By Thu Vuong, Alison Ritter, Marian Shanahan, Robert Ali, Nhu
Nguyen, Khue Pham, Thu T.A. Vuong and Le M. Giang.

In Vietnam, like many countries in East and Southeast Asia, the government has invested heavily in center-based compulsory treatment (CCT) as the mainstay demand reduction strategy for illicit drug use. This approach has been criticised on human rights grounds. Meanwhile, community-based voluntary methadone maintenance treatment (MMT) has been implemented for nearly a decade with promising results. To date, there have been no comparative Vietnamese studies of these approaches. The study, involving 208 CCT participants and 384 MMT participants with heroin dependence, was a combined retrospective and prospective observational study conducted over three years between 2012 and 2014 (with data at five time-points). The primary outcome was: self-report heroin use (confirmed by urinalysis). The four secondary outcomes were: illegal behaviours, overdose, blood-borne virus (BBV) risk behaviours, and monthly drug expenditure. Mixed effects regression analyses, which took into account baseline differences between the groups, were used to analyse the data. This study is registered with ClinicalTrials.gov, number NCT03071315.

The study found MMT was more strongly associated with four outcome measures compared to CCT (reduction in heroin use (β = 3.39, SE = 0.31, p < .0001) (equivalent to an odds ratio of 29.67 (95% CI 21.76–40.45)), reduction in illegal behaviours (β = 0.94, SE = 0.39, p < .0001), (equivalent to an odds ratio of 2.56 (95% CI 1.79–3.78)), reduction in BBV risk behaviours (β = 1.08, SE = 0.17, p < .0001), (equivalent to an odds ratio of 2.94 (95% CI 2.48–3.49)), and reduction in monthly drug spending (β = −VND1,515,200 (equivalent to US$72.00), SE = VND452,900, p < .0001)). The analyses did not support the hypothesis that MMT was associated with better outcomes pertaining to overdose (β = −0.27, SE = 0.30, p = .62), probably due to the infrequency of these self-reported events. Our observational study suggests that MMT is associated with greater reductions in heroin use, BBV risk behaviours, drug-related illegal behaviours, and monthly drug spending compared with CCT. In the context that the CCT approach has been criticized for human rights violations, this study provides evidence to support the scale up of MMT and the transition of CCT to voluntary community based treatment.

Outcomes of compulsory detention compared to community-based voluntary methadone maintenance treatment in Vietnam

This report prepared by the UN Secretary-General for the 72nd Session of the General Assembly provides an overview of the global situation on drugs, and crucially highlights cross-UN efforts to implement the UNGASS Outcome Document. In April 2017, the Secretary-General tasked UNODC with coordinating efforts across the UN system to support governments in operationalising the UNGASS Outcomes. This work should promote “efforts to achieve the Sustainable Development Goals as well as strategies to strengthen human rights-based and health-based approaches” and should further elaborate “a comprehensive organization-wide strategy across the three founding pillars of the United Nations system — development, human rights, and peace and security — in support of the preparations for the sixty-second session of the Commission, to be held in 2019” (para 20).

International cooperation against the world drug problem: Report of the Secretary-General (72nd Session of the General Assembly)

On November 6, 2012, Colorado and Washington became the first two states – and first two jurisdictions in the world – to legalize marijuana for adult use. Two years later Alaska, Oregon and Washington, D.C. followed suit. In 2016 voters in four additional states – California, Massachusetts, Maine and Nevada – also approved ballot measures legalizing marijuana. In January 2018, Vermont became the first state to legalize marijuana through a state legislature. More states are expected to legalize marijuana in the near future.

Evidence shows that marijuana legalization is working so far. States are saving money and protecting the public by comprehensively regulating marijuana for adult use. This success has likely contributed to the historically high levels of public support for marijuana legalization in the U.S., which has steadily grown to an all-time high of 64 percent. The majority of Americans, across party affiliations, support legalizing marijuana, with 51 percent of Republicans now in favor.

Arrests and court filings for the possession, cultivation and distribution of marijuana have plummeted since voters legalized marijuana for adult use in eight states and Washington, D.C. These states have saved millions of dollars and prevented the criminalization of thousands of people.

Marijuana legalization has a positive effect on public health and safety. Nationally, and in states that have legalized marijuana, youth marijuana use has remained stable or declined. Legal access to marijuana is associated with reductions in some of the most troubling harms associated with opioid use, including opioid overdose deaths and untreated opioid use disorders. DUI arrests for driving under the influence, of alcohol and other drugs, have declined in Colorado and Washington, the first two states to establish legally regulated adult use marijuana markets. In addition, crash rates in both states have remained similar to those in comparable states that have not legalized marijuana.

