Lancet Report Calling For Drug Decriminalisation Means Reformists Can No Longer Be Branded 'Crazed Drug Users'

'Countries are neglecting their legal responsibilities'

24/03/2016 14:09

A major study on drugs led by a prestigious medical publication and a world leading medical school has called for minor drug offences to be decriminalised as a "first and urgent step".

The study by 'The Lancet' and Johns Hopkins University, a UK reformist said, should mean policy makers can no longer dismiss drug reform arguments as the "ravings of crazed drug users, libertarians or extremists".

The research calls for all non-violent minor drug offenses including use, possession, and petty sale, to be decriminalised, and said by not doing so countries are "neglecting their legal responsibilities to their citizens". 

Researchers found that fifty years of drugs policy had caused serious "detrimental effects on the health, wellbeing and human rights" of both drug users and the general public.

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A study by The Lancet and Johns Hopkins University has called for minor drug offences to be decriminalised

While calls for decriminalisation are nothing new, the "huge significance of the report is its provenance", said Steve Rolles, of drugs reform think-tank Transform. He hopes the report will "shake the medical and public health establishment out of its stupor".

Rolles said: "Its [the report] in the world's leading medical journal in conjunction with the world's leading medical school," the senior policy analyst said, adding: "Its an astonishingly thorough piece of public health analysis compiled by leading scholars from around the world."

For those in the drug reform movement, Rolles said, the report is another "huge vote of confidence from the scientific academic community". 

"When these arguments come from respected public figures, academics, parents and professionals its no longer possible to dismiss them as the ravings of crazed drug users, libertarians or extremists," he said. 

"In fact its the advocates of the failed war on drugs who are now looking like anti-science ideologues. The case for reform has always been compelling, but who is making the argument is crucial. This stunning piece of work in such a lofty academic journal can only help accelerate much needed change."

Rolles said "professional bodies and royal colleges have been incredibly weak on this issue, historically", but now had a clear "road map" of how to improve drug policy. 

He added: "We've come to expect this from cynical populist politicians, but medical professionals no longer have any excuse - we are long overdue some meaningful action from them."

The report published Thursday comes ahead of the United Nations General Assembly Special Session (UNGASS) on April 19 – the first UNGASS meeting on drugs since 1998.

In the 18 years since the last meeting attitudes to drugs policy have almost completely changed. Cannabis has been legalised in Uruguay and in four US states  - Washington, Colorado, Oregon, and Alaska -  and leading public and political figures have spoken out in favour of reforms. 

Last month former UN Secretary-General Kofi Annan wrote a blog for the Huffington Post's US site arguing why it's time to legalise all drugs, and in October 2015 Sir Richard Branson leaked a report by the UN Office on Drugs and Crime calling on governments worldwide to decriminalise all drugs. Branson had feared the UNODC would soften its stance before publication. 

The last UNGLASS meeting, convened under the theme, 'A drug-free world—we can do it!'—endorsed drug-control policies with the goal of prohibiting all use, possession, production, and trafficking of illicit drugs which it said were a "grave threat to the health and wellbeing of all mankind".

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'When it comes to drugs, standard public health and scientific approaches have been rejected', the study found

The new report said that "compelling evidence" now showed that decriminalisation worked, as proved in the Czech Republic and Portugal, who decriminalised all drugs in 2001. Both countries had experienced "significant health benefits, cost savings, and lower incarceration with no significant increase in problematic drug use", the study found. 

Commissioner Dr Chris Beyrer said that drug laws were based on "ideas about drug use and drug dependence that are not scientifically grounded".

Beyrer, from the Johns Hopkins Bloomberg School of Public Health, added: “The global ‘war on drugs’ has harmed public health, human rights and development. It’s time for us to rethink our approach to global drug policies, and put scientific evidence and public health at the heart of drug policy discussions.” 

Commissioner Dr Joanne Csete said reducing harm was central to public policy in so many areas, from tobacco and alcohol regulation to food or traffic safety, "but when it comes to drugs, standard public health and scientific approaches have been rejected". 

