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.

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

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.

Promoting drug policy reform at the UN Commission on Crime

This piece was first published by the ICSDP

With the UNGASS on the World Drug Problem now a year behind us, member states are looking towards the next international drug policy milestone, a High Level Ministerial Meeting in 2019. Simultaneously, member states are over a year into efforts to achieve the Sustainable Development Goals (SDGs), a set of global targets to end poverty, protect the planet, and ensure prosperity by 2030. Given increasing recognition that the impacts of global drug policy are intrinsically linked to a number of SDGs, the Government of Switzerland, Health Poverty Action (HPA), International Drug Policy Consortium, Centro De Estudios Legales Y Sociales (CELS), Social Science Research Council, Global Drug Policy Observatory (GDPO), and the ICSDP came together at the 60th Session of the Commission on Narcotic Drugs (CND) to explore how drug policy indicators could aid member states in more effectively achieving the sustainable development agenda.

Natasha Horsfield, Policy & Advocacy Officer from HPA, outlined crucial ways in which drugs and drug policy interact with several of the SDGs, and suggested that metrics for measuring how drug policies are contributing to the SDGs should be prioritized in preparations for 2019. Speaking about goal 1 on poverty, goal 2 on food security, and goal 5 on gender equality, Ms. Horsfield explained that marginalization and inequality are important elements in the drug trade, with poverty and food insecurity a frequent factor in involvement in illicit drug markets, and women particularly becoming involved as drug couriers because of their gendered social and economic vulnerabilities. Gender inequality is reflected in the disproportionate and alarming increase in the incarceration of women for minor drugs offences. Given these and other intersections between drug policy and the SDGs, the clear, measurable, and internationally agreed framework of targets and indicators contained within the sustainable development agenda could be adapted to measure drug policy outcomes. For example, new indicators could be adopted at national level under goal 5 to measure women and girls involved in the drug trade or incarcerated for drug crimes. Ms. Horsfield also stressed that the High Level Ministerial Meeting in 2019 presents an opportune moment to align the timeline for the next drug policy framework with the 2030 deadline for implementing the SDGs.

Elaborating on Ms. Horsfield’s remarks, Luciana Pol, Senior Fellow in Security Policy & Human Rights from CELS, pointed to improvements that could be made to drug policy indicators to support the achievement of SDG 5 on gender equality. Ms. Pol noted that the Special Rapporteur on violence against women has identified anti-drug policies specifically as a leading cause of the rising rates of incarceration of women globally, and data demonstrates that a portion of women incarcerated for drug offences are coerced into trafficking and others engage as a result of lacking viable economic opportunities. Ms. Pol described concrete ways to improve the quality of data on how drug policies impact women. First, prison data should have a gender perspective by including, for example, information on the amount of pregnant women, of children incarcerated with their mothers, and access to health services for these groups. Second, since laws in many countries don’t distinguish between different types of drug offences, small and large scale trafficking are categorized together. Differentiating between the conduct for which they are incarcerated and the roles women play will improve our understanding of incarcerated populations. Ms. Pol reminded the audience that improving our understanding of how drug policies impact women is not only essential to ensuring the achievement of SDG 5, but is also a central component of last year’s CND resolution 59/5. Ms. Pol therefore called on member states to take these and other concrete steps to mainstream a gender perspective in their collection of data relevant to drugs and drug policy, and urged UN agencies to guide member states in this process of broadening and expanding their drug policy metrics.

