The Mainline annual report offers highlights on the activities and projects of the foundation in 2015.

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

Mainline Annual Report 2015

Recognizing the urgent need for strong, forward-thinking action, and evidence-informed, rights-based, well-resourced, community-led HIV responses, civil society emphatically call for a more progressive vision in the 

2016 Political Declaration on Ending AIDS

. It is toward this goal that we, the undersigned civil society advocates and organizations, engage with the process of the 

 in good faith and with hope for ending the HIV epidemic by 2020. We seek to align the HIV response to the 2030 Agenda, and were encouraged by the initial (zero) draft of the Political Declaration, and to that end commend the co-facilitators (H.E. Jürg Lauber from Switzerland and H.E. Mwaba Patricia Kasese Bota from Zambia) and recognize the efforts made by many member states to secure a bold and progressive vision and set of commitments.

Civil society and communities declaration to end HIV: Human rights must come first

This is the second annual edition in our 

 series produced by Penal Reform International, describing key global trends in the use and practice of imprisonment and the pressing challenges facing states that wish to organise their penitentiary systems in accordance with international norms and standards.

Topics include for example: developments in international criminal justice policy; notable changes to policy at the national level; prison population trends; prison management issues (eg. security and violence, radicalisation, corrections in fragile and conflict states, corruption) and new technologies. The 2016 also has a new section on the provision of food in prisons, with some representative data on food expenditure.

Significant international developments and recent research projects are highlighted throughout.

The report also includes a Special Focus pull-out section – 

Working in a prison requires specific skills, but prison staff can be poorly paid, under‑trained and experience high levels of work‑related stress and violence. This special feature provides a global perspective on prison staff recruitment, pay and conditions, professional training, and issues relating to their health, safety and well‑being.

Global Prison Trends 2016

This publication is a chapter from a four-part Report, Roadmaps to Regulation: Cannabis, Psychedelics, MDMA, and NPS, that will be published later this year. The Report was convened by Amanda Feilding, and principally funded by the John Paul Getty Jr. Foundation with further assistance from the Open Society Foundations (OSF).

The Report aims to bring together the best available evidence on the regulation of psychoactive drugs in a rigorous, yet accessible way. In part, it is an invitation to think differently about drug policy options.

The wealth of expertise that we have gained from our work in the drug policy field strengthens our conviction that the strict legal regulation of drugs is the ultimate goal of drug policy reform. The governments of the world, duty-bound to safeguard their citizens’ well-being, surely would do a better job of minimising the overall harms of drugs than the criminal organisations currently profiting from the illicit market. It is no longer acceptable to simply assume that the risks of a legal market will exceed those of prohibition, especially when there is already the beginnings of a scientific evidence-base to show that a regulated market can provide effective ways of reducing harms. In view of this, the Report was established to provide policymakers with tools to move beyond the blanket application of reactive prohibition. Our aim is to provide guidelines for considering the best available evidence, and for utilising this knowledge in supporting decisions about how to move forward with the complicated issues surrounding the regulation of different categories of psychoactive substances.

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

Roadmaps to regulation - New psychoactive substances

The current prescription opioid and heroin overdose epidemic has brought greater attention to injection drug use in public spaces. A recent New York Times article noted incidents of public injecting reported by local media in several states, stating:

“With heroin cheap and widely available on city streets throughout the country, users are making their buys and shooting up as soon as they can, often in public places. Police officers are routinely finding drug users — unconscious or dead — in cars, in the bathrooms of fast-food restaurants, on mass transit and in parks, hospitals and libraries.”1

Public injecting poses a significant policy challenge for public health and safety. Injecting in public spaces has been associated with greater risk of overdose and HIV transmission. Many people who use drugs are unable to use them in safe and private environments but instead must turn to venues such as public bathrooms, empty warehouses, and parks. The reasons are complex. Drug use is both illegal and stigmatized; some people who use drugs are homeless, unstably housed or risk loss of housing if found using drugs. This lack of privacy and dignity, particularly when drugs are injected, compromises the health, wellbeing and safety of the people injecting the drugs and of the surrounding community.

Reducing public injection of drugs requires a multipronged approach ranging from accessible drug treatment to affordable supportive housing. This consultation on Alternatives to Public Injection was focused on one solution that has been implemented in a number of countries: supervised injection facilities (SIFs), also known as drug consumption rooms. Supervised injection facilities have received increased attention and consideration in recent months. Legislation to support the establishment of SIFs has been introduced in Maryland and California. SIF proposals are actively under discussion in Seattle, WA and Ithaca, NY. Outside of the United States, new SIFs are expected to open in France, Ireland and Canada.

Currently, there are nearly 100 SIFs in operation outside the United States, but as yet no U.S. jurisdiction has established a supervised injection facility. In light of growing policy interest in this strategy, Harm Reduction Coalition collaborated with Open Society Foundation and amFAR, The Foundation for AIDS Research to convene a consultation on Alternatives to Public Injection on September 30, 2015. Representatives from the NYS Department of Health AIDS Institute and the New York City Department of Health and Mental Hygiene participated in the consultation, along with stakeholders representing harm reduction, drug user health advocates, law enforcement and social service providers. Harm Reduction Coalition invited experts from several countries to share their various SIF models, planning and policy development process, implementation challenges, and evaluation results.

This report by Harm Reduction Coalition is a summary of the proceedings of the consultation. The report provides insights on the potential role of supervised injection facilities in the United States, and considerations for advancing policy, planning and implementation of SIFs based on experiences in other countries.

