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.

Our clubs and bars, once at the forefront of creating safer dancing environments, now find themselves relying on guidance that is over two decades out of date. A refocusing of national drug policy and resources away from harm reduction has left our night life environments more vulnerable to drug-related harm than ever. Licensing fears and landmark closures have left venues obliged to harden their ‘zero tolerance’ rhetoric towards drugs, leaving them ill-equipped to deal with the unavoidable realities of drug use. Alongside the post-austerity squeeze on public services, many local authorities and police forces fail to acknowledge their role in protecting the public from drug-related harm, directing responsibility towards licence holders.

The UK’s drug market is rapidly evolving, with common street drugs continuing to increase in strength and purity, an ever-widening array of substances in circulation, and misselling and adulteration a major and growing public health concern. Combined with this, we have a new generation of recreational drug users, many of whom are less familiar with the basic harm reduction practices of previous generations.

 documents the substantial costs resulting from this failure to address drug-related harm. The burden on hospital Accident and Emergency departments from incidents associated with club drugs has more than doubled in the last four years, while disorder in the NTE relating to poor drug use practices, often exacerbated by co-consumption of alcohol, is also estimated to have increased dramatically. Every drug-related death that occurs in the NTE, as well as being a tragedy in its own right, requires significant police resources, including a week of police time, and costs in excess of £10,000 of taxpayers’ money. Such incidents are often the trigger that leads to the closure of venues, the city centre hubs for young and not-so-young adult community engagement, such as London’s Fabric, Birmingham’s Rainbow and Glasgow’s Arches, and to other venues remaining precarious to closure, such as the UK’s dramatically decreasing number of LGBTQ venues. The social, economic and cultural costs are substantial, but could be vastly reduced by the implementation of effective harm reduction initiatives such as those recommended in this report.

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.

The report identifies the perceived barriers to implementation of these initiatives for stakeholders in the NTE and presents solutions to these barriers. 

Strengthen the ability of venues to uphold the objectives of the Licensing Act 2003, promoting both public safety and the prevention of crime;

Provide a distinctive and effective means of reducing drug and alcohol-related harm;

Promote orderly and vibrant night life environments;

Reduce the workload of security staff, police and health services that work in the NTE;

Promote partnership working between industry and other stakeholders;

Add value to local public health strategies by addressing wider public health concerns beyond club drug use to ‘make every contact count’, and by providing a valuable point of contact for a demographic that rarely engages with public services.

Night lives: Reducing drug-related harm in the night time economy

The international community has made efforts, since the beginning of the last century, to address the social problem of the use of narcotic and psychotropic substances through a control system based on limitation of their cultivation, production and availability for medical and scientific purposes. Cultivation and production for other uses is prohibited and prosecuted with severe criminal penalties. In 1961, the United Nations (UN) adopted, after many years of negotiations, the “Single Convention on Narcotic Drugs, 1961”, with the aim to eliminate the illicit cultivation of opium, the coca bush and the cannabis plant. Following the Single Convention on Narcotic Drugs, that has been amended by the 1972 Protocol, two more conventions on drugs have been adopted: the 1971 International Convention on Psychotropic Substances and the International Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances of 1988. These three international conventions are the basis of the legislation of the UN Member States on narcotic and psychotropic substances. The vast majority of the UN member states has signed and most of them have ratified these three international conventions.

The implementation of the three conventions has not achieve, up to now, their objectives. On the contrary, the cultivation, production, trafficking and use of psychotropic substances, beyond their use for medical and scientific purposes, has expanded all over the world and new psychoactive substances have been added to the list of illegal substances.

The international community has repeatedly evaluated the effectiveness of the drug control system. General finding is, that the phenomenon of use of narcotic and psychotropic substances continues to exist and that the approach of prohibition, suppressive measures and punishment does not work. Despite this finding, UN member states are reluctant to distance themselves from the current system. In the period after 1961 until recently, mainly the position of the great powers and in particular the position of the United States of America prevailed. The known as “war on drugs” not only did not bring the expected results, but had also serious negative consequences such as the creation of criminal groups for the trafficking of illicit substances, investment in repressive measures of punishment and imprisonment of users, than prevention and treatment, exacerbation of corruption, the black economy and money laundering. With the major political, social and economic changes of the 1990s, voices of disagreement, with the current control system of narcotic and psychotropic substances and the search for different methods to address the problem, increased. The UN General Assembly Special Session on drugs in 1998, despite the high expectations for change, ended up with the continuation of the repressive policies.

