It’s time for the world to change its approach to drugs, with governments needing to legalise and regulate all illicit substances, say Juan Manuel Santos, Ernesto Zedillo, and Ruth Dreifuss.

The market for illicit drugs represents the world’s largest criminal commodity business.

With an estimated annual turnover of up to €650bn, it is approximately one-third the size of the global oil market, and it is controlled by criminals who care little for others’ health, rights, and safety.

Around the world, drug-related deaths have been surging, rising from 183,500 in 2011 to roughly 450,000 in 2015 — an increase of 145% in just four years.

Meanwhile, more than €100bn continues to be spent every year in a futile attempt to eradicate the illegal drugs market. Over the last 50 years, many countries have even gone so far as to militarize their response.

But while some drug cartels have been dismantled, some kingpins brought to justice, and the area under cultivation for cannabis, coca, and poppy reduced, these successes have proved only temporary.

Worse, in many cases, the problem has simply been foisted onto other countries, causing a “balloon effect”. For instance, after the early 2000s, coca production declined in Colombia and rose in Peru, only to double back to Colombia in more recent years. Because drug traffickers can adapt and change, progress is always reversible.

The human costs have been nothing short of shocking. According to the National Institute of Statistics and Geography, there were more than 250,000 recorded homicides in Mexico between 2006 and 2017.

In the Philippines, there have been as many as 20,000 extrajudicial killings since President Rodrigo Duterte assumed office in 2016.

And in Colombia, many political leaders, policemen, soldiers, judges, and prosecutors have been murdered, while coca farmers — mostly poor smallholders — have been caught in the crossfire between the army, paramilitary groups, insurgents, and gangs.

Sadly, this level of violence should come as no surprise. When drugs are banned, they are pushed into illegal markets where physical force, intimidation, discrimination, and corruption take the place of state-based regulatory tools.

Moreover, prohibition exacerbates the health and social harms associated with drugs by contributing to epidemics of HIV and hepatitis C, overdose deaths, prison overcrowding, stigma and discrimination, poverty, and weakening institutions.

It is time for the world to change its approach. The use of psychoactive substances is a risky behaviour, and managing such risks is a key function of government.

That is why the Global Commission on Drug Policy, in its recent report, Regulation: The Responsible Control of Drugs, recommends that governments legalise and regulate all currently

illegal drugs.

“Legalisation” is often portrayed inaccurately as an intervention by the state to promote drug use. But what it really means is that authorities acting in the public interest provide a legal framework for the production, distribution, and sale of drugs for adult consumption, with appropriate consideration given to the harms associated with each particular substance. It is a policy that specifically addresses the realities of drug use and the presence of drug markets.

As with all regulation, reforms should be implemented incrementally, and guided by evidence of what works and what does not. Different drugs will naturally require different levels of regulation depending on their relative risks, and approaches will vary from one country and locale to another.

Whereas cannabis might be sold exclusively in licensed retail stores, pharmaceutical-grade heroin could be made available with a prescription to people who are dependent, and for whom other addiction treatments haven’t worked.

Neither policymakers nor voters can hide behind the argument that people who use drugs deserve to be treated differently because they have chosen to engage in potentially harmful activity. Putting aside the fact that drug dependency tends to override one’s capacity to make such choices freely, we all engage in risky, harmful behaviours, from smoking to consuming alcohol, trans fats, processed sugar, and so forth.

Fortunately, we know already how to manage risky behaviours and potentially dangerous products, not just from the legal cannabis markets emerging across the Americas, but also from the successes and failures of food safety, alcohol, and tobacco control.

The lesson from those over-commercialised legal markets is that we need to place appropriate controls on marketing practices and curtail the incentives for commercial enterprises to encourage harmful consumption in pursuit of profits.

We also need more prevention and monitoring programmes, which would be the case with or without legalisation. Experiences with alternative models might also help guide the transition from criminal to regulated drug production and use when they are implemented alongside sustainable socioeconomic development policies.

Thailand, for example, has phased out opium by creating other economic opportunities for rural farmers. And Bolivia and Turkey have introduced legal, regulated coca and poppy cultivation, respectively, to push out illegal operations.

By calling for legalisation, we are not surrendering to the problem posed by drugs. Rather, we are advocating a more effective, lasting, and humane solution.

Though legal regulation is not a panacea for all drug-related problems, it is the best hope we have for building a healthier, safer, and more just world.

Ultimately, the choice is simple. We can hand control to governments or to criminal organisations. There is no third way.

Juan Manuel Santos, a Nobel Peace Prize laureate, is a former president of Colombia and a member of the Global Commission on Drug Policy. Ernesto Zedillo is a former president of Mexico and a member of the Global Commission on Drug Policy. Ruth Dreifuss is a former president of Switzerland and Chair of the Global Commission on Drug Policy.