By Robert Csák, Irena Molnar, Péter Sárosi, Jovana Arsenijević, Bojan Arsenijević

Our results emphasize that drug related harms are generated in a complex system with intricate connections amongst diverse, heterogeneous actors, in an ever-changing assemblage. We tried to illustrate in this paper how the diverse everyday practices of injecting, combined with the different substances available, the social context of injecting, the physical environment where the substance use occur, could shape the risk behaviours of PWID and the risks of substance use as such. The differences in the prevalence of individual risk behaviours represent the differences in injecting practises in the two communities, and these differences underline the importance of tailoring harm reduction services to the specific needs of the local PWID community. Nevertheless if we would like to implement interventions that can effectively reduce the health risks of substance use, it is necessary to consider environmental, structural factors influencing the consequences of substance use, and aim for responses that could promote an enabling environment, despite it could be hard to transform these factors into variables affecting public health indicators directly

Some of the lessons learnt from our research:

Although the demographic characteristics of drug users were the same (mostly men in their mid-thirties, with low educational attainment, and poor labour market position), there were differences in drug use. Whilst in Belgrade most people still inject heroin, in Budapest mostly new psychoactive (cathinone-type) stimulants are injected.

Access to sterile injecting equipment declined significantly in both cities. In Belgrade 78 percent of drug users bought their clean needles in pharmacies. In Budapest, where a few NSPs remained open, this figure was only 51 percent.

The overwhelming majority of users share their equipment in both cities. The situation was more severe in Belgrade, where half of our sample practiced seven or more types of risky behaviour (compared to one quarter of the Budapest sample).

Our research confirmed that injecting drug use is a community activity, shaped by the environment and by mediated drug-sharing practices amongst the same marginalised, criminalised groups. Any future interventions should consider these environmental, structural factors.

In both cities, fewer people have access to HIV/HCV screening and counselling, vein-care products, and social services (eg. housing, employment). The closure of NSPs severely exacerbated the social isolation of their former clients: they reported significantly less access to “a place to sit for a while” or “speaking with social workers”.

The study was conducted by the Rights Reporter Foundation, in co-operation with the NGO ReGeneracija from Belgrade.

Different environments, different risk behaviours: Consequences of decreased coverage of needle exchange programmes in Budapest and Belgrade

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

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

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 

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

From South Africa to Myanmar, from Brazil to Kyrgyzstan, women are resisting the war on drugs. Killings, criminalization, incarceration, denial of medical care, and social stigma are just a few of the effects the war on drugs has had on communities around the world. It targets particular groups, with gender-specific impacts. The war on drugs is clearly a feminist issue.

Yet the effects of repressive drug policies on women, trans and gender-diverse people are rarely discussed in feminist spaces.

Our purpose with this documentation is to share AWID’s experience of strengthening relationships and building trust between feminist movements and women who work on humane drug policy in Eastern Europe and Central Asia (EECA) region, and supporting the inspiring global movement-building process led by women who use drugs

We are keen to share this experience because it has been a valuable and deep learning process for AWID as an organization. We believe this process could be useful to groups and movements involved in other cross-movement conversations, and to strengthen relationships and build new alliances.

How feminism can be enriched by the experiences of women who use drugs

How we designed a movement-support process with women who use drugs

The key learnings we drew from this experience

It is critical for feminist movements to develop awareness of the gendered, racial and class aspects of repressive drug policies and the associated criminalization and stigmatization of people who use drugs.

Harm reduction movements intersect with movements of sex workers, people living with HIV, racial justice, and LGBTQI+ movements, among others.

We must expand what feminist logistics mean to us, and make feminist spaces more accessible, safe and welcoming for women who use drugs. This is a particularly important lesson for us in AWID, as an organization that hosts convenings.

We are honored to share our learnings and experience. It has been an incredible opportunity to build new relationships with a growing and inspiring movement led by and for women who use drugs and are affected by drug policies. We have learned a lot, and hope you will too!

Feminist movements and women resisting the war on drugs

This is the second edition of our annual report on how New Zealand is dealing with alcohol and other drugs. While we are doing well in some areas, in others there is significant room for improvement.

More than 70 deaths have been linked with synthetic cannabinoids since mid-2017. The death rate has dropped in recent months, but there is no room for complacency. Synthetic cannabinoids continue to cause significant harm across the country, and dangerous new substances still regularly enter the market.

