Harm reduction is often a response to crisis. A public health approach which emphasizes reducing the negative effects of drug use rather than eliminating drug use or attaining abstinence (Riley et al., 1999), harm reduction has been adopted around the world to mitigate the effects of epidemics and emergencies, such as the HIV/AIDS pandemic and hepatitis outbreaks, on people who use drugs (PWUD) and the broader community (Des Jarlais & Friedman, 1993; Marlatt, 1998; O'Hare, 2007). Throughout harm reduction's long history, PWUD have effectively improved their lives in the face of public health crises. PWUD are no strangers to managing risk of infection let alone the risks of withdrawal, arrest, stigma, or marginalization. One of the ways this is achieved is through creating intimate connections based on care, trust, and respect amongst PWUD and between PWUD and harm reduction providers.

In the face of the current crisis caused by the global COVID-19 pandemic, PWUD and harm reductionists are now faced with new challenges. A significant consequence of the pandemic is the way that individuals, communities, and organisations have been forced to rethink how they interact with each other. Formal and informal interactions are influenced by the guidelines issued by public health agencies to limit the spread of COVID-19, such as social distancing, handwashing, and masking. These guidelines, however, may be complicating public health efforts that directly affect PWUD.

In this Viewpoint, we discuss the effects of COVID-19 guidelines on the practice of harm reduction in the United States. We argue that there are several contradictions between the guidelines for curbing the transmission of COVID-19 and the highly physically, socially, and emotionally intimate nature of drug use, particularly injection drug use. These intertwined forms of intimacy often enable people to survive physically and mentally through marginalization associated with their drug use. With public health agencies and harm reduction organisations recommending social distancing practices, such as limiting contact between peers who use drugs and other risk reduction practices, PWUD are now asked to choose between avoidance of COVID-19 and the intimacies of drug use that contribute to their survival. Moreover, we argue that the guidelines necessitate a reconfiguration of the intimacy and care so central to harm reduction, which may impede organisations from still meeting the health and social needs of the PWUD that they serve.

Care during COVID-19: Drug use, harm reduction, and intimacy during a global pandemic

In Canada, people who use drugs are dying in record numbers. Between January 2016 and September 2019, more than 14,700 people died of apparent opioid overdoses in this country. In Ontario alone, more than 1450 people died from opioid-related causes in 2018. The overwhelming majority of these overdoses and deaths involve fentanyl or its analogues, a potent drug that is now present in many street drugs. Never before have we experienced an overdose crisis of this magnitude, which is only exacerbated by the criminalization of personal drug possession.

 (“the Good Samaritan law”) was passed as a partial response to this ongoing crisis. The law amended the 

 to give immunity from prosecution for the offence of simple possession of a controlled substance to anyone who calls 911 to report an overdose as well as to anyone who is on the scene when emergency services arrive.

In 2019, with the support of a research grant from the Law Foundation of Ontario, the Canadian HIV/AIDS Legal Network (HIV Legal Network) embarked upon a research study in Ontario to evaluate familiarity with the Good Samaritan law, and what people who have experience with drug use believe to be true about this law. In the midst of the ongoing overdose crisis in Ontario and across Canada, it is critical to understand people’s awareness of this law, how (or whether) they interact with it, and how they experience its real-world impacts.

The Good Samaritan Drug Overdose Act: The good, the bad and the ineffective

While the overall trend in civil society engagement around the drugs issue at the UN Commission on Narcotic Drugs (CND) has been towards greater inclusion and participation in recent years, there have been some troubling developments as of late: members of civil society have been excluded from the meetings leading to one of the most politically controversial and consequential votes at the CND in the last years, namely the deliberations around the Expert Committee on Drug Dependence (ECDD) of the World Health Organization (WHO) recommendations on rescheduling cannabis. This has been accomplished through the use of a newly-branded format of meetings, so-called ‘topical meetings’, the first of which was held in June 2020. The only difference in this new format of meetings from the usual ‘intersessional’ format seems to be that civil society has been excluded.

