Doctors should lead calls for drug policy reform – BMJ

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

People have always consumed psychoactive substances, risking harm.1 2

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,
  • UNAIDS,
  • 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

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5 thoughts on “Doctors should lead calls for drug policy reform – BMJ

  1. Kathy C

    In an ideal world Doctors would be the ones to inform Policy regarding health issues. Unfortunately most Doctors would be unable to voice their own informed ideas. There are a number of problems one being the Media, which has several narratives regarding this issue. Only Doctors who believe the current narrative and reinforce it, while avoiding any conflicts of Interests, are quoted or have their Opinions repeated. Challenging any of the current narrative would mean the end of their careers.
    Many are limited by clauses in their employment contracts with large HMO’s and Hospital Corporations. There are very few independent Doctors anymore. The few that are left that have opinions contrary to the current ideology are rapidly retiring. Doctors sign gag clauses, in order to work for the big Corporations. Their speech is so limited, any infraction could cause a Legal battle, against a Corporation with unlimited resources.
    Recently there was a Nursing Shortage in area Hospitals. Nurses had tolerated the situation for years, which led to high turnover, and patient safety concerns. This problem was easy to observe, and the nurses had legitimate grievances. One theme became very clear, the Media barely followed this issue. This was blamed on “Unions” and politicized, by the Big Hospital Corporations. Another theme was the silence of the Doctors, not one spoke up on this issue, which should have been important to their daily operations. The silence was deafening. One issue that would be clear, the relationship between Patient Safety and Nurse staffing levels. Not one Physician at any Hospital spoke up in support of the Nurses. This should be chilling, to know that they could not even speak up on an issue like this.
    We don’t live in country that is informed anymore, and Policy decisions are based on Public opinion, Media narratives, that are promoted by the Industry. Every single piece of Research, calls for the need for more “research.” No one has asked why there is no research, or where is the data. If the data does not support the current ideology it is not collected.
    The Media uses anecdotes to illustrate their current narrative. The heart wrenching emotional stories of Drug Addicts are the ones informing drug Policy, not statistics and facts. Anyone with an informed Opinion is shouted down with “Oh My God People are dying.” We no longer have “Free Speech” no matter what your occupation. If your “Free Speech” conflicts with the popular narrative you credibility, reputation, career and life is ruined.

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    Reply
    1. Zyp Czyk Post author

      I’m sad to realize you’re right. We can no longer rely on “truth” to settle our differences. With so many conflicts of interest and various gag-policies, even scientific research has become tainted by prejudice.

      All the studies these days are looking for “more of the same”, more proof of how “bad” opioids are. That’s where the money is and money always rules. I hope I don’t become a bitter old lady with all these disappointments.

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    2. david becker

      To suggest that media and corporations control and gag doctors is like saying the tail wags the dog. The AMA is one of the leading lobbying groups in the Nation with over 100 million spent a year in lobbying- and there are numerous other medical organizations that control not only policy and practice but media, as well. Most media on health is sponsored-and a good portion by drug companies- who do you think works in Big Pharma- social workers? construction workers?. Think again. Doctors are not innocent victims of society or media or corporations- n the contrary they have dirty hands in the drug wars- the war against opioids marijuana ketamine cancer herbs, vitamins etc- all fought by and for doctors.
      The public is the ones suffering not nurses or doctors. The public is being disenfranchised by doctors and nurses as being unqualified to have free speech on health care. Even the NYS Education Department tried to silence me recently on pain care saying that i was unqualified- and doesnt that beat all as I am the one who got three pieces of legsialtion in NYS requiring education in pain care and changed the NPS.
      Lets call a spade a spade- doctors like cops like to tell the rest of the world to keep quiet when it comes to matters they like to claim as their exlcusive domain.

      Liked by 1 person

      Reply
      1. Zyp Czyk Post author

        I guess we’ll just have to agree to disagree because I still do not see individual doctors as culprits.

        On the other hand, as in any organized lobbying group, powerful leaders and financial interests have taken over, and I’m sure a good amount of what you say is true of them.

        As has been stated in so many ways and so many times: power corrupts. I’m not sure how that can ever be changed, since humans have always been like this.

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  2. david becker

    To suggest doctors dont dominate the discourse over drug policy is to suggest we dont live in the modern world. When the DEA tried to oppose the use of kratom- they did so by asserting there was insufficient medical basis for such. They did not state that public opinion was against its use or that enough citizens were in favor of its use. So clearly the dea and government is captured by discourse created by and for doctors as being authoritative.
    Doctors largely control the creation, the distribution and use of evidence regarding drugs, vitamins, supplements-the evidence that is used to justify curent policies and practices. Who works in the fda that approves of medications? not social workers or truck drivers.
    To suggest that doctors arent involved in corporations and big money- when their industry is 3 trillion a year is just not credible. They may complain that their organizations are controlling their practices- but they dnt complain that the public is controlling them. So whether it is insurers, corprations doctors complain about- they are dominated by medical discourse that doctors have generated. SO doctors shuldnt blame truck drivers, or joe public for the drug war for doctors supplied the evidence basis that supports the drug war and show no signs of relinquishing their dominance in that arena.

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