The U.S. is facing an unprecedented number of opioid-related overdose deaths, and an array of other countries have experienced increases in opioid-related facilities. In the U.S., naloxone is increasingly distributed to first responders to improve early administration to overdose victims, but its cost-effectiveness has not been studied. Lay distribution, in contrast, has been found to be cost-effective, but rising naloxone prices and increased mortality due to synthetic opioids may reduce cost-effectiveness. We evaluate the cost-effectiveness of increased naloxone distribution to (a) people likely to witness or experience overdose (“laypeople”); (b) police and firefighters; (c) emergency medical services (EMS) personnel; and (d) combinations of these groups.

High distribution to all three groups maximized net monetary benefit and minimized fatal overdoses; it averted 21% of overdose deaths compared to minimum distribution. High distribution to laypeople and one of the other groups comprised the second and third best strategies. The majority of health gains resulted from increased lay distribution. In the societal analysis, every strategy was cost-saving compared to its next-best alternative; cost savings were greatest in the maximum distribution strategy. In the health sector analysis, all undominated strategies were cost-effective. Results were highly robust to deterministic and probabilistic sensitivity analysis.

Increasing naloxone distribution to laypeople and first responder groups would maximize health gains and be cost-effective. If feasible, communities should distribute naloxone to all groups; otherwise, distribution to laypeople and one of the first responder groups should be emphasized.

Click here to read the full article (restricted access)

Cost-effectiveness analysis of alternative naloxone distribution strategies: First responder and lay distribution in the United States

The “war on drugs” was first declared by U.S. President Richard Nixon in 1971, with the goal of eradicating what he viewed as the growing problem of drug addiction. Since then, it has had dire consequences, including the exacerbation of human rights violations and erosion of democratic institutions around the world. Yet human rights groups largely refrain from discussing drug policy.

Hundreds of civil society groups around the world are dedicated to investigating the outcomes of the drug war and advocating drug policy reform based on their findings. However, drug reform advocates often comment that international human rights organizations have been largely absent in these discussions. Human rights reports generally stick to noting human rights violations in affected states as a whole, without investigating the violations’ relation to drug policy and drug trafficking organizations.

Knowing this, the Human Rights Foundation initiated its War on Drugs Research Project to examine data and existing research on the global drug war’s costs and consequences in order to understand drug policy from a human rights perspective. The resulting report is organized in two parts. The first offers a high-level introduction to the drug war’s history and economics. It explains how prohibition was established, how the resulting black market functions, and how its policies have ultimately failed to decrease drug abuse.

Once we have established whether prohibition policies have created the desired outcomes, we look at the negative consequences of the policy — the human rights consequences — through three case studies: Colombia, Mexico, and the United States. These countries were selected because of their positions along the illegal drug supply chain. Colombia is a production country on the cocaine supply chain because of its position in the Andes mountain range, where coca, the plant used to manufacture cocaine, grows. Mexico is a transit country that traffickers pass through on their way to the drugs’ final stop: the United States, a destination country. Drug prohibition has taken different forms in each country because of their position on the supply chain. By examining each country, we hope to understand how different prohibition policies shape human rights outcomes.

The Human Rights Foundation (HRF) is a nonpartisan nonprofit organization that promotes and protects human rights globally, with a focus on closed societies. HRF’s focus shapes the scope of this report. The organization focuses on civil and political rights: the rights to free expression, belief, assembly, association, press; to liberty and security of the person; to access information; to political participation and to vote; and, of course, to life, among others. As many of these rights constitute the definition of liberal democracy, HRF research pays special attention to the political systems of countries in which human rights violations take place. In this report, this means that we have taken special care to understand how the drug war interacts with and affects a country’s democratic health. Colombia, Mexico, and the United States are all categorized as democratic countries under HRF’s Political Regime Research Project,i which categorizes all countries in the world into regime types using a methodology adapted from the one presented in Steven Levitsky and Lucan A. Way in Competitive Authoritarianism.


It is well established that prohibition has failed to reduce consumption and abuse. But prohibition is not just ineffective; it’s harmful. This report shows how prohibition’s policies have directly caused severe human rights violations in affected countries, especially by undermining civil and political rights to such a degree that these policies constitute a threat to democracy. Supply-centric policies have had grave consequences for individuals, communities, and the health of democratic institutions, including high rates of violence, disappearances, kidnappings, and incarceration; impacts on local communities and minority populations; state instability, lack of trust in government, and corruption; and a deterioration of rule of law and electoral competition. The report’s findings suggest that, from a human rights perspective, there must be a shift from international drug policies that focus on criminalization and supply reduction, to ones that have human rights and health at their core.

