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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.

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.

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.

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.

This chapter reviews the history of civil society engagement on drug policy at the UN. Despite the challenging beginnings characterised by small numbers of civil society attendees at the Commission on Narcotic Drugs, coupled with government mistrust, in the last two decades, civil society representatives have made visible progress in advocating for policy reform and changing the terms of the debate.

Efforts by non-governmental organisations (NGOs) in the lead up to, as well as during the 2016 United Nations General Assembly Special Session on Drugs (UNGASS), best illustrate this increase in impact and engagement. Reform-orientated civil society strategised heavily on how to bring ‘comprehensive, diverse, balanced, and inclusive’ representation to the UNGASS and achieved this through the Civil Society Task Force, which was carefully balanced in terms of geographic, gender and ideological diversity, and included nine representatives from affected populations, including people who use drugs, people in recovery from drug use disorders, families, youth, farmers of crops deemed illicit, harm reduction, prevention, access to controlled medicines and criminal justice.

The 2016 UNGASS saw the fruition of greater civil society engagement. Eleven speakers were chosen to speak in the forum showcasing the calibre and diversity of civil society representatives. They made powerful, at times poignant statements and pleas for better, more compassionate treatment of people who use drugs, farmers of crops deemed illicit, as well as respect for human rights, sustainable livelihoods and the need to approach the issue through a public health and human rights lens.

The chapter concludes with the finding that reform-orientated civil society had a significant impact on the UNGASS – both on the gains in the Outcome Document and at the actual event, while noting that the most impactful ways to influence has nonetheless been through reform advocacy efforts outside of the official civil society mechanisms. Civil society engagement remains a serious challenge. International solidarity and global networking remain a central part of the drug policy reform movement’s strategy to advocate for change at the national, regional and global levels.

This chapter provides a critical exploration of the European Union’s impact on the 2016 United Nations General Assembly Special Session (UNGASS) proceedings and Outcome document. It demonstrates that the ability to produce a European ‘common position’ ahead of the UNGASS debates represents a significant step forward in the ability to ‘speak with one voice’ in the global illicit drug policy arena, and has played an important role in ensuring key issues such as human rights and public health remain on the agenda. In highlights, however, a European failure to engage with issues such as the continuing suitability of the international drug conventions to preside over the current climate of drug policy innovation and experimentation, and the unintended consequences of a ‘war on drugs’ approach. Ultimately, therefore, it argues that these failures will hamper the development of a more progressive and effective global drug policy.

This chapter explores the norms and assumptions that frame and sustain international drug policy and the international drug control regime. Drug policy is conceptualised as a ‘policy fiasco’ that persists despite extensive evidence of goal failure. The absence of effective monitoring and evaluation, impact assessment, stakeholder participation and mainstreaming of rights-based approaches, conflict sensitivity and gender sensitivity is emphasised, substantiating the argument that drug policy is a case study of ‘institutional path dependence’. Drug policy has repeatedly missed targets for achievement of a ‘drug free world’. This is explained through reference to the counterproductive and ‘unintended consequences’ of a drug policy approach of criminalisation. The impacts of drug policy enforcement are shown to be negative, pernicious and disproportionately born by the poor, by vulnerable communities and those subject to discrimination on account of race, gender and class.

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.

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.