Six out of ten People with an Opioid Dependence (POD) in the Netherlands are socially marginalized and have problems related to criminality, antisocial behaviour, mental health and living situation. Continuing treatment and guidance are considered a necessity to improve the quality of life and reduce societal costs. A harm reduction strategy, Opioid Substitution Therapy (OST), is used to provide treatment and guidance. In this treatment, heroin is substituted by legal opioids such as methadone and buprenorphine. To create consistency in OST throughout the Netherlands, the Dutch Ministry of Health, Welfare and Sport, commissioned in 2006 the development of the Guideline for Opioid Maintenance Treatment (Richtlijn Opiaatonderhoudsbehandeling, RIOB). RIOB describes the diagnostics, adequate medication policy, several interventions and the patient’s perspective for opioid maintenance treatment.

1) To what extent is RIOB implemented in daily practice in institutions for methadone and buprenorphine provision in the Netherlands and what factors influenced this?

2) To what extent are the principles of shared decision making in establishing a treatment plan implemented in daily practice in institutions for methadone and buprenorphine provision in the Netherlands?

Keep up-to-date with drug policy developments by subscribing to the IDPC Monthly Alert.

Methadone treatment in the Netherlands

O uso da prisão como resposta às drogas afeta desproporcionalmente as mulheres. Na Argentina, Brasil e Costa Rica mais de 60% da população carcerária feminina está privada de liberdade por delitos relacionados a drogas. Muitas delas têm baixo nível educacional, vivem em condições de pobreza e são responsáveis pelo cuidado e sustento de pessoas que dependem delas– crianças, jovens, idosos ou deficientes.

Apesar de serem mais afetadas pelas políticas punitivas, essas mulheres muito raramente representam uma verdadeira ameaça para a sociedade. A maioria é detida por realizar tarefas de menor importância, embora de alto risco, na hierarquia do tráfico de drogas (distribuição de drogas em pequena escala ou transporte de drogas), como uma forma de enfrentar a pobreza ou, às vezes, por coerção de um parceiro ou membro da família. Seu encarceramento pouco ou nada contribui para desmantelar os mercados ilegais de drogas e melhorar a segurança pública. Pelo contrário, costuma piorar a situação, dificultando ainda mais o acesso a trabalhos legais e formais após saírem da prisão, perpetuando um círculo vicioso de pobreza e envolvimento com mercados de drogas e encarceramento.

O encarceramento de mulheres – mães e cuidadoras em particular – pode ter consequências devastadoras para suas famílias e comunidades. Na ausência de redes de proteção social fortes, as pessoas delas dependentes ficam expostas a situações de abandono e marginalidade. O encarceramento da mulher pode inclusive, embora paradoxalmente, aumentar a probabilidade de as pessoas sob sua responsabilidade consumirem drogas ou se vincularem às redes ilegais de tráfico. Tudo isso aumenta a demanda de proteção social por parte dos Estados que, em geral, não costuma ser atendida

Registe-se para recever as Alertas mensais do IDPC e obter informação sobre questões relacionadas com as políticas de drogas.

Mulheres, políticas de drogas e encarceramento

Every 25 seconds in the United States, someone is arrested for the simple act of possessing drugs for their personal use. Around the country, police make more arrests for drug possession than for any other crime. More than one of every nine arrests by state law enforcement is for drug possession, amounting to more than 1.25 million arrests each year. And despite officials’ claims that drug laws are meant to curb drug sales, four times as many people are arrested for possessing drugs as are arrested for selling them.

As a result of these arrests, on any given day at least 137,000 men and women are behind bars in the United States for drug possession, some 48,000 of them in state prisons and 89,000 in jails, most of the latter in pretrial detention. Each day, tens of thousands more are convicted, cycle through jails and prisons, and spend extended periods on probation and parole, often burdened with crippling debt from court-imposed fines and fees. Their criminal records lock them out of jobs, housing, education, welfare assistance, voting, and much more, and subject them to discrimination and stigma. The cost to them and to their families and communities, as well as to the taxpayer, is devastating. Those impacted are disproportionately communities of color and the poor.

