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World Health Day highlights the need to talk about drug policy


Heroin addicts in the government-run Jangalak rehabilitation centre in Kabul, Afghanistan. Jordi Bernabeu Farrús under a Creative Commons Licence

The ‘war on drugs’ has serious implications for public health worldwide, writes Natasha Horsfield.

Current drug policies which focus on prohibition over public health reinforce the vicious cycle of poverty and ill health by increasing the risk of health harms, and limiting access to medical care for people who use drugs. They also impact on entire communities by overly restricting access to essential medicines. In short, drug policy impacts heavily on health.

Although a number of countries take a public health approach to drug policy, many do not. The so called ‘war on drugs,’ which prioritizes the prohibition of illicit drug use, possession, cultivation, production and trafficking, has dominated since the mid-twentieth century. This is despite serious implications for public health.

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The health of people who use drugs are the most obviously impacted by this zero-tolerance approach to drug policy, which restricts their access to medical care and support services for issues directly related to drug use and more generally. The criminalization of people who use drugs, and social stigma which results from this, acts as a barrier that often prevents people who use drugs from accessing health care for fear of legal punishment. Conversely it also results in people who use drugs sometimes being denied access to healthcare because of their status; in particular pregnant women who use drugs.

Strict prohibition drives drug use underground, removing any controls on strength and purity, which increases risk of overdose. The criminalization of drug use and possession of drug paraphernalia in some countries also creates a significant barrier to the provision of harm reduction services, such as needle and syringe exchange programmes, putting people who inject drugs at high risk of contracting blood borne diseases such as HIV and hepatitis. There is also a significant lack of treatment available for diseases such as HIV and AIDS for people who use drugs; only 4 per cent of people living with HIV among those who inject drugs have the opportunity to access anti-retroviral treatment.

Less often discussed is the impact of drug policy on the health of people who don’t use drugs. Prohibition seriously restricts the availability of essential medicines, such as morphine, used for pain relief in the treatment of cancer and other diseases, maternal health care, and for surgical procedures. Despite the intention of international drug regulation being to guarantee availability of controlled drugs for medical use, in reality the focus in many countries is on fighting illegal markets through heavy restrictions. This means 5.5 billion people live with limited or no access to morphine and other essential medicines because of drug policies. Fifty per cent of the world’s cancer patients and 90 per cent of the world’s AIDS patients have access to only 6 per cent of the world’s morphine for pain management.

By prioritizing prohibition over public health outcomes, the ‘war on drugs’ approach causes harm to billions of people worldwide, while having limited impact on its intended goal of achieving a drug free world. These restrictive drug policies also have negative repercussions for the new Sustainable Development Goals (SDGs), particularly health goal three, which aims to ensure health and wellbeing for all, including ending the AIDs epidemic and combating hepatitis. This simply won’t be achieved without a reform of current drug policy in favour of prioritizing public health. Furthermore, the billions spent on enforcing the war on drugs could be better spent on healthcare provision and improving access to harm reduction services.

Health Poverty Action is working to highlight the impacts of prohibition for marginalized communities and achieving the SDGs; we are calling for a rethink of drug policy which puts people’s health and rights first. You can find out more by watching our animation video or help us demand reform by taking our online pledge.

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