“Experiment with legally regulating drugs,” says Lancet / Johns Hopkins public health commission

A commission established by the UK’s leading medical journal, the Lancet, and the leading US medical school, Johns Hopkins, has condemned the disastrous failings of current global drug policy and is calling on governments to begin experimenting with the legalisation and regulation of drug markets.

The Johns Hopkins-Lancet Commission on Drug Policy and Health investigated the public health impact of drug policies based on prohibition and criminalisation, and found that they are fuelling homicides, overdose deaths, the spread of infectious diseases such as HIV/AIDS and hepatitis C, and are preventing people from accessing essential treatment and harm reduction services.

To address these problems, the commission makes a series of recommendations, which include:

  • decriminalising minor, non-violent drug offences, such as drug possession, use and low-level sales;
  • phasing out military involvement in drug law enforcement in countries like Mexico;
  • redirecting police efforts to tackle only the most violent drug-market operatives;
  • using better indicators to assess drug policy, in particular to evaluate its impact on public health and human rights; and
  • experimenting with forms of legal drug regulation.

Calls such as these have of course been made before. Most notably, the World Health Organization, UNAIDS, the UN Development Programme, the current and former UN Secretaries-General, and even the UN Office on Drugs and Crime, have all voiced their support for ending the criminalisation of people who use drugs and low-level drug offenders.

But despite the push for broader drug policy reform, the legal regulation of drugs is an issue that has, to date, received far less attention from such high-level agencies. So it’s hugely significant for a group of the commission's stature to be recommending that governments “move gradually toward regulated drug markets and apply the scientific method to their assessment.” Drawing parallels with alcohol and tobacco control, the commission emphasises that “regulation of the harms of human activity is the essence of public health”.

This recommendation is backed up by the substance of the commission’s report, which is a detailed, thoroughly researched, peer-reviewed analysis produced by leading scholars from around the world. The report is yet more confirmation that the science is on the side of those who support progressive drug policy reform. As the evidence continues to accumulate, it is the advocates of an unending drug war that look like increasingly like anti-science ideologues.

The case for reform has always been compelling, but who is making the argument is crucial. The provenance of today’s report should encourage other medical experts and healthcare professionals to engage in the drug policy debate. When arguably the world’s most respected medical school and medical journal speak out so emphatically on an issue like this, there can be no excuse for inaction. Medical professionals – and the professional bodies that represent them – are rightly among the most trusted voices in society, but a voice that has been inexplicably and inexcusably muted on the drug war’s impacts on public health and the urgent need for reform. They need to speak out, particularly since it is their patients who are being criminalised and punished for what is undeniably a medical, rather than a criminal, issue.

As the commission states:

“We urge health professionals in all countries to inform themselves and join debates on drug policy at all levels. True to the stated goals of the international drug-control regime, it is possible to have drug policy that contributes to the health and wellbeing of humankind, but not without bringing to bear the evidence of the health sciences and the voices of health professionals.”

But politicians and policymakers must play their part too. The commission highlights that the main obstacles to experiments with regulated drug markets are political. For too long, governments have stuck their head in the sand, and prioritised electability over evidence – all at the expense of public health and safety. They need to get out in front of this issue, inform the public, and begin translating the science into policy. Today’s report can only help accelerate this process.