Drug policy reform- the UNGASS 2016 a catalyst for change?

The findings of the largest European project to date in the emerging science of wastewater analysis are taken up in this ‘Perspective on drugs’. The project in question analysed wastewater in around 60 European cities and towns (hereinafter referred to as ‘cities’) to explore the drugtaking habits of those who live in them. The results provide a valuable snapshot of the drug flow through the cities involved, revealing marked geographical variations.

Wastewater analysis is a rapidly developing scientific discipline with the potential for monitoring real-time data on geographical and temporal trends in illicit drug use. Originally used in the 1990s to monitor the environmental impact of liquid household waste, the method has since been used to estimate illicit drug consumption in different cities (Daughton, 2001; Zuccato et al., 2008; van Nuijs et al., 2011). It involves sampling a source of wastewater, such as a sewage influent to a wastewater treatment plant. This allows scientists to estimate the quantity of drugs consumed by a community by measuring the levels of illicit drugs and their metabolites excreted in urine (Zuccato et al., 2008)

In 2010 a Europe-wide network (Sewage analysis CORe group — Europe (SCORE)) was established with the aim of standardising the approaches used for wastewater analysis and coordinating international studies through the establishment of a common protocol of action (1). The first activity of the SCORE group was a Europe-wide investigation, performed in 2011 in 19 European cities, which allowed the first ever wastewater study of regional differences in illicit drug use in Europe (Thomas et al., 2012). That study also included the first intercalibration exercise for the evaluation of the quality of the analytical data and allowed a comprehensive characterisation of the major uncertainties of the approach (Castiglioni et al., 2014). Following the success of this initial study, comparable studies were undertaken over the following four years, covering 56 cities and 19 countries in Europe in 2017. A standard protocol and a common quality control exercise were used in all locations, which made it possible to directly compare illicit drug loads in Europe over a oneweek period during seven consecutive years. For the 2017 wastewater monitoring campaign, raw 24-hour composite samples were collected during a single week in March. These samples were analysed for the urinary biomarkers (i.e. measurable characteristics) of the parent drug (i.e. primary substance) for amphetamine, methamphetamine and MDMA. In addition, the samples were analysed for the main urinary metabolites (i.e. substances produced when the body breaks drugs down) of cocaine and cannabis, which are benzoylecgonine (BE) and THC-COOH (11-nor-9-carboxydelta9-tetrahydrocannabinol).

Wastewater analysis and drugs: A European multi-city study 2018

The VNGOC is a coordinating body for non-governmental organizations (NGOs) around the world concerned with problems related to substances controlled under the three international drug control treaties. The purposes of the Committee include, inter alia:


a) Supporting the activities of NGOs, and promoting contacts and collaboration with the United Nations Office on Drugs and Crime (UNODC), the International Narcotics Control Board (INCB), the UN Commission on Narcotic Drugs (CND), and other relevant UN agencies, offices and fora.
b) Promoting activities that lead to enhanced communication, cooperation and scientific, cultural and social exchanges between NGOs, UN agencies and member states.
c) Promoting increased awareness about issues relating to controlled substances through the dissemination of news and information.
d) Facilitating the representation of NGOs reflecting the broadest possible range of perspectives and groups involved, including affected populations. The VNGOC was established in 1983, and is a legally registered not-for-profit corporation under Austrian law. The VNGOC office is registered in Vienna, although the Committee operates globally.

Vienna NGO Committee on Drugs - Annual Report 2017

This is the tenth year that Harm Reduction International (HRI) has been working on the death penalty for drug offences and, regrettably, prohibitionist and punitive approaches to drugs continue to result in the execution of hundreds of people for non-violent drug offences every year. The majority of those sentenced to death and executed are low level couriers who often experience overlapping and intersecting forms of vulnerability, discrimination and exclusion and who are often subjected to forced confessions and unfair trials. Not only do these executions continue to fail to achieve any reduction in drug use and trafficking, they are also a clear violation of fundamental human rights under international law.

This report looks at the death penalty for drugs in law and practice. It also considers critical developments on the issue. Some of its key findings include:

There are at least 33 countries and territories that prescribe the death penalty for drug offences in law.

At least nine countries still have the death penalty for drug offences as a mandatory sanction, although three of these (Brunei Darussalam, Laos and Myanmar) are abolitionist in practice. Malaysia removed the mandatory sentence for drug offences in November 2017.

