The drug use landscape is dynamic and changing. Changes in public attitudes and laws towards drug use have occurred in an increasing number of countries. Global drug production and consumption are increasing as are the risks and harms to health, while new substances continue to emerge. This Series focuses on opioids, cannabinoids, stimulants, and new psychoactive substances. The Series authors review the evidence on the epidemiology of drug use and related harms and interventions (treatment and policies) to address them. They highlight issues that are likely to become increasingly important in the next decade.

The global drug problem: change but not progression

Strategies to reduce drug-related harm: responding to the evidence base


Louisa Degenhardt, Daniel Wolfe, Wayne Hall, Matthew Hickman, Judy Chang, Julie Bruneau, Michael Farrell, Paul Griffiths

Global patterns of opioid use and dependence: harms to populations, interventions, and future action


Louisa Degenhardt, Jason Grebely, Jack Stone, Matthew Hickman, Peter Vickerman, Brandon D L Marshall, Julie Bruneau, Frederick L Altice, Graeme Henderson, Afarin Rahimi-Movaghar, Sarah Larney

Public health implications of legalising the production and sale of cannabis for medicinal and recreational use


Wayne Hall, Daniel Stjepanović, Jonathan Caulkins, Michael Lynskey, Janni Leung, Gabrielle Campbell, Louisa Degenhardt

Responding to global stimulant use: challenges and opportunities


Michael Farrell, Natasha K Martin, Emily Stockings, Annick Bórquez, Javier A Cepeda, Louisa Degenhardt, Robert Ali, Lucy Thi Tran, Jürgen Rehm, Marta Torrens, Steve Shoptaw, Rebecca McKetin

New psychoactive substances: challenges for drug surveillance, control, and public health responses


Amy Peacock, Raimondo Bruno, Natasa Gisev, Louisa Degenhardt, Wayne Hall, Roumen Sedefov, Jason White, Kevin V Thomas, Michael Farrell, Paul Griffiths

Rebecca McKetin: global leader in methamphetamine research

The Lancet: Drug use series

This document is a compilation of better practices for the use of ayahuasca in non-Amazonian contexts. It covers individual, collective and legal responsibilities.

Ayahuasca is a decoction of different plants with a long history of use in the Amazon, where very old records of its use by native peoples exist. In the last few decades the use of this preparation has been expanding beyond its original context, now reaching many countries outside of the Amazon. One of the consequences of this expansion has been the appearance of new forms of use, which in turn have brought new therapeutic potentials as well as new risks.

It is evident that native communities of the Amazon and other peoples with a long history of ayahuasca use do not need a guide like this. Ayahuasca is part of their cultural and spiritual systems, which include safe ways of working with the effects of the preparation, as well as methods for integrating them into the everyday life of the community. On the contrary, this document is aimed at people who organize or participate in ayahuasca sessions outside of Amazonian contexts.

The objective of this guide is to present a series of minimum safety standards to support ayahuasca sessions in non-Amazonian contexts, as well as to inform potential participants of ayhausca sessions, so that they can better assess the safety and responsibility of the sessions in which they are going to participate, and thus make informed choices.

Towards better ayahuasca practices: A guide for organizers and participants

The Eurasian Harm Reduction Association (EHRA), as part of the implementation of the EECA Regional Platform for Communication and Coordination project supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria, has collected information concerning the availability of HIV and TB-related technical support (TS) for NGOs and CBOs in the EECA region.

All of the information presented in this document was provided, and confirmed, by the organizations listed below and was collected between May and August 2019.

Availability on HIV and TB-related technical support in the EECA region

By the British Columbia Centre on Substance Use

If you are reading this handbook, then you, or someone you know, may need help to deal with opioid use disorder – a situation where you need to keep using heroin, fentanyl, or similar opioids because you feel physically sick if you don’t have them. Taking more opioid drugs will stop the pain, but over time, your body may need more to get the same effect.

