Terminally ill patients, predominantly in the Global South, are dying in pain due to repressive drug policies.

The failed ‘war on drugs’ has led many governments in low and middle-income countries to adopt excessively restrictive drug policies due to the stigma and concern around illegal use. This has reduced access to legal pain medication such as morphine.

Global access to pain relief displays stark inequality. While the US is suffering from an overdose epidemic, the plight of much of the rest of the world is hidden. The majority of people needing pain relief live in poorer countries where access is severely lacking, leaving millions dying in horrendous and preventable pain.

Our briefing, ‘The Hidden Opioid Crisis: How the so-called ‘war on drugs’ leaves patients to die in pain’, examines the impact of the so-called ‘war on drugs’ on access to opioid-based pain relief, such as morphine in three Indian states.

It shows how stigma and misinformation around opioids resulting from the failed ‘war on drugs’ have led to complex bureaucratic regulations and restrictive legislation. This, combined with a lack of understanding of opioid medication and inadequate training means institutions and health workers are failing to prescribe morphine to patients in pain.

As a result, terminally ill patients are forced to travel hundreds of miles just to get pain relief, leaving them with travel costs and loss of income that drive families into debt. Others are simply unable to access it and die in pain.

This is a story that is repeated in many parts of the world.

Health Poverty Action campaigns for the failed ‘war on drugs’ to be replaced with healthier drug policies globally, including the legal regulation of the drugs trade to protect health and lives..

The hidden opioid crisis - How the so-called 'war on drugs' leaves patients to die in pain

Southeast Asia is well known as a major market for both the production and consumption of amphetamine type stimulants (ATS). Myanmar, in particular, has arguably become one of the world’s major suppliers, as highlighted by the record seizures of methamphetamine regularly making the headlines. The topic is ever more frequently debated in the media and is overall perceived as a major concern; yet too little is actually known about these products and the people who use them.

Amphetamine type stimulants include a range of substances, which can vary significantly in their composition, form, potency and the way they are administered. For example, methamphetamine tablets – known as “Ya Ba” in Thailand and “Ya Ma” in Myanmar, crystal methamphetamine (also commonly named “ice” or “Shabu” in the Philippines), and ephedrine tablets (a legally produced medication that is particularly popular in China) all fall within the broad category of ATS.

The illicit nature of the production, distribution and consumption of these substances makes it difficult to study them and to conduct research. People who use them are often reluctant to engage on the topic, due to the fear of arrest. Clinical research, when it is available, largely focuses on the impact of methamphetamine on the health of people using them and the potential cognitive deficits they can cause. The clinical significance of these findings has, however, been questioned by specialists who highlighted flaws in the methodology and raised concerns about the interpretations of their results.

The prevailing view in Southeast Asia, both among the public and policymakers, is that repression is the best solution to tackle drug related problems (see box for a more detailed description of drug laws in the region). The justification offered for imposing harsh penalties on people involved in drug production, trafficking or even use is that exemplary punishment is necessary to deter and discourage future potential offenders. Forcing people who use drugs into compulsory treatment has also been extensively used in the region. There are, however, a growing number of people, including officials, who acknowledge that other approaches, more respectful of people’s health and dignity, are necessary.

This study’s primary objective is to improve our understanding of methamphetamine use in Myanmar, and to a lesser extent in China and Thailand, by shedding light on specific aspects that can help to better comprehend this complex phenomenon. It aims to answer a few basic, yet fundamental questions:

• What types of stimulant drugs are used in the region, and how are these used?

• Who are the people who use these substances, and in what context do they use them?

• What problems might methamphetamine cause to people who use them, but also, what benefits do they experience?

• Does methamphetamine use necessarily lead to problematic or dependent use, and are there ways to reduce harms and exert better control over one’s use?

Finding “solutions” to ATS related problems requires, first of all, a better understanding of the experiences of people who use these drugs, in their own terms and from their own perspectives. In fact, there can be no sound policies or effective interventions without learning first from those who know these substances best – the people who use them.

