sanctions be imposed on those who do not wish to accept the referral.

From the floor, Arild Knutsen, a prominent and tireless Norwegian drug user activist, expressed his joy at the proposal after decades of advocacy to challenge punitive drug laws. In response, Minister Høie made an unprecedented and brave admission noting that after twenty years of debate and disagreement, Arild was right and he had been wrong. A rare and genuinely touching moment in the often polarised setting of the CND – and in an overall worrying context of shrinking civil society space.

Another important side event organised during the week advanced the discussion on gender and drug policy. This issue has received increasing, and well overdue, attention in recent years, catalysed by the UNGASS Outcome Document, which gave greater consideration to women’s specific vulnerabilities and needs.

‘“Were you really raped or did you just not get paid?” Addressing stigma and violence against women who use drugs’ was organised under the auspices of the UNODC Regional Office for Southern Africa, with the participation of the South African Network of People who Use Drugs (SANPUD). The event launched a sobering report with the same name, which documents the pervasive violence, control and extortion faced by women in the community. Speakers highlighted the intersecting forms of oppression that target women who use drugs and compound their situations of vulnerability. But also experiences of sisterhood, empowerment and resistance that signal the way forward.

This event highlighted an important topic that deserves to receive much greater attention and demonstrates how the burden of punitive drug policies and brutal law enforcement practices falls on some of the most vulnerable in society. This issue also strongly came to light at another event commemorating the 10-year anniversary of the UN Bangkok Rules.

In coherence? Countries on the fringes hold on to the outdated Vienna silo

The negotiations of resolutions this year were not as contentious as in previous years. The European Union (EU) tabled two resolutions, one on improving scientific data collection efforts and a second on ensuring access to controlled medicines,with a focus on palliative care. Russia tabled a resolution on the involvement of youth in drug prevention efforts, the US on involving the private sector in drug control efforts and the usual resolution on alternative development was presented by Thailand and Peru.

The issue that sparked most debate this year, both in the negotiations on resolutions and in the plenary, was the push to formally recognise the work of the UN system coordination Task Team on the Implementation of the UN System Common Position on drug-related matters, set up by the UN Secretary-General. Specific wording on this was in the initial draft of the EU’s resolution on data but received pushback from some member states and in the end the final draft referred to ‘effective UN inter-agency coordination’ but not explicitly to the Task Team.

However, in the plenary, many countries expressed their support for the UN Task Team, recognising that the CND and the General Assembly have long sought to strengthen coordination across the UN on drug policy. In the closing session, thirty-four countries expressed their support for the work of the Task Team, with Switzerland requesting a standing agenda item for future CND meetings for updates on their work.

IDPC also made an intervention during the plenary to highlight the critical relevance of Task Team and the need for system-wide coherence to ensure greater human rights oversight in drug control, building on the 2016 UNGASS.

Improving data collection: Steps, not strides, in the right direction

Another event of note at this year’s CND was the adoption of the revised Annual Report Questionnaire (ARQ), the key data collection tool used by UNODC to collect information on the global drug market each year.

After more than two years of negotiations, the revised ARQ was surprisingly adopted in seconds at the Plenary without discussion. Although significantly improved compared to its predecessor, there remain many gaps in the new iteration of the ARQ.

Now the key challenge will be to push for a mechanism that will enable other UN agencies – especially those focusing on human rights and development – to submit additional data on drugs to complement the information submitted through the ARQ. An area of work where the Task Team could make a valuable contribution in the years to come.

Cannabis scheduling recommendations: Yet another delay

Many civil society advocates had hoped that the CND would vote on at least some of the WHO Expert Committee on Drug Dependence (ECDD) recommendations to reschedule cannabis at this session after a delay of 12 months.

The ECDD’s long-overdue critical review of cannabis was undertaken after many years of advocacy that questioned where cannabis had been placed in the international scheduling system. This was the first-ever WHO review of cannabis in the long history of international drug control.

Unfortunately, following many intense behind-closed-doors discussions in the weeks leading up to the CND, a decision was reached to, once again, delay the vote until December 2020.

As became clear at the CND intersessionals last year, the complex interrelated set of recommendations to change the current scheduling of cannabis and cannabinoids under the 1961 and 1971 Conventions, has raised lots of valid questions and legitimate concerns among member states and civil society that merit further clarification and debate.

