International agencies have viewed West Africa as a major player in the global trade in cocaine and heroin and in efforts to control that trade. During the last 10 years there have been media and official reports of escalating arrests of West African drug smugglers, large-scale seizures and concerns about narco-states in the subregion (El Pais, 2009; New York Times, 2010; Observer, 2008; UNODC, 2008). It has been claimed that after decades of the subregion’s insignificant role in the global trade and its control, a substantial share of the drugs available in Western consumer markets transit through West Africa today and are increasingly used there as well. The head of the UN Office on Drugs and Crime (UNODC) stated in 2008.

Let’s be frank: Africa in general, never faced a drug problem – whether we speak about production, trafficking or consumption. Now the threat is there, on all these fronts (Costa, 2008).

By the end of the decade, increasing concern led to depictions of WestAfrica as the ‘coke coast’ andstates suchasGuinea-Bissaucame to be labelled as ‘narco-states’, collapsing under the ‘invisible tide’ of drug trafficking and use (Cockayne & Williams, 2009; ICG, 2008; Vernaschi, 2010). International experts were certain aboutthe evergrowing magnitude of West Africa’s role in the international drug trade. The head ofthe UNODC argued, ‘I haveno doubt we’re going to see production [of cocaine]’ (Costa cited in Kirschke, 2008). Such dramatic claims about West Africa’s drug markets – many of them based on little evidence – have helped to attract public and donor attention to Africa’s drug problems. However, they have also hindered a better understanding of drug trends and policies in the subregion, as they describe West Africa’s drug problems as largely driven by external factors and states in the subregion as too weak, porous and unprepared to withstand this external threat (Cockayne & Williams, 2009; ICG, 2008; UNODC, 2008; Vernaschi, 2010). This article assesses and challenges some of these depictions with a case study of the recent history of drug control in Nigeria – one of West Africa’s most notorious ‘drug hubs’ that attracted attention long before the current concerns with cocaine trafficking in the subregion and a country now hailed as a drug policy model by international experts. In contrast to media and official depictions and by building on the limited drug policy research available on Africa (Bernstein, 1999; Klein, 1999; Obot, 2004), it aims to provide a rare empirically based analysis of the drug policy making and implementation process in West Africa.

The article begins by reconstructing dominant narratives of Nigeria’s drug control, while the subsequent parts assess the political dynamics hidden by these narratives, drawing on an historically grounded and constructivist approach to analysing policy. First, rather than simply being driven by drug-related trends, drug control followed a broader institutional process of exclusion, typical under periods of military rule in West Africa and continuing into democratic Nigeria after 1999. Second and linked to this process, the Nigerian state – rather than being too ‘weak’ to react – showed a strong preference for repressive drug control sidelining the policy alternatives propagated by health officials. Finally, Nigerian drug officials, particularly in the National Drug Law Enforcement Agency (NDLEA), have also begun to externalise their domestic political conflicts over resources and ideas in the last 15 years by drawing in international drug agencies – mostly as a means to prevent policy change and reform. In essence, drug control over the last 25 years has been driven more by concerns over state power rather than Nigeria’s drug problems – evidence of which has been sparse since the country’s earliest drug policies.

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The politics of drug control in Nigeria: Exclusion, repression and obstacles to policy change

Opiate use has been documented in 36 countries in Africa, with its prevalence ranging from an estimated 2.3% of the adult population in Seychelles, to 1% in Mauritius, and 0.3% in Kenya (Ministry of Health of Seychelles, 2011; UNODC, 2014). Injecting drug use has been reported in 28 African countries, with increasing evidence of linked HIV epidemics (Bouscalliou, Evanno, Proute, Inwole, & Kanran, 2016; Kurth et al., 2015; Lepretres et al., 2015; Matiko et al., 2014; Nyandindi et al., 2014; Scheibe et al., 2016; Eluwa et al. 2013). Two scenarios characterize the diffusion of HIV among people who inject drugs (PWID) in the Sub-Saharan African region: there are countries, such as Kenya and Tanzania, that have moved from a long-established generalized HIV epidemic to a recent mixed epidemic with high HIV prevalence among key populations, including PWID; and there are concentrated HIV epidemics among PWIDs emerging in low HIV prevalence countries, such as Mauritius, Seychelles and Zanzibar.

