Thank you for your help in the birth of the Eurasian Harm Reduction Association! 2017 has become almost revolutionary for harm reduction activists in the Central and Eastern Europe and Central Asia (CEECA) region.

Within the association of activists, there has been a challenging process of renovation, the building of a democratic organization with clear processes, and opportunities for activists from all countries of the region to influence the organization’s strategy, policies and activities. It has been possible not only to build a transparent decision-making process, but also to develop an ambitious strategy for our organization through the harmonious and well-coordinated work of the EHRA Steering Committee alongside members and EHRA’s Secretariat. A clear-sighted vision of what is required for sustainable harm reduction programs, and for decent lives of people who use drugs, has helped EHRA to gain strong support from global and regional communities, allies and partner organizations that has encouraged us to build from scratch a solid management system for the organization. From the very beginning of its active operation in 2017, EHRA has already started to implement 9 advocacy projects and has been supporting community groups of people who use drugs in countries of our region; EHRA has also maintained its leadership in regional advocacy to ensure sustainability and efficiency of harm reduction services and for drug policy reform to shift towards being based on public health and human rights.

Now it’s time to mobilize all resources. Drug policy in countries has not improved, but rather has worsened. In most cases, governments are more likely to pay for policemen and prisons than provide social and medical assistance to people who use drugs. In all countries of the region, it has become obvious that we need to change the approach to harm reduction services because the drug scene is changing and people who use drugs are also changing. The issue of government funding of harm reduction services has become very relevant for most of the countries of the CEECA region with international funding rapidly declining and, therefore, EHRA sees its priority in supporting communities in their advocacy for sustainable funding of quality harm reduction services from national sources.

I am proud to be a part of a cohesive and strong team which is ready to fulfill an ambitious strategy!

A good start gives hope for further success!

Ganna Dovbakh, Executive Director of the Eurasian Harm Reduction Association

EHRA in 2017: A good start

On 23 March 2018, the Human Rights Council (HRC) adopted resolution 37/42. The resolution requests the Office of the High Commissioner to prepare a report, in consultation with States, the United Nations Office on Drugs and Crime (UNODC) and other United Nations agencies, civil society and other relevant stakeholders, on the implementation of the joint commitment to effectively addressing and countering the world drug problem with regards to human rights, and to present it to the Human Rights Council at its thirty-ninth session, and also requests the Office of the High Commissioner to share the report with the Commision on Narcotic Drugs (CND), through the appropriate channels, as a contribution to their work in this field and in preparation for the sixty-second session of the Commission, which will include the 2019 Ministerial Segment.

The Office of the High Commissioner on Human Rights launched a call for submissions (Deadline: 18 May 2018) to facilitate civil society contributions. Below are some of the contributions from IDPC members and allies.

Submission by the Rights Reporter Foundation.

Civil society submissions to the Report of the OHCHR on the implementation of the UNGASS Outcome Document with regard to human rights

is the fourth edition in Prison Reform International's annual flagship 

topical developments and challenges in criminal justice and prison policy and practice

. It is published in collaboration with the Thailand Institute of Justice, and features a foreword by the Rt Hon Helen Clark, Member of the Global Commission on Drug Policy, Former Prime Minister of New Zealand and Former Administrator of the United Nations Development Programme.

, including the use of pre-trial detention as an automatic response to suspects; the ongoing challenge of prison overcrowding; and the steady growth in the number of life-sentenced prisoners around the world.

, such as the specific needs of women, children and LGBTI prisoners.

Developments and challenges in prison management

, including record levels of prisoner violence in a number of prison systems; healthcare challenges and shortages of qualified healthcare staff; and the need to address violent extremism and prevent radicalisation in the prison system.

The role of technology in criminal justice and prison systems

, such as the use of ‘telemedicine’ to provide mental healthcare and treatment, and the rise in access to online education and training.

, including community service orders and electronic monitoring, and a growing trend in the use of restorative justice.

rehabilitation and reintegration of offenders in the era of sustainable development

, exploring how the rehabilitation and reintegration of offenders back into their communities can incorporate a broader developmental perspective, contributing to the goals set out in the 2030 Agenda for Sustainable Development.

was launched at the UN Commission on Crime Prevention and Criminal Justice on 15 May 2018.

Global Prison Trends 2018

Poppy cultivation in Mexico and Colombia is part of a local economy geared almost exclusively toward the illegal market abroad: it is driven by demand for heroin, primarily in the United States. North America, including Canada, is currently experiencing a major humanitarian crisis related to this use and the opioids circulating on this market.