Between January 2015 and December 2017, at least 1,320 people are known to have been executed for drug-related offences – 718 in 2015; 325 in 2016; and 280 in 2017. These estimates do not include China, as reliable figures continue to be unavailable for the country

Taking China out of the equation due to a lack of data, Iran has been the world’s top executioner for drug offences by far, with at least 1,176 executions carried out since January 2015. That amounts to nearly 90% of all reported drug-related executions during that period.

Between 2015 and 2017, executions for drug offences took place in at least five countries: China, Iran, Saudi Arabia, Indonesia and Singapore.

The death penalty for drug offenders: Global overview 2017

By Pascal Tanguay (LEAHN — Law Enforcement and HIV Network) and Verapun Ngamee (Ozone Foundation)

In 2016, the Kingdom of Thailand formally decided to re-allocate responsibility for drug dependence treatment from the Ministry of Justice (MOJ) to the Ministry of Public Health (MOPH) by the end of 2018. The reforms are designed to increase voluntary access to client-centred drug dependence treatment where the MOPH will be expected to develop guidelines, operati ng standards and monitoring and evaluati on indicators to assess performance. Although Thailand’s drug treatment system has raised significant concerns over the past 15 years, this change is intended by the Government to indicate a shift in the overall approach to drug use and dependence to one based on health and human rights.

For the transition from public security to public health management of drug dependence treatment to generate positive results, the MOPH will require significant support to ensure adequate capacity to deliver drug treatment services that accord with scientific and international standards. Challenges to an effective transition lie in two key areas:

1. The objectives and guiding principles for a national drug treatment system based on principles of health and human rights are yet to be established, and need to be improved and aligned with international guidelines and good practices in order to generate better health outcomes for people who are dependent on drugs.

2. Diversion of people caught using drugs to drug treatment will still be managed and coordinated under the 2002 Narcotic Addict Rehabilitation Act, which retains punitive and coercive elements such as forced urine testing by law enforcement officers.

This paper offers a brief analysis of these two challenges in light of current policies and practices, along with recommendations for overcoming them to ensure the implementation of a drug treatment system that can result in improved health and human rights outcomes for people who use drugs and people dependant on drugs.

Drug dependence treatment in Thailand: Progress against persistent concerns

Effective international regimes are not static constructs. While there remains definitional variation concerning exactly what constitutes a regime – a situation that exists not only across but also within the increasingly synergistic disciplines of International Relations (IR) and International Law (IL) - there is general agreement that they operate in terms of ‘lifecycles’ and consequently ‘tend to change more or less profoundly during their lifetime.’ Still an area of relatively limited study, the concept of regime evolution takes on increasing salience in light of a significant expansion in the number of international legal instruments in operation today. As the International Law Commission noted in 2006, ‘the volume of multilateral - “legislative” – treaty activity has grown manifold in the past fifty years.’ Furthermore, observe Simmons and Steinberg, such expansion has been accompanied by an increase in ‘the scope of topics and subjects addressed by treaty law, with treaty growth being ‘especially marked in economic affairs, as well as in the areas of human welfare and the environment.’

Although various processes of regime evolution can be found across all three categories, this paper focuses on examples from the fields of human welfare (broadly defined) and the environment; more specifically the treaty regime based upon the United Nations (UN) drug control conventions and the regime of environmental regulation and its underpinning Multilateral Environmental Agreements (MEAs). With a basis in comparative analysis, our aim here is to explore how these multilateral treaty based regimes have altered and are capable of modernization over time in response to changes in circumstances and requirements of regime members. Moreover, within the context of shifts in the way that a growing number of jurisdictions are choosing to deal with the illicit use of cannabis within their territories, the paper seeks to demonstrate the extent to which the evolutionary capacity of what has been usefully called the ‘global drug prohibition regime’ (GDPR), can be considered out of step with a more dynamic regime like that dealing with transnational environmental concerns. In so doing, we hope to help move current discussions concerning the tensions presently surrounding the operation of the GDPR beyond the narrow confines of drug policy analysis and locate them within the broader context of IL, IR and wider investigation of regime evolution and modernization in general.

