War on drugs harmed public health: report

3 decades of the war on drugs had no measurable impact on supply or use

CBC News
 

The goal of prohibiting illicit drugs to protect society hasn't worked, say doctors calling for a rethink. (Sean Gallup/Getty Images)

 
The war on drugs has failed, fuelling higher rates of infection and harming public health and human rights to such a degree that it's time to decriminalize non-violent minor drug offences, according to a new global report.

The authors of the Johns Hopkins-Lancet Commission on Public Health and International Drug Policy call for minor use, possession and petty use to be decriminalized following measurably worsened human health.

"We've had three decades of the war on drugs, we've had decades of zero-tolerance policy," said Dr. Chris Beyrer, a professor of infectious disease epidemiology at Johns Hopkins Bloomberg School of Public Health in Baltimore and the senior author of the report published Thursday in The Lancet.

"It has had no measurable impact on supply or use, and so as a policy to control substance use it has arguably failed. It has evidently failed."

Given that the goal of prohibiting all use, possession, production and trafficking of illicit drugs was to protect societies, the researchers evaluated the health impacts and found they were overwhelmingly negative.

Decriminalize vs. militarize  

For a role model, the authors point to Portugal, which decriminalized not only cannabis but also possession of heroin, cocaine and methamphetamine. HIV transmission, hepatitis C and incarcerations all decreased, Beyrer said, and there was about a 15 per cent decline in substance use by young people in Portugal.

The authors found the biggest factor driving higher rates of infection among drug users was that they were excessively incarcerated and excluded from HIV and hepatitis C prevention, treatment and harm-reduction programs. These include needle and syringe exchanges, safe injection facilities and opioid substitution therapies such as methadone.

Russia is the opposite extreme, the authors said. Opioid substitution is prohibited by law, and needle and syringe exchanges are allowed only sporadically. The official estimate of Russians living with HIV rose to 907,000 by the end of 2014, up from 500,000 in 2010. More than 57 per cent of the cases were attributed to unsafe drug injection. Globally, HIV transmission linked to drug use is also increasing.

The authors' recommendations include:

• Comprehensive HIV, hepatitis C and TB services should be scaled up in prisons as well as in the community.
• Overdose deaths can be greatly reduced by ensuring that people who use opioids have good access to medication-assisted treatment and ensure those who use drugs or are likely to witness overdoses have access to and training in delivering naloxone, a medicine that reverses overdose. 
• Governments and research bodies should seize the opportunity when legally regulated markets for cannabis are introduced to evaluate best practices for public health and safety that can be emulated.

Earlier this week, Health Canada announced naloxone is now available without a prescription in this country.

The Liberal government is consulting on legalizing marijuana.

In the U.S., mandatory minimum sentences clearly played a role in the country's record mass incarcerations, Beyrer said.

"Unfortunately what does happen when substance use is criminalized is you have a huge impact on the people who've been caught up in criminal justice, and many of them end up unable to find work because they have narcotics charges, they have felony charges and they get stuck in the drug use environment," he said.

After Mexico's government turned to the military instead of police in a literal war on drugs, there was an increase in lethality and civilian deaths, Beyrer said, noting it reduced life expectancy measurably.