Despite the COVID-19 pandemic and its associated restrictions on mobility of trade and transport, the methamphetamine market in East and Southeast Asia has continued to expand. While Shan State, Myanmar, remains the main source of illicit manufacture of methamphetamine in the region, there are growing signs that Cambodia is being increasingly targeted for large- scale illicit methamphetamine manufacture, showing organized crime diversifying their methamphetamine supply channels.

As for the past decade, the total amount of methamphetamine seized in East and Southeast Asia has continued to increase, reaching another record level in 2020 with preliminary data showing at least 169 tons of methamphetamine seized. Though there was a decline in seizures in East Asia, it was more than offset by the increase in seizures in Southeast Asia, largely due to the lower Mekong countries,1 which accounted for 71 per cent of the total amount of methamphetamine seized in East and Southeast Asia.

Several trafficking routes have emerged, and seizures of methamphetamine point to diversified sources of the substance. Lao PDR has been increasingly targeted for transit and trafficking of methamphetamine and its related chemicals, as indicated by sharp increases in seizures of the drug along the border between Lao PDR and northeastern Thailand. Sources of methamphetamine have diversified beyond Shan State, Myanmar, with reports of methamphetamine being trafficked to the region from West Asia and South Africa.

COVID-19 and its associated mobility restrictions resulted in only a short-lived disruption to the supply of and demand for methamphetamine. Available quarterly data from both East and Southeast Asia show a drop in seizures in the second quarter of 2020 during the height of the pandemic. However, seizures quickly rebounded from the third quarter onwards, demonstrating the flexibility of organized crime groups to adapt to change and take advantage of porous borders in the region. Wholesale prices of crystalline methamphetamine declined in several countries in Southeast Asia, namely Cambodia, Malaysia, and Thailand, while its purity remained stable, indicating limited impact on the availability of methamphetamine.

Synthetic Drugs in East and Southeast Asia: Latest developments and challenges 2021

Over forty years into the HIV pandemic, East and Southern Africa remains disproportionately affected by the disease. Despite that new HIV infections in the region have declined by 28% since 2010, in 2018 there were still 800,000 new cases – just under half of the global total.

South Africa accounts for over a quarter of new infections in the region, and countries that continue to have high case numbers include Mozambique, Zambia, Malawi and Zimbabwe. Three countries have made significant leaps towards covering 90% of the HIV care cascade: Botswana, Eswatini and Namibia. But other countries in the region lag behind.

As Southern Africa works towards reducing new infections, it is important that donors and governments examine whether their prevention budgets are considering specific populations that are vulnerable to HIV. In the region, young women (aged 15–24 years) make up only 10% of the population, yet account for 26% of new HIV infections. Nearly half of the 254,000 new HIV infections among adolescents globally in 2016 also occurred in the region. And in specific countries, key populations—defined as men who have sex with men, sex workers, people who inject drugs, transgender people and prisoners—also experience unequal infection rates. For example, in Malawi, where 9.2% of the adult population is living with HIV, one in two sex workers in HIV positive.3 Generalised prevention programmes are unlikely to reach or cater to the needs of younger people and key populations. Targeted and increased prevention funding is necessary to accelerate change.

Turning off the tap: The state of HIV prevention funding in Southern Africa

The new EU drugs strategy 2021-25 makes explicit that the European response to drugs should be evidence-based and delivered through a balanced and integrated approach, which ultimately must be judged on its impact on the health, safety and wellbeing of our citizens. The EMCDDA is tasked with helping to provide the evidence needed to ensure that European policies and actions on drugs are effective, well-targeted and responsive to new threats and challenges. The European Drug Report (EDR) 2021 arrives at a difficult time for meeting this objective, as the COVID-19 pandemic has impacted greatly on all areas of life, including the drug situation and our ability to monitor it. I am therefore extremely pleased that we can still provide the detailed analysis presented in this report, which includes an early assessment of the effect of the pandemic on drug markets and drug use. However, I also believe the value of our work is not simply delivered through accurately documenting past events. We also need to look forward and consider what lessons emerge from the findings of the EDR 2021 in order to ensure that we continue in the future to provide the relevant and timely information required to keep our policies and actions commensurate with the growing challenges we face in the drugs area.

