Category Archives: harm reduction

Introducing Spike on a Bike: An interview with the Project Architects.

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By Joe Janes, Lecturer in Criminology, Swansea University and GDPO Harm Reduction project lead


Saddle up! Today, we’re diving deep into harm reduction and the Spike on a Bike project Saddle up! Today, we’re diving deep into harm reduction and the Spike on a Bike project in Dyfed Powys, where a revolutionary project is flipping the script on conventional thinking. We are putting the pedal to the metal with the architects of a project that’s not just changing lives—it’s rewriting the rules.  What follows are excerpts from a conversation with Sian Roberts (Barod Operations Manager) & Paul Thomas (DDAS Assistant Manager).
Spike on a Bike is a service offered by Dyfed Drug and Alcohol Service (DDAS) where clean injecting equipment and other harm reduction services are delivered straight to the door – fast and for free. https://www.spikeonabike.cymru/about

Sian and Paul, thanks for talking to us today. Why did this project begin, and what issues does it address?
Sian: It began as an idea 11 years ago. Someone in the office actually made a bit of a rude joke [regarding a possible title for the concept] and that is where ‘spike on a bike’ came up as a catchy name.  Then we had never really been in a situation where we could afford to deliver that kind of service in our budget. So, it had always been on the back burner. I was always looking for an opportunity for us to do something like that. Then the pandemic came, and we were doing our quarterly reports we saw that our needle exchange activity had changed dramatically. We’d seen a significant reduction in the number of transactions we were seeing through the needle exchange.

Because of this reduction… ‘spike on a bike’ came into my head straight away.  When we had been consulting service users and asking our regular needle exchange users ‘why aren’t you coming in’, there were a lot of things to consider.  There was a fear of COVID-19 transmission, being arrested, or being in trouble with the law because, at the time, people were being told to stay home.

There were also police particularly patrolling in the Ceredigion area and stopping people if they were driving. There were people who were obviously isolated or protected because of their convictions and couldn’t go out and get their clean works, and there were rurality and public transport issues. So, we thought, right, we need to do something… we had some underspent money in our budget…and we thought, what are we going to do with it? That’s where ‘spike on a bike’ came from. I discussed it with our directors, put a business case and proposal together, and asked Paul to give me a hand with it because, at that time, he was the only person I really knew who had ridden motorbikes before, so that is why his kind involvement came in. Paul had been moving into the assistant manager post by then and was already in the leadership team, and that’s why it grew and became a need.

Paul: It’s flourished, hasn’t it? I think the proof is in the pudding. When we look at the most places it is used, it is Ceredigion. Even though the numbers aren’t as huge as I certainly would want at the moment, it has proved the need for it is there, especially for Ceredigion. It has been fantastic to see that the service has taken off and done what it says on the tin. I think we’ve managed to evolve further when we are looking at non-fatal poisoning, drug-related deaths, admission of naloxone and doing follow-ups using ‘spike on a bike’ for that specifically as well.

Sian: Just to add to the non-fatal poisoning that Paul is talking about. We work in conjunction and partnership with the police and A&E. When someone is presented at A&E…they try to prevent them from being a fatal poisoning because drug-related deaths are up in Wales, but down in Dyfed compared to the year before it. One of the things that would be really successful to do in Dyfed is to make sure that those non-fatal poisonings don’t become later fatal.

Sometimes, we’ve seen the need to have several non-fatal poisonings before an intervention, not necessarily in Dyfed, but in Wales. Where an intervention could have been put in place, perhaps that could have saved a life. We make sure we get that notification and we are utilising the ‘spike on a bike’ initiative to get naloxone out in the community to the people and the people surrounding the user.  

What issues would you say ‘Spike on a Bike’ addresses?
Sian: Harm reduction is in our DNA. It is the golden thread that feeds through  all of our services. ‘Spike on a bike’ is just one of those. Harm reduction, how we define it, is not just about how we reduce harm to individuals, but it’s how we reduce harm to society, communities, and our economy. In wound care, for example, people in the community suffer great stigma when they are service-use users. When they present to their GP or A&E quite often they will get a judgemental response, which further impacts their likelihood of seeking treatment from any services.

They could be in a situation where they brought a minor wound, which could be easily managed by the ‘spike on a bike’ scheme because we deliver wound care packs. This may prevent an amputation, a gangrenous infection, or an abscess, which would then further impact our NHS, which is already burdened. We try to make sure people get the appropriate care for what they need at the time that doesn’t need to escalate. Obviously, if somebody needs A&E, a GP or medical treatment, we will signpost them to that. We’ve got people who are interested in Naloxone or hearing more about overdose awareness. The issues it targets are overdose prevention, trying to reduce the number of drug-related deaths, and preventable deaths. Trying to reduce the number of non-fatal poisonings as well as raise awareness about naloxone and what it can do to save people’s lives. Dry blood spot testing relating to bloodborne virus transmission is also important. We know that people who reuse their own works or don’t use clean works or share with other people. When I say works, I mean injecting paraphernalia. We know that they are at greater risk of bloodborne virus transmission, which is hepatitis B, hepatitis C and HIV.

Would you say that Spike on a Bike addresses the stigma of drug use?

Paul: I think, in addition to the services discussed, ‘spike on a bike’ adds extra value in relation to the reduction of stigma that Sian spoke about.  It may not lead to anonymity per se, but there is an element of that. For those individuals who may not be aware of the service or may not have historically come into service, it gives them extra avenues. It addresses the issues that they faced previously and overcomes those barriers of walking in or getting a needle exchange. That’s a big impact, isn’t it?

Sian: Absolutely, and as Paul alluded to there, this service isn’t just targeted for people needing a needle exchange. It is also targeted to professionals who may be working with a client who isn’t in treatment with us; they might go to their home and see loads of used sharps everywhere that need cleaning. Quite often, we have phone calls with professionals or requests on the ‘spike on a bike’ website saying, ‘Can you come and dispose of these sharps safely?’.

So, a SOAB rider will go out and take a sharps bin. We have needle pickers where we can dispose of them safely, take them with us and make that home safe again. Moreover, we do have populations that wouldn’t traditionally come into a needle change or substance use service. The obvious ones that pop up now are your IPED users (image/performance-enhancing drugs). They do not see themselves in the same way as traditional illegal drug users.  

They may access a service like this to get pins and barrels for their consumption of steroids and image-enhancing drugs. Also, people who are concerned about someone else’s drug and alcohol use. It might be their children or adult children living at home. They have sharps in their bedroom, and their mum and dad don’t know what to do with them. They might contact us to come and do that. We are also an avenue, we must not forget, into treatment for people. When they are utilising this service, which is very non-committal, no one has to sign up to enter treatment. No one has to sign up to make any changes. This is all about how we reduce harm and make people safer, including safe sex as well. We provide contraception through SOAB, too.

What would you say are the benefits of this programme?

Sian: We are reducing harm to people who use substances and trying to make them as safe as possible. By doing that, we reducing health-related risks but also the cost to the economy and making our communities safer. It is also about building a compassionate approach to the way we view somebody with a mental health condition.

Most people in our communities have empathy at some level for people with mental health problems. For someone who uses drugs or alcohol, it seems a self-inflicted problem and therefore reduces the levels of empathy for them, even though it’s someone’s son, someone’s daughter, they are someone’s someone. Addiction doesn’t discriminate. It can happen to any of us at any time. The project is very much geared toward reducing stigma to try and make the services as accessible as possible and reduce barriers.

Paul: The main bit for me is the accessibility. Sian and I wanted the service to have an impact on the community. It’s not just our service users, it is for the community as a whole. If you look at needle picking, house clearances, and health advice, they are much broader and more accessible. To reach those people that wouldn’t normally come into the service.

How would you say this project is different from what is currently available?

Sian: Its not, it mimics all the services to people that access it when they come into our buildings. The only difference is that we are taking that service, which historically has been a fixed service in a building, out in the community, to wherever it needs to be. No one is disadvantaged regardless of their rurality, regardless of disability or physical health, even their anxiety. The nature of our clients is that they will feel stigmatised and nervous, maybe suffering from other mental health problems and struggling to leave their homes. The service is exactly the same, but the way you access it is different.

Paul: It’s the flexibility, it’s an exaggerated outreach project that covers all areas of the community. That’s a unique selling point, it’s the flexibility and mobile aspect of it.

Sian: You might not have people who are that trusting of services. Going online and being able to order your equipment discretely are I think how we are different in that respect to the rest of Wales or Europe. This is the only service of this kind in Wales or Europe.  We are pioneering, although taking inspiration from Spikes on Bikes, push bikes, a Canadian intervention service launched in 2016 in response to the overdose crisis. The programme offers harm reduction supplies to drug users and responds to overdoses and reports of discarded injections across Vancouver’s Downtown East Side and West End.

Who would you say is the clientele of this service, and would you expect this service to bring out a different demographic?

Sian: We hope so. We would hope to see people who have not historically engaged with us. Or who have chosen not to come into treatment services for whatever reason. Those might be people with physical health problems or in the depth of the hard-of-hearing community or LGBTQ+ who wouldn’t know we are diverse in our staffing and people who use the services. It could be they are worried about facing stigma or that they physically can’t come into the building. We are hoping to reach people who are traditionally harder to reach. It is a service for anyone.

