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The war on drugs has failed: doctors should lead calls for drug policy reform

BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i6067 (Published 14 November 2016) Cite this as: BMJ 2016;355:i6067

Rapid Response:

Re: The war on drugs has failed: doctors should lead calls for drug policy reform

The war on drugs has failed and doctors should lead calls for drug policy reform say BMJ editor in chief, Fiona Godlee and features and debates editor, Richard Hurley .

However, despite overwhelming evidence most doctors’ professional organisations still have little to say about this needed reform . They say it’s not a medical problem even though drug-related deaths in the UK are the highest since records began . Most of these deaths were preventable but received little press coverage. In other areas of care this would be front-page news and answers would be sought at the highest level.

The evidence base for harm reduction interventions such as Opioid Substitution Treatment (“OST”) and Needle and Syringe Programmes (“NSP”), is extensive but access is very limited all over the world.
Health outcomes for people who inject drugs (“PWID”) are far worse in countries where punitive attitudes and actions are preferred to health focused interventions. In Russia where drug policy is punitive and OST is illegal, HIV infections among PWID have just passed one million but have been successfully prevented in many countries .
The Global State of Harm Reduction 2016, released only a few days ago (16.11.2016) shows “services to reduce drug-related harms are failing to keep up with growing need, despite pledges to combat AIDS among people who inject drugs and the drive to scale-up needle and syringe programmes and opioid substitution therapy for people who inject drugs has stalled” . The UN has pledged to end AIDS by 2030 but no new countries have established NSP since 2014. Only 90 out of the 158 countries where injecting drug use is reported provide NSP, leaving 68 without. OST is now available in 80 of these countries but only in three new countries (Monaco, Senegal and Kenya) since the last report two years ago. In some countries NSP and OST site provision has fallen since 2014. Report author Katie Stone said: “The 2011 UN target to halve HIV among people who inject drugs by 2015 was missed by 80% (6).

A study by Harm Reduction International found that over 40 states apply some type of judicial corporal punishment for drug and alcohol offences . Also 90% of people who inject drugs will be incarcerated at some point and HIV and hepatitis rates are much higher in prisons.

International Doctors for Healthier Drug Policies (“IDHDP”) is an international network of medical doctors challenging the ill-conceived drug policies that increase disease, reduce access to essential medicines and prevent people receiving treatment.

IDHDP wants to see policies based on the best possible evidence not on dogma nor political expedience. Good drug policy leads to improvement in the health and wellbeing of everybody. Like all good policies they should be subject to regular review and evaluation.

Switzerland is an example that has used the four pillar approach and the results speak for themselves :
• Between 1991 and 2004, drug related deaths declined by more than 50%
• Levels of new HIV infections divided by 8 within 10 years
• 90% reduction of property crime committed by drug users
• 70% of injectors are now in some kind of treatment

The BMJ editorial clearly identifies the huge role doctors must play if the health of the individual and society is to be at the centre of future drug policies. Increasing numbers of doctors from all over the world are questioning current policies that continue to allow an increase in drug related deaths, a huge increase in HIV and Hepatitis C infections and the continued mass incarceration of the most marginalised members of society.

At IDHDP we are seeing increasing numbers of obstetricians, paediatricians, cardiologists, surgeons and other specialists joining the more obvious candidates of HIV/AIDS and addiction specialists in calling for change.

Change is coming, and doctors need to be in there leading this change. Please join IDHDP now and be part of that change.

Dr Chris Ford Clinical Director and Sebastian Saville Executive Director IDHDP

Godlee F and Hurley R BMJ 2016; 355 doi: http://dx.doi.org/10.1136/bmj.i6067 (Published 14 November 2016)
Hurley R Doctors, their leaders, and the drug policy debate
BMJ 2016; 355 doi: http://dx.doi.org/10.1136/bmj.i6087 (Published 14 November 2016)
Cite this as: BMJ 2016;355:i6087
Office for National Statistics. Deaths related to drug poisoning in England and Wales: 2015 registrations. 2016. https://www.ons.gov.uk/releases/deathsrelatedtodrugpoisoninginenglandand...
Csete J, Kamarulzaman A, Kazatchkine M, et al. Public health and international drug policy[The Lancet-Johns Hopkins Commission]. Lancet2016;387:1427-80. doi:10.1016/S0140-6736(16)00619-X pmid:27021149.
http://www.independent.co.uk/news/world/europe/russian-hiv-cases-reach-r...
https://www.hri.global/files/2016/11/14/GSHR2016_14nov.pdf
Inflicting Harm: Judicial corporal punishment for drug and alcohol offences in selected countries. Harm Reduction International 2012
From the Mountaintops: What the world can learn from drug policy change in Switzerland October 2010 by Joanne Csete Global Drug Policy Program

Competing interests: No competing interests

22 November 2016
Chris H Ford
Clinical Director
Sebastian saville
IDHDP
13 Victoria Mews London NW6 6SY