There is now wide consensus in the region that the adoption of the comprehensive package of nine evidence-informed interventions recommended by United Nations (WHO, UNODC and UNAIDS, 2012), and the United States President’s Emergency Fund for AIDS Relief (PEPFAR) tenth intervention, namely outreach, can help significantly reduce new HIV and hepatitis infections among PWID and their sexual partners. The global evidence in support of combination HIV prevention for PWID is compelling (Degenhardt et al., 2010; MacArthur, Minozzi, & Martin, 2012), and this has framed initiatives supported by PEPFAR in the region since 2010 towards fostering policy change supportive of the development of harm reduction. The combination of interventions promoted includes mutually reinforcing biomedical, behavioural, and structural interventions, which are not only evidenceinformed but rights-based as well as community-owned. Countries have begun to endorse and develop a package of HIV prevention intervention for PWIDs, including to varying extent, medically assisted therapies for treating opiate use and addiction, low threshold access to antiretroviral HIV treatment, needle and syringe distribution and exchange, sexual behaviour change communication, and community outreach. There is also a need for structural interventions to address critical social, legal, political, and environmental enablers of HIV risk.

Policy change towards implementing harm reduction in Sub-Saharan Africa

Wherever there are significant numbers of people injecting in public, there is a clear need for supervised injecting facilities.

The introduction of Supervised Injecting Facilities in Scotland is one of three recommendations in a report published by Kirsten Horsburgh, National Naloxone Coordinator at Scottish Drugs Forum, following her Winston Churchill Memorial Trust Travel Fellowship to Australia.

Kirsten was awarded the 6 week Fellowship to research strategies adopted in Australia to reduce drug-related deaths. During this trip she spent 2 weeks in the Medically Supervised Injecting Centre (MSIC) in the Kings Cross area of Sydney to gather learning from this service to inform key stakeholders and decision-makers in Scotland.

Drug-related deaths in the UK are at an all time high. In Scotland, these deaths are among the highest in Europe, per head of population. 613 people lost their lives to accidental and preventable overdoses in 2014.

Reducing drug related deaths in Scotland

Study rationale and methods In recent years signals from both formal and informal monitoring sources based in a number of countries have been flagging critical new developments within Europe’s MDMA/ecstasy market. These include signs of increased MDMA production and availability, the opening of new online markets, reports of increased use, the issuing of alerts on both high-dose MDMA tablets and adulterated tablets, and evidence of low but potentially rising numbers of MDMA-related hospital admissions, and even deaths in some countries.

In order to investigate these changes and developments in the supply and demand of one of Europe’s more established illicit drugs, a targeted ‘trendspotter’ study was initiated by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and carried out between August and October 2015. The primary aim of the study was to increase understanding of recent changes in the MDMA market in Europe. More specifically, the study set out to explore: levels and patterns of MDMA use; the MDMA market including production, supply and product availability; MDMA-related harms and deaths; and implications for law enforcement, health and social responses.

The study commenced with a phase of data collection and a literature review undertaken by a team drawn together from different sectors within the EMCDDA, and culminated in an expert meeting in Lisbon on 22–23 October 2015. Fourteen experts attended the meeting, sharing their experiences and contributing to an in-depth analysis of the topic, providing insights from drug research and monitoring, wastewater analysis, law enforcement and health perspectives.

The trendspotter study methodology incorporates a range of different investigative approaches and data collection from multiple sources. This study included two expert web surveys, a review of the international literature and available monitoring data, 15 expert presentations and findings from three facilitated working groups. Analysis was based on triangulation of these information sources, with a view to providing as complete and verified a picture as possible. The combination of routine and survey data with key informant reports and law enforcement intelligence provided a rich and in-depth view of a rapidly changing phenomenon. This report summarises the study findings and conclusions. Where results are literaturebased, references are cited, otherwise findings are based on EMCDDA monitoring and the qualitative sources described above.

Recent changes in Europe’s MDMA/ecstasy market

Desde que a Convenção Única sobre Entorpecentes foi adotada, criando a estrutura para o sistema global de controle de drogas, há uma evidência crescente de que a abordagem da “Guerra às Drogas” levou às sérias consequências negativas 2 . Como resposta, o debate sobre a política de drogas internacional tem incorporado de forma crescente a ideia de uma abordagem de saúde mais equilibrada. Na ‘Declaração Ministerial Conjunta’ das Nações Unidas sobre drogas de 2014, estados membros chegaram a um consenso de que “o problema mundial das drogas ... demanda uma abordagem integrada, multidisciplinar, equilibrada e de reforço mútuo.”3 Em abril desse ano, a Sessão Especial da Assembleia Geral das Nações Unidas (UNGASS) sobre o problema mundial das drogas incluirá uma mesa redonda dedicada às “Drogas e à Saúde”.