Alcohol is still the most harmful drug in New Zealand. Twenty percent of New Zealanders drink hazardously, and it’s the substance most people seek help for. Alarmingly, alcohol is more affordable now than in the 1980s. The Government must prioritise minimum prices, and phase out alcohol advertising and sponsorship.

Methamphetamine use is an ongoing issue: August 2019 saw the biggest methamphetamine seizure on record. While overall use remains low, across the total population methamphetamine causes huge amounts of harm in some communities.

Māori continue to suffer disproportionately from the harms caused by alcohol and other drugs, bearing the brunt of our criminal justice approach to drug use, with high rates of arrest and conviction.

However, there is a lot to be hopeful about.

A new amendment to the Misuse of Drugs Act, passed in August, means Police may only prosecute for possession and use of drugs if it is ‘required in the public interest’. They must determine whether a health-centred or therapeutic approach would be more beneficial to the public interest than a prosecution. How this will affect prosecution rates remains to be seen, but we’re hopeful low-level drug offences will decrease, or be eliminated altogether.

We’d like to see a massive overhaul of our outdated drug laws. Next year’s cannabis referendum is a great opportunity: people are still being arrested and convicted for cannabis. In the past decade 45,665 people were convicted of a cannabis offence, and 6,583 of those were sent to prison. We look forward to moving towards health-focused legal regulation.

State of the Nation 2019: A stocktake of how New Zealand is dealing with the issue of drugs

Naloxone is used to treat respiratory depression caused by opioids. Opioids produce their effects by acting on opioid receptors in the brain and nervous system. Naloxone works by blocking these opioid receptors, thus stopping opioids from acting on them. This reverses the effects of the opioid primarily in their role as CNS depressants. It is a front-line response against overdose. Naloxone may be given by injection into a vein, muscle or under the skin, or via a drip into a vein (intravenous infusion).

This guidance offers best practice for the provision of naloxone for people who might experience or witness an opioid overdose.

Building on the findings from Release’s research on naloxone in England, Release hosted the Naloxone Steering Group 2019 in April 2019, in partnership with the National Addiction Centre at King’s College London. The objective of the steering group was to get key stakeholders together for a day to discuss some of the main aspects of naloxone provision in the UK and to produce guidelines on the provision of naloxone for people who might experience or witness an opioid overdose.

Drug-related deaths are on the rise in every devolved nation and “9 out of 10 overdose deaths (89 %) in the UK involved some form of opioid”1. Naloxone is a critical and life-saving intervention for those at risk of opioid drug poisoning. To mitigate the risk of fatal opioid overdose, we must foster an approach that is grounded in evidence and facilitates the enjoyment of human rights, with a goal of achieving the highest attainable standard of health for people who use drugs. To this end, the following overarching principles will need to be respected, if we are to achieve best practice in providing naloxone to those who might experience or witness an opioid overdose.

Presumption to provide - decisions should be guided by a presumption in favour of providing naloxone.

Duty to provide - naloxone should be part of the basic standard of care offered to people as part of harm reduction.

There are no real external barriers - any barriers that exist in supplying naloxone are internal and can be addressed.

Funding - there should be a clear and specific funding stream to protect funding and remove fragmentation in funding for naloxone.

Change the narrative - naloxone saves lives. Stigmatising, harmful and damaging messages surrounding naloxone and people who use (or have used) drugs are dangerous and pervasive. It is important the narrative is renewed to one that emphasises the importance of preserving life.

Naloxone is only part of the solution - naloxone should be part of a broader response to preventing drug-related deaths. The quality of drug treatment and harm reduction is also imperative to saving lives

Saving lives: Best practice guidance on the provision of Naloxone for people who might experience or witness an opioid overdose

Developed jointly by UNODC and INPUD, in collaboration with other partners, the guidance document Implementing Comprehensive HIV Programmes with People who Inject Drugs: Practical Approaches from Collaborative Interventions – otherwise known as the Injecting Drug User Implementation Tool (IDUIT) – was published in 2016. It describes how to implement effective programmes and services for HIV and HCV prevention interventions for and with people who inject drugs (PWID).

The IDUIT is based on previously published United Nations (UN) guidance documents, mainly the WHO/UNODC/UNAIDS Technical Guide for Countries to Set Targets for Universal Access to HIV Prevention, Treatment and Care for Injecting Drug Users (rev. 2012) and the WHO Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations (rev. 2016).