In 2019, the EMCDDA conducted, with its stakeholders, a foresight and horizon-scanning exercise to increase our awareness of how the evolution of the drug situation may impact on our work. Among the overarching conclusions of this work was that many of the factors that would shape the drug problems of the future were external ones. Globalisation, developments in information technology, demographic shifts, alongside issues like climate change and human migration, are likely to have important implications for the future drug problems we face. We already see this, as both the drug market and patterns of drug use are becoming ever more dynamic, complex and globally connected. This has made us reflect on the need for more timely reporting, and to consider if both the data sources we use and the targets we select for our analysis are sufficient to meet both current and future policy development needs.

What we did not expect was that the events of 2020 would demonstrate so profoundly the importance of this reflection. Within a few weeks, we needed to reorientate our work to support our stakeholders by providing enhanced resources for sharing information and best practices. The speed of developments required us to recognise that this could only be achieved through a more interactive model for knowledge co-production. I am proud of the work of the EMCDDA during this period, but I recognise that this was only possible because of the input we received from stakeholders across Europe. Particularly important was the possibility provided by our Reitox network of national focal points to engage in an ongoing conversation on national responses to the pandemic. This highlighted the value of sharing experiences and preliminary information when there is a need for rapid action. Beyond this, we also launched a series of trendspotter studies to collate qualitative and emerging quantitative data to provide a near real-time complementary data source to accompany our routine monitoring information. The latest insights from our third COVID-19 trendspotter, published recently, are summarised here. These results are preliminary, but they help us identify some of the possible longer-term effects of the pandemic on drug markets, drug use and our responses.

European Drug Report 2021

This report is produced on behalf of the Civil Society Forum on Drugs (CSFD), an expert group of the European Commission, created in 2007 on the basis of the Commission Green Paper on the role of civil society in drugs policy in the EU. The CSFD membership comprises 45 civil society organisations (CSOs) from across Europe and representing a variety of fields of drug policy and stances within those fields.

One of the thematic working groups of the CSFD aims to assess and promote civil society involvement in the field of drug policy. In 2020, the working group conducted a literature review to assess existing guidelines and recommendations on how civil society can be involved in policy making in a meaningful way. Based on the findings of the review, this report presents quality standards of civil society involvement to guide both decision-makers and civil society on how to create mechanisms that facilitate the building of dialogue and partnership between them.

According to the European Monitoring Centre on Drugs and Drug Addiction (EMCDDA), quality standards are generally accepted principles and a set of rules for the best/most appropriate implementation of interventions. They are used as benchmarks, based on professional consensus, to judge whether an activity is of high quality. An example is the European Drug Prevention Quality Standards (EDPQS), which aims to guide professionals on how to design, implement, monitor and evaluate interventions in drug prevention.

Quality standards of civil society involvement in drug policies

Opioid substitution therapy (OST) is a recognized approach to treating opioid dependent people and managing the problems associated with this condition. Evidence suggests that it significantly improves the quality of life of the program beneficiaries and their loved ones. It reduces the spread of blood-borne infections, the use of illegal opioids, conflicts with the law, health-damaging and risky behaviors related to HIV transmission, overdoses and etc. (NIDA, 2018). The OST programs are supported by the World Health Organization, the United Nations Joint Program on HIV/AIDS, and the United Nations Office on Drugs and Crime (WHO, UNODC and UNAIDS, 2012).

Today, the OST programs are widely implemented in different regions and countries of the world. Based on this experience, both international and national guidelines and protocols have been developed to help meet quality standards. A number of such documents focus on clinical issues (dosing, admission criteria, treatment of groups with special needs, etc.), e.g., the guide of the World Health Organization (WHO, 2009). In addition, documents have been developed and continue to be developed that focus on more practical issues - such as how to implement and develop a program, based on the local context, i.e. the local socio-economic and cultural specifics of a country or a region (WHO, 2014).

Researching the OST programs are critical to developing manual documents and practical recommendations described above for a particular region or a country. This includes, on the one hand, the study of the program effectiveness and the effectiveness determinants; On the other hand, the study of the service satisfaction and the satisfaction determinants by the beneficiaries of the OST programs.

