On November 25, we commemorate the International Day to Eliminate Violence Against Women, which this year takes place under the banner of “Leave No One Behind”. That such a day is taking place this year amidst controversies involving acts of sexual harassment and abuse by prominent male celebrities and other high-profile public figures speaks volumes of the continued, structural, oppression of women worldwide, thirty-six (36) years after the entry into force of the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) in 1981.

While we can only laud the courage of the women speaking out against sexual violence, a large number of women remain invisible and extremely vulnerable to different forms of abuse – Among them, women incarcerated for drug-related offences.

Women make up a small percentage of the global prison population, but the number of women in prison are increasing and at a much faster rate than their male counterparts. Many women in prison are incarcerated for low-level, non-violent drug-related offences, ranging from about 25% in Europe and Central Asia, to as high as two-thirds (2/3) of women in federal prisons across the United States. A Thailand Institute of Justice study shows that a whopping 80% of women in Thai prisons are incarcerated for drug related offenses.

Punitive drug laws and the criminalisation of drug use and possession have resulted in overcrowded prisons, including facilities for women. Many women in prison do not have access to basic health care and other gender-specific services. They are vulnerable to physical and sexual abuse and potentially-fatal infectious diseases. Moreover, the stigma against women incarcerated for drug offences is magnified exponentially by stereotyped ideas on womanhood and femininity, and intersecting forms of discrimination. Women imprisoned for drug use, possession or low-level drug trafficking are often ostracised by their own families and communities, with terribly negative impacts on life outcomes.

As we call for the elimination of violence against women, let us not forget the women who are invisible because they are locked up in prisons. Aside from pushing for the full implementation of universal standards for the treatment of women prisoners, like the Bangkok Rules, we must not lose sight of the main culprit – punitive drug policies that prioritise criminalisation over human dignity.

Thumbnail: Jessamine Bartley-Matthews/Washington Office on Latin America

“Leaving no one behind”? For women incarcerated for drug offences, there is no justice without reform.

At the Lisbon Addictions Conference in October 2017, a team of researchers launched two ground- breaking new global reviews: one looking at the prevalence of injecting drug use and various sociodemographic factors, and the other estimating the global, regional and national coverage of harm reduction services. Both papers have been published in The Lancet and are currently available through open access, to ensure their widespread use and dissemination. They represent long overdue updates to the previous Lancet papers by the former UN Reference Group on HIV and Injecting Drug Use from 2008 and 2010.

After considering tens of thousands of articles, sources and datasets, the headline figures include:

Evidence of injecting drug use found in 179 countries (31 more than in 2008)

A new global estimate of 15.6 million people who use drugs (range: 10.2 – 23.7 million)

An estimated 18% of people who use drugs are living with HIV – with prevalence as high as 25% in Eastern Europe, and 36% in Latin America

More than 50% of people who use drugs globally are living with hepatitis C – and in Eastern Europe this affects two third of people who use drugs

Needle and syringe programmes were available in 93 countries: but with low coverage in most cases

Around 16% of people who inject drugs are receiving opioid substitution therapy

60% of people who inject drugs reported being arrested in the past

The numbers – and particularly the coverage data – are a stark reminder of the continuing funding gap for harm reduction services, despite their increasing acceptance around the world. Reassuringly, the research team found more and better quality data than before, but significant gaps remain (hence the large ranges provided for most of the estimates they have made). Most of the new reports of injecting drug use came from countries in Sub-Saharan Africa: 13 of which reported this behaviour in 2007, compared to 36 in 2017.

Crucially, the research also estimated the global rates of incarceration and arrest of people who inject drugs – identified as two of the main risk factors and “structural barriers” for this population. A staggering 60% of people who inject drugs reported being arrested in the past (equating to more than 9 million people), and just fewer reported being incarcerated. Arrest rates were higher than 90% in the Americas, and the incarceration rate was as high as 82% in the Caribbean and 81% in the Middle East and North Africa. These data show the negative impact that current drug laws are having on this population. As the authors note:

“roughly three in five [people who inject drugs] surveyed globally report exposure to incarceration, where high levels of risk often occur both in terms of drug use and other risks to wellbeing.Prisons often have limited or no health-care services, an issue of importance given that risk of drug withdrawal, suicide, and overdose following prolonged abstinence can all be elevated in that environment”.

