TRENDS IN THE USE OF IMPRISONMENT more widely available for drug offenders and that they implement them effectively and monitor and evaluate their effectiveness.151 At the national level, there is growing polarisation in the approach to drug policy, and so far 26 countries have adopted a decriminalisation model.152 In late 2018, the South African Constitutional Court ruled that a law banning marijuana use in private was ‘unconstitutional and therefore invalid’.153 Also in 2018, several countries enacted laws allowing or expanding the medical use of marijuana – including New Zealand, Thailand, Luxembourg, Portugal and Greece. In a bid to address prison overcrowding, Thailand took steps to amend its drug laws to ensure more proportionate penalties for drug offences, and to allow for the licensed medical use of marijuana and kratom (a local plant used as a stimulant and painkiller).154 Myanmar is in the process of reviewing its drug legislation to address the ongoing imprisonment of large numbers of people involved in the illicit drug market. Canada adopted a legally regulated market for cannabis in July 2018, and various Caribbean countries are considering similar initiatives.155 Elsewhere, countries impose strict zero-tolerance drugs policies that directly or indirectly result in increases in the use of imprisonment. In South and Southeast Asia in particular, governments have emulated the punitive drug control approach taken by President Duterte in the Philippines, which has resulted in the killings of an estimated 27,000 suspected drug offenders, mass arrests and arbitrary detention in overcrowded and unsanitary conditions.156 In May 2018, the Prime Minister of Bangladesh launched a nationwide anti-drugs campaign that led to the arrest of approximately 7,000 people and resulted in the deaths of 200 people at the hands of the police.157 The country also took steps to reinstate the death penalty for ‘patrons of drug traders, drug syndicates, and godfathers’.158 Similarly, the President of Sri Lanka declared that he was ‘ready to sign the death warrants of repeat drug offenders’ as part of the country’s efforts to combat drug-related crime.159 Following presidential elections in Colombia and Brazil, both countries cracked down on people involved in illicit drug activities, resulting in increased levels of violence, human rights abuses and, in the case of Brazil, an exacerbation of its prison overcrowding crisis.160 to harm reduction – a key measure in preventing harms associated with drug use, including the transmission of HIV – is so limited that the prevalence of infectious diseases is two to 10 times higher than in the community.161 According to Harm Reduction International, only 10 countries implemented needle and syringe programmes in at least one prison in 2018.162 The same study reports that opioid substitution therapy is provided in prisons in only 54 countries and women prisoners in general have no access to such services. (See Special Focus, centrefold). RECOMMENDATION 08 Drug policies should be evidence-based and include the decriminalisation of minor offences, proportionality of sentencing, and non-custodial alternatives to imprisonment. Measurements of the outcomes of drug policies should include their impact on human rights, health, peace, and security and development. The ongoing criminalisation of people who use drugs and the stigma associated with drug use is a significant barrier to prisoners’ right to health. In prisons, access Penal Reform International and Thailand Institute of Justice | Global Prison Trends 2019 | 19