Escolar Documentos
Profissional Documentos
Cultura Documentos
REPORT OF THE
GLOBAL COMMISSION
ON DRUG POLICY
Upper Left: Protesters at London’s
Russian Embassy demand the
introduction of opiate substitution
therapy and the scale-up of
syringe access programs.
Photo: International Network of
People who Use Drugs
www.inpud.net
The global war on drugs is driving the HIV/AIDS pandemic However, data from the United Nations Office on Drugs
among people who use drugs and their sexual partners. and Crime demonstrate that the worldwide supply of illicit
Throughout the world, research has consistently shown opiates, such as heroin, has increased by more than
that repressive drug law enforcement practices force drug 380 percent in recent decades, from 1000 metric tons in
users away from public health services and into hidden 1980 to more than 4800 metric tons in 2010. This increase
environments where HIV risk becomes markedly elevated. coincided with a 79 percent decrease in the price of heroin
Mass incarceration of non-violent drug offenders also in Europe between 1990 and 2009.
plays a major role in increasing HIV risk. This is a critical
public health issue in many countries, including the United Similar evidence of the drug war’s failure to control drug
States, where as many as 25 percent of Americans infected supply is apparent when US drug surveillance data are
with HIV may pass through correctional facilities annually, scrutinized. For instance, despite a greater than 600 percent
and where disproportionate incarceration rates are among increase in the US federal anti-drug budget since the early
the key reasons for markedly higher HIV rates among 1980s, the price of heroin in the US has decreased by
African Americans. approximately 80 percent during this period, and heroin
purity has increased by more than 900 percent. A similar
Aggressive law enforcement practices targeting drug pattern of falling drug prices and increasing drug potency is
users have also been proven to create barriers to HIV seen in US drug surveillance data for other commonly used
treatment. Despite the evidence that treatment of HIV drugs, including cocaine and cannabis.
infection dramatically reduces the risk of HIV transmission
by infected individuals, the public health implications of As was the case with the US prohibition of alcohol in
HIV treatment disruptions resulting from drug law the 1920s, the global prohibition of drugs now fuels
enforcement tactics have not been appropriately re- drug market violence around the world. For instance,
cognized as a major impediment to efforts to control it is estimated that more than 50,000 individuals have
the global HIV/AIDS pandemic. been killed since a 2006 military escalation against drug
cartels by Mexican government forces. While supporters
The war on drugs has also led to a policy distortion of aggressive drug law enforcement strategies might
whereby evidence-based addiction treatment and public assume that this degree of bloodshed would disrupt the
health measures have been downplayed or ignored. While drug market’s ability to produce and distribute illegal drugs,
this is a common problem internationally, a number of recent estimates suggest that Mexican heroin production
specific countries, including the US, Russia and Thailand, has increased by more than 340 percent since 2004.
ignore scientific evidence and World Health Organization
recommendations and resist the implementation of With the HIV epidemic growing in regions and countries
evidence-based HIV prevention programs – with devastat- where it is largely driven by injection drug use, and with
ing consequences. In Russia, for example, approximately recent evidence that infections related to injection drug use
one in one hundred adults is now infected with HIV. are now increasing in other regions, including sub-Saharan
Africa, the time for leadership is now. Unfortunately,
In contrast, countries that have adopted evidence-based national and United Nations public health agencies have
addiction treatment and public health measures have seen been sidelined. While the war on drugs has been fueling
their HIV epidemics among people who use drugs – as well the HIV epidemic in many regions, other law enforcement
as rates of injecting drug use – dramatically decline. Clear bodies and UN agencies have been actively pursuing an
consensus guidelines exist for achieving this success, but aggressive drug law enforcement agenda at the expense
HIV prevention tools have been under-utilized while harmful of public health. Any sober assessment of the impacts
drug war policies have been slow to change. of the war on drugs would conclude that many national
and international organizations tasked with reducing the
This may be a result of the mistaken assumption that drug drug problem have actually contributed to a worsening of
seizures, arrests, criminal convictions and other commonly community health and safety. This must change.
reported indices of drug law enforcement “success” have
been effective overall in reducing illegal drug availability.