This handbook talks about opioid agonist treatment (OAT) – including buprenorphine/naloxone (brand name Suboxone®), methadone (brand name MethadoseTM or Metadol-D®), slow-release oral morphine (brand name Kadian®), and injectable treatment options (hydromorphone or Dilaudid® and diacetylmorphine or prescription heroin). These medications are also opioids, but they provide stable, long-acting relief from withdrawal and cravings. They replace the street heroin or fentanyl that you or someone you know are taking with a regular dose of a medication that allows for a stable life.

A lot has changed since the first edition of this handbook came out in early 2017, so it has been updated and re-written to share all the new things we know about treating opioid use disorder and saving lives. In the past, methadone was the main medication prescribed to people with opioid use disorder (sometimes called opioid dependence or opioid addiction). However, harsh government policies existed that made it hard for doctors to prescribe it. Now, more OAT options are being scaled up and barriers to access are being removed (including barriers to accessing different types of methadone). Policies are changing to increase people’s access to these medications. More people can make choices in their drug use that don’t involve using street drugs that might be contaminated.

Throughout this handbook, OAT options may be referred to by their brand names (for example, Suboxone) or their generic name (for example, methadone), depending on which name is more commonly known. However, even though we might use specific brand names in this guide, we do not represent or endorse any pharmaceutical companies.

This resource sets out to answer some of the common questions that people have when they need help in dealing with opioid use or opioid dependence.

Opioids: A survivor's guide

Safety First: Real Drug Education for Teens

 is the nation’s first harm reduction-based drug education curriculum for high school teachers. The free curriculum consists of 15 lessons that can be completed in a 45- to 50-minute class period.

Each lesson is designed to engage students through interactive activities such as discussions and role-playing. The curriculum is aligned with National Health Education Standards as well as Common Core State Standards so it can be easily integrated into Health classes.

The Curriculum is available on the website of the Drug Policy Alliance.

1. What is a Drug?
Students examine their own beliefs about alcohol and other drugs by answering the question: “What is a drug?” They take a pre-class survey to assess their prior knowledge and skills.

2. Introduction to Harm Reduction
Students learn about harm reduction concepts and strategies, including abstinence, that will empower them to make healthy choices for themselves and others regarding substance use.

3. How Drugs Work
Students learn how drugs affect the body and the brain, and specifically the teenage brain. They further discuss the factors that contribute to physical dependence.

4. Drug Classes: Stimulants
Students learn about stimulant drugs, their effects, benefits and risks. They further discuss the harm reduction concepts particularly related to prescription stimulant drugs.

5. Drug Classes: Cannabis – Part 1
Students play “Fact or Fiction About Cannabis” activity to see how much they know about the drug. They work in groups to research statements about cannabis, and use the CRAAP test to evaluate their sources’ credibility.

6. Drug Classes: Cannabis – Part 2
Students learn about cannabis’ effects, potential risks and benefits, including the effects of edible cannabis. Student then share and evaluate each other’s research on statements about cannabis.

7. Vaping & E-Cigarettes
Students explore the inner workings of e-cigarettes in-depth. They conduct research to examine the health effects of vaping, using the CRAAP test to evaluate their sources’ credibility.

8. Drug Classes: Alcohol & Other Depressants
Students learn about the effects of depressant drugs with a focus on alcohol. They learn how to perform the recovery position and give advice about how to reduce alcohol-related harms using practice scenarios.

9. Drug Classes: Prescription & Other Opioids
Students take an in-depth look at opioid drugs, their effects, risks, and benefits. They will learn how to recognize the signs of an opioid overdose and respond appropriately.

10. Drug Classes: Psychedelics
Students learn about psychedelic drugs, their effects, risks and benefits. They reflect on drug references in the media, specifically music, and how they influence teens. They also complete an activity that demonstrates the risks of illicit drug adulteration, and learn about the harm reduction practice of drug checking.

11. Mental Health and Coping
Students discuss how drug use can be a mechanism for dealing with mental health issues, specifically stress and anxiety. They learn how to locate resources that can help them cope.

