By Carey Wedler

“The war on drugs has failed,” the editors of the peer-reviewed British Medical Journal declared this week, arguing that doctors should lead the global effort to reform drug policy.

Fiona Godlee, the journal’s editor-in-chief, and Richard Hurley, its features and debates editor, penned an analysis citing academic and scientific reports to argue global policies on drug use — including the United Nations’ — have fallen drastically short.

Godlee and Hurley note the annual cost of prohibition, which entails criminalizing “producers, traffickers, dealers, and users,” totals at least $100 billion annually.

“But the effectiveness of prohibition laws, colloquially known as the ‘war on drugs,’ must be judged on outcomes,” they write. “And too often the war on drugs plays out as a war on the millions of people who use drugs, and disproportionately on people who are poor or from ethnic minorities and on women.”

The authors cite a variety of reasons why the global war on drugs has been a failure.

Citing an academic study on international drug policy from the Lancet medical journal, the authors argue that “prohibition and stigma encourage less safe drug consumption and push people away from health services.”

These policies have other negative consequences. Godlee and Hurley highlight the current situation between Russia and Crimea, “where patients in Crimea died after the Russian invasion because they were forced to stop taking methadone, which is viewed as opioid misuse and illegal in Russia.”

Further, though opioid addiction is a growing epidemic, “drug control policies effectively deny two-thirds of the world’s population—more than five billion people—legitimate access to opioids for pain control.”

Another problem [pdf] with prohibition policies, they argue, is that “they impede research into medical use of cannabis and other prohibited drugs despite evidence of potential benefit.”

This is the case in the United States, where the federal government’s designation of cannabis as a Schedule I drug has hampered the ability of scientists to research the medical effects of the plant. The Drug Enforcement Administration (DEA) recently ruled to maintain this classification. This decision was largely deemed hypocritical, especially considering the United States government holds a patent on cannabis for its antioxidant properties. The federal government’s National Cancer Institute also admits cannabis can help treat the symptoms of cancer and that “[c]annabis has been shown to kill cancer cells in the laboratory.” In spite of the promise of the plant, it remains prohibited under federal law.

Still, Godlee and Hurley argue, the effects of the drug war aren’t limited to health. They extend to the realm of human rights:

All wars cause human rights violations, and the war on drugs is no different. Criminally controlled drug supply markets lead to appalling violence—causing an estimated 65 000-80 000 deaths in Mexico in the past decade, for example [pdf]. Mandatory sentencing for even minor drug offences has helped the United States attain the highest rate of incarceration in the world [pdf]. The Philippines has seen 5000 extrajudicial killings [pdf] since July, after President Rodrigo Duterte’s call for vigilantism against drug dealers.

The paper also cites countries around the world that have moved to lessen the invasiveness of the drug war. They cite Portugal, which famously removed criminal penalties for drugs 15 years ago.

Further, they note:

Jurisdictions such as Canada, Uruguay, and several US states, now including California, and have gone further, to allow regulated non-medical cannabis markets, retaking control of supply from organised crime. The Netherlands has tolerated regulated cannabis sales for decades.

The editors of the BMJ acknowledge drugs can cause harm. But they argue “governments should decriminalise minor drug offences” and “strengthen health and social sector approaches,” as well as move toward regulated drug markets.

Most importantly, they assert doctors should play a key role in developing drug policy.

Health should be at the centre of this debate and so, therefore, should healthcare professionals. Doctors are trusted and influential and can bring a rational and humane dimension to ideology and populist rhetoric about being tough on crime.

The BMJ editors are not the first to condemn the war on drugs. Earlier this year, over 1,000 world leaders, scientists, and medical experts condemned the U.N.’s half-hearted effort to reform its drug policies. In a separate criticism of the U.N.’s proposed solutions, 194 advocacy groups also expressed disappointment.

Similarly, a group of doctors in the United States called Doctors for Cannabis Regulation has advocated an end to marijuana prohibition in favor of regulation of the market.

BMJ acknowledges efforts like these but asserts “such calls are far from universal—and far from loud enough.”

Doctors and their leaders have ethical responsibilities to champion individual and public health, human rights, and dignity and to speak out where health and humanity are being systemically degraded.

“Change is coming,” they conclude, “and doctors should use their authority to lead calls for pragmatic reform informed by science and ethics.”

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