“Our data highlight the substantial exposure of [people who inject drugs] to risk environments, suggesting that efforts to reduce harms among [them] also need to address structural and environmental factors”.

Finally, the global estimates for injecting drug use are also notable for being significantly higher than the UNODC data from their World Drug Report 2017 (which reports an estimated 11.8 million people who inject drugs, and a HIV prevalence of 13.1%). While the new Lancet reviews employ a systematic analysis of the available scientific data, the cross-UN estimates are predominantly reliant on self-reporting from governments. This demonstrates the value and need for independent scientific analysis on these issues. It is worth noting that, while the previous 2008 and 2010 reviews were performed under the guise of a UN Reference Group on HIV and Injecting Drug Use, this Group was defunded by the UN soon after. Thankfully, these latest independent reviews were at least part-funded by the Open Society Foundations, the Global Fund, the World Health Organization, UNAIDS and UNODC – due in part to their collective participation in the UN Strategic Advisory Group on HIV and Drug Use (which IDPC currently chairs).

New reviews show global extent of criminalisation among people who inject drugs

0n 7th September 2017, the Ugandan Ministry of Health authorized the Uganda Harm Reduction Network (UHRN) and Community Health Alliance Uganda (CHAU) to pilot needle and syringe programmes (NSP) in a few designated health facilities in the country.

This passage was the culmination of years of work by UHRN and our partner organisations. Although it has long been recognized that Uganda has a problem regarding drug use, unsafe injecting drug use was something that most of the people had limited knowledge about. In Uganda, people who inject drugs are one of the key population groups who together account for about 21% of new HIV infections. Recent studies estimate that HIV prevalence among this group is between 17-20% - much higher than the 6% prevalence in the general population.

Through advocacy by UHRN in partnership with CHAU and other stakeholders, the Government and general public have started recognizing the issue of unsafe injecting drug use in relation to HIV and hepatitis transmission. UHRN and CHAU have engaged with Uganda’s Ministry of Health and the Parliament’s committee for health, culminating with a realization of the need for NSP as a key intervention for strengthening Uganda’s HIV/AIDS response. As a result of several engagement meetings, Standard Operating Procedures (SOPs) are being drafted to allow for a demonstration NSP project in the designated health facilities in Mulago MARPI Clinic, Mbarara Regional Referral Hospital, Mbale Regional Referral Hospital, Gulu Regional Referral Hospital, and Butabika National Referral Hospital in Uganda.

The introduction of these supervised injecting facilities will have a real and positive impact in Uganda, both for people who inject drugs and for the wider community.

Slowly but surely, harm reduction programming is taking shape in Uganda and across the region, and we look forward to working with different partners and stakeholders to give UHRN the necessary support for implementing NSP in Uganda. The struggle continues – Support Don’t Punish!

Keep up-to-date with drug policy developments by subscribing to the IDPC Monthly Alert.

Thumbnail: Support. Don't Punish action, Mozambique

Finally, the Ugandan Government agrees to start harm reduction!

The INCB was once regarded as the ‘dinosaur’ of the international drug control regime, opposed to policy-innovation and unwilling to speak out on human rights issues. However, its has recently condemned the Philippines over its continued acts of violence toward those suspected of involvement in drug-related crimes. The previous President, Mr Werner Sipp, was critical of the Philippines actions.

This year, however, the current INCB President, Professor Viroj, had spoken out on the Philippines as part of his presentation on the ‘International Day against Drug Abuse and Illicit Trafficking’ which takes place each 26 June. However, the recent speech is more explicit and more radical than any previous dialogue.

‘The Board’, states the INCB, ‘is also deeply troubled by allegations that these acts have been condoned and encouraged by senior Government officials’. It goes on to reiterate in ‘the strongest possible terms’ that such extrajudicial responses that drug-related crimes are ‘in clear violation of the international drug control conventions’, and reaffirms its ‘categorical rejection’ of extrajudicial acts of any kind.

