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Ketamine secured for medical and veterinary use!

Originally posted here

By Willem Scholten

On Friday 13th March, the Commision on Narcotic Drugs discussed the possible bringing of ketamine under international drug control. Initially, China proposed to add the substance under Schedule I of the UN Convention on Psychotropic Substances. Such a scheduling means that the substance can be used for medical purposes only under direct governmental supervision, and in very limited situations. The proposal was very inappropriate for an essential medicine. However, thanks to the efforts of many, China amended its proposal to the less strict Schedule IV of the same convention. Again we opposed this and thanks to our opposition, China withdrew this morning its entire proposal. The CND then decided to postpone its decision on scheduling ketamine to a future date to allow more information to be gathered. A transcript of the debate is available on the CND Blog.

 

Source: http://drugabuse.com/library/the-effects-of-ketamine-use/

 

This is a very good result and I want to thank everyone who was involved in the lobbying to keep access to ketamine as a human and veterinary medicine for his or her efforts. In the end we had 87 endorsements on the fact sheet and several organizations came to Vienna to convince the delegates personally. Many went to their governments to convince the ministries of health and the drug controllers that any scheduling of ketamine was not a good idea.

Over the past few weeks it became more and more clear that we were successful, and many countries declared that they would oppose the scheduling. Initially, we were able to find over 19 CND members opposing schedule IV, and once we had these, we continued to  convince more CND Member countries to oppose all scheduling. This became clear only gradually toward last weekend. In my messages you may have seen the countries I recommended to focus your lobby on. On purpose we decided not to be transparent on the countries we had convinced. I hope for your understanding, as such transparency would have made it easy for China to lobby these countries back into its camp.

During the week at the CND (which started last Monday), we discussed with country delegations the possible ways forward, being afraid of unwanted precedents in the procedure. But finally today, it happened as some had predicted: China withdraw its proposal while saving face by saying that this allows for more data collection. How serious this “more data collection” is, is in this stage not completely sure. It may be that we never hear back about ketamine scheduling, but some vigilance is needed in the coming years.

What further to do? There are over 50 countries who have scheduled ketamine in their national legislation (i.e. independent form the international drug control conventions). In several of these countries, veterinarians and physicians may have experienced reduced availability of ketamine already. They and their organizations may want to discuss the issue now with their governments in order to re-increase availability. Because of this CND and Chinas proposal, the climate may have changed now. After some of the preparatory meetings, someone mentioned that this was the first time ever that the countries at the CND discussed medicines availability for over three hours. Never before there was such a focus at the internaitonal levle on the relation between drug control and medicines availability. Therefore, this is the moment that most drug controllers around the world are seeing that drug control has also the negative side for public health of medicines unavailability.
Medical and veterinary organizations may also want to use the opportunity for discussing the availability of medicines controlled as drugs more in a general way, e.g. the availability of opioid analgesics, long-acting opioids for the treatment of opioid dependence, phenobarbital and other controlled medicines.

For those who want to take action in this regard, I also refer to the WHO Guidelines on this issue, available in multiple languages, including English, French and Spanish.

 

Another UN agency savages the drug war

Originally posted here

The United Nations Development Programme (UNDP), the UN agency charged with developing strategies to reduce global poverty, has strongly criticised current international drug policy, highlighting the disastrous costs it is producing – particularly for the world’s poor.

In the agency’s formal submission to the UN General Assembly Special Session (UNGASS) on drugs (PDF), launched at the annual UN Commission on Narcotic Drugs which began last week in Vienna, the UNDP argues:

"While drug control policies have been justified by the real and potential harms associated with illicit drug production, trafficking, and use (e.g., threats to safety and security, health problems, crime, decreased productivity, unemployment, and poverty), evidence shows that in many countries, policies and related enforcement activities focused on reducing supply and demand have had little effect in eradicating production or problematic drug use."

The agency goes on to say:

"As various UN organizations have observed, these efforts have had harmful collateral consequences: creating a criminal black market; fuelling corruption, violence, and instability; threatening public health and safety; generating large-scale human rights abuses, including abusive and inhumane punishments; and discrimination and marginalization of people who use drugs, indigenous peoples, women, and youth".