We don’t like to propose stereotypes because addiction affects everybody. People who choose to inject, who are using drugs and alcohol, whether that’s in a problematic way or recreational way. People who have been addicted to prescription drugs through irresponsible prescribing of over-the-counter medications. Family members, friends, and loved ones of those using. Professionals also working with our service users. It could be anybody.

Paul: Someone asked me once what our criteria were for eligibility criteria to use our service. I said there isn’t one if someone needs our help. Whether that is a concerned other, whether they are dependent on alcohol or other substances. That question came from a health professional, and they were aghast that there wasn’t a criteria. A core ethos of harm reduction approach of Dyfed and DDAS is that the service is open to everyone.

Thank you both, keep fighting the good work.

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My Harm Reduction Journey from the University to an NGO

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By Temitope Salami

I arrived in Swansea University from Nigeria in October 2020, a week after my Masters programme in Applied Criminal Justice and Criminology had commenced. This was a difficult time considering the pandemic had morphed into phase two and there was talk in the media about a possible second nationwide lockdown amid a Welsh ‘firebreak’ to control the spread of coronavirus.

There was wide uncertainty about studying and teaching through a pandemic. For a moment, it appeared higher education institutions were ‘winging it’ as much as students were. Personally, being new to the United Kingdom, and having to adjust to a different culture and education system made it much more challenging.

Despite having a background in political science, being an ardent viewer of crime documentaries, and having served in a national security committee within the Nigerian Senate, I was new to the discipline of criminology. In fact, a huge part of the motivation to understand the nature of crime and how criminal justice systems operated stemmed from these experiences. At Swansea, I quickly developed an interest in one of the first semester modules – Advanced Topics in Drugs, Alcohol, and the Criminal Law (ASCM26) convened by Rick Lines, Associate Professor of Criminology and Human Rights. Why was I so taken by this course? Two things: Here I was being familiarised with the histories and politics of drug control and how ‘illicit drugs’ came to be so determined by global institutions, the role of state and non-state actors in the creation and evolution of the drug problem/war on drugs, the impact on vulnerable communities and global responses to this challenge. Secondly, my lay knowledge of criminal justice responses to the proliferation of drug use, which has taken many lives and resources and yielded very little positive outcomes. In addition, the knowledge-driven expert teaching provided by academics and guest practitioners on the course increased the appeal, further fuelling my interest in the negative unintended consequences of the global response to drugs which failed to safeguard the health and human rights of people who use drugs.

This cemented my desire to explore what the alternatives were to an approach that has consistently generated significantly poor outcomes whether that be over-incarceration, stigma and discrimination, over-representation of racial minorities in the criminal justice system, gender-based violence, high mortality rates etc. associated with the ‘war on drugs’ mentality.

After concluding my research on an essay focused on Harm Reduction in Prisons for Women Who Use Drugs over the Christmas break, I emailed my professor expressing my interest in volunteering with organisations within the drug policy reform space. Graciously, I was introduced to Harm Reduction International (HRI) where I got recruited at the end of January 2021 as an intern in the Human Rights and Justice team.

At HRI I supported the team with research on statements, recommendations, and other relevant statistics, documents made by UN and regional human rights mechanisms on the use of the death penalty for drug offences for the ‘Global Overview: Death Penalty for Drug Offences 2020’ report. I conducted research on standards developed by UN and regional human rights mechanisms on selected topics related to drug policy and harm reduction and supported the development of briefings on such human rights standards. Subsequently, I was engaged as a consultant to conduct a desk-based review and rapid scan of Global Fund’s Breaking Down Barriers initiative to identify and boost synergies on the implementation of the

seven key programmes and its intersections with human rights programming for people who use drugs. Examining whether programmes addressed legal, social, and structural barriers associated with punitive drug policy. Most recently, I supported HRI’s work on Resist Emergency Powers, mapping available resources on the impact of COVID-19 and of COVID-19 securitized responses on people who use drugs around the world, including other marginalized groups, such as people living with HIV, sex workers, and migrants.

My work with HRI was very rewarding in that it exposed me to current trends in harm reduction and drug policy reform through evidenced-based research, conferences, and publications on the success and benefits of health-centred, rights-based approaches to drugs. This experience helped me build valuable connections in the field which facilitated my Masters dissertation research – Proposing a Harm Reduction Framework to Youth Drug Use in Nigeria – for which I received a distinction. A summary of my research was later published as a blog for the Global Drug Policy Observatory.

I maintained the relationship with my new connections including HRI and a few months after my graduation, a position opened in the Public Health and Social Policy team which I applied for and got shortlisted for an interview. Fortunately, out of 79 applications I was the successful candidate and received an offer of employment as Project Coordinator and Researcher, ‘Global State of Harm Reduction 2022’ – a flagship publication of the charity and important resource for practitioners within the field.

I start my new post at HRI this week.

Key learnings:

● A university education is much more than earning a degree. It is making the right connections and building productive relationships. Students should be cognizant of this and take full advantage of the ‘soft power and access’ they possess within the ivory tower.

● University faculties and staff are available and willing to signpost/provide guidance. Students need to be highly motivated and committed to connect the dots and achieve success.

● Harm reduction is the ‘Trojan Horse’ in the ‘War on Drugs’. Therefore, there is a need for passionate and talented young people to build on the labour of the past.

● In your journey to finding a career path, prioritise knowledge and relationships over the urge to make money. Volunteering and internships are a great way to get there!

● Discover an area of interest and find a mentor!

Thank you for your time and I hope this inspires you to action.

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“The disposable foot soldiers of crime” – Media, County Lines and Moral Panics

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By Ellie Harding, MA candidate in Applied Criminal Justice and Criminology, Swansea University

‘We are cutting the head off the snake and taking down the kingpins behind these deadly supply lines…Drug abuse and addiction ruins communities, devastates lives and tears families apart.’

So announced Priti Patel in her speech to the annual Conservative Party conference earlier this month. Strong words from the Home Secretary, and certainly a standpoint that will strike fear in the electorate. This is arguably what the speech was intended to do. To generate fear and concern in the populace, rather than inform a discussion about a complex and multifaceted topic of drugs, crime and society.

A ‘moral panic’ is a criminological concept which suggests that stylised and stereotypical media reporting of a ‘threat’ to society results in a panicked response from the public, often leading to knee-jerk policy responses. In 1998, Kenneth Thompson identified several essential elements of a moral panic.  These include (a) something is defined as a threat, (b) the threat is portrayed in the media, (c) the threat emerges rapidly in the public consciousness and (d) the threat provokes a response from the authorities.

Drugs as a moral panic in the UK is not a new phenomenon, and Priti Patel’s framing of the issue of county lines is certainly in keeping with that troubling tradition. As most audiences do not experience crime first-hand, they instead develop their understanding of criminality through media depictions. Since 2017, county lines drug trafficking has increased as has high profile media attention of the issue. This raises the concern of whether the representation of county lines in the British media is fuelling fear rather informing debate, and whether it meets the threshold of a ‘moral panic’.

Existing research around this topic lacked depth, therefore I conducted a study to examine whether media portrayal of county lines in the UK met the definition of a moral panic. To test this question, this research reviewed 132 online news articles from five major media outlets (BBC, Daily Mail, The Guardian, ITV and Sky News) and studied the language and imagery each used to report county lines. It examined how different players in the situation are represented – young people, ‘gang leaders’, police – and drew conclusions about the impact of these characterisations on public understanding of county lines.  The results of the analysis concluded that the representation of county lines can comfortably be described as a moral panic.

The research documented the common use of terms such as ‘exploited’ (used 210 times) or ‘vulnerable’ (used 192 times) to describe the young people involved in the county lines drug trade, paired with stylised images of drugs (used 38 times). It found that the articles were empathetic to these individuals, who were often referred to as ‘victims’ (used 58 times) rather than criminals, with a focus on their vulnerabilities and associated risks. For example, one article described the children involved in county lines as “the disposable foot soldiers of crime”.

On the other hand, dehumanising descriptions were evident of those described as controlling or directing these trafficking operations. It was common to find the use of gang terminology such as “professional gangsters exploiting vulnerable minors”, despite the societal stigma associated with such language. The articles’ language often focused on the control and coercion associated with county lines (combined use of 64 mentions). This representation was paired with the use of mugshots (being featured 59 times), giving the audience a voyeuristic look into the criminal consequences of county lines. The impact of county lines was typically depicted using violence and weapons (mentioned 139 times with nine images of weapons), overall adding to public fear. ­­

Articles also focused on the response from the government and law enforcement. This included language such as ‘crackdown’ (used 35 times) and images of the police (featured 60 times). Articles emphasised that policing county lines is a priority for government and law enforcement, using statistics of arrest rates and seizures of drugs and money to prove to the public the success of the police. This, combined with the repeated use of images of the police reinforces to the public that county lines is a threat to society, contributing to a sense of moral panic.

The research found the Daily Mail relied particularly heavily on information from the Home Office when reporting on the issue. Many of its articles focused on Priti Patel’s response to county lines and the new ‘Beating Crime Plan’ from a personal perspective. “I will not tolerate county lines drugs gangs terrorising our communities and exploiting young people, which is why I have made tackling this threat a priority”. The Home Secretary was featured in Daily Mail reporting far more often than in any of the other news sources examined.

