By Gillian Kolla and Carol Strike / The Harm Reduction Journal

Popular perception of people who sell drugs is negative, with drug selling framed as predatory and morally reprehensible. In contrast, people who use drugs (PWUD) often describe positive perceptions of the people who sell them drugs. The “Satellite Sites” program in Toronto, Canada, provides harm reduction services in the community spaces where people gather to buy, use, and sell drugs. This program hires PWUD—who may move into and out of drug selling—as harm reduction workers. In this paper, we examine the integration of people who sell drugs directly into harm reduction service provision, and their practices of care with other PWUD in their community.

Data collection included participant observation within the Satellite Sites over a 7-month period in 2016–2017, complemented by 20 semi-structured interviews with Satellite Site workers, clients, and program supervisors. Thematic analysis was used to examine practices of care emerging from the activities of Satellite Site workers, including those circulating around drug selling and sharing behaviors.

Satellite Site workers engage in a variety of practices of care with PWUD accessing their sites. Distribution of harm reduction equipment is more easily visible as a practice of care because it conforms to normative framings of care. Criminalization, coupled with negative framings of drug selling as predatory, contributes to the difficultly in examining acts of mutual aid and care that surround drug selling as practices of care. By taking seriously the importance for PWUD of procuring good quality drugs, a wider variety of practices of care are made visible. These additional practices of care include assistance in buying drugs, information on drug potency, and refusal to sell drugs that are perceived to be too strong.

Our results suggest a potential for harm reduction programs to incorporate some people who sell drugs into programming. Taking practices of care seriously may remove some barriers to integration of people who sell drugs into harm reduction programming, and assist in the development of more pertinent interventions that understand the key role of drug buying and selling within the lives of PWUD.

Practices of care among people who buy, use and sell drugs in community settings

Lack of opportunities, marginalization and state neglect typify drug crop production worldwide. But while these issues are at the heart of economic and social development policies, drug crops are primarily conceptualized as a crime and security issue. In the Andes, this has led to policies over the past 40 years that prioritize the forced eradication of the coca leaf, the principal raw material in refined cocaine, under intense pressure from the U.S. government.

Turning over a new leaf: Regional applicability of innovative drug crop control policy in the Andes

By the Canadian Agency for Drugs and Technologies in Health (CADTH)

Five relevant reports were identified. These comprised one systematic review, two randomized controlled trials (RCT), and two economic evaluations.

One systematic review found that compared to patients treated with other treatments (i.e., methadone, or any other treatment program) those treated with injectable diacetylmorphine (DAM) (with or without the addition of methadone) had statistically significantly greater retention in treatment, reduction in illicit drug use, reduction in criminal activities, and fewer convictions and imprisonments, but no statistically significant difference in mortality and greater occurrence of adverse events.

One RCT showed that injectable hydromorphone (HDM) was not inferior to injectable DAM with respect to days of street opioid use, and proportions of urinalysis positives for street heroin metabolites in urine samples. There were no statistically significant between-group differences with respect to retention to treatment, criminal activity, and physical health and psychological health, however there was statistically significantly higher risk of adverse events related to the intervention in the DAM group compared to the HDM group.

One crossover RCT with 28 patients showed that there was statistically significant improvement after injectable DAM treatment compared to before treatment with respect to anxiety, anger, emotional excitement and well-being, and statistically significantly less heroin craving with injectable DAM compared to injectable placebo.

The results of the economic evaluations, considering a lifetime time horizon and societal perspective, indicated that DAM and HDM treatments each provided more benefits than methadone treatment, and at lower cost for individuals who had previously used other treatment options. Based on incremental cost-effectiveness ratios, it was found that both DAM and HDM dominated methadone. One evaluation reported that the probability of DAM being cost-effective was 76% at a willingness-to-pay (WTP) threshold of $0 per QALY gained, and 95% at a WTP threshold of $100,000 per QALY gained. The second evaluation did not report the WTP threshold.

Findings need to be interpreted with caution, considering the overall limited quantity of evidence, and that the economic evaluations were based on several assumptions.

Injectable opioid agonist treatment for patients with opioid dependence: A review of clinical and cost-effectiveness

By Monash University, the Anti-Death Penalty Asia Network and Harm Reduction International

This report considers whether Malaysian death penalty trials for drug-related offences comply with fair trial guarantees, and whether accused persons are provided with the high level of procedural fairness and access to justice required.

Part 1 of this report sets out the legal framework and standards which apply in capital cases involving drug charges under both international law and Malaysian law.

In Part 2, we examine whether Malaysia’s domestic legislation adheres to fair trial benchmarks in cognate common law countries and international human rights standards.

Part 3 builds upon this analysis with a discussion of relevant decisions and interviews with Malaysian lawyers who have experience in criminal law, and specifically death penalty cases. A comprehensive methodology is attached in Appendix 1.

Part 4 of this report provides an analysis of how the peculiarities of Malaysia’s DDA undermine the fair trial rights of accused persons charged with drug offences.

