“We reiterate our commitment to strengthen our efforts in addressing and countering emerging and persistent challenges and threats of all aspects of the world drug problem … and we recommend the following: … promote, as appropriate, the use and analysis of relevant, reliable and objective data … to improve the implementation of comprehensive, integrated and balanced national drug control strategies, policies and programmes … and encourage the sharing of best practices and lessons learned.”

Outcome document of the special session of the General Assembly on the world drug problem, entitled “Our joint commitment to effectively addressing and countering the world drug problem”

The World Drug Report 2016 is published in the wake of the landmark moment in global drug policy, the special session of the General Assembly on the world drug problem. Chapter I provides a global overview of the supply of and demand for opiates, cocaine, cannabis, amphetamine-type stimulants (ATS) and new psychoactive substances (NPS), as well as their impact on health. It also reviews the scientific evidence on polydrug use, treatment demand for cannabis and developments since the legalization of cannabis for recreational use in some parts of the world. Chapter II focuses on the mechanisms of the interaction between the world drug problem and all aspects of sustainable development through the lens of the Sustainable Development Goals.

It is estimated that 1 in 20 adults, or a quarter of a billion people between the ages of 15 and 64 years, used at least one drug in 2014. Roughly the equivalent of the combined populations of France, Germany, Italy and the United Kingdom, though a substantial amount, it is one that does not seem to have grown over the past four years in proportion to the global population. Nevertheless, as over 29 million people who use drugs are estimated to suffer from drug use disorders, and of those, 12 million are people who inject drugs (PWID), of whom 14.0 per cent are living with HIV, the impact of drug use in terms of its consequences on health continues to be devastating.

With an estimated 207,400 drug-related deaths in 2014, corresponding to 43.5 deaths per million people aged 15-64, the number of drug-related deaths worldwide has also remained stable, although unacceptable and preventable. Overdose deaths contribute to between roughly a third and a half of all drug-related deaths, which are attributable in most cases to opioids. The time period shortly after release from prison is associated with a substantially increased risk of death from drug-related causes (primarily as a result of drug overdoses), with a mortality rate much higher than from all causes among the general population.

In many countries, prisons remain a high-risk environment for infectious diseases, which is a significant concern for prison health. A number of studies report high levels of drug use in prison, including the use of opiates and injecting drug use. In addition, the prevalence of HIV, hepatitis and tuberculosis among persons held in prison can be substantially higher than among the general population. However, despite the high-risk environment and scientific evidence for effective health interventions, there are significant gaps in prevention and treatment services in many prisons around the world.

PWID experience some of the most severe health-related harms associated with unsafe drug use, overall poor health outcomes, including a high risk of non-fatal and fatal overdoses, and a greater chance of premature death. One in seven PWID is living with HIV, and one in two with hepatitis C. PWID are a key at-risk population for HIV and hepatitis, with almost a third of new HIV infections outside sub-Saharan Africa occurring among PWID. Moreover, studies have found people who inject stimulants to engage in more risky sexual behaviours, resulting in a higher risk of HIV infection than for those injecting opiates.

Cannabis remains the most commonly used drug at the global level, with an estimated 183 million people having used the drug in 2014, while amphetamines remain the second most commonly used drug. With an estimated 33 million users, the use of opiates and prescription opioids is less common, but opioids remain major drugs of potential harm and health consequences. The fact that a sharp increase in heroin use has been documented in some markets (particularly North America) where it was previously declining, shows that heroin remains one of the major drugs of public health concern.

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World drug report 2016

As MSMGF reported last week with NSWP, IRGT, GATE, and the Global Platform to Fast‐Track the HIV and Human Rights Responses Among Gay and Bisexual Men and Other Men Who Have Sex with Men (The Platform), United Nations member states adopted a very weak political declaration at the UN High‐Level Meeting to End AIDS (HLM) in New York City. While the Political Declaration sets ambitious goals to accelerate HIV prevention and treatment targets to deliver treatment to 30 million people by 2020 and end AIDS by 2030, the document’s failure to adequately include, define, and commit to programming for gay and bisexual men and other men who have sex with men, sex workers, people who use drugs, and transgender people seriously undermines any potential to meet the Declaration’s ambitious targets to end AIDS.

