By Susan E. Collins, Heather S. Lonczak, Seema L. Clifasef

Drug users and dealers frequently cycle through the criminal justice system in what is sometimes referred to as a “revolving door.” Arrest, incarceration and prosecution have not deterred this recidivism. Seattle’s Law Enforcement Assisted Diversion (LEAD) program was established to divert these individuals to case management and supportive services instead of jail and prosecution. A nonrandomized controlled evaluation was conducted to examine LEAD effects on criminal recidivism (i.e., arrests, criminal charges). The sample included 318 people suspected of low-level drug and prostitution activity in downtown Seattle: 203 received LEAD, and 115 experienced the system-as-usual control condition. Analyses were conducted using logistic generalized estimating equation models over both the shorter term (i.e., six months prior and subsequent to evaluation entry) and longer term (i.e., two years prior to the LEAD start date through July 2014). Compared to controls, LEAD participants had 60% lower odds of arrest during the six months subsequent to evaluation entry; and both a 58% lower odds of arrest and 39% lower odds of being charged with a felony over the longer term. These statistically significant differences in arrests and felony charges for LEAD versus control participants indicated positive effects of the LEAD program on recidivism.

Seattle’s Law Enforcement Assisted Diversion (LEAD): Program effects on recidivism outcomes

By Jenna Mae L.Atun, Ronald U.Mendoza, Clarissa C.David, Radxeanel Peviluar N.Cossid, Cheryll Ruth R.Soriano.

As soon as President Rodrigo Duterte assumed office in 2016, the Philippine government launched a nationwide antidrug campaign based on enforcement-led anti-illegal drugs policies primarily implemented by the national police. This was followed by a spate of killings resulting from both acknowledged police operations and by unidentified assailants. This study assembles a victim-level dataset of drug-related killings covered by the media during the Philippine government’s antidrug campaign, and presents a spatial and temporal analysis of the killings.

The dataset covers information on 5021 people killed from May 10, 2016 to September 29, 2017. Data collected systematically through online search procedures and existing listings of media organizations detailing information about incidences of drug-related police operations and drug-related killings in 'vigilante-style' manner reveal patterns for who were being killed, where, and how.

Over half of the killings were due to acknowledged police operations, and the rest were targeted in so-called 'vigilante-style' killings. The first three months after Mr. Duterte was sworn in were the deadliest months. Those who were killed were mostly low-level drug suspects.

The analysis of temporal pattern reveals the scale of killings in the country, with rapid escalation starting in July 2016 and lasting throughout the rest of that year. Observable declines occurred during periods when the 'drug war' was suspended and operations were moved to a non-police enforcement unit and rose again when police were brought back into operations. The spatial analysis indicates a large concentration of deaths in the National Capital Region (40%) compared to the rest of the country with wide variations across cities and regions.

Overall, the Philippine 'drug war' exhibits similarities with violent wars on drugs waged in other countries such as Thailand, with heavily police-led interventions leading to fatalities in the thousands over a span of under two years. Findings of this study point to important policy adjustments that need to be made, including the role that local governments play in drug policy implementation, the disproportionate negative impacts of enforcement-led policies against drugs on urban and poor areas, the targeting of low-level suspected drug dealers and users, and the importance of proper data monitoring and transparency by the government to inform policy adjustments in the face of high costs to human life. We also discuss the importance of independent monitoring systems when the government reports conflicting information.

Click here to read the full article (restricted access).

The Philippines’ antidrug campaign: Spatial and temporal patterns of killings linked to drugs

Several drug policy researchers have noted that the concept of harm reduction could be applied to the field of drug policing in order to assess the negative consequences and potential benefits of policing in this area. However, the application of harm reduction principles to drug policing has only been realized to a limited extent in the current responses to drug use and markets. Accordingly, studies that empirically investigate already existing policing practices, which might be described as operating within such a harm reduction framework, are relatively scarce. In order to address this gap, this article provides an investigation of how policing of an open drug scene has been organized in Denmark since drug possession has been partly decriminalized, following the introduction of drug consumption rooms in Copenhagen. The policing of this open drug scene was investigated through document analysis, interviews, and observations with a patrolling police officer. The article argues that decriminalization has resulted in a shift in the “logics” of policing by enabling the production of an alternative “governable identity” for the drug-using subject, where people who use drugs could more readily be perceived as citizens with rights rather than just as offenders. Accordingly, in this new logic, the violence and victimization experienced by marginalized people who use drugs could more readily be identified as proper objects for police action. The study contributes to our knowledge of how the police can become potential allies rather than adversaries in harm reduction initiatives and broader public health concerns.

