The arbitrary and excessive use of pretrial detention around the world is a massive form of human rights abuse that affects in excess of 14 million people a year. The right to be presumed innocent until proven guilty is well established. Yet this right is violated widely and often—in the developed and developing world alike—and the violation goes largely unnoticed. Few rights are so broadly accepted in theory, but so commonly abused in practice. It is fair to say that the global overuse of pretrial detention is one of the most overlooked human rights crises of our time.

Given that the presumption of innocence is universal, detaining arrestees pending trial should be rare. However, many jurisdictions around the world violate the principle that pretrial detention should be used sparingly, as a last resort. Instead, it has become the default setting of criminal justice systems.

One out of three people behind bars has not been found guilty of a crime. In some parts of the globe, pretrial detainees outnumber convicted prisoners. At this moment, 3.3 million people are in pretrial detention worldwide. And that is a conservative estimate, because official data ignore the tens of thousands of people detained in police stations. Cutting the number of pretrial detainees could resolve prison overcrowding, limit the spread of disease, reduce poverty, and spur development.

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Presumption of guilt: The global overuse of pretrial detention

Interest has been growing in ketamine as a treatment of depression (Aan Het Rot, et al 2012; Diamond et al., 2014) and there is some genuine excitement among some of the elvish bloggers.

Mainly used in veterinary surgery, ketamine has been discovered to rapidly improve even the most severe cases of unipolar and bipolar depression. However, as yet there are still many questions left unanswered before ketamine can become a licensed treatment alternative.

For one, there needs to be more clarity about the safety and effectiveness of the drug before an informed weighing of pros and cons is feasible. In addition, in order to stay on top of the immense interest ketamine has spurred, it is essential to have an updated overview of all studies out there. To this end McGirr et al have provided the most recent systematic review of methodologically sound studies (McGirr et al, 2014).

Ketamine for depression: new review highlights the need for an RCT 

Recreational drug use in men who have sex with men (MSM) is of concern because it might be linked to the transmission of HIV and other sexually transmitted infections. Evidence about drug use in HIV-diagnosed MSM in the UK is limited by representativeness of the study populations. We describe patterns of drug use and associations with sexual behaviours in HIV-diagnosed MSM in the UK.

We used data from the cross-sectional ASTRA study, which recruited participants aged 18 years or older with HIV from eight HIV outpatient clinics in the UK between Feb 1, 2011, and Dec 31, 2012. We examined data for MSM, assessing the prevalence of recreational drug use and polydrug use in the previous 3 months and associations with sociodemographic and HIV-related factors. We examined the association of polydrug use with measures of condomless sex in the previous 3 months and with other sexual behaviours.

Our analysis included data for 2248 MSM: 2136 (95%) were gay, 1973 (89%) were white, 1904 (85%) were on antiretroviral treatment (ART), and 1682 (76%) had a viral load of 50 copies per mL or lower. 1138 (51%) used recreational drugs in the previous 3 months; 608 (27%) used nitrites, 477 (21%) used cannabis, 460 (21%) used erectile dysfunction drugs, 453 (21%) used cocaine, 280 (13%) used ketamine, 258 (12%) used 3,4-methylenedioxy-N-methylamphetamine (MDMA), 221 (9%) used gamma-hydroxybutyrate or gamma-butyrolactone, 175 (8%) used methamphetamine, and 162 (7%) used mephedrone. In the 1138 individuals who used drugs, 529 (47%) used three or more drugs and 241 (21%) used five or more. Prevalence of injection drug use was 3% (n=68). Drug use was independently associated with younger age (p<0·0001), not being religious (p=0·001), having an HIV-positive stable partner (p=0·0008), HIV-serostatus disclosure (p=0·009), smoking (p<0·0001), evidence of harmful alcohol drinking (p=0·0001), and ART non-adherence (p<0·0001). Increasing polydrug use was associated with increasing prevalence of condomless sex (prevalence range from no drug use to use of five or more drugs was 24% to 78%), condomless sex with HIV-seroconcordant partners (17% to 69%), condomless sex with HIV-serodiscordant partners (10% to 25%), and higher-HIV-risk condomless sex after taking viral load into account (4% to 16%; p≤0·005 for all). Associations were similar after adjustment for sociodemographic and HIV-related factors. Methamphetamine was more strongly associated with higher-HIV-risk condomless sex than were other commonly used drugs.

