Huge shift needed in global drug policy

Leading global public health experts have urged for reform in the global blueprint on drug policy, saying prevailing policies that put drug users through the criminal justice system have had “serious detrimental effects” on health and human rights and led to lethal violence.
Non-violent, minor drug offences such as possession and petty sale should instead be decriminalised, while health and social services should be strengthened, a major new report led by The Lancet and Johns Hopkins University in the United States recommended.
The report cited “compelling evidence” from countries that decriminalised such offences, such as Portugal and the Czech Republic, which have seen significant public health benefits, cost savings and reduced incarceration.
The authors of the Johns Hopkins-Lancet Commission on Public Health and International Drug Policy include 22 experts from both developed and developing nations. Prof Dr Adeeba Kamarulzaman, dean of Universiti Malaya’s Faculty of Medicine, is one of two co-chairs of the commission and attended the release of the report in New York on Thursday.
The report comes ahead of an important United Nations General Assembly Special Session on April 19, during which intense debate on future global drug policy is expected.
Mexico, Colombia and Guatemala – where vast sums of money have been spent in a futile and violent attempt to control drug supply – made the initial call for the special session, urging the UN to “conduct an in-depth review analysing all available options”.
The last similar UN session in 1988 called for a “drug-free world”. The failure of this goal, the inability of punitive policies to impact drug markets and behaviour, as well as the evidence of decriminalisation in some countries, has led to growing momentum for an overhaul of drug laws.
“The scientific evidence has been accumulating over the last few decades that shows current drug policies do more harm than good,” says Dr Adeeba in an exclusive e-mail interview with Star2.

It is imperative for the issue of illegal drug use to be viewed through a health lens, says Dr Adeeba.

She adds that “it was imperative that evidence be put together” ahead of the special session and the issue be viewed “through a health lens”.
For decades in Malaysia, the battle against drugs has involved a strong punitive and criminal approach, with hundreds of thousands of drug users arrested and jailed or sent to rehabilitation centres, “Pusat Serenti”, for two years.
Last year, roughly half of all local prisoners were behind bars for a drug-related offence; in Selangor’s Kajang Prison, the nation’s largest jail, that figure was 60%. With relapse rates of 70-90% according to local research, many drug users end up repeating the cycle, and in the process, may acquire an infectious disease.
Harsh sentences
The commission, which reviewed the health impacts of global drug policies, said current policies had led to public health crises. It blamed the “excessive use of incarceration” as the biggest contributor towards higher rates of infection (namely hepatitis C and tuberculosis) among drug users.
“Harsh prison sentences are associated with higher rates of hepatitis C infection among injecting drug users,” the report noted. In addition, drug users were often also systematically excluded from disease prevention and treatment services “on the grounds of being thought unworthy or unreliable”.
The commission also said that deaths from overdoses could be “greatly reduced” by improving access to medication-assisted treatment and access to naloxone, a medicine that reverses overdose.
Countries that have adopted different models of decriminalisation include Belgium, Estonia, Australia, Mexico, Uruguay, the Netherlands and Portugal.
Decriminalisation is often mistakenly equated with legalising drugs; in fact, it usually refers to taking a non-criminal approach to drug possession although drugs and trafficking remain illegal. (Some American states have also allowed legally-regulated markets of cannabis, which is a different issue in this respect.)
“Decriminalisation of non-violent minor drug offences is a first and urgent step in a longer process of fundamentally re-thinking and re-orienting drug policies,” says Commissioner Dr Joanne Csete, from the Mailman School of Public Health, Columbia University, New York. “As long as prohibition continues, parallel criminal markets, violence and repression will continue.”
Under Portugal’s decriminalisation scheme, getting caught with drugs may mean a small file and a referral to a treatment programme – not arrest, jail and a criminal record. Despite fears to the contrary, decriminalisation has not led to drug mayhem. Since the scheme began in 2001, drug usage in many categories has actually declined, notably among 15- to 24-year-olds; HIV transmission and drug overdoses have also dropped.
“Governments should really look at countries where (decriminalising) has worked and led to enormous benefits,” says Dr Adeeba. She adds that mindsets and ideology would be the biggest barrier to change.
Drug policy has already shifted in Malaysia. A decade ago, amid rising HIV infection, “harm reduction” programmes were introduced, involving provision of clean needles by NGOs and methadone treatment from clinics. The idea is first to reduce the harm to health from drug use, and then to direct drug users to treatment.

Malaysian police personnel guarding addicts arrested during an operation last year. Health experts from around the world argue that petty, non-violent drug offences should be decriminalised and the focus put on health and social services instead.

Encouraging results
One immediate result has been a decline in new HIV infections from needle sharing. The treatment results from Cure & Care clinics providing methadone therapy are also encouraging. Half of them do not relapse in a year, says Dr Adeeba. Conversely, former inmates of Pusat Serenti often relapse within weeks after release.
A local study on cost-effectiveness of these programmes, done with the involvement of the World Bank, found that harm reduction had helped avert 12,600 new infections, saving the healthcare system RM47mil. Over a 10-year period, up to 2023, the programme is expected to avert roughly 23,000 new infections, and savings of more than RM200mil.
Despite such results, coverage of these programmes is limited, and there is some concern about long-term public funding. The law-and-order approach still predominates.
Dr Adeeba says the need for change is urgent. “Maintaining the status quo means thousands and thousands of young people (will get) incarcerated, which really spells the end of any kind of opportunities and a reasonable life for them. Not only does it destroy them but also the people and families around them.
“It also means that we are not able to control the epidemics of HIV, HCV and TB effectively.”
Commissioner Dr Chris Beyrer, from the Johns Hopkins Bloomberg School of Public Health, says the origin of drug policy was based on ideas rather than any science or what actually works.
“The goal of prohibiting all use, possession, production and trafficking of illicit drugs is the basis of many of our national drug laws, but these policies are based on ideas about drug use and drug dependence that are not scientifically grounded,” he says.
“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.”
It remains to be seen whether science, not politics or ideology, will win the battle at next month’s UN session.