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The United Nations Office on Drugs and Crime (UNODC) links its latest World Drug Report with the outcome of the Special Session of the United Nations General Assembly held earlier in 2016. In particular, the report follows up the Special Session’s observation that "efforts to achieve the Sustainable Development Goals and to effectively address the world drug problem are complementary and mutually reinforcing.” The report uses the data it has collected on the prevalence, supply of and demand for opiates, cocaine, cannabis, amphetamine-type stimulants (ATS) and new psychoactive substances (NPS) and their impact on health to explore the interaction between the world drug problem and the United Nations’ 17 Sustainable Development Goals (SDGs).
The UK newspaper The Guardian reports that 30 people suspected of involvement with the illicit drug trade have been shot dead by police in the week following the inauguration of the new president of the Phillipines, Rodrugo Duerte. In the evening of his inauguration day, Duerte visited a slum in Manila where he reportedly said to the crowd, “If you know of any addicts, go ahead and kill them yourself as getting their parents to do it would be too painful.” This follows an election campaign in which Duerte threatened to kill tens of thousands of criminals to combat crime in the country and advocated extrajudicial killings.
Enterparse reports that the European Union (EU) has decided to end an agreement with Philip Morris International (PMI) which aimed to reduce trade in illicit cigarettes. The agreement was made in 2004 when the EU showed that three major tobacco companies were colluding with the black market in cigarette smuggling that was costing EU governments an estimated €10bn a year in lost revenue. Under the terms of the 2004 agreement, PMI agreed to monitor more closely cigarettes which have not had the correct duty paid on them as well as pay a contribution to the EU. Members of the European Parliament (MEPs) had voted earlier in 2016 to call on the European Commission not to renew the agreement with PMI, pointing out that the WHO Framework Convention on Tobacco Control calls for a general separation of governments and tobacco companies. MEPs were also angry that part of the €2bn being paid to the EU over 15 years by the big three tobacco companies had helped fund OLAF, the EU’s anti-fraud office that had been investigating the tobacco industry. PMI had also challenged the EU’s Tobacco Products Directive in the courts. EU officials said that the major decline in seizures of illicit cigarettes together with tougher EU anti-tobacco laws that came into force in 2016 meant that the agreement was no longer necessary.
The UK newspaper the Guardian reports that Iran is under increasing pressure to end its use of the death penalty for drug trafficking offences. The UN Office on Drugs and Crime (UNODC) approved a five-year country partnership programme for Iran that was aimed at providing about $20m in 2015. But a number of European countries, including the United Kingdom, Italy, Germany, Austria, Denmark, Ireland and Norway, have indicated that they are no longer willing to contribute to Iran’s anti-drug campaign. There have been indications that Iran wants to end drug-related executions, and more than 70 Iranian MPs introduced a bill to end such executions in December 2015. Iran’s chief prosecutor said in June 2016 that “we are not in favour of death penalty and we don’t think it’s appropriate.” There has been a fall in the number of executions in the first half of the year compared with 2015, but activists say it is too early to tell whether this reflects a change of policy. David Dadge, UNODC spokesperson, said: “The programme received funding in 2015 and there are pledges for 2016 from countries. It would therefore be premature to make any judgment on funding levels for the programme, especially as we are only halfway through the year.”
New York state governor Andrew Cuomo signed into law in June a range of measures to address the opioid crisis in the state that included limiting opioid drug prescriptions for acute pain to seven days of painkillers following a patient's initial visit to a doctor. Refills or renewals can be made after further consultations and there are exceptions for chronic pain and hospice and palliative care. The law also requires insurers to cover initial inpatient drug treatment without prior approval provided the insurance company is notified within 48 hours of admission; extends from 48 to 72 hours the time someone can be held for emergency treatment; and adds 270 more beds and 2,335 addiction treatment slots state-wide. Opioid-related emergency rooms visits in the state increased by 73 percent during the years 2010 to 2014, with 952 deaths in 2013, according to state health officials.
The Mental Health Research Programme, a UK-based collaboration between the Forces in Mind Trust, the Centre for Mental Health and King's Centre for Military Health Research, has launched a 5 year multi-million pound research programme with the aim of encouraging high quality research in the field of veterans' and their families' mental health. The programme encourages applications for research funding that propose innovative ways to understand and address substance misuse and addiction amongst UK ex-Service personnel and their families.
