Drug use, regulations and policy in Japan - International Drug ...
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Briefing paper
April 2020
Drug use, regulations and policy in Japan
By Goro Koto,1 Masayoshi Tarui,2 Harue Kamioka,3 Kanna Hayashi4
Summary
This briefing paper provides an overview of drug use
Box 1 Policy recommendations
in Japan, regulatory efforts by police and the judiciary, for responding to drug use in
governmental and legislative responses and support Japan
for people who use drugs amongst civil society actors.
The paper ends with a number of recommendations Promote social understanding of drug use as
developed on the basis of this information. a health issue.
Since 1995, the proportion of people in Japan who Increase budgets for community-based
have used drugs in their lifetime has been estimat- health programmes.
ed to be 2-3%, while the proportion who have used Provide support focused on the individual’s
drugs in the past year has been estimated to be as health and well-being, rather than punitive
low as 0.1%. The most commonly used drugs are measures.
methamphetamine and organic solvents (e.g. paint Listen to the voices of people who use drugs
thinner), but the use of cannabis has increased in when developing measures that affect or
recent years. Since 2008, the annual number of concern them.
newly reported cases of HIV in the general popula- Provide counselling services to discuss drug
tion has ranged from 1,600 to 1,400. Approximately problems openly.
70-80% of those cases are among men who have Provide support that is responsive to gender,
sex with men, many of whom reported having used and tackles violence and poverty.
drugs during sex.
Assess the possible harms caused by drug
Stimulants, opioids, cannabis and other drugs are reg- use, and develop appropriate and evi-
ulated by six laws in Japan, which will be described dence-based responses.
in detail below. These laws impose severe penalties Conduct a fact-finding investigation into the
for all activities associated with the illicit drug trade, non-medical use of prescription drugs and
with the maximum penalty for drug offences being over-the-counter medicines.
life imprisonment. As a result, 14,019 people were Actively consider alternatives to punishment
arrested for drug offences in 2017 alone. Of those, for people who use drugs and who are in
73% involved methamphetamine, with personal use possession of drugs for their personal use.
and possession accounting for 90%. The propor- Scientifically evaluate the impacts of current
tion of repeat offenders, accounting for two thirds drug policies and implement policies that
of arrests, has recently increased while the overall have been proven effective.
number of arrestees and first-time offenders fell. The Adhere to international standards.
application of severe penalties against drug offenders
has led to a large proportion of the prison population
being incarcerated for drug offences – in 2017, 27.7% prisoners were imprisoned for methamphetamine-re-
of new male prisoners and 36.7% of new female lated offences. While alternatives to incarceration do
1
Table 1: 12-month prevalence of drug use: International comparison
(ages 16-64; Japan: 2017, Global: 2016)
Cannabis Amphetamines Opioids Opiates Organic solvents
Japan
psychiatric facility in Japan. According to the 2016 2. Poisonous and Deleterious Substances Control
report,7 among patients who had used drugs within Act (enacted in 1950): Possession/use of organic
the past year, the most commonly reported drug was solvents such as paint thinner is punished by up to
methamphetamine (42.8%), followed by sleeping one year in prison or a fine of up to ¥500,000 (or a
pills/anti-anxiety agents (31.3%) and over-the-coun- combination of both).
ter drugs (8.7%). The report also warns that, despite
3. Stimulants Control Act (enacted in 1951): Posses-
the small number of cases involving prescription
sion/use of amphetamine-type stimulants includ-
pain-relief medications (both opioid and non-opioid),
there is a need to continue careful surveillance. ing methamphetamine is punished by up to 10
years in prison.
HIV and drug use 4. Narcotics and Psychotropics Control Act (enact-
Two surveys of people living with HIV were conducted ed in 1953): Possession/use of heroin is punished
in 2014. One survey was conducted through question- by up to 10 years in prison. Other narcotics and
naires distributed by medical staff at regional centers narcotic plants (cocaine, MDMA, magic mush-
for HIV diagnosis and treatment, later collected by rooms, etc.) are punished by up to seven years
mail,8 while the other survey was conducted online.9 in prison.
The surveys collected responses from 1,100 and 913
5. Opium Act (enacted in 1954): Possession/use of
people, respectively. The lifetime prevalence of drug
opium is punished by up to seven years in prison.
use among people living with HIV was 2.5 to 4.6%
for organic solvents, 9 to 15.7% for cannabis, 8.8 to 6. Act on Securing Quality, Efficacy and Safety of
16.9% for methamphetamine and 12.5 to 38.6% for Products Including Pharmaceuticals and Medi-
NPS. The past 12-month prevalence was 0.1 to 0.2%, cal Devices (enacted in 1960): Possession/use of
0.4 to 1.0%, 2.3 to 5.1% and 4.8 to 13.6%, respective- designer drugs is punished by up to three years in
ly. Compared to the general population survey, these prison or a fine of up to ¥3,000,000 (or a combina-
rates are measurably higher. Poppers (alkyl nitrites) tion of both).