The Board reminds the Government of the Philippines of the conventions’ commitment to prevention, treatment, education and aftercare, and to a humane and balanced approach to people who use drugs. The President of the INCB, Dr Viroj Sumyai, calls on the Government of the Philippines to cease immediately perpetrating and supporting acts of violence against those suspected of drug-related crimes and to ensure that due process is fully observed. An equivalent message appeared in the INCB Annual Report.

This statement by the INCB represents an encouraging example its progressive position, and its support for human rights and due process in the carrying out of drug control policy. It demonstrates the newly energised and radical force that the INCB has become.

The ‘dinosaur’ has evolved into a progressive force.

INCB speaks out over Philippines killings

The INCB has produced a series of alerts, including one in late June on the therapeutic use of cannabis. This INCB alert represents a much more considered discussion than some of the earlier accounts published by the Board, in keeping with the organisation’s discourse under the leadership of Werner Sipp, which ended on 14th May 2017.

The alert notes that a growing number of governments have authorised the use of cannabis for medical purposes. Such a policy is permissible under the 1961 Single Convention on Narcotic Drugs, as amended by the 1972 Protocol.

However, a number of conditions must be met by the government in question. First, they should produce estimates of anticipated consumption, which should be submitted to the INCB along with further details such as the numbers of people using the drug for medical purposes. If cultivation is planned, details of the area and geographical location must be included. Furthermore, cultivation must be accompanied by the formation of a national cannabis agency to oversee proceedings, according to articles 23 and 28 of the 1961 Single Convention.

According to the alert, the INCB has ‘urged in the past all Governments that have established programmes for the use of cannabis for medical purposes to ensure that the prescription of cannabis for medical use is performed with competent medical knowledge and supervision and that prescription practice is based on available scientific evidence and consideration of potential side effects’.

The World Health Organisation is presently reviewing the therapeutic utility of cannabis, and the results will be made available in due course.

While these are positive developments, particularly in contrast to the attitudes and position adopted by the Board in the past, they fail to engage with the problems of the present and future: the non-medical use of cannabis for pleasure and entertainment. The medical and scientific use of drugs has been permitted – at least in theory – since the foundational treaties of the Hague Opium Convention of 1912 and the following international legislation passed in Geneva under the auspices of the League of Nations.

Several of the states of the United States of America, along with Uruguay, have already permitted the legal use of non-medical consumption of cannabis (with Canada next in line), and it is estimated that cannabis is the most widely illicitly used drug, for the purpose of pleasure, in global society. It is in this territory that the INCB remains a conservative force, with the Board in its 2016 Annual Report reminding governments ‘that, in recognition of the public health risks associated with its abuse, cannabis has been subjected to the highest levels of control under the international drug control treaties through its inclusion in Schedules I and IV of the 1961 Convention’. To reiterate: cannabis is subject to 

Doubtless there are pharmacological risks to health from cannabis; however, cannabis and other controlled drugs are imbued with added dangers, both medical and legal, superimposed upon it by the framework of international and national controls. It is these, too, with which we would like to see the INCB come to terms.

INCB on therapeutic cannabis

On 26th June, thousands of people across 205 cities in 93 countries took part in the fifth global day of action for the Support Don't Punish campaign to call for an end to the war on drugs. Four years ago, I wrote a blog about the "growing momentum for drug policy reform", after the first ever 'Global Day of Action' had taken place - with 41 cities holding events. This year, the global movement for drug policy reform got even bigger!

There were concerts, large public protests, seminars, radio shows, street art, sports matches and meetings with policy makers. The actions were imaginative, innovative, diverse and vibrant. In the UK, students from the University of East London ran an information stand outside of a busy shopping centre to inform the public about harmful drug policies and the "Rat Park" experiments of the 1970s. In India, colleagues embarked on a 470-kilometre motorcycle outreach tour with public interactions and photoshoots along the Delhi-Rajasthan highway. In Paris, drug users opened a mock "drug store". In Mauritius, there was a silent protest in front of Parliament, and meetings with religious leaders. In some cities, a handful of people gathered, taking photos and sharing the Support Don't Punish message. The Global Commission on Drug Policy joined the campaign this year, adding their political weight to the campaign's message. People from all four corners of the globe came out in their droves to join the ever-growing community that Support Don't Punish has now become.

