Over the past three decades, European governments have been moving to protect people who use drugs from drug-related health harms.

Drug use has been recognised as a public health concern, and needle and syringe programmes, safe injection facilities, and drug checking, combined with a wide range of treatment options, have been set up throughout Europe.

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The Swiss exampled has almost eliminated HIV transmission among people who inject drugs (Photo: Michael Bird)

Furthermore, ceasing to see people who use drugs as criminal offenders has led many countries in Europe towards de jure or de facto decriminalisation of drug use and possession for personal use.

In Portugal, consumers may be actively directed to these facilities by the police or social services.

These measures have contributed to easing the problems related to open drug markets and other public safety issues and contributed to decreasing the stigma and discrimination associated with drug use.

Enabled and supported by strong state institutions and quasi-universal health coverage, they have led to considerable improvements in major areas of concern for public health.

The number of new HIV cases among people who use drugs in the EU/EEA fell by 36 percent between 2004 and 2013, with HIV prevalence rates among people who inject drugs (PWID) below 5 percent in 18 of the 27 EU/EEA countries.

In Switzerland, the transmission of HIV among PWID dropped from 937 new cases in 1989 to nine in 2014, almost eliminating HIV transmission among people who use drugs.

In Portugal, a model cited worldwide for its health-centred approach to drug policy, the per capita rate of drug-related deaths is 86 times lower than that of the US, which saw over 70,000 overdose deaths in 2017.

The Harm Reduction International Conference is the largest international gathering on this topic and is taking place in Porto, Portugal this week, and represents a unique opportunity to celebrate these achievements.

In doing so, however, we must not ignore a fundamental contradiction of European drug policy.

While it takes a health-centred approach to consumption, European drug policy favours coercion and a repressive, law enforcement approach when addressing the cultivation, production and trafficking of drugs.

The critical element at hand is prohibitive and punitive approaches do not result in negative consequences for European people alone.

These negative consequences – and often the most harmful – are borne mainly and primarily by the populations of neighbouring countries, those deemed as "producing and transit countries" for the European "wealthy and consumer" market, while these countries are often less well equipped to address their own drug-related problems.

Albanian drug hub

In Albania, efforts were made to eradicate cannabis crops and arrest cultivators to undermine trafficking – but without addressing the structural dimensions that make organised crime powerful in the country, or the causes questioning the structures of border control or the institutional vulnerability to corruption.

The result was that drug traffickers adapted to the new market structures and added cocaine to their heroin and cannabis portfolios.

Albania became, after this counterproductive local episode of the "war on drugs", a major global drug hub at the doorstep of the EU.

In West Africa and the Sahel, countries are increasingly used as a transshipment point for cocaine from South America to Europe.

Knock-on affects in Mali

This drug-trafficking has played a direct or indirect role in political upheaval in Guinea-Bissau and Mali, contributed to the opportunistic funding of extremist groups, and fuelled a growing problem with drug use in the region.

The response, also funded by European countries, has focused mainly on failed attempts to controlling the flow of drugs and strengthening law enforcement, rather than addressing weaknesses in state institutions that provide fertile ground for the establishment of this trafficking route.

And while Europe in large part recognises that people who use drugs do not forgo their right to health and offers them social protections, elsewhere human rights violations are rife: arbitrary arrests in Africa, harsh penalties for the possession of even minor quantities of drugs throughout much of Asia, as well as capital punishment for drug trafficking, and extrajudicial killings in Bangladesh and the Philippines encouraged by politicians and tolerated by the state.

Within Europe's own borders, this emphasis on a criminal justice approach to 'fight drugs' and keep them away from consumers has contributed to a worsening situation in prisons, with overcrowding – a form of human rights violation – considered a serious problem in many countries such as France or Belgium.

The question then is how long can European governments allow these injustices to be perpetrated in the name of reducing the presence of drugs on their streets?

Should they not instead seek to fully integrate global issues and development challenges in the European approach to international drug control.

This means addressing root causes rather than symptoms.

It means actively confronting political and governance challenges that incite corruption, and supporting reforms in electoral funding in developing countries and other measures aimed at strengthening the proper functioning of state institutions – rather than creating well-funded but isolated drug police units or paying for a scanner here and there at ports of entry, without any global strategic approach to reducing drug use while preserving people's dignity.

When Europe talks about balanced drug policies, these must include balance in external assistance between support for security and justice efforts and support for public health, including treatment and harm reduction services.

Governments now have the evidence to show that the current approach is not working. And while reforms require societal debates that can take a long time, lives are at stake.

There is an urgent need to start the process towards providing technical assistance to modernise drug control in developing countries, until such time that they can own an evidence-based response to drugs, operationalise it and fund it.