In a leading article, “Breaking Good,” the major British newspaper The Times has supported a call on the government by the Royal Society for Public Health (RSPH) to decriminalise both the possession and use of all illegal drugs. A report from the RSPH and the Faculty of Public Health on illegal drugs concludes that drug use should be regarded as a health problem rather than a crime. The Times editorial adds that: “The government should be encouraged to think of decriminalisation not as an end in itself but as a first step towards legalising and regulating drugs as it already regulates alcohol and tobacco.”
InSight Crime reports that Colombia's government and the Revolutionary Armed Forces of Colombia (Fuerzas Armadas Revolucionarias de Colombia: FARC) agreed in June on a voluntary programme to replace coca crops in ten communities surrounding the municipality of Briceño in Colombia. This is Colombia's first coca substitution programme involving FARC and the pilot project aims to help around 450 families who currently grow coca move to alternative crops, such as coffee and passion fruit. The United Nations Office on Drugs and Crime, the International Office for Migration and the UN’s Food and Agriculture Organization will be involved in the project. InSight Crime notes that there is relatively good infrastructure and alternative sources of income in Briceño compared with the rest of the country. InSight Crime also observes that in other less well-placed parts of Colombia it will be much more difficult to persuade farmers to switch to crops that are not guaranteed to bring in the same earnings as coca and that there is no guarantee that the FARC will put their full weight behind the agreement. In addition there are other illegal armed groups who would want to take control of Colombia's illicit drug production. Displacement is on the rise in Colombia, a trend InSight Crime suggests is probably linked to clashes between armed groups seeking to exploit the criminal opportunities created by the expected demobilization FARC, Colombia's biggest guerrilla force.
Uniform packaging regulations for tobacco were introduced in the UK in May after a legal challenge against the new law was dismissed by the UK High Court. Four large tobacco companies had challenged the regulations which the UK government was introducing in line with the European Union’s Tobacco Products Directive. The directive stipulates that graphic health warnings with photos, text and cessation information must cover 65% of the front and the back of cigarette and roll-your-own tobacco packs and is in furtherance of the policy laid down by the World Health Organization’s Framework Convention on Tobacco Control. The EU’s directive also allowed the UK to introduce its own regulations, requiring all tobacco products to be sold in uniformly olive green packaging with large images designed to act as health warnings, a move that had received a large parliamentary majority in its favour. According to Mr Justice Green’s ruling the tobacco companies had attacked the EU regulations, and the UK parliamentary process that had adopted them, “deploying the full gamut of challenges ranging from international law through EU law and human rights law right down to domestic common law.” Among their arguments, the companies claimed that the government had acted unlawfully because it attributed only “limited” weight to the evidence the companies had presented against plain packaging “upon the (erroneous) basis that it lacked independence and otherwise failed to meet ‘best practice’ standards for the preparation of evidence.” Mr Justice Green dismissed all their grounds of challenge, saying, "The essence of the case is about whether it is lawful for states to prevent the tobacco industry from continuing to make profits by using their trade marks and other rights to further what the World Health Organisation describes as a health crisis of epidemic proportions and which imposes an immense clean-up cost on the public purse," and that "In my judgment the regulations are valid and lawful in all respects."
The Food and Drug Administration (FDA) released its regulations on e-cigarettes and vaping products in May. The FDA first announced its intent to regulate e-cigarettes in 2011. In April 2014 the FDA first proposed bringing e-cigarettes and other non-traditional tobacco products, including cigars, hookah tobacco and pipe tobacco, under its authority but the timetable to finalise the proposal by June 2015 slipped due to resistance from the tobacco industry. The new rules bring e-cigarettes under federal oversight for the first time and will subject all manufacturers, importers and/or retailers of the newly-regulated tobacco products to any applicable provisions, and bring them into line with other tobacco products the FDA has regulated under the Family Smoking Prevention and Tobacco Control Act (TCA) since 2009. Under the new rules manufacturing companies must seek marketing authorization for any tobacco product introduced after 15 Feb 2007. E-cigarette brands will have to undergo a federal review to assess their impact on public health in order to stay in the market. Manufacturers have two years to submit product applications to the FDA for review, and the FDA has another year to finish the evaluation. Products already on the market are allowed to remain on sale during this period.The FDA review process will evaluate new products by assessing factors such as “ingredients, product design and health risks, as well as their appeal to youth and non-users.” Those e-cigarette manufacturers that do not submit the required information or do not meet federal standards would have their products removed from the market. The new rules will also limit e-cigarette sales to over-18s, although this ban will only affect Michigan and Pennsylvania as the other 48 states already ban sales of e-cigarettes to under-18s. E-cigarettes must carry warnings that they contain nicotine from May 2018. In Vox Mitch Zeller, director of the FDA's Center for Tobacco Products said: “as a regulatory agency, we have to make decisions at the population level. That's where it gets complicated. E-cigarettes have a positive and negative impact. In the US, that kids' use of e-cigarettes is way [up] is a negative. When it comes to adults, we have a disproportionate percentage of adults using e-cigarettes and cigarettes together.”
