By Penal Reform International, Linklaters LLP, International Drug Policy Consortium

Drug‑related offences are known to have a particular and disproportionate impact on women. Eighty-two per cent of all women in prison in Thailand are imprisoned for a drug offence; in the Philippines, the proportion of women in prison for a drug offence is 53% and in Peru and Costa Rica it is more than 60%.

This report considers five key questions relating to the sentences imposed on women for drug‑related offences across criminal justice systems in 18 jurisdictions. The research was undertaken by Linklaters LLP for Penal Reform International on a pro bono basis, and is co-published by Penal Reform International, Linklaters LLP, and the International Drug Policy Consortium. The study is instrumental in building a better understanding of the case law around women accused of drug‑related offences and forms a solid basis for the development of policy guidance and recommendations to legislators and sentencing authorities (which will be published in 2020).

The complex reasons and pathways of women’s confrontation with criminal justice systems for drug‑related offences are not adequately reflected in legislation or (where existing) sentencing guidelines, nor sentencing practices across the 18 jurisdictions.

While there is a variety of considerations mentioned in a number of jurisdictions’ legal instruments that can mitigate culpability or lessen a sentence for a woman prosecuted or convicted for drug‑related offences, the impact on their sentence received is less certain.

Factors typically include consideration of pregnancy, single-parent status, or other circumstances such as experience of violence or coercion, role in the crime, or status of vulnerability. Where such factors are explicitly mentioned, they are given weight of differing degrees or discretion is limited by the applicable law or sentencing guidelines (including mandatory minimum sentences), thus limiting their impact. In cases where they have been taken into account, it is difficult to quantify the effect on the sentence given.

In a number of jurisdictions covered, non-custodial sentences are the more common form of sentences for low‑level drug‑related offences for women (for example, in England and Wales, Germany and New Zealand). In contrast, in Russia, non-custodial sentences are only issued in about 4% of drug‑related offences cases.

Jurisdictions covered by the study are: Argentina, Australia, Colombia, Costa Rica, Ecuador, England and Wales, France, Germany, Hong Kong, Japan, Mexico, New Zealand, the Philippines, Poland, Portugal, Russia, Spain, and the United States.

Sentencing of women convicted of drug-related offences

In excess of 11 million people are in prison globally, including more than 714,000 women and girls. According to the World Health Organization (WHO), one in four people will be affected by mental or neurological disorders at some point in their lives. People in prison have a disproportionately high rate of poor mental health; research suggests that around one in seven prisoners has a serious mental health condition.

A high proportion of women in prison have poor mental health. There are many factors that can affect a person’s mental health. Many people have difficult life histories and prisons can be very tough places. This guide does not claim to solve these challenges. Instead, it gives ideas of practical steps that can help.

Prison staff have an important role to play in protecting and promoting health and well-being in prison and need adequate training as well as support from their managers. In planning and delivering prison healthcare services it is good practice to involve service users alongside health and social care professionals, relevant voluntary groups and prison staff.

This guide is written to help understand how life in prison can affect a person’s mental health, with a focus on women. It describes how to recognise the signs of poor mental health and how best to respond. The guide aims to break down the stigma and discrimination attached to poor mental health, especially for women in prison.

This guide has been written primarily for prison staff and others who work with women in prison or may be making decisions that affect them. It may also be helpful for women in prison, as well as for their families and friends. Many of the points in this guide are equally relevant to men in prison. However, there are particular approaches that should be taken to meet the specific needs of women.

At the national level, improvements in mental healthcare both within prison and the wider community need leadership from politicians and policy-makers. Aspects of prison life which have an impact on prisoners’ well-being fall within the responsibility of senior prison management and national prison administrations. In the Appendix a checklist based on international human rights standards is designed to help with the implementation of key aspects of prison reform and advocacy initiatives in line with international standards and norms.

This guide does not deal with the diagnosis and treatment of specific mental health conditions. This is the responsibility of specialised mental healthcare professionals. Neither does this guide replace mental health training for prison staff. All prison staff should receive basic and ongoing mental health training as part of their professional development, especially in relation to the prevention of suicide and self-harm.