12. Understanding Zero Tolerance
Students learn about zero-tolerance drug policies and their impact on students’ health and well-being. Students also learn about restorative justice practices.

13. Health & Policy
Students learn about drug policies and America’s war on drugs. They discuss how drug policies impact health, and learn ways in which harm reduction-based drug policies can help improve health outcomes.

14. Looking Back, Looking Forward
Students review what they have learned by playing the “Just The Facts” Kahoot game. Students reflect on what they have learned by writing a letter to their future selves about drugs and drug use.

15. A Healthy Future
Students discuss their advocacy assignment from Lesson 12. They take a posttest to assess their understanding of the content covered in the curriculum.

Safety first: Real drug education for teens

Hoo Yew Wah, a Malaysian national of Chinese ethnicity, has been on death row in Bentong prison, Pahang State, since 2011. Arrested in 2005 at the age of 20 for possession of 188.35 grams of methamphetamine, he was convicted on the basis of a statement he made at the time of arrest in Mandarin, his mother tongue, without a lawyer present and which the police wrote down in Malay. He later contested this statement in court, noting inaccuracies and adding that the police had tortured him by breaking his finger during interrogation and threatened to beat his girlfriend to make him sign it. With the judge dismissing these claims without further investigation, Hoo Yew Wah was automatically presumed to be guilty of the charge of trafficking drugs and was sentenced to death, the only possible punishment for this offence. His judicial appeals failed and his petition for a pardon has been pending since 2014. Like all others on death row, he is not at imminent risk of execution since the government has established a nation-wide moratorium on executions in July 2018 – but remains in limbo.

Hoo Yew Wah’s case illustrates the many violations of international human rights law and standards associated with the use of the death penalty in Malaysia, as documented in this report. These include lack of adequate and timely legal assistance, concerns of torture and other ill-treatment during police interrogation, the reliance on statements or information obtained without a lawyer present, the presumption of guilt in cases of drug trafficking, secretive pardon processes and the extensive use of this punishment for offences that do not meet the threshold of the “most serious crimes” or intentional killing to which the death penalty must be restricted under international law.

The scale of the problem is significant. As of February 2019, 1,281 people were reported to be on death row in Malaysia, including 568 (44%) foreign nationals. Of the total, 73% have been convicted of drug trafficking. This figure rises to a staggering 95% in the cases of women. Some ethnic minorities are overrepresented on death row, while the limited available information indicates that a large proportion of those on death row are people with less advantaged socio-economic backgrounds.

Fatally flawed: Why Malaysia must abolish the death penalty

This report, issued jointly by United Nations Assistance Mission to Afghanistan (UNAMA)1 and the Office of the United Nations High Commissioner for Human Rights (OHCHR),2 examines the scope of civilian harm resulting from the United States Forces – Afghanistan (USFOR-A) 3 airstrikes on alleged drug facilities located in Bakwa district, Farah province, and parts of the bordering Delaram district, Nimroz province on 5 May 2019. The report sets out that drug facilities and associated workers may not be lawfully made the target of attack based on their possible economic or financial contribution to the war effort of a party to a conflict.

On 5 May 2019, USFOR-A carried out a series of airstrikes targeting more than 60 sites that they had identified as drug production facilities, often referred to as “drug labs”,4 across multiple areas in Bakwa district, Farah province, and parts of the bordering Delaram district, Nimroz province. Credible allegations soon emerged of significant civilian harm caused. Although airstrikes on reported drug labs had taken place before, this was the first time that UNAMA had received reports of a high number of civilian casualties resulting from such an operation.

UNAMA conducted extensive fact-finding into the 5 May incident in Bakwa district over a period of four months. After weeks of careful preparation, on 26 June, UNAMA undertook a fact-finding mission, together with the Afghanistan Independent Human Rights Commission (AIHRC), to Bakwa district, which is under Taliban control. Given the remoteness of the location and the lack of a permanent United Nations, governmental or military presence in the area, UNAMA considered the mission to be of significant value to the fact-finding process. The delegation conducted face-to-face interviews with individuals who were impacted by the airstrikes and saw some of the impact sites. The Government of Afghanistan, the Taliban, and NATO Resolute Support Mission all provided various means of support to the mission.