The following action must be taken by national heroin-assisted treatment. These strategies
leaders and the United Nations Secretary reduce disease and death, and also limit the size
General, as well as the United Nations Office on and harmful consequences of drug markets by
Drugs and Crime, UNAIDS and the Commission reducing the overall demand for drugs.
on Narcotic Drugs:
7. All authorities – from the municipal to
1. Acknowledge and address the causal links international levels – must recognize the clear
between the war on drugs and the spread of failure of the war on drugs to meaningfully
HIV/AIDS, drug market violence and other health reduce drug supply and, in doing so, move
(e.g., hepatitis C) and social harms. away from conventional measures of drug law
enforcement “success” (e.g., arrests, seizures,
2. Respond to the fact that HIV risk behavior convictions), which do not translate into positive
resulting from repressive drug control policies effects in communities.
and under-funding of evidence-based approaches
is the main issue driving the HIV epidemic in 8. Measure drug policy success by indicators that
many regions of the world. have real meaning in communities, such as
reduced rates of transmission of HIV and other
3. Push national governments to halt the practice infectious diseases (e.g., hepatitis C), fewer
of arresting and imprisoning people who use overdose deaths, reduced drug market violence,
drugs but do no harm to others. fewer individuals incarcerated and lowered rates
of problematic substance use.
4. Replace ineffective measures focused on the
criminalization and punishment of people who 9. Call for public health bodies within the United
use drugs with evidence-based and rights- Nations system to lead the response to drug
affirming interventions proven to meaningfully use and related harms and to promote evidence-
reduce the negative individual and community based responses. Other bodies, including the
consequences of drug use. International Narcotics Control Board, should
be subjected to independent external review to
5. Countries that under-utilize proven public health ensure the policies they promote do not worsen
measures should immediately scale up evidence- community health and safety.
based strategies to reduce HIV infection and
protect the health of persons who use drugs, 10. Act urgently: The war on drugs has failed, and
including sterile syringe distribution and other millions of new HIV infections and AIDS deaths
safer injecting programs. Failure to take these can be averted if action is taken now.
steps is criminal.
* The recommendations from the Global Commission
6. The public and private sectors should invest on Drug Policy’s 2011 “War on Drugs” report are
in an easily accessible range of evidence-based summarized on the inside back cover of this report.
options for the treatment and care for drug
dependence, including substitution and
Far Upper Right: An injecting drug user is injected with heroin, locally
known as brown sugar, by his companion by a roadside in the eastern
Indian city of Siliguri.
Photo: Reuters / Rupak De Chowdhuri
Where Public Health Approaches Are Remarkably, despite the extensive body of clinical research
Ignored, the HIV Epidemic Is Out of Control proving the benefits of methadone maintenance therapy
in reducing the individual and community harms of heroin
In addition to increased HIV risk behavior and barriers use as well as HIV risk,35,36 the use of methadone remains
to HIV treatment, the war on drugs has also led to the limited in many countries and is illegal in Russia. Similarly,
distortion of public policy, whereby evidence-based in the Central Asian republics and other countries of
addiction treatment and public health interventions have the former Soviet bloc, methadone programs tend to
been ignored or downplayed. In 2008, the Executive be “perpetual pilot programs” created in some cases in
Director of the United Nations Office on Drugs and response to donor pressure but never brought to anything
Crime acknowledged this reality, reflecting on the prior approaching the scale that would meet existing demand.
decade of drug control:
A recent UN report describing the HIV prevention situation
“Public health, which is clearly the first principle of in Poland, which was critical of the nation’s anti-drug laws,
drug control, also needs a lot of resources. Yet the noted that “in the context of HIV, there has been a gap in
funds were in many cases drawn away into public funding and work on HIV prevention, which in turn impacts
security and the law enforcement that underpins it. the availability of prevention services including harm
The consequence was that public health was displaced reduction measures.”37 Settings where HIV prevention
into the background, more honored in lip service and measures have been curtailed as a result of economic
rhetoric, but less in actual practice.” concerns have been particularly vulnerable to increases in
HIV risk among injection drug users. For instance, a greater
The emphasis on drug law enforcement has created than 10-fold increase in newly diagnosed HIV infections
legal barriers to evidence-based HIV prevention among injecting drug users has recently been reported
measures, such as the provision of clean syringes, and from Greece during the first seven months of 2011.38
evidence-based addiction treatment methods, such as Although the Russian Federation was recently investing
methadone maintenance therapy. These public health close to US$800 million annually in HIV-related initiatives,
approaches have been proven to reduce HIV risk and less than one percent of this amount was targeted toward
are widely endorsed by major international medical prevention for people who use drugs, among whom the
and public health bodies.32,33 Methadone, for instance, Russian epidemic is concentrated.39 As a result of the lack
is on the World Health Organization’s Model List of of evidence-based addiction treatment and HIV prevention
Essential Medicines, and various scientific reviews of measures, about one in one hundred Russian adults is now
the effectiveness of sterile syringe provision in reducing infected with HIV (Figure 1).