The research also examined the extent to which the media offered support and protection to the vulnerable individuals involved in county lines (both the children used as drug couriers and the adult victims whose homes may be ‘cuckooed’ and taken over for drug dealing activities). Only two out of the five media outlets (BBC and ITV) consistently used their platforms to promote support and protection services. This included profiling organisations that offer services and other ways to promote the support and protection of the vulnerable individuals.

The overall conclusion from this research suggested that the manner in which county lines is portrayed in the British media meets the definition of a moral panic. The study indicates that the media are more focused on selling a story using a ‘scary’ narrative rather than supporting vulnerable people involved in county lines. This moral panic arguably gets in the way of the more important discussions about the context of county lines, drug markets and criminalisation.

The research found that the contributing factors driving county lines (although alluded to) need further emphasis from the media, as this would allow the public to better understand the issue and potentially have a more empathetic response. For example, the socio-economically disadvantaged backgrounds of many of the individuals involved in county lines needs to be further featured in media news outlets. This includes more focus on issues such as poverty, lack of employment opportunities and the impacts of austerity, which are often drivers of county lines involvement. Similarly, the increasing rates of school exclusions (especially racially motivated ones) need to be addressed by governing bodies as well as the media, as this highlights the vulnerability of children who are then exploited by county lines organisations.

Regardless of reporting, while there is demand there will be supply of drugs. The counterproductive ‘war on drugs’ therefore needs to be addressed, but the moral panic surrounding county lines gets in the way of discussing bigger policy issues. The ‘war on drugs’ is driven through law enforcement, however these efforts against county lines often result in displacement, whereby “one county lines closes another quickly opens”. Therefore, the media reporting of county lines may not highlight the true extent of the problem, or the limitations of a law enforcement centred approach.

Within the county lines discourse there is also little discussion of the negative short and long-term impacts of the early introduction of the young people involved into the criminal justice system. Prevention/education and harm reduction programmes are not represented, and the issues of decriminalisation or legalisation are often the subject of their own moral panic.

Overall, not only the media but society as a whole need to support and protect the vulnerable individuals involved in county lines, rather than the moral panic style reporting which is more focused on selling stories rather than the potentially damaging effect of their reporting styles.

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Proposing a Harm Reduction Framework for Youth Drug Use in Nigeria: A Research Inspired Commentary

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Temitope Salami

Drugs is a hotly debated subject that attracts the attention of policymakers, especially regarding the perceived effects drug use has on society. But, following scientific research and targeted campaigns, it is apparent that the ‘war on drugs’ rhetoric has lost its gloss and public health alternatives are increasingly embraced over criminal justice measures. As an MA student in Applied Criminal Justice and Criminology this reality, together with losing a friend to drug misuse, inspired me to investigate for my dissertation harm reduction as an alternative approach to criminalising drug use in Nigeria.

Nigeria takes a relatively firm stand against illicit drugs. This is reflected in national policy, where drugs and drug-related activities are proscribed by law. Unfortunately, young people, who account for two-thirds of the national population, are disproportionately affected by these policies. Consequently, my research sets out to investigate the reasons behind the punitive response to drug use (especially cannabis which is the top drug of choice among young people globally). To achieve my aims, the research examined three questions:

How would a harm reduction approach to drug use be beneficial to young people in Nigeria?

Whether a harm reduction approach can be complimentary to a criminal justice framework?

Whether the criminalisation of young people who use drugs is harmful and discriminatory?

These lines of questioning were informed by the desire to develop a better understanding of the motivations for drug use, the challenges of prohibitionist legal framework, and the impact on the health and social wellbeing of young people who use drugs. To fulfil these aims, the research included elite interviews with academics, researchers, law enforcement, policy makers, rights campaigners and people who use drugs in Nigeria and on the international scene. Interestingly, factors inconsistent with popular understandings of the impacts of drug use were common themes revealed from the discussions. The key findings are summarised below:

Harm reduction demonstrates that drugs are not ‘inherently evil’.

Interviews with participants revealed broad support for a harm reduction approach to drug use because it proves that drugs are not ‘inherently evil’ and protects young people from the stigma and discrimination associated with criminalisation. Findings revealed how negative perceptions of drugs feed into socio-cultural and linguistic norms that shape public responses to drugs and drug use. This finding is important as it explains locally held beliefs that ‘drugs are a taboo that promote crime and deviance’, which serves as a barrier to recognising the benefits of harm reduction. In addition, it demonstrates that scapegoating drugs, drug use, and young people to combat rising insecurity is short-sighted. It neglects other systemic factors such as poor government policies, poverty, unemployment, climate change, mass illiteracy, poor leadership, and a weak justice system.

Furthermore, despite popular use of the term, there was a lack of clear understanding of what ‘harm reduction’ means by both law enforcement (especially officials in the National Drug Law Enforcement Agency and police) and civil society. For many state officials, ‘harm reduction’ is confused with demand and supply reduction activities, and often used in a political sense rather than as an urgent call to action. The need for full spectrum harm reduction programmes which take account of the social welfare needs (housing, education, employment, equality of care) of people who use drugs was emphasised as a determinant of health needed to address some of the harms of criminalisation. Addressing these equally addresses some systemic challenges faced by the state.

AU UN IST PHOTO / David Mutua – AMISOM Public Information, CC0, via Wikimedia Commons


A mixed system is problematic but achievable. However, it is far from the ideal.

Another key finding is that the Nigerian drug regime is perhaps consciously and/or unconsciously biased towards criminalisation, without a consideration of the local and national implications of this approach. Yet despite the harms associated with criminalisation, this approach can coexist with public health-based interventions provided legal reform, market regulation, and stakeholder education are utilised as pillars of success. The danger of criminalising supply however remains for production and transit countries predominantly in the global south with many relying on alternative livelihoods for survival.

Young people are using drugs in a way that has yet to be captured by state policy and harm reduction programming.

Young people are adventurous and impulsive, rarely worrying about the position of the law in making decisions. Thus, criminalising drug use becomes counterproductive. It is held that criminalisation serves as cover for social control, and the ‘war on drugs’ is more about maintaining social order and increasing state power than it is about drugs. Consequently, criminalisation deprives young people who use drugs from services that they need. While the National Drug Law Enforcement Agency acknowledges the benefits of decriminalisation of cannabis for personal use in private communication, it maintains strong opposition to cannabis use and/or legalisation in public statements. These inconsistences further expose young people to the whims of law enforcement.

Other key findings include a misunderstanding of the role of drug reform advocates by law enforcement and the Nigerian public, which views them as ‘promoting drug use’ rather than seeking to save lives and reduce harm. However, efforts have been made to foster partnership working and training to unify purpose and enhance mutual success.

Conclusions

Drug control is heavily nuanced. It has political utility for the global north (control of the political economy of the international system) and south (funding of development programmes and regime support). Flowing from the findings of this research, it would appear that African states (including Nigeria) prioritise their international image over human rights and public health. Hence, drug control priorities tend to reflect the international reputation sought by the political establishment at the expense of people who use drugs who may require services.

Although, Nigeria might be regarded as a conservative state, the government prioritises its international drug control commitments at the expense of health and human rights obligations. Ultimately, you cannot arrest your way out of ‘the drug problem’. Therefore, legal (market) regulation and harm reduction remain the better approach to drug control, and the provision of a safe and legal supply of cannabis would be a great leap forward. It would better account for the health, welfare, and safety of many young people, an achievement that has consistently eluded blanketed drug prohibition. The main recommendations of the research are proper education for stakeholders; provision of targeted services to address context-specific needs of young people; political commitment to drug reform; and legal regulation of drugs.

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Drugs, Prisons and ‘Unintended Consequences’ – Does drug interdiction drive drug-related harms?

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Rick Lines, Olivia Howells and Daniel Webb*

The availability of drugs in prisons around the world is well documented. In Europe alone, up to seventy percent of people in prison have used an illicit drug. In Canada, forty-eight percent of prisoners in federal correctional institutions have had ‘problems’ with drugs. In Australia, one in six people discharged reported using illicit drugs during their sentence.

The 2018-19 Annual Report of HM Chief Inspector of Prisons for England and Wales stated, ‘we are regularly told how easy it is to get hold of illicit drugs in prisons, and of the shockingly high numbers who acquire a drug habit while they are detained’. The Chief Inspector was ‘particularly concerned by the high number of prisoners who said they had developed a problem while in prison – 13% of adult men in our survey reported that they had developed a problem with illicit drugs since they had arrived’. Here in Wales, a Cardiff prison survey found that fifty-two percent of prisoners said it was easy to get illegal drugs into the prison.

The availability and use of drugs in prisons cannot be separated from wider drug policy. The criminalisation of drugs and the people who use or sell them fuels mass incarceration in many countries, and in doing so creates large profitable markets for drugs behind bars. To counter this, prison systems around the world have deployed a wide range of supply reduction and drug interdiction measures – from searches to sniffer dogs to drug testing – to try to stop drugs entering prisons, and to disrupt internal markets.

Are these measures effective at deterring drug use or shrinking illicit markets? The high levels of drug use in prison cited above suggest the impacts are limited at best, and that despite the efforts of prison security, drugs continue to flow into places of detention with relative ease.

Photo by Matthew Ansley on Unsplash

Although supply reduction efforts in prisons may be ineffective overall at eliminating drug markets, that does not mean they do not have an impact on drug consumption. As noted in 2008 by Antonio Maria Costa, former Executive Director of the UN Office on Drugs and Crime, efforts to control illicit drugs often have negative ‘unintended consequences’ not considered at the time they were implemented. In other words, drug enforcement efforts often have the effect of creating problems worse than those they were intended to solve. In prisons, one of these ‘unintended consequences’ is increased drug-related risk and drug-related harms.

