THE WORLD DRUG REPORT 2019: PERSPECTIVES ON PROTECTING PUBLIC HEALTH

With the Ministerial Declaration of March 2019 having ostensibly set the direction of international drug policy for the next decade or so, the launch of the 2019 World Drug Report only three months later was arguably surrounded by less expectation than the year before. Then, while missing the opportunity to provide a review of progress made in the 10 years since the Political Declaration, its contents still had the potential to feed directly into the deliberations surrounding the UN’s latest soft law instrument pertaining to drugs. Nonetheless, as is the case regardless of the UN’s own review cycle, the World Drug Report remains significant. Not only does it provide much needed information to member states about the global drug situation, generally referred to simply as the ‘world drug problem’, but its contents also do much to set the ‘mood music’ for debates within the Commission on Narcotic Drugs (CND or Commission), the UN’s central policy making body on the issue, as well as signpost key points for discussion beyond the rarefied conference rooms of the United Nations Office in Vienna. And so it was that this year’s edition of the United Nations Office on Drugs and Crime (UNODC or Office) flagship publication was launched in the Austrian capital on – as is traditional – 26 June; the United Nations International Day against Drug Abuse and Illicit Trafficking.

While retaining the separate ‘reader-friendly’ booklet format introduced in 2017, for the first time in the publication’s history this year’s Report groups drugs by their psychopharmacological effect. As such, following on from the summary and overview of latest estimates of, and trends in, supply, use and ‘health consequences’ contained within booklets 1 and 2 respectively, the three subsequent booklets look more specifically at recent trends in the markets for depressants (including opioids, sedatives, tranquilisers and hypnotics), stimulants (including cocaine, amphetamine-type stimulants and new psychoactive substances) and cannabis and hallucinogens. The substantial section on cannabis in booklet 5 also includes a full and largely unpoliticised review of the latest developments in the increasing number of jurisdictions that have adopted measures permitting non-medical use of the substance. Despite this relatively substantial re-ordering of data and related analysis, the central themes remain familiar, if more nuanced.

As one has come to expect from the UNODC, the 2019 Report – to borrow Mr. Fedotov’s words in the Preface – certainly does a great deal to ‘shed further light on the world drug problem’ (1, p. 2) across the broad spectrum of what is a multi-faceted issue area. In line with the now usual high standards, when read together, the set of booklets provide full and detailed sets of data and analysis about, among other things, fluctuations in drug crop cultivation, shifting and increasingly complex trafficking patterns (including in relation to the darknet) and the worrying and ongoing boom in the synthetic opioid market, particularly in North America. Following previous years’ practice, the Office also offers quite detailed ‘Conclusions and Policy Implications’ (1, pp. 23-29) and, acknowledging enduring uncertainty concerning many aspects of the illicit market, continues in many instances to integrate discussion of market interventions with the pursuit of the Sustainable Development Goals (SDGs). Our focus here, however, relates to several specific issues raised at various points and to varying extents within the Report. Rather than exclusively critiquing the publication itself and in its entirety, this analysis uses selectively the Report’s contents as entry points to not only highlight ongoing issues of concern but also to help initiate discussion about aspects of dynamic drug markets and associated policy responses that receive less attention. As such, using the issue of public health as a unifying theme, analysis here begins with the familiar issue of the adverse health consequences associated with the use of drugs. It then moves on to more in-depth discussion of emerging legal frameworks around regulated cannabis markets, the non-medical use of tramadol in Africa and some related discussion of data, metrics and law enforcement.

IDPC response to the 2018 World Drug Report

IDPC response to the 2017 World Drug Report

IDPC response to the 2016 World Drug Report

IDPC response to the 2015 World Drug Report

IDPC response to the 2014 World Drug Report

IDPC response to the 2013 World Drug Report

IDPC response to the 2012 World Drug Report

IDPC response to the 2011 World Drug Report

IDPC response to the 2010 World Drug Report

IDPC response to the 2009 World Drug Report

IDPC response to the 2008 World Drug Report

IDPC response to the 2007 World Drug Report

IDPC response to the 2006 World Drug Report

The World Drug Report 2019: Perspectives on protecting public health

We recommend a radical change in UK drugs policy from a criminal justice to a health approach. A health focused and harm reduction approach would not only benefit those who are using drugs but reduce harm to and the costs for their wider communities. Responsibility for drugs policy should move from the Home Office to the Department of Health and Social Care.