As a contributor on law enforcement indicators to the World Drug Report, Christian Schneider, Strategic Analyst at the Federal Office of Police in Bern, Switzerland, shared his firsthand knowledge that the incomplete nature of data on drug markets can prohibit efforts to derive meaningful policy recommendations. In addition to communicating uncertainties, Mr. Schneider proposed that gaps in the data could be addressed by adopting a more comprehensive set of indicators. Sharing technical recommendations for implementing Mr. Schneider’s suggestion, Dave Bewley-Taylor, Director of GDPO, focused on how a review of the Annual Report Questionnaires (ARQs) could support the achievement of the SDGs by aligning drug policy metrics with the sustainable development agenda. According to Prof. Bewley-Taylor, despite the limitations of self-reporting, the ARQs are a useful mechanism through which member states report on their efforts to address the world drug problem. As the nature of the world drug problem has evolved, however, there have been increasing gaps in the data collected by the ARQs. This recently came into sharp focus, as the UNGASS Outcome Document included an operational recommendation to use relevant human development indicators in alignment with the SDGs to increase understanding and improve impact assessments. Within this context, Prof. Bewley-Taylor stressed that there is a clear need to review the structure and questions of the ARQs to bring them into alignment with the SDGs by incorporating indicators related to human rights, public health, and human security. Such a review could be conducted through an interagency expert group established by the Statistical Commission, which has already begun considering these issues.

Discussions on drug policy indicators and their relationship to the sustainable development agenda are undoubtedly of utmost importance at the CND, and in other forums, such as the meeting of the high-level political forum on sustainable development in July 2017. Yet, much more than discussion is needed. As Ms. Horsfield said, advancing past this critical juncture will require political will from member states beyond simply reaffirming their commitment to SDGs, but towards deemphasizing drug control efforts that undermine the SDGs and funding those that contribute positively to their achievement. Aligning drug policy metrics with the SDGs is an important step in this direction.

Click here to visit the CND Blog’s live reporting from this side event.

Preparing for 2019: Drug policy objectives and indicators, system-wide coherence and the Sustainable Development Agenda

Despite perceived novelty, drugs have been 

 from the Internet’s very beginnings. Anecdotal as it may be, it is widely understood that the very first transaction on ARPANET involved a small amount of cannabis. Ever since, cyberspace has provided fertile ground for all sorts of drug-related exchanges.

The appeal of the Internet for people who use drugs is evident. Faced with criminalisation, misinformation and stigma “offline”, the 

 can offer people who use drugs a space to interact in [relative] anonymity and safety. Online forums, such as Erowid, have provided a platform for people to share experiences and advice related to their drug use; fostering a sense of community that remains difficult to replicate "

Silk Road, however, was a game changer. Launched in February 2011, the site was the first “archetypical” crypto-drug marketi. This “eBay for drugs” combined sophisticated encryption, communications and trust technologies to offer a broad range of [mostly illicit] products and services to users around the world. Cannabis, LSD, MDMA and other controlled substances were now just a click away… plus shipping & handling.

As it is often the case with drug-related developments in a context of prohibition, the initial response from public authorities ranged from cluelessness, to politically expedient outrage, to repression. Less than three years into the Silk Road experiment, and before the site’s impact on the market could be fully understood, the FBI shut it down. Its convicted mastermind, Ross Ulbricht, now serves a life sentence without parole in a federal prison in New York.

Mirroring the reality of “physical” markets, dismantling the Silk Road, and subsequent similar operations, have achieved anything but the intended effects. The original site might no longer exist, but dozens more have been created in its stead, with overall sales and reach continuing to grow at a gradual but unwavering pace.

Despite the available evidence, the role of public authorities in this evolving ecosystem continues to go unchecked. The UNGASS Outcome Document urges Member States to “strengthen law enforcement, criminal justice and legal responses, as well as international cooperation, to prevent and counter drug-related criminal activities using the Internet” (Art. 5 p). As if expecting different results from doing the same thing over and over again.

In stark contrast with a mainstream law enforcement discourse that perceives these online markets essentially as “a safe haven for criminals”, the burgeoning field of research on crypto-drug markets reveals a more nuanced landscape. An interdisciplinary research project on trust in these markets by the Global Drug Policy Observatory (GDPO)ii, for instance, can shed light on the short-sightedness of fundamentally repressive law enforcement interventions targeting crypto-drug markets.

Borrowing tools from linguistics, ethnography and computer science, the investigators have sifted through thousands of megabytes of messages from the now-defunct Silk Road[s] 1 and 2iii. The careful analysis of “collocates”iv has made it possible to produce a statistically meaningful snapshot of some of the prevailing discourses in these communications.

