The EU Drug Markets Report 2019 is the third comprehensive overview of illicit drug markets in the European Union by the EMCDDA and Europol. The analysis presented in this report spans numerous topics such as the links between drugs and other crimes, the licit economy and society more generally as well as the processes and players involved in the trade, from production and trafficking to distribution. Taking an evidence-based approach, the report reviews the markets for heroin, cocaine, cannabis, amphetamine, methamphetamine, MDMA and new psychoactive substances. It also provides action points to inform policy development at EU and national level. This publication is an essential reference for law enforcement professionals, policymakers, the academic community and indeed for anyone seeking up-to-date information and analysis on drug markets in Europe.

EU Drug Markets Report 2019

By the House of Commons Scottish Affairs Committee

The rise in drug deaths in Scotland has been relentless, reaching an all-time high of 1,187 deaths last year. This tragic increase over the last two decades shows that a new approach is needed to tackle problem drug use. The UK Government must declare a public health emergency and be open to taking radical steps to implement innovative evidence-based solutions if we are to stand a chance of halting Scotland’s spiralling drug crisis.

The UK Government currently treats drugs as a criminal justice matter. However, the evidence we have heard overwhelmingly shows that the current approach is counterproductive. We therefore recommend that the UK Government adopts a public health approach to drugs, and transfers lead responsibility for drugs policy from the Home Office to the Department for Health and Social Care. We also recommend, in line with this approach, that there should be full protection for people with problem drug use in key equality legislation.

There have been calls to introduce safe drug consumption facilities as part of the immediate solution to Scotland’s drug crisis. Our evidence suggests that these facilities, where people can take drugs in safe and supervised conditions, are proven to reduce overdoses, drug deaths, blood-borne virus infection rates, and public injecting, and witnesses told us that the case for such a facility in Glasgow is amongst the most compelling in Europe. We are therefore disappointed that the Home Office has blocked the proposal despite the overwhelming evidence that they work and has not made the legal changes necessary to allow such a facility to be opened. We therefore recommend that the UK Government brings forward the legislation necessary to allow for the lawful establishment of a pilot safe drug consumption facility in Scotland. If the UK Government is unwilling to do this, we argue that it should devolve the necessary powers to allow the Scottish Parliament to do so.

However, safe consumption facilities and the adoption of a public health approach will not address all the problems caused by the criminalisation of drugs. Going further would require decriminalising drugs. Drawing on international case studies and examples of localised decriminalisation schemes in the UK, we outline clear evidence that decriminalisation is a pragmatic response to problem drug use, and an effective way of reducing stigma and encouraging people into treatment. As such, we recommend that the UK Government commits to decriminalising the possession of small amounts of drugs for personal use.

Throughout our inquiry we heard that the UK Government routinely ignores the evidence on what would be the most effective approach to reducing problem drug use. We call on the UK Government to take an evidence-based approach to drugs policy and accept expert advice.

Finally, Scotland’s drug crisis is not just the responsibility of the UK Government. The Scottish Government is responsible for health delivery, and there is undoubtedly more it could do within its existing powers to address problem drug use. We believe the Scottish Government should improve its response to problem drug use in areas that are already devolved, and that funding for drug-related health services in Scotland must be protected.

Problem drug use in Scotland

The 2019 update to Harm Reduction International’s flagship publication, the Global State of Harm Reduction, includes updates to some of the key data in the report, including the opening of new drug consumption rooms, availability of needle and syringe programs, and references to harm reduction in national policy documents, among many other things.

The Global State of Harm Reduction is a biennial report from Harm Reduction International. First published in 2008, it involves a coordinated effort across practitioners, academics, advocates and activists to map global data and responses to drug-related harms.

It is the only report to provide an independent analysis of the state of harm reduction in the world and has become the go-to source on global harm reduction developments for researchers and advocates in our sector and beyond.

In November 2019, the Public Health and Social Policy team at Harm Reduction International worked to provide an update one year on from the publication of the Global State of Harm Reduction 2018.

Global State of Harm Reduction 2019

The UN Common Position on drug policy is available here.

