The Global Fund to Fight AIDS, Tuberculosis and Malaria is the largest donor for harm reduction in low and middle countries (LMICs), providing two-thirds of all international donor support. In May 2019, the Global Fund Board will approve the 2020-2022 allocation methodology and catalytic investment priorities, ahead of replenishment for the Global Fund in October 2019. These will have significant implications for harm reduction in LMICs and as such, the ability of the Global Fund to step up the fight and get back on track to end AIDS by 2030.

This briefing, developed in collaboration with the International HIV/AIDS Alliance, compiles evidence of the crucial nature of catalytic investment funds for harm reduction. In the briefing, we urge the Global Fund Board to safeguard catalytic investment funds—including multi-country grants, matching funds and strategic initiatives—regardless of the replenishment outcome, in order to sustain life-saving services for people who inject drugs and to incentivise domestic investment in harm reduction.

Harm Reduction International joint briefing on Global Fund catalytic investments for harm reduction

The distribution of death as an organised exercise of state power, militarised topographies where experiencing the early burial of peers is part of the socialisation of generations of people, the vocabulary of homicide and slaughter integrated into the formation of black people’s experience from the time of their childhood in war-torn territories and necropolitics, which promotes a set of racialised and racialising categories and undertakings, define the political agenda, permeate televised narratives and distribute fear to market the idea of social peace. These are all part of a broad range of actions legitimised by the idea of war, including against other peoples, under another spectre of war – the so-called 

. The selectiveness of prohibitionist drug policies is one of the tools used to perpetuate a series of injustices that are the result of a perverse regime that operates today via an economy marked by violence, which continues to have effects even today.

The massacre of black Brazilians in the war on drugs

Por Nathália Oliveira e Eduardo Ribeiro

A distribuição da morte como exercício organizado do poder de Estado, as topografias militarizadas onde gerações passaram a ser socializadas pela experiência do enterro precoce de seus pares, o vocabulário do homicídio e da chacina na formação da experiência negra desde a infância em territórios de guerra e a necropolítica que impulsiona um conjunto de categorias e empreendimentos racializados e racializantes definem a agenda política, percorrem as narrativas televisivas, distribuem o medo para comercializar a paz social e cabem no amplo leque de ações legitimadas pela ideia da guerra, inclusive contra outras populações, sob outro espectro da guerra, os chamados efeitos colaterais. E a seletividade da política de drogas proibicionista é um exemplo de instrumento da manutenção de um conjunto de injustiças que são fruto de um perverso regime realizado por meio de uma economia de violências que produz efeitos ainda hoje.

O massacre negro brasileiro na guerra às drogas

The first edition of these Standards was published in 2013, summarizing the evidence of drug use prevention at the global level with a view to identify effective strategies, ensuring that children and youth, especially the most marginalized and poor, grow and stay healthy and safe into adulthood and old age.

Member States and other national and international stakeholders recognised the value of this tool, with the Standards acknowledged multiple times as useful basis to improve the coverage and quality of evidence-based prevention. In addition, in 2015, the Member States of the United Nations made a series of wide-ranging commitments in the Sustainable Development Goals to be achieved by 2030 and Target 3.5 pledges to strengthen the prevention and treatment of substance abuse. In April 2016, the Special Session of the United Nations General Assembly on the world drug problem heralded a new era for addressing drug use and drug use disorders through a balanced and healthcentred system approach.

In the context of this renewed emphasis on the health and wellbeing of people, UNODC and WHO are pleased to join forces and present this updated second edition. As in the case of the first edition, the Standards summarize the currently available scientific evidence on the basis of overview of recent systematic reviews, and describe interventions and policies that have been found to improve drug use prevention outcomes. In addition, the Standards identify the major components and features of an effective national prevention system. This work builds on, recognizes and is complementary to the work of many other organizations (e.g. EMCDDA, CCSA, CICAD, CP, NIDA) which have developed other standards and guidelines on various aspects of drug use prevention.

