Implementation of the International Guidelines on Human Rights and Drug Policy – current experiences

Hi all!

A warm welcome to the “International Guidelines on Human Rights and Drug Policy: Reviewing Progress and Catalysing Future Action” consultation! I will be one of your moderators, together with colleagues that will also introduce themselves.

We are excited to hear your views, reflections, and experiences as we assess how the International Guidelines on Human Rights and Drug Policy have been implemented and what more can be done to strengthen human rights–based drug policy. The Guidelines mark a milestone in aligning drug control with human rights obligations — and this consultation is an opportunity to take stock of progress, identify challenges, and envision the road ahead. You can dowload them in English, Spanish, Russian and Portuguese here.

You can respond to the questions above in any order and you can also bring other issues from your work and experience and we look forward to engage and learn from these conversations.

Feel free to contribute in any language by clicking the language button at the top right of the page — the platform will automatically translate your comments.

We look forward to a rich, thoughtful, and engaging discussion this week. Thank you for joining us in this important conversation!

Hi! We are Youth RISE, an international network of young advocates, including young people who use drugs and youth affected by punitive drug policies. Much of our work draws from the International Guidelines on Human Rights and Drug Policy—especially the section on youth—as the foundation for our advocacy, program design, and evidence generation. These guidelines guide our priorities: advancing youth rights, meaningful youth participation, and non-discriminatory access to health and harm reduction services in all settings.

Every day, young people who use drugs face barriers to accessing health and support. Such barriers are documented in the 2025 Youth Statement on the new Global AIDS Strategy and Future High-Level Political Commitments on the AIDS Response, created by organisations led by young key populations worldwide. The statement will be posted on Tuesday, October 21st (keep tuned!). Youth RISE encourages you to read and share the Statement within your networks.

Gaps in harm reduction are stark for all age groups, but the outlook for young people is even grimmer. Indeed, young people account for a quarter of all people who inject drugs globally, with 15–24-year-olds experiencing HIV and Hepatitis C risks 1.5 times greater than adults. Only about 22% of all people who inject drugs live in countries that meet UNAIDS-recommended needle and syringe programme coverage, and even fewer have equitable access to opioid agonist therapy and peer-led services. Evidence points out that nearly a quarter of all people who inject drugs experience a non-fatal overdose each year, with younger groups hardest hit. New generations of young people are starting to inject drugs, and they are being failed by the very systems meant to protect them.

Last year, Youth RISE, in collaboration with the International Network of People who Use Drugs and the Global Fund, conducted a study on youth-friendly health services. We found that barriers range from age-restricted service models to legal frameworks that criminalize rather than support. Patterns documented in Nigeria (where 72% of clients in needle exchange pilots are under 30), Kyrgyzstan (where less than 10% of young people who use drugs can access harm reduction), and Tanzania (where parental consent is required for those under 18) all highlight the urgent need to eliminate structural barriers and discrimination. Data shows that age and other legal restrictions leave youth caught between criminalization and adult-centered services. 

The global context for harm reduction and AIDS work is now profoundly concerning. The planned sunset of UNAIDS by 2026 threatens the infrastructure and unique energy that UNAIDS has brought to rights-based responses, harm reduction, and youth participation. UNAIDS was the first UN agency to invest in Youth RISE, catalyzing opportunities for us to collaborate with other UN partners and securing youth representation in major policy spaces. Its loss puts at risk not just vital funding, but core mechanisms for youth and key population inclusion at the very heart of the AIDS response.

There is growing international consensus—across leading UN outputs and expert recommendations—that upholding young people’s rights in drug policy is non-negotiable. For example:

• The latest UNDP report on drug regulation demonstrates the development benefits of moving away from punitive models towards legally regulated and rights-based approaches.
• The UN System Common Position on Drug Control affirms the need for shared, integrated action focused on public health, human rights, and proportional responses.
• The International Guidelines on Human Rights and Drug Policy remain a critical instrument to guide reform and inspire accountability, particularly as States prepare for major reviews and commitments.
• The UN Special Rapporteur on the right to health and the 2023 OHCHR report highlight the preventable harms resulting from repressive drug policies, and urge States to prioritize harm reduction, address discrimination, eliminate punitive barriers to care and consider drug pollicy reform based on discriminalization.