In every country in the world, gay and bisexual men and other men who have sex with men, sex workers, people who use drugs, and transgender people shoulder disproportionate HIV incidence and prevalence, lack equitable access to HIV services, are criminalized, and face unrelenting stigma, discrimination and violence. No country can end its epidemic unless it effectively addresses HIV in all four of these key populations – whether in Africa or anywhere else in the world.

As MSMGF made clear in signing with over 80 civil society allies a Global Civil Society Organization (CSO) Declaration, we recognize the Political Declaration’s important commitments in several areas, including: strong references to the connection between gender‐ based violence and HIV, explicit positive reference to harm reduction as an important HIV strategy, consistent attention to stigma and discrimination as significant challenges to effective HIV responses, and explicit reference to the importance of meaningful stakeholder participation including people living with HIV, women, youth groups, feminists, human rights defenders, national human rights institutions, and other civil society organizations.

Yet, we are dismayed that the needs and rights of key populations are again considered expendable in a major policy debate setting priorities for the global HIV response. In April, we were heartened by several provisions made in the Zero Draft of the Political Declaration released by the HLM co‐facilitators Switzerland and Zambia. These included the naming of key populations, calls for programming specifically for key populations, and calls to address punitive legal and policy frameworks, including laws and policies that criminalize same‐sex behavior.

Moving on from a High‐Level Failure: Advocacy Entry Points and Follow‐Up to the United Nations High‐Level Meeting to End AIDS Political Declaration

The world has committed to ending the AIDS epidemic by 2030. How to reach this bold target within the Sustainable Development Goals is the central question facing the United Nations General Assembly High-Level Meeting on Ending AIDS, to be held from 8 to 10 June 2016. The extraordinary accomplishments of the last 15 years have inspired global confidence that this target can be achieved.

UNAIDS recommends a Fast-Track approach: substantially increasing and frontloading investment over the next five years to accelerate scale-up and establish the momentum required to overcome within 15 years one of the greatest public health challenges in this generation.

The latest UNAIDS data, covering 160 countries, demonstrate both the enormous gains already made and what can be achieved in the coming years through a Fast-Track approach. In just the last two years the number of people living with HIV on antiretroviral therapy has increased by about a third, reaching 17.0 million people—2 million more than the 15 million by 2015 target set by the United Nations General Assembly in 2011. Since the first global treatment target was set in 2003, annual AIDS-related deaths have decreased by 43%. In the world’s most affected region, eastern and southern Africa, the number of people on treatment has more than doubled since 2010, reaching nearly 10.3 million people. AIDSrelated deaths in the region have decreased by 36% since 2010.

Global AIDS update 2016

本报告中，国际药品政策联合会（IDPC）根据实证和良 好实践案例提出亚洲关于毒品使用政策的改革建议，即 将刑事定罪和惩罚向公共卫生和减低伤害的方向转变。 报告描述了对毒品使用去罪化的有效途径。报告也探讨 了在亚洲实施的被证实无效的一些方法，如将毒品使用 者拘留在强制中心进行“康复”

本报告旨在为亚洲的政策制定者、立法者、毒品使用者 社群和公民社会组织提供资源。报告的整体目标是提供 让毒品使用者从刑事定罪和惩罚中脱离的步骤指南，使 各国可据此制定毒品政策以达到更好的公共卫生成果。 报告也描述了那些不太有效的毒品政策，如将毒品使用 者拘留在强制拘留中心，强迫尿检、强制登记和其他惩 罚性措施。

随时掌握与药物政策发展相关的最新信息。

解决亚洲地区毒品使用问题的公共卫生方法： 去罪化的原则与实践

The Human Immunodeficiency Virus (HIV), Tuberculosis (TB) and Hepatitis C (HCV) – are a major health concern in prisons, evidenced by the fact that prevalence rates tend to be substantially higher among prison populations than in the general population.

