By H.R. Sumnall, A.M. Atkinson, K.M.A. Trayner, S.H. Gage, A. McAuley

There is evidence to suggest that medically supervised drug consumption rooms (DCRs) may form part of responses to reduce drug-related harm. Although DCRs have been established globally, they are perceived by some to be a controversial approach in the UK, and Government has repeatedly rejected proposals to establish one in Glasgow, Scotland. As public support is an important component of policy development and enactment, we sought to investigate the effects of different types of message framing on public support for DCR.

We undertook a cross-sectional online study with a randomised design, conducted with a nationally representative sample. Participants were randomised to one of six message conditions comprising combinations of four components. All conditions included i) a 

 description of a DCR, and conditions included combinations of ii) 

 of common public concerns about DCR; and/or iv) a 

 narrative describing a mother whose son died from a heroin overdose. After reading each message, participants completed a bespoke measure assessing support for DCR. Data were analysed using ANCOVA.

Complete data were obtained from 1591 participants (50.3% Female; mean age 44.9 ± 16.1 years). Compared to reading a basic description of DCR alone, there was greater support for DCR in participants receiving the 

 < .001) message conditions. Presenting 

 messages alone were not associated with increased support.

Our findings suggest that public support for DCRs is not improved through communication of factual statements outlining potential benefits of the intervention alone. Advocates seeking to foster public support, and thus influence policy making, should also consider communication campaigns that address common concerns that the public might have about DCRs, and present the intervention in relation to potential benefits that they hold for people indirectly affected by drug-related harm.

Effects of messaging on public support for drug consumption rooms in Scotland, UK

This assessment has been initiated by the Eurasian Harm Reduction Association (EHRA) to assess the progress in reaching sustainability of the opioid agonist therapy (OAT) programme in the Republic of Belarus in the context of transition from donor support to domestic funding. The sustainability assessment of the OAT programme in the Republic of Belarus in 2020 was implemented with the funding provided through the technical support mechanism (TSM) of the Joint United Nations Programme on HIV/AIDS (UNAIDS).

This assessment was carried out in Belarus in February – April 2020. It covers the current situation, progress made, risks and opportunities to ensure the sustainability of OAT programs in the Republic of Belarus, with a focus on programmatic aspects and a focus on the following three areas: politics and management, finance and resources, and services. The assessment includes a review section, analysis of progress, obstacles and opportunities in each of the areas, as well as general conclusions and recommendations for government ministries and departments, national coordinating bodies, practitioners, civil society, technical partners and donors. The evaluation also includes relevant recommendations on adaptation of the OAT programs in the context of the COVID-19 pandemic.

Аssessment of the sustainability of the opioid agonist therapy programme in the context of transition from donor support to domestic funding in Belarus

On the path toward building up its internal security, on 24 July 2020, the European Commission adopted a new EU Agenda and Action Plan on Drugs 2021-2025 (and the Annex) as part of the Security Union Strategy. The new EU Agenda and Action Plan on Drugs 2021-2025 sets out the political framework and priorities for action in the next five years.

The objective is to protect citizens through better coordinated actions to address the security and health implications of drug trafficking and drug use. It reinforces the evidence-based, integrated and balanced approach to demand and supply reduction of drugs, through a comprehensive, multidisciplinary lens.

The current drugs situation in the EU requires comprehensive security and health responses covering the scientific, environmental, socio-political, technological and international dimensions of the issue.

The EU Agenda on Drugs outlines 8 strategic priorities which are divided under

Enhanced security (focused on all aspects of illicit trafficking of drugs).

Increased prevention (of the adverse effects of drugs including link to violence).

Addressing drug related harms (through access to treatment, risk and harm reduction, and a balanced approach to the issue of drugs in prisons).

It is accompanied by an Action Plan covering concrete operational steps and activities.

EU Agenda and Action Plan on Drugs 2021-2025

By Dr James Rucker, Dr Jesse Schnall, Dr Daniel D’Hotman, David King, Timmy Davis, Professor Joanna Neill / Adam Smith Institute / Conservative Drug Policy Reform Group (CDPRG)

Even before the Covid-19 emergency, global rates of depression were staggeringly high. It would be surprising if they did not rise further still in response to the measures taken to contain the virus. Since the advent of modern antidepressants in the late 1980s, the use of these medications has become so widespread that they are almost ubiquitous in the treatment of depression. This is despite their often severe side effects, and the fact that they are so regularly ineffective; usually working to minimise the symptoms of depression rather than alleviate the disease itself.

Psychedelic medicines such as psilocybin act in an entirely different way, being administered once or twice by a clinician in a clinical setting and getting to the root of the suffering. Patient access to this novel psychiatric intervention remains totally illegal in the UK, outside of the small sample sizes of the very few and hugely costly on-going clinical trials. The reports of those lucky enough to have received this treatment legally read as unequivocal endorsements, yet the possibility of scaling up the research necessary to roll out these treatments on the widespread scale so desperately needed remains at almost impossible reach.