To understand the dynamics of this market and to evaluate whether political responses to the phenomenon are appropriate and effective, we present this report on opium poppy cultivation in Mexico and Colombia, which, together with Guatemala, are the poppy-producing countries of Latin America. While it was not possible to include Guatemala in this study, we attempt to provide some relevant information about this Central American country. Because the U.S. government tends to look to producing countries to explain the causes of the emergency situation in its country, it is important to consider the problem from broader and more inclusive perspectives.

This report is based on fieldwork by two researchers in Mexico and Colombia, relevant data and literature, and analyses of the U.S. market for heroin, primarily by the U.S. Drug Enforcement Agency (DEA). Due to lack of information, it does not include detailed discussion of or data from Canada, although a similar situation is understood to exist there.

Poppies, opium, and heroin: Production in Colombia and Mexico

By Lee Edson Yarcia, MD - Policy & Research Officer, NoBox Transitions

Following the government’s ongoing ‘war on drugs’, law enforcement operations increased, leading to a rapid rise in the numbers of people held in detention and prison facilities. This, in turn, worsened already poor prison conditions in the Philippines. Official government data revealed a 511% congestion rate in Philippine jails and current trends show a surge in jail population attributable to ‘the increase in the number of drug-related cases’.

The most recent United Nations Human Rights Council’s Universal Periodic Review of the Philippines has also highlighted this problem and especially its impact on the prisoner’s right to health. In particular, the UN High Commissioner for Human Rights took note of the inadequate standards of medical care in prisons. Additional stakeholders went further, stating that ‘[p]risons were no longer able to ensure the health and safety of prisoners or meet minimal standards under international law’. The Committee Against Torture echoed these observations, particularly noting that the incidence of infectious diseases was ‘extremely high’. The UN country team added that treatment for health conditions for communicable diseases was ‘grossly inadequate’ in prisons.

With regard to particular infections, HIV/AIDS and hepatitis C (HCV) have become critical public health problems for the Philippine prison population. Regarded as ‘twin epidemics’, HIV and HCV infections and co-infections are especially serious issues among marginalised socio-economic groups, with prisoners particularly vulnerable. The country already has one of the fastest-growing HIV epidemics in the world, and HIV incidence among prisoners has been increasing across jails, with the head of the Public Attorney’s Office claiming that as many as ‘one to three in every jail cell’ are infected. While HCV infection has not demonstrated a similar spike in incidence, its prevalence remains higher than HIV/AIDS amongst the general population and Department of Health (DOH) surveys have found incidences of HCV infection in local jails.

Kalusugan sa kulungan: Examining the policy for people living with HIV/AIDS and hepatitis C in Philippine prisons

The UK’s night time economy is failing to protect its most valuable asset: the people who go out and enjoy it. 

Night Lives: Reducing Drug-Related Harm in the Night Time Economy

, a joint report by the All-Party Parliamentary Group for Drug Policy Reform, Durham University, The Loop and Volteface, advocates for the adoption of a set of bold yet practical initiatives across our towns and cities to address this failure. Aimed at stakeholders including the night time industry, local authorities, police forces and public health, 

 offers new ideas for reducing drug-related harm in the UK’s night time economy (NTE).

The history of drug-related harm in the NTE reveals that drug-related deaths have acted as a catalyst for most policy and licensing developments relating to drugs, whether progressive, such as Manchester City Council’s early adoption of Newcombe’s Safer Dancing Guidelines, or regressive, such as the repeated attempts to close Fabric in London. This report bucks that trend.

Drug-related deaths due to ecstasy and cocaine continue to rise and are at their highest since records began, while hospital admissions due to these drugs have risen dramatically in recent years. Admissions for cocaine alone have increased by 90 percent since 2011. This rise is seen despite drug usage rates remaining broadly consistent over the same time period.

Based on in-depth interviews with over 50 key stakeholders, this report concludes that the major perceived barriers to implementation of initiatives to reduce drug-related harm can be overcome through partnership working and a greater understanding of their wider positive impact among all stakeholders. The report also recommends the introduction of four key initiatives for the night time economies of our towns and cities:

Drug safety testing services available to the general public in night life districts;

An independent information campaign on reducing drug-related harm;

Training for night life staff in how to respond effectively to drug use in the NTE;

The adoption of the UK festival drug policy of ‘3Ps: Prevent, Pursue, Protect’ in licensed venues.

