By Bridget Freisthler, ; Rouba A. Chahine, ; Jennifer Villani,; et al

Importance: The HEALing Communities Study (HCS) evaluated the effectiveness of the Communities That HEAL (CTH) intervention in preventing fatal overdoses amidst the US opioid epidemic.

Objective: To evaluate the impact of the CTH intervention on total drug overdose deaths and overdose deaths involving combinations of opioids with psychostimulants or benzodiazepines.

Design, Setting, and Participants: This randomized clinical trial was a parallel-arm, multisite, community-randomized, open, and waitlisted controlled comparison trial of communities in 4 US states between 2020 and 2023. Eligible communities were those reporting high opioid overdose fatality rates in Kentucky, Massachusetts, New York, and Ohio. Covariate-constrained randomization stratified by state-allocated communities to the intervention or control group. Trial groups were balanced by urban or rural classification, 2016-2017 fatal opioid overdose rate, and community population. Data analysis was completed by December 2023.

Intervention: Increased overdose education and naloxone distribution, treatment with medications for opioid use disorder, safer opioid prescribing practices, and communication campaigns to mitigate stigma and drive demand for evidence-based interventions.

The primary outcome was the number of drug overdose deaths among adults (aged 18 years or older), with secondary outcomes of overdose deaths involving specific opioid-involved drug combinations from death certificates. Rates of overdose deaths per 100,000 adult community residents in intervention and control communities from July 2021 to June 2022 were compared with analyses performed in 2023. RESULTS In 67 participating communities (34 in the intervention group, 33 in the control group) and including 8 211 506 participants (4 251 903 female [51.8%]; 1 273 394 Black [15.5%], 603 983 Hispanic [7.4%], 5 979 602 White [72.8%], 354 527 other [4.3%]), the average rate of overdose deaths involving all substances was 57.6 per 100 000 population in the intervention group and 61.2 per 100 000 population in the control group. This was not a statistically significant difference (adjusted rate ratio [aRR], 0.92; 95% CI, 0.78-1.07; P = .26). There was a statistically significant 37% reduction (aRR, 0.63; 95% CI, 0.44-0.91; P = .02) in death rates involving an opioid and psychostimulants (other than cocaine), and nonsignificant reductions in overdose deaths for an opioid with cocaine (6%) and an opioid with benzodiazepine (1%). CONCLUSION AND RELEVANCE In this clinical trial of the CTH intervention, death rates involving an opioid and noncocaine psychostimulant were reduced; total deaths did not differ statistically. Community-focused data-driven interventions that scale up evidence-based practices with communications campaigns may effectively reduce some opioid-involved polysubstance overdose deaths 

JAMA Netw Open. 2024;7(10):e2440006. doi:10.1001/jamanetworkopen.2024.40006

By Romi Sigsworth and Shaun Shelly

South Africa’s prohibitionist and punitive response to people who cultivate, sell and use drugs has failed to reduce the supply, demand or harms related to the use and trade in scheduled drugs. This report explores the universal costs and consequences of prohibition before providing a global contextualisation of current drug policy debates. It then outlines the historical context of drug policy in South Africa and suggests what might be done differently in the present and future to reduce the burden of drugs and drug policy in the country. Key findings • Despite the vast expenditure on a prohibitionist and criminal justice approach to drugs globally over more than five decades, drugs are more readily available at lower prices, drug use has increased significantly and the social and health harms associated with current policies and responses to drugs are substantial. • In South Africa, the criminalisation of people who use drugs is a massive burden on the police, courts and correctional services, as well as a significant barrier to resolving the economic, social and health challenges that communities face in developing an equitable and just society. • The current societal and political attitude towards people who use drugs, however, means that any changes to drug policy are unlikely to be radical or rapid until communities are  able to see the benefits of alternative approaches.

ENACT Africa, 2020. 28p.  

By María Calderón 

Mexican cartels represent a multifaceted and complex problem with significant implications for Mexico and the United States. These criminal organizations have long been a U.S. national security concern, which has become more severe with an increase of lethal drugs smuggled into the U.S., impacting millions of lives in North America. There are debates between governments and organizations on the most impactful way to combat these illicit groups. These have included the question of whether designating Mexican cartels as Foreign Terrorist Organizations (FTOs) would debilitate transnational criminal organizations and reduce the amount of drugs entering the United States. An FTO is a legal designation the United States government uses to identify foreign organizations that engage in premeditated, politically motivated acts of terrorism against noncombatant targets. Designating a group as an FTO carries legal and financial implications aimed at protecting national security. In the past, when Mexican cartels have harmed American citizens, members of Congress and other experts have been quick to propose an FTO designation for these organizations. However, designating a group as an FTO requires completing a specific and multi-faceted legal process and meeting certain criteria. The potential designation of Mexican cartels as FTOs is complex and contentious as it involves considering various implications, including security concerns, legal issues, and human rights impacts. This paper aims to explain the stages of an FTO designation and the roles of the various government stakeholders involved. Clarifying the complexities and technicalities of this process may prove beneficial when engaging in debates and weighing the potential impact of an eventual FTO designation for Mexican cartels.