The latest European Drug Report from the European Monitoring Centre on Drugs and Drug Abuse (EMCDDA) provides an overview and summary of the European drug situation and responses to it. The statistical data in the report relate to 2014 (or the last year available) and is based on information provided to the EMCDDA by the EU Member States, the candidate country Turkey, and Norway. The report notes a resurgence in the use of ecstasy and that synthetic cannabinoids account for over 60% of the seizures of novel psychoactive substances. Twenty-five of the 98 new substances detected for the first time in 2015 and reported to the EU Early Warning System for new psychoactive substances were synthetic cannabinoids. The report also highlights new concerns about rises in deaths associated with heroin and other opioids particularly in countries in the north of Europe. In the preface to the report the Chair of the EMCDDA’s Management Board, Laura d’Arrigo, and the recently elected Director of the EMCDDA, Alexis Goosdeel, also draw attention to the demands on treatment services in Europe having to respond to the more complex health needs presented by an ageing cohort of heroin users.
The briefing paper, Cannabis Regulation and the UN Drug Treaties: Strategies for Reform, is produced by a range of drug policy and human rights organizations. Taking into account the discussions at the 2016 United Nations General Assembly Special Session (UNGASS) on drugs, the briefing examines options for the alignment of recent cannabis policy changes in countries like the US and Uruguay with obligations under the international drug control system.
In May the U.S. Food and Drug Administration (FDA) approved Probuphine, the first buprenorphine implant for the maintenance treatment of opioid dependence. The FDA said: “Probuphine provides a new treatment option for people in recovery who may value the unique benefits of a six-month implant compared to other forms of buprenorphine, such as the possibility of improved patient convenience from not needing to take medication on a daily basis.” The approval is part of the FDA’s opioid action plan to expand the use and availability of medication-assisted treatment.
Prompted by interest in the US in supervised injecting facilities (SIFs), the Harm Reduction Coalition convened a meeting in 2015 with international law enforcement and public health experts to explore the lessons learnt from the setting up of SIFs in Frankfurt, Germany; Sydney, Australia; and Vancouver, Canada. Among the major themes emerging from the meeting was that the key to the success of the SIFs “has been in cooperation, coordinated efforts, local participation, and a commitment to creating a safer and healthier community for everyone.”
BBC News reports that AXA, one of the world's biggest insurers, announced in May that it will stop investing in the tobacco industry and sell its investments in the industry worth more than €1.6bn (£1.3bn). The Economist noted that while AXA plans to sell its €184 million of equity holdings immediately, it planned to retain its €1.6bn of tobacco industry bonds until their maturity. In making the announcement AXA said that the role of healthcare providers is changing and that prevention is becoming more important. Thomas Buberl, Deputy CEO and incoming CEO of AXA said that the decision would generate savings by resulting in fewer claims for tobacco-related diseases and added: "It makes no sense for us to continue our investments within the tobacco industry. The human cost of tobacco is tragic - its economic cost is huge." Mr Buberl also said that the firm wanted to encourage other institutional investors to follow its lead.
The Globe and Mail reports that Health Canada has announced that it plans to allow doctors to apply for special access to prescribe diacetylmorphine to severe addicts under Health Canada's Special Access Programme (SAP). The SAP allows doctors access to non-marketed or otherwise unapproved drugs for patients with serious or life-threatening conditions. The move overturns a ban imposed by the previous Conservative government after clinical trials at Insite, the supervised injection site in Vancouver, Canada, found prescribed heroin safe and effective for patients who had failed to respond to standard medical treatment options such as methadone and buprenorphine. Patients in the trial continued to receive prescribed heroin despite the ban after challenging the Conservative government decision and winning an injunction.
Dr Leonie Brose at the Addictions Department, King’s College, London, UK, has been awarded the Fred Yates Prize for 2016. The prize is awarded annually, following open competition, by the Society for the Study of Addiction. The award is based on the outstanding research contribution of the mid-career researcher and recognises Dr Brose’s contribution to the field of smoking cessation, harm reduction and policy.