We recommend that the Government should consult on the decriminalisation of drug possession for personal use from a criminal offence to a civil matter. The Government should examine the Portuguese system, where decriminalisation was implemented as one part of a comprehensive approach to drugs, including improving treatment services, introducing harm reduction interventions, and better education, prevention and social support. Decriminalisation of possession for personal use saves money from the criminal justice system that is more effectively invested in prevention and treatment.

Decriminalisation will not be effective without investing in holistic harm reduction, support and treatment services for drug addiction. Doing so would save lives and provide better protection for communities.

Evidence based guidelines for treating people with drug dependency do exist, but there is an unacceptable gap between best practice and what services are actually able to deliver to people, as well as wide variation.

Many people using drug treatment services are growing older and living with complex illnesses. Those living with both addiction and underlying mental illness find it difficult to access adequate treatment and services.

Drug treatment services have faced funding cuts of 27% over the past three years, at a time when costs are rising.

Although our inquiry has focused on the harms caused by illicit drugs, dependency on prescription medicines is an emerging and worrying issue which requires greater attention from government.

Harm reduction interventions–including needle and syringe programmes, drug checking services, naloxone, drug consumption rooms and heroin assisted treatment–can all play an important role in preventing deaths amongst drug users as well as protecting their communities by reducing the harm from discarded syringes and drug related crime.

We call on the Government to direct significant investment into drug treatment services as a matter of urgency, and to also make sufficient funding available to ensure that heroin assisted treatment, naloxone, and needle and syringe programmes are available. Drug consumption rooms should be piloted in areas of high need. There should be greater efforts to support those at higher risk, including people in prison and at the point of release from prison.

We recommend that the Government conduct a review of the commissioning of drug treatment services to consider how they should be strengthened to enable them to co-ordinate and deliver the much-needed improvements to drug treatment services as effectively as possible. The Government should also address the current and predicted future workforce shortfall.

UK House of Commons Health and Social Care Committee report on drug policy

1. The Human Rights Council, in its resolution 32/31, emphasized the essential role of civil society in subregional, regional and international organizations. In that regard, the Council reaffirmed the right of everyone, individually and in association with others, to unhindered access to and communication with subregional, regional and international bodies, and their representatives and mechanisms. The Council further asserted that civil society facilitated the achievement of the purposes and principles of the United Nations and that undue restriction of civil society space therefore had a negative impact upon their achievement. In that respect, the Council requested the United Nations High Commissioner for Human Rights to prepare a report compiling information on the procedures and practices in respect of civil society involvement with regional and international organizations, and the contribution of civil society to their work and challenges and best practices.

2. According space to civil society is not optional. Everyone has the right, individually and in association with others, to promote and to strive for the protection and realization of human rights and fundamental freedoms at the community, national, regional and international levels, to exercise the freedoms of opinion and expression, of peaceful assembly and association, and to have access to information and participate in public affairs. International law also protects the lives, liberty, physical integrity and privacy of civil society actors. Article 5 of the Declaration on the Right and Responsibility of Individuals, Groups and Organs of Society to Promote and Protect Universally Recognized Human Rights and Fundamental Freedoms (the Declaration on Human Rights Defenders) recognizes the right of everyone, individually and in association with others, at the national and international levels, to communicate with civil society and intergovernmental organizations.

3. Human rights impose obligations on States to respect, protect and fulfil the rights of every individual to freedom of opinion and expression, access to information, peaceful assembly and association and the right to participate in public affairs and to protect individuals from interference, including by non-State actors. Those rights apply to domestic and other levels of decision-making, including in the intergovernmental sphere. 1 United Nations entities have to respect the norms and freedoms they helped to enshrine in human rights instruments, including the rights and freedoms that are indispensable for civil society to develop and operate. More and more decisions that affect the lives of ordinary people — sometimes profoundly — are taken at the regional and international levels, including in United Nations forums. In practice, having unhindered rights to form or join groups, have access to information, express one’s views and participate in decision-making is indispensable for effective civil society engagement at all levels. Limiting meaningful and effective participation of civil society essentially silences the voices of the people whom the organizations are meant to serve.

