By David Stuart and Ignacio Labayen De Inza

If you feel a person is too high on G, what can you do? Firstly, what does “too high” mean? Respecting a person’s autonomy over their own actions, choices, behaviour is very important; even if that behaviour might manifest as (what you believe to be) not in their best interests. But; if their behaviour suggests that they might acutely harm themselves or others, or that they might not be able to consent to things that are currently happening/about to happen – you might choose to intervene. Of course there is a difficult judgment call here. Are they upright, or mobile? When you speak to them do they respond, or acknowledge you? If so, there are some dos and don’ts and suggestions here. (If they are completely nonresponsive, there is a section below about what to do; pages 5 and 6). Don’t induce vomiting.

Although there is a logic to forcing a potentially fatal dose of GHB/GBL out of the stomach by vomiting, it carries other risks to do with aspiration, breathing, infection of the lungs, choking. Vomiting can be a helpful thing when the body does it naturally (and that should never be prevented if it occurs), but forcing a vomiting episode upon oneself (or someone else) is a violent thing to do to the stomach, oesophagus and airway, and is not advised in a chemsex environment. Call an ambulance; in London, an ambulance can be with you in approximately eight minutes guaranteed. Tell the telephone operator that the person has ingested a potentially fatal dose of a toxin. Don’t give them any more drugs; one myth is that giving them a stimulant (eg, methamphetamine, cocaine or mephedrone) can be helpful; this isn’t true, and just adds to the toxicity that is causing the problem in the first place. (Even if this method seems to have worked in the past, don’t do this; the negative consequences outweigh the positive consequences, so best not. Giving the person more drugs will increase the person’s toxicity, and it is toxicity that is causing the problem; it is more likely to complicate the situation. Simple rule of thumb; don’t give a person who is too high, more drugs.

Chemsex - First aid

In some ways this is a dark time for human rights. Yet while the autocrats and rights abusers may capture the headlines, the defenders of human rights, democracy, and the rule of law are also gaining strength. The same populists who are spreading hatred and intolerance are spawning a resistance that keeps winning its share of battles. Victory in any given case is never assured, but it has occurred often enough in the past year to suggest that the excesses of autocratic rule are fueling a powerful counterattack. Unlike traditional dictators, today’s would-be autocrats typically emerge from democratic settings. Most pursue a two-step strategy for undermining democracy: first, scapegoat and demonize vulnerable minorities to build popular support; then, weaken the checks and balances on government power needed to preserve human rights and the rule of law, such as an independent judiciary, a free media, and vigorous civic groups.

Even the world’s established democracies have shown themselves vulnerable to this demagoguery and manipulation. Autocratic leaders rarely solve the problems that they cite to justify their rise to power, but they do create their own legacy of abuse. At home, the unaccountable government that they lead becomes prone to repression, corruption, and mismanagement. Some claim that autocrats are better at getting things done, but as they prioritize perpetuating their own power, the human cost can be enormous, such as the hyperinflation and economic devastation in once oil-rich Venezuela, the spree of extrajudicial killings as part of the “drug war” in the Philippines, or China’s mass detention of upwards of 1 million Turkic Muslims, primarily Uyghurs.

Because they dislike human rights scrutiny, autocratic leaders also tend to retreat from the defense of human rights beyond their borders. This retrenchment has made it easier for brutal leaders to get away with large-scale atrocities, such as Syria’s war on civilians in areas held by anti-government forces, the Saudi-led coalition’s indiscriminate bombing and blockade that are killing and starving Yemeni civilians, and the Myanmar army’s mass murder, rape, and arson against Rohingya Muslims.

HRW: World report 2019

Around the world the so called ‘war on drugs’ is collapsing. Many countries are replacing the prohibition of illicit drugs, with new approaches which prioritise and protect people’s health and wellbeing. Whilst reform is underway, it is not happening nearly fast enough or reaching far enough. The prohibitionist criminal justice approach that has dominated drug policy for the past 50 years continues to destroy livelihoods and claim lives. The people most affected aren’t those in charge of the drugs trade. Instead, it’s those caught up at the lowest levels in a trade that is destroying their lives and communities, particularly in the global south. Prohibition has failed to reduce the world’s supply of illicit drugs.

