Harm reduction aims to reduce the health, social and economic harms associated with drug use. Where scaled up sufficiently harm reduction interventions, such as needle and syringe programmes and opioid substitution therapy, have had a significant impact on reducing new HIV infections, mortality, and rates of crime.

The success of harm reduction is rooted in the fact that it goes beyond a set of highly effective interventions. It is an approach that is underpinned by the principles of pragmatism, dignity, human rights and public health, and one within which people who use drugs are firmly at the centre. This approach, often implemented in the face of resistance, has saved countless lives and helped people to stay healthy.

Despite such success harm reduction programmes remain underfunded and coverage falls short of what is required to impact HIV epidemics among people who inject drugs. Of the 158 countries or territories which report injecting drug use around 90 countries or territories have at least one needle and syringe programme, and 80 provide opioid substitution therapy. In prison settings the situation is far worse with just 7 countries providing needle and syringe programmes, and only 44 providing opioid substitution therapy, in at least one prison.

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

The potential to end AIDS among people who inject drugs

Towards the end of 2014, as NATO was preparing to cease formal combat operations in Afghanistan, the U.N. Office on Drugs and Crime (UNODC) announced Afghan farmers had cultivated a record 209,000 hectares of opium poppy over the course of the previous year. This level of production had occurred, a Reuters report commented, ’despite years of counter-narcotics efforts that have cost the United States $7.6 billion’.1 The US Department of Defense put the blame squarely on their local allies who, officials said, had not properly implemented the chosen policies. The drug policy community generally considers technical problems to have undermined ‘counternarcotics’ efforts, which are, it is commonly argued, poorly chosen, under-funded, and lacking in appreciation of local context. This conception of an occupying army committed to counter-narcotics but failing in its wellintentioned efforts has little basis in fact. It is sustained by a general tendency within the drug policy community to accept the boundaries of debate handed-down by policy-makers. Not just in Afghanistan but around the globe, investigating vitally important context such as 2 the strategic and economic objectives of the occupying powers has been considered strictly off-limits. Taking these factors into account, and locating ‘counter-narcotics’ operations within the wider war effort, suggests the picture most commonly presented has little relation to what has actually been taking place in Afghanistan over the past 14 years.

Through a broken glass, darkly: Drug policy and the war in Afghanistan

Compiled by Students for Sensible Drug Policy with collaboration from Canadian Students for Sensible Drug Policy, Students for Sensible Drug Policy UK, Youth Organisations for Drug Action, and YouthRIse

Recognizing our common goals of working towards evidence-based drug policies that reduce the harms of drug use and are grounded in human rights principles, including the right to health, the organizations listed above, working in informal coalition and representing thousands of youth in every region of the world, acknowledge the many impacts of drug use, drug markets, and drug control on our communities. Punitive drug policies have failed our generation and our society, impeding the development of young people and our full enjoyment of basic human rights. Governments typically justify their drug policies by invoking the need to protect young people. But we can speak for ourselves, and if policies are being implemented in our name, our voices must be heard.

Despite extensive efforts to reduce the consumption and supply of illicit substances, drug use and drug control policies continue to be major causes for concern, impacting the health and well-being of young people globally. While one of the main goals of drug policy has always been to protect the world’s youth, the voices of young people have often been absent from the debate. We therefore welcome the UN’s effort to provide a space for open debate around drug policy at the upcoming UNGASS, where SSDP and coalition partners are best suited to represent issues that directly affect youth populations.

Global youth coalition consultation

The international drug control regime and the international response to HIV have both failed at significantly reducing HIV transmission among people who inject drugs (PWID). HIV prevalence in PWID is 28 times higher than in the general population, and only 14% of PWID living with HIV are receiving antiretroviral therapy;1 the situation of viral hepatitis among PWID is even worse.

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

Cities central to HIV response for people who use drugs

The global commitment to ending the AIDS epidemic, as affirmed in the 2030 Agenda for Sustainable Development, represents an unparalleled opportunity to end one of modern day’s most devastating health challenges and also to build on the momentum of the AIDS response to accelerate results across the sustainable development agenda.

Even when confronted with the immense scale of the global AIDS epidemic, the response to HIV has never lost sight of the value and experience of each individual affected—their hopes and frustrations and their right to health and well-being. I have had the privilege of spending time with people engaged in the AIDS response, including people living with HIV. I have learned about their difficulties in getting access to the antiretroviral medicines that keep them alive and about the fear and stigma they live with each day. Many have also expressed their unwavering belief that we can end this epidemic. Their stories of courage and hope embody the resolve of all those involved in the AIDS response. Today, we can appreciate the remarkable progress we have made together, but also how far we have to go to ensure that no one is left behind.