In addition to the nine key interventions of the WHO/UNODC/UNAIDS Comprehensive Package for HIV and PWID, it includes prevention and management of overdose and sexual and reproductive health and rights (SRHR). The IDUIT also covers critical enablers, strategies, activities and approaches to increase the accessibility, acceptability, coverage, quality and uptake of interventions and services for key populations.

It contains examples of good practice from around the world that may support efforts in planning programmes and services, describes issues that should be considered and advises on how to overcome challenges.

The IDUIT tool does not seek to ignore the complex policy and legislative environment around drugs and injecting drug use in most countries, nor the need for advocacy to confront the stigma, discrimination and human rights violations faced by PWID. However, it aims primarily to address the question: what can we do now, with the resources we have, in the kinds of environments we face, to prevent the spread of HIV and hepatitis C among PWID?

Click here to access the publication on INPUD's website.

Injecting Drug User Implementation Tool (IDUIT) Training Manual

In the last decade, an increasing number of donors are withdrawing their support for healthcare. This has been especially true for middle-income countries, where the growth of domestic resources was one of the triggers for donor funding reduction. The Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) has termed this process as “transition”, although the terms such as “graduation” (USAID terminology), “sustainability” and “self-reliance” are also used.

Development Assistance for Health (DAH) is decreasing, including for HIV/AIDS. In the Eastern Europe and Central Asia (EECA) region, DAH has decreased by 33% from 2010 to 2017, resulting in the withdrawal of over US$64 million from HIV/AIDS programs . This has created pressure on national ¹ budgets and has resulted in a significant gap in HIV/AIDS funding in low- and middle-income countries where overall growth of a country’s Gross National Income (GNI) has not been accompanied with an equivalent increase in public allocations for health and social services, especially for interventions that target key affected populations.

The Global Fund remains the largest multilateral donor in the field of HIV/AIDS, especially in Europe. From 2003 to-date, it has invested over US $2,573 million in the EECA region, out of which US$1,431 million has been for HIV/AIDS .

Sustainability Bridge Funding (SBF) is an idea that has been discussed among donors and civil society organizations (CSO’s) as a way of mitigating the negative effects of transition and in providing support for key essential services for communities and key populations. As a safety net mechanism, it should respond to gaps in funding and mitigate adverse effects of donor funding withdrawal. Nevertheless, very few donors have provided this type of targeted donor support for countries losing Global Fund support. Open Society Foundations (OSF) first piloted the idea of SBF in Southeastern Europe — a region where the withdrawal of Global Fund has led to the collapse of services in countries including Romania, Bosnia and Herzegovina and Serbia — by supporting civil society to navigate the transition process and engage in effective budget advocacy.

Building on this work, in 2018 OSF, through the Eurasian Harm Reduction Association (EHRA), initiated the project, Budget Advocacy and Monitoring in countries of South East Europe³. It provided funding to three transitioning countries in the Balkan region – Bosnia and Herzegovina (BiH), Montenegro, and Serbia — through the sub-regional network organization, Drug Policy Network South East Europe (DPNSEE), to support budget advocacy for harm reduction services.

This case study looks at the implementation of this project as one of the demonstrations of the SBF mechanism, with the objectives to:

Document the SBF pilot in 3 Balkan countries and to analyze the strengths and weaknesses of this approach and to develop suggestions for improvement; and, Document the results, successes, and

Document the challenges of the budget advocacy projects supported through the SBF approach.

Interviews were recorded between April and July 2019. During the development of this case study, project implementation was not completed, although it was at an advanced stage, allowing for the interpretation of results.

Sustainability Bridge Funding: Case Study from Bosnia and Herzegovina, Montenegro and Serbia

In July 2016, the Colombian government enacted Law 1787, which regulates the use of medicinal cannabis and its trade in the country. With this decision and a series of subsequent resolutions, Colombia joined the more than a dozen countries that have put into practice different types of regulation to explore the advantages of this plant as an alternative pharmaceutical. Through the issuing of four types of licences (for the cultivation of psychoactive cannabis and non-psychoactive cannabis, for the use of seeds for planting and for the manufacture of by-products), the door was opened not just to scientific research but to a business that is going from strength to strength all over the world, and that some predict will be worth about $54 billion (US dollars) by 2025.2 More than 300 licences have been issued since the law entered into force and the country is experiencing a ‘green gold’ fever, which has attracted the attention of large investors who see cannabis as the business of the future. The country’s geography and climate, the cost of labour and inputs, and a robust long-term legal framework have made Colombia an ideal place for growing cannabis and an appealing location for transnational corporations to do business.

