Opening and results of CSTF engagement in UNGASS preparatory process

Chair, CSTF – Many different groups are affected by the world drug problem, and there is thus a common and shared responsibility to engage in the debate in good faith. Many events held by the CSTF have honored this obligation. Working together can be challenging, especially when strong views are held. Hold an open mind. Inclusive and balanced processes are the most likely to ensure optimal results. Here for the benefit of all affected populations. For now, there are areas of strong consensus among civil society, such as access to essential medicines and concerns about the death penalty. There is a keen interest in a public health approach to drug policy, access to medicines, and adequate harm reduction services. The role civil society can play has been highlighted again and again. Civil society is a key resource in designing and implementing interventions. Need for funding, particularly for youth initiatives, must be provided to make harm reduction interventions available to all demographics that use drugs. Diverse opinions are also expressed, notably about decriminalization and legalization trends. Some advocate for making use of the flexibility within the conventions, other suggest that time has come to rethink approaches and experiment with other policy options outside the conventions. In conclusion, when negotiating the outcome document, please remember to walk in the shoes of those whose health and welfare we are trying to promote.

Vice-Chair, CSTF – Informal Interactive Stakeholder Consultation convened in NYC by the PGA to support inclusive, active, and substantive input of civil society into the UNGASS process. Supported by CSTF and UNODC. PGA opened and closed the meeting. Secretary General also spoke. Two roundtable discussions, one on drugs and health and the other on drugs and human rights, communities, and development. Inclusive event. Over 150 people present from all over the world, as well as UN agencies and member states. Speakers were chosen through an open call conducted by the CSTF, who then gave recommendations to the PGA. Speakers were from all over the world. Spoke on many topics, from treatment to prevention and harm reduction. Inclusive and participatory part of the UNGASS process. Summary was issued by the PGA. Official document of the UNGASS process. Key themes that emerged, not areas of consensus, include: Need for people and human rights centered approach. Lack of access to controlled medicines. Harm reduction services and consensual treatment must be scaled up. Gender and age sensitive services. Services available in closed settings, like prisons. Drug problem perceived as a health issue, not a criminal justice issue. Critical need for active involvement of young people in design of drug policies. Drug policies must take into account social and economic vulnerabilities. Criminalization of drug use undermines health and wellbeing of people who use drugs. Alternatives should be considered, such as decriminalization and regulation. Civil society input is critical to success of UNGASS. Second roundtable: Focus on link between poverty, drug problem, insecurity and violence. Abolition of the use of the death penalty. Proportionality. Traditional uses of plants should be recognized and even removed from prohibition. Farmers should be included in design of alternative development programs. Enhanced system-wide coherence needed to ensure SDGs are achieved. More effective use of metrics and indicators. Varying points of view on legalization of drugs, but merits further discussion. No consensus on drug free world language. Independent expert group to provide suggestions at the 2019 review. Event video recording is available online.

CSTF Representative on Prevention – Short summary on CSTF survey. Answers came from NGOs around the world. Web-based survey. Nine questions were qualitative in nature. Aim of survey to identify and explore work of NGOs, find key priorities to be addressed at UNGASS, and what the expected outcome of UNGASS was. Report written in English translated into multiple languages. Report based on 1,172 responses. Aim of CSTF is to be as inclusive as possible. Some organizations working on local level felt they were outside of the preparations. Barriers limit participation, such as financial means and language. Include affected populations more in preparations, such as women, farmers, recovered users, LGBT, etc. Concerned that UNGASS will not lead to a real change, and not affect people working on the ground. Drugs and health – Need for evidence-based prevention, specifically for youth. Widespread adoption and availability of harm reduction. Funding concerns for prevention and treatment. Concern over treatment availability. More public health response to drug use. Address stigma. Access to controlled medicines. Drugs and crime – Unequal enforcement of policies. Harms of drug trafficking. Evaluate current system using better indicators. Divided view on policy experimentation. Drugs and human rights, women, and communities – Drug related issues affecting youth need more attention. Gender issues. New challenges, threats, and realities – NPS and the implications they have. Measures for treatment and harm reduction for NPS. Diverse views on conventions, as some are concerned over current developments of trying to change conventions while others welcome it. Diverse views on regulation and decriminalization. Alternative development – Concerns over local development. Concerns over farmers and their views not being heard enough.

