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Por Dra. Kelly San Martín Duran y Dr. Juan Pablo Yaeger Monje, Sociedad Médica de Cuidados Paliativos de Chile

Durante la sesión de la Comisión de Salud de la Cámara de Diputados de Chile, el día martes 18 de junio del 2019 se aprobó por decision unánime legislar para ampliar en Chile la atención garantizada de Cuidados Paliativos a la población. Hasta ahora, el acceso de Cuidados Paliativos está solo disponible en el país para los pacientes con diagnóstico de cáncer, sin embargo, este primer apoyo legislativo unánime abrirá las barreras para que la medicina paliativa llegue en Chile a quien la necesite.

Esta ley tiene por finalidad reconocer, proteger y regular el derecho de las personas en situación de enfermedad terminal a una adecuada e integral atención de salud, orientada a aliviar, dentro de lo posible, los padecimientos asociados a una enfermedad avanzada, generando un marco sanitario normativo que siente sus bases de una cultura de alivio de síntomas y muerte digna. Define las garantías que acompañan al diagnostico de un paciente con enfermedad incurable, basado en una atención multiprofesional especializada y el acompañamiento en la toma de decisiones, privilegiando el mejor cuidado que el paciente decida para sí mismo y su familia, recalcando que ninguna medida tendrá por objetivo acelerar artificialmente la muerte.

Desde hace mas de un año, la Sociedad Médica de Cuidados Paliativos ha tenido multiples conversaciones con diferentes autoridades del pais para promover este cambio legislativo. Durante el Primer Encuentro de Alto Nivel “Cuidados Paliativos: Fortaleciendo el Sistema Sociosanitario”, realizado en Lima en octubre  del 2018, participaron autoridades chilenas que actualmente son parte de las que apoyan esta moción.  Como paliativistas, nos sentimos felices y orgullosos que este proceso de acercamiento que se ha estado produciendo de muchos integrantes del sistema sociosanitario del pais, con el objetivo de ampliar cada vez mas la cobertura de los cuidados paliativos, ya este dando muestras de resultados positivos en Chile.

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On 13 June 2019, the Belarusian House of Representatives passed amendments to the notorious Article 328 of the country's Criminal Code. In the new version of the legislation, the lower limit of punishment under the 2nd and 3rd parts of the article that account for drug distribution is reduced by 2 years.

Credit: Legalize Belarus

Since the president toughened the country’s drug laws in 2014, those have been criticized by civil society activists and international organisations alike. The Ministry of Internal Affairs was the main opponent to amending the country’s legislation with a view to punish drug possession and consumption. But three days after the resignation of Ihar Šunievič who has served as Minister of Internal Affairs since 2012, the new legislation was adopted.

The “Mothers 328” movement, a group of mothers of people convicted of drug offences, went on a hunger strike on 11 June, and are unlikely to stop their protest. For the past 15 days, they have only been drinking water to demand the release of their children, as well as improvements to Article 328.

“More than 10 thousand people are imprisoned under a single article of the Criminal Code. Unless the government starts responding to complaints and revise criminal cases, the adopted amendments are just a cosmetic improvement aiming to bring more people to the II European Games, that are taking place in Minsk”, — said the leader of the “Mothers 328” movement, Łarysa Žyhar.

In a joint statement, released by the mother’s group and the Legalize Belarus civil movement on 30th May, activists identified a number of key points for meaningful drug policy reform:

  1. The amendments don’t affect the first part of the article that establishes criminal liability for possessing drugs for personal use. People are still subjected to prosecution for possession of even a small amount of cannabis or other controlled substances.
  2. The amendments did not introduce a clear demarcation of responsibility based on the quantity and type of a drug. In other words, a wholesale supplier and a small dealer will receive the same punishment under the current legislation. The vast majority of people convicted under  parts 2-4 of the article are either people who used drugs in a group or low-level deliverymen.
  3. The 4th part of the article still provides punishment of up to 20 years in prison. Numerous cases were reported of people convicted of “activities within an organized criminal group” simply because they had bought drugs from the same dealer.
  4. The amendments do not change the situation of minors – in Belarus, criminal liability under Article 328 starts from the age of 14. International activists demanded the release of all convicted for drug-related crimes who were under 18 when arrested.
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Today, thousands of people from over 240 cities all over the world will unite in solidarity for the 7th Support. Don’t Punish Global Day of Action to call for an end to the so-called ‘war on drugs’. Diverse and beautiful actions taking place include a pop-up mock ‘drug store’ installation in Lille, a series of flash-mobs in ten cities in Ukraine, and a public debate in Sierra Leone, artistic events in Mexico City, among many other activities.

March, talk show and music performance about the disproportionate impact of the war on drugs on women in Bekasi, Indonesia

The 26th June is also the International Day Against Illicit Drug Trafficking and Drug Abuse and too often governments have commemorated this day by showing off their drug control might by burning huge piles of seized drugs or, in the most extreme case, executing people charged with drug trafficking.

There is an ongoing, deeply concerning and unmitigated human rights crisis that has resulted from punitive drug control policies. The latest UN’s World Drug Report, released today, estimates that the number of drug use-related deaths soared to 585,000 in 2017 alone. The terrible truth is that most of these deaths could have been prevented if harm reduction and other health services had been available to those in need. The death toll from punitive approaches rises dramatically if extrajudicial killings, other unlawful killings and the use of the death penalty for drug offenders are added to this number.