In following this path, the CND has departed from its own recent practices and political commitments regarding civil society participation. This concerning development is already resulting in a less fruitful and genuine debate, and must be remedied for the upcoming meetings set for August and September.

Closing doors: The exclusion of civil society at the ‘topical meetings’ of the UN Commission on Narcotic Drugs

The 63rd session of the Commission on Narcotic Drugs (CND or Commission) took place in Vienna between 4 and 6 March 2020. Incredible as it now seems, held during the early phases of the current global health pandemic, only the precautionary absence of a few full delegations and warnings regarding healthcare counter measures made it feel any different from previous ‘normal’ sessions. Indeed, since this year’s meeting followed on from the Commission’s 2019 Ministerial Segment and multilateral agreement on the associated Ministerial Declaration expectations were relatively low. Indicative of this was the tabling of only five resolutions, around half the number seen in previous years. Nonetheless, as has been increasingly the case the twin issues of complexity and tension were identifiable throughout the week. Put simply, with intricacy, fluidity and dynamism continuing to characterize illicit drug markets has come growing variations in national policy approaches designed to deal with them and attendant inter-state and state-UN system tensions at the international level.

Implicit and explicit manifestations of this reality were evident from the opening session. For example, the CND Chair, Ambassador Mansoor Ahmed Khan, spoke of the ‘need to understand each other’s perspective’. While the new UNODC Executive Director, Ms. Ghada Fathi Waly, deliberately highlighted the mythical ‘Vienna spirit of consensus’; something she evidently found ‘quite inspiring’ upon arrival in the Austrian capital. Yet, amidst some welcome areas of agreement, including notably access to controlled substances for medical use, the revised Annual Report Questionnaire and – at a rhetorical level at least – support for the Sustainable Development Goals, increasing divergence was impossible to hide. Within the General Debate some countries still chose to deploy the language of a ‘drug free world’ while others were more pragmatic in their support for drug policies genuinely underpinned by a human rights and public health-based approach. Indeed, while not unique to Vienna, interpretative variation around the concept of human rights remains.

This could be seen both within the Plenary and the Committee of the Whole (CoW), where resolutions are negotiated, in relation to differing views on the Chief Executive Board’s 2018 UN System Common Position on Drug Policy and the work of the associated UN System Coordination Task Team. While not alone, the Russian Federation was arguably most vocal and active in opposing supportive references to this new initiative to improve system-wide coherence, including in relation to cooperation with human rights bodies and better data collection and analysis. And maintaining its role as the most vociferous supporter of the shape of the extant control system, the Russian Federation was also especially active in challenging the recommendations of the WHO’s Expert Committee on Drug Dependence (ECDD) regarding cannabis classification; an issue that played out at various points across the session and due to the hard fought second postponement of a vote by Commission members has taken on the mantle of an almost ‘too hot to handle’ issue. Although largely overshadowed by the debates around the ECDD’s recommendations, tensions around legally regulated markets for non-medical adult use also remained, with the INCB legitimately flagging it up as an ongoing issue of concern. This is particularly so considering declared and potential legislative shifts in Luxembourg and New Zealand respectively.

With engagement spanning a range of issue areas, civil society was once again highly visible and active at this year’s CND. As members of country delegations as well as NGO delegations in their own right, representatives were involved in the organisation of side events, often in collaboration with member states and UN agencies, and delivered several statements within the plenary. Beyond this, the now formalized ‘informal dialogues’ with UN bodies continued. Although she was unfortunately unable to attend due to illness, these included Executive summary 2 The 2020 CND Report of Proceedings dialogues with the UNODC Executive Director, the INCB President – and for the first time – representatives of the WHO.

While any assessment of the outcomes of the 63rd session must now be re-framed within the context of COVID-19, it is fair to conclude that, with the inescapable sands of divergence within its gears, the CND’s consensus driven machinery continues to grind away, but in an increasingly laboured and shuddering fashion. It is true that this year, as at recent sessions, the system has been able to tolerate divergence in high-level views on the quest for a ‘drug free world’ versus a preference for harm reduction and market management approaches, and even to a certain extent endure diverging views on some aspects of human rights. But, as events in March revealed, increasing endeavour is now required to keep the wheels turning as intended.