Women in prison: Mental health and well-being – A guide for prison staff

By Luis Felipe Cruz Olivera, Teresa Garcia Castro, Kathryn Ledebur, and Isabel Pereira

In Latin America, the lives of women who grow plants destined for illicit markets are marked by several forms of discrimination: because they are women, because they are rural farmers, and because their livelihood depends on an activity that has been declared illegal. The so-called “war on drugs” and the marginalization of rural life have erected walls behind which the role of women as agents of social transformation is hidden and rendered invisible. Beyond the numerous challenges they face, women growers of coca and opium poppy have played a critical role in sustaining and improving rural livelihoods, caring for families, in community organization, and in social movements. From their fight to assert the rights of coca-grower movements in Bolivia to their contribution to peace building in Colombia, women growers have been crucial agents of change in their communities. Their active participation—whether in farmer organizations, assemblies, agrarian unions, or other collectives—has given them new tools and knowledge for interacting with government entities and achieving important local objectives. Women coca or poppy growers not only build knowledge and capacities in their territories; they also contribute on a daily basis to the transformation and improvement of their realities, and that of their families and villages. Given the silence and dearth of information regarding the role of women in community life in areas where crops declared illicit are grown, this report explores who these women growers are, their socioeconomic contexts, their involvement in the production of crops destined for illicit markets, their organizing experiences, and their participation in decisionmaking processes—taking into account case studies from Bolivia and Colombia. Furthermore, the report presents recommendations focused on ensuring the participation of women growers in political and public life at all levels of decision-making.

Women coca and poppy growers mobilising for social change

It is now a year since Canada moved to legally regulate cannabis for recreational use, becoming the second country after Uruguay, and the first major G7 economy, to do so (excluding the 11 US states that have now done so outside of US federal jurisdiction). While legal access to cannabis was already available for medical purposes, this marked a groundbreaking policy shift away from criminalisation of the drug and the people who use it in a country of nearly 40 million people.

The Canadian Government emphasised three key goals of regulation: the protection of public health; the protection of young people; and the reduction in criminality associated with the illegal market.1 The
reforms built on years of evidence demonstrating that the illegal status of cannabis did not prevent rising consumption and was associated with a range of other risks, from increased potency to the empowerment of criminal gangs

Historically, Canadian provinces have developed separate systems for regulating the sale of alcohol, and a similar devolved principle was applied to cannabis. As a result, a ‘patchwork’ of regulatory models has now emerged across the country. Some provinces have been more successful than others and many have experienced ‘teething’ issues during early implementation. Importantly, the Cannabis Act only allowed for herbal cannabis and oils to be sold in the first year. The sale of cannabis ‘edibles’ and concentrates are subject to separate regulations and are due to go on sale later this year in phase 2 of the implementation.2

Establishing an entirely new regulated market – aimed at displacing well-established illegal supply – was a unique challenge. While some have raised concerns that the intensity of cannabis regulation has slowed participation in the new legal market, others remain worried about creeping commercialisation. It will inevitably take time for the new system to bed in and for emerging problems to be addressed. Policy will hopefully evolve as evidence is gathered, and learning is shared across provinces. This briefing reviews the early data since legalisation and considers lessons other countries might draw from the Canadian experience.

Cannabis legalisation in Canada – One year on

The sixty fourth session of the Commission on the Status of Women marks the twenty fifth anniversary of the Beijing Declaration and Platform for Action. In parallel, the international community committed to the implementation of the United Nations General Assembly Special Session on Drugs outcome document featuring recommendations to advance the rights of women in drug policy. This submission demonstrates how current drug policies undermine key rights and commitments included in the Beijing Declaration and Platform for Action’s strategic objectives and offers concrete recommendations to address these damaging inconsistencies.