With regard to the harmful impacts on international development specifically, the UNDP states that international drug policy is having a negative effect on “poverty and sustainable livelihoods; governance and the rule of law; human rights; gender equality; the environment; and on indigenous peoples and traditional and religious practices.”  Detailed sections on each of these topic areas follow in the body of the report.

View From the Ground: Rosario, Argentina

In early January around 2,000 members of Argentina’s military-style border force – known as the gendarmeria – left the country’s second city of Rosario.  They had arrived 9 months earlier, on April 9th, carried clandestinely into the city as part of an elaborate rouse involving a fake climate change conference.  In a surprise display of force the local press justifiably described as “cinematic”, six helicopters hovered above while more than 80 raids were launched on known ‘bunkers’, the one room buildings that serve as illicit drug dispensers and are almost wholly located in the villas, the poor neighbourhoods that form a loose rim around the city centre.  At the forefront of proceedings was the National Security Secretary, Segio Berni.  “This was the largest operation in the history of Argentina, with the objective of pacifying the area of Rosario,” he told the press.

Since 2012 drug trafficking and violence have become issues of public debate in the city.  The violence and the trafficking had been going on in isolation in the villas, separate from the affluent heart of the city, but the issue was forced into the public eye and onto the political agenda thanks to the dedicated work of the activist organisation Frente Popular Dario Santillan after three of its members were killed on New Year’s Day 2012 by a local drug gang who mistook them for rivals.  Since a spike in mid-2010, violence has been spiralling upwards.  The city’s homicide rate is now the highest in the country.  Overwhelmingly, the victims are young men and boys; confrontations between rival gangs involved in the drug trade – generally small outfits, and often family-run – are considered to be behind a sizeable proportion of the deaths.  In response, “insecurity” has become the buzzword among politicians and the media.  It’s election time here at the moment and the posters blanketing every advertising space promise to combat insecurity, to bring back security, to make Rosario normal again.  Official mentions of the root causes – poverty, exclusion, corruption – are rare.  Policies designed to address them are even rarer.  (I know an activist group that struggled for a year and a half just to have lights put above a football pitch so the kids in one villa could have something to do in the evenings.)  The growing use of Argentina as a transit point for cocaine headed to Europe has increased the stakes and likely contributed to the violence, as have a provincial police force heavily involved in the trade and the lacklustre efforts of the judiciary and the government.  But in the public mind, and according to government policy, the embodiment of insecurity, the cause and the consequence, is a drugged-up 16 year old with a gun (a forthcoming GDPO Situation Analysis will discuss the treatment of children here involved in the trade).  “What these kids need,” local journalist, author, and political candidate Carlos del Frade told me, “is education, sport, art, activities.  They don’t need the gendarmeria in the neighbourhood.”  But that’s what they got.

It was something of an omen of things to come that while the mega-operation of April 9th looked impressive, the haul that day – 25 low-level actors involved in small-scale selling, “three guns, a couple of thousand dollars and some drugs”, quoting the former governor of the province – was less so.  The gendarmeria continued the established trend of pursuing the lowest and most visible link in the trafficking chain. Over their 9 month stay they did reduce violence in certain areas of the city; when they were replaced by the provincial police, shootings resumed.  Their presence also resembled an occupation and abuses were reported.  A university study of one area found selling alcohol was not permitted after 10pm, shopping receipts needed to be kept at hand to show proof of purchase, youngsters were detained arbitrarily and prevented from gathering outside, and people riding motorbikes were constantly stopped and searched.  Drug traffickers, local sources suggest, responded by selling more at night, and switching from ‘retail’ selling to ‘delivery’ – a text message is sent and a motorbike appears with the goods.  After the bandage was ripped off in January the blood began flowing again – as would be expected.