Every 25 seconds: The human toll of criminalising drug use in the United States

As Arizona, California, Maine, Massachusetts, and Nevada prepare to vote on marijuana legalization next month, all eyes are on the initial outcomes of those states that have already legalized marijuana. In 2012, Colorado and Washington became the first two U.S. states – and the first two jurisdictions in the world – to approve ending marijuana prohibition and legally regulating marijuana production, distribution and sales. In the 2014 election, Alaska and Oregon followed suit, while Washington D.C. passed a more limited measure that legalized possession and home cultivation of marijuana (but did not address its taxation and sale due to D.C. law).

A new report by the Drug Policy Alliance brings good news for the states considering legalization at the ballot on November 8, 2016, and the broader marijuana legalization movement. Since the adult possession of marijuana became legal, these states have benefitted from a dramatic decrease in marijuana arrests and convictions, as well as increased tax revenues. During the same period, these states did not experience increases in youth marijuana use or traffic fatalities.

So far, so good: What we know about marijuana legalisation in Colorado, Washington, Alaska, Oregon, and Washington D.C.

To address its serious drug use problems, Myanmar should change its drug policy towards a harm reduction approach. Instead of a repressive approach, voluntary and evidence-based treatment and public health services, including harm reduction, should be made available and become generally accepted by enforcement officials and by the community at large.

Situated in South East Asia’s ‘Golden Triangle’ , Myanmar is well known for poppy cultivation and opium production. International reports claim that the country is the world’s second largest opium producer after Afghanistan . Opium cultivated in Myanmar is locally consumed, especially in the mountainous ethnic regions where it also has traditional and medicinal uses. However, a large amount of opium is turned into a more dangerous form - heroin - for the local market as well as for export, mostly to countries in the region, especially China. Myanmar is also under international surveillance because of its production and export of amphetamine type stimulants (ATS). In Myanmar prevalence of problematic drug use is high, though there is no reliable data on the issue. According to official reports, the most commonly used illicit substances are heroin, opium, methamphetamines, and cannabis. Major health problems such as HIV, hepatitis B and C, drug overdoses and tuberculosis are related to risky injection practices and the sharing of smoking paraphernalia. Problematic drug use is especially related to unsafe practices by injecting heroin users.

‘Found in the dark’:  The impact of drug law enforcement practices in Myanmar

Paraguay is the principal producer of cannabis in South America. Despite its importance as a supplier of cannabis in South America, there has been a surprising absence of serious studies of its impact on its own society, and on the play of offer and demand in neighbouring countries.

The history of Paraguay in the import/export and processing of illicit drugs, together with the growing and exportation of cannabis, goes back to the late 1960s, when cannabis growing became established in the department of Amambay, around the town of Pedro Juan Caballero, on the northeastern frontier with Brazil. At the same time venal and cash-hungry central authorities discovered that this trade allowed them to finance a corrupt local political structure, heavily dependent on illegal cash flows and closely tied to the pre-existing caudillo system.

The chain of drug trafficking has evolved considerably from the amateurish structures of the 1960s, and has taken root within the state. The real question is what will happen next. Will Paraguay continue increasing the violence on its civilian population and with it the number of murders and forced disappearances? The most optimistic scenario is that a discussion about some form of legal regulation will move the debate forward, for without this, the prevailing structures of poverty and inequality will only continue to feed into present levels of corruption, money laundering and illicit trafficking.

Paraguay: The cannabis breadbasket of the Southern Cone

Drug overdose factsheet (MENAHRA)

This report argues that this rationale for continuing with an enforcement-led approach to drugs is poorly supported by empirical research, and that alternative policies – in particular the decriminalisation of personal drug possession or the introduction of legally regulated drug markets – can produce better outcomes while also avoiding dramatic increases in use. It also makes the case that overall levels of drug use are not an accurate indicator of levels of drug-related harm, and should not be considered as such.

Given the pace at which real-world alternatives to criminalisation and prohibition have taken hold in recent years, and the extent to which drug policy reform has become a mainstream issue, there is now no shortage of claims and counterclaims about how different policies affect levels of drug consumption. This report attempts to cut through this debate, addressing the widely held concern about increased use by reviewing the evidence acquired since the modern international drug control framework was established in the 1960s, and looking at what is known about other approaches to managing a range of substances. Ultimately, the intention is to provide a representative overview of what is known about the relationship between drug policy, drug use, and related harms.

