The INCB Annual Report, prepared in accordance with the international drug control treaties, examines the global drug control situation, and makes recommendations to Governments and regional and international organizations.

The thematic chapter of the INCB annual report for 2019 focuses on improving prevention and treatment services for young people. The year 2019 marked the thirtieth anniversary of the Convention on the Rights of the Child. In article 33 of that Convention, States parties committed to taking measures to protect children from the illicit use of narcotic drugs and psychotropic substances and prevent the use of children in the illicit production and trafficking of drugs.

The Report is accompanied by the 2019 Precursors report on the implementation of article 12 of the 1988 convention.

INCB Annual Report 2019

By Luis Felipe Cruz Olivera, Teresa Garcia Castro, Kathryn Ledebur, and Isabel Pereira

In Latin America, the lives of women who grow plants destined for illicit markets are marked by several forms of discrimination: because they are women, because they are rural farmers, and because their livelihood depends on an activity that has been declared illegal. The so-called “war on drugs” and the marginalization of rural life have erected walls behind which the role of women as agents of social transformation is hidden and rendered invisible. Beyond the numerous challenges they face, women growers of coca and opium poppy have played a critical role in sustaining and improving rural livelihoods, caring for families, in community organization, and in social movements. From their fight to assert the rights of coca-grower movements in Bolivia to their contribution to peace building in Colombia, women growers have been crucial agents of change in their communities. Their active participation—whether in farmer organizations, assemblies, agrarian unions, or other collectives—has given them new tools and knowledge for interacting with government entities and achieving important local objectives. Women coca or poppy growers not only build knowledge and capacities in their territories; they also contribute on a daily basis to the transformation and improvement of their realities, and that of their families and villages. Given the silence and dearth of information regarding the role of women in community life in areas where crops declared illicit are grown, this report explores who these women growers are, their socioeconomic contexts, their involvement in the production of crops destined for illicit markets, their organizing experiences, and their participation in decisionmaking processes—taking into account case studies from Bolivia and Colombia. Furthermore, the report presents recommendations focused on ensuring the participation of women growers in political and public life at all levels of decision-making.

Women coca and poppy growers mobilising for social change

It is now a year since Canada moved to legally regulate cannabis for recreational use, becoming the second country after Uruguay, and the first major G7 economy, to do so (excluding the 11 US states that have now done so outside of US federal jurisdiction). While legal access to cannabis was already available for medical purposes, this marked a groundbreaking policy shift away from criminalisation of the drug and the people who use it in a country of nearly 40 million people.

The Canadian Government emphasised three key goals of regulation: the protection of public health; the protection of young people; and the reduction in criminality associated with the illegal market.1 The
reforms built on years of evidence demonstrating that the illegal status of cannabis did not prevent rising consumption and was associated with a range of other risks, from increased potency to the empowerment of criminal gangs

Historically, Canadian provinces have developed separate systems for regulating the sale of alcohol, and a similar devolved principle was applied to cannabis. As a result, a ‘patchwork’ of regulatory models has now emerged across the country. Some provinces have been more successful than others and many have experienced ‘teething’ issues during early implementation. Importantly, the Cannabis Act only allowed for herbal cannabis and oils to be sold in the first year. The sale of cannabis ‘edibles’ and concentrates are subject to separate regulations and are due to go on sale later this year in phase 2 of the implementation.2

Establishing an entirely new regulated market – aimed at displacing well-established illegal supply – was a unique challenge. While some have raised concerns that the intensity of cannabis regulation has slowed participation in the new legal market, others remain worried about creeping commercialisation. It will inevitably take time for the new system to bed in and for emerging problems to be addressed. Policy will hopefully evolve as evidence is gathered, and learning is shared across provinces. This briefing reviews the early data since legalisation and considers lessons other countries might draw from the Canadian experience.