In November 2018, the UN System CEB adopted the ‘UN system common position supporting the implementation of the international drug control policy through effective inter-agency collaboration’, expressing the shared drug policy principles of all UN organisations and committing them to speak with one voice. The CEB is the highest-level coordination forum of the UN system, convening biannual meetings of the heads of all UN agencies, programmes and related institutions, chaired by the UN SecretaryGeneral. The CEB’s mandate dates back to the early days of the formation of the UN system, when ECOSOC in 1946 requested the UN Secretary-General to establish a standing committee to coordinate the activities of the multiple specialised entities of the UN system. The resolution led to the establishment of the Administrative Committee on Coordination (ACC), the predecessor of today’s CEB.

The 2000 Millennium Summit represented the first significant streamlining of inter-agency structures, away from individual programme areas, and focusing on cross-sectoral policy objectives, such as sustainable development and gender mainstreaming. It marked ‘the beginning of a new phase, where the organizations of the system now have, in the United Nations Millennium Declaration, a single overarching policy framework, to which they are individually and collectively committed’. The CEB, the new name given to the ACC in 2001, ‘intended to reflect this new state of play and this collective commitment’: ‘The expression “Chief Executives Board” rather than Committee is meant to reflect the transition from a collection of organizations that come together to “compare notes”, to a collegial body whose participants share a collective responsibility for nurturing the new reality that the system has come to represent’.

The subsequent 2005 World Summit Outcome Document called for ‘stronger system-wide coherence’ by strengthening linkages between the normative work of the UN system and its operational activities, and invited the UN Secretary-General ‘to launch work to further strengthen the management and coordination of United Nations operational activities so that they can make an even more effective contribution to the achievement of the internationally agreed development goals, including the Millennium Development Goals’.9 In response, UN Secretary-General Kofi Annan set up the High-level Panel on UN System-wide Coherence, which published its report with recommendations in November 2006 under the title ‘Delivery as One’, focusing on the areas of development, humanitarian assistance and the environment. The work of the UN ‘is often fragmented and weak’ and, according to the Panel: ‘Inefficient and ineffective governance and unpredictable funding have contributed to policy incoherence, duplication and operational ineffectiveness across the system. Cooperation between organizations has been hindered by competition for funding, mission creep and by outdated business practices’. The Panel also called on the CEB to review its functions ‘with a view to improving its performance and accountability for system-wide coherence’, because although the CEB ‘has led to some improvement in interagency coordination […] the Board’s potential has been underexploited and its decision-making role has been underused’.

The transition from the ‘Millennium’ to the ‘Sustainable’ Development Goals in 2015 was accompanied by a policy review of operational activities for development in the UN system, because ‘the integrated nature of the 2030 Agenda for Sustainable Development requires a United Nations development system that works in a coordinated and coherent manner’. The General Assembly also requested the UN SecretaryGeneral to present proposals to improve the collective support of the UN development system for the implementation of the 2030 Agenda, including through a more robust Resident Coordinator system.

Referring to the Secretary-General’s ‘overall vision to focus on root causes and the prevention of crises and vulnerabilities across all pillars’, Deputy Secretary-General Amina Mohammed ‘emphasized that tangible results achieved on the ground benefitting the people that the United Nations system served would be the true test of the reform efforts’. She underscored that the UN system ‘would have to embrace change in order to live up to the ambition set by Member States through the 2030 Agenda and other commitments’ and that ‘a common understanding of the direction of change was emerging towards a better coordinated, integrated and coherent country presence, with real accountability for system-wide results’.

Within this broader UN reform context, and following up on the outcomes of the 2016 UNGASS, the drugs issue came to the agenda of the CEB as one of the cross-cutting issues for which a more coherent approach needed to be developed. The resulting UN System Common Position on drug policy, released in January 2019, commits to ‘supporting Member States in developing and implementing truly balanced, comprehensive, integrated, evidence-based, human rights-based, development-oriented, and sustainable responses to the world drug problem, within the framework of the 2030 Agenda for Sustainable Development’. It supports ‘policies that put people, health and human rights at the centre’ and promotes ‘measures aimed at minimizing the adverse public health consequences of drug abuse, by some referred to as harm reduction’, ‘sustainable livelihoods through adequatelysequenced, well-funded and long-term developmentoriented drug policies in rural and urban areas affected by illicit drug activities’, and ‘alternatives to conviction and punishment in appropriate cases, including the decriminalization of drug possession for personal use’. It also calls ‘for changes in laws, policies and practices that threaten the health and human rights of people’ and ‘to cooperate to ensure human rights-based drug control and address impunity for serious human rights violations in the context of drug control efforts’. The CEB members also committed to stepping up their joint efforts to ‘provide Member States with a necessary evidence base to make informed policy decisions and to better understand the risks and benefits of new approaches to drug control, including those relating to cannabis’.

