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Csete J, Kamarulzaman A, Kazatchkine M, Altice F, Balicki M, Buxton J, Cepeda J, Comfort M, Goosby E, Goulão J, Hart C, Kerr T, Lajous AM, Lewis S, Martin N, Mejía D, Camacho A, Mathieson D, Obot I, Ogunrombi A, Sherman S, Stone J, Vallath N, Vickerman P,. 
“Public health and international drug policy”. 
Lancet. 2016 Mar 29.
In September, 2015, the member states of the UN endorsed Sustainable Development Goals (SDGs) for 2030, which aspire to human-rights-centred approaches to ensuring the health and wellbeing of all people. The SDGs embody both the UN Charter values of rights and justice for all and the responsibility of states to rely on the best scientifi c evidence as they seek to better humankind. In April, 2016, these same states will consider control of illicit drugs, an area of social policy that has been fraught with controversy and thought of as inconsistent with human rights norms, and in which scientific evidence and public health approaches have arguably had too limited a role.


Conclusions and recommendations Policies meant to prohibit or greatly suppress drugs present a paradox. They are portrayed and defended vigorously by many policy makers as necessary to preserve public health and safety, and yet the evidence suggests that they have contributed directly and indirectly to lethal violence, communicable-disease transmission, discrimination, forced displacement, unnecessary physical pain, and the undermining of people’s right to health. Some would argue that the threat of drugs to society might justify some level of abrogation of human rights for protection of collective security, as is provided for in human rights law in case of emergencies. International human rights standards dictate that, in such cases, societies still should choose the least harmful way to address the emergency and that emergency measures should be proportionate and designed specifi cally to meet transparently defi ned and realistic goals. The pursuit of drug prohibition meets none of these criteria.


Standard public health and scientific approaches that should be part of policy making on drugs have been rejected in the pursuit of prohibition. The idea of reducing the harm of many kinds of human behaviour is central to public policy in traffi c safety, tobacco and alcohol regulation, food safety, safety in sports and recreation, and many other areas of human life where the behaviour in question is not prohibited. But explicitly seeking to reduce drug-related harms through policy and programmes and to balance prohibition with harm reduction is regularly resisted in drug control. The persistence of unsafe injection-linked transmission of HIV and HCV that could be stopped with proven, costeff ective measures remains one of the great failures of the global responses to these diseases.

Drug policy that is dismissive of extensive evidence of its own negative impact and of approaches that could improve health outcomes is bad for all concerned. Countries have failed to recognise and correct the health and human rights harms that pursuit of prohibition and drug suppression have caused, and, in doing so, neglect their legal responsibilities. They readily incarcerate people for minor off ences but then neglect their duty to provide health services in custodial settings. They recognise uncontrolled illegal markets as the consequence of their policies, but do little to protect people from toxic, adulterated drugs that are inevitable in illegal markets or the violence of organised criminals, which is often made worse by policing. They waste public resources on policies that do not demonstrably impede the functioning of drug markets, and miss opportunities to invest public resources wisely in proven health services for people often too frightened to seek services.

To move towards the balanced policy that UN member states have called for, we off er the following recommendations:

• Decriminalise minor, non-violent drug off ences— use, possession, and petty sale—and strengthen health and social-sector alternatives to criminal sanctions.

• Reduce the violence and other harms of drug policing, including phasing out the use of military forces in drug policing, better targeting of policing on the most violent armed criminals, allowing possession of syringes, not targeting harm-reduction services to boost arrest totals, and eliminating racial and ethnic discrimination in policing.

• Ensure easy access to harm-reduction services for all who need them as a part of responding to drugs, in doing so recognising the eff ectiveness and costeff ectiveness of scaling up and sustaining these services. OST, NSP, supervised injection sites, and access to naloxone—brought to a scale adequate to meet demand—should all fi gure in health services and should include meaningful participation of people who use drugs in planning and implementation. Harm-reduction services are crucial in prison and pretrial detention and should be scaled up in these settings. The 2016 UNGASS should do better than the UN Commission on Narcotic Drugs (CND) in naming harm reduction explicitly and endorsing its centrality to drug policy.

• Prioritise people who use drugs in treatment for HIV, HCV infection, and tuberculosis, and ensure that services are adequate to enable access for all who need care. Ensure availability of humane and scientifi cally sound treatment for drug dependence, including scaled-up OST in the community and in prisons. Reject compulsory detention and abuse in the name of treatment.

• Ensure access to controlled drugs, establish intersectoral national authorities to determine levels of need, and give WHO the resources to assist the International Narcotics Control Board in using the best science to determine the level of need for controlled drugs in all countries.

• Reduce the negative impact of drug policy and law on women and their families, especially by minimising custodial sentences for women who commit nonviolent off ences and developing appropriate health and social support, including gender-appropriate treatment of drug dependence, for those who need it.

• Efforts to address drug-crop production need to take health into account. Aerial spraying of toxic herbicides should be stopped, and alternative development programmes should be part of integrated development strategies, developed and implemented in meaningful consultation with the people aff ected.

• A more diverse donor base is needed to fund the best new science on drug-policy experiences in a nonideological way that, among other things, interrogates and moves beyond the excessive pathologising of drug use.

• UN governance of drug policy should be improved, which should including respecting WHO’s authority to determine the dangerousness of drugs. Countries should be urged to include high-level health offi cials in their delegations to CND. Improved representation of health offi cials in national delegations to CND would, in turn, be a likely result of giving health authorities an important day-to-day role in multisectoral national drug-policy-making bodies.

• Health, development, and human rights indicators should be included in metrics to judge success of drug policy, and WHO and the UNDP should help to formulate them. The UNDP has already suggested that indicators such as access to treatment, frequency of overdose deaths, and access to social welfare programmes for people who use drugs would be useful indicators. All drug policies should also be monitored and assessed as to their impact on racial and ethnic minorities, women, children and young people, and people living in poverty.

• Move gradually toward regulated drug markets and apply the scientifi c method to their assessment. Although regulated legal drug markets are not politically possible in the short term in some places, the harms of criminal markets and other consequences of prohibition catalogued in this Commission will probably lead more countries (and more US states) to move gradually in that direction—a direction we endorse. As those decisions are taken, we urge governments and researchers to apply the scientifi c method and ensure independent, multi disciplinary, and rigorous assessment of regulated markets to draw lessons and inform improvements in regulatory practices, and to continue evaluating and improving. We urge health professionals in all countries to inform themselves and join debates on drug policy at all levels. True to the stated goals of the international drug-control regime, it is possible to have drug policy that contributes to the health and wellbeing of humankind, but not without bringing to bear the evidence of the health sciences and the voices of health professionals.
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