Cannabis legalisation in Canada – One year on

On 3rd February 2020, Ms. Ghada Fathi Waly started in her new role as Executive Director of the United Nations Office on Drugs and Crime (UNODC), and as Director-General of the United Nations Office in Vienna. The International Drug Policy Consortium (IDPC) warmly welcomes Ms. Waly as she takes up her new role and we look forward to a fruitful and constructive collaboration. We take this opportunity of new leadership at the UNODC to present key recommendations for Ms. Waly’s consideration as we continue to encourage the UNODC to develop, implement and engender a truly balanced, evidencebased, human rights-centred, and developmentoriented drug policy.

Ms. Waly’s appointment comes at a watershed moment. Much progress has been made over the past decade in UN drug policy. The 2016 United Nations General Assembly Special Session (UNGASS) on drugs and its resulting Outcome Document is the clearest call to date for a more balanced, evidence-based, and human rights-compliant approach to international drug policies that incorporate a stronger focus on gender and development. The goals and aspirations established within the Outcome Document were reiterated within the 2019 Ministerial Declaration.

In addition, in November 2018 the UN Chief Executives Board for Coordination adopted the ‘UN system common position on international drug control policy through effective inter-agency collaboration’, a much-needed update of the previous UN system guidance that reflected the outcomes of the 1998 UNGASS.The Common Position notably incorporates many of the 2016 UNGASS outcomes. This Common Position allows the UN family to speak with one voice on drug policy issues, to share and integrate the knowledge of all UN entities that deal with the multidimensional effects of drug control on health, human rights, security and development, and to support member states in developing drug policies aligned with the founding pillars of the UN system and the 2030 Agenda for Sustainable Development.

Despite these positive policy developments many challenges remain in global drug policy. The 2009 Political Declaration had sought to achieve a ‘drug-free world’, a goal that failed to materialise and appears more distant than ever. In its latest World Drug Report, the UNODC acknowledged that illicit cultivation, trafficking and use had reached record high levels.5 The punitive approach to drug policy has also driven widespread human rights violations,6 and hampered the health response for people who use drugs, with an estimated 585,000 preventable drug use-related deaths in 2017. At the same time, the majority of the world’s population remains with limited or no access to controlled medicines to treat moderate or severe pain. The aim of improved security is often the justification offered for implementing punitive drug policies, but in a significant number of countries, punitive drug policies have exacerbated levels of violence, corruption and money laundering. This has had direct
consequences on the achievement of the Sustainable Development Goals (SDGs), in particular SDG 1 on poverty, 3 on health, 5 on gender equality, 10 on reduced inequalities, 16 on peace, justice and strong institutions, and 17 on global partnerships. The global drug control debate in Vienna has also become increasingly polarised, in particular on issues such as the use of the death penalty and human rights more generally, new developments in the legal regulation of cannabis, decriminalisation and harm reduction.

In this context, the UNODC has an essential role to play and, working together with relevant UN entities, can show strong leadership by bringing a sense of urgency to the drug policy discussion. We respectfully offer the following recommendations related to the most pressing concerns for Ms. Waly’s consideration, including issues related to facilitating UN system-wide coherence in drug policy, promoting a human rights and health approach, promoting the decriminalisation of people who use drugs, improving access to controlled medicines, promoting a development-oriented approach, expanding the scope of data collection, and ensuring the meaningful participation of civil society in drug policy debates.

Recommendations for the new UNODC Executive Director: Opportunities and challenges in global drug policy

By Kylie Valentine, Ciara Smyth, and Jamee Newland

Policy concern with families has led to the framing of ‘good parenting’ as a skill set that parents must acquire while ‘poor parenting’ is linked to a raft of social problems, including child maltreatment. A range of professionals are responsible for monitoring parents for evidence of ‘poor parenting’, and for reporting those parents to statutory child protection authorities. Little is known about how parents in vulnerable circumstances negotiate these dual pressures of ‘good parenting’ and surveillance.

Eight parents who use drugs were interviewed about raising children well. The data is drawn from a project that used a positive deviance approach to understand the practices and norms that contribute to positive child outcomes in communities where positive outcomes are unexpected or statistically anomalous.