One widely used measure to deter drug use in prisons is mandatory drug testing (MDT). The UK Ministry of Justice states that 67% of prisoners surveyed in 2014/15 had participated in some form of MDT. While the UK government states that MDT is intended to ‘deter prisoners from misusing drugs’ and to ‘contribute to drug supply reduction, and contribute to prisoner safety, violence reduction, order and control’, the evidence suggests that random drug testing may actually undermine all of those objectives.

Cannabis is the most commonly used drug by people in prison in the UK, with a reported 79% lifetime prevalence of use. It is also a drug that remains highly detectable in the body for long periods after use. As such, cannabis users in prison have a ‘high risk of detection through mandatory drug tests’. One of the ‘unintended consequences’ of MDT in prisons is therefore a switch from cannabis use to heroin use among prisoners. As heroin is undetectable via MDT after only two to three days, heroin use becomes a logical choice for people who want to use drugs and minimise their risk of being caught. This switch to heroin use can also lead to a switch from smoking to injecting as a route of administration, with the attendant risks of blood-borne virus transmission and vein damage from sharing and reusing scarce injecting equipment in prisons.

There are also increasing indications that drug interdiction activities in prisons are driving the availability and use of new psychoactive substances (NPS), with mandatory drug testing again playing a role. Many varieties of NPS are not detectable by drug testing, creating an incentive to choose new psychoactives as a way to minimise risk of detection. As noted by one observer, ‘due to testing…cannabis, which is argued to be a lower risk substance, has been replaced by spice – a substance perceived to have more dangerous health implications’. A study commissioned for the National Offender Management Service found that prevalence of synthetic cannabinoids was twice as high among prisoners at time of release than at the time of admission. In that study, synthetic cannabinoids were the only substance for which a higher prevalence was detected upon release than upon admission, suggesting a statistically significant uptake of use of NPS by people in detention.

The European Monitoring Centre on Drugs and Drug Addiction (EMCDDA) has noted that ‘the avoidance of positive drug tests has been suggested as motivation for drug users to switch to NPS while in prison’ and that ‘increases in NPS use in prisons may therefore, arguably, be an unintended negative consequence of random mandatory drug testing programmes in some European prisons’.

While the UK and Germany have recently incorporated detection of synthetic cannabinoids into its MDT programme, this ultimately will not address the issues of drugs in prisons, or the creation of risk. As noted by EMCDDA, ‘One possible outcome…is that there may be displacement from use of synthetic cannabinoids to other substances, such as synthetic opioids, which may also be extremely harmful.’ Indeed, the EMCDDA notes that the use of synthetic opioids in Latvian prisons ‘has been accompanied by more overdoses and an increase in injecting, including needle-sharing’.

The UK Prison Inspectorate has stated that ‘NPS have created significant additional harm and are now the most serious threat to the safety and security of the prison system’. The widespread use of NPS, driven in part by random drug testing, suggests that the MDT is having the opposite effect of that intended by the government. In 2005, MDT was withdrawn from Scottish prisons as it was deemed a waste of funds that had little effective impact on drug use amongst prisoners.

Such negative ‘unintended consequences’ can also be identified from other supply reduction efforts. Drug detecting sniffer dogs are widely used throughout the UK prison regime. A 2014 review of supply reduction activities in Australian prisons described the impact of sniffer dogs as ‘modest’. However, even this ‘modest’ success is undermined in the case of new psychoactives. The EMCDDA, for example, cautions that, ‘Sniffer dogs are not trained to recognise the many different types of NPS.’ The UK Prison Inspectorate has noted that ‘Synthetic cannabis has no distinctive odour and is therefore harder to detect than non-synthetic cannabis, making it more attractive to smuggle in’. Even where dogs are trained specifically to identify one type of NPS, such as ‘Spice’, the longer-term effectiveness of this is made difficult by ‘the ever-changing composition’ of new psychoactives, making the programmes ‘ineffectual’.

Drug use is as much a part of the prison environment as it is the outside community. Overall, the supply reduction activities of prison regimes fuel drug-related risk and drug-related harms among people in detention. The advent of NPS only exacerbates this, creating an environment in which use of new psychoactive substances, substances often more dangerous than the traditional drugs they are created to mimic, are the easiest to smuggle in, and the most logical to use if wishing to avoid detection.

If governments are truly serious about addressing drug use and reducing drug-related harm, they must move away from enforcement-focussed responses, and instead implement laws and policies that reduce the number of people in prison for drug-related offences, and to provide comprehensive harm reduction programmes for people in detention.

*Dr Rick Lines is Associate Professor of Criminology and Human Rights at the School of Law, Swansea University. He is also a Senior Research Associate with the Global Drug Policy Observatory. Olivia Howells is a Law and Criminology student at Swansea University and Daniel Webb  is a Criminology and Criminal Justice student at Swansea University.

This research was conducted as part of the Swansea Paid Internship Network programme, a scheme enabling School of Law students to obtain experience working on an active research project under the guidance of an academic supervisor.

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Nowhere to hide: It’s high time we measured countries’ performance in drug policy


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By Marie Nougier IDPC Head of Research and Communications & Dave Bewley-Taylor, GDPO Director

First published here by IPDC, October 2019 

Traditionally, the UN and governments have measured progress in drug policy in terms of flows and scale; principally the numbers of people arrested, hectares of drug crops eradicated and the amounts of drugs seized. For years now, IDPC and many civil society colleagues (in particular the Global Drug Policy Observatory (GDPO), CELS, the Centre on Drug Policy Evaluation, and the Social Science Research Council among others), have advocated against such an approach, because of its inability to truly assess the real impacts of drug control policy – especially for communities affected by the illicit drug trade on the one hand and by drug policies on the other.

The 2016 UN General Assembly Special Session (UNGASS) was instrumental in pushing the boundaries of UN drug policy to consider issues related to health, human rights, social inclusion, criminal justice reform and how all of this might contribute to the 2030 Agenda for Sustainable Development. However, while recent years have seen a welcome increase in focus on the adverse health consequences of drug use and interventions aiming to reduce them, the United Nations Office on Drugs and Crime (UNODC) and many member states have thus far been resistant to incorporate these critical elements into their main data collection tool – the Annual Reports Questionnaire (ARQ). The ongoing review of this tool has so far been a missed opportunity to fully reconsider what success in global drug policy should look like.

In 2018, IDPC published our landmark Shadow Report ‘Taking stock: A decade of drug policy’, in which we assessed the progress made – or rather, the lack thereof – in global drug policy since the adoption of the 2009 Political Declaration and Plan of Action on drugs, to inform the Ministerial Segment of March 2019. Collaborative work by the IDPC network and other civil society experts was instrumental to obtaining a full picture of the global situation relating drug control approaches on demand and supply, but also on the impacts of drug policies on the broader UN priorities of promoting human rights, development, and advancing peace and security. What we found was extremely worrying. While the UN was in many ways side-stepping difficult questions, drug policies in many parts of the world had become responsible for increased HIV and hepatitis C infections among people who inject drugs, half a million drug use-related deaths in 2015 alone, and tens of thousands of people falling victim to extrajudicial killings, as well as arbitrary and compulsory detention. In the meantime, the prevalence of drug use, the hectares of crops cultivated for the illicit drug trade, and the tons of drugs trafficked had reached record highs. But far from being a wake-up call, UN drug policy debates in Vienna have mainly continued to rely on the business-as-usual approach.

Faced with the clear lack of appetite from both governments and the UN to evaluate the impacts of drug control on communities worldwide in any meaningful way, it seems likely that civil society will once again need to take a proactive stance. The critical role played by civil society in holding governments accountable by creating transparent and informative policy evaluation tools is not a new idea. This has been done before in various policy areas. For instance, Transparency International has, for some time now, been tracking progress made by countries across the world in reducing corruption, with the Global Corruption Perception Index. Journalists without Borders has done the same with their World Press Freedom Index. And the list continues. Indeed, it is now widely recognised that the ‘soft power’ of indices is capable of exerting considerable social pressure and can – via a number of interrelated process – be a potent lever for the generation of policy change.

With this in mind, IDPC and GDPO have now embarked on a similar endeavour, faced with the urgent need to develop a tool that would enable us to track drug policy developments worldwide in a systematic and scientific way, as well as to assess how effective these turned out to be on the ground. The results of this analysis would enable us to compare policies adopted between various countries, and track evolution over time, as well as rank countries according to how well their drug policies have been able to foster improved health, human rights protection, gender equality, social inclusion or violence reduction.

Learning from other composite indices, the proposed Global Drug Policy Index (GDPI) would be a collaborative civil society endeavour (as was the case for the Shadow Report), with the aim of increasing transparency in decision making processes around drugs, promoting new indicators to evaluate drug control, facilitating the participation of civil society in data collection, and ultimately supporting more humane policies and reforms.

We are still in the preliminary stages of development and fundraising for this ambitious tool, but we are excited by the advocacy opportunities that a carefully designed Global Drug Policy Index will bring to the global and national debates on drug policy for the years to come. Stay tuned for more information!