The 2019 Commission on Narcotic Drugs and its Ministerial Segment: Report of Proceedings

IDPC report of proceedings: The 2018 Commission on Narcotic Drugs

IDPC report of proceedings: The 2017 Commission on Narcotic Drugs

IDPC report of proceedings: The 2016 Commission on Narcotic Drugs and its special segment on preparations for the UNGASS on the world drug problem

IDPC report of proceedings: The 2015 Commission on Narcotic Drugs and its special segment on preparations for the UNGASS on the world drug problem

IDPC report of proceedings: The 2014 Commission on Narcotic Drugs and its High Level Segment

IDPC report of proceedings: The 2013 Commission on Narcotic Drugs

IDPC report of proceedings: The 2012 Commission on Narcotic Drugs

IDPC report of proceedings: The 2011 Commission on Narcotic Drugs

IDPC report of proceedings: The 2010 Commission on Narcotic Drugs

IDPC report of proceedings: The 2009 Commission on Narcotic Drugs

IDPC report of proceedings: The 2008 Commission on Narcotic Drugs

IDPC report of proceedings: The 2007 Commission on Narcotic Drugs

The 2020 Commission on Narcotic Drugs - Report of Proceedings

This technical brief describes how interventions for people who use drugs are to be incorporated into funding requests to the Global Fund. The Global Fund is the major source of international funding in low-and middle-income countries for harm reduction, and it supports evidence-based interventions aimed at ensuring access to HIV prevention, treatment, care, and support for all key populations, including people who use drugs.

According to Global Fund policy, lower-middle and upper-middle income countries applying for funding must focus 100% of budget on key populations and 50% of budget on underserved populations, as well as on the highest-impact interventions. Low-income countries are also strongly encouraged to target resources to those at highest risk.

It is therefore strongly recommended that all countries with evidence of HIV transmission among people who use drugs include in their proposals harm reduction programs for people who use drugs, both in the general community and in prison and other closed settings.

The harm reduction interventions outlined in this brief include those recommended in the World Health Organization’s (WHO) Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations (2016). Those guidelines expanded upon the ones issued by WHO, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations Office on Drugs and Crime (UNODC) in the WHO, UNAIDS, UNODC Technical Guide for Countries to Set Targets for Universal Access to HIV Prevention, Treatment and Care for Injecting Drug Users –2012 Revision.

This technical brief is also aligned with the programmatic guidance in Implementing Comprehensive HIV and HCV Programmes with People Who Inject Drugs: Practical Guidance for Collaborative Interventions (the “IDUIT”, 2017), which combines the experience and expertise of United Nations agencies, other international partners, and organizations and networks of people who use drugs.

Technical brief: Harm reduction for people who use drugs

This technical brief describes how HIV and TB interventions for people in prison and other closed settings can be incorporated into funding requests to the Global Fund. The Global Fund supports evidence-and rights-based interventions aimed at ensuring access to HIV and TB prevention, treatment, care, and support for key populations, including people in prison.

Global Fund resources should be used to fund interventions that are in line with internationally agreed standards and technical guidance and have a significant impact on the HIV and TB epidemics in a country. Global Fund policy requires upper-middle income countries to focus 100% of their funding on programs benefiting key and vulnerable populations, lower middle income countries must demonstrate that 50% of funding is focused on the same. Low-income countries are also strongly encouraged to target resources to those at highest risk. Global Fund resources can also be used to advocate for laws and policies that enable an effective human-rights-based HIV and TB response and the removal of policies and laws that present obstacles to this.

HIV and TB are leading causes of morbidity and mortality in prisons, and a significant public health issue affecting all regions of the world. The UNAIDS Strategy 2016-2021, the World Health Organization (WHO) Global Health Sector Strategy on HIV 2016-2021, and the WHO End TB strategy identify people in prison as a key population whose needs must be addressed to achieve the targets for ending AIDS and TB.

