In last year’s letter, we touched on the COVID-19 pandemic, then just bursting into our collective consciousness. A year later, much of the world is deep in another brutal wave, an outcome predicted by public health experts, and one that could and should have been prevented had political decision-makers been willing to act sooner and take human rights seriously.

This only underscores the lessons to be learned, many of them first imparted by the HIV pandemic, but too often ignored. COVID has demonstrated yet again that public health is fundamentally connected to human rights and that failing to respect and protect rights — and, especially, to take positive measures to fulfill rights — leads to more infection, illness, and death. Although COVID differs from HIV in important ways, they both travel along the fault lines of social inequities. The only way we will overcome both pandemics is if we act to respect, protect, and fulfill human rights.

This means ensuring freedom of expression: the silencing of health advocates leads to crucial delays in the response. It means realizing the right to health through equitable access to prevention tools including vaccines, to testing, and to treatment. It means ensuring workers’ rights to a safe workplace and to just working conditions, including paid sick leave. It means ending poverty, which leaves people with fewer options to protect their health. It means addressing the systemic racism that impedes access to care and treatment. It means accountability for the ageism and ableism that left care homes chronically underfunded and understaffed, and left some of those most vulnerable to get sick and die of COVID.

The importance of human rights in an effective response to a public health crisis was seen at the beginning of the HIV pandemic in the early 1980s; what was true then is still the case today with COVID, 40 years later.

A moment of breakthrough: Annual report 2020-2021

As a low-income West African country, Sierra Leone like other countries in West Africa have real “problematic” policies (drug laws) around drug use and people who use drugs (PWUD). This mission provided a better understanding of the context of drug use and drug policies or laws in Sierra Leone. The methodology included a bibliographic research, interviews (semi-structured, individuals and collectives) with many actors and different profiles, participant’s observations and focus groups (FGs), facilitated the collection of data that was used for analysis and recommendations. Out of an estimated number of 5000 ‘problematic/precarious’ PWUD in Freetown. They frequent at least a 100 open consumption scenes. It seems difficult to directly consume the drugs (Heroine and crack) on the spot. The main illegal drug consumed remain to be cannabis.

Particular to Sierra Leone, the consumption of synthetic cannabinoid is becoming more popular. However, we were able to observe and confirm a significant consumption of cocaine in the form of crack, and non- prescription drugs (tramadol, valium, diazepam, etc.). The participative observations are not able to directly confirm the presence of Heroine and injecting drug's users. NGOs and Drug Users confirmed their presence. “But they are few, and less numerous compared to Libéria”. At first, it was easy to observe, that interventions related to the use and abuse of drugs (from a global health point of view), will require a multisectorial and holistic approach. The analysis of the data collected revealed a strong will on the part of all stakeholders to reform the current laws or policies and strong expectations and needs on the part of the PWUD.

Sierra Leona have the first official Needles and Syringes exchange Program (NSP) in West Africa (WA). Funded by Global Fund (GF), this program was visited during the mission. Some known actors, are already investing in Harm Reduction (HR) Programs and on drugs policy. HR is included in the national plan and on the NFM3 of the GF. Globally, PWUD have declared their simple needs and Primary care: "for housing, food, access to healthcare and social integration", and “to put the drugs at distance”.

Sierra Leone mission report: Community and contextual analysis on drug's use and drugs policies in Sierra Leone

Around the world, drug law enforcement disproportionately targets people of African descent, with heightened negative social, economic, health, and legal impacts. Research on different countries consistently shows that Black people are systematically discriminated against in all stages of the criminal justice process, being disproportionately policed, arrested, harshly sentenced, and incarcerated for drug offences. This has distinct repercussions not only on their liberty, but also on their health, and on the health and safety of their communities. The disparity is such that drug policy has been described as a “key mechanism for racial and social control within society”. Far from being unintended consequences, drug control is in fact being employed “to justify excessive surveillance, criminalization and the targeting of people of African descent worldwide."

That drug control works to criminalise and dehumanise certain individuals more than others also emerged in the case of George Floyd, where the presence of ‘potential intoxicants in his system’ was reported as a potential reason for his death, in an attempt to deflect from the responsibilities of police officers who ended Mr. Floyd’s life.