Proposals to reduce drug-related harms in the night time economy 

This study of student drug use takes a twopronged approach. Firstly, it included an exploration of students’ attitudes to, and experiences of, drugs through the 2,810 students at UK providers who responded to the Students’ Drug Survey launched in February 2018. Secondly, it incorporated an analysis of the policy responses of UK higher education institutions relating to drug use. This data was collected through freedom of information requests sent to a sample of 151 universities/colleges and an independent assessment of those institutions’ policies and support relating to student drug use via a content analysis. For the purposes of this research the term ‘drugs’ is restricted to all controlled or illegal substances as well as non-prescribed drugs and novel psychoactive substances (previously known as legal highs). Whilst tobacco and alcohol are also psychoactive substances we have excluded them from our definition.

While care should be taken in extrapolating these findings to the student population generally as it is not a prevalence study, we found that drug use is a fairly common, although infrequent, behaviour among survey respondents. The vast majority do not report having experienced problematic drug use: Thirty-nine per cent of students responding to the survey currently use drugs, with a further 17 per cent having done so in the past. Just over half (56 per cent) of respondents have therefore used drugs. Cannabis was the most frequently taken drug, having been used at some point by 94 per cent of respondents who said that they have used drugs. Cannabis was also the only drug in our survey that was more likely to be used regularly, rather than on special occasions. Ecstasy/MDMA was the second most commonly used drug, having been taken by two thirds (67 per cent) of respondents who have used drugs. Nitrous oxide and cocaine have both been used by just over a half of this group. Six per cent of respondents who have used drugs said that they use ‘study drugs’ (drugs taken to improve focus and motivation) at least once a month and one in five of this same group have taken them at some point. Overall one in ten of all students responding to the survey have ever taken study drugs. Respondents were most likely to take drugs at home/in student accommodation, with 86 per cent of respondents who have used drugs saying they do so here. This was also the location with the highest amount of reported daily use, with one in seven respondents (14 per cent) saying they have used drugs here. House parties were a similarly popular location for drug taking (86 per cent), though this was more likely to take place on special occasions. Respondents were least likely to report using drugs in students’ union venues such as the bar. (...) 

Taking the hit: Student drug use and how institutions respond in the UK

By Kathryn Ledebur and Coletta A. Youngers

In the Plurinational State of Bolivia, women account for 8 percent of the country’s more than 17,000 people behind bars. In only three other Latin American countries (Guatemala, El Salvador and Chile) do women comprise a larger share of the overall incarcerated population. Almost 40 percent of the women behind bars in Bolivia are held for lowlevel drug offenses, often as a result of structural socioeconomic conditions, such as poverty and the pressures of single parenting. These women are typically poor, have limited education, and do not have access to stable jobs with decent pay; a startling percentage have been victims of domestic and sexual violence. They are often driven into the drug trade out of economic necessity. High rates of pretrial detention have also contributed to severe prison overcrowding. Indeed, Bolivian prisons are ranked as the eighth most congested in the world.

In response to extreme prison overcrowding, between 2012 and 2018 the government of President Evo Morales enacted six prison pardon, sentence reduction, and amnesty initiatives, leading to the release of almost a third of Bolivia’s total incarcerated population. Specific gender-sensitive clauses benefited mothers and caregivers. These pardon, sentence reduction, and amnesty initiatives with a gender focus, paired with poverty reduction and increased state support for mothers, contributed to an 84 percent decrease between 2012 and 2017 in the number of women incarcerated for drug offenses, going against the trend of increasing female incarceration for drug-related offenses in most Latin American countries.

But Bolivia’s considerable progress in reducing the incarceration of women for drug offenses risks reversal without the enactment and implementation of broader judicial reform efforts. Bolivia’s 1988 drug law, Law 1008, includes harsh provisions that fail to distinguish between small, medium, and large-scale trafficking, with disproportionally high sentences for all offenses ranging from 10 to 25 years. Law 1008 initially mandated pretrial detention for anyone accused of a drug offense and blocked those individuals from benefitting from alternatives to incarceration.

Upon assuming office in January 2006, the Morales Administration promised to reform Law 1008 and to propose separate legislation for coca cultivation. More than 10 years later, in 2017, the Bolivian legislature finally passed new laws on coca and on controlled substances. A new penal code approved later that year would have reduced sentences for drug offenses and could have significantly reduced the number of incarcerated women. However, in the face of widespread protests, the legislature subsequently revoked it, meaning that the extremely high sentences for drug offenses provided under Law 1008 remain in effect.