"It is vital that we examine the effectiveness of the War on Drugs approach, and its consequences for human rights" ~

António Guterres, United Nations Secretary-General

So, what does all this achieve? There may be a long way to go until we can really say that the war on drugs has ended - but days like this show that the momentum is on our side. To have people taking to the streets on this scale for an issue like reforming drug policy would have been unthinkable ten years ago. Support Don't Punish has managed to capture and feed an appetite for action - whether through organising an event, turning up on the day, or even tweeting a photo. The 26th June - despite being the UN's official day against drugs - was once again turned into 'Support. Don't Punish Day', a global show of force for social justice, for human rights and for fairer drug laws.

Here's why drug policy activists in 205 cities took to the streets last month...

The recently elected President of the INCB, Professor Viroj Sumyai, gave a statement to mark the ‘International Day against Drug Abuse and Illicit Trafficking’ which takes place each 26 June.

As is so often the case in drug control, the INCB President’s discourse remains ambivalent. While the broad theme consists of an anti-drug message, the specific contents involve many of the more progressive elements that have featured in the INCB’s discourse in recent years.

‘The health and welfare of humankind is at the heart of the drug control conventions’, said Professor Sumyai, noting that the Board has recently emphasized ‘that the conventions are founded upon respect for human rights and the principle of proportionality in responding to drug-related offences’. Professor Sumyai went on to stress the importance of human rights and proportionality in drug-related sentencing. The INCB also encouraged states that still maintain the use of the death penalty to abolish it in the case of drugs offences. Adding that women are too often the victims of disproportionate sentencing for minor offences, he completed what is a largely powerful and progressive statement of the Board’s objectives.

He also strongly contested the use of extrajudicial killings, which is not only contrary to the international drug control conventions, ‘but is also a serious breach of human rights and an affront to the most basic standards of human dignity. The Board strongly, categorically and unequivocally condemns extrajudicial targeting of people suspected of illicit drug-related activity’.

It is encouraging to see that the INCB maintains its new, progressive stance, as was widely hoped within civil society. It appears, at least in the short to mid-term, that the Board’s position has been consolidated, and is set to endure, and that the new President will continue on the lines of his predecessor.

The new INCB President speaks on human rights and dignity

On Friday June 16, 2017, the President’s Commission on Combating Drug Addiction and the Opioid Epidemic held its first meeting at the White House. The meeting occurred after months of a lack of clarity regarding the Commission’s position within the federal government. Although established by executive order in late March 2017, the Commission’s role had remained unclear since its inception.

Observers questioned what relationship the Commission would have with the Office of National Drug Control Policy (ONDCP), an organization already established to provide federal guidance on drug-related issues. The Commission’s role became even less clear when a New York Times Article published in May of 2017 claimed a document obtained from the Office of Management and Budget showed that President Trump’s budget proposal intended to remove 95% of funding from the Office of National Drug Control Policy.

Richard Baum, President of ONDCP, later stated that this 95% figure was inaccurate and clarified the role of the Commission in relation to ONDCP. The Commission serves to review the state of drug dependence and the opioid epidemic and make recommendations to the President regarding how the federal government can best address the opioid crisis. Baum further explained that the Commission is staffed by the ONDCP. The White House has underpinned Baum’s explanations, writing that the Commission’s role is to review the state of drug addiction and the opioid epidemic and make recommendations regarding how the federal government can best address the opioid problem. The Commission is also charged with monitoring drug dependence treatment services, identifying and reporting on best practices for drug prevention and examining the effectiveness of state and federal prescription drug monitoring program, as well as writing a report advising the President on these issues, among other responsibilities. It was in this context that the first meeting was publicly held.

The Commission’s membership includes New Jersey Governor Chris Christie (chair), Massachusetts Governor Charlie Baker, North Carolina Governor Roy Cooper, former U.S. Representative Patrick Kennedy, and Dr. Bertha Madras of Harvard Medical School, all of which were present for the June 16th meeting. Following statements by U.S. Secretary of Health and Human Services Tom Price and and U.S. Secretary of Veterans Affairs David Shulkin, nine stakeholders and non-profit organizations working in the field of drug dependence spoke about addressing drug addiction in the United States.

