18/09/2013 07:34 BST | Updated 17/11/2013 05:12 GMT

Doctor Drug Czar - Give Public Health a Voice in Drug Policy

The world is used to identifying the drug war as a US project.

A long-time bankroller and cheerleader for punitive drug policies, the United States is typically viewed as a defender of the status quo.

But change is in the air in American drug policy. The Attorney General has recognized the damaging effects of mass incarceration on vulnerable communities, the national drug control body is adopting the rhetoric of a health-based approach, and a majority of voters now support legalization of marijuana.

However concrete changes remain somewhat incremental - especially considering the numbers of people arrested or incarcerated for minor drug offenses every year. It's high time for the US to move beyond mere rhetoric, and the drug czar vacancy presents a major opportunity.

This summer Gil Kerlikowske, a former police chief, resigned as head of the Office of National Drug Control Policy to become the government's Customs Commissioner. During his time at the helm of ONDCP, the language around drug policy made significant improvements (even if the reality has yet to catch up).

The ONDCP, and other drug control agencies, now claim to support a public health-based approach to drugs and are trying to move away from the 'war on drugs' terminology. If action follows the new vernacular, then it represents the beginning of something very important.

One way to show that the US is indeed taking a fresh approach towards drugs would be to appoint a public health professional as the new drug czar.

After all, it's worked in other countries.

In the Netherlands, for instance, which has the lowest problematic drug use in Europe, the drug portfolio is based at the Ministry of Health.

The Netherlands' focus on health led to pioneering programs like needle exchange and safer consumption rooms, the decriminalization of possession of small quantities of drugs and easy-to-access treatment services. Its pragmatic policies and groundbreaking harm reduction interventions have resulted in low prevalence of HIV among people who inject drugs, which has virtually disappeared in the country,

In the Czech Republic, since the end of the Soviet occupation in the late 1980s, the drug policy coordinators have been health and social service professionals, all people who knew the day-to-day reality of providing essential services to people who use drugs. They have worked successfully to ensure that drug policing focuses on major traffickers rather than targeting individual users. Excellent access to HIV prevention services helped the Czech avoid the injection-linked HIV epidemics of other countries.

Portugal's landmark drug policy reforms, including decriminalization of all drugs, made addiction and demand reduction a part of health policy and not criminal justice. In addition, the dissuasion commissions - that seek to deter people from drug use and which replaced the criminal courts as the state's forum for responding to drug use - were placed under the Ministry of Health, rather than the Ministry of Justice.

After some of these reforms were introduced, the number of new HIV infections among people who use drugs dropped from 1,430 to 116 over the next decade.

These are just a few examples. But considering that the US is at or near the head of the pack in so many drug war failures (mass incarceration, problematic drug use, fatal overdose, etc.) perhaps it's time for a little humility and consideration of what we can learn from countries that have done better.

In addition, it seems only fair to adopt some international best practices since nothing the US does is ever in a vacuum. It has impacts all over the world.

For better or worse, the US is a leader on the issue of drugs and many other countries watch its actions as a bellwether.

It would make a tremendous difference if the US used this leadership opportunity to make a concrete statement that the US does indeed support a public health-based approach to drugs.