By Chris Beyrer and Michel Kazatchkine
America's growing epidemic of prescription drug and heroin abuse is forcing a long-overdue reckoning with failed national drug policies. Having long treated substance use as a matter for the police and prisons, many policymakers are finally coming to understand drug dependence as a disease and public health problem, to be faced with science and empathy.
While recent efforts by the U.S. Senate and White House to expand access to treatment and mental health services for substance users are a welcome move, they represent only a small shift and not the radical change that is needed to effectively address the problem.
In the U.S. and many countries around the world, drug policies have not only failed to curb drug use, they are causing massive harm to the people and societies they are supposed to serve, from spurring violence to driving epidemics of infectious disease.
In a few weeks, world leaders will have a chance to start reversing this tragedy in a special session of the UN General Assembly focused on the global drug problem. The last such meeting was nearly two decades ago, and its focus on zero tolerance for substance use, enforcement and punishment has fueled many of the harmful anti-drug polices we see around the globe today. Both science and experience say the world can do better.
A recent report issued by a group of global health and drug policy experts convened by Johns Hopkins University and The Lancet demonstrates some of the worst effects of today's policies:
Epidemics of HIV, tuberculosis and viral hepatitis, driven in part by aggressive policing and incarceration. In Thailand, for example, nearly two thirds of hepatitis C transmission happens in prison; in Scotland, it is more than half. TB stubbornly persists in no small part because vulnerable drug users are forced into the shadows - and out of their nations' healthcare systems. Ending the AIDS epidemic will be the big focus of this summer's 21st International AIDS Conference in South Africa, however the continued marginalization of people who use drugs is a primary barrier to achieving that vision.
- Lethal violence, ranging from continued gang violence in America's cities to dramatic increases in murder rates that have dented Mexico's life expectancy.
-Disproportionate harm to people of color and women. The mass incarceration of black and Latino men in the U.S. is a prime example, yet in most countries it is women who are more likely to be penalized harshly for drug offenses, in part because they lack the power or influence to contest their treatment by law enforcement.
-The direct effects of drugs, including lethal overdoses. In the U.S. alone, heroin-related overdose deaths quadrupled between 2002 and 2013, and deaths from prescription opioid overdose quadrupled from 1999 to 2010.
Change will mean overcoming entrenched ways of thinking, and it won't be easy. But global agreements matter, making this month's UN meeting critical. The prohibitionist UN framework of the late 1990s has been enshrined in many national laws. Changing it will send a strong signal to governments that the policies of the past 20 years have failed.
We know that tough policy changes are possible. In the U.S., a drug-related HIV outbreak in rural Indiana prompted Congress to overturn a long-standing ban on the use of federal money for syringe exchange programs, which are proven to reduce HIV infections without increasing drug use. Meanwhile, the gradual decriminalization of individual marijuana use - together with a nascent movement to reform the criminal justice system and sentencing laws - promises to keep more men and women out of the corrections system and provide those that need them with services that can prevent recidivism and improve health.
At the upcoming UN meeting, the Obama Administration and other world leaders must advocate forcefully for these kinds of changes. The next global agreement should be backed by science and promote strategies proven to improve public health, not hurt it.
A critical first priority is to decriminalize minor, non-violent drug offenses - an approach being pursued successfully in the Czech Republic, Portugal, some U.S. states and elsewhere. Legal changes should be paired with public health strategies recommended by the World Health Organization and other UN agencies to reduce the harms of drug use. These include syringe exchange programs that can halt transmission of HIV and hepatitis; access to heroin substitution therapies, which are helping people overcome addiction in countries as varied as Switzerland and Tanzania; and full access to medical care for people affected by HIV, TB and hepatitis, regardless of their drug use status. To make these changes durable, the resources currently devoted to enforcing repressive policies must be redirected to prevention, harm reduction, treatment and care.
Meanwhile, countries need to ensure that regulation of opioids doesn't limit access to these medicines for legitimate uses. In fact, adequate pain relief is already beyond reach for many people worldwide who suffer excruciating pain from injuries or diseases such as cancer.
Bold changes in drug policies will take courage. An impressively diverse set of countries is showing it can be done - and that their citizens' lives can be improved in the process. Now the world needs to follow their lead.
Chris Beyrer is president of the International AIDS Society and international chair of the 21st International AIDS Conference
Michel Kazatchkine is United Nations Special Envoy for HIV/AIDS in Eastern Europe and Central Asia