The war on drugs has failed

Taken from the online bmj:

The war on drugs has failed: doctors should lead calls for drug policy reform

Subtitle: Evidence and ethics should inform policies that promote health and respect dignity.

But the effectiveness of prohibition laws, colloquially known as the “war on drugs,” must be
judged on outcomes. And too often the war on drugs plays out as a war on the millions of people who use
drugs, and disproportionately on people who are poor or from ethnic minorities and on women.

Prohibition and stigma encourage less safe drug consumption and push people away from health
services. Sharing of injection equipment has led to huge epidemics of bloodborne infection, including
HIV and hepatitis C. And just one in every six of the 29 million people worldwide with a drug use
disorder received treatment in 2014.

At a UN general assembly in April, many countries asked for health and human rights to be prioritised over punitive responses. Many countries have removed criminal penalties for personal drug possession. Portugal replaced criminal sanctions for drug use with civil penalties and health interventions 15 years ago. The UK Psychoactive Substances Act 2016 criminalises importation, production, and sale but not use of these substances.

Jurisdictions such as Canada, Uruguay, and several US states, now including California, and have gone
further, to allow regulated non-medical cannabis markets, retaking control of supply from organised
crime. The Netherlands has tolerated regulated cannabis sales for decades.

This year a thorough review5 of the international evidence concluded that governments should
decriminalise minor drug offences, strengthen health and social sector approaches, move
cautiously towards regulated drug markets where possible, and scientifically evaluate the outcomes to
build pragmatic and rational policy.

Health should be at the centre of this debate and so, therefore, should healthcare professionals. Doctors are trusted and influential and can bring a rational and humane dimension to ideology and populist rhetoric about being tough on crime.

Some doctors’ organisations have called loudly for change, including International Doctors for
Healthier Drug Policies and the UK Royal Society for Public Health and the Faculty of Public Health.
Recent BMA policy is for the Department of Health to take responsibility for UK drug policy and for
“legislative change” to prioritise treatment over punishment of drug users. But such calls are far
from universal—and far from loud enough.

Doctors and their leaders have ethical responsibilities to champion individual and public health, human rights, and dignity and to speak out where health and humanity are being systemically degraded. Change is coming, and doctors should use their authority to lead calls for pragmatic reform informed by science and ethics.