Technical brief: Addressing HIV and TB in prisons, pre-trial detention and other closed settings

By T. Santini, A. Klein, Stella, l’amie de Maimie, and Butterfly Asian and Migrant Sex Worker Support Network

This document was created to contribute to sex worker organizations’ reflections about, and their capacity to evaluate and use, the language of harm reduction as it relates to sex work, particularly when interfacing with policy makers, funders, media, researchers and other actors. Currently, harm reduction language is used more and more frequently by people outside of criminalized and affected communities (e.g. politicians, lawyers/judges, academics, service providers, prohibitionists, etc.). As a result, narrow and problematic representations of harm reduction are getting more air time and visibility.

Using the word “harm” in discussions around sex work may suggest that sex work itself is harmful. As a result, people who seek to eradicate sex work and sex workers may try to co-opt the language of harm reduction. Also, these days, public conversations around criminalized activity, such as drug use or sex work, often suggest that policy options are limited to either prohibition through criminal law enforcement or harm reduction. Oversimplifying responses to sex work in this way excludes other frameworks like labour rights and other human rights from policy discussions. At the same time, harm reduction has been a rallying point across many criminalized communities, particularly around responses to the overdose crisis.

It is important to use harm reduction language in the context of sex work in a way that is nuanced, clear and remains in solidarity with broader communities of people who use drugs. This document:

• summarizes basic features of harm reduction – as identified and articulated by Stella and Butterfly;
• describes how these basic features can be erased, distorted or overshadowed when public harm reduction conversations extend outside of criminalized or marginalized communities and to new issues, highlighting how sex workers’ rights are ignored and violated because of flawed understandings of harm reduction;
• serves as a guide for identifying discourse, programs and policies that use harm reduction language yet run counter to basic harm reduction principles, and for responding to such discourse, programs and policies; and
• compiles research on existing harm reduction discourse, particularly as it relates to sex work (e.g. government sources, NGOs, academic, media).

Sex work and harm reduction discourse

By CELS, Dejusticia, Equis: Justice for Women, the Institute for Judicial Investigations at the Autonomous University of Chiapas, IDPC, the Prison Ombudsman’s National Office in Argentina, Instituto Pro Bono & WOLA

COVID-19 has shed light on the need for governments across the Americas to take steps to address prison overcrowding, given the high risk of deadly outbreaks in places of detention where social distancing and other sanitary measures are difficult to achieve. In this context, some governments have promoted decarceration measures and alternatives to incarceration including house arrest—that is, court-ordered detention of a person in their place of residence—as a way to reduce overcrowding.

When implemented effectively, house arrest is meant to be a less restrictive form of confinement and to help those deprived of liberty reintegrate back into their communities and avoid landing back in prison. But as detailed in a new report, 

Imprisoned at Home: Women under House Arrest in Latin America

, imposing strict house arrest without guaranteeing fundamental human rights, particularly for people in low-income situations, can make house arrest just as punitive as incarceration.

House arrest should not simply replace one form of incarceration for another.

 Governments across the Americas should guarantee that people subjected to this measure have their rights protected. If you’re placed under house arrest but aren’t given the option to remain employed or seek emergency medical help when you need it, those are unacceptable conditions. 

Authorities must ensure that those under house arrest receive the support they need to provide for their families and reintegrate into their communities.

The study focuses on the impact of house arrest on women across the Americas, given that, over the past two decades, the population of women deprived of liberty in this region has grown exponentially and the vast majority of these women come from situations of poverty and social exclusion, lending greater urgency to the need for alternatives to incarceration with a special focus on women. The report is the result of a collaboration between human rights and advocacy groups including the Center for Legal and Social Studies (

, CELS), Dejusticia, Equis: Justice for Women, the Institute for Judicial Investigations at the Autonomous University of Chiapas (

Instituto de Investigaciones Jurídicas de la Universidad Autónoma de Chiapas

), the International Drug Policy Consortium (IDPC), the Prison Ombudsman’s National Office in Argentina, Instituto Pro Bono, and the Washington Office on Latin America (WOLA).