Medicinal use of psilocybin: Reducing restrictions on research and treatment

This assessment has been initiated by the Eurasian Harm Reduction Association (EHRA) to assess the progress in reaching sustainability of the opioid agonist therapy (OAT) programme in the Republic of Tajikistan in the context of transition from donor support to domestic funding. The sustainability assessment of the OAT programme in the Republic of Tajikistan in 2020 was implemented with the funding provided through the technical support mechanism (TSM) of the Joint United Nations Programme on HIV/AIDS (UNAIDS).

This assessment was carried out in Tajikistan in February – March 2020. It covers the current situation, progress made, risks and opportunities to ensure the sustainability of OAT programs in the Republic of Tajikistan, with a focus on programmatic aspects and a focus on the following three areas: politics and management, finance and resources, and services. The assessment includes a review section, analysis of progress, obstacles and opportunities in each of the areas, as well as general conclusions and recommendations for government ministries and departments, national coordinating bodies, practitioners, civil society, technical partners and donors. The evaluation also includes relevant recommendations on adaptation of the OAT programs in the context of the COVID-19 pandemic.

Аssessment of the sustainability of the opioid agonist therapy programme in the context of transition from donor support to domestic funding in Tajikistan

As of 2020, North America is now into the fifth year of an unprecedented increase in drug overdose deaths driven by a toxic, unpredictable, and unregulated drug supply. While the genesis and drivers of and response to the opioid overdose crisis have wide regional variations, structural violence, prohibitions against illicit drug use, and stigma consistently play a central role. The criminalization of users of illicit drugs has led directly not only to users’ incarceration, but also to their marginalization and isolation and to violence, entrenched poverty, and a vicious cycle of trauma. This policy has created an environment wherein any initiatives to prevent and reverse overdoses have been severely restricted. While a war on drugs and the people who use them has been widely criticized as destructive and unwinnable, the criminal policies that support the war on drugs have not changed even in response to this unprecedented crisis.

How Structural Violence, Prohibition, and Stigma Have Paralyzed North American Responses to Opioid Overdose

By Andréanne Bergeron, David Décary-Hétua and Luca Giommoni

The COVID-19 pandemic has had unprecedented consequences on the world economy. The impact of the pandemic on the illicit drug market remains scant. We expose the potential consequences the COVID-19 pandemic could have on the ability of people who use drugs to source their illicit drugs via cryptomarkets.

We analyzed 262 self-reported submissions of illicit drug transactions on the darkweb. The self-reports include the date of the transaction, the types of illicit drugs bought/sold, and whether the shipment of the illicit drugs succeeded, had issues (ex. unusually long delivery, an error in the type of drug shipped, quantity or concentration of the drug), or failed.

Between January 1st, 2020 and March 21, 2020, successful deliveries represented 60% to 100% of transactions. Starting on March 21 however, the share of shipments that had issues or failed increased rapidly and represented a majority of all shipments. At the peak of the market disruption, the successful deliveries represented only 21% of all transactions.

Illicit drug transactions on the darkweb were disrupted at the same time as lockdowns were put in place in the United States and in the United Kingdom. While no causation link can be established, the correlation suggests that lockdowns could have disrupted drug cryptomarkets activities. We discuss the market disruption in light of the literature.

Preliminary findings of the impact of COVID-19 on drugs crypto markets

Harm reduction is often a response to crisis. A public health approach which emphasizes reducing the negative effects of drug use rather than eliminating drug use or attaining abstinence (Riley et al., 1999), harm reduction has been adopted around the world to mitigate the effects of epidemics and emergencies, such as the HIV/AIDS pandemic and hepatitis outbreaks, on people who use drugs (PWUD) and the broader community (Des Jarlais & Friedman, 1993; Marlatt, 1998; O'Hare, 2007). Throughout harm reduction's long history, PWUD have effectively improved their lives in the face of public health crises. PWUD are no strangers to managing risk of infection let alone the risks of withdrawal, arrest, stigma, or marginalization. One of the ways this is achieved is through creating intimate connections based on care, trust, and respect amongst PWUD and between PWUD and harm reduction providers.

In the face of the current crisis caused by the global COVID-19 pandemic, PWUD and harm reductionists are now faced with new challenges. A significant consequence of the pandemic is the way that individuals, communities, and organisations have been forced to rethink how they interact with each other. Formal and informal interactions are influenced by the guidelines issued by public health agencies to limit the spread of COVID-19, such as social distancing, handwashing, and masking. These guidelines, however, may be complicating public health efforts that directly affect PWUD.