Major themes emerged early in stakeholder presentations, including calls for increased access to ‘medically-assisted addiction therapy’ (that is, substitution treatment), access to long-term drug treatment programs and the need for comprehensive and integrated solutions that did not glorify one response over another. The need to diversify approaches to reducing drug dependence was echoed by Roy Cooper, Governor of North Carolina, who stated “we cannot arrest our way out of this problem”. Many participants insisted that the issue of parity was central to the problem and questioned why drug use was treated less seriously than physical diseases such as cancer. Stakeholders also voiced concern about stigma and the need to understand drug dependence as a health issue, and not a moral failing.

Over the course of the two-hour meeting, a tone of empathy and compassion was employed to discuss individuals dependent on drugs as well as their families. Participating stakeholders stressed that the obstacle to relieving opioid related deaths was not one of a lack of knowledge or understanding. “We know what to do, the money is available, we’ve known for years what to do” stated a representative from the American Academy of Addiction Psychiatry. “It’s really simple, we have the CDC guidelines” said a representative from ShatterProof, a not-for-profit organization dedicated to ending the effects of addiction on families.

But while participants stressed that they already were aware of ways to effectively reduce drug dependence, harm reduction policies – a critical response for many people who use drugs – were unfortunately not mentioned. This is likely a result of the lack of presence of harm reduction representatives invited to testify at the meeting. Some participating stakeholders, particularly from the health and science-based organizations, noted the importance of equipping first responders with the opioid-reversing drug Naloxone. But beyond overdose prevention measures, harm reduction interventions such as needle and syringe programs, the promotion of safe-injection facilities, and increased access to drug checking kits were not mentioned.

The silence on these harm reduction strategies was made worse by the fact that only five days earlier the American Medical Association, one of America’s most esteemed medical organizations, came out in support of piloting safe-injection facilities. And while a common theme of the discussions was the need for a public-health based approach to drug use and dependence, criminal justice reform was mentioned only once by any of the participants (the intervention on criminal justice was made by the American Academy of Addiction Psychiatry). This is particularly concerning in a country where 80% of drug-related arrests between 1993 and 2011 were for simple possession for personal use. As in other parts of the world, it seems clear that any health-based approach will not be possible unless the country reviews its overly repressive stance on drug control.

The Commission is due to submit their report to the President in October of 2017. If the first meeting of the Commission is any indication of this future report’s contents, it is likely that any success the report could have in advising the President on addressing drug use will be diminished by its failure to consider harm reduction strategies.

The first meeting of the US Commission on opioid dependence hears calls for a ‘health-based approach’ to addiction, but ignores harm reduction

The INCB visited Egypt between 11th and 14th June 2017.The previous visit was in May 2001, and was included in the INCB’s Annual Report 2001, when the Board congratulated the commitment of Egypt to international drug control. These congratulations were prompted by actions such as the country’s determination to eradicate cannabis and opium crops in the Sinai Peninsula. The INCB were more critical, however, of the availability without prescription of controlled substances.

The purpose of the latest visit was to review the implementation of the three international drug control treaties, and to discuss drug control developments since the 2001 mission. Likewise, the INCB wished to review the country’s challenges in the availability of controlled drugs for medical purposes, an area of particular relevance given Egypt’s concerns with tramadol.

The INCB appear to have had a close relationship in recent years over the synthetic opioid tramadol. At the 60th CND, Egypt submitted a conference paper concerning the tightening of control over tramadol, in which it made extensive use of INCB documentation dealing with tramadol including the Annual Reports for 2012, 2013, 2014 and 2015. The Conference Paper then states that:

The Egyptian authorities believe that the negative consequences of tramadol abuse necessitate that its control be expanded beyond a national control mechanism to be included under international control. In 2013, the Egyptian government proposed to the CND during its 56th session, a draft decision to support the international cooperation to prevent non-medical use of tramadol.

