Contribution to MMI Annual Report 2014

For health organisations, it might seem obvious that the issue of illicit drugs is a public health issue. However, current policies at the national and international level treat drugs strictly as a law enforcement problem. This has serious negative consequences, not just for people who use drugs, but for public health as a whole, including among some of the poorest and most marginalised communities around the world. Health Poverty Action has recently released a report, Casualties of War, discussing these consequences and calling for a fresh approach to illicit drugs policy.

Current illicit drug policies take a strictly prohibitionist approach to drug control, rooted in law enforcement and often backed up by military force. This means that people who use drugs are effectively criminalised. The net effect of these policies is to drive drug use underground, which removes any controls on drug strength and purity, and means that injection is frequently done with unsterile equipment in unsafe conditions. In fact, in a number of countries, possessing drug paraphernalia is a crime in itself, which discourages people from getting sterile injecting equipment. This increases the risk of overdose and the spread of blood-borne viruses.

Strict drug prohibition fosters stigma that leads governments to underspend on harm reduction measures such as education, opioid substitution therapy, needle exchange, and safe injecting sites, and on treatments for drug dependency. This stigma, combined with the fear of punishment, also deters people who use drugs from seeking life-saving medical care – not just for drug addiction, but for any conditions that may be linked to drug use, such as HIV/AIDS. Among people who use drugs, less than 8% have access to a needle and syringe programme, less than 8% have access to opioid substitution therapy, and less than 4% of those living with HIV have access to HIV treatment.

Those who argue in favour of strict prohibition say that it is ultimately beneficial for health, because it reduces drug use. However, the evidence shows that this is not the case. The current international drug control regime is more than fifty years old, and it has failed to reduce drug use; if anything, the drugs available on the street are becoming cheaper, and the illicit drug trade has diversified and spread across the globe in direct response to enforcement efforts.

Drug policy and pain medication

The health impacts of current drug policies aren’t limited to people who use drugs and their families. Current drug policies also seriously restrict access to essential medications in poorer countries. Pain medication – a vital part of healthcare from the treatment given to patients with terminal diseases to the anaesthetic doctors need for life-saving operations in war zones – is hardest hit. Five billion people live in countries with little or no access to pain medication. This isn’t because the medicine is too expensive for those countries to afford. Opioid pain medications like morphine are plentiful and relatively cheap. But governments concerned that morphine and similar drugs, or their ingredients, could end up on the illicit market put barriers in place that make it extremely difficult for health workers to access, prescribe, and distribute pain medication. A recent study found that 84% of countries surveyed had unnecessarily high policy barriers keeping people from accessing essential pain medicines.

Wider consequences of the war on drugs

Prohibitionist policies have much wider consequences, beyond effects on harm reduction and access to medicines. In fact, the current approach to illicit drugs undermines development. Strict prohibition means that government funding is frequently channelled into the military and law enforcement to uphold drug laws, and to fight ongoing, often unwinnable wars with drug cartels. The cost of enforcing drug prohibition falls disproportionately on poor countries, as wealthier countries put pressure on poor countries’ governments to spend increasing amounts on enforcement. At the same time, by keeping illicit drugs expensive, prohibitionist drug laws keep the drug trade profitable, and ensure that cartels have the funds they need to weaken or control governments through bribery and intimidation. This creates widespread corruption that diverts further funding away from health systems, social welfare, and broader measures to address poverty and inequality.

The annual global price tag for enforcing anti-drug policies is estimated at US$100 billion – rivalling the $130 billion worldwide aid budget. If a fraction of this money could be freed up for spending on public health, poor countries could have stronger economies and better health systems. In fact, the Overseas Development Institute (ODI) estimates that the additional financing needed to meet the proposed Sustainable Development Goal of universal health care is US$37 billion a year – only a little over a third of the amount that is already spent worldwide enforcing failing drug policies.

Beyond these direct impacts, drug policy affects the underlying determinants of health: community security, sustainable livelihoods, and other key building blocks of public health. A law enforcement approach to drug policy fuels conflicts between governments and cartels, which can threaten the stability and disrupt the governance of already fragile countries. It also creates an environment where human rights are often treated as secondary to drug law enforcement, leading to widespread human rights violations, especially affecting ethnic minority groups. The resulting violence and instability pose serious threats to public health and to the strength of health systems.

Strict drug prohibition also deepens poverty in some of the world’s most marginalised communities. Most farmers who grow drug crops do so because they lack other viable options to support their families. Criminalising these farmers and eradicating drug crops before any other livelihoods are in place punishes small-scale producers and their communities by seeking to eliminate their only sustainable source of income. Poverty places people at greater risk for ill health, and makes it difficult for them to access health services.

Time for change?

Health Poverty Action has begun working with health and development NGOs in the UK to advocate for a public health and human rights approach to illicit drug policy, in order to address the negative impacts of current policies on public health and wider development. In April 2016, the UN General Assembly will hold a special session (UNGASS) to discuss the future of international drug policy – an issue with serious implications for the fight against global poverty. This is a crucial opportunity to ensure that the needs of the world’s poorest and most vulnerable are at the centre of drug policy.

What we are calling for

  1. Genuinely open and informed debate on the future of drug policy at national and international levels.
  2. Evidence-based, pro-poor policies that reduce harm to people who use drugs, small-scale producers and traffickers, and vulnerable communities.
  3. Analysis of impacts on poverty, health, and development as a key component of the development and monitoring of any drug policy.
  4. A role for national health ministries and development agencies in determining drug policy.



More information and references:

  • Casualties of War. How the War on Drugs is harming the world’s poorest.
    Catherine Martin, Health Poverty Action report, February 2015 (PDF)
  • Photo: Burning hashish seized in Operation Albatross, a joint operation of Afghan officials, NATO and the DEA. © DEA (taken from the cover of the “Casualties of War” report)


Contribution by Health Poverty Action to the Annual Report 2014 of the MMI Network