Survey of client satisfaction with opioid substitution program in western Georgia

The 1st ‘Brandenburg Forum (BBF) in Geneva’ took place on 11th February 2021, within the framework of the Global Partnership on Drug Policies and Development (GPDPD). The event has originally been conceived as an in-person meeting in 2020 but, in response to the global COVID-19 pandemic and related restrictions, it was delayed and then adapted to work as an interactive, three-hour online meeting instead. The Forum was cohosted by the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH on behalf of the German Federal Ministry for Economic Cooperation and Development (BMZ), the German Federal Drug Commissioner, the Government of the Netherlands, the Norwegian Ministry of Health and Care Services, the Swiss Federal Office of Public Health, the Transnational Institute (TNI), and the International Drug Policy Consortium (IDPC).

The Forum, held under the ‘Chatham House Rule’ in order to facilitate openness, sought to build upon the series of high-profile Brandenburg Forums on Drugs and Development Policies held in Germany since 2016 – providing a trusted space for important discussion and debate to strengthen the drug policy focus within the key health and human rights bodies in Geneva. The online nature of the Forum allowed the co-hosts to bring together a diverse group of 72 participants (38 women and 34 men) from around the world. This included representatives from the United Nations (UN) Office of the High Commissioner for Human Rights (OHCHR), the World Health Organisation (WHO), the International Narcotics Control Board (INCB), the UN Human Rights Committee, the UN Working Group on Arbitrary Detention, the UN Development Programme (UNDP), the UN Office on Drugs and Crime (UNODC), and the Joint UN Programme on HIV/AIDS (UNAIDS). Furthermore, there were representatives from other intergovernmental bodies, a number of experts from relevant civil society and community-led organisations, and 38 government officials from 14 countries (Albania, Argentina, Finland, France, Germany, Jamaica, Mexico, the Netherlands, Norway, Portugal, Sweden, Switzerland, Thailand and Uruguay).

The event began with warm welcomes from Swiss Ambassador H.E. Felix Baumann the Federal Drug Commissioner of Germany Daniela Ludwig MP, and senior officials from the Governments of Norway and the Netherlands. Ambassador Baumann reiterated Switzerland’s belief that the multifaceted world drug situation “cannot be discussed without its health and human rights aspects”, and highlighted the importance of cooperation between UN entities – especially in light of the UN system common position on drug-related matters4 and the 2030 Agenda for Sustainable Development.5 The Federal Drug Commissioner of Germany further highlighted the International Guidelines on Human Rights and Drug Policy6 (whose development was supported by GPDPD and the Swiss Government as well as UNDP) and its reference in the European Union Drug Strategy 2021-20257 (adopted under the German Presidency of the EU Council) as sending out a “strong signal to those violating fundamental human rights” in the name of drug control. Several participants underlined how the COVID-19 pandemic has put a magnifying glass on different societal problems we face.

1st Brandenburg Forum (BBF) in Geneva "Building bridges between the drug policy and human rights regimes of the United Nations"

The so-called war on drugs has resulted in a large and disproportionate increase in detention and imprisonment for drug-related offences. Some States have gone well beyond what is required by the international drug control treaties in terms of criminalization and associated penalties, while others have demonstrated excessive zeal in applying the criminalization provisions of those treaties. These disproportionate actions have frequently resulted in widespread human rights violations leading to increased arbitrary detention. Association of the military with drug control efforts has aggravated the situation in several States and has frequently resulted in more and worse human rights violations and punitive outcomes that have not proven effective in reducing the incidence of drug-related offences. The war on drugs has also generated a culture of corruption within law enforcement bodies, particularly regarding payments made to avoid arrest or to affect the outcome of judicial proceedings. States that provide financial or technical assistance to other States, including for drug enforcement operations, should ensure that their assistance does not contribute to human rights violations.