Reports from Regional and Thematic Consultations

Western Europe – Held a meeting with mostly NGOs from Western Europe. In addition to this meeting, there was a broad electronic consultation. Three different consultation events. Consulted with over 100 different organizations over 30 countries. In Western Europe, found that a pragmatic public heath and evidence-based approach works well. In terms of the conventions, people thought they provided sufficient flexibility. Many more challenges. Tackling NPS. Use of internet for supply and distribution. Funding, for harm reduction services and rehabilitation programs. We have quite good drug treatment services. They are supplied by different people in different places, but they are not talking to each other. People can’t easily progress through the pathway of different services. Over reliance on enforcement, rather than health. Evidence about what works. Broad support against the use of the death penalty. Focus should be on large criminal networks and governmental corruption, rather than low-level drug traffickers. Proportionality in sentences, and alternatives to incarceration. Respect for human rights. Ensure that EU funding is not complicit in abusive forms of drug rehabilitation and use of the death penalty. Address changes happening outside of UN conventions and explore mechanisms to address these tensions before 2019. On alternative development, many people thought it should be a key theme of the UNGASS process. Not only does development need a stronger role in drug policy, drug policy should play a stronger role in development. Programs should be bottom up to meet the needs of communities. AD programs should focus on survival, sufficiency, and sustainability. Indicator for developments should be included in UNODC metrics. UNDP play a larger role. More research on effectiveness of AD programs.

Australia, New Zealand, and the Pacific – There are many positive aspects to our drug policies. The early adoption of harm reduction approaches has ensured that we have saved thousands of lives and have one of the lowest rates of HIV around the world. Research finds that harm reduction saves substantial financial resources. These very services have not been extended to prisons, one of the major sources of the spread of blood borne viruses. Health and law enforcement work together and has been fundamental to an integrated approach to the reduction of supply, demand, and harm. National drug strategy includes illicit and licit drugs, and is a real strength. Disproportionate attention going to increased security, law enforcement, interdiction, and border protection. Insufficient attention on prevention and treatment. Evidence on effectiveness in response to drugs. Civil society members are not able to participate in closed or informal processes. NPS regulation in NZ. Australia now is looking at new regimes for medical cannabis. Innovative approaches remain pilot projects or get caught up in political debates, and haven’t been scaled up. More innovation needed to meet the ever evolving complexities of drug markets. Evidence needs to play a more central role in determining where funding goes. Good data on treatment, but resources don’t go there. Harm reduction proven to be very effective yet not much finding. Indigenous people are shockingly overrepresented in criminal justice system. Need to recognize and prioritize the UN convention on the rights of indigenous people. Human rights need to be front and centre to any approaches to drugs.

Michael Botticelli, USA – Thank you to CSTF for hard work and evidence-based policy work they are doing. NGOs that do this work are the laboratories of innovation. Learned a lot about substance use disorder. Millions of people in my nation and around the world not seeking treatment for addiction is tragic. Need to get help to those who need it. Time to move beyond talk and to action. Use evidence-based policies, like naloxone. US congress recently reversed a ban on funds for federal funding of needle and syringe programs. Funding for demand and supply reduction are equivalent for the first time in the US drug budget. Reduce stigma to encourage people to seek treatment. How we view people with substance use disorders impacts policy. Include people’s individual privacy rights. Request for treatment should not be seen as a chance to add a name to a government database, but as an opportunity to promote public health. Must reject failed policies of the past. Add my voice to the calls for a strong and meaningful role of civil society.

Eastern Europe and Central Asia – Support for harm reduction services. Only when there is collaboration between law enforcement and harm reduction services can we keep blood borne infections under control. Ingredients for success include harm reduction, OST, and decriminalization. People who use drugs should be referred to treatment instead of incarcerated. More investment in treatment and social integration. Should be different treatment for different needs. Proportionality in sentencing. Better alternatives for incarceration. Removal of criminal offences. Drugs and human rights. Prevention-based strategies. Need to adapt alternative development practice to religious and cultural practices. No fumigation or eradication. Only pushes farmers further into poverty.