However, the key recommendation to remove cannabis from Schedule IV of the 1961 Convention, reserved for the substances deemed most dangerous, with little or no medical or therapeutic usefulness, is quite straightforward and cannot be questioned from a scientific point of view, and has been strongly welcomed by civil society.

Given the growing evidence and acceptance of cannabis’ important medical properties, the removal from this schedule is simply a recognition of the current state of evidence and practice, as amply documented in the ECDD critical review reports.

The fact that this straightforward recommendation has triggered so much controversy, demonstrates the highly politicised nature of the Vienna diplomatic arena.

For those championing evidence-based drug policy decisions at the CND, defending the role and mandate of the WHO’s ECDD in making science-based scheduling recommendations is of utmost importance.

Inconsistencies in the treaty system itself, and the contentious nature of the CND debate around cannabis, especially following Canada’s legal regulation initiative, may have been taken into consideration in some of the other ECDD recommendations – a question that we have raised before.

In particular, the recommendation to keep cannabis in Schedule I of the 1961 Convention, alongside heroin and cocaine – in spite of the technical reports which make it clear that cannabis is associated with lesser risks – appears to reflect a concern not to further inflame an already divisive debate.

More intersessional meetings will take place in the fall to further clarify these issues, hopefully resulting in a productive preparation for a vote at the reconvened CND session in early December. Postponing the vote again would show disrespect for the WHO’s treaty mandate and the important work of the ECDD.

New Director, new directions? CND welcomes UNODC’s incoming ED

Finally, it was the first CND for the incoming UNODC Executive Director, Ghada Waly, from Egypt, who in her opening statement focused more on supply-reduction priorities, mentioning law enforcement’s lives lost but concerningly not the serious public health and human rights crises resulting from punitive drug control measures.

In advance of the CND, IDPC had sent a welcome message to Ms Waly, including an advocacy note enumerating the key priorities for her from the network’s perspective and called strongly for her to promote health and human rights in drug policy.

As is now customary, the Executive Director holds an informal dialogue with civil society during the week and this year the event was highly anticipated. Sadly, Ms Waly was unwell and unable to meet with civil society at the informal dialogue this year. We very much look forward to having the opportunity to meet with her either later this year, travel restrictions permitting, or at the next CND.

In the context of the global pandemic of COVID-19, some governments have been releasing a substantial number of inmates from overcrowded prisons to reduce infection risk in these settings. These are urgent and welcome developments and the UN should continue to call on governments to consider these measures.

However, in parallel, many governments are ramping up draconian and stringent measures to criminalise transmission, as well as non-compliance with public health measures, which is deeply concerning.

What we know from drug policy is that the burden of repression and punishment is borne by the most marginalised, and that the use of criminal law is not appropriate nor effective in advancing public health goals.

We must now broaden our advocacy efforts, increase solidarity across social movements and ensure that governments do not justify eroding human rights commitments in the name of disease control.

In the heartbeat before global lockdown: Business as usual in Vienna drugs debate

On Friday 3 April, the INCB announced that it would be postponing the 128th session of the Board’s meeting, which was scheduled from 4 to 15 May 2020, in view of the COIVD-19 pandemic. The new dates for the postponed session are yet to be decided.

The INCB holds three sessions a year, typically in February, May, and November of each year. The dates and agenda of each session can be consulted here.

The open call for civil society to apply for a slot in the thematic INCB hearing on the use of drugs among older persons, which was meant to take place during the postponed session, will be kept open for the moment. It will also be relaunched once the new date is released.

On other COVID-19 related actions, in a 17 March press release the INCB called on governments to ensure that measures put in place to counter the pandemic do not disrupt the international supply chain of controlled medicines for pain relief, palliative care, and mental health and neurological conditions.

INCB postpones its 128th session, originally scheduled for May 2020

On Friday, 20th March, the Parliament of Ghana passed the Narcotics Control Commission Bill into law. This brought great excitement to many who have been following the legislative process since 2015, when the Bill was first introduced. Many civil society organizations (CSOs) in Ghana laud the Government for this significant moment in the history of drug policy reform in the country. The new law makes huge inroads towards more humane drug policy, and will pave way for other good examples to emerge in the sub-region.

