The war on drugs has failed: doctors should lead calls for drug policy reform – BMJ – Fiona Godlee, editor in chief, Richard Hurley, features and debates editor – Published 14 November 2016
Evidence and ethics should inform policies that
promote health and respect dignity
A quarter of a billion adults—one in 20 worldwide—took an illegal drug such as cannabis, cocaine, or heroin in 2014.3
Three United Nations treaties, the oldest from 1961, seek to “advance the health and welfare of mankind” by prohibiting the non-medical use of some drugs. To this end, countries criminalise producers, traffickers, dealers, and users at an annual cost of at least $100bn.7
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.1
Prohibition and stigma encourage less safe drug consumption and push people away from health services.1
The ideological goal of a “drug-free world” encourages ideologically driven medical practice.
This is like asking for a greed-free world: such a thing cannot exist as long as humans are involved.
Drug control policies effectively deny two thirds of the world’s population—more than five billion people—legitimate access to opioids for pain control.10
And they impede research into medical use of cannabis and other prohibited drugs despite evidence of potential benefit.11
Criminally controlled drug supply markets lead to appalling violence—causing an estimated 65 000-80 000 deaths in Mexico in the past decade, for example.12
Mandatory sentencing for even minor drug offences has helped the United States attain the highest rate of incarceration in the world.13
It is no surprise, then, that there have been calls for reform, including from
- the World Health Organization,
- the UN Development Programme, and
- the UN human rights agency,15
as well as
- non-governmental organisations,16
- former heads of state,10
- UK parliamentarians,17
- some law enforcers, and
- medical journals.
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.10
This year a thorough review 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.1
- Different drugs
- with different harms
- in different contexts
- may need different approaches.
And any change must be supported by investment in evidence based education, counselling, and treatment services to deter drug use and increase safety among users.
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.
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.
BMJ2016; 355doi: http://dx.doi.org/10.1136/bmj.i6067