MPs taking leadership and calling for drugs policy reform in Nairobi, Kenya

Until 2013, the message on the 26th June in the media was predominately focused on drug law enforcement efforts with scant regard for the resulting disastrous violations of human rights. For the past six years, the Support. Don’t Punish campaign has aimed to ‘message jam’ this dominant narrative and reclaim the message of the day – through a broad and diverse Global Day of Action. Through visible and global activism, the campaign does not allow governments to shy away from the true human cost of their drug control efforts.

We reject any celebration, on the 26th June or otherwise, of the unjust, and disastrous ‘war on drugs’ that has detrimentally and disproportionately impacted millions of lives – from people who use drugs to subsistence farmers of drug-linked crops, people of colour, women and so many others. The burden of draconian drug law enforcement is borne by people who are marginalised and in situations of vulnerability. We have witnessed this so clearly in recent weeks in the UK with white, privileged politicians admitting to past drug use with little to no impact on their life outcomes, whilst at the same time Black people are disproportionately policed and convicted for drug offences.

A mass lobby with families affected by the war on drugs in the Parliament in London, UK

Increasingly, repressive drug control measures are being understood as a form of state violence that serves to deepen and entrench structural inequalities, and the Global Day of Action brings together the growing, diverse and beautiful Support. Don’t Punish community to reject and challenge this.

The Global Day of Action is about building and showcasing solidarity, care and compassion, while promoting human rights and dignity for all the people worldwide who are, or have been, impacted by repressive drug policies. It is an opportunity for affected communities and civil society to have our voices heard, to demand alternative approaches to the war on drugs, and to engage in a real discussion with decision makers and the general public on meaningful reforms.

Today, we stand together from Amsterdam to Nairobi to Buenos Aires to New York to Bangkok and raise our collective voices that will not be silenced to loudly clamour for an end to repression and punishment as instruments of drug control.

In a global political climate where the space for activism is increasingly under threat, international solidarity matters more than ever. Together we can, and we must, work to end the war on drugs. Hundreds of thousands of lives depend on it.

Photos from the 2018 Global Day of Action
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Road to 2030: Concrete actions to scale up human rights-based approaches to harm reduction. A call to action for HCV, HIV and TB elimination among people who use drugs

By Gefra Fulane1,2, Joana Santos1,3,4, Cristina Bernardo1, Ricardo Baptista Leite1,5,6

Eleven years to reach the 2030 Sustainable Development Goals (SDGs), infectious diseases are still serious health threat. Global estimates indicate that 71.1 million people are living with chronic hepatitis C [1], 36.9 million people are living with HIV/AIDS [2], and 10 million people are ill with Tuberculosis [3]. Higher mortalities and transmission rates are found among key subpopulations such as drug users and drug injectors who, in many settings, lack basic rights to health care [4–7]. Environments like prisons are more likely to carry high burden of HCV, HIV and TB, with, for instance, HIV prevalence in prison worldwide considered to be up to 50 times higher than in general public [7]. Risky drug usage behaviour and lack of affordable health care services are a predominant way of disease transmission [7–10], and sharing needles and syringes among drugs injectors accounts for 23% of new infections globally [4].

Despite the efforts to prevent the initiation or continued use of drugs, many people continue to use psychoactive substances. Harm reduction strategies prove to be cost effective at reducing negative consequences associated with the use of drugs in people unable or unwilling to stop [11]. Notwithstanding, harm reduction exists at some level in only half of total countries in the world, the number of countries implementing needle and syringe programs has reduced from 90 in 2016 to 86 in 2018, whereas prevalence of HCV and HIV are still high among people who use drugs  if compared with general populations [4]. The implementation of harm reduction strategies fall far short of reaching most people in need, who frequently see their health-related human rights violated [13]. 

Photo of Members of Parliament after the signature of the call to action at the Joint Action Policy Day 2019 (Porto, 27 April 2019)

Considering that members of parliament have powerful tools to contribute to the elimination of the threat infectious disease pose within this population group, UNITE UNITE, the Global Parliamentarians Network to End HIV/AIDS, viral hepatitis and other infectious diseases has taken action and organized the Joint Action Policy Day 2019, held in Porto City, Portugal, entitled Road to 2030: Concrete Actions to Scale up Human Rights-based approaches to Harm Reduction. A Call to Action for HCV, HIV and TB Elimination among People Who Use Drugs. Co-organized with the Piaget Agency for Development (APDES) and the Harm Reduction International (HRI), the event was attended by 184 participants coming from 30 countries, across 5 continents, including 15 members of parliament, 37 community organizations, 8 scientific entities, 22 government representatives, and 12 donor representatives. Case-examples of Portugal, China, West Africa, France, Brazil and the US were discussed. Participants agreed that:

Good policies that are effectively implemented are needed to assure human rights-grounded services for people using drugs. Proved to be cost-effective, accessible harm reduction services that are integrated and human-centered, and do not cause financial hardship, have the potential to reduce the burden of Hepatitis C, HIV/AIDS and TB among people using drugs, and ultimately contribute to ending infectious diseases as threat to global health.

