Debating drugs: Explaining how they are a health, rather than a criminal justice, issue


The below is an extract from Transform's new publication, Ending the war on drugs: How to win the global drug policy debate'.

The aim to protect and improve public health can be framed, from a more reactive perspective, as minimising problematic drug use and associated health harms, including drug-related deaths. 

Although this sounds uncontroversial, it actually challenges a central tenet of current drug policy – namely, that all illicit drug use is problematic. This assertion ignores the reality that problematic drug users, commonly defined as being in need of health, social or criminal justice interventions, are only a small fraction of the drug-using population.1 The vast majority of users cause themselves no significant harm, and would in fact assert that they derive benefits from their drug use. Use that is non-problematic should be only a marginal concern for policy makers, beyond efforts to prevent its progression into problematic use. You can use the widely understood distinction between the use and misuse of alcohol to easily illustrate this point.

Adequate provision of support and drug treatment for people seeking help is another key element of effective drug policy that all can agree on. It is, however, important to be clear that support for drug policy reform complements rather than challenges proven public health measures such as prevention, treatment, recovery and harm reduction. Employing punitive measures against people who use drugs, and leaving criminals in control of the drug trade, increases a range of health risks and creates practical and political obstacles that prevent effective responses to problematic drug use.

A comprehensive approach based on public health and human rights principles will also aid the development of government strategies for other serious ongoing or emerging challenges in the drugs field. These include preventing or reducing the misuse of legal substances (such as alcohol, tobacco and volatile substances like aerosols), novel psychoactive substances (sometimes unhelpfully described as "legal highs"), and increasingly popular stimulants such as crack cocaine or methamphetamine. Highlighting this point can help you to focus the reform debate on the more immediate concerns of a particular community or politician. Under this umbrella aim of protecting and improving public health are a number of principles that you can bring into the discussion:

Drug use is primarily a public health and social issue

It is often stated that drugs are primarily a health issue. Indeed, this has become a common refrain in the high-level drugs debate. This is a useful point to emphasise because it highlights just how anomalous the status of prohibited drugs is in the context of wider health policy. It raises the following questions:

  • If drugs are primarily a health issue, why is the primary response punitive in nature, involving the police and military, rather than doctors and health professionals?
  • In which other areas of public health do we criminalise patients or key populations we are aiming to help?

Drug-related issues cut across a range of policy areas, but for illegal drugs the balance has shifted to the point where consideration of public health has been increasingly marginalised by an excessive focus on enforcement, as the UN Office on Drugs and Crime has itself noted.2 3

All drug use is risky

Making this point clear early on establishes distance between you and any preconceptions or stereotypes about the reform position being "pro-drugs", "defending" drugs, or implying drugs are completely safe. It also takes the sting out of many anti-reform arguments that are based on fear-mongering facts and anecdotes about how dangerous drug use is. Getting drawn into debates about the relative harms of drugs is often a distraction from more important issues, not least as such debates rarely lead anywhere useful. Each side will naturally draw on evidence that supports their own position and the audience will be left none the wiser.

Of course, the fact that all drug use involves risk does not mean all drug use involves harm. Risk is simply a probability of harm occurring, and while this probability can be quite low (particularly when people know what they are consuming, and have proper information on dosage, potency, etc), it is never zero.

It is more important to be clear that the potential risks of drugs are the very reason why they should be regulated effectively: we need to regulate drugs because they are risky, not because they are safe. However risky drugs are, they are more risky when produced and sold by criminals.

So while it is obvious that if a drug is relatively safe the solution is to legally regulate and control it, it will require some explanation for your audience to grasp why the same solution applies to a drug that is relatively dangerous.



1. The 2007 UNODC World Drug Report estimates only 12.5% of total users are "problematic".
2. “The expanding criminal black market obviously demanded a commensurate law enforcement response, and more resources. The consequence was that public health was displaced into the background, more honoured in lip service and rhetoric, but less in actual practice” – Costa, A. (2008) 'Making drug control “fit for purpose”: Building on the UNGASS decade', UNODC. CND-Session51/CND-UNGASS-CRPs/ECN72008CRP17.pdf
3. This shift is reflected in the evolution of the UN drug conventions – the 1961 convention was framed as a response to the threat of drugs themselves, with addiction being described as an "evil" which we must "combat", establishing the ground for the "war on drugs" discourse that followed. By contrast, the 1988 convention is a response to the threat from the involvement of transnational organised crime in the resulting illicit drugs markets.