Afghanistan: Protection on civilians in armed conflict

Civil Society Forum on Drugs (CSFD) is an expert group of the European Commission. Its members are selected by the Commission for a three-years mandate based on their competences, knowledge and expertise. Forum has been established to provide a space for a dialogue in order to support European drug policy design and implementation through practical advice provided by the civil society to the European Commission.

This publication is a result of the efforts of the CSFD’s Working Group on the EU Action Plan on Drugs, whose work – among others – aims to promote the EU Drug Strategy and Action Plan on Drugs among the European civil society organisations and policy-makers working in the field of drug policy and improve its implementation in the EU member states. Adopted by all EU member states, the Action Plan on Drugs is a document of remarkably progressive content and notably meaningful civil society involvement in its preparation.

Civil society organisations (CSOs) play a pivotal role in the delivery of various services, also within the drug policy area. They are also important actors in policy-making processes, advocating for the rights of people who use drugs (PWUD). CSOs, having the first-hand experience in working with PWUD, can provide invaluable input in order to make new policies informed by the knowledge otherwise not available for the decisionmakers. CSOs involvement in decision-making is also in line with the contemporary principles of good governance, where processes should be participatory, transparent and accountable. Notwithstanding, the experience shows that often CSOs are left out if it comes to policy design processes. To address this issue, we present four case studies of good practices of CSOs involvement in policymaking.

Civil society actions at the national level: Good practices in the drug policy field: Study of the Civil Society Forum on Drugs

By prohibiting drugs that are increasingly in demand, an extremely lucrative market has been gifted to organised crime.This briefing exposes the exploitation of young and vulnerable people as a direct result of drug prohibition, through the ‘county lines’ drug supply phenomenon. In regulated markets for legal products, which are bound by strict legal frameworks, there is significantly less opportunity to exploit young and vulnerable people. Legal regulation would allow for governments to regain control over the drugs market, and help force unregulated suppliers out of the business.

‘County lines’ is the term used to describe a drug supply network set up by organised crime groups (OCGs) between urban and suburban locations, typically rural and coastal towns and villages. The practice usually involves OCGs coercing children and vulnerable adults into acting as drug runners and dealers often using intimidation, violence and sexual exploitation. Many victims have mental health issues, learning difficulties, come from broken homes, have chaotic and traumatic lives, or have been reported as missing.

The National Crime Agency (NCA) estimates there are over 2000 county lines, with activity in at least 88% of police force areas. It has become a key feature of UK heroin and crack cocaine markets. The NCA recognises the vulnerable individuals involved in county lines are often victims being trafficked into remote markets to work, while others are effectively imprisoned in their own homes when OCGs commandeer them to use as a local base for dealing (so-called ‘cuckooing’). The Children’s Commissioner estimates that 46,000 children are involved in gang activity in England, and 4,000 teenagers in London alone are being exploited by county lines networks each year. Many of these children are drawn into gangs for protection, a sense of belonging and identity, or social status. For some, the drug trade offers far more income than any available conventional work.

‘County lines’ drug supply: Exploiting the young and vulnerable; Enriching organised crime

Between January and March 2018, a survey was carried out by the European Centre for Disease Prevention and Control (ECDC) to collect data to monitor implementation of the 2004 Dublin Declaration [1]. The monitoring questionnaire was disseminated to the 53 countries that are part of the WHO European Region, plus Kosovo1 and Liechtenstein via an online survey. National health authorities were requested to complete the Dublin Declaration survey between mid-February and the end of March 2018.