and foxy (5-MeO-DIPT) were found to be particularly
common, with a lifetime prevalence of 41.2 to 69.6% In Japan, with the exception of the Cannabis Con-
and 25.1 to 37.7% respectively, and a 12-month prev- trol Act, these laws apply both to drug use and pos-
alence of 10 to 25.1% and 0.5 to 1.8%. session for personal use, and there is no distinction
in the penalties imposed on whether acquisition is
Approximately 80% of respondents (78.8 to 84.9%) associated with personal use or for intent to supply
attributed their infection to male-to-male sexual con- for a profit. In practice, for personal use (or posses-
tacts, while 0.8 to 1.9% attributed it to syringe sharing sion for personal consumption) of methamphet-
(0.4% in the report of the AIDS Trends Committee of the amine, which accounts for approximately 70% of
Ministry of Health, Labour and Welfare). 44 to 70.7% arrests, first-time offences are typically punished
said that they were under the influence of drugs when with a prison sentence of one year and six months,
having sex. These results indicate that drug use may suspended for three years, while repeat offend-
be considerably higher among men who have sex with ers are normally sentenced to approximately two
men (MSM) than in the general population. In compari- years’ imprisonment.
son, there were only a few cases of HIV associated with
injecting drug use. Other studies also suggested that The most severe penalty prescribed within the above
drug use made it more difficult for MSM living with HIV laws is life imprisonment for the production, importa-
to adhere to anti-retroviral treatment10 and increased tion or exportation of amphetamine-type stimulants
the risk of contracting hepatitis C virus.11 (Stimulants Control Act) and heroin (Narcotics and
Psychotropics Control Act) with the intent to profit.
Drug control laws and penalties The death penalty is not prescribed in any drug con-
trol laws in Japan.
Laws and penalties
The coexistence of these various laws is due to an
Drug control is governed by six laws in Japan. Below accumulation of hasty legislation and amendments
is an overview of each of these laws, as well as the in response to issues that were topical at the time.
actions it criminalises in relation to personal use along Hasty changes in the law to deal with poppers (de-
with the stipulated punishment.12 spite the lack of scientific evidence around their
1. Cannabis Control Act (enacted in 1948): Posses- harmfulness) and 5-MeO-DiPT have also been ac-
sion/use of cannabis is punished by up to five years companied with the emergence of new designer
in prison. drugs on the market.13
3
Suspended sentence system for drug Current state of drug policy and
offenders governance
The Act on Penal Detention Facilities and the Treat- Governance
ment of Inmates (enacted in 2005)14 provides that
people who have received a prison sentence under Japan’s drug policy is focused on a criminal jus-
drug control laws can access some drug treatment tice-based approach and overseen by the National Po-
and rehabilitation. The standard programme uses a lice Agency, the Ministry of Justice, the Ministry of Fi-
group work approach based on cognitive behavioural nance (customs), the Ministry of Land, Infrastructure,
therapy. It consists of 12 sessions held over the course Transport and Tourism (Japan Coast Guard) and the
of 3 to 6 months inside prisons. Ministry of Health, Labour and Welfare. The Compli-
ance and Narcotics Division of the Ministry of Health,
In 2016, the Act to Revise a Part of the Penal Code Labour and Welfare is at the centre of this system. The
and the Act on the Partial Suspension of Punish- Division is responsible for matters related to drug con-
ment for Offences Including Drug Use15 introduced trol, as well as matters related to the duties of feder-
a system that allows for the partial suspension of a al and prefectural drug control agents.19 Federal drug
sentence for people convicted of use or possession control agents hold authority as special judicial police
of illicit drugs. For example, a person who would pre- officials under the Criminal Procedure Code, are as-
viously have received a two-year prison sentence for signed to the narcotics departments of eight Regional
methamphetamine use can, under the new system, Offices of Health across Japan, and operate under the
be sentenced to serve one and a half years of their jurisdiction of the Ministry of Health, Labour and Wel-
two-year sentence in prison, plus a two-year suspen- fare’s Compliance and Narcotics Division.20
sion period with probation (including the remaining
In 2018, the Ministry of Health, Labour and Welfare
six months of their prison sentence). In this situation,
established the Addiction Countermeasures Office
with the last six months of their suspended sentence,
within its Mental Health and Disability Health Divi-
the period of incarceration would be shortened by 6
sion, which has jurisdiction over matters related to
months, but the period of criminal justice supervision
drug treatment and rehabilitation. The office is now
would be extended by a year. Over the two-year sus-
in charge of measures in response to dependence,
pension period, the offender would be subject to a
not only for illicit drugs, but also for other types of
mandatory probation programme in their community dependence such as on alcohol and gambling.
intended to address their dependence on metham-
phetamine and prevent recidivism. This would include The Five-Year Drug Abuse Prevention
regular interviews with probation officers, drug tests Strategy
and participation in relapse prevention programmes
Japan’s drug policy is updated by the Cabinet Office
(see Section 5.3). Probation is imposed on about 10%
every five years. The Council for Promoting Measures
of all people given suspended sentences. In 2017, that
to Prevent Drug Abuse is held as part of the Cabinet’s
comprised 384 people, but there were an additional
Ministerial Meeting Concerning Measures Against
208 people given partially suspended sentences due
Crime, with the Minister of Health, Labour and Wel-
to these new legislations.16
fare serving as the chair. The latest policy is outlined
The Reoffending Prevention Promotion in the Fifth Five-Year Drug Abuse Prevention Strategy
Plan that was established in 2018.21 The strategy was put
together mainly by the Compliance and Narcotics Di-
In response to the rise in recidivism, the Reoffending vision of the Ministry of Health, Labour and Welfare.
