INCB Annual Report 2015

However, INCB is convinced that these challenges can be met by fully implementing the conventions and the principles of the political declarations. The drug control system is a balanced system, driving towards improving public health and welfare, based on the underlying principles of proportionality, collective responsibility and compliance with international human rights standards. Implementing this system means putting the health and welfare of mankind at the core of drug policies, applying comprehensive, integrated and balanced approaches to elaborating drug control policy, promoting human rights standards, giving higher priority to prevention, treatment, rehabilitation and the reduction of the negative consequences of drug abuse, and strengthening international cooperation based on shared responsibility

States parties to the treaties have a certain flexibility in their interpretation and implementation of the treaties, within the boundaries that they themselves set out and agreed upon during treaty negotiations. The treaties provide for alternatives to punishment: they do not require the incarceration of drug users for drug use or minor offences. Instead of or in addition to conviction or punishment, States can take measures for the prevention of abuse of drugs and for education, early identification, treatment, aftercare, rehabilitation and social reintegration of affected persons. In addition, States have a certain latitude regarding the sanctions they apply against unlawful behaviour, subject to their constitutional principles and the basic concepts of their legal systems

33. Incorporating the provisions of the international drug control conventions into national law is subject to the internationally recognized principle of proportionality. That principle guides a State’s response to acts prohibited by law or custom. When applied to the criminal justice system, the principle permits punishment as an acceptable response to crime, provided that it is not disproportionate to the seriousness of the crime

34. Whether or not a response to drug-related offences is proportionate depends in turn on how the legislative, judicial and executive arms of government respond in both law and practice. Given their limited resources, Governments should ensure that law enforcement and justice systems accord high priority to investigating, prosecuting and convicting the most violent of actors and those involved in the illicit supply chain, such as those who control, organize, manage or provide inputs, production and other services for drug trafficking organizations

35. The conventions oblige States to ensure that possession of drugs—even in small quantities—shall be a punishable offence. At the same time, the conventions offer alternatives to conviction or punishment including treatment, education, aftercare, rehabilitation and social reintegration. The 1988 Convention allows a certain flexibility regarding sanctions for possession for personal consumption, making that obligation subject to the constitutional principles and the basic concepts of the legal system of States. As the Board has stated on numerous occasions, the international drug control conventions do not require the incarceration of drug users. Rather, they oblige States parties to criminalize supply-related behaviour while encouraging them to consider prevention, treatment and rehabilitation as alternatives to punishment

36. Drug control action must be consistent with international human rights standards. (…) The Board has also advised all countries that continue to retain the death penalty for drug related offences to consider abolishing capital punishment for this category of offences

44. States should provide effective and humane help to people affected by drug abuse, including both medically appropriate and evidence-based treatment. Drug users should be offered alternatives to punishment. Harsh treatment programmes, including any that involve the use of physical punishment, should be discontinued. Evidence based treatment modalities that have been found to reduce drug abuse behaviour deserve consideration. Reducing drug abuse is a major step towards protecting and improving the health and well-being of individuals and societies. Reducing the adverse health and social consequences of drug abuse is a complementary element of a comprehensive demand reduction strategy. However, prevention of substance abuse in society in general, and in particular among young people, should remain the primordial objective of government action

48. INCB has urged Governments, in their implementation of the treaty obligations incumbent upon them, to take a balanced approach to the formulation of drug policy. Such an approach should have the welfare of humankind at its centre and should reflect the following imperatives: the need to control licit trade in controlled substances to prevent their diversion for trafficking purposes while not hindering their availability for legitimate medical and scientific purposes; the need to have structures in place for the prevention of drug abuse, the early identification and treatment of drug abuse and the education, aftercare, rehabilitation and social reintegration of persons affected by drug abuse; and the need to have drug policies that respect human rights and penal policies that are proportionate and measured, in keeping with the 2009 Political Declaration and Plan of Action on International Cooperation towards an Integrated and Balanced Strategy to Counter the World Drug Problem

138. According to the French authorities, the establishment of drug consumption rooms is part of the country’s “harm reduction” policy and has three main objectives: to forge links with drug users who constitute a marginalized group often having little or no contact with the formal health-care system and to bring them back into the system; to reduce the transmission of blood-borne diseases among individuals who abuse drugs by injection and reduce drug overdose cases; and to reduce the nuisance and disturbance to public order of drug abuse by injection

147. The National Commission on Narcotic Drugs of Morocco has continued to adopt measures for the implementation of the international drug control treaties. Over the past two years, Morocco has extended its national action plan on drug use, creating more treatment centres throughout the country. Morocco has implemented its national action plan on harm reduction, launching new opiate substitution treatment programmes and initiating the first such programme in a prison setting.

349. The Government of Senegal has increased the availability and accessibility of services for the evidence based treatment and care of drug dependence by setting up in December 2014 the Dakar integrated treatment centre for persons with addictions. The centre, located at the University Hospital of Dakar, also provides a methadone maintenance programme, drug dependence treatment services, outreach programmes and programmes for the treatment of HIV infection and hepatitis infection for drug users.