Harm reduction policing: From drug law enforcement to protection

The Dundee Drugs Commission has been an intensive and rapid review of the recent history of the impact of drug use across Dundee, and the help available for people who use drugs in the city. Local Commission members have been supported by experts from across Scotland and the wider UK. To be clear, the Commission was set up in part to assess the effectiveness of the strategic planning and delivery of services co-ordinated by the Dundee Alcohol and Drug Partnership and more broadly across community planning partners (Objective #4). During the course of our work, we have learned about inadequacies in our local systems and services. We have frequently heard from individuals and families who feel that the system has failed them. All our recommendations are born out of the experiences of people in Dundee.

As a Commission, over the course of the last year, we have received evidence from over a thousand different people – those with lived experience of problems with drugs (current and past); family members; members of the public; clinicians and GPs; staff who work in drug treatment and support services; staff who work in wider health and social care services; senior officials within NHS Tayside, Dundee City Council and Dundee’s third sector; politicians and elected members; and academics.

Some individuals and families have spoken in great detail to us about positive experiences of the help and support they’ve received and the strategies they have used themselves to move towards recovery from drug use. Many individuals and families shared their grief and loss over the devastation that has been caused by drug use. We have heard numerous stories of immense challenges and barriers put in front of those who require help and support, compounded by the pervasive stigma that is still attached to being a person who experiences drug problems. Staff working in services have shared both positive and enthusiastic accounts of their efforts to help those who present to services, as well as details of immense frustration and anger when things do not work as they should.

Our review of a substantial amount of evidence has taken time to distil and balance. We have been aware that when an independent Commission is set-up then you tend to have all the stories coming to the fore of how things are not working. However, we have also taken the time to seek out and listen to those who have a positive story to tell – whether one of how they’ve successfully made changes to their drug use by themselves (or with help from family and others) – or whether a story of how they have received the help required from local services. By so doing, we believe that we have achieved a balanced understanding of the reality of issues faced.

Our review has led us to identifying a number of key messages – all of which we have used to form the challenging set of recommendations. The key messages in our report are structured underneath the key themes of our work:

Responding to drug use with kindness, compassion and hope - Report by the Dundee drugs commission

Welcome to our latest Progress Report which chronicles another remarkable year for IDPC. The most critical highlight is our civil society shadow report, Taking Stock: A Decade of Drug Policy, which we produced together with many IDPC members and partners from around the world. We undertook this ambitious report to address the lack of a formal review by governments, or the UN, of progress towards the goals and targets set out in the 2009 Political Declaration and Plan of Action on drugs to significantly reduce or eliminate the global drug market by 2019.

The report attracted widespread global media attention and helped to secure the comprehensive ‘stock-taking’ language in the 2019 Ministerial Declaration by not allowing governments to shy away from the inconvenient truth of a growing global drug market despite the billions invested to eliminate it. The first report of its kind in UN drug control fora, it represented a watershed moment of civil society creating crucial accountability in the UN debate on drugs and consolidated the IDPC network’s role as watchdog in this space.

The drug policy reform movement continues to strengthen and diversify with many new players joining the calls for a serious re-think of repression and punishment as instruments of drug control. Repressive drug control measures are increasingly being understood as a form of state violence that serves to deepen and entrench structural inequalities which has garnered stronger interest in challenging current drug policies from other social movements such as those working on racial inequality, women’s rights, indigenous rights, LGTIQ+ rights to prison abolition and beyond. Building cross-movement solidarity on key human rights and social justice issues is more important than ever in the current troubling geo-political context and will be a core focus of the IDPC Secretariat in the coming years.

This year, I am pleased to share this foreword with Alison Holcomb, Chair of IDPC’s Board of Directors and Bikas Gurung, Asia representative on IDPC’s Members Advisory Council, who give their reflections on the past year for the network. We hope you enjoy reading this Progress Report!

IDPC Progress Report 2018-2019

By Bryce Pardo, Jirka Taylor, Jonathan P. Caulkins, Beau Kilmer, Peter Reuter, Bradley D. Stein

Deaths involving synthetic opioids in the United States increased from roughly 3,000 in 2013 to more than 30,000 in 2018. In fact, synthetic opioids like fentanyl are now involved in twice as many deaths as heroin. This book offers a systematic assessment of the past, present, and possible futures of synthetic opioids in the United States. It is rooted in secondary data analysis, literature reviews, international case studies, and key informant interviews. The goal is to provide decisionmakers, researchers, media outlets, and the public with insights intended to improve their understanding of the synthetic opioid problem and how to respond to it.