CELS, IDPC, WHRIN and WOLA statement to the 64th session of the Commission on the Status of Women

The Americas are at the forefront of processes and efforts to reform cannabis-related laws and policies. The regulated markets established in Uruguay and Canada will very likely be joined soon by Mexico, where President Andrés Manuel López Obrador has backed a legislative proposal that, at the time of this writing, was being considered in the legislature. In the United States, ten states and the District of Columbia have adopted legal, regulated markets for recreational use. Also at the time this report was being finalized, a bill was being presented before Colombia’s Congress to reform Article 49 of the Constitution with regard to the prohibition of narcotic substances, with a view to paving the legal way for future regulation. In 2018, the Regional Commission on Marijuana of the Caribbean Community (CARICOM) concluded that the prohibitionist system “is not fit for purpose” with regard to international drug control treaties, and it called for a paradigm shift.

At the same time, medical marijuana is growing by leaps and bounds. In the United States, 33 of its 50 states along with the District of Columbia permit the medical use of cannabis, while in Canada this use has been legal since 2001. In Latin America, some form of medical marijuana is allowed in Argentina, Brazil, Chile, Colombia, Mexico, Paraguay, Peru and Uruguay. As this publication was being finalized, Ecuador’s National Assembly was concluding a debate on a legislative proposal that would create the means of access to medical marijuana in that country. However, it is important to note that in the majority of these countries, reforms are quite limited and do not ensure access for all people who could benefit from medical marijuana.

In addition, more tolerant attitudes toward cannabis do not necessarily translate into public support for broader drug policy reform. In the majority of Latin American countries, a change in the discourse has not led to significant domestic policy reforms. At the Organization of American States (OAS) and the United Nations (UN), Latin American countries have spearheaded efforts to promote debate about the failure of the prohibitionist paradigm and the need to explore alternative approaches. However, as tends to happen, this rhetoric has not been matched by concrete actions. In other words, drug policy reforms in the region have been minimal despite the tremendous societal costs of current policies, and governments continue to rely on repression and criminalization.

That is why, for people in countries where there are still no legal markets, the consequences of being caught with any amount of cannabis can be severe. Previous studies by the Research Consortium on Drugs and the Law (Colectivo de Estudios Drogas y Derecho, CEDD) have shown that throughout the region, people who consume cannabis face stigmatization and harassment by police, and they are often detained for growing plants or for simple possession of the substance. In several of the countries studied, people who use cannabis constitute a significant percentage of those impacted by drug laws. Many of them end up being subjected to the criminal justice system and, on occasion, they are referred to compulsory (or semi-compulsory) treatment, even when they do not show signs of a drug dependency. In several countries, “drug court” models are making headway, which repeat the logic of using the criminal justice system to refer people who use drugs to treatment programs. To sum up, harsh and disproportionate cannabis-related laws in the region cause significant harm to people, their families, their communities, and to society in general.

This disconnect between the trend toward regulating cannabis in the Americas, on the one hand, and the continuation of a punitive approach in nearly all Latin American countries, on the other, led CEDD to undertake its current research, which analyzes the way in which punitive drug laws disproportionately affect people who use, grow, and sell small amounts of cannabis.

Cannabis is also the most widely used substance declared to be illicit in Latin America. Its medical uses are beneficial, and its problematic use causes less harm than other drugs, licit or illicit. Therefore, it is the only substance for which there is an impetus for reform. The expansion of legal and regulated marijuana markets would have a significant impact on reducing the damage caused by repressive drug policies, and we hope that this research contributes to that aim.

Cannabis in Latin America: The green wave and challenges for regulation

In September 2019, Transform Drug Policy Foundation and St George’s House convened a meeting of international experts on drug policy to discuss a scenario that many people feel may be edging closer to realisation: a world in which currently illicit drugs are legally regulated. This event provided an opportunity to discuss candidly the challenges and opportunities of this potential reality.

Transform is a leading global advocate for the legal regulation of drugs. However, the participants came from a range of backgrounds and brought different views on the question of drug policy reform. Participation did not imply, or require, agreement on the principle of legal regulation and the input of participants reflected this.