 Recommendations on policy actions to accelerate the attainment of health-related SDGs by tackling hepatitis C, HIV/AIDS and TB on people using drugs include:

  1. Drug use is not a criminal issue, it is a health issue! Punishment is counterproductive. Parliamentarians have a role to play in promoting political responses to end drug use criminalization and move towards legal regulation of currently illicit substances in their nations, regions and ultimately across the globe. Portugal is an example of how cost-effective decriminalization can be in reducing drug-related deaths, overdose and HIV/AIDS among drug users. But decriminalization is not a ‘magic bullet’. It is a component within a comprehensive approach that includes the implementation of harm reduction services, while ensuring access to care across the whole cascade from prevention, diagnosis to treatment.
  2. If harm reduction works in your neighboring country it will work in yours! Integrated harm reduction services comprise needle and syringe programs, opioid substitution therapy, test and treatment of HIV, hepatitis C and Tuberculosis, antiretroviral therapy, condom programs, psychosocial, sexual and reproductive health services, education and communication, overdose management, psychosocial support, and livelihood development programs. Lessons from a community-based organization Casa da Vila Nova (Norte Vida) show clearly the impact of service integration in the reduction of hepatis C, HIV, Tuberculosis and syphilis among drug users. This is an issue to advocate for in countries like Brazil where harm reduction’s era is at the end.
  3. Harm reduction and love have a shared common denominator: they must be unconditional! If harm reduction services are introduced, they need to be focused on health determinants and based on human rights. Abuses to rights of people using drugs need to be tackled with good laws, which will ultimately decrease stigma and discrimination. Members of parliament need to guarantee that civil rights and health rights of people using drugs are safeguarded. 
  4. Community-based outreach and peer-support needs to be proved to increase the access and uptake of harm reduction services. Policymakers need to understand, respect and value the role of peers in establishing the bridge towards the access to healthcare services, social services, and psychosocial aid for people using drugs. The recently opened mobile drug consumption room in Lisbon is a step to illustrate that proximity can increase the adherence to health-related services and increases autonomy of people using drugs.
  5. People in prison used to live in the society and they will come back after their release. Go there and Solve it! And take a Micro-elimination approach. “Breaking down national goals into smaller goals for specific populations, for which treatment and prevention interventions can be delivered more quickly and efficiently” [14]., requires a new approach, in which services are moved to outside conventional health facilities to improve the linkage to care. The challenge to strengthen harm reduction in prison settings is not unique to France. Many countries still fail to address prison health as public health.
  6. Actions need to be based on high quality evidence! Gathering data to monitor and evaluate how far we go and whether adjustments are needed, is paramount. Thus, policies must anticipate how results will be monitored, which sources will be used and whether data is available to provide decision makers with the good evidence. Providing good health information systems is central to overcome lack of data and show where we stand. Actors in the Western African region are engaging policymakers to move forward on data driven actions.
  7. Assuring Universal Health Coverage! It is important to go beyond drug users and include other key populations at high risk of being infected with hepatitis C, HIV, and TB. Do not leave anyone behind! GAT, the Activists Group under Treatment, has developed a wide range of actions that provide diagnosis, counselling and treatment to populations with high risk of infectious diseases. Some specific actions include education, as well as network and peer support in outreach strategies, as these increase empowerment and reduce stigma, thus easing the access to health services. Informed citizens are more prone to end with a meritocracy of care, thus ensuring universality of health care coverage.
  8. But First, Funding! Current funding models are not sustainable. Although international funding has a role to play, national governments are invited to fill the gap and replenish harm reduction services. Funding has to guarantee community-based organizations do their work without prejudice of their autonomy. At international level it is important to call attention to this issue to increase allocation of budget. A good example is that ALL Members of Parliament present at the event signed the call to action People before politics: HR19 call to action on harm reduction funding and Global Fund replenishment stating their support to sustainable funding of harm reduction.
  9. New ways of doing partnerships: reinvention and diversification. Partnerships are key to go further as it reinforces engagement and commitment towards common goals. Engaging prosecutors-supported interventions such as law-enforcement assisted diversion in countries, as well as media groups and youth groups is paramount as these are opinion makers; actually, sharing successful stories can have a considerable impact in people´s awareness. At a lower level, alliances like peer networks and support among drug users can help navigate among formal and informal social services. In the United States, the NGO Fair and Prosecution is working with a network of prosecutors to reduce incarceration driven approaches among drug users. Rather, they promote harm reduction by taking advantage of prosecutors unique role in this matter.
  10. Political will, political advocacy, political leadership: people’s health and safety first! Evidence for harm reduction is out there. Actually, it is no longer a matter of what works. It is a matter of political will and leadership to propose and implement proper actions and take the lead. Local and global networks are both required.

References

1. Blach S, Zeuzem S, Manns M, Altraif I, Duberg AS, Muljono DH, et al. Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. Lancet Gastroenterol Hepatol. 2017;2:161–76.

2. UNAIDS. Global HIV & AIDS statistics. 2018.

3. WHO. Tuberculosis. 2018.

4. Stone K, Shirley-Beavan S. The Global State of Harm Reduction 2018. London; 2018. www.ihra.net.

5. Csete J, Kamarulzaman A, Kazatchkine M, Altice F, Balicki M, Buxton J, et al. Public health and international drug policy. Lancet. 2016;387:1427–80.

6. Greely J, Bruneau J, Lazarus J V., Dalgard O, Bruggmann P, Treloar C, et al. Research priorities to achieve universal access to hepatitis C prevention, management and direct-acting antiviral treatment among people who inject drugs. Int J Drug Policy. 2017;47:51–60.

7. Sander G. Human Rights, Minimum Standards and Monitoring at the European and International Levels 1 Monitoring HIV, HCV, TB and Harm Reduction in Prisons: A Human Rights-Based Tool to Prevent Ill Treatment HIV, HCV, TB AND HARM REDUCTION IN PRISONS www.ihra.net. 2016.

8. Gountas I, Sypsa V, Blach S, Razavi H, Hatzakis A. HCV elimination among people who inject drugs. Modelling pre- and post–WHO elimination era. PLoS One. 2018;13:1–15.

9. Nelson PK, Mathers BM, Cowie B, Hagan H, Des Jarlais D, Horyniak D, et al. Global epidemiology of hepatitis B and hepatitis C in people who inject drugs: Results of systematic reviews. Lancet. 2011;378:571–83.