An alternative to incarceration for people who use drugs

One of the stated purposes of Ghana’s new drug law is to treat drug use and dependence as a public health issue. The new law has converted the prison term for drug possession for personal use into a fine of between 200-500 penalty units (translating to GHC 2,400 – 6,000). This does not mean that drug use has been legalised, as portrayed by some media outlets. It means that instead of sending people to prison for up to 10 years for simple possession of drugs for personal use, they will offer alternatives to incarceration. This is in line with current programs and policies to decongest our prisons, notably the Justice for All program, instituted in 2007.

Under the old law, too many people were being put behind bars simply for possession of 1 or 2 rolls of marijuana or any other drug for personal use – yet the consumption of all kinds of drugs appeared to continue increasing. The evidence is that disproportionately repressive approaches to drug control, and particularly to drug use, have not succeeded in eradicating drug markets and related harms. Instead, these policies ‘have led to serious unintended consequences and often disproportionately impact upon the poor and marginalised, while creating a rich and powerful criminal market that undermines the security of states.’

The fundamental goal of drug policies, therefore, ‘should be to improve the health, safety, security and socio-economic well-being of people by reducing drug use, drug-related harms, illicit trafficking and associated crimes.’ In line with this, there has been a global shift towards evidenced-based policies instead of focusing on the failed 'war on drugs'.

As a country, these pragmatic steps are also completely in line with our obligations under the three international drug control conventions, as well as other UN resolutions and commitments to address drug use and possession, including the UNGASS Outcome Document, agreed to by the international community in 2016.

The Bill gives hope back to people who have been neglected by society, and have been continually punished and demonised instead of provided support as needed.

Since the passage of the law, there have been a lot of misconceptions in the media and civil society circles that drug use has now been legalized. This is definitely not the case! Drug use, as well as supply, production and trafficking, remain offences under the new Bill; same as before. The difference in approach is rather on how authorities respond to drug use: fines, rather than imprisonment.

Ghana is not alone in this move. Numerous countries have adopted this approach, and indeed gone further into less punitive responses to all drug use, with a great deal of success.

The new law will also allow, for the first time, the implementation of lifesaving harm reduction services for people who use drugs, which will help curb the transmission of bloodborne viruses (such as HIV and hepatitis B and C), overdose deaths and drug dependence.

These steps are clearly in line with Sustainable Development Goal 3: Health and well-being for all, which won’t be achieved if we continue to leave people who use drugs behind when they may need health services.

By offering alternatives to incarceration for people who use drugs, Ghana’s criminal justice system will be less congested, our prisons will be less overcrowded and our law enforcement agencies will be able to focus on those at the helm of the drugs trade, rather than predominantly young, poor and vulnerable groups.

Changes in relation to cannabis and hemp for industrial, medical and research purposes

Another key area that has been of great interest, and that has also led to confusion in the media, is the incorporation of some special provisions relating to cannabis. The new Bill will regulate the production of cannabis products that contain very small amounts (less than 0.3%) of tetrahydrocannabinol (THC) —a key compound associated with the cannabis “high”— for industrial, medical and research purposes.

This step mirrors current global discussions. In 2019, the World Health Organization’s Expert Committee on Drugs Dependence (ECDD) delivered the results of a detailed review of the evidence around cannabis. One of the recommendations is about removing cannabis from ‘Schedule IV’ of the 1961 UN Convention on Narcotic Drugs, a move that acknowledges that the drug has ‘substantial therapeutic advantages’ for the treatment of pain and other medical conditions, such as epilepsy and spasticity associated with multiple sclerosis.

Those who fear that this will open a floodgate for illicit drug use are catastrophising, ignoring the evidence from over 30 countries where thousands of patients benefit from medical access.

Many are also questioning if Ghana is not breaching its international obligations by taking such steps, but let me be clear that the international conventions are designed at their core to ensure the availability of controlled drugs for medical and scientific purposes, while preventing their diversion for illicit purposes.

Further to this, the new law also permits the cultivation of non-psychoactive cannabis plants (hemp) for industrial purposes. This is a great step in the right direction as many of us have argued that we cannot achieve SDG 1 to ‘end poverty in all its forms everywhere’ by 2030 if we do not provide our people, in particular the poor and the vulnerable, with means to access economic resources, basic services, land ownership, etc.

In this regard, the law offers an opportunity to respond to the needs for sustainable livelihoods of our rural farmers, particularly young people who have relied on cannabis farming to survive. In implementing the law, authorities must favour the transition towards formality of those historically pushed to the margins.

Recalibrating the role of the Narcotics Control Board

The new Bill also seeks to make the Narcotics Control Board (NACOB) an autonomous body that can oversee all drug-related issues.