One strand of the project, led by Professor Nuria Lorenzo-Dus, revealed that trust among users was largely mediated by the exchange of personal experiences and other forms of knowledge, as well as the provision of advice on how to reduce potential harmful effects of drug use. User-based harm reduction strategies have been previously identified in crypto-drug markets and offline communitiesv. However, by focusing on the issue of trust, the authors centre and highlight the social bonds underpinning this “indigenous harm reduction”. Public authorities should consider the opportuneness of law enforcement responses that might entail weakening these community strategiesvi, favouring interventions that support the life and health of people who use drugs insteadvii.

A second project strand, headed by Martin Horton-Eddison, provides further evidence on the unintended, although not unexpected, consequences of “hard” law enforcement interventions. Using the same methodology and sources, the study suggests the takedown of Silk Road by the FBI acted as a 

 for technological innovation in crypto-drug markets - resulting in even more difficulties for law enforcement to target the dark net. Specifically, this research captures the emergence of collective concerns about the “escrow” system.

Escrow has been an essential trait of crypto-drug markets, mitigating some of the multiple risks associated to online transactions. A number of these risks are related to the non-abidance by one of the parties to the terms of the sale/purchase. In the absence of formal institutions to act as arbiters, crypto-drug markets stepped in to fill the gap, offering a service that holds the funds until the other parties (in this case the buyer and seller) both agree to release them. When Silk Road 1 was seized, the FBI expropriated $3.6million from the system. Immediately after Silk Road 2 came to exist, users began to discuss ways to offset these potential losses. Intensified by major “exit scams”, these anxieties in the community seem to have led to the development of better alternatives, such as decentralised and multi-signature escrow systems. Law enforcement action, in short, made crypto-drug markets more resilient and possibly sustainable.

The insights from these studies strongly mirror certain realities of offline drug markets. The global drug control regime has a conspicuous track record of futile interventions that are not motivated, and in fact come at the expense of the wellbeing of people who use drugs. Crypto-drug markets, which are often framed as a threat in international policy debates, might actually offer an opportunity to provide remedial action. Public authorities should rethink their engagement with these spaces, capitalising on the self-regulatory and harm reduction practices deployed by these communities to positively influence, support and empower people who use drugs on- and offline.

This blog post draws on material presented at the Roundtable on Cyber-Trust in Crypto-Drug Markets: Implications for Policy and Policing (London, 21 February 2017), organised by the International Institute for Strategic Studies (IISS) and the Global Drug Policy Observatory (GDPO), with support from the International Drug Policy Consortium (IDPC) and the Challenging Human Environments and Research Impact for a Sustainable and Healthy Digital Economy (CHERISH-DE) fund.

i Crypto-drug markets can be defined as “digital platforms that facilitate P2P trade of goods and services with the added features of recommendations systems and a reliance on cryptocurrencies such as bitcoin. They utilize anonymizing Internet-routing technologies [....] to conceal the physical-[world] identity and location of users and create and open network for such interactions”.

iii February 2011 - October 2013 and Nov. 2013 - November 2014, respectively.

iv Words that co-occur with statistical significance, denoting “features of the data that are both salient and peculiar”. Di Cristofaro, M. & Horton-Eddison, M. (2017) 

Corpus Linguistics on the Silk Road(s): The Escrow Example

v See, for instance: Bancroft, A., & Reid, P. S. (2016). 

Concepts of illicit drug quality among darknet market users: Purity, embodied experience, craft and chemical knowledge

. International Journal of Drug Policy, 35, 42–49; and Friedman, S. R., de Jong, W., Rossi, D., Touzé, G., Rockwell, R., Des Jarlais, D. C., & Elovich, R. (2007). 

Harm reduction theory: Users’ culture, micro-social indigenous harm reduction, and the self-organization and outside organizing of users’ groups

. International Journal of Drug Policy, 18(2), 107–117.

vi For more on law enforcement and harm reduction, see, for instance: Monaghan, G., Bewley-Taylor, D., 2013. 