The cost and consequences of the war on drugs

The IDPC membership survey was shared with IDPC members in English, French and Spanish on 10 December 2018 and received responses until 18 January 2019. Out of IDPC’s 182 member organisations at the time, 67 eligible responses were received (i.e. 37% of IDPC’s members1 ). Responses originated from 47 individual countries, with three responses adopting a regional outlook. In terms of regional representation, Western Europe (16 responses) and Latin America (15) provided the highest amount of responses, followed by SubSaharan Africa (7), North America (6), Oceania (5), South East Europe (5), South East Asia (4), Eurasia (4) and the MENA region (1).

IDPC Membership Survey 2018: Summary of results

By Gregory Midgette, Steven Davenport, Jonathan P. Caulkins, Beau Kilmer

Substance use and drug policy are clearly in the national spotlight. Provisional data from the Centers for Disease Control and Prevention suggest that drug overdose deaths in 2018 exceeded 68,000, of which more than 47,000 involved opioids. Although heroin, prescription opioids, and synthetic opioids (such as fentanyl) receive most of the attention, deaths involving methamphetamine and cocaine are both on the rise. In addition, more than 25 percent of the U.S. population lives in states that have passed laws that allow for-profit firms to produce and sell marijuana for nonmedical purposes to adults ages 21 and older.

To better understand changes in drug use outcomes and policies, policymakers need to know what is happening in the markets for these substances. This report updates and extends estimates of the number of users, retail expenditures, and amount consumed from 2006 to 2016 for cocaine (including crack), heroin, marijuana, and methamphetamine in the United States, based on a methodology developed by the RAND Corporation for the Office of National Drug Control Policy. The report also includes a discussion of what additional types of data would help quantify the scale of these markets in the future, including the new types of information produced by the legalization of marijuana at the state level.

What users in the USA spend on illegal drugs

The research was largely based, on the one hand, on content analysis of legal and policy documents, academic journals, media reports and other state and non-state actors’ reports, and on the other hand on interviews of individuals and focus groups comprising of drug dealers, traffickers, people who use drugs and their relatives as well as clinicians, government and security officials.

This composite report summarises and brings together the main findings of each of the three country-specific reports. The main findings are grouped into five broad areas, namely: i) state of drug market ii) impacts of drugs on the state and society iii) national frameworks and actions against illegal drugs, iv) challenges and constraints, and v) actions points to effect positive change. Before delving into the research findings in each of the three countries, a brief overview of the regional perspective on how drug trade and use is addressed in the region is presented.

West Africa has become an important hub for the global trade of illegal drugs. Psychoactive drugs are substances that either stimulate (such as cocaine or amphetamines) or inhibit (such as heroin or sedative-hypnotics) the central nervous system or cause hallucinogenic effects (such as marijuana or LSD) to the effect that their use has been prohibited globally (International Encyclopedia of the Social & Behavioral Sciences, 2001). According to report of the United Nations Office on Drugs and Crime, (UNODC, 2016), Africa is the second main market for cannabis in the world after the Americas. Between 2009 and 2014, West Africa accounted for 78% of the total cocaine seizures in Africa (World Drug Report, 2016). Equally worrying is the rising number of clandestine laboratories in West Africa producing synthetic drugs including methamphetamine. It is estimated that the West African region is now producing up to 1.5 tonnes of methamphetamine every year.

This problematic situation of the drug problem was further underscored in a report produced in 2014 by the West Africa Commission on Drugs (WACD), warning against the dangers posed by the drug trade to the democratisation process, economic growth, human rights, women empowerment and rule of law across West Africa.

In view of the growing threats of the drug trade, the regional body, the Economic Community of West African States (ECOWAS) is working through its Action Plan 2016- 2020 to promote a regional approach. Other important legal documents of ECOWAS include the Conventions on Extradition and on Judicial Assistance to fight organised crime and money laundering in West Africa. At the level of the West African Economic and Monetary Union (WAEMU), member states are mandated to establish a centralised agency to address the drug trade.

Despite the progress made in terms of providing policy and legal frameworks as well as creating specialised agencies, the regional approach towards drugs faces several challenges and constraints at the regional level. These include little inter-state cross-border collaboration and operations, no centralised regional agency and database system on the illegal drug trade and organised criminal networks, and inadequate financial, material and human resources to tackle the problem. It is evident that the challenges at regional level are a reflection of the dire situation at the level of states.

Towards a new approach to address drug trafficking, production and consumption in West Africa: Case studies of Benin, Ghana & Senegal

By the National Infections Service, Public Health England

These tables present data from the Unlinked Anonymous Monitoring (UAM) Survey of People Who Inject Drugs (PWID) in contact with specialist services. This annual cross-sectional survey is co-ordinated by Public Health England, with support from Public Health Wales and Public Health Agency Northern Ireland. It is completed by people who inject psychoactive drugs. These data tables are updated annually and made available on the Public Health England GOV.UK website. Data from the biennial survey of people who inject image and performance enhancing drugs can be found in a separate set of tables published on the same webpage. The data within these tables are discussed in an accompanying report which is also available on the Public Health England GOV.UK website.