10. World Health Organization. Global Hepatitis Report, 2017. 2017.

11. What is harm reduction. IHRA Off Website. 1996;44.

12. Degenhardt L, Peacock A, Colledge S, Leung J, Greely J, Vickerman P, et al. Global prevalence of injecting drug use and sociodemographic characteristics and prevalence of HIV, HBV, and HCV in people who inject drugs: a multistage systematic review. Lancet Glob Heal. 2017;5:1192–207.

13. International Harm Reduction. The Global State of Harm Reduction. 2016. https://www.hri.global/contents/1421.

14. Lazarus, Jeffrey V., et al. "Micro-elimination–A path to global elimination of hepatitis C." Journal of hepatology 67.4 (2017): 665-666.

Affiliations

1. UNITE, the Global Parliamentarians Network to End HIV/AIDS, viral hepatitis and other infectious diseases
2. Nova SBE, New University of Lisbon
3. Instituto Nacional de Saúde Dr. Ricardo Jorge
4. Faculty of Public Health, University of São Paulo
5. Faculty of Health, Medicine and Life Sciences, Maastricht University
6. Institute of Health Sciences, Católica University of Portugal

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This article was originally published on the Dianova website. 

In March 2019, the international community gathered in Vienna for a high-level Ministerial Segment. The goal: to take stock of the past 10 years of global drug policy and chart the course for the coming decade in UN drug control. No only a key opportunity for civil society to influence the debates. But also call for more effective drug policies going forward.

Finally, building upon the momentum created in 2016 by the UN General Assembly Special Session (UNGASS) on drugs and its relatively progressive Outcome Document.

Acknowledging the failures of the past decade of drug policy

Ahead of the 2019 event, there was the absence of any meaningful official review of progress made in international drug policy since the adoption of the 2009 Political Declaration on drugs. Hence, IDPC – a global network of more than 180 NGOs working towards more humane drug policies – conducted its own analysis of the past decade.

Our analysis ‘Taking stock: A decade of drug policy’ utilised the available research from the UN, governments, academia and civil society. Specifically, to find out what the international community had achieved over the past ten years.

It underscored that cultivation, trafficking and consumption have all increased since 2009. As have the numbers of drug use-related deaths, in particular a recent surge in preventable overdose deaths. The report also highlights the catastrophic human rights toll of repressive drug policies. Including: severely overcrowded prisons, the continued use of the death penalty, extrajudicial killings, compulsory detention and corporal punishment.

Instead of promoting development and security, punitive approaches towards drugs have exacerbated violence, corruption, poverty, stigma and marginalisation.

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By Chokwan Kitty Chopaka, Highland Network

25th December of 2018 was a historical day for cannabis enthusiasts in Thailand. The (interim) Parliament voted, 166-to-0, to pass new amendments to the country’s Narcotics Act. These legislative changes will allow for the cultivation, importation/exportation, distribution, possession and use of cannabis for medical and research purposes in the Kingdom. The move is regarded by many as a big leap forward, especially as the country still retains a criminal penalty (one year of imprisonment) for the simple use of illicit drugs, including cannabis.

While the drug law is being reformed in relation to cannabis, people who use drugs remain highly discriminated against and stigmatised in Thailand. Indeed, the consumption of drugs deemed illicit for non-medical purposes, including cannabis, remains a criminal offence. And this against the progressive realisation, by jurisdictions worlwide and the UN system itself, that criminalising people who use drugs is an obstacle to realisation of health and human rights objectives.

The penalty for its "unauthorised" use will still be in place, and random, surprise public urine tests will still be carried out. This is far from being a safe, effective and evidence-based response to drug use, especially for those that need to use cannabis for medical purposes but may not qualify for a government-issued license or permit to do so given the strict requirements that are likely to be put in place. 

The implementation of the legal provisions on medical cannabis, which took effect on 18 February 2019, has triggered debate on several issues including who might be permitted to cultivate and produce cannabis, and under what conditions people may be allowed to consume cannabis for medical purposes.

While the government is still in the process of fleshing out the implementation of these legislative changes, an amnesty for people who already use, cultivate and possess cannabis for medical purposes has been provided for. People who use cannabis for these purposes will have to declare it by 19 May 2019. During this period, State organisations, pharmacists, dentists, veterinarians, practicioners of traditional Thai medicine and certified folk healers, as well as private higher-education institutions that do research or teach medicine/pharmacology, may qualify for a permit for access.

Legally-registered community and social enterprises, as well as agricultural cooperatives that work with or under the supervision of approved state organisations or private schools, international transport services, Thais who travel overseas with medical marijuana and others who have been authorised under ministerial regulations, may also qualify.

Those who sought amnesty and do not qualify for permission will need to surrender the cannabis they have in their possession.

In April 2019, officers from the Office of the Narcotics Control Board (ONCB) raided the premises of a non-profit organisation, known as the Khaokwan Foundation, and arrested one of its employees. The Foundation had been cultivating cannabis and providing it for medical use for several years. There was a strong backlash against the government’s actions, including from non-governmental organistions advocating on biodiversity, agricultural and consumer rights issues, particularly since the amnesty period had yet to expire. There were also accusations from the community that the government had been acting on pressure from pharmaceutical companies, who are likely to want to see highly restrictive regulations to ensure their relative control of the cannabis market. The ONCB subsequently released the employee and announced that it will not take legal action against Khaokwan Foundation as it still has time to apply for amnesty.

Overall, this approach to studying the effect of a drug on the community is almost unheard of in Thailand and, as a cannabis legalisation advocate, I feel that this is a step in the right direction. It is comforting to see that at least there is a search for answers to better understand and manage drugs.