HIV risk have led the United Nations to strongly
recommend sterile syringe provision.34 In spite of evidence of a long and expanding problem of
heroin injection in many coastal areas of sub-Saharan Africa,
Nevertheless, public health assessments have shown especially the East African coast,2 a small methadone
extremely low rates of coverage of proven interven- program in Mauritius and one begun in February 2010
tions, including in those settings where they are most in Tanzania are virtually the only public sector opioid
urgently needed.24 For example, contrary to the advice maintenance therapy programs south of the Sahara.
of many scientific bodies and the recommendations Similarly, methadone remains effectively inaccessible in
of the World Health Organization, a number of many parts of South and East Asia even where opiate
countries, including the US and Russia, have resisted injection is known to occur on a significant scale.
the implementation of evidence-based HIV prevention
programs. In the US, Congress has recently reinstated Thailand is also an important case study, as the country is
the ban on federal funding of syringe exchange often credited with successfully reducing HIV among sex
programs both domestically and abroad, just two years workers and their clients by distributing and promoting the
after lifting what had been a 21-year ban. Access to use of condoms, along with other evidence-based mea-
sterile syringes is limited in various other countries with sures. Among female commercial sex workers in Thailand,
high HIV rates among injecting drug users. the estimated HIV prevalence has declined from a peak of
more than 40 percent in 1995 to less than 5 percent
in recent years. At the same time, however, Thailand has
FIGURE 1. 1,000,000
of HIV-infected 800,000
Russian Federation
HIV-infected individuals
600,000
Programme on HIV/AIDS
400,000
300,000
200,000
100,000
Figure 2. Figure
Figure
1994
2.2.
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
FIGURE 2. 60 60
60
Estimated HIV
Estimated HIV prevalence (%)
50 50
50
Estimated HIV prevalence (%)
prevalence among
different risk groups 40 40
40
in Thailand
30 30
30
Source: Thailand Bureau of
Epidemiology, HIV Total Sentinel 20 20
20
Surveillance. Ministry of Public
Health (2011) 10 10
10
0 00
1989
1990
1991
1989
1989
1992
1990
1990
1993
1991
1991
1994
1992
1992
1995
1993
1993
1996
1994
1994
1997
1995
1995
1998
1996
1996
1999
1997
1997
2000
1998
1998
2001
1999
1999
2002
2000
2000
2003
2001
2001
2004
2002
2002
2005
2003
2003
2006
2004
2004
2007
2005
2005
2008
2006
2006
2009
2007
2007
2008
2008
2009
2009
Injection drug Injection
Injection
Injection
usersdrugdrug
drug users
users
users Female commercial
Female commercial
Female
Femalecommercialsex
commercial
sex workers
sexworkers
sex
workers
workers
Male clients
MaleMale
Male
at STI clients
clients
clients atatat
clinics STISTI
STI clinics
clinics
clinics Blood
Blood donors
Blooddonors
Blooddonors
donors
Pregnant women Pregnant
Pregnant
Pregnant women
at women
antenatal
women at
atat
careantenatal
antenatal
antenatal care
clinicscare
care clinics
clinics
clinics
Source: Thailand
Source:
Source:
BureauThailand
Thailand
of Epidemiology,
Bureau
Bureauofof
Epidemiology,
HIV
Epidemiology,
Total Sentinel
HIV
HIV
Surveillance.
Total
Total
Sentinel
Sentinel
Ministry
Surveillance.
Surveillance.
of Public
Ministry
Ministry
Health
of(2011)
of
Public
Public
Health
Health
(2011)
(2011)
maintained its longstanding war-on-drugs approach Even when different regions within countries are
to illicit drug use, with drug users being considered compared, higher HIV rates are clearly evident in areas
“security threats.” The 2003 crackdown on suspected with the most intense drug law enforcement. For instance,
drug dealers resulted in the heinous extrajudicial killing a study of the 96 largest US metropolitan areas found
of more than 2,500 persons.40 The crackdown and a that measures of anti-drug “legal repressiveness” were
continued repression made it less likely that people who associated with higher HIV prevalence among injectors
use drugs would seek health services, including HIV and concluded: “This may be because fear of arrest
treatment. Not surprisingly, therefore, while HIV pre- and/or punishment leads drug injectors to avoid using
valence among sex workers has declined dramatically, syringe exchanges, or to inject hurriedly or to inject in
HIV rates among Thai drug users have remained shooting galleries or other multiperson injection settings
persistently high, with estimated HIV prevalence to escape detection.”41
approaching 50 percent in recent years (Figure 2).