The Board is currently under the auspices of the Ministry of Defence and Interior, and heavily relies on the Prosecuting Unit of the Ghana Police Service and the Attorney General Department to prosecute cases on drugs.

The Bill gives NACOB the status of a Commission, equipping the Board with a legal department to carry out prosecutions and granting the Board with powers to formulate policies to flesh out the bill.

The expectation is that the Narcotics Control Commission will be more autonomous, preventing interference by the governing political power. This remains to be seen.

A West African approach to drug policy [reform]

This new Bill represents an important example for drug policy reform advocacy in West Africa. Historically, drug policies have been imported to our region. And it is under these imported rules that we have seen drug production and trafficking skyrocket; which offers further evidence that ‘tough-on-drugs’ laws do not work.

Ghana’s example shows civil society and government can engage in dialogue to realign our countries’ priorities, to ensure participation, to advance sustainable development and to seek a brighter future for our youth.

Ghanaians should be enthusiastic and optimistic about this new drug law. It is not perfect; and results from complex debates and compromise. But our Parliament has shown leadership in getting this reform over the line.

I call on other West African governments to demonstrate the political will to follow on Ghana’s footsteps and do all within their power to break the cycles of poverty, vulnerability and criminalisation.

The “war on drug” revealed itself to be a war on people, creating obstacles for the realisation of the Sustainable Development Goals, violating human rights, undermining public health. And I am so glad that Ghana has turned its back on it and begun to move away from this failed approach.

Parliament of Ghana passes historic new drug law, paving the way for a West African approach

In February 2020 the INCB launched its Annual Report, which provides an analysis of the functioning of the international drug control system during 2019, and makes recommendations to UN member states.

In this year’s report, the INCB continues to decry the growing number of member states that are regulating cannabis for adult use, citing its controversial status regarding the prohibitionist stance of the drug control conventions, and its alleged consequences for health and well-being.

On a more welcome note, the INCB also makes clear that states that violate international human rights standards are also violating the drug control conventions, and calls on all member states put a halt on extrajudicial executions and on the death penalty for any drug-related activity. Beyond these salient issues, the thematic chapter in this year’s report concerns drug prevention and treatment for young people.

As we have been doing in previous years, in the following months IDPC will publish a response to the INCB Annual Report 2019, which will provide a detailed summary and analysis of its content.

INCB launches its Annual Report 2019

The International Narcotics Control Board (INCB) will host the third civil society hearing for the INCB board members on the margins of this years INCB board meeting. The hearing will be on the topic of "The Use of Drugs Among Older Persons" and is planned for May 13, 2020, 10 a.m. to 1 p.m. in Vienna, Austria. Due to the rapidly changing situation in regards to COVID-19 the hearing might be held in another format, postponed or even cancelled.

At the event, up to 12 NGOs will have the possibility to present their work and positioning on the issue of the use of drugs among older persons. The hearing will last two hours. Each speaker will have 7-10 minutes to present their work.

In order to apply, civil societies need to fill out the provided form by 08 April 2020 at 11:55 p.m. (CEST, Vienna local time). The form requires:

Name of the representative who will give the presentation

Confirm that the presentation will be submitted before 05 May 2020 and that it will comply with the title and abstract submitted

INCB thematic hearing on "the use of drugs among older persons"

The inequities caused by drug control are made sharply apparent by the enduring global epidemic of pain caused by the lack of availability of controlled substances for scientific and medical purposes. Morphine offers a critical example. Despite its fundamental role in pain management and sedation, it is estimated that ¾ of the world have little to no access to this essential medicine.

With this in mind, it is commendable that the INCB continued to advocate for improved access to [at least some] controlled medicines over the last quarter of 2019. Activities in this direction included a regional training seminar held in Moscow for drug control officials from various Russian-speaking countries, and the INCB’s 126th session during which the Board’s Standing Committee on Estimates met to review national requirements for internationally controlled drugs, in an effort to ensure availability for medical and scientific purposes. At the session, the INCB President noted that:

‘The lack of availability of narcotic drugs and psychotropic substances for legitimate medical use represents a pressing public health problem in many regions of the world that countries must address without further delay’.

This issue was further highlighted in the INCB President’s statement for World Mental Health Day, in which he concluded that ‘Addressing the lack of availability of internationally controlled substances, particularly in middle and low-income countries, is essential in order to alleviate the suffering of people, as well as help to prevent suicide’.