4. The Human Rights Council, in its resolution 32/31, recognized the crucial importance of unhindered access to international and regional processes and of transparency and accountability at all levels, which are indispensable for building peaceful, prosperous and democratic societies. In a statement to the Council, the Secretary-General asserted that the Council’s growing engagement with civil society strengthened much of its work and was especially vital at a time when civil society space was shrinking in so many places.2 He also noted the vital role of civil society on the Sustainable Development Goals,3 Goal 16 of which called for the promotion of peaceful and inclusive societies for sustainable development, the provision of access to justice for all and building of effective, accountable and inclusive institutions at all levels (target 16.6), and for ensuring responsive, inclusive, participatory and representative decision-making at all levels (target 16.7).

5. The present report is based on 82 written submissions received by the Office of the United Nations High Commissioner for Human Rights (OHCHR) following its requests for inputs sent on 31 November 2016 to Member States, national human rights institutions, civil society organizations and international and regional organizations.

Procedures and practices in respect of civil society engagement with international and regional organizations

The drug use landscape is dynamic and changing. Changes in public attitudes and laws towards drug use have occurred in an increasing number of countries. Global drug production and consumption are increasing as are the risks and harms to health, while new substances continue to emerge. This Series focuses on opioids, cannabinoids, stimulants, and new psychoactive substances. The Series authors review the evidence on the epidemiology of drug use and related harms and interventions (treatment and policies) to address them. They highlight issues that are likely to become increasingly important in the next decade.

The global drug problem: change but not progression

Strategies to reduce drug-related harm: responding to the evidence base


Louisa Degenhardt, Daniel Wolfe, Wayne Hall, Matthew Hickman, Judy Chang, Julie Bruneau, Michael Farrell, Paul Griffiths

Global patterns of opioid use and dependence: harms to populations, interventions, and future action


Louisa Degenhardt, Jason Grebely, Jack Stone, Matthew Hickman, Peter Vickerman, Brandon D L Marshall, Julie Bruneau, Frederick L Altice, Graeme Henderson, Afarin Rahimi-Movaghar, Sarah Larney

Public health implications of legalising the production and sale of cannabis for medicinal and recreational use


Wayne Hall, Daniel Stjepanović, Jonathan Caulkins, Michael Lynskey, Janni Leung, Gabrielle Campbell, Louisa Degenhardt

Responding to global stimulant use: challenges and opportunities


Michael Farrell, Natasha K Martin, Emily Stockings, Annick Bórquez, Javier A Cepeda, Louisa Degenhardt, Robert Ali, Lucy Thi Tran, Jürgen Rehm, Marta Torrens, Steve Shoptaw, Rebecca McKetin

New psychoactive substances: challenges for drug surveillance, control, and public health responses


Amy Peacock, Raimondo Bruno, Natasa Gisev, Louisa Degenhardt, Wayne Hall, Roumen Sedefov, Jason White, Kevin V Thomas, Michael Farrell, Paul Griffiths

Rebecca McKetin: global leader in methamphetamine research

The Lancet: Drug use series

This document is a compilation of better practices for the use of ayahuasca in non-Amazonian contexts. It covers individual, collective and legal responsibilities.

Ayahuasca is a decoction of different plants with a long history of use in the Amazon, where very old records of its use by native peoples exist. In the last few decades the use of this preparation has been expanding beyond its original context, now reaching many countries outside of the Amazon. One of the consequences of this expansion has been the appearance of new forms of use, which in turn have brought new therapeutic potentials as well as new risks.

It is evident that native communities of the Amazon and other peoples with a long history of ayahuasca use do not need a guide like this. Ayahuasca is part of their cultural and spiritual systems, which include safe ways of working with the effects of the preparation, as well as methods for integrating them into the everyday life of the community. On the contrary, this document is aimed at people who organize or participate in ayahuasca sessions outside of Amazonian contexts.

