Two main needs emerged from this revision. First, the importance of strengthening operational systems and linking services. The idea is to strengthen links with existing partners in the implementation of programmes which are already underway, to ensure that those reached on the field are redirected to the services offered by PILS or the government. On the one hand, PILS has revised its internal organisation in order to develop synergies between the various functions that comprise the association today. Particular attention is given to collaborative work, with the setting up of several committees within the association, so that everyone can contribute as much as possible to decision-making.

On the other is the strengthening of community systems and the involvement of communities at all stages of business processes and decision-making. This is reflected in the development of our community health services in 2017. This unit already offers de-medicalised and community-based screening services, as well as counseling and referral care services. In addition, a patient committee composed of community leaders will be set up, which will be at the heart of the reflections on the needs, priorities, implementation, management and evaluation of these services.

Our actions and efforts, I am sure, will be supported by the new government in Mauritius and the Minister of Health, who has demonstrated his willingness to work with civil society. We will never cease to say that only full collaboration between the different actors in the fight against AIDS can ensure an effective national response. We are also delighted with the reintroduction of the methadone induction program announced by the Minister of Health, and we are pleased that those who have been waiting for some for the past two years can finally participate in this harm reduction program.

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

Prévention Information Lutte contre le Sida (PILS): Annual Report 2016

By International Center for Enthnobotanical Education Research and Service

Ayahuasca is the Quechua word referring to a liquid produced by the slow decoction of the Amazonian Banisteriopsis caapi vine – as well as to the vine itself – which contains harmine, harmaline and tetrahydroharmine. It is traditionally used throughout the Northwestern Amazon, originating from indigenous cultures that have used it for hundreds of years for medicinal and ritual purposes. At the beginning of the last century, syncretic religions combining Amerindian shamanism, African religiosity, European esotericism, and Christianity began to use ayahuasca. In the 1980s, these churches expanded from the Amazon into Brazilian urban centers (Labate 2004) and, since the 1990s, globally (Labate & Jungaberle, 2011).

Based on the intended use of the decoction of the vine called ayahuasca, Amazonian group or healer with experience using ayahuasca, adds different plants to the decoction with the objective of communicating with a specific spirit depending on the disease to be healed or ritual to be performed. Ethnographic studies suggest that there are more than 5000 different recipes of ayahuasca (Fericgla, 1997) and more than 200 admixture plants to ayahuasca, all using B. caapi as their base (McKenna et al., 1986). Some of the traditional recipes involving ayahuasca, considering both the indigenous cultures and the religions that use ayahuasca as their sacrament (or “ayahuasca religions”), include adding leaves of the Psychotria viridis bush, which contains DMT (N,N-Dimethyltryptamine), along with the B. caapi vine (Schultes & Hofmann, 1992). Ayahuasca is currently being popularized as the combination of B. caapi and P. viridis, likely because the international expansion of ayahuasca practices was initiated by these churches (Sánchez y Bouso, 2015).

Ayahuasca: Technical Report 2017

Psychoactive drugs have mind altering properties. They are often consumed to produce a wide range of desirable physical and psychological effects and there are hundreds of substances available.

Psychoactive drugs can occur naturally (e.g. cannabis and psilocybin); be extracted from natural sources (e.g. cocaine and heroin) or produced synthetically (man-made) in a laboratory (e.g. MDMA and methamphetamine).

People choose to take drugs for many reasons including relaxation, insomnia, pain relief, escapism, peer pressure and social norms, to get high, self-medication, to have fun, to lower inhibitions, to feel different, because they want to, to increase connection with others and music, to increase creativity, increase sexual arousal, curiosity, tradition, religious or spiritual beliefs, to lose/gain weight, to cope with grief, loneliness, trauma etc.

People from all strata of society have the potential to consume drugs and we must avoid stereotypes. Most drug use is recreational and not recorded; however, pockets of problematic use exist in a range of settings. The use of drugs is widespread and includes not just illegal substances but alcohol, nicotine, caffeine and medicines - which many people do not consider to be drugs.

Psychoactive Drugs

The prevention of drug use is one of the primary goals of the War on Drugs. However, despite investment in high-profile interventions such as social marketing campaigns and enforcement-based deterrence, these efforts have generally failed. With the emergence of novel policy frameworks to control and regulate drug use, a window of opportunity exists to test approaches to drug prevention that take into account existing evidence and the rights of individuals who use drugs. Specifically, there is a growing consensus that entry into drug use is a socially-defined event that individuals experience within particular socio-structural contexts. This understanding, coupled with a distinction between the value of preventing problematic drug use rather than all drug use, provides a useful framework within which to develop effective and rights-based approaches to drug prevention.

Click here to read the full article (restricted access).