Promoting gender-sensitive drug policies in Bolivia

We are pleased to introduce this special issue of the Bulletin on Narcotics, which is devoted to the theme of alternative development. In addition to this introduction, it consists of five academic articles that provide important insights and experiences regarding the current state and future directions of this development-driven strategy. The articles were selected following an open call for submission announced in December 2015. Some of the articles offer a programmatic perspective, distilling lessons learned and best practices from projects and programmes implemented in various countries and contexts. Others present a more general analytical perspective, examining some of the principles and conceptual underpinnings of alternative development.

Integrated development with coca in the Plurinational State of Bolivia: shifting the focus from eradication to poverty alleviation

By Thomas Grisaffi, Linda Farthing and Kathryn Ledebur,

The innovative “coca yes, cocaine no” policy of the Plurinational State of Bolivia, in place since 2006, provides valuable insight into the benefits of a sustainable livelihood approach to supply-side drug crop control without prior forced eradication. While the policy has inevitable limitations, its focus on the social welfare, human rights and economic stability of coca-farming families has proven effective and sustainable in diversifying the economy and fostering political and economic stability. The direct participation of communities and grass-roots organizations, such as the coca grower unions, in finding more effective and sustainable approaches to drug control have been crucial elements in its success. The elements of the policy’s key programme also correspond with the Sustainable Development Goals, adopted by the United Nations in 2015.

UNODC bulletin on narcotics: Alternative development: practices and reflections

By Sofía Aguilar, Víctor Gutiérrez, Lisa Sánchez and Marie Nougier

Although cannabis remains a prohibited substance worldwide, in recent decades a series of political, legislative and judicial processes in various parts of the world have given rise to various forms of legal regulatory regimes for the medical and therapeutic use of the plant. This trend seems to be consolidating in the Americas, in particular in Latin America and the Caribbean, where the largest number of available experiences is concentrated, and where the regulatory changes are occurring successively, in a sort of domino effect.

Although this progress is not exclusive to Latin America, and is still far from being a won battle, there is a clear shift in the global drug policy debate, particularly on cannabis. A variety of factors played a role here, including the growing availability of scientific evidence, the inability of the international drug control regime to accommodate and respond appropriately to new evidence, the emergence of a new public health paradigm in the area of drugs, the adoption of alternative policies at local level – sometimes at the expense of the international legal framework – and the growing perception that the costs of the ‘war on drugs’ far outweigh its benefits.

Unfortunately, and despite the growing number of regulatory experiences, the world has not yet reached a consensus on how to proceed, and continues to resist any possibility of activating the legal and institutional mechanisms within the scope of the United Nations to adapt the current treaty framework to this new situation. The United Nations General Assembly Special Session (UNGASS) on the ‘world drug problem’ in 2016 was the clearest example of the reluctance to openly discuss cannabis and its regulation.5 Although it occurred at a historic moment – when the legalisation of medicinal cannabis was already a reality in 16 countries (or 40 jurisdictions if US states are counted individually) – the Outcome Document of the global summit6 made no mention of the issue, or even acknowledge its existence.

It is in the midst of this contradiction that the legal regulation of medicinal cannabis is currently moving ahead. However, as with all innovative approaches, major obstacles remain in terms of its acceptance and of the restrictions imposed by the rigid international legal framework. Indeed, although medicinal cannabis per se is not prohibited under the UN drug control conventions, the inclusion of the substance in Schedule IV of the 1961 Single Convention on Narcotic Drugs restricts medical research and strict rules must be followed to allow the medicinal and scientific use of the substance. The lack of internationally sanctioned scientific consensus on medicinal cannabis is also a major issue, with no standardised or consistent products being used worldwide. These and additional factors which will be described in this paper have resulted in wide-ranging policies, requiring a certain degree of compromise (when done at the sub-national level, for example), and governed by a diversity of norms and institutions. Inevitably, the scope and impact of these policies vary greatly.

As will be discussed below, all experiences are different, and no international or regional standards currently exist. While the regulation of medicinal cannabis in Uruguay resulted from government policy and coexists with licit recreational use in a clear effort to improve public health, in countries like Argentina, Brazil and Mexico, timid legislative reforms responded to citizen initiatives which, for lack of political support, only managed to open the minimum space necessary to comply with court orders and allow the importation of pharmacological preparations produced abroad. Meanwhile, North America is silently consolidating industrial-commercial models of regulation. Although not immune to political backlash and court decisions, Canada and the United States are now at the vanguard of scientific innovation, while also meeting clear revenue-collection goals, and providing a solid basis to expand recreational and industrial systems.