Prevention Promotion Act17 was enacted, with the The strategy’s overall goal is “the eradication of drug
Ministry of Justice playing a central role. The Act came abuse”. As shown in Table 2, the objectives of the new
into effect in 2016. The following year, the Cabinet policy continue to focus entirely on reducing supply
developed the Reoffending Prevention Promotion and demand for drugs. There are few differences from
Plan,18 which specifies violations of the Stimulants the previous policy, which was not scientifically eval-
Control Act as one type of crime where repeat offenc- uated. The most significant changes made from the
es are common. The plan puts forth various measures previous version include the strengthening of meas-
and interventions for people with drug dependence, ures against drug smuggling and trafficking and the
such as the establishment of drug counselling pro- addition of a new initiative to strengthen controls
grammes in prisons/probation facilities and enhance- on unregulated substances and psychotropic drugs.22
ment of support and treatment for drug dependence The strategy document argues that the majority of
in the community. drugs used in Japan are smuggled into the country
4
Table 2: Comparison of drug policy objectives (2013 and 2018)
Fourth Five-Year Drug Abuse Preven- Fifth Five-Year Drug Abuse Prevention
tion Strategy (2013)23 Strategy (2018)24
Five goals Five goals
1. To prevent people from abusing drugs by 1. To prevent drug abuse by promoting respect for
enhancing efforts to raise awareness among young social norms across Japan through outreach and
people, families and communities, and by boosting awareness efforts focused on young people
normative consciousness
2. To strictly prevent relapse into drug abuse by 2. To prevent relapse into drug abuse by providing
supporting drug abusers through treatment and drug abusers with appropriate treatment and
reintegration into society and by increasing support effective support for reintegration into society
for their families
3. To eliminate drug trafficking organisations 3. To eliminate drug trafficking organisations,
thorough controls over end-users, and strengthen thorough controls over end-users and
oversight of diversifying drugs being abused prevent the distribution of drugs by promptly
responding to new drugs, etc.
4. To interdict entry of illicit drugs into Japan through 4. To prevent smuggling of drugs into Japan with
a strict crackdown at the border thorough border protections
5. To promote international cooperation to interdict 5. To prevent drug abuse through international
drug smuggling collaboration as a member of the international
community
from abroad. As such, emphasis within the strategy is stigma and marginalise people who use drugs and the
placed on understanding the drug situation overseas people around them, including their family.
and stopping the flow of drugs coming into Japan. It
is worth noting that the strategy explicitly expresses Harm reduction
concern over the recent trend of legalising marijuana For the first time in its history, the 2018 strategy26 re-
for recreational use in other countries. ferred to harm reduction in the following sentence:
As the Addiction Countermeasures Office was also “With regard to the discussions on harm reduction
newly established within the Ministry of Health, La- in the international community, we ask for under-
bour and Welfare in 2018, the strategy’s content in standing of our country’s perspective on the neces-
relation to psychiatric care and social rehabilitation sity of carrying out policies based on each country
was made more substantial compared to the previ- or region’s unique circumstances and maintaining a
ous policy document. However, the inclusion of thor- balance in reducing supply and demand for drugs”.
ough enforcement of regulations against people who While the government’s position on harm reduction
use drugs as a policy objective clearly shows that Ja- is not clearly expressed in this policy document, on 15
pan’s drug policy remains focused on prohibition and March 2018, the Japanese delegate in a Plenary Ses-
punishment. Indeed, the Ministry of Health, Labour sion of the UN Commission on Narcotic Drugs stated
and Welfare has promoted the “No, absolutely NO!” that: “We understand that some measures on harm
campaign to eradicate drug use since 1987. As part reduction are effective in some situations, e.g. in
of that campaign, the Ministry produces and distrib- combating the spread of infectious diseases. Howev-
utes educational materials that treat people who use er, harm reduction should not be recommended for
drugs as criminals, using such phrases as “Once You all countries. The UN should not excessively recom-
Take Drugs, You Won’t Be Able to Stop,” “Drug Abuse mend harm recommendation [emphasis added; the
Will Destroy Your Life” and “You Will Hurt Others If authors believe it is a typo and meant ‘reduction’].
You Use Drugs.”25 The effectiveness of these educa- Japan has been effective in stemming drug abuse
tional materials and campaigns has not been scientifi- including through social rehabilitation programmes
cally evaluated, and there are concerns that they fuel and strict enforcement on methamphetamine abuse.