Where Addiction is Treated as a Health Issue, In Switzerland, the government responded to the
the Fight Against HIV is Being Won burgeoning HIV epidemic among injection drug users
in the 1980s by implementing innovative policies that
The experience in Russia, Thailand, the US and provided clean syringes, supervised injecting facilities,
other countries where the war on drugs has been easily accessible methadone therapy, heroin prescription
aggressively waged can be contrasted with countries and antiretroviral treatment.45 This strategy has led to a
that have adopted evidence-based addiction treatment marked reduction in the number of new HIV infections
and public health measures to address the HIV linked to drug injection, from an estimated 68 percent in
epidemic. In the latter countries, including a number 1985 to about 15 percent in 1997 and about 5 percent
of western European countries and Australia, newly in 2009.45 Likewise, in British Columbia, Canada, the
diagnosed HIV infections have been nearly eliminated response to the explosive HIV epidemic that emerged
among people who use drugs, just as vertical among injection drug users in the mid-1990s has involved
transmission of HIV has been eliminated in countries antiretroviral therapy, opioid substitution (including
where broad access to prevention of mother-to-child heroin prescription), syringe distribution and medically
transmission of the virus is available. supervised injecting facilities, with resulting declines in
HIV incidence and AIDS deaths among intravenous drug
Indeed, as early as 1997, a global survey found that users there (Figure 3).
in 52 cities without syringe exchange, HIV prevalence
increased by approximately 6 percent per year, whereas While modest gains have been made with respect to
prevalence decreased by approximately 6 percent per treatment of opioid dependence, methamphetamine and
year in the 29 cities with syringe exchange programs.42 other stimulants dominate illicit drug use in many parts
Since that time, similar results have consistently been of the world, and scientifically sound treatment options
reported from around the globe.32 For example, in for them are more limited.19 The Commission sees an
Tallinn, Estonia, a country with one of the highest per urgent need for more research on maintenance and
capita HIV rates in Europe, a decrease in HIV infection other therapeutic approaches to managing stimulant use,
among new injectors, from 34 percent to 16 percent, including as a component of HIV prevention programs.
coincided with an increase in the number of syringes
exchanged, from 230,000 in 2005 to 770,000 in
2009.43 Similarly, in Portugal in 2001, the government
decriminalized the use and possession of a modest
quantity of illegal drugs for personal use, so as to focus
on drug addiction as a public health issue. As a result,
between 2000 and 2008, the number of new cases of
HIV decreased from 907 to 267, while the number of
cases of AIDS dropped from 506 to 108 among people
there who inject drugs.44
FIGURE 3. Methadone provision paired with highly active antiretroviral therapy begins
400
Decline in new HIV
cases attributable 350
250
coinciding with public Syringe
cases
exchange Supervised
health interventions 200 expansion injecting
HIV
facilities open
HIV
50
0
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Source: BC Centre for Disease Control and BC Centre for Excellence in HIV/AIDS
HIV/AIDS Has Spread Because the War on the global illicit opiate supply increased by more than
Drugs Has Not Reduced Drug Supply 380 percent overall, from 1000 metric tons in 1980 to
more than 4800 metric tons in 2010 (Figure 4).47 This
Evidence that the war on drugs has fueled the HIV increase, the bulk of which occurred in Afghanistan,
epidemic is irrefutable, and yet policy has been contributed to a greater than 75 percent decrease in
remarkably slow to change. This may largely be a result the price of heroin in Europe between 1990 and 2009
of the mistaken assumption that drug seizures, arrests, (Figure 5).