There was agreement that the so-called ‘War on Drugs’ has been waged at a high price in terms of fuelling crime and violence, drug-related health harms and deaths, undermining of institutions through corruption, and the exploitation and abuse of some of the world’s most vulnerable communities. This reflects wider shifts in attitudes towards drug policy. Global consensus on the goal of achieving ‘drug free society’ through the criminalisation of production, supply and possession has decisively fractured, with a growing number of jurisdictions experimenting with both the decriminalisation of possession, and more recently, the legal regulation of cannabis supply (including Canada, Uruguay, Mexico, and 11 US states, including California). Bolivia has also regulated the production of coca.

This consultation sought to grasp that moment and imagine a scenario where the legal regulation of drugs became a more global reality, for different drugs in different regions. The intention was not to anticipate the circumstances through which regulated markets might come to pass, or to rehearse well-trodden arguments for or against prohibition, but rather to imagine what consequences such an eventuality might have for everybody involved in, or impacted by, the global drugs market. It was an opportunity to envision that possible world, and for participants to freely and candidly discuss their responses.

This report summarises the discussions held over the two days of consultation and draws out consensus conclusions which we hope will be useful to advocates, policymakers, researchers and other parties interested in navigating a way forward. It was drafted by the independent rapporteur, Peder Clark, with editorial input from Transform Drug Policy Foundation.

Taking the points of consensus together, we propose seven principles as emerging from the discussion. Rather than focusing on what drug policy should be, these set out some key values on which reform should be based.

Challenges for a world where drugs are legally regulated

The U.S. is in the throes of a deadly overdose crisis that claimed almost 70,000 lives in 2018. Of those, around 30,000 deaths involved synthetic opioids like fentanyl,a Policymakers have responded to the overdose crisis with a rhetorical emphasis on “treatment instead of incarceration,” leading journalists to comment that we are in the midst of a “gentler war on drugs.” However, despite a change in discourse, draconian policies have persisted and in many cases been expanded. This is exemplified by many lawmakers’ reaction to fentanyl and other analog drugs, both on the state and federal level.

Since 2011, 45 states have proposed legislation to increase penalties for fentanyl while 39 states and Washington DC have passed or enacted such legislation. At this moment, some members of Congress are working to codify harsher penalties by placing fentanyl analogs permanently into Schedule 1 in both the Senate and the House with proposed legislation like the Stopping Overdoses of Fentanyl Analogues Act of 2019 (SOFA) and the FIGHT Act. In his annual State of the State 2020 address this month, New York’s Governor Cuomo proposed banning fentanyl analogs and expanding access to medication assisted treatment in the very same sentence. Legislators have dusted off the drug war playbook and proposed a variety of new punitive measures including new mandatory minimum sentences, homicide charges, involuntary commitment, expanded powers for prosecutors and more. These efforts repeat the mistakes that epitomize the failed war on drugs, while undermining efforts to reform our criminal justice system and pursue a public health approach to drug use. Indeed, such proposals risk compounding the overdose crisis.

Punitive approaches to fentanyl are particularly disturbing because they run counter to recent policy shifts that have been largely bipartisan in nature. One recent policy shift is a growing promotion of public health approaches to drug use. There is mounting support for a number of policies and interventions – such as increasing access to voluntary, medication-assisted treatment and naloxoneb – as more effective responses to the current overdose crisis than the revolving door of jail or prison. Another notable policy shift is the long-overdue recognition that decades of harsh and racially-biased drug enforcement have had devastating consequences on individuals and communities, while wasting billions of taxpayer dollars. A recent analysis of federal fentanyl sentencing revealed that 75% of all individuals sentenced for fentanyl trafficking were people of color, suggesting that fentanyl enforcement already mirrors other disparate drug enforcement.

The criminal justice reform movement has made tremendous progress on reducing drug sentences at the local, state and federal levels. The trend toward tougher penalties for fentanyl presents a threat to the reform movement, undercutting initiatives to reduce mass criminalization and incarceration. To date, none of the states that enacted harsher penalties for fentanyl, nor the federal government, have demonstrated a reduction in fentanyl-involved deaths because of these new laws.

In this context, the criminal justice reform movement must do more to combat punitive proposals, putting as much energy into challenging the exceptionalism around fentanyl as other efforts to reduce sentences.