5
By developing the five-year drug abuse strategy, Ja- same time, it launched the Project for Introducing Ev-
pan through the collaboration of multiple agencies idence-based Relapse Prevention Programs to Drug
has succeeded by educating young people and com- Dependence Treatment and Rehabilitation Centers in
munities on the dangers of drug abuse, recognition the Philippines. These two projects aim to establish
therapy, and support of families to prevent recur- treatment facilities and develop a drug dependence
rence of drug use”.27 Thus, while Japan has not gone treatment programme based on the US Matrix Mod-
so far as to oppose the implementation of harm el. Here again, it is worth noting that this grant was
reduction programmes in other countries, it does allocated to the Philippines after President Duterte
clearly oppose the introduction of harm reduction launched his war on drugs that has already cost the
into its own policies and global recommendations on lives of 27,000 people.31 Nonetheless, the Japanese
harm reduction by the UN. government has announced that the projects would
approach the drug problem from a medical perspec-
Foreign policy tive: by providing the financial support necessary for
Japan makes a large contribution to the United Na- the establishment of drug treatment facilities and im-
tions Office on Drugs and Crime (UNODC) each year. provement of treatment programmes, the projects
In 2017, Japan pledged to contribute $25,080,000 would strengthen the systems and policies put in
(approximately ¥2.7 billion; $180,000 to the gener- place by the Philippine Department of Health for the
al-purpose fund and $24,9 million to the special-pur- treatment of people dependent on drugs.32
pose fund), the fourth largest amount after Colombia,
the United States and the EU. The figures published Current state of drug law
by the UNODC show that Japan pledged to contrib- enforcement
ute $5.11 million in 2009, $8.57 million in 2014 and
$10.65 million in 2015, making the 2017 pledge ap- Number of arrests
proximately 5 times larger than the 2009 pledge.28 Methamphetamine: 14,019 people were arrested
by the police for drug offences in 2017.33 In 2000,
The reason for the increase in contributions and the
approximately 20,000 were arrested, but arrests fell
purpose for which they were to be spent has not been
below 15,000 in 2006, and have since then either
made public. However, several priority areas and pri-
continued to decline or remained stable.34 In 2017,
ority regions are listed in the Joint Plan of Action for
10,284 people were arrested for methamphetamine,
Cooperation Between Japan and UNODC, an agree-
accounting for 73% of the total of those arrested for
ment between the Ministry of Foreign Affairs and
drug offences, and 64% were between 30 and 40
the Executive Director of the UNODC that has been
years old. Together, possession for personal use and
continually amended since 2013.29 According to this
consumption accounted for 90% of drug offences,
document, the Middle East and North Africa (includ-
while assignment/acquisition and smuggling account-
ing Afghanistan and neighbouring countries), Asia and
ed for approximately 10%.35
Africa are designated as priority regions, while priori-
ty areas for cooperation include countering terrorism Methamphetamine was used by the military during
and violent extremism, trafficking of drugs and other World War II. After the war, it was marketed by ma-
contraband, human trafficking and cybercrime. The jor pharmaceutical companies and spread through-
document expresses particular concern over the strik- out the general population. In 1951, the Stimulants
ing rise in cultivation of opium poppies in Afghanistan. Control Act banned amphetamine-type stimulants in-
It notes that Japan has been working in cooperation cluding methamphetamine, and they became a new
with the UNODC and Russia since 2012 to strengthen source of revenue for criminal organisations. In 1954,
the capacity of the national police forces of Afghan- as many as 55,664 people were arrested for meth-
istan and Central Asia to combat drugs. As of 2018, amphetamine-related charges (the first and largest
147 narcotics officers had received training in Russia peak), but the number of arrests declined thereafter,
as part of this effort. The Japanese government stated falling under 1,000 from 1957 to 1969. In 1970, the
that the three parties would continue to explore ways number began to rise, reaching 24,372 in 1984 (the
to enhance their collaboration.30 It should be noted second peak), after which it slowly declined. Approxi-
here that Russia has long adopted a severely punitive mately 15,000 people were arrested in 1995. By 1997,
approach towards people who use drugs, both do- the number had risen to 19,937 (the third peak). It be-
mestically and abroad. gan to slowly decline again after 2001, and has ranged
from 12,000 to 11,000 since 2006.36, 37
In 2017, Japan provided a grant of ¥1.85 billion to
the Philippines for the Programme for Consolidated Since 2006, the percentage of methamphetamine-re-
Rehabilitation of Illegal Drug Users (CARE). At the lated offences committed by people previously
6arrested for the same crime has gradually increased. Prisoners convicted of drug offences
In 2017, the Ministry of Health, Labour and Welfare
reported a recidivism rate of 65.5% based on data ag- In 2017, 4,661 men were newly imprisoned for vi-
gregated from the National Police Agency, the Japan olations of the Stimulants Control Act, accounting
Coast Guard and its own records.38 While there is also for 26.7% of all new male prisoners.44 The respec-
an upward trend in the proportion of offences in gen- tive figures for women were 694 and 36.7%. The to-
eral committed by repeat offenders, this only amount- tal number of men imprisoned for violations of the
ed to 48.7% in 2017.39 Stimulants Control Act as of the end of 2017 was
10,687, accounting for 24.9% of all male prisoners
Cannabis: 3,218 people were arrested for canna- (n=42,841), the second highest proportion after theft
bis-related offences in 2017, accounting for 23% of all (25.8%). A total of 1,483 women were imprisoned for
drug offences, with 74% of arrestees being between violations of the Stimulants Control Act. While this is
20 and 30 years old. Cannabis offences increased for low compared to the number of men, it accounted
four years in a row from 2014, reaching their highest for 38.4% of all female prisoners (n=3,861), which is
level since 1971. Eighty percent were arrested for pos- more than for any other crime.45 According to a re-
session, while acquisition, smuggling and cultivation port of the UNODC, 19% of male prisoners and 35%
together accounted for 15%.40, 41 of female prisoners worldwide are imprisoned for
drug offences,46 which is lower than the rates report-
NPS: The number of deaths related to the use of NPS
increased sharply in 2014 (112 people), spurring a ed in Japan for both sexes.