Modernising Drug Law Enforcement – Report 1 Police Support for Harm Reduction Policies and Practices Towards People Who Inject Drugs

. International Drug Policy Consortium, London

The Emergence of Deep Web Marketplaces: A Health Perspective. The Internet and Drugs Market

 (European Monitoring Center for Drugs and Drug Addiction). Publications Office of the European Union, Luxembourg; 2016.

Trust in the crypto-drug markets

At the 60th CND in March 2017, there were a number of substances placed under international control (‘scheduled’). The majority of these were recommended by the WHO’s Expert Committee on Drug Dependence.

United Nations Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances

, the mandate for assessing chemicals used in the illicit manufacture of drugs – precursors – lies with the INCB. The Board recommends to the CND, which makes the final decision. Scheduling issues were dealt with on the Thursday morning session under agenda item 8b, ‘Changes in the scope of control’. INCB President Mr Werner Sipp presented data and recommendations on two such precursor chemicals: ANPP and NPP. The Board recommended that these substances should be included in Table 1 of the 1988 Convention, imposing upon them international controls. The CND went on to vote unanimously in favour of scheduling ANPP and NPP.

In the course of his remarks at CND, Mr Sipp stated that the scheduling of fentanyl precursors demonstrates that the international conventions protect public health. He argued that their inclusion in Table 1 of the 1988 Convention would not interfere in their availability for licit purposes, which consist primarily in the production of fentanyl for medical purposes.

UNODC’s Global SMART Update, which focuses on synthetic drugs – Amphetamine Type Stimulants and New Psychoactive Substances – recently published on fentanyl and its analogues. Fentanyl is approximately 100 times the potency of morphine, and is linked to an expansion in fatalities associated with overdose, particularly in North America. Fentanyl itself is controlled under Schedule l of the 1961 Single Convention. As the SMART Update notes, fentanyl is ‘often sold under the guise of heroin or prescription medicines, such as oxycodone, and this exacerbates the risk of overdose and associated fatalities’. This context, in which substances are bought and sold on an illicit market, is one that Mr Sipp fails to take into account. In a legally regulated market, consumers would know what they are buying, whereas at present they may believe that they are purchasing (for example) heroin, when in fact they may be sourcing the fentanyl analogue carfentanil, a drug with 10,000 times the strength of morphine.

The INCB and the scheduling of precursors at CND 2017

In a little corner of the United Nations each year in March, governments get together to debate drug policies at the "Commission on Narcotic Drugs", or "CND". In many respects, these annual gatherings in Vienna are routine and seemingly unremarkable. However, upon closer inspection, it becomes apparent that the needle is inching forward in the global drug policy debate.

The pretence of a consensus on how to deal with the illicit drug market has long been stripped away, and the space that has been created allows different priorities, approaches and ideas to emerge. It is still a difficult environment, with divergent views that result in tense negotiations at times, but the progress that is being made towards putting health, human rights and development at the centre of drug policies should not be underestimated.

This momentum has been spurred on by last year's UN General Assembly Special Session (UNGASS) in New York, the first global drugs summit in eighteen years and the highest level of political debate possible on the topic. The UNGASS had been urgently called for by Colombia, Mexico and Guatemala - all countries that have suffered huge collateral damage in their fight to end the drug trade - a fight that has been futile in achieving its stated objectives, while instead fuels violence, corruption, mass incarceration and devastating abuses of human rights. The summit's declaration, while unfortunately failing to explicitly acknowledge the damage wreaked by misguided policies, calls for greater attention than ever before to the human rights dimensions of the response to drugs. It specifically calls for proportionate sentences for drug-related crimes and the provision of alternatives to conviction or punishment, as well as adherence to due process and the rule of law. In addition, the declaration's strong focus on health calls for action on the global epidemic of pain created by overly strict controls on opiate painkillers like morphine and outlines specific harm reduction measures to prevent HIV, overdose deaths and other harms. Finally, a strong link is made to the Sustainable Development Goals, in recognition that the pursuit of drug control targets must not undermine the global commitment to human development.

It is clear that the rhetoric on drugs is changing at the UN, although the reality on the ground in many countries still falls short of these emerging aspirations. So it is crucial to leverage the gains made at the UN to push for governments to re-think bad and misguided drug policies.