Prisons and other places of detention are high-risk environments for the transmission of these diseases. This is related to the over-incarceration of vulnerable and disadvantaged groups who carry a disproportionately high burden of disease and ill-health; the criminalisation of drug users and high levels of injecting drug use; overcrowded and substandard prison conditions; inadequate health care; and the denial of harm reduction services.

Several international, regional and national human rights mechanisms are in place to monitor and inspect prison conditions in order to prevent torture and ill-treatment – including the Subcommittee on the Prevention of Torture (SPT), under the Optional Protocol to the UN Convention against Torture (OPCAT), with National Preventive Mechanisms (NPMs), as well as within the Committee for the Prevention of Torture (CPT) of the Council of Europe, and national bodies in a number of European countries.

Improving prison conditions by strengthening the monitoring of HIV, HCV, TB and harm reduction

AYOTZINAPA. TLATLAYA. SAN FERNANDO. These places in Mexico are known for the atrocities committed there—they are perhaps the best known of the country’s open wounds. But there are many others, perhaps less well known, such as Ojinaga, Allende, and Apatzingán. Nine years after the Mexican government first deployed federal armed forces to combat organized crime, civilians continue to suffer: killings, disappearances, and torture are carried out both by cartels and by the federal and state forces who are supposedly fighting them. From December 2006 through the end of 2015, over 150,000 people were intentionally killed in Mexico. Countless thousands have disappeared.

The Open Society Justice Initiative and five independent Mexican human rights organizations have spent four years examining the extent and nature of this crisis. We have concluded that there is a reasonable basis to believe that both state and non-state actors have committed crimes against humanity in Mexico.

Undeniable atrocities: Confronting crimes against humanity in Mexico

The Mainline annual report offers highlights on the activities and projects of the foundation in 2015.

Mainline Annual Report 2015

There has been huge international interest in the new direction that Portugal has taken in its drug policy since 1999. In that year, a new national drug strategy was adopted. This included a new law that decriminalised the possession of all illicit drugs, which came into force in July 2001 (Lei n.° 30/2000, de 29 de novembro 2000). It also included a broader expansion of public health, prevention and treatment services. The Portuguese approach has recently been described as a ‘model of best practices’ by the President of the International Narcotics Control Board (Sipp, 2015).

This chapter will describe these developments and will provide data that enables some assessment of their effects. It draws on research published in previous articles (Hughes & Stevens, 2010, 2012; Hughes & Stevens, 2007) and more recently published data1. These studies themselves drew on secondary analysis of documents and data produced, as well as interviews with key stakeholders in Portugal in 2007 and 2009. It should be stated at the outset that there remains contestation about some of the outcomes from this reform (for an overview of the two most divergent accounts see Hughes & Stevens, 2012). It is also very difficult to identify whether the patterns in drug use and related problems have been caused by the new strategy, especially as little data is available on the situation prior to 2001. It is even more difficult to identify which parts of the strategy may have led to which particular outcomes. The Portuguese strategy must be seen as an integrated package of measures, rather than attributing any changes observed to decriminalisation alone.

Decriminalisation and public health: the Portuguese approach to drug policy

Drug control policies have left an indelible footprint on human development. In many instances, they have fuelled the poverty, marginalization and exclusion of people and communities linked with illicit drug use or illicit drug markets. They have entrenched and exacerbated systemic discrimination against poor and the most marginalized populations and resulted in widespread human rights violations.

Involvement in drugs — whether its cultivation, production, sale or use — has traditionally been treated as a criminal problem, with the solution found through law enforcement. In recent years, there has been growing recognition that this vision is narrow and counterproductive. There has likewise been growing recognition that the connection between drugs and crime is not so straightforward and that drug control efforts focused on criminal law responses have had harmful ‘unintended’ consequences.

