By Marilou Gagnon / Journal of Mental Health and Addiction Nursing

: Supervised consumption sites (SCS) have been implemented in Europe, North America and Australia, reaching a total of 158 sites worldwide. In addition to reducing harms and preventing overdoses and overdose deaths, SCS act as a point of service for people who use drugs to access much needed health care services. Registered nurses who work in SCS provide care, support, education, and resources to reduce health risks and improve health. It has been clearly established that these interventions fall within the legislated scope of practice of registered nurses but the actual role of nurses in SCS remains poorly defined and understood, especially by decision-makers, employers, health care providers, and the broader community.

: To address this significant practice, policy and research gap, a consensus statement was developed based on information generated by 17 content experts from 10 countries namely, Canada, Spain, Australia, France, Denmark, Norway, Ireland, Switzerland, Germany, and Scotland. The statement was developed from “the ground up” by gathering information on three content areas: nursing practice in SCS, training, and needs. This information was summarized, and then submitted to two rounds of voting using a modified Delphi method to build consensus.

: The final content of the consensus statement is comprised of five sections: 1) Philosophy of care, 2) Framework, 3) Nursing role, 4) Training requirements, and 5) Needs of nurses.

: This consensus statement is a first step toward a better understanding of the role of nurses in SCS. There is an immense responsibility on nurses in this setting, as the majority of people who access SCS face many barriers in accessing other health and social services, even when their need for those services may be critical. For these reasons, it is essential to better prepare nurses for these realities. It is our hope that this first international consensus statement can serve as a foundation to guide practice, policy, research, and operational decisions in SCS.

International consensus statement on the role of nurses in supervised consumption sites

It’s time for a grown-up conversation about the racialization of antidrug policies. Ethnic and racial minorities are incarcerated, policed, shot, and killed at growing rates across the globe. The UN Working Group of Experts on People of African Descent called for drug laws to be amended in light of racial injustice. The reasons for this injustice are not rooted in any problem with these communities, but rather because of problems with the criminal justice systems that disproportionately punish them. Indeed, the war on drugs was designed specifically for this purpose.

The first step in trying to address this challenge is for countries to collect data on drug crimes; tracking data (on race, ethnicity, gender, nationality, etc.) of those arrested and prosecuted for such offenses is particularly needed. Lax data collection can have serious pitfalls, and distort our understanding of what’s actually happening in countries in ways that carry problematic consequences.

Consider the case of Portugal, a country lauded for leading the world in progressive drug policy reform. As a 2016 study shows, there is a sharp difference between the number of men and women incarcerated on drug offenses in Portugal; women made up 76 percent of the total number of people imprisoned on drug offenses, while men accounted for 40 percent. To put those figures in context, the disparity between women and men in 2005 was 60 percent to 25 percent; in 2000, it was 47 percent to 19 percent.

Why had the number of women incarcerated on drug charges climbed so high?

The uncounted victims of the war on drugs

The chief of police in the Philippines has stepped down after facing historical accusations in the Senate that he protected officers who had resold confiscated drugs and received some of the profits.

It was a rapid fall from grace for Oscar Albayalde, the head of the Philippine National Police (PNP), who rose to fame as the enforcer of Rodrigo Duterte’s war on drugs in Manila before Duterte was appointed president. Albayalde has denied the allegations.

Thousands of people have been killed as part of Duterte’s campaign against illegal drugs. Amnesty International called it a “large-scale murdering enterprise”.

“After careful deliberation, I have come to the decision to relinquish my post as chief, PNP, effective today and go on a non-duty status. I have submitted my letter of intent to [interior secretary Eduardo Año] which he accepted and favourably endorsed to the president,” Albayalde said in an address to police on Monday morning. It comes weeks before his scheduled retirement on 8 November.

The shocking allegation stemmed from a 2013 anti-drug raid in Pampanga province in Central Luzon, when he was a provincial police chief. He allegedly sought to stop the dismissal of officers under him who were found to have taken and hidden more than 100kg of 

 or methamphetamine, as a bribe from a drug suspect so he could escape. A fall guy was arrested instead.