Again, as it did in the case of ketamine, the INCB is arguably exceeding its mandate under the international drug control conventions by making a similar argument to the Egyptian government. Recommendation on the scheduling of substances lies within the mandate of the WHO’s Expert Committee on Drug Dependence (ECDD), which has repeatedly undertaken pre-reviews on tramadol in recent years. Most recently, the ECDD carried out an update, which was contained in its 36th Report from 2014. Its recommendation on tramadol was: ‘Based on the evidence available regarding dependence, abuse and risks to public health, the Committee recommended that a critical review of tramadol is not warranted at this time.’ A critical review is the next step in the ECDD review process, and without its being undertaken a substance cannot be scheduled.

Amongst those who contributed evidence and views into the 2014 update process were pain specialists and pharmaceutical manufacturers, who commented that:

International control of tramadol would unnecessarily adversely affect the availability of tramadol for medical purposes in many countries worldwide that are not in need of further controls. In addition it is important to stress that tramadol is in many countries the only available stronger analgesic for patients suffering from moderate to severe pain. Therefore, an unwarranted scheduling of tramadol would contribute to worsening of the existing under-treatment of pain and lead to needless suffering of pain patients, especially in developing countries.

It will necessary to maintain a watch on the INCB and countries such as Egypt and their conduct in relation to tramadol. The campaign that prevented the international scheduling of ketamine can be marshalled again, but we cannot be certain that it will be as successful.

Keep up-to-date with drug policy developments by subscribing to the IDPC Monthly Alert.

INCB Mission to the Arab Republic of Egypt

By Marcus Keane (Head of Policy, Ana Liffey Drug Project)

On Tuesday 16th May 2017, the President of Ireland signed into law the Misuse of Drugs (Supervised Injecting Facilities) Act 2017, thereby creating a legal framework within which SIFs can legitimately operate in the country.

The passage was the culmination of a number of years of work by many stakeholders. Although it has long been recognised that Ireland, and Dublin in particular, has a problem regarding unsafe injecting drug use in public places, it is only in recent years that an impetus and focus has been given to SIFs as a viable policy option. In 2012, the Ana Liffey Drug Project (ALDP), an IDPC member and NGO working in Ireland, specifically named the establishment of a supervised injecting facility in their strategic plan. As part of this work, the organisation sought a detailed analysis of the legal landscape as it related to SIFs in late 2013. This analysis provided a review of both international and domestic sources of law relevant to the operation of SIFs and concluded that in order for a SIF to operate in a stable legal environment, legislative change would be required.

Seeking support for the next phase of work, ALDP approached the Voluntary Assistance Scheme (VAS), a project of the Bar of Ireland which works to provide access to high quality legal services for established NGOs. In early 2014, the VAS established a legislative drafting committee, a group of lawyers with significant and specific experience in relevant areas of law, such as legislative drafting, healthcare and criminal law. This group took a pragmatic, solution-focused approach to the work, adopting a minimum intervention approach which sought to change in law only that which was strictly necessary to enable a facility to operate. This group gave a significant amount of their time, 

, over the course of a year to work on this problem. They produced a refined and updated legal opinion on the key issues, a draft bill and an explanatory memorandum to the bill, which was handed over to ALDP and to the then Minister with responsibility for the National Drugs Strategy, Aodhán O’Ríordáin TD in May 2015. Minister O’Ríordáin had previously been a teacher in a school in Dublin’s inner city. He understood the harms that injecting in the public domain caused, both on individual levels and chose to champion the legislative change.

In December 2015, he brought the legislation to Cabinet, where it was agreed that the project would be progressed. Minister O’Ríordáin lost his seat in the general election in early 2016, but the commitment to legislate survived into the new programme for government, and the incoming Minister, Catherine Byrne TD continued to champion the project. The bill was progressed by the Department of Health through the normal channels for developing legislation, with input provided from other government departments and stakeholders, including NGOs like ALDP and statutory bodies like An Garda Síochána (the police force in Ireland), and with a final draft being produced by the Office of the Attorney General. The bill was introduced to the Dáil (the Lower House of the Irish Parliament) in February 2017.

ALDP lobbied members of Parliament on the bill, mainly focused on seeking to ensure there would be no unnecessary amendments tabled which, while well intended, would have the practical effect of making the opening of a facility more difficult, such as a statutory ban on opening within a certain distance of a school, for example. The bill passed in the Dáil wthout amendment and was introduced to the Seanad (Upper House), where it also passed without amendment. Ireland’s statutory health service, the Health Service Executive, is now tasked with establishing the new service. It is working with stakeholders, including people who inject drugs, to develop a plan for this, with the new service expected to be in place by late 2017.