Polydrug use is prevalent in HIV-diagnosed MSM and is strongly associated with condomless sex. Specialist support services for MSM with HIV who use recreational drugs might be beneficial in the reduction of harm and prevention of ongoing transmission of HIV and other sexually transmitted infections.

Recreational drug use, polydrug use, and sexual behaviour in HIV-diagnosed men who have sex with men in the UK

The prohibitionist model for combatting drugs has run its course in Brazil, as shown by the violence associated with the drug traffic, illegal trade of adulterated substances, lost fiscal revenues, waste of public resources, diversion of attention from society’s real problems (in favor of a false solution), and lack of clinical studies on the efficacy and effectiveness of currently banned medicinal plants. However, the Brazilian Legislative Branch appears to be aware of the population’s evolving opinions on the issue. The National Senate and Chamber of Deputies recently launched a discussion on the regulation of marijuana in Brazil, urged by a citizens’ petition submitted in February 2014.

The website of the National Senate provides a mechanism for citizens’ participation called the e-Citizenship Portal, established by Ruling no. 3/2011 of the Senate Steering Board. Legislative Ideas is the link in this portal that offers citizens the possibility of petitioning for bills to create new laws, amend existing ones, or improve the National Constitution. The ideas are analyzed according to the portal’s terms of usage, verifying the wording’s consistency and coherence, absence of inappropriate, disparaging, or offensive terms, and non-violation of inalterable Constitutional provisions.

Regulation of marijuana by the Brazilian Senate: a public health issue

In November 2012, Colorado voters decided to experiment with marijuana. Formally, they approved Amendment 64, modifying the state constitution. This move was historic and did something which, to that point, no other state or modern foreign government had ever done: legalize retail (recreational) marijuana.

As part of the amendment, the state was required to construct legal, regulatory, and tax frameworks that would allow businesses to cultivate, process, and sell marijuana not simply to medical patients—as had been happening in Colorado for over a decade—but to anyone 21 and older. This change came despite existing federal prohibition of marijuana and opposition from the governor, state attorney general, many mayors, and the law enforcement community.

At its heart, this report is about good government and takes no position on whether the legalization of retail marijuana was the correct decision. Instead, it takes for granted that Amendment 64 and its progeny are the law and should be implemented successfully, per voters’ wishes. The report examines what the state has done well and what it has not. It delves into why, and how, regulatory and administrative changes were made. Finally, it offers an evaluation of how effective the implementation has been.

Colorado’s rollout of legal marijuana is succeeding: A report on the state’s implementation of legalization

analizzando i disastri di questa guerra, fece tremare i palazzi proibizionisti nazionali e planetari. Questo, sia per i suoi contenuti, sia per le firme di molti pezzi grossi dell’establishment internazionale, a partire dall’ex segretario generale dell’Onu Kofi Annan, assistiti da una scelta schiera di esperti. Dopo il rapporto del 201, la Commissione ha seguitato a lavorare su specifici problemi, per esempio i costi dell’applicazione della legge penale e la riduzione del danno (vedi il rapporto fra droghe, Hiv/Aids ed epatite C; v. http://www.globalcommissionondrugs.org/ ). Finché il 9 settembre scorso è stato pubblicato il nuovo rapporto 

Taking Control: Pathways to Drug Politics that Work

 – “Prendere il controllo: percorsi verso politiche delle droghe che funzionino”.