A retired police general made the revelation accidentally during a Senate inquiry on another topic. Benjamin Magalong, the retired head of the criminal investigation and detection group, testified that Albayalde made a call to intervene in the investigation of the raid. Senators pursued the matter and another retired general, who investigated the controversial raid, came forward to allege Albayalde told him he “got a little” from the profits.

The Senate probe established irregularities in the controversial raid and found the reports the police filed were inconsistent. It also found the police were slow in punishing corrupt personnel. Magalong claimed the officers involved in the raid were given desirable posts under Albayalde.

Albayalde’s resignation comes after a weekend conversation with Año, whom Duterte ordered to investigate allegations against him.

Philippines police chief and Duterte drug war enforcer resigns in meth scandal

Covering topics from crystal meth use to the unexplored world of Indonesian women in rehabilitation, this collection of articles provides a comprehensive overview of the drug policy field in Indonesia. The following articles highlights the impact of drug policy in dictating the experiences of individuals, as well as policies' disproportionate impact on vulnerable groups. Combining photography with case studies and historical analyses of how the country's drug policy came to be, this collection is an essential for anyone who wishes to learn about the experiences of people who use drugs in Indonesia.

Drugs and drug policy | By Claudia Stoicescu and Wayne Palmer

Crystal meth users in Indonesia | By Laura Nevendorff and Ignatius Praptoraharajo

Photo essay: Woman to woman | By Alexandra Radu

From drug control to harm reduction | By Emily Rowe

Drugs and the death penalty | By Puri Kecana Putri & Aghniadi

Populism versus justice | By Ricky Gunawan & Raynov T. Pamintori

Cannabis, for starters | By Dania Putri

Indonesia's drug policy

One year ago, the newly elected government of Malaysia officially announced its intention to abolish the death penalty. This was an historic moment not only for Malaysia — where over 1200 people are currently on death row, overwhelmingly for drug-related offenses — but for the entire region.

Just a few months later, however, the same government started backtracking on its promise, citing a lack of public support for abolition as a key reason for this choice.

This deference to public opinion is not exceptional. Rather, public support is often used as a central justification for pursuing populist policies, including violent drug wars and the death penalty. While examples of populist anti-drug campaigns can be found around the world, in some extreme cases – such as Indonesia, Sri Lanka, and the Philippines – these campaigns have triggered calls for the use or reintroduction of capital punishment as a tool of drug control. This stands in contrast with an established global trend of moving away from the death penalty for drug offenses, as recorded by Harm Reduction international.

A closer look at developments in these countries raises the question: what does the public 

think about the death penalty for drug offenses?

In an effort to better understand these phenomena, Harm Reduction International recently analyzed a selection of 39 valid public opinion surveys conducted in 5 key countries in Asia — a region that holds 16 of the 35 countries which still retain the death penalty for drug offenses. This included surveys from China, Malaysia, Thailand, Singapore, and the Philippines.

From this analysis, we learnt that public support for capital punishment, both in general and for drug offenses specifically, is much more complex and nuanced than often depicted.

Public support for the death penalty appears to be based on a belief in the deterrent potential of capital punishment, and in the conviction that the criminal justice system works perfectly. If and when the public learns otherwise, and especially when it learns of the many people who are wrongfully convicted or executed, support drops significantly.

Public support for the death penalty also appears to be “abstract”, almost a gut feeling: while most respondents claimed to support the death penalty in theory, people were much more measured in their views when presented with real-life scenarios. This suggests that when faced with the human cost of capital punishment, the public may exercise more caution and be more reluctant to support the death penalty.

The death penalty for drugs: What public opinion surveys in Asia teach us

Five years later, Inez Feria still remembers the line snaking around the block outside the clinic in Cebu City. Men and women were smiling and laughing as they queued for clean hypodermic needles. For Feria, an advocate for the rights of drug users, it felt like a hopeful moment.