Party politics is central to all this.  When the gendarmeria were withdrawn, Berni, of the ruling Frente Para la Victoria party, could not resist using the opportunity to fire some parting shots at the Socialists who govern Rosario and Santa Fe.  The Socialists blame the national government for not sealing up the borders and not acting on drug trafficking, which is a federal, not provincial crime.  The national government blame local corruption.  Both have a case.  Berni rightly took some flak for politicising the issue, but this was merely an open recognition of what previous actions have made clear.  Even major operations are largely reactive and serve to score political points: when the provincial government were impelled to move on the city’s biggest drugs gang two years ago, the national government sent their forces into the province to capture a powerful drug trafficker – “I’m caught in the middle of a political war”, he somewhat justifiably told the press.  Nice rhetoric aside, the national government, which has sworn not to follow a War on Drugs approach, has done exactly that with the sending of the gendarmeria.

For now there are few signs things will improve.  Post-gendarmeria, the public debate is focused on the narrow question of whether they should come back or not; the governor of the province, Antonio Bonafatti, is adamant they return.  The national government seems to be enjoying watching their provincial rivals suffer.  Not enough is being done or said, on a national or provincial level, about the conditions behind the violence and trafficking – present in many cities across the country – or about the corruption in the police, the judiciary and the government; some local experts are incensed the provincial government didn’t use the breathing space provided by the national forces to overhaul the notoriously corrupt police force.  The short term seems to be the sole consideration for parties focused on upcoming elections. “The long term exists only for theoretical dalliances,” remarked a local columnist while discussing the dominance of the “security” issue within local political campaigns.  But serious, sustained programs designed to address deep-rooted issues are imperative if the many youngsters growing up in the villas who feel helpless and excluded and angry, who have lost a sense of value for life, are to have a better future than the one offered to them today.  Youngsters like 23 year old Pablo Martinez, who died this February while playing russian roulette.

By Ross Eventon

Worrying proposals to discuss the international scheduling of Ketamine at the CND in March 2015

As noted in the 2014 TNI – IDPC report Scheduling in the international drug control system, although often viewed as an obscure technical issue, the problem of scheduling lies at the core of the functioning of the international drug control system. Scheduling – the classification of a substance within a graded system of controls and restrictions, or ‘schedules’ – must take place in order for a substance to be included in the international control framework, and determines the type and intensity of controls to be applied. For this reason, the topic is of central importance.  Within this context, recent years have seen ketamine become an increasing point of contention.  Concerned by ‘recreational use’, some states, China key among them, have been pushing for international control of the drug.  This goes against repeated recommendations from the WHO, the body responsible for providing expert guidance on scheduling decisions within the UN Commission on Narcotic Drugs (CND).  As the WHO points out, while some non-medical use certainly takes place within some parts of the world, international scheduling would likely have damaging consequences on medical access to the drug (a WHO listed essential medicine) in developing countries.  Here it is the only available anaesthetic for essential surgery in most rural areas.

This Fact Sheet on the Proposal to Discuss International Scheduling of Ketamine at the 58th CND – endorsed by a wide range of civil society organisations, including the GDPO – provides background on the issue and explains why international scheduling would go against all the scientific evidence on the issue, be procedurally unsound and generate considerable negative public health impacts in parts of the world where there is already an acute crisis in essential surgery.

GDPO Summer School Success

In July, Global Drug Policy Observatory staff Professors David Bewley Taylor and Julia Buxton delivered the 10 day intensive Human Rights and Drug Policy summer school, at the Central European University (CEU) in Budapest, Hungary. Funded by the Open Society’s Global Drug Policy Programme, the summer school was attended by 24 participants from across the world. This included colleagues from Nigeria, India, Pakistan, Bangladesh, Hong Kong, Kyrgyzstan, Georgia, Lithuania, Tajikistan, Hungary, Jamaica, Mexico, Argentina, Brazil, United States of America, Poland, Ireland and the United Kingdom. With backgrounds in journalism, social work, harm reduction, legal services, advocacy, political service and the security sector, the participants brought extensive professional experience to the course, which presented an excellent opportunity for global networking and knowledge exchange.