The CEB Common Position – not a binding document for Member States but a powerful instrument to harmonise the voice and activities of all UN entities – represents a significant step towards improving UN system-wide coherence and can guide the global drug policy debate towards a more health, development and human rights-based approach. Crucially, to ensure that the Common Position does not simply remain a piece of paper, a UN system coordination Task Team has been established to ensure that coherent efforts are undertaken to realise its commitments, and it will serve as an authoritative policy directive to UN Resident Coordinators for implementing drug-related programmes on the ground and assisting Member States in policy development.

Achieving more system-wide coherence under the banner of ‘Delivering as One’ or ‘One UN’, and aligning with the overarching SDG framework has been a particularly difficult challenge in the area of drug policy. This briefing paper reconstructs the long and troubled process that led to the adoption of this ground-breaking UN System Common Position.

UN Common Position on drug policy - Consolidating system-wide coherence

This brief provides a preliminary synthesis of Canada’s experience with cannabis legalization in the first year of retail sales. The brief focuses on evidence available to indicate progress against the public health and safety objectives of the Cannabis Act.

Canada’s relationship with legal cannabis is evolving. The market is still developing, and the pending introduction of new product formats means that Canada can expect to see considerable changes in both retail and consumer behaviour at least into the next year.

The National Cannabis Survey* indicates that Canadians’ use of cannabis has been fluctuating both before and after legalization among both youth and adult age groups. However, the changes in use have varied by reporting quarter.

More people are trying cannabis following legalization. Since legalization, those trying cannabis for the first time are more likely to be older (e.g., 45 years of age and up) compared to those trying for the first time before legalization.

More information is needed to better understand the nature of any increases in use, including whether the older population is seeking products with higher CBD due to beliefs about possible health benefits.

The National Cannabis Survey also indicated a significant decrease in Canadians accessing cannabis directly from the illegal market or from friends and family following legalization.

Revenues from cannabis sales have been significantly lower than anticipated.

The legislated three-year review of the Cannabis Act provides an opportunity for critical review of the nature and implementation of the regulations, and to make course corrections.

Looking forward, priority areas for education about lower-risk use include the difference between ingested and inhaled products, and the effects of impairment on driving and in the workplace.

The Cannabis Act permitted the sale of cannabis within a legal regulatory system as of October 17, 2018.

The federal government is responsible for issuing production, processing, import/export, testing and research licences.

The provinces and territories are responsible for retail sales and distribution. Each province and territory established a unique approach, with considerable variation among them in terms of public versus private sales, licensing, number and distribution of retail stores, oversight bodies, pricing and taxation, supply, and places of consumption, for example.

Cannabis legalisation in Canada: Year one observations

In recent years, services and options for people with opiate dependence have expanded to include a range of prolonged-release buprenorphine formulations. Although these new options can represent the right solution for some individuals, a significant risk of a coercive use exists, especially in countries where people who use drugs are highly criminalised and discriminated against. In such contexts, these medications could be used as a means to reduce people’s choice with regard to their bodily integrity and their drug use. In return, this could essentially enforce prohibition and morally-driven ideas of abstinence. This paper outlines the position of the International Network of People who Use Drugs (INPUD), developed after extensive research and in consultation with people who use drugs and our allies.

Extended-Release Opioid Agonist Products: A community position statement 

Despite much speculation and conjecture over potential crossovers between terrorists and the drug trade in Europe, no study has examined the issue. This paper fills this gap by empirically examining such crossovers in the European Union between 2012 and 2017. Based on a unique open- source database, two main themes emerge. Firstly, the only area with deep and sustained crossovers is Northern Ireland, where Republican and Loyalist paramilitaries have sought to influence or control the drug trade. The consequences are threefold: conflict with “regular” criminals; internal divisions within paramilitaries; and the potential alienation of the very communities they claim to represent. Secondly, many European jihadists have backgrounds in consuming or dealing drugs, and their radicalisation does not always change this behaviour. Indeed, of the 69 jihadists who carried out an attack in Europe between 2012 and 2017, there is evidence that at least 5 individuals (7% of the total) consumed illicit drugs in the days or hours prior to their attack. This suggests that extremists do not automatically break from familiar, habitual, and possibly addictive patterns, and that radicalisation is no guarantee of an absolute, abrupt, and permanent change in lifestyle.