convictions and other commonly reported indices of
drug law enforcement “success” have been effective at Similar evidence of the drug war’s failure is provided by
reducing drug supply. Indeed, stressing the importance US drug surveillance data. For example, from 1981 to
of supply reduction tactics, the 2012 US National Drug 2011, the budget of the US Office of National Drug
Control Strategy concludes: “Reductions in supply Control Policy increased by more than 600 percent
are often closely tied to reductions in drug use and its (inflation-adjusted). However, despite increasing annual
consequences.”46 However, the assumptions about the multibillion dollar investments in drug control, US
benefits of drug law enforcement, implied each time the gov-ernment data suggest an approximate inflation- and
fruits of the latest “drug bust” are displayed before the purity-adjusted decrease in heroin price of 80 percent,
public, have not been critically evaluated. and a greater than 900 percent increase in heroin purity
between 1981 and 2002, clearly indicating that ex-
Specifically, if the kind of intensive drug law enforce- penditures on interventions to reduce the supply of heroin
ment that has been practiced under the global war on into the United States were unsuccessful (Figure 6).*
drugs was achieving its stated objectives of meaningfully
reducing drug supply, one would expect that increasing While the links between the war on drugs and HIV/AIDS
anti-drug expenditures would coincide with higher drug warrant a focus on heroin, similar patterns emerge when
prices, decreased drug potency and fewer drugs available anti-drug spending and indices of availability for other
overall. However, evidence from around the world drugs are examined. For instance, through a variety of
indicates that this has not been the case. initiatives, the United States has directed considerable
FIGURE 4. 10,000
production of illicit
Global production of opiates (metric tons)
8000
opiates 7000
6000
Source: United Nations
World Drug Report 2011, 5000
United Nations Office on Drugs
and Crime 4000
Global production
3000
1000
0
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Figure 5. Average estimated heroin prices in Europe
FIGURE 5. 600
Average estimated
Retail price per gram (USD)
500
Retail price per gram (USD)
100
0
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Figure 6. Change inFigure
Figure
estimated
6.6. Change
Change
Figure
heroin6.
inin
price
estimated
Change
estimated
and purity
inheroin
heroin
estimated
in price
the
price
context
heroin
and
andpurity
purity
price
of the
inand
inincreasing
the
the
purity
context
context
inannual
the
ofofthe
the
context
drug
increasing
increasing
control
of theannual
annual
increasing
budgetdrug
drug
in annual
the
control
control
drug
budget
budget
control
ininthe
the
budget in the
United States United
UnitedStates
States
United States
Change in estimated 45 45
45 45
gram (USD)
(USD)
1500 1500
1500 1500 30 30
30 30
per gram
Purity (%)
Purity
Purity (%)
25 25
25 25
price per
United States
(%)(%)
Retail price
1000 1000
1000 1000 20 20
20 20
Retail
22.59
22.59
22.59
23.52
23.52
23.52
23.52
16.51
16.51
16.51
16.51
11.88
11.88
11.88
11.88
19.23
19.23
19.23
19.23
23.06
23.06
23.06
23.06
18.64
18.64
18.64
21.68
18.64
21.68
21.68
21.68
19.44
19.44
19.44
19.44
18.79
18.79
18.79
18.79
23.15
23.15
23.15
23.15
18.19
18.19
18.19
18.19
20.71
20.71
20.71
20.71
17.79
17.79
17.79
17.79
4.44
4.44
4.44
4.44
8.80
8.80
8.80
8.80
5.82
5.82
5.82
5.82
3.94
3.94
3.94
3.94
3.68
3.68
3.68
3.68
9.32
9.32
9.32
9.32
5.03
5.03
5.03
5.03
5.66
5.66
5.66
5.66
1982
1983
1984
1981
1981
1985
1982
1982
1986
1983
1983
1987
1981
1984
1984
1988
1982
1985
1985
1989
1983
1986
1986
1990
1984
1987
1987
1991
1985
1988
1988
1992
1986
1989
1989
1993
1987
1990
1990
1994
1988
1991
1991
1995
1989
1992
1992
1996
1990
1993
1993
1997
1991
1994
1994
1998
1992
1995
1995
1999
1993
1996
1996
2000
1994
1997
1997
2001
1995
1998
1998
2002
1996
1999
1999
1997
2000
2000
1998
2001
2001
1999
2002
2002
2000
2001
2002
resources toward disrupting the cocaine trade. Plan US National Institute on Drug Abuse has concluded that
Colombia, for example, was a multibillion dollar over the last 30 years of cannabis prohibition, the drug
investment in the eradication of coca crops in Colombia has remained “almost universally available to American
through aerial and manual eradication, military training 12th graders,” with between 80 percent and 90 percent
and support, and other means. Nevertheless, despite consistently reporting that the drug is “very easy” or
steady increases in the US budget for international supply “fairly easy” to obtain.49
reduction and counter-narcotics activities, the purity of
cocaine has remained persistently high, while the purity- Recent United Nations Office on Drugs and Crime
and inflation-adjusted price of cocaine in the US has estimates have concluded that production of
concurrently dropped by more than 60 percent during amphetamine-type stimulants has risen dramatically
this period (Figure 7). These long-term trends suggest in the last decade, so much so that this class of illegal
that the overall supply of cocaine has overwhelmed drug is now used more frequently than any but marijuana.
law enforcement efforts and highlight how recent US However, aggressive drug law enforcement strategies
government reports of diminishing cocaine supply to the targeting users of new synthetic drugs have the same
US must be interpreted with a great deal of skepticism.48 negative public health effects.