The objective of this guide is to present a series of minimum safety standards to support ayahuasca sessions in non-Amazonian contexts, as well as to inform potential participants of ayhausca sessions, so that they can better assess the safety and responsibility of the sessions in which they are going to participate, and thus make informed choices.

Towards better ayahuasca practices: A guide for organizers and participants

The Eurasian Harm Reduction Association (EHRA), as part of the implementation of the EECA Regional Platform for Communication and Coordination project supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria, has collected information concerning the availability of HIV and TB-related technical support (TS) for NGOs and CBOs in the EECA region.

All of the information presented in this document was provided, and confirmed, by the organizations listed below and was collected between May and August 2019.

Availability on HIV and TB-related technical support in the EECA region

By the British Columbia Centre on Substance Use

If you are reading this handbook, then you, or someone you know, may need help to deal with opioid use disorder – a situation where you need to keep using heroin, fentanyl, or similar opioids because you feel physically sick if you don’t have them. Taking more opioid drugs will stop the pain, but over time, your body may need more to get the same effect.

This handbook talks about opioid agonist treatment (OAT) – including buprenorphine/naloxone (brand name Suboxone®), methadone (brand name MethadoseTM or Metadol-D®), slow-release oral morphine (brand name Kadian®), and injectable treatment options (hydromorphone or Dilaudid® and diacetylmorphine or prescription heroin). These medications are also opioids, but they provide stable, long-acting relief from withdrawal and cravings. They replace the street heroin or fentanyl that you or someone you know are taking with a regular dose of a medication that allows for a stable life.

A lot has changed since the first edition of this handbook came out in early 2017, so it has been updated and re-written to share all the new things we know about treating opioid use disorder and saving lives. In the past, methadone was the main medication prescribed to people with opioid use disorder (sometimes called opioid dependence or opioid addiction). However, harsh government policies existed that made it hard for doctors to prescribe it. Now, more OAT options are being scaled up and barriers to access are being removed (including barriers to accessing different types of methadone). Policies are changing to increase people’s access to these medications. More people can make choices in their drug use that don’t involve using street drugs that might be contaminated.

Throughout this handbook, OAT options may be referred to by their brand names (for example, Suboxone) or their generic name (for example, methadone), depending on which name is more commonly known. However, even though we might use specific brand names in this guide, we do not represent or endorse any pharmaceutical companies.

This resource sets out to answer some of the common questions that people have when they need help in dealing with opioid use or opioid dependence.

Opioids: A survivor's guide

Safety First: Real Drug Education for Teens

 is the nation’s first harm reduction-based drug education curriculum for high school teachers. The free curriculum consists of 15 lessons that can be completed in a 45- to 50-minute class period.

Each lesson is designed to engage students through interactive activities such as discussions and role-playing. The curriculum is aligned with National Health Education Standards as well as Common Core State Standards so it can be easily integrated into Health classes.

The Curriculum is available on the website of the Drug Policy Alliance.

1. What is a Drug?
Students examine their own beliefs about alcohol and other drugs by answering the question: “What is a drug?” They take a pre-class survey to assess their prior knowledge and skills.

2. Introduction to Harm Reduction
Students learn about harm reduction concepts and strategies, including abstinence, that will empower them to make healthy choices for themselves and others regarding substance use.

3. How Drugs Work
Students learn how drugs affect the body and the brain, and specifically the teenage brain. They further discuss the factors that contribute to physical dependence.

4. Drug Classes: Stimulants
Students learn about stimulant drugs, their effects, benefits and risks. They further discuss the harm reduction concepts particularly related to prescription stimulant drugs.

5. Drug Classes: Cannabis – Part 1
Students play “Fact or Fiction About Cannabis” activity to see how much they know about the drug. They work in groups to research statements about cannabis, and use the CRAAP test to evaluate their sources’ credibility.

6. Drug Classes: Cannabis – Part 2
Students learn about cannabis’ effects, potential risks and benefits, including the effects of edible cannabis. Student then share and evaluate each other’s research on statements about cannabis.