Parents use a range of strategies to minimise risk of harm from drug use. Participants resist negative stereotypes that portray their parenting primarily in terms of risk; and in contrast to previous research, describe feelings of guilt but not shame. Systemic barriers to safe environments include the nature of illicit drug markets and the surveillance and policing responsibilities of service agencies.

The findings contribute to an understanding of safe and competent parenting by parents who use drugs and highlight how drug laws and fear of intervention can work against the creation of safe family environments.

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

‘Good enough’ parenting: Negotiating standards and stigma

The sixty fourth session of the Commission on the Status of Women marks the twenty fifth anniversary of the Beijing Declaration and Platform for Action. In parallel, the international community committed to the implementation of the United Nations General Assembly Special Session on Drugs outcome document featuring recommendations to advance the rights of women in drug policy. This submission demonstrates how current drug policies undermine key rights and commitments included in the Beijing Declaration and Platform for Action’s strategic objectives and offers concrete recommendations to address these damaging inconsistencies.

CELS, IDPC, WHRIN and WOLA statement to the 64th session of the Commission on the Status of Women

New research from St Mungo’s investigates the growing number of people sleeping rough who are living with, and dying of, preventable drug and alcohol problems. The research finds that 12,000 people sleeping rough, or at risk of doing so, missed out on life-saving drug and alcohol treatment in 2018/19. The research includes new data analysis, in-depth interviews and peer research from across the country looking at the issues behind people’s drug and alcohol problems and the challenges they face accessing housing and support.

Knocked back: Failing to support people sleeping rough with drug and alcohol problems is costing lives 

By Hannah Carver, Nicola Ring, Joanna Miler, and Tessa Parkes

 People experiencing homelessness have higher rates of problematic substance use but difficulty engaging with treatment services. There is limited evidence regarding how problematic substance use treatment should be delivered for these individuals. Previous qualitative research has explored perceptions of effective treatment by people who are homeless, but these individual studies need to be synthesised to generate further practice-relevant insights from the perspective of this group.

 Meta-ethnography was conducted to synthesise research reporting views on substance use treatment by people experiencing homelessness. Studies were identified through systematic searching of electronic databases (CINAHL; Criminal Justice Abstracts; Health Source; MEDLINE; PsycINFO; SocINDEX; Scopus; and Web of Science) and websites and were quality appraised. Original participant quotes and author interpretations were extracted and coded thematically. Concepts identified were compared to determine similarities and differences between studies. Findings were translated (reciprocally and refutationally) across studies, enabling development of an original overarching line-of-argument and conceptual model.

 Twenty-three papers published since 2002 in three countries, involving 462 participants, were synthesised. Findings broadly related, through personal descriptions of, and views on, the particular intervention components considered effective to people experiencing homelessness. Participants of all types of interventions had a preference for harm reduction-oriented services. Participants considered treatment effective when it provided a facilitative service environment; compassionate and non-judgemental support; time; choices; and opportunities to (re)learn how to live. Interventions that were of longer duration and offered stability to service users were valued, especially by women. From the line-of-argument synthesis, a new model was developed highlighting critical components of effective substance use treatment from the service user’s perspective, including a service context of good relationships, with person-centred care and an understanding of the complexity of people’s lives.

 This is the first meta-ethnography to examine the components of effective problematic substance use treatment from the perspective of those experiencing homelessness. Critical components of effective problematic substance use treatment are highlighted. The way in which services and treatment are delivered is more important than the type of treatment provided. Substance use interventions should address these components, including prioritising good relationships between staff and those using services, person-centred approaches, and a genuine understanding of individuals’ complex lives.

What constitutes effective problematic substance use treatment from the perspective of people who are homeless? A systematic review and meta-ethnography

By Ryan J. Watson, Minjeong Park, Ashley B. Taylor, Jessica N. Fish, Heather L. Corliss, Marla E. Eisenberg, and Elizabeth M. Saewyc

 Using representative school-based data and community-level primary data, we investigated how environmental factors (e.g., school and community climate) might be protective against substance use behaviors among a vulnerable population of adolescents.