Following on from the UNGASS last year, ensuring commitments to human rights, development and public health were strands that ran throughout the Vienna debates last month more prominently than ever before. Here are five significant moments from last month's CND meeting:

1. "We must not forget that the ultimate objective of drug control policies is to save lives" Margaret Chan, Director-General of the World Health Organisation, addressed the delegates at the opening of the 60th Session of the CND

Vienna is home to the UN Office of Drugs and Crime (UNODC) and is where the CND meetings are held. In this setting, the law enforcement response to drug use has traditionally prevailed, trumping considerations of the health and rights of people who use drugs. Dr Chan's personal appearance in the opening session (alongside the Executive Director of UNODC, Yury Fedotov) - and her strong support for harm reduction as central to drug policies based on evidence rather than ideology - underlines the paradigm shift that has taken place. It is no longer acceptable to singularly pursue draconian and disastrous drug policies based on repression and punishment, and those countries that continue to do so can expect to be called out.

The new UN Secretary General, António Guterres, who sent a video address for the opening, called for reinforcing the links between drug policies, health and human rights. He reminded the CND that when he was the Prime Minister of Portugal, the government had decriminalised the use of drugs as part of a comprehensive approach, before encouraging the CND to 'deepen reflection' on the future of drug policies.

Since President Duterte took power in the Philippines in June 2016, there have been more than 8,000 extrajudicial killings of people suspected of using, dealing or trafficking drugs. This year in Vienna, many governments, UN officials and NGO representatives called for an end to the death penalty for drug offences and an end to extrajudicial killings - even if they could not diplomatically single out the Philippines in their public statements. Stark violations of human rights committed in the name of drug control are increasingly being highlighted and condemned in the UN drug policy debates, and bodies such as the International Narcotics Control Board (INCB) now speak out strongly against these violations, whereas only a few years ago they did not deign to intervene or even acknowledge such violations. Since the UNGASS last year, human rights have become more embedded in the Vienna discourse on drugs than ever before.

3. Committing to ending the HIV/AIDS epidemic

The CND meeting broke new ground this year by passing a resolution that directly calls for increased funding for the harm reduction response for people who inject drugs. This funding is urgently needed given the devastating increase of 33% in new HIV infections among people who inject drugs between 2011 and 2015 - over the same period during which the global community had committed to reduce such infections by half. There is a huge global funding gap for harm reduction measures, partly due to a decline in HIV funding, but also related to an ideological resistance to harm reduction. Globally, most of the available funding for drug policies continues to be channelled towards law enforcement to deter drug use, rather than towards proven health interventions that save lives. This imbalance has resulted in a burgeoning HIV epidemic among people who inject drugs. This call for funding from governments within a drug control setting is unprecedented and will have far reaching implications.

4. Drug consumption rooms and drug checking

Drug consumption rooms, or safer injecting facilities, have long remained controversial even in countries that have accepted other harm reduction measures, such as distributing sterile needles and syringes or providing substitution therapy for people who use heroin (which are explicitly mentioned in the declaration from last year's UNGASS). No one has ever died from a drug overdose in a drug consumption room - a facility set up for the safe consumption of drugs under the supervision of medical personnel. This is particularly important in contexts like the USA, Canada and the UK, countries that are facing alarming increases in preventable deaths from opioid overdose. There are approximately 90 of these facilities around the world, mostly in Europe, but also in Canada and Australia. This year, for the first time, the INCB deemed that drug consumption rooms could be justified providing that they are offered within a broader health continuum that also encourages drug treatment and social support - which is generally the way these facilities work anyway. In addition, another innovative harm reduction measure, drug checking (sometimes called pill testing or adulterant screening) was discussed for the first time at CND in a prominent side event during the CND meeting for the first time, and is receiving increasing attention as a way to reduce the risks associated with drug use. The side event was organised by NGOs and underlines the crucial role that civil society advocates have in continuing to push the debate on drugs forward.