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What have the Russians done for us in the international drug policy field? A timely reminder to take back control


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Axel Klein, GDPO Senior Research Associate.
April 24, 2019.

At the 62nd meeting of the UN Commission on Narcotic Drugs (CND) in March this year the tensions between states with widely diverging drug policies finally came to the surface. On the floor of the plenary meeting the Russian delegation took Canada to task for ‘violating international law [by] legalising cannabis.’ (http://cndblog.org/2019/03/plenary-item-9-implementation-of-the-international-drug-control-treaties-cont-2/)

The Russia delegate also took issue with the Expert Commission on Drug Dependence of the World Health Organisation for recommending that cannabis be moved from schedule 4 of the 1961 Single Convention on Narcotic Drugs and placed in the less strict schedule 1. Interestingly, the objection had nothing to do with either the new assessment of the harms posed by cannabis or its medical potential. What had given cause to offence was that the ‘perception of the world of the community would be that legalisation is fine and dandy. Probably the experts don’t have to go through the turmoil of thinking through the repercussions of their decisions. They are technical experts. Nothing more’ (emphasis added).

Technical issues, say of patient benefit, the need to address discrimination and stigma, or pre-empt trafficking were not touched upon. The Russian Federation’s statement also glossed over the fact that the placement was not designed to be permanently fixed. The original founders of the system expected that substances would move across the schedules as more scientific evidence became available. Important to recall here is that at the time that cannabis was slotted into schedule 4, tetrahydrocannabinol, the most important psychoactive substance, had not even been discovered.

The point of Russia’s attack on countries like Canada, Uruguay and several US states– though only Canada was singled out – was the risks that legalisation was having consequences.

Consequentialism has not been a driving force in the history of international drug control, given the ontological foundation of the treaties on the ‘welfare of mankind’. The system architects recruited ‘mankind’ to labour in the construction and then retire. Hence the object of Russian concern were not people in their totality or diverse sub-populations – patients, drug consumers, communities – but the ‘international drug control system’ itself.

Taking this to its logical conclusion, we then understand that adhering to the provisions of the three drug control conventions and the various associated agreements and protocols is only indirectly to do with problems of addiction and substance misuse. Their overriding purpose lies in protecting the functionaries and officials who work in it.

Such proposals tend to resonate particularly with representatives of countries with natural resource-based economies and authoritarian regimes. If the recent focus on human rights has already opened a divide between countries, the question of accountability is likely to push them even further apart. Justifying costly layers of administration to tax-paying electorates (though not to universities), is difficult at the best of times, but particularly when they fail to have a positive purpose.

And yet this is what the international system has long been lacking, at least according to Antonio Maria Costa, the former head of UNODC. In a seminal address to the CND in 2008 he stated with counter-intuitive perspicacity, that the ‘system was no longer fit for purpose’ and unable to contain a number of displacements.(Costa, Antonia Maria, Making drug control ‘fit for purpose’ Building on the UNGASS decade, Report by the Executive Director of the UNODC, 2008) The first he mentioned was the ‘huge criminal black market that now thrives in order to get prohibited substances from producers to consumers.’ Along with these markets comes the full spectrum of crime from large, police and policy corrupting syndicates to addiction fueled shoplifting. Such crime is the trade-off for containing the public health that is threatened by open drug markets. It is on this Faustian pact that the system is build.

Antonia Maria Costa

(Antonia Maria Costa, UNODC)

Picking up on the admonition by the Russian delegate to consider the repercussions of our actions we need to review the criminogenic effect of drug control. This has to be done repeatedly and publicly precisely because it runs counter to the popular assumptions. In popular folklore, police and paramilitaries are believed to be breaking down doors and shooting up laboratories in ‘response’ to drug criminals. In effect, the causal effect runs the other way. The harder police and magistrates squeeze drug supply, the more devious and brutal the industry becomes when meeting the demand.

The fact that drug control generates crime needs to be repeated to policy makers at every level and may even hold sway with an audience that is otherwise immune to arguments about human rights, patient needs or stigmatization.

At the CND in Vienna most national delegations are comprised of and led by senior law enforcement officers or officials of the Ministry of Interior. If the realisation that vigorous enforcement is resulting in ever more vigorous criminality has not so far had much effect comes down to one of two possible sets of explanation. First, it could be that they are (i) simply not listening, (ii) the causal chain has not been understood, or (iii) is simply not believed. But the second explanation is that the criminal justice sector agencies and public have different objectives. The former are interested in expanding and increasing means and powers to enforce the law. And if public safety is one of the outcomes, so much the better.

In accordance with key tenets of institutional economics we hold that drug control and law enforcement are driven by motives of any social organism – self perpetuation. Hence the need for continuous checks and assessments of policy purpose and outcomes. Since all institutions also include well intentioned and dedicated professionals the need for restating the arguments of criminogenic consequence has to be repeated over and over.

Naturally it is much more difficult to achieve results in thematic areas where key policy decisions have been abstracted by remote and unaccountable international bodies. As the Russian delegate reminds of the importance of repercussions, it is high time to take back control.


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View from the Ground – Harm reduction, drug policy and the law in the Maghreb: focus on Tunisia and Mauritania


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View from the Ground – Harm reduction, drug policy and the law in the Maghreb: focus on Tunisia and Mauritania

Khalid Tinasti
Honorary Research Associate, Swansea University
July 2017

Introduction:

The Maghreb countries – Algeria, Libya, Mauritania, Morocco and Tunisia – while seldom discussed, are crucial to global debates on drug control policies. These countries are at the heart of drug trafficking routes for various substances, from Latin America to Europe, from the Middle East to Europe, and from West Africa to North America. The region is also home to the largest producers of cannabis, as well as amphetamine type stimulants (ATS). Illicit drugs are prohibited and drug laws are harsh if not efficient – Mauritania retains death penalty for drug-related offences.

The Maghreb (in green), copyright epidop.com

This blog will focus on two of these countries, Tunisia and Mauritania, who share common religious, ethnic groups, cultural and socio-economic realities, but face clearly different challenges related to illicit drugs.[i] The two countries nevertheless face a drug trafficking framework which is unparalleled. In fact, the Maghreb and its neighbouring Sahel region represent large desert areas, sparsely populated, with porous borders and the existence of terrorist and other separatist groups. These parameters, combined with failed states and inadequate drug control policies, make drug trafficking thrive. This blog attempts – through available data and literature – to analyse the drug situation currently in both countries, review their drug control laws, and evaluate the outcomes of their implementation. The piece also narrates the current efforts to reform the drug law by the Tunisian government.

The current situation:

There are an estimated 140,000 people who use drugs (PWUD) in Tunisia,[1] with around 10,000 people injecting drugs.[2] Other sources report up to 400.000 PWUD in the country.[3] In 2015, 21.44% of new HIV infections were among people who inject drugs.[4] Moreover, HIV prevalence among this same population has increased from 3% in 2011 to 4% in 2014, while it is of 0,1% in the general population.[5] This increase takes place in the absence of a national strategy of harm reduction. There are no opioid substitution programmes, and the distribution of syringes is mainly undertaken by non-governmental organizations. In 2013, the 48.000 syringes distributed in the country were by the ATIOST, the ATUPRET and the ATL-MST.[6] The prevalence of hepatitis C in the same population is 29%.[ii]

Drug control policies are steered through law 52 adopted in February 1992 – referred to as law 92-52. The law, which sentences prison terms even for simple use or consumption, has resulted in an unprecedented prison overcrowding, mainly targeting young males incarcerated on cannabis use charges. Out of the 25.000 inmates in the country prisons, 8.000 are incarcerated for drug offences, of which it is estimated that 9 out of 10 are there for simple possession or personal use,1 the law allowing for urine tests in prisons and in the community to prove the consumption. In 2015, 7.451 people were arrested and prosecuted for drug offences, of which about 70% were related to cannabis possession or consumption.[7] A year later, 8.984 people were arrested on the same charges, with 6.212 of them aged 18 to 30 years old.[8]

In Mauritania, data on the prevalence of drug use is unavailable. Similarly, the prevalence of HIV among the general population reaching 0,6%, the prevalence among people who inject or use drugs is unavailable. More worryingly, the National Committee to fight AIDS does not recognize PWID as a key population most at risk of acquiring HIV.[9], The non-inclusion of PWUD as a key population deters a discussion on evidence-based interventions to respond to AIDS, including prevention, harm reduction services and treatment.

Copyright West Africa Commission on Drugs, 2014

Rather, the debate on drugs focuses heavily on trafficking, with Mauritanian authorities, media and other stakeholders considering that the country is only a transit country. This vision of a country where illicit drugs transit – through the routes of Senegal, Mali, Algeria, Niger, Morocco or the Canary Islands – and where there is no local consumption is emphasized by the geographic position of Mauritania, its limited population (4 million inhabitants), and a large, desert and difficult to control territory. Whether such assertion is true or not – it remains difficult to define in the lack of data on illicit drug use – the country rightly faces challenges related to the smuggling and trafficking of drugs, intertwined with terrorist groups’ financing and their unlawful intrusion in the Mauritanian territory. Drug-related cases often make the headlines in Mauritanian media, due to the large seizures of illicit drugs by customs and law enforcement agents, including cases where relatives of former Presidents or former Presidents themselves are cited.[10][11] The nature of the implication of political authorities in drug trafficking remains anecdotal since it is not proven. Nevertheless, the characteristics of drug trafficking depends on many parameters that are specific to Mauritania and the Sahel region. As stated earlier, the country has a large desert territory that is difficult to control. Moreover, trafficking relies on ethnic groups, their inter-relationships and their control of their territories that transcend the Sahel borders.[12]

Drug seizure in northern Mauritania by the Gendarmerie (military law enforcement). Copyright Sahara Medias

Very limited data shows that there is a small cannabis production in the south of the country near the Senegal River, while cocaine is imported from Latin America and heroin from Asia through Nigeria or other West African countries.[13] Trafficking of illicit drugs includes alcohol, which is a banned substance in Mauritania. Moreover, Mauritania’s authorities address money laundering as the banking system is sensitive to drug profits laundering, mainly due to the important volume of foreign currency circulating from tradespeople and other economic emigrants working mainly in the Gulf countries.