The introduction of supervised injecting facilities will have a real and positive impact in Dublin, both for people who inject drugs and for the wider community. However, the process of how the country got to this point is also instructive – the reality is that no one actor can unilaterally implement effective drug policies. However, by working together, and recognising each others’ respective strengths, state and civil society actors can effectively work together on discrete projects, building trusting relationships which can be leveraged to ensure there is constant progress towards person-centred drug policies which are supported by the best available evidence.

Ireland set to open first supervised injection facility

The INCB met last month in Vienna, and at the top of its agenda was the election of new Bureau members and a new President. Dr Viroj Sumyai, a Thai citizen, was elected President for a term of one year.

Following the tenure of former president Mr Werner Sipp, who was a very humane and in many ways progressive leader of the INCB, driving forward its agenda toward public health and human rights, there is some concern amongst progressive civil society groups that Mr Sipp’s replacement may be inclined to undo the positive reforms that the Board has undergone in recent years. While obviously it is early days, the election of Dr Sumyai has done little to allay these anxieties.

While the new President no doubt possesses the necessary technical knowledge for the position, his views in the recent have been highly questionable. He was noted for his insistence on the INCB’s ‘neutrality’ in relation to the death penalty for drugs offences. For example, in the Bangkok Post of 29th February 2012, an article appeared that discussed the death penalty for drugs offenders. In the article, entitled ‘UN drugs agency won't take stand on swifter executions’, it was reported that, ‘The agency says it neither supports nor opposes the death penalty for drug-related offences’. This was reinforced by a quote from Dr Viroj Sumyai, who stated that, ‘We are an impartial body and respect the rule of law and jurisdiction of countries.’

This is in contrast to the views of Mr Sipp, who has repeatedly spoken out against the use of the death penalty, for example, in the cases of Indonesia and the Philippines. Indeed, the last years have seen the INCB stabilise its more progressive stance, and it is probably unlikely that the advent of a new President will drive it to regress to its former role as the dinosaur of the drug control regime. Nonetheless, it is important that civil society continues to monitor the Board’s discourse and actions.

Dr. Sumyai set out three key priorities for his term as President of the Board, and these suggest a continuity with Mr Sipp’s leadership:

improving access to and availability of opiate pain medications, especially in low- and middle-income countries;

working with governments towards improving the availability and quality of treatment services for people dependent on drugs; and

encouraging application by States of the principle of proportionality in responding to drug-related crime, particularly through using alternatives to imprisonment, such as treatment and rehabilitation.

The other elected members of the INCB are Professor Sevil Atasoy and Dr. Galina Korchagina, who have both served on the Board in the past, in addition to two entirely new members, Luis Alberto Otárola Peñaranda and Dr. Cornelis de Joncheere. The latter was formerly Director, Department of Essential Medicines and Health Products at the World Health Organization in Geneva; he entertained cordial relationships with civil society and can be relied upon to advocate for public health.

Elections and a new President at the International Narcotics Control Board

Last week, governments gathered in Vienna for the 26th Session of the Commission on Crime Prevention and Criminal Justice (CCPCJ). At the occasion of the Session, IDPC partnered with Penal Reform International (PRI) and the government of Costa Rica to organise a side event that aimed to link the UNGASS outcomes with the work of the CCPCJ.

Olivia Rope, PRI’s Programme Officer, opened the discussions with one compelling statistic – currently, one in five prisoners worldwide are incarcerated for a drug offence. 21% of them are in for drug possession, and the greater part of those incarcerated for drug trafficking are only involved at the lowest levels of the illicit drug chain. In a nutshell, this means that instead of targeting the most ruthless and violent individuals involved in organised crime activities, our drug control strategies have focused on the small fish, those that are often engaged in illicit drug activities because of lack of opportunities, poverty, stigma and marginalisation. Unsurprisingly, this zero-tolerance strategy has resulted in massive prison overcrowding.