Wayne Hall writes: In April this year the Marron Institute at New York University hosted a 2 day Cannabis Science and Policy Summit. Mark Kleiman, who convened the summit, said that his intention was to “pry cannabis policy from the culture wars,” dispel the false policy polarisation between prohibition and legalisation to ensure that legalisation and prohibition were not seen as exhausting the cannabis policy space.
In the opening plenary, Jon Caulkins from Carnegie Melon University argued that cannabis should be regulated as a dependence producing, performance degrading, temptation good by using taxation and regulation to minimise the amount of heavy cannabis use (which accounted for most consumption) and the harms arising from it.
In the remainder of the meeting a series of parallel sessions covered topics as varied as the effects of cannabis on the brain; the impacts of medical marijuana and recreational cannabis legalisation on cannabis and other drug use (especially the opioids); emerging new medical and recreational cannabis products, such as edibles and extracts with a THC content up to 40%; and the implications of US cannabis policies for the international drug control treaties.
The old tension between supporters of cannabis legalisation and prohibition was replaced by another tension familiar to those in the alcohol policy field, namely, a split between public health advocates who advocated regulations and taxation policies to reduce heavy use and harms and representatives of the emerging legal cannabis industry who argued that restrictions on potency would limit consumer choice; that restrictive regulations, higher taxes and testing would limit their success in replacing the cannabis black market. The cannabis industry’s answers were always better consumer education and self-regulation.
The main take home messages for me were confirmation of an impression formed at a distance that it is much too early to judge how legal cannabis markets will be regulated, how soon they will increased availability and lower prices, and how these changes will affect rates of cannabis use and cannabis-related harm. There were some indications that liberal medical marijuana laws have reduced prices and increased the frequency of regular use among current users but it will take longer still to detect any increases in new users.
A major surprise was the increased use in legalisation states of high potency cannabis products, especially edibles and concentrates with up to 40% THC. Public health attendees raised concerns about increased risks of dependence, psychosis and other acute adverse effects. The industry was more concerned about pesticide contamination because pesticide levels (which are a minor issue for herbal cannabis products) increase along with the THC content in these concentrated products.
There are plans for similar summits in future to monitor the effects of cannabis legalisation. It will be interesting to see how many more will include representatives of cannabis industry and the public health community on the organising committee and among the speakers.
A report from the Royal College of Physicians (RCP), Nicotine without Smoke: Tobacco Harm Reduction, examines “the science, public policy, regulation and ethics surrounding e-cigarettes and other non-tobacco sources of nicotine.” The report concludes that e-cigarettes “represent an important means to reduce the harm to individuals and society from tobacco use” and that they should continue to receive government support and be promoted as a harm reduction strategy for tobacco.
The United Nations adopted a new framework that puts “people at the centre of global policies on drug control” at the UN General Assembly Special Session on the World Drug Problem (UNGASS) in April. “Putting people first means balanced approaches that are based on health and human rights, and promote the safety and security of all our societies. Putting people first means looking to the future, and recognizing that drug policies must most of all protect the potential of young people and foster their healthy styles of life and safe development,” said the Executive Director of the United Nations Office on Drugs and Crime, Yury Fedotov. The framework had been drafted in March by the Commission on Narcotic Drugs in Vienna and was adopted on the special session's opening day. The document, Our Joint Commitment to Effectively Addressing and Countering the World Drug Problem, reaffirmed a commitment to "promote a society free of drug abuse," and recognized the three UN drug control treaties as "the cornerstone of the international drug control system." Margaret Chan from the World Health Organization told the meeting that “In the view of WHO, drug policies that focus almost exclusively on use of the criminal justice system need to be broadened by embracing a public health approach. A public health approach starts with the science and the evidence.” Advocates of a change of international drug policy away from a prohibitionist approach were disappointed by the outcome of the meeting. In The Guardian, former president of Switzerland and critic of current drug policy Ruth Dreifuss said, “the world community is not ready, is not willing, to have the change of politic that is absolutely necessary.”
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18 - 21 August 2016, Denver, Colorado, USA.
20 - 23 August 2016, Seattle, Washington, USA.
7 - 9 September 2016, Oslo, Norway.
17 - 20 September 2016, Vienna, Austria.
21 - 22 September 2016, Abuja, Nigeria.
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25 - 27 September 2016, Bethesda, Maryland, USA.
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23 - 26 March 2017, Madrid, Spain.
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4 - 6 October 2017, Melbourne, Australia.
24 - 26 October 2017, Lisbon, Portugal.