When cannabis, the drug that has been the central focus Taken together, these indicators clearly suggest that
of the US government’s decades-long war on drugs, is the overall drug supply (as evidenced by various
considered, the results have been the same. Specifically, indicators of increasing production, declining prices
the potency- and inflation-adjusted price of cannabis in and increasing potency) has been largely unimpeded
the US has declined by 33 percent while its potency by the multibillion dollar investments that have gone
has increased by 145 percent since 1990. In fact, the into trying to disrupt supply through costly policing,
arrests and interdiction efforts.
FIGURE 7.
Dramatic decline in domestic cocaine prices despite increasing spending for overseas
drug suppression efforts by the United States
Figure 7.
Note: Cocaine prices are purity- and inflation-adjusted and spending is inflation-adjusted. All prices expressed in 2011 USD.
Source: US by theof
Office United States
National Drug Control Policy
Figure 6.
Figure
Change
6. Change
in estimated
in estimated
heroin heroin
price and
price
purity
and in
purity
the context
in the context
of the of
increasing
the increasing
annual annual
drug control
drug control
budgetbudget
in the in the
United United
States States
800 7
2500 2500 50 50
700 6
45 45 US spending on international
US
600
Retail price per gram (USD)
Retail price per gram (USD)
drug
2000 2000 40 40 5
spending
drug control (billions)
500 35 35
Retail price per gram (USD)
control
4
1500 1500 30 30
400
on(billions)
Purity (%)
Purity (%)
3
international
25 25
300
1000 1000 20 20
2
200
15 15
100 1
500 500 10 10
0 5 5 0
22.59
22.59
23.52
23.52
1990 16.51
16.51
1989 11.88
11.88
19.23
19.23
23.06
23.06
18.64
18.64
21.68
21.68
19.44
19.44
18.79
18.79
23.15
23.15
18.19
18.19
20.71
20.71
17.79
17.79
1981
1982
1983
1984
1981 1985
1982 1986
1987
1984 1988
1985 1989
1986 1990
1987 1991
1988 1992
1989 1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
1983 4.44
4.44
1988 8.80
8.80
1986 5.82
5.82
1982 3.94
3.94
3.68
3.68
1987 9.32
9.32
5.03
5.03
1985 5.66
5.66
0 0 0 0
1981
1984
1983
1991
1990
1992
1991
1993
1992
1994
1993
1995
1994
1996
1995
1997
1996
1998
1997
1999
1998
2000
1999
2001
2000
2002
2001
2002
Price per gram (USD) US international drug control spending (billions USD)
PriceEstimated
per
Estimated gram
price (USD) (USD)
price (USD) US
Estimated international
Estimated
purity (%)
purity (%) drug control spending
Drug control (billions
Drug control
budget USD)
budget
(in billions
(in billions
USD) USD)
Program Program
The Drug War Spreads Violence other drug law enforcement strategies that remove
in Addition to HIV individuals from the lucrative drug market contribute
to violence by having the “perverse effect of creating
Overwhelming evidence now clearly demonstrates new financial opportunities,” resulting in fights over
that, analogous to the case of alcohol prohibition market share.
in the United States early in the 20th century, prohibition
of drugs has contributed to increased levels of drug- While drug market violence can be viewed as a natural
related mortality and drug market violence. Research consequence of drug prohibition in nearly all countries,
from Switzerland, for example, has demonstrated that certain drug-producing regions have been particularly
mortality levels among Swiss heroin users decreased as hard hit. In Mexico, for example, following a 2006
a result of opioid substitution treatment but increased government-initiated crackdown on drug cartels,
following periods of intensified street-level drug drug-related violence involving the Mexican military,
law enforcement.50 Similarly, according to a recent police and cartel factions has become entrenched on
systematic review of published research investigating a massive scale. While accurate numbers are difficult,
the association between drug law enforcement and if not impossible, to obtain, the most widely used
drug-related violence, virtually all studies on the subject estimates suggest that the total number of deaths
have concluded that increased levels of enforcement attributable to drug market violence since 2006 is in
activity have been associated with increased drug market excess of 50,000 (Figure 8).52 Other estimates suggest
violence.51 This study concluded that drug arrests and that a further 10,000 individuals are missing and more
than 1.5 million have been displaced by fighting related
to drug control.