Arbitrary detention relating to drug policies - Study of the UN Working Group on Arbitrary Detention

The Global AIDS Strategy 2021-2026 recognizes that ending inequalities is essential to ending AIDS. Since 2010, the global AIDS response has made remarkable progress—tripling the number of people on ARV treatment and reducing deaths by 39%. But globally, only 26 countries are on track to achieve the goal of a 90% reduction in AIDS-related mortality by 2030 and only 23 countries are on track to reduce new HIV infections by 90%. Most countries in the world did not achieve the 90-90-90 treatment goals by 2020.

At the High-Level Meeting on HIV/AIDS (June 8-10, 2021), UN member states will recommit to the goal of ending AIDS by 2030. The Political Declaration is expected to recognize the central role that inequalities, stigma and discrimination, and violence play in fueling the HIV pandemic and the necessity of reforming laws and policies that drive discrimination and undermine access to HIV prevention and treatment.

The Political Declaration follows on UNAIDS’ release of the Global AIDS Strategy 2021-2026: End Inequalities. End AIDS. At the core of the strategy, an ambitious new set of targets, the 10-10-10 targets, call on countries to repeal punitive laws/policies that target key populations and to implement supportive laws/policies that combat stigma, discrimination, and gender-based violence.

These targets will not be achieved without transparency, evidence, and accountability—transparency around the laws/policies that countries have in place, evidence to show why policy change is necessary and beneficial, and advocacy to hold governments accountable for acting on their commitments and achieving the 10-10-10 targets.

Global law & policy progress on human rights, equality, stigma and discrimination

By Thomas Santo Jr. et al. / JAMA Psychiatry

The review found that people with opioid dependence were less likely to experience overdose-related, suicide, alcohol-related, cancer, and cardiovascular-related mortality while receiving OAT.

Researchers from the NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol and National Drug and Alcohol Research Centre (NDARC) at UNSW Sydney, and several other global institutions reviewed the relationship between OAT and mortality across type of drug, setting and participant groups from over 700,000 participants, which is six times the number of any other previous review.

The review found that mortality risk was lower for those receiving either buprenorphine or methadone treatment, the two most common forms of OAT for people with opioid dependence.

Lead author, Thomas Santo Jr, PhD candidate at NDARC, said: “People with opioid dependence who receive OAT are not only at lower risk of overdose than those who do not, but also at lower risk of suicide and several other common causes of death.”

Click here to read the full article (restricted access).

Association of opioid agonist treatment with all-cause mortality and specific causes of death among people with opioid dependence

It took 10 more years for the world to take concerted action. In 2001, the United Nations (UN) General Assembly convened the first-ever special session on a pandemic. By then, AIDS-related illnesses had become the number one cause of death in Africa and the fourth leading cause of death worldwide. The collective voice of affected communities had also grown, marshalling networks of support and demanding stronger action from governments. An innovative joint programme of entities across the UN system, UNAIDS, became operational in 1996, urging countries and communities in every region to join a new global pandemic response.

The General Assembly’s 2001 Declaration of Commitment on HIV/AIDS was a major milestone in global leadership on the right to health, and it set a common agenda that propelled global efforts to reverse the pandemic’s course. Activists living with HIV successfully pushed for affordable HIV treatment to reach developing countries, and the number of AIDS-related deaths tumbled. New HIV infections also decreased. Global momentum was sustained through high-level meetings of the General Assembly in 2006 and 2011. When world leaders gathered at the UN General Assembly for a fourth time to confront HIV in 2016, ambitious targets were set for 2020, with the aim of ending AIDS by 2030, as called for in the Sustainable Development Goals (2).

Five years later, dozens of countries across a range of epidemic settings and economic classifications have reached or exceeded many of those targets. These countries have shown that a pandemic that seemed almost unassailable 20 years ago ca be brought under control. However, other countries and entire regions are off-track. In some places, previous gains are being reversed, and COVID-19, conflicts and humanitarian emergencies have created additional challenges. Across all regions, the most vulnerable and stigmatized populations are most often left behind. Key populations continue to be marginalized and criminalized for their gender identities, sexual orientation, livelihoods and dependencies, or for simply living with HIV.2 Gender inequalities and gender-based violence restrict the rights of women and adolescent girls, including their ability to refuse unwanted sex or negotiate safer sex, and to access HIV and sexual and reproductive health services.