Washington, DC:  Woodrow Wilson International Center for Scholars, 2024. 16p.

By Jane Shim, and Alison Leal Parker

  Drug laws are being reformed across the United States to move away from the harsh punitive approaches of the war on drugs, but federal immigration law continues to treat drug offenses, including decades-old offenses, as grounds for deportation of immigrants. Those harmed, authorized and unauthorized immigrants alike, often have deep connections to the country, where they have formed families, attained education, and built their lives. “Disrupt and Vilify” analyzes new federal government data from 2002 to 2020, finding the US has deported 500,000 people whose most serious offense was drug-related. Of these, 240,000 were deported between 2013 and 2020, amounting to about one of every five deportations of immigrants with a criminal conviction for that period. A conviction for even minor drug offenses—for example, drug possession (including marijuana)—can carry devastating immigration consequences that far outstrip the criminal sentence imposed. Some would not be criminal offenses if committed today or involve conduct that is now legal under state law. There are significant racial disparities in the imposition of immigration penalties. One out of five noncitizens facing deportation on criminal grounds is Black. Human Rights Watch and the Drug Policy Alliance call on the US Congress to reform federal law to ensure that immigrants with criminal convictions, including drug offenses, are not subject to “one-size-fits-all” deportations. Instead, immigration judges should have the discretion to make individualized decisions. Congress should impose a statute of limitations on deportations for past offenses. Drug policy reforms should prioritize evidence-based policies rooted in public health and human rights to address the root causes of the overdose crisis and problematic drug use, and not continue the vilification of immigrants.  

 New York: Human Rights Watch, 2024. 97p.

By The United Nations Office on Drugs and Crime (UNODC)

Understanding the changing dynamics of heroin and methamphetamine flows from Afghanistan, through southwest Asia to Eastern and Southern Africa, continues to be important, particularly in light of the Taliban’s drug ban in Afghanistan and the harmful effects drugs have on the populations along the route. In order to improve information sharing and to help build connections between countries and International Organisations and to strengthen regional co-operation, UNODC held an Expert Working Group in Maputo, Mozambique during 10th-11th October 2023. Topics discussed at the EWG included an update on the current drug situation in Afghanistan, the opiate and methamphetamine flows from southwest Asia to Eastern and Southern Africa, regional drug seizures, the nature of organized crime groups and a summary of the drug demand situation in the region. The findings of the EWG are published in this report. This EWG report covers the flow and distribution of heroin along the Southern Route, highlighting key trends and vulnerabilities. Exploration of the routes utilized for drug trafficking sheds light on movements from Afghanistan into Eastern and Southern Africa, within Africa, and towards other destination countries. Moreover, an overview of the demand for illicit drugs in the region offers insights into the societal impact and challenges faced by communities. Insight into the fragmented groups and the critical role played by brokers, as well as the strong presence of criminal networks, provides valuable context on the organized crime landscape. Furthermore, the EWG discussed the regional cooperation efforts aimed at addressing drug trafficking challenges and promoting collective action underscores the importance of collaborative approaches in responding to the drug trade in the region. An examination of the policy and law enforcement responses implemented by affected countries provides valuable insights into national efforts to address the supply and demand dynamics. Analysis of the various modus operandi and trafficking methods employed by organized crime groups, including poly drug trafficking and links to other crime types, enhances understanding of the operational tactics used in the region. Finally, recommendations for policy interventions and follow-up actions aim to enhance counter-trafficking efforts and promote regional security and stability. Through a comprehensive examination of these topics, this report seeks to provide valuable insights and inform stakeholders on the complexities of drug trafficking along the Southern Route, with the ultimate goal of fostering effective strategies and initiatives to combat illicit drug trade in the region.   

 Vienna:  UNODC  2024. 36p.