In relation to another substance, kratom, the ONCB is now permitted to operate specifically zoned areas which allow for kratom cultivation and use. These areas will permit research to improve understanding of consumption patterns and cultivation methods, and its impacts on the community. This measure will mean that the cultivation, distribution, possession and use of kratom will be decriminalised in certain communities.

To learn more about the Highland Network, you can visit their website or Facebook accounts (in English / in Thai).

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This article was originally posted, in Spanish, on the Animal Político website.

The populations affected by punitive drug policies must attend international forums. The voices of women such as myself, formerly deprived of liberty, as well as female users, growers, couriers, dealers, relatives – among many others – must be heard.

By Natacha Lopvet *

From the grey walls behind which I served a ten-year sentence for transporting drugs, and which I left two years ago, I travelled towards the tall buildings of the United Nations. The place was overseen by tight security, a space where protests are not welcome and where diplomacy and the language of protocol are befitting. The only colourful detail lay in the flags that undulated to the beat of the Viennese climate. There, I achieved what would seem to be an unreachable dream to any person deprived of liberty in the world.

At the 62nd session of the Commission on Narcotic Drugs (CND), I had many questions, criticisms and uncertainties. I witnessed about a hundred roundtable discussions and conversations on drug policies around the world. I was struck by the large quantity of reports, data, scientific evidence, testimonies and accounts reflecting the problems found in each country, in each region, on this issue.

While civil society organisations can consider themselves to be guardians of democracy – by reminding governments of their duties as States – their massive presence this year reflected (among other things) an increase in humiliations and human rights violations, lack of freedoms, impoverishment, criminalisation, mass incarceration, structural failings and the violence faced by hundreds of communities throughout the world, because of punitive drug policies implemented in different countries. Although many might not appreciate it, civil society organisations play a leading role at the United Nations. They are the ones that bring information that contrasts with that submitted by governments. They are the ones that build bridges between affected communities and UN agencies, since most governments refuse to implement public policies that protect human rights for all.

Although organisations are building these bridges, it is also necessary for the populations affected by punitive drug policies to attend these meetings. The voices of women such as myself, formerly deprived of liberty, as well as women who use, grow, transport and deal drugs and their families – among many others – must be heard at these forums. Together, we observe how urgent it is for delegates to hear not only about the prevention and treatment of drug dependence, but also about the multiple human rights violations caused by mass incarceration arising from punitive drug policies.

The role of international agencies cannot be limited to inspecting prison conditions. They must approach those who live in those prisons and listen to the voices of the women affected by these policies. They must check under which criteria they were incarcerated, verify that their human rights are protected, and advocate for addressing the harms done by authorities, as well as for creating measures for non-repetition.

But there is a disconnect with reality. This can be seen in the traditional zero-tolerance drug policies implemented by various governments. Over the years, dozens of women, mothers and young people have been sent to prison for possessing or transporting drugs, destroying families and condemning women to search for a life of dignity amid the violence created by the war on drugs.

Meanwhile, the Mexican government is hardening its prohibitionist policy. In light of this, it is surprising that the international agencies in charge of UN drug policy did not call for a reduction of the harms precisely caused by the failed war on drugs strategy, through the legalisation, regulation and/or decriminalisation of drugs, and the prevention of drug dependence. The most emblematic proposal is that focusing on the treatment of drug dependence – it is not a substantive proposal but rather a mere plaster to tackle drug use while ignoring the clear consequences of the war on drugs from the past decade, including mass incarceration.

Once again, I am disappointed to see that prisons are managed the same way countries are being administered. I have now been able to confirm this is also the case at global level. The proposals, initiatives and actions presented there do not include a profound or tangible structural change that would improve the situation of people in prison settings, those who are in conflict with the law for offences against health.

The delegates representing various governments refused to answer these questions. UN agencies had a hard time recognising the failure of the past decade, and did not present concrete proposals to address the disastrous and unchecked spread of private prison systems.

Using my own experience and the hundreds of stories I heard during my time in prison, during the event I tried to put forward the need for proposals focused on people, and on the impact of incarceration on their lives, their psychological well-being, their families, towns, provinces, cities and society as a whole.

To ensure that public policies do evolve, those who implement them must change as well. During my stay in Vienna, I saw that UN officials were not necessarily moved by the reports conveying the harms caused by the war on drugs, and they had little access to the testimonies of people directly affected. How can we advocate more effectively to achieve a quicker change in drug policy? It seems that reports and figures are no longer enough. For the next session, it looks like we will have to come with a large delegation of formerly incarcerated women, women who use, grow, transport and deal drugs and entire families so that this crisis – and the urgent need to modify failed drug policies around the world – are finally acknowledged.

* Natacha Lopvet is a Project Officer at EQUIS: Justice for Women (@EQUISJusticia).

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This article was originally published on the Drug Reporter website. 

Drugreporter’s team attended the UN Commission on Narcotics Drugs (CND), please read some take home messages and watch some videos we produced there!

1. The CND is still dreaming about a drug-free world

Drug-free World: Reloaded. This was the title we gave to our video report about the 2009 Commission on Narcotic Drug meeting, when governments, despite of the evidence that their policies clearly don’t work, basically copy-pasted and repeated the 1998 political declaration. That is, they adopted another action plan to “eliminate or significantly reduce” drug use and trafficking in 10 years. I still remember the disappointment I felt: what is wrong with these people? This year I was not disappointed at all – everything went according to my expectations (I got older and more skeptical). The ministerial statement failed to draw conclusions from the evidence that they could not achieve any reduction in demand and supply and they reconfirmed their commitment to achieve a drug-free world. There were some strong, critical speeches at the opening, for example, the president of Bolivia defended coca legalisation again. But what we see is polarisation of opinions rather than linear progress.