Case studies and lessons from the field show that only strong, youth-led, peer-based, stigma-free interventions—built and evaluated with young people—achieve better health, social, and development outcomes. We highlight:

• Laboratorio Juvenil Sin Rodeos in Colombia addresses youth-specific concerns, including linking harm reduction with sexual and reproductive health, and directly involves young people in programme design and delivery. See more at: COPOLAD Innovation Lab Colombia and YES! Magazine article on Colombia's drug use destigmatization
• ToxiBot Argentina offers online peer-delivered education, virtual drug-checking, and harm reduction training, using digital tools tailored by youth for youth needs. 
• The Community Outreach through Radical Empowerment (CORE) program in the United States goes beyond classic harm reduction by providing youth-focused expungement clinics, housing support, and case management—all peer-led and inclusive of those directly affected. 
• Rauschzeit in Vienna, Austria provides peer-led counseling and harm reduction in nightlife settings, integrated with the CheckIt! drug checking service. Young people are at the forefront, ensuring accessible information, support, and laboratory drug analysis for their peers. See more at: checkit! Wien – rAUSchZEIT and Drugreporter on Vienna's CheckIt! model
• Kosmicare in Lisbon, Portugal offers youth-focused peer support, crisis response, and harm reduction, working closely with their recognized drug checking laboratory. Kosmicare combines outreach, on-site festival interventions, and queer-inclusive support, providing evidence-based counseling and drug testing for youth and partygoers. See more at: Kosmicare homepage and Kosmicare Association profile

Youth RISE will continue pushing for:

• The removal of all age, legal, and structural barriers to youth access to harm reduction;
• The full implementation of international guidelines and recommendations;
• Sustainable funding and meaningful engagement of youth-led networks at every policy table.

The current landscape is a crossroads. Government and multilateral action must move now to secure the infrastructure and vision built over the past decade for youth and communities affected by HIV and punitive drug policy. Sustaining inclusive, evidence-informed, and rights-based practice in this era is only possible with youth leadership at its core. 

In last year’s Pact for the Future, Member States have pledged to protect the rights of all young people and include them in policy decisions. As a new generation of young people who use drugs emerges, policymakers must advance drug policies that don’t undermine the development opportunities of new generations.

Youth is not a problem to be solved. We are experts in our own lives, ready to partner in building evidence-based programs that reduce inequality, improve wellbeing, respect autonomy, and save lives.

Hi! Youth RISE again! 

In response to your question Juana about what governments and international partners can do to support youth-led harm reduction initiatives, we want to share the newly released (today) 2025 Youth Statement on the 2026-2031 Global AIDS Strategy and Future High-Level Political Commitments on the AIDS Response .
This was created by organisations led by young key populations worldwide, including Youth RISE, to call for action, underlining the priorities identified by youth and urging for bolder, youth-centered commitments in the next era of HIV policy. Youth RISE encourages you to read and share the Statement within your networks!

Hello, my name is Teresa Castro. I am a social worker, harm reduction activist, and a person who uses drugs from Portugal. I have been working directly with communities of people who use drugs and other marginalized communities, in Portugal, for the last 12 years, as a case manager, peer worker, and project manager for different NGOs. Currently I coordinate a project that promotes South-Asian migrants' access to health, I collaborate with Kosmicare, and I am also an International Working Group Member from Youth RISE, and more recently part of the Quality of Life Committee of EATG.

• How have the International Guidelines on Human Rights and Drug Policy been used or referenced in your country, region, or organization’s work?

In Portugal, I wasn't much involved in advocacy until more recently, and I have honestly (and unfortunately) never seen the Guidelines being used in any context. I would like to see it happen though, because I believe they address many limitations we still face in Portugal, and being a social worker, I particularly like how it focuses on political, structural and social determinants of health, and also the meaningful participation of people who use drugs. Regarding Youth RISE's work, Rebecca and Ruby already answered the question, and it was actually due to Youth RISE that I became aware of the existence of the Guidelines.