As the evidence-base for the therapeutic potential of psychedelic substances continues to grow, we can only hope that the INCB will also acknowledge the obstacles that prohibition has imposed on clinical research concerning mental health.

The INCB also intervened at the first series of thematic CND discussions on the implementation of the 2019 Ministerial Declaration. On 16th October, the INCB raised both political and practical impediments to ensuring adequate access to controlled medicines, while preventing their diversion for non-medical use. Positively, the INCB’s closing remarks also tackled the issue of human rights:

‘I wish to reiterate yet again that if drug control measures adopted by States violate internationally recognised human rights standards and norms, they also violate the international drug control conventions. No crimes should be committed in the name of drug control’.

Going further in his statement delivered at the Reconvened 62nd Session of the CND in December, the INCB urged for:

‘…the immediate cessation of extrajudicial actions against suspected drug-related behaviour, and again call on countries that maintain capital punishment for drug-related offences to consider its abolition’.

Finally, from 7th to 9th October 2019, the INCB conducted a visit to Jordan, the only recorded country mission conducted during Q4 2019.

INCB highlights dearth of access to controlled medicines as ‘pressing public health problem’

The 20th International Conference on AIDS and STIs in Africa was held from the 2-7th December in Kigali, Rwanda. It brought together over 6000 participants from across Africa and beyond. The conference took place under the banner of “

AIDS FREE AFRICA - Innovation, Community, and Political Leadership

The aim of the conference was to engage the whole continent in the Post-SDG Framework, in order to ensure the sustainability of the response and achieve the 90/90/90 goals.

But it was clear from the conference that an 

 remains a mirage, in a context in which the human rights of people who use drugs are acutely neglected. It is more urgent than ever that governments, and all relevant stakeholders, join arms in ramping up efforts to implement evidence-based harm reduction programmes for people who inject drugs in Africa.

The conference did a commendable job in providing an overview of progress, including by showcasing successful HIV interventions, and identifying remaining gaps. However, the spaces dedicated to conversations about the needs of people who use drugs were visibly few.

Considering the enormous challenges the HIV response faces in the African continent when it comes to people who inject drugs (including high prevalence rates, poor data collection and availability, limited service provision, criminalisation and exclusion, among many others), one would have expected harm reduction and drug policy reform would feature prominently in many of the sessions. Alas, this was far from the case. And the same could be said about conversations on making the Universal Health Coverage (UHC) process work for key populations.

Overall, many of us, representing civil society and networks of affected communities, felt the discussions were not honest enough. We continue to dig our heads in the sand while our communities suffer. We must ask ourselves: 

 agenda be if we leave behind a whole key population?

Despite these major shortcomings, the [very] few events focusing on harm reduction and issues affecting people who use drugs at ICASA were a great success; including two major satellite discussions and 5 poster presentations.

These sessions focused on progress and policies with regard to harm reduction in Africa. They provided an overview of the various programmes and policies in place, and highlighted success stories that should serve as learning for the HIV community as a whole. The events were also an opportunity to take stock of remaining challenges and imagine how different our continent’s future could be, if only the harm reduction response were adequately funded and supported!

For IDPC members attending, ICASA was a great opportunity to meet, discuss and strategise. We all agreed on the importance of continuing to build on each other’s experiences to improve the work on the ground and highlighted the key transformative role that the decriminalisation of drugs for personal use could have on most vulnerable communities.

ICASA also saw the Support. Don’t Punish campaign extend its networks, sharing its message with dozens of people who stopped by our collective booth to join the Photo Project and learn about harm reduction.

As we move towards ICASA 2021, in Uganda, it seems important to push for harm reduction to make it to the top of the agenda; for the rights and wellbeing of people who use drugs to make it to the top of the agenda. Supported by data, research and the wealth of experience of the communities that we belong to and stand in solidarity with, we know that we cannot be successful in achieving an Africa free from AIDS if we continue down the path of neglect and complacency.

Uganda 2021 must see a new ICASA; one that embraces all affected communities, and especially those who remain relegated to the margins. We cannot afford another conference in which people who use drugs and harm reduction are not central to the discussion.