Beyond the fact that environmental regimes have been the subject of the most study on evolution and change, the focus on MEAs as a principle comparator to the GDPR rests on two factors. The first of these is the important, although very different, role that the advancement of scientific knowledge plays in the lifecycle of both regimes. The second relates to the regimes’ age and the associated structures and mechanisms that come with it. As will be discussed, such factors go some way to help explain why from an IL perspective the GDPR has been described as ‘Jurassic’ with its underpinning drug conventions ‘so stubbornly resistant to change compared to other treaty systems’ that they almost seem ‘“frozen in time.”’

The paper begins with an overview of the GDPR. This includes discussion of structural and normative mechanisms, processes and examples of regime ‘change’ and transformation as well as their limitations. It then moves on to an examination of MEAs and the key elements of the environmental regime that allow for change; the existence of a Conference or Meeting of the Parties and related legal structures allowing for the incorporation of far-reaching changes to environmental instruments. Examples of these mechanisms and other relevant features are explored specifically through structural analysis of the 1987 Montreal Protocol, the Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES) and the UN European Commission for Europe Convention on Access to Information, Public Participation in Decision-making and Access to Justice in Environmental Matters (the Arhus Convention).

The modernisation of treaty regimes: Contrasting cases of international drug control and environmental regulation

Responding to paediatric HIV has been high on every national political agenda for the last decade, with encouraging results in terms of declining new infections among children by 70% between 2000 and 2015. Yet, adolescents aged 10 to 19 years old continue to pay a high toll to HIV in terms of new infections, AIDS-related deaths and lack of access to antiretroviral therapy (ART) and other relevant services. This age group represented 260,000 [81,000 to 450,000] of the total 1,800,000 [1,600,000 to 210,000] new infections (all ages) in 2016, with new infections and AIDS-related deaths expected to continue to increase. Among adolescents and young people, subgroups most at risk of acquiring HIV such as those who use drugs have not been adequately addressed yet, prompting an increase in HIV infections through injecting and non-injecting drug use.

However, new HIV infections among adolescents are not all related to drug use, as illustrated in sub-Saharan Africa, where new HIV infections are high among young women and adolescent girls. In South Africa alone, adolescent girls represented 24% of all new infections in 2012. International organizations, funders, civil society and national authorities are teaming to address the stigma, the policy barriers and the lack of gender- and age-tailored interventions for this subgroup, while their investments in other subgroups, such as those who use drugs, remain marginal.

It is accurate, nevertheless, that the policy response to HIV among adolescents who use drugs (AWUD), at the international level, is extremely complex. The complexity of the response is based on multilayered interactions between a large set of conventions, political declarations and resolutions from the HIV and AIDS, drug control, and children’s and human rights sectors. However, this complex response needs to be efficient, as it is necessary to address an alarming situation. While there is no disaggregated data on the prevalence of drug use or injection among adolescents, or on the prevalence of HIV among adolescents who use or inject drugs, people who inject drugs (PWID) of all age groups are the key population with new infections increasing by 30% between 2011 and 2015, while the 2011 political declaration on HIV and AIDS committed its signatory countries to halve the transmission among this population. Moreover, 86% of PWID who know their status did not have access to ART in 2013.

To achieve the All In 2020 targets and end AIDS among AWUD by 2030, this commentary will focus exclusively on policy development by reviewing countries’ obligations through legally binding conventions (Convention on the Rights of the Child (CRC), 1989; drug control conventions, 1961, 1971, 1988) as well as non-binding commitments countries took through designated political declarations (on the world drug problem, 2009 as complemented by the UNGASS 2016 outcome document; on ending AIDS by 2030, 2016; and on the public health dimension of drugs at the WHA, 2017). It will then lay down the role of the Sustainable Development Goals (SDGs) as a general policy framework allowing a multisectoral response to HIV among AWUD, before framing HIV and drug use within the SDGs agenda to illustrate the needed policy interventions to end AIDS among adolescents by 2030.

HIV and AIDS among adolescents who use drugs: Opportunities for drug policy reform within the sustainable development agenda