It is our hope that the Standards will continue to guide policy makers and other national stakeholders worldwide to develop programmes, policies and systems that are a truly effective investment in the future of children, youth, families and communities.

International standards on drug use prevention - Second updated edition


The New Zealand Drug Foundation’s vision is for an
Aotearoa free from drug harm.

This State of the Nation is the first of what will be an annual report. It’s intended to track how New Zealand is dealing with alcohol and other drugs, and show a starting point against which we can assess the impact of any policy changes.

While we are doing well in some areas, there is massive room for improvement. Top of the list is the horrifying number of deaths (as many as 50) linked to synthetic cannabinoids since mid-2017.

There is room for hope, though, with some welcome announcements from the government in December. They plan to ensure Police no longer prosecute people for possession and personal use of any drug “where a therapeutic approach would be more beneficial, or there is no public interest in a prosecution”. This could be a game-changer for ensuring people can get the help they need.

Also in December, the government passed new medicinal cannabis legislation and declared the 2020 cannabis referendum will be binding. And already this year, the Police Minister acknowledged the importance of drug checking at festivals.

However there is no room for complacency. Illicit drug convictions are creeping up again after falling for many years, with 5,710 people convicted in 2017. It’s concerning that 61% of those convictions were for low-level offences, such as possessing or using drugs. And Māori continue to suffer disproportionate harm both from drugs and our drug laws.

And a note on drug statistics: New Zealand does not have adequate ones. With all that is going on, it’s essential we rectify this in a hurry. How else will we know what’s working and what’s not working?

New Zealand Drug Foundation’s State of the Nation report 2018

The drug crisis our country faces today is unprecedented. It has evolved over the past several decades and has steadily worsened with time. Every state and county, and every socioeconomic group in our country, is directly affected by the negative consequences of illicit drug use. However, today we can see American ingenuity across the Nation, sparked by the commitment to save lives, at work to establish lasting solutions to this monumental problem. Law enforcement and public health innovators working side-by-side at the local level, assisted and inspired by families who have lost loved ones to the scourge of drug use, resourced by government agencies at every level working with private sector partners, are already making a difference. This National Drug Control Strategy, the Trump Administration’s first, establishes the President’s priorities for addressing the challenge of drug trafficking and use, now and in coming years. It also provides the strategic direction necessary for the Federal government to prevent initiates to drug use through education and evidence-based prevention, provide treatment for those suffering from the disease of addiction so they can reach long-term recovery, and reduce the availability of these dangerous drugs in every American community.

The President’s top priority is to address, head on, the current opioid crisis and reduce the number of Americans dying from these dangerous drugs. This crisis alone has resulted in more American deaths in just two years than in the course of the entire Vietnam War. In 2017, there were more than 70,200 drug overdose deaths in the United States according to the Centers for Disease Control and Prevention (CDC). More than 47,500 of these deaths involved an opioid, and more than half of these deaths involved a synthetic opioid such as illicit fentanyl or one of its analogues. From 2014 to 2017, the number of deaths attributed to synthetic opioids like fentanyl and its analogues increased 413 percent, and these synthetic opioids are now involved in more deaths than any other drug such as prescription opioids, heroin, or cocaine. Along with the current opioid crisis, overdose deaths involving heroin, cocaine, methamphetamine, and prescribed opioid painkillers have all increased since 2014 as well, and many of these deaths involved more than one drug.

The Trump Administration is matching the magnitude of today’s historic crisis with a historic level of focus and resources. In addition to providing an array of Federal grants across the spectrum of drug issues the Presidentincreased resources in his Fiscal Year(FY) 2019 Budget dedicated to the opioid crisis, held two opioid summits at the White House, established The President’s Commission on Combating Drug Addiction and the Opioid Crisis (herein referred to as the Commission) via Executive Order in March 2017, and announced his Initiative to Stop Opioid Abuse and Reduce Drug Supply and Demand in March 2018.