In this Viewpoint, we discuss the effects of COVID-19 guidelines on the practice of harm reduction in the United States. We argue that there are several contradictions between the guidelines for curbing the transmission of COVID-19 and the highly physically, socially, and emotionally intimate nature of drug use, particularly injection drug use. These intertwined forms of intimacy often enable people to survive physically and mentally through marginalization associated with their drug use. With public health agencies and harm reduction organisations recommending social distancing practices, such as limiting contact between peers who use drugs and other risk reduction practices, PWUD are now asked to choose between avoidance of COVID-19 and the intimacies of drug use that contribute to their survival. Moreover, we argue that the guidelines necessitate a reconfiguration of the intimacy and care so central to harm reduction, which may impede organisations from still meeting the health and social needs of the PWUD that they serve.

Care during COVID-19: Drug use, harm reduction, and intimacy during a global pandemic

In Canada, people who use drugs are dying in record numbers. Between January 2016 and September 2019, more than 14,700 people died of apparent opioid overdoses in this country. In Ontario alone, more than 1450 people died from opioid-related causes in 2018. The overwhelming majority of these overdoses and deaths involve fentanyl or its analogues, a potent drug that is now present in many street drugs. Never before have we experienced an overdose crisis of this magnitude, which is only exacerbated by the criminalization of personal drug possession.

 (“the Good Samaritan law”) was passed as a partial response to this ongoing crisis. The law amended the 

 to give immunity from prosecution for the offence of simple possession of a controlled substance to anyone who calls 911 to report an overdose as well as to anyone who is on the scene when emergency services arrive.

In 2019, with the support of a research grant from the Law Foundation of Ontario, the Canadian HIV/AIDS Legal Network (HIV Legal Network) embarked upon a research study in Ontario to evaluate familiarity with the Good Samaritan law, and what people who have experience with drug use believe to be true about this law. In the midst of the ongoing overdose crisis in Ontario and across Canada, it is critical to understand people’s awareness of this law, how (or whether) they interact with it, and how they experience its real-world impacts.

The Good Samaritan Drug Overdose Act: The good, the bad and the ineffective

While the overall trend in civil society engagement around the drugs issue at the UN Commission on Narcotic Drugs (CND) has been towards greater inclusion and participation in recent years, there have been some troubling developments as of late: members of civil society have been excluded from the meetings leading to one of the most politically controversial and consequential votes at the CND in the last years, namely the deliberations around the Expert Committee on Drug Dependence (ECDD) of the World Health Organization (WHO) recommendations on rescheduling cannabis. This has been accomplished through the use of a newly-branded format of meetings, so-called ‘topical meetings’, the first of which was held in June 2020. The only difference in this new format of meetings from the usual ‘intersessional’ format seems to be that civil society has been excluded.

In following this path, the CND has departed from its own recent practices and political commitments regarding civil society participation. This concerning development is already resulting in a less fruitful and genuine debate, and must be remedied for the upcoming meetings set for August and September.

Closing doors: The exclusion of civil society at the ‘topical meetings’ of the UN Commission on Narcotic Drugs

The 63rd session of the Commission on Narcotic Drugs (CND or Commission) took place in Vienna between 4 and 6 March 2020. Incredible as it now seems, held during the early phases of the current global health pandemic, only the precautionary absence of a few full delegations and warnings regarding healthcare counter measures made it feel any different from previous ‘normal’ sessions. Indeed, since this year’s meeting followed on from the Commission’s 2019 Ministerial Segment and multilateral agreement on the associated Ministerial Declaration expectations were relatively low. Indicative of this was the tabling of only five resolutions, around half the number seen in previous years. Nonetheless, as has been increasingly the case the twin issues of complexity and tension were identifiable throughout the week. Put simply, with intricacy, fluidity and dynamism continuing to characterize illicit drug markets has come growing variations in national policy approaches designed to deal with them and attendant inter-state and state-UN system tensions at the international level.

Implicit and explicit manifestations of this reality were evident from the opening session. For example, the CND Chair, Ambassador Mansoor Ahmed Khan, spoke of the ‘need to understand each other’s perspective’. While the new UNODC Executive Director, Ms. Ghada Fathi Waly, deliberately highlighted the mythical ‘Vienna spirit of consensus’; something she evidently found ‘quite inspiring’ upon arrival in the Austrian capital. Yet, amidst some welcome areas of agreement, including notably access to controlled substances for medical use, the revised Annual Report Questionnaire and – at a rhetorical level at least – support for the Sustainable Development Goals, increasing divergence was impossible to hide. Within the General Debate some countries still chose to deploy the language of a ‘drug free world’ while others were more pragmatic in their support for drug policies genuinely underpinned by a human rights and public health-based approach. Indeed, while not unique to Vienna, interpretative variation around the concept of human rights remains.