The authors conclude that (1) fentanyl and other synthetic opioids are becoming dominant in some parts of the United States and Canada, but remain less common in other parts of these countries; (2) a confluence of factors, including the dissemination of simplified and novel synthesis methods and increasing e-commerce, helps explain the surge in synthetic opioids; (3) much can be learned from other countries' experiences with synthetic opioids; (4) supplier decisions, not user demand, drive the transition to fentanyl; (5) fentanyl's spread is episodically fast and has ratchet-like persistence; (6) synthetic opioids drive up deaths rather than the number of users; (7) problems with synthetic opioids are likely to worsen before they improve, and states west of the Mississippi River must remain vigilant; (8) improving surveillance and monitoring is crucial; and (9) limiting policy responses to existing approaches seems unlikely to reverse this tide.

The future of fentanyl and other synthetic opioids

In its resolution 36/16, the Human Rights Council requested the United Nations High Commissioner for Human Rights to submit a report on violence, death and serious injury in situations of deprivation of liberty, drawing on the experience of United Nations and regional human rights mechanisms, and seeking the views of States, including on their policies and best practices, civil society, and other relevant stakeholders. It requested the report to be presented at the forty-second session of the Human Rights Council. In preparation of this report, contributions were sought from Member States; international and regional organisations; national human rights institutions; and non-governmental organisations. 1 In addition to information received from these entities, the report draws on a range of public sources, including from United Nations human rights mechanisms, and work by civil society organisations.

The issue of violence, death and serious injury was identified by the Secretary General as one of the most important challenges pertaining to the protection of persons deprived of their liberty.2 By depriving persons of their liberty, States assume the responsibility to protect the life and bodily integrity of such persons. States are thus obligated to prevent the illtreatment of, and violence against such persons and to ensure that the conditions of a dignified life are met.

The human rights of persons deprived of their liberty are enumerated in core international human rights instruments. The right to life of all individuals, including of persons deprived of their liberty is enshrined in Article 6 of the International Covenant on Civil and Political Rights (ICCPR), as is the prohibition on arbitrary deprivation of life. The right to be protected from the use of torture or cruel, inhuman or degrading treatment or punishment is found in Article 7 of the ICCPR and in the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment. Persons deprived of their liberty must also be treated with humanity and respect for the inherent dignity of the human person per Article 10 of the ICCPR. The United Nations Standard Minimum Rules for the Treatment of Prisoners, also known as the Mandela Rules, provide States with important and detailed guidelines for protecting and fulfilling the human rights of persons deprived of their liberty.

The present report addresses the intersection between situations of deprivation of liberty and violence, death and serious injury. The report examines the vertical, horizontal and environmental causes of violence, death and serious injury in situations of deprivation of liberty. It then considers measures which should be taken to address such incidents.

With regard to drug policy and related issues, the report:

Recognises people who use drugs as a group “facing an increased risk of torture and ill-treatment [in detention], as law enforcement officials in some cases deliberately take advantage of the pain and suffering associated with the withdrawal syndrome displayed by drug users deprived of their liberty to elicit forced confessions. Human rights mechanisms concluded that the use of withdrawal symptoms to obtain information or confessions, to punish or to intimidate or coerce may amount to torture”; (para 6)

Condemns the intentional withholding of drug treatment from a person who uses drugs as a form of punishment (para 7);

Addresses the lack of essential healthcare in prison, also touching upon drug dependence and people living with HIV, and acknowledges that “lack of healthcare or inadequate treatment in detention for persons who use drugs can also contravenes the right to health and can contribute to deaths in detention. Access of detainees to medical treatment, including access to opioid substitution therapy, is often severely restricted even if it has been demonstrated that therapy is the most effective intervention available for the treatment of opioid dependence and that it contributes to reducing mortality” (paras 29-34);

Condemns violence against people who use drugs perpetrated “under the guise of treatment when placed in mandatory administrative detention” (para. 32).

Submissions by Harm Reduction International and the Canadian HIV/AIDS Legal Network.

Earlier this year, Harm Reduction International submitted two reports to OHCHR on violence, death and serious injury in situations of deprivation of liberty – one on conditions of death row, and one on forms of violence in situations of deprivation of liberty for drug-related offences.

Human rights in the administration of justice - Report of the United Nations High Commissioner for Human Rights

The number of Australians who die from unintentional drug overdose each year continues its long-term rise. This report examines drug-induced deaths, where the death is directly attributable to the drug use, with a focus on unintentional-drug induced deaths. This report presents key statistics about unintentional drug-induced deaths in Australia from 2001 to 2017, with a snapshot of 2017 data provided in Figure 1.