Ao nível regional, o Plano de Ação para o Controle de Drogas da União Africana (2013- 2017), inclui serviços sociais e de saúde como um dos quatro resultados prioritários. 5 Recentemente, a Posição Comum Africana para a UNGASS enuncia que uma abordagem mais equilibrada é necessária para focar na saúde e nos direitos humanos de pessoas que usam drogas”.6 Essa narrativa tem sido usada de forma crescente por múltiplos estados.

Ao mesmo tempo que essa mudança de tom é bem-vinda, é crucial que o conceito de políticas de drogas equilibradas e baseadas em saúde não se tornem frases diplomáticas vazias. Essa retórica tem de ser combinada com uma mudança real sobre como reagimos em campo na África e no resto do mundo. Portanto, essa nota para advocacia busca elaborar como seria a prática de uma abordagem de saúde na África, e explora cinco áreas específicas que precisam ser urgentemente tratadas pelos governos.

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Política de Drogas na África: O que é uma abordagem “baseada em saúde”?

Joint Open Letter by the UN Working Group on Arbitrary Detention; the Special Rapporteurs on extrajudicial, summary or arbitrary executions; torture and other cruel, inhuman or degrading treatment or punishment; the right of everyone to the highest attainable standard of mental and physical health; and the Committee on the Rights of the Child, on the occasion of the United Nation General Assembly Special Session on Drugs New York, 19-21 April 2016

We have the honour to address you in regard to the upcoming General Assembly special session on the world drug problem convening on 19-21 April 2016. We have been following the preparatory process closely since the adoption of Human Rights Council resolution 28/28 and General Assembly resolution 70/181, and the subsequent discussions and negotiations around the existing draft outcome document.

We have welcomed the opportunity to contribute towards this preparatory process and view the UNGASS as an important occasion to reflect upon the achievements and challenges of international drug control, and its impact upon the enjoyment of human rights and fundamental freedoms. The UNGASS is also a vital moment to make bold commitments that ensure the promotion and protection of human rights is central to the development of the upcoming 2019 Political Declaration and Plan of Action on drugs.

As human rights experts of the United Nations system, we are encouraged by the presence of human rights language and standards throughout the current outcome document, which is an important acknowledgment that human rights is central to international drug control. However, in our opinion, the text fails to sufficiently articulate the binding nature of human rights obligations in the context of international drug control and continues to embrace the harmful concept of a ‘drug-free world’. While specific human rights content could not be agreed during the closed negotiations and is thus absent from the outcome document, we would like to remind States that they remain legally bound by their obligations to respect, protect, and fulfil human rights including while developing and implementing their responses to drugs."

Joint UN statement ahead of the UNGASS 

Biometric technology allows for efficient programming and improved quality of services. But when working with key populations, there are concerns around privacy. Can biometrics be responsibly implemented when working with a key population such as People who Use Drugs?

Biometrics: acceptability & feasibility when working with key populations

Three Kenyan harm reduction organisations conducted a study with the support of Mainline on the needs of female drug users (FDUs) on the Kenyan coast. This investigation was done in order to adapt and design services based on the needs of FDUs. In addition, female specific barriers to accessing services was investigated based on observations that FDUs often face higher access barriers than their male counterparts. In this report, results of the study will be discussed.

The report starts with an introduction as to why special attention should be payed to FDUs, the context of the Kenyan coastal area and what makes FDUs a hard-to-reach population. Next we look at the barriers in accessing services, followed by health risks and predominant needs. This reports ends with intervention suggestions which respond to the needs of FDUs, and considerations for the implementation of these interventions in order to challenge the service barriers which FDUs experience.

Women who use drugs in kenya

The teams of outreach workers in Cape Town, Durban and Pretoria (South Africa) have systematically documented human rights violations among People who Use Drugs under the Bridging the Gaps programme. The result from this hard work is a report that reveals large numbers of serious human rights violations.

Human right violations in South Africa

In 2011, the Indonesian Government issued the Government Regulation Number 25 Year 2011 regarding the Implementation of the Compulsory Report of Drug Dependents which regulates the practice of compulsory report and rehabilitation for drug users in Indonesia. By this regulation, Indonesia produced a new institution called the Compulsory Report Institution (Institusi Penerima Wajib Lapor or usually abbreviated as IPWL). This institution is not only the place where drug users can access treatment, but also the place to note, gather, and process the data of drug users.

Looking at its importance, there is a need to understand the implementation of compulsory report and its effect on drug users’ life. This research attempts to explore how the compulsory report system has addressed drug users’ human rights. Besides that, this research also tries to assess the effectiveness of IPWL according to the client’s need.