This could be seen both within the Plenary and the Committee of the Whole (CoW), where resolutions are negotiated, in relation to differing views on the Chief Executive Board’s 2018 UN System Common Position on Drug Policy and the work of the associated UN System Coordination Task Team. While not alone, the Russian Federation was arguably most vocal and active in opposing supportive references to this new initiative to improve system-wide coherence, including in relation to cooperation with human rights bodies and better data collection and analysis. And maintaining its role as the most vociferous supporter of the shape of the extant control system, the Russian Federation was also especially active in challenging the recommendations of the WHO’s Expert Committee on Drug Dependence (ECDD) regarding cannabis classification; an issue that played out at various points across the session and due to the hard fought second postponement of a vote by Commission members has taken on the mantle of an almost ‘too hot to handle’ issue. Although largely overshadowed by the debates around the ECDD’s recommendations, tensions around legally regulated markets for non-medical adult use also remained, with the INCB legitimately flagging it up as an ongoing issue of concern. This is particularly so considering declared and potential legislative shifts in Luxembourg and New Zealand respectively.

With engagement spanning a range of issue areas, civil society was once again highly visible and active at this year’s CND. As members of country delegations as well as NGO delegations in their own right, representatives were involved in the organisation of side events, often in collaboration with member states and UN agencies, and delivered several statements within the plenary. Beyond this, the now formalized ‘informal dialogues’ with UN bodies continued. Although she was unfortunately unable to attend due to illness, these included Executive summary 2 The 2020 CND Report of Proceedings dialogues with the UNODC Executive Director, the INCB President – and for the first time – representatives of the WHO.

While any assessment of the outcomes of the 63rd session must now be re-framed within the context of COVID-19, it is fair to conclude that, with the inescapable sands of divergence within its gears, the CND’s consensus driven machinery continues to grind away, but in an increasingly laboured and shuddering fashion. It is true that this year, as at recent sessions, the system has been able to tolerate divergence in high-level views on the quest for a ‘drug free world’ versus a preference for harm reduction and market management approaches, and even to a certain extent endure diverging views on some aspects of human rights. But, as events in March revealed, increasing endeavour is now required to keep the wheels turning as intended.

The 2019 Commission on Narcotic Drugs and its Ministerial Segment: Report of Proceedings

IDPC report of proceedings: The 2018 Commission on Narcotic Drugs

IDPC report of proceedings: The 2017 Commission on Narcotic Drugs

IDPC report of proceedings: The 2016 Commission on Narcotic Drugs and its special segment on preparations for the UNGASS on the world drug problem

IDPC report of proceedings: The 2015 Commission on Narcotic Drugs and its special segment on preparations for the UNGASS on the world drug problem

IDPC report of proceedings: The 2014 Commission on Narcotic Drugs and its High Level Segment

IDPC report of proceedings: The 2013 Commission on Narcotic Drugs

IDPC report of proceedings: The 2012 Commission on Narcotic Drugs

IDPC report of proceedings: The 2011 Commission on Narcotic Drugs

IDPC report of proceedings: The 2010 Commission on Narcotic Drugs

IDPC report of proceedings: The 2009 Commission on Narcotic Drugs

IDPC report of proceedings: The 2008 Commission on Narcotic Drugs

IDPC report of proceedings: The 2007 Commission on Narcotic Drugs

The 2020 Commission on Narcotic Drugs - Report of Proceedings

This technical brief describes how interventions for people who use drugs are to be incorporated into funding requests to the Global Fund. The Global Fund is the major source of international funding in low-and middle-income countries for harm reduction, and it supports evidence-based interventions aimed at ensuring access to HIV prevention, treatment, care, and support for all key populations, including people who use drugs.

According to Global Fund policy, lower-middle and upper-middle income countries applying for funding must focus 100% of budget on key populations and 50% of budget on underserved populations, as well as on the highest-impact interventions. Low-income countries are also strongly encouraged to target resources to those at highest risk.

It is therefore strongly recommended that all countries with evidence of HIV transmission among people who use drugs include in their proposals harm reduction programs for people who use drugs, both in the general community and in prison and other closed settings.

The harm reduction interventions outlined in this brief include those recommended in the World Health Organization’s (WHO) Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations (2016). Those guidelines expanded upon the ones issued by WHO, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations Office on Drugs and Crime (UNODC) in the WHO, UNAIDS, UNODC Technical Guide for Countries to Set Targets for Universal Access to HIV Prevention, Treatment and Care for Injecting Drug Users –2012 Revision.

This technical brief is also aligned with the programmatic guidance in Implementing Comprehensive HIV and HCV Programmes with People Who Inject Drugs: Practical Guidance for Collaborative Interventions (the “IDUIT”, 2017), which combines the experience and expertise of United Nations agencies, other international partners, and organizations and networks of people who use drugs.

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