We hope that this report will contribute to a better understanding of this topic by the public and policy makers alike, and ultimately, support the adoption of a more rational and effective approach to drug control, based on evidence, public health and human rights.

Méthamphetamine use in Myanmar, Thailand and Southern China: assessing practices, reducing harms

By the International Drug Policy Consortium (IDPC), the Global Drug Policy Observatory - Swansea University (GDPO), the Drugs, Security and Democracy Program - Social Science Research Council (DSD-SSRC), the Centre on Drug Policy Evaluation (CDPE), the International Peace Institute (IPI)

In CND Resolution 60/1, the United Nations Office on Drugs and Crime (UNODC) was officially invited to ‘reflect on possibilities to strengthen and streamline its existing data-collection and analysis tools, including improving the quality and effectiveness of the annual report questionnaire, and to report to the Commission on possible ways to enhance these, for consideration by the Commission at its sixty-second session’.

A year earlier, the drugs ‘omnibus’ resolution, adopted by the UN General Assembly in 2016, also invited member states ‘to consider the need to review the set of national drug policy metrics and tools for the collection and analysis of accurate, reliable, comprehensive and comparable data to measure the effectiveness of programmes to address all relevant aspects of the world drug problem, including, as appropriate, as related to the 2030 Agenda for Sustainable Development’ (emphasis added).
On this basis, the UNODC initiated a review of its main data-collection tool on drugs – the Annual Reports Questionnaire (ARQ). Such a review is urgently needed. First of all, the current ARQ does not cover many of the new issues and operational recommendations included in the 2016 UNGASS Outcome Document – including, but not limited to, access to controlled medicines, proportionate sentencing, alternatives to prison or punishment, gender- and age-disaggregated data on access to health services and within the criminal justice system, and issues related to development.

Secondly, the adoption of the Sustainable Development Goals (SDGs) in 2015 requires that the ARQ be revised to ensure that tracking progress in drug control is in line with – and feeds into – the achievement of the 2030 Agenda for Sustainable Development. As a functional commission of the Economic and Social Council (ECOSOC), the UN Commission on Narcotic Drugs (CND) is mandated to report back to ECOSOC on its contribution to the achievement of the SDGs. Tracking progress towards drug control through the SDG lens is essential in this task. Tracking such progress is also critical to ensure more coherence within the UN system, in particular in making sure that drug policies contribute to, rather than undermine, the broader objectives of the United Nations.

Thirdly, a simplification and streamlining of drug-related indicators is urgently needed to increase the response rate to the ARQ, especially in Africa, Latin America and Asia.

The UNODC kicked off the ARQ review process at an expert working group meeting on 29th to 31st January 2018, to discuss quality, gaps and challenges in data collection. However, the meeting fell short of a meaningful reconsideration of the ARQ, and little discussion took place on how to incorporate UNGASS implementation and the achievement of the SDGs in a revised version of the ARQ. IDPC raised these and other concerns in a letter which was eventually shared by the UNODC to the participants of the meeting.

Civil society contribution to the 50th session of the UN Statistical Commission - Agenda item 3(q) on ‘Drugs and drug use statistics’

In 2018, Youth RISE implemented small grant initiatives in 10 countries: the Czech Republic, Georgia, Ghana, Ireland, Kenya, Lithuania, Mexico, Nepal, Pakistan and Ukraine. Two national groups (representing the Czech Republic and Pakistan) had the opportunity to implement additional follow-up activities. The majority of initiatives focused on young people who use drugs and the police, developed and implemented in accordance with varying drug policies and political climates. The small grants in Georgia and Ukraine, as well as part of activities described in this report from Pakistan, were implemented as part of the “Count Me In” project. Youth LEAD, Y+ and Youth RISE successfully bid the Global Fund (GF) Community Rights and Gender (CRG) Special Initiative grant for 2017-2019. The project was named “Count Me In” and given the general aim to achieve meaningful engagement of key youth populations in the Global Fund. This project was implemented in Asia and the Pacific, Africa and Eastern Europe.