strengthening of controls over these substances. In
the same year, 840 people were arrested for NPS-re- Figure 2. Number and proportion
lated offences, and over the following year, 215 stores of men and women newly
and 189 websites selling NPS were shut down. In 2015, incarcerated for violations of
the number of deaths had decreased to 11.42 In the the Stimulants Control Act
same year, the number of arrests increased to 1,196 compared to other offences
(996 for possession, 80%), but fell to 920 in 2016 and (2017 data)
651 in 2017. Of those, 605 were people who use drugs
rather than suppliers, and more than 50% were over
the age of 40.43
Figure 1. Number of drug-related
arrests for methamphetamine
and NPS (2017 data)
Community support and advocacy
Prevention of drug use/dependence and
recovery from dependence
Because the use of stimulants and other drugs is
viewed as a criminal justice matter rather than a
health issue, with the exception of awareness cam-
paigns to prevent drug use, the prevention and sup-
port programmes available in the community are
severely limited. According to the UNODC, it is esti-
mated that 89% of people who use drugs worldwide
7do not experience drug dependence. For them, there However, while these self-help-based recovery facil-
is a need for health and social services to address ities have spread throughout Japan, the majority of
everyday problems (if any) and outreach through programmes are dominated by male users, and very
health interventions, including harm reduction ser- few were developed with women and other genders
vices, to prevent dependence and the spread of in- in mind, although the prevalence of drug use and de-
fectious diseases. Further, the UNODC and World pendence among these groups is increasing.
Health Organization also promote a comprehensive
range of treatment services that can better respond Activities conducted by people who use
to the individual needs of people suffering from drug drugs, their families and their supporters
dependence and seeking treatment. This includes
Networks and activities led by people who use drugs
‘outreach services, brief psychological interventions,
have not developed in Japan’s local communities. Due
diagnostic assessment, outpatient psychosocial
to Japan’s punishment-focused approach to drugs, it
treatment, evidence-based pharmacological treat-
is clear that such activities would be difficult to con-
ment, services for management of drug-induced
duct. However, 12-step programmes to help people
acute clinical conditions such as overdose, with-
with drug dependence stay abstinent, such as DARC
drawal syndromes and drug-induced psychoses, in-
and NA, have been steadily developed nationwide.52
patient services for the management of severe with-
As for DARC, 90% of their facilities receive public sub-
drawal, long-term residential services, treatment of
sidies for their support programmes, although over
common comorbidities’.47
70% remain in financial distress.53 DARC was founded
Such schemes, however, are rare in Japan. There is a in 1985, but it was not until the 2000s that NGOs fo-
very limited number of highly specialised psychiatric cusing on drug dependency and NGOs working on HIV
institutions that provide drug dependence treatment. began to provide hotlines for telephone consultations
General psychiatric institutions have a strong tenden- and educational programmes to prevent the spread
cy to avoid patients with psychiatric disorders related of infectious disease.54 In the 2010s, people with lived
to drugs, and only a minority of such institutions are experience, their family and experts on drug depend-
willing to provide treatment for drug-related mental ence began to hold study groups, overseas tours and
illness.48 Additionally, as drug injection, in particular public lectures to study drug policy from a health and
of heroin, is rare in Japan, traditional harm reduction human rights perspective. In 2015, this movement
programmes such as needle and syringe programmes, evolved into the Japan Advocacy Network for Drug
opioid agonist therapy and supervised drug injection Policy, a project that promotes understanding of drug
sites are not available. Abstinence-based drug recov- use, dependence and health services among civil so-
ery programmes are the only services that are availa- ciety, elaborates policy recommendations, and so on.
ble in Japan. Like most countries in the world, in Japan, the over-
Programmes like the Serigaya Methamphetamine Re- whelming majority of women who use drugs are vic-
lapse Prevention Program (SMARPP) use a group work tims of violence and have PTSD or suffer from other
approach based on cognitive-behavioural therapy to mental illnesses.55 The DARC Women’s House has
help participants discontinue drug use, taking inspi- been operating as a recovery support facility for wom-
ration from the Matrix Model of the United States. en with drug dependence for 30 years.56 Since then,
Such programmes have been implemented at approx- several facilities have been set up, and programmes
imately 70 locations, including in medical institutions to provide support to women who are facing difficul-
and mental health centres.49 ties in their lives (not limited to drug dependence)
have been developed, but they are overwhelmingly
In the community, the most prominent drug recovery insufficient to meet potential needs. The DARC Wom-
programmes are operated by Narcotics Anonymous en’s House is also committed to providing support to
(NA), a nongovernmental self-help group. 463 NA mothers and children. As part of that commitment,
meetings are held each week in Japan.50 Various other the organisation has developed a programme to ac-
NGOs offer self-help programmes for recovery from tively provide comprehensive support to women with
alcohol and drug dependence based on the 12-step criminal convictions and their children.57 Many wom-
model of Alcoholics Anonymous (AA) and NA. The en involved in drug recovery programmes are dealing
Maryknoll Alcoholic Center (MAC) and Drug Addiction not only with dependency, but also social challenges
Rehabilitation Center (DARC) are representative of Ja- like raising children, poverty, violence and gender dis-
pan’s drug recovery facilities, with approximately 130 crimination. Despite this, public funding for interdis-
locations across Japan providing support to people ciplinary approaches to addressing women’s needs is
who use drugs.51 severely lacking.