Csete, from the Mailman School of Public Health, Columbia University, New York, added: "Worse still, by dismissing extensive evidence of the health and human rights harms of drug policies, countries are neglecting their legal responsibilities to their citizens.

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Portugal decriminalised all drugs in 2001 and had had experienced 'significant health benefits, cost savings, and lower incarceration with no significant increase in problematic drug use', the study found

"Decriminalisation of non-violent minor drug offenses is a first and urgent step in a longer process of fundamentally re-thinking and re-orienting drug policies at a national and international level. As long as prohibition continues, parallel criminal markets, violence and repression will continue.”

The Commission also found that drug law enforcement had been applied in a "discriminatory way" against racial and ethnic minorities and women, and has "undermined human rights".

As an example, the Commission said new estimates suggest that prisoners in Mexico were now more likely than before to be subjected to torture and abuse, since the government’s 2006 decision to use military force against drug traffickers.

And in the US in 2014, the report found, African American men were more than five times more likely than white people to be incarcerated for drug offences in their lifetime, even though there is no significant difference in rates of drug use among the populations.

"The impact of this bias on communities of people of colour is intergenerational and socially and economically devastating," the study found. 

The Commission also found substantial gender biases in current drug policies.

Of women in prison and pre-trial detention around the world, the proportion detained because of drug infractions is higher than that of men even though women tended to be on the lower rungs of the drug trade. 

The study found: "Gender and racial biases have pronounced overlap, resulting in an intersectional threat to women of colour and their children, families, and communities."

The Commission also reviewed the "global evidence base" on health impacts of drug policy and found the biggest contribution to higher rates of infection among drugs users was the "excessive use of incarceration and the systematic exclusion of people who use drugs from HIV and hepatitis C prevention, treatment and harm reduction (including needle exchange and opioid substitution therapy) – whether in the community or in prison".

It added that harsher prison sentences are associated with higher rates of hepatitis C infection among injecting drug users.

The Commission found that the  continued criminalisation of drug use fuels HIV, hepatitis C and tuberculosis transmission within prisons and the community at large.

"There is another way. Programmes and policies aimed at reducing harm should be central to future drug policies,” said Commissioner Professor Adeeba Kamarulzaman,University of Malaya, Kuala Lumpur, Malaysia. 

The Commission concluded:
  • A number of countries, mostly in Europe, have decriminalised minor drug offenses with good results, including more ability to reach people with health and social services and better capacity of the police to focus their efforts on high-level trafficking offenses. Drug use, low-level possession and petty sale of drugs should not be subjected to criminal penalties, including prison sentences, and health and social services for drug users should be improved.
  • People who use drugs have been shown in many countries to be keen to take advantage of prevention and treatment services, but they are often systematically excluded on the grounds of being thought unworthy or unreliable as patients. Governments should invest in comprehensive HIV, TB and hepatitis C services for people who use drugs. While sexually transmitted HIV is on the decline globally, HIV transmission linked to drug use is increasing. 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 by ensuring that people who use drugs or are likely to witness overdoses have access to and are trained in delivering naloxone, a medicine that reverses overdose.
  • Increasing numbers of national governments and sub-national jurisdictions (such as US states) are introducing legally regulated markets of cannabis. Governments and research bodies should see these as opportunities for rigorous scientific research and evaluation so best practices for public health and safety can be identified and emulated.
  • Over-zealous drug control policies are limiting access to pain medications for legitimate clinical use in too many countries. Governments must find balanced policies for ensuring that people have access to controlled medicines such as opioids for the relief of pain while still impeding non-medical use of these substances.
A 2015 report from the UN High Commissioner for Human Rights highlighted some of the main ways in which drug-control policies cause violations of human rights. It found policies had resulted in arbitrary arrest, detention, and ill treatment of people who use drugs; unjust use of the death penalty for drug offences; cruel and inhumane treatment of people who use drugs in the guise of treatment; racial and ethnic discrimination in drug-law enforcement; denial of lifesaving care and prevention interventions to people who use drugs; excessive use of incarceration as a response to minor drug infractions; denial of the cultural rights of indigenous peoples; and poor access to opioids and other controlled drugs for pain management and other clinical uses, among other human rights violations

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