The Youth RISE representative in the Czech Republic aimed to organise a public Forum focused on issues within the drug checking1 service establishment. Recent history has shown that, in the Czech Republic, the attempts to include drug checking into existing harm reduction programs fails. The police tend to be strictly against the intervention and are very vocal about their position. Taking this into account, the main purpose of the Forum was to open a public discussion on the unavailability of drug checking interventions in the Czech Republic.

Youth rise: Annual report 2018

The Global Fund to Fight AIDS, Tuberculosis and Malaria is the largest donor for harm reduction in low and middle countries (LMICs), providing two-thirds of all international donor support. In May 2019, the Global Fund Board will approve the 2020-2022 allocation methodology and catalytic investment priorities, ahead of replenishment for the Global Fund in October 2019. These will have significant implications for harm reduction in LMICs and as such, the ability of the Global Fund to step up the fight and get back on track to end AIDS by 2030.

This briefing, developed in collaboration with the International HIV/AIDS Alliance, compiles evidence of the crucial nature of catalytic investment funds for harm reduction. In the briefing, we urge the Global Fund Board to safeguard catalytic investment funds—including multi-country grants, matching funds and strategic initiatives—regardless of the replenishment outcome, in order to sustain life-saving services for people who inject drugs and to incentivise domestic investment in harm reduction.

Harm Reduction International joint briefing on Global Fund catalytic investments for harm reduction


The New Zealand Drug Foundation’s vision is for an
Aotearoa free from drug harm.

This State of the Nation is the first of what will be an annual report. It’s intended to track how New Zealand is dealing with alcohol and other drugs, and show a starting point against which we can assess the impact of any policy changes.

While we are doing well in some areas, there is massive room for improvement. Top of the list is the horrifying number of deaths (as many as 50) linked to synthetic cannabinoids since mid-2017.

There is room for hope, though, with some welcome announcements from the government in December. They plan to ensure Police no longer prosecute people for possession and personal use of any drug “where a therapeutic approach would be more beneficial, or there is no public interest in a prosecution”. This could be a game-changer for ensuring people can get the help they need.

Also in December, the government passed new medicinal cannabis legislation and declared the 2020 cannabis referendum will be binding. And already this year, the Police Minister acknowledged the importance of drug checking at festivals.

However there is no room for complacency. Illicit drug convictions are creeping up again after falling for many years, with 5,710 people convicted in 2017. It’s concerning that 61% of those convictions were for low-level offences, such as possessing or using drugs. And Māori continue to suffer disproportionate harm both from drugs and our drug laws.

And a note on drug statistics: New Zealand does not have adequate ones. With all that is going on, it’s essential we rectify this in a hurry. How else will we know what’s working and what’s not working?

New Zealand Drug Foundation’s State of the Nation report 2018

In some ways this is a dark time for human rights. Yet while the autocrats and rights abusers may capture the headlines, the defenders of human rights, democracy, and the rule of law are also gaining strength. The same populists who are spreading hatred and intolerance are spawning a resistance that keeps winning its share of battles. Victory in any given case is never assured, but it has occurred often enough in the past year to suggest that the excesses of autocratic rule are fueling a powerful counterattack. Unlike traditional dictators, today’s would-be autocrats typically emerge from democratic settings. Most pursue a two-step strategy for undermining democracy: first, scapegoat and demonize vulnerable minorities to build popular support; then, weaken the checks and balances on government power needed to preserve human rights and the rule of law, such as an independent judiciary, a free media, and vigorous civic groups.

Even the world’s established democracies have shown themselves vulnerable to this demagoguery and manipulation. Autocratic leaders rarely solve the problems that they cite to justify their rise to power, but they do create their own legacy of abuse. At home, the unaccountable government that they lead becomes prone to repression, corruption, and mismanagement. Some claim that autocrats are better at getting things done, but as they prioritize perpetuating their own power, the human cost can be enormous, such as the hyperinflation and economic devastation in once oil-rich Venezuela, the spree of extrajudicial killings as part of the “drug war” in the Philippines, or China’s mass detention of upwards of 1 million Turkic Muslims, primarily Uyghurs.

