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.

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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.

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Policy paper on preventing risks and reducing harm linked to the use of psychoactive substances

Almost two years have passed since the Center for Disease Control and Prevention found that the number of people who live with HIV has in-creased among injecting drug users (IDUs). In the meantime, a coordinated and effective response mechanism to deal with the phenomenon should have been introduced, although we are well aware that the effects of interventions in such epidemics are not easily visible right away. What happened and no satisfactory progress was made in the plans and strategies that were com-prehensively described in detailed reports and findings of competent bodies in Greece, as well as of experts from the European Union and the international community?

The current briefing paper aims to address this issue; it draws up a brief history of the course of a serious problem for public health and human rights, together with the efforts to tackle the problem; it cites the views of competent state bodies and institutions actively involved in offering services to injecting drug users; finally, it openly calls towards all directions, so as for slop-piness, exploitation of the phenomenon for petty political reasons and stigmatisation of people who live in difficult conditions, to stop. What is needed is thorough analysis of the facts, ac-countability, consultation, collaboration, short-, medium- and long-term objectives and frequent assessments.

The HIV epidemic among injecting drug users in Greece during the economic crisis

Britain is to criminalise the distribution and consumption of the chewable leaf khat – a mild stimulant imported from Kenya and Ethiopia. This follows the Home Secretary Teresa May’s decision in July 2013 to introduce legislation classifying khat as a class C drug, with possession resulting in a maximum two year prison sentence (or fine) and up to 14 years for supply related offences under the 1971 Misuse of Drugs Act.

The pending legislation will bring the UK into line with European and North American countries, and is being introduced on the basis that: a) use of khat among the Somali migrant community has detrimental impacts on health and family life; b) the UK has become an international distribution point for khat; c) khat use and the proceeds from the sale of khat contribute to criminal and terrorist activity.

Adverse consequences should be anticipated from the criminalisation of the shrub.

The UK khat ban: Likely adverse consequences

The much trumpeted closure in October 2013 of the Tor-accessible illicit market known as Silk Road and arrest of its founder Robert Ulbricht struck a blow to consumer trust in the market for illicit goods and specifically narcotic drugs that are hosted on the Tor network. However, this success for the US multi-agency task force (involving the Federal Bureau of Investigation, Drug Enforcement Administration, Department of Homeland Security, Internal Revenue Service, US Postal Inspection, Secret Service and Bureau of Alcohol, Tobacco, Firearms and Explosives) does not mark the end of black markets hosted on the Tor network, or the availability of drugs anonymously bought online. Rather it spurred innovations in online illicit trading, underlining the hydra headed nature of ‘successful’ interdiction effort.

Silk road and bitcoin

In 2010 the international HIV/AIDS community called on countries to take action to prevent HIV transmission among people who inject drugs (PWID). To set a baseline we proposed an “accountability matrix”, focusing upon six countries accounting for half of the global population of PWID: China, Malaysia, Russia, Ukraine, Vietnam and the USA. Two years on, we review progress.

Prevention of HIV infection and access to HIV treatment for PWID is possible. Whether countries with concentrated epidemics among PWID will meet goals of achieving universal access and eliminating new HIV infections remains unknown. As long as law enforcement responses counter public health responses, health-seeking behaviour and health service delivery will be limited.

What has been achieved in HIV prevention, treatment and care for people who inject drugs, 2010–2012?

To coincide with the 17th International Conference on AIDS and STIs in Africa (ICASA), the International AIDS Society, Médecins du Monde (MdM), the International Drug Policy Consortium (IDPC), and the United Nations Office on Drugs and Crime (UNODC) hosted this High Level Panel for around 50 participants including policy makers, journalists and programme managers.

This High Level Panel was the first event of its kind in Africa, warning the participants about the HIV response thoughout the country.

The High Level Panel was expertly chaired by Anso Thom, a leading health journalist from SECTION27 in South Africa – who reminded participants that this was the first event of its kind in Africa, following similarly themed meetings in Asia and elsewhere.

Report from the high-level panel on HIV, drug policy and public health in Africa

This new report aims to assess the various policy responses to new psychoactive substances (so called "legal highs") in five European countries - Hungary, Poland, Portugal, Romania and Serbia - , from the perspective of researchers, service providers, law enforcement officials and activists working with the most affected communities of people who use drugs.

The not-so-balanced approach: Policy responses to new psychoactive substances

This Crane Survey provides information about most-at-risk populations in Uganda (people who use drugs, female sex workers and men who have sex with me).

Crane survey: High risk groups conducted in 2008/2009 in Kampala, Uganda

People who inject drugs (PWID) are at high risk of contracting and transmitting and hepatitis C virus (HCV). While accurate screening tests and effective treatment are increasingly available, prior research indicates that many PWID are unaware of their HCV status.

The results suggest that drug-injecting individuals who reside in non-urban settings, who have poor access to primary care, or who have less education may encounter significant barriers to routine HCV screening. Expanded access to primary health care and prevention services, especially in non-urban areas, could address an unmet need for individuals at high risk for HCV.

Barriers and facilitators of hepatitis C screening among people who inject drugs: A multi-city, mixed-methods study 

The vast majority of countries are signatories to international treaties that prohibit the production, distribution and possession of cannabis for non-medical and non-scientific purposes. The treaties have not changed in nearly 25 years, but laws and policies pertaining to cannabis have changed in some countries.

Several jurisdictions have reduced the penalties for possessing cannabis for personal use (and in some places even for home cultivation), making the maximum penalty a fine and/or participating in some type of diversion programme or community sentence. Some jurisdictions have taken more dramatic steps and changed their laws and practices with respect to producing and distributing cannabis.

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