Northern Africa and the Middle East/Central Asia – Global civil society survey translated and disseminated to the region. Designing and convening an “Expert Advisory Group.” Couple of national consultations in Iran, Afghanistan. Online survey also designed and distributed to the region. Criminalization and punishment of possession for personal use should be reduced in favor of alternatives. Punishment is not the appropriate approach. Consider abolition of the death penalty. Terrorism is linked to drugs. Lower drug purity leads to more harm for the individual and community. Alarming rate of death because of impurity of substances. People should have choice of a wide range of approaches to abstinence-based treatment. A lot was discussed about the role of international organizations in the region, and challenges with working with them. Alternative development. Strive for inclusive economic growth. Corruption should be tackled immediately. Eradication policies are ineffective.

Sub Saharan Africa – Visited eight countries for the consultation. Drugs and health – Need to prioritize health over law enforcement. Need resources to support economic challenges of states. States should ensure that there is access to scheduled substances for palliative care. More than a billion people living in countries without access to essential medicines. More research in the region to develop our own evidence-based services in line with regional and country realities. Drugs and crime – Rebalance of funding from law enforcement to health. Need more synergy between civil society and diplomats aboard. Human Rights, Women, Children, and Communities – Eliminate death sentences for drug-related offences. PWUD deserve health services, not incarceration. Have the right to health and social services, and respect for their human rights. Everything should be done to prevent children from accessing illegal drugs. Current model hasn’t accomplished this, and need to consider other models. New challenges – Alternatives to incarceration for some drug-related offences. Facilitate access to health including treatment, rehabilitation. Drugs and development – International funding mechanism to provide equitable means for alternative livelihoods. Stop aerial spraying of cannabis crops by law enforcement.

Voices of Harm Reduction – A number of consultations. Harm reduction has been successful in a number of settings. Harm reduction should be seen as an underpinning principle, rather than a set of interventions. Support for harm reduction as a means for realizing the highest attainable standard of health has never been stronger, but the gap in funding is substantial. Other challenges include human rights violations against PWUD, high levels of overdose, mass incarceration, blood borne infections. Acknowledge missing the global goal to reduce HIV infection among people who inject drugs. Endorse and adopt harm reduction as a key strategy. End the criminalization of PWUD. Urgently scale up harm reduction programs including OST and NSP, including in prisons. Corse package of interventions in the WHO, UNODC and UNAIDS Technical Guide. Close compulsory drug treatment centres.

Voices of Youth – Online survey format. We reached 71 organizations and 269 individuals with representation from every region. Survey was active and open between November and December 2015. What has worked well is preventing drug use through youth empowerment. Lack of engagement from society in preventing harm. Increased responsibility by national government. Civil society do not find government take responsibility they should. Lack of funding for civil society initiatives. Lack of opportunity for employment. NPS. Drugs and health – Treat world drug problem as a health issue. Increase civil society initiatives focused on prevention. Increase access to treatment and social services. Acknowledge mental health issues. Improve controlled access to prescription drugs. Drugs and crime – Measures to challenge stigma. Consider option of treatment over incarceration. Abolish the death penalty. Drugs and human rights – Protect children from drugs use. CRC. Protect children from domestic violence. Counter human rights violations. Improve access to harm reduction and health care measure. Introduce policies effectively countering NPS. Improve access to evidence-based information. Alternative development – Empower low income communities. Reduce stigma. Introduce employment opportunities.

Voices of Farmers – Sixty people involved from forty different countries. Forced eradication affects the human rights of farmers. Environment is also affected. Many lives are lost. Other plants are destroyed. Families lose their incomes because of eradication, pushing them further into poverty. Traditional and modern uses of plants must be recognized. International controls limit legal access to traditional plants. Without access to modern healthcare, rely on these substances. Cannabis, coca, opium. No access to alternative development programs. Eradication should not be a precondition to receiving support from international donors. Famers face conflict through interventions of authorities to control crops, and through drug market itself. Go against the real drug trafficker, not farmers. Should not be criminalized for growing these crops. Stop investing in war, invest in us. Heemskerk Decalaration will be brought to NYC at UNGASS as the voices of farmers.