The economical crisis has a huge impact on the public health situation in most of the European countries. Severe budget cuts and austerity measures aimed at NGO’s and low threshold services strongly affect the social and health situation of marginalised and vulnerable groups.

This newsletter is devoted to this urgent issue and presents examples and reports from Correlation partners in South and South East Europe. Greece, for example, is in the middle of a public health disaster. To meet budget-deficit reduction targets set by the European Central Bank, European Commission, and International Monetary Fund (the so-called troika), Greece’s public health budget has been cut by more than 40%. As Greece’s health minister observed, “these aren’t cuts with a scalpel, but with a butchers knife.

The spending was reduced to 6% of GDP, a figure lower than the UK, at 8%, and Germany, at 9%.As a result, HIV infections have jumped by more than 200% since 2010, mainly affecting intravenous drug users, as needle-exchange programme budgets were cut in half.

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

Policy paper: Who is paying the price for austerity?

) has been associated with a large number of physiological and societal harms, leading to calls for it to be controlled in the UK. The evidence of these harms is often equivocal, limited by confounding factors, or entirely anecdotal: high-powered, quality-controlled studies are lacking.

Regardless, the body of relevant literature indicates that the once socially-regulated use of khat has been eroded. Some individuals have developed excessive consumption patterns, either using khat daily or in binge-sessions, though daily consumption is not necessarily problematic per se. The majority of users seem to use khat in moderation, where the associated harms appear low.

Khat: A systematic review of evidence and literature pertaining to its harms to UK users and society 

This article examines how commodity price shocks experienced by rural producers affect thedrug trade in Mexico. Our analysis exploits exogenous movements in the Mexican maizeprice stemming from weather conditions in U.S. maize-growing regions, as well as export áows of other major maize producers. Using data on over 2200 municipios spanning 1990-2010, we show that lower prices differentially increased the cultivation of both marijuana and opium poppies in municipios more climatically suited to growing maize.

This increase was accompanied by differentially lower rural wages, suggesting that households planted more drug crops in response to the decreased income generating potential of maize farming. We also Önd impacts on downstream drug-trade outcomes, including the operations of drug cartels and killings perpetrated by these criminal groups. Our Öndings demonstrate that maize price changes contributed to the burgeoning drug trade in Mexico, and point to the violent consequences of an expanding drug sector.

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

From maize to haze: Agricultural shocks and the growth of the Mexican drug sector

The UN Special Rapporteur on Torture has joined the growing list of health experts and human rights bodies urging a move long advocated by the Legal Network: the implementation of prison-based needle and syringe programs (PNSPs). In fact, we were among the invited experts at a meeting convened by the Special Rapporteur last year, to examine how to strengthen the UN's existing Standard Minimum Rules for the treatment of prisoners and people in other places of detention.

Informed by that meeting, the Special Rapporteur's latest report (see "Latest reports") to the UN General Assembly highlights the particular vulnerability to abuse in detention of people living with HIV, people who use drugs, women, sex workers, and LGBT people. It reaffirms that health care in prisons should be equivalent to that in the community, going so far as to state that the new UN rules on prisons should oblige states:

"to ensure that all harm-reduction measures, including ... needle and syringe exchange programmes and evidence-based substance abuse treatment, are available to people who use drugs at all stages of their detention."

The Special Rapporteur also reiterated (from a previous report) concerns about the practice in some settings of withholding methadone or other drug dependence treatment as an interrogation technique.

This latest report represents a significant step forward in the international recognition of the rights of prisoners and people who use drugs. Nevertheless, the Canadian government continues to resist scientifically proven harm reduction services, even working to undermine them at the international level. Such recalcitrance only underscores the necessity of our ongoing court case seeking the implementation of needle and syringe programs in federal prisons, as well as the need for us to keep our engagement internationally as UN member states begin a review of global drug policy over the next two years.

UN Rapporteur on Torture: Provide clean needles in prisons

Criminal justice and public health systems can work together to provide comprehensive HIV prevention and treatment inside and outside correctional facilities. Incarceration presents a window of opportunity for primary prevention, screening, treatment and establishing comprehensive, pro-active transitional linkages for persons approaching release and follow-up.

What is the role of prisons and jails in HIV prevention? 

Why do people start injecting is a key question for harm reduction in Kenya and around the world. Injecting brings with it high risks of HIV, other viral infections, vein and skin damage and increased addiction. Many people start using heroin and other drugs by smoking, chasing or sniffing, and then gradually move on to start injecting. This briefing paper explains the reasons why people are attracted to inject drugs through a study case in Kenya.

Why do people start injecting? - Access to care study in Kenya

, highlights a shift toward multilateral support for hemispheric drug policy reform. This report by the Organization of American States (OAS) reviews failures of the U.S.-led prohibitionist “war on drugs” and urges states to reconsider orthodox “supply-side” strategies (including interdiction and drug crop eradication), and to focus more on demand-side policy experimentation. In Central America, a key zone of drug transit that is being ripped apart by narco-fueled violence and corruption, the push for reform signals hope that the conditions fueling drug traffickers' profits and corrosive political influence may eventually be dismantled.