8Efforts to reduce stigma against people who use drugs programs without being properly assessed for drug
have also emerged among civil society. At the Research dependence but on the grounds that they have com-
Center for Advanced Science and Technology in the mitted a drug offence. The programs typically extend
University of Tokyo,58 researchers and people with drug for a few years. If one is repeatedly offending, tests
dependence are working together to research effec- positive for drugs, or talks about their ongoing drug
tive methods for reducing the stigma associated with use during the programme, they may be reported to
drug dependence. Their research revolves around ‘con- the police. In the worst-case scenario, their parole or
tact-based learning’,59 which attempts to fight stigma partial suspension of the sentence may be denied,
not through education or formal complaints, but by and they may be incarcerated.
having people with drug dependence talk frankly about
their own experiences and feelings.60 Interventions targeting drug offenders continue to be
more punitive. In April 2019, the ‘No Drugs Police De-
The families of people dependent on drugs are also partment’ programme was established by the Met-
actively engaged in advocacy work. Japan’s punish- ropolitan Police Department in Tokyo. At the same
ment-focused view of people who use drugs as se- time, the ‘Relapse Prevention Office’ was established
rious criminals has given rise to deep-rooted stig- by the Narcotics Control Department of the Ministry
ma that has long tormented both people who use of Health, Labor and Welfare’s Kinki Regional Bureau
drugs and their families. The National Federation of Health and Welfare. While participation in these is
of Families of People with Drug Addictions (Yakka- not compulsory, the vulnerability of many offenders
ren) comprises family associations from various re- makes it difficult for them to refuse. Furthermore,
gions of Japan.61 The federation works to pressure these interventions are often carried out either di-
the government and expand support for families. rectly by police and drug law enforcement officers
In response to the misunderstandings, prejudices who lack expertise in health and welfare, or by ex-
and defamatory claims that are common in media perts who are working under the direction of law en-
coverage of dependence, in 2016, people with alco- forcement. In many cases, offenders must agree to
hol, drug and gambling dependency, together with regular drug tests, and positive results on those tests
Yakkaren and specialists in health, psychology and may result in prosecution, which clearly shows that
medicine, launched a network to promote more the tests are carried out for surveillance, rather than
accurate media coverage.62 The following year, the for the sake of the individual’s health. While these in-
network proposed guidelines for media coverage of terventions are purported to be in support of recov-
drug dependence, and it continues to strengthen its ery and rehabilitation, they are effectively a product
media engagement. of the criminal justice system intended to increase
monitoring and control over local communities.
Involvement of public institutions
The services offered by the mental health centres
located in each administrative division of Japan (in-
Recommendations
cluding ordinance-designated cities and core cities63) The analysis above shows how drug use in Japan is
include family programmes, group programmes using regarded primarily as a crime, and rehabilitation and
texts based on cognitive-behavioural therapy and pri- prevention efforts are focused on punishment. How-
vate consultations. ever, considering the high recidivism rate, this ap-
proach does not appear to be effective. Because drug
Interventions targeting drug offenders in the com- dependence is a health problem, perspectives based
munity are punitive in nature, rather than health fo- on health protection and recovery should be more
cused, and are therefore implemented in probation strongly emphasised.
offices across Japan, the Metropolitan Police Depart-
ment in Tokyo and certain drug control agencies. Internationally, on both an individual and social lev-
For example, probation offices provide mandatory el, drug use is increasingly being treated as a health
relapse prevention programmes for those on parole issue. The need to remove criminal sanctions for
and those with partially suspended sentences (see drug use and possession for personal consumption
Section 2.2). The programmes include regular inter- has indeed been recognised by the heads of 31 UN
views with probation officers, drug tests and partic- agencies within the first ever ‘UN system common
ipation in group sessions focusing on cognitive be- position on international drug control policy through
havioural therapy. The group sessions are facilitated effective inter-agency collaboration’, which recom-
mainly by probation officers, rather than health or so- mends “alternatives to conviction and punishment
cial workers, and held once or twice per month. Peo- in appropriate cases, including the decriminalization
ple are required to participate in these standardised of drug possession for personal use”.64 The health
9approach towards drug use and dependence is en- who use drugs and people dependent on drugs, as
shrined in Sustainable Development Goal 3.5. The well as links with mental healthcare and welfare
2030 Agenda for Sustainable Development is an in- and social services for those in need and their fam-
ternational agreement adopted by all UN member ily, including anti-poverty programmes, protection
states at a Summit held in 2015.65 In relation to this against gender-based violence, and maternal and
goal, the UNODC supports initiatives on drug use child healthcare.