 We analyzed a sample of 2678 sexual minority adolescents using a combination of student-level data (British Columbia Adolescent Health Survey) and primary community-level data (assessing lesbian, gay, bisexual, transgender, and queer [LGBTQ]-specific community and school environments). Using multilevel logistic regression models, we examined associations between lifetime substance use (alcohol, illegal drugs, marijuana, nonmedical use of prescription drugs, and smoking) and community-level predictors (community and school LGBTQ supportiveness).

 Above and beyond student characteristics (e.g., age and years living in Canada), sexual minority adolescents residing in communities with more LGBTQ supports (i.e., more supportive climates) had lower odds of lifetime illegal drug use (for boys and girls), marijuana use (for girls), and smoking (for girls). Specifically, in communities with more frequent LGBTQ events (such as Pride events), the odds of substance use among sexual minority adolescents living in those communities was lower compared with their counterparts living in communities with fewer LGBTQ supports.

 The availability of LGBTQ community-level organizations, events, and programs may serve as protective factors for substance use among sexual minority adolescents. In particular, LGBTQ-supportive community factors were negatively associated with substance use, which has important implications for our investment in community programs, laws, and organizations that advance the visibility and rights of LGBTQ people.

Associations between community-level LGBTQ-supportive factors and substance use among sexual minority adolescents

 To explore the feasibility of delivering community-based drug safety testing(drug checking), to trial service design characteristics and to compare with festival-based testing.

In total, 171 substances of concern were submitted on 5 dates at 3 venuesin 2 UK cities and tested using up to 6 analytical techniques. Test results and harmreduction advice were distributed directly to over 200 service users through 144 tai-lored healthcare consultations, to stakeholders, and through early warning systems,media and social media alerts.

 The 171 samples were submitted and identified as MDMA (43.3%), cocaine(12.9%), ketamine (12.9%), various psychedelics submitted by students, and heroinand a synthetic cannabinoid submitted by rough sleeping communities, with 76% ofsamples' test results as expected. The 144 primary service users identified as 91.7%white, 68.1% male, with an average age of 26.7 years. Reported harm reductionintentions included alerting friends and acquaintances (37.5%), being more carefulmixing that substance (35.4%), lowered dosage (27.8%), disposal of further sub-stances (6.9%) and additionally 2.8% handed over further substances for verifieddestruction.

 Community-based drug safety testing (drug checking) was piloted for thefirst time in the UK—within a drugs service, a community centre and a church—withconsideration given to meso-level operational feasibility and micro-level behaviouraloutcomes. Service design characteristics such as venue, day of week, prior publicity,service provider, and direct and indirect dissemination of results all may impact onoutcomes. Future studies should consider cost–benefit analyses of community andevent-based testing and context-appropriate macro, meso and micro-levelevaluations.

City checking: Piloting the UK's first community-based drug safety testing (drug checking) service in 2 city centres

 The Canadian government legalized non-medical cannabis use by adults in October 2018 in order to minimize associated harms and re-direct profits from criminals.

 Seven quarters of (NCS) data were combined into two groups: pre- and post-legalization periods - to examine changes in: cannabis use (overall, daily or almost daily (DAD)), source of product, driving after consumption and riding in a vehicle with a driver who had consumed.

 By 2019, overall cannabis use had increased (16.8% vs. 14.9%), particularly among: males, adults aged 25 and older, and in Newfoundland and Labrador, Nova Scotia, New Brunswick, and Alberta. DAD use, at 6.0%, remained stable, as did the prevalence of driving within 2 hours of consumption (13.2%). Riding in a vehicle with a driver who had used declined, overall (from 5.3% to 4.2%) and among: females, persons aged 25 and older, and in Newfoundland and Labrador, Ontario and Alberta. Where Canadians reported obtaining their cannabis also changed, with increasing percentages reporting getting some or all of their cannabis from legal sources, and fewer using illegal sources or relying on friends/family. Some provinces experienced more change than others.

