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In 2006, IHRA received a 5‐year grant from DFID to develop a conducive policy environment for the implementation and scaling up of harm reduction activities on a global scale. An independent evaluation of the DFID programme focused primarily on IHRA's work with multilateral agencies such as those of the United Nations and civil society organisations, in particular harm reduction networks and drug users groups. This work, based largely on a human rights approach to harm reduction, included developing and disseminating evidence‐ based reports and publications, advocacy and lobbying with a wide range of national and international partners and planning the annual International Harm Reduction Conference.

This article aims to analyze the incorporation of harm reduction health workers with lived experience in all services focused on the care for drug users in Belo Horizonte’s mental health network, one of the largest Brazilian Psychosocial Care Networks (Rede de Atenção Psicossocial [RAPS]), and reports the findings of a qualitative study on the life stories, recovery journeys and the professional practice of harm reducers in Belo Horizonte.

For the development of this research, the authors chose the following methodological tools: documentary research; follow-up of harm reduction interventions; access to harm reducers’ field diaries; joint writing of the life stories of the harm reducers.

It indicates that these professionals, as harm reducers empowered by their life experience, have developed various elements and active ingredients of peer support. Their practices and the results of their actions have consolidated their inclusion as Belo Horizonte RAPS’ health workers and highlight that recovery-oriented care and peer support are a real possibility in Brazil.

In this research, harm reducers are coauthors and report their own life experience. In this article, they also talk about the impact of this experience on their work and on the lives of users of mental health services, emphasizing the protagonism and exercise of citizenship by harm reducers.

Following the example of many northern European countries, harm reduction strategies were introduced in Italy at the beginning of the 90s in response to the spread of HIV/Aids. The peculiarities of Italian culture and tradition led to the adoption of a ‘Latin’ model, while in northern countries the culture of pragmatism and evidence‐based practices, together with a long tradition of public health policy were determinant in promoting harm reduction. In Italy, the ‘social perspective’ on the drug problem adopted by a large part of professionals working in public services and by most non‐governmental organisations (NGOs), has prompted a synergy between ‘cure’ and ‘care’ (ie. treatment and harm reduction), leading to the ‘integration’ of harm reduction and the traditional drug‐free work on addiction. As a result, since the mid 90s, public services and therapeutic communities have been cooperating to build a complex system of low to high threshold facilities. Until the 90s, most NGOs only ran drug‐free programmes in therapeutic communities, but from then onwards many began running harm reduction programmes as well, especially street units and needle exchange programmes, secondary prevention units at rave parties, drop‐in centres, and low‐threshold detoxification centres. Similarly, there has been an increase in methadone maintenance in public services, after the ‘retention in treatment’ of clients was established as the primary objective in the effort to protect users from drug related death and HIV infection. Though harm reduction interventions are far from being fully implemented, data shows that in the past 15 years the harm reduction/treatment system has reduced health risks for drug users and has been instrumental in referring a remarkable number of injecting drug users into treatment programmes. In the mean time, drugs of choice, patterns of use and ways of drug consumption have substantially changed. Now the question is, will the Italian approach be able to address these new challenges?

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 paper aims to explore multiple problematisation processes through a former needle exchange programme run by Kék Pont (a non-governmental organisation) in the 8th district of Budapest. By presenting a collage of ethnographic stories, this paper attempts to preserve tacit knowledge associated with the programme and thereby keep its office alive as a “drug place”, the operation of which was made impossible in 2014.

Drawing on the insights of Foucauldian governmentality studies and actor-network theory, this paper focusses on drug use as a problem in its spatial-material settings. Based on ethnographic fieldwork, the contribution traces multiple problematisation processes and related infrastructures.

From the needle exchange programme’s perspective, drug use is not a singular problem but the effect of multiple problematisation processes. Although those processes are often in conflict with each other, the question is not which one is right, but how social workers manage to hold them together. It is a fragile achievement that requires years of training and ongoing negotiation with local actors. By eliminating Kék Pont’s 8th district office, the Hungarian Government did not only hinder harm reduction in the area but it had also rendered tacit knowledge associated with the needle exchange programme as a “drug place” inaccessible.

The paper is a melancholy intervention – an attempt to preserve tacit knowledge that had accumulated at the needle exchange programme. The retelling of ethnographic stories about this “drug place” is one way of ensuring that other drug policies remain imaginable.

The authors aimed to examine the incarceration experiences of injecting drug users in accessing harm reduction, and HIV‐related services inside prisons in India.

The authors conducted three focus groups with a purposive sample of 23 formerly incarcerated male IDUs and four key informant interviews with a former police official, a drug dealer and service providers. Data were analyzed using a constant comparative method.

Participants reported availability of alcohol and injectable or oral drugs such as heroin, dextropropoxyphene, and marijuana inside prisons. Inmates obtained drugs and clean syringes (one syringe bought for 2.5‐4 USD) through prison staff, and collected used syringes and needles from the dustbins in prison sickrooms. Needles and syringes were reused and shared. Prisons did not have needle and syringe programmes, detoxification, overdose management or opioid substitution treatment. Drug‐using prison inmates faced several challenges in accessing antiretroviral treatment and HIV testing.

