Drugs have been cast as the enemy in a global “war” over public health and morality, while behind closed doors levels of narcotic use continue to rise – along with the many dangers associated with their consumption. On the eve of a United Nations General Assembly Special Session (UNGASS), where UN member states will meet to discuss global drugs policy, experts within the scientific community are now calling for change, urging political leaders to end the so-called “war on drugs” in favor of more evidence-based approaches to resolving this thorny dilemma.

The official call to arms against illicit substances was first sounded at the 1961 UN Single Convention on Narcotic Drugs, before being renewed at the 1998 UNGASS with the adoption of the motivational slogan, “A Drug Free World – We Can Do It.” Decades later, the results are in: we couldn't do it. Not only do millions of people worldwide continue to manufacture, traffic, and consume drugs, but, according to a recent report by a multi-disciplinary scientific commission, it is the war on drugs itself that is responsible for creating many of the public health costs surrounding these substances.

The alternative – decriminalization – is often greeted as a radical, risky idea, equivalent to opening all the cages and letting the animals out of the zoo, leading to a free-for-all as drugs flood the streets. However, as whispers become shouts and increasing numbers of public health experts back the call to end the penalization of drug use, it's about time we took a serious look at what the real implications of this would be.

Harm Reduction

^{Under the current system, drug users receive punishment rather than treatment. AVN Photo Lab/Shutterstock} 

As everyone knows, drugs can be harmful to users’ health, causing an array of negative side-effects, including the big one – death – when overdoses occur. The fact that drug use remains a criminal issue, however, means that many who experience these drawbacks are unable to seek medical help. Maria Phelan, deputy director of Harm Reduction International, told IFLScience that “the crux of the problem lies in the fact that, as a stigmatized population, [drug users] often aren't receiving healthcare,” and as such are unnecessarily suffering and even dying.

On top of this, difficulties in accessing clean syringes mean needle sharing is alarmingly common among people who inject drugs, leading to the spread of diseases. It is currently estimated that around a third of all HIV infections outside of sub-Saharan Africa are caused by the unsafe use of syringes.

Decriminalizing injectable drugs such as heroin, however, would enable the creation of health services like needle exchange programs and supervised injection centers. Portugal, for instance, decriminalized all drugs in 2001, a year in which 1,016 drug users were diagnosed with HIV. By 2012, this figure had dropped to just 56.

Harm Reduction International is now campaigning for the Portuguese model to be applied globally, estimating that if just 7.5 percent of the $100 billion spent each year on punitive drug controls were redirected towards harm reduction initiatives, HIV infections among drug users could be cut by 94 percent by 2030.

Phelan hopes to see this money invested in services like opiate substitution treatments, which provide addicts with synthetic opioids like methadone that they can take without injecting. Studies have shown that access to these treatments produces a 54 percent reduction in the risk of HIV infection among people who inject drugs. In contrast, Phelan says, “if you look at Russia, where methadone is illegal and needle exchange is not funded, you’re looking at HIV rates of up to 70 percent among injectors.”

Legal Regulation

^{Needle sharing contributes to the spread of diseases like HIV and hepatitis C. Diego Cervo/Shutterstock} 

While decriminalization might facilitate a paradigm shift in global drug policy, placing the focus on healthcare rather than punishment, some are calling for governments to go one step further and actually legalize narcotics.

George Murkin, policy and communications officer of Transform, which campaigns for the legal regulation of drugs, told IFLScience that “decriminalization means that the drug market is still controlled by criminals, because it’s still illegal to sell drugs. But legal regulation brings the whole trade above ground.”

As such, “you can apply controls to the preparation and packaging of drugs, so people have information about what they are actually taking.” This, he says, could eliminate the risk of drug users unwittingly consuming impurities and adulterants like fentanyl, a synthetic opioid around ten times stronger than heroin that's often added to street drugs to increase their potency. Consequently, Murkin explains, “users end up overdosing because what they are taking is actually far stronger than they think it is.”

Naturally, many will see the open sale of hard drugs as a recipe for disaster, fearing that increased access to narcotics will ravage populations like some sort of zombie apocalypse. However, while no country has yet to legalize all drugs, a report by the European Monitoring Centre for Drugs and Drug Addiction found no evidence that decriminalizing drugs actually leads to increased use. “All the respectable research into the subject points to the fact that decriminalization doesn’t really have much of an effect on drug use levels,” says Murkin. Instead, “it tends to be things like social trends or cultural fads that dictate whether people use drugs,” he insists.

More to the point, he says, is the fact that “drug use isn’t intrinsically harmful.” Rather, it is problematic drug use that causes damage to both individuals and society, in the form of addiction, overdoses, and unsafe administration. As such, it is feasible that under legal regulation, “drug use could rise slightly, but the harms of drug use could actually fall.”

Perhaps, then, the coveted “drug free world” that current drug policies aspire to is neither feasible nor necessary. Rather than attempting to wipe narcotics from the face of the planet, maybe we should concentrate on how best to live alongside them.

Towards A New Objective?

^{Street drugs are often cut with a potentially lethal cocktail of impurities and adulterants. ShutterDivision/Shutterstock} 

Dr. Dan Werb, executive director of the International Center for Science in Drug Policy, told IFLScience that “we have to look at the way we evaluate drug policy.” For instance, focusing on overall levels of drug use actually “tells us nothing about how communities are being impacted by drugs. But if we were capturing data on how many people have a substance use disorder, we’d get a much better sense of how we need to construct our drug policies.”

Switzerland, for example, has introduced heroin-assisted treatment clinics, where users can access pure, medical grade heroin – known as diamorphine – under the supervision of healthcare professionals. While this has not curbed overall levels of drug use, those involved in these programs have managed to break their reliance on street drugs. As such, they are able to integrate better into society, as they no longer need to commit robberies in order to secure money for their fix.

In contrast, many other countries operate compulsory drug detention and rehabilitation centers for those found in possession of drugs. According to Werb, “these drug detainment centers have become a key part of the war on drugs, but they have no kind of scientific basis.” Commenting on a recent systematic review into their effectiveness, he explains that “when people are released from compulsory drug treatment centers, their drug use returns to the levels that they were at previously.”

While the UNGASS is expected to produce limited reforms to a global policy that is increasingly being criticized as “not scientifically grounded,” there is clearly a mutiny going on among the rank and file of the war on drugs, with a ceasefire now seen by many as the only reasonable solution.