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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.

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.

As prison drug use continues to be a concern worldwide, harm reduction practices serve as an alternative approach to traditional abstinence-only or punishment-oriented methods to address substance use behind bars. The purpose of this study is to present a summary of research surrounding prison-based harm reduction programs.

This narrative review of the international literature summarizes the harms associated with prison drug use followed by an overview of the literature surrounding three prison-based harm reduction practices: opioid agonist therapy, syringe exchange programs and naloxone distribution.

A collection of international research has found that these three harm reduction programs are safe and feasible to implement in carceral settings. Additionally, these services can effectively reduce some of the harms associated with prison drug use (e.g. risky injection practices, needle sharing, fatal overdoses, etc.). However, these practices are underused in correctional settings in comparison to their use in the community.

Various policy recommendations are made based on the available literature, including addressing ethical concerns surrounding prison populations’ rights to the same standard of health care and services available in the community. By taking a public health approach to prison drug use, harm reduction practices can provide a marginalized, high-risk population of incarcerated individuals with life-saving services rather than punitive, punishment-oriented measures.

The purpose of this paper is to inform readers of developments in drug policy debate in Australia following the publication of the Global Commission Report. To explain the activities, discussions and findings of events organised by the Australian NGO Australia21. To provide some key contextual information and references.

Overview of international situation following publication of Global Commission Report. Summary of current Australian national policy and its origins. Summary of recent national reports and their impact on policy. Account of NGO reports and recommendations.

Civil society agencies have entered national debate on drug policy and recommended an abandonment of prohibition-based approaches, using the Global Commission Report as a catalyst. First steps have been taken to introduce this debate into the Australian parliament.

Incomplete knowledge of relevant national documentation.

Probable delay in government developing debate and acting on recommendations in an election year.

Case study of developments and debate in one jurisdiction resulting from Global Commission Report. Aligns with similar debate and moves in other nations. Adds to knowledge of developments which challenge existing international policy debate and practical approaches which reject prohibition.

The purpose of this paper is to discuss priorities for effective responses to illicit drugs in West Africa in a changing international policy environment.

The paper analyzes published research, technical papers and reports on drug use and policy responses in West Africa and opines on priorities for drug policy in the region within the post-United Nations General Assembly Special Session (UNGASS) 2016 policy environment.

Drug use and related harms continue to increase in West African countries despite efforts to reduce drug trafficking and use through legal prohibition. The UNGASS 2016 outcome document enables flexibility in policy interpretation and implementation, which provides an opportunity for governments to prioritize national needs in drug policy. West African countries should prioritize and support research and data collection, prevention, treatment and harm reduction and sustainable livelihoods.

The paper emphasizes the need for West African countries to seize the opportunity created by the ineffectiveness and weakening of the prohibition regime as well as new treaty flexibility following UNGASS 2016 to reform drug policies to prioritize regional and national needs.

The purpose of this paper is to examine the extent to which the dominant metrics currently used to measure the success of the UN based global drug prohibition regime are in many ways inadequate and consequently contribute to systemic inertia. Within this context, it seeks to explore the potential of explicitly linking drug policy to the recently launched sustainable development agenda (SDA) and the associated sustainable development goals (SDGs) to initiate a change in approach.

Framing the topic in terms of international relations (IR) and regime analysis, prominent examples of where current metrics are imprecise (the relationship between production and seizures), misconceived (drug use) and missing (a range of drug and drug policy related harms) are explored. Attention is then given to an examination of international development as a model for measuring drug control outcomes, including a discussion of the SDGs in general and the intersection between drug policy interventions and several goals in particular.

While aware of the complexity of the issue area, the paper finds that there are considerable shortcomings in the way international drug policy outcomes are currently assessed. Although methodological problems are likely to persist, linking drug policy with the SDGs and their associated metrics offers the potential to help to shift the focus of international policy in a manner that would benefit not only UN system-wide coherence on the issue, but also assist in the achievement of the regime’s own overarching goal; to safeguard the “health and welfare” of humankind.

With the next high-level review of international drug policy due to take place in 2019, the paper offers policy makers with a way to begin to refocus drug policy metrics, and subsequently review outcomes, in line with the UN system-wide SDA.

As an emerging domain of inquiry, the paper not only explores a hitherto largely unexplored – yet increasingly important – facet of UN level policy evaluation, formulation and implementation, but also helps to fill a gap in the IR literature on regime dynamics.

This paper aims to consider the nature of cannabis-related harms under the UK’s Misuse of Drugs Act (MDA). Written for the specific context of this four-paper special section on 50 years of the MDA, it argues that the MDA may cause more harm than it prevents.

An opinion piece offering a structured overview of cannabis-related harms under prohibition. It summarises existing evidence of the ways in which prohibition may exacerbate existing – and create new – harms related to the production, distribution, use and control of cannabis.

The paper argues that prohibition of cannabis under the MDA may cause more harm than it prevents.

It has long been argued that the MDA does not accurately or fairly reflect the harms of the substances it prohibits, and much existing research points to different ways in which drug prohibition can itself be harmful. The originality of this paper lies in bringing together these arguments and developing a framework for analysing the contribution of prohibition to drug-related harm.

The purpose of this paper is to compare the response to HIV/AIDS and drug use (drugs harm reduction) with tobacco harm reduction.

Analysis of historical and contemporary sources, combined with personal knowledge of key stakeholders in the history and development of both fields.

Both drugs harm reduction and tobacco harm reduction share a similar objective – to reduce health risks for people who are unwilling or unable to stop using their drug of choice. Both also share a broader public health aim of helping people to make healthier decisions. Drugs harm reduction – as a response to HIV/AIDS – included the adoption of a wide range of radical harm reduction interventions and was a public health success. It became an established part of the professional Public Health agenda. In contrast the Public Health response to e-cigarettes and tobacco harm reduction has ranged from the negative to the cautious. A recent Public Health England report is exceptional for its endorsement of e-cigarettes.

Highlights contradictions in Public Health responses to drugs and tobacco; and that public health interventions can be implemented without and despite the contribution of professional Public Health.

The purpose of this paper is to explain how international drug policy continues to have a hugely damaging effect on population health, human rights and wellbeing, not only on individuals who consume and/or sell drugs but also on societies as a whole. And to review whether anything has changed after United Nations General Assembly Special Session.

UNGASS had been seen as a real opportunity for scientific evidence to become the driver of future drug policy. This paper looks at any changes that have since taken place that might support such an aspiration.

The authors found the criminalisation and incarceration of people who use drugs, mainly from the most marginalised sections of society, remains the primary response in almost every member state of the UN and there are at least 33 countries that retain the death penalty for drug offences. The impact on the health of people who inject drugs (PWIDs) living with HIV is devastating and overdose and AIDS related mortality are the leading causes of death. Hepatitis C infections among PWIDs are increasing at epidemic levels even though this now a curable disease.

Changes in drug policy urgently needed.

This paper is an important review of the health implications of bad drug policy.