• What concrete changes—legal, policy, or programmatic—have been influenced by the Guidelines?

In Portugal, none that I can identify. Since 2019 we have had no major changes in drug policy or harm reduction (it was in that year that DCR opened, and a permanent drug checking service in Lisboa), no increase in funding or in the relevance of peer-led/drug user-led organizations. We have recently finally "let go" of the thresholds we had in our law regarding personal use, which is positive, but I do not think it is related in any way to the Guidelines. This change means that we are no longer limited by what was defined as "10 day average quantity for consumption" to separate automatically what is considered trafficking (crime) and what is considered personal use (administrative offence). The limits were not updated since the law was made in 2001, and did not make any sense, for example: 1g of heroin (meaning the daily average quantity was considered 0,1), cannabis was 25g, LSD 500 micrograms. Currently, these limits are no longer fixed, and if someone has more than those quantities, it still has to be proven that it is not for personal use (for example, having  a lot of money with you, or the substance divided in separate bags, etc).

However, even when cited, there’s still a huge gap between theory and implementation when it comes to the Guidelines.

• What challenges have you faced in promoting or implementing rights-based drug policy reforms?

The way the international community sees Portugal as an amazing role model makes it difficult to critique our model or fight for further developments because we are supposed to already be the example of the perfect approach (which we aren’t). Portugal has a very weak or almost non-existing peer network/peer-led org compared with many other countries, which hinders structural changes and participation of PWUD in decision making. Harm reduction funding is not enough, peers are not recognized, stigma and paternalism from institutions and people is still a reality, there has been an increase of police harassment, PWUD are excluded from some housing solutions and even from shelters for victims of domestic violence - institutional violence, in social and health services., NGOs etc We have been seen more and more police harassment, still housing/shelter exclusion, institutional violence

Undocumented migrants have almost NO rights whatsoever, we have no services for specific populations such as women and gender diverse people or young people. Salaries and working conditions are very precarious.

• What opportunities and challenges exist in decriminalization in your context?

Very interesting question, given where I am from. We did decriminalize personal use of drugs in 2001, however, many of the same problems of criminalization persist (we can’t ignore that decrim is still part of a prohibitionism model). We still have to resort to the same illegal and unsafe and unpredictable markets, despite decrim it took us YEARS, sometimes decades to have some essential harm reduction services that were already available for years in other countries that did not had the need to decrim to implement them (first DCR in 2019 and was mobile, now we have 3 in Lisboa but none at the moment accepts smoking use which is the most prevalent, and 2 in Porto; first fixed drug checking service also only in 2019, and only in Lisboa and limited access). The Dissuasion Committees have a paternalistic and coercive rationale behind and there’s a huge pathologization of drug use and people who use drugs. 

However, it did prove that removing criminal penalties IS POSSIBLE and does not increase drug use or worsens the situation (for the contrary), and it does reduce the human rights violations faced by PWUD. If there is political will, everything is possible. But pushing for legal regulation in this context is seen as “messing with something that is working", ignoring that this is not working for those it impacts the most and that they are not being listened to. 

• Are there examples of promising practices or innovations that could inform efforts elsewhere?

Safer supply in Canada for example, which also covers people who use stimulants and until now had no pharmacological options, we also see more and more conversations about legal regulation. Many peer/drug user-led groups and orgs around the world are getting stronger, more relevant, and doing amazing work. Also DULF for example, also Canada. 

• How have affected communities contributed to advancing the Guidelines’ implementation?

I would say that they are the ones who have contributed to it the most, even the ones that are not aware of the Guidelines’ existence. We could see that during COVID for example

• What types of support (e.g., technical assistance, funding, political engagement) would help scale up implementation?

Political will. Money/adequate funding for harm reduction services and to adequately pay peers, more research led by PWUD

• What recommendations do you have for the usage of the International Guidelines to better have an impact on lived realities on the ground? 

