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Global policies to control illegal drug use tend to ignore scientific evidence and can undermine development efforts, global experts warn.

Repressive policies meant to protect people from the damage caused by drugs have caused disease, deadly violence and discrimination, says the Johns Hopkins-Lancet Commission on Drug Policy and Health, drawing on decades of research.

They say that efforts to clamp down on drug use have helped spread HIV and other infectious diseases, as users are forced to take drugs in secret and struggle to access sterile equipment such as syringe needles.

The report also highlights a spike of homicides in countries where governments use military forces against drug traffickers, which, in turn, causes drug gangs to arm themselves.

“Alternative development programmes really haven’t addressed the underlying factors that lead people to cultivate drugs.”

Rebecca Schleifer, Yale University

Ahead of a special UN meeting on the subject in New York, United States, on 19-21 April, the commission urges governments to focus on reducing harm from drug use rather than on punishment.

“The war on drugs and zero-tolerance policies that grew out of the prohibitionist consensus are now being challenged on multiple fronts, including their health, human rights and development impact,” the researchers explain in a paper published in medical journal The Lancet on 2 April.

The report highlights “aggressive and harmful practices” against farmers who grow drug crops such as coca, cannabis and opium poppies. This includes the forcible destruction of coca fields in the Andes through large-scale herbicide spraying, which causes health problems and environmental damage among affected communities and can force farmers to abandon their land.

Meanwhile, “alternative development” programmes to encourage farmers to switch to other crops have largely failed through poor design, says an appendix to the report.

“Alternative development programmes really haven’t addressed the underlying factors that lead people to cultivate drugs,” says Rebecca Schleifer, who studies drugs and human rights issues and is a fellow at Yale University in the United States. For example, she says, some programmes require farmers to destroy their crops before they can get aid.

“But if you do that before alternatives [are in place] you just undermine these farmers’ livelihoods,” Schleifer says.

The Lancet paper argues that minor, non-violent drug offences should be decriminalised. It recommends focusing on harm reduction services, such as providing supervised injection sites and prescribing replacement drugs for those addicted to opioids such as heroin, instead of aggressive drug policing.

The authors also endorse a gradual move towards regulated legal drug markets — as Uruguay has done with cannabis, for example — and for this change to be assessed scientifically.

In addition, they “call to broaden the research agenda around drug use [beyond] brain pathology” to include economic and social science, says commission co-chair Adeeba Kamarulzaman, an infectious disease specialist at the University of Malaya in Malaysia. On a practical level, the indicators used to evaluate drug policies should change, the paper suggests. “Success has been measured in hectares [of drug crops] eradicated, in kilos [seized], numbers of people arrested, convicted, incarcerated,” Schleifer explains. “These don’t really measure anything apart from scale of effort.”

The paper references the Sustainable Development Goals (SDGs) and related promises for governments “to rely on the best scientific evidence” as they seek to ensure the “wellbeing of all people”.

But drug policy discussions are still far from adopting the language of SDGs, says Kamarulzaman. “Most countries are still stuck on criminalisation and zero tolerance,” she says.

Schleifer is more optimistic. While drug control policies and development efforts used to be completely separate, links between the two have been increasing in recent years, she says.

The same people who adopted the SDGs last September are returning later this month for the high-level UN meeting on drugs, she says. “It’s a tough road ahead, but even controversial subjects such as decriminalisation are on the table.”


Joanne Csete and others Public health and international drug policy (The Lancet, 2 April 2016)