The AIDS response has delivered more than results. It has delivered the aspiration and the practical foundation— the medical advancements, interventions and partnerships—to end the epidemic by 2030. All that truly remains— the missing link that will determine whether Fast-Track targets will be met or missed—is the political commitment to implement our proven tools adequately and equitably.

For those who missed the discussions, recordings are available below:

On the Fast-Track to End the AIDS epidemic

In late 2013 DrugScope, on behalf of the Recovery Partnership, conducted the first State of the Sector survey, the findings of which were reported in January 2014. Consultation for the second report followed a year later, being published in early 20151 .

This, the third State of the Sector report, has been produced by Adfam on behalf of the Recovery Partnership and draws on an online survey and series of telephone interviews conducted between September and December 2015. It uses the findings from a substantial online survey and a series of interviews with senior figures in the sector to evaluate the experiences of community drug and alcohol treatment services in England.

The 2015 State of the Sector survey for adult community and residential services includes responses from 176 services from across England. A survey of prison drug and alcohol services has also been conducted as part of the project. This will be published at a later date as an annexe to this report.

 Third State of the Sector report - Adfam and the Recovery Partnership

The public health imperative for rights-based drug control policy: A statement for the UN General Assembly Special Session on the World Drug Problem

The Global Fund to Fight AIDS, Tuberculosis and Malaria

The Global Fund to Fight AIDS, Tuberculosis and Malaria welcomes the UN General Assembly Special Session on the world drug problem as an opportunity to bring public health and human rights concerns to the center of drug control policy.

The Global Fund was created as a partnership. Working together, over the past 15 years, we have contributed to great progress in the fight against HIV, as well as TB and malaria. Through a collective effort, combining the contributions of governments, civil society, the private sector and affected communities, the Global Fund disburses nearly $4 billion per year to support local programs that prevent infections and the premature deaths of millions of people from HIV, TB, and malaria.

The HIV response over the past 15 years has been tremendous. In 2000, there was no global public health response to the HIV epidemic. In 2016, almost every country around the world is implementing prevention and treatment programs. Just as important, there is widespread recognition that HIV discriminates, and does not affect people equally. The community of people who use drugs in all their diversity, including women, men, trans* and young people, have been left behind in the global response.

To end the HIV epidemic, we must do more to prevent HIV and other infections among people who use drugs, and ensure that those living with HIV and other infections have access to care, treatment and support. We need to recognize that the level of criminalization, discrimination, and violence that people who use drugs face, can only result in driving risk-taking behaviors, including in detention settings, excluding them from the social and health support systems they need. We must move toward treating everyone, including people who use drugs, as fellow human beings.

As a health financing institution that aims to invest in evidence- and rights-based programs that provide the greatest value for money, we add our voice to that of our technical partners, in particular, UNAIDS and WHO, and express our concern that current drug control policy undermines, rather than supports, the reach and impact of health programs for people who use drugs. Experience and evidence show that the International Community could do much better and dramatically improve health and human rights outcomes.

The UNGASS on the world drug problem has the opportunity to rethink policies that undermine health programs and to shape drug policy that will facilitate good health outcomes. Good drug policy can help in many ways, including:

• by ensuring adequate investment in essential, cost-effective health services for people who use drugs, including comprehensive HIV, TB, and Sexual and Reproductive Health services;

• by supporting the meaningful participation of people who use drugs in health programs;

• by ensuring that resources are used for programs that minimize health harms and protect human rights, rather than incarceration of large numbers of people who use drugs.

Essential HIV and TB services for people who use drugs :

 A large body of evidence shows that needle and syringe programs (NSP) and opioid substitution therapy (OST) are among the most effective and cost-effective prevention and treatment programs in the world – and among the most widely evaluated. (See annex to this statement for a summary of some key research.) People who inject drugs readily utilize harm reduction services when programs are welcoming and non-judgmental. NSP services have the additional benefit of refering people who wouldn't attend mainstream services to other services to address and manage their health and social needs. Many countries have found that NSP yield significant returns on investments, over reduced burden of HIV care on health systems. OST is a not only highly effective in treating opioid dependence but also helps prevent HIV and hepatitis as well as overdose by reducing the frequency of injecting. OST also reduces crime and social instability. Investment in NSP and OST – combined with HIV treatment for people living with HIV who use drugs – is good public health practice, fiscally responsible, and part of the fulfillment of states’ human rights obligations to their citizens. NSP and OST services in prisons and in the community are both crucial.

