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The landscape for international drug policy is shifting rapidly as the tensions between the objectives, assumptions and activities that are being introduced at local level are tearing apart the assumptions on which the system was founded. Countries are divided into camps that pursue different aims with drug policy. In addition to an established distinction between those that seek to reduce drug harms and those pursuing a vision of a drug-free world, some UN member states have established licit markets for products that the conventions hold are available for medical and scientific purposes. This incongruence is matched by states in the other camp who apply capital and corporal punishment ostensibly in pursuit of a public health objective. These differences over underlying values, but also in the use of evidence, and interpreting the purpose of the drug control system are no longer reconcilable. While there is pressure on maintaining the system, it no longer serves an organic function and continues mainly for the benefit of constituent members. With the dissolution of US leadership, drug policy is no longer operating within an effective international framework.

As in other parts of the world, the ‘war on drugs’ in West Africa has led to significant focus on criminal justice, compromising public health and human rights without reducing the scale of drug trafficking, production and use. West Africa is not only a transit zone, local production and consumption continue to rise unabated. The Economic Community of West African States has described drug issues as the enemy of the state and the rule of law, and has called on members States to fight the ‘scourge’.

The failure of the current policies has been vividly documented by the West Africa Commission on Drugs through its 2014 report titled ‘‘Not Just in Transit: Drugs, the State and Society in West Africa’’.

In response, civil society organisations and activists have contributed to raising awareness of the harm being caused by the current repressive drug policies in West Africa and engaged their respective national governments in evidence-based drug policy reform.

These engagements culminated in regional consultations that gave birth to the West African Common Position for the 2016 United Nations General Assembly Special Session (UNGASS) with a call for harm reduction and an evidence based drug policy for the region. Unfortunately, the UNGASS outcome was not as revolutionary as expected by the West African progressive voices, who have therefore continued to engage their governments to make the 2019 High Level Ministerial segment a turning point in the global drug debate.

Both Bolivia and Uruguay broke ranks with the global drug prohibition regime by introducing novel drug policies. State control of the production and supply of coca and cannabis represents a clear departure from both the spirit and the letter of the international drug conventions. Although, the rationale, processes and outcomes of policy change were distinctive in many regards, this chapter posits that there are conceptual resemblances. In both countries, the leadership of a charismatic and idiosyncratic president has to be considered. Furthermore, in both countries, mobilisation and activism were also decisive. Lastly, in both countries novel drug policy responded to specific problems that decision-makers faced. Approaching drug policy reforms in Bolivia and Uruguay in terms of personal leadership, mobilisation and policy problems provides a useful analytical first-cut to assess the continuity and change in drug policy observable elsewhere. Additionally, scrutinising the reasons and motivations for undertaking drug policy reform also allows to better understand each country’s behaviour on the international stage.

The intersection between drug control and the death penalty represents a key nexus for human rights and drug reform advocacy and constitutes one of the most visible examples of the link between abusive law enforcement and drug control in the current period. The issue has emerged as a flashpoint of international debates on drugs and is one that raises important questions and challenges for both ‘abolitionist’ countries that oppose the death penalty and ‘retentionist’ States that continue to execute people. The death penalty for drug offences cannot be dismissed as simply an internal matter for States. Not only do executions for drug offences violate significant international human rights legal protections, domestic capital punishment laws in many cases cannot be separated from the influence of the international drug control treaty regime. This chapter will explore the question of the death penalty for drug offences and the challenges it presents for the international drug control regime more broadly.¹