The summer school was delivered by academics and practitioners through lectures, discussion groups and workshops that enabled participants to analyse core issues and debates at the interface of human rights and drug policy. This began with David Bewley Taylor’s day-long session exploring the treaty framework and institutions of the international drug control regime administered by the United Nations Office on Drugs and Crime (UNODC). Key questions included the remit and mandate of bodies such as the Commission on Narcotic Drugs (CND) and the International Narcotics Control Board (INCB), and the extent to which current reform of cannabis laws constitute a breach of the 1961 Single Convention. On the second day, participants considered international human rights conventions and obligations supported by key cases in human rights law. Delivered by Damon Barrett, Deputy Director and Head of Research and Advocacy at the Harm Reduction International and Director of the International Centre on Human Rights and Drug Policy, the session incorporated a focus on the rights of children and of minority religious groups particularly Rastafari.

Niamh Eastwood, the Executive Director of the drug policy reform and legal services organisation Release delivered the third day’s session. This addressed racial disparities in drug policy enforcement, trends in incarceration for drug related offences, and, returning to a theme raised earlier by Bewley Taylor, the politics of drug scheduling. Course participants welcomed back Peter Sarosi and Denes Balazs from the Hungarian Civil Liberties Union (HCLU) at the end of the week. The first engagement for participants at the beginning of the course had been an informative and moving visit to a needle injecting facility with Peter Sarosi. In this second session with HCLU, participants enjoyed a day of media training in drugs advocacy. This involved submitting to a recorded camera interview, which was played back to the class for comments.

As the summer school is an intensive course, designed to maximise the ability of professionals to take time from work to attend, participants were back in the classroom on Saturday with Dr Katherine Pettus, Advocacy Officer at the International Association for Hospice and Palliative Care. This was a challenging session, requiring participants to focus on the impacts in poor and developing countries of lack of access to essential medicines. The session threaded with earlier discussions on the scheduling of controlled drugs and the role of drug control bodies (CND but particularly the INCB) in impeding access to medicines that are essential for pain relief in terminal illness. Participants did enjoy a break on the Sunday, with the majority taking the opportunity of a boat cruise along the Danube to Szentendre.

The final three days of the course were delivered by Kasia Malinowska Sempruch the Director of the Open Society Global Drug Policy Programme and Julia Buxton. With Kasia, participants examined the record and principles of global harm reduction initiatives, including safe injecting facilities and methadone maintenance programmes. The impact on women of drug policy enforcement was considered, developing the argument forwarded earlier in the course by Niamh Eastwood relating to bias in the policing and treatment of drug-related offences. Julia Buxton examined why the international community focuses attention on naturally occurring (cocaine and opioid) drugs that are produced in the Global South, rather than more widely abused synthetic drugs manufactured in Europe, North America and China. Following this discussion, participants considered the cost paid by developing and conflict prone countries in their role as ‘front line’ states in the international drug war. The final session was applied in orientation, and focused on writing drug policy reports. Participants presented and discussed different topics for a Situation Analysis, supporting each other in constructing brief, focused analytical pieces.

Feedback from the course was extremely positive, with friendship and close working relations making for excellent group dynamics throughout the 10 day period of study. This was the final year Human Rights and Drug policy will be delivered at the CEU, with the course relocating to other institutions in India, Ghana and Mexico for 2015. With Julia Buxton’s move to the School of Public Policy at the CEU in January 2015, work will begin to develop a Masters level programme in Human Rights and Drug Policy; a programme that will aim to maintain a close relationship with Swansea University and the GDPO.

2014 The World Drug Report: The Titanic sails at dawn

This post was originally published here by the International Drug Policy Consortium.

As it its customary practice, the UNODC released its flagship publication on June 26th, the UN’s designated ‘International day against drug abuse and trafficking’ as well as the occasion of the ‘Support Don’t Punish’ day of action, which seeks to draw attention to the collateral damage of the ‘war on drugs’. So the growing debate over the failure of the international drug control system, which has now entered mainstream political discussion, provides the context for the publication of the most recent World Drug Report.