Qui solo qualche rapido cenno ai contenuti del rapporto, a partire dalle raccomandazioni finali:

spostare il più possibile risorse dalle azioni repressive e punitive agli interventi sanitari e sociali di provata efficacia;

porre fine sia alla criminalizzazione dell’uso e del possesso di droghe per uso personale (l’italica depenalizzazione di uso e possesso è il più delle volte una tragica frode, almeno dalla Jervolino-Vassalli in poi e ancor più negli anni della Fini-Giovanardi), sia ai trattamenti obbligatori (quasi una allusione a certe nostre comunità terapeutiche);

cogliere l’opportunità della prossima assemblea generale Onu sulle droghe (Ungass) del 2016 per cambiare le convenzioni internazionali, sinora ricalcate sul modello proibizionista varato a Vienna nel 1961;

puntare sulle alternative al carcere per i “pesci piccoli” del narcotraffico (piccoli produttori, corrieri al dettaglio, piccoli spacciatori);

permettere e incoraggiare i diversi esperimenti di legalizzazione controllata, a partire da (ma non fermandosi a) cannabis, foglie di coca e parte delle nuove sostanze psicoattive; quindi

puntare a una riduzione del potere delle organizzazioni criminali per ridurre la violenza e l’insicurezza alimentate dalle competizioni tra di loro e con lo Stato; infine

assicurare l’equo accesso ai farmaci essenziali, in particolare gli oppiacei per il dolore (per incidens, l’ultima relazione ad hoc al Parlamento del nostro Ministero della salute mostra qualche progresso, ma anche quanto siamo ancora lontani dagli standard di altri paesi soprattutto del centro e nord-Europa e del nord-America).

Poco spazio resta per le parti analitiche del rapporto. Il fallimento delle strategie di controllo è documentato dagli aumenti di produzioni e consumi di droghe pesanti; il danno alla salute pubblica e alla sicurezza dalla frequenza delle adulterazioni e delle morti da overdose, dalle restrizioni alle strategie di riduzione del danno (solo in Russia 1.800.000 iniettori sono infetti da virus HIV); l’attacco ai diritti umani dagli oltre mille giustiziati all’anno per reati di droghe, dagli innumerevoli carcerati e reclusi in “centri speciali”, dalle gravi discriminazioni a danno delle minoranze etniche e razziali; l’incentivazione della criminalità e dell’arricchimento dei criminali dai quasi quattrocento miliardi di dollari annui di vendite al dettaglio, dall’escalation della violenza e del finanziamento del terrorismo; giù giù, sino ai dati sul dilagare della corruzione, sull’inquinamento dell’economia legale, e chi più ha più ne metta. Insomma, conclude la Commissione, vi supplichiamo, potenti della terra, facciamola finita; e per fortuna, aggiunge, qualcuno qua e là ha iniziato a capire l’antifona.

Prendere il controllo: percorsi verso politiche delle droghe che funzionino

In a joint submission the International Network of People Who Use Drugs (INPUD), International Network of Women who Use Drugs (INWUD), the Women and Harm Reduction International Network (WHRIN), National Advocates for Pregnant Women (U.S.A.) (NAPW), SisterReach, the Sexual Rights Initiative, Family Law & Cannabis Alliance (U.S.A.) (FLCA), and Native Youth Sexual Health Network, have produced this report which focuses on the United States of America’s failure to address and curtail the growing body of counterproductive and regressive state laws, policies, and practices that are increasingly being used to substantially undermine women’s dignity and status as persons under the law.

Based on a devastating combination of ideological prejudice and misinformation, prosecutors, courts, and legislators across the United States are overtly discriminating against many of society’s most traumatized and marginalized pregnant women. This is manifested in the reinterpretation of existing laws and the creation of new laws to punish pregnant women for the circumstances or outcomes of their pregnancies.

The arrest and incarceration of pregnant women and new mothers, coupled with interventions by child welfare authorities not only deprive women of their fundamental rights, but also threaten maternal, fetal and child health across the United States. The effect of these policies is most devastating to women who are marginalized by race, socioeconomic status, and use of prescribed or illicit drugs.

INPUD human rights submission against USA's treatment of pregnant women

Eastern Europe and Central Asia continue to see rapid increases in HIV infections among men, women and children. Despite some notable successes in responding to the epidemic, it is unlikely that the Universal Access targets and the Millennium Development Goals (MDGs) related to HIV/AIDS will be achieved. Access to antiretroviral treatment is still among the lowest in the world, and stigma and discrimination that violate the basic rights and dignity of people living with and affected by HIV, including children, are hampering further progress in prevention, care and support.

