Abstract
While it is common for United Nations member states in international meetings to espouse ‘public health approaches’ to drug policy, actual policies appear not to have caught up with this rhetoric. There is a lingering over-emphasis in narcotic drug policies on policing and incarceration at the expense of urgently needed investment in health and social services for people who use drugs. These policies have lethal consequences in the transmission of potentially fatal infections and preventable overdose deaths, and they impede progress in social and economic development. The experience of a number of countries, mostly in the European Union, highlights that bringing public health evidence into the center of drug policy decision-making can have broad social, economic and public health benefits.
Highlights
To judge by the rhetoric in United Nations discussions, the era of public health-friendly, evidence-based policy on control of psychotropic drugs is well enshrined
Csete: The Elusive Search for Rights-Centred Public Health Approaches to Drug Policy. This commentary suggests that there is an urgent need for pragmatic evidence-based policies that can undo the harms of politically expedient, criminal-law-heavy policies and demonstrate that drug control can be consistent with sustainable development, human rights and public health
As the Lancet Commission concluded, overzealous efforts to control non-medical use of opioids have resulted in lopsided policies that fail to achieve a balance between preventing diversion of opioids to non-medical use and ensuring their availability for those who need them (Ibid.) This is the policy balance that World Health Organization (WHO) has long espoused (WHO 2011), but it seems unattainable when drug laws are so harsh that doctors’ fear of criminal sanctions overwhelms their desire to relieve their patients’ pain
Summary
While it is common for United Nations member states in international meetings to espouse ‘public health approaches’ to drug policy, actual policies appear not to have caught up with this rhetoric. Provision of sterile injection and smoking equipment to people who use drugs, furnishing them with a place where they can consume drugs in relative safety with medical intervention as needed, and ensuring that they have ready access to effective treatment for drug use disorders have long since proven their worth in cost-effective HIV prevention (Wilson et al 2015), but they remain underutilized Reducing overdoses and their harm requires thinking beyond the package of HIV-related harm reduction measures, and that thinking is handicapped by ill-informed fears. People who use drugs are at high risk of tuberculosis (TB), in some settings linked to high prevalence of HIV and because they are over-represented in prison and pretrial detention, which are high-risk environments for TB transmission (Stop TB Partnership 2016)
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