Terrorism and drugs in Europe

华裔的何有华是马来西亚公民，在 2011 年被判死刑成为死囚，之后一直遭关押在彭亨州文冬（Bentong） 监狱里。2005 年，当时 20 岁的他因持有 188.35 克冰毒而被捕。被捕时，他在没有律师在场的情况下用 母语华语作出陈述，警察则用马来语记录，该陈述成为他被定罪的根据。后来，他在法庭上质疑该陈述 的内容，指出其不准确之处，并补充指警察在审问他的过程中折磨他，打断了他的手指，且威胁要殴打 他的女友，以迫他签字。法官未经进一步调查就驳回了这些指控，何有华被想当然地假定为犯有贩毒罪， 并被判处死刑这项唯一的惩罚。他的司法上诉均告失败，而他的赦免申请自 2014 年至今仍没有结果。由 于政府已于 2018 年 7 月在全国暂停执行死刑，因此他与所有其他死囚一样，没有被即时处决的风险，但 却前景不明。

如本报告所述，何有华一案显示了马来西亚使用死刑时有许多违反国际人权法和国际人权标准的问题， 包括缺乏适当和及时的法律援助，警察审问过程中实施酷刑和其他虐待，当局依赖没有律师在场时所取 得的陈述或信息，嫌犯在贩毒案件中被推定为有罪，赦免程序秘而不宣，以及死刑被广泛应用于未达到 “最严重罪行”门槛或不是故意杀人的罪行，而国际法规定死刑必须仅限于以上二者。

上述的问题十分严重。截至2019年2月，马来西亚据报有1,281名死囚，包括568名（44%）外国公民。 被判死刑的 1,281 人中，73%因贩毒被定罪。而在女性死囚中， 更有 95%的人涉及贩毒罪，情况令人震 惊。 此外，在死囚中，一些少数族裔所占的比例异常高，而且，根据所取得的有限信息，社会经济背景 欠佳的人在死囚中占了一个很大的比例。

目前，马来西亚对 33 项罪行保留了死刑，其中 12 项作为强制性刑罚。近年来，被判处死刑的人主要涉及 谋杀罪和贩毒罪。国际特赦组织在审议一些案件时发现，大多数男女死囚因运送毒品而被定罪，他们所 致命的缺陷 为何马来西亚必须废除死刑 国际特赦组织 4 涉及的毒品数量较少，只是充当快递员，并没有使用暴力。国际法禁止判处强制性死刑，而且死刑仅限 于达到“最严重罪行”门槛的罪行，亦即故意杀人罪。

不过，马来西亚也有一个变革的重要契机。2018 年 7 月，新组建的政府即时暂停执行死刑，后来更承诺 全面废除死刑。预计在 2019 年末，马来西亚政府将向国会提交法案，废除 11 项罪名中强制性死刑的刑 罚。虽然这是朝着正确方向迈出的一步，但与政府先前所做有关全面废除死刑的承诺相去甚远。马来西 亚国会将于 2019 年 10 月复会，国际特赦组织建议当局尽快提交立法草案，以解决本报告所述的重大缺 陷，目的是避免当局任意判处死刑，以此作为全面废除死刑的第一步。

本报告以国际特赦组织进行案头研究和访问所收集的信息为基础，最新的访问在 2019 年 8 月进行。国际 特赦组织分析马来西亚死囚问题时，所使用的数据在 2019 年 2 月从官方来源取得，并辅以网上查到的 150 项法院判决资料 。国际特赦组织也与死囚的亲友、有重大死刑案件经验的律师及外国使馆代表等进 行了 32 次面对面的访问。此外，本组织亦从另外 13 名死囚的家人那里收到了书面资料。国际特赦组织多 次要求马来西亚当局提供死囚的信息和联系渠道，包括为编写本报告而提出请求。可惜在发布本报告之 时，马来西亚当局皆拒绝或没有回应以上要求。