ECDC further harmonised data collection with UNAIDS and WHO’s Regional Office for Europe to ensure compatibility and reduce burden on health authorities. ECDC took responsibility for collecting a core set of Global AIDS Monitoring (GAM) indicators through Dublin Declaration implementation monitoring for EU/EEA Member States, meaning there was no separate GAM reporting for EU/EEA Member States. Non-EU/EEA Member States continued to report to GAM through UNAIDS and were therefore asked to complete a shortened ECDC Dublin Declaration questionnaire, with any GAM questions removed. The data collected through these processes were then combined and included in the analysis for this report.

In May 2018, the information reported by each country was cleaned up and returned for validation. Subsequent notifications of corrections were used to update the information reported. Validation of data collected through the GAM process was conducted by UNAIDS.

The survey contained specific questions in relation to the HIV epidemic among people who inject drugs (PWID) in addition to questions relating to current national prevention interventions, policies and barriers to the public health response to the epidemic.

HIV and people who inject drugs: Monitoring implementation of the Dublin Declaration on partnership to fight HIV/AIDS in Europe and Central Asia: 2018 progress report 

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

The 4th Brandenburg Forum on Drugs and Development Policies took place from 11th to 13th February 2019 in Liebenberg, Germany. The Forum was organised within the framework of the Global Partnership on Drug Policies and Development (GPDPD). 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 Drug Commissioner of the Federal Government of Germany, the Ministry of Foreign Affairs of the Netherlands, the Norwegian Ministry of Health and Care Services, the International Drug Policy Consortium (IDPC) and the Transnational Institute (TNI).

The Forum brought together 47 expert participants, including government representatives from Austria, Brazil, Canada, Colombia, France, Germany, Jamaica, Mexico, the Netherlands, Nigeria, Norway, Peru, Portugal, Romania, Spain, Sudan, Switzerland, Thailand and the United Kingdom. The Forum was also attended by representatives from the United Nations Office on Drugs and Crime (UNODC), the International Narcotics Control Board (INCB), the Joint United Nations Programme on HIV/AIDS (UNAIDS), the United Nations Development Programme (UNDP), and the Council of the European Union, as well as several leading civil society organisations and representatives of the affected populations. 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.

4th Brandenburg Forum on Drugs and Development Policies - Looking ahead to the next decade of drug policies

Switzerland’s current drug policy, founded on the 4 pillars, dates from the 1990s. In hindsight, it can be considered a success. Nevertheless, things have changed since then. Countries have adopted new legal frameworks and it is time for Switzerland to draw up a state of affairs report and to outline the drug policy that it wishes to promote and lead in the next ten years. The basis for this report lies in the request of the author of the Postulate (‘Postulat Rechsteiner’), to the Swiss government to draw up a state of affairs review of the country’s drug policy, taking into account the current developments at the national and international levels.

This report focuses on the developments that have taken place internationally and presents the current state of affairs regarding a certain number of countries’ drug policies, according to specific indicators. It complements the reports that the Federal Commission on Questions related to Addiction (CFLA) is producing on the adequacy of the Drug Law (LStup; RS812.121) and the relevant decrees, in light of scientific and social development of the past 10 years. Ultimately, this report will form part of the material which the Federal Council will rely upon to produce a report to Parliament by the end of 2019 on the perspectives of the Swiss drug policy for the next ten years.

The first question that needs to be addressed when examining the developments of the international drug control system is what exactly the international drug control system is. For the purposes of this paper, it is considered to mean the international bodies, mandated to specifically examine drug-related questions: the UN Office on Drugs and Crime (UNODC); the Commission on Narcotic Drugs (CND); and the International Narcotics Control Board (INCB). However, these bodies are not the only ones acting in the field of drugs in the international arena, as will be seen throughout this study. Other (health, human rights and other actors) are starting to address drug-related questions more closely, from their respective points of view.

Nevertheless, UNODC, INCB and CND remain the entities that are consistently referred to when discussing the international drug control regime. In fact, the three Drug Control Conventions (1961, 1971 and 1988) are considered the cornerstone of the international drug control system (Bewley-Taylor and Jelsma, 2012). Naturally, the system wouldn’t exist without State governments interacting with the international drug control system so they can also be considered part of the wider system.

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