Data are presented separately for the whole of England, Wales and Northern Ireland, and sub-divided by country and PHE region. In some of these areas regional breakdowns could not be provided due to small numbers. Regional level data should be interpreted cautiously as figures may be from a small number of sites or a single site. For clarity, percentages are given to two significant figures. Confidence intervals are not presented but are available for the main findings within the accomapanying HPR.

This set of data tables presents data for the period 2008 to 2018. Data from the survey for earlier years (the survey has been running since 1990) can be found in past sets of data tables which are available via the Public Health England GOV.UK website.

This voluntary unlinked anonymous survey recruits people who inject drugs through specialist agencies within England, Wales and Northern Ireland. These agencies provide a range of services to those who inject drugs, from medical treatment to needle and syringe programmes and outreach work. People using these services that are either currently injecting drugs or who have done so previously are asked to take part in the survey by service staff. Those who agree to take part provide a biological specimen that is tested anonymously for HIV, hepatitis C and hepatitis B. Behavioural and limited demographic information is collected through a brief anonymous subject-completed questionnaire linked to the specimen but unlinked from any client identifying information. This includes questions on the uptake of diagnostic (voluntary confidential) testing for HIV and hepatitis C, hepatitis B vaccination and the sharing of injecting equipment; participants may opt out of answering any questions. The questions asked have varied over time.

Data tables of the Unlinked Anonymous Monitoring Survey of HIV and Hepatitis in people who inject drugs in the UK

Case study from: Brazil, Dominican Republic, Nicaragua & Uruguay; By Enrique Saavedra, Paula Lappado, Matilde Bango & Federico Mello

Over the past two decades, the number of people incarcerated in Latin America has skyrocketed, with more than 1.2 million prisoners overcrowding correctional facilities across the region. Accompanying this, we estimate that the number of children with an incarcerated parent in the region is currently around 1,5 to 1,9 million (see Appendix A for more details).

This marginalized and vulnerable group of young people has been neglected by, and remained virtually “invisible” to public policies, programs and civil society.

In order to assess the situation and needs of these children, and following the recommendations made by the UN Committee on the Rights of the Child during its Day of General Debate in 2011, CWS, with the technical leadership of Uruguayan NGO Gurises partnered with organizations in Brazil, Dominican Republic and Nicaragua to conduct the first regional study of children with incarcerated parents.

The participating organizations surveyed 193 children with an incarcerated parent (or adult referent), and 50 of these children and 46 of their caregivers or guardians were interviewed. 23 government officials and regional experts working in child protection were also surveyed. The results of this study demonstrate the profound impact that the incarceration of a parent has on the life of a child. Families face increased financial strains which force many children to work outside the home or assume adult roles in their household. Children undergo emotional changes, becoming sad, withdrawn or sick, and they face social stigmatization and discrimination in their communities. Their experience with police and the justice system typically creates a negative perception of these authorities, and these elements combine to alter the development of childrens’ self-identity, leading some to develop identities based on resistance to existing social structures. Research confirms that maintaining the child-parent relationship during the incarceration is one of the best ways to help children cope with such difficulties. However, it is difficult for families to maintain such relationships when their only face-to-face interaction is through prison visits, where children must endure unhealthy prison conditions, invasive body searches, and mistreatment from prison guards.

Government officials and experts working in the area acknowledge the vulnerability of this group of children, and provide important insight into their situation. They describe the justice and penal systems as “adult-centric,” looking at matters only from the perspective of the adults involved. In fact, no country in the region even systematically documents or registers the number of children of prisoners. Without any idea of the scope of the problem, it is nearly impossible to create policies and programs to address it. Likewise, the judicial system does not account for the best interests of related children when it decides appropriate punishment for those convicted of crimes.

While the legal rights and responsibilities of fathers and mothers are identical, some experts prioritize the issue of incarcerated mothers, particularly those whose children live with them in prison. It appears that the incarceration of a mother has a more dramatic impact on family dynamics and significantly increases vulnerability of children. Whether it is the mother or father that is convicted of a crime, the use of alternative punishments (eg. open and semi-open prisons) would lessen the negative impact on children. Likewise, improved coordination between state actors involved in the justice system and child protection would improve services and support to children of incarcerated parents.

It is clear that governments are the main responsible of protecting the rights of all children, and that they should, in coordination with civil society, begin to develop policies, programs and initiatives that support and empower children of incarcerated parents.

Invisible no more: Children of incarcerated parents in Latin America and the Caribbean

Today we launch our latest drug trend report covering 2017 to 2019. We have included information about the most commonly used drugs in Scotland, emerging trends and have provided context to the recently released drug-related death statistics.