The laws and policies for drug use and trafficking:

Tunisia, country of the Jasmine revolution and youth-driven democratization, has the harshest law in terms of repression of drug use and possession for personal use. Mauritania, on the other hand, is the only Maghreb country sentencing drug traffickers and growers/producers to death penalty.

The Tunisian law – to be explored in more detail below – punishes individuals who consume or possess a narcotic or psychotropic drug with imprisonment of one to five years and with a monetary fine between 400 and 1.200 USD (1.000 to 3.000 Tunisian Dinars). It also punishes the attempt to consume or possess drugs with the same sanction. Therefore, the Tunisian law punishes the possession for the purpose of consumption and for the actual consumption even if there is no possession involved. The court may as well force the convicted offender to undergo detoxification for a period set by a medical doctor at a public hospital. If the detoxification is refused, a permit can be issued by the president of the court forcing the offender to undergo this treatment in a compulsory manner.[14] The most problematic provision of the law, until its partial reform in April 2017 (see following section), was article 12 of the law, providing that judges cannot take into account mitigating factors, and have to pronounce a prison sentence for drug use offences. This was problematic as the law 52 was the only one in the Tunisian criminal code to deprive judges of their free choice and of sentencing proportionally to the offences. Under the terms of the law as well, traffickers and growers of narcotics are sentenced to prison terms from 6 to 10 years, while those importing or exporting drugs face a minimum of ten years of incarceration, up to a life sentence.

“Our kids and friends are not criminals #end law 52”[iii]

In Mauritania, the law responds to drug use and possession for personal use by a prison term of a maximum of two years and a monetary fine between 140 and 280 USD (50.000 to 100.000 Mauritanian Ouguiya). Prosecutors also have the obligation to inform health authorities about the arrest of people who use drugs. The health authorities investigate the health conditions and family conditions of the arrested individual, and prescribe mandatory detoxification. Producers and growers of illicit drugs face 15 to 30 years in prison, the same penalty as drug traffickers. This punishment, in case of recidivists, becomes a sentence to the capital punishment. Finally, laundering illicit drugs’ profits is punished by a prison term between 10 to 40 years.[15]

It is also important to note that both laws have been amended and adopted following the adoption of the United Nations Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances in 1988 and right before the adoption of the Arab Convention against Illicit Use of and Traffic in Narcotic Drugs and Psychotropic Substances in 1994. The articles of both countries’ laws and the lack of proportionality vis-à-vis the real severity of the offences represent an example of the interpretation countries make of the international drug conventions, and the impact these conventions have on people’s lives when implemented on the ground, far from the debates of diplomats drafting and negotiating them in multilateral forums.

What reform for the Tunisian drug law?

In Tunisia, the excessive number of young people arrested under the provisions of law 92-52 started a heated debate on the need for its reform. This debate has been deepened through the use of the law provisions to arrest young Jasmine revolutionaries, and by their own capacity to stand for their rights in the post-Revolution era.[16] Movements such as the Sajin52 (prisoner 52) emerged and denounced the law. In his 2014 presidential campaign, the current head of state Béji Caïd Essebsi promised a reform of the law and denounced the use of prison terms for first-time drug use. In December 2015, his government approved a new narcotics bill to amend law 52, and introduce the following provisions: i) the establishment of a national drug observatory to collect data; ii) the establishment of treatment centres, including the introduction of substitution therapy; iii) the diversion of first and second-time offenders, arrested for use, to social services (third-time offenders will serve the same terms as the current law provides, between one and five years); and iv) the possibility of judges to decide on the most appropriate sentences.[17]

Infographic by the movement “Al habes lé” (no incarceration) calling to reform law 52

The latter, targeted at article 12 of law 92-52, has been amended in April 2017 when Parliament gave judges the right to apply Article 53 of the Criminal Code to reduce penalties, not only for consumption, detention and consumer intent (Article 4 of law 52) but also for attending consumption spaces (Article 8 of Law 52).[18]

The process leading to this partial amendment started with the submission to Parliament of bill 79 amending law 52. With the bill not finding a majority necessary for passage into law for more than 12 months, President Essebsi decided in January 2017 to use his executive powers to freeze all the arrests related to Law 92-52, and urged Parliament to find a consensus and vote for the reform. A month later, the President convened a meeting of the National Security Council, which decided to revise the criteria for granting special grace to people charged with drug use or possession, and to have the Grace Committee meet once a month to overturn the judges’ decisions on arrests. The National Security Council also repealed partially law 92-52, and specifically its article 12 leading to the reform of April 2017 by Parliament, giving judges the capacity to take into account mitigating factors.

In the current economic, social and security framework in Tunisia, where tensions among society are numerous – from the declining standards of living of the population, the decline of the industrial, tourism and service sectors, as well as the security and fight against terrorism – the calendar of the adoption of bill 79 in Parliament remains unclear.

Conclusion:

The debate on drug policies in the Maghreb, when it occurs, is usually focused on Morocco, the largest producer of cannabis in the world, and one of the main suppliers of the European Union due to its geographic proximity with Spain. With the deterioration of the security situation in the Sahel and the rise of terrorist risks, along with some evidence that terrorist groups are either involved in trafficking, protect traffickers or benefit from trafficking revenues,[19] combined with the disintegration of the state apparatus in the fifth Maghreb country, Libya, is also beginning to attract some interest.

Nevertheless, as discussed here, other states within the region are increasingly worthy of attention with debate around drug policy emerging for a complex range of internal, societal and social peace reasons.
Tunisia is currently being driven to reform its policies due to the population’s pressure, while this debate does not exist in Mauritania. However, while differences exist on this point,, the two countries seem to share a common lack of understanding of drug policies, providing similar legal responses to people who use drugs (PWUD), to small players in the illegal drug market (small dealers, farmers and other couriers), and to large-scale traffickers and terrorist groups suspected of trafficking illicit drugs to fund their terror actions. Such policies, intended to deter drugs’ presence in society, are failing to achieve their objectives and are extremely costly to society, to the criminal justice and health systems.

While it remains unclear when the Tunisian drug policy reform will take place, it provides the brightest prospect of reform in the Maghreb, as bill 79 will bring along the first policies based on evidence, and provide space for scientific monitoring to inform and fill gaps in the future. The adoption of this bill, its successful implementation and flexibility, as well as its tight monitoring is all highly important not only for the Tunisian society but the whole Maghreb.

[I] This is the second and last blog on drug policy in the Maghreb. The first blog was published in October 2016 and titled “View from the Ground – Harm reduction, drug policy and the law in the Maghreb: focus on Morocco and Algeria”.

[ii] In Mauritania, HIV key populations are female sex workers and their clients, women and youth, inmates, people living with STIs, truckers, sailors and fishermen.

[iii]Protest against law 52 in front of the Assembly of the Representatives of the People (Parliament) on 28 December 2015. Copyright Nawaat

[1] Amraoui, A. Drogues : une jeunesse victime de l’échec de la politique de prévention. Nawaat.org; September 2015. Available from: https://nawaat.org/portail/2015/09/05/tunisie-drogues-jeunesse-victime-echec-politique-prevention/ (accessed 10 July 2017) 

[2] Tunisie Numérique. 10 000 toxicomanes usagers de drogue intraveineuse en Tunisie. Turess; April 2012. Available from: http://www.turess.com/fr/numerique/119208 (accessed 10 July 2017) 

[3] Bentamansourt, N. Tunisie-Drogue : 3,9% des consommateurs contaminés par le VIH! African Manager; October 2016. Available from: https://africanmanager.com/mots-cles/association-tunisienne-de-la-prevention-contre-la-toxicomanie/ (accessed 10 July 2017)

[4] Africaine Santé. VIH/SIDA en Tunisie: Où en est-on? December 2015. Available from: http://africaine-sante.com.tn/a-la-une/vihsida-en-tunisie-ou-en-est-on/ (accessed 10 July 2017)

[5] UNAIDS. Key Populations Atlas: Tunisia- People who inject drugs: HIV Prevalence 2014. UNAIDS; 2014. Available from: http://www.aidsinfoonline.org/kpatlas/#/home (accessed 10 July 2017)

[6] National HIV/AIDS Programme of Tunisia. Rapport d’activités sur la riposte au sida 2012-2013. UNAIDS; 2014. 