Because they dislike human rights scrutiny, autocratic leaders also tend to retreat from the defense of human rights beyond their borders. This retrenchment has made it easier for brutal leaders to get away with large-scale atrocities, such as Syria’s war on civilians in areas held by anti-government forces, the Saudi-led coalition’s indiscriminate bombing and blockade that are killing and starving Yemeni civilians, and the Myanmar army’s mass murder, rape, and arson against Rohingya Muslims.

HRW: World report 2019

Around the world the so called ‘war on drugs’ is collapsing. Many countries are replacing the prohibition of illicit drugs, with new approaches which prioritise and protect people’s health and wellbeing. Whilst reform is underway, it is not happening nearly fast enough or reaching far enough. The prohibitionist criminal justice approach that has dominated drug policy for the past 50 years continues to destroy livelihoods and claim lives. The people most affected aren’t those in charge of the drugs trade. Instead, it’s those caught up at the lowest levels in a trade that is destroying their lives and communities, particularly in the global south. Prohibition has failed to reduce the world’s supply of illicit drugs.

Meanwhile the heavy handed and often militarised law enforcement approach that often goes with it – directed primarily at those involved at the lowest level in the production and supply of illicit drugs – has fueled poverty, inequality, corruption and violence. This is felt most sharply by marginalised communities and women who engage in the small-scale trade out of necessity or lack of alternatives. In these contexts of significant vulnerability, powerlessness and poverty, the drugs trade can offer a decent income or means of survival, where no other exists.

Punishing poverty - How the failed ‘war on drugs’ harms vulnerable communities: Case studies of Brazil and India

Why do some political actors sustain that the armed forces should intervene in affairs other than their primary mission of defending a country from military attack? Are there security threats that can be equated with outside threats and that justify the use of military might inside borders? In order to respond to these questions, we must examine how the notion of “new threats” was constructed, who is promoting it as doctrine, and what these supposed dangers are.

In the 1980s and 1990s, a process of democratization put an end to the military governments that had proliferated in Latin America during the twentieth century. The “national security doctrine,” pushed by the United States and adopted throughout the Americas, was also abandoned once the ghost of Communism could no longer be used to conjure internal enemies. At the same time, democracy weakened the existing tensions between the countries of the region.

War with a neighboring country, which had been the main hypothesis of military confl ict for most Latin American countries, began to disappear from the realm of possibility. With nuances depending on the situation and history of each country, the armed forces generally began to lose relevance as political actors in the wake of democracy. In the same period, the issues of crime and citizen security became central themes on the political agenda throughout the region. This led many countries to favor military involvement in “combating crime.”

To varying extents in each country, the persistence of economic disparities and the expansion of illegal markets such as arms and drug traffi cking—underpinned by increased consumption in the United States—contributed to transforming Latin America into one of the most violent regions in the world.

The internal war: How the fight against drugs is militarising Latin America

Iga Kender-Jeziorska (Youth Organisations for Drug Action) and Péter Sárosi (Rights Reporter Foundation)

The involvement of non-state actors on various levels of policy-making has been one of the important issues of the European Union agenda for some time already. One of the manifestations of the EU efforts to include civil society representation in the work of various EU bodies has been creating Civil Society Fora – spaces where European non-governmental organisations can work together and sit at the round table with EU representatives.

The Civil Society Forum on Drugs (CSFD) is an expert group of the European Commission. Its members are selected by the Commission for a three-years mandate based on their competences, knowledge and expertise. One of its thematic working groups is concerned with the EU drug strategies and action plans.