that focus on people’s health without discriminat- • Provide support focused on the individual’s health
ing against people who use drugs. The UNODC has and well-being, rather than punitive measures:
resolved to strengthen its provision of comprehen- At present, as an alternative to punishment, pro-
sive services that are evidence-based and gender-re- bation offices and narcotics control departments
sponsive, including alternatives to conviction and impose a system of control on people condemned
punishment for people who use drugs or who are for their drug use or possession for personal use,
dependent on drugs.66 Finally, the Commission on in the form of ‘recovery and rehabilitation sup-
Narcotic Drugs adopted a resolution in 2019 aiming port’. They are generally obliged to participate in
to reduce stigmatising attitudes towards people who identical programmes. The effectiveness of these
use drugs in access to healthcare settings.67 sanction-oriented interventions has not been ad-
In line with these international agreements and glob- equately evaluated. There is a need to provide tai-
al evidence on drug policy, we propose the following lored support focused on the well-being of each
recommendations for consideration by the Japanese individual on a case-by-case basis, to promote and
government. facilitate their voluntary participation. Such sup-
port should be developed based on an assessment
• Promote social understanding of drug use as of the individual’s health and living circumstances
a health issue: Virtually all of the information by a health and welfare specialist.
disseminated by the government and the media
in Japan leads to the isolation, stigmatisation • Listen to the voices of people who use drugs
and social exclusion of people who use drugs, when developing measures that affect or concern
who are depicted as criminals. There is a need them: The voices of people with drug dependence
to disseminate information and evidence that who maintain abstinence are finally starting to at-
explains that drug use and dependence are a tract notice. However, the people we most need to
health issue and that it is possible to tackle drug be heard, in order to better understand the kind of
dependence with non-judgemental support and support they require, are those who are currently
care. Such information should also raise aware- using drugs. That includes not only people who use
ness of the fact that not all drug use is harmful illegal drugs, but also people who use prescription
or results in dependency. drugs and over-the-counter drugs for non-medical
purposes. The social treatment of people who use
• Increase budgets for community-based health drugs should be reformed in order to address the
programmes: In recent years, criminal justice in- stigma, discrimination and prejudice that labels
itiatives have been expanded to focus on illicit them as criminals.
drug use and dependence, including rehabilitation
programmes in probation offices and the estab- • Provide counselling services to discuss drug
lishment of the Narcotics Control Department’s problems openly: There are extremely few places
Relapse Prevention Office. This is in contrast with where people who use drugs, their family and their
other substance use disorders involving licit sub- friends can ask for advice about the problems and
stances such as alcohol, nicotine, prescription needs they are facing. Because drug use is consid-
drugs and over-the-counter drugs, for which local ered a crime, the threshold for approaching gov-
health and welfare organisations provide support ernment services for counselling is high, and many
and care services, instead of the criminal justice people are unwilling to do so. There is a need to
system. The same should be done for drug de- provide low-threshold services where people who
pendence by increasing local resources to allow use drugs can ask for advice and receive support
local health and welfare organisations to provide for their social needs openly and without stigma
evidence-based health interventions. More fund- or judgement.
ing is required both for those public institutions • Provide support that is responsive to gender, and
and NGOs that provide support in the communi- tackles violence and poverty: In a male-dominated
ty, as well as for the training of support workers. society, support that is responsive to women’s issues
There should be a comprehensive menu of servic- and specificities has generally lagged far behind.
es (including harm reduction) available for people Support for women who use drugs is no exception.
10There is a pressing need to investigate and improve announced that it will “consider measures for ef-
gender-responsive support for women and their fam- fective rehabilitation from drug dependence that
ilies. Many women also suffer from violence, mental have been implemented overseas as alternatives
illness and other difficulties. Additionally, it is neces- to various forms of detention”, suggesting the
sary to ensure that appropriate support is provided possibility that it may adopt alternatives to pun-
to address the financial distress that a woman may ishment for drug use. It has been demonstrated
be facing since many people experiencing problems internationally that severe punishment aggra-
with their drug use live in poverty. vates health and social problems.69 In Japan, even
• Assess the possible harms caused by drug use, now, when an individual commits a minor non-vi-
and develop appropriate and evidence-based olent drug offence, such as personal use, posses-
responses: In Japan, where use of injected drugs sion, or small-scale transactions, the sanctions
such as heroin and other opioids is rare, there is imposed on them can lead to job loss and other
little discussion of traditional harm reduction pro- harms to their lives. These can be prevented if, for
grammes such as needle and syringe programmes example, judges suspend the sentence, prosecu-
and opioid agonist therapy. However, harm reduc- tors defer the prosecution, or the police shorten
tion is needed for all types of drugs and patterns of the custodial period.