 ICASA 2019: People who use drugs continue to be side-lined in the HIV response

Between 19 - 21 November 2019, the sixty-sixth regular session of the Inter-American Drug Abuse Control Commission (CICAD), an OAS advisory body, was held in the city of Miami, Florida. This would usually not be noteworthy news, however on this last occasion we identified important setbacks that contrasted with the slow but constant progress that we had registered in the civil society space in the Forum since 2014.

Since then, CICAD's regular sessions had experienced an unprecedented openness to emerging issues and those traditionally excluded from the government agenda such as Human Rights in the framework of international drug control, legal cannabis regulation, harm reduction at festivals and the implementation of the operational recommendations of UNGASS 2016. However, on this occasion, things had changed and it became very clear that the position of the organisation had returned to the default of the supply and demand reduction, as if in more than six terms they would not have discussed anything else.

What changed? In macro terms, the political pendulum and the leadership of the commission - which went from countries with less punitive visions like Bahamas and Mexico to others with a tougher line in the United States. In micro terms, the non-maintenance of recently acquired practices where the significant involvement of civil society was allowed in the planning and execution of a panel with topics and speakers that complemented the official agenda and were brought from all corners of the continent without the economic support of States or the Commission.

Because of this loss of collaboration schemes in favor of the traditional forms of States that invite their civil society, this meeting witnessed the return of national discussions and practices that point towards criminalization and stigmatization, as well as punitiveness against people who use drugs, lack of treatment services, the persistence of compulsory and forced treatments and the militarization of drug control.

A clear example of this situation is the renewed centrality of drug courts on the Commission's agenda, which in previous years had been blurred in favor of other alternative measures that could be activated even before the judicialization of cases and which had the potential to break the vicious circle between drug use and the criminal justice system.

In this regard, remember that in previous forums there were panels dedicated exclusively to regional efforts to implement and follow up on the operational recommendations of UNGASS, where emphasis was placed on human rights, development, harm reduction and even the promotion of alternatives such as the effective decriminalization of drug possession for personal use- visions that were ignored during the exposition of the panels on this occasion.

Another example of the regression that occurred during this sixtieth regular session of CICAD was the total forgetfulness of civil society interventions, which at the time allowed visualizing such sensitive issues as access to prevention, treatment and care services in HIV aimed at drug users, the generation of scientific evidence for drug policy formulation abandoning traditional criminalizing discourse, and the exposition of lessons learned as a result of local intervention from civil society with people who use drugs.

As a consequence of this landscape, we denounced through a declaration of civil society on behalf of United Mexico Against Crime (MUCD), of the Center for Law, Justice and Society Studies - Dejusticia, Intercambios Civil Association, the Washington Office on Latin America (WOLA) and the International Drug Policy Consortium (IDPC), the absence of a space to share lessons learned from civil society. We are saddened that, on this occasion, the forum was lost to know experiences, actions and research that are generated from this space. Therefore, we made a respectful call for the diversity of voices to be included in the next meetings held by CICAD.

CICAD 66: A setback in drug policy in the Western Hemisphere 

This article, consisting of two parts, was originally posted, in Spanish, on the Animal Político website (Part 1 / Part 2). We are grateful to Karen Torres (IDPC volunteer) for the Spanish-to-English translation below.

'Well, I am a person who has relapsed several times, I have been in different rehabilitation centres, I have been in different street situations […]. More than anything, I would like to help, to support people, because sometimes we are harshly labelled as ‘addicts’ or as ‘consumers’ and, not to try to justify myself but, we all have our stories and reasons'.

And this is how our interview begins with Tamara, a 23-year-old woman admitted to a private residential treatment centre in Baja California. Her testimony is part of the more than 40 voices collected for an investigation carried out by EQUIS Justicia para Mujeres (

) focused on adolescents and women who use drugs who are in treatment centres or in jail.

Through this research, we seek to investigate the conditions of detention of people who use drugs. Moreover, we are particularly interested in knowing, from the narratives of the women themselves, what their relationship with drugs has been, what substances they have used and how they talk about drugs in relation to their life stories.

In line with what is reported regionally and internationally, in Mexico women consume significantly less than men and experience lower rates of dependence. They also face greater social, structural and cultural barriers to access treatment, as well as greater stigma.

As Lesly, who was admitted to a public treatment centre in Chiapas, points out: 'A man who uses drugs is seens as a ‘user’. A woman who uses drugs is deemed a ‘user’ and a ‘whore’'. Therefore, women are subject to a double penalty: on top of the marginalisation, stigmatisation and criminalisation to which all people who use drugs are subjected, women also experience the moral condemnation of having transgressed the gender axioms that frame the ideal of a ‘good woman.’