Will drug use rise? Exploring a key concern about decriminalising or regulating drugs

A special session of the General Assembly took place in April revealing a growing divergence in the global drug policy landscape. Difficult negotiations resulted in a disappointing outcome document, perpetuating a siloed approach to drugs at the UN level. There is a clear need to realign international drug policies with the overarching 2030 Agenda and the Sustainable Development Goals, embedding the drugs issue comprehensively within the UN’s three pillars: development, human rights, and peace and security. The UNGASS process has helped to set the stage for more substantial changes in the near future, towards the next UN review in 2019.

Struggling to present an image of unity, the UNGASS on drugs in April 2016 failed to hide the increasing diversity among Member States. This undeniable reality, earlier described by the Executive Director of UNODC as ‘a very b-r-o-a-d consensus’, was reflected in a weak outcome document.

Although the timing of the UNGASS was prompted by ongoing and disproportionate suffering and violence from the ‘war on drugs’ in Latin America, as on previous occasions, the event did little to address underlying structural problems, including arms trafficking and money laundering.

Despite constructive inputs from a range of UN bodies, Member States and civil society organisations, the Vienna-dominated UNGASS preparatory process suppressed discussion that questioned the existing architecture of the UN drug control system. While containing some positive attributes in relation to access to controlled medicines, health-oriented interventions and proportional sentencing, the outcome document in the main supports the status quo and fails to refer explicitly to harm reduction, decriminalization or the abolition of the death penalty for drug offences.

An increasing point of tension within the drug control treaty framework, the issue of regulated cannabis markets, remained very much the ‘elephant in the room’ with efforts within the outcome document to dissipate pressure resulting in denial and confusion.

In spite of a growing need to address the fragmentary UN approach and the recent adoption of the 2030 Agenda for Sustainable Development, the outcome document did much to sustain a siloed approach to the drug issue.

The UNGASS process as a whole has set the stage for more substantial changes at the next high-level meeting in 2019, in relation to human rights, the Sustainable Development Goals, regulated cannabis markets and the creation of an expert advisory group to improve the functioning and coherence of the global drug control system.

UNGASS 2016: A broken or b-r-o-a-d consensus?

Over the last two decades South Africa has undergone a massive transformation. We have moved from being one of the most oppressive countries in the world ruled by the infamous apartheid regime, to having one of the world’s most progressive constitutions, recognising the human rights of all our people. Unfortunately we have lagged behind in the area of drug policy. Drug use is often featured in our headlines, and “substance abuse” is seen as one of the major causes of broken communities and increasing levels of crime and gangsterism. South African drug policy is guided by the National Drug Master Plan.

There is an undue emphasis on supply reduction and policing strategies to address demand reduction by targeting end users. These policies have resulted in significant harms to our communities in general and drug users specifically. Large portions of our most vulnerable populations are criminalised by their drug use and the stigma and discrimination entrenched by these policies limits access to health and other services. Despite the obvious harms and rights violations caused by our policies and associated drug-control measures, with the exception of the cannabis lobby, there was no credible civil society voice or initiatives motivating for progressive drug policy.

There have been no organised, sustained or collaborative efforts to advocate for the health and human rights of drug users. The popular narrative that drugs were the cause of the breakdown of communities, and by extension drug users should be criminalised, remained largely unchallenged in the mainstream. Internationally the imperative to limit the spread of HIV/AIDS has motivated services for drug users, and particularly injecting drug users. However, in South Africa people who inject drugs (PWID) where considered to be an insignificant minority and despite a commitment to Step Up Overview The Step Up Project, run by TB/HIV Care Association (THCA) and OUT Wellbeing, with support from CDC, PEPFAR and Mainline, aims to provide a package of mobile outreach HIV prevention and linkage to care services to PWID in selected areas of Cape Town, Durban and Pretoria.

This package of services is recommended by PEPFAR, WHO, UNODC and UNAIDS. It includes: HIV Counselling and testing; referrals and successful linkages to antiretroviral treatment; needle and syringe programmes, condom programs and IEC materials; screening and referral for the management of TB and STIs and where possible viral hepatitis and peer based outreach services. One of the major barriers has been the policy framework, hence the need for policy & advocacy initiatives. Page 6 of 52 achieve the goals of the Political Declaration on HIV, including the 90-90-90 target, there were no sustainable services for PWID.

With funding from PEPFAR/CDC, in 2014 TB/HIV Care Association launched the Step Up Project aimed at delivering the WHO/UNODC/UNAIDS recommended “comprehensive” package of HIV prevention services for PWID. The funding provided was limited to programme delivery and excluded funding for policy and advocacy work. The project has utilised a variety of consultative processes and continues to do so. Academic, experts, civil society and members of drug using communities have been, and continue to be included, in this process.