This report precisely highlights this diversity of experiences, approaches and directions. The purpose of this analysis is to enhance our understanding of the current state of reforms and the lessons to be learned from them. Although the authors have done their utmost to gather as much information as possible, this paper does not claim to be comprehensive review but rather a selection of key models of medicinal cannabis being developed around the world as of March 2018. Based on the findings, we offer general recommendations, in an effort to improve public policies in areas where legislation has already changed, and inform decision-making processes in countries where reform is still pending.

Medicinal cannabis policies and practices around the world

Given the limited scientific knowledge of the day, it is understandable to a degree that the architects of the current international enforcement regime on drugs believed sixty years ago in the concept of total eradication of drug production and use. Nowadays, however, it is impossible to ignore the scientific insights and experiences that have been acquired since then in this regard: it is impossible to reduce production and trafficking in illegal drugs and their consumption on a global scale, and certainly not within the border-free European Union. In other words: the global ‘war on drugs’ launched in the 1980s cannot be won and only serves to create additional problems such as corruption, violence and illegal drug revenue in a number of countries worldwide (e.g. Paoli, Reuter & Greenfield, 2009). For decades, debate surrounding alternative regulatory models has been suppressed with the argument, among others, that international agreements and obligations do not permit it (Van Dijk, 1997). But after years of apparent immobility, several countries are presently engaged in an active search for ways to abandon the ‘war on drugs’ path – especially with respect to cannabis. A significant change of course via established international accords is unlikely in the short term because consensus is necessary in this regard and a number of traditionally exceptionally repressive countries might be inclined to obstruct already complicated procedures (Bewley-Taylor, 2003; Hall & Lynskey, 2009). Moreover, international organizations such as the United Nations (via the activities of the International Narcotics Control Board) – in addition to the European action plans – steer consistently in the direction of a uniform and strict approach to the drugs phenomenon. (Boekhout van Solinge, 2002; Roberts et al., 2005; Blom, 2006; Van Kempen & Fedorova, 2014).

In the meantime, many countries are well aware that the points of departure of the ‘war on drugs’ can only be disavowed on the basis of a policy realignment at the local and national levels, in particular when it comes to cannabis (Levine, 2003; Teurlings & Cohen, 2005; Chatwin, 2007). More and more countries, regions and cities have been testing the flexibility of the international agreements because they want to gain deeper insights into the complex character of the drugs phenomenon and potential strategies to deal with it (Bewley-Taylor, 2003; Roberts et al., 2005). They are no longer willing to wait and see what will happen in terms of the revision of international accords and agreements, but are determined by contrast to develop a policy without delay that will allow them to get a grip of the phenomenon and its problematic dimensions (Bewley-Taylor, 2003).

Uruguay and several American states (e.g. Colorado and Washington) have already opted for a regulation of the entire cannabis market, which Canada has announced that it plans to do the same in the summer of 2018. The Dutch coalition agreement of October 2017 allows for an experiment whereby a number of large municipalities are permitted to stock local Coffee Shops via government regulated cannabis production. The authoritative Global Commission on Drug Policy (members including Javier Solana, George Schultz, Kofi Annan, Richard Branson and the former presidents of Brazil, Chile, Colombia, Greece, Mexico, Poland and Portugal) has advocated uninterruptedly for an end to the global ‘war on drugs’ since June 2011 (Global Commission on Drug Policy, 2011). In Europe, countries such as Portugal, Switzerland and the Czech Republic have already implemented important reforms in terms of decriminalization.

Time for a new Belgian policy on cannabis?

Legal tensions are growing within the international drug control regime as increasing numbers of member states or jurisdictions therein move towards or seriously consider legal regulation of the cannabis market for non-medical purposes, a policy choice not permitted under the existing UN legal framework.

Reaching a new global consensus to revise or amend the UN drug control conventions to accommodate cannabis regulation, or that of other psychoactive plants and substances currently scheduled in these treaties, does not appear to be a viable political option in the foreseeable future.

The application of dubious or ‘untidy’ legal arguments to accommodate regulated cannabis markets does little for the integrity of the regime, undermines respect for international law more broadly and is not sustainable.

Appealing to human rights obligations can provide powerful arguments to question full compliance with certain drug control treaty provisions, but does not in itself resolve the arguable conflict between different treaty obligations.

States may wish to adopt a stance of respectful temporary non-compliance as they pursue legally valid and appropriate options for the re-alignment of international obligations with domestic policy.

Amongst reform options not requiring consensus, inter se modification appears to be the most ‘elegant’ approach and one that provides a useful safety valve for collective action to adjust a treaty regime arguably frozen in time.

Publications from IDPC Members