Post-war prevention: Emerging frameworks to prevent drug use after the War on Drugs

Drug use can reduce the ability to drive a motor vehicle safely on the public road. European countries have developed various legal mechanisms to address this issue, using laws on road traffic or on drug control. This topic overview briefly describes the national laws in EU Member States and Norway, along with EU legislation, on drugs and driving. Here you can find out for each country whether the legal provisions exist in drug control laws or road traffic laws, the substances addressed, the levels of penalties, any blood-drug or impairment levels established, and whether drivers can be stopped and tested at any time or if the police require some form of suspicion beforehand.

Legal approaches to drugs and driving

In the Middle East and North Africa (MENA) region, the access to Harm Reduction (HR), Human Immunodeficiency Virus (HIV) treatment, care and support services remains limited among People Living with HIV/AIDS-(PLHIV)-People Who Use Drugs (PWUDs)/People Who Inject Drugs (PWIDs). To acquire a comprehensive understanding of the drug use and HR situation among PLHIV-WUDs/WIDs, a Multicentre Operational Research (OR) was conducted by the Middle East and North Africa Harm Reduction Association (MENAHRA) with support from the Global Fund. A.

Research Objectives: i) To explore the drug use context among PLHIV-WUDs/WIDs; ii) To measure the levels of knowledge about HIV/AIDS, harms of drug use, and HR and healthcare services; iii) To identify HR and healthcare services and service provision; iv) To define the reasons leading to stigma and discrimination; v) To identify barriers and facilitators hindering/facilitating access to HR, HIV treatment, care and support services; and vi) To provide recommendations for improved HR and healthcare services for PLHIV-WUDs/WIDs in the region

OR subjects included 230 participants: 149 PLHIV-PWUDs/PWIDs and 81 key informants (KIs) from Morocco, Tunisia, Lebanon, Egypt, Pakistan and Afghanistan. Data were collected by trained fieldwork teams through focus group discussions (FGDs), case studies and semi-structured interviews and analysed using a socioecological framework.

Multicentre operational research on drug use & harm reduction among people living with HIV/AIDS in the Middle East & North Africa region

Our model drug law is based on evidence and research from New Zealand and around the world about the best way to reduce the harms caused by both drugs and our current drug laws.

We think New Zealand is ready to have this discussion. It’s time to move the conversation past the question ‘Should we reform?’ to ‘How should we reform?

We know that 64% of us now think the law on cannabis prohibition should be changed, for example. And calls are getting louder by the day for a new approach to methamphetamine in our communities.

New Zealand has some excellent and world-leading harm-reduction approaches in place already, such as our needle exchange programme and Police diversion schemes. We want to build on that. We can also build on our National Drug Policy 2015–2020, which rightly sees drug use as a health issue.

So let’s start making the changes we all want to see. Let’s aim for better health, less crime and better outcomes for rangatahi.

Whakawātea te Huarahi - A model drug law to 2020 and beyond

This article analyses the ways in which the state ‘treats’ addiction among precarious drug (ab)users in Iran. While most Muslim-majority as well as some Western states have been reluctant to adopt harm reduction measures, the Islamic Republic of Iran has done so on a nationwide scale and through a sophisticated system of welfare intervention. Additionally, it has introduced devices of management of ‘addiction’ (the ‘camps’) that defy statist modes of punishment and private violence. What legal and ethical framework has this new situation engendered? And what does this new situation tell us about the governmentality of the state? Through a combination of historical analysis and ethnographic fieldwork, the article analyses the paradigm of government of the Iranian state with regard to disorder as embodied by the lives of poor drug (ab)users.

Maintaining disorder the micropolitics of drugs policy in Iran

Despite significant progress in combatting HIV, driven in large part by increased investments, the epidemic remains a global emergency and several challenges threaten future progress. One such challenge is an ongoing resource gap; UNAIDS estimates that although US$19.1 billion from both international and domestic sources was available to address HIV in low- and middle-income countries in 2016, US$26.2 billion will be needed annually by 2020 (to be gradually reduced by 9% by 2030) to meet global targets to end AIDS as a global public health threat by 2030. While funding from all sources is critical to achieving further progress, funding from donor governments represents a significant share of the total and is particularly important in the lowest income countries.

This report provides the latest data on donor government resources available to address HIV in low- and middle-income countries. It is part of a collaborative effort between UNAIDS and the Kaiser Family Foundation that began more than a decade ago, just as new global initiatives were being launched to address the epidemic. This current report provides data on donor government disbursements in 2016, the most recent year available. It includes data from all members of the Organisation for Economic Co-operation and Development (OECD)’s Development Assistance Committee (DAC), as well as non-DAC members where data are available. Data are collected directly from donors, the Global Fund, and UNITAID, and supplemented with data from the DAC. Fourteen donor governments that account for 98% of total disbursements are profiled in this analysis. Both bilateral assistance and multilateral contributions to the Global Fund and UNITAID are included.6 See methodology for more detail.

