The Affordable Care Act (ACA) represents a remarkable opportunity for criminal justice and drug policy reform advocates to advance efforts to enact policy changes that promote safe and healthy communities, without excessively relying on criminal justice solutions that have become so prevalent under the war on drugs, and which fall so disproportionately on low-income communities and communities of color.

Even with its challenges, the ACA sets the stage for a new health-oriented policy framework to address problems such as substance use and mental health disorders by more appropriately and effectively casting substance use and mental health disorders as matters of public health and not of criminal justice.

To assist advocates in navigating this new terrain, 

Healthcare Not Handcuffs: Putting the Affordable Care Act to Work for Criminal Justice and Drug Law Reform

 outlines some of the major provisions of the ACA immediately relevant to criminal justice and drug policy reform and explores specific applications of those provisions, including program and policy examples and suggested action steps.

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

Healthcare, not handcuffs: Putting the Affordable Care Act to work for criminal justice and drug policy reform

The report shows clearly that the stigma and discrimination underpinning repressive drug policy is part of a wider project of social spoiling or stigmatization directed at the marginalization and demonization of other communities including LGBTQ people and sex workers.

The report concludes by calling for sex workers, people who use drugs, and other similarly marginalized communities to engage in “parallel battles for autonomy and empowerment in the face of crosscutting social exclusion, control, stigmatisation, and an undermining of agency and self-determination, battles against the same modes of silencing, pathologisation, and disempowerment.”

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

The harms of drug use: Criminalisation, misinformation and stigma

This is the first issue of Drugs – Policies and Practices. Healthy Options Project Skopje (HOPS) put together this magazine quite quickly, but we went a long way until it materialized. The authors of the articles are people who have been working on drug related issues for a long time and are very well informed about both the situation in Macedonia, and about global trends and currencies. Their knowledge is supported by their long-term experience and hands-on work and contacts with people who use drugs, and also by their participation in initiatives related to the creation of a more humane drug policy and treatment for drug dependent persons. Of course, this magazine presents the experiences, opinions and needs of people who use drugs, also.

This magazine aims to serve as an incentive to widen the debate and produce more responsible actions towards the implementation of policies and practices for a humane treatment of people who use drugs, and at the same time will serve as a source of knowledge and information regarding drug related topics.

HOPS Magazine - Treating drug dependencies

Drug trafficking is not a new phenomenon in the Argentinian city of Rosario. Since the 1990s, and largely under the public radar, the distribution of illicit drugs in the poor, peripheral neighbourhoods of the city has been managed by family-run gangs and small-time dealers; poverty and social marginalisation have facilitated the trade; young gang members, known as

, have fought over territory; local demand for illegal drugs has provided the engine; illicit profits have been laundered in collaboration with local lawyers and financial advisors; and corruption among the police and local officials has ensured that the main traffickers, while their identities are widely known, can operate with few concerns other than threats from rivals. This last element appears to explain why, until the issue was forced into the public domain, there had been a conspicuous lack of political concern with drug trafficking in the city.

The change came on New Year’s Day 2012. That day, three community activists were shot and killed in the Villa Moreno neighbourhood by gang members who mistook them for rivals. The killings were not unique, but the victims were: unlike the usual casualties, the activists had a movement behind them. Their deaths led to local demonstrations and calls for action. The press and local officials were suddenly impelled to pay attention to drug trafficking and related violence. Since then, a spate of official investigations has deepened public understanding of the nature of the drug trade in the city. They have also provided further evidence of the complicity of the security forces and the negligence of the state that have long been known to facilitate trafficking.

Maintain the focus on the leadership of the most powerful and violent gangs, including following the money trail, and reverse the trend where simply increasing the number of security forces in violent areas is considered a sufficient policy response.

Re-focus the judiciary away from a two-tiered approach: recognize underage gang members as a vulnerable population, and that confronting the culture of violence will require special initiatives.

Root out corruption in the local and provincial security forces, recognise the way the state's approach facilitates this complicity, and produce more reliable statistics to better inform policymakers.

Eyes wide shut: Corruption and drug-related violence in Rosario

India has a long history of opium and cannabis use, especially for medicinal, religious and recreational reasons. State regulation and community tolerance ceased after the enactment of the Narcotic Drugs and Psychotropic Substances Act (NDPS) in 1985, which created a restrictive regime around drugs. Clampdown on cannabis and opium in the late 1980‟s purportedly triggered more dangerous use – chasing and injecting heroin and other opioids.

The NDPS Act, 1985 is one of the harshest laws in the country. It prohibits cultivation, production, possession, sale, purchase, trade, use and consumption of narcotic drugs and psychotropic substances except for medical and scientific purposes under license. The Act has been amended twice; in 1989 and 2001. The first amendments in 1989 leaned towards greater stringency by introducing mandatory minimum sentences of 10 years, restrictions on bail and mandatory capital punishment for repeat offenders. Following the amendments, persons caught with small amounts of drugs faced long prison sentences, without the possibility of release on bail. Courts criticized the harsh and disproportionate sentencing structure, which led to a fresh set of reforms in 2001 to rationalize punishment on the basis of whether the quantity of drugs involved is ‘small’, ‘commercial’ or ‘intermediate’ and provide some leniency towards drug offenders who also use drugs.