Finally, Part 5 of this report makes key recommendations. Crucially, our research finds that death penalty sentences for drug related offences in Malaysia have been imposed following proceedings that do not meet either the international fair trial standards or similar benchmarks found in the common law.

Drug offences and the death penalty in Malaysia: Fair trial rights and ramifications

By the European Monitoring Centre for Drugs and Drug Addiction & Europol

What effect is COVID-19 having on the drug market in the EU? This joint publication from the EMCDDA and Europol analyses the impact of the pandemic on the market for the main drug types (cannabis, heroin, cocaine, amphetamines, NPS), including demand, production, trafficking and availability. It reports higher prices, local shortages and reduced purity for some drugs, while noting continued violence among suppliers and distributors. It also shows how organised crime groups remain active and resilient, by adapting transportation models, trafficking routes and concealment methods, even during the pandemic.

EU drug markets - Impact of COVID-19

In its resolution 41/2, the Human Rights Council requested the High Commissioner for Human Rights to prepare a comprehensive written report on the situation of human rights in the Philippines and to present it at its forty-fourth session.1

This report presents an overview of the current human rights situation in the Philippines, guided by concerns highlighted in the preamble of Council resolution 41/2. It considers critical, ongoing issues, particularly where there are indications of long-standing, systematic causes underpinning them. In establishing trends and patterns, the report examines data since 2015 where possible, while also taking into account relevant developments prior to that.

The report is based on information collected and analysed by the Office of the United Nations High Commissioner for Human Rights (OHCHR), including through a public call for submissions. By 31 January 2020, OHCHR had received 893 written submissions, including joint submissions. These included 793 individually signed template-based letters. The Government of the Philippines provided substantial written input, including in response to two extensive lists of questions. OHCHR has also analysed official data and documents from governmental and non-governmental sources, including legislation, policy guidelines, court documents, police reports, videos, photos and open source reports, all used to corroborate information, along with interviews with victims and witnesses, remotely and in person. All sources were guaranteed confidentiality and are not named unless they provided specific consent.

OHCHR has had several exchanges with representatives of the Government of the Philippines, including detailed discussions on 13 and 14 February 2020 in Bangkok, Thailand.

OHCHR is grateful to the Government for its openness to dialogue. OHCHR did not receive permission from the Government to conduct a visit to the Philippines.

Situation of human rights in the Philippines - OHCHR report

 - A new report from the United Nations Office on Drugs and Crime (UNODC) warns that the synthetic drug market in East and Southeast Asia continues to expand and diversify, and the price of methamphetamine has dropped to the lowest level in a decade as the supply has surged.

Released today, the report titled “Synthetic Drugs in East and Southeast Asia: Latest Developments and Challenges”, confirms that the variety and volume of synthetic drugs have increased in the past year. “It is hard to imagine that organized crime have again managed to expand the drug market, but they have”, remarked Jeremy Douglas, UNODC Representative for Southeast Asia and the Pacific. “While the world has shifted its attention to the COVID-19 pandemic, all indications are that production and trafficking of synthetic drugs and chemicals continue at record levels in the region.”

Seizures of methamphetamine in East and Southeast Asia have increased year-on-year over the last decade, something not observed in any other part of the world. Countries in the region have already confirmed seizures of 115 tons of methamphetamine in 2019, but the figure does not yet include any data from China which has seized an average of nearly 30 tons per year the last five years.

The report highlights that intensified supply has resulted in methamphetamine becoming cheaper, reaching its lowest price points in the last decade in East and Southeast Asia. Decreases in prices of methamphetamine were also observed in the high profit markets of Australia, New Zealand and the Republic of Korea in 2019. Despite declining prices, the purity of Southeast Asian methamphetamine remains high and has even increased in some countries. “In short, organized crime groups are in a position to provide better quality methamphetamine at much cheaper prices compared to a decade ago, increasing affordability and harm at the same time”, observed Inshik Sim, UNODC Illicit Drugs Analyst.

East and Southeast Asia are also witnessing the steady rise of dangerous synthetic opioids. While there were only three opioids identified in the illicit drug supply of the region to 2014, the number increased to 28 in 2019, and seizures are being made in new locations as organized crime continue to push the limits of the business. “Synthetic opioids like fentanyl and even more potent variations deserve much more attention than they receive in the region,” commented Douglas. “Production is known to migrate into places with deep governance problems like the Golden Triangle, and we are concerned Southeast Asia could become a source for other parts of the world while these substances get mixed into or displace part of the regional heroin supply.”

Beyond methamphetamine and synthetic opioids, the report confirms a wide range of synthetic drugs, including ecstasy, ketamine and cannabinoids, are found across the region. “It is clear that the synthetic drug market in East and Southeast Asia is dynamic and continues to evolve”, according to Justice Tettey, Chief of the UNODC Laboratory and Scientific Section. “Strategies in the region, and in fact elsewhere in the world, should be built with an understanding of the clandestine manufacture and chemical profiles of synthetic drugs, which is why forensic science and precursor control capacities are critical for countries and the region to effectively respond.”