drug use.68 Frontline healthcare and social workers • Scientifically evaluate the impacts of current drug
are well aware that some people who use drugs die policies and implement policies that have been
from drug-related harm. Therefore, drug use in Ja- proven effective: The Fifth Five-Year Drug Abuse
pan is not harmless; drug-related harms are simply Prevention Strategy was released in 2018, but no
hidden or unexamined. It is necessary to conduct attempt was made to scientifically evaluate the ef-
surveys and research into what kinds of risks and fects of the fourth strategy. The Japanese govern-
harms are associated with drug use in the country, ment has agreed to a UN resolution to implement
and take appropriate measures to reduce them. drug initiatives based on scientific evidence.70 It
Harm reduction measures function alongside, and has also announced that it would begin carrying
complement, evidence-based drug prevention and out evidence-based policy making.71 When imple-
treatment services. menting the Fifth Five-Year Drug Abuse Prevention
• Conduct a fact-finding investigation into the Strategy, the Reoffending Prevention Promotion
non-medical use of prescription drugs and over- Plan and other policies, scientific evaluations of the
the-counter medicines: Due to Japan’s national effects of such strategy and programmes should be
health insurance programme, prescription drugs carried out and published.
and over-the-counter medicines can be easily ob- • Adhere to international standards: The Japanese
tained at low prices. It can be inferred from some government has finally recognised the effective-
anecdotal reports from healthcare and social ness of harm reduction as a foreign policy and
workers in communities that there are a consid- refrained from opposing its introduction in other
erable number of people who use these drugs for countries. However, given that many countries that
non-medical purposes and use them in conjunc- need harm reduction programmes lack the imple-
tion with other substances like alcohol and meth- mentation of such programmes, Japan should go
amphetamine. Interventions that target only ille-
a step further by refraining from opposing future
gal drugs will overlook the possible health risks
recommendations on harm reduction at the UN.
and harms caused by the non-medical use of pre-
Furthermore, when offering development assis-
scription drugs and over-the-counter medicines.
tance to other countries, Japan should adhere to
For example, people who stop using illegal drugs
human rights norms and evidence and condition
and begin taking large doses of prescription med-
their foreign aid to the adherence to such princi-
icines may be at risk of death through overdose.
ples, for instance in the Philippines. In that case
To address this problem, it is essential to conduct
and others, Japan should use its diplomatic and
a fact-finding investigation first, and then design
financial influence to help eliminate the severe
measures that can adequately address the risks
infringements on the human rights of people who
and harms associated with such use.
use drugs and other people involved in drug-relat-
• Actively consider alternatives to punishment for ed non-violent activities. Some international stand-
people with minor non-violent drug offences: ards on drug-related matters are listed in Annex 1.
Japan’s criminal justice system is moving towards
relaxing its focus on punishment. As a strategy to
prevent drug reoffending, the government has
11Acknowledgements
We express our sincere gratitude to Ms. Marie Nougi-
er and Ms. Gloria Lai at the International Drug Policy
Consortium for her very helpful review of and input
into the previous versions of this document. Japan Ad-
vocacy Network for Drug Policy is funded by the Open
Society Foundation. Kanna Hayashi is supported by
the Canadian Institutes of Health Research New Inves-
tigator Award (MSH-141971), a Michael Smith Foun-
dation for Health Research Scholar Award, and the
St. Paul’s Foundation. Masayoshi Tarui was supported
by Sciences Research Grants for HIV/AIDS Policy from
Japanese Ministry of Health, Labor and Welfare.
12Annex 1 Selection of international • Harm reduction and brief interventions for ATS us-
ers85
standards on drug-related
matters72 • Guidelines for the psychosocially assisted pharma-
cological treatment of opioid dependence86
International standards related to • Principles of Drug Dependence Treatment87
health:
• International standards on drug use prevention73
International standards related to
human rights:
• Treatment and care for people with drug use dis-
orders in contact with the criminal justice system: • International Guidelines on Human Rights and
alternatives to conviction or punishment74 Drug Policy88
• Implementing comprehensive HIV and HCV pro- • Joint statement: Compulsory drug detention and
grammes with people who inject drugs: Practi- rehabilitation centres89
cal Guidance for collaborative interventions (the • Joint United Nations statement on ending discrim-
“IDUIT”)75 ination in health care settings90
• International Standards for the Treatment of Drug International standards related to
Use Disorders76 women who use drugs:
• Tool to set and monitor targets for HIV prevention, • Women who inject drugs and HIV: Addressing spe-
diagnosis, treatment and care for key populations77 cific needs91
• HIV and young people who inject drugs78 • Guidelines for identification and management
• Community management of opioid overdose79 of substance use and substance use disorders in
• HIV prevention, treatment and care in prisons and pregnancy92
other closed settings: A comprehensive package of
interventions80
International standards related to
incarceration:
• WHO, UNODC, UNAIDS technical guide for coun-
tries to set targets for universal access to HIV pre- • United Nations Standard Minimum Rules for
vention, treatment and care for injecting drug us- the Treatment of Prisoners (the Nelson Mandela
ers81 (2012 edition) Rules)93
• Guidance on Prevention of Viral Hepatitis B and C • United Nations Rules for the Treatment of Women
Among People Who Inject Drugs82 Prisoners and Non-custodial Measures for Women
Offenders (the Bangkok Rules)94
• Therapeutic interventions for users of ampheta-
• United Nations Standard Minimum Rules for
mine-type stimulants83
Non-custodial Measures (The Tokyo Rules)95
• Principles of prevention and treatment for the use
of amphetamine-type stimulants84
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