At the same time, states are filling their coffers with hundreds of millions of dollars in marijuana tax revenues. These revenues are being allocated for social good – to fund education, school construction, early literacy, bullying prevention, behavioral health and alcohol and drug treatment. In addition, the legal marijuana industry is creating jobs; it currently employs approximately 200,000 full and part-time workers across the country.

From prohibition to progress: A status report on marijuana legalisation

The ’war on drugs’ is collapsing. Now let’s build the alternative. The ‘war on drugs’ was built on shaky foundations. Now, countries around the world from Canada, to Uruguay, Portugal and many US states are beginning to dismantle it piece by piece. Its collapse is good news for people and communities around the world, providing us with the opportunity to build a new approach to drugs that prioritises, promotes and protects human health and well-being. This shift, from a criminal justice approach to health-based policy making, is essential if we want to take drug policy into the 21st century. It is time for the UK to catch up, and develop and promote appropriate, evidence-based, and sustainable alternatives both in the UK and globally.

This new approach will ensure that rather than penalising or criminalising people involved in the drug trade, we recognise that it is often injustice, inequality and vulnerability that drives them to engage in that trade in the first place, whether that is as consumers, producers or suppliers. Rather than compounding problems like poverty, powerlessness and stigma with a hard-line prohibitionist approach, which has failed on its own terms, we must aim to approach drug policy in a way that works to address these drivers of engagement with the drug trade, and at the same time makes engaging in that trade as harm-free as possible. If we do this effectively we have the chance to develop and build a whole new paradigm to replace the ‘war on drugs.’ Below are six key steps the UK government can take to lead the way in ending the ‘war on drugs’ at home and abroad.

Building a 21st century approach to drugs

Almost two years after the United Nations General Assembly Special Session on the World Drug Problem (UNGASS), the implications of the resultant Outcome Document remain unclear, and complex. At a structural level, it can legitimately be regarded as a homeostatic text that does much to help prop up the increasingly creaky UN international drug control framework. Yet, as member states move to operationalize its key provisions, it is becoming increasingly obvious that the Document has in fact generated considerable concern among what might be called status quo countries seeking to preserve the treaty system in its current form.

One need only look at the debates and country statements within the UN’s central policy making body on the drugs issue, the Vienna based Commission on Narcotic Drugs (CND or Commission) for evidence to support this view. That prohibition oriented states like the Russian Federation are investing considerable effort and political capital to argue that the Outcome Document does not supplant previous soft law instruments, particularly the 2009 Political Declaration and Plan of Action, suggests that the progressive character of the Document exceeds what might have been initially thought as the dust settled in April 2016.

Although problematic in many respects, the 2016 instrument does to a certain degree move away from the Declaration’s simplistic goal for states to ‘eliminate or reduce significantly and measurably’ illicit drug supply and demand, the diversion and trafficking of precursors and money laundering.’ This, it should be recalled, was agreed nearly ten years ago with a target date of 2019. Indeed, while the operationalization of many aspects of the Document merit ongoing scrutiny, key among them is how the international community refines its measurement of what has become known simply and somewhat vaguely as the ‘world drug problem’. This is especially so as we approach what has now been agreed to be a high-level ministerial segment of the CND in March 2019 and not only what is likely to be an awkward review of progress made against the targets within the Political Declaration, but also negotiations regarding how the Commission approaches international drug control in the decade up to 2029.

Beginning with an overview of the Annual Report Questionnaire (ARQ), the key mechanism by which the UN system collects data on various facets of the state of the world’s illicit drug market, this Working Paper examines the content of the UNGASS Outcome Document in terms of its reference to indicators and some of the problems surrounding the current framework. It then goes on to discuss the increasing attention given to the ARQ within Vienna since the UNGASS before concluding with a critique of the process leading to the meeting of an ‘Expert Group’ to revise the ARQ. With the Group scheduled to meet in late January 2018, there are growing expectations that the revision process will seize the opportunity to move the Questionnaire mechanism beyond traditional indicators.

Measuring the ‘world drug problem’: ARQ revision. Beyond traditional indicators?

This case study was conducted by the TB/HIV Care Association, which works to prevent, find and treat TB and HIV in communities in South Africa. Partly through funding and support from Bridging the Gaps Alliance partner Mainline, TB/HIV Care and its partner OUT Wellbeing (providing direct health services to LGBT people, MSM, sex workers, and injecting drug users) have established a joint programme for people who inject drugs (PWID). Bridging the Gaps played a key role in the initial procurement of sterile injecting equipment, enabling the launch of the project, and has continued to support Step Up’s advocacy for the human rights of PWID.

This case study illustrates how TB/HIV Care Association (THCA), and its partner OUT Wellbeing (OUT), have implemented the Step Up Project, an innovative joint initiative to support PWID in South Africa.