FIGURE 8. 18,000
2000
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Source: Government and news report estimates as reported in Transborder Institute, “Drug Violence in Mexico” and WM Consulting,
Figure 9. Heroin production in Mexico
“Mexico Total Dead, 2011”
FIGURE 9.
40
Heroin production
in Mexico
35
Heroin production (metric tons)
Source: US Department of
Justice, National Drug Intelligence 30
Heroin production (metric tons)
20 Mexican
drug war
begins
15
10
0
2004 2005 2006 2007 2008
Source: US Department of Justice, National Drug Intelligence Center, National Drug Threat Assessment 2010
Public Health Approaches Can Reduce user-level illegal drug policies did not have lower levels
Rates of Drug Use of use than countries with liberal ones.”57 National
studies of drug use patterns further support these
The Global Commission on Drug Policy’s previous trends. For example, a 10-year study of drug arrests
report called for a public health approach to address the from 93 large US metropolitan areas concluded that
harms of drug use and drug prohibition. Unfortunately, higher rates of drug arrests did not correspond to lower
the report was met with criticism from the US White rates of drug injecting.58
House, with an Office of National Drug Control Policy
spokesperson widely quoted as saying: “Drug addiction Rather than decreasing drug use, empirical evidence
is a disease that can be successfully prevented and shows that drug law enforcement can have exactly
treated. Making drugs more available, as this report the opposite effect. In the US, where one-eighth of
suggests, will make it harder to keep our communities young adults report that their biological father has
healthy and safe.”56 This comment implies an inaccurate been incarcerated at some time, a recent study found
interpretation of our first report and is problematic for that paternal incarceration was significantly associated
two reasons. First, US drug strategy remains focused with adolescent drug use, even after taking into
on a criminal justice approach to drug use, with account other factors such as family background and
overwhelming federal and state drug control budgets individual characteristics.59 These types of unintended
dedicated to drug law enforcement and enforcement- consequences of the war on drugs on families may
based prevention programs and interdiction rather than help to explain why, for example, rates of cannabis
public health measures or the treatment of addiction. use remain consistently higher in the US than in
Second, the assumption that a public health approach Portugal, where cannabis use has been decriminalized,
to drug use will lead to increased rates of drug use or or in the Netherlands, where cannabis sales have
other adverse impacts on communities is not consistent been quasi-legalized.44,60
with empirical evidence.
The evidence clearly suggests that health-based
A study completed as part of the World Health policies do not increase rates of drug use but rather
Organization’s World Mental Health Survey Initiative have the potential to significantly decrease rates of
that looked at patterns of drug law enforcement and use. Numerous reviews have proven, for example,
rates of drug use internationally concluded: “Globally, that drug use is not increased by syringe exchange
drug use is not distributed evenly and is not simply programs.61 Similarly, supervised injecting facilities,
related to drug policy, since countries with stringent where drug users can inject street-obtained illicit drugs
The Vienna Declaration: Scientific Support for and addressed. Following the Declaration’s launch, more
the Global Commission’s Call for Change than 20,000 individuals and more than 400 high-level
organizations from every region of the globe endorsed
The Vienna Declaration is a scientific statement seeking the statement. Among the signatories to date are several
to improve community health and safety by calling for Nobel laureates, thousands of scientific and academic
evidence-based policies on illegal drugs. It was drafted experts, a diversity of health, faith-based, and civil society
by a writing committee of international experts in the organizations, law enforcement leaders, and the judiciary
fields of HIV/AIDS, drug policy and public health, under from countries around the world. Signatories to the
the leadership of the International AIDS Society. Vienna Declaration specifically call upon governments
and international organizations, including the United
The Vienna Declaration was adopted as the official Nations, to:
conference declaration of the XVIII International AIDS
Conference, held in Vienna from July 18 to 23, 2010. • Undertake a transparent review of the effectiveness of
This was one of the world’s largest public health current drug policies;
conferences, attracting more than 20,000 delegates. • Implement and evaluate a science-based public health
It was convened by the International AIDS Society approach to address the individual and community harms
along with various international conference partners, stemming from illicit drug use;
including the World Health Organization, the Joint • Decriminalize drug users, scale up evidence-based drug
United Nations Programme on HIV/AIDS (UNAIDS), dependence treatment options and abolish ineffective
the United Nations Office on Drugs and Crime (UNODC) compulsory drug treatment centers that violate the
and the European Commission. Universal Declaration of Human Rights;
• Unequivocally endorse and scale up funding for the
The Declaration stressed that the war on drugs implementation of the comprehensive package of HIV
had not achieved its stated objectives and called interventions spelled out in the WHO, UNODC and
for its harmful consequences to be acknowledged
The Vienna Declaration: Scientific Support for the Global Commission’s Call for Change
UNAIDS Target Setting Guide;
• Meaningfully involve members of the affected
community in developing, monitoring and implementing
services and policies that affect their lives.
