Reasons for drug policy reform: prohibition enables systemic human rights abuses and undermines public healthBMJ 2017; 356 doi: https://doi.org/10.1136/bmj.i6586 (Published 17 January 2017) Cite this as: BMJ 2017;356:i6586
All rapid responses
Pūras and Hannah’s observations about drug policy reform misrepresented the facts by conflation, and should have been balanced.(1)
First, it mixed prohibition and criminalisation as in “Drug prohibition and criminalisation is a failed policy model.” Partial prohibitions can produce substantial public health benefits at an acceptable social cost, in the absence of substantial enforcement. (2) Public health must be evidence based, not emotion or assumption based.
Second, it also mixed decriminalisation and legalisation as in “It is now time for decriminalisation and the move towards legal regulation of controlled substances.“
Even in the USA, the leading country for locking up people, police officers assist those who are suffering from addiction: “Any addict who walks into the police station with the remainder of their drug equipment or drugs and asks for help will NOT be charged, instead we will walk them through the system toward detox and recovery and send them for treatment on the spot”(http://www.nytimes.com/2016/01/25/us/massachusetts-chiefs-tack-in-drug-w...). In most countries, no one dares to pledge against decriminalisation.
Legalisation has no relationship with decriminalization. Legalisation cannot be a model. The examples with tobacco and alcohol are frightening. I am not aware of a single country applying the beginning of a comprehensive alcohol control policy (eg. Minimum unit price and restriction advertising). However, as a Frenchman living in a country that is the barrel and the chimney of Europe, I may have a dark view about control of legal drugs by governments: alcohol and tobacco are responsible for 59,000 and 79,000 premature deaths each year, respectively.
Third, obviously “laws banning opioids such as methadone and morphine for medically indicated treatment and regulations unnecessarily restricting their prescription or use undermine healthcare professionals in the delivery of ethical healthcare”. (1) Similarly, access to evidence based treatments for smoking cessation is a problem. Eg. all over the world, cognitive behavioural therapy plus nicotine replacement therapy (patch + oral forms) is far from usual for prisoners, although smoking prevalence is significantly higher than that of the general community and prison increases their vulnerability to addiction. (4) Worst, in France, the mandatory (and costly) Health care scheme do not reimburse varenicline.(5)
Last, all this is not about “war”, as stated by the editor in the heading.(1) It is only about implementing comprehensive and evidence based public health policies. War is about destruction and death, mostly of civilians. Exaggerated language is misleading doctors, patients, and the public.
1 Pūras D, Hannah J. Reasons for drug policy reform: prohibition enables systemic human rights abuses and undermines public health. BMJ 2017 17;356:i6586.
2 Hall W. What are the policy lessons of National Alcohol Prohibition in the United States, 1920-1933? Addiction 2010;105:1164-73.
3 Braillon A. The Framework Convention on Tobacco Control. Lancet. 2016;387:1907
4 Turan O, Turan PA. Smoking-related behaviors and effectiveness of smoking cessation therapy among prisoners and prison staff. Respir Care 2016;61:434-8.
5 Braillon A. When will French smokers be concerned by varenicline's benefit-to-risk ratio? Lancet Respir Med. 2016;4:e13.
Competing interests: No competing interests