A number of intervention gaps have been identified. Some of the key gaps identified by the process were:

The high level of stigma, exclusion and human rights abuses that have significant effect on the rights and well-being of drug users in South Africa.

The contradictory policy legal frameworks that hinder the implementation of evidence based interventions for drug users.

Lack of evidence based harm reduction within the policy framework.

The lack of advocacy efforts around drug user rights and the development of effective drug policy.

The lack of drug user representative groups who could take part in advocacy efforts and policy debate. Mainline provided initial funding for human rights and advocacy work.

Keep up-to-date with drug policy developments by subscribing to the IDPC Monthly Alert.

Policy advocacy and human rights report July 2015 – July 2016

The year 2015 saw excellent progress for the International HIV/AIDS Alliance, with 13 out of 14 of our milestones exceeded. The year marked the start of a new era towards ending AIDS. In September 2015, the UN adopted the Sustainable Development Goals (SDGs). The Alliance worked closely with many others to ensure HIV was included as part of a new health goal to promote health and wellbeing for all, with a specific target to end AIDS by 2030.

The coming year will be critical in helping us working to meet this 2030 goal. It is a year where we have the possibility of securing new, bolder commitments to the response to AIDS at the global level through the UN High Level Meeting on AIDS and will be crucial in terms of ensuring that AIDS stays on the agenda for funders. With other competing development priorities like the European refugee crisis, political support for official development assistance (ODA) has continued to decrease. This has created a greater sense of urgency around efforts to diversify financial support. Opportunities and challenges facing the Alliance for the coming year are discussed in greater detail below.

Significant achievements of the Alliance during 2015 included the following:

In 41% of Alliance countries, our Linking Organisations contributed 10% or more of the national coverage for HIV prevention, care or treatment (target 30% of Alliance countries).

1,300,000 defined packages of HIV prevention services were provided to key populations; 30% higher than the target set.

One million people received HIV testing and counselling services for HIV, and received their test results; 25 Linking Organisations contributed to this target in 2015.

Nearly 1.2 million adults and children living with HIV received care and support services; a 29% increase since 2014. • 1,599,000 people were reached with integrated HIV and sexual and reproductive health (SRH) activities; 900,000 were women and girls.

2,174 community-based organisations (CBOs) received grants through the Alliance (target 2000); 83% achieved their programmatic and financial targets.

809 CBOs and networks were supported by the Alliance to monitor and report on human rights-related barriers to access services (2015 target 350).

9 Linking Organisations are Global Fund Principal Recipients (PR), managing one of the largest Global Fund civil society portfolios with a value of $310 million.

We organised a number of high-level events to influence decision makers in the year leading up to the agreement of the new Sustainable Development Goals, including at the Financing for Development Conference and the UN Summit. We also had a strong presence at the international harm reduction and the international family planning conferences.

International HIV/AIDS Alliance annual report 2015

Penal Reform International's Annual Report 2015 tracks progress towards the goals of its new Strategic Plan 2015-2020. The highlights of the year include but are not limited to:

The unanimous adoption of the revised UN Standard Minimum Rules for the Treatment of Prisoners – now the UN 

 – by the UN General Assembly in December 2015. The Rules are regarded by states as the primary source of standards on the treatment of prisoners. The Nelson Mandela Rules contain substantive new guidance for governments and prison management, including on healthcare, the conduct of searches and on the use of solitary confinement. PRI engaged intensively in the four-year revision process.

Growing engagement by PRI on the issue of 

Progress on improving protection of children in conflict with the law in 

. Following research on violence against children in Kazakhstan, Kyrgyzstan and Tajikistan and its presentation at a regional conference, the Government of Kazakhstan and of Tajikistan made concrete commitments to start legal and policy reform.

 to tackle overcrowding in prisons through the introduction of community service programmes. PRI’s popular 10 point plan on addressing prison overcrowding now forms the basis of Tunisia’s national strategy to reduce overcrowding.

Legislative and policy changes improving the treatment of vulnerable prisoners in 

A new juvenile justice code and the introduction of pre-sentence reporting for children in 

. PRI’s South Caucasus office were active in advocating for the new code and in supporting the implementation of the new procedures by probation and social workers.

Publications from IDPC Members