This chapter discusses the genealogy and development of the ‘access abyss in palliative care and pain relief’ affecting 80 per cent of the world’s people. It argues that the larger context is an epistemic abyss constituted by incomplete information about the need for controlled medicines for pain relief, and that decades of drug policy based on supply control have prevented development of the necessary knowledge base in many countries. Transnational civil society organisations are working to map and bridge this abyss through education, advocacy and action. Deeper (original) systemic and tensions in the original multilateral drug control narrative produced the current epistemic/clinical abysses and now provide space for more participatory civil society involvement. Where the earlier narrative focussed on a fear-based drive to discipline and punish non-medical use of controlled substances, the evolving (and still contested) ‘world drug problem’ narrative foregrounds person centred, human rights based, public health approaches to drug policy that explicitly support improved access to internationally controlled essential medicines. Recommended policies can only be operationalised through a concerted ‘all hands on deck’ effort guided by the international law principle of ‘mutual and shared responsibility’ for improving access within the context of the 2030 Agenda for Sustainable Development. This calls for enhanced communication, concerted advocacy, collaboration and pluralist praxis to fill the often gaping abyss between ‘black letter law’ — what is actually written in the drug control conventions — and how member states learn to interpret and operationalise it.

The United Nations General Assembly Special Session on drugs has provided countries with internationally agreed recommendations to adapt their drug policies for more efficiency and better outcomes. This chapter focusses on the Russian Federation’s role in international drug policy, through an analysis of its national approaches and their design, as well as on its diplomatic efforts at the bilateral and multilateral levels to oppose drug policy reform. A systematic review of peer-reviewed, grey literature, policy documents, UN reports and news reports on the country’s response to drugs internally and externally was conducted between September and December 2017. Despite its efforts to oppose drug policy reform and the prioritisation of public health, the Russian Federation faces major epidemics of imprisonment and HIV. Internationally, while it has not been successful in addressing the ongoing reforms in Europe and the Americas, it has been effective in preserving its international priorities by opposing harm reduction and maintaining the prohibition paradigm at the multilateral level.

In Europe, the Netherlands, Portugal and the Czech Republic are the countries increasingly portrayed as having the most ‘progressive’, ‘liberal’, or even ‘radical’ drugs policies in Europe. In a post-United Nations General Assembly Special Session (UNGASS) 2016 period and with the 2019 UN target date approaching, the EU and these countries within are bound to play a key role in the definition of an international drug policy for the next decade. This chapter analyses how the perceptions of these countries match against the drugs legislations and how they fit into the overall EU drug policy approach.

States in the Middle East and North Africa (MENA) have historically leaned towards conservative, reactionary models of drugs policy. The combination of authoritarian forms of government, whether dynastic monarchies (Morocco, Jordan and Persian Gulf countries), semi-military republics (Syria, Egypt and Algeria) or religiously sanctioned republics (Iran), with the strong influence of Islamic law and norms, has signified that the region has enforced strict forms of drug prohibitions. For that matter, the region is home to cultural and social norms that are less permissive than in other regions of the world: for instance, with regard to premarital sex, homosexuality, clothing, alcoholic drinks and freedom of expression. This image of the MENA region is often overplayed by media commentators and Western scholars, especially in the field of drugs policy. The almost total absence of studies of drugs policy or drugs history in the MENA, excluding works in epidemiology, speaks well about the oblivion to which the region has been relegated over the last decades. The chapter provides first a background on the main questions regarding MENA drugs policy, looking at the historical developments in drug regulations and drug trends. Then, it discusses the current policies that operate across the region and, if pertinent, the prospects of policy development. When necessary, the argument refers to contextual elements that have influenced the direction in national and transitional drugs policy. Conscious of the fact that the MENA is as vast and diverse as a continent, I have opted to focus on three paradigmatic cases (Iran, Lebanon and Saudi Arabia), which provide an adequate geographical and thematic coverage of the MENA drugs policy. The three cases cover different aspects of today’s MENA drugs policy spectrum, from draconian repressive measures to progressive harm reduction programmes. Taken in their geographical dimension one can appreciate the variety and difference that exists within the MENA region, therefore supporting one of the key objectives of this chapter, which is to provide a nuanced analysis of drugs policy against the grain of homogenising and culturally reductive approaches.