If you want to learn more about why the ministerial declaration is a disappointment, read this excellent statement from the International Drug Policy Consortium!

Watch our video about how Jamie Bridge addressed the opening of the CND on behalf of the Civil Society Task Force!

The Civil Society Task Force on Drugs (CSTF): Getting Our Voices Heard Within the United Nation
The Civil Society Task Force on Drugs (CSTF): Getting Our Voices Heard Within the United Nation - YouTube

YouTube

2. Cannabis is being rescheduled

The big news last November was that the Expert Committee on Drug Dependence (ECDD) of the World Health Organisation (WHO) proposed the UN to reschedule cannabis from schedule IV (same class as heroin, with high abuse potential and no recognised medical value) to schedule I (low abuse potential, recognised medical value). This decision was made after the WHO conducted the first ever scientific review on cannabis. Yes, the first, because when cannabis was placed on the list of prohibited substances in 1961, this was not preceded with any scientific review. It is likely that this CND will not make a decision about WHO’s proposal because there are still many issues to be clarified – but this is clearly a historical step to the right direction.

If you would like to learn more about cannabis rescheduling and its implications on global/national/local cannabis policies, watch this online video session we streamed from the UN Headquarters on Thursday!

Rethinking Cannabis: The Global Debate - DRUGREPORTER LIVE
Rethinking Cannabis: The Global Debate - DRUGREPORTER LIVE - YouTube

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3. UN agencies call for drug policy reform

Unlike the CND, which reflects the consensus of member states, UN agencies are getting more progressive from year to year. In early March, right before the CND, the bosses of 31 UN agencies adopted a joint declaration in which, among others, they promote the decriminalisation of drug use. They “call for changes in laws, policies and practices that threaten the health and human rights of people.” Although several UN agencies adopted statements before in support of decriminalisation, this current one means that it is the official position of the whole UN family now. In addition to this statement, a task team that was created by the UN chief executives reviewed global drug policies and published a report. This report condemns punitive drug policies as “ineffective in reducing drug trafficking or in addressing non-medical drug use and supply.” This is a revolutionary statement in comparison with the dull ministerial declaration.

4. Landmark UN human rights guidelines published

Although member states acknowledged on paper that drug control policies must be implemented “in full conformity with all human rights and fundamental freedoms”, we know that 1) drug control policies often violate human rights and 2) what constitutes a human rights violation in the context of drug policies has been open to interpretation. Now this can change because a new International Guidelines on Human Rights and Drug Policy was published and presented at the CND this year. These guidelines cover all aspects of the drug phenomena and show how specific human rights violations intersect with drug control measures. Following these guidelines, member states will be able to develop human rights compliant drug policies – and critical NGOs will be able to make governments accountable. Please watch the video we produced at the CND about the side event where the guidelines were presented:

5. Strong civil society presence creates tensions

There is an unprecedented number of civil society representatives in Vienna this year, with loads of side events organised by NGOs and several activists speaking at the thematic debates. This is clearly beneficial not only for civil society – but for the CND as well. Tons of expertise and knowledge is channelled to the sometimes rather dull conversations. But not everybody is happy with this change. Several member states still consider NGOs hostile forces who disturb the business-as-usual operation of the UN. In this they have the full support of the security staff of the UN HQ, which is a fossil from another historical age and treats civil society representatives in a disgraceful manner. Those governments that are responsible for gross human rights violations hate to be named and shamed publicly by activists. The government of the Philippines has a booth in the rotunda of the UN HQ with a huge poster with Duterte’s picture, praising drug policies of a country that murders thousands of people in the name of drug control. When activist organised a peaceful die-in action in front of the Philippine booth, the security intervened. Just like when Support. Don’t. Punish organised a joint photo taking outside the building. I think it is time for the UN to reform not only its outdated drug control system – but also its outdated rules and security procedures. The peaceful expression of opinion is not a threat to the UN basic principles but an exhibition praising mass murder is.

Credit: Drug Reporter

We thank the International Drug Policy Consortium for supporting our work at the CND this year!

Text: Peter Sarosi
Video: Istvan Gabor Takacs

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By Bianca Maria Daiana Filipoiu, BSc Criminology and Criminal Psychology, University of Greenwich*

Imprisonment trends for drug-related offences tell us a rather compelling story about drug policy and its misguided reliance on repression. Recent research conducted by the Council of Europe shows considerably diverging patterns in imprisonment rates for drug offences in the region between 2005-2015. Countries such as Albania, Azerbaijan, Estonia, Lithuania, Russia and Turkey saw the highest increase in the proportion of people sentenced for drug offences among CoE member states over this period. In Estonia, this uptick was significant. People in prison serving sentences for drug offences went from 8.2% of the total prison population, in 2005, to 28.3% in 2015.

These changes, however, are not surprising. Despite a growing consensus on the negative impact of criminalising people who use drugs, and a body of evidence that points to a disconnect between imprisonment and lower crime, a significant number of countries still struggle to rid themselves of a tough-on-crime approach to public security.

Drug law offences in Estonia. EMCDDA. Estonia, Country Drug Report 2018

In Estonia, legal reforms aimed to reduce the burden of criminality on people who use drugs, enacted in 2005, have had mixed results. The Narcotic Drugs and Psychotropic Substances and Precursors Act provides a framework for drug control in Estonia. The law states that unauthorised consumption or possession of narcotics or psychotropic substances in small quantities and without a prescription is subjected to a fine of up to 1,200 euros or detention for up to 30 days. What is more, any act of illegal possession [or supply] of drugs which is deemed not solely intended for personal use is considered a criminal offence, irrespective of the type and amount of illicit drugs. Thus, illegal manufacture, acquisition, theft or robbery, storage, transport or delivery of narcotic drugs with the intent to supply are punishable by up to three years’ imprisonment for the smallest quantities and by 6 to 20 years’ imprisonment or even life, depending on the quantities involved. According to the latest data, almost 8 out of ten reported offences in Estonia were related to use and possession.