UNODC is working closely with Thailand and other countries in the region through the Global SMART Programme and Mekong MOU on Drug Control to monitor the drug situation and provide advice on cooperation, detection, precursor chemical control and public health strategies, and importantly to help countries collaborate together on joint and border operations. Secretary General of the Office of the Narcotics Control Board of Thailand, Niyom Termsrisuk, noted “our partnership with UNODC and other Mekong countries is essential for success. The challenge we face is significant, and we will only be able to make progress through regional and international cooperation.”

Synthetic drugs in East and Southeast Asia: Latest developments and challenges

By the Canadian Association of Social Workers

Social workers across Canada are working tirelessly to address the ongoing and devastating opioid crisis, often impeded by the continued criminalization of substance use throughout Canada. Since their expansion in 2012, mandatory minimum sentences have deepened the opioid crisis, while contributing to the near doubling of federally incarcerated Indigenous people in Canada. Moreover, the continued use of mandatory minimum sentences for drug-related charges contradicts commitments made by this government to uphold and implement the recommendations of the Truth and Reconciliation Commission which call for the elimination of mandatory minimum sentencing. The alternative to criminalization of substance use is a public health approach based on the principles of social justice, human rights, and equity, accompanied by equitable access to evidence-informed treatment and addressing the underlying determinants of health.

Ending mandatory minimums for drug offences in Canada

Cannabis is now legal for adult non-medical use in 11 US states, but the details of how this works in practice are not widely understood. In this report, we explore how regulation compares across the states that have legalised and consider what lessons can be learnt for drug policy reform in future – especially how it can deliver better outcomes for public health and social justice.

Altered States: Cannabis regulation in the US

Learn more about our joint work with the Global Partnership on Drug Policies and Development (GPDPD)

The 5th Brandenburg Forum on Drugs and Development Policies took place from 11th to 13th February 2020, at the Schloss Lübbenau in Brandenburg, Germany. The Forum was organised within the framework of the Global Partnership on Drug Policies and Development (GPDPD).1 GPDPD is commissioned by the German Federal Ministry for Economic Cooperation and Development (BMZ) and implemented under political patronage of the German Federal Government’s Drug Commissioner. The meeting was co-hosted by the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH on behalf of BMZ, the Office of the German Federal Drug Commissioner, the Government of the Netherlands, the Norwegian Ministry of Health and Care Services, the Transnational Institute (TNI), and the International Drug Policy Consortium (IDPC).

The Forum brought together 48 participants (25 male and 23 female), including government representatives from Albania, Belgium, Canada, Colombia, Finland, Germany, Ghana, Mexico, Myanmar, the Netherlands, Norway, Pakistan, Peru, Portugal, Spain, Switzerland, and the United Kingdom – alongside representatives from the European Union (EU) and African Union (AU), as well as the International Narcotics Control Board (INCB), the Joint United Nations Programme on HIV/AIDS (UNAIDS), the Office of the United Nations High Commissioner for Human Rights (OHCHR), the United Nations Development Program (UNDP), and the United Nations Office on Drugs and Crime (UNODC). The meeting was also attended by several leading civil society and academic organisations, including representatives of people who use drugs.

In order to promote open dialogue, the discussions were conducted under ‘Chatham House Rule’ whereby the contents can be shared and used, but neither the identity nor the affiliation of any participants may be revealed.

5th Brandenburg Forum on Drugs and Development Policies report

Many countries in East and Southeast Asia have compulsory detention centres in the name of “treatment” for people who use drugs.

A Joint UN Statement on compulsory drug detention and rehabilitation centres in Asia and the Pacific in the context of COVID-19, signed by regional directors of 13 United Nations agencies from 16 regional offices in the region, calls on UN Member States to permanently close compulsory drug detention and rehabilitation centres and implement voluntary, evidence-informed and rights-based health and social services in the community.

The Statement was prepared by the UNAIDS regional office in partnership with OHCHR Asia as part of advocacy efforts to transition to voluntary community-based treatment and services for people who use drugs.

UN joint statement: Compulsory drug detention and rehabilitation centres in Asia and the Pacific in the context of COVID-19

Similar advocacy notes have been published with a focus on South East Asia, Europe and Latin America.

Prisons and detention facilities are high-risk environments for the spread of COVID-19, especially where they are overcrowded, cannot maintain adequate standards of physical distancing, sanitation and hygiene, and are limited in their capacity to ensure access to medical treatment.

In several countries around the world, the heightened risks of COVID-19 infection in prisons, combined with new restrictions on visits and communication with people outside prison, has intensified anxiety and tensions amongst people held within them, in some cases resulting in riots, escapes and violence.

Ensuring the safety and health of both prison staff, and people deprived of liberty, requires urgent action to reduce the risks and consequences of widespread COVID-19 infection.

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