The needle exchange — part of an international push to slow the region’s skyrocketing HIV transmission rate — was the largest of its kind in the Philippines. When it started in 2014, about half the city’s drug-using population (approximately 6,000 people) was HIV-positive, and three-quarters of those people contracted the virus after sharing contaminated needles. By almost every metric, the pilot program exceeded its targets: fewer drug users reported sharing needles, more were being tested for HIV and all could access basic medical services.

But only months after the clinic was up and running, the Cebu City Anti-Drug Abuse Council filed an official letter demanding that it be shut down. In April 2015, five months into the planned two-year program, the clinic’s syringe distribution was suspended due to “political pressure,” according to the American medical non-profit Population Services International (PSI), which started the program.

A few weeks later, Philippine Senator Vicente Sotto gave a speech condemning the service. “Harm reduction strategy is, in reality, a pro-illegal drugs strategy,” he declared. “This nonsense must stop.” Needle distribution at the clinic permanently halted, and, according to a PSI review, “multiple clients were lost to follow up,” while new referrals slowed to a trickle.

“It was really sad,” Feria said. “It wasn’t just about providing syringes. It had a bunch of different services, HIV testing, counseling. People got connected to all these services that they otherwise wouldn’t have. It showed that people do want to take care of themselves.”

Fighting for compassion in the Philippines’ brutal drug war

Governments, businesses and philanthropists gathered in France pledged just over $14 billion on Thursday to the Global Fund to Fight AIDS, tuberculosis (TB) and malaria, exceeding the targeted amount, its chief executive Peter Sands announced.

Beside French President Emmanuel Macron, who hosted the replenishment conference and had urged governments to open their wallets wide, Sands said the target was even slightly exceeded, reaching $14.02 billion (€12.07bn). The fund says the money will help save 16 million lives and avert 234 million infections by 2023.

A dozen heads of state and government, mostly from African countries, were attending the two-day conference.

Macron, who was hosting the conference in the city of Lyon, wanted the event to raise more than the $12.2 billion (€11.07bn) brought in at the last conference in 2016.

The French leader urged leaders to accelerate the donations in his opening speech. “If we meet our commitments in the next three years, 16 million lives can be saved,” Macron said. “We must reach $14 million in the next three hours.”

He said this morning that France had raised its pledge by 15 percent to €1.5 billion and later pledged an additional €60 million.

International donors meet target of $14 billion to fight AIDS, TB and malaria at conference in France

"Do you feel that some drugs are inherently worse for the user than others?”

A man had approached the stage at the Horizons NYC 2019 psychedelic conference on Saturday, where Dr. Carl Hart, a Columbia University psychology professor and harm reduction expert, was taking questions after his keynote address.

“I have seen methamphetamine have very destructive consequences for a lot of people, and opioids even more so in my view,” the man continued.

“You should probably broaden your scope of people who use them,” Hart responded. “You’re looking at someone who uses all of those drugs.”

Hart’s closing address at New York’s largest annual psychedelic science event, held at The Cooper Union, was titled “Dispelling the Lies that the Psychedelic Community Believes About Drugs.” He explained to an audience of psychedelic researchers, advocates, and enthusiasts why the concept of “psychedelic exceptionalism” is so destructive (among other topics).

Psychedelic exceptionalism is an ideology that claims purportedly less-harmful or less-addictive drugs—such as cannabis, psilocybin mushrooms, or ayahuasca—to be inherently better, safer, or more desirable for people to use than other drugs.

Heroin, alcohol, or crack cocaine are treated as their contrast. When taken to its extremes, psychedelic exceptionalism stigmatizes not just certain drugs but also the people who use them.

How psychedelic exceptionalism harms drug users

The drug-overdose crisis is the most acute health emergency that Canada has faced in a generation. More than 12,800 people have died of an opioid overdose since Health Canada began counting in January 2016.

There are now so many fatal overdoses that this single cause of death has stalled the average life expectancy for the entire population. “Life expectancy at birth did not increase from 2016 to 2017 for either males or females, a first in over four decades,” Statistics Canada warned last May.

There’s a federal election less than one week away, on October 21. And yet more than 4,000 fatal overdoses each year is something that no one is talking about.