The women interviewed have, for the most part, been victims of sexual abuse on multiple occasions. Violence against children, coupled with gender violence against women and girls, manifests in the home and in the community and is deployed by grandparents, cousins, uncles - in short, close relatives of whom no one suspects.

Tamara herself, whom we cite at the beginning of this article, was abused for years by her cousins, every Sunday, after Mass.

Rape by a family member means that children do not talk about what happens or, if they do, no one believes them. This is the case of Diana, also admitted to a treatment centre on the northern border, who at the age of sixteen was raped by her maternal grandfather. When she told her mother, she didn't believe her. Diana ended up being deprived of freedom in a prison for minors in the United States for two years for having stabbed her grandfather to death.

In the stories collected in prisons and treatment centres, symmetries appear: sexual violence; drug use starting in the family setting or through a partner and, among the youngest, with friends; alcohol as the first drug and the beginning of substance use; as well as the development of dependence, since adolescence. In their narratives, drugs appear as an element of support/coping mechanism serving different purposes: to forget the experience of abuse, to deal with violence, to feel pleasure.

Bruno, a teenager whom we interviewed in Chiapas, to approach the experiences of young men and adolescents, was a victim of abuse by his grandfather since childhood. He smoked crystals and when he was under the effect of the drug, he imagined going for walks with his grandfather, playing with him, having the childhood he could only dream of. When we interviewed him, he was two days away from release. To the question 'What do you feel when you think about your departure?', he replied: 'I fear that I will be live the same way again'. That answer was shared by the other three young men we interviewed with Bruno.

Drugs are part of a search for solutions and an aid to try to address difficult situations and not, as people with substance dependence are usually represented, as means to brush off or abdicate on extremely difficult and painful situations. In fact, at the beginning of women's narratives, drugs are not important per se, rather they act as a pivot to deal with the rest. At some point the relationship changes and everything starts to revolve around substances. At that time of high vulnerability and cumulative exclusion, treatment centres become crucial.

The huge problem of treatment centres in Mexico

Mexico does not have enough public treatment centres. Most outpatient and residential centres are private, religious, and based on a mutual aid scheme. All the people interviewed who have been in private treatment centres report having witnessed or suffered physical, verbal, psychological and even sexual abuse.

This is the case of Yolanda; whose first pregnancy was the result of a rape by an operator of a treatment centre. In several cases, women were picked up by trucks and taken to the centres by force: Basically, a kidnapping operated by the so-called ‘Celestial Patrol.’

In addition to the dubious legitimacy and legality of most private centres - often becoming illegal prisons where inmates live indefinitely incarcerated - women who use drugs suffer further stigma. For example, we find that in some mixed centres, dress codes are stricter for women than for men. In the case of a girl who one day wore tights, the centre raised a report with a line that said: '[...by dressing like that] You are asking to be raped.' The young woman had been a victim of rape since she was three years old. In another centre they told us that men can go outside to do tasks or to get goods in kind or in money for the centre. Women, on the other hand, can never go out.

These are just some of the topics developed in the interviews. The findings and proposals derived from the cases collected will be part of a document that EQUIS will present at the beginning of the following year and that will be shared in this space over the coming months.

— ’Before, I was a happy girl ... happy ...’ Alejandra said.
— Were you hurt? - I asked.

Ale turns her eyes into the past, and the story of hell begins.

She was thirteen when she walked to school, in a rural town in a state of Mexico that, for her safety, we will not mention. Two men she already knew approached her and began to hit her with a stick on her ankles, pushing her to a vacant lot, where they beat her and raped her for hours. Before letting her go, they told her to stay quiet or they would do the same to her sisters.

Days later, the same men kidnapped her and kept her locked up for three days, marked by blows and more rape. Ale reports that in the room where they had her tied up, there were some boys her age. When her kidnappers raped her, they would tell them: 'This is how you treat women.'

Ale is currently deprived of liberty in a women's social reintegration centre for the crime of robbery with violence. Between the rape and her current detention, Ale experienced drug dependence, worked as a sex worker and was deprived of liberty due to homicide.