Meanwhile the heavy handed and often militarised law enforcement approach that often goes with it – directed primarily at those involved at the lowest level in the production and supply of illicit drugs – has fueled poverty, inequality, corruption and violence. This is felt most sharply by marginalised communities and women who engage in the small-scale trade out of necessity or lack of alternatives. In these contexts of significant vulnerability, powerlessness and poverty, the drugs trade can offer a decent income or means of survival, where no other exists.

Punishing poverty - How the failed ‘war on drugs’ harms vulnerable communities: Case studies of Brazil and India

Why do some political actors sustain that the armed forces should intervene in affairs other than their primary mission of defending a country from military attack? Are there security threats that can be equated with outside threats and that justify the use of military might inside borders? In order to respond to these questions, we must examine how the notion of “new threats” was constructed, who is promoting it as doctrine, and what these supposed dangers are.

In the 1980s and 1990s, a process of democratization put an end to the military governments that had proliferated in Latin America during the twentieth century. The “national security doctrine,” pushed by the United States and adopted throughout the Americas, was also abandoned once the ghost of Communism could no longer be used to conjure internal enemies. At the same time, democracy weakened the existing tensions between the countries of the region.

War with a neighboring country, which had been the main hypothesis of military confl ict for most Latin American countries, began to disappear from the realm of possibility. With nuances depending on the situation and history of each country, the armed forces generally began to lose relevance as political actors in the wake of democracy. In the same period, the issues of crime and citizen security became central themes on the political agenda throughout the region. This led many countries to favor military involvement in “combating crime.”

To varying extents in each country, the persistence of economic disparities and the expansion of illegal markets such as arms and drug traffi cking—underpinned by increased consumption in the United States—contributed to transforming Latin America into one of the most violent regions in the world.

The internal war: How the fight against drugs is militarising Latin America

The research aimed to examine client perspectives on mmT, with particular attention directed to the lived experience of methadone treatment, participants’ social relationships and their health and social care needs. To be eligible for participation in the study, service users had to be over the age of 18, have accessed drug treatment for the frst time at least 10 years prior to participating in the research and report at least one episode of opioid substitution treatment since they frst entered treatment.

Participants were recruited through contact with specialist addiction clinics, community and voluntary addiction services, primary care settings and a supported temporary accommodation service, all based in the Dun Laoghaire Rathdown area. The research and, consequently, the recruitment process, was particularly focused on enlisting clients of specialist addiction services, individuals who would generally be expected to have less stability in their lives than those attending primary care settings.

The in-depth interview was used to explore a broad range of issues deemed relevant to understanding participants’ experiences of MMT. These included: drug use and drug treatment history; experiences of drug treatment; education and employment; housing; family and peer relationships; physical and mental health; perceived social and health care needs and participants’ perspectives on the future. To aid the construction of a detailed sample profle, a brief questionnaire was administered to record demographic and healthrelated data.

"Just maintaining the status quo"? - The experience of long term participants in methadone maintenance treatment

Almost a decade ago, the international community agreed upon a Political Declaration and Plan of Action on International Cooperation towards an Integrated and Balanced Strategy to Counter the World Drug Problem. The Declaration included the decision to establish 2019 as the target date for the goals set within it, specifically for states to ‘eliminate or reduce significantly and measurably’ the illicit cultivation, production, trafficking and use of internationally controlled substances, the diversion of precursors and money laundering. Consequently, despite the conclusion of a series of additional soft law instruments since 2009 – including the Outcome Document from the UN General Assembly Special Session on the ‘World Drug Problem’ in 2016 – we are fast approaching a critical juncture for the UN- based international drug control regime.