华裔的何有华是马来西亚公民，在 2011 年被判死刑成为死囚，之后一直遭关押在彭亨州文冬（Bentong） 监狱里。2005 年，当时 20 岁的他因持有 188.35 克冰毒而被捕。被捕时，他在没有律师在场的情况下用 母语华语作出陈述，警察则用马来语记录，该陈述成为他被定罪的根据。后来，他在法庭上质疑该陈述 的内容，指出其不准确之处，并补充指警察在审问他的过程中折磨他，打断了他的手指，且威胁要殴打 他的女友，以迫他签字。法官未经进一步调查就驳回了这些指控，何有华被想当然地假定为犯有贩毒罪， 并被判处死刑这项唯一的惩罚。他的司法上诉均告失败，而他的赦免申请自 2014 年至今仍没有结果。由 于政府已于 2018 年 7 月在全国暂停执行死刑，因此他与所有其他死囚一样，没有被即时处决的风险，但 却前景不明。 如本报告所述，何有华一案显示了马来西亚使用死刑时有许多违反国际人权法和国际人权标准的问题， 包括缺乏适当和及时的法律援助，警察审问过程中实施酷刑和其他虐待，当局依赖没有律师在场时所取 得的陈述或信息，嫌犯在贩毒案件中被推定为有罪，赦免程序秘而不宣，以及死刑被广泛应用于未达到 “最严重罪行”门槛或不是故意杀人的罪行，而国际法规定死刑必须仅限于以上二者。 上述的问题十分严重。截至2019年2月，马来西亚据报有1,281名死囚，包括568名（44%）外国公民。 被判死刑的 1,281 人中，73%因贩毒被定罪。而在女性死囚中， 更有 95%的人涉及贩毒罪，情况令人震 惊。 此外，在死囚中，一些少数族裔所占的比例异常高，而且，根据所取得的有限信息，社会经济背景 欠佳的人在死囚中占了一个很大的比例。 目前，马来西亚对 33 项罪行保留了死刑，其中 12 项作为强制性刑罚。近年来，被判处死刑的人主要涉及 谋杀罪和贩毒罪。国际特赦组织在审议一些案件时发现，大多数男女死囚因运送毒品而被定罪，他们所 致命的缺陷 为何马来西亚必须废除死刑 国际特赦组织 4 涉及的毒品数量较少，只是充当快递员，并没有使用暴力。国际法禁止判处强制性死刑，而且死刑仅限 于达到“最严重罪行”门槛的罪行，亦即故意杀人罪。 不过，马来西亚也有一个变革的重要契机。2018 年 7 月，新组建的政府即时暂停执行死刑，后来更承诺 全面废除死刑。预计在 2019 年末，马来西亚政府将向国会提交法案，废除 11 项罪名中强制性死刑的刑 罚。虽然这是朝着正确方向迈出的一步，但与政府先前所做有关全面废除死刑的承诺相去甚远。马来西 亚国会将于 2019 年 10 月复会，国际特赦组织建议当局尽快提交立法草案，以解决本报告所述的重大缺 陷，目的是避免当局任意判处死刑，以此作为全面废除死刑的第一步。 本报告以国际特赦组织进行案头研究和访问所收集的信息为基础，最新的访问在 2019 年 8 月进行。国际 特赦组织分析马来西亚死囚问题时，所使用的数据在 2019 年 2 月从官方来源取得，并辅以网上查到的 150 项法院判决资料 。国际特赦组织也与死囚的亲友、有重大死刑案件经验的律师及外国使馆代表等进 行了 32 次面对面的访问。此外，本组织亦从另外 13 名死囚的家人那里收到了书面资料。国际特赦组织多 次要求马来西亚当局提供死囚的信息和联系渠道，包括为编写本报告而提出请求。可惜在发布本报告之 时，马来西亚当局皆拒绝或没有回应以上要求。

致命的缺陷 为何马来西亚必须废除死刑 概要

By Richard Stranz (Aides), Eurosider Project

Drugs users and community health workers (CHW) in France both expressed the need to have their reality of their work around injection practices legitimised and formalised as interventions being beneficial to the health of drug users (DU).

As a result back in 2009, a community-based research study, called AERLI (Accompagnement et éducation à la réduction des risques liés à l’injection), was instigated in France between AIDES, Médecins du Monde and the INSERM research institute. Its aim was to identify how CHW by being present at the moment of injection could improve DU health outcomes.