Although data are incomplete, evidence also suggests a substantial and growing population of women injecting drugs worldwide. Women and men have different experiences of injecting drug use and related risks and harms. Even within a community that faces high levels of violence and social exclusion, gender shapes the way people access and receive services. As a result, women who use drugs have significantly higher rates of morbidity and mortality ascompared to their male counterparts, and in particular higher rates of HIV infection. Gender sensitive harm reduction programs are therefore critical to ensure equitable access to services and to address the significant overlap between gender, drug use, sex work, and nonconforming gender identities. The Global Fund urges member states to deal with the issue of gender in the context of drug use as key to ensuring equitable access to services as part of their obligation to their citizens.

In spite of the preponderance of public health and economic evidence for harm reduction interventions, including some notable examples from programs implemented with Global Fund resources, investment in them remains far too low, particularly from national resources, and reliance on external resources such as the Global Fund is unsustainable in the long-term. As a result, a very small percentage of people who use drugs in the world have regular access to NSP and OST; and it is estimated that up to 86% of people who inject drugs who are living with HIV lack access to antiretroviral therapy. The Global Fund urges member states at the UNGASS to support drug policies that enable scale-up of these services.

In some countries, people who use drugs are still held in centers purporting to provide “treatment” or “rehabilitation,” with widely reported violations of human rights, little or no judicial process or medical evaluation of those held, and no evidence of effectiveness. In 2012, twelve UN agencies called for the closure of all compulsory treatment facilities, including compulsory drug detention centers. The Global Fund has made repeated calls for the closure of drug detention centers while expressing concerns that those detained illegally within them must not be denied access to essential health care. In October 2014, the Global Fund Board decided that the Global Fund would not fund any interventions in compulsory drug detention centers. The Global Fund urges member states at the UNGASS to call for the immediate closure of all drug detention centers, in line with the call made by the United Nations in 2012.

People who inject drugs are also at high risk of TB in many settings, and HIV and TB co-infection is very high among them. As WHO experts note, criminalization and penalization of minor drug offenses undermine national TB responses. People who use drugs who fear that seeking health services will put them in the path of the police are less likely to be reached by TB testing or to complete treatment. Moreover, prison and pretrial detention are very high-risk environments for TB and multi-drug-resistant TB (MDR-TB) in many countries. Overcrowding and poor sanitation and ventilation in prisons contribute to the risk of airborne transmission, and access to testing and treatment is often limited. Global Fund-supported programs have shown that the high TB risks in the prison environment can be effectively addressed by sustained investment in prevention and care, especially when there is continuity of services between prisons and the community.

Global Fund submission to the UNGASS process

An uneasy but critical partnership for health and human rights

At a high-level meeting of Association of Southeast Asian Nations (ASEAN) countries, held in Malaysia in October 2015, ministers yet again reiterated their commitment to rid the region of drugs:

‘While some drug-related support services may be implemented, ASEAN is committed to a zero-tolerance approach to realise its regional vision of a Drug-Free ASEAN, so as to provide our people and communities with a society free from drug abuse and its ill-effects.’

Consistent with ASEAN’s prior work plan on drugs, ‘some drug-related support services’ likely refers to drug use prevention and rehabilitation, while the aim of achieving ‘a society free from drug abuse’ directly contradicts the provision of harm reduction measures for people who use drugs.

ASEAN’s unwavering commitment to achieving a drug-free region has justified the brutal criminalisation and punishment of people who use drugs, along with unbalanced investment in law enforcement at the expense of health and harm reduction interventions, thereby fuelling HIV and hepatitis epidemics among people who inject drugs in the region.

Over a decade after harm reduction programs were introduced in several countries throughout South East Asia, ASEAN’s drug policy makers clearly have not shifted their stance in support of them. Yet efforts to build collaboration between law enforcement, harm reduction, civil society and communities of people who use drugs have taken root in certain localities throughout the region.

In the context of global shifts away from criminalisation and punishment, such developments provide further evidence of the need for ASEAN to update their policies in response to drug use.

ASEAN’s contradictory approach to HIV and drug use

As with many other parts of the world, drugs are regarded first and foremost as a security threat to South East Asia. In its drug strategy and work plan, ASEAN portrays drug markets as a key security concern, and as a cause of individual suffering weakening ‘the social fabric of nations’, direct and indirect economic costs to governments, along with criminal activities that could threaten the stability of states.

 outlines a broad strategy for eradicating the production, trafficking and use of controlled drugs in the region by 2020. In 2000, to highlight the urgent need to tackle expanding drug markets for use and supply, the target year for achieving a drug-free region was brought forward to 2015.