Disappointingly, the UNGASS Outcome Document failed to recognise this global prison crisis. It nonetheless includes several recommendations on criminal justice reform. The CCPCJ has a significant role to play in ensuring that best practice and criminal justice standards are fully incorporated in drug control approaches – and the event was an opportunity to highlight best practice examples of countries having moved towards more proportionate sentencing and alternatives to incarceration for drug offences.

One of the key aspects of criminal justice reform as it relates to drug control is addressing the specific needs of women. Maria del Pilar Saborío de Rocafort, Costa Rican Ambassador in Vienna, offered Costa Rica’s experience in this regard. ‘The worst kind of blindness is the refusal to see’, the Ambassador started, reflecting on the fact that we cannot continue with the same punitive approach if we know it is not working. And Costa Rica has been innovative here. In 2013, the country reviewed its drug law to reduce the prison sentence of vulnerable women condemned for trafficking drugs in prisons. At the time, 75% of the female prison population were incarcerated for a drug offence. Most of those imprisoned for smuggling in drugs (generally to a partner or family member) in penitentiary facilities were sharing a similar background – poverty, sole carer of several children and/or elderly relatives, limited formal education and lack of job opportunities. Their incarceration was not only affecting them, but also their children and sometimes entire families. In recognition of their situation of dire vulnerability, the new law reduced penalties from 8-20 years to 3-8 years, and offered alternatives to incarceration with the help of a comprehensive social support network to address the underlying causes of their involvement in the drug trade. When the law was enacted, 150 women were immediately released from prison – and only 1% reoffended. Costa Rica also established a Restorative Justice Programme, whereby first-time offenders who commit a minor crime (generally theft) because of drug dependency are offered alternatives to incarceration. The Costa Rican example is incredibly important in a region where the high prison rates for women are mainly driven by repressive drug laws. It is also a more humane strategy that aims to support those in need, instead of pushing them further into cycles of poverty, marginalisation and crime.

Discussions then moved on to Georgia’s recent Constitutional Court decision in favour of cannabis decriminalisation. Guro Imnadze, from the Human Rights Education and Monitoring Centre, was one of the lawyers involved in the case. He explained that between 2006 and 2012 the Georgian government had adopted a zero-tolerance approach towards drugs, with disproportionate penalties applied for all drug offenders, going as high as life imprisonment. As in every other region of the world, this repressive approach led to a major prison crisis, with 30% of prisoners incarcerated for low-level drug offences. In late 2015, the Constitutional Court considered the case of Beka Tsikaririshvili v. Parliament of Georgia, involving a man who had been caught with small amounts of cannabis for personal use. The Court abolished imprisonment for simple cannabis possession. But the fight for drug policy reform is only beginning. Advocates are now turning to cases involving people caught for using other drugs – and who are therefore still criminalised under Georgian drug legislation. However, this ruling did open space for activism and civil society involvement in drug policy debates. A platform was created by drug experts and civil rights advocates calling for systematic reform, including the drafting of a proposal for legal amendments to decriminalise all drugs, heavily relying on the Portuguese decriminalisation model.

I then took the floor on behalf of IDPC to propose a series of recommendations on how the CCPCJ could better engage in the post-UNGASS process. The UNGASS Outcome Document is clearly relevant for the Commission, in particular on proportionality of sentencing, alternatives to incarceration or punishment, better access to healthcare in prisons (in line with the Bangkok and Mandela Rules), as well as improving access to due process and ending arbitrary detention or ill-treatment in criminal justice proceedings. In practice, many countries have already adopted – or are currently considering – these policies, such as Costa Rica and Georgia, but also countries as diverse as the UK, Thailand, Myanmar and others.

If nothing else, the UNGASS process has demonstrated the importance of ensuring better coordination within and across the UN system. The Sustainable Development Goals are also a unique mechanism requiring a synergy of efforts to achieve the complex targets set out for 2030. And of course, member states are now gearing up for the next big moment in global drug control, set to take place in 2019, when they will decide on their global drug strategy for the next decade. Considering the critical role of the CCPCJ in dealing with criminal justice matters, it is our hope that the CCPCJ can better engage in these processes by promoting evidence-based and humane criminal justice approaches and critical guidance such as the Tokyo Rules, the Bangkok Rules and the Mandela Rules.

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