Canada announced its intention to legally regulate cannabis in a bland and matter-of-fact statement. Having undertaken a lengthy study to assess how best to do this in the Canadian context, the government has recently announced that it will happen by 1st July 2018. As more and more jurisdictions move to regulate cannabis, it is becoming harder for the UN to ignore. Many hardline countries, however, still staunchly oppose these moves, and the general view is that the legal regulation of cannabis is outside of the limits of the UN conventions on drugs. Meanwhile, cannabis will soon be reviewed for the first time ever by the WHO's Expert Committee on Drug Dependence, who in examining the evidence, may recommend less restrictive cannabis policies. Watch this space!

Drugs at the UN: The needle inches forward

At this, the 60th CND and the first since the 2016 Special Session of the General Assembly on the ‘World Drug Problem’, the INCB found itself busily engaged in the proceedings.

The opening statement by Mr Werner Sipp, the President of INCB, was an ambivalent presentation: though it was, at times, perhaps the least progressive of the interventions made by the Board during the week, it nonetheless included a powerful defence of the human rights of people who use drugs and a searing critique of governments who continue to abrogate those rights. While applauding the results of the 2016 UNGASS, Mr Sipp concentrated on the role of the international drug control conventions in underpinning the global response to drugs. He spoke critically of those ‘voices (that) continue to talk about a need to “modernise” or “reform” the conventions’. INCB, however, remains staunch in its defence of the flexibility of the conventions, which do not permit states to legalise or regulate the non-medical use of narcotic drugs or psychotropic substances. This stance is unfortunate, since it is, arguably, precisely in non-medical forms of use that greater flexibility is needed from the international drug control system.

The INCB President then spoke of the Board’s annual report, which this year includes a thematic chapter on the issues surrounding women and drugs. He urged governments to ensure that their drug control structures take into account the specific needs of women, while repeating the Board’s support for human rights and the principle of proportionality in their legal responses to drugs offences. ‘(T)he drug control conventions do not require the imprisonment of people who use drugs or who commit minor drug related offences’, emphasised Mr Sipp. For IDPC, Ms Marie Nougier welcomed the annual report, in particular the chapter on drugs and women, while urging states – in accord with the INCB’s recommendations – to desist from the use of the death penalty of suspected drug traffickers and extrajudicial killings.

The INCB’s focus on proportionality was illustrated by the side event on the issue that the Board organised on 16th March, during which Mr Sipp again spoke at length, underlining that, despite the right of states to assign their choice of punishment, ‘disproportionate responses undermine the aims of the conventions and undermine the rule of law’. He went on to urge states that continue to use capital punishment to consider its abolition for all drug offences. In his opening speech, Mr Sipp had condemned, ‘in the strongest possible terms’, the extra-judicial targeting of people suspected of drug offences, which he termed a ‘serious breach of human rights’ and ‘an affront to the most basic standards of human dignity’. While in keeping with the standards of diplomacy, no countries were named, the object of the Board’s condemnation was clear.

Returning to a topic featuring in its latest annual report, the INCB President’s opening presentation touched on Drug Consumption Rooms. While its position has softened in respect of these facilities, the INCB stressed that in order that they comply with the conventions, a number of conditions must be met. ‘The ultimate objective of such facilities,’ said Mr Sipp, ‘must be to reduce the adverse consequences of drug abuse 

 condoning or increasing drug abuse or encouraging drug trafficking.’

The recently instituted ‘Informal Dialogue with Civil Society’, an encounter in which the Board has now been involved for several years, took place again this year, with Mr Sipp in attendance. The event was chaired by Esbjorn Hornberg and Katherine Pettus, both of the Vienna NGO Committee, and involved an interesting discussion structured around questions and answers. VNGOC asked the INCB to submit a list of organisations with whom the Board met on its country missions. Mr Sipp explained that this would pose problems, however, as the INCB meets with certain CSOs who adopt positions running counter to those of the government; confidentiality is required in order to conduct an open dialogue.

A wide range of questions from CSOs included one from IDPC, asking whether, in the light of INCB’s recent acknowledgement that decriminalisation and proportionality are within the terms of the conventions, the Board could produce a document supporting the options and explaining how they could be translated into practice. Mr Sipp stated that the INCB had repeatedly elaborated on the issues of proportionality and decriminalisation, and would continue to do so.