In March 2019, the UN Working Group of Experts on People of African Descent stated that: “Enduring and entrenched racial disparities in the criminal justice system – as well as ongoing tolerance of race-based outcomes in policing, entrenched racial disparities, and ongoing selective enforcement of the law – reflect harmful stereotypes grounded in the historical legacies of the global trafficking in enslaved Africans, colonisation, and the ways in which modern social narratives evolved from rhetoric designed to justify these institutions and the exploitation of people of African descent.”

Similarly, in its 2015 study on the impact of the world drug problem on the enjoyment of human rights, the UN High Commissioner for Human Rights has acknowledged that ethnic minorities “may be particularly subject to discrimination in the context of drug enforcement efforts.”

This report focuses on racism and discrimination against people of African descent in drug law enforcement. A detailed reconstruction and in-depth analysis of the racial undertones of drug control laws, their enforcement, and their impacts on people of African descent around the world goes well beyond the scope and space of this report. As such, this submission merely provides some (among many) examples from the USA, the United Kingdom, South Africa, and Brazil, on policing, arrest, sentencing and incarceration of people of African descent for drug offences; and comments on some social and health impacts of this phenomenon, whilst referring to more detailed sources.

Release and Harm Reduction International's submission to the OHCHR on human rights and the policing of African people and people of African descent

The capacity to alter one’s own consciousness is an ‘implicit assumption’ of our daily life. It can be achieved through a very broad range of methods, from practicing meditation to the use of psychoactive substances, legal or illegal.

While the right to freedom of thought has been a historically neglected concept, an emerging literature argues that this freedom should be construed as entailing a right to self-determinate one’s own brain chemistry and consciousness –in other words, the right to control and alter one’s perceptions, thoughts, and thought processes.

This submission by IDPC and Instituto Ria shows that the alteration of one’s own consciousness through psychoactive substances –including through internationally controlled drugs like cannabis, mescaline, or LSD– occupies a central role in religious, spiritual, and cultural practices around the world, in both the Global North and South.

It also argues that the blanket prohibition of such practices, as established in the UN drug conventions and in certain national laws, constitutes an unlawful limitation on the right to the freedom of thought in two critical ways:

First, because it is inconsistent with the available scientific evidence on the harms to individual and society associated to the use of drugs.

Second, because it has a discriminatory nature, as it prohibits psychoactive substances traditionally used by communities in the Global South, while allowing for the alteration of one’s consciousness through substances that are central to the way of life of communities in the Global North, such as alcohol.

On the right to freedom of thought, cognitive liberty, and the global drug control regime - Submission to the UN Special Rapporteur on freedom of religion or belief:

Spread across Brazil and attaining an unparalleled political force, therapeutic communities are as inescapable in the debate on drug policy as they are complex to define. Although they are not a Brazilian creation, they have been operating in that country for decades, and their dissemination intensified in the 1990s. In 2011, they were officially incorporated into Brazil's Psychosocial Care Network (Rede de Atenção Psicossocial, or RAPS). Since then, therapeutic communities have been at the center of public debates about their regulation; about how they should—or even if they should—be a part of the healthcare system; about the level of supervision to which they should be submitted; about their sources of funding, particularly whether or not they should have access to public funding; and, most importantly, about the quality of the services they offer and the many reports of rights violation that have been made public.

However, a well-informed public debate can only flourish if the available information is based on sound evidence. The SSRC’s Drugs, Security and Democracy Program is concerned with the policy relevance of the research projects it supports, and the debate around therapeutic communities in Brazil points to a clear need for impartial research that addresses different cross-cutting aspects of this topic in its various dimensions: legal, regulatory, health, and observance of human rights, among others.

It is in this context that we publish this working paper series on therapeutic communities in Brazil. The eight articles that compose this series offer a multidisciplinary view of the topic, expanding and deepening the existing literature and offering powerful contributions to a substantive analysis of therapeutic communities as instruments of public policy. Although they can be read separately, it is as a whole that the strength of the eight articles that make up this series becomes more evident. Even though they offer different perspectives, they are complementary works in—and already essential for—delineating and understanding the phenomenon of therapeutic communities in Brazil.