Opioids (including both pharmaceutical opioids and heroin) continue to be the primary drug group associated with unintentional drug-induced deaths, though there have been significant changes in the types of opioids since 2001. While deaths involving pharmaceutical opioids have continued to rise, and comprise the largest proportion of deaths involving opioids, there have been dramatic rises in deaths involving heroin since 2012.

Benzodiazepines remain the second most common group of drugs identified in unintentional drug-induced deaths, behind opioids, though these are predominantly identified in poly-substance overdose deaths. Since 2013 there has been a significant increase in unintentional drug-induced deaths involving benzodiazepines in both Western Australia and Victoria, and to a lesser extent, New South Wales.

There has been a sharp rise in deaths involving stimulants (including methamphetamine) in Australia since 2012, which is seen in both regional and urban areas.

Deaths involving other prescription medications – such as anti-convulsant medications used as treatment for neuropathic pain, and anti-psychotics – have increased markedly in the last few years, although they account for only a small proportion of all unintentional drug-induced deaths.

Drug-induced death is not confined to either illegal drugs or those taken as medicines; alcohol may also be involved in unintentional drug-induced deaths. When used in conjunction with other drugs, alcohol may contribute to a fatal overdose, or rarely, be the sole cause of an unintentional drug-induced death. Up until recently, alcohol was the third most common drug involved in unintentional drug-induced deaths, though it has recently been surpassed by stimulants.

While a single drug may be identified in an unintentional drug-induced death, it is rare for a death to be attributable to toxicity from a single drug; deaths involving multiple drugs are the norm rather than the exception. Poly-drug deaths involving four or more substances have increased significantly in recent years.

While drug use is commonly associated with younger people, this report shows that it is middle-aged Australians (30-59 years) who have the highest incidence of unintentional drug-induced mortality. Further, the gap between this middle-aged cohort and Australians under-30 or over-60 has expanded in the last fifteen years and continues to widen. Unintentional drug-induced deaths overall are more prevalent among men, with the number of deaths for males increasing more rapidly than for women in recent years. Similarly, the rate of unintentional drug-induced death remains higher for Aboriginal Australians than for non-Aboriginal Australians, and this gap is widening. Finally, unintentional drug-induced deaths occur across all socio-economic areas, with small differences in prevalence observed between the most advantaged neighbourhoods and the most disadvantaged neighbourhoods.

Drugs and overdose also tend to be associated with urban areas; the data, however, reveal that the highest growth in unintentional drug-induced deaths is occurring in regional settings, away from capital cities. This trend poses significant challenges for responding to overdose, as regional areas tend to have less access to drug treatment and support services and may have longer delays in ambulance attendance.

Penington Institute has compiled this report based on data from the Australian Bureau of Statistics (ABS).

Australia's annual overdose report 2019

By András Költő, Alina Cosma, Honor Young, Nathalie Moreau, Daryna Pavlova, Riki Tesler, Einar B. Thorsteinsson, Alessio Vieno, Elizabeth M. Saewyc and Saoirse Nic Gabhainn

Sexual minority youth are at higher risk of substance use than heterosexual youth. However, most evidence in this area is from North America, and it is unclear whether the findings can be generalized to other cultures and countries. In this investigation, we used data from the 2014 Health Behaviour in School-aged Children (HBSC) study to compare substance use in same- and both-gender attracted 15-year-old adolescents from eight European countries (n = 14,545) to that of their peers who reported opposite-gender attraction or have not been romantically attracted to anyone. Both-gender attracted, and to a lesser extent, same-gender attracted adolescents were significantly more likely to smoke cigarettes, consume alcohol, get drunk and use cannabis, or be involved in multiple substance use in the last 30 days compared to their opposite-gender attracted peers. Those adolescents who have not been in love had significantly lower odds for substance use than all other youth. The pattern of results remained the same after adjusting for country, gender and family affluence. These findings are compatible with the minority stress and romantic stress theories. They suggest that sexual minority stigma (and love on its own) may contribute to higher substance use among adolescents in European countries.

Romantic attraction and substance use in 15-year-old adolescents from eight European countries

This is the first issue of the information digest produced by the Eurasian Network of People who use drugs.

The digest provides information about the activities of ENPUD members and updates on developments in activism and the policy landscape in the EECA region.