While confronting today’s drug crisis to arrest its growth and reduce its effects, we must also further develop the capability, knowledge, and infrastructure to respond to the evolving nature of the drug threat aswemovedeeperintothe twenty-first century.Drug traffickerswill continue toattempttosecure ever-greater profits by expanding their customer base, reducing overhead, and mitigating risks to their supply chains. The exponential growth in the availability and use of synthetic drugs in the United States, especially synthetic opioids like fentanyl and its analogues, provides a window into the likely future of drug use and trafficking. Drug trafficking organizations can avoid the costly process of harvesting illicit crops and producing plant-based drugs by the much cheaper and faster process of chemical synthesis. Potent synthetic drugs can be smuggled across our borders in small quantities that can be more easily concealed than bulkier plant-based drugs. They can also be purchased cheaply on the dark web using cryptocurrencies that provide anonymity, and shipped into the United States through international mail or as express consignment shipments. The combination of low production cost, the anonymity of the darkweb and cryptocurrencies, and drugs with higher potency than plant-based drugs, creates a favorable risk-reward structure that drug traffickers will embrace to an even greater degree in the years to come.

Along with the emergence of the greater availability and trafficking of synthetic drugs, we must also confront an emerging crisis of cocaine availability and use in the United States. The increased cultivation of coca and production of cocaine in Colombia, the source of more than 90 percent of the cocaine in the U.S. market, has once again reached record levels. Moreover, the suspension of aerial eradication programs in Colombia during its peace process, from 2015 until today, has led to even greater yield from coca plants,resulting in increased production and purity levels. Cocaine use in the United States started rising again after many years of decline. From 2016 to 2017, overdose deaths in which cocaine was the primary contributing drug increased 34 percent according to the CDC, and the National Survey of Drug Use and Health (NSDUH) shows that in 2017 past-month users of cocaine aged 12 and above increased from 1.9 million Americans to 2.1 million and new initiates to cocaine use increased to 1 million, averaging approximately 2,800 per day

Given the current drug crisis facing America, and the President’s priorities, this Strategy adopts a strong bias toward action. It focuses on leveraging our understanding of the complex interplay between the availability of drugs in the U.S. market and their use, anticipating changes in the drug environment in both the public health and law enforcement domains, and adapting our actions to seize the initiative to make lasting progress against this historic challenge. The global drug trafficking enterprise is vast, dynamic, and adaptable, but it is not without vulnerabilities. It is only through a unified effort in which the Federal government works with, and in support of, creative and resourceful individuals and organizations across the country, that can we address this complex national security, law enforcement, and public health problem.

United States national drug control strategy - 2019

By Sedona Sweeney, Zoe Ward, Lucy Platt, Lorna Guinness, Matthew Hickman, Vivian Hope, Lisa Maher, Jenny Iversen, Sharon J. Hutchinson, Josie Smith, Rachel Ayres, Ingrid Hainey & Peter Vickerman


To evaluate the cost‐effectiveness of needle and syringe programmes (NSPs) compared with no NSPs on hepatitis C virus (HCV) transmission in the United Kingdom.


Cost‐effectiveness analysis from a National Health Service (NHS)/health‐provider perspective, utilizing a dynamic transmission model of HCV infection and disease progression, calibrated using city‐specific surveillance and survey data, and primary data collection on NSP costs. The effectiveness of NSPs preventing HCV acquisition was based on empirical evidence.


UK settings with different chronic HCV prevalence among people who inject drugs (PWID): Dundee (26%), Walsall (18%) and Bristol (45%)


Current NSP provision is compared with a counterfactual scenario where NSPs are removed for 10 years and then returned to existing levels with effects collected for 40 years.


HCV infections and cost per quality‐adjusted life year (QALY) gained through NSPs over 50 years.


Compared with a willingness‐to‐pay threshold of £20 000 per QALY gained, NSPs were highly cost‐effective over a time‐horizon of 50 years and decreased the number of HCV incident infections. The mean incremental cost‐effectiveness ratio was cost‐saving in Dundee and Bristol, and £596 per QALY gained in Walsall, with 78, 46 and 40% of simulations being cost‐saving in each city, respectively, with differences driven by coverage of NSP and HCV prevalence (lowest in Walsall). More than 90% of simulations were cost‐effective at the willingness‐to‐pay threshold. Results were robust to sensitivity analyses, including varying the time‐horizon, HCV treatment cost and numbers of HCV treatments per year.