We hope the report is accessible, informative and helps everyone understand the current situation we are seeing around drug use in Scotland today.

Drug-related harm in Scotland is rising. The harms caused by drugs and drugs legislation are wide-ranging and, in this report we discuss what they are and how they impact on individuals, families and society. This includes drug-related death, the ultimate drug-related harm, and we delve into the details behind the figures.

Drugs at Crew Trend Report 2017-2019

By Maíra Rocha Machado, Mariana Celano de Souza Amaral, Matheus de Barros and Ana Clara Klink de Melo

Brazil has the third largest prison population worldwide—over 700,000 people. At least 28% of them are in prison for drug trafficking. Given that situation, this paper explores the conflicts among the law; the Supremo Tribunal Federal, or Brazilian Federal Supreme Court (STF) and lower court precedents. Based on a qualitative and quantitative study of Tribunal de Justiça de São Paulo, or São Paulo State Supreme Court (TJSP) and Superior Tribunal de Justiça, or Brazilian Superior Court of Justice (STJ) decisions between 2017 and 2018, this paper focuses on the arguments put forward by those courts to prevent the imposition of non-custodial sanctions on people convicted of drug trafficking even though they may be first-time offenders with no criminal record. Our research shows the main arguments used are related to the amount, type and variety of seized drugs; the convict’s criminal history; the person’s employment status at the time of arrest and the insufficiency of non-custodial sentences in cases of drug trafficking. Our conclusion is that the reasoning behind convictions for drug trafficking favors imprisonment even in situations in which the law and the STF precedents would allow non-custodial sentences.

Incarcerating at any cost: Drug trafficking and imprisonment in Brazilian court reasoning

By Charlie Lloyd, Heino Stöver, Heike Zurhold, and Neil Hunt

Drug consumption rooms (DCRs) enable the consumption of pre-obtained drugs under supervised conditions. While 24 DCRs exist in Germany, there are none in the UK despite similar levels of drug-related harms. The first official, German DCRs were introduced in Hamburg and Frankfurt in the mid-1990s. A key influence was the appearance of “open drug scenes” in such cities over this time, whereby large numbers of users congregated in parks or shopping centers. This led to powerful coalitions of politicians, police, and treatment agencies and DCRs were seen as a professional response to these problems. In the UK, there have been two high-profile recommendations for the piloting of DCRs, which have been rejected by the government for a number of reasons, including lack of evidence, legal problems, and negative media responses. In explaining the different situations in the two countries, key factors are the potential for city-level policies, the stigma attached to drug users in media reporting, and the historical development of open drug scenes. Chance has also played a part, particularly in the UK. Drug policy is rarely a government priority, and drug policy decisions are therefore affected by wider political goals and pressures in unpredictable ways.

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

Low impact, wrong direction: Why São Paulo State drug policy is inefficient and ineffective

By Francisco Inácio Pinkusfeld Monteiro Basto

Estimates on burden of disease published by the Institute for Health Metrics and Evaluation show that the use of alcohol and other substances is one of the leading risk factors for death and disability in Brazil. This estimate places the 3rd National Survey on Drug Use by the Brazilian Population (“3rd National Survey”) at the center of the institutional mission of FIOCRUZ, namely: “To produce, disseminate, and share knowledge and technologies focused on strengthening and consolidating the Unified National Health System (SUS) and contributing to the Brazilian population’s health promotion and quality of life, the reduction of social inequalities, and the dynamics of national innovation, with the right to health and full citizens’ rights as central values.”

This report, which presents the Methods and Results of the 3rd National Survey, is the result of a partnership between the Oswaldo Cruz Foundation (FIOCRUZ) and the National Secretariat for Drug Policies (SENAD), established through a decentralized cooperative agreement in August 2014. The study received additional funds from FAPERJ (“Carlos Chagas Filho” Rio de Janeiro State Research Foundation) and CNPq (National Council for Scientific and Technological Research), which allowed developing specific stages of the Survey as a whole, besides expanding the sample in the city of Rio de Janeiro (that is, in simple terms, representing the city in greater detail and with greater capacity to focus the analysis on certain key aspects), which will be the object of specific publications. In the current publication, the municipality of Rio de Janeiro is analyzed on the basis of the formulation and respective quantitative statistics described in the chapter on the sampling plan.

It is our hope that the data presented here will help support policies and programs aimed at reducing the consequences of harmful substance use in Brazil.

On behalf of FIOCRUZ, as the project’s Overall Coordinator, I wish to thank the approximately 300 professionals who made this survey possible – the largest of its kind in Brazil to date. Finally, I thank the 16,273 Brazilians who generously welcomed us in their homes, granted the interviews, and trusted that the information they provided will be “used to support public policies and initiatives in Brazil, including the organization of social strategies and programs for the prevention and treatment of psychoactive substance use”

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