Support Drug Policy
Based On Science, Anand Grover, the UN Special Rapporteur on the right to
the highest attainable standard of health, wrote of the
Not Ideology. Vienna Declaration:
Sign on at
www.viennadeclaration.com
39
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Friedman SR, Cooper HL, Tempalski B, et al. Relationships of deterrence drug deterrence. Am J Public Health, 2011; 101(2): 344-349.
and law enforcement to drug-related harms among drug injectors in US 59
Roettger ME, Swisher RR, Kuhl DC, Chavez J. Paternal incarceration and
metropolitan areas. AIDS, 2006; 20(1): 93-99.
trajectories of marijuana and other illegal drug use from adolescence into
42
Hurley SF, Jolley DJ, Kaldor JM. Effectiveness of needle-exchange young adulthood: evidence from longitudinal panels of males and females
programmes for prevention of HIV infection. Lancet, 1997; 349(9068): in the United States. Addiction, 2011; 106(1): 121-132.
1797-1800. 60
Reinarman C, Cohen PDA, Kaal HL. The limited relevance of drug policy:
43
Anneli U, Des Jarlais Don KM, Kristi R, Katri AO, Ave T. Expanded syringe cannabis in Amsterdam and in San Francisco. Am J Public Health, 2004;
exchange programs and reduced HIV infection among new injection drug 94(5): 836-842.
users in Tallinn, Estonia. BMC Public Health, 2011; 11: 517. 61
Vlahov D, Des Jarlais DC, Goosby E, et al. Needle exchange programs for
44
Hughes CE, Stevens A. What can we learn from the Portuguese the prevention of human immunodeficiency virus infection: epidemiology
decriminalization of illicit drugs? Brit J Criminol, 2010; 50(6): 999-1022. and policy. Am J Epidemiol, 2001; 154(12 Suppl): S70-S77.
45
Csete J, Grob PJ. Switzerland, HIV and the power of pragmatism: lessons 62
Wood E, Tyndall MW, Zhang R, et al. Attendance at supervised injecting
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2512-2514.
46
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ondcp/2012_ndcs.pdf. treatment case register analysis. Lancet, 2006; 367(9525): 1830-1834.
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United Nations Office on Drugs and Crime. World drug report 2010. 64
Ferri M, Davoli M, Perucci CA. Heroin maintenance for chronic
http://www.unodc.org/unodc/en/data-and-analysis/WDR-2010.html. heroin-dependent individuals. Cochrane Database Syst Rev, 2011; 12:
CD003410.
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1. Break the taboo. Pursue an open debate and 7. Promote alternative sentences for small-scale
promote policies that effectively reduce con- and first-time drug dealers.
sumption, and that prevent and reduce harms
related to drug use and drug control policies. 8. Invest more resources in evidence-based
Increase investment in research and analysis prevention, with a special focus on youth.
into the impact of different policies and programs.
9. Offer a wide and easily accessible range of options
2. Replace the criminalization and punishment of for treatment and care for drug dependence,
people who use drugs with the offer of health and including substitution and heroin-assisted
treatment services to those who need them. treatment, with special attention to those most
at risk, including those in prisons and other
3. Encourage experimentation by governments with custodial settings.
models of legal regulation of drugs (with cannabis,
for example) that are designed to undermine the 10. The United Nations system must provide lead-
power of organized crime and safeguard the health ership in the reform of global drug policy. This
and security of their citizens. means promoting an effective approach based
on evidence, supporting countries to develop drug
4. Establish better metrics, indicators and goals to policies that suit their context and meet their
measure progress. needs, and ensuring coherence among various
UN agencies, policies and conventions.
5. Challenge, rather than reinforce, common mis-
conceptions about drug markets, drug use and 11. Act urgently: The war on drugs has failed, and
drug dependence. policies need to change now.
GOALS
• Review the basic assumptions, effectiveness and
consequences of the ‘war on drugs’ approach
www.globalcommissionondrugs.org
22 GLOBAL COMMISSION ON DRUG POLICY