Having agreed the process at its 60th session, March 2019 will see the Commission on Narcotic Drugs (CND) convene a two-day Ministerial Segment to take stock of progress made and define a global drug strategy for the next ten years or so. While always important in helping to set the narrative for debates within the Commission, the publication of the World Drug Report 2018 comes at a particularly important moment, representing as it does the last major publication to come out of the United Nations Office on Drugs and Crime (UNODC or Office) before the high-level meeting. It is difficult to ignore the fact there remains no UN produced comprehensive review of the impacts of drug policies worldwide over the past decade to help inform the forthcoming discussion in Vienna, the home of the UN’s drug control apparatus. Moreover, that the Report fails to explicitly examine market trends since 2009 also appears to be a missed opportunity.

Nonetheless, as has been the case in recent years, the flagship publication remains rigorous in its analysis and provides an impressiveoverview of the latest developments and trends in the world’s illicit drug markets. Surely of significance for deliberations at the Ministerial Segment, the consistently high-quality research reveals a similar, if not more challenging, picture to previous years. Amidst the ongoing theme of uncertainty and issues around reliable and comprehensive data, readers learn of the increasing complexity and scale of the global drug market. As the UNODC’s Executive Director, Mr. Yury Fedotov, remarks in his preface, ‘Both the range of drugs and drug markets are expanding and diversifying as never before’ (1. p. 1). This view is echoed in the Report’s ‘Conclusions and Policy Implications’ section. Here the Office notes how ‘The information presented in the World Drug Report 2018 illustrates the unprecedented magnitude and complexity of the global drug markets’. ‘The adverse health consequences caused by drug use remains significant’, it continues, ‘drug related deaths are on the rise…’ (1, p. 23). And it is the adverse health consequences of drug use, particularly, although not exclusively those relating to injecting drug use, as well as policies and interventions designed and implemented to mitigate them, that will be the focus of this analysis.

Departing from the well-tried format of previous IDPC responses to, and analyses of, the World Drug Report, a series of publications dating back to 2006, our intention this year is to narrow our focus and explore just a few of the many facets of the ‘World Drug Problem’ to be found within the Office’s latest offering. Intending to supplement – in the absence of any UN level analysis – IDPC’s recent report, Taking stock: A decade of drug policy – A civil society shadow report (see Box 1), the pages that follow contain a discussion of not only the alarming scale of the negative health impacts of drug use described in the Report, but also the woefully inadequate provision of a range of scientifically proven interventions; interventions that operate comfortably within the existing confines of the three UN drug control treaties. Mindful of member states’ apparently increasing commitment to the 2030 Sustainable Development Agenda within the context of drug policy, a perspective notably incorporated within the 2016 UNGASS Outcome Document, we also make deliberate reference to the Sustainable Development Goals (SDGs) and the potential of the Agenda to improve progress towards the long soughtafter goal of UN system-wide coherence around drugs. A focus on the Report’s discussion of the complexities surrounding drug use patterns and treatment needs of specific groups – women, young people and old people – also reveals how conceptualisation of the intersection between the Goals and the issue of drug use can still be broadened. Indeed, as we suggest, in order to appropriately heed Mr. Fedotov’s call for the international community to ‘step up its responses to cope with’ the myriad ‘challenges’ explored in the Report, (1, p. 1), member states must resist the temptation of remaining in a Vienna bubble and connect drug policy more effectively to the broader goals of the UN system of which it is one small part.

IDPC response to the 2017 World Drug Report

IDPC response to the 2016 World Drug Report

IDPC response to the 2015 World Drug Report

IDPC response to the 2014 World Drug Report

IDPC response to the 2013 World Drug Report

IDPC response to the 2012 World Drug Report

IDPC response to the 2011 World Drug Report

IDPC response to the 2010 World Drug Report

IDPC response to the 2009 World Drug Report

IDPC response to the 2008 World Drug Report

IDPC response to the 2007 World Drug Report

IDPC response to the 2006 World Drug Report

IDPC analysis of the UNODC World Drug Report 2018

Iga Kender-Jeziorska (Youth Organisations for Drug Action) and Péter Sárosi (Rights Reporter Foundation)

The involvement of non-state actors on various levels of policy-making has been one of the important issues of the European Union agenda for some time already. One of the manifestations of the EU efforts to include civil society representation in the work of various EU bodies has been creating Civil Society Fora – spaces where European non-governmental organisations can work together and sit at the round table with EU representatives.

