Public health and international drug policy

Abstract

Executive summary In September 2015, the member states of the United Nations endorsed sustainable development goals (SDG) for 2030 that aspire to human rights-centered approaches to ensuring the health and well-being 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 scientific 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, seen as inconsistent with human rights norms, and for which scientific evidence and public health approaches have arguably played too limited a role. The previous UN General Assembly Special Session (UNGASS) on drugs in 1998 – convened under the theme “a drug-free world, we can do it!” – endorsed drug control policies based on the goal of prohibiting all use, possession, production, and trafficking of illicit drugs. This goal is enshrined in national law in many countries. In pronouncing drugs a “grave threat to the health and well-being of all mankind,” the 1998 UNGASS echoed the foundational 1961 convention of the international drug control regime, which justified eliminating the “evil” of drugs in the name of “the health and welfare of mankind.” But neither of these international agreements refers to the ways in which pursuing drug prohibition itself might affect public health. 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 Johns Hopkins – Lancet Commission on Drug Policy and Health has sought to examine the emerging scientific evidence on public health issues arising from drug control policy and to inform and encourage a central focus on public health evidence and outcomes in drug policy debates, such as the important deliberations of the 2016 UNGASS on drugs. The Johns Hopkins-Lancet Commission is concerned that drug policies are often colored by ideas about drug use and drug dependence that are not scientifically grounded. The 1998 UNGASS declaration, for example, like the UN drug conventions and many national drug laws, does not distinguish between drug use and drug abuse. A 2015 report by the UN High Commissioner for Human Rights, by contrast, found it important to emphasize that “[d]rug use is neither a medical condition nor does it necessarily lead to drug dependence.” The idea that all drug use is dangerous and evil has led to enforcement-heavy policies and has made it difficult to see potentially dangerous drugs in the same light as potentially dangerous foods, tobacco, alcohol for which the goal of social policy is to reduce potential harms. Health impact of drug policy based on enforcement of prohibition The pursuit of drug prohibition has generated a parallel economy run by criminal networks. Both these networks, which resort to violence to protect their markets, and the police and sometimes military ...

The impact of buprenorphine and methadone on mortality: a primary care cohort study in the United Kingdom

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HIV and AIDS among adolescents who use drugs: opportunities for drug policy reform within the sustainable development agenda

“…In 2014, there were 11.7 million (8.4 to 19.0 million) people who inject drugs (PWID) (aged 15 to 64) globally, of which 24% resided in Eastern Europe alone. This region is highlighted as it faces the largest number of new HIV infections through drug injection as a mode of transmission in the world, and concentrates countries that oppose in policy and in practice the evidence‐based harm reduction measures 8. For instance in the Russian Federation, the country with the highest injection burden in the world with 2 million PWID (1.8 to 2.2 million) 9, HIV prevalence among young people aged less than 25 in Moscow reached 12% in 2012 10, while it reached 37.4% – strongly linked to drug injection – among homeless AWUDs in Saint Petersburg 11.…”

Prevalencia del VIH en niños, niñas y adolescentes en situación de calle y explotación sexual comercial: una revisión sistemática

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