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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 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.

Global drug control is coming under increasing criticism. Failures to stop or even reduce drug use and the increasing power of the black market highlight prohibition. Alan Steel explores the potential benefits of licensing drug sales using models from alcohol and tobacco licenses. In a time of consumer choice and increasing disregard for unworkable policies might it be time to regain control?

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 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.

The purpose of this study is to understand the complex interplay between illicit opioids trade and consumption practices and state policies that aim to reduce their misuse.

The study adopted an exploratory design. Data were gathered through in-depth interviews with 31 commercially oriented drug dealers in Uyo, Nigeria. The framework approach was used in data analyses, while “friction” provided the interpretive lens.

Accounts revealed public concerns over the misuse of tramadol and other opioids among young people and the associated health and social harms. These concerns provided support for enforcement-based approaches to prescription opioids control, including police raids on pharmacy stores. These measures did not curtail opioids supply and consumption. Instead, they constrained access to essential medicines for pain management, encouraged illegal markets and fuelled law enforcement corruption in the form of police complicity in illegal tramadol trade.

The findings reveal the frictions of drug control in Nigeria, wherein enforcement-based approaches gained traction through public concerns about opioids misuse but also faced resistance due to the persistence of non-medical use and illegal supply channels made possible by law enforcement complicity. These indicate a need to prioritize approaches that seek to reduce illegal supply and misuse of opioids while ensuring availability of these medications for health-care needs.

The study is unique in its focus on the creative tension that exists between state control measures and local opioids supply and consumption practices.

This paper seeks to present an investigation on building controlled drug delivery device (DDD) matrix using fused deposition modelling (FDM) rapid prototyping (RP) process. The focus of the study is on the effect of FDM fabricated macro‐features of reservoir‐matrix DDD models on the drug release rates through the diffusion process.

Using various parameters involved with FDM, polymeric DDD matrices with different macro‐features are designed and fabricated on the FDM3000 machine. Experiments are conducted to study the release characteristics and porosity of the fabricated models with a model drug and to see how they are affected by FDM build parameters.

Experimental results show that FDM parameters, raster gap and raster angle, play significant roles in controlling the structure and drug release characteristics of the FDM fabricated DDDs. The experimental observations reveal that appropriate FDM parameters can be selected to fabricate controlled DDD device with desired release rate of drug and the desired period of operation of the device.

The paper introduces a novel application of FDM RP system in the development and fabrication of polymeric controlled DDDs. The controlled release of drugs is an important area in which RP techniques can be successfully used in developing models of release matrix for DDDs with added benefits of accuracy, uniformity and low costs compared with conventional methods.

The prevalence of cocaine use has been increasing since the mid-1990s in many European countries, Italy included. There is a large variety of patterns of cocaine use in natural settings, but on the whole, the existence of different patterns of cocaine use remains widely unknown to drug professionals, as well as to public opinion. The purpose of this paper is to investigate patterns and trajectories of use, the meaning of use within the context of users’ life styles, the perception of controlled/uncontrolled use, personal strategies to keep drug use “under control”.

This paper illustrates findings from a qualitative study among 115 cocaine users. Participants were recruited using the snow ball sampling (a minimum lifetime experience of 20 instances of cocaine use was required).

The findings confirm the variability of cocaine use trajectories and the prevalent tendency towards more moderate patterns of use. Such variability is in patent contrast to the disease model of addiction and its assumed predetermined linear trajectories. Set, and particularly setting and all the environmental factors, such as life events, appear to be the variables that can better explain the dynamic course of patterns of use.

The main limit concerns the non-randomisation in the selection of the nominees. Participants were recruited in the night entertainment scene of the main Tuscan cities through personal contacts of staff from risk reduction facilities: in spite of the personal and confidential approach, the number of “non institutionalized” users willing to collaborate was too low, therefore the authors decided to omit the randomisation.

The findings bear social implications as they can contribute to a change in the social representation of users so as to reduce the stigma. They can also prompt innovation in the operational models of drug services.

It is the first qualitative research from the “control” perspective ever led in Italy.