She is one of the almost 50 women who generously agreed to speak with us. Her testimony is part of an investigation by Equis, Justicia para Mujeres (Equis, Justice for Women), which will be published next year, focusing on adolescents and women who use drugs who are detained in public and private drug dependence treatment centres and in reintegration centres. As we mentioned in the first part of this series, this document will aim both to share their narratives, and to make visible the intersection between gender norms and access to treatment.

Every life story collected in these months is unique. One after another, adolescents and women - mostly young people - with whom we spoke, had the strength to share with us stories they had never shared with anyone else. Within said uniqueness, patterns are discernible, namely regarding the intersection between gender norms, violence against women and punitive drug policies.

In roughly 90% of cases, when asked how they started using drugs, most begin by reporting sexual violence in their childhood (from ages three to eleven), by stepparents, grandparents, uncles and other men in their close social circles. Usually, when they share what happened with their mothers or other relatives, they do not believe them or accuse them of being the instigators of sexual violence.

Two predominant scenarios ensue: Fleeing from home and living on the streets, or starting a relationship with an adult or adolescent man. Gina, a 23-year-old woman with a career as a hitman for almost a decade, says: ‘I felt safer on the streets than with my family.’

When the only option to escape violence, neglect and abuse is a relationship in adolescence, the consequences are almost always teenage pregnancies and more violence. Sexual violence against children is replaced by gender violence against girls and women. There are multiple perpetrators: Boyfriends, husbands, fellow people who use drugs, dealers, police officers and staff of rehabilitation treatment centres.

Women who use drugs are victims of multiple forms of violence: i) domestic violence, in the private, family or couple sphere; ii) violence in childhood; iii) specific violence in drug use circles, mainly of a sexual nature; iv) violence linked to sex work/prostitution; v) violence experienced by women victims of human trafficking; vi) institutional violence.

Adding to the gendered violence experienced by women who use drugs, women who use psychoactive substances in their childhood or adolescence are also subject to the penalties of punitive drug policies. In our next article, we will talk specifically about gender-based violence in drug treatment centres, based on the right to health approach.

As noted by a group of women deprived of liberty with whom we talked, mostly prosecuted for multiple homicides and related activities, no one denounces, persecutes or repairs the violence that women were victims of during their childhood. No one asks and no one believes them.

Criminal organisations find them in their adolescence and ‘fashions them [to their benefit]’: Young women with a form of military training, who coldly kill one victim after another, until they feel nothing. They evolve into single mothers who find a space of equality and empowerment in their work as hitwomen, as well as a source of income that allows them to keep their daughters and sons cared for. Women deprived of liberty who face sentences of more than one hundred years and who state, in their lucid and unappealable analysis: ‘the State only stops us, hits us or kills us’.

Women who use drugs and who are detained in prisons or treatment centres are completely invisible and stigmatised; they live in a circle of violence, systematic and widespread, that needs to be stopped. If we want to eradicate violence against all women and girls, it is necessary to listen to them and incorporate their experiences and their voices in the debates and policies that affect them.

* Corina Giacomello is a consultant for Equis – Justicia para las Mujeres.

Women who use drugs and access to treatment in Mexico: Between violence and stigma

This article was originally published on the Drug Policy Network South East Europe website.

From 23 to 27 June 2019, The International Narcotics Control Board (INCB) conducted a mission to Pristina, Kosovo to review the drug control situation there with a view of facilitating access to controlled substances while preventing their diversion.

INCB is an independent, quasi-judicial expert body established by the Single Convention on Narcotic Drugs of 1961 for monitoring member states’ implementation of the UN drug control treaties. It has 13 members, each elected by the Economic and Social Council for a period of five years.

The mission was led by Ambassador (ret.) David Johnson, Member of the Board, supported by Mr. Nodirjon Ibragimov of the INCB secretariat. The mission was facilitated by the United Nations Interim Administration Mission in Kosovo (UNMiK).

The delegation met with the representatives of Kosovo agencies involved in pharmaceutical regulation; the administration of justice, including prosecutorial services and the judiciary; law-enforcement, customs and forensics; and public health, addiction treatment and rehabilitation.

The INCB delegation also met with leaders of the international community supporting local institutions, including the EU Office in Pristina, EULEX, the OSCE Mission, UNDP, UNODC, and UNMiK. In addition, meetings were held with officials from the NGO “Labyrinth”, a DPNSEE member organisation, which provides opioid substitution treatment and other elements of a comprehensive treatment and reintegration programme and with the leader of the NGO Community Development Fund, which supports “Labyrinth”.

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