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In the years leading up to United Nations General Assembly Special Session (UNGASS), Southeast Asia drew the attention of the drug policy world because of its refusal to drop the goal of becoming a drug-free region and for the extreme methods used in striving to achieve it. This chapter presents an analysis of the official positions taken by governments in the regional body known as the Association of Southeast Asian Nations from before until after the UNGASS in the context of one of the most punitive drug policy environments in the world and offers a perspective on what we could expect from them in 2019.

This chapter looks at the past, present and future of international cannabis control required by the UN drug control conventions in the post-2016 United Nations General Assembly Special Session era with an eye on the next High Level Ministerial Segment (HLMS) at the UN Commission on Narcotic Drugs in 2019, and beyond. From a policy analysis perspective, the author meanders through the increasing tendency to legally regulate recreational cannabis markets notwithstanding the obligation enshrined in the UN drug control conventions to limit cannabis exclusively for ‘medical and scientific’ purposes. Taking into account relevant national and international developments, the chapter describes how the growing discomfort with the status of cannabis and the prohibitive and punitive approach stemming from the international drug control regime went through a process from soft to hard defections of the treaty obligations. The case of the Netherlands demonstrates the difficulty faced by reform-minded states in reconciling their wish for a different cannabis control mechanism with their obligations under international law, resulting in an incomplete regulation of its coffee-shop system, where small amounts of cannabis are tolerated for sale, but where the illicit supply to the shops remained unregulated. Subsequent more wide-ranging reforms to regulate cannabis from seed to sale in Uruguay, several US States and – in 2018 – in Canada, are clearly violating the obligations of the UN drug control conventions. Nevertheless, the HLMS will likely leave the elephant in the room untouched. The emerging paradigm shift regarding cannabis shows that a modernisation of the UN drug control regime is long overdue. This chapter discusses some of the options available.

This chapter analyses major issues surrounding the Annual Report Questionnaire (ARQ) – the key mechanism through which the UN collects data on various facets of the world’s illicit drug market. As the ARQ is currently under review by the United Nations Office on Drugs and Crime (UNODC), the authors suggest ways to incorporate the gains made at the United Nations General Assembly Special Session (UNGASS) on the World Drug Problem.

The UNGASS Outcome Document has, to certain degree, enabled the international community to move away from the simplistic goals of a drug-free world enshrined in the 2009 Political Declaration and towards a more comprehensive health- and human rights-based approach. The UNGASS has also laid important groundwork for the 2019 Ministerial Segment, where member states will delineate the global drug control approach for the next decade. In this context, the issue of metrics and indicators has a critical political role to play as it will shape how member states will measure progress against their international drug control commitments.

Starting with a review of the ‘triple trouble’ – poor data quality, low response rates from Member States and other inconsistencies that have long persisted with the ARQ – the chapter moves on to offer substantive critiques on the content of the Questionnaire and ways to better incorporate issues related to health, human rights and development. The chapter concludes by providing guidance on possible synergies with the Outcome Document and the Sustainable Development Goals, bringing international drug control in line with the UN Charter.

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.

This chapter explores the relationship between the global drug policy agenda and the United Nations Sustainable Development Goals (SDGs). Development is one of the key pillars of the UN's charter; however, sustainable development and drug policy have existed in separate policy spaces for decades. During 2015 and 2016, two parallel processes took place at the UN – the adoption of the 2015 SDGs, superseding the Millennium Development Goals, and the 2016 UN Special Session on the world drug problem (UNGASS), a global convening of countries to create a way forward to address illicit drugs. This chapter explores how a group of reform-oriented countries, UN agencies and civil society stakeholders used the UNGASS to advocate for better policy alignment with development principles. While some headway was made, tensions remain about allowing a development approach into the drug policy realm. This chapter argues that given strong pushback to maintain a law enforcement-driven agenda by many countries, better alignment will not happen without more clarity on what sustainable development–driven drug policy is and without champions to push these ideas in the drug policy arena.

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.

This chapter explores the historical context of drug control in the United States, the ongoing regulation of the cannabis market at the State level and the role of the United States in the international negotiations related to the United Nations General Assembly Special Sessions (UNGASS) on drugs in 1998 and 2016. We continue by analysing the position, allies and activities of the United States before and during UNGASS 2016 to provide an understanding of possible scenarios related to the 2009 Political Declaration and Plan of Action review to take place via a High-level Ministerial Segment within the 2019 Commission on Narcotic Drugs meeting. While US drug policy is not expected to positively shift in the next few years, State-level regulation of cannabis is expected to continue and create pressure from below.

The Swiss drug policy once was very progressive in the 1990s when the harm related to drug use was most visible to the public. Failure of repression opened the room for more innovative harm reduction approaches. In 2008, the four-pillar model including the legal basis for substitution and heroin-assisted treatment of opioid use disorders as well as for other harm reduction facilities was approved by the population that had learned about the success of these measures. Less violence, better health outcomes among people who use drugs and less stigma supported the change of attitudes in the population towards a public health-based approach when dealing with drug use. Switzerland first received heavy criticism for the autonomous policy change at the international level while it is nowadays often cited as best practice example for dealing with people with an opioid use disorder. Otherwise, the country has usually been quiet in drug policy discussions at the UN level. Nevertheless, Switzerland’s reappointment to the Commission on Narcotic Drugs, the central drug policy-making body within the United Nations for a period of four years starting in 2018 is promising, given their unblemished recommendation for human rights-based drug policies including the abolition of the death penalty for drug offences, among other things. Alongside cannabis policy changes at the international level, Switzerland witnessed an unexpected development in cannabis availability and sales. However, the country is still rather conservative with regard to current cannabis policies, although cannabis with less than 1% of THC can be sold legally and the possession of up to 10 g will be followed by a fine only, if at all. Switzerland is open to experiment with new regulations but only if the law allows for that. To conclude, the strong sense of connectedness with the international community may support Switzerland’s next steps towards public health and evidence-based harm reduction.