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Charting a New Global Course for Dealing With Illicit Drug Use

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International Overdose Awareness Day 2022 in Barcelona. The annual UN Commission on Narcotic Drugs session agreed to make a major policy shift on drug use, moving from a criminalization approach toward harm-reduction measures. TELUOBIR/CREATIVE COMMONS

This year’s meeting of the United Nations Commission on Narcotic Drugs in Vienna marked a significant shift in policy when it agreed to focus on drug use as a public health issue that required an approach of harm reduction. This stance moves from the criminalization of drug use and brings the commission in line with the approach of the UN General Assembly, the World Health Organization, UNAIDS and the UN Office of Human Rights, all of which revised their policies a decade or more ago.

The annual meeting of the CND, as it’s known, helps set the direction of drug policy for UN member states, and in previous years it reflected the position of the UN Office on Drugs and Crime, its parent entity. The focus was on suppressing the use of drugs and policing, which has not been successful, and I’ve been advocating for more than two decades for an evidence-based approach to address drug production and use.

The CND reached this new policy partly by discarding its past agreement that all its decisions need to be reached by consensus (the so-called “Vienna spirit”) and held votes on the resolutions for the first time. This allowed the shift to a harm-reduction policy, a term that was excluded from resolutions because of opposition from the handful of countries committed to the criminal justice approach.

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The United States also put forward a resolution on overdose prevention that focused on harm reduction, reflecting a shift in attitudes in the American government that would have been unimaginable until relatively recently. There is an acknowledgment across various levels of government and law enforcement that the “war on drugs” strategy has failed. More 100,000 overdose deaths in the US last year were linked to the opioid epidemic, setting a grim new record.

For the vote on the US harm-reduction resolution, 38 commission members supported it, with six abstaining (Algeria, Armenia, Bangladesh, Dominican Republic, Iran and Zimbabwe). Only Russia and China voted against it. Both decisions — to move from consensus decision-making and to approve the US resolution — reflected other fundamental changes evident at the CND, which is partly driven by geopolitics.

The main international champion of the punitive approach to drug use is now Russia — its international position mirroring its domestic focus on repression, criminalization and punishment. But since its full-scale invasion of Ukraine two years ago, Russia’s diplomatic clout at the UN has dwindled. At the CND, Russia’s views on drug policy held less power as well, and few countries were sympathetic to allowing its domestic political agenda to obstruct the evolution of global policy.

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This change also created a forum where members from the global South could share their views. The ministerial segment of the CND opened this year with Colombia leading a coalition of 62 countries to call for reform, denouncing the failures of the existing international drug control system and its focus on interdiction and suppression, and calling for new policies based on human rights and evidence-based approaches.

Colombian President Gustavo Petro said in his video address that the drug control system in Vienna “has failed” and that there is a critical need for a new approach that places public health above criminalization. Petro added: “Illicit drugs are easily accessible to everyone, while controlled medicines do not reach the patients who need them most.”

The shift is long overdue. We know that moving away from criminalization and incarceration and implementing harm reduction at scale, such as needle and syringe exchange programs, will encourage people who need help to seek support. We know criminalization of personal drug use prevents people from coming forward even when resources are available.

This year’s CND session also underscored the indispensable role of civil society in engaging with like-minded countries. With more than 100 side events, civil society organizations played a crucial role in broadening the scope of discussions and advocating for evidence-based applications to drug policy.

As for the US, Secretary of State Antony Blinken, who attended the meeting in Vienna, in March, told delegates that the US is now dedicating more resources to tackling demand for drugs than to halting the supply. That includes more resources for public awareness as well as efforts to prevent and treat drug use and prevent overdose and other harms, alongside measures to combat the illicit manufacturing and trafficking of drugs.

What happens next? The resolution passed at the 67th Commission in Vienna is only effective if countries actively support and implement harm-reduction and nonpunitive approaches. Progress has been slow: Since 2018, only five countries have met the target of providing 200 sterile needles and syringes per person who injects drugs. In the same time period, only three countries have achieved the target of 50 percent coverage of opioid agonist maintenance therapy among people who inject drugs, according to UNAIDS.

The criminalization of drug use and possession for personal use in at least 145 countries, combined with stigma, discrimination and violence, continues to limit access to life-saving harm-reduction services. Can we seize this moment to join leaders from Colombia and others and bring the conversation from Vienna into the real world, driving change and progress?

This evolution of the conversation around the world makes me hopeful that the health-focused approach centered on harm reduction is gaining traction and will help the world deal with the scourge of drug use in a more intelligent, effective manner.


This is an opinion essay.

We welcome your comments on this article.  What are your thoughts on the harm reduction approach?

Kasia Malinowska-Sempruch, Ph.D., directs the Open Society Foundation’s Drug Policy Program.

We would love your thoughts. Please comment:

Charting a New Global Course for Dealing With Illicit Drug Use
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Dr Bilali Camara
Dr Bilali Camara
24 days ago

Kasia, this is an excellent input re CND-UNODC future policy direction with the support of member states, however without China, Russia and Africa in general the new approach will not achieve the impact it should achieve. Therefore, to prevent polarisations it would be better that future policy proposals at CND-UNODC will come from countries which are successful in harm reduction strategies through human rights approach and evidence-based public health policies and to avoid proposals coming from a member of the United Nations Security Council such as the USA. I would like to add that during my career, I had the opportunity to serve in a Methadon-Bus in Amsterdam and help in the Coffeeshops and manage clean syringes programmes and these public health approaches work very well for the peoples directly (wellbeing and health of the people, demand reduction, etc..) and indirectly (e.g. reduction in transmission of diseases such as HIV, Hepatitis, etc.), so I fully agree with this new policy direction of the CND-UNODC and encourage all member states to adopt and implement for the benefit of we the peoples.

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