One aspect of this research was that the CHW were trained implement the research protocol. This protocol also standardised the steps of the intervention. These were transformed into a training manual.

The results of AERLI 1 published in 2016 proved that interventions at the time of injection reduced risky behaviour for infectious diseases (HIV and Hep C particularly) and also in the long term both as one off and if repeated (ref).

Since then, through training workshops very similar to the one laid out in this manual AIDES has been reinforcing the capacities of its own volunteers and salaried staff as well as from other organisations to implement this intervention adapting. It has also trained staff from other organisations.

The EUROSIDER project, a lighter version of the AERLI study, was carried out with the support of EU funding via DG JUSTICE call: JUST-2016-AG-DRUG.

The main objective of this project was to contribute to reducing the risk of HIV-HCV transmission and to better international Hepatitis C policy and practice by studying the transferability of an effective community-based, Individually-Tailored Support and Education for Safer Injection (ITSESI) intervention in four different political and epidemiological contexts.

As one of the deliverables of the project, this training manual resembles the one used during the training sessions implemented during the project.

It has been enriched with the feedback from the trainers in the four target countries Bulgaria, Greece, Portugal and Romania.

ITSESI: European training manual

MDMA is well established as a popular psychoactive substance across much of the Western world. Hundreds of thousands of people break the law to access its effects, which include increased energy, euphoria, and enhanced sociability. The categorisation of MDMA as a Class A drug in the UK and Schedule I drug internationally – categories reserved for drugs deemed to pose the highest risk to individuals and society – has never meaningfully disrupted its supply, nor its widespread use. MDMA is cheaper and purer than ever before and is available at the click of a mouse via darknet drug markets.

For several years, MDMA-related adverse events and fatalities have been increasing in the UK, with some claiming that taking MDMA today is the riskiest it has ever been. Responses are polarised between those who assert that the risks of MDMA use necessitate mitigation through prohibition and increased law enforcement, and those who perceive prohibition to be exacerbating these risks by exposing users to an unregulated market of pills and powder of unknown strength and quality. Whichever view you take, current policy is not meeting its goal of reducing harms, and greater control of MDMA production, distribution, purchase, and consumption is needed in order to prevent MDMA-related emergencies.

This report examines the acute, sub-acute, and chronic harms related to MDMA use in detail. We examine the production, distribution, purchase, and consumption of the drug; related risks and harms; and the impact prohibition has on these, as well as the potential impact of alternative policies. Crucially, our evidence shows that most harms associated with MDMA use arise from its unregulated status as an illegal drug, and that any risks inherent to MDMA could be more effectively mitigated within a legally regulated market.

Under prohibition, people purchase MDMA pills, crystal, and powder from an illegal market, with little certainty as to what these contain. Given that illegal drugs are not subject to strict production standards, consumers are exposed to the risks of poisoning or accidental overdose as a result of contamination, adulteration, and unknown strength and purity. Naïve commentators demonise the drug and simply urge young people to ‘just say no’, whilst failing to account for those who say ‘yes’. In the meantime, preventable deaths continue to occur, and otherwise law-abiding people are punished for non-violent offences such as the possession or social supply of MDMA. Governments and the mainstream media persist in perpetuating the myth that the War on Drugs is winnable if it were fought harder, and those calling for drug policy reform – as we do here – are framed as ‘radicals’ who have little or no regard for the health and wellbeing of citizens.

This characterisation could not be further from the truth. Those calling for careful reform to existing drug policy include the parents of young people whose lives have been lost or ruined by harms related to the prohibition of MDMA. We incorporate their voices in this report alongside those of academics and former police officers, highlighting the ‘broad church’ of those dedicated to fighting for reform. This includes scientists undertaking ground-breaking research into the therapeutic potential of MDMA, who work within a regulatory regime that makes such research exorbitantly expensive and time-consuming, because of the Schedule 1 status that MDMA holds in the UK.