The criminalisation and stigmatisation that PWID experience in South Africa, combined with a fear of using health services due to the criminalisation of PWID, has contributed to the widespread use of unsafe injecting practices, such as the sharing and improper use of injecting equipment. In addition to facing stigma and discrimination from health service providers and the public, PWID also face abuse by law enforcement agencies.

The prevalence of high-risk injecting practices identified by a United Nations Office of Drugs and Crime (UNODC) 2013 study, indicated that services were urgently required to address the potential public health impact of injecting drug use, and improve the wellbeing of PWID.

Introducing and developing harm reduction strategies in South Africa

The 2016 Coca Crop Monitoring Report is the result of joint work between the Government of Peru and the United Nations Office on Drugs and Crime (UNODC) through the Integrated Illicit Crop Monitoring System (SIMCI) that supplies the methodology established by the Global Illicit Crop Monitoring Program (ICMP). The methodological innovations of this System were discussed and agreed upon under the framework of the Technical Monitoring Committee, comprised by technical entities of the national counterparts and headed by the National Drug Commission (DEVIDA) and the United Nations Office on Drugs and Crime (UNODC).

Within this context, the results of this fifteenth Coca Crop Monitoring Report indicated that as compared to 2015 the surface of coca cultivation increased by 9% from 40,300 hectares to 43,900 hectares. This trend was in line with the rise in other coca growing countries, including Colombia and the Plurinational State of Bolivia, which put the global coca cultivation estimate at 213,000 hectares for 2016 (36% more than in 2015). This increase coincided with the growth pf the global cocaine market as stated in the World Drug Report, which reported record levels of seizures, an increased use of cocaine in North America ad Europe and the expansion of trafficking in Asia.

At the national level, the coca growing areas in VRAEM, La Convencion y Lares and Inambari-Tambopata together represented 79% of the total area under cultivation. None of these three areas was subject to interventions by the CORAH Eradication Program. The areas of major increase in absolute terms were VRAEM and Alto Huallaga ewith 1,971 hectares and 922 hectares respectively. In relative terms, the Bajo Amazonas (249%) and Aguaytia (187%) areas had the highest increase in coca cultivation.

Coca Crop Monitoring Report 2016

This case study was conducted by International Charitable Foundation “AIDS Foundation East-West” (AFEW-Ukraine), together with its partners New Family (located in Chernivtsi), Blago (Kharkiv), Return to Life (Kropyvnytskyi), and Public Health (Poltava). It focuses on adolescent drug users aged 10 to 19 years of age. Since 2011, partners have been providing direct services to young people who use drugs (PWUD) within the framework of the Bridging the Gaps programme. AFEW-Ukraine’s role is to provide technical support in piloting new approaches and interventions, build partner-capacity, and support experience sharing on a national level.

This case study illustrates how AFEW-Ukraine and its partners implemented a project to ensure the meaningful involvement and engagement of young PWUD. This demographic faces limited access to high quality and friendly HIV, SRHR, and harm reduction services. These include rapid testing on HIV, Hepatitis B and C and other sexually transmitted diseases, counselling on sexual violence prevention, referrals to gynaecologists or other specialists, and the distribution of kits with condoms, pregnancy tests, gynaecological and hygiene items.

AFEW-Ukraine’s practical experience and the feedback they have received from clients and service providers, substantiates that young PWUD have limited access to these services due to a lack of information and understanding of their needs. Young PWUD are not always a visible population, and have minimal opportunities to speak up about their needs. Such service providers receive no special training, programmes or standards for working with young PWUD in Ukraine. Due to the country’s strict morality standards, drug use or sexual activity are often not addressed by health professionals or social workers. Practical experience also shows that young PWUD face a lot of barriers in accessing services, such as stigmatising attitudes or confidentiality violations.

Raising a new generation of young advocates: Challenges and perspectives from Ukraine

In 2017, the Central Committee for Drug Abuse Control (CCDAC) of the Myanmar Police Force of the Republic of the Union of Myanmar collaborated for the 15th time with the United Nations Office on Drugs and Crime (UNODC) to implement an opium survey. 2016 and 2017 surveys focused on different aspects of opium production: in 2016, the survey focused on the socio‐economic conditions of farmers in opium growing areas , and in 2017 on estimating the extent of poppy cultivation and opium production. The area and production survey in 2017 has focused on major opium producing states, Shan and Kachin . In addition, a selective sampling rate has been applied for the collection of the satellite imagery, using an approach that guarantees comparability with 2015 results.

The 2017 opium survey estimates that 41,000 ha of opium poppy has been cultivated in Shan and Kachin States. Compared to the 2015 estimate, this represents a 25% decrease.