Infodigest from ENPUD - July 2019

The U.S. is facing an unprecedented number of opioid-related overdose deaths, and an array of other countries have experienced increases in opioid-related facilities. In the U.S., naloxone is increasingly distributed to first responders to improve early administration to overdose victims, but its cost-effectiveness has not been studied. Lay distribution, in contrast, has been found to be cost-effective, but rising naloxone prices and increased mortality due to synthetic opioids may reduce cost-effectiveness. We evaluate the cost-effectiveness of increased naloxone distribution to (a) people likely to witness or experience overdose (“laypeople”); (b) police and firefighters; (c) emergency medical services (EMS) personnel; and (d) combinations of these groups.

High distribution to all three groups maximized net monetary benefit and minimized fatal overdoses; it averted 21% of overdose deaths compared to minimum distribution. High distribution to laypeople and one of the other groups comprised the second and third best strategies. The majority of health gains resulted from increased lay distribution. In the societal analysis, every strategy was cost-saving compared to its next-best alternative; cost savings were greatest in the maximum distribution strategy. In the health sector analysis, all undominated strategies were cost-effective. Results were highly robust to deterministic and probabilistic sensitivity analysis.

Increasing naloxone distribution to laypeople and first responder groups would maximize health gains and be cost-effective. If feasible, communities should distribute naloxone to all groups; otherwise, distribution to laypeople and one of the first responder groups should be emphasized.

Click here to read the full article (restricted access)

Cost-effectiveness analysis of alternative naloxone distribution strategies: First responder and lay distribution in the United States

The “war on drugs” was first declared by U.S. President Richard Nixon in 1971, with the goal of eradicating what he viewed as the growing problem of drug addiction. Since then, it has had dire consequences, including the exacerbation of human rights violations and erosion of democratic institutions around the world. Yet human rights groups largely refrain from discussing drug policy.

Hundreds of civil society groups around the world are dedicated to investigating the outcomes of the drug war and advocating drug policy reform based on their findings. However, drug reform advocates often comment that international human rights organizations have been largely absent in these discussions. Human rights reports generally stick to noting human rights violations in affected states as a whole, without investigating the violations’ relation to drug policy and drug trafficking organizations.

Knowing this, the Human Rights Foundation initiated its War on Drugs Research Project to examine data and existing research on the global drug war’s costs and consequences in order to understand drug policy from a human rights perspective. The resulting report is organized in two parts. The first offers a high-level introduction to the drug war’s history and economics. It explains how prohibition was established, how the resulting black market functions, and how its policies have ultimately failed to decrease drug abuse.

Once we have established whether prohibition policies have created the desired outcomes, we look at the negative consequences of the policy — the human rights consequences — through three case studies: Colombia, Mexico, and the United States. These countries were selected because of their positions along the illegal drug supply chain. Colombia is a production country on the cocaine supply chain because of its position in the Andes mountain range, where coca, the plant used to manufacture cocaine, grows. Mexico is a transit country that traffickers pass through on their way to the drugs’ final stop: the United States, a destination country. Drug prohibition has taken different forms in each country because of their position on the supply chain. By examining each country, we hope to understand how different prohibition policies shape human rights outcomes.

The Human Rights Foundation (HRF) is a nonpartisan nonprofit organization that promotes and protects human rights globally, with a focus on closed societies. HRF’s focus shapes the scope of this report. The organization focuses on civil and political rights: the rights to free expression, belief, assembly, association, press; to liberty and security of the person; to access information; to political participation and to vote; and, of course, to life, among others. As many of these rights constitute the definition of liberal democracy, HRF research pays special attention to the political systems of countries in which human rights violations take place. In this report, this means that we have taken special care to understand how the drug war interacts with and affects a country’s democratic health. Colombia, Mexico, and the United States are all categorized as democratic countries under HRF’s Political Regime Research Project,i which categorizes all countries in the world into regime types using a methodology adapted from the one presented in Steven Levitsky and Lucan A. Way in Competitive Authoritarianism.


It is well established that prohibition has failed to reduce consumption and abuse. But prohibition is not just ineffective; it’s harmful. This report shows how prohibition’s policies have directly caused severe human rights violations in affected countries, especially by undermining civil and political rights to such a degree that these policies constitute a threat to democracy. Supply-centric policies have had grave consequences for individuals, communities, and the health of democratic institutions, including high rates of violence, disappearances, kidnappings, and incarceration; impacts on local communities and minority populations; state instability, lack of trust in government, and corruption; and a deterioration of rule of law and electoral competition. The report’s findings suggest that, from a human rights perspective, there must be a shift from international drug policies that focus on criminalization and supply reduction, to ones that have human rights and health at their core.

Publications