UNODC Executive Director Yuri Fedotov acknowledged that the Report is being published at a key moment for drug policy. As ever, the UN claims to be external to these disputes and to constitute a neutral source of data, the Report continues to position the UNODC as a supporter of the current drug control regime and the international treaties that underpin it. In his Foreword, Mr. Fedotov refers to the recent Commission on Narcotic Drugs as providing a ‘much needed forum for an open and inclusive dialogue’, and to ‘a shared understanding of a way forward’ to counter the ‘world drug problem’. This, at best, is wishful thinking. The Report’s fundamental terms are not up for negotiation. What exactly the ‘world drug problem’ is (i.e. the lack of access to essential medicines for billions of people, the alienation produced by drug law policing, the market opportunity the system offers to organised crime) is a question that the Report does not ask, let alone answer.

As to the main body of the 2014 World Drug Report, the most prominent headlining issue recalls a familiar narrative at the UNODC: the stability of global drug use, its containment by the present drug control arrangements, which restrict drug use to about 5 per cent of the world population – some 243 million individuals having illicitly consumed drugs in 2012. ‘Problem drug users’ have meanwhile continued to represent about 0.6 per cent of the global population, around 1 in every 200 individuals. Opium production in Afghanistan and Myanmar has expanded, while Novel Psychoactive Substances continue to proliferate. Global use of cannabis ‘seems to be down’, but has increased in North America. Although these data can inevitably only provide us with approximations, they are impressive enough, and will be analysed in depth when IDPC produces its annual response to the World Drug Report (to be released in early October).

But for now, in the build up to the UN General Assembly Special Session (UNGASS) on Drugs in 2016, when the consensus of which the UNODC speaks is fast disappearing, a more clear-eyed recognition of the facts is needed. As countries around the world grow weary of a system devised in very different circumstances and that fails to meet the policy needs of the contemporary age, the time for platitudes is surely past.

Christopher Hallam, IDPC Research Officer

Peace Wins in Colombia

When the Colombian presidential elections headed into a run-off in May, and voters were given the choice between the right-wing incumbent Santos administration and Óscar Iván Zuluaga, a right-wing protégé of former President Alvaro Uribe Velez, journalist Mario López, writing in the local newspaper El Espectador, noted, “Whichever candidate wins the country is not going to change its economic model, this is the reason the establishment has supported and financed both candidates in the same proportion.  The only considerable difference is the peace process moving forward in Havana, and, perhaps, the personal style of leadership.”  The article was titled “War or Peace?”  Zuluaga’s stance softened slightly in respect to the talks, but for those opposed to both the right and the ultra-right an essential dilemma remained: vote to save the peace process in its current form, or submit a blank vote in protest at the constrained choice?  (A cartoon doing the rounds on social media showed a cow standing at the crux of two paths, one with a sign saying ‘Santos’, the other ‘Zuluaga’.  After a small distance the paths could be seen to converge and enter a dark tunnel, above which a sign read “Well-being”, replacing the scrubbed-out but still legible “Slaughterhouse”).   It looks like the decision by centre and left wing groups to support Santos may have been the critical factor in giving him a 5 point victory in the run-off, ensuring the survival of the peace talks and the tentative steps that have so far been made, including the agreed upon but not-yet-finalised commitments to radically alter the country’s approach to the questions of illicit drug production and consumption.  Leading opposition figures afterwards celebrated the victory under the banner “Peace Won.”   Left wing senator Ivan Cepeda Castro told local press that the vote for Santos was a pragmatic one. Those who made the choice, he said, would not forfeit their role as the opposition.

The elections have been a reminder of the conservative sentiments held by powerful sectors of Colombian society and a significant proportion of the population (a recent poll suggested only about half of Colombians thought democracy was preferable to authoritarianism, a result that maybe says more about the specific nature of what ‘democracy’ has entailed in the country rather than widespread anti-democratic sentiments among the people).  It also demonstrated the fragility of even minor progressive gains in the current political climate.

Just prior to the run-off, the government announced they would be opening peace talks with the second largest guerilla group in the country, the ELN (The National Liberation Army), in the near future.