Testimony by women held under house arrest sheds light on how some of the challenges associated with home detention often remain hidden. When house arrest is implemented without accounting for an individual’s right to access education, work, healthcare, or food, it is worse than being in prison, some women said. Nora Laura Calandra, a formerly incarcerated woman from Argentina who now works as an advocate, described a case in which a woman who had gone into labor was told she couldn’t leave her house and go to the hospital without first receiving court authorization. Others noted that at least in prison, they were guaranteed something to eat.

If house arrest is implemented in overly harsh conditions, it’s counterproductive.

 For house arrest to be effective, it needs to be implemented in such a way that women can meet their basic needs, improve their living situation and resolve the underlying problems that led them to come into contact with the criminal justice system.

The report examines house arrest legislation in seven countries across the Americas—Argentina, Brazil, Colombia, the Dominican Republic, Ecuador, Mexico, and Peru—and includes case studies on the challenges for implementing house arrest effectively. Especially amid the COVID-19 pandemic, states are facing the critical task of reducing the population in prison—this will likely necessitate increasing the number of people under house arrest. But if authorities do not consider combining home detention with educational or job-training programs, evidence-based drug treatment programs, or other forms of community support, this severely limits the benefits of house arrest over incarceration, the report states.

More often than not, across the Americas house arrest is being used to harshly punish people when what’s needed are policies that actually protect the health and welfare of communities.

 Should COVID-19 make house arrest a more popular option as states look for ways to reduce prison overcrowding, it’s critical that authorities implement house arrest in a humane, rights-respecting way.

Imprisoned at home: Women under house arrest in Latin America

The Human Rights Council, in its resolution 42/22, requested "the Working Group to prepare, as suggested by the Working Group in its report submitted to the Human Rights Council at its thirtieth session, 

a study on arbitrary detention relating to drug policies

 to be submitted to the Council at its forty-seventh session, and to bring the report to the attention of the Commission on Narcotic Drugs as the policymaking body of the United Nations with prime responsibility for drug-control matters". The document below is one of IDPC's submissions to the Call released by the UN WGAD.

A different submission, in Spanish, submitted with Equis Justicia para las Mujeres, el Instituto de Investigaciones Jurídicas de la Universidad Autónoma de Chiapas, la Oficina de Washington para América Latina, y el Centro de estudios de Derecho, justicia y sociedad (Dejusticia), is available here.

The International Drug Policy Consortium (IDPC, www.idpc.net) welcomes the opportunity to provide a submission to the United Nations Working Group on Arbitrary Detention (the Working Group) concerning cases of arbitrary detention as they relate to drug policies. This submission outlines the main global trends concerning arbitrary detention and connected human rights violations carried out in the name of the drug policies implemented by UN member states.

We respectfully urge the Working Group to include the following issues in their study:

The criminalisation of drug use and drug possession for personal use remains a key driver of arrests and incarceration worldwide, with an estimated 470,000 individuals in prison for drug use only. Detention for drug possession or use is inherently arbitrary, as it is a manifestly inappropriate response to drug use and drug dependence, causes disproportionate harm, and is applied in a fundamentally discriminatory way, targeting certain populations on the basis of gender, race, ethnic origin and socio-economic status.

The disproportionate criminal punishment of drug offences. Over 1.7 million people are in prison worldwide for drug trafficking offences. Mandatory pre-trial detention, minimum mandatory prison terms equal to those envisaged for serious and violent crimes, the wholesale exclusion of drug offenders from prison benefits, and legal regimes that do not allow for the consideration of the personal circumstances of the alleged offender, result in disproportionate penalties.

The continued use of compulsory drug detention centres, in which over 400,000 people who use drugs are currently held worldwide. These centres constitute a manifest form of arbitrary detention, as they are not an appropriate response to drug use, in some cases operate without any form of fair trial protection, and they subject people who use drugs to serious ill-treatment, ranging from corporal punishment to the denial of appropriate care.