The 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. One of its thematic working groups is concerned with the EU drug strategies and action plans.

EU Drug Strategy is a document “provid[ing] the overarching political framework and priorities for EU drugs policy identified by Member States and EU institutions” (European Council, 2012), thus setting the general directions of the field development. It is based on the EU values and principles on the one hand, and international agreements (e.g. United Nations conventions on psychoactive substances) on the other. The strategy constitutes a “base” to guide Action Plans on Drugs – documents encompassing 4-year periods and enlisting more specific actions and measures to be undertaken.

The current EU Drug Strategy was adopted for the years 2013-20, and its Action Plans for 2013-16 and 2017-20, respectively. The documents focus on few areas of drug policy: drug demand reduction, drug supply reduction, coordination, international cooperation, and information, research, monitoring and evaluation. With its vocal support for solutions that are evidence-based and strongly embedded in human rights and public health approach to the drug problem, they are by all means the most progressive EU documents of this type so far. However, EU strategy and action plans are documents of recommendation character only, i.e. they are not legally binding. Therefore, each and every EU member state has a full discretion over its drug policy (unless restricted by ratified international treaties), which means that the degree of following EU recommendation and reflecting them in domestic policies and laws can vary significantly from country to country.

For this reason, CSFD’s Working Group on the EU Drug Strategy and Action plan has been involved in in the evaluation of the EU drug strategy (2013-20) and the previous Action Plan on Drugs (2013-16), as well as the preparation of the new Action Plan (2017-20). The Forum has also decided to contribute to the monitoring and evaluation of the current Action Plan (2017-20). To do so, we have conducted a research among European NGOs working in the field to assess their perspectives and views on how relevant actions of the document are implemented in their countries.

This report consists of five main parts. First, we will describe the methodology and data sources of this inquiry. Second, we will discuss the services accessibility and quality in general. Third, we will provide a comparative analysis of the European regions included in the study. Fourth, we will look more closely at services accessibility and quality in the context of few specific and vulnerable populations: youth, elderly, women, ethnic minorities/immigrants and inmates. Finally, we will present barriers to the effective implementation of the EU Action Plan and draw a set of recommendations for various stakeholders.

Civil society views on the implementation of the EU Action Plan on Drugs: Report by the Civil Society Forum on Drugs

Laurent Jansseune, Mafalda Pardal, Tom Decorte and Òscar Parés Franquero

Cannabis Social Clubs (CSCs) are a nonprofit model for the supply of cannabis originating in Spain. This article aims to provide an overview of current CSC practices in Barcelona, exploring the role played by CSC Federations in shaping them. This analysis draws on 32 semistructured interviews with CSC managers (n = 15) and with other stakeholders in Barcelona (n = 17). We build also on field observations at other CSCs based in Barcelona. We found a heterogeneity of CSC practices, some of which were not in line with the self-regulatory codes developed by the CSC Federations. In applying an earlier CSC typology, we identified also country-specific CSC features. While the CSC Federations have contributed to unifying the cannabis movement and made efforts to homogenize CSCs’ practices, in the absence of (government) cannabis regulation, their efforts have to some extent been undermined.

Revisiting the birthplace of the cannabis social club model and the role played by cannabis social club federations

: In a year when UK drug-related deaths and festival drug-related deaths reached their highest on record, a pilot festival drug safety testing service was introduced with the aim of reducing drug-related harm. This paper describes the operational and behavioural outcomes of this pilot and explores the relationship be-tween drug use, supply and policing within festival grounds.