This paper aims to shine a light on the danger that harsh fentanyl penalties present to the criminal justice reform movement and efforts to end the war on drugs:

Harsh penalties for fentanyl are detrimental to public health and exacerbate the overdose crisis.

People who use and sell drugs are often unaware of the composition and potency of their drugs and have little control over the quality of product available.

Fentanyl in heroin is increasingly the “new norm” in many parts of the country.

Lawmakers may believe they are addressing an issue that may pass with time, but fentanyl is no passing trend.

There are already harsh penalties in effect for fentanyl and they disproportionately target communities of color.

Differentiating between people who use and sell drugs is not possible.

The most effective ways to address the fentanyl crisis are evidence-based public health and harm reduction approaches. We recommend that policy makers and advocates focus their efforts to promote the following:

Expand and protect 911 Good Samaritan laws,

Expand community-based naloxone access and distribution,

Improve drug checking, surveillance and data collection and make them more widely accessible,

Authorize supervised consumption sites (SCS)c on the state and local level,

Fund pilot injectable opioid treatment as an option for some people with chronic heroin use disorder.

For lawmakers to respond meaningfully to fentanyl, public health solutions are a much more viable and affordable approach without additional harsh penalties and further criminalization. The criminalization of drug use only drives people who use drugs into more dangerous situations. This makes it less likely that they will seek support; rather it makes it more likely that they will suffer a fatal overdose.

Advocates have made considerable gains in promoting criminal justice reforms to address the many collateral consequences of our failed war on drugs. While the criminal justice reform, treatment and harm reduction movements have many victories to celebrate, there is a real risk that the proliferation of harsh penalties for fentanyl will lead to an increase in the prison population, subverting the fight to end mass incarceration.

Criminal justice reform in the fentanyl era: One step forward, two steps back

Harm Reduction International (HRI), the International Drug Policy Consortium (IDPC), the International Network of People who Use Drugs (INPUD), NoBox Philippines, and the World Coalition Against the Death Penalty welcome the opportunity to submit information to the Human Rights Committee ahead of the adoption of the List of Issues for the review of the Philippines.

This submission will assess the impact of the Philippines’ drug policy on the enjoyment of civil and political rights, with a focus on developments since the intensification of the anti-drug campaign in July 2016; and provide suggestions for issues to be raised with the government of the Philippines. In particular, this submission will provide information on:

Arbitrary deprivation of life in the context of anti-drug operations (Article 6);

Failure to protect the life of people who use drugs (Articles 6 and 26);

Attempts at reinstating the death penalty, specifically for drug offences (Article 6);

Torture and ill-treatment in detention (Articles 7 and 10);

Compulsory drug detention and treatment (Articles 7 and 9);

Proportionality of the criminal justice response to drugs and prohibition of arbitrary arrest and detention (Articles 9 and 14);

Arbitrary interference with the right to privacy (Article 17);

Shrinking civil society space: targeting of human rights defenders and drug user activists (Articles 19 and 21).

Submission to the United Nations Human Rights Committee ahead of the fifth periodic review of the Philippines

This publication was part of a two-part series on overdose prevention. Click here to access 'Overdose prevention - New technology-based solutions'.

By Graham Shaw & Jean-Paul Grund / Stop Overdose Now (SON)

Fatal and non-fatal overdoses related to opiates use are on the rise in many parts of the world, with North America, Australia and Central Asia being the most affected regions. In Europe as well opioid-related overdose deaths show a continuous increase, at least since 2013. Naloxone is the centrepiece of the response to opioid overdose. This opioid antagonist medication rapidly and completely reverses the effects of opioids and thus, when timely administered, prevents opiate overdose death. Globally, about half of the countries (101 out of 196) had registered injectable naloxone by September 2017, a requirement for the drug to be legally available in the country and for licenses to be issued for the manufacture, importation and/or distribution of the drug. In Europe, by the same time, 80% of the countries (37 out of 45) had Naloxone registered by national authorities. Lack of legislation and registration can hinder Naloxone access. Policymakers and advocates can count with several guidelines to support them in drafting required policies and standard operating procedures to allow the drug’s manufacture, importation and/or distribution. Another barrier to Naloxone access is the costs. Generic and domestically produced naloxone, as well as country-collaboration for bulk purchase can help addressing this. Finally, fostering Good Samaritan Laws, positive media, community education and the meaningful involvement of people who use drugs can help broadening naloxone access, as it fights stigma and discrimination.