As we enter the fourth decade of MDMA’s widespread use, new thinking is needed on how to better control production and distribution, and on how to reduce the risks associated with its consumption. There is growing evidence to support reorienting drug policy away from an ideologically driven criminal justice-led model to one rooted in pragmatic health and harm reduction principles. This is reflected in the widespread reform of cannabis laws occurring in numerous jurisdictions around the world, and the growth of treatment programmes for heroin users which include prescription heroin and supervised injecting rooms. These hard-fought policy changes acknowledge the failure of prohibition to meet its goals and produce a ‘drug-free world’. They are built on a robust and ever-growing evidence base which demonstrates how permitting or prescribing the use of legally regulated drugs improves health and safety outcomes for people who use drugs and their communities at a reduced cost to the state, whilst also providing wider employment and economic opportunities. This logic can be extended to the use of MDMA and other currently prohibited psychoactive substances.

follows this pragmatic path and pursues policy aims which many of us share, such as improvements in public health promotion, targeted harm reduction, evidence-informed policy and practice, human rights, social justice, participatory democracy, and effective governmental expenditure. For the first time, we outline detailed recommendations for drug policy reform to better control the production, distribution, purchase, and consumption of MDMA products. Reform and the reduction in MDMA-related harms this will bring cannot happen overnight. The changes we outline here, which culminate in a strictly regulated legal market for MDMA, are to be phased in gradually and closely evaluated through independent policy research to ensure health and social outcomes are properly documented, with findings folded back into the ongoing reform process.

The report is available on the Beckley Foundation's website.

Roadmaps to regulation: MDMA

The phenomenon of new psychoactive substances (NPS) started decades ago with the growth and production of drugs that replicate the effects of controlled drugs (such as amphetamines, cocaine, cannabis and heroin) but avoid legislative control based on different chemical structures.

In recent years, the increasing use of NPS has led to new threats for health of people who use drugs (PWUD) – including overdose, psychotic reactions, high HIV risks due to multiple injections and increased number of sexual contacts. However, in many countries service providers such as harm reduction, drug treatment programs and ambulance services are not prepared to provide PWUD with quality support and counselling to reduce risks of NPS.

In the Central and Eastern Europe and Central Asia (CEECA) region the situation with NPS is truly alarming and has become one of the major challenges for the national public health systems, local NGOs, communities PWUD.

EHRA in partnership with School of Law, Swansea University conducted a research “New Psychoactive Substance Use in Moldova and Belarus”. It aimed to analyze and determine the presence of new psychoactive substances (NPS) in Belarus and Moldova. Results from this project will supplement scarce international data on the use of NPS in these countries, present a more accurate picture of its use, and provide information to national civil society organizations for political advocacy.

In 2020, research will be expanded into 4 more countries: Kazakhstan, Kyrgyzstan, Georgia and Serbia.

New psychoactive substance use in Moldova and Belarus

People who inject drugs (PWID) are at high risk of acquiring and transmitting blood-borne viruses, including HIV, from unsafe injection practices and risky sexual behaviors. The United Nations Office on Drugs and Crime (UNODC) estimates that around 29.5 million people suffer from drug use disorders worldwide of the estimated 15.6 million PWID in the world, subSaharan Africa has 1.4 million. The Southern and Eastern coasts of Africa are important routes for global heroin trafficking originating from Asia, and the region is fast becoming a final destination for these drugs, with a growing number of African consumers.

HIV prevalence among PWID is 18% globally, nearly 28 times higher than HIV prevalence among the general adult population. A systematic review determined that HIV prevalence among PWID in subSaharan Africa was 56%, but estimates in the region vary widely.

Adverse health outcomes among PWID are further intensified by punitive legal environments, a variety of human rights abuses and poor access to services. Few harm reduction programs and PWID-specific HIV prevention, care and treatment services are available in sub-Saharan Africa. As of 2017, only seven countries had publicly funded syringe exchange and medication-assisted opioid treatment programs. In Mozambique, publicly funded harm reduction and HIV care and treatment programs for PWID did not exist prior to this study.

An estimated 13.2% of the adult population in Mozambique are living with HIV; the percentage of PWID living with HIV was unknown. Information on blood-borne disease burden and demographic and behavioral characteristics of PWID are necessary to assess the unique prevention, care and treatment needs of this population. For this purpose, we conducted the first biological and behavioral survey (BBS) among PWID in two urban areas of Mozambique. PWID are one of five priority populations surveyed as part of the national HIV behavioral surveillance system, which include men that have sex with men, female sex workers, long-distance truck drivers, and mine workers. This manuscript presents the main findings of the PWID BBS survey.

High prevalence of HIV, HBsAg and anti-HCV positivity among people who injected drugs: Results of the first bio-behavioral survey using respondent-driven sampling in two urban areas in Mozambique

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