: Chemists in a temporary laboratory analysed 247 substances submitted by the public to a free, confidential testing service across four days at a UK festival in July 2016. Test results were returned to service users embedded in 230 healthcare consultations delivered to approximately 900 festival-goers (one in five drug using festival-goers) that included harm reduction advice and the opportunity to use a disposal service for further substances of concern. Consultation data were collected at point of care, matched with test results, coded and analysed using SPSS.

: Test results revealed that one in five substances was not as sold or acquired. One in five service users utilised the disposal service for further substances of concern in their possession and another one in six moderated their consumption. Two thirds of those whose sample was missold disposed of further substances, compared with under one in ten whose sample was as sold. Service users who acquired substances onsite at the festival were more than twice as likely to have been missold them as those acquired offsite, were nearly twice as likely to use the disposal service and were on average two years younger. Women were more likely to be using the drug for the first time and more likely to use the disposal service. Test results were shared with emergency services; alerts issued across site and an unanticipated feedback loop occurred to some drug suppliers.

: This pilot suggests that festival-goers engage productively with onsite drug safety testing services when given the opportunity, such services can access harder-to-reach and new user groups and can play a part in reducing drug-related harm by identifying and informing service users, emergency services and offsite drug using communities about substances of concern. Disposals to the testing service for onward police destruction provide an externally corroborated measure of impact, reducing harm to the individual and others by removing such substances from site. Evidence of differential dealing onsite and its potential negative consequences has implications for future research and policing.

Drug safety testing, disposals and dealing in an English field: Exploring the operational and behavioural outcomes of the UK’s first onsite ‘drug checking’ service

This section presents the absolute numbers received from the Prison Administrations of the 47 member States of the Council of Europe, as well as the rates, ratios and percentages estimated by the authors of this study on the basis of those numbers. The first version of the database was established on the basis of the data received from the Prison Administrations for each annual SPACE survey.

Prisons in Europe, 2005-2015

In 2008, Harm Reduction International (HRI) released the first Global State of Harm Reduction, a report that mapped responses to drug-related HIV, viral hepatitis and tuberculosis (TB) around the world for the first time. The data gathered for the report provided a critical baseline against which progress could be measured in terms of the international, regional and national recognition of harm reduction in policy and practice.

Since 2008, the biennial report has become a key publication for researchers, policymakers, civil society organisations, UN agencies and advocates, mapping harm reduction policy adoption and programme implementation globally. Over the last decade, reports of injecting drug use and the harm reduction response have increased; harm reduction programmes are currently operating at some level in almost half of the 179 countries in the world where injecting drug use has been documented.

The Global State of Harm Reduction 2018

Prepared by Public Health England, Health Protection Scotland, Public Health Wales, and Public Health Agency Northern Ireland

Drug use in the UK is among the highest reported in Western Europe. In 2017- 2018, around 3.0 million (9.0%) 16-59 year olds in England and Wales reported using a drug in the last year. This proportion has reduced over the past 2 decades, but has remained stable over the last 8 years. The Scottish Crime and Justice Survey (2014- 15) estimated 6.0% of 16-59 year olds reported using a drug in the past 12 months. There were 199,339 people who received treatment for drug misuse in England in 2016-17. Of those who newly presented to treatment, 37% were currently injecting, or had previously injected, drugs. The proportion currently or previously injecting among new presentations to drug treatment differed between those starting treatment for opiates (60%) and non-opiates (9%)

People who inject drugs (PWID) are vulnerable to a wide range of viral and bacterial infections, which can result in high levels of morbidity and mortality. HIV, hepatitis B virus and hepatitis C virus are very effectively transmitted through the use of shared needles and syringes. Unsterile injection practices are also associated with bacterial infections such as Staphylococcus aureus and Group A streptococci. Rare but lifethreatening infections with spore-forming bacteria such as tetanus, botulism and anthrax can be associated with contaminated drugs. Public health surveillance of infectious diseases, and the associated risk and protective behaviours among PWID, provides important information to understand the extent of these infections, the risk factors for their acquisition and for monitoring the effectiveness of prevention measures.

Publications