Resistance to a ‘War on Drugs’ in West Africa

It has long been known that the most cost-effective way to combat the drug trade is through treatment, prevention, and education at home.  These methods continue to be underfunded in the the main consumer countries.  Instead, the focus is on supply, a policy choice that has, among many other disastrous implications, served to push routes around the globe in a cat and mouse war of attrition between cartels and law enforcement agencies.  In recent years, West Africa has experienced an uptick in interdictions of illicit drugs bound for Europe.  This has inevitably led to official discussion, mainly among foreign states and agencies, of the need to confront the trafficking problem through militarised, punitive, supply-focused means.  Civil society and observers of the drug war elsewhere have been arguing against such an approach.  GDPO itself has produced two reports on the region.  Last November a report discussed the strategic goals that underlie the agenda being pushed by foreign actors, and this month another policy brief highlighted the risks involved in a War on Drugs type approach to the region.  The Institute of Development Studies released a paper on West Africa this month, written by a technical advisor to GDPO.  The report is a critique of the calls for “building up increased regional law enforcement and interdiction capacities to curb illicit flows.”  In a similar vein, the West Africa Commission on Drugs, a group of experts headed by former UN Secretary General Kofi Annan, this month released a comprehensive assessment of the present situation in the region.  The group warn against the adoption of War on Drugs-style policies and reiterate a now common conclusion: “that criminalisation of drug use worsens health and social problems, puts huge pressures on the criminal justice system and incites corruption.”  Instead they recommend partial decriminalisation, and that drugs be treated as a public health concern.  Such high-level advocacy is an important step in saving West Africa from the drug policy related nightmares experienced elsewhere.

The Commission’s report is online here.

 

A Temporary Aberration?

The punitive element of the War on Drugs at home has led to record rates of incarceration.  Of the world’s entire prison population, twenty five percent are now in the US.  More than half the inmates are there on drug-related charges, and of these the majority were arrested for simple possession.

On this note, here is an excerpt from a speech given in 1993 by Federal Judge Jack B. Weinstein of Brooklyn, New York, at the Cardozo School of Law, in Manhattan:

“The sentencing guidelines which Congress requires judges to follow result, in the main, in the cruel imposition of excessive sentences, over-filling our jails and causing unnecessary havoc to families, society, and prisons. Most judges today take it for granted, as I do, that the applicable guideline for the defendant before them will represent an excessive sentence. Drug cases, particularly those involving low-level smugglers or “mules” who are poverty-stricken, present a special problem, because the sentences mandated are so overwhelming.  I am now so depressed by the drug situation that this week I sent a memorandum to all the judges and magistrate judges in my district stating:

One day last week I had to sentence a peasant woman from West Africa to forty-six months in a drug case. The result for her young children will undoubtedly be, as she suggested, devastating. On the same day I sentenced a man to thirty years as a second drug offender – a heavy sentence mandated by the Guidelines and statute. These two cases confirm my sense of frustration about much of the cruelty I have been party to in connection with the “war on drugs” that is being fought by the military, police, and courts rather than by our medical and social institutions.  I myself am unsure how this drug problem should be handled, but I need a rest from the oppressive sense of futility that these drug cases leave. Accordingly, I have taken my name out of the wheel for drug cases. This resolution leaves me uncomfortable since it shifts the “dirty work” to other judges.  At the moment, however, I simply cannot sentence another impoverished person whose destruction can have no discernible effect on the drug trade. I wish I were in a position to propose some solution but I am not. I’m just a tired old judge who has temporarily filled his quota of remorselessness. 

Until we can address and deal with the rotten aspects of our society that lead to drug dependence, we will not deal effectively with the drug problem.  I believe that in the future we will look back on this horrendous period of overpunishment as a temporary American aberration. Apart from everything else, the expense of this foolishness is too great for the taxpayers to bear.”

PG Network Meeting Held in London

The PG Network held it’s 3rd official meeting on Friday 25th April at Kings College London.

The network continues to grow and this time we welcomed three new members to the group: Burke Basaranel, Emrah Ozdemir and David Perez Esparza.

The network members all gave a short summary of their research and John Collins reported back to the group on the UN Commission on Narcotic Drugs (CND) meeting held in Vienna in March 2014.

The next meeting will be held in Bristol at the end of July (date and venue tbc).  New members always welcome!