UN Secretary-General Ban Ki-moon has also identified illicit drugs and crime as a “severe impediment” to achieving sustainable development, as well as to securing human rights, justice, security and equality for all (UN, 2012). There has also been increased attention to the multidimensional relationship between drug control and development outcomes and to devastating consequences of drug control efforts on public health, security and development. As various UN organizations have observed, these efforts’ harmful collateral consequences include: creating a criminal black market;

fuelling corruption, violence and instability; threatening public health and safety; generating large-scale human rights abuses, including abusive and inhumane punishments; and discrimination and marginalization of poor and the most marginalized populations, including people who use drugs, indigenous peoples, women and youth (UNDP, 2015; UNODC, 2008; OHCHR, 2014; WHO, 2011; UN Women, 2014; UNAIDS, 2014).

UNODC has recognized the “vicious cycle” of drug production, drug trafficking, poverty and instability, as well as the harmful consequences of drug control policies on the health and human rights of people who use drugs and those who live in communities where drugs are cultivated.

Reflections on drug policy and its impact on human development: Innovative approaches 

Asia and the Pacific is home to the second highest number of people living with HIV after sub-Saharan Africa. Our culturally, politically and economically diverse region has an epidemic that is predominantly concentrated among key populations - men who have sex with men, sex workers, transgender people and people who use drugs - but also impacts heavily on women and girls, migrants, young people and adolescents, people in prisons, indigenous peoples, orphans, vulnerable children, and ageing populations.

In 2011, two UN-ESCAP Resolutions called for regional action to achieve universal access to HIV prevention, treatment, care and support. Underlying these are specific calls for political leadership to amend or remove laws, policies and practices that fuel stigma and discrimination; ensure sufficient investment to sustain the response; address all forms of gender-based violence; and promote access to affordable medicines, diagnostics and vaccines. Resolution 67/9 also named key populations of people who use drugs, sex workers, men who have sex with men and transgender people. In 2013, governments in the region again committed to addressing policy and legal barriers for key affected populations, and furthermore to eliminating discrimination on the basis of sexual orientation and gender identity and scaling up efforts to achieve Universal Access.

Ending AIDS in 2030: Do not leave Asia-Pacific behind.

The Middle East and North Africa region is at the centre of many of the burning issues of our globalized and inter-dependent world. When it comes to drug use, infectious diseases and marginalized populations, however, the debate falls short. While the incidence and prevalence rates of drug injection and of related HIV infections remain low compared to other regions of the world, tough drug policies and discrimination against vulnerable populations remain embedded in the social, economic and cultural contexts of the region.

Drug policy and human rights in the Middle East and North Africa: Harm reduction, legal environment and public health

Cultivation of cannabis for medicinal or scientific purposes needs considered management before it is rolled out as a therapeutic good

Since the publication in the Journal last year of a perspective on cannabis that stated: “Australia is behind the times on the medicinal use of cannabis”, there appears to have been a palpable change in community attitudes around cannabis as medicine. This has occurred alongside anecdotal reports from people with intractable illnesses who have had symptomatic benefit with cannabis. Palliative care specialists have acknowledged a potential role for medicinal cannabis in their specialty. Internationally, the scene is also changing. For example, the Netherlands Office of Medicinal Cannabis enables dispensation through pharmacies after purchase from a contracted company, which also exports to other European countries. In the United States, 23 states and Washington, DC, have legalised marijuana in some form, mostly for medicinal purposes, since June 2015.

In Australia, the New South Wales Government Terminal Illness Cannabis Scheme (TICS), established in 2014, enables compassionate access to adults with a terminal illness. Under TICS, a registered medical practitioner involved in a person’s ongoing care must certify that he or she has a terminal illness as defined by the scheme. In 2015, the New South Wales Government-funded trials of cannabis in palliative care and in children with a specific type of epilepsy, and in Victoria, a cannabidiol study for paediatric epilepsy is also in process.

Publications