Good practice interventions to respond to opioid overdoses include naloxone take-home programs, peer-to-peer naloxone programs, prison and treatment pre-release programmes, and broader interventions such as drug consumption rooms and safe injecting facilities, heroin assisted treatment, and drug checking services (including fentanyl test stripes). These interventions demonstrate that Naloxone and overdose prevention must move from mainly hospital and clinical settings into the hands of people in the community (street users, carers, agency staff) to improve access and timely response. Peers can be a great asset both to improve Naloxone availability and to provide training to various actors in how to administer the drug. Training prison staff and engaging prisoners who use opiates with local health services in the weeks following their release also helps preventing overdose deaths in this population.

Overdose prevention - Status quo and challenges

Many people who inject and use drugs experience negative interactions with the police and, as a result, are over represented in criminal justice systems, prisons and compulsory drug treatment centres. This happens because in many countries, the production, trafficking and use of some drugs is illegal and police are tasked with enforcing the law. Harm reduction programmes at their core recognize that drug use has implications for individual and public health, and these harms must be reduced as a fundamental step towards ensuring the human right to health. Despite these policy and programmatic shifts, people who use and inject drugs frequently report being targeted and searched by police, as well as experiencing harassment, humiliation, extortion, violence and arbitrary detention at the hands of the police.

In many countries, research has documented that these types of police practices increase vulnerability of HIV acquisition and onwards transmission, and are not conducive to access and retention in care for HIV and other related health services for people who use and inject drugs. In recognition of this, the World Health Organization recommends the decriminalization of drug use and possession for personal use as a critical enabler for an effective HIV response. The police have a central role in creating supportive environments where harm reduction programmes can exist and that, by fulfilling this role and becoming a partner in harm reduction, both the police and the broader communities in which they serve benefit immeasurably.

Law enforcement must work in partnership with the community, including people who use drugs, in pursuit of creating a rights- and health-affirming environment. While protecting public health is not the primary function of the police, operating within a human rights framework that improve health and well-being is part of progressive and effective policing practice.

Reducing harm: Police as partners in preventing HIV, promoting public health and protecting the rights of people who use drugs

This report enriches the information and knowledge base of harm reduction interventions in Europe from the viewpoint of civil society organisations (CSOs) that directly work for, and with, people who use drugs. This approach is a necessary, and useful, contribution to the development of drug policy in the region and C-EHRN plans to repeat this reporting on an annual basis to identify developments, changes and trends over time.

The report consists of four parts. The introduction provides background information concerning the development of the questionnaire, the data collection process, methodology used, and the nature of the data. Chapters 2-5 report on civil society involvement in drug policy and related decision-making processes as well as on hepatitis C and drug overdose prevention and management services together with the use of new drugs and new patterns of consumption. Each chapter begins with a short summary of the main results and ends by discussing conclusions and policy implications.

Most CSOs responding to the C-EHRN survey are experienced in contributing to data collection and, crucially, have close contact with many important actors in the field and have access to timely and quality information that complements the data collection mechanisms already in place. Consequently, this report reinforces the added value of the role played by CSOs in the collection of data that can inform harm reduction practice. In most countries, civil society involvement is, to some extent, enabled through dialogue and/ or information exchange but, often, the impact is regarded as unbalanced and ineffective. Permanent and formalised structures that ensure dialogue between civil society and government representatives are beneficial for such civil society involvement as structures allow for cooperation on a regular basis and oversee both the formulation of policy and its implementation. Formalised structures, however, do not safeguard meaningful involvement of civil society if they do not lead to accountable outcomes.