The narcotic drugs and psychotropic substances act: Ignoring health, infringing rights

How can we encourage activism for the improvement of the quality of addiction treatment programmes among the most stigmatised group of citizens in Macedonia?

How can institutions be made to accept that people using drugs can be constructive participants in the process of improving the quality of drug addiction treatment programmes? How can drug policies be freed from ideological models of thinking and adapt to current trends and the needs of those concerned the most? According to the literature describing community monitoring and advocacy available on the internet, an impression is formed that disenfranchised communities should have the necessary motivation and capacity to independently mobilise themselves and jointly fight issues of common interest, but it is hard to bring this ideal model into reality in
which, evidently, wider social and political factors should be taken in consideration.

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

Community monitoring and advocacy in highly stigmatising circumstances: Eliminating institutional barriers for the improvement of quality of drug addiction treatment programmes in Macedonia

The European Association for Palliative Care (EAPC), the International Association for Palliative Care (IAHPC), the Worldwide Palliative Care Alliance (WPCA) and the Human Rights Watch (HRW) are working together to advocate for access to palliative care as human right.

Access to palliative care is a legal obligation, as acknowledged by the United Nations conventions, and has been advocated as a human right by international associations, based on the right to the highest attainable standard of physical and mental health.

The Prague Charter: Urging governments to relieve suffering and recognize palliative care as a human right

This 57-page report documents government violations of the right to health and other abuses of most-at-risk populations in New Orleans. It calls for changes in state and local laws and policies that stigmatize, discriminate against, and facilitate police abuse of sex workers and drug users, and interfere with health services for people at high risk for HIV.

The report was released in advance of the third annual Southern Harm Reduction and Drug Policy Conference, which opens in New Orleans on December 12, 2013.

In harm's way - State response to sex workers, drug users and HIV in New Orleans

The 55-page report documents the experiences of people recently confined in the centers, who described being thrashed with rubber water hoses and hit with sticks or branches. Some described being punished with exercises intended to cause intense physical pain and humiliation, such as crawling along stony ground or standing in septic water pits. Former female detainees described rape and other sexual abuse by male guards. Many detainees said they were forced to work unpaid in the centers – and in some cases, on construction sites – and those who refused were beaten.

Mistreatment of drug users and “undesirables” in Cambodia’s drug detention centres

Ever since its foundation in 2007, the Middle East and North Africa Harm Reduction Association (MENAHRA) has worked to support harm reduction based on scientific data. Unfortunately, in our region, there are a limited number of empirical studies available besides the bio-behavioral studies conducted by individual countries. There is an apparent weakness in the epidemic surveillance systems for the proportions of HIV prevalence. This gap reflects a lack of priority in the region in providing harm reduction services. It also confirms that sharing needles is the second cause for HIV/AIDS transmission in the MENA region.

This study arises from within MENAHRA's course of work to search for the reality of the situation with an empirical approach in order to increase the level of response to HIV/AIDS in the region.

This report should allow decision-makers and civil society organizations to expand their knowledge in regards to the needs and weaknesses of available services by guiding programs in becoming more focused on harm reduction in the region. Therefore, this report shall assist stakeholders in providing a wider scope of HIV/AIDS prevention services among people who inject drugs.

Assessment of situation and response of drug use and its harms in the Middle East and North Africa

Uptake of harm-reduction services among women is low in the Middle East and North Africa (MENA) region. A qualitative operational research was conducted to provide recommendations on how to improve the uptake of harm reduction services among women injecting drug users (WIDUs). By understanding the factors that influence service uptake, program managers can develop meaningful strategies to increase uptake of their services.

To explore the context of drug use among WIDUs

To identify barriers and facilitators to accessing harm-reduction services

To provide recommendations on how to improve access to harm-reduction services.

Women injecting drug users in the Middle East & North Africa Region 

In 2010, the 63rd World Health Assembly (WHA) adopted the first resolution on viral hepatitis (WHA63.18). A new resolution will be presented at the 67th WHA.

Globally, an estimated 185 million people have been infected with hepatitis C virus (HCV). Since 2010, more than a million people have died from HCV, although it is treatable and curable. Nine to twelve million people have been infected since 2010, although HCV is preventable. Most new infections occur among people who inject drugs (PWID), yet access to HCV prevention tools (such as sterile injection equipment) is woefully inadequate, reaching a tiny percentage of those who need it. This shocking public health failure allows the epidemic to continue spreading.

Only a tiny fraction of people who have been infected with HCV are aware of their status. Most live in low and middle-income countries (LMICs) and have no access to diagnostics, care, or treatment. Pegylated interferon (peginterferon, or PEG-IFN), the backbone of the current standard of care for HCV, is priced cruelly out of reach. Even in places where HCV treatment is available, injecting drug use is often used as a criteria for denying access: only 2-4 percent of people who inject drugs are currently receiving treatment.

We, people living with HCV, HIV/AIDS, people who use drugs and our advocates, urge United Nations Member
States to act strongly in order to tackle the hepatitis C epidemic; it is feasible!

Publications from IDPC Members