The medical community must fight for the rights of people with drug-use problems and offer them “solidarity and protection from the worst excesses of populist politics,” according to an editorial published today in the medical journal The Lancet.

The editorial, which appears in a special drugs issue that contains four new papers detailing the latest developments on cannabis, opioids, stimulants, and new psychoactive substances, points out that “policies that might improve the lives of people with health problems relating to drug use are not seen as substantial vote winners.”

“Indeed, punitive approaches to drug use are seen by some as a way to project the image of firm moral leadership, however inhumane or ineffective they might be. It is time to recognise the humanity of drug users...the medical community must stand up for the rights of people with drug use disorders to receive evidence-based care.”

The Lancet’s move to publish a drugs issue exemplifies its history of taking a strong stance on public health and harm reduction, said Pamela Das, co-editor of the series. "Many of the recommendations in the series are not new, but they continue to be dismissed despite the huge amount of scientific evidence of what works."

The authors of the paper on opioids said that although opioid dependence is the third-most damaging substance-use disorder after tobacco and alcohol, “coverage of interventions to prevention of opioid­ related harms to health is woefully inadequate in most countries.” It said the best way to combat this was by moving away from criminalization and expanding treatment using methadone and buprenorphine.

An analysis of legalized cannabis in the U.S. found that while it had reduced the illicit market and allowed governments to regulate and tax cannabis, potency had increased, adult use had risen and prices had fallen. It said claims that medical use of cannabis for pain relief has reduced deaths from opioid overdose is based on weak evidence.

It warned that by the time the true costs and benefits of legalization become available, “legalisation might be difficult to reverse because a profitable commercial cannabis industry will have been created that contributes substantial revenue to governments.”

On stimulants, the paper in The Lancet said that little had been done to tackle the rising problems around cocaine and amphetamines such as meth. “No effective pharmacotherapies are available that reduce stimulant use. The absence of an effective policy response to the scale and severity of harms related to stimulant use, combined with the fear and stigmatisation of so-­called problem users, has restricted the allocation of resources to reduce stimulant ­related harms.”

It said the world had instead relied on law enforcement to deal with the stimulant problem, most notably in Asia. “Globally, and particularly in the Asia­Pacific region, policy has been dominated by incarceration, with an estimated 235000 people detained in compulsory drug detention centres in which major infringements of human rights occur.”

Finally, in an impressive moment of prophecy, a paper looking at the expansion of new psychoactive substances quoted from a previous study, way back in 1988, which predicted with chilling accuracy our current state of affairs concerning fentanyl: “The future drugs of abuse will be synthetics rather than plant products. They will be synthesized from readily available chemicals. A single gram of any very potent drug...could be synthesized in one location, transported to distribution sites worldwide, and then formulated into many thousand, perhaps a million, doses.”

“This editorial demonstrates frustration with the international policy paralysis that continues to cause harm to people when there is sufficient evidence to support the need for policy that sees these problems for what they are: human suffering borne out of social inequality,” said Ian Hamilton, senior lecturer in addiction and health at the University of York in the U.K. “The Lancet’s audience—doctors, researchers, and policy makers—will pay attention to this editorial position and the accompanying report. That matters, as these groups shape the health experience that people who have problems with drugs encounter.”