The obligation to report in Indonesia

HIV risk behaviors among crystal-meth users might contribute to increasing HIV prevalence rates in Indonesia. Related risks can be reduced if people have access to crystal-meth related health services. Prior to the development of interventions, a comprehensive understanding of structural, social, interpersonal and personal factors related to the use of crystal-meth in Indonesia is crucial. This includes a better understanding of individual and environment factors surrounding drug use and HIV-related risk behaviors, which will allow for the designing of better interventions. This study aims to gain better knowledge on patterns of meth use and its implications on HIV risk and health seeking behavior among crystal-meth users in Indonesia, including a better understanding of on individual and environmental factors shaping drug use.

A qualitative research design was developed with the aim of producing a deeper understanding of the diverse patterns of meth use and its implications for HIV risk and related health seeking behaviors. The study looked at patterns of initiation of meth use, sustained use and attempts of reducing and stopping the use of the drug, and how the drug use influenced users’ behaviors, including daily activities, HIV risk behaviors, exposure to legal problems, as well as users’ social and sexual networks and health seeking behaviors.

Chrystal meth use in Indonesia

Evaluation of a century of international efforts invested in controlling drugs, done by UNODC, showed that the system of drugs controlling and its application had some sideffects. One of these is lack of investments solving the question of harmfull consequences for public health caused by drug use. With global acceptance of the fact that drug dependence is a chronical, but preventable disease, but also a disease that one can be cured or recovered from, a widely accepted standing point is that measures and interventions directed towards achieving apstinence and recovery have to be accompanied by measures that can significantly contribute to decrease of risks and harmfull consequences of drug use. Today, interventions in the area of risk prevention and harm reduction are considered fundamental and necessary, due to the fact that there is a wide scope of evidences that can prevent disease, save lives and protect the community. On a global level we have a highly present tendency that the practice of drug use harmful consequences’ reduction is being spread and finds its application in the area of illegal, but also legal psychoactive substances use, as well as in the work of the law enforcement services. In the same time the concept of harm reduction became a mean to achieving golas of the public health policies, policies in the area of community security, policies of social protection aiming to decrease social, legal and economic problems related to psychoactive substances use.

Harm reduction approach and interventions derived from it have been introduced on a larger basis, principally as a response to a high number of overdose cases as well as fast spread of HIV&AIDS and other STIs due to intrevenous drug use. From the perspective of public health, subpopulations with a high infections burden have direct and indirect onerous effect on the society, and prevention can substantially limit these effects. The first effect is direct morbidity due to heavy forms of chronical infections, having high treatment expenses as a result. The second is reflected in the lost of human productivity, which increases social expenses. The third is high prevalence of diseases among persons who use drugs, which, especially if sustained a long period of time, can increase the risk in the wider population. Practice shows that harm reduction measures represent a noteworthy input to the conventional public health approach, can have a strong effect on spreading blood-borne and other infections among people who inject drugs, therefore the society in general. Prevention is feasible and effective if populations most at risk of acquiring infection have been provided with adequate services, in an adequate manner, in their own surrounding and in the adequate time.

Harm reduction measures, i.e. prevention and reduction of mortality, reduction of health and social risks and harms, as well as general feeling of insecurity of the community due to drug use,in most countries of Europe and world represent an integral part of national strategies and policies of fight against drugs, applied in different scope and combinations, dependant to drug policies’ goals. All European and international refferent organizations and bodies strongly support harm reduction as an efficient, evidence based approach to prevention of infective diseases transmition and treatment of persons who use drugs.

Harm reduction approach has been supported by the “Strategy of Montenegro for prevention of drug abuse 2013 – 2020”, but there is no unique national doctrine, i.e bylaws that regulates this particular area. Although there are the most important harm reduction services set in place, which proved their worth and necessity on multiple occasions, ending of a nine year long donation program of the Global Fund for Fight against AIDS, Tuberculosis and Malaria in July 2015, brought the sustainability of certain services into question and the same are facing closure. This is especially related to service functioning within the NGO sector, without which the harm reduction approach in a certain country can not be neither complete nor efficient, daily centers i.e. drop in centers for people who inject drugs and outreach work with most at risk populations in respect to HIV, Hepatitis C and B. In order to make services mentioned mentainable and developed according to growing needs, it is necessary to permanently secure their functioning and sustainability. Due to all things mentioned it is necessary to adopt this document as a referent conceptual and practical framework for further development and improvement of the national policy in the domain of reduction of harm caused by drug use in Montenegro, according to strategic goals set. Drug users’ access to adequate treatment must not be a priviledge, but a right coming from the fundamental right to health, as well as an obligation of every responsible system. Likewise, the possibility of access to programs and measures of decreasing drug related harm represents the right of every individual, which must be recognized as such.

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