The Transnational Institute, which quoted the High Commissioner for Human Rights at the 2016 UNGASS, who had stated that that ‘indigenous peoples should be allowed to use drugs in their traditional or religious practices’. The questioner asked Mr Sipp if he agreed that there exists a legal conflict between the Single Convention and human rights? The answer was refreshingly frank: this was ‘an extremely difficult question’, requiring much closer dialogue between the treaty bodies in Vienna and Geneva. ‘If I stayed in my post longer,’ declared Mr Sipp, ‘I would reinforce the dialogue between these spheres’.

Unfortunately, though, Mr Sipp’s period of office comes to an end this year, and as yet we have little idea who will be his successor and what their stance will be. We can only hope that Werner Sipp is succeeded by somebody equally open minded and willing to continue the INCB’s recent focus on human rights – and its willingness to speak out against the excesses of governmental violence. Overall, the Board has acted as a progressive force at the 60th CND, which constitutes a major change from its role as the drug control dinosaur less than ten years ago.

IDPC will continue to monitor the discourse and practices of the INCB across this period of transition.

The Board at the 60th CND

At the 60th Commission on Narcotic Drugs this month – the annual UN meeting on drug policy, which takes place in Vienna – the world’s governments agreed a series of resolutions as they do every year. This year, however, this list included – for the first time in Vienna – a specific resolution calling attention to the harm reduction and HIV funding crisis.

Resolution 60/12 is the latest in a long line of CND resolutions focused on the HIV epidemic among people who use drugs (see box). But it is the first to call so explicitly for increased funding for this issue, and therefore represents another step forward in the debates that take place in Vienna.

The Resolution – the draft version of which can be found here – acknowledges the appalling 33% increase in new HIV infections among people who inject drugs (from 114,000 cases in 2011 to 152,000 in 2015, as reported by UNAIDS) – during a period when governments had pledged to reduce infections by 50 percent. It also acknowledged that donor government investments in HIV/AIDS in low- and middle-income countries declined by more than $1 billion in 2015.

The Resolution then calls on member states to “ensure continued political commitment to effectively addressing and countering HIV/AIDS among people who use drugs” in light of the Sustainable Development Goals, and then calls on UNODC to continue its “leadership and guidance”.

Crucially, it also “Urges Member States and other donors to continue to provide bilateral and other funding for the global HIV/AIDS response, including to the Joint United Nations Programme on HIV/AIDS”, and “Encourages Member States and other donors to make extrabudgetary contributions to the HIV/AIDS work of the United Nations Office on Drugs and Crime to secure adequately financed, targeted and sustainable responses related to HIV and drug use, and HIV in prison settings”.

A number of government delegations in Vienna fought hard for this language, and in doing so showed their commitment to, and support for, the UNODC HIV/AIDS Section who had half of their funding inexplicably withdrawn by UNAIDS in 2016 and who continue to operate in financial uncertainty. UNODC is one of the 11 co-sponsors of the Joint UN Programme on HIV/AIDS – and the lead for HIV among injecting drug users and in prison settings. The Resolution was proposed and led by Norway, and was eventually co-sponsored by Andorra, Costa Rica, Ecuador, Guatemala, Liechtenstein, Malta (on behalf of all 28 EU Member States), Switzerland, Tanzania, Togo, Uruguay and the USA.

It is a crucial time for the HIV-related harm reduction response, with the Global Fund recently announcing its new funding allocations for countries and a new Catalytic Investment Framework designed (in part, to channel additional resources to programmes for key populations such as people who inject drugs), and UNAIDS commissioning a Global Review Panel to make important recommendations about the future model and working of UNAIDS in light of ongoing funding concerns surrounding the global HIV response. This latest resolution from the CND in Vienna should go some way towards helping the situation, but there remains much work to be done by the harm reduction sector to ensure the funding needed to improve coverage and quality and end AIDS among people who use drugs.