The word “overdose” appears in the incumbent Liberal party’s 85-page election platform exactly once.

“The opioid crisis is the greatest public health emergency since the AIDS epidemic,” it reads. Then there are only another two paragraphs.

The Liberals promise “new investments” in treatment services and briefly outline a plan to divert people charged with possession away from the criminal system and into “drug treatment court”. In addition, injection sites will hopefully operate with longer hours. That’s it.

The Conservative party’s 2019 platform gives the opioid epidemic a little more space, but that’s not necessarily a good thing. Andrew Scheer’s plan to reduce overdose deaths appears to be nothing more than the same tough-on-crime, abstinence-only approach to addiction that’s failed in every jurisdiction across North America for more than half a century now.

Canada's 2019 election shows that nobody in any position of power cares how many drug users die

As a Thematic Network, we have the opportunityto produce a Joint Statement. This JointStatement has been co-created by NLOinitiative participants with input from broaderstakeholders via theEU Health Policy Platform.

In health and social policy, the EU’s main roleis to support and complement the activitiesof Member States by encouraging cooperationand best practices. The EU can introduce policyframeworks that foster good health by supportingdynamic health systems that are integratedand people-centred, as called for by the G7 andOrganisation for Economic Co-operation andDevelopment (OECD), and address inequalitiesby engendering financially sustainable socialprotection and inclusion policies.

This Joint Statement aims to providepolicymakers with a range of priorities, principlesand recommendations on how to improve accessto health and social care for Europe’s mostunderserved people. It aims to translate theunderstanding of the determinants of poor healthand unequal access, together with good practicesand experiences of target communities, intoconcrete calls to action. Inequity is not inevitable.

Improving healthcare access for marginalised people

It is not our search for pleasure that is so damaging to the environment, but corporal greed, social injustice, and inequality.

“You can’t call yourself a climate change activist if you’re doing coke,” says Dan Burkitt in his opinion piece for the Metro. “MDMA is killing trees,” says a video on VICE. It seems the idea that drug users should be blamed and shamed for destroying the planet is a very virulent one. The environmental damage these people refer to is real and it is related to the production of substances many people use, such as cocaine or MDMA. However, if you have a closer look at the arguments, you will see that it is not people who use these substances who should be blamed – but governments who keep the production of these drugs unregulated.

In the early 20th century the coca leaf was a legal agricultural commodity and cocaine was a legal substance widely used in medicine. The German pharmaceutical company, Merck, imported coca leaf and crude cocaine paste from South America to produce hundreds of kilos of cocaine in its laboratories in Frankfurt. An Italian entrepreneur, Angelo Mariani, invented a popular beverage called Vin Mariani, containing low levels of alcohol and cocaine. He also imported coca leaf from Peru and produced thousands of bottles in his factory in Neuilly, France.

Drug users are not damaging the environment, the war on drugs is

History was made last week in Lyon, when governments, philanthropic donors and the private sector pledged US$14 billion for the Sixth Global Fund Replenishment, more than any other global health institution has ever raised. Harm Reduction International, Eurasian Harm Reduction Association, International Network of People Who Use Drugs and the India HIV/AIDS Alliance congratulate the Government of France, the Global Fund to Fight HIV, Tuberculosis and Malaria (Global Fund) and the broad network of health advocates, academics and policy makers on this tremendous success.

Recognising that a strong and fully-funded Global Fund is vital to the harm reduction response, over 150 organisations and parliamentarians around the world signed on to the Call to Action on harm reduction funding earlier this year.

However, US$14 billion was the minimum amount required for the Sixth Replenishment and will not be enough to meet 2030 targets. The Global Fund also assumes a very ambitious 48% increase in domestic resources from low- and middle-income governments between 2021-2023. Yet, most governments have not prioritised harm reduction in their spending to date, even where the epidemic is concentrated among people who use drugs.

A seismic change is needed if we are serious about achieving Sustainable Development Goals and ending AIDS and combating viral hepatitis among people who use drugs by 2030. Much more is needed to address the funding and political crisis for harm reduction around the world.

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