Mart Kalvet, an activist representing LUNEST, a Estonian organisation of people who use drugs, offered a revealing explanation for these statistics. In an interview with Drugreporter, he argued that the drug laws in Estonia have changed so that the possession of an amount of any illicit drug smaller than “the amount needed to intoxicate ten or more people” is no longer considered a criminal offence. He states that this is an improvement because: “On one hand, it has actually made possible the emergence into the public consciousness of drug users rights advocacy sentiments, but, on the other hand, it discriminates heavily against chronic users of opioids and other drugs with a high addiction”. The lack of clarity and limitations of relatively subjective thresholds might be contributing to what experts call “net widening”, which means that an increased number of people who use drugs are in contact with the criminal justice system; particularly those in situations of increased vulnerability. In turn, this approach fuels vulnerabilities and exclusion through criminal convictions and an increased reluctance to be in touch with harm reduction and health services. It would be difficult not to see a correlation with the significant increase of drug-related deaths in Estonia.

 

Incarceration rates in Estonia (drug offences vs. other offences). Council of Europe (2018). Prisons in Europe 2005-2015

In contrast, countries such as Portugal, Switzerland and Spain reported a decrease in the percentage of prisoners sentenced for drug offences (and either stable or decreasing absolute numbers). Portugal decided to decriminalise the possession of drugs for personal use in 2001 and to adopt a radically different approach, one that prioritises public health. An increased number of harm reduction interventions were adopted, including needle and syringe programmes, drop-in centres/shelters and contact units. This new approach has led to a big positive impact in terms of reductions in deaths and harm in general. The HIV infection rates have dropped significantly from 104.2 new cases per million in 2000 to 4.2 cases per million in 2015. The number of deaths associated with drug-use have also decreased significantly from 80 in 2001 to 16 in 2012. This makes Portugal the country with the lowest rate of drug induced deaths in Western Europe. While challenges remain, Portugal can serve as a model in this case of what kind of approach should be adopted; one that focuses on decriminalising possession for personal use by emphasising public health and well-being. As a result, this can lead to shifting people’s attitudes regarding drug abuse and therefore making it is easier for drug users to seek the treatment, they need without being stigmatised.

In Spain, unlike Portugal, decriminalisation has been a prominent feature of the legal system for decades. Subnational authorities and local activism have contributed to shape reform at the local level even without the assistance from the federal government. Their approach to drug policy based on harm reduction led to the expansion of opioid agonist treatment (OAT) and needle-and syringe programmes, which led to an improvement in health-related quality of life for people who use heroin. Studies showed that those who had access to OAT reported a noticeable improvement after only 30 days. Spain has also pioneered other harm reduction interventions, such as drug checking and safer consumption spaces. The latter provide people who use drugs with the opportunity to use drugs in a safe setting under medical supervision, with sterile equipment and the possibility of accessing other social and health support services. These spaces are supported by research, which shows they are linked with a decline in the rate of overdose deaths.

Even though there is evidence that we are moving towards a less punitive approach to drug policy, with countries such as Portugal, Switzerland and Spain providing clear examples; there is still so much more to be done in terms of harm reduction interventions and the effectiveness of the current drug policies. The ‘tough on crime’ approach to drug policy has been proved, countless times, to be ineffective, leading to overcrowded prisons, severe punishments for minor infringements, and the incarceration of individuals who might need support, not a prison sentence. As long as politicians rely on generating a moral panic for ideological, electoral purposes, rather than basing policymaking on compassion and kindness, we will continue see devastating repercussions.

* This blog post was produced within the framework of an 8-month volunteering experience placement at the International Drug Policy Consortium, organised by the Department of Law and Criminology of the University of Greenwich. The scheme offers students in their penultimate year of studies the opportunity to volunteer with public, private and third sector organisations that work with/in relation to the criminal justice system in order to develop skills and capacities applicable to work settings.

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Over the past six decades, the international drug control regime has relied upon the implementation of the three UN drug conventions, under strict supervision from the Vienna-based UN drug control bodies – the UN Office on Drugs and Crime (UNODC), the UN Commission on Narcotic Drugs (CND) and the International Narcotics Control Board (INCB). This highly centralised international drug control regime exerts a great deal of normative pressure on national and regional drug policies.

In fact, narrow interpretations of the UN drug control treaties are often presented by the UN drug control bodies and governments opposed to reform to justify continuing repressive responses and to stifle progressive approaches, for example resistance to harm reduction measures and decriminalisation, and more recently cannabis regulation initiatives.

Sustained civil society advocacy in favour of drug policy reform at the international level has been crucial in shifting the rhetoric towards upholding human rights, ensuring the centrality of health outcomes as well as promoting just and proportionate criminal justice responses and highlighting the development dimension (linking strongly to the Sustainable Development Goals). All of this progress is visible in the 2016 UNGASS Outcome Document, where the IDPC network played a central role in supporting progressive governments to fight for strong language on the key areas of priority for the Consortium.

In the past five to ten years, and in particular in the lead up to the UNGASS, civil society has increased in strength and visibility in the global drug policy debate. This is an important achievement because civil society voices have traditionally not been valued within drug policy debates, and it has been a fight to ensure that civil society organisations and representatives of affected communities could be heard. For the first few decades of UN drug policy discussions, civil society voices focused almost exclusively on pushing for stronger prohibition, which indirectly encouraged repressive measures to reduce demand and supply. Visible and credible reform-minded groups have been important in redressing that balance.