Res. 60/12 (2017): Promoting measures to prevent HIV and other blood-borne diseases associated with the use of drugs, and increasing financing for the global HIV/AIDS response and for drug use prevention and other drug demand reduction measures

Res. 56/6 (2013) Intensifying the efforts to achieve the targets of the 2011 Political Declaration on HIV and AIDS among people who use drugs, in particular the target to reduce HIV transmission among people who inject drugs by 50 per cent by 2015

Res. 54/13 (2011) Achieving zero new infections of HIV among injecting and other drug users

Res. 53/9 (2010) Achieving universal access to prevention, treatment, care and support for drug users and people living with or affected by HIV

Res. 51/14 (2008) Promoting coordination and alignment of decisions between the Commission on Narcotic Drugs and the Programme Coordinating Board of the Joint United Nations Programme on HIV/AIDS

Res. 49/4 (2006) Responding to the prevalence of HIV/AIDS and other blood-borne diseases among drug users

Res. 48/12 (2005) Expanding the capacity of communities to provide information, treatment, health care and social services to people living with HIV/AIDS and other blood-borne diseases in the context of drug abuse and strengthening monitoring, evaluation and reporting systems

Res. 47/2 (2004) Prevention of HIV/AIDS among drug users

CND approves its first resolution on funding the HIV epidemic

The international drug control conventions require the International Narcotics Control Board (INCB) to publish an annual report which provides an analysis of world drug situation. The 2016 Report has been launched today.

The Board’s President, Mr Werner Sipp, provides a Foreword to the document, which will represent the final Annual Report to appear under his watch, which ends later this year. The Report carries the tone of Mr Sipp’s Presidency, one of the most progressive of figures to have led the INCB. This is despite the fact that the Board has continued to provide strong support for the international drug control conventions as the foundation of the international community’s response to both the medical and scientific use of drugs and the attempt to control non-medical consumption and supply.

The most significant and progressive move made by the Board in this year’s Report is its changing position with respect to Drug Consumption Rooms (DCRs). In the past, the INCB has repeatedly – and often in strident terms – criticised these facilities as counter to the provisions of the international drug control conventions. While continuing to express its reservations regarding the consumption of drugs purchased outside the DCRs, the INCB acknowledges the dialogue it has shared with the Government of Denmark, which has introduced national legislation that forms the foundation for DCRs. Similar measures have been taken in France. The Board observes that: ‘“Drug consumption rooms” must be operated within a framework that offers treatment and rehabilitation services as well as social reintegration measures, either directly or by active referral for access, and must not be a substitute for demand reduction programmes, in particular prevention and treatment activities.’

As ever, the Report contains a thematic chapter on a specialised topic, on this occasion ‘Women and Drugs’. The chapter deals with the specificity of women’s relationships with drug use; violence, sex-workers, pregnancy and children, mental illness, imprisonment, barriers to access to treatment for women, as well as recommending measures that governments should adopt to improve the situation. The last of these recommendations states that: ‘INCB encourages Governments to take into consideration the specific needs and circumstances of women subject to arrest, detention, prosecution, trial or the implementation of a sentence for drug-related offences, including appropriate measures to bring to justice perpetrators of abuse of women in custody or in prison settings for drug-related offences.’

Another topic explored by Chapter 11 is the possible impact of legislation permitting the non-medical or recreational use of cannabis. A number of member states receive advice in this regard, though not of the strident kind associated with several former Presidents. Canada is addressed by the Board as a country that plans to legalise and regulate the use of non-medical cannabis use. The INCB reminds the Canadian authorities that such use of cannabis is inconsistent with the provisions with the 1961 and 1988 Conventions. It advised Canada to reach its health objectives, the protection of young people and non-prosecution of minor, non-violent offences through means that do not violate the existing conventions.

The Annual Report mentions harm reduction without the use of either ‘scare quotes’ or a social context that casts a dubious light upon the concept. This again reflects positively on the leadership of Werner Sipp. The key problem with what is overall a useful Report lies in its continuing refusal to consider reforms to the conventions, which, in the long run, are going to be necessary components in declaring peace in the century-old battle against the use of drugs.