The entry into force of this law signified a change in the country’s drug policy. Colombia’s recent history has been marked by the presence of drug trafficking and violence associated with social conditions in the country. During the 1960s and 70s Colombia was one of the world’s main marijuana producers, and for the last 40 years it has been the leading producer of cocaine.3 This went hand in hand with a social and agrarian conflict that continued for more than half a century. The conflict lead to a war between guerrilla organisations, who saw drugs as a way to finance their political project, and other drug trafficking groups, whose leaders set up their own armies to defend themselves against extortion and threats from these insurgents. Compounded by a prohibitionist national drug policy, this situation led to new outbreaks of violence, the infiltration of drug traffickers into pre-existing social conflicts, and clashes with state security forces, ultimately resulting in about 6 million casualties.4 For decades, the Colombian government’s response to the problem of drug trafficking focused on prohibition and military attacks, causing even more negative effects rather than providing a real solution.

This is why this change in the law not only offers an alternative in terms of public health but also represents a key component in the rebuilding of a society that has suffered armed conflict for decades. In addition to this shift, in 2016 the Colombian government put an end to more than 50 years of armed conflict with the FARC guerrilla movement by signing a peace agreement. One section of this agreement focuses precisely on crop substitution and the need for a change in drug policy. Although the approach to cocaine is still punitive, Law 1787 was also designed to offer an alternative to families who were involved in drug trafficking, enabling them to move into a legal business by growing medicinal cannabis.

Although it is not clear how many people depend on this crop, the figures show that marijuana is the most commonly used drug in Colombia. The national market for medicinal cannabis is estimated to comprise some 5 million patients5 – a demand which small-scale growers can undoubtedly help to meet. However, this opportunity has been swiftly seized by large national investors, such as those formerly in the flower industry, and has attracted an influx of foreign capital. Due to the type of regulation introduced by the law, which aims to develop a pharmaceutical industry, small- and medium-scale growers have found it difficult to enter the market because they are unable to invest the millions that the business requires.

Even though the law stipulates that 10 per cent of production should come from small- and mediumscale growers, the reality is that most of the business has been dominated by large local and foreign investors. Although there are cases of associations of small-scale farmers who have come together to obtain a licence, the majority have only managed it by going into partnership with transnational corporations, most of them Canadian, which already have experience in the business. Because of this, since the law was enacted the government has passed resolutions that seek to incentivise and promote local production. However, the situation is far from ideal for local producers and discontent has already arisen. This article analyses Law 1787’s entry into force in 2016 and the challenges posed by implementing the arrangements for medicinal cannabis, especially with regard to the involvement of small- and medium-scale producers.

The first section of the paper briefly reviews the recent history of cannabis and its use in Colombia. It then focuses on the changes in the legislation that led to the approval of Law 1787 in 2016. The third section provides an in-depth analysis of the law’s implications, the types of licence and subsequent resolutions. It goes on to present an overview of the current situation in the cannabis business, the companies involved and the role of small- and medium-scale rural producers. The final section offers suggestions for how this legislation could provide more benefits to the first links in the supply chain – the people who have not only suffered the most from the negative impacts of drug trafficking but also from problems related to land distribution.

The challenges of medicinal cannabis in Colombia

This document is a compilation of better practices for the use of ayahuasca in non-Amazonian contexts. It covers individual, collective and legal responsibilities.

Ayahuasca is a decoction of different plants with a long history of use in the Amazon, where very old records of its use by native peoples exist. In the last few decades the use of this preparation has been expanding beyond its original context, now reaching many countries outside of the Amazon. One of the consequences of this expansion has been the appearance of new forms of use, which in turn have brought new therapeutic potentials as well as new risks.

It is evident that native communities of the Amazon and other peoples with a long history of ayahuasca use do not need a guide like this. Ayahuasca is part of their cultural and spiritual systems, which include safe ways of working with the effects of the preparation, as well as methods for integrating them into the everyday life of the community. On the contrary, this document is aimed at people who organize or participate in ayahuasca sessions outside of Amazonian contexts.

The objective of this guide is to present a series of minimum safety standards to support ayahuasca sessions in non-Amazonian contexts, as well as to inform potential participants of ayhausca sessions, so that they can better assess the safety and responsibility of the sessions in which they are going to participate, and thus make informed choices.

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