By Ben Mostyn

This article presents archival data produced by Australian diplomats in the 1980s that report on the ‘drug problem’ in various host countries. The reports reveal growing concern in many countries at a rapid increase in drug use. The second half of the article focusses on diplomatic reports from the United Nations where discussions were beginning about creating a third convention against drug trafficking. These early drafts of the convention labelled drug trafficking a ‘crime against humanity’—a criminal charge that had not been prosecuted since the Nuremburg trials. The article applies elements of moral panic theory, neorealism, and the sociology of punishment. Combining these theories suggests that condemning drug traffickers in the 1980s allowed diplomats to create a global social solidarity that may have helped end the Cold War.

Critical Criminology, August 2024. Crit Crim (2024).

By Drug Policy Alliance

In 2020, Oregon voters overwhelmingly approved Ballot Measure 110. This made Oregon the first state in the U.S. to decriminalize possession of small amounts of all drugs, while greatly expanding addiction services and social supports. But in 2024, state leaders recriminalized drug possession after a disinformation campaign led by drug war defenders and backed by corporate interests. Statewide criminal penalties for drug possession returned on September 1, 2024. Promised deflection programs were not ready, meaning people will be arrested and prosecuted because of their addictions. As before, drug use will be used as an excuse to arrest Black and Brown Oregonians at higher rates (they are statistically more likely to face incarceration and harsher sentencing due to targeted policing and enforcement). Oregon’s public defender shortage continues. People who are arrested will likely have their cases dismissed for lack of counsel. In a return to the failed war on drugs, people will cycle through the criminal legal system without connection to services. The successes of Measure 110 should neither be downplayed nor contributed to H.B. 4002. Measure 110 provided over $300 million for addiction services, including a program where police connect people to care without arrest. Policymakers must focus on implementing a thorough public health approach to drugs and real solutions to other pressing issues, not on the false promises of criminalizing drug possession.

New York: Drug Policy Alliance, 2024. 5p.

By Jo‑Anne Kramer,  Arjan A. J. Blokland, ·Edward R. Kleemans, Melvin R. J. Soudijn

In order to launder large amounts of money, (drug) criminals can seek help from financial facilitators. According to the FATF, these facilitators are operating increasingly business like and even participate in professional money laundering networks. This study examines the extent to which financial facilitators in the Netherlands exhibit business-like charac teristics and the extent to which they organize themselves in money laundering networks. We further examine the relationship between business-like behavior and individual money launderers’ position in the social network. Using police intelligence data, we were able to analyze the contacts of 198 financial facilitators who were active in the Netherlands in the period 2016–2020, all having worked for drug criminals. Based on social network analysis, this research shows that financial facilitators in the Netherlands can be linked in extensive money laundering networks. Based on the facilitators’ area of expertise, roughly two main types of professional money laundering networks can be discerned. Some subnetworks operate in the real estate sector, while others primarily engage in underground banking. Furthermore, the application of regression models to predict business-like behavior using individual network measures shows that facilitators with more central positions in the net work and those who collaborate with financial facilitators from varying expertise groups tend to behave more business-like than other financial facilitators

Kramer JA, Blokland AAJ, Kleemans ER & Soudijn MRJ 2023. Money laundering as a service: Investigating business-like behavior in money laundering networks in the Netherlands. Trends in Organized Crime.

By Luca Giommoni

This review examines a series of twelve studies led by James K. Cunningham and his team, focusing on the effects of precursor regulation on illicit drug markets. Their research shows that the regulation of chemicals essential for the production of drugs such as heroin, cocaine, and methamphetamine is associated with several positive outcomes. These include a decrease in drug purity, a reduction in seizures, lower demand for treatment and hospitalization, and an increase in drug prices. According to the research, this decrease in harmful outcomes results from a combination of diminished overall consumption and a reduction in harm per dose. However, this review identifies some inconsistencies within their studies. These inconsistencies include premature assumptions about the timing of intervention impacts, uneven influences of similar interventions, variations in the implementation of these interventions, and the disregard of alternate explanations for sudden shifts in drug markets. Cunningham's work can be considered one of the most substantial contributions in this field. However, to secure the full confidence of the drug policy community in the authenticity of their findings, they must effectively address the issues identified in this review.