7. Vaping & E-Cigarettes
Students explore the inner workings of e-cigarettes in-depth. They conduct research to examine the health effects of vaping, using the CRAAP test to evaluate their sources’ credibility.

8. Drug Classes: Alcohol & Other Depressants
Students learn about the effects of depressant drugs with a focus on alcohol. They learn how to perform the recovery position and give advice about how to reduce alcohol-related harms using practice scenarios.

9. Drug Classes: Prescription & Other Opioids
Students take an in-depth look at opioid drugs, their effects, risks, and benefits. They will learn how to recognize the signs of an opioid overdose and respond appropriately.

10. Drug Classes: Psychedelics
Students learn about psychedelic drugs, their effects, risks and benefits. They reflect on drug references in the media, specifically music, and how they influence teens. They also complete an activity that demonstrates the risks of illicit drug adulteration, and learn about the harm reduction practice of drug checking.

11. Mental Health and Coping
Students discuss how drug use can be a mechanism for dealing with mental health issues, specifically stress and anxiety. They learn how to locate resources that can help them cope.

12. Understanding Zero Tolerance
Students learn about zero-tolerance drug policies and their impact on students’ health and well-being. Students also learn about restorative justice practices.

13. Health & Policy
Students learn about drug policies and America’s war on drugs. They discuss how drug policies impact health, and learn ways in which harm reduction-based drug policies can help improve health outcomes.

14. Looking Back, Looking Forward
Students review what they have learned by playing the “Just The Facts” Kahoot game. Students reflect on what they have learned by writing a letter to their future selves about drugs and drug use.

15. A Healthy Future
Students discuss their advocacy assignment from Lesson 12. They take a posttest to assess their understanding of the content covered in the curriculum.

Safety first: Real drug education for teens

Hoo Yew Wah, a Malaysian national of Chinese ethnicity, has been on death row in Bentong prison, Pahang State, since 2011. Arrested in 2005 at the age of 20 for possession of 188.35 grams of methamphetamine, he was convicted on the basis of a statement he made at the time of arrest in Mandarin, his mother tongue, without a lawyer present and which the police wrote down in Malay. He later contested this statement in court, noting inaccuracies and adding that the police had tortured him by breaking his finger during interrogation and threatened to beat his girlfriend to make him sign it. With the judge dismissing these claims without further investigation, Hoo Yew Wah was automatically presumed to be guilty of the charge of trafficking drugs and was sentenced to death, the only possible punishment for this offence. His judicial appeals failed and his petition for a pardon has been pending since 2014. Like all others on death row, he is not at imminent risk of execution since the government has established a nation-wide moratorium on executions in July 2018 – but remains in limbo.

Hoo Yew Wah’s case illustrates the many violations of international human rights law and standards associated with the use of the death penalty in Malaysia, as documented in this report. These include lack of adequate and timely legal assistance, concerns of torture and other ill-treatment during police interrogation, the reliance on statements or information obtained without a lawyer present, the presumption of guilt in cases of drug trafficking, secretive pardon processes and the extensive use of this punishment for offences that do not meet the threshold of the “most serious crimes” or intentional killing to which the death penalty must be restricted under international law.

The scale of the problem is significant. As of February 2019, 1,281 people were reported to be on death row in Malaysia, including 568 (44%) foreign nationals. Of the total, 73% have been convicted of drug trafficking. This figure rises to a staggering 95% in the cases of women. Some ethnic minorities are overrepresented on death row, while the limited available information indicates that a large proportion of those on death row are people with less advantaged socio-economic backgrounds.

Fatally flawed: Why Malaysia must abolish the death penalty

This report, issued jointly by United Nations Assistance Mission to Afghanistan (UNAMA)1 and the Office of the United Nations High Commissioner for Human Rights (OHCHR),2 examines the scope of civilian harm resulting from the United States Forces – Afghanistan (USFOR-A) 3 airstrikes on alleged drug facilities located in Bakwa district, Farah province, and parts of the bordering Delaram district, Nimroz province on 5 May 2019. The report sets out that drug facilities and associated workers may not be lawfully made the target of attack based on their possible economic or financial contribution to the war effort of a party to a conflict.