Donor Government Funding for HIV in Low- and Middle-Income Countries in 2016

Following the submission of a funding request to the Global Fund, there continues to be a critical role for communities and civil society to play.

This information is an update of the alert prepared by ICASO in 2015 to provide advice to civil society and community groups on how to engage in grant-making activities once a funding request has been developed.

Describes the steps involved in moving from a funding request to a signed grant.

Recommends entry points, resources, and technical assistance available to support communities and civil society during this phase.

This information will be of interest to community and civil society representatives on Country Coordinating Mechanisms (CCMs) as well as disease-specific non-governmental organizations (NGOs), vulnerable and key population networks, gender and human right activists, and other groups that participated in the funding request development process.

How civil society and communities can engage in the Global Fund grant-making processes

Getting to the Briceño region in the heart of Antioquia requires an excellent vehicle, and a lot of time and luck. The week before our journey there in mid-July, heavy rains wiped out part of the road between Briceño and Pueblo Nuevo, stranding folks on one side or the other. We were lucky on the day of our journey – no rain. But it took a six-hour drive to get from Medellín to Briceño, and another three hours of sometimes harrowing curves to Pueblo Nuevo. The dirt-road drive itself was a stark reminder of the challenges Colombia faces as it seeks to eliminate 50,000 hectares of coca this year through the crop substitution program, 

Programa Nacional Integral de Sustitución de Cultivos de Uso Ilícito

 (National Comprehensive Program for the Substitution of Illicit Crops), known by the acronym PNIS.

The PNIS is at the heart of point four of the peace accord signed between the government and the FARC, the part that pledges to bring a “Solution to the Illicit Drugs Problem” and to eliminate the illicit cultivation of coca, cannabis, and opium poppy. The government is signing accords at the community level as well as with individual families, in which the farmers commit to “voluntarily” eradicate their coca in exchange for immediate cash compensation during the first year and small project investments in the second year. The accords delineate that each farmer will receive a total of 36 million pesos spread over two years (about US$12,000), and also serve as a government promise to invest in transforming these rural economies in the longer term. About a month before our visit to the Briceño region, about 650 families had each received two million pesos (about US$675) for the first two months, which set the clock ticking. They then had 60 days to uproot their coca bushes (no easy task) or lose their right to receive any further development assistance and potentially face criminal prosecution.

Coca and the Colombian Peace Accords: A commentary on the pilot substitution project in Briceño

The Government has now published the 2017 Drug Strategy. We express great concern at the lack of focus on harm reduction - an evidence-based response that protects people and ultimately saves lives - at a time when drug-related deaths are the highest on record.

Heroin and morphine deaths rose by 109 percent in the England and Wales between 2012 and 2016, when the evidence is overwhelming that harm reduction initiatives can reduce them. Initiatives such as opioid substitution treatment (OST) and needle and syringe programmes are only mentioned fleetingly within the Strategy, and others such as drug consumption rooms and heroin assisted therapy (HAT) are completely absent.

It is appalling that the Government acknowledges in the strategy that the rise in drug-related deaths is ‘dramatic and tragic’, but proposes no concrete action plan to reduce them. For example, the strategy comments on the importance of naloxone to prevent overdose deaths but proposes no national systematic approach to naloxone provision, nor any new funding for this vital intervention. It is shocking that whilst drug-related deaths have outstripped both road traffic fatalities and deaths from blood borne virusesivv , there is no coordinated response from central government.

This erosion of services continues against a backdrop of funding for all drug services being continuously reduced. Public health spending has reduced by more than 5% since 2013 , and according to analysis a further £22 million in cuts are to made for drug treatment by the end of 2017/18 . Without funding drug services will not be able to function effectively.

The Government has dismissed decriminalisation of drug possession offences as being simplistic. Yet the World Health Organisation and a multitude of United Nations agencies have called for the end of criminal sanctions for possession and use of drugs in recognition that criminalisation creates barriers to those needing treatment and increases health harms.

People who use drugs are often vulnerable and marginalised.This new Drug Strategy simply does not begin to support them and reduce drug-related deaths. We call on the Government to implement the recommendations of the Advisory Council on the Misuse of Drugs to tackle opiate related deaths, these include: optimal OST prescribing; easier access to naloxone; a national HAT programme; and that drug consumption rooms are implemented where there is need. The Government must also ensure a minimum level of care by requiring local authorities to provide drug treatment and harm reduction services by law.

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