The Senior Level Policy Dialogue "Addressing HIV and TB Challenges: from Donor Support to Sustainable Health Systems" was held in Tallinn, Estonia in December 2017 as an official event in the programme of the Estonian Presidency of the Council of the European Union.
The event, organized by the Ministry of Social Affairs and National Institute for Health Development from Estonia, WHO European Region, UNAIDS, and the Global Fund, brought together representatives of the health and financial ministries of Europe, the Balkan and Eastern Partnership countries, representatives of the European Commission, international organizations, as well as community representatives and institutions involved in funding programmes and offering services to tackle HIV and TB.
DPNSEE and 4 participating member organizations representatives (Margina, Viktorija, Cazas and Juventas) actively contributed to the meeting. Both the experiences from South East Europe and challenges we face were presented, emphasized and mentioned by many participants.
The main focus of the meeting was to:
- Present and discuss good practices at political and technical level of integrating HIV and TB services into national health systems, including challenges, risks, and opportunities;
- Present and discuss current financial and programmatic sustainability gaps and challenges, with particular focus on effective national investment to ensure universal access to health care, including key affected populations;
- Discuss roles and responsibilities of national governments, EU and international partners, as well as civil society partners in transition processes, to effectively and sustainably address HIV and TB.

DPNSEE October-December newsletter 

A previous version of this briefing can be found here

The 2016 UNGASS on drugs was hailed as an opportunity ‘to conduct a wide-ranging and open debate that considers all options’. Although the UNGASS process had some challenges, it was nonetheless a critical moment for global drug policy reform. In June 2017, the UN Secretary General welcomed the UNGASS Outcome Document as a ‘forward-looking blueprint for action’ and called on governments to ‘honour the unanimous commitments’ made.

The next opportunity to build on the important progress made at the UNGASS is the ‘High Level Ministerial Segment’ of the 62nd Session of the Commission on Narcotic Drugs (CND), as agreed in CND Resolution 60/1: ‘Preparations for the sixty-second session of the Commission on Narcotic Drugs in 2019’. 2019 is the target date established in the 2009 Political Declaration and Plan of Action ‘for States to eliminate or reduce significantly and measurably’ illicit drug supply and demand, the diversion and trafficking of precursors and money laundering.Evidence from the UN itself shows that these targets are unachievable, and in the 2017 World Drug Report, the UNODC states clearly that the ‘drug market is thriving’.

The 2019 moment is fast approaching, and the modalities for the event will likely be finalised with the approval of Resolution L3 ‘Preparations for the sixtysecond session of the Commission on Narcotic Drugs, in 2019’, presented by the CND Chair for discussion at the 61st session of the CND.In this context, it is critical that a clear process be established to:
• Review progress made in light of the 2019 target date set in paragraph 36 of the 2009 Political Declaration, including main trends, achievements and gaps
• Conduct a genuine debate on the state of global drug policy, considering ‘all options’, and involving all relevant stakeholders
• Delineate a roadmap for 2019 and beyond to effectively operationalise the recommendations included in the UNGASS Outcome Document.

To inform these deliberations, this IDPC advocacy note outlines some of the key issues and possible options for 2019.

What comes next? Post-UNGASS options for 2019 (Version 5)

The United Nations General Assembly Special Session (UNGASS) on drugs – held in New York from 19th to 21st April 2016 – was a major milestone in the slow evolution of the international drug control system. As part of its preparations for the UNGASS, IDPC worked in close consultation with its member organisations and partners in 2014 and 2015 to develop five core ‘asks’ in order to support and frame our collective advocacy efforts.

Now that nearly two years have passed since the UNGASS itself, this document aims to re-visit these ‘asks’ in order to outline where gains were made in 2016, and where progress remains a challenge. In doing so, this document represents the last in a suite of IDPC reports and briefings that have attempted to unpack and analyse the outcomes from the UNGASS. By assessing the ‘asks’ one-by-one, this report will also explore their potential relevance as we approach the next big United Nations ‘moment’ on drug control – the Ministerial Segment of the UN Commission on Narcotic Drugs (CND) in March 2019.

The IDPC ‘UNGASS Asks’: Progress made and remaining challenges

• Opioid use disorder is often a chronic, relapsing condition associated with increased morbidity and death; however, with appropriate treatment and follow-up, individuals can reach sustained long-term remission.

• This guideline strongly recommends opioid agonist treatment with buprenorphine–naloxone as the preferred first-line treatment when possible, because of buprenorphine’s multiple advantages, which include a superior safety profile in terms of overdose risk.

• Withdrawal management alone is not recommended, because this approach has been associated with elevated risks (e.g., syringe sharing) and death from overdose in comparison to providing no treatment, and high rates of relapse when implemented without immediate transition to long-term evidence-based treatment.

• This guideline supports using a stepped and integrated care approach, in which treatment intensity is continually adjusted to accommodate individual patient needs and circumstances over time, and recognizes that many individuals may benefit from the ability to move between treatments.

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