HIV remains a pandemic driven by inequalities. When the data from UN Member States’ 2020 reports to UNAIDS are aggregated, the unfortunate conclusion is that all of the global targets for 2020 have been missed. Time is running out on the global effort to end AIDS by 2030.

Global commitments, local action: After 40 years of AIDS, charting a course to end the pandemic

The pandemic offered a stress test for political institutions, and most were found wanting. The inadequacy of many systems of healthcare and social support was revealed, and the ways in which economies fail to work for many people were once again demonstrated. The world was not ready: international cooperation was needed to respond to a global challenge, but was lacking as governments asserted narrow self-interest, birthing the dismal practice of vaccine nationalism. Vast disparities in vaccination rates between economically powerful states and the rest exposed an ugly reality in which the value of a human life depends on the lottery of birthplace.

State after state asserted top-down, command-and-control approaches that seemed to show little trust in the wisdom of people and communities. The first instinct of many presidents and prime ministers was to act as though the pandemic was a threat to their power, rolling out well-rehearsed routines of repression. States took on broad emergency powers, and at least some clearly used the pandemic as a pretext to introduce rights restrictions that will last long after the crisis has passed. At a time when scrutiny was more difficult, the suspicion was that some political leaders were opportunistically consolidating their power, rushing through repressive measures they had long wanted to unleash.

Many states poured out official propaganda and, under the banner of controlling ‘false information’, sought to control the flow of information, ramping up censorship and criminalising legitimate inquiry and commentary, including attempts to hold them to account for poor pandemic performance and whistleblowing by healthcare workers. China’s customary response of controlling narratives and suppressing dissent enabled the virus to become a pandemic, but the state did not relent. China was in the front rank of states that expanded surveillance practices and trampled on the right to privacy, on the grounds of preventing virus spread, developing surveillance capacities that will likely enable ongoing intrusion.

States increased their coercive power, unleashing violent enforcement of restrictions on movement and suppressing protests, treating the public as targets for enforcement measures rather than partners in defeating the virus. In the Philippines, people were put in dog cages for breaking pandemic regulations. In several Middle East and North African states, including Bahrain, Egypt, Iran and Saudi Arabia, civil society activists imprisoned for their work to defend rights remained in crowded jails, at increased risk of contracting the virus and with little hope of access to adequate healthcare. In Algeria, the state freed some prisoners on safety grounds but filled up the space with activists newly sent to jail.

State of civil society report 2021


This Transition Monitoring Tool was developed to assist key affected communities to stay more informed and engaged in the monitoring of the transition process and to thereby advocate for the sustainability of national HIV responses.

Based on the Global Fund’s vision, sustainability and transition are now integral parts of any grant; in the Eastern Europe and Central Asia region, transition process is advanced. Although the respective governments have declared a set of commitments with regards to the HIV response, information is scarce as to where the public sector stands in terms of the fulfillment of those obligations. This limits the capacity of communities to identify shortcomings and to advocate for the development of solutions to address such shortcomings.

To strengthen community engagement in the transition and sustainability process of national HIV responses, this Transition Monitoring Tool has been designed to collect and evaluate the achievement of countries with regards to the commitments made and to benchmark those achievements between countries using the following core components:– Identification of key public commitments with respect to HIV responses for key populations;

– Engagement of communities and national experts through consultations in the assessment process;

– Development of a matrix for data collection and analysis which will facilitate repetition of the process in the future; and,

– Calculation of transition scores for programmes for key populations by component, referred to as Health System Domains in this Tool.

This Tool is primarily designed to trace commitments by governments which have been stated in public documents; however, the opinions of communities and experts are included in identifying priority commitments for the purpose of monitoring, and for filling in information gaps where commitments are not clearly defined for the purpose of monitoring.

The publication was created in 2020 by Eurasian Harm Reduction Association (EHRA) and published within the framework of the regional project called “Sustainability of Services for Key Populations in Eastern Europe and Central Asia which is carried out by the Alliance for Public Health, in a consortium with the 100% Life (All-Ukrainian Network of PLWH), the Central Asian HIV’ Association and the Eurasian Key Populations Health Network with the aid from the Global Fund to Fight AIDS, Tuberculosis, and Malaria.

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