The war on drugs has had devastating effects on human rights and public health worldwide, argue experts in The BMJ today.
In November, the journal argued that prohibition laws have failed and called on doctors to lead the debate on alternative rational policies that promote health and respect dignity.
This week, key players in this debate discuss the harms of prohibition and criminalisation and outline their reasons for drug policy reform.
In the first article, Dainius Puras, UN special rapporteur on the right to health, and Julie Hannah co-director of the International Centre on Human Rights and Drug Policy at the University of Essex, say harsh enforcement of prohibition undermines the right to health and fundamental dignity.
They argue that mass incarceration has overburdened criminal justice systems and left countless people languishing in deplorable facilities in inhumane conditions around the world. While outside the criminal justice system, compulsory detention centres hold people identified as drug users without due process.
Yet they point out that, despite the devastating health and human rights effects, incarceration has failed to deter drug consumption or trafficking.
They believe that drug prohibition and criminalisation is a failed policy model and urge health professionals "to lead efforts to combat societal prejudices and enable reforms that rightfully place individuals and communities at the heart of the response."
Because of harsh national policies to fulfil international treaties that insist on prohibition of non-medical drug use, more than five billion people - 80% of the world's population - have little or no access to medicines such as morphine to treat moderate to severe pain, warns Katherine Pettus at the International Association for Hospice and Palliative Care, in a second article.
She points out that in 2012 the European Society for Medical Oncology described a "pandemic of untreated cancer pain" as a global health scandal. Four years later, a narrative to improve availability of medicines to treat pain has gained traction and precision globally, but "the changes on the ground in some countries are too little and too slow," she argues.
Availability of controlled medicines must be commensurate with clinical need, with safe distribution and dispensing systems, to overcome the scandalously low consumption levels that for too long have been distorted by the "war on drugs," she concludes.
In a final article, Michel Kazatchkine, UN secretary general special envoy on HIV/AIDS in Eastern Europe and Central Asia, argues that the war on drugs leads to denial of evidence based treatment for drug users.
Comprehensive and compelling evidence shows that providing clean needles, opioid substitutes like methadone and antiretroviral therapy to people who inject drugs reduces HIV transmission and long term drug dependency, cuts crime and public disorder, and improves quality of life, he writes.
Russia, however, is strongly prohibitionist and rejects all such policies - and, as he points out, is the only region in the world that still has a growing HIV epidemic.
Harm reduction "has become an example of how health is increasingly being politicised and how policy decisions can be disconnected from scientific evidence," he concludes.
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