 While too soon to observe the longer-term impacts associated with the Cannabis Act, early indications based on data collected in the months surrounding enactment suggests some cautions and also some assurances. Ongoing monitoring will be essential particularly given the 2.0 Act modifications and the ever-changing provincial retail and regulatory landscapes.

What has changed since cannabis was legalized in Canada?

The Americas are at the forefront of processes and efforts to reform cannabis-related laws and policies. The regulated markets established in Uruguay and Canada will very likely be joined soon by Mexico, where President Andrés Manuel López Obrador has backed a legislative proposal that, at the time of this writing, was being considered in the legislature. In the United States, ten states and the District of Columbia have adopted legal, regulated markets for recreational use. Also at the time this report was being finalized, a bill was being presented before Colombia’s Congress to reform Article 49 of the Constitution with regard to the prohibition of narcotic substances, with a view to paving the legal way for future regulation. In 2018, the Regional Commission on Marijuana of the Caribbean Community (CARICOM) concluded that the prohibitionist system “is not fit for purpose” with regard to international drug control treaties, and it called for a paradigm shift.

At the same time, medical marijuana is growing by leaps and bounds. In the United States, 33 of its 50 states along with the District of Columbia permit the medical use of cannabis, while in Canada this use has been legal since 2001. In Latin America, some form of medical marijuana is allowed in Argentina, Brazil, Chile, Colombia, Mexico, Paraguay, Peru and Uruguay. As this publication was being finalized, Ecuador’s National Assembly was concluding a debate on a legislative proposal that would create the means of access to medical marijuana in that country. However, it is important to note that in the majority of these countries, reforms are quite limited and do not ensure access for all people who could benefit from medical marijuana.

In addition, more tolerant attitudes toward cannabis do not necessarily translate into public support for broader drug policy reform. In the majority of Latin American countries, a change in the discourse has not led to significant domestic policy reforms. At the Organization of American States (OAS) and the United Nations (UN), Latin American countries have spearheaded efforts to promote debate about the failure of the prohibitionist paradigm and the need to explore alternative approaches. However, as tends to happen, this rhetoric has not been matched by concrete actions. In other words, drug policy reforms in the region have been minimal despite the tremendous societal costs of current policies, and governments continue to rely on repression and criminalization.

That is why, for people in countries where there are still no legal markets, the consequences of being caught with any amount of cannabis can be severe. Previous studies by the Research Consortium on Drugs and the Law (Colectivo de Estudios Drogas y Derecho, CEDD) have shown that throughout the region, people who consume cannabis face stigmatization and harassment by police, and they are often detained for growing plants or for simple possession of the substance. In several of the countries studied, people who use cannabis constitute a significant percentage of those impacted by drug laws. Many of them end up being subjected to the criminal justice system and, on occasion, they are referred to compulsory (or semi-compulsory) treatment, even when they do not show signs of a drug dependency. In several countries, “drug court” models are making headway, which repeat the logic of using the criminal justice system to refer people who use drugs to treatment programs. To sum up, harsh and disproportionate cannabis-related laws in the region cause significant harm to people, their families, their communities, and to society in general.

This disconnect between the trend toward regulating cannabis in the Americas, on the one hand, and the continuation of a punitive approach in nearly all Latin American countries, on the other, led CEDD to undertake its current research, which analyzes the way in which punitive drug laws disproportionately affect people who use, grow, and sell small amounts of cannabis.

Cannabis is also the most widely used substance declared to be illicit in Latin America. Its medical uses are beneficial, and its problematic use causes less harm than other drugs, licit or illicit. Therefore, it is the only substance for which there is an impetus for reform. The expansion of legal and regulated marijuana markets would have a significant impact on reducing the damage caused by repressive drug policies, and we hope that this research contributes to that aim.

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