Reductions have taken place in East and South Shan (‐37% and ‐29% respectively), whereas in North Shan and Kachin States the cultivation remained practically stable (‐3% and ‐7%). Continued turmoil in North Shan and Kachin appear to be linked to the steady cultivation levels. The reported amount of eradication has also been very low in these two states (less than 130 ha), whereas the large majority (85%) of the total eradication (3,533 ha) has been reported from South Shan.

In terms of opium production, part of the area reduction has been offset by an increase in yields per hectare in South Shan, which have risen by 43% to 14.2 kg/ha. Combined with the reduced cultivation areas, this resulted in a 14% decrease of potential dry opium production in Shan and Kachin states. In 2017, South Shan state remains the largest opium producer supplying almost half (43%) of the total estimated potential production of 550 metric tons.

Myanmar Opium Survey December 2017

As has been the case in recent years, the World Drug Report for 2017 – the flagship publication of the United Nations Office on Drugs and Crime (UNODC or Office) - represents an impressive overview of the latest developments and trends in the world’s illicit drug markets, including in many instances linkages to the Sustainable Development Agenda (SDA) and specific Sustainable Development Goals (SDGs). A feat of data synthesis and analysis, the combination of a new five booklet format and interactive maps and data sets on the UNODC website arguably make the Report one of the agency’s most thorough and accessible publications, or publication packages to date.

Data within the Report are contextualised in terms of the operationalisation of the UNGASS Outcome Document agreed in New York in April 2016, and preparations for the high-level ministerial segment (HLS) at the 2019 Commission on Narcotic Drugs (CND). The policy context – particularly in relation to the HLS and work on some form of document to guide international drug policy for the next decade or so – may be somewhat different to previous years, yet many of the key conclusions and overarching themes are familiar.

Global markets remain dynamic and ‘thriving’ and are becoming increasingly complex and diversified in terms of production, trafficking and use. The previously dominant narrative of market stability, however, is not so obvious. In terms of headline figures, the Report informs us that an estimated quarter of a billion people – around 5% of the global adult population – used drugs at least once in 2015 and that about 29.5 million of those suffer from what the UNODC refers to as ‘drug use disorders’.

It is important to note, nonetheless, that while the Office’s analysis is increasingly sophisticated, there is an ongoing level of uncertainty linked to the paucity of data upon which this analysis is based, especially in relation to Africa and Asia. Such uncertainty pertains to both the state of drug markets and the nexus between the ‘drug problem’ and organised crime, illicit financial flows, corruption and terrorism. This topic is the focus of Booklet 5 – what would, in previous years, have been labelled the Report’s thematic chapter.

IDPC response to the 2016 World Drug Report

IDPC response to the 2015 World Drug Report

IDPC response to the 2014 World Drug Report

IDPC response to the 2013 World Drug Report

IDPC response to the 2012 World Drug Report

IDPC response to the 2011 World Drug Report

IDPC response to the 2010 World Drug Report

IDPC response to the 2009 World Drug Report

IDPC response to the 2008 World Drug Report

IDPC response to the 2007 World Drug Report

IDPC response to the 2006 World Drug Report

IDPC analysis of the UNODC World Drug Report 2017

Welcome to the Ana Liffey Drug Project’s Strategic Plan for 2018-2020. The last number of years have seen significant and welcome changes in Ireland, both in terms of the general economic outlook for the country and in terms of broad drug policy trends.

The Ana Liffey Drug Project’s primary activity is to provide ‘low threshold - harm reduction’ services to people who use drugs. By low threshold, we mean that the barriers to availing of our services are kept as low as possible. By harm reduction, we mean that we seek to reduce the harm that drug use causes to individuals, families and communities. In addition to our direct services, we also perform advocacy and support roles at an organisational level in the addiction sector in Ireland and beyond.

We will work hard, we will work together internally as a unit and in partnership externally to achieve these goals and ensure that we continue to deliver on our mission to work with people affected by problem substance use and the organisations that assist them.

Safer From Harm: the strategic plan of the Ana Liffey Drug Project 2018-2020

By International Drugs Policy Unit at the LSE US Centre

The US Department of Defence (DoD) has relented. After 16 years of refusing to bend to the pressure of those driving the counternarcotics effort in Afghanistan and destroy the 'labs' where opium is processed, DoD finally issued the authorities that allowed these buildings to be destroyed. On the first night of the campaign on 19 November 2017, 10 buildings were levelled. It was claimed that each was a drugs lab funding the Taliban. With the onset of this campaign, those working or residing in these labs were no longer viewed as civilians involved in a criminal activity but as enemy combatants and subject to lethal force. These labs and those operating them now represent in the words of General Nicholson, Commander of both US Forces in Afghanistan (USFOR-A) and the North Atlantic Council Organization (NATO) Resolute Support Mission, the 'Taliban’s narcotics financing'.

The report is available on the IDPU's website.

Publications