ASEAN Work Plan on Combating Illicit Drug Production, Trafficking and Use (2009–2015)

 (the Work Plan) to set out agreed priorities for eradicating supply through the ‘elimination’ of syndicates involved in the production and trafficking of drugs and their precursors, and for reducing the prevalence of drug use, primarily through preventative education programs.

The ASEAN Senior Officials on Drug Matters, comprising senior officials from agencies with responsibility for drug-related issues from each member state, has responsibility for coordinating, monitoring and evaluating implementation of the Work Plan.

Despite high levels of HIV prevalence among people who inject drugs throughout the region (see Table 1), there is only one mention of HIV/AIDS in the entire ASEAN Work Plan on drugs: as a component of preventative education programs for the general population and people who use drugs.

Table 1: HIV prevalence among people who inject drugs in ASEAN countries


* The HIV prevalence rates among people who inject drugs in some cities are significantly higher than national prevalence rates, for example, 56% in Jakarta (Indonesia). The HIV prevalence rates among people who inject drugs in Brunei and Lao PDR are not known.


International feature: Harm reduction and drug policy in ASEAN

The 2016 EU Drug Markets Report provides a unique insight into the operation of illicit drug markets in the EU. The report assesses the impact of the drug market on society and the factors driving it. It explores the market for cannabis, heroin, cocaine, amphetamines, MDMA and new psychoactive substances. Understanding these hidden markets, and the actors involved, is essential to making sound policy decisions with lasting impact. The report combines the analytical power of the EMCDDA’s drug monitoring system with Europol’s operational intelligence on trends in organised crime.

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

EU Drug Markets Report

Chaining, public humiliation, abduction, and prayer. If these were treatments offered for diabetes or heart disease, we would see them as cruel and abusive. Yet these are tactics used widely in centers for the “treatment and rehabilitation” of people who use drugs in Latin America and the Caribbean.

These abusive centers often operate unlawfully and without medical or governmental supervision. People are often brought to these centers against their will, by family members, by police, or by gangs of center residents. Families are not aware of the conditions in the center, or don’t know where else to turn. These practices run counter to evidence-based drug treatments recommended by the World Health Organization and the United Nations Office on Drugs and Crime, and reveal how often drug dependency is treated as a moral failing rather than a medical condition. As regional governments prepare for the United Nations General Assembly Special Session (UNGASS) on drugs in April, defining what truly constitutes a “public health approach” to drug policy is increasingly important.

No Health, No Help: Abuse as Drug Rehabilitation in Latin America & the Caribbean 

is a compilation of reports by researchers and civil society in six countries—Brazil, Colombia, the Dominican Republic, Guatemala, Mexico, and Puerto Rico. The report details the extreme human rights abuses occurring in the name of “rehabilitation,” and offers recommendations for how governments can work to improve drug treatment in these countries.

No health no help: Rehabilitation centres in Latin America

 - On the side-lines of the 59th Session of the Commission on Narcotic Drugs, the UNODC HIV Section today launched a second Scientific Statement - Science addressing Drugs and HIV: State of the Art.

The side event was co-chaired by Kristian Ødegaard from the Permanent Mission of Norway to the United Nations in Vienna and Aldo Lale-Demoz, Deputy Executive Director, Director of Division for Operations and Global Coordinator for HIV/AIDS, UNODC.

"The role of science in the development of a balanced health oriented drug policy is critical," said Mr Ødegaard.

The paper is an outcome of a two-day UNODC scientific consultation on the latest developments in the field of HIV and drug use held in Vienna 10 - 11 March.

Four of the scientists made presentations on three thematic areas. Dr. Clemens Benedikt, Technical Specialist, Global HIV/AIDS Programme, World Bank, made a presentation on Allocative And Implementation Efficiency of HIV Prevention and Treatment for People who Inject Drugs.

Science addressing drugs and HIV: State of the art

For over two decades the US has funded repressive forced coca eradication in Peru, Colombia and Bolivia to reduce the illegal cocaine trade. These policies have never met their stated goals and have generated violence and poverty. In 2006 Bolivia definitively broke with the US anti-narcotics model, replacing the militarized eradication of coca crops with a community-based coca control strategy. The program substantially reduced the coca crop while simultaneously respecting human rights and allowing farmers to diversify their livelihoods. This article outlines the elements of the Bolivian initiative that ensure its continued successful functioning. It explores to what extent this model can be translated to other Andean contexts.

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