Therapeutic communities in Brazil

Funding for HIV programs tailored to the needs of gay and bisexual men and other men who have sex with men, sex workers, people who inject drugs and transgender people remains shockingly low worldwide: only 2% of global funding for HIV programs targets key populations. Yet according to UNAIDS, key populations and their partners accounted for 62% of new adult HIV infections in 2019.

The Global Fund to Fight AIDS, TB and Malaria (The Global Fund), has made reaching key populations a top strategic priority, and has set up a variety of policies, procedures, and technical support opportunities toward that end. Nevertheless, the complexity of these mechanisms can cause challenges for key populations working to access those funds.

At a country level, key populations advocates can influence their country’s overall priorities by participating in the Country Coordinating Mechanism (CCM). CCMs are national committees that write and submit funding applications to the Global Fund, and that oversee the implementation of successful grants on behalf of their countries. They are comprised of representatives from across government, implementing partners, people living with the three diseases, technical experts, and grant writers, among others.

Officially, CCMs are spaces where advocates can push for the inclusion of key populations programs in funding applications to the Global Fund. (Notably, the Global Fund requires representation of all key populations at the CCM - see more about Global Fund commitments to Key Populations in Part 3, below). The reality, however, can be challenging; just being ‘in the room’ is not enough.

Roadmap for key populations advocates navigating the Global Fund

Over 11 million people are imprisoned worldwide today, the highest number ever recorded. Globally, the dominant response to drugs remains prohibition-based drug policies backed by criminal sanctions that have contributed to the increase in the prison population.

Despite some moves towards the decriminalisation and regulation of drugs, drug offences remain one of the biggest drivers of incarceration. At least one in five people in prison globally is held for drug-related offences. Approximately half a million people are serving sentences for personal drug possession. UNAIDS estimates that up to 90% of people who inject drugs will be incarcerated at some point in their life. There are also more than 400,000 people detained in forced rehabilitation and compulsory drug detention centres in Asia alone, with forms of compulsory drug treatment also existing in Latin America and the Caribbean, Eastern Europe and Central Asia and elsewhere. This punitive approach has the greatest impact on already marginalised populations, including women, racial and ethnic minorities, indigenous people and foreign nationals.

Incarceration is also an enormous waste of money and resources. Over USD 100 billion is spent globally on drug law enforcement every year, but just USD 131 million was spent on harm reduction in low- and middle-income countries in 2019. This means that we spend more than 500 times the amount on punitive responses than we do on life-saving services for people who use drugs.

Systematic reviews of evidence find that there is no clear link between imprisonment and crime rates or between compulsory treatment and drug use. In fact, there is more evidence for links between reduced welfare systems and social inequality, and increased imprisonment rates. Nevertheless, in many countries, and even more so in the context of a surge of oppressive regimes in many parts of the world, the punitive “lock them up” response to drugs remains the easiest answer to a complex issue.

The harms of incarceration: The evidence base and human rights framework for decarceration and harm reduction in prisons

In this submission to the UN Special Rapporteur on health, IDPC, Corporación Humanas Colombia, and Penal Reform International provide some examples of the impact of the COVID19 pandemic on the sexual and reproductive health of incarcerated women, with a focus on period poverty.

Approximately 740,000 women are deprived of liberty across the world. An estimated 35% of them are in prison for drug offences, though that percentage is much higher in the countries with larger female prison populations, particularly in the Americas, and in South East Asia.

The world’s prison systems have been built by, and for, men. Women's specific needs are routinely ignored and deprioritised. One of the best examples of this trend is the disregard for the right to sexual and reproductive health of women deprived of liberty. This submission focuses on a particular aspect of this problem: the lack of access to menstrual health products, such as sanitary towels, for women who are in prison – also known as period poverty.

Even before the pandemic, in many countries women deprived of liberty had to rely on their family for the supply of menstrual health products, or for money to buy such products within prisons themselves.

When the pandemic hit these prison systems, the preferred response by many authorities was to completely cut off any visits and contact between prisons and the community, thus leaving women deprived of liberty with no access to the most basic menstrual health products.

Drawing on several country examples, and particularly on the research of Corporación Humanas Colombia, this submission explains this phenomenon, and how it constitutes a serious breach of the right to sexual and reproductive health of women deprived of liberty.

Period poverty in prisons during the COVID-19 pandemic: Submission to the UN Special Rapporteur on health

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.

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