[7] Human Rights Watch. « Tout ça pour un joint » La loi répressive sur la drogue en Tunisie et comment la réformer. Tunis; December 2015. Available from: https://www.hrw.org/sites/default/files/report_pdf/tunisia0216fr_sumandrecs_.pdf (accessed 11 July 2017)

[8] African Manager. Tunisie-stupéfiants : Le bilan de 2016 en chiffres. March 2017. Available from: https://africanmanager.com/tunisie-stupefiants-le-bilan-de-2016-en-chiffres/ (accessed 10 July 2017)

[9] Comité national de lutte contre le Sida. Rapport d’activité sur la réponse au sida en Mauritanie 2014. Nouakchott; March 2014. Available from: http://www.unaids.org/sites/default/files/country/documents/MRT_narrative_report_2014.pdf (accessed 10 July 2017)

[10] Berghezan, G. Panorama du trafic de cocaïne en Afrique de l’Ouest. Group for Research and Information on Peace and Security: Brussels; June 2012.

[11] Attar, A. Mauritanie : fin de parcours pour Mohamed Ould Abdel Aziz ?. Afrik.com; February 2013. Available from: http://www.afrik.com/mauritanie-fin-de-parcours-pour-mohamed-ould-abdel-aziz (accessed 10 July 2017)

[12] Simon, J. « Le Sahel comme espace de transit des stupéfiants. Acteurs et conséquences politiques ». Hérodote, 142 (3); 2011: pp. 125-142.

[13] Dialogues, propositions, histoires. « La situation des drogues en Mauritanie ». DPH: Paris; citing the Observatoire géopolitique des drogues; November 1994. Available from: http://base.d-p-h.info/fr/fiches/premierdph/fiche-premierdph-2016.html (accessed 11 July 2017)

[14] Official Journal of the Tunisian Republic No. 33 of 1992. Law No. 92-52 of 18 May 1992 on Narcotic drugs. Tunis; 1992.

[15] République Islamique de Mauritanie. Loi No. 93-37 relative à la répression de la production, du trafic et de l’usage illicite des stupéfiants et substances Psychotropes. Nouakchott ; July 1993.

[16] Tinasti, K. Are cannabis laws used for political repression in the Arab Spring countries?.  Addiction, 110 (12); 2015: p. 2037.

[17] Tunisian government. Projet de loi N 79 de l’année 2015 relatif aux stupéfiants. Tunis; 2015.

[18] Huffpost Tunisie. Tunisie-La loi 52 a été amendée: “Une étape considérable franchie” se félicite l’avocat Ghazi Mrabet. Huffpostmaghreb.com; April 2017. Available from: http://www.huffpostmaghreb.com/2017/04/25/tunisie-loi-52-stupefiant_n_16231606.html (accessed 12 July 2017) 

[19] UNODC. World Drug Report 2017, booklet 5. Vienna; June 2017


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British System, American Century: A short case study


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British System, American Century: A short case study

Chris Hallam

This blog shows the intimate ties between the international and domestic domains of drug control. This is a well-known phenomenon; however, it involves considerable complexity. The lengths to which governments will go to reduce potential tension at the international level are apparent. This is especially so when states – as in the following case – are wary of the US position. At the same time, powerful domestic forces can counteract the influence of international powers, even when the United States is concerned, as in the aftermath of the Second World War.
The blog selects the example of Britain during that period in which the negotiations leading to the Single Convention were taking place. The then-famous ‘British System’ of drug treatment was a key aspect of Britain’s drug policy relationships; stemming from Sir Humphrey Rolleston’s inquiry into addiction that reported in 1926, the ‘British System’ permitted any doctor to supplyheroin, morphine, cocaine and other drugs to those who were dependent upon them. Unlike the present mode of ‘Heroin Assisted Treatment (HAT), the British System imposed few requirements on patients, who could take their prescription to a pharmacy, collect their drugs and consume them more or less at will. This depended on the regulatory context, the liberal views and the largesse of the doctor, but these were generally forthcoming.
Both the international and the domestic domains played a part in the changes that overtook the British regulatory framework in the 1950s and 60s, leading to the demise of the ‘British system’ of prescribing and its replacement with a much more restrictive ‘clinic’ system in 1968. The international dimension was always important, but in the period preceding the agreement of the 1961 Single Convention, it was especially significant as countries sought to shape the draft treaty to suit their national interests, or (less rationalistically) to forge the global order of intoxication according to their mythological image.

Sir Humphrey Rolleston

Following the war and the continuing rise of the United States as an international military, political and economic superpower, there was friction between it and Britain over aspects of the latter’s drug policies. The 1955 American attempt to impose a global prohibition on heroin was eventually faced down by the British government after internal pressure from the medical profession in support of the drug’s retention in medical therapeutics, including in the treatment of drug dependence. The medical profession was a powerful force in British politics and culture, sufficient to bring the government to resist US pressure.
Britain’s representative at the Commission on Narcotic Drugs (CND), the policy-making body for the new UN international drug control system, was J.H. ‘Johnnie’ Walker. Bing Spear, the Home Office civil servant who had written extensively on UK drug policy, identified Walker as providing the initiative that led to the first Brain Committee, which, commencing its meetings in 1958, reviewed the British drug control system for the first time since Rolleston did so in the 1920s. Government documentation from the mid- to late-1950s supports this claim. The context for Walker’s views was largely international, with the British System undergoing criticism from a number of countries, particularly the United States, through the mechanism of the new United Nations drug control regime.
In 1955, Walker sent a lengthy and thoughtful memorandum to the Home Office suggesting that it was time to look again at the British drug control system. Despite the system’s smooth domestic running, said Walker: ‘It so happens that a number of problems have arisen, or are on the horizon, which indicate that this is a suitable moment to review the present system of control.’ These problems or potential problems included the proliferation of new synthetic drugs such as pethidine and methadone; the UK policy on addiction (by which was meant in particular the Rolleston-inspired regulations permitting the long term of maintenance of opiate habits and the belief in the ‘stabilised addict’); addict doctors; and improper prescribing and supplies to addicts (the issues surrounding ‘script doctors’). The memorandum paid the greatest attention to the second and the fourth of these categories, replicating the situation that obtained when the Rolleston Committee reported and showing that the issue of doctors prescribing dangerous drugs to addicts had remained at the heart of governmental anxieties. Walker claimed that the Rolleston Committee never intended the ‘lavish supply of dangerous drugs to addicts merely for the maintenance of addiction’. He then made reference to a ‘small but potentially dangerous group of drug addicts (mainly heroin addicts) in London at the present time’. This group was ‘disturbing’, as it represented ‘the first real sign of a significant increase in heroin addiction for very many years’. The group’s members had become addicted young and were mostly under thirty – often nearer twenty; many shared an involvement in one particular field of entertainment and therefore met socially at regular intervals – a reference to the jazz club scene. The social context of this drug use made it ripe for proselytism, contended Walker, ‘always one of the more dangerous features of drug addiction’.
He continued that many ‘appear to obtain supplies from a small number of doctors who make no attempt whatever at cure or even, so far as can be judged, at reduction of the dose. In other words, their addiction is deliberately fed, almost certainly in some instances for purposes of gain.’ Walker concluded that: ‘The “script doctor” who thus makes drugs freely available to addicts represents a special problem…’
Walker’s memorandum showed that the Home Office was by this time fully aware of the flourishing new London addict subculture, a full ten years before these facts were published in the Second Brain Report. As noted by Spear, the peculiar thing is that the first Brain Committee did not address it in their deliberations nor their report. At the Home Office, it was Tom Green (who succeeded Walker at the Drugs Branch) who led the drafting of the advice and information sent to the Ministry of Health, from which emerged the shape of the review. For ‘some inexplicable reason’, while drawing heavily on Walker, Green did not include evidence of the emergence of London’s expanding heroin subculture.
One possible reason for this startling omission lay in the international relations around the topic of drug control. Walker points out that US medical opinion was firmly against maintenance and the notion of the stable addict. The ‘strongly held’ view in the American medical profession was that it is ethically unacceptable to condemn a patient, especially a young patient, to perpetual addiction by offering this form of treatment. It was also remarked that the CND and World Health Organisation were highly critical of ambulatory treatment of the kind practiced in the UK. Indeed at its 10th session, the CND ‘expressed the view that ambulatory treatment (including the so-called “clinic” method) was not advisable and asked the World Health Organization to prepare a study on the appropriate methods of treatment.’ Furthermore, a clause had recently been inserted into the draft Single Convention which spoke of treatment being given on ‘a planned and compulsory basis, in properly conducted and duly authorised institutions’. However, by virtue of a qualifying clause that was initiated by the UK, such measures would be applicable only in those countries having a large addict population; it was this proviso that permitted the UK government to sign the 1961 treaty despite its differences with respect to drug treatment. Notwithstanding this, Walker expressed concern that the general trend at the CND was toward compulsion, and that there may in due course be concerted pressure for the removal of the UK clause. He added that, ‘it is unlikely that the United Kingdom could ever accept an obligation to require compulsory treatment of drug addicts in a closed institution’. In fact, Walker made it clear that such a measure could prevent the UK from signing the treaty, and would have been in conflict with the overall trend of mental health policies in Britain at this time, as expressed in Lord Percy’s 1957 Report of the Royal Commission on the Law relating to Mental Illness and Mental Deficiency. This optimistic document led the trend away from confinement, toward voluntary and community based mental health treatment, and fed into the 1959 Mental Health Act. In relation to addiction, Walker commented in closing that: ‘There is a limit to what the State should attempt, and the deprivation of personal liberty for medical reasons is far too serious a matter to contemplate unless there is overwhelming evidence of the need for it because of some widespread and particularly virulent social problem. This need does not exist in the United Kingdom’.
This last sentence is the key one. In order to fight its corner at the CND, the UK government needed powerful evidence that the domestic drug problem continued to be so small as to be negligible, a point which some other countries disputed. Consequently, ‘there would be much to be said from the point of view of strengthening our case in international circles for obtaining an authoritative opinion from a body of experts on the necessity for, and the feasibility of, providing special treatment for drug addicts in this country.’77 In other words, a Committee set up to review Britain’s arrangements could prove very useful in providing the government with ammunition which to fight its international drug policy corner, so long as this evidence indicated that the problem was tiny and relatively insignificant.
Although, as Spear claims, Walker’s superiors at the Home Office were initially unreceptive to his argument, the Brain Committee may well have been influenced by it at the meetings which produced the first report. Green led the way in producing the documentation for the Committee; mention of the expansion of the opiate subculture was entirely absent, and the growth in heroin addiction strongly downplayed. Accordingly, its Report was structured on precisely the lines that would support the government in its negotiations at the CND. It stated baldly: ‘After careful examination of all the data put before us we are of the opinion that in Great Britain the incidence of addiction to dangerous drugs… is still very small.’
This argument remains for the present a speculative one; nonetheless, the omission of the West End heroin subculture from the Home Office memorandum of evidence to the first Brain Committee, and the Report’s conclusion, which supports the UK’s requirements at CND in the run up to the 1961 Single Convention, are highly suggestive. Beyond this specific question, however, it is clear that the construction of international drug policy is a matter of both international and domestic (and transnational) domains, and that it is impossible to understand countries’ conduct in international fora without taking into account international politics and culture. And vice versa.