International Journal of Drug Policy 17 June 2024, 104498

By Tobias Kammersgaard  , Kristian Relsted Fahnøe  , Nanna Kappel  , Katrine Schepelern Johansen , Esben Houborg 

Based on a survey (n = 249) and qualitative interviews (n = 38) with marginalized people who use drugs (PWUDs) in Copenhagen, Denmark, we investigate the experiences of this group with the police in a context where drug possession had been depenalized in and around drug consumption rooms (DCRs). Our findings point to positive experiences with the police, especially with the local community police in the depenalization zone, who refrained from drug law enforcement and practiced ’harm reduction policing.’ However, marginalized PWUDs also reported that they were still targeted for drug possession by other sections of the police despite the depenalization policy. Specifically, the drug squad of the police would continue to confiscate illicit drugs for investigatory purposes to counter organized drug crime, as well as continue to target user-dealers who were not formally included in the depenalization policy. The findings illustrate how marginalized PWUDs still found themselves in a precarious legal situation without any legal rights to possess the drugs that they were dependent on, even though possession of drugs had been depenalized in and around DCRs.

International Journal of Drug Policy 127 (2024) 104393 

By Peter Leasure

Nearly all states, including Ohio, have laws increasing punishments for drug trafficking in or near schools, though there are long-standing concerns for how these laws function. With a novel inquiry of school leaders, the current study explores whether Ohio schools displayed signage that was viewable by the general public stating that drug traffickers could face enhanced penalties if the conduct occurred on or near school premises. The current study also sought to gauge school principal perception about the deterrence effectiveness of such signs and whether enhanced penalty laws should explicitly require that individuals know they are on or near school premises to receive a penalty enhancement. The results of this survey of Ohio school principals suggested that the vast majority of Ohio schools lack any signage seeking to notify individuals of enhanced penalties for drug trafficking or that generally seek to deter drug trafficking. The results also showed that a majority of Ohio principals believed that the Ohio Revised Code should require that individuals know they are on or near a school's premises to receive increased penalties for drug trafficking (e.g., selling drugs) on or near school premises. Policy recommendations informed by the above findings are discussed.

Drug Enforcement and Policy Center. March 2024, 11pg

By Jonathan Goodhand, Patrick Meehan, Camilo Acero, and Jan Koehler

This research paper is the second in a three-part series analysing the nexus between paramilitaries, illicit economies and organised crime in borderland and frontier regions. This research challenges the idea that paramilitaries are symptomatic of state breakdown, flourishing in marginal spaces suffering from ‘governance deficits’; and that they can primarily be understood as apolitical, predatory self-enriching actors, driven by economic motives, and operating outside formal political systems.

In this research paper, a set of detailed case studies are presented that explore coercive brokerage in Afghanistan, Colombia and Myanmar that seek to address these ideas, drawing upon data and analysis generated by a four-year Global Challenges Research Fund (GCRF) project, Drugs & (Dis)order (https://drugs-disorder.soas.ac.uk), and other relevant research.

Birmingham, UK:  University of Birmingham. 2023, 65pg

By R. Santamarina  D. Caldicott , J. Fitzgerald , J.L. Schumann 

Background : Illicit drug use is overrepresented in music festival attendees compared with the general population. Drug use often involves a wide range of substances with the potential to cause drug toxicity. Law enforcement-centred strategies intended to deter drug use and supply at these mass gatherings have been implemented throughout Australia. However, many have been criticised for their lack of effectiveness, with evidence suggesting that they can inadvertently increase the risk of drug harm. Drug deaths are often multifactorial, providing added challenges in the development of prevention strategies. This study aimed to determine the frequency of deaths involving alcohol and other drugs at music festivals in Australia and to identify potential risk factors that may inform future harm reduction strategies.

Methods : A descriptive case series study was conducted using the National Coronial Information System (NCIS) to investigate drug-related deaths at music festivals throughout Australia between 1 July 2000 (Queensland from 1 January 2001) and 31 December 2019, using a list of keywords comprising music festival names and terms.

Results : There were 64 deaths, of which most involved males (73.4%) aged in their mid-20s (range 15-50 years). Drug toxicity was the most common primary cause of death (46.9%) followed by external injuries (37.5%). The drug most commonly detected or reported as being used was MDMA (65.6%), followed by alcohol (46.9%) and cannabis (17.2%), with most cases reporting the use of two or more drugs (including alcohol) and 36% reporting a history of drug misuse in the coroner's findings. Most deaths were unintentional, with less than a fifth of cases (17.2%) involving intentional self-harm. Clinical intervention was involved in 64.1% of cases and most festivals occurred in inner city locations (59.4%).

Conclusions : The findings suggest that drug-related deaths at music festivals in Australia typically involve young people using multiple illicit substances in combination with alcohol. Most are unintentional and could potentially be prevented through the implementation of a range of harm reduction strategies, including mobile medical care, drug checking services, and increased consumer education and awareness.

International Journal of Drug Policy Volume 123, January 2024, 104274