By David Powell, Rosalie Liccardo Paccula and Mireille Jacobson

Recent work finds that medical marijuana laws reduce the daily doses filled for opioid analgesics among Medicare Part-D and Medicaid enrollees, as well as population-wide opioid overdose deaths. We replicate the result for opioid overdose deaths and explore the potential mechanism. The key feature of a medical marijuana law that facilitates a reduction in overdose death rates is a relatively liberal allowance for dispensaries. As states have become more stringent in their regulation of dispensaries, the protective value generally has fallen. These findings suggest that broader access to medical marijuana facilitates substitution of marijuana for powerful and addictive opioids.

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Do medical marijuana laws reduce addictions and deaths related to pain killers?

By International Network of Drug Consumption Rooms

Drug consumption rooms (DCRs) and supervised injecting facilities (SIFs) target the most vulnerable people who use drugs (PWUD) – particularly people who use opioids, people who inject drugs (PWID), people who use drugs heavily1 or high-risk drug users (HRDI)2 . While decreases in risky injecting behaviours are an outcome of DCR use, HCV prevention and treatment in these settings haven’t been adequately described. There are no international DCR standards for HCV practice and surveys are yet to address HCV prevention, treatment or sero-prevalence status of DCR clients. This online survey provides a ‘snapshot’ of DCR clients’ HCV status; approaches to HCV in DCRs, and what DCRs need to expand these services.

Fifty-one responses were collected from representatives of the 92 operating DCRs in Australia, Canada, Denmark, France, Germany, Luxembourg, Netherlands, Norway, Spain and Switzerland participated in the survey; thus over half of the DCRs were directly represented (55 %) and several respondents had filled the survey on behalf of several DCR’s within their organisation. All countries where DCRs are operated were represented.

An estimated mean 71% of SIF/DCR clients had been tested for HCV and about 58% were HCV positive. Most DCRs provided HCV testing onsite (67%); of these majority tested via blood samples (65%) and several used finger prick (31%) or saliva (31%). Several DCRs referred to offsite HCV testing (75%). Only four European DRCs provided HCV treatment onsite at the time of the survey; twowere providing DAAs (“new treatment”) and two were providing both interferon and DAAs treatments. The majority of SIFs/DCRs referred clients offsite for treatment (96%). Several offered disease self-management support (50%) or monitoring liver health (24%). Overall, DCRs reported that HCV support (94%), new treatments (92%) or treatment with interferon (50%) were available for their clients at other services.

To provide further HCV-related services, DCR indicated that they need more staff time (51%) and staff training (45%), that they would have to expand staff qualifications (30%) and that further funding for equipment and services would be needed (38%). A change in national HCV treatment guidelines for active drug users was also identified as a need (23%). When it comes any additional funding, the respondents indicated they would use it on employing additional medical staff (52%), develop client education (52%) or on additional staff training (46%).

DCR involvement in HCV prevention and treatment is crucial. SIFs/DCRs should to be supported to provide an entry point to HCV treatment as they are working on the frontline with the most marginalised PWID and are capable of removing barriers to HCV treatment in this population. Also, options for colocation of HCV services at DCRs or provision of HCV treatment onsite should be considered.

Online census of drug consumption rooms (DCRs) as a setting to address HCV: Current practice and future capacity

EQUIS is presenting the following Shadow Report for the Committee on the Elimination of Discrimination Against Women (CEDAW) in light of the pre-sessional working group meeting that will take place in Geneva in November 2017.
EQUIS is a feminist organization whose mission is to transform institutions, laws and public policies, and women’s leadership to improve women’s access to justice. EQUIS contributes to the advancement of women’s human rights and gender equality through the use of advocacy and litigation strategies at national and international level.
This document includes data EQUIS has collected through the implementation of its projects, all of which target issues that converge with recommendations made to the Mexican state.

Shadow report on women's access to justice in Mexico

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.

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