On 5 May 2019, USFOR-A carried out a series of airstrikes targeting more than 60 sites that they had identified as drug production facilities, often referred to as “drug labs”,4 across multiple areas in Bakwa district, Farah province, and parts of the bordering Delaram district, Nimroz province. Credible allegations soon emerged of significant civilian harm caused. Although airstrikes on reported drug labs had taken place before, this was the first time that UNAMA had received reports of a high number of civilian casualties resulting from such an operation.

UNAMA conducted extensive fact-finding into the 5 May incident in Bakwa district over a period of four months. After weeks of careful preparation, on 26 June, UNAMA undertook a fact-finding mission, together with the Afghanistan Independent Human Rights Commission (AIHRC), to Bakwa district, which is under Taliban control. Given the remoteness of the location and the lack of a permanent United Nations, governmental or military presence in the area, UNAMA considered the mission to be of significant value to the fact-finding process. The delegation conducted face-to-face interviews with individuals who were impacted by the airstrikes and saw some of the impact sites. The Government of Afghanistan, the Taliban, and NATO Resolute Support Mission all provided various means of support to the mission.

Afghanistan: Protection on civilians in armed conflict

Civil Society Forum on Drugs (CSFD) is an expert group of the European Commission. Its members are selected by the Commission for a three-years mandate based on their competences, knowledge and expertise. Forum has been established to provide a space for a dialogue in order to support European drug policy design and implementation through practical advice provided by the civil society to the European Commission.

This publication is a result of the efforts of the CSFD’s Working Group on the EU Action Plan on Drugs, whose work – among others – aims to promote the EU Drug Strategy and Action Plan on Drugs among the European civil society organisations and policy-makers working in the field of drug policy and improve its implementation in the EU member states. Adopted by all EU member states, the Action Plan on Drugs is a document of remarkably progressive content and notably meaningful civil society involvement in its preparation.

Civil society organisations (CSOs) play a pivotal role in the delivery of various services, also within the drug policy area. They are also important actors in policy-making processes, advocating for the rights of people who use drugs (PWUD). CSOs, having the first-hand experience in working with PWUD, can provide invaluable input in order to make new policies informed by the knowledge otherwise not available for the decisionmakers. CSOs involvement in decision-making is also in line with the contemporary principles of good governance, where processes should be participatory, transparent and accountable. Notwithstanding, the experience shows that often CSOs are left out if it comes to policy design processes. To address this issue, we present four case studies of good practices of CSOs involvement in policymaking.

Civil society actions at the national level: Good practices in the drug policy field: Study of the Civil Society Forum on Drugs

By prohibiting drugs that are increasingly in demand, an extremely lucrative market has been gifted to organised crime.This briefing exposes the exploitation of young and vulnerable people as a direct result of drug prohibition, through the ‘county lines’ drug supply phenomenon. In regulated markets for legal products, which are bound by strict legal frameworks, there is significantly less opportunity to exploit young and vulnerable people. Legal regulation would allow for governments to regain control over the drugs market, and help force unregulated suppliers out of the business.

‘County lines’ is the term used to describe a drug supply network set up by organised crime groups (OCGs) between urban and suburban locations, typically rural and coastal towns and villages. The practice usually involves OCGs coercing children and vulnerable adults into acting as drug runners and dealers often using intimidation, violence and sexual exploitation. Many victims have mental health issues, learning difficulties, come from broken homes, have chaotic and traumatic lives, or have been reported as missing.

The National Crime Agency (NCA) estimates there are over 2000 county lines, with activity in at least 88% of police force areas. It has become a key feature of UK heroin and crack cocaine markets. The NCA recognises the vulnerable individuals involved in county lines are often victims being trafficked into remote markets to work, while others are effectively imprisoned in their own homes when OCGs commandeer them to use as a local base for dealing (so-called ‘cuckooing’). The Children’s Commissioner estimates that 46,000 children are involved in gang activity in England, and 4,000 teenagers in London alone are being exploited by county lines networks each year. Many of these children are drawn into gangs for protection, a sense of belonging and identity, or social status. For some, the drug trade offers far more income than any available conventional work.

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