The proliferation of private drug ‘rehabilitation’ centres in which people who use drugs are interned against their will and subjected to “rehabilitation” that is not supported by evidence, and that can sometimes amount to torture or ill-treatment, or result in death. Some member states have facilitated this development by failing to ensure the provision of evidence-based services and programmes in response to drug use and dependence, by failing to monitor, regulate and evaluate the effectiveness of such private centres, and in some cases by sustaining them with public funding and legal frameworks that effectively mandate the completion of treatment or rehabilitation programmes for people arrested for drug use.

The impact of COVID-19 on detentions and drug control. A significant number of countries reduced their prison population to prevent the spread of the COVID-19 pandemic. While this is encouraging proof that it is possible to tackle the role of mass incarceration in drug policies, in some countries people charged with drug offences have been categorically excluded from these measures, showing the dehumanising power of punitive drug control.

For each of these issues, we provide an overview of the elements that lead to arbitrary deprivations of liberty, and we cite – where possible – good practice examples.

On arbitrary detention in drug policies - Submission to the UN Working Group on Arbitrary Detention

The need to change our language in relation to people who use drugs has become an increasing topic of discussion, but there is still a long way to go. People who use drugs are highly diverse and their relationship with drug use takes many different forms. Current prohibitionist approaches to drug use and ‘war on drugs’ rhetoric does little to encourage language that acknowledges this diversity. Instead, it promotes and maintains negative stereotypes that construct people who use drugs as morally flawed, inferior, unreliable, and dangerous.

Language does not stand still. It is dynamic, and the language and words we use are always changing. This makes it difficult to be absolute in the way we use language. Nevertheless, there are times when certain language and words used in relation to people who use drugs can be disempowering, divisive, confusing, or give offence.

Compiled by INPUD and the Asian Network of People who Use Drugs (ANPUD), this guide aims to explain our current position on the use of language and to provide clear advice on what is acceptable to us as communities of people who use drugs. We want to encourage all people to be thoughtful about the language and words they use, and have therefore provided a reference guide that identifies stigmatising language and gives non-judgemental, strengths-based, and respectful alternatives.

Words Matter! Language Statement & Reference Guide

By Mafalda Pardal, Tom Decorte, Melissa Bone, Òscar Parés & Julia Johansson

Cannabis Social Clubs (CSCs) are typically non-profit associations of adult cannabis users who collectively produce and distribute cannabis among themselves. Since the emergence of the model in Spain during the 1990s, other countries may have seen the appearance of CSCs (or CSC-like associations) but there is a dearth of knowledge about the phenomenon in Europe. The goals of this analysis are to: (1) map the presence of CSCs across the European Union; and (2) examine how CSCs are operating in such settings. The data included in our analysis derive from a 2018–19 survey. The 30-item questionnaire comprised questions about CSCs’ origins and relations with other stakeholders and organizations, the types of activities the CSCs developed and their views on cannabis regulation. The questionnaire was translated into all the official languages of the EU zone and sent via email to the participants. In total, 81 CSCs completed the questionnaire. Beyond Spain and Belgium, where the CSC presence has already been documented, we were able to identify CSCs in 11 other countries. The longest-running CSC in our sample was established in 1999, but most emerged in the past decade. The smallest CSC in our sample reported 6 registered members, whereas the largest counted a total of 5000 members. Most CSCs were cultivating or distributing cannabis to their members at the time of the survey, but engaged in other informative, entertainment and activist activities as well. The CSC model remains prohibited across the EU. CSC activists have thus by and large shaped the way CSCs operate, often adapting to domestic law particularities or law enforcement activities. In this article, we present and discuss the range of CSC practices from 13 different European countries, and what these represent for the consideration of the CSC model in current policy debates.

Mapping cannabis social clubs in Europe

The Community, Rights and Gender Strategic Initiative (CRG SI) is a three-year $15-million catalytic investment, aimed at strengthening the meaningful engagement of civil society and communities in Global Fund-related processes.

It works through three mutually reinforcing components: (1) A short-term technical assistance program, (2) long-term capacity strengthening of key and vulnerablepopulation networks and organizations, and (3) six regional communication and coordination platforms.

Publications