many negative“ unintended consequences” of drug enforcement, increasingly shifting its public rhetoric away from its former aspirational goals of a“ drug free world,” towards“ containment” of the problem at current levels.
The Problem with prohibition
Despite this emerging consensus on the nature of the problem, the debate about how policy can evolve to respond to it remains driven more by populist politics and tabloid headlines than by rational analysis or public health principles. The criminalisation of drugs has, historically, been presented as an emergency response to an imminent threat rather than an evidence based health or social policy intervention 18. Prohibitionist rhetoric frames drugs as menacing not just to health but also to our children, national security, and the moral fabric of society itself. The prohibition model is positioned as a response to such threats 1920, and is often misappropriated into populist political narratives such as“ crackdowns” on crime, immigration, and, more recently, the war on terror.
' The debate remains driven by populist politics and tabloid headlines rather than by rational analysis or public health principles '
This conceptualisation has resulted in the punitive enforcement of drug laws becoming largely immune from meaningful scrutiny 21. A curiously self justifying logic now prevails in which the harms of prohibition— such as drug related organised crime or deaths from contaminated heroin— are confused or conflated with the harms of drug use. These prohibition related harms then bolster the apparent menace of drugs and justify the continuation, or intensification, of prohibition. This has helped create a high level policy environment that routinely ignores or actively suppresses critical scientific engagement and is uniquely divorced from most public health and social policy norms, such as evaluation of interventions using established indicators of health and wellbeing.
Challenges to the status quo
Despite this hostile ideological environment, two distinct policy trends have emerged in recent decades: harm reduction 22 and decriminalisation of personal possession and use. Although both are nominally permitted within existing international legal frameworks, they pose serious practical and intellectual challenges to the overarching status quo. Both have been driven by pragmatic necessity: harm reduction emerging in the mid-1980s in response to the epidemic of HIV among injecting drug users, and decriminalisation in response to resource pressures on overburdened criminal justice systems( and, to a lesser extent, concerns over the rights of users). Both policies have proved their effectiveness. Harm reduction is now used in policy or practice in 93 countries 23, and several countries in mainland Europe 2425, and central and Latin America have decriminalised all drugs, with others, including states in Australia and the United States, decriminalising cannabis 26.
18
Barrett D. Security, development and human rights: Normative, legal and policy challenges for the international drug control system. Int J Drug
Policy2010; 21:140-4. CrossRef Medline Web of Science 19
United Nations. United Nations convention against illicit traffic in narcotic drugs and psychotropic substances. 1988.
www. unodc. org / pdf / convention _ 1988 _ en. pdf 20
Brown G. Prime minister’ s questions. Hansard2010 Mar 24. www. publications. parliament. uk / pa / cm200910 / cmhansrd / cm100324 / debtext / 100324-
0003. htm # 10032434000735 21
Committee on Data and Research for Policy on Illegal Drugs. Informing America’ s policy on illegal drugs: what we don’ t know keeps hurting us. National
Research Council, National Academy Press, 2001 22
International Harm Reduction Association. What is harm reduction? A position statement. 2010. www. ihra. net / Whatisharmreduction
23 The global state of harm reduction 2012. Harm Reduction International 2012 http:// www. ihra. net / global-state-of-harm-reduction-2012
24 European Monitoring Centre for Drugs and Drug Addiction. Illicit drug use in the EU: legislative approaches. EU, 2005
25
Rolles S, Eastwood N, Drug Decriminalisation Policies in Practice: A Global Summary 2012 http:// www. ihra. net / files / 2012 / 09 / 04 / Chapter _ 3.4 _ drugdecriminalisation _. pdf 26
Room R, Hall W, Reuter P, Fischer B, Lenton S. Global cannabis commission report. Beckley Foundation, 2009 revolutionise. it 46