Needle and syringe programmes are a highly effective low‐cost intervention to reduce hepatitis C virus transmission, and in some settings they are cost‐saving. Needle and syringe programmes are likely to remain cost‐effective irrespective of changes in hepatitis C virus treatment cost and scale‐up.

Evaluating the cost‐effectiveness of existing needle and syringe programmes in preventing hepatitis C transmission in people who inject drugs

By FIDH - International Federation for Human Rights

Thailand’s prison population has steadily increased over the years and the country has the dubious distinction of having the largest prison population and the highest incarceration rate among Association of Southeast Asian Nations (ASEAN) member states.

For more than a decade, United Nations (UN) human rights mechanisms have expressed concern over prison conditions in Thailand. Regrettably, successive Thai governments have failed to make any progress in the implementation of the UN’s recommendations and to uphold their own commitments to improve prison conditions. In addition, since the 2014 military coup, Thailand’s junta has enforced measures that have caused conditions in the prisons to deteriorate. The junta also increased the use of military facilities to detain civilians.

As documented in this report, Thailand’s ongoing failure to enact a comprehensive prison reform has created conditions for human rights violations to be rife in its prison system in breach of the country’s obligations under international instruments to which it is a state party

The Thai Department of Corrections’ motto, ‘Caring Custody, Meaningful Rehabilitation, International Standard Achievement’,1 could not be further from the reality of the Thai prison system. Research conducted by FIDH and UCL on two large prisons in Bangkok suggests that Thailand’s prison conditions fail to meet international standards and to create an environment conducive to the rehabilitation of prisoners.

Overcrowding remains the most pressing issue in Thai prisons. Thailand’s average yearly prison population has steadily increased over the years and, aside from the periodic royal amnesties, no other effective and sustainable measures have been adopted to significantly reduce the population. Based on a standard to provide a surface area per prisoner of 2.25m2 , available official statistics representing 74% of Thailand’s prisons and 91% of its overall prison population show that these prisons are operating with a prison population of more than double the intended capacity – with an occupancy level of 224%.

Inadequate access to medical treatment, insufficient food and potable water, and poor sanitation facilities continue to plague the prisons examined in this report. It is likely that similar conditions exist in other prisons across Thailand. Medical care and special arrangements for pregnant women are particularly lacking. Prisoners are often subjected to exploitative labor practices characterized by harsh working conditions and insufficient remuneration. Punishment in prisons contravenes international standards and, in some cases, may amount to torture and ill-treatment. Prisoners’ statements indicate that restraining devices, such as shackles, have been excessively used. Finally, inmates have reported unreasonable restrictions placed on visits and correspondence with family and friends. While procedures for making complaints exist, prisoners are afraid to lodge complaints out of fear of retaliation at the hands of prison officials.

The situation has not improved since the 22 May 2014 military coup. Under the National Council for Peace and Order (NCPO) access to prisons has become more difficult. In addition, based on interviews with former prisoners and families of current inmates, FIDH and UCL were able to document that prison authorities have enforced stricter prison regulations and further curtailed prisoners’ rights. Of particular concern is the increased use of military bases to detain civilians, which do not afford detainees many of their basic rights. The use of the Nakhon Chaisri temporary detention facility inside the 11th Army Circle base in Bangkok illustrates this trend. Since the establishment of Nakhon Chaisri less than two years ago, there has been a lack of access for independent monitors, two custodial deaths, and allegations of torture have surfaced.

This report recommends numerous measures to improve detention conditions, including providing independent inspection bodies unfettered access to all prisons and allowing non-governmental organizations with a relevant mandate to conduct visits to places of detention, interview inmates, and assess conditions without undue hindrance.

Behind the walls: A look at conditions in Thailand’s prisons after the coup 

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.

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