Read here the full article (restricted access)

Drug policy as conservation policy: Narco-deforestation

Concerns about the availability and use of methamphetamine in Europe have been growing for some time. Historically, the use of methamphetamine has been confined largely to the Czech Republic and Slovakia; however, recent signs of the spread of methamphetamine linked to different European countries have sparked further investigation of this topic. The methodology used is based on the triangulation of data collected using a number of investigative approaches and from multiple sources. The findings summarised in this paper include insights into the chemistry of methamphetamine and the history of its use in Europe since the 1930s. Signs of increased involvement of organised crime groups in methamphetamine markets and possible scaling-up of production are noted. In some countries, there is evidence to suggest that methamphetamine use is increasing, while new injection trends have been detected among small groups of gay men in large cities (London, Paris).

Worrying reports are emerging from south-east Europe that crystal methamphetamine smoking is a limited, but emerging, problem, with the possibility of spreading among vulnerable populations. Negative consequences for physical and mental health are associated with the use of methamphetamine, which may also involve high levels of sexual risk-taking. Evidence exists for effective health and social responses, based on cognitive behavioural and contingency management approaches. The study notes that the knowledge available in Europe on the use of methamphetamine and the associated problems remains incomplete, and highlights information and research gaps. The report concludes that, although methamphetamine use is not a major phenomenon in Europe, even at a relatively low prevalence, it is a drug that has the potential to cause significant harm.

Exploring methamphetamine trends in Europe

Antiretroviral therapy has transformed the global HIV response, but whether people living with HIV benefit from the life-saving and prevention benefits of treatment depends too often on where they live. Worldwide, HIV treatment coverage is lowest in the WHO Eastern Mediterranean Region and UNAIDS Middle East and North Africa Region (referred to in this report as the “Region”), and does not exceed 15% of the estimated people in need of treatment. The situation in the Region is critical and we are not keeping up with the global pace of treatment access – the rate of growth in treatment coverage is lower in the Region than it is globally and this disparity is increasing over time.

This needs to change. Not only do people living with HIV have the same rights to treatment as their peers in other parts of the world, but antiretroviral treatment prevents new infections. Even as the global community celebrates the decline in new infections worldwide, the Region is one of two in the world where new HIV infections are still on the rise.

The WHO and UNAIDS report outlines what needs to be done to close the gap and move towards universal access to treatment. We need to ensure that policies reflect recent advances in science emphasizing the
importance of earlier testing and treatment, particularly for key populations. Putting the Region on track to reach universal access will require intensified focus on the geographical settings and populations where both HIV prevalence and unmet needs for testing and treatment services are highest.

Accelerating HIV treatment in the WHO Eastern Mediterranean and UNAIDS Middle East and North Africa regions

More than 5.5 billion people (83% of the world’s population) in over 150 countries have low to non-existent access to morphine and other controlled medicines for pain relief, palliative care or opioid dependency.

Although access to morphine has increased exponentially over the last two decades, global inequalities in access to pain relief are stark. Ninety per cent of the global consumption of morphine, fentanyl and oxycodone registered in 2009 occurred in Australia, Canada, New Zealand, the United States and several European countries (See Map below). All these medicines are ‘scheduled’ and controlled under the UN 1961 Single Convention on Narcotic Drugs. Widespread lack of access in lower and middle-income countries (LMICs), however, underlines the serious limitations of the current regulatory regime.

Untreated pain in the lower and middle-income countries

In spite of a decades-long 'war on drugs', the global drug trade persists as a significant problem for international security given its scale, the number of deaths related to trafficking and consumption it creates, and the organized crime and corruption it fuels. The international drug control system has been ineffective in reducing the size of the market and in preventing the emergence of new drugs and drug routes that cause and shift instability around the world.

Current drug policies have been counter-productive, often causing more harm than the drugs themselves through capital punishment for offences, widespread incarceration, discrimination in law enforcement, violation of basic human rights in forced 'treatment' centres, and opportunity costs.

In the last three years, the drug policy debate has evolved more than in the previous three decades. There remain a number of political obstacles to making recent developments sustainable ahead of the UN General Assembly Special Session (UNGASS) on drugs in 2016, but these should not be used as excuses for continuing with a failed status quo.

Illicit drugs and international security: Towards UNGASS 2016

Long perceived as an offense or a deviant behaviour, drug addiction is now widely acknowledged as a medical condition. As such, access to appropriate treatment for those who suffer from addictive behaviour is no privilege, it is a right. The right to equitable access to health care services derives from the fundamental right to health which is enshrined in international law, and especially in the International Covenant on Economic, Social and Cultural Rights.

This policy paper provides a practical and widely applicable definition of risk and harm reduction.

Publications