351. In Kenya, after an opioid substitution treatment facility (known locally as a medically assisted therapy clinic) was opened in Nairobi in December 2014, a second facility was opened in Malindi in February 2015 and two others were opened in Mombasa in September 2015. The national medically assisted therapy programme, launched on 18 August 2015, has been made available to people who inject drugs. In 2014, there were approximately 18,327 injecting drug users in Kenya, about 18 per cent of whom were HIV-positive, which is significantly higher than the HIV prevalence in the general population (5.6 per cent).

405. In February 2015, the United States Government announced that the President’s 2016 budget submission to Congress would request historic levels of public funding for “health responses to illicit drug use” totalling more than $25 billion. (…) Additional funding will be provided to the Centers for Disease Control and Prevention to study measures to curb heroin overdose deaths and provide naloxone, which is used to rapidly counteract the effects of opioid overdose, to first responders and train them in its use. Part of the earmarked funds will also be used to offer substance abuse treatment to all eligible federal prison inmates through the Department of Justice’s Federal Bureau of Prisons.

406. In July 2015, Health Canada announced that it was reviewing the prescription requirement for naloxone. That initiative comes at a time when opioid overdoses continue to increase across the country. As a first step towards facilitating access to the medicine, the federal Government was undertaking consultations with provincial and territorial health authorities to collect information about the use of naloxone, in particular with respect to the possibility of allowing a wider range of professionals, including first responders, to inject patients with naloxone.

438. While the Canadian Pharmacists Association have identified fentanyl-related overdoses as a public health threat affecting people from all parts of the country, the problem has been particularly acute in the provinces of British Columbia, Alberta and Ontario. According to the British Columbia Coroners Service, of the 300 deaths related to opioid overdose in 2014, approximately 25 per cent involved fentanyl, compared with 5 per cent in 2011. In Alberta, public health authorities have indicated that 120 people died as a result of fentanyl-related overdoses in 2014, compared with 6 overdoses in 2011. In order to address the growing public health risk, British Columbia launched the “Know your source” initiative in March 2015 to make the public aware of the dangers of 60 INCB REPORT 2015 consuming fentanyl-laced drugs, suggest ways of minimizing overdose risks and direct the public to public health resources. The province has also increased its distribution of “take-home naloxone kits”, which began in 2012. In August 2015, provincial health authorities announced that 250 overdoses in the province had been reversed since the kits first became available in 2012. Similarly, the Government of Alberta began implementing a “take-home naloxone” programme across the province in the summer of 2015 in response to the growing number of fentanyl-related deaths in the province. The take-home project provides naloxone kits to people who are at high risk of overdose so that the drug can be administered immediately should an overdose occur.

536. In 2014, the Indian Parliament adopted the Narcotic Drugs and Psychotropic Substances (Amendment) Act, 2014. The amending act introduced major changes to national policy and legislation, including the establishment of a new category of drugs referred to as “essential narcotic drugs”, through which the central Government could list drugs of medical and scientific use and which would include morphine, fentanyl, methadone, among other drugs. Narcotic drugs identified as essential were made subject to a single set of rules that applied throughout the country, whereas before the amendment, each state used to have its own regulations. The power to amend the rules were vested in the central Government to ensure uniformity. Under the amending act, institutions wishing to use essential narcotic drugs would require a single licence instead of the several licences previously needed. The changes were likely to simplify access to drugs essential for pain relief and palliative care, making them more readily available to the patients who needed them

453. The countries of the region are taking action to ensure the availability of narcotic drugs and psychotropic substances for medical purposes. The Inter-American Convention on Protecting the Human Rights of Older Persons, adopted in June 2015 by the General Assembly of OAS, which in its article 19, entitled “Right to health”, urges Member States to ensure the availability of controlled medicines for the rehabilitation and palliative care of older persons. Palliative care is required in the treatment of cancer and many other diseases and for end-of life patients of all ages. Some countries in the region have reported a low level of consumption of narcotic drugs and psychotropic substances for medical use

763. (…) The international drug control system should promote the application of scientific knowledge, respect for human rights and the principle of proportionality in dealing with the set of problems related to drugs.

764. (…) Recommendation 2: States should promote alternative livelihood programmes in order to support communities and provide farmers engaged in illicit drug crop cultivation with licit and sustainable income-generating activities that can reduce and eliminate their dependency on income from that illicit crop cultivation. Such programmes include, inter alia, services related to health, education, infrastructure, community development and security

765. Recommendation 3: (…) Reducing the adverse health and social consequences of drug abuse is an essential element of a comprehensive demand reduction strategy. States should provide effective and humane assistance to people affected by drug abuse, including both medically appropriate and evidence-based treatment. (…) States should ensure that sanctions for drug-related criminal offences are proportionate and, where such offences are committed by drug users, consider alternatives to conviction and punishment as provided for in the treaties, such as treatment, education, after-care, rehabilitation and social reintegration