The reform narrative has gained significant ground which is most clearly demonstrated by the progressive tone coming from the UN system. In the lead up to the UNGASS, nearly all the UN entities which engaged with the process highlighted the failures and damage of prohibition and many of them called for reforms including specifically the decriminalisation of people who use drugs. In addition, many of the civil society groups from the other end of the spectrum have increasingly taken on a more moderate rhetoric, reflecting that reform groups have been successful in shifting the debate. At – and since – the UNGASS, the reform messages have dominated the civil society narrative.

There is an undeniable link between global and national-level drug policy. And ensuring the participation of civil society representatives, and supporting their advocacy efforts, at UN forums on drugs exposes them to what their government says at the UN and encourage accountability back at the national level. For instance, attending the CND enables civil society delegates to meet with their national delegations, follow up back in capitals, and feedback to their civil society colleagues at national level.  During the UNGASS, the reform movement was able to draw on these efforts. Many credible and vocal civil society actors were represented on the Civil Society Task Force (the official NGO engagement mechanism in the UNGASS process), and were able to speak in the UN meetings, engage with their national governments and report back to national civil society networks. The Civil Society Task Force was revived ahead of the 2019 Ministerial Segment and has been active in ensuring diverse views and voices are represented in the UN debates in the preparations over the past year – including with Civil Society Hearings held in New York last week, and in Vienna tomorrow.

Looking back to 2016, many civil society groups initially had mixed feelings about the results of the UNGASS. At the time, there was disappointment as the language in the Outcome Document was felt to have fallen short of expectations. Some actors who had optimistically hoped that the 2016 Session would bring an end to the ‘war on drugs’ felt disappointed. However, most NGOs quickly realised – as did many policy makers – that the UNGASS Outcome Document was, in fact, the most progressive, forward-looking document on global drug control to date. The key areas of progress included:

  • An important shift away from the traditional 3 pillars (demand reduction, supply reduction, money laundering) towards a new 7 theme structure that includes specific themes on access to controlled medicines, on human rights and gender and on development. This was strongly advocated for by IDPC and other reform-minded NGOs ahead of the UNGASS.
  • Improvements in language on access to controlled medicines, human rights, overdose prevention, gender issues, proportionate sentencing and appropriate and just criminal justice responses.
  • An irrevocable break in the long revered global consensus on punitive drug control with member states in open disagreement with each other at the UNGASS in New York on many key issues (decriminalisation, death penalty, the failure of the war on drugs, legal regulation).
  • For the first time, a strong engagement of UN agencies working on health, human rights, security, development and gender on drug policy issues, with progressive statements calling for reform.
  • Compared with the last UNGASS in 1998, no UN officials called for ‘a drug-free world’. The President of the General Assembly in closing said, ‘With your experience and expertise, you have brought home to us the immense human cost of this problem and indeed, at times, of the approaches we take to address it’. He also acknowledged that affected populations ‘need interventions that have proven to work and perhaps as importantly: they need honesty about those that have failed’. This kind of admission of the failure of drug control policies was unprecedented at the General Assembly.

The UNGASS also marked a real shift in the tone of the UN drug control bodies such as the INCB and the UNODC with respect to their strict view on how to implement drug control. Both organisations have since become more vocal regarding some of the most serious human rights violations committed under the guise of drug control – for example around the question of the death penalty in Indonesia, extrajudicial killings in the Philippines and Bangladesh, and human rights abuses more broadly.

IDPC, alongside many other reform-minded NGOs, has made a direct contribution to this shift in rhetoric. We have been consistent and unwavering in our advocacy with respect to the UN debates for many years, seeking to create pressure and tension in the system and to draw out the inconsistencies. Ultimately, we will continue to push for an honest debate about serious failures of punitive drug policies, and make adherence to the status quo of repressive and damaging policies untenable. With our shadow reports which have reviewed progress over the last decade of global drug policy (with analysis focusing on global-level progress and a regional report centred on the Asia region), we have presented the evidence of the (in)effectiveness of the current repressive regime to the highest levels of decision making at UN and national level.

However, there is reason to be worried about the current state of the debates. As the international community is preparing to meet at a Ministerial Segment in a few weeks, member states have embarked in difficult negotiations on a consensus-based resolution that would pave the way to the strategy to be adopted by UN member states for the next decade of global drug control.

As the negotiations are progressing, it seems clear that there are some irreconcilable differences hampering a global consensus on the way forward. The main point of disagreement remains the question around what the overarching objective of global drug control should be for the next decade. Various member states are keen to acknowledge the failings of current drug control (which IDPC has summarised in the Shadow Report) and the need to adopt a comprehensive and human rights-based approach to drug policy – as laid out in the UNGASS Outcome Document. However, this more progressive position has been met by vocal and well-organised block of conservative member states wishing to revert back to the 2009 Political Document and its overly punitive, zero-tolerance approach to drug control.

In a geo-political context vastly different from the ‘mood of change’ that had characterised the 2016 UNGASS debate, it is critical that reform-minded NGOs keep the pressure on both governments and the UN – and continued advocacy at the UN level to challenge the international regime to retain the gains made at the UNGASS is a priority. This, in turn, will insert downward normative pressure at the national level. At a time when populist and authoritarian regimes are taking hold of various countries around the world, coordinated, vibrant and vocal global advocacy by reform NGOs will ensure that the international community can no longer ignore the voices and plea for reform of those most affected by repressive drug policies.

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