Alternatives to public injecting

Civil society organizations (CSOs) in Middle East and North Africa (MENA) are the principal partners of government in scaling up the response to HIV and in implementing national policies. In return, CSOs expect endorsement of their work by the governments. Some CSOs face weaknesses and need capacitybuilding in order for them to reach the level of response required for reducing drug-related harm in this region. Substance use and the transmission of HIV are increasing in the MENA region. The limited data available on drug use show that there are approximately 630,000 people who inject drugs (PWID) across the region. The HIV epidemic remains concentrated among PWID and other key populations in the region. Comprehensive harm reduction programs which include prevention, care, and HIV treatment for PWID are being implemented by CSOs. This could not happen without the presence of a conducive environment which has been facilitated by the CSOs, and which aims to lead to a positive response in health policies, and thus to harm reduction programs in some countries in the region. However, based on the international data, antiretroviral therapy (ART) coverage remains low in these countries, even if the number of people living with HIV (PLHIV) receiving ART is increasing. This increase can sometimes mask important challenges in equity: in several countries PWID are the most likely to be infected with HIV while being the least likely to be receiving care and ART. Therefore, concentrated efforts need to continue toward the goal of having mainstream harm reduction approaches in region.

Drug policy and harm reduction in the Middle East and North Africa: The role of civil society

Injecting drug use is a global health and social issue from which various health and social harms often arise. These harms include health problems, such as HIV/AIDS, viral hepatitis and fatal overdose, as well as social and legal problems, and others. In recent years, an increase in drug use has been reported in many countries in the Middle East and North Africa (MENA) region. The number of People Who Inject Drugs (PWID) from the 20 countries covered by the Middle East and North Africa Harm Reduction Association (MENAHRA) is estimated to be around 570,000 (MENAHRA, 2014).

In many countries of the MENA region, unprotected sex and unsafe injecting drug use are the primary drivers of the HIV epidemic. However, the response has not been appropriate to the size of the problem (MENAHRA, 2014).

An estimated 90,000 people who inject drugs are living with HIV/AIDS within the region, which represents an HIV prevalence of over 15 percent in this population. There is also sufficient evidence showing that injecting drug use contributes significantly to the Hepatitis C Virus (HCV) epidemic in this region (MENAHRA, 2014).

MENAHRA communication guide on harm reduction

In many countries, very large numbers of people in prison have not been convicted of a criminal offence but are waiting for their guilt or innocence to be established by a court. Some will eventually be acquitted of any crime; all should be presumed innocent.Yet in many cases their period of detention on remand may last months or years. Conditions are often worse than for convicted offenders and in many countries detainees are subject to highly restricted regimes with limitations on visits and on opportunities to take part in education, training or work. Countries with the highest levels of overcrowding also have prison populations with the highest proportions of pre‑trial detainees. In 40 countries more than half of prisoners are held on remand.

Ten-point plan on reducing pre-trial detention

Opium farmers and representatives of their communities came together to discuss the challenges they face in their lives, and to share experiences and find ways to solve their problems. This is their statement.

We, opium farmers and representatives of Kayah, Kayan, Shan, Pa-O, Lahu, Ta- ang (Palaung) and Kachin opium farming communities from Kayah State, Southern, Eastern and Northern Shan State, and Kachin State, came together in Loikaw, in Kayah State in Myanmar, to discuss the challenges we face in our lives, and to share experiences and find ways to solve our problems.

We would like to make the following recommendations to the new government of Myanmar:

We grow opium because we are poor and do not have other livelihood opportunities to feed our families and send our children to school, as well as for medicinal and traditional uses. We are not involved in the drug trade, we are not criminals, and we are not commercial farmers. Some of us also grow it for traditional and medicinal uses. It is important to differentiate between small- holder farmers like us, and those people who grow opium commercially and/or who invest in it.

The government should not carry out any force eradication of our opium fields unless and until they have provided access to sustainable crop substitution programmes and alternative livelihoods to our communities. Eradication should especially not take place during the harvest season. By that time we have already invested a lot and also cannot grow another crop anymore that season.

Statement of the 4th Myanmar opium farmers’ forum

Wherever there are significant numbers of people injecting in public, there is a clear need for supervised injecting facilities.

The introduction of Supervised Injecting Facilities in Scotland is one of three recommendations in a report published by Kirsten Horsburgh, National Naloxone Coordinator at Scottish Drugs Forum, following her Winston Churchill Memorial Trust Travel Fellowship to Australia.

Kirsten was awarded the 6 week Fellowship to research strategies adopted in Australia to reduce drug-related deaths. During this trip she spent 2 weeks in the Medically Supervised Injecting Centre (MSIC) in the Kings Cross area of Sydney to gather learning from this service to inform key stakeholders and decision-makers in Scotland.

Drug-related deaths in the UK are at an all time high. In Scotland, these deaths are among the highest in Europe, per head of population. 613 people lost their lives to accidental and preventable overdoses in 2014.

Reducing drug related deaths in Scotland

Biometric technology allows for efficient programming and improved quality of services. But when working with key populations, there are concerns around privacy. Can biometrics be responsibly implemented when working with a key population such as People who Use Drugs?

Biometrics: acceptability & feasibility when working with key populations

Three Kenyan harm reduction organisations conducted a study with the support of Mainline on the needs of female drug users (FDUs) on the Kenyan coast. This investigation was done in order to adapt and design services based on the needs of FDUs. In addition, female specific barriers to accessing services was investigated based on observations that FDUs often face higher access barriers than their male counterparts. In this report, results of the study will be discussed.

The report starts with an introduction as to why special attention should be payed to FDUs, the context of the Kenyan coastal area and what makes FDUs a hard-to-reach population. Next we look at the barriers in accessing services, followed by health risks and predominant needs. This reports ends with intervention suggestions which respond to the needs of FDUs, and considerations for the implementation of these interventions in order to challenge the service barriers which FDUs experience.

Publications from IDPC Members