Punitive measures simply drive drug use underground. A more effective way is to adopt harm reduction interventions.
While the world has been fixated on the results of the presidential election in the United States, less attention has been paid to another outcome of the vote: significant steps toward the decriminalisation of drugs in several states.
Oregon is now set to abolish criminal penalties for possession of small quantities of all illegal drugs, from heroin to methamphetamine. This approach should be applauded — and adopted far more broadly.
According to 2018 data, about 269-million people around the world use illicit drugs, including 11-million who do so by intravenous injection. Nearly half of those who inject drugs are living with hepatitis C and 1.4-million with HIV. According to the United Nations Office on Drugs and Crime, in 2017, more than 500 000 people died from drug use.
This is a preventable tragedy, but it’s fuelled by the cruel and counter-productive approach exemplified by the so-called war on drugs. Launched in the 1970s by US president Richard Nixon, drug possession today is a criminal offence in most countries, and users face severe social stigma.
The war logic is simple: the risk of harsh punishment will act as a deterrent, causing drug use to diminish. But this isn’t what happens. Despite increasingly punitive approaches, global drug sales and use continue to increase, causing more overdoses, HIV, hepatitis C and tuberculosis.
The threat of punishment and discrimination doesn’t drive people to quit or avoid drugs, but rather to hide their use, including from their doctors. By discouraging those who use drugs from consulting the health systems, criminalisation and stigmatisation‚ as well as racism, which compounds drug-related discrimination — contribute to negative outcomes outcomes for people and their neighbourhoods.
There is a better way. Rather than attempting to force people to forswear drug use, we should be trying to minimise its negative effects on their health and well-being. Harm-reduction interventions include needle-exchange programmes, whereby people can get sterile needles and syringes; drug-consumption rooms, where people can safely use drugs without risking an overdose; opioid agonist therapy, such as using a methadone replacement; and housing and employment initiatives.
Decades of research and practice show that harm-reduction interventions work and are cost effective. For example, opioid agonist therapy decreases the likelihood of overdose and needle exchange programmes substantially reduce the spread of hepatitis C and HIV. In Portugal, HIV rates have plummeted since possession of all drugs was decriminalised and harm-reduction interventions were ramped up almost 20 years ago.
The good news is that, as the latest report from Harm Reduction International states, significant progress has been made in the provision of such services. Over the past few decades, 86 countries have implemented needle and syringe programmes, and 84 provide some form of opioid agonist therapy. But much more remains to be done.
As the Harm Reduction International report shows, there are still huge gaps in access to harm-reduction services, even in places that offer them, such as Australia, Canada and Western Europe. For example, there are few services tailored to women and gender nonconforming people. And harm reduction services consistently fail to meet the needs of the groups that have borne the brunt of punitive drug policies, such as African Americans and indigenous people around the world.
Moreover, the services are often concentrated in cities, and users in rural areas are neglected. People in jail, who are at a high risk of contracting HIV and hepatitis C and of overdosing when they are released, usually have no access to them.
According to Harm Reduction International, progress in expanding access to programmes has been stalled for more than five years. As long as limited resources are allocated to law enforcement, rather than harm reduction, significant further gains will remain elusive.
When people who use drugs suffer and die, they are often reduced to statistics and dismissed as “criminals” or “lowlifes”. But they are our friends and families, neighbours and colleagues. They are humans, who have a right to health, equality and respect regardless of their gender, sexuality, race, nationality, legal status or drug-use habits or histories.
If Covid-19 has taught us anything, it is that the health and well-being of all are interconnected. Only an approach to drug use based on public-health imperatives and human-rights principles — and that protects the most vulnerable among us — can end a war that never should have been fought. — © Project Syndicate
Tlaleng Mofokeng, of the Commission for Gender Equality in South Africa, is a United Nations special rapporteur on the right to health. The views expressed here do not necessarily reflect those of the UN