The authors' findings emphasize the need to protect the health of injection drug‐using inmates by introducing harm reduction programmes and removing barriers to HIV testing and antiretroviral treatment.

This study illustrates, for the first time, the contexts behind high risk injecting drug use behaviours among prison inmates in India. It also highlights the lack of availability of harm reduction services such as needle and syringe programmes, drug detoxification and opioid substitution treatment inside prisons. Further, it demonstrates the difficulties faced by HIV‐positive prison inmates in getting timely and uninterrupted antiretroviral treatment.

The negotiations leading to the UN Special Session (UN General Assembly Special Session on drugs (UNGASS)) on drugs have highlighted the lack of consensus among the global players, with some strengthening the prohibitionist approach and others seeking policy reforms. The purpose of this paper is to focus on the Russian Federation’s national policies and diplomatic activism to influence the outcome of the negotiations at the multilateral level.

A systematic review of the federal legislation on drug control and the legislation on HIV/AIDS has been undertaking in October 2016. Peer-reviewed, grey literature, policy documents, UN reports and news reports were used to gather information on the country’s response to drugs internally and externally.

Despite its limited regional influence on harm reduction and declining financial power, the Russian Federation has been successful in preserving its international priorities by opposing harm reduction and maintaining the prohibition paradigm in the UNGASS outcome.

Every effort was made to identify valid sources of information on the levers of influence of the Russian Federation. Little data were available on the real outcome of the efforts deployed in influencing the BRICS and other regional and international assemblies.

This paper presents an overview of the national policies of the Russian Federation, a global player, and provides a better understanding of how the national approach to illicit drugs and their perception influences its international position. It analyses the geographic, economic and diplomatic sphere of influence of the country in drug policies, and provides explanations on the successes and shortcomings of the Russian influence at the multilateral discussions on drugs.

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.

The purpose of this paper is to first, inform readers of the roles, activities and contexts of drug users unions in Denmark and Sweden. Second, to show the achievements and impacts of the two. Third, to illustrate the differing social and political situations in the two countries and how they determine the priorities and activity of the unions.

The paper is written by a UK commentator who bases the text on meetings, interviews and conversations with members and representatives of the two unions. Spokespersons for both unions have contributed to, commented on and clarified draft texts and provided contextual papers and information.

The two unions have differing roles and levels of acceptance and influence according to the political and legal situations in the two countries. There are differing situations and needs in Denmark and Sweden, reflected in the levels of drug-related deaths. There is no “Scandinavian” model. In Denmark the users union is involved in high-level discussions on policy making and practice. In Sweden the new unions are starting to be involved in local discussions about provision and practice.

Danish experience shows how political acceptance of the existence of a drug using population is leading to improved health and well-being amongst that population, and to social policy responses which are inclusive of this and other marginalised groups, and to a reduction of stigma and demonisation. Swedish experience differs and can be seen as essentially prohibitionist and punitive. Many Swedish drug users are moving to Denmark because of the levels of service and social attitudes. It may be of interest to UK policy to adopt a similar approach to drug users organisations – as distinct from service users’ voices.

Strengthening the role of drug users unions in all countries and including them in national policy making discussion and debate.

Accepting the existence and needs of drug using groups in society and developing responses informed by their views and experience. Adopting inclusive social policies and recognising the variety of need and choices in treatment. Combatting stigma and demonisation.

The paper is based on extensive interviews and conversations whose results and content are recorded, not interpreted. The Danish work was conducted in Danish, adding to the number of voices and conversations it was possible to include. A distinction between policy and practice in Denmark and Sweden is established which may run counter to UK impressions of “Scandinavian” rather than national realities.

The purpose of this paper is to investigate a group of Romanian injecting substance users “migrating” from heroin to novel psychoactive substances (NPS) as a counterpublic seeking to escape the stigma of drug abjection.

The findings are drawn from interview and observational data collected mainly at drug services sites in Bucharest, Romania.

The stimulant powders sold by head shops appealed to experienced drug users because they seemed to emulate a consumerist ethos and cultivate a healthy, rational agent that popular discourses of addiction deem incompatible with drug careers. NPS and head shops were thus initially understood as a possibility of escaping “junk identities”. However, they ultimately sealed injectors as abject bodies that obstructed the collaborative goals of rehabilitation and health restoration. A sense of symbolic distance shaped by notions of moral and bodily hygiene separated heroin and NPS users, as the latter increasingly came to be seen and see themselves as flawed consumers of health and freedom.

NPS retail spaces could present valuable opportunities to insert harm-reduction resources and harness counterpublic health strategies.

Dominant definitions of substance use as unavoidable paths into self-destruction push users towards unknown compounds they can attach more fluid meanings to. This suggests that prohibitionist language still obscures rational dialogue about existing and emerging drugs.

The paper traces ATS/NPS in an Eastern European context offering an alternative vantage point to harm-focused perspectives.