Its implementation must be guided by people with lived/living experience, adapted to different contexts, maybe use them more to report on country's violations, inform more people working on the ground about the existence of these Guidelines and train people on how to use them in their actual work

Thank you so much Teresa for your contribution. Your reflection on how Portugal is internationally celebrated yet still failing PWUD at the structural level is so important. The tension you describe between being seen as a “success case” and that blocking further progress resonates strongly as well.

I would like to high by what you shared about how the Guidelines remain largely invisible at the operational level despite being so aligned with the realities you name.

A few follow-up questions, if you are open to sharing more:

• From your experience, what would make frontline social workers, harm reduction teams and peer-led initiatives actually use the Guidelines? Is it a question of format, political legitimacy, language, or something else?

• You mentioned the lack of specific services for women, gender-diverse people and migrants — what would you most urgently want stakeholders to do differently there?

• In a context where “Portugal is already the model”, what kinds of narratives or evidence do you think could make policymakers move again? 

Teresa Castro, many thanks for your contribution! A quick question: is Portugal partnering with other countries, in Europe and beyond, to advance drug policy reform? If yes, could you provide some examples where this has worked? Many thanks again!

Boyan Konstantinov Not at all that I am aware. Or maybe I did not understand exactly what you mean with partnering? Sorry, could you rephrase it? And you are welcome!

We are Ado Reporters Africa (ADRA), a feminist youth-led organization amplifying the voices of girls, young women, and marginalized communities across Africa, including LGBTQ+ persons, women with disabilities, widows, orphans, and women who use drugs.

Our engagement is rooted in community realities, where we advocate for rights-based, inclusive, and non-punitive approaches to drug policy. Through our media initiatives, documentation network RADAR (Alert and Documentation Network on Anti-Rights Attacks and Resistances), and community actions, we highlight the lived experiences of those most affected by criminalization, stigma, and social exclusion.

We believe that implementing the International Guidelines on Human Rights and Drug Policy requires intersectional, community-driven strategies that link human rights, public health, and gender justice. In our contexts, progress depends on listening to affected communities, promoting decriminalization, and supporting feminist and youth-led organizations that work at the grassroots level to change narratives and realities.

Geraude Maribelle ADOUKONOU 

President - ADRA / [email protected] 

PERLE SOCIALE ONG (Benin), member of the International Drug Policy Consortium (IDPC), observes that in West Africa, particularly in Benin, the implementation of the International Guidelines on Human Rights and Drug Policy remains limited due to the persistence of punitive frameworks and the lack of community participation. However, civil society actors are increasingly mobilized to advocate for a human rights–based approach that prioritizes prevention, harm reduction, and reintegration rather than punishment. PERLE SOCIALE promotes local education initiatives, awareness campaigns, and social reintegration activities targeting rural youth and women affected by substance use or drug-related offenses. These grassroots experiences confirm that when communities are empowered and stigma is reduced, prevention and rehabilitation become more effective. Integrating the Guidelines into national strategies would help shift drug policy from repression to social inclusion and public health protection.

Katherine Pettus, PhD International Association for Hospice and Palliative Care (IAHPC.org). Thank you for organizing this consultation. Access to internationally controlled essential medicines is an extremely challenging aspect of drug policy as it is underemphasized in many discourses, and in the training of health service and regulatory personnel. Additional challenges include affordability, unduly restrictive regulatory policies dating back to the 20th century, before the development of palliative medicine, and physician and nurse lack of education in prescribing and safe use. The North American opioid overdose epidemic has been blamed on the substances (opioids) rather than the multifactorial underlying stressors, including lack of appropriate government regulation and health personnel training in safe prescribing. All these blockages and challenges can be fixed through informed advocacy, which the IAHPC is engaged in, and sufficient funding for civil society work. In the meantime, though, more than 85% of the world's population with palliative care and other clinical needs lacks access to controlled medicines and continues to suffer and die in ways that traumatize survivors, cause complicated grief, and prevent sustainable development. Training in hospice and palliative care with adequate access to medicines could not only improve health services but increase education at community level, improve gender equality (80% of all caregivers are women and girls with little or no professional support) and boost good employment as properly trained support staff for the increasing population of older persons with palliative care needs.