Dr John Petro

[1] Departmental Committee on Morphine and Heroin Addiction: Report (London: HMSO, 1926). (Rolleston Report)

[2] 59 D. R. Bewley Taylor, The United States and International Drug Control, 1909-1997 (London and New York: Continuum, 1999) p.141.

[3] Spear, H. B. & (ed) Mott, J. Heroin Addiction, Care and Control: The British System. London: Drugscope, 2002. Pp.65-89.

[4] Spear, H.B., Heroin Addiction, Care and Control p.90

[5] The National Archives HO 319/1 and MH 58/565.

[6] McAllister, W. B. Drug Diplomacy in the Twentieth Century: An international history. London and New York: Routledge, 2000. Pp.185- 211.

[7] TNA HO 319/1 ‘Dangerous Drugs Administration and Policy in the United Kingdom’ 25 October 1955.

[8] Ibid.

[9] Ibid.

[10] Ibid.

[11] Ibid.

[12] Ibid.

[13] Spear, H.B., Heroin Addiction, Care and Control, p.92.

[14] Ibid.

[15] The Tenth Session of the Commission on Narcotic Drugs, 1955. http://www.unodc.org/unodc/en/data-and-analysis/bulletin/bulletin_1955-01-01_2_page005.html Accessed 3rd September 2016

[16] TNA HO 319/1, ‘Dangerous Drugs Administration and Policy in the United Kingdom’ 25 October 1955. In this passage, Walker was quoting from a 1954 CND draft of the Single Convention.

[17] Ibid.

[18] E. Percy Baron of Newcastle Report of the Royal Commission on the Law relating to Mental Illness and Mental Deficiency (London: HMSO, 1957).

[19] TNA HO 319/1, ‘Dangerous Drugs Administration and Policy in the United Kingdom’ 25 October 1955.

[] Report of the Interdepartmental Committee on Drug Addiction 1961 London: HMSO. Paragraph 24.


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Preparing for 2019: Drug Policy Objectives and Indicators, System-wide Coherence and the Sustainable Development Agenda


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Preparing for 2019: Drug Policy Objectives and Indicators, System-wide Coherence and the Sustainable Development Agenda

Side event held at the 60th Commission on Narcotic Drugs offers insights into how drug policy indicators could aid in achieving the sustainable development agenda.

Nazlee Maghsoudi, Knowledge Translation Manager at the ICSDP

Click here to visit the CND Blog’s live reporting from this side event.

With the UNGASS on the World Drug Problem now a year behind us, member states are looking towards the next international drug policy milestone, a High Level Ministerial Meeting in 2019. Simultaneously, member states are over a year into efforts to achieve the Sustainable Development Goals (SDGs), a set of global targets to end poverty, protect the planet, and ensure prosperity by 2030. Given increasing recognition that the impacts of global drug policy are intrinsically linked to a number of SDGs, the Government of Switzerland, Health Poverty Action (HPA), International Drug Policy Consortium, Centro De Estudios Legales Y Sociales (CELS), Social Science Research Council, Global Drug Policy Observatory (GDPO), and the International Centre for Science in Drug Policy (ICSDP) came together at the 60th Session of the Commission on Narcotic Drugs (CND) to explore how drug policy indicators could aid member states in more effectively achieving the sustainable development agenda.

Natasha Horsfield, Policy & Advocacy Officer from HPA, outlined crucial ways in which drugs and drug policy interact with several of the SDGs, and suggested that metrics for measuring how drug policies are contributing to the SDGs should be prioritized in preparations for 2019. Speaking about goal 1 on poverty, goal 2 on food security, and goal 5 on gender equality, Ms. Horsfield explained that marginalization and inequality are important elements in the drug trade, with poverty and food insecurity a frequent factor in involvement in illicit drug markets, and women particularly becoming involved as drug couriers because of their gendered social and economic vulnerabilities. Gender inequality is reflected in the disproportionate and alarming increase in the incarceration of women for minor drugs offences. Given these and other intersections between drug policy and the SDGs, the clear, measurable, and internationally agreed framework of targets and indicators contained within the sustainable development agenda could be adapted to measure drug policy outcomes. For example, new indicators could be adopted at national level under goal 5 to measure women and girls involved in the drug trade or incarcerated for drug crimes. Ms. Horsfield also stressed that the High Level Ministerial Meeting in 2019 presents an opportune moment to align the timeline for the next drug policy framework with the 2030 deadline for implementing the SDGs.

Elaborating on Ms. Horsfield’s remarks, Luciana Pol, Senior Fellow in Security Policy & Human Rights from CELS, pointed to improvements that could be made to drug policy indicators to support the achievement of SDG 5 on gender equality. Ms. Pol noted that the Special Rapporteur on violence against women has identified anti-drug policies specifically as a leading cause of the rising rates of incarceration of women globally, and data demonstrates that a portion of women incarcerated for drug offences are coerced into trafficking and others engage as a result of lacking viable economic opportunities. Ms. Pol described concrete ways to improve the quality of data on how drug policies impact women. First, prison data should have a gender perspective by including, for example, information on the amount of pregnant women, of children incarcerated with their mothers, and access to health services for these groups. Second, since laws in many countries don’t distinguish between different types of drug offences, small and large scale trafficking are categorized together. Differentiating between the conduct for which they are incarcerated and the roles women play will improve our understanding of incarcerated populations. Ms. Pol reminded the audience that improving our understanding of how drug policies impact women is not only essential to ensuring the achievement of SDG 5, but is also a central component of last year’s CND resolution 59/5. Ms. Pol therefore called on member states to take these and other concrete steps to mainstream a gender perspective in their collection of data relevant to drugs and drug policy, and urged UN agencies to guide member states in this process of broadening and expanding their drug policy metrics.
As a contributor on law enforcement indicators to the World Drug Report, Christian Schneider, Strategic Analyst at the Federal Office of Police in Bern, Switzerland, shared his firsthand knowledge that the incomplete nature of data on drug markets can prohibit efforts to derive meaningful policy recommendations. In addition to communicating uncertainties, Mr. Schneider proposed that gaps in the data could be addressed by adopting a more comprehensive set of indicators. Sharing technical recommendations for implementing Mr. Schneider’s suggestion, Dave Bewley-Taylor, Director of GDPO, focused on how a review of the Annual Report Questionnaires (ARQs) could support the achievement of the SDGs by aligning drug policy metrics with the sustainable development agenda. According to Prof. Bewley-Taylor, despite the limitations of self-reporting, the ARQs are a useful mechanism through which member states report on their efforts to address the world drug problem. As the nature of the world drug problem has evolved, however, there have been increasing gaps in the data collected by the ARQs. This recently came into sharp focus, as the UNGASS Outcome Document included an operational recommendation to use relevant human development indicators in alignment with the SDGs to increase understanding and improve impact assessments. Within this context, Prof. Bewley-Taylor stressed that there is a clear need to review the structure and questions of the ARQs to bring them into alignment with the SDGs by incorporating indicators related to human rights, public health, and human security. Such a review could be conducted through an interagency expert group established by the Statistical Commission, which has already begun considering these issues.

Discussions on drug policy indicators and their relationship to the sustainable development agenda are undoubtedly of utmost importance at the CND, and in other forums, such as the meeting of the high-level political forum on sustainable development in July 2017. Yet, much more than discussion is needed. As Ms. Horsfield said, advancing past this critical juncture will require political will from member states beyond simply reaffirming their commitment to SDGs, but towards deemphasizing drug control efforts that undermine the SDGs and funding those that contribute positively to their achievement. Aligning drug policy metrics with the SDGs is an important step in this direction.

Click here to visit the CND Blog’s live reporting from this side event.


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