C-EHRN Monitoring shows that people who inject drugs (PWID) are still not allowed access to treatment of the hepatitis C virus (HCV) in 10 European countries. Although 23 countries have guidelines that include specific HCV management for PWID, many C-EHRN respondents are somewhat pessimistic about the impact of such guidelines on improving access to the HCV cascade-of-care in their country, especially to good practice, integrated, test-and-treat services at the same site. HCV testing and treatment at pharmacies remains very rare. On a more positive note, 23 European countries reported PWID organisations working actively to increase political awareness concerning HCV interventions. Compared to 2018, more attention has been paid over the past year to HCV awareness campaigns (in 15 countries), to testing at the service providers’ own premises (in 18 countries), and to treatment at the service providers own site (in 15 countries). The main barriers to address HCV among PWID include a lack of funding, knowledge, recognition, political support and skilful staff as well as weakness of civil society organisations and legal barriers.

In 15 countries of the region, the government monitors the number/proportion of people who progress through each stage of the HCV cascade-ofcare at the national level, with monitoring at the regional or local level also performed in 12 countries whereas monitoring is not performed at any level in a further 9 countries. There are still big differences within Europe as to where and how PWID can undertake a HCV test. This means PWID are in an unequal position in different European countries, regions and cities. Rapid HCV testing is available to prisoners in 21 countries.

Treatment of HCV using direct acting antivirals (DAAs) is available in all countries of the region except North Macedonia. However, 10 of 34 countries still place restrictions on access to DAA’s for those people who are active drug users. However, if access to DAA treatment is achieved, the costs are reimbursable by health insurance or through the public health service in all countries except the United Kingdom.

Consequently, to reduce the HCV-related disease burden among PWID and achieve the 2030 elimination goals as set out in the WHO Global Health Sector Strategy on Hepatitis, a radical change in the HCV response is needed in many European countries. National treatment guidelines that specifically address recommendations for treating PWID, guaranteed access by PWID to DAA treatment, improvements in the continuum-of-care and introduction of one-stop HCV testing and treatment services - including such services delivered by harm reduction organisations - needs to be further developed and adopted by all government and civil society stakeholders.

A further key contribution by civil society is collecting data on the context of drug-related overdose events and interventions at a local level, feeding into already existing data and reports. Only 5 countries reported separate overdose prevention strategies or action plans. Much improvement is needed to be able to adequately respond to overdoses in Europe. Evidence demonstrates that a range of measures – including drug consumption rooms (DCR), take-home naloxone (THN) programmes in the community, and naloxone distribution before release from prison - can reduce opioid and other drug-related overdose deaths. However, C-EHRN Monitoring shows a mixed picture of policies and measures across Europe. There is a significant disparity in how, and by whom, such overdose data is collected which can ultimately influence what is recorded as a drug-related death. To address this, the EMCDDA should encourage the respective national health authorities, their own Reitox Network, as well as others who collect such data, to collaborate more with national harm reduction networks and experts in their field of work. Furthermore, due to the uneven status of naloxone – the safe and simple response to an opioid overdose as recommended by WHO – political authorities are called upon to take appropriate legal initiatives to ensure, without delay, that naloxone is available free of charge and without prescription in pharmacies for people who use drugs; experience from Italy can be the basis for this action. In addition, to obtain a real overview of the number of doses of naloxone administered and data on the successful use of naloxone, a national reference point should be established to collect and analyse this and other data.

In general terms, the results of C-EHRN Monitoring correspond with what we know from other sources concerning new drug trends. In addition, the process of data collection as undertaken by C-EHRN Focal Points in each country has the potential of generating additional information and at a quicker pace than other methods, bringing added, qualitative value to this sector.

A review of the approach used by C-EHRN Monitoring to collect such information suggests that focus groups held several times each year would be more effective than a questionnaire as it would lead to consensus-based data. Also, a focus on drug trends, including new drugs, is preferable rather than the emergence of specific drugs. In addition, the focus should be at the city/urban level, rather than national, as this will likely provide higher quality data, and a reduction in the number of questions is recommended.

Publications from IDPC Members