This report brings to life the experiences of children, families and young people living with HIV. It gives voice to their stories of despair, stigma and social exclusion, as well as to their courage and hope. It explores the systemic failures in responding to their needs and outlines some good practices. It also describes the contradictions that children and young people, particularly those who are most at risk of HIV, face on a daily basis: societies insist that they conform to social norms, yet exclude them and brand them as misfits; health and social protection systems do not serve their needs and diminish their chances of living normal lives, but blame them when they fail to cope. The report also features some compelling photographs of the realities of living on the edge.

Policy reforms, programmatic shifts and a reallocation of resources to strengthen health and social protection systems are required if the further spread of the epidemic is to be halted. Reforms must aim to expand and grant equitable access to services for all, including those who are currently excluded and missed. Successes in HIV prevention, treatment and care can only be increased and sustained if they are underpinned by social environments that advance human and child rights, gender equality and social justice. Blame and Banishment is a call to address the remaining gaps in the response to HIV in the region. It is a call for protecting the rights and dignity of children and young people who are vulnerable, at risk and living with or affected by HIV. It is also a call to build an environment of equity, trust and care rather than blame and banishment.

Blame and banishment: The underground HIV epidemic affecting children in Eastern Europe and Central Asia

It is unfortunate that 35 years after the first chemical spraying in the Sierra Nevada de Santa Marta, we are still writing about aerial sprayings in Colombia, demanding the current government – how many governments have not happened since! –to definitely defer an ecocide and incompetent policy. Throughout these years we have seen increasing national and international voices opposing the spraying of coca with the herbicide Roundup (glyphosate).

To the protests of the affected rural communities, soon began to join environmental and human rights NGOs, political groups, a neighboring country (Ecuador) affected by the spraying at the border, researchers associated with respectable academic institutions, the Inter-American Commission on Human Rights (IACHR), and more recently even the United Nations.

Colombia, more than three decades of toxic spraying. Enough!

This paper focuses on the often neglected set of individuals who engage in both the use and selling of illicit drugs; user-dealers. It reports the findings of a qualitative study conducted among cocaine dealers operating in Parisian techno parties, highlighting the routes into and out of using-dealing, the particular risks faced by this population, and the need for health and criminal justice agencies to better understand and address these issues.

User-Dealer, those who have been forgotten by harm reduction

The hepatitis C virus (HCV) is highly prevalent globally among people who inject drugs (PWID). Among the estimated 15.9 million PWID worldwide, 10 million are estimated to be HCV antibody-positive, compared with about three million who are HIV-positive. Australia has relatively good coverage of harm-reduction initiatives among PWID, with low HIV prevalence and incidence. Conversely, high prevalence and incidence of HCV among Australian PWID have been documented.

Between 1995 and 2010, HCV prevalence among needle and syringe program (NSP) attendees nationwide remained between 50% and 60%,6and an incidence rate of 44.1/100 person-years was observed in a community-based cohort of PWID in south-western Sydney in 1999–2002. However, a reported decline in HCV infection at the population level suggests that the epidemiology of HCV among PWID in Australia may be changing. There have been no recent data from community-based cohorts of PWID to evaluate whether population-level reductions in HCV incidence may be related to a reduction in the PWID population size 

 reduced risk among individual PWID. Such data would also provide key indicators for evaluating the impact of Australia's National Hepatitis C Strategy.

The authors examined the acquisition of HCV among PWID enrolled in a prospective observational study based in Sydney, New South Wales. Specifically, they assessed HCV incidence from 2009 to 2011, and risk and protective factors associated with incident infection, including uptake of NSPs and opioid substitution therapy (OST — methadone or buprenorphine).

The study concluded that HCV incidence was substantially lower than the incidence of 30.8/100 py observed a decade earlier in a similar NSW-based cohort, suggesting a decline in HCV incidence among PWID. This is likely due to increased coverage of OST, combined with a probable decrease in the population of PWID.

Opioid substitution therapy protects against hepatitis C virus acquisition in people who inject drugs

This report outlines important suggestions by international experts to improve the health of people in prison and to reduce the risks posed by imprisonment to both health and society. In particular, it aims to facilitate better prison health practices in the fields of:

It is aimed at professional staff at all levels of responsibility for the health and well-being of detainees and at people with political responsibility. The term “prison” covers all institutions in which a state holds people deprived of their liberty.

Publications