EU Drug Strategy is a document “provid[ing] the overarching political framework and priorities for EU drugs policy identified by Member States and EU institutions” (European Council, 2012), thus setting the general directions of the field development. It is based on the EU values and principles on the one hand, and international agreements (e.g. United Nations conventions on psychoactive substances) on the other. The strategy constitutes a “base” to guide Action Plans on Drugs – documents encompassing 4-year periods and enlisting more specific actions and measures to be undertaken.

The current EU Drug Strategy was adopted for the years 2013-20, and its Action Plans for 2013-16 and 2017-20, respectively. The documents focus on few areas of drug policy: drug demand reduction, drug supply reduction, coordination, international cooperation, and information, research, monitoring and evaluation. With its vocal support for solutions that are evidence-based and strongly embedded in human rights and public health approach to the drug problem, they are by all means the most progressive EU documents of this type so far. However, EU strategy and action plans are documents of recommendation character only, i.e. they are not legally binding. Therefore, each and every EU member state has a full discretion over its drug policy (unless restricted by ratified international treaties), which means that the degree of following EU recommendation and reflecting them in domestic policies and laws can vary significantly from country to country.

For this reason, CSFD’s Working Group on the EU Drug Strategy and Action plan has been involved in in the evaluation of the EU drug strategy (2013-20) and the previous Action Plan on Drugs (2013-16), as well as the preparation of the new Action Plan (2017-20). The Forum has also decided to contribute to the monitoring and evaluation of the current Action Plan (2017-20). To do so, we have conducted a research among European NGOs working in the field to assess their perspectives and views on how relevant actions of the document are implemented in their countries.

This report consists of five main parts. First, we will describe the methodology and data sources of this inquiry. Second, we will discuss the services accessibility and quality in general. Third, we will provide a comparative analysis of the European regions included in the study. Fourth, we will look more closely at services accessibility and quality in the context of few specific and vulnerable populations: youth, elderly, women, ethnic minorities/immigrants and inmates. Finally, we will present barriers to the effective implementation of the EU Action Plan and draw a set of recommendations for various stakeholders.

Civil society views on the implementation of the EU Action Plan on Drugs: Report by the Civil Society Forum on Drugs

Laurent Jansseune, Mafalda Pardal, Tom Decorte and Òscar Parés Franquero

Cannabis Social Clubs (CSCs) are a nonprofit model for the supply of cannabis originating in Spain. This article aims to provide an overview of current CSC practices in Barcelona, exploring the role played by CSC Federations in shaping them. This analysis draws on 32 semistructured interviews with CSC managers (n = 15) and with other stakeholders in Barcelona (n = 17). We build also on field observations at other CSCs based in Barcelona. We found a heterogeneity of CSC practices, some of which were not in line with the self-regulatory codes developed by the CSC Federations. In applying an earlier CSC typology, we identified also country-specific CSC features. While the CSC Federations have contributed to unifying the cannabis movement and made efforts to homogenize CSCs’ practices, in the absence of (government) cannabis regulation, their efforts have to some extent been undermined.

Revisiting the birthplace of the cannabis social club model and the role played by cannabis social club federations

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Societal stigma and punitive legal frameworks often severely impede key populations’ rights to raise families free from interference and discrimination. The experiences of key population groups (gay, bisexual and other men who have sex with men, people who use drugs, sex workers, and transgender people) are diverse, and are informed by varying levels of criminalisation, stigma and discrimination, and individual factors such as socioeconomic status, gender, race, and health status. This paper explores these challenges, and provides recommendations for policymakers.

This Policy Brief is a joint effort by three global key population-led networks (INPUD, MPact, and NSWP) to bring attention to the lived experiences of key populations and their families, and highlight the ways that stigma and discrimination inform these experiences. The Policy Brief is available here.

A Community Guide is also available here. It provides an overview of the full Policy Brief, and provides key recommendations for policymakers and other stakeholders. As with the Policy Brief, this paper is a collaborative effort between the International Network of People who Use Drugs (INPUD), MPact Global Action for Gay Men’s Health and Rights (formerly MSMGF) and the Global Network of Sex Work Projects (NSWP).

Publications from IDPC Members