Here's How Zero-Tolerance Drug Policies Have Damaged Public Health Worldwide

This story is part of a partnership between MedPage Today and VICE News.

Ahead of the first special session of the United Nations General Assembly on global drug policy in nearly two decades health officials from around the world have formed a commission and authored a report to persuade officials to walk back the zero-tolerance policies of the past 50 years, which they say have harmed public health instead of protecting it.

The theme of the last special session on drugs in 1998 — "A drug-free world — we can do it!" — advocated drug eradication and a draconian approach to drug use. In calling for decriminalization of minor drug offenses and increased social and health services for drug users, the 22 members of the Johns Hopkins-Lancet Commission on Public Health and International Drug Policy hope their 54-page report will encourage officials to undo some of that damage when the three-day session begins on April 19.

Hailing from a dozen countries, including the United States, Switzerland, Mexico, and Nigeria, the commission's 22 members wrote in the Lancet medical journal that the zero-tolerance stance wasn't based on scientific evidence, and ultimately spurred "lethal violence, communicable-disease transmission, discrimination, forced displacement, unnecessary physical pain, and the undermining of people's right to health."

"It's time for us to rethink our approach to global drug policies, and put scientific evidence and public health at the heart of drug policy discussions," Dr. Chris Beyrer of the Johns Hopkins Bloomberg School of Public Health, a commission member, said in a statement.

In Russia, for example, where opioid substitution therapies like methadone clinics are illegal and needle exchange programs are effectively prohibited, the number of people living with HIV rose by 7 percent between 2013 and 2014, surging to 907,000. More than half of the new cases were attributed to unsafe injections.

"All of those policies fail to treat addicts, and aid and abed HIV spread," said Beyrer, who also serves as president of the International AIDS Society. "We're actually seeing public policies that are the drivers of the epidemic."

The report compares policies and their outcomes in different countries, looking at barriers to needle exchange programs and non-injectable opioid substitution therapies. It found that in Scotland, where opioid substitution therapies are often available to inmates, the rate of hepatitis C infection contracted in prison is only 5 percent. In Thailand, where people are injecting instead of getting these therapies, that rate is 56 percent.

The report called out North America for having the highest rates of drug use and drug-related deaths in the world, and the authors explained that this has allowed the region to heavily influence the global drug discussion. The ongoing opioid epidemic in the United States is unique because it has resulted in an alarming spike in deaths among middle-aged white people, which is why some pundits say it's getting so much attention. The report points out that a 2015 HIV outbreak linked to a synthetic opioid called oxymorphone in rural (and white) Indiana helped push the state to lift its ban on needle exchange programs.

The National Institute on Drug Abuse has said that an increase in prescription opioid abuse in the US has led to a corresponding increase in heroin use because heroin is a cheaper, readily available alternative. Overall, the report found that prescription opioid overdose deaths in the US quadrupled between 1999 and 2010, while heroin overdose deaths quadrupled between 2002 and 2013. In 2014, prescription pain relievers and heroin killed a record-breaking 28,647 people out of the 47,055 drug overdose deaths that year, according to the CDC.

The commission didn't confine itself to health administration, noting that the "virtually unprecedented" spike in homicides in Mexico over recent years (164,345 homicides between 2007 and 2014) was linked to the increased use of military forces against drug traffickers that began in 2006 — a by-product of an untenable escalation of the drug war.

"Drugs are not the problem oftentimes," commission member Carl Hart, a neuropsychopharamacologist at Columbia University, remarked at a press conference earlier this week. "Should we incarcerate or should we treat drugs like a health problem? Neither. The vast majority of people who use drugs — 80 to 90 percent — don't have a problem. They're responsible people that take care of their families, pay their taxes. They even sometimes become president of the United States."

Joanne Csete, an expert on health and human rights at Columbia University who also sits on the commission, said current drug policies don't match up with scientific evidence and are instead rooted in racism and scapegoating.

The report noted that the "best documented" example of discriminatory drug law enforcement was in the United States, where black men were five times more likely to be incarcerated than white men in 2014, despite no real difference in drug use rates.

Csete pointed out that the war on drugs started shortly after the civil rights movement.

"Those policies have their roots in racist and reactionary calculations to put blacks in place following a period of sweeping civil rights," she said. "It's easy, it turns out, to create and sustain a narrative about how drugs and race and social evils exploded in the black community and turn the police on it."

Hart also noted that US officials blamed high unemployment in 1982 and the peak murder rate in 1980 on crack cocaine. But crack cocaine wasn't introduced into the country until 1984. A similar situation is happening in Brazil, he said.

"The times don't add up, but drugs are a convenient scapegoat," he said.

He added that the "most important" thing he's learned in his 20 years of experience studying drugs is that "we in science have exaggerated the harmful effect of illicit drugs." He pointed out that the illicit drug methamphetamine is "nearly identical" to the attention deficit disorder drug Adderall, the only difference between the molecules being one methyl group (and a fair amount of relative neurotoxicity).

"I hope that this report will help you all understand that we have misinformed the public about drugs," he said. "And I hope that as you read the newspapers about the opioid epidemic, that you will read it in a new, critical way, with a new, critical eye."

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